Co-planting Brassica napus and Salix nigra as a phytomanagement alternative for copper contaminated soil

Phytoremediation of copper contaminated soil poses particular difficulties because of the low Cu mobility in the soil. Although several plant species, such as willows or Brassicaceae, have been used in the phytomanagement of abandoned brownfields, certain trace elements, such as copper often remain difficult to treat or remove from contaminated soils. An experiment was conducted under semi-controlled conditions to test the phytoremediation potential of co-planting two crop species, Brassica napus L. and Salix nigra 'S05', in soil spiked with two concentrations of Cu (500 mg kg^-1 and 800 mg kg^-1). Particular attention was given to the potential of 1) the co-plantation design and 2) uprooting, to efficiently mimic the remediation of a Cu-contaminated soil. Results showed that most Cu was found in plant roots and that the polyculture treatment produced the most overall biomass and maximum stabilization and extraction of Cu of the three treatments tested, regardless of contamination level.

Differences in the cluster of depressive symptoms between subjects with type 2 diabetes and individuals with a major depressive disorder and without diabetes

BACKGROUND

Depressive disorder encompasses a wide spectrum of somatic and psychological symptoms. It is not known whether there are differences regarding the cluster of depressive symptomatology between subjects with depression with and without T2DM.

PURPOSE

To explore whether the cluster of depression that prevails among depressive subjects with T2DM differs from individuals with depression, but without T2DM.

METHODS

87 T2DM patients with a pathological Beck Depression Inventory test (BDI) were compared with 50 age- and gender-matched individuals with a major depressive disorder. All 21 items expressed in the BDI were compared between the two groups.

RESULTS

The score obtained after administering the BDI was comparable between patients with T2DM and significant depressive symptoms and the control group (18.8 ± 2.7 vs 18.9 ± 3.4; p = 0.9). Subjects with T2DM had higher scores compared with the control group in the following items: sadness (1.4 ± 0.9 vs 0.9 ± 0.9; p = 0.011), difficulty in concentration (1.3 ± 0.8 vs 0.8 ± 0.8; p = 0.01), indecisiveness (1.1 ± 0.8 vs 0.5 ± 0.9; p = 0.012), worries about their health (1.3 ± 0.9 vs 0.6 ± 0.9; p < 0.0001), fatigue (1.2 ± 0.6 vs 0.8 ± 0.7; p = 0.003) and loss of sexual appetite (2.7 ± 0.6 vs 1.2 ± 1.3; p = 0.0001). Suicidal ideation was significantly lower among subjects with T2DM compared with the control group (0.1 ± 0.3 vs 0.6 ± 0.8; p = 0.0001).

CONCLUSIONS

Subjects with T2DM and a positive screening for depression presented a different cluster of depression compared with depressed subjects without T2DM, with a predominance of somatic-biological depressive symptoms rather than psychological-cognitive cluster and negative emotions, such as suicidal ideation.

Physiological responses of the hybrid larch (Larix × eurolepis Henry) to cadmium exposure and distribution of cadmium in plantlets

Phytoextraction of Cd is a growing biotechnology although we currently know few Cd hyperaccumulators, i.e., plant species able to accumulate at least 0.1 mg Cd g(-1) dry weight in aerial organs. Owing their deep root system and high biomass, trees are more and more preferred to herbaceous species for phytoextraction. Assuming that conifers could be relevant models under cold climates, we investigated cadmium tolerance of the hybrid larch Larix × eurolepis Henry (Larix decidua × Larix kaempferi) and the efficiency of this species to store this metal. In vitro grown larches were chosen in order to reduce time of exposure and to more rapidly evaluate their potential efficiency to accumulate Cd. One-month-old plantlets were exposed for 2 and 4 weeks to 250 and 500 μM Cd. Results showed that they tolerated a 4-week exposure to 250 μM Cd, whereas the content of photosynthetic pigment strongly dropped in plantlets growing in the presence of 500 μM Cd. In the presence of 250 μM Cd, shoot growth slightly decreased but photosynthetic pigment and total soluble carbohydrate contents were not modified and no lipid peroxidation was detected. In addition, these plantlets accumulated proline, particularly in shoots (two to three times more than control). In roots, Cd concentration in the intracellular fraction was always higher than in the cell wall fraction contrary to shoots where Cd concentration in the cell wall fraction increased with time and Cd concentration in the medium. In shoots, Cd concentration was lower than in roots with a ratio of 0.2 after 4 weeks of exposure but stayed around 0.2 mg g(-1) dry weight, thus a value higher than the threshold requested for Cd hyperaccumulators. Hybrid larch would thus be a relevant candidate for field test of Cd phytoextraction.

Douglas fir (pseudotsuga menziesii) plantlets responses to as, PB, and sb-contaminated soils from former mines

Phytoremediation of metalloids by conifers is not widely studied although they may be relevant for several contaminated sites, especially those located in cold areas and sometimes under dry climates. Here, seeds of Douglas fir were sown in greenhouse on three soils collected in two French former mines: a gold mine (soils L1 and L2) and a lead and silver mine (soil P). These soils are highly contaminated by Pb, As, and Sb at different concentrations. Plants were harvested after ten weeks. Growth parameters, primary metabolite content, and shoot and root ionomes were determined. Douglas firs grown on the soils L1 and P had a lower biomass than controls and a higher oxidation status whereas those grown on the soil L2 exhibited a more developed root system and only slight modifications of carbon and nitrogen nutrition. Based on trace element (TE) concentrations in shoots and roots and their translocation factor (TF), Douglas fir could be a relevant candidate for As phytoextraction (0.8 g. kg(-1) dry weight in shoots and a TF of 1.1) and may be used to phytostabilize Pb and Sb (8.8 g and 127 mg. kg(-1) in roots for Pb and Sb, respectively, and TF lower than 0.1).

Ultrasound-guided saphenous nerve block is an effective technique for perioperative analgesia in ambulatory arthroscopic surgery of the internal knee compartment

OBJECTIVES

Arthroscopic knee surgery is a minimally invasive technique with moderate pain during the first 24h. Our main objective was to evaluate the efficacy of ultrasound guided saphenous nerve block as a method of pain control intraoperatively and postoperatively for this surgery.

MATERIAL AND METHODS

A prospective and observational study. All patients received general anesthesia with laryngeal mask in the saphenous group, nerve block was performed with 10 ml ropivacaine 0.475%. Location of the surgery (external compartment group/internal compartment group), morphine consumption, VAS for pain at 5, 30, 60 and 120 min and 24 h after surgery, need for rescue medication, onset of nausea and vomiting, length of stay in PACU, delayed discharge and satisfaction were evaluated.

RESULTS

The study included 73 patients. Of these, 46 received saphenous nerve block and 27 didn't receive it. Consumption of intraoperative, postoperative and total morphine was significantly lower in the saphenous group as well as VAS at 24h. In the subgroup of internal compartment surgery differences in VAS 24 h, morphine consume and lenght of stay in PACU were mantained.

CONCLUSIONS

The ultrasound-guided block of saphenous nerve, particularly in the internal compartment arthroscopic knee surgery, decreases analgesic requirements, obtaining more effective pain control in the first 24 h postoperatively and without any known side effects.

[Outcome of critically ill patients with acute renal failure and multiple organ failure treated with continuous venovenous haemodiafiltration]

OBJECTIVE

Acute renal failure (ARF) is associated to multiple organ failure (MOF) in critically ill patients and its mortality is high. The main objective was to evaluate the outcome of critically ill patients with ARF and MOF treated with continuous venovenous hemodiafiltration (CVVHDF).

DESIGN

Retrospective and observational study on critically ill patients.

SETTING

Medical-surgical Intensive Care Unit (ICU) in a University Hospital of Girona.

PATIENTS

Patients admitted in ICU that developed ARF and MOF and were treated with CVVHDF.

PRIMARY VARIABLES OF INTEREST

We collected data on demographic, and severity and organic dysfunction scores (SOFA). To study the risk factors for mortality, a comparative and multiple regression statistical analysis was performed, with the main effect of the study being mortality at 30 days.

RESULTS

We studied 139 patients. The most frequent predisposing factors were hypotension (98%) and sepsis (82%). the most frequently affected organs were cardiocirculatory (94%) and respiratory (47%) associated to ARF. Mean SOFA score was 11.4 + or - 2.7 points. Survival was better in traumatic and in non-oliguric patients. The 30-day mortality was 61% and the logistic regression analysis showed that age > or = 60 years [OR=3.3 (95% CI 95=1.5-7.0)] and SOFA score > or = 11 points [OR=2.5 (95% CI=1.1-5.3)] were related to mortality.

CONCLUSIONS

The mortality rate of critically ill patients with acute renal failure and multiple organ failure remains high. Traumatic and non-oliguric patients have a better survival. Age > or = 60 years and SOFA > or = 11 points were independent risk factors associated with mortality.

Differential inhibition of rat and human hepatic cytochrome P450 by Andrographis paniculata extract and andrographolide

The inhibitory effect of Andrographis paniculata extract (APE) and andrographolide (AND), the most medicinally active phytochemical in the extract, on hepatic cytochrome P450s (CYPs) activities was examined using rat and human liver microsomes. For this purpose, CYP1A2-dependent ethoxyresorufin-O-deethylation, CYP2B1-dependent benzyloxyresorufin-O-dealkylation, CYP2B6-dependent bupropion hydroxylation, CYP2C-dependent tolbutamide hydroxylation, CYP2E1-dependent p-nitrophenol hydroxylation and CYP3A-dependent testosterone 6 beta-hydroxylation activities, were determined in the presence and absence of APE or AND (0-200 microM). APE inhibited ethoxyresorufin-O-deethylation activity in rat and human liver microsomes, with apparent Ki values of 8.85 and 24.46 microM, respectively. In each case, the mode of inhibition was noncompetitive. APE also inhibited tolbutamide hydroxylation both in rat and human microsomes with apparent Ki values of 8.21 and 7.51 microM, respectively and the mode of inhibition was mixed type. In addition, APE showed a competitive inhibition only on CYP3A4 in human microsomes with Ki of 25.43 microM. AND was found to be a weak inhibitor of rat CYP2E1 with a Ki of 61.1 microM but did not affect human CYP2E1. In conclusion, it cannot be excluded from the present study that APE could cause drug-drug interactions in humans through CYP3A and 2C9 inhibition.

Estrategias para un control eficaz de la hipertensión arterial en España. Documento de consenso

Blood pressure (BP) control is inadequate among treated hypertensive patients in Spain. Control rates are lower than 40% of all treated patients and the cause of this problem is multifactorial. Despite the fact that possible solutions to this problem have been repeatedly suggested by expert groups along the last 10 years, BP control rates are still low. This fact have a negative impact on cardiovascular morbidity and mortality of patients with hypertension. The aim of the present document has been to achieve a consensus on effective specific measures in order to improve hypertension control rates in Spain. These measures involve health care professionals (physicians, nurses, pharmaceutics), health care authorities and patients. The document summarizes the consensus conference of several scientific societies involved in cardiovascular medicine in five group of measures: a) improvement of the methodology of office BP measurement; b) improvement of compliance to treatment by patients; c) clarification of pressure targets to be achieved in hypertensive patients; d) optimization of life style modifications and pharmacological treatment of hypertension; and e) continuous medical education. The document emphasize life style changes as a crucial aspect to be implemented in all patients. These changes have a beneficial impact on pressure reduction, contribute to a better control of associated cardiovascular risk factors, and increase the effectiveness of antihypertensive drugs. Health care professionals should base their clinical practice on the recommendations of guidelines in order to modify their therapeutic attitudes in patients whose targets have not been achieved.

[Multicenter study on incidence of total parenteral nutrition complications in the critically-ill patient. ICOMEP study. Part I]

OBJECTIVE

To assess parenteral nutrition complications in a prospective cohort of patients admitted to the ICU.

MATERIAL AND METHODS

Prospective, multicenter study of patients admitted to the ICU and that received total parenteral nutrition (TPN). A 14-item questionnaire was done. Total number of admissions and TPN-treated patients were recorded. Demographical data, diagnosis, APACHE II, multiorgan dysfunction index and TPN indications were included. Each complication was previously defined and was related to the route, administration, serum electrolytes unbalances, active ingredients, liver dysfunction, and nosocomial infections. An independent group managed the databases. Data were expressed in absolute values or by their median and percentile (25-75). The rate and incidence density of complications are determined.

RESULTS

The number of admissions during the study period was 3409. Three hundred and seventy (11%) were valid cases that were treated with PN. Two hundred and thirty seven were men, 142 patients were admitted for medical causes, 195 for surgical causes and 33 for trauma. One hundred and twenty patients were moderately or severely underfed, 181 received PN for 7 days (3-11), and 189 received PN and EN. The main indication for PN was paralytic ileus, in 145 patients. TPN was withdrawn for switching to EN in 121 cases and for complications in 5 cases. PN summed up 3220 days. The incidence of complications was: access route 9.32%, maintenance 19.7% and 0.8 per 100 days. Administration, 5.6% and 6.4 per 100 days. Nutrients, 94.3% and 10.8 per 100 days. Catheter-induced sepsis, 54.6% and 0.44 bacteriemias per 100 days with catheter. Nosocomial infection, 54.6% and 6.27 per 100 days on TPN.

CONCLUSIONS

hyperglycemia and liver dysfunction have a greater incidence. Hyperglycemia, electrolyte unbalances and catheter complications have a greater number of therapeutic interventions, but does not mean that TPN should be withdrawn.

[Multicenter study on incidence of total parenteral nutrition complications in the critically-ill patient. ICOMEP study. Part II]

OBJECTIVE

To assess enteral nutrition complications in a prospective cohort of patients admitted to the ICU.

MATERIAL AND METHODS

Prospective, multicenter study of patients admitted to the ICU and that received enteral nutrition (EN). Demographical data, main diagnosis, and nutritional and severity indexes were included. Complications were previously defined and were categorized as gastrointestinal or infectious. An independent group managed the databases and performed the statistical analysis. Data were expressed in absolute values or by their median and percentile (25-75). The rate and incidence density of complications and the odds ratio for complications were determined.

RESULTS

544 out of 3409 patients received enteral nutrition. Three hundred and three patients were admitted for medical causes, 149 for surgical causes and 92 for trauma. Ninety nine patients were underfed, and the nutritional risk index was 69.7. The incidence of gastrointestinal complications was 6 episodes per 100 days of nutrition, and in 89 patient they resulted in enteral nutrition withdrawal. Early enteral nutrition did not yield more complications than late EN. Vomiting was more frequent in late EN (OR 0.4; 95%CI: 0.2-0.7). Temporary withdrawal of diet in 140 patients was the most used procedure, which resulted in a lower caloric intake (median of 2 kcal/kg/d) than programmed. Nosocomial infection rates were 7.47% for catheter-induced sepsis and 51% for other nosocomial infections, and 35% developed pneumonia.

CONCLUSIONS

Gastrointestinal complications with enteral nutrition are frequent, result in insufficient caloric intake and definitive withdrawal of diet in a significant number of cases. Early enteral nutrition is not associated with an increased number of complications. Episodes of increase of the gastric residue do not increase the incidence of pneumonia. Other infectious complications are within the range of what has been published and seem to be little modified by the use of enteral nutrition.

Time course of cytochromes P450 decline during rat hepatocyte isolation and culture: effect of L-NAME

The present work describes an isozyme-related effect of collagenase perfusion on hepatocyte microsomal cytochrome (CYP)-dependent monooxygenase activities: CYP 1A1/2-, 2B1/2-, 3A1/2- and 2E1-dependent activities in microsomes from rat hepatocytes after isolation were about 60% of that of liver microsomes, and CYP 4A1-dependent activity was equivalent to liver microsomes. In contrast, the microsomal protein content of the various CYP isoforms was not affected by hepatocyte isolation. This is in accordance with the hypothesis of CYP inactivation during the process of hepatocyte isolation by collagenase digestion. L-NAME (1 mM) was found unable to protect from the decline of CYP-dependent monooxygenase activities following hepatocyte isolation. It is possible that the decrease in glutathione peroxidase activity observed in the presence of L-NAME, namely depression of defense against peroxynitrite, could counteract the beneficial effect of L-NAME on nitric oxide synthesis inhibition. The present work also shows that L-NAME could not avoid the progressive, isoform-specific, most probably turnover-related, decline of CYP proteins and related monooxygenase activities in cultured hepatocytes. Dysregulations in the mechanisms of CYP expression in rat hepatocyte cultures, presently unknown but nitric oxide independent, thus appear to occur in cultured rat hepatocytes.

Usefulness of patch tests for diagnosing selective allergy to captopril

Captopril, enalapril, and lisinopril are angiotensin-converting enzyme (ACE) inhibitors widely prescribed for hypertension and heart failure. Cutaneous side effects of captopril include angio-edema, anaphylactoid reactions, maculopapular eruptions, pitiryasis rosea-like rash, toxic erythema, and exfoliative dermatitis. Some of the immunological captopril-induced cutaneous adverse reactions have been diagnosed in recent years by patch tests. A case of a cutaneous immune adverse reaction to captopril with tolerance to enalapril and lisinopril demonstrated both by patch tests and double-blind challenge tests is reported for the first time. A 71-year-old nonatopic woman suffered a generalized pruriginous maculopapular rash. Two months earlier, she had started oral treatment with captopril 50 mg t.i.d and glibenclamide 5 mg daily. After the rash appeared, she stopped both drugs and the reaction cleared. A skin biopsy from one of the lesions showed perivascular lymphocytic infiltrate of the upper dermis. Skin prick tests with captopril and glibenclamide and patch tests with enalapril, lisinopril, and glibenclamide at 1% and 10% pet., and with mercaptobenzothiazole (a sulfhydryl group-containing chemical at 1% pet were negative. Only patch tests with captopril at 1% and 10% concentrations were positive at 48 h. Oral double-blind challenge tests with glibenclamide, enalapril, lisinopril, and placebo showed good tolerance. The patient was advised to avoid only captopril. Because captopril is the only ACE inhibitor containing a sulfhydryl group and has occasionally been implicated in complex immunological diseases, this chemical group has been considered the culprit of allergic reactions to captopril. The lack of cross-reactivity between captopril, enalapril, and benazepril has been demonstrated in a few patients by patch tests. In our patient, patch tests identified captopril as the drug responsible for a probably immune adverse reaction not due to the sulfhydryl group. Patch tests are useful and safe in the diagnostic work-up of allergic drug reactions and in studies of cross-sensitivity among ACE inhibitors.

[Rational prescribing and cost reduction in the treatment of arterial hypertension: a simulation exercise]

INTRODUCTION

Cost of antihypertensive drugs in Spain raises 100.000 millions of pesetas. The utilization of new drugs more expensive than classics diuretics and beta blockers is the main reason of this cost increase.The Joint National Commission on Hypertension 6th Report supports the utilization of diuretics and beta blockers as the first choice in patients without any special condition, based in their best efficience. Other professional group don't point out any therapeutic drugs because each of them have their indication. Health authorities have implemented measures intended more to achieve savings than to improve prescriptions. There are not any studies which demonstrate that the second type of measures are more efficient than first one.

AIM

To realize an economic evaluation, of a program of blood hypertension treatment taking and not taking into account the The Joint National Commission on Hypertension 6th Report.

METHODS

Descriptive, prescription-indication study. Cost minimization. Health center from Valencia (Spain). Three hundred and thirteen patients were studied, randomly selected. Three strategy of cost decrease were considered: a) same prescription profile using the cheapest drugs, b) change of profile taken into account JNC-VI recommendations using the original drugs, and c) second option, but using the cheapest drugs.

RESULTS

Ninety seven percent of diuretics had specific indications, 84% of beta blockers, 64.5% of IECAS, 31.6% of alfa blockers and 13% de calcium channel blockers. Diuretics were counter-indicated in 3.5% of patients, beta blockers in 10.5%, and both in 3.1%. Total cost of the unmodifed prescription was 12.412.839 pesetas, cost of the first strategy was 10.067.107, of the second 5.311.783 pesetas and of the third 1.999.094 pesetas.

CONCLUSIONS

Our prescription profile don't follow JNC VI recommendations and this is not justified on indications or counterindications of diuretics and beta blockers. Following JNC VI is more efficient than looking only for the cheapest drug.

[What lines of action should the Valencia Society of Family and Community Medicine adopt over the next 4 years?]

OBJECTIVE

To identify the areas of activity in which the Valencia Society of Family and Community Medicine (SVMFyC) should become involved over the next four years.

DESIGN

Qualitative research.Setting. SVMFyC members.

PATIENTS AND OTHER PARTICIPANTS

27 experts belonging to the SVMFyC took part.

INTERVENTIONS

Qualitative consensus-seeking techniques. Reliability and validity of the technique were ensured through triangulation and the selection of experts from among the different professional groups within the SVMFyC.

MEASUREMENTS AND MAIN RESULTS

To determine the recommended lines of action, productivity, spontaneous representativity, intensity of recommendation and degree of agreement were analysed. The priority lines recommended were: defending the MIR path, proposing reforms in undergraduate study plans, watching over the transparency of job selection procedures and the annual OPE selection, promoting the professional degree course, creation of posts for teachers in family and community medicine, defining the size of the population registered with a doctor, proposing an incentives list and studying alternatives to uniform salaries in the form of target-linked remuneration.

CONCLUSIONS

The lines of action recommended by the experts were established.

Tracheal colonisation within 24 h of intubation in patients with head trauma: risk factor for developing early-onset ventilator-associated pneumonia

OBJECTIVE

To investigate if tracheal colonisation within 24 h of intubation is a risk factor for developing early-onset ventilator-associated pneumonia (EP) in patients with head trauma.

DESIGN

A prospective study in an intensive care unit of a university hospital.

POPULATION

One hundred intubated patients were included with head trauma and Glasgow coma score at admission < or =12.

METHODS

We took tracheal aspirate samples within 24 h of intubation and performed a protected bronchoalveolar mini-lavage when clinical diagnosis of pneumonia was made.

MEASUREMENTS AND RESULTS

On admission time 68 patients (68%) were colonised in trachea, 22 patients were colonised by Staphylococcus aureus, 20 by Haemophilus influenzae, six by Streptococcus pneumoniae and 20 by gram-negative bacilli. The incidence of EP was 26%, and the microorganisms involved were Staph. aureus (44%), H. influenzae (31%), Strep. pneumoniae (12%), and gram-negative bacilli (13%). A multivariate logistic regression analysis showed that the tracheal colonization by Staph. aureus, H. influenzae or Strep. pneumoniae within 24 h of intubation was an independent risk factor for developing EP (odds ratio: 28.9; 95% confidence interval: 1.59-52.5).

CONCLUSION

Colonisation of the trachea within 24 h of intubation by Staphylococcus aureus, Haemophilus influenzae or Streptococcus pneumoniae is a risk factor for developing EP in patients with head trauma.

Effect of spontaneous breathing trial duration on outcome of attempts to discontinue mechanical ventilation. Spanish Lung Failure Collaborative Group

The duration of spontaneous breathing trials before extubation has been set at 2 h in research studies, but the optimal duration is not known. We conducted a prospective, multicenter study involving 526 ventilator-supported patients considered ready for weaning, to compare clinical outcomes for trials of spontaneous breathing with target durations of 30 and 120 min. Of the 270 and 256 patients in the 30- and 120-min trial groups, respectively, 237 (87.8%) and 216 (84.8%), respectively, completed the trial without distress and were extubated (p = 0.32); 32 (13.5%) and 29 (13.4%), respectively, of these patients required reintubation within 48 h. The percentage of patients who remained extubated for 48 h after a spontaneous breathing trial did not differ in the 30- and 120-min trial groups (75.9% versus 73.0%, respectively, p = 0.43). The 30- and 120-min trial groups had similar within-unit mortality rates (13 and 9%, respectively) and in-hospital mortality rates (19 and 18%, respectively). Reintubation was required in 61 (13.5%) patients, and these patients had a higher mortality (20 of 61, 32.8%) than did patients who tolerated extubation (18 of 392, 4.6%) (p < 0.001). Neither measurements of respiratory frequency, heart rate, systolic blood pressure, and oxygen saturation during the trial, nor other functional measurements before the trial discriminated between patients who required reintubation from those who tolerated extubation. In conclusion, after a first trial of spontaneous breathing, successful extubation was achieved equally effectively with trials targeted to last 30 and 120 min.

[Mortality and risk factors in patients with acute renal failure and multiple organ dysfunction]

BACKGROUND

Acute renal failure (ARF) associated to multiple organ dysfunction (MOD) deserves currently a poor survival. The aim of this study was to analyze the risk factors for mortality in ARF-MOD patients treated by means of continuous renal replacements strategies.

PATIENTS AND METHODS

All the ARF-MOD patients treated by means of continuous renal replacement techniques (CRRT) in a single center in the period 1989-1995 have been evaluated. MOD was defined by the 1992 American Conference criteria. Both demographic and the scored clinical data were analysed by means of descriptive and comparative statistics and by multiple logistic regression for the mortality risk factors.

RESULTS

103 patients have been evaluated. The median age was 62 years (range 20-80), 73.8% were males and the mean APACHE II score was 22.7 (SD 5.5). In the 17.4% the ARF-MOD condition corresponded to multiple trauma, the other medical and surgical pathologies represented the 82.6% of cases. At least two organic systems were involved in all patients. Both urea and creatinine values significantly decreased in all the patients and the fluid removal was of 8.9 (2.6) l/24 h. The mortality rate was 78.6%. The risk for death, as evaluated by logistic regression, was higher in patients older than 60 years (OR: 3.45; Cl 95%: 1.1-10.78; p = 0.03), and lower in those with remaining diuresis (OR: 0.65; Cl 95%: 0.48-0.9; p = 0.008). Survival was better among ARF-MOD traumatic patients.

CONCLUSIONS

The mortality rates among ARF-MOD patients remains high. The CRRT were useful for removing uremic toxins and fluids. By logistic regression only advanced age and low urine output were the main risk factors for mortality.

Protective effect of intravenously administered cefuroxime against nosocomial pneumonia in patients with structural coma

In comatose patients admitted to an ICU, particularly those with head injury, the incidence of early onset pneumonia is exceedingly high. We performed an open, prospective, randomized, and controlled clinical trial aiming at the reduction of the incidence of ventilator-associated pneumonia in head-injured patients and patients with stroke requiring mechanical ventilation. One hundred patients were included because of head injury or coma caused by medical stroke and with Glasgow coma scores < or = 12 and mechanical ventilation > 72 h. Patients eligible for the study (n = 50) received cefuroxime intravenously (two 1,500-mg doses 12 h apart after intubation) (the cefuroxime group) and 50 patients not receiving cefuroxime formed the control group. In the former group patients did not receive any other antibiotics before the end-point determination, whereas in the latter, 17 patients received prophylactic antibiotics as prescribed by the attending physician. The global incidence of microbiologically confirmed pneumonia was 37% (n = 37); 12 (24%) belonged to the cefuroxime group, and 25 (50%) belonged to the control group (p = 0.007). Early-onset pneumonia accounted for 70% of all the pneumonia episodes (n = 26), eight (67%) belonging to the cefuroxime group, and 18 (72%) belonging to the control group (p = 0.02). In the control group, four of 17 (23%) patients receiving prior antibiotics developed pneumonia, whereas 21 of 33 (64%) patients who did not receive antibiotics developed pneumonia (p = 0.016). The multivariate analysis revealed that the duration of mechanical ventilation (per each day) was an independent risk factor significantly associated to the development of pneumonia. Furthermore, the use of cefuroxime and/or prior antibiotics in the control group, before the pneumonia episode, had a protective effect against its development. No differences were found with regard to mortality and morbidity when comparing the study population with the control group. Nevertheless, when comparing patients with pneumonia (from both study and control groups) with those without it, there was a decrease in total hospital stay (35 +/- 13 versus 25 +/- 14 d, p = 0.048) and ICU stay (20 +/- 11 versus 11 +/- 7 d, p = 0.001). The study demonstrated that the administration of two single high doses 1,500 mg each of cefuroxime after the intubation of patients comatose because of head injury or medical stroke is an effective prophylactic strategy to decrease the incidence of ventilator-associated pneumonia.

Prevalence of mental disorders among children in Valencia, Spain

A 2-stage survey was carried out to establish the point-prevalence of mental disorders and help-seeking behaviour in children aged 8, 11 and 15 living in the city of Valencia. Global prevalence rates, rates by age and rates by sex, as well as rates of specific diagnosis according to DSM-III-R criteria are described. Help-seeking behaviour was found to be related to an interaction between internalizing and externalizing symptoms and sex.

[Value of the transcranial Doppler examination in the diagnosis of brain death]

BACKGROUND

Transcranial Doppler examination (TCD) is a non invasive method capable of detecting the interruption of cerebral flow in patients with criteria of brain death. Its recognition as an alternative to isoelectric EEG for the diagnosis of brain death requires previous validation.

METHODS

Twenty-six patients in profound coma were examined by TCD. Of 23 patients with technically adequate study 13 manifested clinical criteria and EEG of brain death. Of these patients 9 had received barbiturate treatment and 4 had not.

RESULTS

Changes in the flow waves of the TCD were observed in the form of diastolic reflux or systolic points of slight amplitude without diastolic flow in at least 2 arteries in 12 of 13 patients with criteria of brain death (sensitivity = 92%) and in none of the 10 patients without criteria of brain death (specificity = 100%). The use of barbiturates did not modify the normal anterograde flow detected by TCD in the absence of criteria of brain death.

CONCLUSIONS

Transcranial Doppler is a good method for confirming the clinical diagnosis of brain death, fundamentally in patients undergoing treatment with drugs depressing the central nervous system.

Treatment charts in radiation therapy. An analysis of European treatment records

The radiotherapy treatment chart (dose prescription, set-up parameters, dose computation and daily dose recording form) represents an important working tool in radiotherapy, not only as a compilation of data, but also as a method of communication among physicians, physicists and technicians. In addition to administrative and medical data, physical and simulation data that are indispensable for the daily accurate reproduction of the therapy procedures should be recorded, as well as accurate daily entries of the fractional and cumulative absorbed doses. Moreover, any radiation therapy quality assurance programme must rely on the accessibility of the radiation treatment history and a correct record of the therapy protocol in order to be verifiable. We have analysed the treatment charts of 92 European Departments of Radiation Oncology, with the aim of identifying their salient characteristics and data recorded. The study shows strong differences among the charts analysed, not only in the amount of information recorded, but also in the kind of data and concepts used.

Pericardial tamponade and coronary sinus thrombosis associated with central venus catheterization

We report the rare occurrence of fatal cardiac tamponade due to coronary sinus and right atrial thrombosis associated with central venous catheterization. The clinical course was extremely rapid, with death occurring a few minutes after the acute clinical event. Other causes of acute cardiac tamponade were ruled out by the postmortem studies.

Functional sequences of the myosin head

Muscle contraction originates from the sliding of myosin filaments on actin filaments, the energy for which is supplied by the hydrolysis of adenosine-5-triphosphate (ATP) by myosin. The nucleotide first binds to the acto-myosin complex in the myosin head (or subfragment-1), producing a conformational change which induces actin dissociation. The release of phosphate (Pi) then allows a return to the strong actin-myosin association, corresponding to the rigor state. We discuss here certain controversial points arising from current concepts of the actin and nucleotide binding regions at the amino acid sequence level within the subfragment-1 heavy chain. We consider the actin and nucleotide binding regions to be two distinct sites (for each of these regions) one of which is shared competitively between actin and the nucleotide. In our model the cyclical actin-S1 association-dissociation steps correspond to different ATP, actin and ADP affinities for the same amino acid sequence of the S1 heavy chain, contributing alternatively to a single hydrolytic nucleotide site or a strong actin site. We propose the existence of a flexible segment that forms or dismantles the nucleotide or actin sites. The large region (amino acids 540-707) overlapping the actin-myosin interface appears to be the main flexible region of the S1 molecule and we propose that this particular sequence plays a key role in the dissociation pathway of the actin-myosin complex and in the conversion of chemical energy into the mechanical energy of contraction.

The actin-myosin subfragment-1 complex stabilized by phenyldiglyoxal

Nuclear magnetic resonance studies have revealed the importance of arginine residues in the actin-myosin interface (Moir, A. J. G., and Levine, B. A. (1986) J. Inorg. Chem. 27, 271-278). In the present study, we tested the involvement of these residues in the rigor complex between actin and subfragment-1 (S1) by chemical cross-linking experiments using phenyldiglyoxal. Two kinds of linkages were observed, one within the S1 heavy chain itself (120-kDa product) and the other between actin and the S1 heavy chain (200-kDa product). The phenyldiglyoxal had an effect similar to that of phenylglyoxal on S1 ATPase activities. We also show that phenyldiglyoxal (of 0.6-0.8 nm arm length) cross-links an arginine residue of the 50-kDa domain to one in the 20-kDa domain of the S1 heavy chain in the absence of actin or to an arginine in actin when actin is present. The presence of Mg2+, adenosine 5'-diphosphate or 5'-adenylyl imidodiphosphate suppressed the intermolecular linkage with actin, and favored the intramolecular cross-link, (i.e. between 50-kDa and 20-kDa fragments). We propose that the same arginyl residue in the N-terminal part of the 50-kDa domain can be cross-linked to a nearby arginine in either the 20-kDa domain or the actin molecule. In accordance with the amino acid sequence of each protein this also implies that the actin-myosin interaction involves arginine residues located either after residue 28 of the N-terminal part of actin, since this actin region is devoid of arginine residues, or in the N-terminal portion of the 50-kDa domain, i.e. between residues 239 and 455.

The presence of non-neuronal cells influences somatostatin release from cultured cerebral cortical cells

We examined the effect of non-neuronal cells on somatostatin release from cultured cerebral cortical cells. Three culture models were used: (1) neuron-enriched cultures obtained from cortex of 17-day-old rat embryos and exposed to 10 microM cytosine arabinoside (Ara C) for 48 h between days 3 and 5 after plating; (2) whole cell cultures obtained by using the same protocol but untreated with Ara C; (3) glial primary cultures obtained from newborn rats. We studied: (i) the cellular composition of the cultures by using two astroglial markers: vimentin and glial fibrillary acidic protein (GFAP); (ii) the spontaneous and forskolin-stimulated somatostatin release. In 8-day-old cultures morphological data revealed that Ara C treatment reduced glial cells to 6%. At 7 and 10 days of culture somatostatin spontaneously released from Ara C-treated cells was higher than that measured from untreated cells. On the 17th day of culture, neuron-enriched cultures contained a lower amount of somatostatin than whole cell cultures. Forskolin elicited a dose-dependent release of somatostatin from whole cell cultures, but had no effect on neuron-enriched cultures. Astroglial released media (ARM) from glial primary cultures exposed to forskolin for 20 min induced somatostatin release from neuron-enriched cultures. HPLC analysis of endogenous amino acids of ARM showed that glutamate, glutamine, glycine and alanine were significantly increased after forskolin stimulation. Our results suggest a functional interaction between glial cells and neurons secreting somatostatin.

The internal crosslinking of the S1 heavy chain from smooth muscle probed by dibromobimane

The reaction of the crosslinker dibromobimane has recently revealed a functionally important internal loop structure within the skeletal myosin S1 heavy chain where Cys-522 of the 50K domain and Cys-707 (SH1) of the 20K region are spatially juxtaposed. Here we have studied the possible relevance of this topological feature to the architecture and transducing activity of the myosin head in general, by extending the dibromobimane modification to smooth muscle myosin. Treatment of chicken gizzard myosin S1 with dibromobimane resulted in intramolecular crosslinking between the C-terminal 25K and central 50K segments of the S1 heavy chain. The data suggest a conservation at the 50K-25K interface of smooth muscle S1 heavy chain and the importance of the neighboring SH1 region, whose conformation may play an important role in energy transduction by the myosin head.