New detection method of SARS-CoV-2 antibodies toward a point-of-care biosensor

The outbreak of COVID-19, a disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, is regarded as the most severe of the documented coronavirus pandemics. The measurement and monitoring of SARS-CoV-2 antibody levels by serological tests are relevant for a better epidemiological and clinical understanding of COVID-19. The aim of this work was to design a method called the SARS-CoV-2 antibody detection method (SARS-CoV-2 AbDM) for fluorescence immunodetection of anti-SARS-CoV-2 IgG and IgM on both plate and microfluidic chip. For this purpose, a system with magnetic beads that immobilize the antigen (S protein and RBD) on its surface was used to determine the presence and quantity of antibodies in a sample in a single reaction. The SARS-CoV-2 AbDM led to several advantages in the performance of the tests, such as reduced cost, possibility of performing isolated or multiple samples, potential of multiplex detection, and capacity to detect whole blood samples without losing resolution. In addition, due to the microfluidic chip in conjunction with the motorized actuated platform, the time, sample quantity, and operator intervention during the process were reduced. All these advantages suggest that the SARS-CoV-2 AbDM has the potential to be developed as a PoC that can be used as a tool for seroprevalence monitoring, allowing a better understanding of the epidemiological and clinical characteristics of COVID-19 and contributing to more effective and ethical decision-making in strategies to fight against the COVID-19 pandemic.

Disparities in Local Wellness Policies Implementation Across Maryland Schools

BACKGROUND

School-level implementation of district-level local wellness policies (LWPs) is needed to create school environments that promote nutrition and physical activity (PA). Disparities in classroom-specific LWPs implementation were examined.

METHODS

An administrator survey (N = 756 schools; 24/24 districts) included 6 classrooms LWP best-practice items (fully/not fully implemented: restricting food celebrations or rewards, incorporating PA breaks or integrating PA in curricula, restricting withholding or using PA as punishment). A sum score (alpha = .71; elementary and middle/high examined separately) was used to examine associations with student body income (free-and-reduced priced meals (FARMS): ≤40%, 41-75%, ≥75%), race/ethnicity, and school location (rural/urban/suburban), accounting for district-level clustering, with moderation examined.

RESULTS

Classroom implementation scores were: elementary = 3.1 ± 1.8 (range: 0-6/6 items) and middle/high = 2.3 ± 1.6 (range:0-5/5 items). Among elementary and middle/high schools, 65% and 55% had >40% FARMS, 39% and 46% had ≥50% white student body, and 24% and 23% were urban, respectively. Elementary schools with >40% of FARMS-eligible students and middle/high schools with <25% white students reported implementing fewer items. Location was not associated with classroom practices nor was moderation observed.

CONCLUSIONS

Disparities in classroom-specific LWP best practices implementation were observed by income and race/ethnicity. Tailored support may be needed to improve classroom LWP implementation in schools serving low-income students.

Building Blocks for Healthy Children: Evaluation of a Child Care Center-Based Obesity Prevention Pilot Among Low-Income Children

OBJECTIVE

To assess the impact of a multilevel nutrition intervention for low-income child care environments, staff, and center-enrolled children.

DESIGN

A cluster-randomized, controlled trial conducted among eligible centers. Staff and parent self-report surveys and objective field observations at baseline and follow-up were conducted.

SETTING

A total of 22 low-income child care centers (enrolling ≥ 25 2- to 5-year-old children).

PARTICIPANTS

Children aged 18-71 months; 408 children and 97 staff were randomized into intervention (208 children and 50 staff) and waitlist-control groups (200 children and 45 staff). Retention rates were high (87% for children and 93% for staff).

INTERVENTION(S)

A 6-session, 6-month director's child nutrition course with on-site technical support for center teachers.

MAIN OUTCOME MEASURE(S)

Center nutrition/physical activity environment; staff feeding styles, dietary patterns, and attitudes about food; child food preferences and dietary patterns.

ANALYSIS

Covariance regression analyses to assess the intervention effect, adjusting for clustering within centers.

RESULTS

Significant intervention effects were found for the center nutrition training/education environment (b = 3.01; P = .03), nutrition total scores (b = 1.29; P = .04), and staff-level prompting/encouraging feeding styles (b = 0.38; P = .04). No significant intervention effects were found for child-level measures.

CONCLUSIONS AND IMPLICATIONS

Curriculum-driven training and implementation support improved nutritional policies and practices and staff-child interactions during meals. Future research could extend the intervention to families and the evaluation to children's dietary behaviors and weight changes.

Addison's Disease Secondary to Prostatic Carcinoma. A Case Report

Adrenal cortical insufficiency secondary to destruction of the cortex by a metastatic tumor is a rare condition. Addison's disease is usually caused by an autoimmune process or by a tuberculous infection. We report a case of adrenal Insufficiency as the first clinical manifestation of a metastatic prostate carcinoma that occurred simultaneously with an active pulmonary infection by M. tuberculosis.

Optimal design for parameter estimation in EEG problems in a 3D multilayered domain

The fundamental problem of collecting data in the ``best way'' in order to assure statistically efficient estimation of parameters is known as Optimal Experimental Design. Many inverse problems consist in selecting best parameter values of a given mathematical model based on fits to measured data. These are usually formulated as optimization problems and the accuracy of their solutions depends not only on the chosen optimization scheme but also on the given data. We consider an electromagnetic interrogation problem, specifically one arising in an electroencephalography (EEG) problem, of finding optimal number and locations for sensors for source identification in a 3D unit sphere from data on its boundary. In this effort we compare the use of the classical D-optimal criterion for observation points as opposed to that for a uniform observation mesh. We consider location and best number of sensors and report results based on statistical uncertainty analysis of the resulting estimated parameters.

Comparative effect of simulated solar light, UV, UV/H2O2 and photo-Fenton treatment (UV-Vis/H2O2/Fe2+,3+) in the Escherichia coli inactivation in artificial seawater

Innovative disinfection technologies are being studied for seawater, seeking a viable alternative to chlorination. This study proposes the use of H2O2/UV254 and photo-Fenton as disinfection treatment in seawater. The irradiations were carried out using a sunlight simulator (Suntest) and a cylindrical UV reactor. The efficiency of the treatment was compared for Milli-Q water, Leman Lake water and artificial seawater. The presence of bicarbonates and organic matter was investigated in order to evaluate possible effects on the photo-Fenton disinfection treatment. The photo-Fenton treatment, employing 1 mg L(-1) Fe(2+) and 10 mg L(-1) of H2O2, led to the fastest bacterial inactivation kinetics. Using H2O2/UV254 high disinfection rates were obtained similar to those obtained with photo-Fenton under UV254 light. In Milli-Q water, the rate of inactivation for Escherichia coli was higher than in Leman Lake water and seawater due to the lack of inorganic ions affecting negatively bacteria inactivation. The presence of bicarbonate showed scavenging of the OH(•) radicals generated in the treatment of photo-Fenton and H2O2/UV254. Despite the negative effect of inorganic ions, especially HCO3(-), the disinfection treatments with AOPs in lake water and seawater improved significantly the disinfection compared to light alone (simulated sunlight and UV254). In the treatment of photo-Fenton with simulated sunlight, dissolved organic matter had a beneficial effect by increasing the rate of inactivation. This is associated with the formation of Fe(3+)-organo photosensitive complexes leading to the formation of ROS able to inactivate bacteria. This effect was not observed in the photo-Fenton with UV254. Growth of E. coli surviving in seawater was observed 24 and 48 h after treatment with UV light. However, growth of surviving bacteria was not detected after photo-Fenton with UV254 and H2O2/UV254 treatments. This study suggests H2O2/UV254 and photo-Fenton treatments for the disinfection of seawater, in spite its high concentration of salts.

Sensitivity analysis for the EEG forward problem

Sensitivity analysis can provide useful information when one is interested in identifying the parameter θ of a system since it measures the variations of the output u when θ changes. In the literature two different sensitivity functions are frequently used: the traditional sensitivity functions (TSF) and the generalized sensitivity functions (GSF). They can help to determine the time instants where the output of a dynamical system has more information about the value of its parameters in order to carry on an estimation process. Both functions were considered by some authors who compared their results for different dynamical systems (see Banks and Bihari, 2001; Kappel and Batzel, 2006; Banks et al., 2008). In this work we apply the TSF and the GSF to analyze the sensitivity of the 3D Poisson-type equation with interfaces of the forward problem of electroencephalography. In a simple model where we consider the head as a volume consisting of nested homogeneous sets, we establish the differential equations that correspond to TSF with respect to the value of the conductivity of the different tissues and deduce the corresponding integral equations. Afterward we compute the GSF for the same model. We perform some numerical experiments for both types of sensitivity functions and compare the results.

Pattern formation driven by an acid-base neutralization reaction in aqueous media in a gravitational field

We report the hydrodynamic instabilities found in a simple exothermic neutralization reaction. Although the heavier aqueous NaOH solution was put below the lighter layer of aqueous HCl solution, fingering at the interface in a Hele-Shaw cell was observed. The reaction front, which propagates downward, becomes buoyantly unstable in the gravity field. The mixing zone length and wave number depend on the reactant concentrations. The mixing zone length increases and the wave number decreases when the reactant concentrations decrease.

Comparative study of several lymphocyte functions in two strains of mice with different models of endotoxic shock

Previously, the changes in phagocyte functions such as adherence, chemotaxis or TNFalpha production were found to be associated with oxidative stress in endotoxin-induced septic shock. However, in this type of oxidative stress the lymphocyte involvement has rarely been studied. In the present report, we analyzed the above functions in peritoneal lymphocytes from male and female BALB/c mice with a lethal endotoxic shock caused by intraperitoneal injection of E. coli lipopolysaccharide (LPS) (100 mg/kg), male and female Swiss mice with lethal endotoxic shock caused by intraperitoneal injection of LPS (150 and 250 mg/kg, respectively) or non-lethal endotoxic shock (100 mg/kg). In peritoneal lymphocytes obtained at 0, 2, 4, 12 or 24 h after LPS injection, the first two functions of these cells in the immune response, i.e. adherence to tissues and directed migration (chemotaxis), were studied. At 0, 0.5, 1, 1.5, 2, 4, 12 and 24 h after LPS injection, TNFalpha released by lymphocytes was also analyzed. The results show that endotoxic shock increases the adherence and TNFalpha release, and decreases the chemotaxis of peritoneal lymphocytes. These changes were more significant in mice with lethal than with non-lethal endotoxic shock, a fact that confirms the important role of lymphocytes during endotoxic shock.

Enzyme-mediated solvent extraction of carotenoids from marigold flower (Tagetes erecta)

Marigold flowers are the most important source of carotenoids for application in the food industry. However, the extraction gives almost 50% losses of the carotenoids depending on conditions for silaging, drying, and solvent extraction. In the past decades, macerating enzymes have been successfully applied to improve the extraction yield of valued compounds from natural products. In this work, an alternative extraction process for carotenoids is proposed, consisting of a simultaneous enzymatic treatment and solvent extraction. The proposed process employs milled fresh flowers directly as raw material, eliminating the inefficient silage and drying operations as well as the generation of hard to deal with aqueous effluents present in traditional processes. The process developed was tested at the 80 L scale, where under optimal conditions a carotenoid recovery yield of 97% was obtained.

31Phosphorus magnetic resonance spectroscopy in the assessment of head and neck tumors

PURPOSE

31Phosphorus magnetic resonance spectroscopy (31P-MRS) provides biochemical information in a noninvasive way. The aim of this work was: (a) to characterize the 31P spectrum of advanced head and neck tumors, and (b) to evaluate the spectral changes after treatment and to correlate them with the pathologic response.

METHODS AND MATERIALS

A total of 20 patients diagnosed with advanced head and neck tumors and 7 healthy controls participated in the study. The tumor mass and its contralateral side were studied by means of 31P-MRS before and after treatment. Neck muscles of a control group were also studied.

RESULTS

Tumors presented ratios of phosphomonoesters (PME), phosphodiesters (PDE), and inorganic phosphate (Pi) with respect to the adenosine triphosphate (ATP), significantly higher and a PCr (phosphocreatine)/ATP ratio lower than the neck muscle of volunteers or the contralateral side. The PDE/ATP and PME/ATP ratio values obtained before therapy were similar, independent of the later response to treatment. However, when there was a complete response, the ratios measured after treatment were decreased.

CONCLUSION

These results show the existence of significant differences between the 31phosphorus spectrum of tumors and neck muscle, but also between the tumors and their contralateral sides. Moreover, 31P-MRS is able to detect metabolic changes after a complete response. These results suggest that 31P-MRS would be useful in the evaluation of the clinical response of head and neck tumors.

Cisplatin and vinorelbine followed by radiotherapy in the treatment of stage III-B non-small-cell lung cancer patients

Combined chemotherapy/radiotherapy treatments appear to yield better results in locally advanced non-small-cell lung cancer (NSCLC) than radiotherapy alone. The optimal induction chemotherapy regimen remains to be established. In the present study, chemotherapy with cisplatin and vinorelbine was used prior to radical radiotherapy in Stage III-B NSCLC. Thirty-three patients were entered prospectively into a Phase II study. Treatment consisted of three cycles of chemotherapy with cisplatin 100 mg/m2 on day 1 and vinorelbine 30 mg/m2 on days 1 and 8, followed by thoracic radiotherapy (60 Gy). Twenty-two percent of the 33 patients had grade 3-4 leukopenia, and there were six episodes (in 4 patients) of neutropenia-associated fever. Gastrointestinal toxicity was generally moderate. Peripheral neuropathy was present in 42% of the patients, although in most of them it was slight. The main radiotherapy toxicity was esophagitis grade I-II. Evaluation of response after the third chemotherapy course showed an objective response in 16 patients (48%), whereas in three patients (9%) the disease progressed during therapy. The median survival of the entire group was 13 months. Cisplatin plus vinorelbine followed by radiotherapy is an effective schedule for patients with locally advanced non-small-cell lung cancer.

Fluorouracil and high-dose leucovorin with radiotherapy as adjuvant therapy for rectal cancer. Results of a phase II study

The purpose of this phase II study was to evaluate the efficacy and toxicity of fluorouracil and high-dose leucovorin (5-FU/LV) with pelvic irradiation as adjuvant therapy for patients with macroscopical resected rectal or recto-sigmoid cancer. Following surgery for stages II-III primary (52) or recurrent rectal cancer (4), 56 patients received 8 cycles of 5-FU/LV and pelvic irradiation. 5-FU doses were 200 mgr/m2 for cycles 2-3 and 300 mgr/m2 for cycles 1 and 4-8. LV doses remained fixed at 200 mgr/m2. Pelvic radiation was started in the third week, between the first and second cycle. The total dose was 50.4 Gy. No severe complications had been recorded. The incidence of grade 3 diarrhea was 19%. Three patients presented leukopenia grade 3 (5%). In 44 patients (78%) the planned treatment could be administered. The median follow-up was 40 months (range 22-66). Seven patients had a local relapse (13%) and 6 developed distant metastasis (10%). The 3-year disease-free survival was 72% and the overall survival was 76%. These preliminary results show that combined post-operative 5-FU/LV and pelvic radiotherapy are well tolerated and present a reasonable local control and survival rates. This adjuvant treatment should be evaluated in randomized trials.

[C-erbB-2 protein in ovarian epithelial cancer: correlation between expression in tumor tissue and blood levels]

BACKGROUND

Among 20 to 30% of the patients with ovarian cancer present overexpression of the c-erbB protein in the tumor tissue although its clinical significance has not been clearly established. In patients with a disseminated neoplasm and overexpression of c-erbB an increase in the extracellular portion of this protein may be detected in serum. The aim of this study was to determine the c-erbB protein in serum and in tumoral tissue in patients diagnosed with ovarian epithelial carcinoma.

METHODS

The serum concentration of the c-erbB protein was quantified by ELISA techniques in 60 blood donor women (control group) and in 99 patients with ovarian cancer. Likewise, the expression of the c-erbB protein was determined in tumoral tissue by immunohistochemical techniques in the 99 patients with ovarian cancer. The correlation between overexpression and elevated serum values was analyzed.

RESULTS

The mean c-erbB values obtained in the serum of the control group was 10.9 U/ml (SD: 2.8) with a range of 1.5-17.0. Serum determination was carried out in absence of the tumor in 49 patients being positive in 2 cases. In 7 patients the determination was performed in the presence of peritoneal implants of a diameter of less than 2 cm with none being positive. Serum determination was carried out in 43 patients in the presence of implants greater than 2 cm and 14 (32.5%) were positive. A further 153 determinations were performed during follow up of the 99 patients, 62 in tumor absence (3.2% positive), 2 in the presence of a tumor of less than 2 cm (none positive) and 89 in the presence of a tumor greater than 2 cm (34.8% positive). A correlation was found between elevated c-erbB serum values in the presence of a disseminated tumors and overexpression of tumoral tissue (p: 0.0011).

CONCLUSIONS

A third of the patients with ovarian cancer and peritoneal implants of a diameter greater than 2 cm present elevated serum levels of the c-erbB.2 protein. A correlation was found between serum c-erbB positivity and overexpression of the protein in tumoral tissue.

Overexpression of c-erbB-2 in epithelial ovarian cancer. Prognostic value and relationship with response to chemotherapy

BACKGROUND

Overexpression of the c-erbB-2 protein has been reported in tumors from approximately 25% of patients with epithelial ovarian cancer. However, its clinical significance has not been well established.

METHODS

Overexpression of the c-erbB-2 protein was studied by immunohistochemistry in paraffin-embedded tumor tissue from 106 patients with ovarian cancer.

RESULTS

Tumors from 23 patients (21.7%) had c-erbB-2 overexpression. The percentage of tumors with overexpression was higher in those with Stages III/IV disease (29.2%) compared with those with Stages I/II disease (5.9%) (P = 0.057), in patients with residual tumor greater than 2 cm after initial surgery (37.2%) compared with those with tumor less than 2 cm (9.5%) (P = 0.01), and in patients who failed to respond to chemotherapy with carboplatin and cyclophosphamide (75%) compared with those who responded (18.6%) (P = 0.0043). No correlation was found between c-erbB-2 expression with age, the degree of differentiation, or the histologic subtype. Median survival of the 23 patients with protein overexpression was 62 weeks, whereas 75% of the 83 patients without overexpression were alive at 123 weeks (P = 0.0000). Of the patients with advanced stage disease (III/IV), survival was also lower in those presenting with overexpression (60 weeks) compared with those without expression (75% alive at 93 weeks) (P = 0.0000). Multivariate analysis of possible prognostic factors showed that c-erbB-2 overexpression and residual tumor greater than 2 cm resulted in a worsening of survival rates.

CONCLUSION

c-erbB-2 overexpression in tumors from patients with ovarian cancer resulted in a poorer prognosis than for patients whose tumors did not have overexpression.

A comparative study of aerobic capacity and fitness in three different horse breeds (Andalusian, Arabian and Anglo-Arabian)

Aerobic capacity and fitness was studied in three different horse breeds (Andalusian, Arabian and Anglo-Arabian) using a four-level exercise test of gradually increasing intensity (15, 20, 25 and 30 km/h). The lactate concentration at the first three exercise levels was significantly lower for Arabian and Anglo-Arabian horses relative to Andalusian horses, but similar for the three breeds at the last level. Arabian and Anglo-Arabian horses reached a higher rate than Andalusian horses at plasma lactate concentration of 2 mmol/l (VLA2) and 4 mmol/l (VLA4). Andalusian horses exhibited a significantly lower heart rate at rest than the other two breeds, but the differences virtually disappeared at 15 km/h. At 20 km/h, Andalusian horses reached a higher heart rate than Arabian and Anglo-Arabian horses; at 25 km/h, however, their heart rate only exceeded that of Anglo-Arabian horses. Finally, no significant differences between breeds were observed at 30 km/h. No differences between breeds as regards heart rate were found if this was expressed as a function of lactate plasma concentrations of 2 mmol/l (HRLA2) and 4 mmol/l (HRLA4). At a heart rate of 150 (VHR150) and 200 beta/min (VHR200), Andalusian horses achieved the lowest speeds.

Long-term survival in advanced ovarian cancer after cytoreduction and chemotherapy treatment

Ninety-one patients with untreated epithelial ovarian cancer, stages III and IV, were treated according to a therapeutic protocol including cytoreductive surgery whenever possible, chemotherapy with CAP (cyclophosphamide, doxorubicin, and cisplatin) and second-look laparotomy for those patients achieving a clinical remission. Optimal cytoreductive surgery (residual tumor < 2 cm) was not performed in 66 patients (72.5%). A negative second-look laparotomy demonstrated a pathological complete remission in 26 patients (28.5%). After a median follow-up of 80 months, the disease-free survival is 19.7% (18 of 91 patients). Median survival was greater in optimal cytoreductive surgery patients (47 months) than in the rest of the patients (22 months) (P = 0.0000). Survival was also better in pathological complete remission patients (46 months) than in partial remission (PR) or no response patients (22 months) (P = 0.0001). Optimal secondary cytoreductive surgery was possible in 11 patients in PR after chemotherapy. Survival in this group was similar to that of pathological complete remission cases. Currently, 53% of patients with initial residual tumor < 2 cm and complete response at second-look remain free of disease. In a multivariate analysis, residual tumor > 2 cm and stage IV disease were the most significant prognostic factors. The same analysis indicates that response to chemotherapy at second laparotomy is not an independent prognostic factor. In conclusion, our study indicates that the two most important prognostic factors in advanced ovarian carcinoma are the extent of the initial surgery and stage.

[The 2-chambered right ventricle with an anomalous muscle bundle]

The clinical picture, course, electrocardiogram and chest X-Ray of 30 patients with the angiocardiographic diagnosis of double-chambered right ventricle, along with the echocardiogram in 18 and surgical results in 26 are analyzed. A ventricular septal defect was associated in most of the patients, that had spontaneous closure in some of them. The clinical picture and serial catheterization in some cases suggested progressive obstruction of the right ventricular outflow tract. In this, as in most of the reported series, the history, physical examination, ECG and roentgenogram were inconclusive for diagnosis of this entity. Two-dimensional echocardiography was the most reliable non invasive method to assess this malformation, even superior to catheterization in some aspects. The angiocardiographic findings are quite distinctive, allowing differentiation of other types of subpulmonary stenosis. In order to achieve a good surgical result is essential a precise diagnosis of this malformation and of the associated anomalies. The long-term prognosis was good as in most of the reported series.

alpha Interferon in the management of essential thrombocythaemia

Thirteen patients (mean age 60.7 years; female:male ratio 10:3) with essential thrombocythaemia were treated with 3 million units (MU)/day interferon alfa-2b subcutaneously (s.c.) for 12 weeks, with all patients requiring a dose reduction after 4 weeks. The mean pretreatment platelet count was 1,400 x 10(9)/L and megakaryocytes were increased in all cases. Splenomegaly was present in six patients and haemorrhagic phenomena were observed in two. Nine patients (69.2%) had objective responses, including two (15.4%) complete responses (platelets less than 450 x 10(9)/L) which were then maintained with 5 MU interferon twice a week. Acute toxicity consisted of flu-like symptoms in 12 patients. Chronic toxicity (mainly leucopenia) was observed in nine patients. In conclusion, initial therapy and then requiring maintenance therapy at a reduced dose. However, the frequent side effects observed make it advisable to use a low dose of interferon alfa-2b, and to treat only those patients with significant symptoms and signs of thrombocytosis.

[Alternating chemotherapeutic treatment in patients with localized undifferentiated small-cell carcinoma of the lung]

The results obtained from 23 patients suffering small cell lung carcinoma limited to the thorax, treated with 4 cycles of cyclophosphamide, adriamycin, vincristine alternating with cisplatin and VP/16, followed by mediastinal and holocranial prophylactic radiotherapy in patients with a complete response (CR) are here presented. An 87% of global responses were obtained with a 64% rate of RC. The average survival rate was 12 months with an 18% of patients alive two years after treatment. The main toxicity was hematologic and neurologic. Even if this alternating regime produces a high response rate, the results are not superior to those obtained with conventional chemotherapy.

Life expectancy of patients with chronic nonleukemic myeloproliferative disorders

This study determines, within the frame of current therapeutic possibilities, the impact of chronic nonleukemic myeloproliferative disorders on expected survival. The survival data for 1067 patients (454 with polycythemia vera, 247 with essential thrombocythemia, and 366 with idiopathic myelofibrosis) were collected from 38 Spanish institutions. The actuarial survival probability of each group of patients was compared with that of the age-matched and sex-matched control population. The survival of the patients with polycythemia vera and essential thrombocythemia did not differ from that of the control population (P = 0.92 and, 0.22, respectively), whereas the survival of the patients with idiopathic myelofibrosis was strikingly reduced with respect to the control population (P = 0.0000000007). Thus, in terms of survival, current therapeutic procedures may be considered as quite satisfactory in patients with polycythemia vera and essential thrombocythemia. On the other hand, due to poor survival of patients with idiopathic myelofibrosis, new therapeutic approaches for this condition are clearly needed.

Influence of age on the ventricular activation and recuperation processes in the pig

In order to establish if the electrical ventricular systole is affected by physical maturation, the electrocardiographic outline of 30 Landrace x White Belgian pigs was analyzed at ages of 1 day, 5, 20 and 45 days and 3, 4 1/2 and 6 months. Throughout the first 6 months of life the values for the parameters which represent the ventricular activation underwent an increase with physical maturation. The Q wave duration increased significantly from 45 days, and the R wave between 1 day and 45 days and from 4 1/2 months. The duration of the QRS complex and the QT interval experienced a significant increase from 5 days and between 5 and 45 days of age, respectively. The changes on the amplitude were most evident when using the lead V10 with which the R wave experienced the most significant increase during the first 20 days of life. With regard to the ventricular recuperation, the T wave duration underwent a gradual increase throughout the first six months of life. A similar evolution was experienced in the amplitude recorded in the aVF and V10 leads although in the latter the most significant increase took place between the 1st and 5th day of age. Likewise, the duration of the ST segment increased with physical maturation and more significantly between 5 and 45 days of age.

Epithelioid hemangioendothelioma of the liver with myocardial metastases

Epithelioid hemangioendothelioma is an unusual type of endothelial-derived vascular tumor located mainly in the soft tissues of the limbs. The present report describes a 48-year-old woman with an epithelioid hemangioendothelioma located in the liver with very unusual metastases to the myocardium. While the disease itself was controlled by adriamycin the patient died as a consequence of portal hypertension due to the abundant fibrotic component distinctive of this type of tumor. An epithelioid appearance can sometimes lead to a mistaken diagnosis of metastatic carcinoma, as happened initially in our case. The endothelial origin of the tumor must be confirmed by electron microscope identification of Weibel-Palade bodies or by immunohistochemical staining of factor VIII-related antigen. To the authors knowledge, this is the first case of myocardial metastases from an epithelioid hemangioendothelioma of the liver to be reported in English in the medical literature.

Circulating CA 15-3 levels in the postsurgical follow-up of breast cancer patients and in non-malignant diseases

Circulating CA 15-3 antigen levels were evaluated in patients with benign diseases and breast cancer patients with no clinical evidence of disease after surgery (NED). Patients with breast cancer NED were followed for tumor recurrence or death during a median of 12.9 months (range 1 to 25 months). CA 15-3 and carcinoembryonic antigen (CEA) were compared in the same breast cancer NED patient population. Elevated CA 15-3 levels (greater than 40 U/ml) were observed in 38 of 1220 patients with benign diseases (3.1%) and in 25 of 350 breast cancer NED patients (7.1%). Elevations of CEA (greater than 5 ng/ml) were observed in 23 patients with breast cancer NED (6.5%). Benign diseases that produced significant elevations of CA 15-3 were chronic hepatitis (42.9%), liver cirrhosis (13.3%), sarcoidosis (16.7%), tuberculosis (9.7%), and systemic lupus erythematosus (6.7%). In breast cancer NED, initial elevations of CA 15-3 were observed in 12 of the 297 patients that remained free of disease during the follow-up, and in 13 of the 40 patients that relapsed (4.0% vs. 32.5%, p less than 0.001). Initial CEA levels were elevated in 16 patients that remained NED and in 7 patients that relapsed (5.3% vs. 17.5%, p less than 0.001). Serial determinations of CA 15-3 in patients continuously NED showed persistent elevations in 4 cases. Three of these exhibited concomitant benign diseases. In relapsing patients, serial tumor marker determinations showed that elevations of CA 15-3 before any other clinical evidence of recurrence occurred significantly more frequently than elevations of CEA (45% vs. 25%, p less than 0.001). Overall, two or more serial elevated values of CA 15-3 were observed in 7 cases, and 6 of them (85%) eventually relapsed. Median survival from study entry was 18.3 months in patients with breast cancer NED that had initial elevated CA 15-3, compared to 25+ months in those with negative CA 15-3 (p less than 0.0001). We conclude that circulating levels of CA 15-3 antigen can be elevated in some patients with non-malignant diseases, and that serial determinations of CA 15-3 may be useful in the postsurgical follow-up of patients with breast cancer when specific types of benign diseases that may cause elevations of the antigen are excluded. Additionally, CA 15-3 is more sensitive than CEA in the early diagnosis of breast cancer recurrences, and the simultaneous assay of CEA does not add information to that of CA 15-3 alone.

Influence of age on the electrical auricular systole in swine

The electrocardiographic outline from 30 Landrace x Blanco Belga swines was analysed at ages of 1, 5, 20, 45 days, 3, 4 1/2 and 6 months in order to establish how the heart rate and the auricular electrical systole were affected by physical maturation. All parameters analysed undergo significant changes throughout the study phase. The first change could be observed between the 1st and 5th day of postnatal life which resulted in an increase of the heart rate, a decrease of the RR and PQ intervals and PQ segment, and in a decrease of the amplitude (leads I and V10) and duration (leads aVF and V10) of the P wave. From 5 days of age all the parameters analysed underwent a new change in the opposite direction that was detected in a more significant manner between 5 and 45 days of age.

Five-year results of combined chemotherapy and mediastinal radiation therapy in small cell lung cancer

Eighty-five patients with small cell lung cancer (limited disease = LD in 39, extensive disease = ED in 46) received the combination of cyclophosphamide, methotrexate, vincristine and CCNU, and mediastinal radiotherapy given simultaneously after the third course of chemotherapy. The duration of treatment was approximately 12 months. A complete response was obtained in 41% of LD and in 15% of ED patients, and a partial response in 38 and 22%, respectively. Median survival was 55 weeks for LD and 37 weeks for ED patients. Two patients (5%) with LD have survived free of disease more than 3 years since their diagnosis.

Experimental evaluation of atriopulmonary anastomosis in the presence of high pulmonary resistance

We studied pulmonary resistance as a surgical criterion for atriopulmonary shunt. We created a model of experimental pulmonary hypertension by establishing a systemic-pulmonary shunt in 11 dogs. Two to 3 months after the shunt operation, total pulmonary resistance was calculated before (7.24 +/- 1.54 U . m2) and after (3.50 +/- 1.54 U . m2) ligation of the shunt. An atriopulmonary anastomosis technique was then performed and the hemodynamic status of the dogs during the first 2 postoperative hours was evaluated. Pathologic study of the lungs disclosed no arterial lesions. From our experimental work, we conclude that the surgical criterion for establishing the indication for this operation should be pulmonary resistance, which is conditioned by the state of the intrapulmonary vessels. We propose a procedure for determining real pulmonary resistance in the course of preoperative catheterization.

Complete atrioventricular canal. Anatomic study and presentation of a new technique for total correction

A new surgical technique for total correction of complete common atrioventricular canal was evolved from study of 34 specimens from affected infants who had died in the first year of life. An interventricular patch was fashioned to reconstruct the interventricular septum and the atrioventricular valves. The patch had two distinct components, one superior or atrial and the other inferior or ventricular. The division was made by inserting a lateral support at different levels on either face of the patch, to which the anterior and posterior atrioventricular cusps were sutured. The interatrial defect was closed with a patch that, together with the atrial component of the interventricular patch, produced a foramen ovale type closure mechanism. The authors present the pathologic observations which served as a basis for development of the surgical technique.

[In vitro comparative study of piperacillin-aminoglycosides combinations against Enterococci and Enterobacteriaceae]

The hundred and ninety-two combinations were tested against 17 strains chosen from the results of MIC determination (disc method): 5 enterococci exhibiting low level resistance (r) or high level resistance (R) to streptomycin (S) and gentamicin (G): 2 strains Sr Gr, 2 strains SR Gr and 1 strain Sr GR; 12 enterobacteria chosen for their resistance phenotypes to beta-lactams and aminoglycosides and because they are the most frequent clinical isolates: 2 strains Amos Tics Ctns (group 1), 4 strains AmoR Tics CtnR (gr. II), 4 strains AmoR TicR Ctns (gr. III) and 2 strains AmoR TicR CtnR (gr. IV). MIC and MBC were assessed for the 17 strains (Mueller Hinton broth). Combinations were carried out by a checkerboard micromethod. FBC index was calculated for each combination. Against enterococci the 50 combinations were: piperacillin versus ampicillin + aminoglycosides (streptomycin, tobramycin, amikacin, gentamicin, netilmicin). Against enterobacteria piperacillin was combined with different aminoglycosides depending on their resistance phenotypes. These combinations were compared with ticarcillin or mezlocillin or cefotaxime + aminoglycosides (total number 142). The species studied produced different results: with the enterococci Gr synergistic effects (FBC = 0.62-0.75) were rare; additive and indifferent effects were predominant. With the GR strain some antagonistic effects were observed. With the enterobacteria, in groups I and II synergistic effects were frequent and almost equivalent regardless of the beta-lactam chosen. In groups III and IV (TicR) piperacillin MICs were greater than or equal to 128 mg/l and mezlocillin MICs greater than 512 mg/l; the synergistic effects were significant (FBC from 0.25 to 0.62). beta-lactam + amikacin or netilmicin, and especially piperacillin + amikacin, were found to have the most frequent synergistic effects upon the strains tested. Mezlocillin combinations cannot be used clinically; the use of piperacillin combinations requires further discussion. On the other hand, cefotaxime + aminoglycosides combinations are active against those TicR strains.

Treatment of chronic lymphocytic leukemia in advanced stages. A randomized trial comparing chlorambucil plus prednisone versus cyclophosphamide, vincristine, and prednisone

Ninety-six patients with advanced chronic lymphocytic leukemia (CLL) (Stage C; anemia and/or thrombocytopenia of nonimmune origin) were randomized to receive either chlorambucil (CLR) (0.4 mg/kg orally, day 6) plus prednisone (PDN) (60 mg/m2 orally, days 1-5) every 2 weeks or cyclophosphamide (600 mg/m2 intravenously, day 6), vincristine (1 mg/m2 intravenously, day 6) and prednisone (60 mg/m2 orally, days 1-5) (COP) each month for 5 months. Complete remission (CR) was defined as the total disappearance of signs and symptoms related to the disease. Partial remission (PR) was considered to be achieved when, after treatment, the clinical stage changed to a less advanced one. Thirty (59%) responses (8% CR) with CLR plus PDN and 14 (31%, 2% CR) with COP were observed (P less than 0.01). The survival was not significantly different for the two groups. Patients previously treated had a lower number of responses (11/35, 31%) than those with no previous treatment (33/61, 54%) (P less than 0.05). Patients who attained a CR or a good PR had longer survivals (median not reached) than those with a poor PR (median, 25.2 months) or those who did not respond to treatment (median, 11.5 months) (P less than 0.005).

[Importance of the tissue polypeptide antigen level in neoplastic patients. Its correlation with other tumor markers]

In order to know the behavior of the tissue polypeptide antigen (TPA) as a tumor marker, the authors determine its amount in serum by means of radioimmunoassay (TPA Prolifigen RIA) in 441 patients having respiratory, digestive, urogenital, hematopoietic, mammary and other malignant tumors. The obtained results indicate that: TPA has no tumor specificity; however it increases in tumors without any other known tumor marker. TPA has no diagnostic value, but it is useful for the following up of digestive, mammary, respiratory, ovarian and testicular cancer; amounts of TPA comprised between 90 and 120 U/l are not specific and have no clinical significance; and it is very useful the simultaneous determination of CEA and TPA in the respiratory, digestive and mammary malignant neoplasms to help the clinical data in the evaluation of tumor mass (CEA) and tumor activity (TPA) without indication of tumor localization.