Global homogenization of the structure and function in the soil microbiome of urban greenspaces

The structure and function of the soil microbiome of urban greenspaces remain largely undetermined. We conducted a global field survey in urban greenspaces and neighboring natural ecosystems across 56 cities from six continents, and found that urban soils are important hotspots for soil bacterial, protist and functional gene diversity, but support highly homogenized microbial communities worldwide. Urban greenspaces had a greater proportion of fast-growing bacteria, algae, amoebae, and fungal pathogens, but a lower proportion of ectomycorrhizal fungi than natural ecosystems. These urban ecosystems also showed higher proportions of genes associated with human pathogens, greenhouse gas emissions, faster nutrient cycling, and more intense abiotic stress than natural environments. City affluence, management practices, and climate were fundamental drivers of urban soil communities. Our work paves the way toward a more comprehensive global-scale perspective on urban greenspaces, which is integral to managing the health of these ecosystems and the well-being of human populations.

The structure and function of soil archaea across biomes

We lack a predictive understanding of the environmental drivers determining the structure and function of archaeal communities as well as the proteome associated with these important soil organisms. Here, we characterized the structure (by 16S rRNA gene sequencing) and function (by metaproteomics) of archaea from 32 soil samples across terrestrial ecosystems with contrasting climate and vegetation types. Our multi-"omics" approach unveiled that genes from Nitrosophaerales and Thermoplasmata dominated soils collected from four continents, and that archaea comprise 2.3 ± 0.3% of microbial proteins in these soils. Aridity positively correlated with the proportion of Nitrosophaerales genes and the number of archaeal proteins. The interaction of climate x vegetation shaped the functional profile of the archaeal community. Our study provides novel insights into the structure and function of soil archaea across climates, and highlights that these communities may be influenced by increasing global aridity.

A prospective observational study of the clinical and pathological impact of stereotactic body radiotherapy (SBRT) as a neoadjuvant strategy of chemoradiation in pancreatic cancer

PURPOSE/OBJECTIVE(S)

To improve the curative resection rates and prognoses, a variety of neoadjuvant (NA) strategies have been explored in PDAC. In our institution, non-metastatic PDACs have been treated with a NA intent with induction multiagent chemotherapy and SBRT. The primary endpoint was to increase R0 resection rate. The secondary endpoints were the analysis of the clinical tolerance, the pathological response, the local control (LC) and the OS.

MATERIALS/METHODS

All consecutive patients with non-metastatic PDAC underwent SBRT as part of the NA strategy were included. A total dose of 40-62 Gy were delivered in 5-10 fractions. Surgery was performed after SBRT and restaging.

RESULTS

Since February 2014 to December 2018, 45 patients were enrolled. Thirty-two patients underwent surgery (71.1%), 10 out of 15 were initially unresectable disease patients (66.75%). R0 resection rate was 93% (30 patients) and pN0 status was achieved in 20 patients (60.6%). Tumour regression grade (TRG): 12 patients with complete response or marked response (TRG 0-1: 37.5%), 16 patients with moderate response (TRG 2: 50%) and four patients with poor response (TRG 3: 12.5%). The median follow-up was 16.2 m (range 6.6-59.6 m) since diagnosis. The LC rate achieved was very high (95.5%). Actuarial 12 and 24 m OS was 67.4% and 35.9% respectively. No grade 3 or higher toxicity related to SBRT was observed.

CONCLUSION

The results are encouraging, suggesting that SBRT has a significant role in the management of these patients and further studies will be necessary to prove these findings.

Choice of pyrolysis parameters for urban wastes affects soil enzymes and plant germination in a Mediterranean soil

The production of organic waste has steadily increased in recent years, with subsequent impact on the environment. The European Union committed to diminish the volume of biodegradable municipal waste disposed of in landfills by 2016-2020. The synthesis of biochar from urban waste and its application to improve soil quality can constitute a novel route for valorization. The aim of this paper was to study the effect of three biochars originated from pyrolysis of the organic fraction of urban waste at two different temperatures (300°C and 500°C) and two residence times (1h and 5h) on the biochemical properties of an agricultural soil. Soil was amended with biochars at a rate of 8% and incubated for 74days. A phytotoxicity assay, using garden cress as the test species, was conducted. CO₂ emissions, microbial biomass C and the enzymes dehydrogenase, phosphomonoesterase and β-glucosidase were measured in tested soils. Biochars prepared at 300°C resulted in lower germination index values, which could partly be ascribed to a higher bioavailability of heavy metals and higher soluble organic matter, while the biochar prepared as 500°C exhibited a phytostimulant effect. Biochars produced at 300°C (B300-1h, B300-5h) augmented soil CO₂ emissions while there was no effect on microbial respiration in the soil amended with the biochar prepared at 500°C. Pyrolysis temperature and, for some enzymes, residence time, controlled soil enzymatic activity.

Local allergic rhinitis is an independent rhinitis phenotype: The results of a 10-year follow-up study

BACKGROUND

The knowledge about the natural history of local allergic rhinitis (LAR) is limited. One unmet question is to demonstrate whether LAR should be considered the first step in the development of allergic rhinitis (AR) or an independent phenotype. The aim of this study was to prospectively evaluate the natural history of a population with LAR, the potential conversion to AR with systemic atopy and the development of asthma during 10 years.

METHODS

This is the second phase of a 10-year follow-up study of a cohort of 176 patients with LAR of recent onset and 115 age- and sex-matched healthy controls prospectively evaluated from 2005 to 2016. Clinical-demographic questionnaire, spirometry, skin prick test and specific IgE were evaluated yearly. Nasal allergen provocation tests (NAPT) with Dermatophagoides pteronyssinus, Alternaria alternata, Olea europaea and grass pollen were performed at baseline, and after 5 and 10 years.

RESULTS

After 10-year LAR, patients experienced a significant and clinically relevant worsening of the rhinitis, with increase in emergency assistance, development of asthma, loss of allergen tolerance and impairment of the quality of life. This worsening became significant after 5 years and progressed throughout 10 years. A similar rate of development of AR with systemic atopy was detected in patients and controls (9.7% vs 7.8%, log-rank P=.623). In 5 patients, conversion to systemic atopy occurred >10 years (3%).

CONCLUSIONS

LAR is a well-differentiated clinical entity with a low rate of development of systemic atopy, a natural evolution towards worsening and a risk factor for suffering asthma.

Preoperative treatment with gemcitabine plus nab-paclitaxel is a safe and effective chemotherapy for pancreatic adenocarcinoma

INTRODUCTION

Recently, novel chemotherapeutic agents like nab-paclitaxel and gemcitabine demonstrated a survival benefit over gemcitabine alone in metastatic pancreatic cancer. However, there are limited clinical results using this chemotherapy in potentially resectable pancreatic adenocarcinoma. Our aim is to report the oncological results of patients affected by potentially resectable pancreatic adenocarcinoma that underwent surgery after a combination of gemcitabine and nab-paclitaxel.

METHODS

A total of 25 patients have been included. We evaluated: (1) Drug toxicity; (2) tumoral response (tumoral size at CT scan, SUV of FDG PET-CT scan and CA 19.9; (3) resection rate; (4) R0 resection rate and histopathological response and (5) survival and disease free survival.

RESULTS

Overall treatment was well tolerated. Treatment resulted in a statistical decrease of CA19-9 (p = 0.019) tumoral size (p = 0.04) and SUV (p = 0.004). The resection rate was 68% (17/25 patients). All specimens were R0 and 13 of 17 specimens had major pathological regressions (complete and important response). Median survival and medial disease free survival of patients that underwent surgery was 21 months and 19 months, respectively at a mean follow up of 38.5 months.

CONCLUSIONS

This data suggests that nab-paclitaxel and gemcitabine is a safe and effective neoadjuvant treatment for potentially resectable pancreatic adenocarcinoma. This promising data should be confirmed in larger, randomized studies.

Recommendations of a group of experts for the pathological assessment of tumour regression of liver metastases of colorectal cancer and damage of non-tumour liver tissue after neoadjuvant therapy

Colorectal cancer (CRC) incidence has increased during the past decades in Spain, being the first malignant tumour in incidence. Observed mortality for CRC is mainly due to liver and lung metastases. The only curative treatment is surgery; new surgical techniques and neoadjuvant treatments have increased the number of surgery candidate patients. Patients should be managed with a multidisciplinary approach that includes imaging techniques, chemotherapy, surgery and pathological assessment. As an answer to this approach, a group of pathology experts interested on CRC liver metastases aimed to review the diagnosis and prognosis of liver mestastases and developed practical recommendations for its assessment. The expert group revised the current literature and prepared questions to be discussed based on available evidence and on their clinical practise. As a result, recommendations for the assessment of tumour regression of liver metastases are proposed, which could be implemented in oncology centres allowing assessment standardisation for these patients. Prospective multi-center studies to evaluate these recommendations validity will further contribute to improve the standard care of CRC liver metastases patients.

Stromal disrupting effects of nab-paclitaxel in pancreatic cancer

Background:

Nab-paclitaxel and gemcitabine have demonstrated a survival benefit over gemcitabine alone in advanced pancreatic cancer (PDA). This study aimed to investigate the clinical, biological, and imaging effects of the regimen in patients with operable PDA.

Methods:

Patients with operable PDA received two cycles of nab-paclitaxel and gemcitabine before surgical resection. FDG-PET and CA19.9 tumour marker levels were used to measure clinical activity. Effects on tumour stroma were determined by endoscopic ultrasound (EUS) elastography. The collagen content and architecture as well as density of cancer-associated fibroblasts (CAFs) were determined in the resected surgical specimen and compared with a group of untreated and treated with conventional chemoradiation therapy controls. A co-clinical study in a mouse model of PDA was conducted to differentiate between the effects of nab-paclitaxel and gemcitabine.

Results:

A total of 16 patients were enrolled. Treatment resulted in significant antitumour effects with 50% of patients achieving a >75% decrease in circulating CA19.9 tumour marker and a response by FDG-PET. There was also a significant decrement in tumour stiffness as measured by EUS elastography. Seven of 12 patients who completed treatment and were operated had major pathological regressions. Analysis of residual tumours showed a marked disorganised collagen with a very low density of CAF, which was not observed in the untreated or conventionally treated control groups. The preclinical co-clinical study showed that these effects were specific of nab-paclitaxel and not gemcitabine.

Conclusion:

These data suggest that nab-paclitaxel and gemcitabine decreases CAF content inducing a marked alteration in cancer stroma that results in tumour softening. This regimen should be studied in patients with operable PDA.

Advanced techniques for characterization of organic matter from anaerobically digested grapemarc distillery effluents and amended soils

The effects of grapemarc distillery effluents on the quality of soil organic matter is extremely important to ensure the environmentally-safe and agronomically efficient use of these materials as organic amendment. In this work, the effects of the application of untreated (UG) and anaerobically digested grapemarc distillery effluents, either added with (AGM) or without mycorrhiza (AG), on soil humic acid (HA) were investigated in field plot experiments in comparison to HAs from a control soil and an inorganic fertilized soil. The humic acid-like fractions (HALs) isolated from UG, AG and soils were characterized for compositional, structural and functional properties by the use of elemental and functional group analysis, and ultraviolet/visible, Fourier transform infrared and fluorescence spectroscopies. Results obtained indicated that anaerobic digestion of effluents produced an extended mineralization with loss of organic C and stabilization of residual organic matter by increasing the content of HALs in the effluent. With respect to control soil HA, HALs isolated from UG and AG were characterized by smaller acidic functional group contents, a prevalent aliphatic character and smaller aromatic polycondensation and humification degrees. The chemical and spectroscopic characteristics of native soil HA were not substantially modified by application of UG, AG and AGM to soil, which suggests the occurred incorporation of the effluent HAL into native soil HA. In conclusion, these results showed the possibility of a beneficial and safe recycling of grapemarc distillery effluents as soil amendment.

Influence of humified organic matter on copper behavior in acid polluted soils

The main purpose of this work was to identify the role of soil humic acids (HAs) in controlling the behavior of Cu(II) in vineyard soils by exploring the relationship between the chemical and binding properties of HA fractions and those of soil as a whole. The study was conducted on soils with a sandy loam texture, pH 4.3-5.0, a carbon content of 12.4-41.0gkg(-1) and Cu concentrations from 11 to 666mgkg(-1). The metal complexing capacity of HA extracts obtained from the soils ranged from 0.69 to 1.02molkg(-1), and the stability constants for the metal ion-HA complexes formed, logK, from 5.07 to 5.36. Organic matter-quality related characteristics had little influence on Cu adsorption in acid soils, especially if compared with pH, the degree of Cu saturation and the amount of soil organic matter.

Variability in As, Ca, Cr, K, Mn, Sr, and Ti concentrations among humic acids isolated from peat using NaOH, Na4P2O7 and NaOH+Na4P2O7 solutions

Sphagnum peat has been found to efficiently remove heavy metals, oil, detergents, dyes, pesticides and nutrients from contaminated waters since its major constituents, i.e., unesterified polyuronic acids, cellulose, and fulvic and humic acids (HA), show functional groups (e.g., alcohols, aldehydes, carboxylic acids, ketones and phenolic hydroxides) which may adsorb pollutant species. The influence of the extractant on the analytical characteristics of HA is an old but still open topic that should be studied in relation to the nature of the matrix from which they originate. While a number of works have been published on the effects of different reagents on the extraction yields and structural properties of HA from soils, relatively little attention has been devoted to peat HA. In this work, the contents of some major and trace elements (As, Ca, Cr, K, Mn, Sr, and Ti) in five Sphagnum-peat samples and in their corresponding HA fractions isolated using three common extractant solutions, i.e., 0.5M NaOH, 0.1M Na(4)P(2)O(7), and 0.5M NaOH+0.1M Na(4)P(2)O(7), where investigated by X-ray fluorescence spectroscopy. In general, Cr, Mn, and Ti concentrations of bulk peat samples were higher than those of the corresponding HA fractions regardless of the extractant used. Arsenic, Ca, K, and Sr concentrations in the HA fractions were affected by the extraction procedure, although at different extents depending on the extractant utilized. In particular, compared to both NaOH and NaOH+Na(4)P(2)O(7), the Na(4)P(2)O(7) extractant yielded HA generally richer in As, Ca, K, and Sr, and poorer in Ti. These results may be related to both the nature of each HA fraction and the physical and chemical form of each element supplied to the studied bog via atmospheric deposition.

Organic matter humification in olive oil mill wastewater by abiotic catalysis with manganese(IV) oxide

The chemical changes occurring in an olive oil mill wastewater (OMW) sample digested catalytically with MnO2 for 30 and 60 days were evaluated comparatively with those occurring in the same OMW left standing for the same time in an open-air lagoon. Both treatments increased the pH and electrical conductivity and decreased the contents of dry matter, total organic C and total N, and C/N ratio of OMW. The humic acid (HA)-like fraction isolated from the fresh OMW was characterized by a marked aliphatic character, small O and acidic functional group contents, marked presence of proteinaceous materials, partially modified lignin moieties and polysaccharides-like structures, extended molecular heterogeneity, and small degrees of aromatic ring polycondensation, polymerization and humification. With increasing the time of either lagooning or catalytic digestion, a loss of aliphatic materials and an increase of extraction yield, oxygenation, acidic functional groups, carbohydrates and aromaticity occurred in the HA-like fractions. The more evident changes measured for the HA-like fractions from catalytically-digested OMW, with respect to those from lagooned OMW, indicated that MnO2 was able to catalyze organic matter humification in OMW.

Organic matter humification by vermicomposting of cattle manure alone and mixed with two-phase olive pomace

The chemical changes occurring in a cattle manure (CM) and a mixture of two-phase olive pomace and CM (OP+CM) after vermicomposting with Eisenia andrei for eight months were evaluated. Further, humic acid (HA)-like fractions were isolated from the two substrates before and after the vermicomposting process, and analyzed for elemental and acidic functional group composition, and by ultraviolet/visible, Fourier transform infrared and fluorescence spectroscopies. Before vermicomposting, the HA-like fractions featured a prevalent aliphatic character, large C contents, small O and acidic functional group contents, a marked presence of proteinaceous materials and polysaccharide-like structures, extended molecular heterogeneity and small degrees of aromatic ring polycondensation, polymerisation and humification. After vermicomposting, the total extractable C and HA-C contents in the bulk substrates increased, and the C and H contents, aliphatic structures, polypeptidic components and carbohydrates decreased in the HA-like fractions, whereas O and acidic functional group contents increased. Further, an adequate degree of maturity and stability was achieved after vermincomposting, and the HA-like fractions, especially that from OP+CM, approached the characteristics typical of native soil HA. Vermicomposting was thus able to promote organic matter humification in both CM alone and in the mixture OP+CM, thus enhancing the quality of these materials as soil organic amendments.

Copper(II) complexation by humic and fulvic acids from pig slurry and amended and non-amended soils

The effect of the consecutive annual additions of pig slurry at rates of 0 (control), 90 and 150 m3 ha(-1) y(-1) over a 4-year period on the binding affinity for Cu(II) of soil humic acids (HAs) and fulvic acids (FAs) was investigated in a field plot experiment under semiarid conditions. A ligand potentiometric titration method and a single site model were used for determining the Cu(II) complexing capacities and the stability constants of Cu(II) complexes of HAs and FAs isolated from pig slurry and control and amended soils. The HAs complexing capacities and stability constants were larger than those of the corresponding FA fractions. With respect to the control soil HA, pig-slurry HA was characterized by a much smaller binding capacity and stability constant. Amendment with pig slurry decreased the binding affinity of soil HAs. Similar to the corresponding HAs, the binding affinity of pig-slurry FA was much smaller while that of amended-soil FAs were slightly smaller when compared to the control soil FA. The latter effect was, however, more evident with increasing the amount of pig slurry applied to soil per year and the number of years of pig slurry application.

[Valsartan in patients with arterial hypertension and type 2 diabetes mellitus. The lapaval study]

Arterial hypertension and diabetes mellitus give rise to a situation of high cardiovascular risk. The potential renoprotection from inhibition of the renin-angiotensin system is a valid option in this type of patient.

OBJECTIVE

Evaluate the effect of valsartan on blood pressure (BP) and renal function in albuminuric patients with type 2 diabetes and arterial hypertension.

PATIENTS AND METHODS

This was a prospective, observational study. Seventy-four diabetic patients with a blood pressure of > or = 140/90 mmHg, with micro or macroalbuminuria and a) blood creatinine levels lower 1.5 mg/dl (group 1) or b) blood creatinine levels between 1.5 and 2 mg/dl (group 2), were studied and followed up for a 12-week period. Treatment was started with valsartan 80 mg/d, increasing to 160 mg/d, adding torasemide at a dose of 5 mg/d if the target blood pressure of 130/85 mmHg has not been achieved. The degree of BP reduction was analyzed comparatively using a mercury sphygmomanometer and a semi-automatic monitor, the Omron HEM 705 CP.

RESULTS

All patients showed a significant reduction of the systolic (SBP) and diastolic (DBP) blood pressures (p< 0.001) over the study period, decreasing from 150.7 +/- 12.8 to 130.8 +/- 9.6 and from 94.7 +/- 7.7 to 76.8 +/- 6.3 mmHg, respectively. A significant reduction was observed only for diastolic blood pressure (101.4 +/- 8.8 to 79.4 +/- 5.6; p < 0.001) in the group 2 of patients. Lowest BP values were always obtained with the semiautomatic device. At the end of the study, 9.5% maintained valsartan 80 mg/d and 36.5% reqcuired the addition of a second or third drug to valsartan 160 mg in order to achieve the therapeutic target BP A significant reduction was observed in the microalbuminuria (75.5 +/- 9.5 to 54.7 +/- 7.3 microg/min; p < 0.001) and macroalbuminuria (n = 20; 0.93 +/- 0.4 to 0.68 +/- 0.4 g/day; p < 0.001).

CONCLUSION

Valsartan significantly reduced SBP and DBP Valsartan at 160 mg/d had a significantly greater effect in reducing micro and macroalbuminuria. No changes were observed in renal function, HbA1c or serum potassium. The rate of adverse events was very low.

Endovascular repair of abdominal aortic aneurysm in a renal transplant patient

A 65-year-old man presented with an asymptomatic infrarenal abdominal aortic aneurysm of 6 cm in transverse diameter. Five years before he received a cadaveric renal transplant. The patient also had the following risk factors and associated diseases: arterial hypertension, coronary artery disease, previous myocardial infarction, coronary angioplasty and stent, ileal resection secondary to Chron disease, hepatopathy, hyperlipidemia and hepato-renal cystic disease. The ASA classification was III, IV. Considering previous abdominal operations and risk factors, we decided to repair the aneurysm with a minimal aggression. The aneurysm was successfully approached by an endovascular route implanting a 22x10 bifurcated aorto-iliac endovascular prosthesis. The patient died 13 months later after being diagnosed of enterocolitis by cytomegalovirus complicated with sepsis and lung infection. We consider this less invasive modality of treatment a valid and useful alternative in this high-risk group of patients.

Effects of the novel multiple-action agent carvedilol on severe nephrosclerosis in renal ablated rats

Antihypertensive drugs have differing effects on renal hemodynamics and morphology. We analyzed whether the use of a new beta adrenoceptor antagonist and vasodilator, carvedilol (CVD), slows the progression of nephrosclerosis and whether the renoprotective effect as well as reduction in cardiac hypertrophy is dependent on the degree of blood pressure reduction. Fifty-four adult male Sprague-Dawley rats were distributed among five groups: group I served as untreated controls with 5/6 nephrectomy (Nx); group II, sham (no renal ablation or drug treatment); group III, CVD 5 (5/6 Nx and treatment with oral CVD at 5 mg/kg/day); group IV, CVD 10 (5/6 Nx and treatment with oral CVD at 10 mg/kg/day); and group V, CVD 20 (5/6 Nx and treatment with oral CVD at 20 mg/kg/day). Tail-cuff blood pressure and 24-hr urine samples were obtained before and at 3, 5 and 11 weeks of treatment with CVD. At the end of the study period, blood was taken to measure serum creatinine, plasma renin activity and CVD levels, as well as the remnant kidney and heart for morphological studies. There was a significant reduction in 24-hr U(ProtV) in all the CVD-treated groups, and it was increasingly evident with the highest dose used. However, only rats receiving doses of 10 and 20 mg/kg/day of CVD exhibited significant decreases in blood pressure. Elevated serum creatinine levels seen in untreated controls were significantly decreased by CVD in treated rats (P < .01), indicating that glomerular filtration rate was improved by this drug. This was associated with a significant increase in U(NaV). Concomitant and significant (P < .01) decreases in plasma renin activity were observed in sham and CVD-treated rats. CVD-treated animals had considerably reduced renal damage (P < .01) and cardiac hypertrophy (P < .01) compared with untreated controls. These data indicate that CVD is effective in delaying progression of renal damage and provides beneficial effects in the remnant kidney and cardiac hypertrophy, even at nonhypotensive doses.

Treatment of renovascular hypertension with percutaneous transluminal angioplasty: experience in Spain

PURPOSE

The clinical results of percutaneous transluminal angioplasty (PTA) were evaluated in patients with renovascular hypertension, and the effect of PTA on blood pressure and renal function was determined.

PATIENTS AND METHODS

Between February 1982 and December 1990, 93 hypertensive patients underwent 123 renal artery PTA procedures. Mean patient age was 43.4 years (range, 12-78 years). Average baseline blood pressure was 162/111 mm Hg (range, 140-230/95-150 mm Hg). The cause of renovascular hypertension, as determined with angiography, was atherosclerosis in 37 patients, fibromuscular dysplasia in 27, and mixed disease in one; 28 patients had renal transplant arterial stenosis.

RESULTS

In patients with atherosclerotic renal vascular disease or fibromuscular renal artery stenosis, systolic and diastolic blood pressure decreased significantly (P < .001) at 96 months after PTA. In patients with renal transplant arterial stenosis, blood pressure also decreased significantly (P < .001) at 12 months after PTA. Technical success was achieved in 78% of patients with atherosclerosis, 92% of patients with fibromuscular dysplasia, and 76% of patients with renal transplants. Complications were seen in 4.8% and were related to renal failure and vessel dissection.

CONCLUSION

PTA is the therapy of choice in patients with renovascular hypertension due to fibromuscular dysplasia. Patients with atherosclerotic renal artery stenosis or stenosis of a renal artery in a transplanted kidney should be selected according to the anatomy of the lesion and clinical patient characteristics.

Resistance to the antimicrobial agents of bacteria isolated from non-sterile pharmaceuticals

The in vitro antimicrobial resistance of 391 bacterial strains isolated from 389 samples of oral and topical medicaments was examined. The numbers of strains isolated (and percentage of samples that present them) were: 234 Bacillus (32.1%), 79 Staphylococcus (13.6%), 46 Micrococcus (11.3%), nine Pseudomonas (1.5%), eight Acinetobacter (1.5%), five Enterococcus (1.2%), three Alcaligenes (0.8%), two Escherichia and Enterobacter (0.5%), one each Providencia, Serratia and Streptococcus (0.2%). Gram-positive bacteria were isolated from topical and oral medicaments and Gram-negative rods were detected only in topical medicaments. The 97.4% of Bacillus strains were resistant to lincomycin and B. cereus was resistant to beta-lactam and trimethoprim-sulphamethoxazole. Staphylococcus spp. showed a high percentage of resistant strains to ampicillin (51.8%), tetracycline (40.5%) and trimethoprim-sulphamethoxazole (48.1%). Staphylococcus epidermidis had the highest number of multiresistant strains. The 23.9% of Micrococcus strains were resistant to colistin. Enterococcus and Streptococcus strains showed multiresistance to penicillin G, aminoglycosides and erythromycin. The 61.5% of Gram-negative rod strains showed multiresistance to beta-lactam antibiotics and erythromycin; Pseudomonas spp. were the most resistant.

[Comparative study in pediatric inhalation anesthesia. Clinical characteristics and anesthetic complications with halothane and isoflurane]

OBJECTIVES

Comparative study of clinical characteristics and complications during induction, maintenance, and recovery in pediatric inhalational anesthesia between two commonly used fluoride agents (halothane and isoflurane).

MATERIAL AND METHODS

We studied 66 children aged 1 month to 13 years undergoing general anesthesia for short lasting surgery who were divided into two groups of 33 patients each one: Isoflurane group and halothane group. Induction and maintenance anesthesia was performed with the corresponding inhalant agent. Parameters measured were duration of unconsciousness, time elapsed for intubation and recovery, heart rate, arterial blood pressure, and incidence of complications.

RESULTS

Children anesthetized with isoflurane showed a shorter period of unconsciousness (1.55 +/- 0.11 min) than those anesthetized with halothane (1.91 +/- 0.12 min); whereas that the time required for intubation was significantly more prolonged (8.94 +/- 0.51 and 6.57 +/- 0.32 min, respectively). The incidence of complications was higher in the isoflurane group, mainly expressed as laryngeal spasm during the induction period. Both groups of patients showed a similar hemodynamic behaviour, although diastolic arterial pressure during maintenance anesthesia was significantly lower with isoflurane. Anesthesia recovery was faster and more predictable with isoflurane than with halothane.

CONCLUSIONS

Anesthetic agent isoflurane is less appropriate than halothane for induction in pediatric anesthesia due to a high incidence of complications, specially laryngeal spasm.

Low turnover bone disease is the more common form of bone disease in CAPD patients

CAPD is considered a risk factor for low turnover bone disease. This was previously attributed to aluminum accumulation. We evaluated by biochemical and histomorphometric parameters (including double tetracycline labelling), 26 patients maintained on CAPD for 12-14 months. Three (11.5%) showed mild hyperparathyroidism, 5 (19.2%) osteitis fibrosa, 3 (11.5%) mixed forms, 4 (15%) osteomalacia and 11 (42.3%) adynamic bone disease. Only one patient with diabetes mellitus showed an aluminum stained bone surface > 10%. Intact PTH serum levels were lower in LTBD (133.2 +/- 128 vs 468.2 +/- 451 pg/ml; p < 0.05). We also evaluated prospectively 11 patients who underwent a bone biopsy at start of dialysis and after 12 months of CAPD treatment. Bone biopsies pre CAPD demonstrated normal-high bone turnover disease in 8/11 (72.7%) and low turnover bone disease in 3/11 (27%). In the follow-up biopsies, 2 patients showed osteitis fibrosa and other two mild forms. Low turnover bone disease was found in 7 patients (3 osteomalacia and 4 adynamic bone disease). We conclude that the predominant bone lesion in our CAPD patients is low turnover bone disease, predominantly adynamic forms, and aluminum does not seem to play a role on its genesis. Low intact PTH serum levels may be a predictor of low turnover bone disease.

Could CAPD modulate the hemodynamic changes induced by rHuEPO treatment?

Hemodynamic response to treatment with erythropoietin has been analyzed on two different groups of patients. The first group of 25 patients was treated with hemodialysis. The second group of 27 was treated with peritoneal dialysis. Both groups were studied before starting the treatment with erythropoietin, after reaching the hemoglobin target point, and after one year of treatment. The following parameters were recorded: basal and hemoglobin target point, time and dosage of response, incidence of arterial hypertension, diastolic and systolic left ventricular diameters, interventricular septum and posterior wall thickness, ejection fraction, fractional fiber shortening, left ventricular mass index, cardiac output index and peripheral resistance index. The incidence of hypertension was 28.8% and, in both techniques, stabilization of left ventricular mass index occurred a year later. When the hemoglobin target point was reached, a decrease in cardiac output and an increase in peripheral resistance was found. These changes were more evident in the group of patients treated with HD. After a year of treatment, both peripheral resistance and cardiac output were similar to basal values in both groups of patients.

Peritoneal dialysis efficiency in CAPD patients in treatment with rHuEPO

Possible modifications in peritoneal behaviour that can be caused by erythropoietin (EPO) treatment and/or correction of anemia in the ultrafiltration and peritoneal diffusion were studied in 24 CAPD patients. The evolution of the patients on the medium run was also studied. The dialysate to plasma ratio, the peritoneal clearance and the mass transfer coefficient of urea and creatinine and the ultrafiltration volume were studied, baseline, after reaching the hemoglobin target, and after eight months of treatment. The group of patients developed a decrease in the dialysate to plasma ratio and in the peritoneal clearance of creatinine. After evaluating the effects of the hemoglobin and the hematocrit, we found a decrease in the dialysate to plasma ratio of urea and creatinine, and in the peritoneal clearance of creatinine. A decrease was also found in the mass transfer coefficients of urea and creatinine. An increase in the ultrafiltration was also found in the patients with hemoglobin levels higher or equal to 11 g/dl. Those changes are reversible after turning the hemoglobin levels back to levels lower than 11 g/dl.

Effect of recombinant human erythropoietin treatment on hemodynamic parameters in continuous ambulatory peritoneal dialysis and hemodialysis patients

We studied the hemodynamic changes and the incidence of hypertension after correction of anemia with recombinant human erythropoietin (rhEPO) in 25 hemodialysis (HD) and in 27 continuous ambulatory peritoneal dialysis (CAPD) patients with a mean age of 44.6 years and a mean time on dialysis of 43.6 months. We analyzed basal and final hemoglobin concentrations, time elapsed to reach target hemoglobin, rhEPO dosage, and the following echocardiographic parameters: left ventricular end-systolic and end-diastolic diameters and volumes, posterior wall thickness, interventricular septum, ejection fraction, fractional fiber shortening, cardiac output index, and peripheral vascular resistance index. We did not find any significant difference between HD and CAPD patients in basal and final hemoglobin, concentrations, time elapsed to reach target hemoglobin, dose of rhEPO received for response, and incidence of hypertension. Changes were more evident in HD patients, with a decrease of 15% in cardiac output index and an equal increase of peripheral vascular resistance,. In the patients on CAPD, these variations were less important, with a decrease in cardiac output index of 10% and no significant change in peripheral vascular resistance. Despite both techniques showing the occurrence of hypertension, the left ventricular mass stabilized during the study time. We conclude that CAPD seems to modulate the changes observed in hemodynamic parameters after rhEPO treatment.

Anemia in dialysis: its relation to acquired cystic kidney disease and serum levels of erythropoietin

Acquired cystic kidney disease has been related to improvement of anemia in dialysis patients. It has been suggested that this could be due to erythropoietin production by the cysts. We studied 110 patients, 58 on hemodialysis and 52 on continuous ambulatory peritoneal dialysis, with an age of 48.6 +/- 14.78 years and a time on dialysis of 44.5 +/- 35.53 months. A renal echography was performed in every patient, evaluating presence and number of cysts. These findings were related to the blood levels of hemoglobin, ferritin, and erythropoietin as well as to the number of transfusions prescribed during the year of the study. The serum erythropoietin level was 18.23 +/- 12.14 U/l in hemodialysis patients, 15.04 +/- 12.35 in patients on continuous ambulatory peritoneal dialysis, and 12.4 +/- 4.7 U/l in the control group. Hemoglobin and erythropoietin were significantly higher in patients with polycystic kidney disease. Patients without cysts had the lowest levels of hemoglobin and erythropoietin, although no significant difference was found in those with multiple bilateral cysts or in those with 1-3 isolated cysts.