Soluble meso and deuteroporphyrin analogs of the malaria pigment hematin anhydride

Two soluble heme analogs of the insoluble malaria pigment hematin anhydride (HA, or β-hematin), [Fe(III)(protoporphyrin)]2, with either mesoporphyrin (MHA) or deuteroporphyrin (DHA) are characterized by elemental analysis, SEM, IR spectroscopy, electronic spectroscopy, paramagnetic 1H NMR spectroscopy and solution magnetic susceptibility. While prior single crystal and X-ray powder diffraction results indicate all three have a common propionate linked dimer motif, there is considerable solid state variation in the conformation. This is associated with enhanced solubility of MHA and DHA. As with HA, DHA undergoes thermally promoted reversible hydration/dehydration in the solid state. Solution 1H NMR studies of DHA suggest a high spin dimeric structure with the porphyrin methyls distributed between two isomers which are also present in the solid state. These soluble iron(III)porphyrin dimers allow for the first direct solution studies by NMR and UV-Vis spectroscopies of these key species. Taken together the results illustrate the importance and utility of varying the substituents on the periphery of the porphyrin for studying heme aggregation and malaria pigment formation.

Irradiation dose does not affect male reproductive organ size, sperm storage, and female remating propensity in Ceratitis capitata

The Mediterranean fruit fly Ceratitis capitata is a globally invasive pest, often controlled with the sterile insect technique (SIT). For the SIT, mass-rearing of the target insect followed by irradiation are imperatives. Sterile males are often less able to inhibit female remating and transfer less number of sperm, and even irradiation could affect male reproductive organs, with consequences for their ability to inhibit female remating. On the other hand, male age could affect their ability to modulate female response after mating. Here, we evaluated the quality of the genetic sexing strain Vienna-8-tsl mass-reared in Bioplanta San Juan, Argentina, under laboratory conditions, with regard to: (i) the ability of sterile males irradiated at 100 or 140 Gy to inhibit female remating, in the same day and at 24 h of first copulation; (ii) the ability of 3, 4 or 5 day-old sterile males to inhibit female remating at 24 h of first copulation, and (iii) the effect of a reduction in irradiation doses on the number of sperm stored by females and reproductive organ size in virgin males. Sterile males were better able than wild males to inhibit female remating in the same day of first copulation and as able as wild males 1 day after first copulation. Male age did not affect their ability to inhibit female receptivity. Number of sperm stored by females, testes size and ectodermal accessory glands size were not affected by male identity, while sterile 100 Gy males had larger mesodermal accessory glands than control lab males. A reduction in irradiation dose does not impact any variable measured, except for percentage of sperm-depleted females: females mated with sterile 100 Gy males had lower probabilities to store sperm. The results showed here are very encouraging for tsl Vienna 8 strain reared in Argentina and are discussed in comparison with previous studies in C. capitata female remating with dissimilar results.

Significant differences in access to tests and treatments for multiple myeloma between public and private systems in Latin America. Results of a Latin American survey. GELAMM (Grupo de Estudio Latino Americano de Mieloma Múltiple)

The incidence of multiple myeloma (MM) has increased in the last 20 years, particularly in middle and low-middle income countries. Access to diagnostic and prognostic tests and the availability of effective care is highly variable globally. Latin America represents 10% of the world population, distributed in countries of varied size, population, and socio-economic development. In the last decade, great improvements have been made in the diagnosis and treatment of MM. Applying these advances in real life is a challenge in our region. Local data regarding MM standards of care and outcomes are limited. A survey was carried out among hematologists from 15 Latin American countries to describe access to MM diagnostic and prognostic tests and the availability of effective care options. This study provides real-world data for MM in our region, highlighting striking differences between public and private access to essential analyses and therapeutic options.

Hydrating the Bispropionate Notch in Malaria Pigment: A New Structural Motif in the Iron(III)(deuteroporphyrin) Dimer

Treating deuterohemin, chloro(deuteroporphyrinato)iron(III), with a non-coordinating base in DMSO/methanol allows for the isolation of [(deuteroporphyrinato)iron(III)]₂ , deuterohematin anhydride (DHA), an analogue of malaria pigment, the natural product of heme detoxification by malaria. The structure of DHA obtained from this solvent system has been solved by X-ray powder diffraction analysis and displays many similarities, yet important structural differences, to malaria pigment. Most notably, a water molecule of solvation occupies a notch created by the propionate side chains and stabilizes a markedly bent propionate ligand coordinated with a long Fe-O bond, and a carboxylate cluster associated with water molecules is generated. Together, these features account for its increased solubility and more open structure, with an increased porphyrin-porphyrin separation. The IR spectroscopic signature associated with this structure also accounts for the strong IR band at 1587 cm^-1 seen for many amorphous preparations of synthetic malaria pigment, and it is proposed that stabilizing these structures may be a new objective for antimalarial drugs. The important role of the vinyl substituents in this biochemistry is further demonstrated by the structure of deuterohemin obtained by single-crystal X-ray diffraction analysis.

Synchronous Presentation of an Askin Tumor and a Plasmacytoma in an Adult Patient

Askin tumor, or malignant small round cell tumor of the thoracopulmonary region, is an extremely infrequent entity occurring primarily in children and adolescents. Its histopathologic and cytogenetic features suggest that it belongs to the family of Ewing's sarcoma and primitive neuroectodermal tumors.

We report the case of a 43-year-old woman affected by an Askin tumor with bone metastases at diagnosis, presenting synchronously with a plasmacytoma. This is the first reported case of the simultaneous occurrence of an Askin tumor and a malignant hemopathy. The progression of the former and the remission of the plasmacytoma during chemotherapy were remarkable, since Askin tumor treatment shares drugs used for the treatment of plasma cell tumors. Given the infrequent presentation of these diseases in a young adult and the coexistence of two neoplasias characterized by typical chromosomal abnormalities, we consider the possibility of a genetic cancer susceptibility in our patient.

Father’s Perceptions of their Role and Involvement in the Family: A Qualitative Study in a Colombian Sample / Percepciones del padre sobre su rol e involucramiento en la familia: un estudio cualitativo en una muestra colombiana

EnglishThe purpose of this study was to explore fathers’ perceptions about their role in the family, and the characteristics of their involvement in their children’s lives in the Colombian context. The sample consisted of 12 Colombian fathers. The study used a qualitative methodology, one-hour in depth interviews were conducted with the participants. Results indicated important changes in the role of fathers and mothers in Colombian families. Fathers’ perceptions departed to some extent from the traditional pattern attributed to nuclear families, where men are considered as the only economic provider and authority figure in the family. This departure places fathers in a category we would call “in transition”, which includes perceptions of more equitable parental roles within the family and a combination of features from other typologies of fatherhood proposed in the literature. Fathers also reported a desire to participate more at home and to be more involved in their children’s lives; they also emphasized the importance of expressing love and affection to their children. Work-family conflict and the impact of the quality of the father-child relationship emerged as important categories in the fathers’ perceptions of their role and involvement in the family. In Colombia research on fathers is scarce and family policies mainly focus on mothers as the principal caregiver. A better understanding of fathers’ roles and involvement in the family and with children will contribute to the development of programs and policies oriented toward all family members and family relationship systems.EspañolEl propósito de este estudio fue explorar las percepciones de los padres sobre su rol en la familia y las características de su involucramiento en la vida de los hijos en el contexto colombiano. La muestra estuvo conformada por 12 padres colombianos. El estudio siguió una metodología cualitativa en la cual se llevaron a cabo entrevistas en profundidad de una hora de duración con los participantes. Los resultados indicaron cambios importantes en el rol de los padres y las madres en las familias colombianas. Las percepciones de los padres se alejaron en alguna medida del patrón tradicional atribuido a las familias nucleares en las cuales los hombres son considerados como los proveedores exclusivos y las figuras de autoridad de la familia. Esta separación ubica a los padres en una categoría que nosotros llamaríamos “en transición”, la cual incluye percepciones de roles parentales más equitativos dentro de la familia y una combinación de rasgos de otras tipologías de la paternidad propuestos en la literatura. Los padres también reportaron un deseo por participar más en sus hogares y por estar más involucrados en la vida de sus hijos. Adicionalmente, ellos enfatizaron en la importancia de expresar amor y afecto a sus hijos. El conflicto entre el trabajo y la familia y el impacto de la calidad de la relación padre-hijo emergieron como categorías fundamentales en las percepciones de los padres sobre su rol e involucramiento en la familia. En Colombia, la investigación sobre los papás es escasa y las políticas de familia se centran principalmente en las madres como cuidadoras principales. Una mayor comprensión del rol de los papás y de su involucramiento en la familia y con los hijos contribuirá al desarrollo de programas y las políticas orientadas hacia todos los miembros de la familia y hacia los diferentes sistemas de relación en el contexto familiar.

Naturally occurring heavy radioactive elements in the geothermal microcosm of the Los Azufres (Mexico) volcanic complex

The Los Azufres geothermal complex of central Mexico is characterized by fumaroles and boiling hot-springs. The fumaroles form habitats for extremophilic mosses and ferns. Physico-chemical measurements of two relatively pristine fumarolic microcosms point to their resemblance with the paleo-environment of earth during the Ordovician and Devonian periods. These geothermal habitats were analysed for the distribution of elemental mass fractions in the rhizospheric soil (RS), the native volcanic substrate (VS) and the sediments (S), using the new high-sensitivity technique of polarized x-ray energy dispersive fluorescence spectrometry (PEDXRF) as well as instrumental neutron activation analysis (INAA) for selected elements. This work presents the results for the naturally occurring heavy radioactive elements (NOHRE) Bi, Th and U but principally the latter two. For the RS, the density was found to be the least and the total organic matter content the most. Bi was found to be negligibly present in all substrate types. The average Th and U mass fractions in the RS were higher than in the VS and about equal to their average mass fractions in the S. The VS mass fraction of Th was higher, and of U lower, than the mass fractions in the earth's crust. In fact for the fumaroles of one site, the average RS mass fractions of these elements were higher than the averaged values for S (without considering the statistical dispersion). The immobilization of the NOHRE in the RS is brought about by the bio-geochemical processes specific to these extremophiles. Its effectiveness is such that despite the small masses of these plants, it compares with, or may sometimes exceed, the immobilization of the NOHRE in the S by the abiotic and aggressive chemical action of the hot-springs. These results indicate that the fumarolic plants are able to transform the volcanic substrate to soil and to affect the NOHRE mass fractions even though these elements are not plant nutrients. Mirrored back to the paleo times when such plant types were ubiquitous, it would mean that the first plants contributed significantly to pedogenesis and the biogeochemical recycling of even the heaviest and radioactive elements. Such plants may potentially be useful for the phytostabilisation of soil moderately contaminated by the NOHRE. Furthermore where applicable, geochronology may require taking into account the influence of the early plants on the NOHRE distributions.

Personal exposure to particulate matter in commuters using different transport modes (bus, bicycle, car and subway) in an assigned route in downtown Santiago, Chile

The objective of this study was to compare personal exposure to particulate matter (fine and ultrafine particles) in commuters using different transport modes (bicycle, bus, car and subway) in a busy, assigned route in downtown Santiago, Chile. Volunteers carrying personal samplers completed scheduled commutes during the morning rush hours, while central site measurements were conducted in parallel. A total of 137 valid commutes were assessed. The impact of central site, traffic and other variables was explored with regression models. PM2.5 personal concentrations were equal to or slightly above central site measurements, while UFP personal concentrations were above them. Regression models showed impacts of both background levels and traffic emissions on personal PM2.5 and UFP exposure. Traffic impacts varied with transport modes. Estimates of traffic impacts on personal PM2.5 exposure were 2.0, 13.0, 16.9 and 17.5 μg m(-3), for car, bicycle, subway and bus, respectively; while for UFP exposure were 8400, 16 200, 25 600 and 30 100 counts per cm(3), for subway, car, bicycle and bus, respectively. After controlling the central site and transport mode, higher temperatures increased PM2.5 exposure and decreased UFP ones, while the wind direction affected UFP personal exposure. In conclusion, we found significant impacts of both central site background measurements and traffic emissions on personal exposure of volunteer commuters in an assigned route in Santiago, with impacts varying with transport modes.

Adverse events related to gastrointestinal endoscopic procedures in pediatric patients under anesthesia care and a predictive risk model (AEGEP Study)

BACKGROUND

Multiple studies have analyzed perioperative factors related to adverse events (AEs) in children who require gastrointestinal endoscopic procedures (GEP) in settings where deep sedation is the preferred anesthetic technique over general anesthesia (GA) but not for the opposite case.

METHODS

We reviewed our anesthesia institutional database, seeking children less than 12 years who underwent GEP over a 5-year period. A logistic regression was used to determine significant associations between preoperative conditions, characteristics of the procedure, airway management, anesthetic approaches and the presence of serious and non-serious AEs.

RESULTS

GA was preferred over deep sedation [77.8% vs. 22.2% in 2178 GEP under anesthesia care (n=1742)]. We found 96 AEs reported in 77 patients, including hypoxemia (1.82%), bronchospasm (1.14%) and laryngospasm (0.91%) as the most frequent. There were 2 cases of severe bradycardia related to laryngospasm/hypoxemia and a case of aspiration resulting in unplanned hospitalization, but there were no cases of intra- or postoperative deaths. Final predictive model for perioperative AEs included age <1 year, upper respiratory tract infections (URTI) <1 week prior to the procedure and low weight for the age (LWA) as independent risk factors and ventilation by facial mask as a protector against these events (p<0.05).

CONCLUSIONS

AEs are infrequent and severe ones are remote in a setting where AG is preferred over deep sedation. Ventilatory AEs are the most frequent and depend on biometrical and comorbid conditions more than anesthetic drugs chosen. Age <1 year, history of URTI in the week prior to the procedure and LWA work as independent risk factors for AEs in these patients.

Synthesis, characterization, and in vitro antimalarial and antitumor activity of new ruthenium(II) complexes of chloroquine

The new Ru(II) chloroquine complexes [Ru(eta(6)-arene)(CQ)Cl2] (CQ = chloroquine; arene = p-cymene 1, benzene 2), [Ru(eta(6)-p-cymene)(CQ)(H2O)2][BF4]2 (3), [Ru(eta(6)-p-cymene)(CQ)(en)][PF6]2 (en = ethylenediamine) (4), and [Ru(eta(6)-p-cymene)(eta(6)-CQDP)][BF4]2 (5, CQDP = chloroquine diphosphate) have been synthesized and characterized by use of a combination of NMR and FTIR spectroscopy with DFT calculations. Each complex is formed as a single coordination isomer: In 1-4, chloroquine binds to ruthenium in the eta(1)-N mode through the quinoline nitrogen atom, whereas in 5 an unprecedented eta(6) bonding through the carbocyclic ring is observed. 1, 2, 3, and 5 are active against CQ-resistant (Dd2, K1, and W2) and CQ-sensitive (FcB1, PFB, F32, and 3D7) malaria parasites (Plasmodium falciparum); importantly, the potency of these complexes against resistant parasites is consistently higher than that of the standard drug chloroquine diphosphate. 1 and 5 also inhibit the growth of colon cancer cells, independently of the p53 status and of liposarcoma tumor cell lines with the latter showing increased sensitivity, especially to 1 (IC50 8 microM); this is significant because this type of tumor does not respond to currently employed chemotherapies.

Air pollution and seasonal asthma during the pollen season. A cohort study in Puertollano and Ciudad Real (Spain)

BACKGROUND

Many studies have demonstrated a positive association between air pollutants and emergency visits for asthma. However, few studies have included pollen when analysing this relationship in mild-moderate asthmatic patients.

OBJECTIVE

To determine the importance of the pollutants such as ozone (O(3)), particles (PM(10)), nitrogen dioxide (NO(2)) and sulphur dioxide (SO(2)) in the clinical course of mild-moderate pollen-allergic asthmatic patients from two Spanish towns in La Mancha: Puertollano (high pollution levels) and Ciudad Real (low pollution levels).

METHODS

We used a Poisson regression model to study a cohort of 137 patients from Puertollano and Ciudad Real during two pollen seasons (2000-2001) and analysed the relationship between air pollutant and pollen levels and daily symptoms, the medication used and peak-flow measurements.

RESULTS

The number of asthma symptoms and the mean values of the PM(10), SO(2) and NO(2) levels were higher in Puertollano than in Ciudad Real. In Puertollano, the risk of asthma increased by 6% with a 3-day lag for PM(10), by 8% with a 3-day lag for O(3), by 4% with a 1-day lag for SO(2) and by 15% with a 3-day lag for O(3) when its values exceeded the health threshold (P < 0.05).

CONCLUSIONS

The air pollution levels in Puertollano were associated with an increased risk of asthma symptoms in pollen-allergic asthmatic patients com pared with a similar group from Ciudad Real.

Decompensation of pollen-induced asthma in two towns with different pollution levels in La Mancha, Spain

BACKGROUND

Allergic diseases have increased in industrialized countries and this increase is associated not only with genetic factors but also with lifestyle and environmental factors such as air pollution. Our hypothesis was that asthma in pollen-allergic patients from two towns with very different pollution levels in La Mancha (Spain) could be affected to a very different degree.

OBJECTIVE

Our objectives were to assess the risk factors associated with decompensation of pollen-induced asthma in the two towns and to perform a comparison between the patients from Puertollano (high pollution level) and Ciudad Real (low pollution level) with respect to daily symptoms, medication used and peak-flow measurements.

METHODS

We designed a cohort study with 137 patients (66 from Puertollano and 71 from Ciudad Real), conducted over 3 years (1999-2001) and including two pollen seasons. The two populations presented similar demographic and clinical characteristics. The variables studied included: area of residence, sex, age, smoking status, asthma symptoms and positive prick tests. Clinical decompensation was monitored by symptoms recorded on diary cards, twice daily peak-flow measurements and the use of protocolized medication.

RESULTS

There was a clinically relevant relationship between the place of residence and clinical decompensation. The risk of clinical decompensation in patients from Puertollano was up to three times higher than that of patients in Ciudad Real (P=0.034). Furthermore, patients from Puertollano and patients with moderate asthma presented more rapid decompensation compared with patients from Ciudad Real (P=0.020) and patients with mild asthma (P=0.049).

CONCLUSION

In conclusion, pollen-allergic asthmatics in Puertollano present a poorer clinical course and become decompensated earlier than those from Ciudad Real and it could be due to air pollution.

Polymorphous low-grade adenocarcinoma of the parotid gland. Case report and review of the literature

Polymorphous low-grade adenocarcinoma (PLGA) is difficult to diagnose both clinically and histologically due to its indolent presentation, and because of its morphological diversity that includes several microscopic patterns. The aggressive biologic behavior seen in minor salivary glands as compared to major glands is apparently associated histologically to a predominance of the papillary pattern in the former. Biologic behavior of PLGA in the major salivary glands is uncertain, as some cases have developed recurrences and metastases independently of the presence of a papillary pattern. A case of PLGA originated de novo in parotid gland is presented a 60 year-old male, treatment was surgically excised through superficial parotidectomy and to postoperative radiotherapy (46 Gy). Forty-eight months later the patient is alive with no signs of recurrence, as well as a review of the literature, with particular emphasis in its differential diagnosis and biological behavior.

[Acquired neuromuscular syndrome in critically ill patients]

AIMS

To analyse the causes and signs of the muscle weakness that critically ill patients develop during their stay in the ICU and to review the literature.

DEVELOPMENT

In the early 80s, Bolton reported a mixed axonal polyneuropathy that he called 'polyneuropathy in critically ill patients'. Clinically it was characterised by muscle weakness that varied in intensity and caused quadriplegia and/or the need for assisted ventilation in its severest forms. It is currently considered to be the most common neurological disorder among critically ill patients. Many patients made a complete recovery after a few months or even a year. Running almost parallel to this, he also described 'acute myopathy in intensive care' among asthmatic patients who were hospitalised in the ICU due to exacerbation of their illness. It was later observed how other types of patients also had this myopathy, for instance, those who had undergone a transplant, sepsis or burns. Some authors consider acute myopathy in intensive care to be the primary cause of muscle weakness in the ICU.

CONCLUSIONS

On many occasions 'polyneuropathy of critically ill patients' and 'acute myopathy in intensive care' can be differentiated and to do so neurophysiological and, if necessary, muscle biopsy studies are a valuable aid. Although some authors prefer to group these conditions under the name 'polyneuromyopathy', we propose the general term 'acquired neuromuscular syndrome in critically ill patients' -a more descriptive expression that does not presuppose a particular mechanism or a single aetiology.

Rapid steroid taper and neoral monotherapy in liver transplantation in Chile: a step in the right direction?

Diabetes, hypercholesterolemia, hypertension, obesity, osteopenia, and increased risk of viral recurrence are among the complications associated with posttransplant steroid use. Steroid withdrawal or rapid taper has been reported to be safe. The aim of this study was to compare the rejection incidence and severity among patients treated with two different steroid taper strategies.

METHODS

This retrospective study included all the adult liver transplant recipients since the program's inception from 1993 to January 2002. The minimum follow-up was 1 year. Exclusions included patients receiving an immunosupressive regimen other than mycophenolate mofetil, steroids, and Neoral, or suffering an autoimmune etiology, or displaying patient or graft survival less than 1 year. The incidence and severity of rejection episodes were compared between the two groups of steroid taper protocols: group A received methylprednisolone (1 g) intraoperatively with a slow taper to 10 mg prednisone per day at 1 year. Group B received methylprednisolone (2 g) intraoperatively followed by a rapid reduction with intention to withdraw by month 4, continuing on Neoral monotherapy. Rejection diagnosis was made on histological bases.

RESULTS

One-month and 1-year rejection rates were 47% and 53%, respectively, among the rapid taper group with Neoral monotherapy, which was similar to 60% and 64%, respectively, in the slow taper group. Rejection severity was also comparable between the two groups.

CONCLUSIONS

Patients treated with a rapid steroid taper protocol followed by Neoral monotherapy or a slow taper protocol showed similar acute rejection incidences and severities. Their survival rates were also comparable. Further study is necessary to evaluate the impact of rapid steroid taper to prevent the complications of steroid use.

A decade of adult liver transplantation in a single center in Chile

INTRODUCTION

Since the early days, liver transplantation (OLT) has conquered several barriers worldwide to become a proven therapy. We assessed the evolution of our adult liver transplant program.

METHODS

We studied all adult patients who underwent OLT since the inception from November 1993 through May 2003. Donor data, recipient pretransplantation evaluation, surgical technique, results, and costs were examined over our evolution, stratifying 3 groups over time, based on the number of adult OLT per year.

RESULTS

Between November 1993 and May 2003, 70 OLT were performed in 64 patients older than 15 years of age. Preoperative Child score, preoperative creatinine level, donor and recipient age, and proportion of emergencies were similar in the 3 groups. Over time, the predominant surgical technique was the piggyback technique (97% of OLT) with a decrease in the use of bypass from 63% to 5% during the last time period. Over the 10 years of our program's existence, warm ischemia time has been reduced to less than 1 hour, whereas cold ischemia time has remained constant at around 5 hours. Biliary and vascular complications decreased over time to around 10%. The mean length of hospital stay (LOS) decreased to 12 days (excluding emergencies). Since inception, our 1-year patient survival rate average is 91%; however, in just the last 3 years of our program (2000 through 2003), the 1-year patient survival rate is 97%.

CONCLUSIONS

In summary, our surgical technique has evolved toward piggyback use without veno-venous bypass with a significant decrease in warm ischemia times. As expected, our results have improved over time and our LOS and costs have decreased. Finally, our current results are similar to the best ones reported in the medical literature today.

Transcystic cholangiogram access via rubber band with early withdrawal after liver transplantation: A safe technique

OBJECTIVE

Since different techniques have been described for cholangiogram access after liver transplantation, we compared two different methods for patients with duct-to-duct biliary anastomoses.

METHODS

Adult liver transplant patients from program inception in 1993 to May 2003 in whom a duct-to-duct biliary anastomosis with a T-tube choledochostomy were compared with those having a transcystic duct catheter using a rubber band. We excluded 10 patients in which a different technique was used or graft or patient survived less than 21 days. Group A (n = 28,) had a number 10 T-tube exteriorized through the recipient main bile duct; and group B (n = 33) a number 5 Bard ureteral stent tied to the cystic stump with reabsorbable suture and secured with a hemorrhoidal rubber ligature.

RESULTS

The biliary complication rate was lower among the transcystic catheter group (9.1%, 3/33) compared to the T-tube group (35.7%, 10/28). Postcatheter withdrawal peritonitis was present in two patients in the T-tube group, one of whom required emergency laparotomy. A satisfactory postoperative cholangiogram was obtained in both groups. The transcystic catheter was withdrawn on average at 29 days, compared to 136 days in the T-tube group.

CONCLUSIONS

Both techniques are equally effective in obtaining a satisfactory postoperative cholangiogram. However, the transcystic catheter technique allows a significantly earlier withdrawal with fewer complications compared to the T-tube technique.

Trends in mechanical ventilation and immediate extubation after liver transplantation in a single center in Chile

INTRODUCTION

Some groups have reported early extubation post-liver transplantation in patients with previously defined criteria, in an attempt to shorten the ICU stay and decrease costs. We review our experience with trends in mechanical ventilation and resource utilization.

METHODS

We retrospectively reviewed the length of mechanical ventilation, ICU stay, hospital stay, transfusions, and costs of liver transplants performed since the program's inception in 1993 and 2002 including 82 OLT in 71 patients. We also report our experience with immediate postoperative extubation, which we have done from October to December of 2002. We compare different periods: the early days (1993 to 1997), namely, fewer than 10 OLT per year, with the subsequent years assessed individually.

RESULTS

There has been a progressive decrease over time in the length of mechanical ventilation, ICU stay, hospital stay, and costs. Since the program's inception actuarial adult patient 1- and 5-year survival rates were 88.7% and 78%, respectively. The 1-year survival rate increased to 97% during the period of 2000 to 2002 (n = 30). From October to the present, we extubated four of seven adult patients who met criteria with none of them requiring reintubation.

CONCLUSIONS

We demonstrate improved results, decreased length of mechanical ventilation, ICU, and hospital stay, and costs. The immediate postoperative extubation may be feasible for patients who meet previously defined criteria.

188Re-labeled antiepidermal growth factor receptor humanized monoclonal antibody h-R3: Labeling conditions, in vitro and in vivo stability 188Re-labeled antiepidermal growth factor receptor humanized monoclonal antibody h-R3: Labeling conditions, in vitro and in vivo stability. ACTA ACUST UNITED AC 2003;25:703-11. [PMID: 14685297 DOI: 10.1358/mf.2003.25.9.793337]

The use of antibodies as targeting agents for the delivery of radioisotopes to tumors is an appealing concept that has received widespread attention since the advent of monoclonal antibody (mAb) technology. The present study describes the (188)Re-direct labeling of anti-epidermal growth factor receptor (EGF-R) humanized mAb h-R3; the analytical methods for quality control of radiopharmaceuticals such as instant thin layer chromatography-silica gel (ITLC-SG); the immunoreactivity and biological recognition of the target antigen assessment of the radiolabeled molecule using flow cytometry analysis; in vitro stability studies using saline 0.9% solution, cysteine, diethylenetriaminepentaacetic acid (DTPA), human serum and human serum albumin (HSA) 1% challenge; and the assessment of in vivo stability through biodistribution studies in normal Balb/c mice. No fragmentation of the reduced molecules was found using 2-ME as a reducing agent. Labeling efficiency was greater than 98.5 +/- 0.6% of rhenium-188 (188Re) bound to IgG1 after 5 h, as determined by paper chromatography in saline 0.9% solution. Radiocolloids determined by albumin impregnated ITLC was 1.04 +/- 0.07% in all cases. The biological activity measured by flow cytometry analysis showed an immunoreactivity fraction and the biological recognition of the target antigen overexpressed on H-125 human lung adenocarcinoma cell line greater than 87%. Challenge studies with cysteine, DTPA, human serum and HSA 1% demonstrated no evidence of transcomplexation of 188Re to DTPA or HSA and showed that 30% and 85% of the 188Re-radiolabeled was transcomplexed to human serum and to 100 mM cysteine after 24 h for human serum and 1 h incubation for cysteine at 37 masculine C, respectively. Biodistribution studies indicated no accumulation of the radiolabeled antibodies in normal organs.

Multiparametric analysis of apoptotic and multi-drug resistance phenotypes according to the blast cell maturation stage in elderly patients with acute myeloid leukemia

BACKGROUND AND OBJECTIVES

Acute myeloid leukemia (AML) is a heterogeneous group of malignant diseases, often characterized by coexistence of more than one subpopulation of blast cells. Multiparametric flow cytometry immunophenotyping has proven to be a reliable and sensitive approach for the discrimination of myeloid blast cells from residual normal cells present in bone marrow samples from AML patients and, at the same time, allows the identification of different maturation compartments among myeloid blasts. Therefore, it provides a unique tool for assessing apoptotic and multidrug resistance (MDR)-associated phenotypes in individual subsets of leukemic cells.

DESIGN AND METHODS

The aim of the present study was to explore the simultaneous expression of proteins related to both apoptosis (APO2.7, bcl-2, bax) and multidrug resistance (MDR1, MRP, LRP) in the different blast cell subpopulations detected at diagnosis in a group of 72 elderly patients with AML. In addition, we included 5 bone marrow samples from healthy adult donors in the analysis.

RESULTS

Immature blast cells (CD34+: subset I) showed a significantly higher level of bcl-2 expression (p <0.0001) together with a lower reactivity for APO 2.7 (p=0.02) as compared to the other more mature CD34- cell subsets. The expression of Bax parallelled that of APO 2.7, although the difference between immature CD34+ blast cells and the mature blast cell subsets did not reach statistical significance (p=0.18). These results translated into a significantly (p<0.0001) higher bcl-2/bax ratio for the CD34+ blast cells as compared to that of the two CD34- blast cell subpopulations. Regarding the expression of the multidrug resistance-associated proteins Pgp and MRP, CD34+ blast cells displayed a greater expression of both proteins as compared to the more mature CD34- AML blast cells, but differences according to maturation stage of AML blast cells did not reach statistical significance. In contrast, LRP expression was significantly lower in the more immature CD34+ blast cell subset than in the more mature ones (p=0.01).

INTERPRETATIONS AND CONCLUSIONS

As far as normal bone marrow is concerned our results suggest that all blast cell subpopulations are more protected from apoptosis than their normal counterparts. We conclude that in elderly patients with AML the more immature blast cells are more resistant to apoptotic processes, which could explain why, when AML relapses, the blast cells frequently display a more immature phenotype than that observed at diagnosis. Contradictory results in multidrug resistance profile support the hypothesis that failure to respond to chemotherapeutic drugs in AML is a multifactorial phenomenon.

[Metabolic response to stress, can we control it?]

When faced by an external aggression such as shock, sepsis, burns or surgery, the body develops a response, known as stress, comprising hypermetabolism and hypercatabolism related to an alteration in tissue sensitivity to insulin. This alteration seems to be rooted in the transmembrane protein GLUT-4 which takes care of the cell uptake of glucose in skeletal muscle. As a result, there are alterations in the metabolism of carbohydrates, fats and proteins (reduction of immunoglobulins). In the case of surgery, it has been shown that, on the one hand, factors such as rest, pre-operative fasting or the release of inflammatory response factors constrain an even greater alteration in the sensitivity to insulin; and on the other hand that the degree of resistance to insulin depends on the magnitude of the surgery, its duration, bleeding, or on hypothermia and extracorporeal circulation in the case of heart surgery. These metabolic alterations may lead to an increase in the number of infections, mean stay in hospital, and even lead to diabetes mellitus in the long term. Over the last few years, all of this has led several researchers to try to minimize the stress response associated with planned surgery through replacing pre-operative fasting by the administration of carbohydrates, whether or not in association with insulin in perfusion. Beneficial results have been described: control of hyperglycaemia, lower consumption of neoglycogenic amino acids and less alteration of plasma immunity (interleukins, TNF). Future studies will evaluate the influence of these measures on plasma immunity, mean hospital stay and morbidity/mortality.

A beta-turn rich oats peptide as an antigen in an ELISA method for the screening of coeliac disease in a paediatric population

BACKGROUND

ELISA methods for the measurement of IgA antigliadin antibodies (AGA), both home-made and commercial systems, routinely employ wheat gliadin fractions as coating antigens. We investigate the sensitivity and specificity for CD diagnosis of a new ELISA method using a highly immunoreactive beta-turn rich gamma3-avenin peptide as an alternative coating antigen.

METHODS

The assay was standardized with antihuman IgA peroxidase-conjugated as the second antibody. Alternatively, an ELISA based on the use of protein A-peroxidase was assayed to measure both IgG plus IgA antibodies. Sixty-three sera from healthy controls were analyzed to establish the system's cut-off point. Sera from 103 coeliac and from 65 noncoeliac children were tested; for diagnosis purposes, a small intestinal biopsy had been performed in all of them.

RESULTS

For the IgA class antibodies assay a high sensitivity and specificity of 90.3% and 98.5%, respectively, was obtained, comparable to those achieved for IgA antiendomysium antibodies (EmA) with the same sera.

CONCLUSIONS

In view of the high sensitivity and specificity obtained together with water solubility of the peptide and easiness for large-scale reproducible synthesis, the new AGA IgA avenin peptide ELISA represents a significant improvement in CD diagnosis in comparison with conventional established AGA IgA ELISA using crude gliadins as coating antigens.

Suspected sexual abuse: an unusual presentation form of congenital myotonic dystrophy

In children, anal abnormalities due to various causes may be confused with sexual abuse. We present the case of a child in whom the suspicion of abuse due to anal dilatation led to the previously unknown diagnosis of myotonic dystrophy. Myopathic involvement of the perianal musculature is a known feature of congenital myotonic dystrophy that usually appears in late childhood or adolescence.

CONCLUSION

We stress the importance of considering an underlying myopathic condition in the differential diagnosis of anal laxity. Further studies, such as anal ultrasonography, may help when the diagnosis of abuse is not clear.

Anal endosonography in children with chronic constipation

BACKGROUND

Hypertrophy of the internal anal sphincter may be apparent in some children, but its significance has not yet been determined.

OBJECTIVE

To assess anal endosonographic findings in children with chronic constipation. Materials and methods. We performed anal endosonography in 46 children with chronic constipation and compared the results with values considered normal.

RESULTS

We did not find a significant relationship between age and thickness of the internal or external anal sphincters. The clinical response to medical management did not differ between patients with or without sphincter hypertrophy.

CONCLUSIONS

Although we did not find a significant correlation between sphincter hypertrophy and constipation or age, further studies may clarify its place amongst other techniques which are used in the investigation of anorectal pathology.