Prospective Evaluation of the Efficacy of Isolated Balloon Eustachian Tuboplasty: Short- and Medium-term Follow-up Results Based on Tubomanometry, ETDQ-7, Tympanometry, and Valsalva Maneuver

Introduction  Balloon eustachian tuboplasty (BET) allows the treatment of the main etiology of eustachian tube disfunction (ETD). Objective  To evaluate the efficacy of isolated BET, through objective and subjective results, in the short and medium term, in patients with chronic obstructive ETD. Methods  Adult patients diagnosed with chronic obstructive ETD who underwent BET between January 2018 and December 2020 were enrolled in the study. We performed a prospective observational study of BET efficacy, by comparing subjective data, based on the Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7), and objective data, obtained by tympanometry, objective Valsalva maneuver and tubomanometry, prior to BET with these outcome tools on postprocedure follow-up. Results  In total, 30 BETs were performed and analyzed. There were no complications with the procedure. Analysis of BET efficacy was performed in the short-term (average of 7.5 weeks) and in the medium-term (average of 8 months). There was a significant reduction ( p  < 0.0001) in the total ETDQ-7 score from baseline to both follow-up periods. A normalization of the ETDQ-7 score was observed in 60 and 83.3% of the performed procedures, in the short- and medium-term, respectively. In tubomanometry, we verified a significant improvement ( p  < 0.0001) at all pressures, with a normalization of tubomanometry values in 53.3% and 43.3% of cases in the short- and medium-term, respectively. Tympanogram normalization occurred in 71.4% of patients with abnormal preoperative assessments. Conclusion  As an isolated procedure, BET results in significant improvements in symptomatology and objective metric results. This, associated with its safety profile, currently makes BET the most indicated therapeutic option in refractory obstructive ETD.

Functional and patient-reported outcomes of bone-anchored hearing aids (BAHA): A prospective case series study

Objective

The purpose of this study was to evaluate the functional and patient-reported outcomes, and their correlation, after percutaneous bone-anchored hearing aid (BAHA) implantation.

Methods

A prospective study was conducted between January 2018 and December 2020 in a tertiary care center. All adult patients who were implanted with a percutaneous BAHA device during this evaluation period were included in the study. Complete auditory function and patients reported outcome measures (PROMs) were assessed in the preoperative period and 6 months after the implant activation. The PROMs included a generic form (Medical Outcome Study 36 Short Form Healthy Survey (MOS SF-36)), and three disease-specific forms (Hearing Handicap Inventory (HHI), Satisfaction with Amplification in Daily Life Scale (SADLS), and Tinnitus Handicap Inventory (THI)).

Results

Twenty-two patients with an average age of 53 years were included in the study. The overall functional gain with the BAHA in sound-field pure tone average (PTA) was 29 dB, with no statistically significant differences according to surgical indication (F(3,18) = 2.319, p = 0.110). The greater the preoperative air-bone gap, the greater the functional gain obtained (r = 0.505, p < 0.05). In the PROMs, we found a significant improvement in HHI scores (p < 0.005) and a significant increase in overall SADLS scores (p < 0.05) with the use of percutaneous BAHA devices. We did not verify any statistically significant correlation between functional and PROMs results.

Conclusions

The BAHA is a safe and effective alternative hearing rehabilitation option in selected patients. The PROMs results prove patient's overall satisfaction.

Central vein sign: A diagnostic biomarker in multiple sclerosis (CAVS-MS) study protocol for a prospective multicenter trial

The specificity and implementation of current MRI-based diagnostic criteria for multiple sclerosis (MS) are imperfect. Approximately 1 in 5 of individuals diagnosed with MS are eventually determined not to have the disease, with overreliance on MRI findings a major cause of MS misdiagnosis. The central vein sign (CVS), a proposed MRI biomarker for MS lesions, has been extensively studied in numerous cross sectional studies and may increase diagnostic specificity for MS. CVS has desirable analytical, measurement, and scalability properties. "Central Vein Sign: A Diagnostic Biomarker in Multiple Sclerosis (CAVS-MS)" is an NIH-supported, 2-year, prospective, international, multicenter study conducted by the North American Imaging in MS Cooperative (NAIMS) to evaluate CVS as a diagnostic biomarker for immediate translation into clinical care. Study objectives include determining the concordance of CVS and McDonald Criteria to diagnose MS, the sensitivity of CVS to detect MS in those with typical presentations, and the specificity of CVS among those with atypical presentations. The study will recruit a total of 400 participants (200 with typical and 200 with atypical presentations) across 11 sites. T2*-weighted, high-isotropic-resolution, segmented echo-planar MRI will be acquired at baseline and 24 months on 3-tesla scanners, and FLAIR* images (combination of FLAIR and T2*) will be generated for evaluating CVS. Data will be processed on a cloud-based platform that contains clinical and CVS rating modules. Imaging quality control will be conducted by automated methods and neuroradiologist review. CVS will be determined by Select6* and Select3* lesion methods following published criteria at each site and by central readers, including neurologists and neuroradiologists. Automated CVS detection and algorithms for incorporation of CVS into McDonald Criteria will be tested. Diagnosis will be adjudicated by three neurologists who served on the 2017 International Panel on the Diagnosis of MS. The CAVS-MS study aims to definitively establish CVS as a diagnostic biomarker that can be applied broadly to individuals presenting for evaluation of the diagnosis of MS.

Toxicity of boron and vanadium nanoparticles on Danio rerio embryos - Phenotypical, biochemical, and behavioral alterations

Engineered nanoparticles (NPs) are emerging contaminants of concern and it is important to understand their environmental behavior and ecological risks to exposed organisms. Despite their ubiquitous presence in the environment, there is little information about the hazards of certain NPs, such as boron (BNPs) and vanadium (VNPs). The aim of the present research was to investigate the effects of commercial BNPs and VNPs (80 to 100 nm) to zebrafish embryos, at different levels of biological organization. A range of nominal concentrations for both NPs (0, 0.01, 0.1, 1, and 10 mg/L) was tested. Due to the presence of triton X-100 in the NPs' stock dispersions, an additional control group was included (0.001% triton X-100). Survival, hatching, and malformations of embryos were assessed for 96 hours (h) exposure. Locomotor behavior was evaluated at 120 h. Furthermore, embryos were exposed to 0, 1, and 10 mg/L of NPs to evaluate a set of biomarker responses after 96 h: cholinesterase (ChE) and glutathione S-transferase (GST) activities, total glutathione (TG) and energy budgets levels. VNPs induced malformations (10 mg/L), hyperactivity (10 mg/L), erratic swimming (0.01 mg/L), altered swimming pattern (>0.01 mg/L), delayed hatching (10 mg/L) and altered biochemical responses involved in antioxidant defense (GST and TG at >1 mg/L), neurotransmission (ChE at 10 mg/L) and energy metabolism (lipids at >1 mg/L and carbohydrates at 10 mg/L). BNPs caused malformations (10 mg/L), affected swimming pattern (>0.01 mg/L), induced erratic swimming (10 mg/L) and decreased TG content and GST activity (>1 mg/L). At the same concentrations, VNPs affected a greater number of endpoints than BNPs, demonstrating a greater toxicity to zebrafish embryos. The present study shows that BNPs and VNPs may affect aquatic organisms, albeit at relatively great non-environmentally relevant concentrations, reinforcing the importance of the risk assessment of different NPs.

[Vestibular Disorders in the Pediatric Age: Retrospective Analysis and Review of the Literature]

INTRODUCTION

Vestibular disorders in pediatric patients is still a controversial subject but has gained relevance over the years. In recent studies, its prevalence varied between 0.7% and 15%. Nevertheless, the true prevalence can be underestimated given that its clinical presentation is expressed compared to adults; it can present as rotatory vertigo, but It can also cause vision complaints, headaches, motor delay, and learning disability. Although middle ear effusion is considered the main cause of vestibular dysfunction in this age group, other diagnoses should be considered. The aim of this study was to describe clinical features of the pediatric population referred to a subspecialist Otorhinolaryngology vertigo clinic in a tertiary hospital between 2013 and 2017. We also aimed to compare the results and carry out a literature about the most common causes, diagnostic features and treatment approach.

MATERIAL AND METHODS

Clinical records of patients referred to a subspecialist Otorhinolaryngology vertigo clinic with suspicion of vestibular dysfunction aged between 0 and 18 years old were reviewed. Patients with middle ear effusion were excluded.

RESULTS

Thirty-seven patients met the inclusion criteria. From these, 59% were female, with a mean age of 10.9 years old during the first consultation. The most common reason for referral was rotatory vertigo. Nausea and headache were also frequent complaints in our population. All patients performed audiometry; videonistagmography was performed in 41% of the cases; imaging studies were done in 59% of patients. The most common causes of vestibular dysfunction were vestibular migraine and benign paroxysmal vertigo of childhood (both in 27% of the cases), followed by vestibular neuritis (in 22% of the cases).

DISCUSSION

Although our findings partially concur with the literature, compared with other specialist centers, the range of reasons for referral and of conditions is not as diverse, which may suggest that there is underdiagnosis of vestibular dysfunction in this age group.

CONCLUSION

Vestibular dysfunction in the pediatric age can have several causes; pediatricians, neurologists, physiatrists, family doctors and otorhinolaryngologists must be aware of the different forms of presentation. Referral and evaluation protocols addressing pediatric patients should be created.

Nasal septum deviation and Eustachian tube function: A prospective case-control study based on tympanometry, tubomanometry, and ETDQ-7

INTRODUCTION

The influence of isolated nasal septum deviation (NSD) in the Eustachian Tube (ET) function is still undetermined.

OBJECTIVE

compare ET function between patients with severe NSD and patients with adequate nasal patency in terms of symptomology and objective exams and assess the impact of septoplasty in ET function in patients with severe NSD. METHODS AND METHODOLOGY: a prospective study was conducted. In the first phase of the study, two opportunistic samples were selected: 35 patients with severe NSD for group A and 35 patients with adequate nasal patency for group B. Both groups were evaluated through Nasal obstruction Subjective Questionnaire (NOSE) and ET dysfunction questionnaire 7 (ETDQ7) -, and through two objective exams to assess ET function - tympanometry, and tubomanometry (TMM); results were compared between group A and B. In the second phase of the study, the patients from group A underwent septoplasty and were re-evaluated through ETDQ7, tympanometry and TMM; results were compared before and after surgery.

RESULTS

we found a statistically significant difference between patients with NSD and patients with adequate nasal patency in NOSE and ETDQ7 (higher scores in the latter), and TMM (worse results in patients with NSD); the difference in tympanometry was not statistically significant. The side of the NSD did not correlate with the side of the dysfunction. After septoplasty, patients from group A had statistically significant lower scores in ETDQ7 and a lower proportion of patients with findings compatible with ET dysfunction using TMM.

CONCLUSION

according to our results, severe NSD alone is a cause of ET dysfunction; septal surgery might improve ET function in these patients.

Is pediatric cholesteatoma more aggressive in children than in adults? A comparative study using the EAONO/JOS classification

INTRODUCTION

chronic otitis media with cholesteatoma (COMC) is a serious condition that may cause severe complications. According to the literature, in pediatric patients this entity can have a more aggressive behavior, leading to higher rates of morbidity. Consensus regarding the definition of aggressive and extensive cholesteatoma was lacking until recently. European Academy of Otology and Neurotology/Japan Otologic Society (EAONO/JOS) proposed a classification and staging system which was highly accepted by a group of otology experts.

OBJECTIVE

to compare cholesteatoma characteristics between pediatric and adult patients using the EAONO/JOS stating system.

MATERIAL AND METHODS

a retrospective analysis of the patients who underwent surgery for cholesteatoma treatment in a tertiary hospital was performed using EAONO/JOS classification. Congenital cholesteatoma, revision surgery, and follow-up losses were excluded. The patients were further divided into two cohorts: a pediatric group (<16 years old) and an adult group (>16 years old). The results were compared between them.

RESULTS

134 patients fulfilled the inclusion criteria, 27 were pediatric, and 107 adult patients. We found a significant difference in supratubal recess, with higher rates of extension to this location in the pediatric group. Also in the pediatric cohort, COMC was accompanied by malleus erosion in a higher frequency, with a significant difference from adults; it also presented in higher stages of the disease according to EAONO/JOS classification. We found no differences in hearing gain post-operatively. Moreover, we found that age younger than 16 years was an independent risk factor for relapse with time.

DISCUSSION AND CONCLUSIONS

according to our data, cholesteatoma in pediatric age has a more aggressive and extensive nature than in adults, and age younger than 16-years-old is an independent risk factor for relapse.

Giant Post-Traumatic Frontoethmoid Osteoma: Diagnostic, Therapeutic and Reconstructive Approach

Paranasal sinus osteomas are rare, slow-growing and benign lesions with potentially serious complications. They usually remain asymptomatic but when osteomas grow they can lead to local complications and cause evident aesthetic deformity due to the direct mass effect and in these situations, surgery is required. This is a report of a 30-year-old man with a rare giant post-traumatic osteoma that occupies the right nasal fossa, ethmoidal cells and frontal sinuses with extension into the right orbit.

MACVIA-LR (Fighting Chronic Diseases for Active and Healthy Ageing in Languedoc-Roussillon): A Success Story of the European Innovation Partnership on Active and Healthy Ageing

The Région Languedoc Roussillon is the umbrella organisation for an interconnected and integrated project on active and healthy ageing (AHA). It covers the 3 pillars of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA): (A) Prevention and health promotion, (B) Care and cure, (C) and (D) Active and independent living of elderly people. All sub-activities (poly-pharmacy, falls prevention initiative, prevention of frailty, chronic respiratory diseases, chronic diseases with multimorbidities, chronic infectious diseases, active and independent living and disability) have been included in MACVIA-LR which has a strong political commitment and involves all stakeholders (public, private, patients, policy makers) including CARSAT-LR and the Eurobiomed cluster. It is a Reference Site of the EIP on AHA. The framework of MACVIA-LR has the vision that the prevention and management of chronic diseases is essential for the promotion of AHA and for the reduction of handicap. The main objectives of MACVIA-LR are: (i) to develop innovative solutions for a network of Living labs in order to reduce avoidable hospitalisations and loss of autonomy while improving quality of life, (ii) to disseminate the innovation. The three years of MACVIA-LR activities are reported in this paper.

Life cycle inference and phylogeny of Ortholinea labracis n. sp. (Myxosporea: Ortholineidae), a parasite of the European seabass Dicentrarchus labrax (Teleostei: Moronidae), in a Portuguese fish farm

Ortholinea labracis n. sp. is described and its life cycle is inferred from a Southern Portuguese fish farm, with basis on microscopic and molecular procedures. This myxosporean parasite infects the urinary bladder of the European seabass Dicentrarchus labrax and the intestinal epithelium of a marine oligochaete of the genus Tectidrilus. Myxospores subspherical in valvular view and ellipsoidal in sutural view measuring 7.6 ± 0.3 (6.8-8.7) μm in length, 7.2 ± 0.2 (6.7-7.7) μm in width and 6.5 ± 0.4 (5.8-7.7) μm in thickness. Two polar capsules, 3.0 ± 0.2 (2.6-3.4) μm long and 2.4 ± 0.1 (2.0-2.9) μm wide, located at the same level, but with divergent orientation and opening to opposite sides of the suture line. Sequencing of the SSU rRNA gene revealed a similarity of 100% between the analysed myxospores and triactinomyxon actinospores. The phylogenetic setting of O. labracis n. sp. shows subgrouping in correlation with tissue tropism, but identifies this parasite as another exception to the main division of Myxosporea into the main freshwater and marine lineages.

Prevalence of bovine milk pathogens in Azorean pastures: mobile versus fixed milking machines

The aims of the present study were (1) to evaluate the influence of using mobile (n=47) or fixed (n=45) milking machines in Azorean herds on the apparent prevalence of several milk pathogens in bulk tank milk (BTM) and (2) to determine whether separated subclinical mastitic cows can serve, in real time, as predictors of milk pathogen prevalence for the remaining animals at the herd level. The use of a mobile or fixed milking machine influenced (P≤0.05) the prevalence of Staphylococcus aureus (72.3 per cent; n=34 v 51.1 per cent; n=23, respectively) and Klebsiella species (46.8 per cent; n=22 v 26.7 per cent; n=12, respectively). S aureus (95 per cent CI OR 1.1 to 6.0) and Klebsiella species (95 per cent CI OR 1.0 to 5.8) were 2.5 times more likely to increase in the BTM of herds using mobile milking machines. The prevalence of coagulase-negative staphylococci (100 per cent; n=92), Escherichia coli (75.0 per cent), Corynebacterium bovis (57.6 per cent), Enterococcus species (55.4 per cent), Streptococcus dysgalactiae (51.1 per cent), Streptococcus uberis (41.3 per cent), Actinomyces pyogenes or Peptostreptococcus indolicus (41.3 per cent) and Streptococcus agalactiae (32.6 per cent) in BTM remained similar among the herds. κ coefficients were always <0.70, indicating intra-herd disagreement of the prevalence of milk pathogens between BTM and separated milking cows. Milking hygiene should be improved in pastures, focusing specifically on herds that use a mobile milking machine. The segregated cows at milking time are not good predictors of milk pathogens in BTM.

Early syphilis treatment in HIV-infected patients: single dose vs. three doses of benzathine penicillin G

BACKGROUND

Current treatment guidelines for early stages of syphilis are the same regardless of HIV serostatus. There is still controversy about the best treatment for syphilis in HIV patients and the current recommendations are based on limited data.

OBJECTIVE

The primary goal of this study was to compare the serological response rates to a single dose vs. three weekly doses of benzathine penicillin G (BPG) in HIV-infected patients with early syphilis and to assess the adequacy of current recommendations.

METHODS

Clinical and laboratory data of HIV patients with early syphilis treated in Sexually Transmitted Disease Clinic between January 2000 and December 2014 were recorded. A good serological response was defined as a ≥4-fold decline in Venereal Disease Research Laboratory (VDRL) titre within 12 months after treatment. Serological failure was defined as a lack of at least fourfold decrease in VDRL titres within 12 months after treatment.

RESULTS

After applying inclusion and exclusion criteria, 60 patients were enrolled in the study. Seventeen (28.3%) patients were treated with a single dose of BPG, while in 43 (71.7%) patients, three weekly doses were used. Fifty eight (96.7%) had a good serological response at 12 months and seroconversion was confirmed in 29 (48.3%) patients. There was no statistically significant difference between the two treatment groups regarding serological response, seroconversion rate and the time needed to obtain a good serological response. Furthermore, treatment response was not affected by the number of CD₄ cells.

CONCLUSIONS

The results of our study support the current international treatment guidelines, recommending early syphilis treatment with a single dose of BPG in HIV patients.

Observation of a New Narrow Axial-Vector Meson a1(1420)

The COMPASS Collaboration at CERN has measured diffractive dissociation of 190  GeV/c pions into the π(-)π(-)π(+) final state using a stationary hydrogen target. A partial-wave analysis (PWA) was performed in bins of 3π mass and four-momentum transfer using the isobar model and the so far largest PWA model consisting of 88 waves. A narrow peak is observed in the f0(980)π channel with spin, parity and C-parity quantum numbers J(PC)=1(++). We present a resonance-model study of a subset of the spin-density matrix selecting 3π states with J(PC)=2(++) and 4(++) decaying into ρ(770)π and with J(PC)=1(++) decaying into f0(980)π. We identify a new a1 meson with mass (1414(-13)(+15))  MeV/c2 and width (153(-23)(+8))  MeV/c2. Within the final states investigated in our analysis, we observe the new a1(1420) decaying only into f0(980)π, suggesting its exotic nature.

Ultrastructure and phylogeny of the parasite Henneguya carolina sp. nov. (Myxozoa), from the marine fish Trachinotus carolinus in Brazil

Microscopic and molecular procedures are used to describe a new myxosporean species, Henneguya carolina sp. nov., found infecting the intestine of the marine teleost fish Trachinotus carolinus on the southern Atlantic coast of Brazil. Spherical to ellipsoid cysts, measuring up to ~750 µm, display synchronous development. Mature myxospores are ellipsoidal with a bifurcated caudal process. Myxospore body length, width, and thickness are 12.7 ± 0.8 (12.0-13.4) µm, 8.8 ± 0.6 (7.5-9.6) µm, and 5.8 ± 0.4 (5.0-6.4) µm, respectively; 2 equal caudal processes are 16.8 ± 1.1 (15.9-18.0) µm long, and the total myxospore length is 29.4 ± 0.8 (28.4-30.4) µm. Two pyriform polar capsules measure 5.0 ± 0.5 (4.6-5.6) × 2.4 ± 0.4 (1.9-2.9) µm, and each contains a polar filament forming 3 to 4 coils. Sporoplasm is binucleated and presents a spherical vacuole surrounded by numerous globular sporoplasmosomes. Molecular analysis of the small subunit rRNA gene by maximum parsimony, neighbor joining, and maximum likelihood reveals the parasite clustering together with other myxobolids that are histozoic in marine fish of the order Perciformes, thereby strengthening the contention that the host phylogenetic relationships and aquatic environment are the strongest evolutionary signal for myxosporeans of the family Myxobolidae.

Comparison of fertility, regular returns-to-estrus, and calving interval between Ovsynch and CO-synch + CIDR protocols in dairy cows

The main aims of the present study were to compare the pregnancy rate (PR), regular returns-to-estrus, and calving interval of a CO-Synch + controlled internal drug release (CIDR) device, commonly used to synchronize ovulations in beef cows, with the classical Ovsynch protocol in high-producing dairy cows. Holstein-Friesian cows (n = 128) from six commercial dairy herds, ≥40 days postpartum and not previously inseminated, were randomly assigned to one of two treatments. Cows submitted to Ovsynch protocol (group OS as control group; n = 66) received 10 μg of a GnRH analogue 7 days before and 48 hours after 25 mg PGF2α, followed by artificial insemination (AI) 16 hours after the second GnRH administration. Cows submitted to CO-Synch + CIDR (1.38 g of progesterone) inserted for 7 days beginning at the first GnRH administration (group CoS + CD; n = 62) had the second administration of GnRH concurrent with AI, 64 hours after CIDR removal/PGF2α administration. Nonpregnant cows with return-to-estrus between 18 and 24 days after first AI were reinseminated (second AI). Logistic regressions were used to analyze PR and returns-to-estrus. No effect of group or herd was observed in PR at first timed AI. However, the sum of cows pregnant at first AI and nonpregnant cows with regular returns-to-estrus and the total PR (first + second AI) were influenced by group treatment. Overall, cows of group CoS + CD (total PR = 56.5%) were 2.1 times more likely to became pregnant after AI and until first regular returns-to-estrus than cows of group OS. The calving interval was lower in group CoS + CD (425.9 ± 78.8 days; ±SD) than in group OS (475.3 ± 83.7 days). The CO-Synch + CIDR protocol was reliable to use in dairy herds and provided reproductive advantages when compared with Ovsynch protocol.

Morphologic, cytometric and functional characterization of the common octopus (Octopus vulgaris) hemocytes

The hemocytes of Octopus vulgaris were morphologically and functionally characterized. Light and electron microscopy (TEM and SEM), and flow cytometry analyses revealed the existence of two hemocyte populations. Large granulocytes showed U-shaped nucleus, a mean of 11.6 μm±1.2 in diameter with basophilic granules, polysaccharide and lysosomic deposits in the cytoplasm. Small granulocytes measured a mean of 8.1 μm±0.7 in diameter, and have a round nucleus occupying almost the entire cell and few or not granules in the cytoplasm. Flow cytometry analysis showed that large granulocytes are the principal cells that develop phagocytosis of latex beads (rising up to 56%) and ROS after zymosan stimulation. Zymosan induced the highest production of both ROS and NO. This study is the first tread towards understanding the O. vulgaris immune system by applying new tools to provide a most comprehensive morpho-functional study of their hemocytes.

Practice and documentation of palliative sedation: a quality improvement initiative

BACKGROUND

Palliative sedation (ps), the continuous use of sedating doses of medication to intentionally reduce consciousness and relieve refractory symptoms at end of life, is ethically acceptable if administered according to standards of best practice. Procedural guidelines outlining the appropriate use of ps and the need for rigorous documentation have been developed. As a quality improvement strategy, we audited the practice and documentation of ps on our palliative care unit (pcu).

METHODS

A pharmacy database search of admissions in 2008 identified, for a subsequent chart review, patients who had received either a continuous infusion of midazolam (≥10 mg/24 h), regular parenteral dosing of methotrimeprazine (≥75 mg daily), or regular phenobarbital. Documentation of the decision-making process, consent, and medication use was collected using a data extraction form based on current international ps standards.

RESULTS

Interpretation and comparison of data were difficult because of an apparent lack of a consistent operational definition of ps. Patient records had no specific documentation in relation to ps initiation, to clearly identified refractory symptoms, and to informed consent in 60 (64.5%), 43 (46.2%), and 38 (40.9%) charts respectively. Variation in the medications used was marked: 54 patients (58%) were started on a single agent and 39 (42%), on multiple agents. The 40 patients (43%) started on midazolam alone received a mean daily dose of 21.4 mg (standard deviation: 24.6 mg).

CONCLUSIONS

The lack of documentation and standardized practice of ps on our pcu has resulted in a quality improvement program to address those gaps. They also highlight the importance of conducting research and developing clinical guidelines in this area.

Ultrastructure of novel thrombocytes in the dog snapper Lutjanus jocu

Myxosporean cysts containing spores of Henneguya sp. were observed in the gills of the dog snapper Lutjanus jocu. Adjacent to the cysts were capillaries, allowing observation of peripheral blood cells. Numerous white blood cells displaying uncommon cytoplasmic projections were observed amongst the erythrocytes. Their morphology allowed them to be identified as thrombocytes (TCs). Each TC displayed 18-26 cytoplasmic projections, most of which were in close proximity to erythrocytes. At their apical end, each cytoplasmic projection presented an ellipsoidal vacuole (c. 0·6 µm × 0·3 µm) from which a secretory tubule, 0·3-0·4 µm long and c. 120 nm in total diameter, extended towards the periphery of the TC plasmalemma and fused with the cellular membrane. From this opening, contents of vacuoles were apparently released into the lumen of the capillaries. Other vacuoles with similar features, and containing an electron-lucent matrix, were observed in the cytoplasm of the TC. This is the first description of fish TC with these ultrastructural features and organization, which suggest that they perform a secretory function.

O protocolo hormonal ovsynch e suas modificações em vacas leiteiras de alta produção: uma revisão

A eficiência reprodutiva em vacas leiteiras de alta produção representa atualmente um dos maiores desafios para a viabilidade das explorações. O presente trabalho teve como objetivo reportar as modificações dos protocolos de indução ovulatória baseados na administração programada de prostaglandina F2α (PGF 2α) entre duas aplicações de hormona libertadora de gonadotrofina (GnRH ), seguida da inseminação artificial em tempo fixo (IATF ). Tendo por base o protocolo hormonal Ovsynch, novos protocolos foram desenvolvidos tentando aumentar a sua eficiência reprodutiva, seguindo diferentes estratégias: (1) manipulação dos padrões de desenvolvimento folicular antes da GnRH -1, (2) otimização do ambiente hormonal peri-ovulatório, (3) otimização do intervalo de tempo entre a PGF 2α e a GnRH -2 e o momento da IA após a GnRH -2, (4) suplementação com progesterona antes da IATF , (5) redução do período de dominância folicular e aumento do proestro, e (6) controlo do crescimento folicular após a IATF . As modificações do protocolo Ovsynch permitiram a manutenção da taxa fertilidade à 1ª inseminação, até aproximadamente 40 %, quando comparada com inseminações realizadas após deteção do cio natural, com a consequente melhoria da gestão reprodutiva das manadas. As pesquisas futuras deste tipo de protocolos de indução ovulatória deverão dar enfase a aspetos nutricionais e de produção leiteira das vacas assim como ao stresse térmico em países de zonas mediterrânicas, subtropicais e tropicais.

Seleção genômica ampla para curvas de crescimento

Foi proposta uma metodologia para avaliação genética de curvas de crescimento considerando-se informações de marcadores SNPs (Single Nucleotide Polymorphisms). Em um primeiro passo foram ajustados modelos de crescimento não lineares (logístico) aos dados de peso-idade de cada animal, e em um segundo passo as estimativas dos parâmetros de tais modelos foram consideradas como fenótipos em um modelo de regressão (LASSO Bayesiano - BL) cujas covariáveis foram os genótipos dos marcadores SNPs. Este enfoque possibilitou estimar os valores genéticos genômicos (GBV) para peso em qualquer tempo da trajetória de crescimento, refletindo na confecção de curvas de crescimento genômicas, as quais permitiram a identificação de grupos de indivíduos geneticamente superiores em relação à eficiência de crescimento. Os dados simulados utilizados neste estudo foram constituídos de 2000 indivíduos (1000 na população de treinamento e 1000 na população de validação) contendo 453 marcadores SNPs distribuídos sobre cinco cromossomos. Os resultados indicaram a alta eficiência do método BL em predizer GBVs da população de validação com base na população de treinamento (coeficientes de correlação variaram entre 0,79 e 0,93), bem como a alta eficiência na detecção de QTLs, uma vez que os marcadores com maiores efeitos estimados encontravam-se em posições dos cromossomos próximas àquelas nas quais se encontravam os verdadeiros QTLs postulados na simulação.

Morphological and molecular characterization of a new myxozoan species (Myxosporea) infecting the gall bladder of Raja clavata (Chondrichthyes), from the Portuguese Atlantic Coast

Microscopic and molecular procedures are used to describe a new myxosporean species, Chloromyxum clavatum n. sp., infecting the cartilaginous fish Raja clavata Linnaeus, 1758 (Chondrichthyes: Rajidae), collected from the northwest Atlantic coast of Portugal. Young plasmodia and mature spores were found floating free in the gall bladder of R. clavata . Spores were spherical to subspherical with a pointed anterior end, measuring14.4 ± 0.5 μm (n = 25) in length, 11.9 ± 0.5 μm (n = 25) in width, and 9.4 ± 0.5 μm (n = 15) in thickness. The spore's wall was composed of 2 equally sized valves, each displaying 6-8 elevated surface ridges and a bundle of several tapering caudal filaments attached to the basal portion. Spores contained 4 pyriform equally sized polar capsules (5.5 ± 0.4 μm × 2.9 ± 0.5 μm) (n = 25), each possessing an obliquely arranged isofilar polar filament coiled in 7-8 coils. Morphological data, host specificity, tissue tropism, and molecular analysis of the SSU rDNA gene identify this parasite as a new species of Chloromyxum. Neighbor-joining and maximum likelihood further reveal the parasite clustering with other species of Chloromyxum infecting the gall bladder of marine cartilaginous fish to form a clade positioned at the base of the freshwater clade, therefore constituting an exception to the major division of the class Myxosporea into the freshwater and marine clades, while supporting the existence of a correlation between tissue tropism and myxosporean phylogeny.

Exercise training increases interleukin-10 after an acute myocardial infarction: a randomised clinical trial

The present study assessed the effects of exercise training on biomarkers of inflammation in postinfarction patients. This single-centre prospective randomized controlled trial encompassed 42 patients after the first myocardial infarction divided into exercise-training (n=22) or usual care (n=20) groups. Complete randomization was performed by choosing one of 2 sealed envelopes. The exercise-training group participated in an 8-week programme comprising 3 aerobic exercise sessions per week. The control group received usual care. The main measures were changes in circulating levels of C-reactive protein, interleukin (IL)-6 and -10, soluble vascular cell adhesion molecule-1 (VCAM-1), soluble intercellular adhesion molecule-1 (ICAM-1), anthropometrics, dietary intake, daily physical activity, and cardiorespiratory fitness. 4 patients terminated the study prematurely, leaving 38 for the statistical analysis (exercise-training, n=20; control group, n=18). In comparison to control group, exercise-training group improved IL-10 levels [1.7(7.0) vs.  - 0.3(2.4) pg/mL, P<0.05], daily moderate-intensity physical activity (12.9±21.3 vs.  - 0.7±13.4 min, P<0.05), and cardiorespiratory fitness (3.0±3.5 vs. 0.3±4.1 ml/min/kg, P<0.05). Additionally, the change in VCAM-1 and ICAM-1 levels was significantly higher in the control group (respectively, 26.6±112.1 vs. 94.1±90.0 ng/mL and 7.3±41.0 vs. 35.0±39 ng/mL, P<0.05). In conclusion, exercise training improved the inflammatory profile in post myocardial infarction patients by enhancing the anti-inflammatory cytokine IL-10.

Henneguya amazonica n.sp. (Myxozoa, Myxobolidae), parasitizing the gills of Crenicichla lepidota Heckel, 1840 (Teleostei, Cichlidae) from Amazon river

The authors present light and electron microscopical data on a myxosporidian found in the gills of Crenicichla lepidota Heckel, 1840 (Teleostei, Cichlidae) from the Amazon river. Based on the spore morphology, it is concluded that this species belongs to the family Myxobolidae, genus Henneguya, and that it constitutes a new species: Henneguya amazonica n.sp. The fine structure of sporogenesis shows that the development follows, in general, the pattern of this and other genera. Nevertheless, some ultrastructural features are reported for the first time in the genus Henneguya: intercellular bridges between daughter generative cells as well as tubuli arranged in aggregates and dispersed within the capsular matrix. The structure of the trophozoite wall suggests that the species is not highly pathogenic, but, to ascertain the true pathogenicity of the species, further studies are needed.

Ultrastructural and molecular characterization of a new microsporidium parasite from the Amazonian fish, Gymnorhamphichthys rondoni (Rhamphichthyidae)

A new species of a microsporidium found in the freshwater teleost Gymnorhamphichthys rondoni, collected on the lower Amazon River, is described based on light, ultrastructural, and phylogenetic studies. This parasite develops in the skeletal muscle of the abdominal cavity, forming whitish cyst-like structures containing numerous spores. Mature spores, lightly pyriform to ellipsoidal with rounded ends and measuring 4.25 ± 0.38 × 2.37 ± 0.42 µm (n  =  30), were observed. The spore wall, which measured about 102 nm, was composed of 2 layers with approximately the same thickness. The isofilar polar filament was coiled, with 9-10 (rarely 8) turns. The posterior vacuole appeared as a pale area, occupying about 1/3 of the spore length, and contained a spherical posterosome composed of granular material that was denser at the periphery. The myofibrils located near the spores appeared to be in advanced degradation. Molecular analysis of the rRNA genes, including the ITS region, and phylogenetic analyses using maximum parsimony, maximum likelihood, and Baysesian inference were performed. The ultrastructural characteristics of the spores and the phylogenetic data strongly suggested that it is a new species related to Kabatana, Microgemma, Potaspora, Spraguea, and Tetramicra. We named this new microsporidian from Amazonian fauna as Kabatana rondoni n. sp.

Role of Brazilian native medicinal plants on VEGF and PDGF receptors expression by glioblastoma cell line GL-15

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Background: Malignant gliomas are typically angiogenic and express greater amounts of angiogenic factors. Vascular endothelial growth factor (VEGF) and platelet derived growth factor (PDGF) are prominent glioblastoma-associated multifunctional cytokines that stimulate migration, invasion and angiogenesis. Their receptor inhibiton is considered an important target for anitumoral therapy. Flavonoids obtained from Dimorphandra mollis and Croton betulaster, native medicinal plants from Bahia-Brazil, have been described as proliferation inhibitors of a human glioblastoma derived cell line and reduce VEGF production by GL-15. In this study, VEGF and PDGF receptors expression by GL-15 cultures treated with bevacizumab and flavonoids were evaluated. Methods: GL-15 cultures were treated or not with pendulitin and rutin flavonoids (100μM) and bevacizumab (1μg/mL). After 24 hours VEGF and PDGF receptors were analyzed by flow cytometry using monoclonal antibodies labeled with FITC. Results: Flow cytometry showed that the GL-15 cells expressed PDGFR alfa (10%), PDGFR beta (52%), VEGFR 1 (26%) and VEGFR 2 (95%). It was observed that the pendulitin and rutin flavonoids treated cells showed a reduction on PDGFR alfa expression (2 and 1,6 % respectively) but the other receptors expression was similar to the non-treated or DMSO treated controls. Conclusions: GL-15 human glioblastoma derived cell line expresses receptors to the angiogenic cytokines studied. VEGFR 2 expression was predominant and bevacizumab didn’t alter the receptors production. Flavonoids extracted from D. mollis and C. betulaster seem to have an inhibitory action on the PDGRF alfa expression but not on the others receptors.

No significant financial relationships to disclose.

Ultrastructural aspects of hepatic coccidiosis caused by Goussia lusca n. sp. (Apicomplexa: Coccidia) infecting Trisopterus luscus (Gadidae) from the NE Atlantic Ocean

Goussia lusca n. sp. is described from the liver of pouting Trisopterus luscus from the NE Atlantic Ocean in Ibero-Atlantic Portuguese and Spanish waters. Mature oocysts were 31.7 (28.8 to 35.4) microm in diameter. Each oocyst contained 4 ellipsoidal sporocysts arranged in an aleatory position, and measuring approximately 13.7 x 9.2 microm. Each sporocyst contained 2 sporozoites. Ultrastructurally, the sporocyst wall consisted of a dense inner layer 115 nm thick, transversely striated, regularly intercalated by thin grooves with electron-lucent spaces, and separated from the outer layer by a thin, light (electron-lucent) space. The outer layer was multilamellated and consisted of parallel dense bands alternating with light spaces. These lamellae formed filamentous extensions of the wall. The dehiscence suture, a characteristic feature of the genus, was present in the sporocysts. No external clinical signs were observed in the host fish. Parasites observed in the liver tissue were often enveloped in a yellowish-brown matrix, generally known as 'yellow bodies'. Sometimes sporocysts were observed in direct contact with the liver cells. Parasites in degeneration and aggregations of amylopectin granules were frequently observed surrounded by host inflammatory cells. In severe infections, we observed large agglomerations of oocysts encapsulated by layers of concentrically arranged connective tissue forming large granulomas, which caused significant replacement of the host liver parenchyma by the parasite.

Unidentified extracellular prokaryotes within the byssal threads of the deep-sea vent musselBathymodiolus azoricus

Bacterial symbiosis and/or parasitism is widespread in hydrothermal bivalves, and is typically developed in gills, with a lower incidence in mantle and digestive glands, while it has never been described in byssus. Using ultrastructural examination, we provide evidence for the existence of a potentially new group of filamentous prokaryotic organism inBathymodiolus azoricusbyssus, with putative parasitic influence. Additionally, a cystic, undefined organism was found with an unclear physiological role within the spongy net of the byssus plaque. Our results indicate that in spite of its antibacterial protective sheath, byssus gives access to prokaryotic organisms becoming prone to failure through damaged collagen fibres.

Inositol pyrophosphates: metabolism and signaling

Inositol pyrophosphates belong to the diverse family of inositol polyphosphate species that have a range of signaling functions. Since the discovery of inositol pyrophosphates in the early 1990s, enormous progress has been achieved in characterising this class of molecules, linking their biological presence to a wide range of cellular functions, including vesicular trafficking, apoptosis, telomere maintenance and protein phosphorylation. The activity of inositol pyrophosphates appears to be related to their rapid turnover in cells and also to their pyrophosphate groups, which are considered to contain high-energy bonds. Together, these observations suggest that inositol pyrophosphates may represent a class of cellular messengers with basic and not yet fully characterised functions. This review aims at summarising the recent progress of our knowledge of this exciting class of molecules, from inositol pyrophosphate discovery to the description of their physiological functions.

Ultrastructural description of an unidentified apicomplexan oocyst containing bacteria-like hyperparasites in the gill of Crassostrea rizophorae

Oocysts of an unidentified coccidian are reported in this study to parasitize the gills of the oyster Crassostrea rizophorae (Mollusca, Bivalvia) collected near the city of Recife (Itamaracá Island, 07 degrees 38' 00" S, 34 degrees 48' 06" W), Brazil. Oocysts appeared as light and dense forms, both containing rod-shaped, bacteria-like hyperparasites (BL). Both light and dense oocysts were spherical, 4.3 to 4.7 pm in diameter, but denser oocysts had irregular contours. Both forms consisted of a thick dense wall (approximately 165 nm thick) consisting of 3 layers. The outermost, a dense and irregular layer about 25 nm thick, possessed numerous bead-like structures and some slender conical projections (up to 1.5 microm long). The inner layer of the wall was formed by a dense and homogenous layer about 125 nm thick. Between these 2 layers, a thin light layer about 12 nm thick was present. Uninucleated sporocysts occupied the internal space of the oocyst and contained some rod-shaped BL and mitochondria surrounded by numerous ribosome-like particles. The dense forms of the oocysts showed the same structures described in the lighter forms and appeared to be the final maturation form of the oocysts. Free sporozoites were occasionally observed among oocysts.

Ultrastructure of Goussia cruciata (Apicomplexa: Coccidia) infecting the liver of horse mackerel, Trachurus trachurus (L.), from Ibero-Atlantic waters

The ultrastructure of developmental stages of Goussia cruciata and the pathology they cause in the liver of Trachurus trachurus (Teleostei: Carangidae) caught off the Galician (North-West Spain) and Portuguese North Atlantic coasts are described. Each oocyst contained four ellipsoidal sporocysts, with two sporozoites. The sporocyst wall consisted of a thick and dense inner layer with transverse striations and a multi-lamellated outer layer formed by parallel dense internal bands alternating with lighter areas. The lamellae formed filamentous extensions of the wall. The sporocyst wall striation period was smaller than that observed in G. clupearum, which has a similar habitat. The dehiscence suture, characteristic of the genus, was present in the sporocysts of G. cruciata. The sporocysts were arranged in a symmetrical and characteristic cross shape. A large number of sporocysts with sporozoites were observed in direct contact with host liver cells. No macroscopic lesions were observed. In heavily infected fish, aggregations of oocysts were often enveloped in a 'yellow body' composed of amylopectin granules derived from the parasite and necrotic or aggregated host cells. Degenerating parasites were frequently observed in liver tissue. Host inflammatory cells were accumulated near some oocysts. The ultrastructure of the parasite, together with its strict host specificity, confirmed G. cruciata as a separate and valid species.

Investigation of Nematopsis spp. oocysts in 7 species of bivalves from Chonburi province, Gulf of Thailand

This is the first detailed report of Nematopsis spp. in Thai bivalves. A monthly survey was conducted on 7 species of commercial bivalves from Chonburi province, on the eastern seaboard of Thailand, from November 2000 to November 2001 to investigate the prevalence of the apicomplexan parasite Nematopsis Schneider, 1892. Nematopsis spp. sporozoites were found in the cultivated bivalves Arcuatula arcuatula, Anadara granosa and Perna viridis as well as the locally harvested Paphia undulata. They were not found in Donax faba, Meretrix meretrix or Saccostrea cucullata. Using light microscopy, we were able to identiby 4 oocyst morphotypes of the gregarine Nematopsis spp. Prevalence of Nematopsis spp. during the 13 mo sampling period was highest in A. arcuatula (91.8%; n = 110) and lowest in A. granosa (59.2%; n = 130). The morphology of the oocysts differed between hosts, with an average (x +/- SD) length/width of 16.28 +/- 0.64/12.01 +/- 0.35 microm (n = 50) for A. arcuatula, 16.90 +/- 0.71/12.69 +/- 0.33 microm (n = 50) for A. granosa, 17.61 +/- 0.69/12.72 +/- 0.36 microm (n = 50) for P. viridis, and 11.21 +/- 0.62/8.55 +/- 0.52 microm (n = 50) for P. undulata. Identification of oocysts of these apicomplexan gregarines to species was not attempted. The prevalence of infection in relation to habitat and time of sampling is discussed.

Ultrastructural details of the xenoma of Loma myrophis (phylum Microsporidia) and extrusion of the polar tube during autoinfection

Xenomas of the recently described new microsporidian species Loma myrophis parasitizing the gut tissue of the Amazonian fish Myrophis platyrhynchus (family Ophichthidae) were described by light- and transmission-electron microscopy. The xenoma consisted of a thin fibrillar wall that surrounded a hypertrophic host cell cytoplasm containing numerous microsporidian developmental stages and spores. Several spores showed different stages of natural extrusion of the polar tube. Numerous longitudinal and transverse sections of the extruded polar tubes were observed in developing life-cycle stages (spores excepted), the nucleus of hypertrophic host cell, the xenoma wall and surrounding fibroblasts. The extruded polar tubes were projected in all directions with no preferential orientation. These aspects suggested that autoinfection occurred within this xenoma.

Light and electron microscopic study of the myxosporean, Henneguya friderici n. sp. from the Amazonian teleostean fish, Leporinus friderici

A new histozoic species of myxosporean was found to infect the gill filaments, gut, kidney and liver of the freshwater teleost Leporinus friderici, collected from the estuarine region of the Amazon, near the city of Belém, Brazil. The plasmodia show asynchronous development, at any one time composed of mature spores and all sporogonic stages. The ellipsoidal spore body, measuring 10.4 microm long and 5.7 microm wide, consists of 2 equal shell valves adhering together along the straight suture line. Each valve has a caudal process measuring 23.3 microm in length. There are 2 symmetric polar capsules, without intercapsular appendix, measuring 5.0 microm x 2.1 microm, and each has a polar filament with 7-8 coils. In general, ultrastructural details of sporoblast and spore development are in agreement with previously described myxosporeans. Some ultrastructural aspects such as cellular alterations of the pericyte in the different organs infected and characterization of the sporoplasmosomes during the sporoplasm maturation are described. This parasite was studied under light and electron microscope and compared with others species of the genus Henneguya, considering also host specificity. From our observations we propose the creation of a new species, Henneguya friderici n. sp.

Ultrastructural aspects of the myxosporean Henneguya astyanax n. sp. (Myxozoa: Myxobolidae), a parasite of the Amazonian teleost Astyanax keithi (Characidae)

This study reports light and electron microscopical aspects of a myxosporean found in the gills of the freshwater teleost Astyanax keithi Géry, Planquete & Le Bail, 1996 (family Characidae), collected from the estuarine region of the Amazon River, near Belém, Brazil. The prevalence of infection was 23%. In interlamellar spaces of the gills, ellipsoidal whitish cyst-like plasmodia structures were present, which contained spores. The spores had a spermatozoa-like appearance (47.8 +/- 0.71 microm in total length) with a fusiform body (15.2 +/- 0.77 pm in length, 5.7 +/- 0.71 microm in width and 4.2 +/- 0.31 microm in thickness), and each of the 2 valves presented a tapering tail (32.6 +/- 1.11 microm in length). The valves surrounded a binucleate sporoplasm cell and 2 polar capsules (5.0 +/- 0.13 microm in length, 1.5 +/- 0.07 microm in width) that contained 8 to 9 coils of the polar filament. In the sporoplasm, several unique sporoplasmosomes were visible. A synoptic table of spore measurements of known Brazilian Henneguya species is presented. The spores differed from those of previously described species. Based on spore morphology, it is concluded that this species belongs to the family Myxobolidae, genus Henneguya, and that it constitutes a new species: H. astyanax n. sp.

Biflagellate spermatozoon structure of the hermaphrodite fish Satanoperca jurupari (Heckel, 1840) (Teleostei, Cichlidae) from the Amazon River

The ultrastructural features of the sperm were studied in the hermaphroditic teleost Satanoperca jurupari HECKEL, 1840 from Amazon River. Spermatocytes, spermatids and sperm develop in the testicular cysts among the different oocyte stages. Different stages of early spermatocyte development, mainly the ones with synaptonemal complexes were often observed. The mature spermatozoa belong to the introsperm type, with a short head (approximately 3 microns long and 1.3 microns wide) without acrosome, short midpiece (approximately 1.2 microns long and 1.8 microns wide) containing several mitochondria surrounding two centrioles and forming a mitochondrial collar. They have two flagella (each approximately 15 microns long) each of which has a common 9 + 2 microtubular pattern. Each flagellum has two opposite lateral cytoplasmic extensions that begin about 3 microns the midpiece still close to the end piece of flagellum.