Preclinical Study of DCD and Normothermic Perfusion for Visceral Transplantation

Considering recent clinical and experimental evidence, expectations for using DCD-derived intestines have increased considerably. However, more knowledge about DCD procedure and long-term results after intestinal transplantation (ITx) is needed. We aimed to describe in detail a DCD procedure for ITx using normothermic regional perfusion (NRP) in a preclinical model. Small bowel was obtained from pigs donors after 1 h of NRP and transplanted to the recipients. Graft Intestinal samples were obtained during the procedure and after transplantation. Ischemia-reperfusion injury (Park-Chiu score), graft rejection and transplanted intestines absorptive function were evaluated. Seven of 8 DCD procedures with NRP and ITx were successful (87.5%), with a good graft reperfusion and an excellent recovery of the recipient. The architecture of grafts was well conserved during NRP. After an initial damage of Park-chiu score of 4, all grafts recovered from ischemia-reperfusion, with no or very subtle alterations 2 days after ITx. Most recipients (71.5%) did not show signs of rejection. Only two cases demonstrated histologic signs of mild rejection 7 days after ITx. Interestingly intestinal grafts showed good absorptive capacity. The study's results support the viability of intestinal grafts from DCD using NRP, contributing more evidence for the use of DCD for ITx.

Effect of the donor´s age and type of extender (egg yolk versus clarified egg yolk) over the sperm quality of Majorera bucks preserved at 4 ºC: in vitro results and fertility trials

This study assessed the effect of donor´s age and two different extenders in the sperm quality of chilled semen in Majorera bucks. In experiment 1, semen was individually processed from 5 young (10–12 months old) and 4 mature (3–5 years old) bucks and then was diluted in two different extenders: EY (Tris‐glucose, 12% egg yolk) and CEY (Tris‐glucose, 12% clarified egg yolk) and cooled at 4°C; semen quality (sperm motility, percentages of alive spermatozoa, acrosome status and abnormal spermatozoa) was evaluated at 24, 48, 72 and 96 hr after cooling. In experiment II, 72 Majorera goats were assigned to four experimental groups: for groups 24‐EY (n = 18) and 24‐CEY (n = 18), goats were inseminated with EY and CEY cooled semen for 24 hr, respectively, while for groups 72‐EY (n = 18) and 72‐CEY (n = 18), goats were inseminated with EY and CEY cooled semen for 72 hr, respectively. In vitro results confirmed that only ejaculate volume and sperm concentration were significantly different between young and mature bucks. In addition, semen quality was similar between both diluents, presenting values for the first 48 hr similar to that recorded in fresh samples. The fertility rate was around 70% after 24 hr (4°C) in both groups, but the kidding rate was significantly lower (44.4%, p < .05) in goats inseminated with EY diluent preserved for 72 hr. Our results showed that the semen samples may be stored at 4°C in media with egg yolk or clarified egg yolk, and, therefore, the use of clarified egg yolk may represent a valid alternative to chill semen samples. Finally, young bucks (older than 10–12 months) of Majorera breed could be successfully used in breeding programmes with similar efficacy to older males.

RAD51 foci as a functional biomarker of homologous recombination repair and PARP inhibitor resistance in germline BRCA-mutated breast cancer

Background

BRCA1 and BRCA2 (BRCA1/2)-deficient tumors display impaired homologous recombination repair (HRR) and enhanced sensitivity to DNA damaging agents or to poly(ADP-ribose) polymerase (PARP) inhibitors (PARPi). Their efficacy in germline BRCA1/2 (gBRCA1/2)-mutated metastatic breast cancers has been recently confirmed in clinical trials. Numerous mechanisms of PARPi resistance have been described, whose clinical relevance in gBRCA-mutated breast cancer is unknown. This highlights the need to identify functional biomarkers to better predict PARPi sensitivity.

Patients and methods

We investigated the in vivo mechanisms of PARPi resistance in gBRCA1 patient-derived tumor xenografts (PDXs) exhibiting differential response to PARPi. Analysis included exome sequencing and immunostaining of DNA damage response proteins to functionally evaluate HRR. Findings were validated in a retrospective sample set from gBRCA1/2-cancer patients treated with PARPi.

Results

RAD51 nuclear foci, a surrogate marker of HRR functionality, were the only common feature in PDX and patient samples with primary or acquired PARPi resistance. Consistently, low RAD51 was associated with objective response to PARPi. Evaluation of the RAD51 biomarker in untreated tumors was feasible due to endogenous DNA damage. In PARPi-resistant gBRCA1 PDXs, genetic analysis found no in-frame secondary mutations, but BRCA1 hypomorphic proteins in 60% of the models, TP53BP1-loss in 20% and RAD51-amplification in one sample, none mutually exclusive. Conversely, one of three PARPi-resistant gBRCA2 tumors displayed BRCA2 restoration by exome sequencing. In PDXs, PARPi resistance could be reverted upon combination of a PARPi with an ataxia-telangiectasia mutated (ATM) inhibitor.

Conclusion

Detection of RAD51 foci in gBRCA tumors correlates with PARPi resistance regardless of the underlying mechanism restoring HRR function. This is a promising biomarker to be used in the clinic to better select patients for PARPi therapy. Our study also supports the clinical development of PARPi combinations such as those with ATM inhibitors.

Failure of Bacillus Calmette-Guérin therapy in non-muscle-invasive bladder cancer: Definition and treatment options

Adjuvant intravesical bacillus Calmette- Guérin (BCG) therapy is the standard conservative adjuvant treatment and the most effective regimen for patients with high-risk non-muscle-invasive bladder cancer (NMIBC). The term "BCG failure" is generally used to refer to recurrence or progression following BCG therapy, as experienced by many patients. However, the term has been defined inconsistently, and several studies have indicated that patients with a particular pattern of BCG failure have a worse prognosis. There are many different treatment options for patients who experience BCG failure.

OBJECTIVE

To summarize the different current definitions of BCG failure and the present treatment options available for patients with high-risk NMIBC who experience BCG failure.

EVIDENCE SYNTHESIS

Overall, the failure rate in response to BCG is about 40-50%. Most guidelines recommend that patients failing BCG should be offered radical cystectomy (RC). The significant potential for progression specific to high-risk NMIBC leads some clinicians to argue that immediate RC should be considered the preferred first-line treatment in high-risk patients, bearing in mind that it achieves a long-term survival rate in excess of 90% with ongoing improvements in morbidity. While other salvage intravesical treatments have to be considered oncologically inferior to RC, several therapies are now available if the patient is unfit to undergo RC or if bladder preservation is the objective, and some agents have shown promise in the context of BCG failure.

CONCLUSIONS

The definition, prediction, and treatment of BCG failure remain topics of debate. Patients with BCG failure need carefully selected, individualized therapy in experienced hands. Stratification of patients with BCG failure into groups can identify those with a better or worse prognosis. RC should be the selected option if a patient experiences BCG failure, but several promising intravesical salvage options are available for those cases in which the patient is unfit for surgery or bladder preservation is preferred. Currently data are still inadequate to allow formulation of definitive recommendations, and larger and higher quality studies of salvage intravesical therapies are urgently required.

Fibroblast Growth Factor 21 (FGF-21) in Peritoneal Dialysis Patients: Natural History and Metabolic Implications

Background

Human fibroblast growth factor 21 (FGF-21) is an endocrine liver hormone that stimulates adipocyte glucose uptake independently of insulin, suppresses hepatic glucose production and is involved in the regulation of body fat. Peritoneal dialysis (PD) patients suffer potential interference with FGF-21 status with as yet unknown repercussions.

Objectives

The aim of this study was to define the natural history of FGF-21 in PD patients, to analyze its relationship with glucose homeostasis parameters and to study the influence of residual renal function and peritoneal functional parameters on FGF-21 levels and their variation over time.

Methods

We studied 48 patients with uremia undergoing PD. Plasma samples were routinely obtained from each patient at baseline and at 1, 2 and 3 years after starting PD therapy.

Results

Plasma FGF-21 levels substantially increased over the first year and were maintained at high levels during the remainder of the study period (253 pg/ml (59; 685) at baseline; 582 pg/ml (60.5–949) at first year and 647 pg/ml (120.5–1116.6) at third year) (p<0.01). We found a positive correlation between time on dialysis and FGF-21 levels (p<0.001), and also, those patients with residual renal function (RRF) had significantly lower levels of FGF-21 than those without RRF (ρ -0.484, p<0.05). Lastly, there was also a significant association between FGF-21 levels and peritoneal protein losses (PPL), independent of the time on dialysis (ρ 0.410, p<0.05).

Conclusion

Our study shows that FGF-21 plasma levels in incident PD patients significantly increase during the first 3 years. This increment is dependent on or is associated with RRF and PPL (higher levels in patients with lower RRF and higher PPL). FGF-21 might be an important endocrine agent in PD patients and could act as hormonal signaling to maintain glucose homeostasis and prevent potential insulin resistance. These preliminary results suggest that FGF-21 might play a protective role as against the development of insulin resistance over time in patients undergoing a continuous glucose load.

Synthesis and photophysical and supramolecular study of π-conjugated (diethylene glycol methyl ether) benzoateethynylene oligomers and polymers

The strong π–π interaction that governs (diethylene glycol methyl ether) benzoateethynylene macromolecules was evidenced by X-ray scattering and HRTEM.

Second transurethral resection and prognosis of high-grade non-muscle invasive bladder cancer in patients not receiving bacillus Calmette-Guérin

OBJECTIVE

To define the natural history of T1G3 bladder tumor not receiving intravesical Bacillus Calmette-Guerin (BCG) and assess the diagnostic and therapeutic value of a second transurethral resection (Re-TUR) in these patients.

PATIENTS AND METHODS

Retrospective study on the natural history of 210 patients treated at two institutions for T1G3 bladder carcinoma without associated CIS. In no case was BCG administered; 79 (37.6%) received TUR alone, and 131 (62.4%) Re-TUR 4 to 6 weeks later; 23 (12.4%) underwent cystectomy for tumor progression.

RESULTS

Median follow-up was 55 (78 IQR) months, male/female ratio 8/1, and mean age 70.6+11.8 (range 37-93). 19.5% were free of recurrence at 10 years, and 61.9% free of progression. Independent prognostic factors for progression were solid pattern (HR: 2.71; P=.0004), multiplicity (HR: 2.26; P=.003), and recurrence at 3 months (HR: 3.4; P=.003). Cancer-specific survival was 81.5% at 5 and 69% at 10 years. Independent predictors of survival were: progression during the first year (HR: 17.9; P<.0001), solid pattern (HR: 2.13; P=.02), multiplicity (HR: 2.05; P=.03), and age>65 years (HR: 2.9; P=.03). Re-TUR avoided under-staging (7.4%), detected T1G3 residual disease (10.7%), reduced recurrence rate at 3 months (11.4 to 4.6%; P=.06), and rate of progression on the 1st year (13.9 to 3.8%; P=.0075). However, in these patients the risk remains and no differences were detected in the long term in terms of recurrence (log-rank, P=.14), progression (P=.91), or cancer death (P=.21) in patients treated with Re-TUR.

CONCLUSION

The recurrence in the first 3 months of a T1G3 tumor not receiving BCG is the main risk factor for progression, and progression of this type of tumors within the first year is the main factor of cancer death. The Re-TUR improves both variables but it does not change the long-term prognosis.

Follow-up of loci from the International Genomics of Alzheimer's Disease Project identifies TRIP4 as a novel susceptibility gene

To follow-up loci discovered by the International Genomics of Alzheimer's Disease Project, we attempted independent replication of 19 single nucleotide polymorphisms (SNPs) in a large Spanish sample (Fundació ACE data set; 1808 patients and 2564 controls). Our results corroborate association with four SNPs located in the genes INPP5D, MEF2C, ZCWPW1 and FERMT2, respectively. Of these, ZCWPW1 was the only SNP to withstand correction for multiple testing (P=0.000655). Furthermore, we identify TRIP4 (rs74615166) as a novel genome-wide significant locus for Alzheimer's disease risk (odds ratio=1.31; confidence interval 95% (1.19-1.44); P=9.74 × 10(-)(9)).

Preparation and characterization of activated carbon from the char produced in the thermolysis of granulated scrap tyres

The char produced in the thermolysis of granulated scrap tyres has few market outlets, reducing the economic viability of the thermolytic process. This paper reports the potential of this char as a low-cost precursor of porous carbons. The tyre-derived char was demineralized in either alkaline or acidic media to reduce its ash, zinc, sulfur, and silica contents. The lowest impurity content was achieved with an HNO3/H2O treatment. The resulting demineralized char was then subjected to activation by KOH or CO2. The Brunauer-Emmett-Teller (BET)-specific surface area of the activated carbon produced by the KOH treatment was 242 m2/g, whereas that of the CO2-activated carbon was 720 m2/g. The textural properties of the latter product were similar to those of some commercial activated carbons. The use of tyre-derived char as a precursor of porous carbons could render the thermolytic treatment of scrap tyres more economically attractive.

IMPLICATIONS

Char produced in thermolysis of granulated scrap tyres has a few market outlets; in this paper an alternative for its use is presented. The char was converted into activated carbon with textural properties similar to those of some commercial activated carbons. This process could render the thermolytic treatment of scrap tyres more economically attractive.

Use of linezolid in critically ill patients admitted to intensive care units

All indications of linezolid (LZD) in Intensive Care Units (ICU) were included as cases in an observational, prospective and multicentre study. One hundred thirty-nine indications were analyzed. In most cases (92.7%), treatment for nosocomial infections was indicated. The most frequent infection was pneumonia (42.7%), followed by catheter-related bacteraemias (CRB). A total of 58.7% of the indications were empirical and in 45.7% of the cases the cultures confirmed infection by gram-positive cocci (GPC). In 43 cases (31.2%), the indication was made as a rescue measure (mainly due to clinical failure) in patients previously treated with glycopeptides. Of isolated GPC, 70.2% were methicillin-resistant. The cure rate of the population per intent-to-treat was 73.2%. Only one case of thrombocytopenia was recorded. Conclusions. LZD is used with a high degree of diagnostic safety. In the ICU, it is primarily indicated to treat pneumonias and CRB with good clinical and microbiological response. This antibiotic has acted as a good therapeutic resource against clinical failure in infections treated with glycopeptides.

[Practical guideline for the management of adverse events associated with BCG installations]

OBJECTIVES

Morbidity secondary to intravesical Bacillus Calmette-Guèrin (BCG) may present both locally and systemically. Most patients suffer a self-limited irritative voiding syndrome. Often, there are not unified criteria for the management of BCG side effects. After treating more than 500 patients with BCG we developed a practical guideline for the management of its morbidity. We present clearly and schematically the practice guideline we follow in our Center when the patient presents symptoms and morbidity secondary to BCG intravesical installations.

METHODS

We analyze and describe, following the literature and our own experience, the management of adverse events experienced by patients treated with intravesical BCG, since the initial implementation of the protocol for its indication in patients with high risk non-muscle invasive bladder tumors and/or CIS.

RESULTS

Irritative voiding symptoms are among the most frequent symptoms, generally self-limited; but if they persist (> 48 hours) will have the urologist treat them depending on intensity and duration. Macroscopic hematuria is not unfrequent and diminishes with an expectant approach and water intake. But, it may also be a urinary tract infection or residual tumor. A febrile syndrome, if present, is usually self-limited to the first 24-48 hours and below 38.5 degrees C without general status affectation. In cases of persistence and/or sepsis, tuberculostatic treatment and/or corticoids should be started. Other clinical pictures may appear, such as orchyoepididymitis, arthritis, etc.

CONCLUSIONS

Proper diagnosis and treatment of adverse events after BCG therapy are basic to allow intravesical immunotherapy be properly prescribed and managed by urologists, enabling a proper treatment of patients and avoiding the possibility of more severe complications.

Inactivation of Cryptosporidium parvum oocysts in water using ultrasonic treatment

Ultrasound in a liquid phase cause mass and heat transfer across the liquid through cavitational processes which act as nanoreactors to generate unstable mechanical equilibrium. The effect of 1 MHz ultrasound on the inactivation of Cryptosporidium parvum was investigated. Continuous irradiation of ultrasound (20 min) increased temperature due to cavitational phenomena. Ultrasound irradiation of liquid containing C. parvum showed significant quantitative changes in pH, temperature and inactivation of C. parvum (102.7 oocysts killed/s) with a minimum energy consumption (0.05 oocysts/s).

[Cervical adenopathy presentation of adenocarcinoma of prostate]

The metastases of prostate cancer shows the regional lymphatic dissemination, being the cervical lymphatic metastases to infrequent and little reported in Literature. In the present work we contributed a new observation of this organization. We displayed a clinical case with lateral mass cervical left, abdominal pain and diarrheic. When making biopsy of cervical adenopathy reported adenocarcinoma prostate metastases. Colonoscopy with biopsy was made whose results were carcinoma little differentiated infiltrated necrotic center to rectum. The complementary studies demonstrated bilateral aortic adenopathys without injuries in thorax. Within the diagnosis differential of the cervical adenopathys in neck in adult men it must consider the prostate carcinoma, because in an early diagnosis and adapting treatment it can prolong the survive.

Cutaneous metastases in renal cell carcinoma

Cutaneous metastases from a renal cell carcinoma are rarely diagnosed during life. We report a case of renal carcinoma metastatic to the skin that occurred 18 months after kidney removal. The cutaneous metastasis was excised. Cutaneous metastases from urological tumors are uncommon and occur in 1% of the patients, and their clinical appearance may mimic other common dermatological disorders affecting patients with advanced malignancies.

How effective is pre-release nematode control in farm-reared red-legged partridges Alectoris rufa?

Game bird farming is associated with high parasite levels that reduce farm productivity, reduce survival after releasing, and may pose a health risk for natural populations. The efficacy of albendazole (orally, 20 mg kg− 1) was evaluated in farmed red-legged partridges naturally infected with the nematodes Aonchotheca caudinflata and Heterakis gallinarum. In treated birds body condition improved, nematode egg deposition was reduced and the proportion of gravid A. caudinflata females was reduced, but not the overall worm burdens. Albendazole was found to be 36.8% and 17.1% effective against A. caudinflata and H. gallinarum, respectively. These results indicate that the anthelmintic treatment used normally in Spanish partridge farms is not effective enough to avoid the introduction of parasites into the field after release.

Changes in parasite transmission stage excretion after pheasant release

The production of parasite transmission stages was investigated in the faeces of 77 farm-bred ring-necked pheasants (Phasianus colchicus). Coccidian oocysts (Eimeria sp.), and nematode eggs (Heterakis sp., and Capillaria-like eggs) were recovered before and after release but all birds were treated prior to release. Treatment with fenbendazole significantly reduced the abundance of transmission-stage excretion for all parasites, and reduced the prevalence in the case of Eimeria sp. and Heterakis sp. Nonetheless, a significant increase in the excretion abundance for all parasites and in the prevalence of Eimeria sp. and Heterakis sp. was found after release. Eggs of Ascaridia sp. were found only after releasing, suggesting infection ocurred in the wild. A negative relationship was found between the pheasant body condition and Heterakis excretion abundance and a higher abundance of Capillaria sp. eggs in female birds. No significant relationship was found between parasite excretion abundance and pheasant survival. Despite this, results suggest that an increase in the excretion of parasite transmission stages follows the release of captive pheasants into the wild. This can in part explain restocking failures, but also means that autochtonous free-living birds may become exposed to new and potentially harmful pathogens. To avoid these risks it is proposed that improved prophylactic measures should be taken.

[Prevalence of metallo-beta-lactamase in carbapenem resistant Pseudomonas aeruginosa at a university hospital of Buenos Aires City]

The present study was conducted to estimate the prevalence of metallo-beta-lactamases in 91 consecutive carbapenem resistant Pseudomonas aeruginosa isolates, recovered from inpatients at Hospital de Clínicas in Buenos Aires. Both, phenotypic and genotypic methods detected the presence of carbapenemases in 10 (11%) isolates, corresponding to VIM-11 in 7/10 and VIM-2 in the others. Codifying genes were all included in class 1 integrons, upstream genes coding for aminoglycoside modifying enzymes. One hundred percent sensitivity and specificity was achieved by the metallo-beta-lactamases phenotypic screening method using EDTA (1 micromol) disks in the Pseudomonas aeruginosa isolates included in this study. Sensitivity to aztreonam in carbapenem resistant isolates was suspicious of the presence of these enzymes.

A novel mutation (K317M) in the MAPT gene causes FTDP and motor neuron disease

BACKGROUND

Frontotemporal dementia with parkinsonism is often linked to chromosome 17 and is related to mutations in the MAPT gene. In some families the genetic basis is still unknown. The authors report two pedigrees with FTDP-17 harboring a novel mutation (K317M) in exon 11 in the MAPT gene.

METHODS

The authors identified two apparently unrelated pedigrees with an autosomal dominant neurodegenerative condition. Thirteen patients were examined and eight autopsies were performed.

RESULTS

Mean age at onset was 48 years. Mean disease duration was 6 years. Dysarthria often heralded the disease. All cases had parkinsonism and pyramidalism and half of them had amyotrophy. Behavioral or personality changes were not a prominent feature. Cognitive decline appeared late in the evolution. Neuropathologically, a massive degeneration of the substantia nigra without Lewy bodies was a constant finding. A variable degree of frontotemporal atrophy was found. Corticospinal tract degeneration and anterior horn neuron loss were present in six of seven autopsies in which the spinal cord was examined. An extensive deposition of abnormal tau protein in a mixed pattern (neuronal, glial) was observed. Pick's bodies were not seen. Biochemical analysis of tau revealed two bands of 64 and 68 kDa.

CONCLUSION

Genetic analysis revealed the same novel mutation (K317M) in exon 11 of the MAPT gene in both pedigrees. A common haplotype between members of the two pedigrees suggests that they belong to the same family.

[Bilateral subthalamic nucleus deep-brain stimulation (STN-DBS) in Parkinson's disease: initial experience in Cruces Hospital]

INTRODUCTION

Clinical outcomes of Parkinson's disease patients treated for 12 months with STN-DBS were analyzed. PATIENTS ADN METHODS: Twelve patients were selected using the CAPSIT protocol criteria and placement of electrodes in the appropriate target was performed according to results of fusion image techniques and intraoperative microrecording.

RESULTS

A reduction in motor UPDRS (44 %) and activities of daily living (58 %) scores during <<off>> phases were observed. <<On>> time with dyskinesias was reduced (86 %), while severe dyskinesias disappeared. Levodopa dosage was also lowered (44 %). Patients and caregivers showed a clear-cut benefit on quality of life (58 % and 61 % respectively). No cognitive deterioration was observed and morbidity was in the same range as that published by other teams.

CONCLUSION

Bilateral STN-DBS is an effective symptomatic therapy for complicated Parkinsońs disease patients. It improves the quality of life of patients and their caregivers and allows a reduction of levodopa dosage.

[Twiddler's syndrome in a patient with implantable cardioverter defibrillator: an avoidable complication?]

The Twiddler's syndrome is an uncommon, but potentially life-threatening complication in patients with an implantable cardioverter-defibrillator. Early identification of repetitive vicious attitudes and a periodic radiological follow-up in predisposed patients, may be useful in the primary prevention of this syndrome.

Maxillary undifferentiated carcinoma with rhabdoid features

The rhabdoid malignant tumor was individualized by Haas et al. as an independent entity within the kidney malignant neoplasms in 1981. From its histopathological characteristics, different cases of rhabdoid extra-renal tumor were documented. This aspect has been also recognized in a wide heterogeneous group of tumors (carcinoma, melanoma, mesothelioma and mesenchymal tumors). The diagnosis of extrarenal rhabdoid tumor is based on the presence of a proliferation of epithelioid cells with large nuclei, prominent nucleoli, abundant eosinophilic cytoplasm, and conspicuous cytoplasmic intermediate filaments, which compress the nuclei. In this article we present the case of a 50-year-old male patient with a malignant maxillary tumor with characteristic rhabdoid features. Its differential diagnosis will be discussed. The literature will also be reviewed.

[Diagnostic clinical trial in children using an allergenic extract of Blomia tropicalis]

BACKGROUND

Blomia tropicalis is a mite that is one of the most important causes of allergic sensitization in studies of tropical and subtropical regions. Nonetheless, there are no published studies of the sensitivity and specificity of B. tropicalis extracts.

METHOD

An open, non-randomized study was carried out in 205 asthmatic children and in 205 non-asthmatic children, both groups with an age range of 1 to 14 years. Duplicate skin prick tests were made using allergen extracts standardized by biological units and positive and negative controls. The test was considered positive when the average diameter of the wheal was > or = 3 mm and negative when it was < 3 mm. The validity of the test was estimated by calculating sensitivity, specificity, and the positive and negative predictive values.

RESULTS

The skin prick test was positive in 82.92% of the asthmatic children and in 10.7% of the non-asthmatic children, yielding a sensitivity of 82.9%, 95% CI 76.9; 87.7 and a specificity of 89.3%, 95% IC 84.0; 93.0. The positive predictive value was 88.5%, 95% IC 83.0; 92.5 and the negative predictive value was 83.9%, 95% IC 78.2; 88.4.

CONCLUSIONS

Blomia tropicalis is an important cause of bronchial asthma among the children of the northern Camagüey region.

[Circulating Haemophilus influenzae in Cuba. Characterization of strains isolated from meningitis]

Haemophilus influenzae B(Hib) is often associated with serious systemic infections in children under 5 years of age. Since 1993, it is the most frequent agent isolated in meningoencephalitis. All the strains isolated in the country have been characterized in the National Reference Laboratory at the "Pedro Kourí" Tropical Medicine Institute. Results revealed that 97% of strains isolated from bacterial meningoencephalitis in Cuba during the period 1993-1995 corresponded to serotype B, 0.6% to serotype A and 2.4 not belong to any serotype. The classification of serotype B-strains into biotypes proved that 76% was biotype I and 21% biotype II, 8 to biotype III and 1.2% was biotype V. This study found the following resistance to ampicillin 40%, to chloranphenicol 43.3%, sulpha metoxazol 36%, trimetroprim 37.3% and tetracycline 31%.

[The determination of antibodies to the human immunodeficiency virus type 1 (HIV-1) in samples of dried blood on filter paper]

The possibility of detecting HIV-1 antibodies by an immunoblotting kit is studied in a panel of 125 known specimens of dried blood spotted on filter paper and their corresponding serum samples. No differences were observed in the patterns of bands with both types of samples or in the sensitivity and specificity, where 100% figures were attained, allowing to conclude that the blood specimen taken on filter paper may be used for the detection of HIV-1 antibodies by the DAVIH-BLOT system and may be kept at 4 degrees C during 30 weeks.

Technetium-99m-labeled anti-EGF-receptor antibody in patients with tumor of epithelial origin: I. Biodistribution and dosimetry for radioimmunotherapy

Accurate estimation of biodistribution and absorbed dose to normal organs and tumors is important for immunoscintigraphic studies and radioimmunotherapy treatment planning.

METHODS

Four patients (3 men, 1 woman; mean age 54.8 +/- 9.2 yr; range 42-64 yr) were administered 3 mg of anti-human epidermal growth factor receptor (anti-hEGF-r) antibody (ior egf/r3), radiolabeled with 99mTc activity of 39.5 +/- 1.1 mCi (range 38.5 mCi-40.7 mCi) by intravenous bolus infusion. After administration, blood and urine samples were collected from three patients up to 24 hr after injection. Whole-body anterior and posterior scans were obtained at 5 min and 1, 3, 5 and 24 hr after injection. Using a computer program, regions of interest were drawn over the heart, liver, spleen, bladder and tumor to measure the activity in the source organs at each scanning time. Time-activity curves for each source organ were then fitted to monoexponential or biexponential functions by nonlinear least squares regression using the flexible polyhedrals method, which adequately fit our data with the correlation coefficient of 0.985 +/- 0.013, and were integrated to determine organ residence times. The mean absorbed doses to the whole body and various normal organs were then estimated from residence times and from blood and urine samples using the methods developed by the Medical Internal Radiation Dose Committee. The effective dose equivalent and effective dose were calculated as prescribed in ICRP Publication Nos. 30 and 60.

RESULTS

Plasma disappearance curves of 99mTc-labeled anti-hEGF-r antibody were best-fit by a two-compartment model in all patients with a distribution half-life (t(1/2alpha)) of 0.207 hr +/- 0.059 hr (mean +/- s.d., n = 3) and an elimination half-life (t(1/2beta)) of 13.9 hr +/- 2.2 hr. Among the various organs, significant accumulation of the radiolabeled antibody was found in the liver (48.5% +/- 4.4%, mean +/- s.d.), heart (3.50% +/- 0.17%) and spleen (3.1% +/- 1.8%) at 5 min postadministration. These values were reduced to 3.2% +/- 0.4%, 0.1% +/- 0.01% and 0.1% +/- 0.1%, respectively, at 24 hr. Mean cumulative urinary excretion of 99mTc-labeled anti-hEGF-r antibody was 4.6% +/- 0.6% at 24 hr postinjection. Estimates of radiation absorbed dose to normal organs in rad/mCi administered (mean +/- s.d., n = 4) were: whole body 0.017 +/- 0.002; gallbladder wall 0.074 +/- 0.007; spleen 0.136 +/- 0.076; and liver 0.267 +/- 0.036. The effective dose equivalent and effective dose estimates for adults were 0.041 +/- 0.008 rem/mCi and 0.027 +/- 0.004 rem/mCi administered.

CONCLUSION

This feasibility study indicates that 99mTc-labeled anti-hEGF-r antibody (ior egf/r3) can be used safely; this analysis provides a dosimetric framework for future studies. This monoclonal antibody, labeled with 188Re, could possibly permit a successful regional radioimmunotherapy of tumors of epithelial origin.

Postoperative follow-up of pituitary adenomas after trans-sphenoidal resection: MRI and clinical correlation

Our purpose was to correlate the morphological changes seen on MRI studies of the sellar region after trans-sphenoidal resection of pituitary adenomas with clinical and hormonal studies. Between January 1993 and March 1994, 16 patients with a pituitary adenoma (9 macroadenomas and 7 microadenomas) were subjected to trans-sphenoidal resection and included in a prospective study. The protocol consisted of MRI, hormonal and visual studies at the following times: immediately postoperative (1st week), 1st month, 4th month and 1st year after surgery. The evolution of the contents of the sella turcica (tumour remnant, packing material and gland tissue), effects on the infundibulum, optic chiasm, cavernous sinus and sphenoid sinus were correlated with the clinical and hormonal studies. Stabilisation of the postsurgical changes occurred by the 4th month. Tumour remnants were noted in the immediate postoperative period in macroadenomas. Compression of the infundibulum was the only reliable indicator of possible involvement. Optic chiasm compression, defined as close contact between the chiasm and the tumour, was the only morphological finding that indicated visual impairment. There was no standard repneumatisation pattern in the sphenoid sinus, since mucosal changes resembling sinusitis were one of the postsurgical changes. We found MRI not to be useful for follow-up of microadenomas.

[Complications associated with nonfunctioning pacemaker electrodes retained within the cardiovascular system]

INTRODUCTION AND OBJECTIVE

The aim of the present study was to evaluate the complications in patients with functionless pacing leads retained in the cardiovascular system.

PATIENTS AND METHODS

We retrospectively studied 39 patients: 31 underwent surgery for electrical or mechanical failure (group I) and eight for cutaneous pocket infection (group II). The follow-up was 45 +/- 34 months.

RESULTS

Only one patient (3%) from group I presented infectious complications probably related to the retained pacing lead. Seven patients (87%) in group II presented recurrence of the infection with persistent fever and/or septicemia due to skin erosion and unnoticed pacing lead infection (p < 0.0005). Removal of the infected generator was performed in 8/39 (21%) of the patients. Thoracotomy to explant the infected retained leads was required in five of them (62%). No patient presented lead migration or venous thrombosis during the follow-up.

CONCLUSIONS

Retained pacing leads in the cardiovascular system are well tolerated. However, in spite of adequate antibiotic treatment, patients with local and pacemaker system infection may present recurrence of the infection with persistent fever and/or septicemia. Early surgical pacemaker system removal is recommended in these patients due to the high morbidity.

Comparative assessment of the leprosy antibody absorption test, Mycobacterium leprae extract enzyme-linked immunosorbent assay, and gelatin particle agglutination test for serodiagnosis of lepromatous leprosy

A comparative assessment of three serological methods for leprosy diagnosis (the fluorescent leprosy antibody absorption [FLA-ABS] test, the Mycobacterium leprae soluble-extract enzyme-linked immunosorbent assay [ELISA], and the M. leprae particle agglutination [MLPA] test) was carried out. The objective was to identify their performance in clinical and epidemiological diagnosis of leprosy. The study group included 45 lepromatous leprosy patients under treatment. Specificity was > 95% for all three assays, and sensitivity was 95, 58, and 74% for the FLA-ABS test, the MLPA test, and the ELISA, respectively. The only cross-reactivity for M. tuberculosis-infected patients was with the soluble-extract ELISA. Although the FLA-ABS test displayed the highest specificity and sensitivity values, it can only be used in well-developed laboratories, and the patient's clinical and epidemiological background must be considered when results are interpreted because the test remains positive after therapeutic success and could be positive for some household contacts. The MLPA test is easier to perform and interpret, and it is adequate for small laboratories and epidemiological studies intended to detect active untreated or irregularly treated leprosy cases. Therefore, the FLA-ABS and MLPA tests are complementary, and both should be used for serodiagnosis of leprosy.

Dietary fiber analysis of cassava using gravimetric methods

We report the application of a method which combines digestion with pancreatin and neutral detergent treatment in the analytical study of dietary fiber from cassava. The use of pancreatin previous to the detergent extraction enabled rapid filtration, thus giving more reproducible results for neutral detergent fiber (NDF). Acid detergent fiber (ADF), hemicellulose, lignin and pectin were also determined. The values obtained for NDF (4.65%) and pectin (1.17%) are very important, considering their role in the digestive process.

Translational pauses during a spider fibroin synthesis

The large ampullate glands of Nephila clavipes synthesize a tissue-specific fibroin for the web and dragline. Its secretory product migrates as one homogeneous band of approximately 320,000 daltons in denaturing electrophoresis. Similar analyses of the secretory epithelium reveal, in addition to the final product, a step ladder array of peptides in a highly reproducible and consistent pattern. We have correlated these peptide ladders with the process of fibroin synthesis. First, the peptides are very prominent in stimulated glands and quite dim in non stimulated ones. Secondly, by offering the cultured glands different amino acids in the incubating medium, we have linked the presence of the bands with those amino acids which abound in the fibroin. The evidence correlates the peptides with active fibroin synthesis, thus they are products of translation, and possibly reflect discontinuities in the translational process such as those demonstrated during the synthesis of Bombyx fibroin.