Hemodialysis vascular access flow measurements by the novel DMed NephroFlow® device: A comparative study with Transonic®

INTRODUCTION

The current Spanish Clinical Guidelines on Vascular Access for Hemodialysis support the need for surveillance and monitoring of vascular access (VA) to avoid complications. Ultrasound dilution (UD) methods are accepted for the evaluation of VA flow and Transonic® has established the gold standard method for the measurement. The DMed NephroFlow (NIPRO®) device, based on UD method has recently been incorporated. We report a comparative study between the classic Transonic® versus the new NephroFlow® device.

MATERIAL AND METHODS

For two consecutive months, measurements of VA flow using both referred systems were performed in patients with a native arteriovenous fistula (AVF) or a graft (AVG) on hemodialysis (HD) in our unit. Both studies were undertaken according to the usual recommendations: VA flow of 250 ml/min, ultrafiltration rate without modifications, both needles in the same vein, and always in the first hour of the HD session.

RESULTS

Forty-five patients were included: 17 women and 28 men, mean age of 67 ± 12 years. Thirty patients were diabetic. The baseline meantime on HD was 51 ± 39 months (range: 3-163). Type of VA was: 17 patients radio-cephalic AVF, 17 brachiocephalic AVF, 7 brachiobasilic AVF, and 3 with a graft. The mean flow estimated by the Transonic® was 1222 ± 805 ml/min and the estimated flow by the NephroFlow® device was 1252 ± 975 ml/min. Good reliability between Transonic® and NephroFlow® was observed, with a reliability index of Cronbach's Alpha of 0.927 and an Intraclass Correlation Index of 0.928.

CONCLUSIONS

The NephroFlow® device seems comparable with the accepted gold standard UD method for estimating VA flow. More studies must be performed to verify these results. However, they should be considered for the surveillance and monitoring of VA flow, in agreement with the Spanish Guidelines.

Preeclampsia and risk of maternal pulmonary hypertension at high altitude in Bolivia

Women with a history of preeclampsia (PE) have a greater risk of pulmonary arterial hypertension (PAH). In turn, pregnancy at high altitude is a risk factor for PE. However, whether women who develop PE during highland pregnancy are at risk of PAH before and after birth has not been investigated. We tested the hypothesis that during highland pregnancy, women who develop PE are at greater risk of PAH compared to women undergoing healthy highland pregnancies. The study was on 140 women in La Paz, Bolivia (3640m). Women undergoing healthy highland pregnancy were controls (C, n = 70; 29 ± 3.3 years old, mean±SD). Women diagnosed with PE were the experimental group (PE, n = 70, 31 ± 2 years old). Conventional (B- and M-mode, PW Doppler) and modern (pulsed wave tissue Doppler imaging) ultrasound were applied for cardiovascular íííassessment. Spirometry determined maternal lung function. Assessments occurred at 35 ± 4 weeks of pregnancy and 6 ± 0.3 weeks after birth. Relative to highland controls, highland PE women had enlarged right ventricular (RV) and right atrial chamber sizes, greater pulmonary artery dimensions and increased estimated RV contractility, pulmonary artery pressure and pulmonary vascular resistance. Highland PE women had lower values for peripheral oxygen saturation, forced expiratory flow and the bronchial permeability index. Differences remained 6 weeks after birth. Therefore, women who develop PE at high altitude are at greater risk of PAH before and long after birth. Hence, women with a history of PE at high altitude have an increased cardiovascular risk that transcends the systemic circulation to include the pulmonary vascular bed.

A Model to Develop Chatbots for Assisting the Teaching and Learning Process

Recently, in the commercial and entertainment sectors, we have seen increasing interest in incorporating chatbots into websites and apps, in order to assist customers and clients. In the academic area, chatbots are useful to provide some guidance and information about courses, admission processes and procedures, study programs, and scholarly services. However, these virtual assistants have limited mechanisms to suitably help the teaching and learning process, considering that these mechanisms should be advantageous for all the people involved. In this article, we design a model for developing a chatbot that serves as an extra-school tool to carry out academic and administrative tasks and facilitate communication between middle-school students and academic staff (e.g., teachers, social workers, psychologists, and pedagogues). Our approach is designed to help less tech-savvy people by offering them a familiar environment, using a conversational agent to ease and guide their interactions. The proposed model has been validated by implementing a multi-platform chatbot that provides both textual-based and voice-based communications and uses state-of-the-art technology. The chatbot has been tested with the help of students and teachers from a Mexican middle school, and the evaluation results show that our prototype obtained positive usability and user experience endorsements from such end-users.

An approach to the classification of educational chatbots

Nowadays, chatbots have become popular tools in such a way that they are used in different sectors like commercial, elderly care, tourism, and education. The COVID-19 pandemic has forced many students and teachers to suspend face-to-face classes. Therefore, schools and governments have found it necessary to continue education remotely, using the resources provided by the Internet. This fact has created a greater interest in educational chatbots, so several projects have been proposed to develop these academic tools, each following its way of implementation and addressing issues from different points of view. This paper presents a proposal for chatbot classification, following the Systematic Mapping Study and an iterative method to review and classify educational chatbots. We also discuss the resulting categories and their characteristics and limitations and possible uses by developers and researchers.

An Architecture for Collaborative Terrain Sketching with Mobile Devices

3D terrains used in digital animations and videogames are typically created by several collaborators with a single-user application, which constrains them to update the shared terrain from their PCs, using a turn-taking strategy. Moreover, collaborators have to visualize the terrain through 2D views, confusing novice users when conceiving its shape in 3D. In this article, we describe an architecture for collaborative applications, which allow co-located users to sketch a terrain using their mobile devices concurrently. Two interaction modes are supplied: the standard one and an augmented reality-based mode, which helps collaborators understand the 3D terrain shape. Using the painting with brushesparadigm, users can modify the terrain while visualizing its shape evolution through the camera of their devices. Work coordination is promoted by enriching the 3D space with each collaborator’s avatar, which provides awareness information about identity, location, and current action. We implemented a collaborative application from this architecture that was tested by groups of users, who assessed its hedonic and pragmatic qualities in both interaction modes and compared them with the qualities of a similar Web terrain editor. The results showed that the augmented reality mode of our prototype was considered more attractive and usable by the participants.

Physicochemical characterization of protein isolates of amaranth and common bean and a study of their compatibility with xanthan gum

Vegetables are considered to be a sustainable source of promising biomaterials such as proteins and polysaccharides. In this study, four protein isolates (amaranth protein isolate API, amaranth globulin-rich protein isolate AGR, bean protein isolate BPI, and bean phaseolin-rich protein isolate BPR) were structurally characterized under different pH conditions (2-12) and their compatibility behavior with xanthan gum (XG) in aqueous medium was described. All protein isolates showed β turn and β sheet (78.24-81.11%), as the major secondary structures without statistically significant difference under the pH conditions surveyed. Protein isolates show solubility at pH ≤ 3 (40.4-85.1%) and pH ≥ 8 (57.6-99.9%) and surface hydrophobicity results suggest protein denaturation at pH ≤ 3. In the compatibility study, API/XG ratios between 1:1 and 5:1 at pH from 7 to 9 and the BPI/XG ratios from 1:1 to 20:1 at pH 7 form gels that do not require heating nor crosslinking agent addition. Zeta potential results, on the other hand, evidenced that formation of gels is driven by attractive electrostatic interaction of the charged regions of both biopolymers and intermolecular interactions such as hydrogen bonds.

Aspectos clave en el mantenimiento de la diuresis residual en pauta de hemodiálisis incremental. Experiencia de diez años

Introducción: La hemodiálisis incremental o progresiva es una modalidad de inicio de hemodiálisis, basada en la diuresis residual y adaptada a las necesidades del paciente, poco extendida pese a sus potenciales beneficios. Para su correcto seguimiento es necesario establecer unas pautas específicas en cada sesión de hemodiálisis, que deben ser conocidas por el personal que atiende a estos pacientes de forma regular. Objetivo: analizar la evolución de los pacientes que han iniciado tratamiento renal sustitutivo con hemodiálisis incremental. Material y Método: Estudio observacional retrospectivo de pacientes incidentes en tratamiento renal sustitutivo mediante hemodiálisis incremental en nuestro centro en los últimos 10 años. Comparación de resultados basales y a los 12 meses de seguimiento. Resultados: En este periodo de tiempo se han incluido 49 pacientes en técnica de hemodiálisis incremental. Aunque la diuresis residual desciende en el primer año de 2030±600 ml/día a 1300±500 (p<0,05), ésta se mantiene por encima de un litro en la mayoría de los casos. El aclaramiento de urea también desciende de 5,7±1,6 ml/min a 3,4±1,6 ml/min al año (p<0,05). Conclusiones: Iniciar tratamiento renal sustitutivo con hemodiálisis incremental puede mantener más tiempo la diuresis residual, para eso es clave el conocimiento de la técnica y su correcto manejo durante las sesiones de diálisis.

EndoPredict® in early hormone receptor-positive, HER2-negative breast cancer

Purpose

Evaluating consecutive early breast cancer patients, we analyzed both the impact of EndoPredict^® on clinical decisions as well as clinico-pathological factors influencing the decision to perform this gene expression test.

Methods

Hormone receptor (HR)-positive and human epidermal growth factor receptor 2 (HER2)-negative early breast cancer patients treated between 2011 and 2016 were included in this study to investigate the role of EndoPredict^® (EPclin) in the treatment of early breast cancer. A main study aim was to analyze the changes in therapy recommendations with and without EPclin. In addition, the impact of clinico-pathological parameters for the decision to perform EPclin was examined by Pearson's chi-squared test (χ²-test) and Fisher's exact test as well as univariate and multivariate logistic regressions.

Results

In a cohort of 869 consecutive early HR-positive, HER-negative breast cancer patients, EPclin was utilized in 156 (18.0%) patients. EPclin led to changes in therapy recommendations in 33.3% (n = 52), with both therapy escalation in 19.2% (n = 30) and de-escalation in 14.1% (n = 22). The clinico-pathological factors influencing the use of EPclin were age (P < 0.001, odds ratio [OR] 0.498), tumor size (P = 0.011, OR 0.071), nodal status (P = 0.021, OR 1.674), histological grade (P = 0.043, OR 0.432), and Ki-67 (P < 0.001, OR 3.599).

Conclusions

EPclin led to a change in therapy recommendations in one third of the patients. Clinico-pathological parameters such as younger age, smaller tumor size, positive nodal status, intermediate histological grade and intermediate Ki-67 had a significant influence on the use of EndoPredict^®.

Electronic supplementary material

The online version of this article (10.1007/s10549-020-05688-1) contains supplementary material, which is available to authorized users.

Are you better off? Perceptions of social mobility and satisfaction with care among Latina immigrants in the U.S

Although the reasons for immigrating to the U.S. vary by Latino groups, many Latinos cite economic or political motivations for their migration. Once in the United States, Latino immigrants may face many challenges, including discrimination and blocked opportunities for social mobility, and difficulties in obtaining health services and quality health care. The purpose of this study was to explore how changes in social mobility from the country of origin to the U.S. may relate to Latina women's health care interactions. We examined whether self-reported social mobility among 419 Latina women immigrants is associated with satisfaction with health care. We also examined the association among social mobility and self-rated health, quality of care, and medical mistrust. Upward social mobility was associated with greater number of years lived in the U.S., and downward social mobility was associated with more years of education. Those who reported no changes in social class (stable social mobility) were older and were the most satisfied with their medical care. Multiple regression analyses indicated that downward social mobility was associated with less satisfaction with care when controlling for demographic covariates, quality of care, and medical mistrust. Results suggest that perceived social mobility may differentially predict Latina immigrants' satisfaction with the health care system, including their trust in U.S. medical institutions. We conclude that perceived social mobility is an important element in exploring the experiences of immigrant Latinas with health care in the United States.

Effect of the in vitro gastrointestinal digestion on free-phenolic compounds and mono/oligosaccharides from Moringa oleifera leaves: Bioaccessibility, intestinal permeability and antioxidant capacity

Moringa oleifera is a plant recognized for its compounds such as dietary fiber (oligosaccharides, amongst others) and polyphenols, with biological activities. These properties depend on bioactive compounds (BC) interactions with food matrix/digestion conditions, which have not been evaluated. Thus, the aim of this study was to evaluate the bioaccessibility, intestinal permeability and antioxidant capacity of BC (free-phenolic compounds (PC); and mono/oligosaccharides (MOS)) from Moringa oleifera leaves (ML) powder during in vitro gastrointestinal digestion. The gallic/caffeic acids, morin, kaempferol, mannose and stachyose showed the highest bioaccessibilities (~6-210%). The PC correlated with the antioxidant capacity (R²: 0.59-0.98, p < .05), whereas gallic/caffeic acids were the highest. The apparent permeability coefficients of bioactive compounds (0.62-36.65 × 10^-4 cm/s) and water flux/glucose transport confirmed the model similarity to in vivo experiments. The results suggest that ML digestion dynamically modifies PC/MOS bioaccessibility/antioxidant capacity while most of them are not completely absorbed in the small intestine.

A direct Primitive Variable Recovery Scheme for hyperbolic conservative equations: The case of relativistic hydrodynamics

In this article we develop a Primitive Variable Recovery Scheme (PVRS) to solve any system of coupled differential conservative equations. This method obtains directly the primitive variables applying the chain rule to the time term of the conservative equations. With this, a traditional finite volume method for the flux is applied in order avoid violation of both, the entropy and “Rankine-Hugoniot” jump conditions. The time evolution is then computed using a forward finite difference scheme. This numerical technique evades the recovery of the primitive vector by solving an algebraic system of equations as it is often used and so, it generalises standard techniques to solve these kind of coupled systems. The article is presented bearing in mind special relativistic hydrodynamic numerical schemes with an added pedagogical view in the appendix section in order to easily comprehend the PVRS. We present the convergence of the method for standard shock-tube problems of special relativistic hydrodynamics and a graphical visualisation of the errors using the fluctuations of the numerical values with respect to exact analytic solutions. The PVRS circumvents the sometimes arduous computation that arises from standard numerical methods techniques, which obtain the desired primitive vector solution through an algebraic polynomial of the charges.

At the Expense of a Life: Race, Class, and the Meaning of Buprenorphine in Pharmaceuticalized "Care"

BACKGROUND/OBJECTIVE

Office-based buprenorphine maintenance has been legalized and promoted as a treatment approach that not only expands access to care, but also reduces the stigma of addiction treatment by placing it in a mainstream clinical setting. At the same time, there are differences in buprenorphine treatment utilization by race, ethnicity, and socioeconomic status.

METHODS

This article draws on qualitative data from interviews with 77 diverse patients receiving buprenorphine in a primary care clinic and two outpatient substance dependence clinics to examine differences in patients' experiences of stigma in relation their need for psychosocial supports and services.

RESULTS

Management of stigma and perception of social needs varied significantly by ethnicity, race and SES, with white educated patients best able to capitalize on the medical focus and confidentiality of office-based buprenorphine, given that they have other sources of support outside of the clinic, and Black or Latino/a low income patients experiencing office-based buprenorphine treatment as isolating.

CONCLUSION

Drawing on Agamben's theory of "bare life," and on the theory of intersectionality, the article argues that without attention to the multiple oppressions and survival needs of addiction patients who are further stigmatized by race and class, buprenorphine treatment can become a form of clinical abandonment.

Ist die Beweglichkeit der HWS bei Patienten mit chronischem Nackenschmerz eingeschränkt?

Hintergrund: Die Untersuchung des Bewegungsumfangs ist fester Bestandteil des Assessments bei Patienten mit Nackenschmerz. Bewegungseinschränkungen gelten als sicheres Zeichen für akute Schmerzzustände. Bei chronischem Nackenschmerz ist das Vorhandensein von Bewegungseinschränkungen jedoch fraglich.

Ziel: Die vorliegende Erhebung untersuchte, ob Patienten mit chronischem Nackenschmerz Bewegungseinschränkungen aufweisen.

Methode: 60 gesunde Probanden und 60 Patienten mit chronischem Nackenschmerz wurden mittels Ultraschalltopometrie während zyklischer Bewegungen der HWS bezüglich des Bewegungsumfangs untersucht und die Mittelwerte beider Gruppen auf signifikante Unterschiede überprüft. Ferner erfolgte die Klassifikation der gemessenen Bewegungsumfänge anhand geschlechts- und altersspezifischer Normwerte als normal, hypermobil oder hypomobil. Für die Validität des Befundes „hypomobil“ in Bezug auf die Erkennung des chronischen Nackenschmerzes wurden die Sensitivität, die Spezifität sowie die positive (LR+) und die negative Likelihood Ratio (LR–) ermittelt.

Ergebnisse: Die durchschnittlichen Bewegungsumfänge beider Gruppen unterschieden sich in alle Richtungen signifikant. Im Vergleich zu den Normwerten wiesen mehr als drei Viertel der Teilnehmer beider Gruppen eine normale Beweglichkeit auf. Die Sensitivität des Kriteriums „Hypomobilität“ lag bei maximal 0,23, die Spezifität bei über 0,9, die LR+ bei maximal 0,93 und der niedrigste Wert der LR– bei 0,65.

Schlussfolgerung: Beim chronischen Nackenschmerz ist das Bewegungsausmaß der HWS nicht vermindert. Für das Assessment fehlt ein objektiver Parameter, der mit psychosozialen Variablen korreliert und von Physiotherapeuten gemessen werden kann.

Integrating Buprenorphine Into an Opioid Treatment Program: Tailoring Care for Patients With Opioid Use Disorders

OBJECTIVES

This report identifies the institutional barriers to, and benefits of, buprenorphine maintenance treatment (BMT) integration in an established hospital-based opioid treatment program (OTP).

METHODS

This case study presents the authors' experiences at the clinic, hospital, and corporation levels during efforts to integrate BMT into a hospital-based OTP in New York City and a descriptive quantitative analysis of the characteristics of hospital outpatients treated with buprenorphine from 2006 to 2013 (N=735).

RESULTS

Integration of BMT into an OTP offered patients the flexibility to transition between intensive structured care and primary care or outpatient psychiatry according to need. Main barriers encountered were regulations, clinical logistics of dispensing medications, internal cost and reimbursement issues, and professional and cultural resistance.

CONCLUSIONS

Buprenorphine integration offers a model for other OTPs to facilitate partnerships among primary care and mental health clinics to better serve diverse patients with varying clinical needs and with varying levels of social support.

[Long-term effect of policosanol on the functional recovery of non-cardioembolic ischemic stroke patients: a one year study]

INTRODUCTION

Stroke is a leading cause of mortality and disability. Policosanol has been effective in brain ischemia models. The aim of this study is to investigate whether policosanol, added to aspirin therapy within 30 days of stroke onset, is better than placebo + aspirine for the long-term recovery of non-cardioembolic ischemic stroke subjects.

PATIENTS AND METHODS

Randomized, double-blind, placebo-controlled study. Eighty patients (mean age: 69 years) within 30 days of onset, with a modified Rankin Scale score (mRS) 2 to 4, were included. They were randomized in two groups (policosanol + aspirine or placebo + aspirine) for 12 months.

RESULTS

Policosanol + aspirine decreased significantly mean mRS from the first interim check-up (1.5 months). The treatment even improved after long-term therapy. More policosanol + aspirin (87.5%) than placebo + aspirine (0%) patients achieved mRSs <= 1. Policosanol + aspirine increased significantly Barthel Index, lowered LDL-cholesterol and increased HDL-cholesterol versus placebo + aspirin.

CONCLUSIONS

Long-term (12 months) administration of policosanol + aspirin given after suffering non-cardioembolic ischemic stroke was shown to be better than placebo + aspirin in improving functional outcomes when used among patients with non-cardioembolic ischemic stroke of moderate severity.

Shifting blame: Buprenorphine prescribers, addiction treatment, and prescription monitoring in middle-class America

Growing nonmedical prescription opioid analgesic use among suburban and rural Whites has changed the public's perception of the nature of opioid addiction, and of appropriate interventions. Opioid addiction has been recast as a biological disorder in which patients are victims of their neurotransmitters and opioid prescribers are irresponsible purveyors of dangerous substances requiring controls. This framing has led to a different set of policy responses than the "War on Drugs" that has focused on heroin trade in poor urban communities; in response to prescription opioid addiction, prescription drug monitoring programs and tamper-resistant opioid formulations have arisen as primary interventions in place of law enforcement. Through the analysis of preliminary findings from interviews with physicians who are certified to manage opioid addiction with the opioid pharmaceutical buprenorphine, we argue that an increase in prescriber monitoring has shifted the focus from addicted people to prescribers as a threat, paradoxically driving users to illicit markets and constricting their access to pharmaceutical treatment for opioid addiction. Prescriber monitoring is also altering clinical cultures of care, as general physicians respond to heightened surveillance and the psychosocial complexities of treating addiction with either rejection of opioid dependent patients, or with resourceful attempts to create support systems for their treatment where none exists.

Buprenorphine Maintenance for Opioid Dependence in Public Sector Healthcare: Benefits and Barriers

Background

Since its U.S. FDA approval in 2002, buprenorphine has been available for maintenance treatment of opiate dependence in primary care physicians’ offices. Though buprenorphine was intended to facilitate access to treatment, disparities in utilization have emerged; while buprenorphine treatment is widely used in private care setting, public healthcare integration of buprenorphine lags behind.

Results

Through a review of the literature, we found that U.S. disparities are partly due to a shortage of certified prescribers, concern of patient diversion, as well as economic and institutional barriers. Disparity of buprenorphine treatment dissemination is concerning since buprenorphine treatment has specific characteristics that are especially suited for low-income patient population in public sector healthcare such as flexible dosing schedules, ease of concurrently treating co-morbidities such as HIV and hepatitis C, positive patient attitudes towards treatment, and the potential of reducing addiction treatment stigma.

Conclusion

As the gap between buprenorphine treatment in public sector settings and private sector settings persists in the U.S., current research suggests ways to facilitate its dissemination.

Effects of regulation on methadone and buprenorphine provision in the wake of Hurricane Sandy

Hurricane Sandy led to the closing of many major New York City public hospitals including their substance abuse clinics and methadone programs, and the displacement or relocation of thousands of opioid-dependent patients from treatment. The disaster provided a natural experiment that revealed the relative strengths and weaknesses of methadone treatment in comparison to physician office-based buprenorphine treatment for opioid dependence, two modalities of opioid maintenance with markedly different regulatory requirements and institutional procedures. To assess these two modalities of treatment under emergency conditions, semi-structured interviews about barriers to and facilitators of continuity of care for methadone and buprenorphine patients were conducted with 50 providers of opioid maintenance treatment. Major findings included that methadone programs presented more regulatory barriers for providers, difficulty with dose verification due to impaired communication, and an over reliance on emergency room dosing leading to unsafe or suboptimal dosing. Buprenorphine treatment presented fewer regulatory barriers, but buprenorphine providers had little to no cross-coverage options compared to methadone providers, who could refer to alternate methadone programs. The findings point to the need for well-defined emergency procedures with flexibility around regulations, the need for a central registry with patient dose information, as well as stronger professional networks and cross-coverage procedures. These interventions would improve day-to-day services for opioid-maintained patients as well as services under emergency conditions.

Turn off the TV and dance! Participation in culturally tailored health interventions: implications for obesity prevention among Mexican American girls

Our evaluation study identifies facilitators and barriers to participation among families participating in the treatment arm of Stanford ECHALE. This culturally tailored obesity prevention trial consisted of a combined intervention with two main treatment components: 1) a folkloric dance program; and 2) a screen time reduction curriculum designed for 7-11 year old Latinas and their families. We conducted 83 interviews (40 parents and 43 girls) in participant homes after 6 months of enrollment in the ECHALE trial. The Spradley ethnographic method and NVivo 8.0 were used to code and analyze narrative data. Three domains emerged for understanding participation: 1) family cohesiveness; 2) perceived gains; and 3) culturally relevant program structure. Two domains emerged for non-participation: program requirements and perceived discomforts. Non-parametric, Spearman's rank correlation coefficients were calculated to assess the relationships with participant attendance data. Sustained participation was most strongly influenced by the domain perceived gains when parents reported better self-esteem, confidence, improved attitude, improved grades, etc. (Spearman r = .45, P = .003). Alternatively, under the domain, perceived discomforts, with subthemes such as child bullying, participation in the combined intervention was inversely associated with attendance (Spearman r = -.38, P = .02). Family-centered, school-based, community obesity prevention programs that focus on tangible short-term gains for girls may generate greater participation rates, enhance social capital, and promote community empowerment. These factors can be emphasized in future obesity prevention program design and implementation.

Declining sexually transmitted infections among female sex workers: the results of an HIV and sexually transmitted infection prevention strategy in Honduras, 2006-08

In 2006, we implemented an HIV and sexually transmitted infection (STI) prevention programme for female sex workers (FSWs) in three Honduran cities. All FSW attending STI clinics underwent regular examinations and STI testing. Information on condom use with different partners was collected at each visit. After three years, we detected a significant decline in the prevalence of syphilis from 2.3% at the first screening to 0.0% at the third screening (P = 0.05), and of chlamydia, from 6.1% to 3.3% (P = 0.01). No changes were observed in the prevalence of gonorrhoea or trichomoniasis. The cumulative HIV prevalence remained constant (P = 0.44). Reports of condom use with clients increased from 93.8% to 98.9% (P < 0.001). The implementation of an HIV/STI prevention programme in FSW has contributed to increases in condom use with clients and the reduction in syphilis and chlamydia prevalence. The intervention should be strengthened and considered as part of a national health policy strategy.

Cytotoxic and antioxidant activities of selected Lamiales species from Mexico

CONTEXT

Methanol extracts obtained from eight species belonging to four families of the Lamiales order native to Mexico were investigated for biological action.

OBJECTIVE

Cytotoxicity and antioxidant activity of methanol extracts have been investigated.

MATERIALS AND METHODS

Cytotoxic activity was evaluated by the sulphorhodamine B protein staining assay against KB (nasopharyngeal), HEp-2 (larynx), HF-6 (colon), MCF7 (breast), PC-3 (prostate), and Ca Ski (cervix) carcinoma cell lines. To analyze the antioxidant activity, common stable radicals chromogens, 2,2-azino-bis(3-ethylbenzthiazoline-6-sulfonic acid (ABTS+) and DPPH (1,1-diphenyl-2-picrylhydrazyl) were used. The ferric reducing antioxidant power (FRAP) and the total phenolic content of the samples were also determined.

RESULTS

Some of the extracts, such as Limosella aquatica L. (Scrophulariaceae), Mimulus glabratus Kunth. (Phrymaceae), Pedicularis mexicana Zucc. ex Benth. (Orobanchaceae), and Penstemon campanulatus (Cav.) Willd. (Plantaginaceae) displayed remarkably selective cytotoxic activity. However, the extract from Veronica americana (Raf.) Schwein (Plantaginaceae) showed the highest activity with IC₅₀ values of 1.46 and 0.169 g/ μL on PC-3 and HF-6 cells, respectively. With the exception of M. glabratus, all the extracts showed different degrees of antioxidant activity with IC₅₀ values from 0.89 up to 1.8 in the ABTS assay; from 0.49 up to 1.25 mg/mL in the DPPH assay and with the FRAP evaluation, 36 to 68 equivalents in mM of FeSO₄. V. americana also showed the highest antoxidant activity with IC₅₀ values from 0.491 and 0.892 mg/mL, on DPPH and ABTS assays, respectively.

DISCUSSION AND CONCLUSION

These findings demonstrated that the species studied have great potential cytotoxic and antioxidant activity.

Florfenicol feed supplemented decrease the clinical effects of Mycoplasma hyopneumoniae experimental infection in swine in México

The therapeutic value of Florfenicol feed supplemented was evaluated in conventional pigs to eliminate consequences of chronic infection of Mycoplasma hyopneumoniae. The experimental animals were pigs with an average of 16 kg, after intratracheally inoculation with M. hyopneumoniae they were divided in two experimental groups: (a) the non-medicated; and (b) the feed supplemented group (20 g Florfenicol/ton of feed) during the ensuing 35 days. The average daily weight gain of the Florfenicol-treated pigs (0.33±0.14 kg/day) was significantly higher than that of the non-treated ones (0.21±0.10 kg/day). In medicated animals was still impaired relative to that of the uninfected ones control group (0.39±0.02 kg/day). The average percentage of pneumonic gross lesions extensions' of the pigs groups was: 13.99% for M. hyopneumoniae infected non-medicated group; 1.79% M. hyopneumoniae infected, Florfenicol-treated group and, 0.56% of the uninfected control group. M. hyopneumoniae; colonization was detected at these levels in 7 and 9 members of the respective infected groups. The extent of the pneumonic lesions and M. hyopneumoniae generally was greater in the non-medicated pigs. Therefore, oral administration of Florfenicol via feed ingestion seemed to be somewhat effective in ameliorating the clinical effects of M. hyopneumoniae infection of swine.

State of the art and recommendations. Kangaroo mother care: application in a high-tech environment

Since Kangaroo Mother Care (KMC) was developed in Colombia in the 1970s, two trends in clinical application emerged. In low-income settings, the original KMC modelis implemented. This consists of continuous (24 h/day; 7 days/week) and prolonged mother/parent-infant skin-to-skin contact; early discharge with the infant in the kangaroo position; (ideally) exclusive breastfeeding and, adequate follow up. In affluent settings, intermittent KMC with sessions of one or a few hours skin-to-skin contact for a limited period is common. As a result of the increasing evidence of the benefits of KMC for both infants and families in all intensive care settings, KMC in a high-tech environment was chosen as the topic for the first European Conference on KMC, and the clinical implementation of the KMC modelin all types of settings was discussed at the 7th International Workshop on KMC Kangaroo Mother Care protocols in high-tech Neonatal Intensive Care Units (NICU) should specify criteria for initiation, kangaroo position, transfer to/from KMC, transport in kangaroo position, kangaroo nutrition, parents'role, modification of the NICU environment, performance of care in KMC, and KMCin case of infant instability.

CONCLUSION

Implementation of the original KMC method, with continuous skin-to-skin contact whenever possible, is recommended for application in high-tech environments, although scientific evaluation should continue.

Vasoactive and antioxidant activities of plants used in Mexican traditional medicine for the treatment of cardiovascular diseases

This study demonstrated that the aqueous extracts of plants employed in Mexican traditional medicine for the treatment of cardiovascular diseases are able to modify the tone of arterial smooth muscle. Agastache mexicana (Kunth) Lint & Epling (Labiatae), Chenopodium murale L. (Chenopodiaceae), Chirantodendron pentadactylon Larreat (Sterculiaceae), Dracocephalum moldavica L. (Labiatae), Psittacanthus calyculatus G. Don (Loranthaceae), Prunus serotina ssp. capuli (Cav. ex Spreng) McVaugh (Rosaceae), and Sechium edule Sw. (Cucurbitaceae) contain secondary metabolites that promote vascular relaxation and display antioxidant activities. As expected, their antioxidant effects showed a significant correlation with the polyphenolics content. However, a lower correlation was found between the antioxidant activity and the maximum vasodilatory effect, suggesting that the vasodilatation elicited by the plant extracts could be only partly attributed to their antioxidant properties. The extract of P. calyculatus, which displayed a maximum vasorelaxant effect that was higher than that of acetylcholine, induced endothelium-dependent vasodilatation. Futhermore, the vasorelaxant response to the P. calyculatus extract was reduced after adding an inhibitor of soluble guanylate cyclase activity, providing evidence that the NO/cGMP pathway is involved. On the other hand, the extracts of Bocconia frutescens L. (Papaveraceae), Magnolia grandiflora L. (Magnoliaceae), and Solanum rostratum Dunal (Solanaceae) induced concentration-dependent contraction of rat aortic rings, suggesting that these plants have potential health benefits for the treatment of ailments such as venous insufficiency. The pharmacological activities of the extracts studied provide scientific support for their ethnomedical use.

Towards universal Kangaroo Mother Care: recommendations and report from the First European conference and Seventh International Workshop on Kangaroo Mother Care

The hallmark of Kangaroo Mother Care (KMC) is the kangaroo position: the infant is cared for skin-to-skin vertically between the mother's breasts and below her clothes, 24 h/day, with father/substitute(s) participating as KMC providers. Intermittent KMC (for short periods once or a few times per day, for a variable number of days) is commonly employed in high-tech neonatal intensive care units. These two modalities should be regarded as a progressive adaptation of the mother-infant dyad, ideally towards continuous KMC, starting gradually and progressively with intermittent KMC. The other components in KMC are exclusive breastfeeding (ideally) and early discharge in kangaroo position with strict follow-up. Current evidence allows the following general statements about KMC in affluent and low-income settings: KMC enhances bonding and attachment; reduces maternal postpartum depression symptoms; enhances infant physiologic stability and reduces pain, increases parental sensitivity to infant cues; contributes to the establishment and longer duration of breastfeeding and has positive effects on infant development and infant/parent interaction. Therefore, intrapartum and postnatal care in all types of settings should adhere to a paradigm of nonseparation of infants and their mothers/families. Preterm/low-birth-weight infants should be regarded as extero-gestational foetuses needing skin-to-skin contact to promote maturation.

CONCLUSION

Kangaroo Mother Care should begin as soon as possible after birth, be applied as continuous skin-to-skin contact to the extent that this is possible and appropriate and continue for as long as appropriate.

State of the art and recommendations. Kangaroo mother care: application in a high-tech environment

Since Kangaroo Mother Care (KMC) was developed in Colombia in the 1970s, two trends in clinical application emerged. In low income settings, the original KMC model is implemented. This consists of continuous (24 h/day, 7 days/week) and prolonged mother/parent-infant skin-to-skin contact; early discharge with the infant in the kangaroo position; (ideally) exclusive breastfeeding; and, adequate follow-up. In affluent settings, intermittent KMC with sessions of one or a few hours skin-to-skin contact for a limited period is common. As a result of the increasing evidence of the benefits of KMC for both infants and families in all intensive care settings, KMC in a high-tech environment was chosen as the topic for the first European Conference on KMC, and the clinical implementation of the KMC model in all types of settings was discussed at the 7th International Workshop on KMC. Kangaroo Mother Care protocols in high-tech Neonatal Intensive Care Units (NICU) should specify criteria for initiation, kangaroo position, transfer to/from KMC, transport in kangaroo position, kangaroo nutrition, parents' role, modification of the NICU environment, performance of care in KMC, and KMC in case of infant instability.

CONCLUSION

Implementation of the original KMC method, with continuous skin-to-skin contact whenever possible, is recommended for application in high-tech environments, although scientific evaluation should continue.

Survival of advanced melanoma patients with normal LDH treated with oblimersen, temozolomide, and nab-paclitaxel

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Background: Oblimersen (OBL), temozolomide (TMZ), and abraxane (ABX) act synergistically in preclinical studies with melanoma cell lines. Bcl-2 antisense therapy in combination with dacarbazine was encouraging in advanced melanoma patients(pts) with normal LDH. Methods: Chemotherapy-naïve advanced melanoma pts (ECOG PS ≤ 2, baseline LDH ≤1.1 × ULN, measurable disease per RECIST) were enrolled on a phase I/II protocol. The treatment regimen consisted of 56-day cycles of OBL (7 mg/kg/d continuous IV infusion, d 1–7 and 22–28), TMZ (75 mg/m2/d, d 1–42), and ABX (175 mg/m2 in Cohort 1, 260 mg/m2 in Cohort 2, d 7 and 28). Immunohistochemical (IHC) staining for Bcl-2, Bcl-XL, BAK and caspase 3 was performed in pre- and post-therapy tumor samples. Serum shed collagen cryptic epitope levels were monitored. Results: 18 pts were treated (Cohort 1 = 14 pts [1–6 cycles];Cohort 2 = 4 pts [2–3 cycles]). Median age was 58 years (range: 34–78). Disease sites included liver (6), other visceral sites (10), skin, subcutaneous tissue, and lymph nodes (2). The overall survival (OS) was 14.7 months and showed a trend towards superiority when compared to both arms of the prior oblimersen trial (DTIC, OS 9.7 months, p = 0.078 and DTIC-OBL, OS 11.4 months, p = 0.31) in pts with the same LDH cut-off (Bedikian et al. JCO. 2006). 50% of pts survived > 1 year. One CR lasted 25+ mo, five PR (>50% tumor reduction) lasted > 2 cycles, and 7 SD lasted > 3 cycles. Five PD after 1 cycle were seen. One ocular melanoma pt survived 15 mo despite PD. Shed cryptic epitopes correlated with clinical response versus disease progression. Alteration of the tumor biology based on phenotypic changes in Bcl-2, Bcl-xL, BAK and caspase 3 correlated with response to treatment. Conclusions: Our data suggest that the combination of OBL, TMZ, and ABX is synergistic in advanced melanoma pts with normal LDH, possibly translating into improved OS compared to prior regimens with dacarbazine ± OBL. Biomarker studies support the rationale that Bcl-2 antisense therapy specifically impacts apoptotic signaling pathways in melanoma cells from metastatic tumor. The survival data in the limited number of pts enrolled in cohort 1 and 2 of this trial are encouraging; further exploration with this combination is underway using 1-hour infusions of OBL.

No significant financial relationships to disclose.

Exciton autoionization in ion-induced electron emission

We report on measurements of electron emission spectra from surfaces of highly oriented pyrolytic graphite (HOPG) excited by 1-5 keV He+ and Li+ which, for He+, exhibit a previously unreported high-energy structure. Through a full quantum dynamic description that allows for the calculation of neutralization and electron-hole pair excitation, we show that these high-energy electrons can arise from autoionization of excitons formed by electron promotion to conduction band states close to the vacuum level. The same calculation explains the observed absence of high-energy excitons for Li+ on HOPG.

Long-term effects of D-003, a mixture of high molecular weight acids from sugarcane wax, on bones of ovariectomized rats: a one year study

This study was done to determine the long-term effect of D-003 on bones of ovariectomized (ovx) rats distrib-uted in 4 groups: a false-operated and three groups of ovx rats: one treated with the vehicle and two with D-003 (5 and 250 mg/kg). D-003 significantly prevented, in a dose-dependent fashion, the trabecular bone volume (TBV), trabecular number (TbN) and trabecular thickness (TbTh) reduction induced in ovx rats and the increase of trabecular separation (TbSp) osteoclast number (OcN) and osteoclast surface (OcS/BS) increased in the positive controls versus the sham group. It is concluded that D-003 administered for 12 months prevented bone loss and decreased bone resorption in ovx rats, without evidences of impaired bone quality.

Effects of early experience and genotype on serotonin transporter regulation in infant rhesus macaques

The moderating effect of early experience on gene-behavior associations has been well characterized. The molecular events that allow for such moderation are not well understood, however. We assessed the impact of early experience and serotonin transporter linked promoter polymorphism (rh5-HTTLPR) genotype on peripheral serotonin transporter (5-HTT) regulation in response to a maternal/social separation and relocation stressor in infant rhesus macaques. We further tested the hypothesis that modulation of 5-HTT regulation by rearing and/or genotype is mediated by glucocorticoid (GC) availability. Fifty-three infant (3-4 months of age) rhesus macaques that were either nursery reared (NR) or mother reared (MR) were genotyped for rh5-HTTLPR. Infants were blood sampled within 2.5 h of maternal or social separation/relocation and again 5 h later. Infants were then administered dexamethasone, a synthetic GC and blood sampled 16.5 h later. 5-HTT RNA was quantified from peripheral blood mononuclear cells. Plasma cortisol was measured at all time points. The MR individuals upregulated 5-HTT significantly during maternal/social separation, while NR individuals did not. Concomitant increases in cortisol were not observed, but dexamethasone treatment stimulated 5-HTT expression regardless of genotype/rearing group, and 5-HTT expression in the post-stressor sample was correlated with plasma cortisol levels at all time points. Our data indicate that early experience exerted a strong influence on 5-HTT regulation during a stressor in infant rhesus macaques independent of rh5-HTTLPR genotype. We also showed that GCs may stimulate 5-HTT expression but that there likely exist faster-acting transcriptional regulators of 5-HTT that are in place as a function of experience.

Molecular characterization of the hemagglutinin-neuraminidase gene of porcine rubulavirus isolates associated with neurological disorders in fattening and adult pigs

"Blue eye disease" is a viral infection of swine endemic in Mexico, which produces fatal encephalitis accompanied by respiratory signs and corneal opacity in suckling piglets. An atypical blue eye disease outbreak presented high rates of neurological signs in fattening and adult pigs from 2000 to 2003. In order to identify the basis of increased neurovirulence, the hemagglutinin-neuraminidase (HN) gene of several porcine rubulavirus isolates were sequenced and compared with that of La Piedad Michoacan virus and other isolates that did not produce neurological disorders in weaned pigs. Nine amino acid mutations distinguished the high neurovirulent PAC6-PAC9 viruses, whereas five mutations characterized the low neurovirulent PAC2 and PAC3 viruses. HN protein three-dimensional models showed that the main conformation and functional domains were preserved, although substitutions A223T and A291D occurred in PAC2 and PAC3 viruses, as well as A511K and E514K presented in PAC6-PAC9 viruses considerably modified the properties of the HN protein surface. The increased positive charge of the HN protein of PAC6-PAC9 viruses seems to be associated with their increased neurovirulence.