Synthetic fibers in atmospheric fallout: A source of microplastics in the environment?

Sources, pathways and reservoirs of microplastics, plastic particles smaller than 5mm, remain poorly documented in an urban context. While some studies pointed out wastewater treatment plants as a potential pathway of microplastics, none have focused on the atmospheric compartment. In this work, the atmospheric fallout of microplastics was investigated in two different urban and sub-urban sites. Microplastics were collected continuously with a stainless steel funnel. Samples were then filtered and observed with a stereomicroscope. Fibers accounted for almost all the microplastics collected. An atmospheric fallout between 2 and 355 particles/m(2)/day was highlighted. Registered fluxes were systematically higher at the urban than at the sub-urban site. Chemical characterization allowed to estimate at 29% the proportion of these fibers being all synthetic (made with petrochemicals), or a mixture of natural and synthetic material. Extrapolation using weight and volume estimates of the collected fibers, allowed a rough estimation showing that between 3 and 10 tons of fibers are deposited by atmospheric fallout at the scale of the Parisian agglomeration every year (2500 km(2)). These results could serve the scientific community working on the different sources of microplastic in both continental and marine environments.

Intensity and amount of physical activity in relation to insulin sensitivity: the Insulin Resistance Atherosclerosis Study

CONTEXT

Exercise training is associated with improved insulin sensitivity (SI), but the potential impact of habitual, nonvigorous activity is uncertain.

OBJECTIVE

To determine whether habitual, nonvigorous physical activity, as well as vigorous and overall activity, is associated with better SI.

DESIGN

A multicultural epidemiologic study.

SETTING

The Insulin Resistance Atherosclerosis Study, conducted in Oakland, Calif; Los Angeles, Calif; the San Luis Valley, Colo; and San Antonio, Tex.

PARTICIPANTS

A total of 1467 men and women of African American, Hispanic, and non-Hispanic white ethnicity, aged 40 to 69 years, with glucose tolerance ranging from normal to mild non-insulin-dependent diabetes mellitus.

MAIN OUTCOME MEASURE

Insulin sensitivity as measured by an intravenous glucose tolerance test.

RESULTS

The mean SI for individuals who participated in vigorous activity 5 or more times per week was 1.59 min(-1) x microU(-1) x mL(-1) x 10(-4) (95% confidence interval [CI], 1.39-1.79) compared with 0.90 (95% CI, 0.83-0.97) for those who rarely or never participated in vigorous activity, after adjusting for potential confounders (P<.001). When habitual physical activity (estimated energy expenditure [EEE]) was assessed by 1-year recall of activities, the correlation coefficient between SI and total EEE was 0.14 (P<.001). After adjustment for confounders, vigorous and nonvigorous levels of EEE (metabolic equivalent levels > or = 6.0 and <6.0, respectively) were each positively and independently associated with SI (P< or =.01 for each). The association was attenuated after adjustment for the potential mediators, body mass index (a measure of weight in kilograms divided by the square of the height in meters), and waist-to-hip ratio. Results were similar for subgroups of sex, ethnicity, and diabetes.

CONCLUSIONS

Increased participation in nonvigorous as well as overall and vigorous physical activity was associated with significantly higher SI. These findings lend further support to current public health recommendations for increased moderate-intensity physical activity on most days.

Mutations in NEUROD1 are associated with the development of type 2 diabetes mellitus

The helix-loop-helix (HLH) protein NEUROD1 (also known as BETA2) functions as a regulatory switch for endocrine pancreatic development. In mice homozygous for a targeted disruption of Neurod, pancreatic islet morphogenesis is abnormal and overt diabetes develops due in part to inadequate expression of the insulin gene (Ins2). NEUROD1, following its heterodimerization with the ubiquitous HLH protein E47, regulates insulin gene (INS) expression by binding to a critical E-box motif on the INS promoter. Here we describe two mutations in NEUROD1, which are associated with the development of type 2 diabetes in the heterozygous state. The first, a missense mutation at Arg 111 in the DNA-binding domain, abolishes E-box binding activity of NEUROD1. The second mutation gives rise to a truncated polypeptide lacking the carboxy-terminal trans-activation domain, a region that associates with the co-activators CBP and p300 (refs 3,4). The clinical profile of patients with the truncated NEUROD1 polypeptide is more severe than that of patients with the Arg 111 mutation. Our findings suggest that deficient binding of NEUROD1 or binding of a transcriptionally inactive NEUROD1 polypeptide to target promoters in pancreatic islets leads to the development of type 2 diabetes in humans.

Delirium in the ICU: an overview

Delirium is characterized by a disturbance of consciousness with accompanying change in cognition. Delirium typically manifests as a constellation of symptoms with an acute onset and a fluctuating course. Delirium is extremely common in the intensive care unit (ICU) especially amongst mechanically ventilated patients. Three subtypes have been recognized: hyperactive, hypoactive, and mixed. Delirium is frequently undiagnosed unless specific diagnostic instruments are used. The CAM-ICU is the most widely studied and validated diagnostic instrument. However, the accuracy of this tool may be less than ideal without adequate training of the providers applying it. The presence of delirium has important prognostic implications; in mechanically ventilated patients it is associated with a 2.5-fold increase in short-term mortality and a 3.2-fold increase in 6-month mortality. Nonpharmacological approaches, such as physical and occupational therapy, decrease the duration of delirium and should be encouraged. Pharmacological treatment for delirium traditionally includes haloperidol; however, more data for haloperidol are needed given the paucity of placebo-controlled trials testing its efficacy to treat delirium in the ICU. Second-generation antipsychotics have emerged as an alternative for the treatment of delirium, and they may have a better safety profile. Dexmedetomidine may prove to be a valuable adjunctive agent for patients with delirium in the ICU.

Viral infection in community-acquired pneumonia: a systematic review and meta-analysis

The advent of PCR has improved the identification of viruses in patients with community-acquired pneumonia (CAP). Several studies have used PCR to establish the importance of viruses in the aetiology of CAP.We performed a systematic review and meta-analysis of the studies that reported the proportion of viral infection detected via PCR in patients with CAP. We excluded studies with paediatric populations. The primary outcome was the proportion of patients with viral infection. The secondary outcome was short-term mortality.Our review included 31 studies. Most obtained PCR via nasopharyngeal or oropharyngeal swab. The pooled proportion of patients with viral infection was 24.5% (95% CI 21.5-27.5%). In studies that obtained lower respiratory samples in >50% of patients, the proportion was 44.2% (95% CI 35.1-53.3%). The odds of death were higher in patients with dual bacterial and viral infection (OR 2.1, 95% CI 1.32-3.31).Viral infection is present in a high proportion of patients with CAP. The true proportion of viral infection is probably underestimated because of negative test results from nasopharyngeal or oropharyngeal swab PCR. There is increased mortality in patients with dual bacterial and viral infection.

Micropollutants in urban stormwater: occurrence, concentrations, and atmospheric contributions for a wide range of contaminants in three French catchments

This study aimed at: (a) providing information on the occurrence and concentration ranges in urban stormwater for a wide array of pollutants (n = 77); (b) assessing whether despite the differences between various catchments (land use, climatic conditions, etc.), the trends in terms of contamination level are similar; and (c) analyzing the contribution of total atmospheric fallout (TAF) with respect to sources endogenous to this contamination. The studied contaminants include conventional stormwater contaminants (polycyclic aromatic hydrocarbons (PAHs), Zn, Cu, Pb, etc.), in addition to poorly or undocumented pollutants such as nonylphenol and octylphenol ethoxylates (NPnEO and OPnEO), bisphenol A (BPA), polybrominated diphenyl ethers (PBDEs), a wide variety of pesticides, and various metals of relevance (As, Ti, Sr, V). Sampling and analysis were performed using homogeneous methods on three urban catchments with different land use patterns located in three distinct French towns. For many of these pollutants, the results do not allow highlighting a significant difference in stormwater quality at the scale of the three urban catchments considered. Significant differences were, however, observed for several metals (As, Cr, Cu, Ni, Sr and Zn), PAHs, and PBDEs, though this assessment would need to be confirmed by further experiments. The pollutant distributions between dissolved and particulate phases were found to be similar across the three experimental sites, thus suggesting no site dependence. Lastly, the contributions of TAF to stormwater contamination for micropollutants were quite low. This finding held true not only for PAHs, as previously demonstrated in the literature, but also for a broader range of molecules such as BPA, NPnEO, OPnEO, and PBDEs, whose high local production is correlated with the leaching of urban surfaces, buildings, and vehicles.

Partition of pollution between dissolved and particulate phases: what about emerging substances in urban stormwater catchments?

This paper presents results about the occurrence, the concentrations of urban priority substances on both the dissolved and the particulate phases in stormwater. Samples were collected at the outlet of a dense urban catchment in Paris suburb (2.30 km(2)). 13 chemical groups were investigated including 88 individual substances. Results showed that stormwater discharges contained 45 substances among them some metals, organotins, PAHs, PCBs, alkylphenols, pesticides, phthalates, cholorophenols and one volatile organic compound, i.e. methylene chloride. With respect to the European Water Framework Directive, these substances included 47% of the priority hazardous substances (n = 8), 38% of the priority substances (n = 10). The remaining substances (n = 27) belong to a list of others specific urban substances not included in the Water Framework Directive but monitored during this work. Finally, stormwater quality was evaluated by comparing the substance concentrations to environmental quality standards (EQS) and the particulate content to Canadian sediment quality guidelines. This showed that stormwater was highly contaminated and should be treated before being discharged to receiving waters in order to avoid any adverse impact on the river quality.

Contribution of different sources to the pollution of wet weather flows in combined sewers

Experiments performed on "Marais" catchment, in central Paris, aimed to follow up the quality of wet weather flows from the entry to the exit of a combined sewer network. SS, VSS, COD, BOD5, Cd, Cu, Pb, Zn concentrations were measured for an important number of rain events in roof, yard, street runoff, as well as in dry and wet weather flows at the catchment outlet. Mass entry-exit totals, at the scale of the catchment, were calculated over 31 rain events in order to evaluate the contribution of different types of runoff, of sanitary sewage and of sewer sediments to the total wet weather pollutant loads at the catchment outlet. The erosion of in-sewer pollutant stocks was found to be the main source of particles and of organic matter in wet weather flows, whereas heavy metal loads mainly originated from roof runoff, due to the corrosion of metallic roofs. Particles eroded inside the sewer during rain events were found to be quite different from the particles constituting the main part of sewer sediments: they are organic and biodegradable, with rather important settling velocities and seem to accumulate during dry weather periods. A change of the chemical form of heavy metals was noticed during the transport in the sewer and it is suspected that a fraction of the dissolved metals from the runoff is adsorbed on sewer sediments.

Niraparib plus abiraterone acetate with prednisone in patients with metastatic castration-resistant prostate cancer and homologous recombination repair gene alterations: second interim analysis of the randomized phase III MAGNITUDE trial

BACKGROUND

Patients with metastatic castration-resistant prostate cancer (mCRPC) and BRCA alterations have poor outcomes. MAGNITUDE found patients with homologous recombination repair gene alterations (HRR+), particularly BRCA1/2, benefit from first-line therapy with niraparib plus abiraterone acetate and prednisone (AAP). Here we report longer follow-up from the second prespecified interim analysis (IA2).

PATIENTS AND METHODS

Patients with mCRPC were prospectively identified as HRR+ with/without BRCA1/2 alterations and randomized 1 : 1 to niraparib (200 mg orally) plus AAP (1000 mg/10 mg orally) or placebo plus AAP. At IA2, secondary endpoints [time to symptomatic progression, time to initiation of cytotoxic chemotherapy, overall survival (OS)] were assessed.

RESULTS

Overall, 212 HRR+ patients received niraparib plus AAP (BRCA1/2 subgroup, n = 113). At IA2 with 24.8 months of median follow-up in the BRCA1/2 subgroup, niraparib plus AAP significantly prolonged radiographic progression-free survival {rPFS; blinded independent central review; median rPFS 19.5 versus 10.9 months; hazard ratio (HR) = 0.55 [95% confidence interval (CI) 0.39-0.78]; nominal P = 0.0007} consistent with the first prespecified interim analysis. rPFS was also prolonged in the total HRR+ population [HR = 0.76 (95% CI 0.60-0.97); nominal P = 0.0280; median follow-up 26.8 months]. Improvements in time to symptomatic progression and time to initiation of cytotoxic chemotherapy were observed with niraparib plus AAP. In the BRCA1/2 subgroup, the analysis of OS with niraparib plus AAP demonstrated an HR of 0.88 (95% CI 0.58-1.34; nominal P = 0.5505); the prespecified inverse probability censoring weighting analysis of OS, accounting for imbalances in subsequent use of poly adenosine diphosphate-ribose polymerase inhibitors and other life-prolonging therapies, demonstrated an HR of 0.54 (95% CI 0.33-0.90; nominal P = 0.0181). No new safety signals were observed.

CONCLUSIONS

MAGNITUDE, enrolling the largest BRCA1/2 cohort in first-line mCRPC to date, demonstrated improved rPFS and other clinically relevant outcomes with niraparib plus AAP in patients with BRCA1/2-altered mCRPC, emphasizing the importance of identifying this molecular subset of patients.

Effect of suturing technique and urethral plate characteristics on complication rate following hypospadias repair: a prospective randomized study

PURPOSE

We studied the effect of suturing technique and the impact of urethral plate characteristics on the complication rate following tubularized incised plate urethroplasty.

MATERIALS AND METHODS

We prospectively studied 80 boys (mean age 4.5 years, range 3 to 7) with primary hypospadias in a randomized fashion between January 2004 and May 2005. Of the patients 64 had anterior and 16 had mid penile hypospadias. Patients were allocated into 2 groups according to suture technique, with continuous sutures used in 40 boys and interrupted sutures in 40. We evaluated urethral plate depth, length and width before and after incision. Correlation between suture technique, plate type, width and length, and complication rate was performed.

RESULTS

Mean followup was 3 years. Success rates were 90% and 69% for anterior and mid penile hypospadias, respectively (p = 0.037). Complications developed in 11 patients (13.8%) and consisted of fistula (8), dehiscence (2) and meatal stenosis (3). On univariate analysis the suture technique, depth and length of urethral plate, width after incision and presence of hypoplasia had no impact on complication occurrence. However, urethral plate width before incision was significantly related to complication occurrence (p = 0.048).

CONCLUSIONS

Suture technique has no influence on the outcome of tubularized incised plate urethroplasty. Urethral plate characteristics do not affect the complication rate except for plate width, which significantly affects the outcome. Adequate urethral plate width (8 mm or greater) is essential for successful tubularized incised plate repair.

Genito-urinary complications of brucellosis

Twelve cases of genito-urinary complications of brucellosis are presented. Ten patients had epididymo-orchitis, 1 presented with right hydronephrosis and 1 with haematuria and dysuria. The 10 cases of epididymo-orchitis were compared with 15 cases of acute non-specific epididymo-orchitis. The former were of longer duration and were not associated with lower urinary tract symptoms; almost all of these patients had ingested unpasteurised milk. Non-specific epididymo-orchitis had a more acute onset, shorter duration and was associated more frequently with pyuria, lower urinary tract symptoms, higher leucocyte counts and insignificant brucella titres. The distinction between these two types of epididymo-orchitis is essential, since the treatments are entirely different.

Volume-Based Feeding in the Critically Ill Patient

INTRODUCTION

Critically ill patients placed on enteral nutrition (EN) are usually underfed. A volume-based feeding (VBF) protocol designed to adjust the infusion rate to make up for interruptions in delivery should provide a greater volume of EN than the more common fixed hourly rate-based feeding (RBF) method.

METHODS

This single-center, randomized (3:1; VBF/RBF) prospective study evaluated critically ill patients on mechanical ventilation expected to receive EN for ≥ 3 days. Once goal rate was achieved, the randomized feeding strategy was implemented. In the VBF group, physicians used a total goal volume of feeds to determine an hourly rate. For the RBF group, physicians determined a constant hourly rate of infusion to meet goal feeds.

RESULTS

Sixty-three patients were enrolled in the study with a mean age of 52.6 years (60% male). Six patients were excluded after randomization because of early extubation. The VBF group (n = 37) received 92.9% of goal caloric requirements with a mean caloric deficit of -776.0 kcal compared with the RBF group (n = 20), which received 80.9% of goal calories (P = .01) and a caloric deficit of -1933.8 kcal (P = .01). Uninterrupted EN was delivered for 51.7% of all EN days in VFB patients compared with 54.5% in RBF patients. On days when feeding was interrupted, VFB patients overall received a mean 77.6% of goal calories (while RBF patients received 61.5% of goal calories, P = .001). No vomiting, regurgitation, or feeding intolerance occurred due to VBF.

CONCLUSIONS

A VBF strategy is safe and improves delivery to better meet caloric requirements than the standard more commonly used rate-based strategy.

NACOB presentation to ASB Young Scientist Award: Postdoctoral. The impact of boundary conditions and mesh size on the accuracy of cancellous bone tissue modulus determination using large-scale finite-element modeling. North American Congress on Biomechanics

The apparent properties of cancellous bone are determined by a combination of both hard tissue properties and microstructural organization. A method is desired to extract the underlying hard tissue properties from simple mechanical tests, free from the complications of microstructure. It has been suggested that microCT voxel-based large-scale finite element models could be employed to accomplish this goal (van Rietbergen et al., 1995, Journal of Biomechanics, 28, 69-81). This approach has recently been implemented and it is becoming increasingly popular as finite element models increase in size and sophistication (Fyhrie et al., 1997, Proceedings of the 43rd Annual Meeting of the Orthopaedic Research Society, San Francisco, CA, p. 815; van Rietbergen et al., 1997, Proceedings of the 43rd Annual Meeting of the Orthopaedic Research Society, San Francisco, CA, p. 62). However, no direct quantitative measurements of the accuracy of this method applied to porous structures such as cancellous bone have been made. This project demonstrates the feasibility of this approach by quantifying its best-case accuracy in determining the trabecular hard tissue modulus of analogues fabricated of a material with known material properties determined independently by direct testing. In addition we were able to assess the impact of mesh size and boundary conditions on accuracy. We found that the assumption of a frictionless boundary condition in the parallel plate compression loading configuration was a significant source of error that could be overcome with the use of rigid end-caps similar to those used by Keaveny et al. (1997 Journal of Orthopaedic Research, 15(1), 101-110). In conclusion, we found that this approach is an effective method for determining the average trabecular hard tissue properties of human cancellous bone with an expected practical accuracy level better than 5%.

Microplastics and microfibers in urban runoff from a suburban catchment of Greater Paris

Microplastics (MPs) and microfibers (MFs) in stormwater have been poorly investigated. Data on their intra and inter rain events variability over time are still sparse. For the first time, the variability of microlitter concentrations in stormwater has been studied. MF and MP concentrations were investigated in stormwater runoff at the outlet of the suburban catchment at Sucy-en-Brie (a suburb of Paris, France), during four rain events. Median MF and MP concentrations were 1.9 and 29 items/L, with an interquartile range of 2.3 and 36 items/L, respectively (N = 18). A different pattern was observed between MFs and MPs. While no relationship or trends were observed for MFs, the highest MP concentrations were observed before the flow rate peak of the rain events. This could indicate a difference in the behaviour between MFs and MPs. We estimated the median MP mass concentration to be 56 μg/L with an interquartile range of 194 μg/L, whereas the mass concentration of macroplastics was estimated to be 31 μg/L with an interquartile range of 22 μg/L at the same sampling site, in a previous study. For this sampling site, MPs and macroplastics have the same order of magnitude. This study may have strong implications on microplastic assessment in urban waters.

Predicting mortality in hospitalized patients with 2009 H1N1 influenza pneumonia

BACKGROUND

Community-acquired pneumonia (CAP) severity scores can identify patients at low risk for mortality who may be suitable for ambulatory care. Here, we follow the clinical course of hospitalized patients with CAP due to 2009 H1N1 influenza.

OBJECTIVE

To evaluate the role of CAP severity scores as predictors of mortality.

METHODS

This was a secondary data analysis of patients hospitalized with CAP due to 2009 H1N1 influenza confirmed by reverse transcriptase polymerase chain reaction enrolled in the CAPO (Community-Acquired Pneumonia Organization) international cohort study. CAP severity scores PSI (Pneumonia Severity Index), CURB-65 (confusion, urea, respiratory rate, blood pressure, age ≥ 65 years) and CRB-65 (confusion, respiratory rate, blood pressure, age ≥ 65 years) were calculated. Actual and predicted mortality rates were compared. A total of 37 predictor variables were evaluated to define those associated with mortality.

RESULTS

Data from 250 patients with CAP due to 2009 H1N1 influenza were analyzed. Patients with low predicted mortality rates (0-1.5%) had actual mortality rates ranging from 2.6% to 17.5%. Obesity and wheezing were the only novel variables associated with mortality.

CONCLUSIONS

The decision to hospitalize a patient with CAP due to 2009 H1N1 influenza should not be based on current CAP severity scores, as they underestimate mortality rates in a significant number of patients. Patients with obesity or wheezing should be considered at an increased risk for mortality.

Towards the determination of an optimal scale for stormwater quality management: micropollutants in a small residential catchment

Stormwater and atmospheric deposits were collected on a small residential urban catchment (0.8 ha) near Paris in order to determine the levels of certain micropollutants (using a preliminary scan of 69 contaminants, followed by a more detailed quantification of PAHs, PCBs, alkylphenols and metals). Atmospheric inputs accounted for only 10%-38% of the stormwater contamination (except for PCBs), thus indicating substantial release within the catchment. On this small upstream catchment however, stormwater contamination is significantly lower than that observed downstream in storm sewers on larger adjacent urban catchments with similar land uses. These results likely stem from cross-contamination activity during transfers inside the sewer system and underscore the advantages of runoff management strategies at the source for controlling stormwater pollutant loads. Moreover, it has been shown that both contamination levels and contaminant speciation evolve with the scale of the catchment, in correlation with a large fraction of dissolved contaminants in upstream runoff, which differs from what has been traditionally assumed for stormwater. Consequently, the choice of treatment device/protocol must be adapted to the management scale as well as to the targeted type of contaminant.

Exfoliation of graphene sheets via high energy wet milling of graphite in 2-ethylhexanol and kerosene

Graphene sheets have been exfoliated from bulk graphite using high energy wet milling in two different solvents that were 2-ethylhexanol and kerosene. The milling process was performed for 60 h using a planetary ball mill. Morphological characteristics were investigated using scanning electron microscope (SEM) and transmission electron microscope (TEM). On the other hand, the structural characterization was performed using X-ray diffraction technique (XRD) and Raman spectrometry. The exfoliated graphene sheets have represented good morphological and structural characteristics with a valuable amount of defects and a good graphitic structure. The graphene sheets exfoliated in the presence of 2-ethylhexanol have represented many layers, large crystal size and low level of defects, while the graphene sheets exfoliated in the presence of kerosene have represented fewer number of layers, smaller crystal size and higher level of defects.

Field performance of two biofiltration systems treating micropollutants from road runoff

The treatment efficiency of a vegetative filter strip and a biofiltration swale treating heavily loaded road runoff are evaluated. Concentrations measured in water drained from the two systems are compared to those in untreated road runoff collected from a reference catchment for a wide range of contaminants including organic carbon, nutrients (N and P), trace metals, and organic micropollutants (polycyclic aromatic hydrocarbons (PAH), total petroleum hydrocarbons (TPH), alkylphenols, bisphenol-A, phthalates), in both total and dissolved phases. Predominantly particulate pollutants, including Pb, Zn and PAH, were very efficiently removed (around 90%) for most events. However, poor particulate removal was observed during a winter period. Relatively few pollutants were significantly removed in the dissolved phase and observed concentration reductions tended to be lower than those of suspended solids and associated pollutants; as such, lower removals were observed for total concentrations of moderately particulate micropollutants, including bisphenol-A, alkylphenols and phthalates. In addition, some pollutants appear to be emitted from various biofilter components (filter media, drainage and lining materials), as low or negative concentration removals were observed during the first months of operation of the biofiltration swale.

Montelukast, a cysteinyl leukotriene receptor-1 antagonist protects against hippocampal injury induced by transient global cerebral ischemia and reperfusion in rats

Cysteinyl leukotrienes (CysLTs) are potent pro-inflammatory and immune modulating lipid mediators involved in inflammatory diseases and were boosted in human brain after acute phase of cerebral ischemia. The antagonism of CysLTs receptors may offer protection against ischemic damage. Therefore it seemed interesting to study the possible neuroprotective effect of Montelukast, a CysLTR1 antagonist in global cerebral ischemia/reperfusion (IR) injury in rats. Global cerebral ischemia-reperfusion was induced by bilateral carotid artery occlusion for 15 min followed by 60 min reperfusion period. Animals were randomly allocated into three groups (n = 30 per group): Sham operated, I/R control and rats treated with montelukast (0.5 mg/kg, po) daily for 7 days then I/R was induced 1 h after the last dose of montelukast. After reperfusion rats were killed by decapitation, brains were removed and both hippocampi separated and the following biochemical parameters were estimated; lactate dehydrogenase activity, oxidative stress markers (lipid peroxides, nitric oxide and reduced glutathione), inflammatory markers (myeloperoxidase, tumor necrosis factor-alpha, nuclear factor kappa-B, interleukin-6 and interleukin-10), apoptotic biomarkers (caspase 3 and cytochrome C), neurotransmitters (glutamate, gamma aminobutyric acid), Cys-LTs contents and CysLT1 receptor expression; as well as total brain infarct size and histopathological examination of the hippocampus were assessed. Montelukast protected hippocampal tissue by reducing oxidative stress, inflammatory and apoptotic markers. Furthermore, it reduced glutamate and lactate dehydrogenase activity as well as infarct size elevated by I/R. These results were consistent with the histopathological findings. Montelukast showed a neuroprotective effects through antioxidant, anti-inflammatory and antiapoptotic mechanisms.

Urinary biomarker N-acetyl-β-D-glucosaminidase can predict severity of renal damage in diabetic nephropathy

Background

Diabetic nephropathy is a clinical diagnosis where proteinuria is present in a patient with diabetes. Early intervention can significantly improve the prognosis. However, imprecision of the currently available biomarkers have impaired effective therapies in a timely manner. Urinary N-acetyl-β-D-glucosaminidase (NAG) is excreted in abnormally high amounts in many renal diseases. The aim of this study was to evaluate urinary NAG as an early biomarker in detection of diabetic nephropathy and whether it parallels the severity of kidney damage in different stages of diabetic nephropathy.

Methods

Fifty patients with type 2 DM were classified into 3 groups (normoalbuminurea, microalbuminurea and macroalbuminurea) and 10 healthy subjects served as a control group. Urinary NAG, albumin and creatinine were measured. Blood urea, serum creatinine, serum albumin, total proteins, serum cholesterol, alanine aminotransferase (ALT), aspartate aminotransferase (AST), fasting and postprandial blood glucose, HbA1c and creatinine clearance were measured for all subjects.

Results

All diabetic patients had a significantly higher level of urinary NAG compared to control. NAG value increased in parallel with the severity of renal involvement.

Conclusion

Urinary NAG expresses the degree of renal impairment in diabetic nephropathy.

Clinical and sonographic patterns of tandem internal carotid artery/middle cerebral artery occlusion in tissue plasminogen activator-treated patients

BACKGROUND AND PURPOSE

The National Institutes of Health Stroke Scale (NIHSS) is predictive of thrombus presence but has limited ability to identify occlusion location in the anterior circulation. We describe clinical and sonographic patterns that are associated with tandem internal carotid artery (ICA) and middle cerebral artery (MCA) occlusions.

METHODS

Consecutive acute ischemic stroke patients receiving intravenous tissue plasminogen activator (TPA) were studied. Pretreatment NIHSS scores and bedside transcranial Doppler (TCD) were obtained for all patients.

RESULTS

A total of 95 patients treated with intravenous TPA at 132+/-60 minutes from stroke onset were studied. On TCD, 48 had isolated MCA occlusion (mean NIHSS 16.8+/-5.8, median 17, range 5 to 28); and 16 had tandem ICA/MCA occlusion (mean NIHSS 18.8+/-5.8, median 22, range 8 to 29; P=NS). In the MCA occlusion and tandem ICA/MCA occlusion groups, 19% and 11%, respectively, had NIHSS scores <12 points. Compared with the NIHSS scores in patients with hemiplegia, forced gaze deviation, and complete neglect, the lower NIHSS scores were attributable to partial arm and/or leg paresis, gaze preference, and partial neglect. In those patients, TCD showed > or =2 major collateral channels and low-resistance flow at the M1 origin, suggesting perfusion of perforating arteries. Although TCD cannot differentiate between high-grade ICA stenosis or occlusion, collateral flow patterns and stenotic signals at the terminal ICA differentiated tandem lesions from isolated MCA occlusion (P<0.01).

CONCLUSIONS

Tandem ICA/MCA occlusion was found on TCD in 17% of TPA-treated patients. NIHSS scores were similar in patients with isolated MCA and tandem occlusions. Lower NIHSS scores were seen in patients with a higher number of major collateral flow channels and higher Thrombolysis in Brain Ischemia (TIBI) flow grades at the MCA origin.

13-14-week fetal anatomy scan: a 5-year prospective study

OBJECTIVES

To assess the potential value of an early (first-trimester) ultrasound examination in depicting fetal anomalies by transabdominal (TAS) and transvaginal (TVS) sonography, to compare it with the traditional mid-trimester anomaly ultrasound examination and to evaluate the degree of patient acceptance of early sonography by the transvaginal route.

METHODS

In this prospective study over a 5-year period (January 2002 to January 2007) 2876 pregnant women underwent a 13-14-week ultrasound examination. The scan was performed by TAS at first and then, if a full fetal anatomical survey was not achieved, by TVS. A mid-trimester fetal anatomy scan was then performed in patients who had not dropped out, miscarried or undergone pregnancy termination (n = 2834).

RESULTS

In the early scan, analyzable data for 2876 TAS and 1357 TVS examinations showed that TVS was significantly better in visualizing the cranium, spine, stomach, kidneys, bladder and upper and lower limbs (P < 0.001). Complete fetal anatomical surveys were achieved by TAS in 64% of cases versus 82% of the cases in which it was attempted by TVS (P < 0.001). Patient body mass index significantly affected the ability of the sonographer to achieve a complete anatomical survey by both TAS and TVS (P < 0.001 and P = 0.004, respectively). The duration of the scan was significantly longer using TVS. The heart and kidneys were not properly visualized in 42% and 27% of cases, respectively, at the 13-week scan compared with 1.6% and 0% at the mid-trimester scan. The total number of cases in which anomalies were detected was 31. At the first-trimester scan, anomalies were detected in 21 fetuses and in 14 of these cases the parents chose pregnancy termination. At the second-trimester scan, anomalies were detected in 17 fetuses: 10 new anomalous cases along with seven cases already detected in the first-trimester scan.

CONCLUSION

Besides its importance in screening for chromosomal abnormalities, the early scan has great potential in visualizing with precision fetal anatomy. TVS can be used to compliment difficult TAS examinations; however, patients do not always agree to undergo TVS. The mid-trimester scan remains crucial for detailed fetal anatomical survey.

Attenuation of the baroreceptor reflex by propofol anesthesia in the rat

The effect of the intravenous (i.v.) short-acting anesthetic propofol on baroreflex control of heart rate (HR) was examined in normotensive rats. Propofol was infused at a fixed rate of 9 mg/kg.h immediately after a bolus dose of 10 mg/kg. Blood pressure (BP) was maintained with a plasma substitute. Conscious rats were used for comparisons. Reflex HR response were recorded after i.v. doses of the pressor agent phenylephrine and the depressor agent sodium nitroprusside. Baroreceptor reflex parameters were determined by sigmoidal computerized curve-fitting. Propofol produced tachycardia at rest and atropine increased HR only moderately. In addition, a limitation in the bradycardiac response to artificial BP increases (lower plateau) was shown. This set of data indicated a vagal depression. The sympathetic component of the baroreflex was equally affected, since the maximal tachycardia resulting from artificial BP decreases (higher plateau) was shifted toward lower values. A marked diminution of the baroreflex gain resulted from the reduced activity of both vagal and sympathetic components. The mechanism for this decrease in the baroreflex-dependent total autonomic effector output (HR range) probably reflects the interaction of propofol with the baroreceptor pathways.

Analysis of genome-wide association studies of Alzheimer disease and of Parkinson disease to determine if these 2 diseases share a common genetic risk

IMPORTANCE

Despite Alzheimer disease (AD) and Parkinson disease (PD) being clinically distinct entities, there is a possibility of a pathological overlap, with some genome-wide association (GWA) studies suggesting that the 2 diseases represent a biological continuum. The application of GWA studies to idiopathic forms of AD and PD have identified a number of loci that contain genetic variants that increase the risk of these disorders.

OBJECTIVE

To assess the genetic overlap between PD and AD by testing for the presence of potentially pleiotropic loci in 2 recent GWA studies of PD and AD.

DESIGN

Combined GWA analysis.

SETTING

Data sets from the United Kingdom, Germany, France, and the United States.

PARTICIPANTS

Thousands of patients with AD or PD and their controls.

MAIN OUTCOMES AND MEASURES

Meta-analysis of GWA studies of AD and PD.

METHODS

To identify evidence for potentially pleiotropic alleles that increased the risk for both PD and AD, we performed a combined PD-AD meta-analysis and compared the results with those obtained in the primary GWA studies.We also tested for a net effect of potentially polygenic alleles that were shared by both disorders by performing a polygenic score analysis. Finally, we also performed a gene-based association analysis that was aimed at detecting genes that harbor multiple disease-causing single-nucleotide polymorphisms, some of which confer a risk of PD and some a risk of AD.

RESULTS

Detailed interrogation of the single-nucleotide polymorphism, polygenic, and gene-based analyses resulted in no significant evidence that supported the presence of loci that increase the risk of both PD and AD.

CONCLUSIONS AND RELEVANCE

Our findings therefore imply that loci that increase the risk of both PD and AD are not widespread and that the pathological overlap could instead be “downstream” of the primary susceptibility genes that increase the risk of each disease.

Enteral nutrition as stress ulcer prophylaxis in critically ill patients: A randomized controlled exploratory study

PURPOSE

We investigated whether early enteral nutrition alone may be sufficient prophylaxis against stress-related gastrointestinal (GI) bleeding in mechanically ventilated patients.

MATERIALS AND METHODS

Prospective, double blind, randomized, placebo-controlled, exploratory study that included mechanically ventilated patients in medical ICUs of two academic hospitals. Intravenous pantoprazole and early enteral nutrition were compared to placebo and early enteral nutrition as stress-ulcer prophylaxis. The incidences of clinically significant and overt GI bleeding were compared in the two groups.

RESULTS

124 patients were enrolled in the study. After exclusion of 22 patients, 102 patients were included in analysis: 55 patients in the treatment group and 47 patients in the placebo group. Two patients (one from each group) showed signs of overt GI bleeding (overall incidence 1.96%), and both patients experienced a drop of >3 points in hematocrit in a 24-hour period indicating a clinically significant GI bleed. There was no statistical significant difference in the incidence of overt or significant GI bleeding between groups (p=0.99).

CONCLUSION

We found no benefit when pantoprazole is added to early enteral nutrition in mechanically ventilated critically ill patients. The routine prescription of acid-suppressive therapy in critically ill patients who tolerate early enteral nutrition warrants further evaluation.