Genetic Variants Associated with Biological Treatment Response in Inflammatory Bowel Disease: A Systematic Review

Inflammatory bowel disease (IBD) is a chronic inflammatory disorder of the digestive tract usually characterized by diarrhea, rectal bleeding, and abdominal pain. IBD includes Crohn's disease and ulcerative colitis as the main entities. IBD is a debilitating condition that can lead to life-threatening complications, involving possible malignancy and surgery. The available therapies aim to achieve long-term remission and prevent disease progression. Biologics are bioengineered therapeutic drugs that mainly target proteins. Although they have revolutionized the treatment of IBD, their potential therapeutic benefits are limited due to large interindividual variability in clinical response in terms of efficacy and toxicity, resulting in high rates of long-term therapeutic failure. It is therefore important to find biomarkers that provide tailor-made treatment strategies that allow for patient stratification to maximize treatment benefits and minimize adverse events. Pharmacogenetics has the potential to optimize biologics selection in IBD by identifying genetic variants, specifically single nucleotide polymorphisms (SNPs), which are the underlying factors associated with an individual's drug response. This review analyzes the current knowledge of genetic variants associated with biological agent response (infliximab, adalimumab, ustekinumab, and vedolizumab) in IBD. An online literature search in various databases was conducted. After applying the inclusion and exclusion criteria, 28 reports from the 1685 results were employed for the review. The most significant SNPs potentially useful as predictive biomarkers of treatment response are linked to immunity, cytokine production, and immunorecognition.

Carcass traits and meat quality assessment of two slow-growing chicks strains fed Acheta domesticus larval meal

Presently, there has been a noticeable rise in the consumption of poultry meat within the general population, particularly focusing on poultry sourced from alternative rearing systems as opposed to intensive ones. This study evaluated the impact of incorporating house cricket (Acheta domesticus,AD) larvae meal into the diet of 2 slow-growing chicken strains on their carcass traits and meat quality. A total of 256 one-day-old male chicks were utilized, with 128 belonging to the Red (R) strain and 128 to the Naked Neck (NN) strain. Chicks from each strain were randomly assigned to 16 replicates of 8 chicks each. Eight replicates were allocated to 2 distinct treatments (n=64 chicks/treatment) based on the diet employed: the control treatments for the Red (R-C) and Naked Neck (NN-C) strains were fed soybean meal, while the other 2 treatments were fed AD meal (R-AD and NN-AD). Three different rations were used throughout the growth cycle of the animals, tailored to meet the nutritional needs of the birds. All chickens were slaughtered at 95 d of age, and eight chickens per treatment were randomly chosen to assess carcass traits and meat quality. Near-infrared reflectance spectroscopy (NIRS) was employed to classify meat based on the feed and the chick strain, achieving a correct discrimination of 100% of the samples. The carcass traits exhibited significant alterations due to the inclusion of insect larval meal in the diet, resulting in reduced values across all parameters for chickens consuming AD meal, irrespective of genotype. The pH and cooking losses were generally higher for chicks fed cricket meal, as occurred with moisture. However, protein content was lower in the meat of chicks consuming cricket meal. Fat content showed lower values for NN chickens. There were minimal differences in the fatty acid profile, with lower C18:3n-3 values for chickens fed cricket meal. Therefore, including Acheta domesticus meal in the diets of slow-growing chick strains is a viable alternative to replace soybean meal. It provides meat quality characteristics comparable to those obtained in conventional systems.

Exploring the influence of density-dependence and weather on the spatial and temporal variation in common vole (Microtus arvalis) abundance in Castilla y León, NW Spain

BACKGROUND

The common vole has invaded the agroecosystems of northwestern Spain, where outbreaks cause important crop damage and management costs. Little is yet known about the factors causing or modulating vole fluctuations. Here, we used 11 years of vole abundance monitoring data in 40 sites to study density-dependence and weather influence on vole dynamics. Our objective was to identify the population dynamics structure and determine whether there is direct or delayed density-dependence. An evaluation of climatic variables followed, to determine whether they influenced vole population peaks.

RESULTS

First- and second-order outbreak dynamics were detected at 7 and 33 study sites, respectively, together with second-order variability in periodicity (2-3 to 4-5-year cycles). Vole population growth was explained by previous year abundance (mainly numbers in summer and spring) at 21 of the sites (52.5%), by weather variables at 11 sites (27.5%; precipitation or temperature in six and five sites, respectively), and by a combination of previous abundance and weather variables in eight sites (20%).

CONCLUSIONS

We detected variability in vole spatiotemporal abundance dynamics, which differs in cyclicity and period. We also found regional variation in the relative importance of previous abundances and weather as factors modulating vole fluctuations. Most vole populations were cyclical, with variable periodicity across the region. Our study is a first step towards the development of predictive modeling, by disclosing relevant factors that might trigger vole outbreaks. It improves decision-making processes within integrated management dealing with mitigation of the agricultural impacts caused by voles. © 2023 Society of Chemical Industry.

Use of Acheta domesticus meal as a full soybean substitute in the feeding of slow-growing chicks

Sustainable poultry meat production involves the use of slow-growing chick strains and the utilization of new protein sources as an alternative to the current monopoly of soybean meal. In this scenario, a study was conducted to assess the effect of replacing soybean meal with domestic cricket (Acheta domesticus) meal on the developing cycle of slow-growing chicks. To this end, a total of 128 one-day-old male chicks (Colorield) were randomly assigned into 16 experimental units, each consisting of 8 chicks, which in turn were grouped into 2 groups fed isoproteic and isoenergetic diets in which the protein source differed: the control group (C) fed soybean meal and the Acheta group (AD) fed Acheta domesticus insect meal as the main protein source. Chicks were slaughtered at 95 d of age. Three different diets (F1, F2 and F3) were used for each experimental group according to the nutritional needs of the birds during their growth. The F1 diet (1-29 d) resulted in higher feed and water intake and higher body weight gain for group C, but a lower feed conversion rate. On the contrary, during F2 (29-60 d) no differences in productive performances were observed between the 2 groups, except for a higher water intake for group C. Finally, during the period corresponding to diet F3 (60-95 d) there were only differences in feed intake, which was higher for the AD group. In conclusion, the substitution of soybean meal for Acheta domesticus meal caused a decrease in feed intake during the first month and consequently a lower body weight. During the first 4 weeks of life of the chicks, a partial replacement of soybean meal may be recommended, since high inclusions of A. domesticus meal in this period seem to be detrimental in young chicks. Given the absence of relevant differences in productive performances between both groups, it could be concluded that the use of A. domesticus cricket meal can be a potential protein alternative to soybean meal.

Classification of airborne multispectral imagery to quantify common vole impacts on an agricultural field

BACKGROUND

The common vole (Microtus arvalis) is a very destructive agricultural pest. Particularly in Europe, its monitoring is essential not only for adequate management and outbreak forecasting, but also for accurately determining the vole's impact on affected fields. In this study, several alternatives for estimating the damage to alfalfa fields by voles through unmanned vehicle systems (UASs) and multispectral cameras are presented. Currently, both the farmers and agencies involved in the integrated pest management (IPM) programs of voles do not have sufficiently precise methods for accurate assessments of the real impact to crops.

RESULTS

Overall, the four multispectral classification methods presented showed similar performances. However, the normalized difference vegetation index (NDVI)-based segmentation exhibited the most accurate and reliable appraisal of the affected areas. Nevertheless, it must be noted that the simplest method, which was based on an automatic classification, provided results similar to those obtained by more complex methods. In addition, a significant direct relationship was found between the number of active burrows and damage to the alfalfa canopy.

CONCLUSION

Unmanned vehicle systems, combined with multispectral imagery classification, are an effective and easily transferable methodology for the assessment and monitoring of common vole damage to agricultural plots. This combination of methods facilitates decision-making processes for IPM control strategies against this pest. © 2022 The Authors. Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

Influence of Mediterranean climate and lunar calendar on milk production in Lacaune breed ewes

Environmental factors affect daily milk production in dairy animals. The aim of this study was to quantify the effects of environmental factors, specifically mean temperature (°C), relative humidity (%), temperature-humidity index (THI), solar radiation (°), pluvial precipitation (mm) and lunar calendar (full moon, waxing quarter, waning quarter, new moon), on milk production (kg/d). The analysis was based on 96,195 morning and evening milking records documented on 109 consecutive days, from 869 Lacaune ewes. Ewes were housed in groups of 174 individuals. The analysis was performed in two independent procedures, a Pearson correlation analysis and a multivariate analysis of the ewe's interrelationships, which was based on the total variance estimate and a Varimax-rotated factorial analysis. Milk yield (kg/d) was significantly (p < 0.05) negatively correlated with mean temperature (-0.24), relative humidity (-0.16), THI (-0.24), and radiation (-0.18), which suggests that the higher these environmental factors, the lower the milk yield. Lunar calendar had a significant (p < 0.01) effect on milk production yield; specifically, yields were higher on the full moon and new moon (2.25 ± 0.05 kg/day) than they were on the crescent or waning moon (2.17 ± 0.05 kg/day). In conclusion, ewes that had been exposed to higher mean temperature, relative humidity, THI and solar radiation had the lowest milk yield, and milk yields are highest on full and new moons. The results of this work may be helpful in making predictions for milk production in Lacaune ewes in the Mediterranean region throughout the year.

[Translated article] Spanish Asthma Management Guidelines (GEMA) v.5.1. Highlights and Controversies

In this fifth phase of development, the contents of the Spanish Asthma Management Guidelines (GEMA), which include versions 5.0 and 5.1, have undergone a thorough review. The aim here is to set the main changes in context. These could be summarized as follows: DIAGNOSIS: new FENO cut-off and severity classification based on treatment needed to maintain control; INTERMITTENT ASTHMA: a more restrictive concept and treatment extended to include a glucocorticoid/adrenergic combination as needed; MILD ASTHMA: glucocorticoid/adrenergic therapy as needed as an alternative in case of low therapeutic adherence to conventional fixed-dose steroids; SEVERE ASTHMA: readjustment of phenotypes, incorporation of triple therapy in a single inhaler, and criteria for selection of a biologic in severe uncontrolled asthma; OTHERS: specific scoring in childhood asthma, incorporation of certain organizational aspects (care circuits, asthma units, telemedicine), new sections on COVID-19 and nasal polyposis.

A High Cattle-Grazing Density Alters Circadian Rhythmicity of Temperature, Heart Rate, and Activity as Measured by Implantable Bio-Loggers

Six cows managed under extensive grazing conditions were used to study the effect of moving the animals to a higher grazing density on the circadian rhythms of temperature (T), heart rate (HR), and activity (ACT), which were recorded by implantable bio-loggers. Cows were maintained at a density of 1.5 livestock units per hectare (LSUs/ha; low density, LD) until they were moved to a grazing area at 128 LSUs/ha (high density, HD). Animals were implanted subcutaneously with a T, HR, and ACT bio-logger, which was programmed to record data at 5-min intervals. For each animal, cosinor rhythmometry (the study of circadian rhythms by fitting a sine wave to a time series) was applied to the data recorded over 5 days in LD and HD. Mean Midline Estimating Statistic of Rhythm (MESOR; the average value around which the variable oscillates), amplitude (difference between the peak and the mean value of a wave), and acrophase (timing of peak activity) were calculated and evaluated statistically. Differences between mean day and nighttime values, and mean LD and HD values were calculated. Cows presented cosinor curves that fit a 24-h rhythm (p < 0.001) in T, HR, and ACT at both densities. MESOR (T: 37.98 vs. 38.02°C; HR: 69.12 vs. 65.91 bpm; ACT: 49.39 vs. 40.41 mg, for LD and HD, respectively) and amplitude (T: 0.28 vs. 0.28°C; HR: 4.12 vs. 3.14 bpm; ACT: 18.14 vs. 11.28 mg, respectively) did not differ significantly between the two densities; however, significant (p < 0.05) differences between densities occurred in the acrophase of the three variables; specifically, the T acrophase was 2 h later at HD (22:45 h) than LD (20:45 h), and HR (LD: 19:51; HD: 16:49 h) and ACT acrophases 3 and 2 h earlier at HD than LD (LD: 14:47; HD: 12:49 h), respectively. T and ACT differed significantly (p < 0.01) between daytime (mean ± SE; 37.92 ± 0.19°C, 40.39 ± 4.74 mg) and nighttime (38.14 ± 0.17°C, 29.93 ± 5.66 mg). In conclusion, our study suggests that a high animal grazing density might exacerbate the social competence for valuable resources for animals, resulting in shifting the circadian rhythmicity of temperature, heart rate, and activity of the cows, advancing or delaying their acrophases.

Spanish Asthma Management Guidelines (GEMA) VERSION 5.1. Highlights and Controversies

In this fifth phase of development, the contents of the Spanish Asthma Management Guidelines (GEMA), which include versions 5.0 and 5.1, have undergone a thorough review. The aim here is to set the main changes in context. These could be summarized as follows: DIAGNOSIS: new FE_NO cut-off and severity classification based on treatment needed to maintain control; INTERMITTENT ASTHMA: a more restrictive concept and treatment extended to include a glucocorticoid/adrenergic combination as needed; MILD ASTHMA: glucocorticoid/adrenergic therapy as needed as an alternative in case of low therapeutic adherence to conventional fixed-dose steroids; SEVERE ASTHMA: readjustment of phenotypes, incorporation of triple therapy in a single inhaler, and criteria for selection of a biologic in severe uncontrolled asthma; OTHERS: specific scoring in childhood asthma, incorporation of certain organizational aspects (care circuits, asthma units, telemedicine), new sections on COVID-19 and nasal polyposis.

Milk Quality and Carbon Footprint Indicators of Dairy Sheep Farms Depend on Grazing Level and Identify the Different Management Systems

Currently, there are very few studies in the dairy sheep sector associating milk quality and indicators regarding carbon footprint and their link to grazing levels. For 1 year, monthly milk samples and records related to environmental emissions and management systems were collected through surveys from 17 dairy sheep farms in the region of Castilla y León (Spain), in order to relate this information to the use of natural pastures under free grazing. Indicators were constructed on the collected data and subjected to a multivariate statistical procedure that involved a factor analysis, a cluster analysis and a population canonical analysis. By applying multivariate statistical techniques on milk quality and carbon footprint indicators, it was possible to identify the management system of the farms. From an environmental point of view, farms with a higher grazing level (cluster 4) were more sustainable, as they had the lowest carbon footprint (lower CO₂, N₂O and CO₂ equivalent emissions per sheep and year) and the lowest energy consumption levels, which were gradually lower than those of farms in cluster 3; both indicators were much lower than those of farms in clusters 1 and 2. The milk quality of cluster 1 and 2 farms was significantly lower in terms of total protein and fat content, dry extract, omega-3 fatty acid levels and α-tocopherol content than farms in clusters 3 and 4, which had higher accessibility to grazing resources. In sum, the higher the use of natural resources, the lower the external inputs the farms required and the lower environmental impact and energy costs they have.

Substance use, mental health and dual disorders on pregnancy: results of prevalence and treatment rates in a developed country

Smoking and substance use during pregnancy are major preventable causes of mortality and morbidity, having a bidirectional and deleterious relationship with the mental health of the mother and child. As part of the WOMAP (Woman Mental Health and Addictions on Pregnancy) initiative, our study aimed to describe the prevalence of co-occurring mental illness and substance use problems, diagnoses and severity of those considered at risk and rates of treatment.A screening of 2,014 pregnant women was done using the AC-OK scale and they were asked about their smoking habits and services use for mental health/substance abuse. Of these, 170 women were considered at risk of co-occurring mental illness and substance use problems (≥ 2 positive responses to the AC-OK-Mental Health subscale, ≥ 1 positive response to the AC-OK-Substance Abuse subscale and/or smoking more than once a month and no use of specialized services) and were assessed with a more extensive battery of measures (Patient Health Questionnaire [PHQ-9], General Anxiety Disorder [GAD-7], Posttraumatic stress disorder [PTSD] Checklist for DSM-5 [PCL-5], Alcohol Use Disorders Identification Test [AUDIT], Drug Abuse Screening Test [DAST] and Fagerström).In the last year, 614 women (30.5%) smoked tobacco (42.5% daily) and 9.8% were positive for both substance use and mental illness per the AC-OK. Only 11.1% of them received specific treatment in the previous three months while another 13.6% were scheduled to attend services in the following month. From the subsample assessed in depth, 62(36.5%) endorsed at least moderate depression, 35(20.6%) endorsed at least moderate anxiety, 32(18.8%) endorsed PTSD on the PCL, and 37 out of 88 alcohol users scored above the threshold in AUDIT (≥ 3).In conclusion, high prevalence and low treatment rates suggest that effective detection mechanisms should be integrated into usual care, allowing for early interventions.

The Effect of Grazing Level and Ageing Time on the Physicochemical and Sensory Characteristics of Beef Meat in Organic and Conventional Production

This study investigated the influence of the production system (conventional vs. organic), the grass consumption level and the ageing period (7 and 14 days) on beef quality. Three groups of samples from Limousin × Avileña calves were analysed: F100, formed by animals fed 100% on forage; F74, formed by animals fed on an average amount of forage of 74%; and F35, formed by animals fed on straw fodder (35%) and concentrate (65%). The results showed that the higher the grass content, the lower the fat oxidation and the higher the n-3 content, but also the higher the SFA level, the initial Warner-Bratzler shear force (WBSF), and the more residue it leaves on chewing. As for the effect of production system, organic samples showed higher intramuscular fat content and lower moisture and MUFA content. These samples were darker and showed lower values for flavour quality. Among the organic samples, F100 had higher n-3 and CLA content and higher values for colour, hardness, odour and flavour quality. Increased ageing time may improve the sensory characteristics of the meat, especially in the case of the F100 samples. The results pointed out that F100 samples aged at least 14 days showed the best physico-chemical, nutritional and sensory characteristics.

Quality of life and 3D-EUS assessment for anal incontinence after childbirth

BACKGROUND

the incidence of obstetric sphincter tears has risen to 15-30% and the prevalence of anal incontinence (AI) symptoms after childbirth may be as high as 40%. The present study evaluates the correlation between obstetric injuries detected by endoanal ultrasound (3D-EUS) and AI symptoms, as well as their impact on the quality of life (QOL) of women after childbirth.

METHODS

a prospective observational study was performed of pregnant women evaluated before (baseline) and three months after childbirth to ensure the integrity of the anal sphincters and to evaluate possible injuries. The Fecal Incontinence Quality of Life (FIQL) questionnaire and the Cleveland Clinic Score of Incontinence (Wexner) were completed before and after childbirth. The questionnaire results were correlated with an assessment of sphincter defects performed by 3D-EUS.

RESULTS

a total of 56 females were included in the study. Overall, 48% developed symptoms of AI after childbirth, with a significant decrease in their FIQL compared to the initial evaluation, 3.9 (0.05) vs 3.4 (0.8), respectively (p = 0.000). In addition, 42% of the cohort presented with some kind of obstetric sphincter defect on the 3D-EUS. Instrumental assisted delivery and the sphincter defects were the only two significant factors identified via multivariate analysis that were associated with a decrease in QOL (0.4, 95% CI, 0.07-0.8).

CONCLUSIONS

AI after childbirth was associated with a huge impact on QOL, especially in patients with sphincter injuries. A complete clinical evaluation, including 3D-EUS, is recommended to prevent, manage or treat AI in primiparous females.

Skip-Connected Covariance Network for Remote Sensing Scene Classification

This paper proposes a novel end-to-end learning model, called skip-connected covariance (SCCov) network, for remote sensing scene classification (RSSC). The innovative contribution of this paper is to embed two novel modules into the traditional convolutional neural network (CNN) model, i.e., skip connections and covariance pooling. The advantages of newly developed SCCov are twofold. First, by means of the skip connections, the multi-resolution feature maps produced by the CNN are combined together, which provides important benefits to address the presence of large-scale variance in RSSC data sets. Second, by using covariance pooling, we can fully exploit the second-order information contained in such multi-resolution feature maps. This allows the CNN to achieve more representative feature learning when dealing with RSSC problems. Experimental results, conducted using three large-scale benchmark data sets, demonstrate that our newly proposed SCCov network exhibits very competitive or superior classification performance when compared with the current state-of-the-art RSSC techniques, using a much lower amount of parameters. Specifically, our SCCov only needs 10% of the parameters used by its counterparts.

Impact of telemedicine on assisted reproduction treatment in the public health system

AIM

Telemedicine has helped to make health care more efficient. However, to date no studies have measured its impact on infertility and fertility healthcare. We assessed the potential care benefits and clinical advantages of an initiative implementing electronic patient portal (EPP) for patients scheduled to undergo assisted reproduction treatment, to reduce waiting times for medical consultation and treatment.

METHODS

This was designed as a retrospective cohort study. The experimental group comprised 1972 referral requests received by the assisted reproduction unit of our institution between 2015 and 2016, which were included in the group receiving telemedicine, while the control group was defined by 283 requests received in 2013, all of which were assigned face-to-face care.

RESULTS

We found a statistically significant reduction in the experimental group in terms of the days elapsed between the receipt of the assessment request and the first outpatient visit (68 days vs. 180 days, p<.001). Time to initiation of treatment was also significantly lower in this group (169 days vs. 229 days; p<.001). The experimental group contained around 7 times as many patients receiving treatment as the control group. No differences were observed in the pregnancy rate (29.9% vs. 31.1%; p=.77) or in the complication rate (3.2% vs. 0%; p=.16).

CONCLUSIONS

Use of telemedicine in electronic portal patient form reduces the total waiting time involved in patient requests for infertility treatment and indirectly increases the number of patients treated, causing no negative impact on treatment outcome.

The Role of Three-Dimensional Endoanal Ultrasound on Diagnosis and Classification of Sphincter Defects After Childbirth

BACKGROUND

Diagnostic tests for fecal incontinence have been improved over time. This study aims to evaluate the role of Three-dimensional endoanal ultrasound (3D-EUS) and the Starck's score in the assessment and treatment of obstetric sphincter injuries.

METHODS

A prospective observational study was performed including primiparous women who were evaluated at 20 wk of pregnancy and 3 mo after childbirth. Sphincter defects were classified according to the Starck's and Obstetrical Anal Sphincter Injuries classifications. Patients also completed the Fecal Incontinence Quality of Life and the Wexner questionnaires before and after childbirth.

RESULTS

Sphincter defects were detected in 45% of the 56 women included, although 85% had an uneventful delivery. Most defects were found isolated to the external anal sphincter except for two cases, classified by a Starck's score >8. Fecal Incontinence Quality of Life and Wexner questionnaires showed a rate of symptomatic patients of around 46%. We observed that 30% of patients with sphincter injuries remained asymptomatic.

CONCLUSIONS

The 3D-EUS is a useful test in assessing sphincter defects after childbirth. This method makes it possible to detect small sphincter defects that otherwise would have gone unnoticed, as 30% of patients with sphincter injuries were asymptomatic. In addition, both the 3D-EUS and the Starck's score were valuable in establishing an algorithm for the treatment of obstetric sphincter injuries.

Multidisciplinary Consensus on the Nonadherence to Clinical Management of Inhaled Therapy in Spanish asthma patients

PURPOSE

Rates of nonadherence to asthma treatment in Spain are between 24% and 76%, which results in poor disease control and increased health care costs. The main objective of this multidisciplinary consensus was to investigate the opinions of health professionals and patients regarding adherence to inhaled therapy in Spain. The results will help to identify the causes of nonadherence and to establish strategies to detect and correct the problem.

METHODS

This research was conducted by using a modified Delphi method organized into 2 rounds and involving a panel of 64 physicians, 16 nurses, and 10 community pharmacists. In addition, 70 patients with asthma completed a simplified 1-round survey, based on the Delphi questionnaire. The items proposed to reach a consensus included topics such as impact and causes of nonadherence, as well as strategies to improve adherence to treatment.

FINDINGS

Expert panelists reached a consensus on ~80% of the items proposed. They agreed that the lack of control in asthma has an important economic impact. The causes of nonadherence with more agreement were the patients' beliefs about treatment and the complexity of the inhalation devices. Panelists agreed that the most important strategies to improve adherence were modification of patients' beliefs, training of professionals in the management of adherence, and personalization of interventions. Most patients only agreed with items that referred to strategies to improve adherence.

IMPLICATIONS

Although the problems, impact, causes, and interventions regarding nonadherence to asthma treatment are known, adequate monitoring of adherence to treatment is not performed. A multidisciplinary and personalized approach is necessary to control and improve adherence.

Activation of the Prostaglandin E2 receptor EP2 prevents house dust mite-induced airway hyperresponsiveness and inflammation by restraining mast cells' activity

BACKGROUND

Prostaglandin E2 (PGE2 ) has been proposed to exert antiasthmatic effects in patients, to prevent antigen-induced airway pathology in murine models, and to inhibit mast cells (MC) activity in vitro.

OBJECTIVE

To assess in a murine model whether the protective effect of PGE2 may be a consequence of its ability to activate the E-prostanoid (EP)2 receptor on airway MC.

METHODS

Either BALB/c or C57BL/6 mice were exposed intranasally (i.n.) to house dust mite (HDM) aeroallergens. Both strains were given PGE2 locally (0.3 mg/kg), but only BALB/c mice were administered butaprost (EP2 agonist: 0.3 mg/kg), or AH6809 (EP2 antagonist; 2.5 mg/kg) combined with the MC stabilizer sodium cromoglycate (SCG: 25 mg/kg). Airway hyperresponsiveness (AHR) and inflammation, along with lung MC activity, were evaluated. In addition, butaprost's effect was assessed in MC-mediated passive cutaneous anaphylaxis (PCA) in mice challenged with 2,4-dinitrophenol (DNP).

RESULTS

Selective EP2 agonism attenuated aeroallergen-caused AHR and inflammation in HDM-exposed BALB/c mice, and this correlated with a reduced lung MC activity. Accordingly, the blockade of endogenous PGE2 by means of AH6809 worsened airway responsiveness in sensitive BALB/c mice, and such worsening was reversed by SCG. The relevance of MC to PGE2 -EP2 driven protection was further highlighted in MC-dependent PCA, where butaprost fully prevented MC-induced ear swelling. Unlike in BALB/c mice, PGE2 did not protect the airways of HDM-sensitized C57BL/6 animals, a strain in which we showed MC to be irrelevant to aeroallergen-driven AHR and inflammation.

CONCLUSIONS & CLINICAL RELEVANCE

The beneficial effect of both exogenous and endogenous PGE2 in aeroallergen-sensitized mice may be attributable to the activation of the EP2 receptor, which in turn acts as a restrainer of airway MC activity. This opens a path towards the identification of therapeutic targets against asthma along the 'EP2 -MC-airway' axis.

Fetal Genotyping in Maternal Blood by Digital PCR: Towards NIPD of Monogenic Disorders Independently of Parental Origin

PURPOSE

To date, non-invasive prenatal diagnosis (NIPD) of monogenic disorders has been limited to cases with a paternal origin. This work shows a validation study of the Droplet Digital PCR (ddPCR) technology for analysis of both paternally and maternally inherited fetal alleles. For the purpose, single nucleotide polymorphisms (SNPs) were studied with the only intention to mimic monogenic disorders.

METHODS

NIPD SNP genotyping was performed by ddPCR in 55 maternal plasma samples. In 19 out of 55 cases, inheritance of the paternal allele was determined by presence/absence criteria. In the remaining 36, determination of the maternally inherited fetal allele was performed by relative mutation dosage (RMD) analysis.

RESULTS

ddPCR exhibited 100% accuracy for detection of paternal alleles. For diagnosis of fetal alleles with maternal origin by RMD analysis, the technology showed an accuracy of 96%. Twenty-nine out of 36 were correctly diagnosed. There was one FP and six maternal plasma samples that could not be diagnosed.

DISCUSSION

In this study, ddPCR has shown to be capable to detect both paternal and maternal fetal alleles in maternal plasma. This represents a step forward towards the introduction of NIPD for all pregnancies independently of the parental origin of the disease.

Overview of Five-Years of Experience Performing Non-Invasive Fetal Sex Assessment in Maternal Blood

Since the discovery of the presence of fetal DNA in maternal blood, non-invasive fetal sex determination has been the test most widely translated into clinical practice. To date there is no agreement between the different laboratories performing such tests in relation to which is the best protocol. As a consequence there are almost as many protocols as laboratories offering the service, using different methodologies and thus obtaining different diagnostic accuracies. By the end of 2007, after a validation study performed in 316 maternal samples collected between the 5th and 12th week of gestation, the fetal sex determination was incorporated into clinical practice in our Service. The test is performed in the first trimester of pregnancy, and it is offered as part of the genetic counseling process for couples at risk of X-linked disorders. As a general rule and in order to avoid misdiagnosis, two samples at different gestational ages are tested per patient. The analysis is performed by the study of the SRY gene by RT-PCR. Two hundred and twenty six pregnancies have been tested so far in these 5 years. Neither false positives nor false negatives diagnoses have been registered, thus giving a diagnostic accuracy of 100%.

Effects of fructooligosaccharides on cecum polyamine concentration and gut maturation in early-weaned piglets

Polyamines are molecules involved in cell growth and differentiation and are produced by bacterial metabolism. However, their production and effects by the microbiota selected by fructooligosaccharides consumption are controversial. In this study, we investigated the influence of supplementation of fructooligosaccharides on the cecal polyamine production by the microflora selected, and its effect on gut maturation in newborn piglets. Twenty piglets were fed a control formula (n = 10) or a formula supplemented with fructooligosaccharides (8 g/l) (n = 10) for 13 days. Colony-forming unit's count of cecal content was done in different media. Several intestinal development parameters were measured as well as the polyamine concentration in the cecal mucosa and cecal content. A dose-dependent study on in vitro polyamine production by fructooligosaccharides addition to the isolated cecal content was performed. Bifidogenic activity of fructooligosaccharides increased polyamine concentration in the cecal content, mainly putrescine, with no beneficial effect on gut maturation. Bifidobacterium spp. were able to produce polyamines, but they were not the most significant bacterial producer of polyamines in the cecum of piglets fed fructooligosaccharides. Bifidogenic activity of fructooligosaccharides did not lead to an increase in gut maturation in piglets of 15 days of age although polyamines were increased in the cecal content.

Significance of the volume of fetomaternal hemorrhage after performing prenatal invasive tests

BACKGROUND

Fetal erythrocytes cross the placenta during gestation, but invasive prenatal procedures might develop into fetomaternal hemorrhage (FMH). We examine whether flow cytometry immunophenotyping might be useful for measuring the volume of FMH after such procedures.

METHODS

Fetal erythrocytes (%) were determined in 153 pregnant women after amniocentesis (129) and chorionic villous sampling (24) using a monoclonal antibody against fetal hemoglobin. Fetal erythrocytes were identified for their high expression of fetal hemoglobin (HbF(++) ). Blood samples from two control groups, 53 healthy males and 21 pregnant women not submitted to invasive tests, were used to establish normal values of circulating HbF(++) erythrocytes in adults.

RESULTS

The highest percentage of HbF(++) erythrocytes in the control groups was 0.015%. The rate of HbF(++) erythrocytes in samples after invasive tests ranged between <0.01% and 0.15%. Seventy-three women (47%) had ≤0.015% HbF(++) erythrocytes, and this rate was higher in 80. Nine women presented >1 ml of FMH (volume of packed cells corresponding to 0.054-0.15% HbF(++) erythrocytes), but only two had sonographic evidence of bleeding.

CONCLUSIONS

Most women in our series had a very low volume of FMH after the invasive tests. Acute bleeding should be thoroughly investigated in women with either more than 1 ml of packed cells or more than 0.05% of HbF(++) erythrocytes. Intermediate values between >0.015% and <0.05%, should be carefully considered depending on the week of gestation. Data obtained before 15 weeks might reflect previous cell trafficking between fetus and mother instead of acute hemorrhage.

Effects of dietary polyamines at physiologic doses in early-weaned piglets

OBJECTIVE

Polyamines are essential for many cell functions, and they form part of the composition of maternal milk; despite this, their addition to infant formulas is currently under evaluation. The aim of the present study was to evaluate the effects of milk formulas designed to resemble sow milk supplemented with polyamines at maternal physiologic milk doses on the gut maturation of early-weaned piglets.

METHODS

We fed 30 newborn piglets with maternal milk (n=10), a control milk formula (n=10), or a milk formula supplemented with polyamines (5 nmol/mL of spermine and 20 nmol/mL of spermidine, n=10) for 13 d (day 2 after birth through day 15). Several growth and intestinal development parameters were measured.

RESULTS

The piglets fed the formula containing polyamine at physiologic doses showed significantly increased crypt depth in the small intestine compared with those fed with the control formula. Villus length was correlated to crypt depth. Although there were no differences in the disaccharidase activities between the animals fed the two formulas, alkaline phosphatase and gamma-glutamyl transferase activities tended to be higher in the jejunum of those fed the polyamine-supplemented diet. Dietary polyamines did not significantly modify the gut mucosal concentrations of putrescine, spermine, or spermidine.

CONCLUSION

Milk formulas supplemented with polyamines at maternal milk physiologic doses slightly enhanced gut growth and maturation in neonatal piglets.

Multi-channel morphological profiles for classification of hyperspectral images using support vector machines

Hyperspectral imaging is a new remote sensing technique that generates hundreds of images, corresponding to different wavelength channels, for the same area on the surface of the Earth. Supervised classification of hyperspectral image data sets is a challenging problem due to the limited availability of training samples (which are very difficult and costly to obtain in practice) and the extremely high dimensionality of the data. In this paper, we explore the use of multi-channel morphological profiles for feature extraction prior to classification of remotely sensed hyperspectral data sets using support vector machines (SVMs). In order to introduce multi-channel morphological transformations, which rely on ordering of pixel vectors in multidimensional space, several vector ordering strategies are investigated. A reduced implementation which builds the multi-channel morphological profile based on the first components resulting from a dimensional reduction transformation applied to the input data is also proposed. Our experimental results, conducted using three representative hyperspectral data sets collected by NASA's Airborne Visible-Infrared Imaging Spectrometer (AVIRIS) sensor and the German Digital Airborne Imaging Spectrometer (DAIS 7915), reveal that multi-channel morphological profiles can improve single-channel morphological profiles in the task of extracting relevant features for classification of hyperspectral data using small training sets.

Previous antimalarial therapy in patients diagnosed with lupus nephritis: influence on outcomes and survival

The aim of this study was to analyze the effect of exposure to antimalarial drugs at diagnosis of lupus nephritis on the outcome of the disease, especially renal failure, comorbid processes, and survival. We analyzed a cohort of 206 consecutive patients with biopsy-proven lupus nephritis. Renal biopsies were categorized according to the classification proposed by the ISN/RPS in 2003. Exposure to antimalarial drugs (chloroquine and hydroxychloroquine) was defined as the use of these drugs before the diagnosis of lupus nephritis independent of dose and duration. Fifty-six (27%) patients had received antimalarials before the diagnosis of lupus nephritis. During the follow-up, these patients had a lower frequency of creatinine values >4 mg/dL (2% vs 11%, P = 0.029) and end-stage renal failure (2% vs 11%, P = 0.044) in comparison with those never treated with antimalarials. Patients exposed to antimalarials also had a lower frequency of hypertension (32% vs 50%, P = 0.027), infections (11% vs 29%, P = 0.006), and thrombotic events (5% vs 17%, P = 0.039). Twenty patients (10%) died during the study period. Patients exposed to antimalarials had a lower mortality rate at the end of the follow-up (2% vs 13% for those not exposed to antimalarials, P = 0.029). Multivariate analysis identified thrombosis and infections as statistically significant independent variables. Kaplan-Meier plots showed a lower rate of end-stage renal failure (log rank = 0.04) in patients exposed to antimalarials. In conclusion, exposure to antimalarials before the diagnosis of lupus nephritis was negatively associated with the development of renal failure, hypertension, thrombosis and infection, and with a better survival rate at the end of the follow-up. This, together with other published data, suggests that antimalarials should be considered a mandatory therapeutic option in all patients diagnosed with systemic lupus erythematosus.

Foetal sex determination in maternal blood from the seventh week of gestation and its role in diagnosing haemophilia in the foetuses of female carriers

The existence of foetal DNA in maternal blood, discovered in 1997, opened new possibilities for noninvasive prenatal diagnosis. This includes foetal sex assessment by the detection of specific Y chromosome sequences in maternal blood, particularly important when a foetus may be affected by an X-linked disorder such as haemophilia. This study aims to validate this sex assessment method and to test its clinical utility in the diagnosis of 15 potentially affected pregnancies in female carriers of haemophilia. In the validation study, 316 maternal blood samples from 196 pregnant women at gestations ranging from 5 weeks to 12 weeks were analysed. In the clinical study, 15 pregnancies at risk of having a haemophilic foetus were tested. All pregnancies in the validation study were correctly diagnosed. The accuracy and specificity of the methodology from the seventh week of gestation was 100%. The sex of all 15 pregnancies identified as being at risk of bearing a haemophilic foetus was correctly diagnosed. Foetal sex assessment by detecting specific Y chromosome sequences in maternal blood is now routinely used in our hospital because of its high accuracy from the seventh week of gestation. Reliable foetal gender determination from maternal blood of pregnant women carriers of haemophilia in the first trimester of gestation can avoid more conventional, invasive methods of prenatal diagnosis.

Double heterozygosity polymorphisms for platelet glycoproteins Ia/IIa and IIb/IIIa increases arterial thrombosis and arteriosclerosis in patients with the antiphospholipid syndrome or with systemic lupus erythematosus

OBJECTIVE

We analysed the genetic polymorphisms in platelet glycoproteins (GP) Ib-alpha, Ia/IIa and IIb/IIIa and their correlation with the development of arterial thrombosis and preclinical arteriosclerosis in patients with antiphospholipid syndrome (APS) or with systemic lupus erythematosus (SLE).

METHODS

We included 131 patients with APS (86 with primary APS and 45 with APS associated with SLE), 102 patients with SLE and 160 healthy controls. GP Ib-alpha VNTR polymorphism, GP Ia/IIa 807 C/T polymorphism and GP IIb/IIIa PlA1/2 polymorphism were determined by polymerase chain reaction. Thrombotic events were assessed clinically and confirmed by objective methods. The presence of preclinical arteriosclerosis was evaluated by a carotid ultrasound study in a subgroup of 70 patients with SLE measuring the intima-media wall thickness and the presence of arteriosclerotic plaque.

RESULTS

A total of 50 episodes of arterial thrombosis in 36 patients with APS have been registered. We found a significant correlation between the 807 T/T genotype of GP Ia/IIa and arterial thrombosis (22% vs 7%, p = 0.04; OR 3.59, 95% CI 1.20 to 10.79). The VNTR Ib-alpha and P1A1/2 IIb/IIIa polymorphisms were not associated with arterial thrombosis in patients with APS when individually analysed. The coexistence of both 807 T and PlA2 alleles increased the arterial thrombosis risk (28% vs 7%, p = 0.005; OR 4.84, 95% CI 1.67 to 13.96). In patients with SLE, no relationship was found between the presence of carotid arteriosclerotic plaque and separate polymorphisms of platelet GP. The coexistence of alleles 807 T of GP Ia/IIa and PlA2 of GP IIb/IIIa was associated with the presence of carotid plaque (35% vs 4%, p = 0.002; OR 12.92, 95% CI 2.39 to 69.81).

CONCLUSIONS

The T/T genotype of 807 C/T polymorphism of GP Ia/IIa may be an additional risk for the development of arterial thrombosis in APS. The coexistence of both 807 T and PlA2 alleles increased the arterial thrombosis risk in patients with APS and preclinical arteriosclerosis in patients with SLE.

Intraoperative intraperitoneal (IP) chemotherapy with cisplatin and escalated dose of epinephrine in patient with recurrent peritoneal carcinomatosis of ovarian cancer: A phase I study

16019

Background: IP epinephrine (E) has been shown to enhance the accumulation and antitumor activity of IP cisplatin in rats with peritoneal carcinomatosis (Duvillard et al. Int J Cancer, 1999). E induces a vasoconstriction of peritoneal vascular bed which limits platin peritoneal leakage and enhances drug penetration into tumor nodules. Results of a phase I study with the association of IP E and IP cisplatin in patient with refractory peritoneal carcinomatosis has been reported (Molucon-Chabrot et al, Anticancer Drugs, 2006). We conducted a phase I study to evaluate intraoperative IP chemotherapy with the association of cisplatin and escalated dose of E. Methods: 18 patients (pts) with recurrent ovarian cancer were enrolled. The median age was 56 years old (range 42–66). After an optimal cytoreductive surgery, IP chemotherapy was performed during surgery by filling twice the peritoneal cavity with 3 liters of an isotonic saline pre heated at 37°C and 90 mg of cisplatin associated with increasing concentrations of E during 1 hour. Results: E was escalated according to the following dosage: 0, 1, 2, 3 mg/L (3 pts by step). No toxicity was observed during and after intraoperative IP chemotherapy in the first 10 patients. The 2nd patient included in the 3 mg/L level of E experienced a tachycardia ≥ 120/min, ventricular extrasystoles (VES) ≥ 2/min, increase of troponine plasmatic concentration without significant electric sign of cardiac ischemia. The 3rd patient at this level experienced a tachycardia ≥ 120/min with ventricular VES ≥ 2/min and no increase of troponine concentration or electric sign of cardiac ischemia. According to the protocol design, 6 additional patients were included in the lower dose of 2 mg/L of E and no toxicity occurred. One can consider that the recommended dose of E was established. Conclusion: The combination of IP E with IP cisplatin in intraoperative chemotherapy after optimal cytoreductive surgery is feasible. The limiting toxicity was the cardiovascular effect which occurred with 3 mg/L dose of E. A phase II-III study is planned to investigate if IP chemotherapy adds to a second look surgery for the initial treatment of stage III ovarian carcinoma.

No significant financial relationships to disclose.

Comparison between experimental and calculated vehicle idle emission factors for Madrid fleet

Experimental vehicle idle emission factors have been compared with calculated factors for 100 vehicles in Madrid. The vehicles were selected according to the distribution (by age and fuel type) of the official, national car fleet (up to 31 December 1997). They were then clustered following the criteria of the Computer Programme to Calculate Emissions from Road Transport (COPERT III) category classification. NO(x) and CO idle emission factors show a wide range of values in each category and an important deviation between the experimental values and the corresponding parameterised ones. Fifteen percent of tested vehicles in this study have been identified as gross emitters generating approximately 50% of the total CO emission volume.

Caspase inhibitors protect against neuronal apoptosis induced by cerebrospinal fluid from multiple sclerosis patients

Neuronal apoptosis has recently been implicated in multiple sclerosis (MS). Apoptotic cell death of neurons is induced in cultures exposed to cerebrospinal fluid (CSF) from MS patients. Since caspases are essential in the regulation of apoptosis, direct evidence was sought linking caspases to CSF-induced neuronal death. Caspase activity was measured in cell extracts from MS CSF-treated cultured neurons by the cleavage of caspase-1 and caspase-3 substrates. Caspase-3 activity, but not caspase-1, was induced in neuronal cultures in response to MS CSF treatment. This caspase-3 activity was inhibited in vitro by Ac-YVAD-cmk and Ac-DEVD-cmk caspase inhibitors. Treatment of MS CSF-incubated neuronal cells with these caspase inhibitors completely preserved neuronal survival and largely attenuated DNA fragmentation detected in situ. These findings show that neuronal cells are rescued from MS CSF-induced death by caspase inhibitors and suggest ways to treat MS.

Intrathecal IgM synthesis predicts the onset of new relapses and a worse disease course in MS

BACKGROUND

The authors have recently described that intrathecal IgM synthesis (ITMS) correlates with a higher disability in patients with clinically definite MS (CDMS).

OBJECTIVE

To follow-up a group of patients with MS in the initial stages of the disease to evaluate if the presence of ITMS correlates with a worse evolution.

METHODS

Oligoclonal IgM bands were performed in 22 patients with MS with a mean of 1.14 months of evolution. Patients were followed for a period ranging from 6 to 36 months (mean, 21.4 months). During follow-up, time to conversion to CDMS, number of relapses, and changes in Expanded Disability Status Scale (EDSS) score were evaluated.

RESULTS

Patients were divided into two groups according to the presence (Group 1, 10 patients) or absence (Group 2, 12 patients) of ITMS. No clinical differences were observed between the groups at inclusion in the study. During the follow-up, the probability of conversion to CDMS was greater in Group 1 (90% of the patients had converted to CDMS after 8 months of follow-up) than in Group 2 (51% of patients had converted to CDMS after 36 months of follow-up) (p = 0.0001). Patients from Group 1 had more relapses (mean, 2.0) than those from Group 2 (mean, 0.58) (p = 0.02). At the end of the study, patients from Group 1 had higher EDSS scores (mean, 1.70) than those from Group 2 (mean, 0.79) (p = 0.02).

CONCLUSION

The presence of oligoclonal IgM bands in CSF can be a prognostic marker in the early phases of MS.

Intrathecal IgM synthesis in neurologic diseases: relationship with disability in MS

The authors studied the intrathecal IgM synthesis (ITMS) in paired sera and CSF samples from 65 patients with MS, 28 with CNS infection, 40 with other neurologic diseases and eight control subjects. ITMS was found in 30 patients with MS and in 20 with CNS infection, but not in patients with other neurologic diseases or in control subjects. In infectious samples, the ITMS is likely a primary response. In MS group, it was associated with higher Expanded Disability Status Scale index (p = 0.017).

Vertebral osteomyelitis due to Pasteurella aerogenes

A case of C6-C7 vertebral osteomyelitis due to Pasteurella aerogenes in a previously healthy 62-y-old man in the absence of any history of animal exposure, debilitating disease or immunosuppression is reported. Culture testing of biopsy samples of the vertebral body using the panels and database of the BBL Crystal enteric/non-fermenter system revealed that the infecting bacterium was P. aerogenes. Treatment with cloxacillin and gentamicin was followed by resolution of bone infection on serial follow-up magnetic resonance imaging scans. Pasteurellae are primarily animal pathogens but are capable of producing a variety of local and systemic diseases in humans.

What happened to our free bioethics search service? The terrible and premature death of BIOETHICSLINE

BIOETHICSLINE, in existence from 1973 thorough 2000, was a bibliographic database covering the English-language literature on bioethical issues. It reflected the cross-disciplinary field of bioethics. During 2001, the National Library of Medicine is expected to dismantle BIOETHICSLINE and incorporate its data into two of their other databases, PubMed and LOCATORplus. Once this is completed, BIOETHICSLINE, as a unified database, will be discontinued. The users of BIOETHICSLINE will no longer have access to this important and useful resource specifically targeted to the vocabulary and cross-disciplinary nature of the bioethics literature. As a scholar and student of bioethics, and as a trained and former reference librarian, I feel it is important to examine these changes and their consequences. There are good reasons to integrate BIOETHICSLINE into these other databases on the NLM Gateway, but I argue that, in addition this integration, BIOETHICSLINE should be continued as a distinct database.

Decline of met-enkephalins concentration after interleukin-2 subcutaneous administration due to renal carcinoma

The authors have described the connections between nervous and immune systems. Endogenous opioids are one of the factors linking both systems. Endogenous and exogenous opioids can modify the function of interferons, humoral factors, antibody production and lymphocytes' activation. Concurrently, some cytokines can modify the endogenous opioid system. The aim of this study was to asses whether the subcutaneous administration of IL-2 influences the Met-Enkephalins concentration in serum after IL-2 single administration due to renal cancer. The Met-Enk level was estimated with RIA method. The IL-2 single administration results in a significant decrease of Met-Enk in serum.

[Development of Escherichia coli strands resistant to quinolones in stools of patients with liver cirrhosis submitted to selective bowel decontamination]

BACKGROUND

Selective intestinal decontamination (SID) with norfloxacin in patients with cirrhosis may promote the development of quinolone-resistant (QR) gram-negative bacteria in stools. It is not known wether this fact may become a predisposing factor for the development of infections due to these bacteria.

MATERIAL AND METHODS

We designed a prospective study to evaluate the incidence of Escherichia coli in stools at admission in patients with cirrhosis that had previously received norfloxacin as primary or secondary prophylaxis of spontaneous bacterial peritonitis (SBP) (group I, n = 28) vs those who did not (group II, n = 55).

RESULTS

QR strains of E. coli were observed in 37.5 and in 1.47% of patients from groups I and II, respectively (p < 0.001). During admission, 36 patients underwent norfloxacin prophylaxis (group III), and 40 did not (group IV). Eleven patients from group III and one patient from group IV showed QR E. coli in stools. We observed 5 bacterial infections in group III and 14 in group IV (p = 0.0039). No patient with QR E. coli in stools developed infections due to this bacteria.

CONCLUSION

The incidence of QR E. coli in stools of patients with cirrhosis is significantly increased in patients previously treated with prophylactic norfloxacin. However, this fact seems not to be associated with an increment in the prevalence of QR E. coli infections.

DA1-receptor stimulation by fenoldopam in the treatment of postcardiac surgical hypertension

BACKGROUND

Besides adequate analgesia, sedation and ventilation, postcardiac surgical hypertension has to be treated frequently with vasoactive drugs to avoid possible complications. In this study the hemodynamic effects of the DA1-receptor agonist fenoldopam (F) are compared to those of the Ca-channel antagonist nifedipine (N).

METHODS

Postoperatively, 64 CABG-patients with a mean arterial pressure (MAP) of more than 105 mmHg over 10 min were investigated. Patients with compromised ventricular function, insufficient surgical repair, arrhythmia or an ECG unable to detect myocardial ischemia were excluded. The study drugs (initial dosage: F: 0.8; N: 0.3 micrograms.kg-1.min-1) were given continuously via a central venous catheter to reduce and to maintain the MAP between 80 and 95 mmHg. Hemodynamic parameters were determined using thermodilution technique.

RESULTS

A significant reduction of the MAP (F: from 121 +/- 11 to 83 +/- 4, N: from 119 +/- 8 to 82 +/- 9 mmHg) and of the calculated systemic vascular resistance (SVR) (F: 2110 +/- 500 to 970 +/- 200, N:1980 +/- 660 to 1020 +/- 300 dyn.s.cm-5) were noted in both groups, whereby in the F group the therapeutic goal could be achieved more quickly with the dosage regimen chosen. As a result, a marked increase of heart rate, cardiac index and stroke volume index could be observed, which was more pronounced due to the initially stronger decrease of SVR with F. There was also a stronger decrease of pulmonary vascular resistance in the F group, but the indices of right ventricular function did not differ between the groups.

CONCLUSION

Fenoldopam seems to be an efficient alternative to nifedipine, especially because of its more rapid onset of action.