Novel markers to early detect degradation on cellulose nitrate-based heritage at the submicrometer level using synchrotron UV-VIS multispectral luminescence

Cellulose nitrate (CN) is an intrinsically unstable material that puts at risk the preservation of a great variety of objects in heritage collections, also posing threats to human health. For this reason, a detailed investigation of its degradation mechanisms is necessary to develop sustainable conservation strategies. To investigate novel probes of degradation, we implemented deep UV photoluminescence micro spectral-imaging, for the first time, to characterize a corpus of historical systems composed of cellulose nitrate. The analysis of cinematographic films and everyday objects dated from the nineteenth c./early twentieth c. (Perlov's collection), as well as of photo-aged CN and celluloid references allowed the identification of novel markers that correlate with different stages of CN degradation in artworks, providing insight into the role played by plasticizers, fillers, and other additives in stability. By comparison with photoaged references of CN and celluloid (70% CN and 30% camphor), it was possible to correlate camphor concentration with a higher rate of degradation of the cinematographic films. Furthermore, the present study investigates, at the sub-microscale, materials heterogeneity that correlates to the artworks' history, associating the different emission profiles of zinc oxide to specific color formulations used in the late nineteenth and early twentieth centuries.

Discoloration of Historical Plastic Objects: New Insight into the Degradation of β-Naphthol Pigment Lakes

Light is a determining factor in the discoloration of plastics, and photodegradation processes can affect the molecular structures of both the polymer and colorants. Limited studies focused on the discoloration of heritage plastics in conservation science. This work investigated the discoloration of red historical polyethylene (PE) objects colored with PR 48:2 and PR 53:1. High-density and low-density PE reference polymers, neat pigment powders, and historical samples were assessed before and after accelerated photoaging. The applied methodology provided insight into the individual light-susceptibility of polyethylenes, organic pigment lakes, and their combined effect in the photoaging of historical plastic formulations. After light exposure, both PE references and historical samples yellowed, PR53:1 faded, and PR 48:2 darkened; however, both organic pigments faded severely in the historical samples. This highlights the role played by the plastic binder likely facilitating the pigment photofading. Fourier transform infrared spectroscopy and mass spectrometry techniques-EGA-MS, PY-GC/MS, and TD-GC/MS-were successfully employed for characterizing the plastic formulations and degradation. The identification of phthalic compounds in both aged β-naphthol powders opens new venues for studies on their degradation. This work's approach and analytical methods in studying the discoloration of historical plastics are novel, proving their efficacy, reliability, and potentiality.

Application of Infrared Reflectance Spectroscopy on Plastics in Cultural Heritage Collections: A Comparative Assessment of Two Portable Mid-Fourier Transform Infrared Reflection Devices

Plastics have been increasingly used to create modern and contemporary art and design, and nowadays, museum collections hold numerous objects completely or partially made of plastics. However, the preservation of these materials is still a challenging task in heritage conservation, especially because some plastics show signs of degradation shortly after their production. In addition, different degradation mechanisms can often take place depending on the plastic composition and appropriate environmental and packaging conditions should be adopted. Therefore, methods for in situ and rapid characterization of plastic artifacts' composition are greatly needed to outline proper conservation strategies. Infrared (IR) spectroscopy, such as attenuated total reflection Fourier transform infrared spectroscopy (ATR FT-IR), is a well-established method for polymeric material analysis. However, ATR FT-IR requires an intimate contact with the object, which makes its application less appropriate for the in situ investigation of fragile or brittle degraded plastic objects. Mid-FT-IR reflectance spectroscopy may represent a valid alternative as it allows in situ measurements with minimum or even no contact, and IR data can be acquired rapidly. On the other hand, spectral interpretation of reflectance spectra is usually difficult as IR bands may appear distorted with significant changes in band maximum, shape, and relative intensity, depending on the optical properties and surface texture of the material analyzed. Presently, mid-FT-IR reflection devices working in external reflection (ER FT-IR) and diffuse reflection infrared Fourier transform spectroscopy (DRIFTS) modes have been used in cultural heritage research studies. As the collected vibrational information depends on the optical layout of the measuring system, differences between ER FT-IR and DRIFT spectra are thus expected when the same polymer is analyzed. So far, ER FT-IR and DRIFT spectroscopy have been individually explored for the identification of plastic objects, but comparative studies between the application of two reflectance FT-IR modes have not been presented yet. In this work, the use of two portable FT-IR spectrometers equipped with ER FT-IR and DRIFTS modes were compared for plastics identification purposes for the first time. Both references of polymeric materials and historical plastic objects (from a Portuguese private collection) were studied and the differences between ER FT-IR and DRIFT spectra were discussed. The spectra features were examined considering the two different optical geometries and analytes' properties. This new insight can support a better understanding of both vibrational information acquired and practical aspects in the application of the ER FT-IR and DRIFTS in plastic analysis.

Prediction of acute kidney injury in cirrhotic patients: a new score combining renal, liver and inflammatory markers

Introduction

Acute kidney injury (AKI) is common in hospitalized patients with cirrhosis and is associated with poor prognosis. A risk prediction score combining values easily measured at admission could be valuable to stratify patients for prevention, monitoring and early intervention, ultimately improving patient care and outcomes. The aim of this study was to develop a risk score for AKI in a cohort of cirrhotic patients.

Patients and methods

We cross-examined the data from a retrospective analysis of 186 patients with cirrhosis admitted to the Gastroenterology and Hepatology Service of Centro Hospitalar Lisboa Norte from January 2003 to December 2005. AKI was defined as an increase in serum creatinine (SCr)≥0.3 mg/dL within 48 hours or a percentage increase in SCr≥50% from baseline. Neutrophil-to-lymphocyte ratio (NLR) was used as a marker for inflammation. A receiver operating characteristic (ROC) curve was produced to assess the discriminative ability of the variables. Cutoff values were defined as those with highest validity. The final AKI risk score model was assessed using the ROC curve.

Results

A total of 52 patients (28%) developed AKI. Higher baseline SCr (p<0.001), more severe liver disease as evaluated by the modified Model of End-stage Liver Disease (MELD)-Na score (p<0.001) and higher NLR (p=0.028) were independently associated with AKI. The area under the ROC (AUROC) curve for the prediction of AKI was 0.791 (95% CI 0.726–0.847) for SCr, 0.771 (95% CI 0.704–0.829) for modified MELD-Na and 0.757 (95% CI 0.689–0.817) for NLR. Cutoff values with the highest validity for predicting AKI were determined and defined as 0.9 for the SCr, 21.7 for the modified MELD-Na and 6 for the NLR. The risk score was created allowing 3 points if the SCr is higher than 0.9, 1 point if the modified MELD-Na is higher than 21.7 and 1 point if the NLR is higher than 6. The AUROC curve of the risk prediction score for AKI was 0.861. A risk score of ≥2 points predicts AKI in cirrhotic patients with a sensitivity of 88.5% and specificity of 72.4%.

Conclusion

A new score combining SCr, MELD-Na and NLR demonstrated a strong discriminative ability to predict AKI in cirrhotic patients.

Living-Donor Kidney Transplantation: Donor-Recipient Function Correlation

BACKGROUND

With the rising prevalence of living-donor kidney transplantation, evaluation of factors correlated with renal function in the donor-recipient pair constitutes a main goal for kidney transplantation clinicians. Our objective was to analyze the more relevant donor characteristics that contribute to donor and recipient estimated glomerular filtration rates (eGFR) after 1 year.

METHODS

We evaluated 48 consecutive donor-recipient pairs from our unit.

RESULTS

Mean donor age was 46 ± 11 years, with 71% being women. Mean recipient age was 35 ± 12 years, with 54% being men. Mean duration of donor hospitalization was 7 ± 2 days. Donor eGFR was 104 ± 11 mL/min/1.73 m² before donation and 70 ± 14 mL/min/1.73 m² at discharge. After 1 year, donor eGFR was 71 ± 12 mL/min/1.73 m² and recipient eGFR was 69 ± 10 mL/min/1.73 m². Donor eGFR <100 mL/min/1.73 m² before donation and age >50 years correlated with 17.7- and 8.9-fold increased risks, respectively, of recipient eGFR <60 mL/min/1.73 m² after 1 year. Donor being female, although statistically associated with worse graft function, compared with a male donor (P = .020), did not represent a significantly increased risk of recipient eGFR <60 mL/min/1.73 m². Higher donor body mass index (BMI) also associated with a lower kidney function for donors (P = .048). In multivariate linear regression to predict pairs' eGFRs after 1 year, only donor eGFR before donation and at discharge retained statistical significance (P ≤ .001 and P = .045, respectively).

CONCLUSIONS

Excluding unpredictable complications in the post-transplantation period, donor eGFR before donation, eGFR at discharge, and age were the best parameters to predict recipient and donor eGFRs after 1 year and can be used as a tool for managing expectations regarding the post-transplantation period.

Organic dyes in illuminated manuscripts: a unique cultural and historic record

In this study, we successfully addressed the challenges posed by the identification of dyes in medieval illuminations. Brazilwood pigment lakes and orcein purple colours were unequivocally identified in illuminated manuscripts dated by art historians to be from the thirteenth to the fifteenth centuries and in the Fernão Vaz Dourado Atlas (sixteenth century). All three works were on a parchment support. This was possible by combining Raman microscopy and surface-enhanced Raman spectroscopy with microspectrofluorimetry. To the best of our knowledge, this is the first time that brazilein, the main chromophore in brazilwood lake pigments, has been unequivocally identified by surface-enhanced Raman spectroscopy in an illuminated work (the Dourado Atlas). Complementing this identification, through microspectrofluorimetry and micro-Fourier transform infrared spectroscopy, it was possible to propose a complete paint formulation by comparison with our database of references; the dark pink hues, in the three case studies, were produced by combining brazilwood pigment lakes and gypsum in a protein- and gum arabic-based tempera. Orcein purple, also known as orchil dye, has been previously identified in medieval manuscripts, dated from the sixth to the ninth centuries. Our findings in fourteenth-sixteenth century manuscripts confirm the hypothesis that this dye was lost during the High Middle Ages, to be later rediscovered.This article is part of the themed issue 'Raman spectroscopy in art and archaeology'.

Acute kidney injury, long-term renal function and mortality in patients undergoing major abdominal surgery: a cohort analysis

Background

Acute kidney injury (AKI) is frequent during hospitalization and may contribute to adverse consequences. We aimed to evaluate long-term adverse renal function and mortality after postoperative AKI in a cohort of patients undergoing major abdominal surgery.

Methods

We performed a retrospective analysis of adult patients who underwent major non-vascular abdominal surgery between January 2010 and February 2011 at the Department of Surgery II of Hospital de Santa Maria–Centro Hospitalar Lisboa Norte, Portugal. Exclusion criteria were as follows: chronic kidney disease on renal replacement therapy, undergoing renal replacement therapy the week before surgery, death before discharge and loss to follow-up through January 2014. Patients were categorized according to the development of postoperative AKI in the first 48 h after surgery using the Kidney Disease: Improving Global Outcomes classification. AKI was defined by an increase in absolute serum creatinine (SCr) ≥0.3 mg/dL or by a percentage increase in SCr ≥50% and/or by a decrease in urine output to <0.5 mL/kg/h for >6 h. Adverse renal outcomes (need for long-term dialysis and/or a 25% decrease in estimated glomerular filtration rate after hospital discharge) and mortality after discharge were evaluated. Cumulative mortality was analysed with the Kaplan–Meier method and log-rank test and outcome predictive factors with the Cox regression. Significance was set at P < 0.05.

Results

Of 390 selected patients, 72 (18.5%) developed postoperative AKI. The median follow-up was 38 months. Adverse renal outcomes and death after hospital discharge were more frequent among AKI patients (47.2 versus 22.0%, P < 0.0001; and 47.2 versus 20.5%, P < 0.0001, respectively). The 4 year cumulative probability of death was 44.4% for AKI patients, while it was 19.8% for patients with no AKI (log-rank test, P < 0.0001). In multivariate analysis, AKI was a risk factor for adverse renal outcomes (adjusted hazard ratio 1.6, P = 0.046) and mortality (adjusted hazard ratio 1.4, P = 0.043).

Conclusions

AKI after major abdominal surgery was independently associated with the risk of long-term need for dialysis and/or renal function decline and with the risk of death after hospital discharge.

Living kidney donor transplantation: an alternative with limitations

BACKGROUND

The major issues involved in the decision to donate are the perioperative risk and the risk of chronic kidney disease or even end-stage renal disease. The usual glomerular filtration rate (GFR) in kidney donors after transplantation is approximately 70% of the predonation rate; however, some have a GFR <60 mL/min/1.73 m(2). So after kidney donation, mild to moderate renal insufficiency may occur. Thus, it is important to identify predictor factors of postdonation kidney function.

OBJECTIVES

To evaluate the influence of predictor factors in the evolution of the remaining kidney function and to quantify nonpredictable and unexpected developments in GFR at 1 year post donation.

METHODS

We performed a study of the evolution of renal function pre- and postnephrectomy of 55 living donors without perioperative comorbidities and a mean follow-up of 6.03 ± 2.7 years.

RESULTS

One year after nephrectomy donor function was 32% lower than the prenephrectomy value and 21% of donors had an eGFR <60 mL/min/1.73 m(2). In multivariate logistic regression a living donor with a predonation eGFR <100 but >80 mL/min/1.73 m(2) had 5.24 times a chance of having an eGFR <60 mL/min/1.73 m(2) at 1 year post donation than if he had an eGFR ≥100 mL/min/1.73 m(2). Among 15 donors with prenephrectomy eGFR ≥80 and <100 mL/min/1.73m(2), 8 (53%), RR = 3.26 (1.517-7.012) had eGFR <60 mL/min/ 1.73 m(2).

CONCLUSIONS

The eGFR predonation and donor age influenced the first-year postnephrectomy eGFR. Some donors had a more accelerated eGFR fall, not always related to predonation eGFR and age.

Renal transplantation in type 1 diabetes mellitus: an unusual case report

Diabetes mellitus (DM) may progress to diabetic nephropathy (DN) in approximately 40% of cases and it accounts for one of the most common causes of end-stage of renal disease (ESRD). The pathogenesis of DN involves complex interactions between metabolic and hemodynamic factors. DM type 1 has a dominant impact on morbidity and mortality after renal transplantation. We report a kidney transplantation patient with DM and DN as the etiology of end-stage renal disease and whose post-transplantation evolution over 19 years was remarkably atypical. DM was diagnosed at the age of 7 years and the patient suffered a rapid and aggressive progression of her disease with early development of DN and diabetic retinopathy. Nineteen years post-transplantation, the patient shows neither deterioration of graft function nor clinical reactivation of DN. There seems to be two quite distinct answers to the same injury supported by a group of factors that led to micro- and macrovascular lesions, all present before transplantation and potentially aggravated through some immunosuppressive therapy. This clinical evolution suggests the hypothesis that not only the graft but also the donor may have inherent characteristics that enabled him to display the resistance to DN despite the genetic susceptibility of the receptor. The answers to these questions would help to explain why some patients with diabetes progress to macro- and microvascular complications and others remain resistant to developing these vascular disorders. In this case, the resistance to DN is apparently a feature related to the donor.

A spectroscopic study of Brazilwood paints in medieval books of hours

In this work, microspectrofluorimetry was for the first time applied to the identification of the red organic lakes that are characteristic of the lavish illuminations found in 15(th) century books of hours. Microspectrofluorimetry identified those red paints, ranging from opaque pink to dark red glazes, as brazilwood lakes. An unequivocal characterization was achieved by comparison with reference paints produced following recipes from the medieval treatise The Book on How to Make Colours, and was further confirmed by fiber optic reflectance spectroscopy (FORS). For these treasured cultural objects, microspectrofluorimetry and FORS proved to be the only techniques that could identify, in situ or in microsamples, the chromophore responsible for the pinkish hues: a brazilein-Al(3+) complex. Additionally, a multi-analytical approach provided a full characterization of the color paints, including pigments, additives, and binders. Microspectroscopic techniques, based on infrared and X-ray radiation, enabled us to disclose the full palette of these medieval manuscripts, including the elusive greens, for which, besides malachite, basic copper sulfates were found; Raman microscopy suggested a mixture of brochantite and langite. Infrared analysis proved invaluable for a full characterization of the additives that were applied as fillers or whites (chalk, gypsum, and white lead) as well as the proteinaceous and polysaccharide binders that were found pure or in mixture.

Ochres and earths: matrix and chromophores characterization of 19th and 20th century artist materials

The present paper describes the main results obtained from the characterization of a wide range of natural and synthetic ochre samples used in Portugal from the 19th to the 20th century, including powder and oil painting samples. The powder ochre samples came from several commercial distributors and from the collection of Joaquim Rodrigo (1912-1997), a leading Portuguese artist, particularly active during the sixties and seventies. The micro-samples of oil painting tubes came from the Museu Nacional de Arte Contemporânea-Museu do Chiado (National Museum of Contemporary Art-Chiado Museum) in Lisbon and were used by Columbano Bordalo Pinheiro (1857-1929), one of the most prominent naturalist Portuguese painters. These tubes were produced by the main 19th century colourmen: Winsor & Newton, Morin et Janet, Maison Merlin, and Lefranc. The samples have been studied using μ-Fourier Transform Infrared Spectroscopy (μ-FTIR), Raman microscopy, μ-Energy Dispersive X-ray fluorescence (μ-EDXRF), and X-ray diffraction (XRD). The analyzed ochres were found to be a mixture of several components: iron oxides and hydroxides in matrixes with kaolinite, gypsum and chalk. The results obtained allowed to identify and characterize the ochres according to their matrix and chromophores. The main chromophores where identified by Raman microscopy as being hematite, goethite and magnetite. The infrared analysis of the ochre samples allowed to divide them into groups, according to the composition of the matrix. It was possible to separate ochres containing kaolinite matrix and/or sulfate matrix from ochres where only iron oxides and/or hydroxides were detected. μ-EDXRF and Raman were the best techniques to identify umber, since the presence of elements such as manganese is characteristic of these pigments. μ-EDXRF also revealed the presence of significant amounts of arsenic in all Sienna tube paints.

Long-term risk of mortality for acute kidney injury in HIV-infected patients: a cohort analysis

Background

Acute kidney injury (AKI) is common in hospitalized human immunodeficiency virus (HIV)-infected patients and is associated with hospital mortality. We aimed to evaluate the impact of AKI on long-term mortality of hospitalized HIV-infected patients.

Methods

Retrospective analysis of a cohort of 433 hospitalized HIV-infected patients who were discharged alive from the hospital. AKI was defined according to ‘Risk Injury Failure Loss of kidney function End-stage kidney disease’ creatinine criteria, as an increase of baseline serum creatinine (SCr) X 1.5 or in patients with baseline SCr > 4 mg/dL if there was an acute rise in SCr of at least 0.5 mg/dL. Cumulative mortality curves were determined by the Kaplan-Meier method, and log-rank test was employed to analyze statistically significant differences between curves. Cox regression method was used to determine independent predictors of mortality. Risk factors were assessed with univariate analysis, and variables that were statistically significant (P < 0.05) in the univariate analysis were included in the multivariate analysis.

Results

Sixty-four patients (14.8%) had AKI. Median follow-up was 37 months. At follow-up 81 patients (18.7%) died. At 1, 2 and 5 years of follow-up, the cumulative probability of death of patients with AKI was 21.2, 25 and 31.3%, respectively, as compared with 10, 13.3 and 16.5% in patients without AKI (log-rank, P = 0.011). In multivariate analysis AKI was associated with increased mortality (adjusted HR 1.7, 95% CI 1.1-3; P = 0.049).

Conclusions

AKI was independently associated with long-term mortality of hospitalized HIV-infected patients.

Evaluation of an instrument for screening patients at risk for chronic kidney disease: testing SCORED (Screening for Occult Renal Disease) in a Portuguese population

Prevalence of chronic kidney disease (CKD) is increasing and CKD has a long asymptomatic phase suitable for screening. SCORED (Screening for Occult Renal Disease) is a prescreening test which has compared favorably with KEEP. We report the results of SCORED testing in subjects attending a World Kidney Day event. After SCORED, subjects were tested for creatinine, urinary albumin and creatinine, and renal ultrasound. Eighty-eight subjects participated (32 men; mean age 59.7 ± 14.8 years; 58% hypertensive and 15.9% diabetics) of which 60 had a high score for kidney disease. Thirty-eight of 47 (80.8%) subjects that were further evaluated had a high-risk score. All subjects with CKD had a high score (100% sensitivity). SCORED showed low specificity (24.3%), but a high negative predictive value (100%). Including albuminuria in the definition of CKD increased the positive predictive value to 43.6%. In conclusion, SCORED is good for prescreening subjects for CKD in a European population as it captures all patients with CKD. Moreover, in subjects with low risk, the probability of CKD is low. SCORED is useful in alerting the general population and the medical community about the risk factors of CKD.

Seroepidemiological survey of transmissible infectious diseases in a portuguese prison establishment

A cross-sectional study was conducted in 151 (71.6%) of 211 male inmates of a regional Portuguese prison in order to establish the seroprevalence for viral hepatitis (HAV, HBV, HCV), human immunodeficiency virus (HIV), syphilis and herpes simplex virus (HSV-1 and HSV-2) and to analyze some psychosocial and criminal characteristics. Mean age was 34 years. Anti-HAV was positive in 69.5% (n = 105) and in 34.4% (n = 52) for anti-HCV. One (0.7%) person had HBsAg and 29 (19.2%) had laboratory markers of past HBV infection. Non-immune inmates for HBV were 40.4% (n = 61). Syphilis was diagnosed in 6.0% (n = 9). The rate of HIV infection was 6.6% (n = 10; all HIV-1). The seropositivity of HSV-2 was 19.9% (n = 30) and of HSV-1 was 82.1% (n = 124). Alcohol dependence was reported by 26.5% (n = 40). Excluding tobacco and prescription medication, 73.5% (n = 111) reported drug use in prison. The most commonly used drugs were: cannabis (100%; n = 111) followed by heroin (56.7%; n = 63). Anti-HCV rate was noteworthy. The HIV infection rate (6.6%) in this regional prison is at least 13 to 22 times greater than in general population. As the inmate return to the community increases the risk of disease exposure for the general population, early detection and counseling is urgently needed for prisoners.

Acute kidney injury in hospitalized HIV-infected patients: a cohort analysis

BACKGROUND

Acute kidney injury (AKI) in hospitalized human immunodeficiency virus (HIV)-infected patients in the highly active antiretroviral therapy (HAART) era has not been extensively addressed. The aim of the present study was to analyze the incidence, etiology, risk factors and the impact of AKI on in-hospital mortality in this population.

METHODS

A total of 489 HIV-infected patients hospitalized in the Department of Infectious Diseases of the Hospital de Santa Maria (Lisbon, Portugal) between January 2005 and December 2007 were retrospectively studied. AKI was defined by 'Risk Injury Failure Loss of kidney function End-stage kidney disease'(RIFLE) criteria based on serum creatinine. Comparisons between patients with and without AKI were performed using the Student's t-test or the χ2 test. Logistic regression method was used to determine predictors of AKI and in-hospital mortality. A two-tailed P-value <0.05 was considered significant.

RESULTS

Eighty-eight patients (18%) had AKI within the hospitalization period. The most common etiologies of AKI were sepsis (59%), nephrotoxic drug administration (37.5%), volume depletion (21.6%) and radiocontrast use (20.5%). Preexisting hypertension [adjusted odds ratio (OR) 2.4, 95% confidence interval (CI) 1.04-5.6, P = 0.04], acquired immunodeficiency syndrome (adjusted OR 2.7, 95% CI 1.2-6, P = 0.02), sepsis (adjusted OR 23, 95% CI 11-45.3, P < 0.001) and nephrotoxic drug administration (adjusted OR 2.8, 95% CI 1.4-5.8, P = 0.004) were risk factors of AKI. Patients with AKI had higher in-hospital mortality than patients without AKI (27.3 versus 8%, P < 0.001). In multivariate analysis, AKI was a risk factor of in-hospital mortality (adjusted OR 2.7, 95% CI 1.3-5.6, P = 0.008).

CONCLUSION

AKI occurred in 18% of hospitalized HIV-infected patients and it was independently associated with increased in-hospital mortality.

Revisiting Perkin's dye(s): the spectroscopy and photophysics of two new mauveine compounds (B2 and C)

Two new components have been identified in an early sample prepared according to the original recipe of Perkin, and perhaps even by Perkin himself around 1860--a new isomer of Perkin's mauveine B (designated as mauveine B2) together with a new mauveine compound (mauveine C)--and these compounds were synthesized again using starting materials chosen to reproduce Perkin's original synthesis and isolated by HPLC-DAD, identified by (1)H NMR, MS and their spectroscopic (UV/Vis and emission) and photophysical behaviour investigated.

[Epidemiological study of lung cancer in Portugal (2000/2002)]

Lung cancer is the most common form of cancer death in the world. Five-year survival is about 15%, without any change to this picture envisaged. It is the 3rd most prevalent type of cancer in Portugal and the primary cause of cancer death. 85% of lung cancer cases are attributable to smoking. One study performed in Portugal for 3 years (2000/2002) by the Lung Oncology Work Committee of the Portuguese Society of Pulmonology in 22 Hospitals showed that of a total of 4396 patients with lung cancer, 81.8% were male and 18.2% were female, with a mean age of 64.49 +/- 11.28 years. About 70% of patients were smokers or former smokers, with 50.3% of patients presenting with performance status (Zubrod) 1. Histologically, 37.5% were adenocarcinoma, followed by squamous carcinoma in 30.5% of cases, and small cell lung cancer in 12.5%; neuroendocrine carcinoma presented in 1.4% of cases; non small cell lung cancer in 10.5%; mixed carcinoma in 0.7%; large cell carcinoma in 2.3%; and others/not specified in 4.6% of cases. Staging (known in 4097 patients), showed 113 patients in stage IA (2.8%)and 250 patients in stage IB (6.1%); only 0.8% in stage IIA and 4.5% in stage IIB; 9.1% in stage IIIA and 29.9% in stage IIIB; 46.9% were already in stage IV by the time of diagnosis. The first therapeutic option was known in 3855 patients. Surgery was performed in 8.2% and 21.8% of cases were treated with combined therapies (surgery and chemotherapy or radiotherapy, or combination of chemotherapy and radiotherapy); chemotherapy alone was first choice in 43.7% of patients and in 20.3% only best support therapy was chosen.

Photochromism of 7-(N,N-diethylamino)-4′-hydroxyflavylium in a water–ionic liquid biphasic system

Photochromism of trans-4-(N,N-diethylamino)-2,4'-dihydroxychalcone, with formation of the photoproduct 7-(N,N-diethylamino)-4'-hydroxyflavylium, is promoted in the ionic liquid phase of a water/[bmim][PF6] biphasic system.

Photophysics of an Indigo Derivative (Keto and Leuco Structures) with Singular Properties

Spectral and photophysical properties of the indigo derivative Cibalackrot in keto and reduced (leuco) forms were studied by absorption spectra, fluorescence and pulse radiolysis and compared with the structurally similar indigo. With the keto form of this dye, fluorescence (phiF = 0.76) and intersystem crossing (phiT = 0.11) are dominant, whereas with indigo, efficient internal conversion (phiIC = 0.99) is observed, probably involving proton transfer through intramolecular hydrogen bonds. With Cibalackrot, this pathway is blocked, supporting the above model for indigo. With the reduced form of Cibalackrot, more than 98% of the absorbed quanta are dissipated through S1 approximately --> S0 internal conversion, which contrasts with leuco-indigo, where fluorescence (phiF = 0.35), internal conversion (phiIC = 0.53) and intersystem crossing (phiT = 0.125) are found to be competitive. In addition, a synthetic precursor of Cibalackrot (preCiba) was also investigated. This has a rigid molecular structure (with a moiety identical to Cibalackrot and the other to indigo), but intra- or intermolecular proton transfer is allowed between adjacent carbonyl and N-H groups. With this precursor in its keto structure the photophysical parameters are generally very close to those of the keto form of indigo, and different from those of Cibalackrot. A more detailed investigation of the time-decay profiles of preCiba in dioxane (and with added water and D2O) has shown that these follow biexponential laws with a shorter component of 14-25 ps, which appears associated with a risetime at longer wavelength emissions (and to a positive preexponential at shorter emission wavelengths) and a longer lived (decay) component of 104-130 ps. In the steady-state spectra of preCiba, the variation with temperature reveals a blue shift of the emission maxima, which is interpreted as the presence (simultaneous emission) of two species (keto and enol) in the excited state. Indigo and deuterated indigo are also found to present a similar behavior. The overall data are interpreted as to be due to an excited-state process involving the proton transfer between keto and enol forms. Rate constants with values of 7 x 10(10) s-1 for preCiba and 1.6 x 10(11) s-1 for deuterated indigo were obtained. This inverse isotope effect is justified on the basis of the proposed model for proton-transfer excited-state deactivation.

Lenograstim as support for ACE chemotherapy of small-cell lung cancer: a phase III, multicenter, randomized study

This phase III study was conducted to evaluate the usefulness of lenograstim as support for ACE (doxorubicin, cyclophosphamide, and etoposide) chemotherapy in previously untreated patients with small-cell lung cancer. Patients were randomized to receive up to six 3-week cycles of either ACE alone (n = 139) or ACE with lenograstim support (150 microg/m2/day subcutaneously, days 4-13, n = 141). Compared with the chemotherapy-alone group, the lenograstim support group was more likely to achieve neutrophil recovery (absolute neutrophil count, > or =1.5 x 10(9) cells/l) by day 14 (95.8-100% vs. 14.3-24.1% across the cycles) and less likely to experience at least one infectious episode (36.7 vs. 54.0%; p = 0.004), chemotherapy delay (51.8 vs. 56.2%; NS), or dose reduction (17.3 vs. 27.7%; p = 0.037). Objective response and event-free and overall survival rates were similar. Lenograstim was well tolerated. Lenograstim may allow the interval between cycles of ACE to be reduced to 2 weeks; such dose intensification may lead to more favorable objective response and survival rates.

Glutathione S-transferase mu polymorphism and susceptibility to lung cancer in the Portuguese population

Epidemiological studies have led to the suggestion that a genetic basis may exist in the individual variation in predisposition to cancer. Interindividual differences in human toxicological response to carcinogenic exposure have been attributed to heritable polymorphisms in metabolism, namely glutathione S-transferases (GSTs) coding for enzymes that are known to be detoxifiers of carcinogens. Within the human GST mu class, there is a specific isozyme that is frequently lacking. To check whether or not this association exists in the Portuguese population with lung cancer, we used polymerase chain reaction (PCR)-based genotyping to examine GSTM1 polymorphism (nulled and non-nulled) in 84 individuals as a control healthy population and a group of 98 lung cancer patients. In this study we were able to find a frequency of the GSTM1 phenotype among our healthy control subjects consistent with earlier genotyping studies in other Caucasoid populations. For the group of individuals with lung cancer as a whole, or in subsets of histological subtypes, our data for the Portuguese population did not show a positive correlation between the null allele and this neoplasm. In contrast, we found a slight increase in the frequency of the wild-type allele in our lung cancer group.

Neonatal cerebral Doppler: arterial and venous flow velocity measurements using color and pulsed Doppler system

OBJECTIVE

To contribute to the establishment of reference values of blood flow velocity assessed by cerebral Doppler in healthy infants related to gestational age and birth weight during the first week of life.

METHODS

Five arteries and three veins were evaluated respectively in 120 (74 premature) newborns and in 100 (70 preterm) infants. In a quarter of the latter three recordings at 5-minute intervals were made to assess reproducibility. The relation between flow measurements and gestational age was assessed by linear regression, means by analysis of variance (or Kruskall-Wallis test) and paired samples by Student's t test.

RESULTS

There was a significant increase of arterial velocities with increasing gestational age and birth weight, but not for venous velocities. Significant higher values were found in the internal carotid artery followed by the medium cerebral artery. The venous velocities were highly reproducible and the main patterns observed were bandlike and sinusoid type.

CONCLUSION

The knowledge of normal cerebrovascular physiology is essential to understand the pathogenesis of neonatal brain damage and can help pediatricians in an accurate interpretation of the flow profile in neurological pathology.

[Cerebral ischemic infarction in newborn infants. Diagnosis using pulsed and color Doppler imaging]

In newborn infant, cerebral infarction is often difficult to distinguish from cerebral hemorrhage, both pathologies being moreover frequently associated. We report a left anterior stroke in a fullterm newborn who had seizures on the third day of life. Ultrasound scanning showed a hyperechogenic zone in the territory of the left anterior cerebral artery. Pulsed and color Doppler imaging showed a decreased blood flow velocity in comparison to the opposite side, thus enabling the diagnosis.