Evaluation of Red Wine Acidification Using an E-Nose System with Venturi Tool Sampling

The quality of wine is checked both during the production process and upon consumption. Therefore, manual wine-tasting work is still valuable. Due to the nature of wine, many volatile components are released, and it is therefore difficult to determine which elements need to be controlled. Acetic acid is one of the substances found in wine and is a crucial substance for wine quality. Gas sensor systems may be a potential alternative for manual wine tasting. In this work, we have developed a TGS2620 gas sensor module to analyze acetic acid levels in red wine. The gas sensor module was refined according to the Venturi effect along with signal slope analysis, providing promising results. The example included in this paper demonstrates that there is a direct relationship between the slope of the MOS gas sensor response and the acetic acid concentration. This relationship is useful to evaluate the ethanol oxidation in acetic acid in red wine during its production process.

Survey of selected pathogens in free-ranging pinnipeds in Uruguay

Marine mammals, regarded as sentinels of aquatic ecosystem health, are exposed to different pathogens and parasites under natural conditions. We surveyed live South American fur seals Arctocephalus australis and South American sea lions Otaria flavescens in Uruguay for Leptospira spp., canine distemper virus (CDV), Mycobacterium spp., Toxoplasma gondii, and Neospora caninum. Samples were collected from 2007 to 2013. The seroprevalence of Leptospira spp. was 37.6% positive, 50.9% negative, and 11.5% suspect for A. australis (n = 61) while for O. flavescens (n = 12) it was 67% positive, 25% negative, and 8% suspect. CDV RNA was not detected in any of the analyzed samples. Most animals tested seropositive to tuberculosis antigens by WiZo ELISA (A. australis: 29/30; O. flavescens: 20/20); reactivity varied with a novel ELISA test (antigens MPB70, MPB83, ESAT6 and MPB59). Seroprevalence against N. caninum and T. gondii was 6.7 and 13.3% positive for O. flavescens and 0 and 2.2% positive for A. australis respectively. To evaluate possible sources of infection for pinnipeds, wild rats Rattus rattus and semi-feral cats Felis catus were also tested for Leptospira spp. and T. gondii respectively. Water samples tested for Leptospira revealed saprofitic L. bioflexa. Pathogenic Leptospira were detected in the kidneys of 2 rats, and cats tested positive for T. gondii (100%). These results represent a substantial contribution to the study of the health status of wild pinnipeds in Uruguay.

Determination of Hansen solubility parameters for sugarcane oil. Use of ethanol in sugarcane wax refining

Currently, the refining of sugarcane wax is carried out with 95% v/v ethanol as solvent. This process has a high rate of ethanol consumption thus, the main objective of this work was to corroborate the feasibility of 95% v/v ethanol as a solvent in the refining of sugarcane wax. The suitability of its performance over other organic solvents was evaluated through the relative energy difference (RED) determined from Hansen solubility parameters (HSPs) of sugarcane oil, which were calculated using HSPiP software. HSPs turned out to be δD = 16.24 MPa½, δP = 3.21 MPa½ and δH = 10.34 MPa½, similar to those reported for pine resin and castor oil. The best solvent was 1-decanol. 95% v/v ethanol turned out to be a bad solvent. Absolute ethanol had a RED value of 0.993, which made it a better candidate since it could reduce consumption rates, and constituted an eco-friendly solvent produced in Cuba for the refining process.

Nociception induces a differential presynaptic modulation of the synaptic efficacy of nociceptive and proprioceptive joint afferents

A previous study has indicated that during the state of central sensitization induced by the intradermic injection of capsaicin, there is a gradual facilitation of the dorsal horn neuronal responses produced by stimulation of the high-threshold articular afferents that is counteracted by a concurrent increase of descending inhibitory actions. Since these changes occurred without significantly affecting the responses produced by stimulation of the low-threshold articular afferents, it was suggested that the capsaicin-induced descending inhibition included a preferential presynaptic modulation of the synaptic efficacy of the slow conducting nociceptive joint afferents (Ramírez-Morales et al., Exp Brain Res 237:1629-1641, 2019). The present study was aimed to investigate more directly the contribution of presynaptic mechanisms in this descending control. We found that in the barbiturate anesthetized cat, stimulation of the high-threshold myelinated afferents in the posterior articular nerve (PAN) produces primary afferent hyperpolarization (PAH) in the slow conducting (25-35 m/s) and primary afferent depolarization (PAD) in the fast conducting (40-50 m/s) articular fibers. During the state of central sensitization induced by capsaicin, there is a supraspinally mediated shift of the autogenic PAH to PAD that takes place in the slow conducting fibers, basically without affecting the autogenic PAD generated in the fast conducting afferents. It is suggested that the change of presynaptic facilitation to presynaptic inhibition induced by capsaicin on the slow articular afferents is part of an homeostatic process aimed to keep the nociceptive-induced neuronal activity within manageable limits while preserving the proprioceptive information required for proper control of movement.

Post-mortem toxicology in the diagnosis of sudden death in young and middle-aged victims

OBJECTIVE

We aimed to investigate the impact of the toxicological results found in cases of sudden death (SD) and to correlate the clinical, autopsy and genetic findings with the toxicology results.

MATERIALS AND METHODS

Consecutive SD in people aged between 16 and 50 years with medico-legal autopsies and toxicology studies were included over a 3-year period. The comparison between the toxicological data and demographic characteristics, clinical circumstances, autopsy, and genetic results were taken into account.

RESULTS

101 cases were finally included. They were predominately males (84%) and the mean age was 39.8 years. 52 (51.5%) cases had positive toxicological findings and in 25 cases (24.8%), toxic compounds were considered the first cause of death. Ethanol was the most frequently identified agent (69%), following by licit drugs (56%) and drugs of abuse (39%). Cases with positive toxicology were younger than those with negative results (37.9±9.1 vs. 41.9±7.8; p=0.02). Patients with more than 3 comorbidities showed an association with positive toxicological results (n=14 vs. n=3; p=0.017). The genetic study was performed in 70 (69.3%) SD cases. We identified pathogenic or likely pathogenic variants in 17.1% cases and uncertain significance variants in 42.8% cases. 58% of these variants were probably related to the cause of death.

CONCLUSIONS

A large fraction of SD victims had positive toxicological findings and a quarter of deaths were directly caused by toxic substances. The identification of the factors that trigger SD provides a good approach to contribute in avoiding future episodes.

Self-referencing mW-scale detection of sub-ns optical phase modulation in acetylene at 1530 nm

Application of the phase memory of acetylene (C₂H₂) vibrational-rotational transitions in the 1520-1540 nm wavelength range for a self-referencing homodyne detection of a sub-nanosecond optical phase modulation is reported. In the proposed configuration the collinearly propagating coherent dipole radiation of the excited molecule acts like a phase-locked reference wave (local oscillator) that enables transformation of the initial phase modulation into the intensity one. This technique does not need high light intensity and can operate in a linear range of the medium optical absorption. The linear optical phase demodulation (i.e., transformation of the phase-to-amplitude light modulation) is interpreted as an introduction of an additional phase shift to the carrier frequency component of the modulated signal in the maximum of the dispersion curve of a narrow optical absorption peak. It has been experimentally demonstrated with the bulk 10 cm long cuvette filled with low pressure (∼2  Torr) acetylene at room temperature. Effective demodulation of the milliwatt-scale incident laser wave of a single- and multi-mode structure is shown. As expected, the response to the fast (<1  ns) phase modulation was quadratic when the acetylene inhomogeneous Doppler-broadened (∼500  MHz) absorption line is excited in its center and was linearized by tuning at one of the absorption line sides. It is of a differentiating (high-pass) type with the cutoff frequency determined by the total spectral width of the utilized absorption line. Expected detection resolution is determined by the photon noise of the incident light intensity.

A comparison of sexual competitiveness and demographic traits of Anastrepha obliqua (Macquart) (Diptera: Tephritidae) among fruit-associated populations

The control of Anastrepha obliqua includes the sterilization of mass-reared insects grown in isolation in a constantly controlled environment. Through time, laboratory mass-reared colonies may produce flies with lower field performance. To recover the genetic variation and aptitude of mass-reared populations, wild insects are introduced into mass-reared colonies. Our aim in this study was to determine whether the host species from two localities influence the life history traits of A. obliqua. We collected flies as larvae from infested fruits of Spondias purpurea, S. mombin, Mangifera indica cv. 'piña', and M. indica cv. 'coche' from two localities in Chiapas, Mexico. There were significant differences in the mating competitiveness of males collected from mango cv. 'coche' compared with mass-reared males. There were no differences in the mating propensity between flies from the two localities, even in the number of matings, when weight was considered as a covariable. The mass-reared strain showed the earliest age at first oviposition. The locality affected the longevity and oviposition period, and these influenced the birth rate, intrinsic rate of increase, finite rate of population increase, mean generation time, and doubling time. According to the demographic parameters, the population of S. mombin would allow artificial colonization in less time, considering that it has a high reproduction rate starting at an early age. Even in the propensity test, it had the highest number of matings. However, males with greater sexual competitiveness and longevity for colonization corresponded to those collected from S. purpurea.

Descending inhibition selectively counteracts the capsaicin-induced facilitation of dorsal horn neurons activated by joint nociceptive afferents

Previous studies from our laboratory showed that in the anesthetized cat, the intradermal injection of capsaicin in the hindpaw facilitated the intraspinal field potentials (IFPs) evoked by stimulation of the intermediate and high-threshold myelinated fibers in the posterior articular nerve (PAN). The capsaicin-induced facilitation was significantly reduced 3-4 h after the injection, despite the persistence of hindpaw inflammation. Although this effect was attributed to an incremented descending inhibition acting on the spinal pathways, it was not clear if it was set in operation once the capsaicin-induced effects exceeded a certain threshold, or if it was continuously operating to keep the increased neuronal activation within manageable limits. To evaluate the changes in descending inhibition, we now examined the effects of successive reversible spinal blocks on the amplitude of the PAN IFPs evoked at different times after the intradermal injection of capsaicin. We found that after capsaicin the PAN IFPs recorded in laminae III-V by activation of high-threshold nociceptive Aδ myelinated fibers increased gradually during successive reversible spinal blocks, while the IFPs evoked by intermediate and low threshold proprioceptive Aβ afferents were only slightly affected. It is concluded that during the development of the central sensitization produced by capsaicin, there is a gradual increase of descending inhibition that tends to limit the nociceptive-induced facilitation, mainly by acting on the neuronal populations receiving inputs from the capsaicin-activated afferents without significantly affecting the information on joint angle transmitted by the low threshold afferents.

Supraspinal modulation of neuronal synchronization by nociceptive stimulation induces an enduring reorganization of dorsal horn neuronal connectivity

KEY POINTS

The state of central sensitization induced by the intradermic injection of capsaicin leads to structured (non-random) changes in functional connectivity between dorsal horn neuronal populations distributed along the spinal lumbar segments in anaesthetized cats. The capsaicin-induced changes in neuronal connectivity and the concurrent increase in secondary hyperalgesia are transiently reversed by the systemic administration of small doses of lidocaine, a clinically effective procedure to treat neuropathic pain. The effects of both capsaicin and lidocaine are greatly attenuated in spinalized preparations, showing that supraspinal influences play a significant role in the shaping of nociceptive-induced changes in dorsal horn functional neuronal connectivity. We conclude that changes in functional connectivity between segmental populations of dorsal horn neurones induced by capsaicin and lidocaine result from a cooperative adaptive interaction between supraspinal and spinal neuronal networks, a process that may have a relevant role in the pathogenesis of chronic pain and analgesia.

ABSTRACT

Despite a profusion of information on the molecular and cellular mechanisms involved in the central sensitization produced by intense nociceptive stimulation, the changes in the patterns of functional connectivity between spinal neurones associated with the development of secondary hyperalgesia and allodynia remain largely unknown. Here we show that the state of central sensitization produced by the intradermal injection of capsaicin is associated with structured transformations in neuronal synchronization that lead to an enduring reorganization of the functional connectivity within a segmentally distributed ensemble of dorsal horn neurones. These changes are transiently reversed by the systemic administration of small doses of lidocaine, a clinically effective procedure to treat neuropathic pain. Lidocaine also reduces the capsaicin-induced facilitation of the spinal responses evoked by weak mechanical stimulation of the skin in the region of secondary but not primary hyperalgesia. The effects of both intradermic capsaicin and systemic lidocaine on the segmental correlation and coherence between ongoing cord dorsum potentials and on the responses evoked by tactile stimulation in the region of secondary hyperalgesia are greatly attenuated in spinalized preparations, showing that supraspinal influences are involved in the reorganization of the nociceptive-induced structured patterns of dorsal horn neuronal connectivity. We conclude that the structured reorganization of the functional connectivity between the dorsal horn neurones induced by capsaicin nociceptive stimulation results from cooperative interactions between supraspinal and spinal networks, a process that may have a relevant role in the shaping of the spinal state in the pathogenesis of chronic pain and analgesia.

Therapy with ombitasvir/paritaprevir/ritonavir plus dasabuvir is effective and safe for the treatment of genotypes 1 and 4 hepatitis C virus (HCV) infection in patients with severe renal impairment: A multicentre experience

Limited data are available on direct-acting antivirals for treating hepatitis C virus (HCV) infection in patients with severe renal impairment. The aim of this study was to evaluate the effectiveness and safety of ombitasvir/paritaprevir/ritonavir (OBV/PTV/r) ± dasabuvir (DSV) ± ribavirin (RBV) in patients with stage 4 or 5 chronic kidney disease (CKD) and HCV genotype 1 or 4 infection in real clinical practice, and to investigate pharmacological interactions. This retrospective study included patients treated with OBV/PTV/r+DSV±RBV or OBV/PTV/r+RBV with CKD stage 4 (eGFR: 15-29 mL/min/1.73m² ) or 5 (eGFR<15 mL/min/1.73m² or requiring dialysis) and HCV infection by genotypes 1 and 4 between April 2015 and October 2015 in nine Spanish centres. Sustained virological response at 12 weeks (SVR12) was assessed, and clinical and laboratory data, fibrosis stage, adverse events and pharmacological interactions were reported. Forty-six patients were included: 10 (21.7%) had CKD stage 4 and 36 (78.2%) CKD stage 5. Seventeen (36.9%) had cirrhosis. SVR12 rate in the intention-to-treat population was 95.7%. Twenty-one (45.6%) received RBV, which was discontinued in two (9.5%) patients. Anaemia (haemoglobin <10 g/dl) occurred in 12 patients (57.1%) with RBV vs 10 (40.0%) without RBV (P=.246). Renal function remained stable during antiviral therapy. Nine patients (19.5%) experienced serious adverse events unrelated to antiviral therapy. Concomitant medication was discontinued or modified in 41.3% of patients. In conclusion, the effectiveness of OBV/PTV/r±DSV±RBV in patients with CKD 4-5 was similar to that observed in those with normal renal function and was not associated with severe adverse events.

Abstract P4-03-16: FAPα (fibroblast activation protein-α) analysis in breast tumor cells and stroma after neoadjuvant treatment

Background: FAPα is a transmembrane serine protease expressed on cancer associated fibroblast that promotes tumour growth and invasion. In patients (pts) with poor outcome and survival FAPα is highly overexpressed. FAPα is also expressed in stroma across all breast cancer subtypes without association with clinicopathological factors. Pts without Complete Pathological Response (pCR) after Neoadjuvant Chemotherapy (NC) had poor outcome. We analysed the relationship between the expression of FAPα in stroma (fibroblast) and in epithelial breast cancer cells of pts without pCR after NC (taxanes, antracyclines and trastuzumab in Her2+).

Methods: 60 pts were included. ER, PR and Ki67 were studied by IHQ (Ventana) and Her2 by FISH (PatnVysion). FAPα expression was determined by IHQ (polyclonal, Ventana). St Gallen guidelines for subtype of breast cancer were used.

Results: 53 pts had tissue. Median age 47 years (range 29-68). Median tumour size 43mm and 10 (18.9%) were multifocal. 37 (69.8%) had positive axillary nodes. 47 were ductal invasive carcinomas. 33 (62.3%) were grade 2 and 20 (37.7%) grade 3. 44 pts (83%) had ER+ (20 luminal B), 17 (32%) Her2+ and 6 (11%) triple negative(TN). Median Ki67 was 22% (p25-75:15-38%). Miller-Payne response was 1.9% G1 (1pt), 43.4% G2 (23 pts), 41.5% G3 (22 pts) and 13.2% G4 (7 pts). The recurrences were 2 local and 12 distant (26.4%). Median FAPα in residual epithelial breast cancer cells after NC was 85% (p25-75:30-95%) and in the stroma 20% (p25-75:10-62%). Median epithelial FAPα was 55% in TN, 85% Her2, 72.5% luminal A and 92.5% in luminal B. Median stromal FAPα was 52.5% in TN, 20% Her2, 15% luminal A and 15% in luminal B. There is not association between stromal FAPα and clinicopathological features, but a higher epithelial FAPα was found in tumours wih higher ER, PR and Ki67. In luminal B subtype, stromal FAPα was smaller in pts with relapses (median 7.5%) than without relapses (median 30%). Conclusions: Stromal FAPα in residual cancer after NC is higher in TN breast cancer but without association with relapses in our small sample. However, in luminal B subtype stromal FAPα is smaller in pts with relapses.

Citation Format: Calvo I, Prieto M, Suárez-Gauthier A, Pérez FJ, Hernández E, Acosta D, Cárdenas JM, López-Ríos F, Estévez LG. FAPα (fibroblast activation protein-α) analysis in breast tumor cells and stroma after neoadjuvant treatment [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-03-16.

Treatment of Chronic Lower Extremity Ulcers with A New Er:Yag Laser Technology

Chronic lower extremity ulcers (CLEUs) have a high prevalence and are difficult to treat due to their various aetiologies. The aim of this study is to evaluate the results achieved in treating CLEUs using an Erbium: YAG (Er:YAG) laser with RecoSMA technology. This laser emits thousands of microbeams of energy causing superficial epidermal ablation and a separation of dermal fibres due to a mechanical-acoustic and resonance effect. The evaluation of the results achieved was carried out by questionnaires completed by 18 patients enrolled in the study. Histological studies and photographs taken before each session (16 sessions in total) were analysed to visually monitor the clinical progress. The analyses were carried out with the help of computer software. The results after 16 treatment sessions showed the complete healing of ulcers or a decrease in their initial area of at least 55% in over 65% of the patients treated. The Student's t-test and Fisher's exact test were used for statistical analysis. The Er:YAG laser and RecoSMA technology ablates few epidermal cell layers, producing a mechanical-acoustic effect with resonance action leading to tissue regeneration mechanisms. This technology offers an effective and safe alternative for treating CLEUs.

Comparison of the effects of mesquite pod and Leucaena extracts with phytoestrogens on the reproductive physiology and sexual behavior in the male rat

Mesquite (Prosopis sp.) and Leucaena leucocephala are widespread legumes, widely used to feed several livestock species and as food source for human populations in several countries. Both mesquite and Leucaena contain several phytoestrogens which might have potential estrogenic effects. Thus, the aim of this study was to evaluate the effects of mesquite pod and Leucaena extracts on several aspects of behavior and reproductive physiology of the male rat. The effects of the extracts were compared with those of estradiol (E2) and of two isoflavones: daidzein (DAI) and genistein (GEN). The following treatments were given to groups of intact male rats: vehicle; mesquite pod extract; Leucaena extract; E2; DAI; GEN. The results indicate that mesquite pod and Leucaena extracts disrupt male sexual behavior in a similar way to DAI and GEN, but less than E2. The main disruptor of sexual behavior was E2, however after 40 and 50days of administration, both extracts and phytoestrogens disrupted sexual behavior in a similar way to E2. The extracts also increased testicular germ cell apoptosis, decreased sperm quality, testicular weight, and testosterone levels, as phytoestrogens did, although these effects were less than those caused by estradiol. The number of seminiferous tubules with TUNEL-positive germ cells increased in extracts treated groups in a similar way to phytoestrogens groups, and E2 caused the greatest effect. The number of TUNEL-positive cells per tubule increased only in Leucaena extract and E2 groups, but not in mesquite- and phytoestrogens-treated groups. Spermatocytes and round spermatids were the TUNEL-positive cells observed in all experimental groups. This effect was associated with smaller testicular weights without atrophy in experimental groups compared with control. Testicular atrophy was only observed in estradiol-treated males. Testosterone decreased in males of all experimental groups, compared with control, this androgen was undetectable in E2 treated males. These results suggest that mesquite pod and Leucaena extracts cause effects similar to those of phytoestrogens in male rat reproduction, these effects were lower than those caused by E2.

A master dynamic flow diagram for the shear thickening transition in micellar solutions

The shear thickening behavior of dilute micellar solutions of hexadecyltrimethylammonium-type surfactants with different counterions (tosylate, 3- and 4-fluorobenzoate, vinylbenzoate and salicylate) and of n-alkyltetradecylammonium bromide (CnTAB), with n = 14, 16 and 18, is examined here. These solutions undergo a shear thickening transition due to the formation of shear-induced structures (SISs) in the shear range studied. Here we report a relationship between the shear thickening intensity and the differences in the hydrophobicity of counterions according to the Hofmeister-like anion series, which leads to a master flow diagram. This master flow diagram is produced by plotting a normalized shear thickening intensity (Iη - 1)/(Imax - 1) versus CD/CD,max, where Iη is the shear-thickening intensity, defined as the largest viscosity obtained in the shear-thickening transition (STT) at a given surfactant concentration CD divided by the Newtonian viscosity η0, and Imax is the largest intensity value obtained in the STT at a surfactant concentration CD,max. The master flow diagram is built using several cetyltrimethylammonium-type surfactants with different counterions, according to a Hofmeister-like series, and by n-alkyltetradecylammonium bromide surfactants with different alkyl chain lengths.

[Tibiotalocalcaneal arthrodesis using a humeral locking plate]

OBJECTIVE

To describe the results of tibiotalocalcáneal arthrodesis (TTC) using a humeral locking plate.

METHODS AND MATERIALS

A retrospective, observational study was conducted between January 2007 and December 2013 in the Hospital Militar Central de Bogotá. The study included patients with symptomatic osteoarthritis diagnosed clinically and radiologically, and who underwent TTC arthrodesis using a humeral locking plate with a minimum follow up of 6 months.

RESULTS

The total number patients was 35, of whom 7 (20%) were women and 28 (80%) men, with a mean age 36.3 years (19.77).

AETIOLOGY

74% with post-traumatic arthritis, most of them secondary to gunshot wounds and fragmentation weapons, and neuropathic in 20%. An autogenous graft was used in 13 cases, and 14 cases using both, with a mean consolidation time of 4.37 months. Complications include, delayed union in 3 cases, and surgical site infection in 4. The postoperative functionality (AOFAS) mean was 66.7/100 points, with a score of 2.35 on a visual analogue pain scale.

CONCLUSION

TTC arthrodesis using a humeral locking plate is a suitable option for fixing this type of arthrodesis, with a low rate of complications, and postoperative results that revealed satisfactory improvement in pain and consolidation.

The Orinoco megadelta as a conservation target in the face of the ongoing and future sea level rise

Currently, risk assessments related to rising sea levels and the adoption of defensive or adaptive measures to counter these sea level increases are underway for densely populated deltas where economic losses might be important, especially in the developed world. However, many underpopulated deltas harbouring high biological and cultural diversity are also at risk but will most likely continue to be ignored as conservation targets. In this study, we explore the potential effects of erosion, inundation and salinisation on one of the world's comparatively underpopulated megadeltas, the Orinoco Delta. With a 1 m sea level rise expected to occur by 2100, several models predict a moderate erosion of the delta's shorelines, migration or loss of mangroves, general inundation of the delta with an accompanying submersion of wetlands, and an increase in the distance to which sea water intrudes into streams, resulting in harm to the freshwater biota and resources. The Warao people are the indigenous inhabitants of the Orinoco Delta and currently are subject to various socioeconomic stressors. Changes due to sea level rise will occur extremely rapidly and cause abrupt shifts in the Warao's traditional environments and resources, resulting in migrations and abandonment of their ancestral territories. However, evidence indicates that deltaic aggradation/accretion processes at the Orinoco delta due to allochthonous sediment input and vegetation growth could be elevating the surface of the land, keeping pace with the local sea level rise. Other underpopulated and large deltas of the world also may risk immeasurable biodiversity and cultural losses and should not be forgotten as important conservation targets.

Tourniquet modification of the associating liver partition and portal ligation for staged hepatectomy procedure

BACKGROUND

In staged liver resections, associating liver partition and portal ligation for staged hepatectomy (ALPPS) achieves sufficient hypertrophy of the future liver remnant (FLR) in 7 days. This is based on portal vein ligation and transection, and on occlusion of intrahepatic collaterals. This article presents a new surgical technique for achieving rapid hypertrophy of the FLR, which also involves adding intrahepatic collateral occlusion to portal vein transection.

METHODS

Patients scheduled for two-stage liver resection for primary or secondary liver tumours, in whom the FLR was considered too small, were enrolled prospectively. In the first stage, a tourniquet was placed around the parenchymal transection line, and the right portal vein was ligated and cut (associating liver tourniquet and portal ligation for staged hepatectomy, ALTPS). The tourniquet was placed on the umbilical ligament if a staged right trisectionectomy was planned, and on Cantlie's line for staged right hepatectomy.

RESULTS

From September 2011, 22 ALTPS procedures were carried out (right trisectionectomy in 15, right hepatectomy in 7). Median FLR at 7 days increased from 410 to 700 ml (median increase 61 (range 33-189) per cent). The median duration of the first stage was 125 min and no patient received a blood transfusion. The median duration of the second stage was 150 min and five patients required a blood transfusion. Fourteen patients had complications, most frequently infected collections, and five patients developed postoperative liver failure. Two patients died.

CONCLUSION

The ALTPS technique achieved adequate hypertrophy of the FLR after 7 days. It may provide a less aggressive modification of the ALPPS procedure.

Different clinical presentation of Klinefelter's syndrome in monozygotic twins

There is a wide variability in the clinical presentation of Klinefelter's syndrome. We report the case of a 45-year-old man who was incidentally diagnosed a 47,XXY/46,XY karyotype in a bone marrow aspiration (case 1). He presented hypogonadic features with undetectable testosterone levels and a height in accordance with mid-parental height. He had a monozygous sibling (case 2) who did not show clinical signs of hypogonadism and whose height exceeded mid-parental height. Both patients had presented language disorders since childhood. The karyotype of lymphocytes in peripheral blood of both subjects was compatible with mosaic Klinefelter's syndrome (46,XY/47,XXY). Testosterone replacement was initiated in case 1. Lack of testicular involvement due to mosaicism and the overexpression of the SHOX gene in case 2 could explain the marked differences in phenotype in these homozygous twins.

[Geriatric assessment and factors associated with mortality in elderly patients with heart failure admitted to an acute geriatric unit]

INTRODUCTION AND OBJECTIVES

Heart failure (HF) is very prevalent in older adults, and is associated with a high mortality. The prediction of the outcome of HF and the identification of patients in advanced stages is difficult. The present work aims at identifying variables of the geriatric assessment and other clinical variables associated with an increased risk of death at one year in older adults with HF.

MATERIAL AND METHODS

Prospective study of 101 patients (mean age, 85.9 ± 6.3 years, 81% women) admitted during 2006 to an Acute Geriatric Unit, with principal diagnosis of HF. We recorded: demographic data, predisposing heart disease, main trigger of exacerbation, comorbidity, number of prescriptions at discharge and specific treatment of HF, average length-of-stay, readmissions, and mortality at one year after discharge. Geriatric assessment included: disability in basic (Barthel index) and instrumental (Lawton index) activities of daily living, cognitive function (Pfeiffer test), comorbidity (Charlson index), and geriatric syndromes.

RESULTS

In a multivariable logistic regression model, previous disability (lower Barthel index) (OR [95%CI]=1.03 [1.01-1.06]; P=.040) and higher number of re-admissions (OR [95%CI]=3.53 [1.19-10.44]; P=.023) were associated with 1-year mortality. Female sex had a protective effect (OR [95%CI]=0.15 [0.04-0.59]; P=.007).

CONCLUSIONS

Disability in the basic activities of daily living and re-admissions were associated with increased 1-year mortality in older adults, whereas female sex was protective. If confirmed in further studies, these data could reinforce the need for a systematic comprehensive geriatric assessment in older adults with HF.

Phenotypic characterization of hereditary epithelial ovarian cancer based on a tissue microarray study

The pathologic and immunohistochemical features of familial epithelial ovarian cancers are not well understood. We have carried out a comprehensive immunohistochemical study of familial ovarian carcinomas from women with and without BRCA1 or BRCA2 mutations, in order to identify specific and/or common features among these different familial case groups (BRCA1, BRCA2 and non-BRCA1/2) and to identify markers of diagnostic value that might help to select more specific treatments. 73 familial primary ovarian carcinomas were analyzed for the expression of 40 antibodies involved in different genetic pathways using a tissue microarray. Serous carcinomas comprised the majority of all three familial case groups. On the other hand, BRCA1 and BRCA2 carcinomas have similar histopathologic features; i.e. they are often high-grade and are usually diagnosed at a more advanced FIGO stage than non-BRCA1/2 carcinomas. In our series, BRCA1 carcinomas had better clinical evolution and they also more frequently over-expressed PR and P53 than BRCA2 and non-BRCA1/2 carcinomas. Unsupervised cluster analysis and survival analysis identified ERCC1 as a potential marker of better clinical outcome for hereditary epithelial ovarian cancer.

Viability of six species of larval and non-larval helminth eggs for different conditions of temperature, pH and dryness

Helminth eggs are the most difficult biological parasites to inactivate in wastewater and sludge. In developing countries, in particular, they are present in high concentrations and are the cause of many diseases that impact seriously on the human population. The process conditions for affordable inactivation are very variable, leading to different inactivation efficiencies. Temperature, dryness, pH and the developmental stage of the eggs must be taken into consideration to achieve complete inactivation. The objective of this research was to study the inactivation of six species of larval and non-larval helminth eggs of medical importance in developing countries under controlled conditions of temperature, pH, dryness and contact time. Results showed considerable differences in inactivation conditions among helminth eggs and a high level of resistance was confirmed for the eggs of Ascaris lumbricoides and Ascaris suum. The appropriate conditions for inactivation of all types of eggs were found by applying combinations of pH, temperature and dryness. At 45 °C it was possible to inactivate all species with a pH of 5.3 and 90% dryness within 6 days. If alkalization was applied, a pH of 12.7 was sufficient over 19 days at the same conditions of dryness and temperature. From these results it is proposed that both Ascaris spp. and Taenia solium may be used as indicators of biological contamination in wastewater and sludge.

Pharmacological properties of S1RA, a new sigma-1 receptor antagonist that inhibits neuropathic pain and activity-induced spinal sensitization

BACKGROUND AND PURPOSE

The sigma-1 (σ(1) ) receptor is a ligand-regulated molecular chaperone that has been involved in pain, but there is limited understanding of the actions associated with its pharmacological modulation. Indeed, the selectivity and pharmacological properties of σ(1) receptor ligands used as pharmacological tools are unclear and the demonstration that σ(1) receptor antagonists have efficacy in reversing central sensitization-related pain sensitivity is still missing.

EXPERIMENTAL APPROACH

The pharmacological properties of a novel σ(1) receptor antagonist (S1RA) were first characterized. S1RA was then used to investigate the effect of pharmacological antagonism of σ(1) receptors on in vivo nociception in sensitizing conditions and on in vitro spinal cord sensitization in mice. Drug levels and autoradiographic, ex vivo binding for σ(1) receptor occupancy were measured to substantiate behavioural data.

KEY RESULTS

Formalin-induced nociception (both phases), capsaicin-induced mechanical hypersensitivity and sciatic nerve injury-induced mechanical and thermal hypersensitivity were dose-dependently inhibited by systemic administration of S1RA. Occupancy of σ(1) receptors in the CNS was significantly correlated with the antinociceptive effects. No pharmacodynamic tolerance to the antiallodynic and antihyperalgesic effect developed following repeated administration of S1RA to nerve-injured mice. As a mechanistic correlate, electrophysiological recordings demonstrated that pharmacological antagonism of σ(1) receptors attenuated the wind-up responses in spinal cords sensitized by repetitive nociceptive stimulation.

CONCLUSIONS AND IMPLICATIONS

These findings contribute to evidence identifying the σ(1) receptor as a modulator of activity-induced spinal sensitization and pain hypersensitivity, and suggest σ(1) receptor antagonists as potential novel treatments for neuropathic pain.

Salmonella Paratyphi B var Java infections associated with exposure to turtles in Bizkaia, Spain, September 2010 to October 2011

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Salmonella Paratyphi B var Java infections associated with exposure to turtles in Bizkaia, Spain, September 2010 to October 2011

Between September 2010 and October 2011, the Unit of Epidemiology in the Department of Public Health in Bizkaia, Spain identified eight cases of Salmonella Paratyphi B var Java infection and three cases of infection with its possible monophasic variant 4,5,12:b:- dT+. Six cases reported contact with turtles and S. Java was isolated from three of these turtles' habitats. The isolates from the patients and their respective turtles were indistinguishable by pulsed-field gel electrophoresis (PFGE). Although other reptiles can also carry Salmonella, turtles pose a special risk, as they are commonly kept as pets for children. This emphasizes the need to give recommendations regarding ownership and handling of aquatic turtles and other reptiles. As parents are often not aware of the risk of infection associated with the presence of turtles in the household, it would be appropriate to inform potential buyers at points of sale about the risk of infection and measures they can take to minimise this risk.

First Report of Tomato chlorosis virus Infecting Sweet Pepper in Costa Rica

In September 2008, a survey of whiteflies and whitefly-borne viruses was performed in 11 pepper-growing greenhouses in the province of Cartago, Costa Rica. During this survey, the vast majority of sweet pepper (Capsicum annuum cv. Nataly) plants showed interveinal chlorosis, enations, necrosis, and mild upward leaf curling. Large populations of whiteflies were present and they were found to be composed only of Trialeurodes vaporariorum. Total RNA from frozen plant samples was extracted with TRI Reagent (Molecular Research Inc., Cincinnati, OH). RevertAid H Minus Reverse Transcriptase Kit (Fermentas, Hanover, MD) was used for reverse transcription of the total RNA extract, with cDNA synthesis directed using random primers. A real-time PCR assay was performed to detect Tomato chlorosis virus (ToCV) (genus Crinivirus, family Closteroviridae) using the SYBR Green PCR Master Mix (Applied Biosystems, Carlsbad, CA). Three sets of primers were used to confirm the presence of ToCV in the samples: TocQ875F/TocQ998R primer set directed to a fragment of 123 bp of the HSP gene (3); ToCVp22RQF (5'-TGGATCTCACTGGTTGCTTG-3')-ToCVp22RQR (5'-TAGTGTTTCAGCGCCAACAG-3') primer pair that amplifies a 198-bp segment of the ToCV p22 gene (R. Hammond, E. Hernandez, J. Guevara, J. A. Vargas, A. Solorzano, R. Castro, N. Barboza, F. Mora, and P. Ramirez, unpublished) and the ToCVCPmRQF (5'-CATTGGTTGGGGATTACGTC-3')-ToCVCPmRQR (5'-TCTCAGCCTTGACTTGAGCA-3') primer pair designed to amplify a 170-bp portion of the ToCV CPm gene (R. Hammond, E. Hernandez, J. Guevara, J. A. Vargas, A. Solorzano, R. Castro, N. Barboza, F. Mora and P. Ramirez, unpublished). Fifteen symptomatic samples per greenhouse were tested for a total of 165 sweet pepper plants. From this total, seven samples from four different greenhouses produced amplification of PCR products with all three sets of primers. One of the seven samples showed mild chlorosis, but others were highly chlorotic with different levels of upward leaf curling. None of the other samples showed amplification with any of the primer sets; the symptoms on these plants could have been due to nutritional deficiencies or infection by viruses. Sequence analysis of the 460-bp HSP PCR products, produced using previously reported primers (3), and 150-bp fragment of the P22 revealed 100% sequence identity with a tomato isolate of ToCV from the United States (GenBank Accession No. AY903448). Because of the low number of samples infected with ToCV and the high incidence of symptoms, DNA extraction and a begomovirus PCR detection assay was performed using primer pair AV494/AC1048 (4). Negative results were obtained for all samples. To our knowledge, this is the first report of ToCV infecting sweet pepper plants in Costa Rica and the third one worldwide. ToCV has also been found to be infecting tomato in open field and greenhouses (1) and other weeds in greenhouses including Ruta chalepensis (Rutaceae), Phytolacca icosandra (Phytolaccaceae), Plantago major (Plantaginaceae), and Brassica sp. (Brassicaceae) (2) in the same region of Costa Rica, suggesting that it has adapted to the conditions of the area and poses an important threat to the vegetable production. References: (1) R. M. Castro et al. Plant Dis. 93:970, 2009. (2) A. Solorzano-Morales et al. Plant Dis. 95:497, 2011. (3) W. M. Wintermantel et al. Phytopathology 98:1340, 2008. (4) S. Wyatt and J. Brown. Phytopathology 86:1288, 1996.

Dry eye disease in chronic graft-versus-host disease: results from a Spanish retrospective cohort study

We describe the incidence, clinical features, and final outcome of dry eye disease (DED) associated with chronic graft-versus-host disease (GVHD) over a 5-year period. We reviewed 109 clinical charts from patients undergoing hematopoietic stem cell transplantation (HSCT) between January 2000 and December 2005, abstracting data from the 57 patients who developed chronic GVHD and survived at least 180 days after allogenic HSCT. DED occurred in 22 (40%) patients at an average of 16.5 months after HSCT. Photophobia, irritation, and foreign body sensation were the most frequent symptoms, while punctate keratitis was the most common sign. DED tended to improve over time, with fewer than 5% of patients requiring more than two topical medications at the end of follow-up. Our study represented a formal evaluation of DED incidence among Spanish chronic GVHD patients. It is of utmost importance to assure patients will undergo a comprehensive ophthalmologic evaluation throughout their follow-up.

Exceptional points and non-Hermitian degeneracy of resonances in a two-channel model

We study the mixing and degeneracy of two unbound energy eigenstates (resonances) in a two coupled channel model of scattering and reactions. We derive the necessary and sufficient conditions for existence of an exceptional point in the extended spectrum of bound and resonance energy eigenvalues in this model and show that these are not the same as in the single channel case. When these conditions are satisfied, in the complex energy plane, the two simple resonance poles of the scattering matrix merge into one double pole at the exceptional point. In parameter space, the surface of the eigenenergies has a branch point of square root type and branch cuts in its real and imaginary parts that start at the exceptional point and extend in opposite directions. The rich phenomenology of crossings and anticrossings of energies and widths of the doublet of unbound states, as well as the changes of identity of the poles of the scattering matrix observed when one control parameter is varied while the other is kept constant, is fully explained in terms of sections of the eigenenergy surfaces.