Retrospective survival analysis of the use of uncemented modular tapered stems for revision in periprosthetic Vancouver B-type fractures. Is instability a threat to survival?

INTRODUCTION AND OBJECTIVES

Periprosthetic hip fractures show increasing incidence and complexity, representing a challenge for the surgeon. We aimed to evaluate the survival of uncemented modular tapered stems in the treatment of periprosthetic Vancouver B2 and B3 type fractures and review the main complications and factors associated with decreased survival.

MATERIALS AND METHODS

We performed a retrospective study of patients submitted to revision arthroplasty for treatment of periprosthetic femoral stem Vancouver B2 and B3 type fractures with an uncemented modular fluted tapered stem (MRP-Titan). Demographic and radiographic parameters were analyzed. The survival rate (free of reoperation) was calculated at 2- and 5-years using the Kaplan-Meier survivorship analysis.

RESULTS

Thirty-nine patients were included with a mean age of 73.5 years and a mean follow-up of 5 years. Arthroplasty survivorship at 2 years was 73.7% and at 5 years was 67.5% (mean 8.4 years; range 6.7-10.2). Survivorship was inferior in the patients with episodes of instability (mean 2.5 years; range 0-5.42) (p<0.001). At least one episode of instability occurred in 26.3% of patients and 60% of these patients had a femoral head size 32mm or lower. At least one episode of instability occurred in 71.4% of patients with a greater trochanter fracture (p=0.008). The consolidation rate was 90.6% and the mortality rate was 23.7%. In the group of patients that died, 55.6% were submitted to at least one revision surgery (p=0.044).

CONCLUSION

Survivorship of an uncemented modular stem (MRP-Titan) in revision for PHF is significantly reduced by episodes of instability.

Effects of a music-based intervention on psychophysiological outcomes of patients undergoing medical imaging procedures: A systematic review and meta-analysis

INTRODUCTION

Musical intervention (MI) is a valuable strategy for addressing the psychological and emotional challenges faced by patients undergoing imaging procedures. This study explores MI's impact on psychophysiological outcomes during imaging procedures, detailing the sound repertoire and technical characteristics employed in MI.

METHODS

A systematic review (SR) and meta-analysis (MA) were conducted. Electronic database searches of PubMed, Web-of-Science, and Scopus were performed encompassing original randomised research and quasi-experimental articles published until June 2023.

RESULTS

Thirteen articles were included in this SR, scoring between 23 and 68 on the Joanna Briggs Institute (JBI) Checklist. Four articles were included to perform a MA concerning anxiety and heart rate (HR) outcomes. Most studies utilised digital playlists as the medium for MI. Headphones were commonly used, with an average volume of 50-60 dB and a musical frequency of 60-80 beats/min. While authors generally preferred selecting musical genres for the repertoire, two articles specifically chose Johann Pachelbel's "Canon in D major" as their musical theme. In terms of psychological parameters, the experimental groups exhibited lower anxiety values than the control groups, with further reductions after MI. However, MA shows that this trend is only marginally significant. Patient comfort and overall examination experience showed improvement with MI. Regarding physiological parameters, HR, especially in the final phase of the examination, was significantly lower in the experimental group compared to the control group.

CONCLUSION

Across multiple studies, MI demonstrated the ability to reduce anxiety and HR. However, no specific music repertoire emerged as the most effective.

IMPLICATIONS FOR PRACTICE

MI arises as a painless, reliable, low-cost, and side-effect-free strategy, presenting imaging departments with a practical means to enhance patient comfort and mitigate anxiety and stress during medical procedures.

The ultimate technique for posterior rib fractures: the parascapular sub-iliocostalis plane block - A series of cases

We report retrospectively a series of four cases involving the successful use of the recently described parascapular sub-iliocostalis plane block (PSIP), for lateral-posterior rib fractures. The efficacy of the PSIP block may potentially depend on different mechanisms of action: (1) direct action in the fracture site by craniocaudal myofascial spread underneath the erector spinae muscle (ESM); (2) spread to deep layers through tissue disruption caused by trauma, to reach the proximal intercostal nerves; (3) medial spread below the ESM, to reach the posterior spinal nerves; and (4) lateral spread in the sub-serratus (SS) plane to reach the lateral cutaneous branches of the intercostal nerves; while avoiding significant negative hemodynamic effects and other possible complications associated to other techniques leading that the PSIP may be considered an alternative in some clinical scenarios to the Erector Spinae Plane block or the Paravertebral block.

Case-case study on comparative vaccine effectiveness against Delta and Omicron SARS-CoV-2 infections

Introduction

Vaccination is the primary pharmacological measure to reduce SARS-CoV-2 transmission and its complications. Timely information on vaccines effectiveness in a context of novel variants of concern (VOC) emergence is essential for public health policies. This study aimed to provide a measure of comparative vaccine effectiveness between Omicron (BA.1) and Delta (B.1.627.2) VOC according to vaccination exposure (complete primary regimen or booster dose) for Portuguese population aged 12 or more years old using routinely collected data from electronic health records.

Methods

We used a case-case study design linking national electronic vaccination registry and surveillance data on 13,134 SARS-CoV-2 RT-PCR laboratory-confirmed cases notified in Portugal during weeks 49-51 of 2021. Notified cases were classified as Omicron or Delta based on whole-genome sequencing or S-gene Target Failure (SGTF) status using the RT-PCR TaqPath™ Covid 19 CE IVD Kit (Thermo Scientific™) assay. The odds of vaccination was compared between Omicron cases and Delta cases using logistic regression adjusted for age group, sex, region and week of diagnosis and laboratory of origin.

Results

The odds of vaccination were higher in laboratory-confirmed cases infected by Omicron (BA.1) VOC compared to Delta (B.1.627.2) VOC for both complete primary vaccination (Odds ratio (OR)=2.1; 95% Confidence Interval (95%CI): 1.8 - 2.4) and booster dose (OR = 5.2; 95%CI: 3.1 - 8.8), indicating vaccine effectiveness reduction against Omicron.

Conclusions

We found significantly higher odds of vaccination in Omicron cases compared to Delta, suggesting lower effectiveness of the primary vaccination and the booster dose in preventing infections by Omicron. Case-case study design has proven to be feasible approach to rapidly compare vaccine effectiveness between VOC in context of novel VOC emergence to timely inform public health stakeholders.

Key messages

• Reduction of vaccine-induced protection against SARS-COV-2 infection with the Omicron compared to Delta after primary and booster vaccination.

• Continuous monitoring of COVID-19 vaccine effectiveness is essential to support public health policies in context of novel VOC emergence.

Patients with resolution of low-lying placenta and placenta previa remain at increased risk of postpartum hemorrhage

OBJECTIVE

To determine whether women who experience resolution of low placentation (low-lying placenta or placenta previa) are at increased risk of postpartum hemorrhage compared to those with normal placentation throughout pregnancy.

METHODS

This was a retrospective cohort study of women who delivered at Mount Sinai Hospital between 2015 and 2019, and who were diagnosed with low-lying placenta or placenta previa on transvaginal ultrasound at the time of the second-trimester anatomical survey, with resolution of low placentation on subsequent ultrasound examination. Women undergoing second-trimester anatomical survey who had normal placentation on transvaginal ultrasound 3 days before or after the cases were randomly identified for comparison. The primary outcome was the rate of postpartum hemorrhage. Secondary outcomes included the need for a blood transfusion, use of additional uterotonic medication, the need for additional procedures to control bleeding, and maternal admission to the intensive care unit. Outcomes were assessed using a multivariable logistic regression model.

RESULTS

A total of 1256 women were identified for analysis, of whom 628 had resolved low placentation and 628 had normal placentation. Women with resolved low placentation, compared to those with normal placentation throughout pregnancy, had significantly higher mean age (33.0 ± 5.4 years vs 31.9 ± 5.5 years; P < 0.01) and lower mean body mass index at delivery (27.9 ± 5.5 kg/m² vs 30.2 ± 5.7 kg/m² ; P < 0.01), and were more likely to have undergone in-vitro fertilization, be of non-Hispanic white race, have posterior placental location (all P < 0.01) and have private/commercial health insurance (P = 0.04). Patients with resolved low placentation vs normal placentation had greater odds of postpartum hemorrhage (adjusted odds ratio (aOR), 3.5 (95% CI, 2.0-6.0); P < 0.01), use of additional uterotonic medication (aOR, 2.2 (95% CI, 1.5-3.1); P < 0.01) and increased rates of additional procedures to control bleeding (aOR, 4.0 (95% CI, 1.3-11.9); P = 0.01).

CONCLUSION

Despite high rates of resolution of low-lying placenta and placenta previa by term, women with resolved low placentation remain at increased risk of postpartum hemorrhage compared to those with normal placentation throughout pregnancy. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

Epidemiology And Outcome Assessment Of Hand Burns: A 3-Year Retrospective Analysis In A Burn Unit

A great number of burns affect the hands, either as part of a more extensive burn or as an isolated injury. These injuries can lead to physical, social and psychological consequences that may reduce quality of life and make difficult the return to work. The goal of this study was to investigate the main epidemiologic characteristics of adult patients with hand burns admitted to a dedicated burn centre, evaluate the outcomes of the treatment, and identify the predictors associated with the worst outcomes. This study found that a considerable amount of burn victims admitted had hand burns (41.5%). Males are more likely to be injured in general, but females are more prevalent in burns by hot liquids. The most common comorbidity was hypertension, followed by dyslipidemia and type II diabetes. Cooking is the activity associated with more accidental victims. Most injuries did not require surgical intervention. Approximately two-thirds of the patients did not have any important sequelae. The most common complications were scar disturbances (26%) and scar contractures (14%). The need for surgery, a higher number of surgeries and higher surface area burn were associated with the worst outcomes. It is imperative to establish a burn prevention education program nationwide, encompassing water temperature control in households, the use of anti-burn equipment, and the replacement of old electrical/ heating equipment.

External causes in women assisted by the Mobile Emergency Service - SAMU, in Espírito Santo, Brazil

Background

External causes are events that lead to traumas, injuries and any health problems, whether deliberate or not, with sudden onset and with immediate consequence, which may or may not lead to death or incapacitating injuries. Studies show that the main causes of death of women in fertile period are external causes, and they associate this fact with the change in habits and lifestyle adopted by this group in modern times that make them more vulnerable to the risks of becoming ill or dying from such causes. The objective of this study is precisely to analyze the prevalence of the main external causes in women assisted by SAMU 192 in Espírito Santo, Brazil, and in this way, assist in the development of accident and violence prevention strategies and also contribute to the scientific society through the description of the profile epidemiological profile of these events.

Methods

This is a cross-sectional study of primary care provided by SAMU 192, in the state of Espírito Santo, in 2015, in which only women victims of traffic accidents, aggression or falls were selected.

Results

Among the women assisted by SAMU 192, 23.5% were victims of accidents and violence. Of this total, 48.6% received assistance for falls, 46.6% for traffic accidents and 4.9% for aggression. Adulthood was the most frequent, with an average age of 44.9 ± 22.7 years.

Conclusions

External causes involving women represent a major problem in Brazil and worldwide. In Espírito Santo, falling was the most common type of external cause and mainly affected the elderly woman, while the traffic accident mainly affected the adult woman. As for the aggressions, these occurred mainly at night with association with the use of alcoholic beverages. Thus, it is immensely necessary to develop actions to promote and prevent external causes of harm to women's health in the state of Espírito Santo.

Key messages

Knowing what affects the most women's health in an emerging country like Brazil, is essential for public policy actions aimed at reducing the femininity, sexism and the death of women in general. Violence against women is an underreported event because of several factors, leading to the concealment of violence, emphasizing once again the importance of public policies for this purpose.

Lisbon Burn Centre experience with intentional burn injuries

Burn injury as a form of hetero or auto-aggression accounts for a significant amount of admissions to a Burn Care Unit, with epidemiologic and clinical specificities. To investigate the differences in risk factors, psychiatric comorbidities, injury severity and mortality among adult patients with accidental or intentional burns, we analyzed routinely collected data from a Central Hospital Burn Unit over a period of 6 years (January 1st, 2010 to December 31st, 2015). We identified 22 intentional burn patients (5%) among all the admissions to our Burn Unit. When compared to the accidental burns, the intentional burn patients are significantly younger (45.7±14.7 vs. 54.9±19.9), have a bigger percentage of body surface area burned (35% vs. 14%), have a higher incidence of inhalation burn (50% vs. 22.8%) and higher mortality (18.2% vs. 6.1%). Fifty-five percent of cases of intentional burns were self-inflicted. Self-inflicted burns have a worse prognosis than hetero-aggressions (inhospital mortality 25% vs. 10%). Psychiatric comorbidities were largely more prevalent in the intentional burn patients (59% vs. 6.6%), namely mood disorders. Compared to patients with accidental burns, intentional burn patients have worse clinical condition and prognosis. A multidisciplinary preventive approach, looking at the specificities of the violent nature of the lesions and identifying risk groups may reduce the incidence and severity of this type of burns.

Predicting incomplete basal cell carcinoma excisions - a large multidisciplinary retrospective analysis in a tertiary center

Introduction: Surgical treatment of basal cell carcinomas is often performed by physicians with different surgical backgrounds. Collecting data from different surgical departments would better reflect their real-life surgical management.Objectives: To identify the rate, recurrence risk, and predictive factors accordingly to their relative contribution for an incomplete basal cell carcinoma excision in a large multidisciplinary real-life settingMethods: Retrospective cohort study of 2305 surgically treated lesions in different departments of a tertiary center.Results: There was a rate of incomplete excisions (15%) and a recurrence rate (35.5% vs. 6.8% in incomplete vs. complete excisions (p < .001)). A third of incompletely excised basal cell carcinoma (BCC) will recur over time. Stratified by relevancy, high-risk histological subtypes (micronodular (OR 5.10 - p < .001) and morpheaform (OR 5.42 - p < .001), smaller specimen sizes ( <0.5 cm or 0.5-1 cm, OR 3.99 and 2.49, respectively, p < .001) high-risk locations (OR 3.06 on the nose, OR 2.77 on the eyelids, p < .001), and recurrent BCCs (OR 1.72, p < .001). are the best predictors of an incomplete excision.Conclusions: Acknowledging the rate, recurrence risk and predictive factors for incomplete excisions may be beneficial for optimal preoperative planning and to prevent unwarranted re-interventions, morbidity, and healthcare costs.

Influence of yeasts of the genus Saccharomyces and not Saccharomyces in elaboration of white wines

Traditionally the Serra Gaúcha region, in the state of Rio Grande do Sul, is known as a barn productor of excellent quality wines. The aromatic complexity of wine in general, and white wine in particular, is what is essential to satisfy an increasingly demanding consumer. Among the most used techniques to achieve this purpose is the addition of yeasts of different genres, thus providing a range of aromatic characteristics that are accentuated in it. In this sense, the objective of this work was to evaluate the use of different strains of yeasts in white wines of Riesling Italic variety, made from grapes grown in the Serra Gaúcha region, in the state of Rio Grande do Sul. Based on the results, it was possible to observe that there were no significant differences between the treatments in relation to the variables pH, total acidity and alcoholic degree. However, with respect to the fermentation yield, T3 was the treatment that obtained the best performance, reaching the ideal density (below 1000 g.cm3) in the course of 6 to 7 days, followed by treatments T1 (Saccharomyces cerevisae) and T5 (Levulia pulcherrima) (7 to 8 days), with treatments T2 (Saccharomyces cerevisaecerevisae) and T4 (Torulaspora delbrueckii), which had the lowest performance (9 to 10 days). The T4 treatment was also the one that presented a higher amount of residual sugars, which proves the less activity of this yeast in more alcoholic means. All the yeasts used have a low production of volatile acidity, but the lowest concentration was Saccharomyces cerevisae cerevisae, used in treatment T2 (0.1 gL−1), and the other treatments presented higher concentrations (0, 4 to 0.5 gL−1), although it is still within the parameters considered ideal for obtaining quality white wines. T2 was also the treatment with lower concentrations of glycerol (5.1 g.L−1). This compound is mainly formed by glyceropyruvic fermentation through the metabolism of yeasts at the beginning of alcoholic fermentation, usually being produced by the first 50 grams of fermented sugars, which may indicate a greater activity of this yeast in this fermentation period. In general, we can say that all the yeasts used have the potential to produce quality white wines, since they had good fermentation yields, satisfactory production of alcohol and glycerol, and low production of volatile acidity.

Cardiac PET/CT with Rb-82: optimization of image acquisition and reconstruction parameters

Background

Our aim was to characterize the influence of time-of-flight (TOF) and point spread function (PSF) recovery corrections, as well as ordered subset expectation maximization (OSEM) reconstruction parameters, in ⁸²Rb PET/CT quantification of myocardial blood flow (MBF) and myocardial flow reserve (MFR).

Rest and stress list-mode dynamic ⁸²Rb PET acquisition data from 10 patients without myocardial flow defects and 10 patients with myocardial blood flow defects were reconstructed retrospectively. OSEM reconstructions were performed with Gaussian filters of 4, 6, and 8 mm, different iterations, and subset numbers (2 × 24; 2 × 16; 3 × 16; 4 × 16). Rest and stress global, regional, and segmental MBF and MFR were computed from time activity curves with FlowQuant^© software. Left ventricular segmentation using the 17-segment American Heart Association model was obtained.

Results

Whole left ventricle (LV) MBF at rest and stress were 0.97 ± 0.30 and 2.30 ± 1.00 mL/min/g, respectively, and MFR was 2.40 ± 1.13. Concordance was excellent and all reconstruction parameters had no significant impact on MBF, except for the exclusion of TOF which led to significantly decreased concordance in rest and stress MBF in patients with or without perfusion defects on a coronary artery basis and in MFR in patients with perfusion defects.

Conclusions

Changes in reconstruction parameters in perfusion ⁸²Rb PET/CT studies influence quantitative MBF analysis. The inclusion of TOF information in the tomographic reconstructions had significant impact in MBF quantification.

Relationships among growth mechanism, structure and morphology of PEALD TiO2 films: the influence of O2 plasma power, precursor chemistry and plasma exposure mode

Titanium dioxide (TiO2) thin films have generated considerable interest over recent years, because they are functional materials suitable for a wide range of applications. The efficient use of the outstanding functional properties of these films relies strongly on their basic characteristics, such as structure and morphology, which are affected by deposition parameters. Here, we report on the influence of plasma power and precursor chemistry on the growth kinetics, structure and morphology of TiO2 thin films grown on Si(100) by plasma-enhanced atomic layer deposition (PEALD). For this, remote capacitively coupled 13.56 MHz oxygen plasma was used to act as a co-reactant during the ALD process using two different metal precursors: titanium tetrachloride (TiCl4) and titanium tetraisopropoxide (TTIP). Furthermore, we investigate the effect of direct plasma exposure during the co-reactant pulse on the aforementioned material properties. The extensive characterization of TiO2 films using Rutherford backscattering spectroscopy, ellipsometry, x-ray diffraction (XRD), field-emission scanning electron microscopy, and atomic force microscopy (AFM) have revealed how the investigated process parameters affect their growth per cycle (GPC), crystallization and morphology. The GPC tends to increase with plasma power for both precursors, however, for the TTIP precursor, it starts decreasing when the plasma power is greater than 100 W. From XRD analysis, we found a good correlation between film crystallinity and GPC behavior, mainly for the TTIP process. The AFM images indicated the formation of films with grain size higher than film thickness (grain size/film thickness ratio ≈20) for both precursors, and plasma power analysis allows us to infer that this phenomenon can be directly related to the increase of the flux of energetic oxygen species on the substrate/growing film surface. Finally, the effect of direct plasma exposure on film structure and morphology was evidenced showing that the grid removal causes a drastic reduction in the grain size, particularly for TiO2 synthesized using TiCl4.

The influence of number of counts in the myocardium in the determination of reproducible functional parameters in gated-SPECT studies simulated with GATE

Myocardial perfusion gated-single photon emission computed tomography (gated-SPECT) imaging is used for the combined evaluation of myocardial perfusion and left ventricular (LV) function. The aim of this study is to analyze the influence of counts/pixel and concomitantly the total counts in the myocardium for the calculation of myocardial functional parameters.

MATERIAL AND METHODS

Gated-SPECT studies were performed using a Monte Carlo GATE simulation package and the NCAT phantom. The simulations of these studies use the radiopharmaceutical (99m)Tc-labeled tracers (250, 350, 450 and 680 MBq) for standard patient types, effectively corresponding to the following activities of myocardium: 3, 4.2, 5.4-8.2 MBq. All studies were simulated using 15 and 30s/projection. The simulated data were reconstructed and processed by quantitative-gated-SPECT software, and the analysis of functional parameters in gated-SPECT images was done by using Bland-Altman test and Mann-Whitney-Wilcoxon test.

RESULTS

In studies simulated using different times (15 and 30s/projection), it was noted that for the activities for full body: 250 and 350 MBq, there were statistically significant differences in parameters Motility and Thickness. For the left ventricular ejection fractio n (LVEF), end-systolic volume (ESV) it was only for 250 MBq, and 350 MBq in the end-diastolic volume (EDV), while the simulated studies with 450 and 680MBq showed no statistically significant differences for global functional parameters: LVEF, EDV and ESV.

CONCLUSION

The number of counts/pixel and, concomitantly, the total counts per simulation do not significantly interfere with the determination of gated-SPECT functional parameters, when using the administered average activity of 450 MBq, corresponding to the 5.4 MBq of the myocardium, for standard patient types.

Monte Carlo simulation of the basic features of the GE Millennium MG single photon emission computed tomography gamma camera

OBJECTIVE

To describe and validate the simulation of the basic features of GE Millennium MG gamma camera using the GATE Monte Carlo platform.

MATERIAL AND METHODS

Crystal size and thickness, parallel-hole collimation and a realistic energy acquisition window were simulated in the GATE platform. GATE results were compared to experimental data in the following imaging conditions: a point source of (99m)Tc at different positions during static imaging and tomographic acquisitions using two different energy windows. The accuracy between the events expected and detected by simulation was obtained with the Mann-Whitney-Wilcoxon test. Comparisons were made regarding the measurement of sensitivity and spatial resolution, static and tomographic. Simulated and experimental spatial resolutions for tomographic data were compared with the Kruskal-Wallis test to assess simulation accuracy for this parameter.

RESULTS

There was good agreement between simulated and experimental data. The number of decays expected when compared with the number of decays registered, showed small deviation (≤ 0.007%). The sensitivity comparisons between static acquisitions for different distances from source to collimator (1, 5, 10, 20, 30 cm) with energy windows of 126-154 keV and 130-158 keV showed differences of 4.4%, 5.5%, 4.2%, 5.5%, 4.5% and 5.4%, 6.3%, 6.3%, 5.8%, 5.3%, respectively. For the tomographic acquisitions, the mean differences were 7.5% and 9.8% for the energy window 126-154 keV and 130-158 keV. Comparison of simulated and experimental spatial resolutions for tomographic data showed no statistically significant differences with 95% confidence interval.

CONCLUSIONS

Adequate simulation of the system basic features using GATE Monte Carlo simulation platform was achieved and validated.

The cytology and DNA detection by the PapilloCheck(®) test in the diagnosis of human papillomavirus infection

The aim of this study was to make a comparison between the results obtained by cytologies and by the detection and genotyping of human papillomavirus (HPV) DNA in the screening of cervical cancer. In this study, there were 994 samples used from human females. These were obtained from liquid-based preparations. The samples were analyzed by cytological technique and by the detection of HPV DNA using the PapilloCheck(®) Test. The HPV was detected in 28% of the samples. Most of the cytology lesions appeared in HPV positive samples and, within these, the most serious injuries occurred mostly in samples with multiple HPV infections. The results indicate that, in general, there is a correlation between the detection of HPV DNA and cytology. However, there were some cases that emphasize the limitations of both diagnosis methods (27% cases with viral HPV DNA positive and normal cytologies and about 2% of cytological lesions detected in samples HPV negatives). It is possible to conclude that none of the two techniques is enough by itself and should be applied together in order to increase the accuracy of cervical cancer screening.

Equisetum arvense hydromethanolic extracts in bone tissue regeneration: in vitro osteoblastic modulation and antibacterial activity

OBJECTIVES

Equisetum arvense preparations have long been used to promote bone healing. The aim of this work was to evaluate osteogenic and antibacterial effects of E. arvense hydromethanolic extracts.

MATERIALS AND METHODS

Dried aerial components of E. arvense were extracted using a mixture of methanol:water (1:1), for 26 days, yielding three extracts that were tested (10-1000 μg/ml) in human osteoblastic cells: E1, E2 and EM (a mixture of E1 and E2, 1:1). Cell cultures, performed on cell culture plates or over hydroxyapatite (HA) substrates, were assessed for osteoblastic markers. In addition, effects of the extracts on Staphylococcus aureus were addressed.

RESULTS

Solution E1 caused increased viability/proliferation and ALP activity at 50-500 μg/ml, and deleterious effects at levels ≥1000 μg/ml. E2 inhibited cell proliferation at levels ≥500 μg/ml. EM presented a profile between those observed with E1 and E2. In addition, E1, E2 and EM, 10-1000 μg/ml, inhibited expansion of S. aureus. Furthermore, E1, tested in HA substrates colonized with osteoblastic cells, causing increase in cell population growth (10-100 μg/ml). E1 also exhibited antibacterial activity against S. aureus cultured over HA.

CONCLUSIONS

Results showed that E. arvense extracts elicited inductive effects on human osteoblasts while inhibiting activity of S. aureus, suggesting a potentially interesting profile regarding bone regeneration strategies.

New records, threatens and conservation status for Dichotomius schiffleri Vaz-de-Mello, Louzada & Gavino (Coleoptera: Scarabaeidae): an endangered dung beetle species from Brazilian atlantic forest ecosystems

Dichotomius schiffleri Vaz-de-Mello et al is often cited as endemic to the preserved coastal sandy-dune vegetation (restinga) of Guriri Island, Espírito Santo state, and is included in the Brazilian List of Endangered Fauna as "critically endangered" (CR). However, we recorded its occurrence in twelve additional sites along the coasts of Espírito Santo, Bahia, Sergipe and Pernambuco. The geographic distribution of D. schiffleri is limited to the coastal Atlantic Forest domain, mainly in preserved restinga patches. We recommend that D. schiffleri remains in the List of Endangered species, but in the "endangered" (EN) category, according to the IUCN criteria.

237 PROTEIN-TYROSINE PHOSPHORYLATION AND CALCIUM UPTAKE IN BOAR SPERM SUBPOPULATIONS AFTER DIFFERENT DISCONTINUOUS PERCOLL GRADIENT CENTRIFUGATIONS

Semen is composed of an heterogeneous population of sperm with varying degrees of structural and functional differentiation. To optimize in vitro fertilization (IVF), different selection methods have been used to isolate sperm subpopulations with high fertilizing capacity. The aim of this study was to evaluate protein-tyrosine phosphorylation (P-Tyr) and calcium uptake in boar sperm subpopulations from the same ejaculate. Spermatozoa from fertile and normozoospermic boars were treated by 2-step discontinuous gradient centrifugation consisting of 3 different combinations of isotonic Percoll (45/60, 60/75, and 45/90%). An aliquot of semen was kept without centrifugation as a control group. Immunofluorescence was employed to determine the localization of proteins phosphorylated in tyrosine residues (Tardif et al. 2001 Biol. Reprod. 65, 784–792). In order to measure intracellular free [Ca2+], spermatozoa treated as described above were incubated with 2.5 μM Fura-2AM in a noncapacitating medium (Tardif et al. 2003 Biol. Reprod. 68, 207–213) for 45 min at 37°C. Then, spermatozoa were resuspended in TALP medium (Rath et al. 1999. J. Anim. Sci. 77, 3346–3352), incubated (5% CO2, 38.5°C) for a further 10 min and then analysed in a fluorescence spectrofluorometer during 30 min with excitation wavelength set at 340–380 nm and emission held at 510 nm. The calculation of intracellular free [Ca2+] was performed according to the equation of (Grynkiewicz et al. 1985 J. Biol. Chem. 260, 3440–3450). The results showed that Percoll treatment increased the percentage of cells with P-Tyr v. control group (P < 0.01). Among Percoll groups, 45/90% showed the highest pattern of cells with signal in equatorial region, acrosome, and tail. As was observed with P-Tyr results, the intracellular free Ca2+ concentration (nM) was different between control group and spermatozoa treated with Percoll gradient (P < 0.01). Among Percoll groups, 45/90% showed the highest levels in calcium uptake and 45/60 showed the lowest levels (299.26; P < 0.01). In conclusion, it could be stated after Percoll centrifugation that sperm subpopulations have different abilities to protein-tyrosine phosphorylation and calcium uptake that could be related to different levels of in vitro fertility. Supported by Fundación Séneca 08752/PI/08.

EFEITO DE EXTRATOS DE ARISTOLOCHIA LAGESIANA (ARISTOLOCHIACEAE) SOBRE A LAGARTA-DA-SOJA, ANTICARSIA GEMMATALIS (LEPIDOPTERA: NOCTUIDAE)

RESUMO Vários relatos de atividades biológicas podem ser encontrados nas espécies de plantas pertencentes ao gênero Aristolochia (Aristolochiaceae), cujas plantas estão distribuídas em todo o território nacional. Visando a obtenção de mais informações sobre essas plantas, avaliou-se a ação de extratos de Aristolochia lagesiana Ule. var. intermedia Hoehne sobre Anticarsia gemmatalis Hüebner, 1818 (Lepidoptera: Noctuidae). O experimento foi conduzido no Laboratório de Biologia e Criação de insetos da FCAV/ UNESP – Jaboticabal e no Laboratório de Química Orgânica do IQ/ UNESP – Araraquara. A toxidade relativa dos extratos foi determinada através da aplicação tópica de uma gota de 1 µL de solução, de cada extrato, que foi aplicada no mesotórax de lagartas de terceiro instar, utilizando-se um aparelho microaplicador. As plantas foram extraídas em acetona, que foi evaporada antes da aplicação e, para isto, os extratos foram re-solubilizados em etanol para obtenção das seguintes dosagens: 6,0; 9,6; 13,2; 16,8; 20,4 e 22,0 mg/?L. Os extratos de A. lagesiana alongam a duração do período larval, reduzem o peso de pupas e também diminuem a viabilidade larval de A. gemmatalis .

Congenital amegakaryocytic thrombocytopenia--report of a new c-mpl gene missense mutation

A 44-month old girl with congenital amegakaryocytic thrombocytopenia, already with pancytopenia, underwent an unrelated allogeneic cord blood transplantation with recovery of normal blood cell counts. The patient was a compound heterozygote for two c-mpl missense mutations inherited from both parents, one of them, a G578A exon 4 mutation leading to a cysteine to tyrosine replacement of codon 193, previously unreported.

Molecular cytogenetic characterization of rearrangements involving 12p in leukemia

Translocations involving the short arm of chromosome 12 are frequent events among patients with various hematologic malignancies. In approximately half of these patients, fluorescence in situ hybridization (FISH) analysis has shown that the breakpoints are clustered within the ETS-variant gene 6 (ETV6) at 12p13, leading to its fusion with a variety of partner genes on different chromosomes. The remaining patients have breakpoints centromeric or telomeric to ETV6 or, less frequently, interstitial 12p13 deletions that invariably involve this gene. In most cases reported, 12p translocations were found to be associated with other structural and/or numerical abnormalities as part of a complex karyotype. Initially using conventional cytogenetic analysis, we characterized the chromosomal breakpoints of three leukemia patients (two with B-acute lymphoblastic leukemia and one with myelodysplastic/myeloproliferative disorder) presenting a t(5;12)(q13;p13), t(12;15)(p13;q22), and dic(9;12)(p11;p11), respectively, as the only structural abnormalities in the karyotype. These rearrangements were further investigated using FISH and molecular studies. Two cases revealed cryptic three-way translocations that had gone undetected in the conventional cytogenetic analyses. One of the cases presented an ETV6 rearrangement with an unsuspected fusion, with the CBFA2 gene at 21q22. In the other two, small and large 12p deletions that included ETV6 were found. This report illustrates the chromosomal and molecular heterogeneity of rearrangements underlying 12p chromosome translocations in leukemia.

Glyconjugates in epidermal, branchial and digestive mucous cells and gastric glands of gilthead sea bream, Sparus aurata, Senegal sole, Solea senegalensis and Siberian sturgeon, Acipenser baeri development

Epidermal, branchial and digestive mucous cells, and the gastric glands of larvae/postlarvae (from hatching until 45 days posthatching) of three fish species (two teleostean and a chondrostean) were investigated using conventional histochemical methods (periodic acid schiff -PAS-, diastase-PAS; alcian blue pH 0.5, 1 and 2.5) in order to distinguish neutral and acidic (carboxylated and sulphated) glycoconjugates, as well as bromophenol blue reaction for identification of proteins. Additionally, the presence and distribution of sugar residues in the oligosaccharide side chains of glycoconjugates were investigated using horseradish peroxidase (HPR)-conjugated lectins (Con A, DBA, WGA and UEA-I). Most mucous cells (digestive, epidermal and branchial) of Siberian sturgeon, Acipenser baeri, sea bream, Sparus aurata and Senegal sole, Solea senegalensis larvae were PAS- and alcian blue- (pH 2.5 and 0.5) positive, with small variations between organs/tissues and species. Bromophenol blue reaction (general proteins) was positive in a minority of the mucous cells, usually in those cells which were PAS-negative. Proteins rich in sulphydryl (-SH) and/or disulphide (-S-S-) groups related with the glycoprotein nature of the glycoconjugates present in mucous cells were also observed. Epidermal, branchial and digestive mucous cells of all studied larvae did not contain glycogen or lipids. Con A lectin staining was negative in all mucous cells types of sea bream and sole, but oesophageal mucous cell of sturgeon were reactive to different lectin reactions, suggesting the presence of mannose -Man- and/or glucose -Glc-, L-fucose -Fuc- ; N-acetyl-D-galactosamine -GalNAc-, as well as N-acetyl-D-glucosamine- GlcNAc - and/or sialic acid -NANA- residues. Digestive mucous cells of all studied larvae were positive to WGA and DBA lectins. Epidermal and branchial mucous cells of sea bream and sole were Con A, DBA and UEA-I unreactive. However, mucous cells of sturgeon larvae were stained with UEA-I lectin. Gastric glands appear very early in sturgeon stomach larvae development (between 5-6 days posthatching) but rather late (around 40 days) during the ontogeny of sole and sea bream larvae. These glands contain neutral glycoproteins with Man and/or Glc, Fuc, GlcNAc- and/or sialic acid and rich in GalNAc- sugar residues, as well as proteins moderately rich in arginine, and others particularly rich in tyrosine and tryptophan.

Translocation (8;17;15;21)(q22;q23;q15;q22) in acute myeloid leukemia (M2). a four-way variant of t(8;21)

We report the results of cytogenetic, fluorescence in situ hybridization (FISH) and molecular analyses in a 15-year-old boy diagnosed with acute myeloid leukemia subtype M2 (AML-M2). Cytogenetic and FISH analyses, the latter with whole chromosome painting probes, revealed a complex translocation involving four chromosomes: t(8;17;15;21)(q22;q23;q15;q22). The observation of breakpoints at 8q22 and 21q22 suggested a rearrangement of the ETO and AML1 genes, respectively. Using a dual-color FISH test with ETO and AML1 probes, we demonstrated an AML1/ETO fusion signal on the derivative chromosome 8. Reverse transcription-polymerase chain reaction (RT-PCR) analysis showed the presence of AML1/ETO fusion transcripts identical to those found in classical t(8;21). The present case highlights the relevant role of the rearranged chromosome 8, which encodes the AML1/ETO fusion product in the pathogenesis of AML-M2.

Ketamine abusers presenting to the emergency department: a case series

Ketamine hydrochloride, familiar to emergency physicians as a dissociative anesthetic, has been abused as a hallucinogen for almost 30 years. The drug produces effects similar to those of phencyclidine but with a much shorter duration of effect. Since 1996, an increasing number of patients have presented to Connecticut Emergency Departments (EDs) after the intentional abuse of ketamine. Because the medical literature contains almost no information on the consequences of ketamine abuse, we have compiled a series of ketamine abusers presenting to the ED. Among the 20 patients in this series, common presenting complaints included anxiety, chest pain, and palpitations. Tachycardia was the most common physical examination finding. Nystagmus, a common finding after phencyclidine use, was seen in only three cases. The most frequent complications after ketamine abuse were severe agitation and rhabdomyolysis. The symptoms of ketamine intoxication appear to be short-lived, with 18 of the 20 patients discharged from the ED within 5 h of presentation. Emergency physicians should include ketamine in the differential diagnosis of drug- or toxin-induced hallucinations. Methods for detecting this drug in biologic fluids are reviewed as are treatment recommendations for managing the patient who presents to the ED after abusing ketamine.

Insertion of the 5' part of BCR within the ABL gene at 9q34 in a Philadelphia-negative chronic myeloid leukemia

We report a chronic myeloid leukemia patient without evidence of a Philadelphia (Ph) chromosome in whom RT-PCR analysis performed in blast crisis demonstrated the existence of both common b3a2 and b2a2 BCR/ABL fusion transcripts. In situ hybridization studies with BCR- and ABL-specific probes showed location of the BCR/ABL fusion gene on chromosome 9, band q34, instead of at chromosome 22q11, and that it resulted from an insertion of the 5' side of BCR within the ABL gene on chromosome 9. The vast majority of cells showed a BCR/ABL fusion gene on both chromosomes 9, which is equivalent to a double Ph chromosome, thus reinforcing the notion that the critical event in CML is the formation of a functional BCR/ABL fusion gene.

Relapsed chronic myeloid leukemia in accelerated phase 10 years after allogeneic bone marrow transplantation: full chimera reconversion with donor peripheral blood stem cells infusion

We report the case of a 44-year-old male who relapsed in accelerated phase chronic myeloid leukemia 10 years after a successful bone marrow transplantation from his HLA-identical brother, and 3 years after 12 months treatment with interferon-alpha (IFN-alpha) for chronic active hepatitis C (CAH). The patient was infused with G-CSF-primed peripheral blood cells (PBSC) from the original bone marrow donor and a full donor reconstitution, with no detectable molecular disease, was obtained within 4 months without clinical aplasia or GVHD, nor help from other forms of chemotherapy or use of biological response modifiers. We speculate that IFN-alpha for CAH delayed the onset of a clinical recurrence of chronic myeloid leukemia and that in advanced disease PBSCs can provide an advantageous alternative to donor lymphocyte infusion (DLI).

Bicarbonate ions and pH regulation of Leishmania major promastigotes

Leishmania major promastigotes are parasites endowed with a plasma membrane electrogenic H+ pump and anionic channels. These systems have been thought to contribute to pH homeostasis of parasites and environmental adaptation by mediating extrusion of protons which are either generated metabolically or result from exogenous acid loads. In this work we show that HCO-3 transport plays a physiological role in supporting pH regulation of parasites. Intracellular pH (pHi) and the membrane potential (Vm) were assessed fluorometrically with pH sensitive and potentiometric dyes. We show that intracellular acidification, caused either by blocking the pump or the putative anion channel or by depleting Cl- from cells, could be largely overcome by addition of HCO-3. Likewise, addition of HCO-3 raises the steady state intracellular pH of untreated cells from 6.76 +/- 0.01 to 6.98 +/- 0.02 and induces membrane hyperpolarization in pump-inhibited cells. We provide evidence for the involvement of HCO-3 transport systems that subserve pH homeostasis in Leishmania promastigotes. A major anionic pathway which is sensitive to anion transport blockers is apparently conductive in nature and accomodates ions such as HCO-3 and Cl-. In physiological conditions, the primary role of H+ pumping is the generation of a relatively large membrane potential (Vm = -113 +/- 4 mV) which subserves electrochemical-driven uptake of nutrients. The involvement of H+ pumping in physiological pH regulation of promastigotes is apparently of a secondary nature.

Chloride conductive pathways which support electrogenic H+ pumping by Leishmania major promastigotes

The proton extrusion mechanisms of Leishmania promastigotes were studied in terms of electrogenic movements of protons and anions (Cl- and HCO3-). Changes in membrane potential (Vm) and intracellular pH (pHi) were monitored fluorimetrically with the potential sensitive dye bis-oxonol and the pH-sensitive dye tetraacethoxymethyl 2',7'-bis-(carboxyethyl)-5,6-carboxyfluorescein, respectively. In nominal bicarbonate-free medium (pHe 7.4, 28 degrees C), Vm and pHi of Leishmania promastigotes were maintained at -113 +/- 4 mV and 6.75 +/- 0.02, respectively. In Cl- free (gluconate-based) medium, cells underwent a time-dependent acidification (0.3 pH units) and a long term membrane hyperpolarization (7-10 mV), both of which were greatly enhanced in the presence of the anion blocker, 4,4'-diisothiocyanodihydrostilbene-2,2'-disulfonic acid (H2DIDS). Cells in Cl(-)-free medium underwent a marked depolarization upon treatment with the H(+)-ATPase inhibitor dicyclohexylcarbodiimide (DCCD), but hyperpolarized after repletion with Cl-. In Cl(-)-depleted cells, replenishment of Cl- led to a H2DIDS-sensitive cytoplasmic alkalinization and a small initial hyperpolarization. Cells exposed either to DCCD or to the H+ uncoupler carbonylcyanide chlorophenylhydrazone caused a marked cytoplasmic acidification and membrane depolarization. In the presence of 25 mM HCO3-, promastigotes maintained an almost neutral cytosol, irrespective of H+ pump action or ionic composition of the medium. The present observations provide evidence for the operation of a DCCD-sensitive electrogenic H(+)-ATPase which contributes to the maintenance of a highly hyperpolarized plasma membrane in Leishmania promastigotes. H+ pump activity required a parallel pathway of Cl- ions in order to dissipate the pump generated electrical potential. In nominally CO2-free media, the two electrogenic systems are implicated in the maintenance of cell pH and indirectly in electrochemically driven nutrient uptake. In physiological CO2/HCO3(-)-containing media, the H+ pump and Cl- channel play a role only secondary to that of HCO3- in pHi homeostasis.