International Nosocomial Infection Control Consortium (INICC) report, data summary of 45 countries for 2012-2017: Device-associated module

BACKGROUND

We report the results of International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2012 to December 2017 in 523 intensive care units (ICUs) in 45 countries from Latin America, Europe, Eastern Mediterranean, Southeast Asia, and Western Pacific.

METHODS

During the 6-year study period, prospective data from 532,483 ICU patients hospitalized in 242 hospitals, for an aggregate of 2,197,304 patient days, were collected through the INICC Surveillance Online System (ISOS). The Centers for Disease Control and Prevention-National Healthcare Safety Network (CDC-NHSN) definitions for device-associated health care-associated infection (DA-HAI) were applied.

RESULTS

Although device use in INICC ICUs was similar to that reported from CDC-NHSN ICUs, DA-HAI rates were higher in the INICC ICUs: in the medical-surgical ICUs, the pooled central line-associated bloodstream infection rate was higher (5.05 vs 0.8 per 1,000 central line-days); the ventilator-associated pneumonia rate was also higher (14.1 vs 0.9 per 1,000 ventilator-days,), as well as the rate of catheter-associated urinary tract infection (5.1 vs 1.7 per 1,000 catheter-days). From blood cultures samples, frequencies of resistance, such as of Pseudomonas aeruginosa to piperacillin-tazobactam (33.0% vs 18.3%), were also higher.

CONCLUSIONS

Despite a significant trend toward the reduction in INICC ICUs, DA-HAI rates are still much higher compared with CDC-NHSN's ICUs representing the developed world. It is INICC's main goal to provide basic and cost-effective resources, through the INICC Surveillance Online System to tackle the burden of DA-HAIs effectively.

Reducing the effective dose of cisplatin using gold nanoparticles as carriers

Nanotechnology is a frequent treatment for cancer. Nanomaterials are the vehicles which deliver drugs in smaller but equally effective quantities. The aim of this investigation is to synthesize gold nanoparticles, functionalize them for the transportation of cisplatin and release them to the cancer-affected area. They have the same cytotoxicity as conventional treatments but with the smallest effective quantity of cisplatin. We synthesized spherical gold nanoparticles using the Turkevich method. We functionalized them with polyethylene glycol and cisplatin, adapting the method used by Sun. Using electronic transmission microscopy, Dynamic Light Scattering and potential Z, we analyzed the size, hydrodynamic size, shape and stability of the synthesized nanoparticles. We analyzed their composition using images from scanning electronic microscopy to carry out energy dispersive spectroscopy measurements, ultraviolet/visible light spectroscopy and Fourier transform infrared spectroscopy. We used MTT tests to find cell viability and obtained the IC50 of the different cancer cell lines. The synthesized nanoparticles were spherical in shape and, after functionalization, were of the core–shell type. They contain approximately 7% cisplatin. The IC50 obtained diminished approximately 7 times (compared to the IC50 of cisplatin used alone) when using the gold nanoparticles. Therefore, this study opens up the possibility of an alternative way of transporting the cisplatin anticancer drug, using gold nanoparticles. It decreases the dose and has the same effect as the cisplatin, so that the undesired side effects decrease.

Irrigation implementation promotes increases in salinity and nitrate concentration in the lower reaches of the Cidacos River (Navarre, Spain)

The shift from rainfed to irrigated agriculture is associated with a change in the fertilization rates due to increases in expected production and the fact of growing more N demanding crops. In addition, the circulation of irrigation return flows (IRF) mobilizes soluble salts stored in soils or geological materials. As a consequence, it implies severe modifications in the dynamics and total amount of soluble salts and nitrogen exported, especially in semi-arid watersheds. In this study, long-term data collected by the regional authorities was used to assess the effects of irrigation implementation on salinity (using electrical conductivity, EC, as a proxy) and nitrate concentration (NO₃^-) after the transformation of ca. 77 km² from rainfed to irrigated agriculture in the Cidacos River (CR) watershed. The results indicate that water quality in the lower reaches of the CR was significantly modified after the diffuse incorporation of IRF. In contrast, neither EC nor NO₃^- were different in those monitoring stations whose contributing watersheds did not include transformed area. In addition, the temporal dynamics in the analysed variables shifted from a rainfed land signal typical in the region to an irrigated land signal, and the hydrochemical type of the CR shifted from mixed-to-Na⁺-mixed-to-HCO₃^- to mostly Na⁺-mixed type, typical of waters affected by IRF in the region. Groundwater EC and NO₃^- also increased in those wells located within the irrigated area. Although there are great uncertainties in the actual amount of salt and N reaching the CR via IRF, the expected contribution of waste water spilled into the CR is minor in comparison to other sources, mostly agricultural sources in the case of N. The observed changes have promoted the designation of the lower reaches of the CR as "affected" by NO₃^- pollution, and the whole CR watershed as a Nitrate Vulnerable Zone, with the emergent question about whether irrigation implementation as carried out currently in Spain is against the environmental objectives of the Water Framework Directive.

Stability of leukocyte research parameters over time on the Sysmex XN: How to quantify the changes in cell morphology

INTRODUCTION

Research parameters of the Sysmex XN-series provide information about the cell morphology. The aim is to quantify time-dependent changes of conventional and research parameters and propose correction factors to be applied to the parameters, which revealed significant changes.

METHODS

284 EDTA blood samples were processed from 0 hours-12 hours and the mean percentage change ( X ¯ t %) of the leukocyte parameters was calculated. Stability was evaluated according to three criteria: metrology criteria according to the between-batch analytical variation, metrology criteria according to within-run analytical variation, by which X ¯ t % could not exceed the Minimum Significant Change (MSC = [±1.65*CV%]) and Biological criteria based on intraindividual biological variation, by which X ¯ t % could not exceed the Desirable Significant Change (DSC = [±0.5*CV_D %]). Mean deviation percentage of the parameters, which suffer significant changes was calculated and a multiplying factor was obtained to correct the signal deviation. Stability of abnormal leukocyte flags was also evaluated.

RESULTS

Most of the cell count parameters are considered stable according to MSC and DSC. However, several research parameters of neutrophils and lymphocytes show alterations in stability after 4 hours, even when their respective cell count parameters are stable.

CONCLUSION

Morphological variations of neutrophils and lymphocytes can be quantified. This data can be used to correct the deviation in samples that cannot be analyzed before 4 hours.

Safe Reduction in CD4 Cell Count Monitoring in Stable, Virally Suppressed Patients With HIV Infection or HIV/Hepatitis C Virus Coinfection

BACKGROUND

It has been suggested that routine CD4 cell count monitoring in human immunodeficiency virus (HIV)-monoinfected patients with suppressed viral loads and CD4 cell counts >300 cell/μL could be reduced to annual. HIV/hepatitis C virus (HCV) coinfection is frequent, but evidence supporting similar reductions in CD4 cell count monitoring is lacking for this population. We determined whether CD4 cell count monitoring could be reduced in monoinfected and coinfected patients by estimating the probability of maintaining CD4 cell counts ≥200 cells/µL during continuous HIV suppression.

METHODS

The PISCIS Cohort study included data from 14 539 patients aged ≥16 years from 10 hospitals in Catalonia and 2 in the Balearic Islands (Spain) since January 1998. All patients who had at least one period of 6 months of continuous HIV suppression were included in this analysis. Cumulative probabilities with 95% confidence intervals were calculated using the Kaplan-Meier estimator stratified by the initial CD4 cell count at the period of continuous suppression initiation.

RESULTS

A total of 8695 patients were included. CD4 cell counts fell to <200 cells/µL in 7.4% patients, and the proportion was lower in patients with an initial count >350 cells/µL (1.8%) and higher in those with an initial count of 200-249 cells/µL (23.1%). CD4 cell counts fell to <200 cells/µL in 5.7% of monoinfected and 11.1% of coinfected patients. Of monoinfected patients with an initial CD4 cell count of 300-349 cells/µL, 95.6% maintained counts ≥200 cells/µL. In the coinfected group with the same initial count, this rate was lower, but 97.6% of coinfected patients with initial counts >350 cells/µL maintained counts ≥200 cells/µL.

CONCLUSIONS

From our data, it can be inferred that CD4 cell count monitoring can be safely performed annually in HIV-monoinfected patients with CD4 cell counts >300 cells/µL and HIV/HCV-coinfected patients with counts >350 cells/µL.

Local verification between the hematological analyzers Sysmex XN-series and XE-5000

INTRODUCTION

The aim of this study was to perform a verification of the hematology analyzer Sysmex XN-2000 by comparing with the previous XE-5000. This study assessed the precision and carryover on the XN-2000 and the systematic error between the both counters according to desirable biological variability criterion and a flag comparison study.

METHODS

Within-run precision and between-batch precision were measured according to the ICSH guidelines. A comparative study was performed analyzing two hundred and six samples of peripheral blood from patients. The statistical study was conducted using the Passing-Bablok and Bland-Altman analyses. The leucocyte flag comparison was made by measuring the efficiency rate.

RESULTS

Between-batch precision was lower than that recommended by the biological variability criterion and manufacturer specifications. The comparison gave nonagreement results for neutrophil and basophil counts according to the criterion of biological variability. Erythroblasts and immature granulocytes showed nonagreement, but there is no available biological variation database for these parameters to compare with. Nevertheless, excellent absolute agreement was found for red blood cell parameters, and for platelet, lymphocyte, monocyte, and eosinophil counts.

CONCLUSIONS

The global results obtained for the precision, comparability, and efficiency provide a satisfactory integration of the XN-2000 in the core laboratory routine and accomplish an optimal reliability.

Contribution of genetic background and antiretroviral therapy to body fat changes in antiretroviral-naive HIV-infected adults

OBJECTIVES

To evaluate the association of host genetics with changes in limb or trunk fat in a group of antiretroviral therapy (ART)-naive HIV-infected patients prospectively followed up according to the initiation and the type of ART.

METHODS

Fifty single nucleotide polymorphisms (SNPs) in 26 genes, associated with obesity, insulin resistance, lipid metabolism or lipodystrophy in previously published genetic studies, were assessed in ART-naive HIV-infected Caucasian patients divided into three groups: 24 (27%) did not start ART, 29 (32.6%) received zidovudine or stavudine and 36 (40.4%) received neither zidovudine nor stavudine in their initial regimen. Patients underwent body fat measurements (using dual-energy X-ray absorptiometry) at baseline and Month 12. A multivariate model using backward stepwise elimination was used to assess the influence of SNPs and baseline levels of non-genetic covariates on changes in limb or trunk fat.

RESULTS

The baseline characteristics were: 73% men, 17% coinfected with hepatitis C virus and/or hepatitis B virus, median age 37 years, median CD4+ T cell count 228/mm(3), median HIV-RNA 5.2 log copies/mL, median plasma glucose 85 mg/dL, median plasma insulin 9.1 IU/mL, median limb fat 5.6 kg and median trunk fat 7.0 kg. There were no baseline differences among the three groups except for the CD4+ T cell count. The decrease in limb fat was greater in the no-ART group relative to the other two groups (P < 0.05). The multivariate model showed associations of rs1801278 in IRS1 (P = 0.029, OR = 0.13), baseline viral load (P = 0.006; OR = 4.453) and baseline glucose levels (P = 0.008, OR = 0.926) with loss of limb fat, and rs2228671 in LDLR (P = 0.012, OR = 0.108), rs405509 in APOE (P = 0.048, OR = 0.205), baseline viral load (P = 0.005, OR = 0.186) and baseline CD4+ T cell count (P = 0.01, OR = 1.008) with gain of trunk fat.

CONCLUSIONS

Specific polymorphisms in IRS1 (limb fat loss) and LDLR and APOE (trunk fat gain) were identified as independent markers of fat changes irrespective of the initiation of ART and the type of ART and deserve further validation.

Prevalence and factors associated with erectile dysfunction in a cohort of HIV-infected patients

To determine the prevalence of erectile dysfunction and its associated factors we conducted an observational study on a consecutive cohort of asymptomatic HIV-positive men. All the patients completed a questionnaire to evaluate erectile dysfunction based on the International Index of Erectile Function, a validated survey for the diagnosis of anxiety and depression (self-administered HAD), and a questionnaire about cardiovascular risk factors. Epidemiological, clinical, and analytical data were collected. In all, 158 men, participated: mean age 46.0 years, 96.2% on antiretroviral therapy (91.3% undetectable viral load), and the mean CD4 count was 534 cells/mL. Erectile dysfunction was present in 106 (67.1%) patients, and associated factors were age (OR 4.5 for each 5 years; 95% CI 4.3−4.7; p = 0.0001) and anxiety (OR 8.2, 95% CI 2.2−30.4; p = 0.002). The prevalence of erectile dysfunction is high in men living with HIV, even in those with good immunovirological control. It is related to increasing age and anxiety, both of which are important factors within our HIV cohort.

First Report of Neofusicoccum australe (Botryosphaeria australis), as a Branch Dieback Pathogen of Avocado Trees in Chile

Since 2007, Chilean avocado (Persea americana Mill.) orchards have been exposed to several abiotic stress conditions, namely frost damage and drought, due to three consecutive seasons of cold winters and shortage of irrigation water. At the same time, a severe disease resulting in tree dieback of cv. Hass, specifically, was observed in north-central Chile. Symptomatic trees exhibited abundant dead twigs in the tree canopy, and wilted leaves remained attached to the twigs in autumn. Closer inspection revealed reddish-brown necrotic lesions on the bark of the dead twigs, which girdled these symptomatic branches. When the bark was removed, the wood below appeared dark brown, in contrast to the yellowish-green coloring of healthy. The fungus was also consistently isolated from rotted fruit. A Neofusicoccum sp. with a yellow colony was consistently isolated from the necrotic lesions on PDA and incubated at room temperature for 3 days. Conidia produced in black pycnidia growing on 2% water agar with sterilized pine needles were smooth, unicellular, hyaline, and with granular contents. One or two septa developed at germination, but rarely before. The average length of the conidia was 27.0 ± 0.9 μm, with a length/width ratio of 3.9 ± 0.2 μm. Based on culture and conidial morphology, the isolates were putatively identified as Neofusicoccum luteum (1). DNA sequence analysis of the rDNA internal transcribed spacer (ITS) region was conducted for four representative isolates using primers ITS1 and ITS4 (4). The sequence analysis of ITS region of kiwifruit isolate H1M4 (Accession No. KC330230) reveled 100% nucleotide identity to N. australe (FJ157187 to FJ157192) (3). Pathogenicity tests were conducted with stem inoculations of 2-year-old cv. Hass plants grow in plastic containers in a sand/lime/peat mixture. For each inoculated plant (n = 8), a 7-mm-diameter agar plug from the margin of a 3-day culture was used as inoculum after wounding the stem to the depth to 7 mm with a cork borer. Negative control (n = 8) were wounded and then 'mock-inoculated' with sterile agar plugs. The inoculation sites were wrapped with Parafilm. All plants were kept in a greenhouse. After 5 months, all inoculated plants showed bark cankers and necrotic lesions beneath the bark, which were 5.2 cm long (n = 8). No symptoms developed on the control plants. N. australe was recovered from the margin of the necrosis lesion of every inoculated plant, thus fulfilling Koch's postulates and confirming its pathogenicity. Botryosphaeraceae spp. are the commonly reported to have ability to survive endophytically in their host, causing disease only when the host is exposed to a stress condition (2). To our knowledge, this is the first report of N. australe as a pathogen of avocado in Chile. The fungal isolates (PaHass No. 1 to 4) were deposited in the Laboratorio de Fitopatología Frutal y Molecular, Departamento de Sanidad Vegetal, Facultad de Ciencias Agronómicas de la Universidad de Chile. References: (1) A. J. L. Phillips. http://www.crem.fct.unl.pt/botryosphaeria_site/ Accessed November 20, 2011. (2) B. Slippers and M. J. Wingfield. Fungal Biol. Rev. 21:90, 2007. (3) B. Slippers et al. Mycologia 96:1030, 2004. (4) White et al. PCR Protocols: A Guide to Methods and Applications. Academic Press, San Diego, 1990.

Diaporthe ambigua Associated with Post-Harvest Fruit Rot of Kiwifruit in Chile

Kiwifruit is an important, expanding commercial crop in Chile. Several fungi have been reported to be associated with post-harvest rots of kiwifruit worldwide (2). During 2011 and 2012, kiwifruit produced in the VI and VII regions of Chile, showing symptoms of inner rot, were investigated with the aim of identifying the disease agent. The affected fruits had brown pubescent skin at the stem end that became soft and lighter in color than the adjacent firm healthy tissues. A watery exudate and white to pale grayish mycelial mats frequently developed at the stem end of the fruit, causing a water-drop stain down the sides on the dry brown healthy skin. The underlying tissue accessed by peeling off the skin was usually water soaked, soft, and lighter green than the healthy tissue. A fermented sour odor occurred frequently on severely decayed fruits. After incubation at 25°C over 7 days on potato dextrose agar (PDA), white to grayish, pale aerial mycelial mats were recovered from fragments of symptomatic kiwifruit superficially disinfected with 95% ethanol. After 2 weeks, black, spherical pycnidia developed, bearing hyaline, ellipsoidal, biguttulate conidia (5.4 to 12.6 × 2.1 to 4.7 μm). After 3 weeks, abundant perithecia embedded in a distinct, black, elevated stroma developed. Perithecia were black, globose, 200 to 500 μm in diameter with necks sinuous, filiform, 550 to 840 × 50 to 95 μm. Clavate, sessile asci, 30.9 to 50.2 × 6.6 to 12.5 μm contained ascospores biseriate, hyaline, smooth, fusoid-ellipsoid, widest just above the septum, tapering towards both ends, medianly septate, constricted at the septum at maturity, with 1 to 2 guttules per cell ascospores, 5.9 to 9.7 × 2.5 to 4.3 μm. All colonies obtained from kiwifruit displayed the same morphological traits and were consistent with those of a Diaporthe sp. (1). The internal transcribed spacer (ITS) region was sequenced using ITS1/ITS4 primers (4). Analysis of ITS region of kiwifruit isolates Damb_12 and Damb_16 (GenBank Accession Nos. KC294545 and KC294544, respectively) revealed 100% nucleotide identity to Diaporthe ambigua (HM575420, HM575419, DQ286274, DQ286270, and DQ286271). Six millimeter plugs from fungal colonies growing on PDA at 25°C for 7 days were used to inoculate 15 healthy untreated, ripe 'Hayward' kiwifruits. Control fruits were inoculated with agar plugs. Inoculated fruits were incubated at 25°C and 80% relative humidity. After 7 days, white to pale grayish mycelial mats developed only on the inoculated fruits, releasing a water drop stain. The underlying tissue was lighter green and water soaked. D. ambigua was reisolated only from the inoculated fruits. D. actinidiae has been previously reported on kiwifruit canes in Chile (3); however, to our knowledge, this is the first report on the occurrence of D. ambigua (Phomopsis ambigua) on kiwifruit in Chile. The fungal isolates (no. 1 to 21) have been deposited in the Laboratorio de Fitopatología Frutal y Molecular, Departamento de Sanidad Vegetal, Facultad de Ciencias Agronómicas de la Universidad de Chile. References: (1) J. C. Jansen van Rensburg et al. Studies in Mycol. 55:65, 2006. (2) L. Luongo et al. J. Plant Pathol. 93:205, 2011. (3) A. Palma and E. Piontelli. E. Bol. Micol. 15:79, 2000. (4) White et al. PCR Protocols: A Guide to Methods and Applications. Academic Press, San Diego, 1990.

Differences between HIV-infected and uninfected adults in the contributions of smoking, diabetes and hypertension to acute coronary syndrome: two parallel case-control studies

OBJECTIVES

The aim of the study was to assess the separate contributions of smoking, diabetes and hypertension to acute coronary syndrome (ACS) in HIV-infected adults relative to uninfected adults.

METHODS

Two parallel case-control studies were carried out. In the first study, HIV-positive adults diagnosed with ACS between 1997 and 2009 (HIV+/ACS) were matched for age, gender and known duration of HIV infection with HIV-positive adults without ACS (HIV+/noACS), each individual in the HIV+/ACS group being matched with three individuals in the HIV+/noACS group. In the second study, each individual in the HIV+/ACS group in the first study was matched for age, gender and calendar date of ACS diagnosis with three HIV-negative individuals diagnosed with ACS between 1997 and 2009 (HIV-/ACS). Each individual in the HIV-/ACS group was then matched for age and gender with an HIV-negative adult without ACS (HIV-/noACS). After matching, the ratio of numbers of individuals in the HIV+/ACS, HIV+/noACS, HIV-/ACS and HIV-/noACS groups was therefore 1 : 3 : 3 : 3, respectively. We performed logistic regression analyses to identify risk factors for ACS in each case-control study and calculated population attributable risks (PARs) for smoking, diabetes and hypertension in HIV-positive and HIV-negative individuals.

RESULTS

There were 57 subjects in the HIV+/ACS group, 173 in the HIV+/noACS group, 168 in the HIV-/ACS group, and 171 in the HIV-/noACS group. Independent risk factors for ACS were smoking [odds ratio (OR) 4.091; 95% confidence interval (CI) 2.086-8.438; P < 0.0001] and a family history of cardiovascular disease (OR 7.676; 95% CI 1.976-32.168; P = 0.0003) in HIV-positive subjects, and smoking (OR 4.310; 95% CI 2.425-7.853; P < 0.0001), diabetes (OR 5.778; 95% CI 2.393-15.422; P = 0.0002) and hypertension (OR 6.589; 95% CI 3.554-12.700; P < 0.0001) in HIV-negative subjects. PARs for smoking, diabetes and hypertension were 54.35 and 30.58, 6.57 and 17.24, and 9.07 and 38.81% in HIV-positive and HIV-negative individuals, respectively.

CONCLUSIONS

The contribution of smoking to ACS in HIV-positive adults was generally greater than the contributions of diabetes and hypertension, and was almost twice as high as that in HIV-negative adults. Development of effective smoking cessation strategies should be prioritized to prevent cardiovascular disease in HIV-positive adults.

Liver retransplantation in HIV-infected patients: a prospective cohort study

Information regarding liver retransplantation in HIV-infected patients is scant. Data from 14 HIV-infected patients retransplanted between 2002 and 2011 in Spain (6% retransplantation rate) were analyzed and compared with those from 157 matched HIV-negative retransplanted patients. In HIV-infected patients, early (≤30 days) retransplantation was more frequently indicated (57% vs. 29%; p = 0.057), and retransplantation for HCV recurrence was less frequently indicated (7% vs. 37%; p = 0.036). Survival probability after retransplantation in HIV-positive patients was lower than in HIV-negative patients, 42% versus 64% at 3 years, although not significantly (p = 0.160). Among HIV-infected patients, those with undetectable HCV RNA at retransplantation and those with late (>30 days) retransplantation showed better 3-year survival probability (80% and 67%, respectively), similar to that in their respective HIV-negative counterparts (72% and 70%). In HIV-infected and HIV-negative patients, 3-year survival probability in those with positive HCV RNA at retransplantation was 22% versus 65% (p = 0.008); in those with early retransplantation, 3-year survival probability was 25% versus 56% (p = 0.282). HIV infection was controlled with antiretroviral therapy after retransplantation. In conclusion, HIV-infected patients taken as a whole have unsatisfactory survival after liver retransplantation, although patients with undetectable HCV RNA at retransplantation or undergoing late retransplantation show a more favorable outcome.

Phase II clinical trial of neoadjuvant trabectedin in patients with advanced localized myxoid liposarcoma

BACKGROUND

To evaluate neoadjuvant trabectedin (1.5 mg/m(2) 24-h i.v. infusion every 3 weeks; three to six cycles) in patients with locally advanced myoxid liposarcoma (ML) previously untreated with chemotherapy or radiation.

PATIENTS AND METHODS

Primary efficacy end point was pathological complete response (pCR) or tumoral regression rate. Objective response according to RECIST (v.1.0) was a secondary end point.

RESULTS

Three of 23 assessable patients had pCR [13%; 95% confidence interval (CI), 3% to 34%]. Furthermore, very good and moderate histological responses were observed in another 2 and 10 patients, respectively. Histological decrement in the cellular and vascular tumor component and maturation of tumor cells to lipoblasts were observed in both myoxid and myoxid/round cell variants. Seven patients had partial response according to RECIST (objective response rate of 24%; 95% CI, 10% to 44%). No disease progression was reported. Neoadjuvant trabectedin was usually well tolerated, with a safety profile similar to that described in patients with soft tissue sarcoma or other tumor types.

CONCLUSION

Trabectedin 1.5 mg/m(2) given as a 24-h i.v. infusion every 3 weeks is a therapeutic option in the neoadjuvant setting of ML.

Stripping in hot mix asphalt produced by aggregates from construction and demolition waste

This paper analyses the effect of water on the durability of hot asphalt mixtures made with recycled aggregates from construction and demolition debris. Indirect tensile stress tests were carried out to evaluate stripping behaviour. The mixtures tested were fabricated with 0, 20, 40 and 60% recycled aggregates. Two types of natural aggregates were used: schist and calcite dolomite. An increase in the percentage of recycled aggregates was found to produce a decrease in the tensile stress ratio of the hot asphalt mixtures. To study this phenomenon, two and three factor analyses of variance (ANOVA) were performed with indirect tensile stress being used as the dependent variable. The factors studied were the percentage of recycled aggregates (0, 20, 40 and 60%), the moisture state (dry, wet) and the type of natural aggregate (schist, calcite). On the basis of the ANOVA results, it was found that the most important factor affecting resistance was the moisture state (dry, wet) of the specimens. The percentage of recycled aggregate also affected indirect tensile stress, especially in the dry state. The type of natural aggregate did not have a significant effect on indirect tensile stress. The hot asphalt mixture specimens made with different percentages of recycled aggregates from construction and demolition debris and of natural quarry aggregates showed poor stripping behaviour. This stripping behaviour can be related to both the poor adhesion of the recycled aggregates and the high absorption of the mortar of cement adhered to them.

[Influence of axial length in refractive outcome after cataract surgery]

PURPOSE

To analyse the influence of axial length (AL) and age on refractive outcome after cataract surgery in terms of uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA) and subjective refraction.

METHODS

A retrospective review of 171 consecutive cases of uncomplicated cataract surgery was done. The refractive outcome was analysed (UCVA, BCVA and postoperative retraction) according AL before surgery (AL < 22 mm, between 22 and 25 mm and AL > 25 mm) and age (< 40, between 40-60 years and > 60 years).

RESULTS

After surgery mean UCVA was 0.6 ± 0.33 Diopters (D) and mean BCVA was 0.93 ± 0.23 D. Mean refractive outcome was 0.89 ± 0.78 D. There were no significant differences in post-operative UCVA, BCVA and refraction between the three age groups. There were statistically significant differences (p = 0.004) in UCVA between the three AL groups. The group with AL between 22 and 25 mm had better UCVA. Mean refractive outcome was -0.95 ± 1.91 D in the group with AL < 22 mm, -0.36 ± 0.88 D in the group with AL between 22 and 25 mm and 0.23 ± 1.15 D in the group with AL > 25 mm.

CONCLUSIONS

AL influences refractive outcome and UCVA after cataract surgery. Eyes with AL < 22 mm have a worse refractive outcome.

[Profile and professional expectations for nursing students]

The authors describe the profile corresponding to students enrolled in first, second and third year courses to become registered nurses in Catalonia, along with their professional and job expectations; the authors examine students' perceptions of the university environment. This information will be a great aid to, on the one hand, update the performances and initiatives taken by those responsible for nursing schools, and on the other hand, to obtain a preliminary view on future nursing professionals. At the same time, this information will provide useful elements for students themselves to reflect on their studies and their future as professionals.

First Report of Verticillium Wilt of Gold Kiwifruit, Actinidia chinensis Cv. Hort 16A, Caused by Verticillium albo-atrum in Chile

Gold kiwifruit, Actinidia chinensis Planch cv. Hort 16A, was first planted in Chile in 2003 and vines started dying within 2 years. By the end of the 2007-2008 growing season, as much as 80% of the plants in several orchards had died. The disease was characterized by a conspicuous reddish brown discoloration of the xylem and the sudden wilting and dieback of plants any time during the growing season. In the spring, entire plants or parts of plants failed to break buds. In others, the buds broke, but juvenile leaf clusters then wilted and died. On severely affected plants, scion watershoots wilted and died. The disease was often accompanied by shallow cracking of the bark and slight sponginess of the underlying cortex. The disease was apparently most severe in sites that had been planted to Gold kiwifruit immediately after removal of apple, pear, citrus, or grape. Orchards planted following long-term maize, wheat, or grass culture were almost disease free. A fungus was consistently isolated from symptomatic vascular tissue disinfected in 1% sodium hypochlorite and plated on potato dextrose agar. Conidiogenous cells were arranged in verticels; conidia were hyaline, elliptical, single celled, and measured 3.5 to 8.5 × 1.8 to 4.3 μm (average 5.5 × 2.5 μm). Dark, resting mycelium developed after 1 to 2 weeks of incubation. On the basis of these morphological characteristics, the fungus was identified as Verticillium albo-atrum Reinke & Berthier. Identification was confirmed by sequencing part of the internal transcribed spacer (ITS) region with primers ITS1 and ITS4. The sequence of a representative isolate showed high homology (98% identity over a length of 494 bp) with a DNA fragment (NCBI Accession No. 108476) of V. albo-atrum from alfalfa. To complete pathogenicity tests, 20 healthy, 1-year-old Hort 16A kiwi vines grafted on Hayward kiwifruit (A. deliciosa Chevalier) seedlings were inoculated by injection of 20 μl of 10⁶ conidia/ml into stems of the scion. Twenty control plants were injected with an equal volume of sterile distilled water. Plants were held in a controlled environment facility at 24°C with 16 h of light per day. Eight weeks after inoculation, typical wilting and dieback symptoms developed on 90% of the plants. Control plants injected with water remained healthy. Verticillium wilt has never been reported on kiwifruit (A. deliciosa) in Chile. V. albo-atrum has a rather narrow host range and is mainly reported as a pathogen on alfalfa, hop, soybean, tomato, and potato (1). To our knowledge, this is the first report of V. albo-atrum causing wilt and dieback on Gold kiwifruit (A. chinensis) cv. Hort 16A. The fungal isolates have been deposited in the Plant Pathology Laboratory of the Sanidad Vegetal Department of Agricultural Sciences Faculty of University of Chile under the name Actinidia chinensis/V. albo-atrum No. 1 to 8. Reference: (1) E. K. Ligoxigakis et al. Phytoparasitica 30:511, 2002.

Bleaching of soda pulp of fibres of Musa textilis nee (abaca) with peracetic acid

In this work, we studied the influence of operational variables in the bleaching of soda pulp of Musa textilis nee (abaca) [viz. temperature (55-85 degrees C), bleaching time (30-150 min) and peracetic acid concentration oven dry pulp (0.5-4.5%)] on the kappa number and viscosity of the bleached pulp, as well as on the breaking length, burst index and brightness of paper sheets made from it. For this purpose, we used a central composite factorial design in order to identify the optimum operating conditions. In this way equations relating the dependent variables to the operational variables of the bleaching process were derived. These equations reproduce the dependent variables with errors less than 12% for all, except the viscosity which was predicted with errors less than 18%. Obtaining bleached pulp with the highest possible viscosity (1519 ml/g), and paper sheets with the maximum possible breaking length (6547 m) and burst index (5.00 kN/g), entails using a temperature of 55 degrees C, a peracetic acid concentration of 4.5% and a bleaching time of 150 min. This provides a brightness of 79.90%, which is only 6.53% lower than the maximum possible value (85.48%).

[Preliminary results of the Spanish Society of Nephrology multicenter study of quality performance measures: hemodialysis outcomes can be improved]

INTRODUCTION

The Spanish Society of Nephrology "Quality in Nephrology Working Group" (QNWG) was created in 2002. The aims of this group are the identification, diffusion, implementation and consolidation of a systematic, objective and comprehensive set of quality performance measures (QPMs) to help along the improvement of patient care and outcomes on hemodialysis, by means of strategies of feedback and benchmarking, and the design of quality improvement projects. The objective of this study is to present the preliminary results of a set of quality performance measures obtained in a group of Spanish hemodialysis centers, as well as to evaluate the repercussion of the application of the aforementioned thecniques on the observed results.

METHODS

During 2007 a total of 28 hemodialysis units participated in the study; 2516 patients were evaluated. A specific software was designed and used to facilitate the calculation of CPMs in each unit. The clinical indicators used refered to dialysis adequacy; anemia; mineral metabolisme; nutrition; viral infections; vascular access; mortality, morbidity (number and days of hospital admissions); and renal transplant. Every three months each center received its own data and its comparison with the rest of the group.

RESULTS

Except for hemoglobin levels we observed a global improvement. The percentage of centers reaching the stablished standards defined by the QNWG passed from 65% to 90,9% for Kt/V Daugirdas II (> 1,3 in > that 80% of the patients); from 71,4 % to 77,2 % for PTH (> 30 % of patients with serum PTH between 150 and 300 pg/ml); and from 42,8 % to 63,5 % for phosphate (> 75 % of patients with a serum phsphate < 5,5 mg/dl). More than 50% of centers showed an improvement in their final results as compared with their own initial results in all analyzed CPMs. Those centers that did not obtained an improvement in their results started the study with better percentages of acomplishment than those that showed a significant improvement in QPMs. (80,6+/-15,4 versus 71,8+/-16,6 respectively; p<0,001)

CONCLUSIONS

We are starting to make progresses in our knowledge of clinical results in our hemodialysis units, although there is still a long way to go over. To monitor and share CPMs results within hemodialysis centers might help to improve their results as well as to reduce intecenters variability.

Safety of triflusal (antiplatelet drug) in patients with aspirin-exacerbated respiratory diseases

BACKGROUND AND AIMS

Aspirin, a cyclo-oxygenase (COX)-1 and COX-2 inhibitor, is the antiplatelet drug of choice to prevent serious vascular events. Adverse reactions to aspirin are frequent particularly among patients with asthma, chronic rhinosinusitis and nasal polyps. COX-1 inhibitors but not COX-2 inhibitors precipitate asthma attacks. Triflusal is a preferential COX-2 inhibitor antiplatelet agent that is as effective as aspirin in the prevention of serious vascular events. The aim of the study was to assess the tolerability of triflusal in patients with aspirin-exacerbated respiratory disease (AERD).

METHODS

We studied 26 asthma patients [11 males, aged 52 (23-75) years] who had suffered asthma episodes triggered by one or more (23% of patients) nonsteroidal anti-inflammatory drugs. Aspirin sensitivity was confirmed by either intranasal or oral aspirin challenge. All subjects underwent a single-blind, placebo-controlled oral challenge with three doses of triflusal separated by 1 week (first cumulative dose = 225 mg; second cumulative dose = 450 mg; third cumulative dose = 900 mg). Cutaneous, respiratory, general symptoms and lung function were monitored for 4 h in the laboratory and for 24 h at home.

RESULTS

No clinical reactions to triflusal were observed. There were no significant changes in lung function measurements.

CONCLUSION

Our study appears to demonstrate that triflusal is a suitable alternative to aspirin as antiplatelet agent to prevent AERD.

[Unnecessary radiology in primary care]

BACKGROUND

The request for diagnostic tests proceeding from primary care shows a progressive increase over time and a great interpersonal variety in the requests, which suggests that ineffective services are being applied. The aim is to determine the characteristics of the those making requests for radiological tests (general radiology and echography) and to quantify the unnecessary tests in primary care.

METHODS

Cross-sectional study of a cluster sample of 23 health centres of Navarre in the month of March 2004. A specific questionnaire was designed to be completed by the doctor requesting the diagnostic test. Logistic regression to study the association between unnecessary tests and the other variables of the study was used.

RESULTS

Tests were asked for on 9 per thousand of the population studied. The inter-professional variability in the request for tests oscillated between 0 and 33.3 per 1,000 health cards of children's age. The radiological studies requested with greatest frequency were osseous (48.9%, IC: 42.4-55.5). In 63.2% of the requests no modifications were made to the treatment prior to the request for a test and 57% (IC: 52.4-61.7) of the tests carried out were requested to rule out pathologies. Twenty-four point seven percent (IC: 17.1-29.2) were unnecessary tests and in 15.2% (IC: 10.7-18.2) there was pressure from the patient in the request. In the multivariant analysis significant differences were observed for thorax Rx, changes in the treatment and pressure from the patient. After adjustment for the other variables, the request for an unnecessary test is 12.55 times greater if the doctor feels under pressure from the patient.

CONCLUSIONS

The correct indication for radiology must be analysed, especially in osseous radiology, and the role of the radiologist in the final decision on carrying out the test must be strengthened.

First Report of Black Foot Disease of Grapevine Caused by Cylindrocarpon macrodidymum in Chile

Black foot disease, caused by Cylindrocarpon macrodidymum Halleen, Schroers & Crous, is reported damaging table and wine grapes (Vitis vinifera L.) for the first time in Chile. During the summer of 2006, 2- to 5-year-old grapevines showed reduced vigor, shortened internodes, and drying and dying shoots along with abnormal development of roots with growth parallel to the soil surface, necrotic root crowns, and development of secondary roots. Internal necrosis extended from the bark to the pith in diseased parts of the plants. Other symptoms included black discoloration of the wood, gum inclusions in xylem vessels, black streaks in the vascular tissue, and reduction in root biomass, with sunken, necrotic root lesions. Eighteen Cylindrocarpon isolates were collected from roots, vascular elements, and pith tissue of grapevines cultivars (Flame Seedless, Red Globe, Thompson Seedless, Merlot, Carmenere, and Cabernet Sauvignon) from 12 locations in Chile. The isolates were identified on the basis of morphological features. All isolates produced micro- and macroconidia (one to three septa) and chlamydospores in short and intercalary chains (1,4), and by internal transcribed spacer (ITS1-5,8S-ITS4) rDNA and β -tubulin (BT₁, and BT₂) partial sequences, identical to those of C. macrodidymum (isolate USS074, GenBank Accession No. AY 997558 and isolate USSO150, GenBank Accession No. AY 997598) (2). Phylogenetic analyses placed these isolates in a clade closely related, but clearly distinct from other clades, to C. destructans and C. liriodendri (2,3). Pathogenicity tests were completed by drench inoculation onto 50 6-month-old rooted cuttings of 'Red Globe' with 25 ml of conidia suspension (10⁶ conidia ml^-1) obtained from four isolates. Ten control cuttings of 'Red Globe' were inoculated with an equal volume of sterile distilled water. The plants were incubated for 4 months in a controlled environment facility at 24°C. All isolates tested were pathogenic. In addition, they caused significant root rot (t-test of disease incidence, P = 0.0048) and no significant level of variation was detected between different isolates. C. macrodidymum was reisolated from the region of brown streaking in all the inoculated cuttings and was not isolated from the water-treated controls. To our knowledge, this is the first report of C. macrodidymum causing black foot disease on grapevine in Chile. References: (1) C. D. Booth. Mycol. Pap. (CMI) 104:1, 1966. (2) F. Halleen et al. Stud. Mycol. 50:431, 2004. (3) F. R. Mantiri et al. Can. J. Bot. 79:334, 2001. (4) E. Petit and W. D. Gubler. Plant Dis. 89:1051, 2005.

Safety impact of engineering treatments on undivided rural roads

This article presents an evaluation of the safety impacts of four engineering treatments implemented in the Autonomous Community of Madrid (Spain): highway upgrading; updating and improvement of traffic signing; repainting of pavement markings and pavement resurfacings. This evaluation was carried out using the Empirical Bayes method with a comparison group. The functioning of a methodology to test the significance of the safety impact is described. The results show that highway upgrading has a positive and significant safety impact, while the updating and improvement of traffic signing, the repainting of road markings and pavement resurfacings do not exhibit a significant impact on safety.

Ozone concentrations at a high altitude station in the Central Massif (Spain)

In order to contribute to current knowledge of ozone concentrations and transport across the Central Massif, a monitoring station was installed at 1780 m on the upper Spanish plateau about 55 km from the city of Madrid. Ozone concentrations and standard meteorological variables were measured in June and July 2002. A smoothed ozone hourly cycle was obtained with mean values of 120 and 110 microgm(-3) during day-time and night-time, respectively. The highest ozone concentrations were recorded in the SE-S-SW wind sectors, proving the influence of transport from the Madrid urban plume to the upper plateau. This assumption was also supported by the satisfactory correlation between ozone peaks obtained at the monitoring site and those recorded in a representative station on the foothill located on the lower plateau during episodic situations. To assess the contribution of long-range transport, backward air mass trajectories were computed each day of measurements at 820 hPa. The lowest ozone mean was linked to Atlantic Ocean air masses, and the highest to air masses from Central Europe.