Malaria surveillance and case management in remote and indigenous communities of Panama: results from a community-based health worker pilot

Background

Panama is one of eight countries in Mesoamerica that aims to eliminate malaria by 2022. Malaria is concentrated in indigenous and remote regions like Guna Yala, a politically autonomous region where access to health services is limited and cases are predominately detected through intermittent active surveillance. To improve routine access to care, a joint effort was made by Guna Yala authorities and the Ministry of Health to pilot a network of community health workers (CHWs) equipped with rapid diagnostic tests and treatment. The impact of this pilot is described.

Methods

Access to care was measured using the proportion of villages targeted by the effort with active CHWs. Epidemiological impact was evaluated through standard surveillance and case management measures. Tests for differences in proportions or rates were used to compare measures prior to (October 2014-September 2016) and during the pilot (October 2016-September 2018).

Results

An active CHW was placed in 39 (95%) of 41 target communities. During the pilot, CHWs detected 61% of all reported cases from the region. Test positivity in the population tested by CHWs (22%) was higher than in those tested through active surveillance, both before (3.8%) and during the pilot (2.9%). From the pre-pilot to the pilot period, annual blood examination rates decreased (9.8 per 100 vs. 8.0 per 100), test positivity increased (4.2% to 8.5%, Χ² = 126.3, p < 0.001) and reported incidence increased (4.1 cases per 1000 to 6.9 cases per 1000 [Incidence Rate Ratio = 1.83, 95% CI 1.52, 2.21]). The percent of cases tested on the day of symptom onset increased from 8 to 27% and those treated on the day of their test increased from 26 to 84%.

Conclusions

The CHW network allowed for replacement of routine active surveillance with strong passive case detection leading to more targeted and timely testing and treatment. The higher test positivity among those tested by CHWs compared to active surveillance suggests that they detected cases in a high-risk population that had not previously benefited from access to diagnosis and treatment. Surveillance data acquired through this CHW network can be used to better target active case detection to populations at highest risk.

Using observed incidence to calibrate the transmission level of a mathematical model for Plasmodium vivax dynamics including case management and importation

In this work, we present a simple and flexible model for Plasmodium vivax dynamics which can be easily combined with routinely collected data on local and imported case counts to quantify transmission intensity and simulate control strategies. This model extends the model from White et al. (2016) by including case management interventions targeting liver-stage or blood-stage parasites, as well as imported infections. The endemic steady state of the model is used to derive a relationship between the observed incidence and the transmission rate in order to calculate reproduction numbers and simulate intervention scenarios. To illustrate its potential applications, the model is used to calculate local reproduction numbers in Panama and identify areas of sustained malaria transmission that should be targeted by control interventions.

Nodal metastatic load in papillary thyroid carcinoma. Morphological and molecular analysis with one-step nucleic acid amplification on more than 550 lymph nodes

BACKGROUND AND OBJECTIVE

The risk of recurrence in papillary thyroid carcinoma (PTC) is likely related to the amount of tumour in the metastatic lymph node (LN). Therefore, the current TNM classification (N0/N1) make it necessary to find a method to quantify the LN metastasis (LNM). We propose that the quantitative molecular assay One-Step Nucleic-Acid Amplification (OSNA), which measures the number of cytokeratin-19 (CK-19) mRNA copies as a marker of LNM, could play this role. Our objective was to describe the characteristics of the LNs from PTC, and to compare the morphological characteristics that have been claimed as criteria for metastatic burden with OSNA.

PATIENTS AND METHOD

Prospective study of LNs from 42 patients. All of the LNs were measured, weighed and analysed by OSNA and also by imprint cytology.

RESULTS

A total of 573 LNs were included, 187 (32.6%) of them were OSNA-positives. The global consistency between cytology and OSNA was 87.4%. Significant differences were observed in the CK-19 copy number between the LNMs<0.2cm and those >3cm, as well as between those from 0.2 to 3cm with respect to those >3cm, but not between those <0.2cm and those between 0.2 and 3cm. The total tumour load per neck dissection showed no differences based on whether there were ≤5 or >5 LNMs.

CONCLUSIONS

In our series the LNMs >3cm show an increased tumour load, but it is unclear if it is necessary to sub-classify the smaller ones as well as the relevance of the number of metastatic nodes according to the cut-off of 5 nodes. We consider that the OSNA analysis avoids the bias of nodal histology and allows for a greater understanding of its real oncological potential.

Nodal metastatic load in papillary thyroid carcinoma. Morphological and molecular analysis with one-step nucleic acid amplification on more than 550 lymph nodes

BACKGROUND AND OBJECTIVE

The risk of recurrence in papillary thyroid carcinoma (PTC) is likely related to the amount of tumour in the metastatic lymph node (LN). Therefore, the current TNM classification (N0/N1) make it necessary to find a method to quantify the LN metastasis (LNM). We propose that the quantitative molecular assay One-Step Nucleic-Acid Amplification (OSNA), which measures the number of cytokeratin-19 (CK-19) mRNA copies as a marker of LNM, could play this role. Our objective was to describe the characteristics of the LNs from PTC, and to compare the morphological characteristics that have been claimed as criteria for metastatic burden with OSNA.

PATIENTS AND METHOD

Prospective study of LNs from 42 patients. All of the LNs were measured, weighed and analysed by OSNA and also by imprint cytology.

RESULTS

A total of 573 LNs were included, 187 (32.6%) of them were OSNA-positives. The global consistency between cytology and OSNA was 87.4%. Significant differences were observed in the CK-19 copy number between the LNMs<0.2cm and those >3cm, as well as between those from 0.2 to 3cm with respect to those >3cm, but not between those <0.2cm and those between 0.2 and 3cm. The total tumour load per neck dissection showed no differences based on whether there were ≤5 or >5 LNMs.

CONCLUSIONS

In our series the LNMs >3cm show an increased tumour load, but it is unclear if it is necessary to sub-classify the smaller ones as well as the relevance of the number of metastatic nodes according to the cut-off of 5 nodes. We consider that the OSNA analysis avoids the bias of nodal histology and allows for a greater understanding of its real oncological potential.

Conocimiento sobre infecciones asociadas a la atención de la salud en estudiantes de Medicina, Licenciatura en Bioanálisis y Licenciatura en Enfermería de una universidad venezolana

Introducción. El conocimiento acerca de las infecciones asociadas a la atención de la salud (IAAS) en profesionales en salud es fundamental para disminuir las tasas de morbimortalidad causadas por estas infecciones.Objetivo. Evaluar el nivel de conocimiento sobre las IAAS en estudiantes del último año de la Escuela de Ciencias de la Salud de la Universidad de Oriente, Venezuela.Materiales y métodos. Estudio descriptivo realizado en una muestra aleatoria estratificada (n=98). Se aplicó una encuesta para determinar los conocimientos de los participantes sobre 3 áreas específicas: generalidades sobre IAAS, precauciones universales e higiene de las manos. Se consideró que los estudiantes tenían un conocimiento adecuado si obtenían un puntaje promedio de 17.5.Resultados. La edad promedio de los encuestados fue 24.9 años y el 74.9% fueron mujeres. En promedio, los estudiantes de Licenciatura en Enfermería, los de Medicina y los de Licenciatura en Bioanálisis obtuvieron 18, 18.04 y 17.25 puntos, respectivamente; el 59.2% de los respondientes aprobó la encuesta y el puntaje promedio total fue 17.87 puntos. En cuanto a las tres áreas de conocimiento evaluadas, la mayoría de estudiantes reprobó Generalidades sobre IAAS (n=78) e Higiene de las manos (n=76), mientras que la mayoría (n=91) aprobó Precauciones universales.Conclusiones. En general, los estudiantes encuestados tienen un conocimiento adecuado de las IAAS y su prevención; sin embargo, independiente del programa académico, se evidenciaron deficiencias en aspectos puntuales del tema, tales como la fuente de los microorganismos causantes de las IAAS y el uso adecuado de guantes, por lo que es necesario que los currículos de estos programas profundicen más al respecto.

Regulation of TSHR Expression in the Thyroid and Thymus May Contribute to TSHR Tolerance Failure in Graves' Disease Patients via Two Distinct Mechanisms

Graves' disease (GD) involves the presence of agonistic auto-antibodies against the thyrotropin receptor (TSHR), which are responsible for the clinical symptoms. While failure of TSHR tolerance is central to GD pathogenesis, the process leading to this failure remains poorly understood. Two mechanisms intimately linked to tolerance have been proposed to explain the association of SNPs located in TSHR intron 1 to GD: (1) differential alternative splicing in the thyroid; and (2) modulation of expression in the thymus. To elucidate the relative contribution to these two mechanisms to GD pathogenesis, we analyzed the level of full-length and ST4 and ST5 isoform expression in the thyroid (n = 49) and thymus (n = 39) glands, and the influence of intron 1-associated SNPs on such expression. The results show that: (1) the level of flTSHR and ST4 expression in the thymus was unexpectedly high (20% that of the thyroid); (2) while flTSHR is the predominant isoform, the levels are similar to ST4 (ratio flTSHR/ST4 = 1.34 in the thyroid and ratio flTSHR/ST4 in the thymus = 1.93); (3) next-generation sequencing confirmed the effect of the TSHR intron 1 polymorphism on TSHR expression in the thymus with a bias of 1.5 ± 0.2 overexpression of the protective allele in the thymus compared to the thyroid; (4) GD-associated intron 1 SNPs did not influence TSHR alternative splicing of ST4 and ST5 in the thyroid and thymus; and (5) three-color confocal imaging showed that TSHR is associated with both thymocytes, macrophages, and dendritic cells in the thymus. Our findings confirm the effect of intron 1 polymorphisms on thymic TSHR expression and we present evidence against an effect on the relative expression of isoforms. The high level of ST4 expression in the thymus and its distribution within the tissue suggest that this would most likely be the isoform that induces central tolerance to TSHR thus omitting most of the hinge and transmembrane portion. The lack of central tolerance to a large portion of TSHR may explain the relatively high frequency of autoimmunity related to TSHR and its clinical consequence, GD.

Predictive capacity of prodromal symptoms in first-episode psychosis of recent onset

BACKGROUND

Both the nature and number of a wide range of prodromal symptoms have been related to the severity and type of psychopathology in the psychotic phase. However, at present there is an incomplete picture focused mainly on the positive pre-psychotic dimension.

AIM

To characterize the prodromal phase retrospectively, examining the number and nature of prodromal symptoms as well as their relationship with psychopathology at the onset of first-episode psychosis.

METHODS

Retrospective study of 79 patients experiencing a first-episode psychosis of less than 1 year from the onset of full-blown psychosis. All patients were evaluated with a comprehensive battery of instruments including socio-demographic and clinical questionnaire, IRAOS interview, PANSS, stressful life events scale (PERI) and WAIS/WISC (vocabulary subtest). Bivariate associations and multiple regression analysis were performed.

RESULTS

Regression models revealed that several prodromal dimensions of IRAOS (delusions, affect, language, behaviour and non-hallucinatory disturbances of perception) predicted the onset of psychosis, with positive (22.4% of the variance) and disorganized (25.6% of the variance) dimensions being the most widely explained.

CONCLUSION

In addition to attenuated positive symptoms, other symptoms such as affective, behavioural and language disturbances should also be considered in the definitions criteria of at-high-risk people.

Seasonal variation of body weight loss after bariatric surgery

Seasonal variations have been described in humans in several variables such as sleep, mood, appetite, food preferences, or body weight. We hypothesized that these variations could also influence the decrease in body weight rate in patients submitted to body weight loss interventions. Thus, here we tested the variations of weight loss according to the time of the year the surgery took place in a group patients (n = 1322) submitted to bariatric surgery in the Hospital Universitari de la Vall d'Hebron in Barcelona (geographical coordinates: 41°25'41″N 2°8'32″E). For the analysis, the percentage of total body weight loss (%TWL), excess body weight loss (%EWL) and percentage of body mass index loss (%BMIL) were calculated at 3 (n = 1255), 6 (n = 1172), 9 (n = 1002), and 12 months (n = 1076) after surgery. For %EWL and %BMIL a statistically significant seasonal variation was detected when the variables were calculated at 3 months, but not at the other times, with more weight loss in summer-fall. However, seasonal variations were not detected for %TWL (p = 0.09). The mean amplitude of the seasonal rhythm for %EWL was of 1.8%, while for the rhythm of %BMIL was 0.7%. Moreover, a second peak was detected in January-February modulating the seasonal rhythm of the two variables. Results confirm seasonal variations in humans and indicate that short term responses to weight loss can be modulated by the time of year.

Seasonal variations of changes in lipid and glucidic variables after bariatric surgery

Seasonality is a phenomenon that is characterized by changes over the year in sleep, mood, behaviour, appetite and body weight. In humans, seasonal variations have been found in certain variables, such as lipid variables and body mass index. We hypothesize that this rhythm could influence the expected variation of the levels of biochemical variables in cases of body weight loss. Thus, the goal of this study was to observe whether the time of year in which bariatric surgery (BS) took place modulated the changes in several variables related to glucidic and lipid metabolism. Blood samples were obtained from 24 women and 10 men before BS and 1 and 3 months after BS. We calculated the percentage of variation that occurred for each individual and for each variable as a function of the time of the year. Data were adjusted to a 12-month period sinusoidal curve, with significance being set at p < 0.05. The results showed that almost all of the studied variables changed due to the BS according to a seasonal rhythm. Most of the variables showed a decrease that was most prominent in winter. In the cases of body mass index (BMI), adrenocorticotropin hormone (ACTH), and cortisol, the highest variation occurred in winter. Insulin and cholesterol in high-density lipoproteins (cHLD) variations were higher in springtime. Glucose variation showed a decrease after surgery with acrophase in summer-fall and plasminogen activator inhibitor-1 (PAI-1) and homeostatic model assessment-insulin resistance (HOMA-IR) in spring-summer. Ghrelin levels showed increases with a rhythm of variation with an acrophase in summer-fall. The seasonal rhythm found in this study fits nearly with the inverse of the endogenous circannual rhythm of the variables studied. The time of the year when the highest variation takes place is related to the circannual rhythm of the variable. The results agree with the manifestation of seasonal rhythm in human biochemical variables, which are reflected in the responses to weight loss after BS.

Morbidly "Healthy" Obese Are Not Metabolically Healthy but Less Metabolically Imbalanced Than Those with Type 2 Diabetes or Dyslipidemia

BACKGROUND

We have investigated the differences between metabolically "healthy" morbidly obese patients and those with comorbidities.

MATERIALS AND METHODS

Thirty-two morbidly obese patients were divided by the absence ("healthy": DM-DL-) or presence of comorbidities (dyslipidemic: DM-DL+, or dyslipidemic and with type 2 diabetes: DM+DL+). We have studied various plasma parameters and gene expression adipose tissue, before and after gastric bypass.

RESULTS

The group DM+DL+ tends to have lower values than the other two groups for anthropometric parameters. Regarding the satiety parameters, only leptin (p = 0.0024) showed a significant increase with comorbidities. Lipid parameters showed significant differences among groups, except for phospholipids and NEFA. For insulin resistance parameters, only glucose (p < 0.0001) was higher in DM+DL+ patients, but not insulin or homeostasis model assessment of insulin resistance (HOMA-IR). The gene expression of adiponectin, insulin receptor (INSR) and glucose receptor-4 (GLUT4), in the subcutaneous fat, decreased in all groups vs. a non-obese control. Interleukin-6 (IL6) and the inhibitor of plasminogen activator type 1 (PAI-1) genes decreased only in DM-DL+ and DM+DL+, but not in "healthy" patients. Leptin increased in all groups vs. the non-obese control. The visceral fat from DM+DL+ patients showed a sharp decrease in adiponectin, GLUT4, IL6 and PAI-1. All parameters mentioned above improved very significantly by surgery, independent of the occurrence of comorbidities.

CONCLUSIONS

The morbidly obese "healthy" individual is not really metabolically healthy, but morbidly obese individuals with diabetes and dyslipidemia are more metabolically imbalanced.

Urinary polycyclic aromatic hydrocarbon metabolites levels in a representative sample of the Spanish adult population: The BIOAMBIENT.ES project

In 2009, the Spanish Ministry of Agriculture, Food and Environment promoted the BIOAMBIENT.ES project, a Human Biomonitoring program on the national scale to estimate reference levels of environmental pollutants on a representative sample of the Spanish adults. The present study focuses on polycyclic aromatic hydrocarbons (PAHs). The urinary metabolites 1-hydroxypyrene, 1-,2-,3-,4- and 9-hydroxyphenanthrene and 3-hydroxybenzo[a]pyrene were selected as indicators of PAH exposure. Urine samples from 957 subjects (16-65 years old) were collected during year 2009-2010. Geometric mean and 95th percentile for 1-hydroxypyrene in μg g(-1) creatinine were 0.117 (non-smoker: 0.079, smokers: 0.184) and 0.67 μg g(-1) creatinine (non-smokers: 0.31, smokers: 0.69) respectively. GM and 95th percentile for sum of hydroxyphenanthrenes in μg g(-1) creatinine were 0.130 (non-smokers: 0.089, smokers: 0.317) and 1.29 (non-smokers: 0.71, smokers: 1.51) respectively. 3-Hydroxybenzo[a]pyrene was below the limit of quantitation (0.05 μg L(-1)) in all cases. Significant differences (p<0.05) regarding smokers and non-smokers, coal and wood heating, body mass index and second hand smoke were found, while other variables like gender, age, or diet showed no significant association. The geographical distribution of the metabolites showed higher levels in people who lived in the north and northwest of Spain. The PAH metabolites levels found were in the same range or lower than those reported from other European countries and they were higher than those found in the U.S. This study represents the first nationwide survey of exposure to PAHs in Spain and provides a background reference range for exposure to PAHs in the Spanish adult occupied population.

Quantitative determination of fentanyl in newborn pig plasma and cerebrospinal fluid samples by HPLC-MS/MS

In this study, a selective and sensitive high performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) method requiring low sample volume (≤100 μL) was developed and validated for the quantitative determination of the opioid drug fentanyl in plasma and cerebrospinal fluid (CSF). A protein precipitation extraction with acetonitrile was used for plasma samples whereas CSF samples were injected directly on the HPLC column. Fentanyl and (13) C6 -fentanyl (Internal Standard) were analyzed in an electrospray ionization source in positive mode, with multiple reaction monitoring (MRM) of the transitions m/z 337.0/188.0 and m/z 337.0/105.0 for quantification and confirmation of fentanyl, and m/z 343.0/188.0 for (13) C6 -fentanyl. The respective lowest limits of quantification for plasma and CSF were 0.2 and 0.25 ng/mL. Intra- and inter-assay precision and accuracy did not exceed 15%, in accordance with bioanalytical validation guidelines. The described analytical method was proven to be robust and was successfully applied to the determination of fentanyl in plasma and CSF samples from a pharmacokinetic and pharmacodynamic study in newborn piglets receiving intravenous fentanyl (5 µg/kg bolus immediately followed by a 90-min infusion of 3 µg/kg/h).

Decreased lipases and fatty acid and glycerol transporter could explain reduced fat in diabetic morbidly obese

OBJECTIVE

The possible differences were investigated in 32 morbidly obese patients depending on whether they were "healthy" or had dyslipidemia and/or type 2 diabetes.

METHODS

Lipid metabolism and insulin resistance were analyzed in subcutaneous (SAT) and visceral adipose tissue (VAT) before and during 6 and 12 months after Roux-en-Y gastric bypass.

RESULTS

Significant differences have been found in lipoprotein lipase (LPL) and hormone-sensitive lipase (HSL) activities in SAT from the different obese group versus normal weight (control) but not between them. The reduced lipase activities in VAT were 43 and 19% smaller (22 and 4% smaller, respectively, vs. control) than the "healthy" obese group for LPL and HSL, respectively, and were accompanied with a reduced expression of these lipases, as well as decreased expression of FAT/CD36, FABP4, and AQ7 in that tissue. In addition, the expression of the other genes measured showed a downregulation not only versus the "healthy" obese but also versus the normal weight group.

CONCLUSIONS

Being obese is not "healthy," but it is even less so if morbidly obese patients with diabetes and dyslipidemia were considered. The reduced fat accumulation in these patients may be attributed to the decrease of the expression and activity of the lipases of their adipose tissue.

Mortality risk factors in critical post-surgical patients treated using continuous renal replacement techniques

OBJECTIVE

To determine the influence of demographics, medical, and surgical variables on 30-day mortality in patients who need continuous renal replacement therapy (CRRT).

MATERIALS AND METHODS

A retrospective-following study was conducted using the data of 112 patients admitted to the postoperative intensive care unit who required CRRT, between August 2006 and August 2011, and followed-up for 30 days. The following information was collected: age, gender, history of HBP, DM, cardiovascular disease, and CKD, urgent surgery, surgical speciality, organic dysfunction according to the SOFA scale, the number of organs with dysfunction, use of mechanical ventilation, diagnostic and origin of sepsis, type of CRRT, and 30-day mortality. General linear models were used for estimating the strength of association (relative risk [RR], and 95% confidence interval [CI] between variables and 30-day mortality.

RESULTS

In the univariant analysis, the following variables were identified as risk factors for 30-day mortality: age (RR 1.04; 95% CI 1.01-1.06; P=.0005), and history of cardiovascular disease (RR 1.57; 95% CI 1.02-2.41; P=.039). Among the variables included in the multivariable analysis (age, history of cardiovascular disease, sepsis, and number of organs with dysfunction), only age was identified as an independent risk factor for 30-day mortality (RR 1.03; 95% CI 1.00-1.05; P=.007).

CONCLUSION

Thirty-day mortality in postoperative, critically ill patients who require CRRT is high (41.07%). Age has been identified as an independent risk factor, with renal failure as the most common indication for the use of these therapies.

Haematological parameters and serum trace elements in "healthy" and "unhealthy" morbidly obese patients before and after gastric bypass

BACKGROUND & AIMS

We have investigated the differences in plasma parameters and serum trace elements between "healthy" and unhealthy morbidly obese patients before and after Roux-en-Y gastric bypass surgery.

METHODS

A group of 32 morbidly obese patients undergoing bariatric surgery were divided into three groups. Group 1 subjects were free of dyslipidemia and type II diabetes mellitus (defined as "healthy" obese, DM-DL-); Group 2 subjects had only the presence of dyslipidemia (DM-DL+), while group 3 patients demonstrated the presence of both (DM + DL+). In all patients, we studied haematological, haemostasis, anaemia, coagulation plasma and trace elements parameters before and 1, 6 and 12 months after gastric bypass surgery.

RESULTS

We found significant differences in some haematological parameters, including haemostasis (e.g., T-Quick, p = 0.0048) and coagulation (e.g., ATIII and PAI-1, p = 0.001 and p < 0.0001, respectively) and in anaemia parameters (e.g., folate, cobalamin and transferrin, p = 0.0002, p < 0.0001 and p = 0.0001, respectively) but also in serum trace elements between the groups. However, the response to bariatric surgery was similar in the three groups.

CONCLUSION

Any healthy morbid obese subject is really metabolically "unhealthy" because he or she has many other haematologic or serum abnormalities that are often not included in the criteria for the definition of "healthy" in these obese subjects.

Pharmaceuticals and organic pollution mitigation in reclamation osmosis brines by UV/H2O2 and ozone

One significant disadvantage of using reverse osmosis (RO) for reclamation purposes is the need to dispose of the RO retentates. These retentates contain a high concentration of micropollutants, effluent organic matter (EfOM) and other inorganic constituents, which are recalcitrant to biological treatment and may impact the environment. The occurrence of 11 pharmaceuticals (concentrations ranging from 0.2 to 1.6 μg L(-1)) and their mitigation in RO retentates by a UV/H2O2 process and ozonation was studied using a wide range of oxidant dosages. Eleven pharmaceuticals were identified at. Initial observed kinetic constants (kobs) were calculated for the different pharmaceuticals. Other typical wastewater parameters were also monitored during the UV/H2O2 and ozonation reactions. The range for kobs was found to be 0.8-12.8L mmol O3(-1) and 9.7-29.9 L mmol H2O2(-1) for the ozonation and UV/H2O2 process, respectively. For ozonation, Atenolol, Carbamazepine, Codeine, Trimethoprim and Diclofenac showed the lowest initial kobs (in the order mentioned). Atenolol and Carbamazepine appeared as the most ozone resistant pharmaceuticals, exhibiting the lowest percentage of elimination at low ozone doses. On the other hand, despite the non-selectivity of HO, differences in the initial kobs were also observed during the UV/H2O2 process. Trimethoprim, Paroxetine and Sulfamethoxazole exhibited the lowest initial kobs values (in the order mentioned). Trimethoprim and Paroxetine also exhibited the lowest percentage removal when low H2O2 doses were assayed. The compounds that were identified as problematic during ozonation were more efficiently removed by the UV/H2O2 process. UV/H2O2 generally appeared to be a more efficient technology for removing pharmaceuticals from RO brines compared to ozonation.

[Visual outcome in patients with macroprolactinoma treated with dopamine agonists]

BACKGROUND

Dopamine agonists (DA) effectively reduce tumor size of macroprolactinomas, with the consequent improvement of eventual visual impairment.

AIM

To study the visual outcomes in patients with macroprolactinoma treated with DA.

MATERIAL AND METHODS

Retrospective cohort study which included patients with macroprolactinoma controlled at a Neuro-endocrinology and Neuro-ophthalmology Department between 1997 and 2011, and treated exclusively with DA (bromocriptine or cabergoline). Patients who were operated or had previous radiotherapy and those with an incomplete follow up, were excluded. We analyzed and compared the visual status before and after the beginning of DA treatment.

RESULTS

Thirty one patients aged 8 to 59 years, were included. Eighteen patients (58%) had visual impairment at the moment of diagnosis (group 1) and 13 had no alterations (group 2). Mean follow up was 36.5 months. Fifteen patients from group 1 (83%) had visual improvement, two remained stable (11 %) and one had a visual deterioration (6%). In group 2, only one non-compliant patient had a visual deterioration.

CONCLUSIONS

DAs are effective in the management of neuro-ophthalmic complications associated to macroprolactinomas and should be considered as first choice therapy in these tumors.

La helicicultura en Argentina: una aproximación desde el enfoque de sistemas blandos

La globalización imprimió características particulares en el sector agroalimentario incrementando el interés por las producciones agropecuarias alternativas; entre ellas, la helicicultura. En Argentina, durante el período 2001-2006, la helicicultura fue fuertemente promocionada desde la visión de los agronegocios, que puede resultar insuficiente para explicar la trayectoria de actividades en las que las relaciones de oposición o marcadas diferencias de poder entre actores ejercen una influencia determinante. La aplicación de herramientas propias de los sistemas blandos podría complementar ese marco teórico poniendo de manifiesto otros elementos e interrelaciones que surgen de la percepción de los actores intervinientes. El objetivo de este estudio fue modelar el sistema helicícola en Argentina durante el período 2001-2012, con el fin de analizar la evolución de la actividad. Se utilizaron tres herramientas metodológicas: 1) Soft systems methodology (SSM) en sus fases 1 y 2; 2) dinámica de sistemas, y 3) configuración de redes sociales. El análisis de la estructura de las redes sociales se realizó a partir de dos indicadores: densidad y centralidad. Los resultados mostraron que el sistema productivo helicícola en Argentina durante el período analizado se desarrolló principalmente a partir de la interacción informal entre representantes de plantas procesadoras y recolectores que, en respuesta a una demanda internacional, comenzaron a utilizar un recurso silvestre local. Esta interacción se mantuvo hasta el año 2006. A partir de ese año, cambios en las variables económicas indujeron a una disminución de la demanda por parte de las plantas procesadoras, desalentando la recolección y explicando así la variación en los índices que caracterizan la estructura de las redes sociales configuradas para los períodos 2001-2006 y 2007-2012. El modelo desarrollado constituye una herramienta complementaria al enfoque de agronegocios, ya que permite identificar el efecto de cambios sobre los elementos que lo componen y proponer estrategias de intervención tendientes a mantener la sustentabilidad del sistema helicícola.

Bacterial community characterization of a sequencing batch reactor treating pre-ozonized sulfamethoxazole in water

Antibiotics are pharmaceutical compounds widely used to treat a broad range of infections. These chemicals appear to be recalcitrant compounds when released to water systems, and their presence at the effluent of wastewater treatment plants and surface waters has been widely documented. Sulfamethoxazole (SMX), a sulfonamide commonly used to treat urinary infections, is one of them. Ozonation was proved to be a suitable method to remove SMX antibiotic in water. However, it is stated that a high ozone dosage would be necessary to achieve the complete mineralization of the intermediates. In this work, ozonation is coupled with a Sequencing Batch Biofilm Reactor (SBBR) in order to completely degrade SMX and its metabolites from water solutions. Moreover, a precise description of the microbial community in the bioreactor is provided by means of traditional microscopy and molecular biology techniques. The results obtained showed high Total Organic Carbon removals at the end of the biological treatment (89% removal). Furthermore, nitrates produced during the aerobic SBBR's performance were monitored and eliminated by adding an anoxic stage, achieving an overall nitrogen removal of 86%. A bacterial community analysis of the SBBR during aerobic and aerobic-anoxic conditions was performed, targeting the bacterial 16S ribosomal ribonucleic acid (rRNA) gene. These results revealed a dominant contribution of bacteria from the Proteobacteria class, with a major contribution from the Rhizobiales and Burkholderiales orders during the bioreactor performance, counting 52% of the total population.

Search for a two-Higgs-boson doublet using a simplified model in pp collisions at sqrt[s] = 1.96 TeV

We present a search for new particles in an extension to the standard model that includes a heavy Higgs boson (H(0)), a lighter charged Higgs boson (H(±)), and an even lighter Higgs boson h(0), with decays leading to a W-boson pair and a bottom-antibottom quark pair in the final state. We use events with exactly one lepton, missing transverse momentum, and at least four jets in data corresponding to an integrated luminosity of 8.7 fb(-1) collected by the CDF II detector in proton-antiproton collisions at sqrt[s]= 1.96 TeV. We find the data to be consistent with standard model predictions and report the results in terms of a simplified Higgs-cascade-decay model, setting 95% confidence level upper limits on the product of cross section and branching fraction from 1.3 pb to 15 fb as a function of H(0) and H(±) masses for m(h)(0) = 126 GeV/c(2).

Reverse osmosis concentrate treatment by chemical oxidation and moving bed biofilm processes

In the present work, four oxidation techniques were investigated (O3, O3/UV, H2O2/O3, O3/H2O2/UV) to pre-treat reverse osmosis (RO) concentrate before treatment in a moving-bed biofilm reactor (MBBR) system. Without previous oxidation, the MBBR was able to remove a small fraction of the chemical oxygen demand (COD) (5-20%) and dissolved organic carbon (DOC) (2-15%). When the concentrate was previously submitted to oxidation, DOC removal efficiencies in the MBBR increased to 40-55%. All the tested oxidation techniques improved concentrate biodegradability. The concentrate treated by the combined process (oxidation and MBBR) presented residual DOC and COD in the ranges of 6-12 and 25-41 mg L(-1), respectively. Nitrification of the RO concentrate, pre-treated by oxidation, was observed in the MBBR. Ammonium removal was comprised between 54 and 79%. The results indicate that the MBBR was effective for the treatment of the RO concentrate, previously submitted to oxidation, generating water with an improved quality.

Measurements of the top-quark mass and the tt cross section in the hadronic τ+jets decay channel at sqrt[s] = 1.96 TeV

We present the first direct measurement of the top-quark mass using tt events decaying in the hadronic τ+jets decay channel. Using data corresponding to an integrated luminosity of 2.2 fb(-1) collected by the CDF II detector in pp collisions at sqrt[s] = 1.96 TeV at the Fermilab Tevatron, we measure the tt cross section, σ(tt), and the top-quark mass, M(top). We extract M(top) from a likelihood based on per-event probabilities calculated with leading-order signal and background matrix elements. We measure σ(tt) = 8.8 ± 3.3(stat) ± 2.2(syst) pb and M(top) = 172.7 ± 9.3(stat) ± 3.7(syst) GeV/c(2).

Search for the standard model Higgs Boson produced in association with top quarks using the full CDF data set

A search is presented for the standard model Higgs boson produced in association with top quarks using the full Run II proton-antiproton collision data set, corresponding to 9.45 fb(-1), collected by the Collider Detector at Fermilab. No significant excess over the expected background is observed, and 95% credibility-level upper bounds are placed on the cross section σ(ttH → lepton + missing transverse energy+jets). For a Higgs boson mass of 125 GeV/c(2), we expect to set a limit of 12.6 and observe a limit of 20.5 times the standard model rate. This represents the most sensitive search for a standard model Higgs boson in this channel to date.

Measurement of the bottom-strange meson mixing phase in the full CDF data set

We report a measurement of the bottom-strange meson mixing phase β(s) using the time evolution of B(s)(0)→J/ψ(→μ(+)μ(-))φ(→K(+)K(-)) decays in which the quark-flavor content of the bottom-strange meson is identified at production. This measurement uses the full data set of proton-antiproton collisions at √s=1.96 TeV collected by the Collider Detector experiment at the Fermilab Tevatron, corresponding to 9.6 fb(-1) of integrated luminosity. We report confidence regions in the two-dimensional space of β(s) and the B(s)(0) decay-width difference ΔΓ(s) and measure β(s)∈[-π/2,-1.51]∪[-0.06,0.30]∪[1.26,π/2] at the 68% confidence level, in agreement with the standard model expectation. Assuming the standard model value of β(s), we also determine ΔΓ(s)=0.068±0.026(stat)±0.009(syst) ps(-1) and the mean B(s)(0) lifetime τ(s)=1.528±0.019(stat)±0.009(syst) ps, which are consistent and competitive with determinations by other experiments.

Precision top-quark mass measurement at CDF

We present a precision measurement of the top-quark mass using the full sample of Tevatron √s = 1.96 TeV proton-antiproton collisions collected by the CDF II detector, corresponding to an integrated luminosity of 8.7 fb(-1). Using a sample of tt¯ candidate events decaying into the lepton+jets channel, we obtain distributions of the top-quark masses and the invariant mass of two jets from the W boson decays from data. We then compare these distributions to templates derived from signal and background samples to extract the top-quark mass and the energy scale of the calorimeter jets with in situ calibration. The likelihood fit of the templates from signal and background events to the data yields the single most-precise measurement of the top-quark mass, M(top)=172.85±0.71(stat)±0.85(syst) GeV/c(2).

Search for the standard model Higgs boson decaying to a bb pair in events with one charged lepton and large missing transverse energy using the full CDF data set

We present a search for the standard model Higgs boson produced in association with a W boson in sqrt[s]=1.96  TeV pp collision data collected with the CDF II detector at the Tevatron corresponding to an integrated luminosity of 9.45  fb(-1). In events consistent with the decay of the Higgs boson to a bottom-quark pair and the W boson to an electron or muon and a neutrino, we set 95% credibility level upper limits on the WH production cross section times the H→bb branching ratio as a function of Higgs boson mass. At a Higgs boson mass of 125  GeV/c(2), we observe (expect) a limit of 4.9 (2.8) times the standard model value.

Measurement of the difference in CP-violating asymmetries in D(0)→K(+)K(-) and D(0)→π(+)π(-) decays at CDF

We report a measurement of the difference (ΔA(CP)) between time-integrated CP-violating asymmetries in D(0)→K(+)K(-) and D(0)→π(+)π(-) decays reconstructed in the full data set of proton-antiproton collisions collected by the Collider Detector at Fermilab, corresponding to 9.7  fb(-1) of integrated luminosity. The strong decay D(*+)→D(0)π(+) is used to identify the charm meson at production as D(0) or D[over ¯](0). We measure ΔA(CP)=[-0.62±0.21(stat)±0.10(syst)]%, which differs from zero by 2.7 Gaussian standard deviations. This result supports similar evidence for CP violation in charm-quark decays obtained in proton-proton collisions.

Combined search for the standard model Higgs boson decaying to a bb pair using the full CDF data set

We combine the results of searches for the standard model (SM) Higgs boson based on the full CDF Run II data set obtained from sqrt[s]=1.96  TeV pp collisions at the Fermilab Tevatron corresponding to an integrated luminosity of 9.45  fb(-1). The searches are conducted for Higgs bosons that are produced in association with a W or Z boson, have masses in the range 90-150  GeV/c(2), and decay into bb pairs. An excess of data is present that is inconsistent with the background prediction at the level of 2.5 standard deviations (the most significant local excess is 2.7 standard deviations).

Search for the standard model Higgs boson decaying to a bb pair in events with no charged leptons and large missing transverse energy using the full CDF data set

We report on a search for the standard model Higgs boson produced in association with a vector boson in the full data set of proton-antiproton collisions at sqrt[s]=1.96  TeV recorded by the CDF II detector at the Tevatron, corresponding to an integrated luminosity of 9.45  fb(-1). We consider events having no identified charged lepton, a transverse energy imbalance, and two or three jets, of which at least one is consistent with originating from the decay of a b quark. We place 95% credibility level upper limits on the production cross section times standard model branching fraction for several mass hypotheses between 90 and 150  GeV/c(2). For a Higgs boson mass of 125  GeV/c(2), the observed (expected) limit is 6.7 (3.6) times the standard model prediction.

Search for the standard model Higgs boson decaying to a bb pair in events with two oppositely charged leptons using the full CDF data set

We present a search for the standard model Higgs boson produced in association with a Z boson in data collected with the CDF II detector at the Tevatron, corresponding to an integrated luminosity of 9.45  fb(-1). In events consistent with the decay of the Higgs boson to a bottom-quark pair and the Z boson to electron or muon pairs, we set 95% credibility level upper limits on the ZH production cross section times the H→bb branching ratio as a function of Higgs boson mass. At a Higgs boson mass of 125  GeV/c(2), we observe (expect) a limit of 7.1 (3.9) times the standard model value.

Single-port transumbilical laparoscopic cholecystectomy: A prospective randomised comparison of clinical results of 140 cases

INTRODUCTION

A novel single port access (SPA) cholecystectomy approach is described in this study. We have designed a randomised comparative study in order to elucidate any possible differences between the standard treatment and this novel technique.

MATERIALS AND METHODS

Between July 2009 and March 2010, 140 adult patients with gallbladder pathologies were enrolled in this multicentre study. Two surgeons (RV and UB) randomised patients to either a standard laparoscopic (SL) approach group or to an SPA cholecystectomy group. Two types of trocars were used for this study: the TriPort™ and the SILS™ Port. Outcomes including blood loss, operative time, complications, length of stay and pain were recorded.

RESULTS

There were 69 patients in the SPA group and 71 patients in the SL group. The mean age of the patients was 43.2 (17-77) for the SPA group and 42.6 (19-70) for the SL group. The mean operative time was 63.9 min in the SPA group and 58.4 min in the SL group. For one patient, the SPA procedure was converted to a standard laparoscopic technique and to open approach in the SL group. Complications occurred in eight patients: Five seromas (two in the SPA group) and three hernias (one in the SPA group).The mean hospital stay was 38.5 h in the SPA group and 24.1 h in the SL group. Pain was evaluated and was 2 in the SPA and 2.9 in the SL group, according to the visual analogue scale (VAS) after 24 h (P<0.001). The degree of satisfaction was higher in the SPA group (8.3 versus 6.7). Similar results were found for the aesthetic result (8.8 versus 7.5). (P<0.001).

CONCLUSION

Single-port transumbilical laparoscopic cholecystectomy can be feasible and safe. When technical difficulties arise, early conversion to a standard laparoscopic technique is advised to avoid serious complications. The SPA approach can be undertaken without the expense of additional operative time and provides patients with minimal scarring. The cosmetic results and the degree of satisfaction appear to be significant for the SPA approach.

Evidence for a particle produced in association with weak bosons and decaying to a bottom-antibottom quark pair in higgs boson searches at the tevatron

We combine searches by the CDF and D0 Collaborations for the associated production of a Higgs boson with a W or Z boson and subsequent decay of the Higgs boson to a bottom-antibottom quark pair. The data, originating from Fermilab Tevatron pp collisions at √s = 1.96 TeV, correspond to integrated luminosities of up to 9.7 fb(-1). The searches are conducted for a Higgs boson with mass in the range 100-150 GeV/c(2). We observe an excess of events in the data compared with the background predictions, which is most significant in the mass range between 120 and 135 GeV/c(2). The largest local significance is 3.3 standard deviations, corresponding to a global significance of 3.1 standard deviations. We interpret this as evidence for the presence of a new particle consistent with the standard model Higgs boson, which is produced in association with a weak vector boson and decays to a bottom-antibottom quark pair.

Search for dark matter in events with one jet and missing transverse energy in pp¯ collisions at √s=1.96 TeV

We present the results of a search for dark matter production in the monojet signature. We analyze a sample of Tevatron pp[over ¯] collisions at √s=1.96 TeV corresponding to an integrated luminosity of 6.7 fb(-1) recorded by the CDF II detector. In events with large missing transverse energy and one energetic jet, we find good agreement between the standard model prediction and the observed data. We set 90% confidence level upper limits on the dark matter production rate. The limits are translated into bounds on nucleon-dark matter scattering rates which are competitive with current direct detection bounds on spin-independent interaction below a dark matter candidate mass of 5 GeV/c(2), and on spin-dependent interactions up to masses of 200 GeV/c(2).

Search for a heavy particle decaying to a top quark and a light quark in pp ¯ collisions at √s=1.96 TeV

We present a search for a new heavy particle X produced in association with a top quark, pp[over ¯]→t(X→t[over ¯]q) or pp[over ¯]→t[over ¯](X[over ¯]→tq[over ¯]), where q stands for up quarks and down quarks. Such a particle may explain the recent anomalous measurements of top-quark forward-backward asymmetry. If the light-flavor quark (q) is reconstructed as a jet (j), this gives a t[over ¯]+j or t+j resonance in tt[over ¯]+jet events, a previously unexplored experimental signature. In a sample of events with exactly one lepton, missing transverse momentum and at least five jets, corresponding to an integrated luminosity of 8.7 fb(-1) collected by the CDF II detector, we find the data to be consistent with the standard model. We set cross-section upper limits on the production (pp[over ¯]→Xt or X[over ¯]t[over ¯]) at 95% confidence level from 0.61 pb to 0.02 pb for X masses ranging from 200 GeV/c(2) to 800 GeV/c(2), respectively.

Evidence for the charmless annihilation decay mode B(s)(0)→π(+)π(-)

We search for annihilation decay modes of neutral b mesons into pairs of charmless charged hadrons with the upgraded Collider Detector at the Fermilab Tevatron. Using a data sample corresponding to 6 fb(-1) of integrated luminosity, we obtain the first evidence for the B(s)(0)→π(+)π(-) decay, with a significance of 3.7σ, and a measured branching ratio B(B(s)(0)→π(+)π(-))=(0.57±0.15(stat)±0.10(syst))×10(-6). A search for the B(0)→K(+)K(-) mode in the same sample yields a significance of 2.0σ, and a central value estimate B(B(0)→K(+)K(-))=(0.23±0.10(stat)±0.10(syst))×10(-6).

Measurement of Bs0→Ds(*)+Ds(*)- branching ratios

The decays Bs0→Ds(*)+Ds(*)- are reconstructed in a data sample corresponding to an integrated luminosity of 6.8  fb-1 collected by the CDF II detector at the Tevatron pp[over ¯] collider. All decay modes are observed with a significance of more than 10σ, and we measure the Bs0 production rate times Bs0→Ds(*)+Ds(*)- branching ratios relative to the normalization mode B0→Ds+D-to be 0.183±0.021±0.017 for Bs0→Ds+Ds-, 0.424±0.046±0.035 for Bs0→Ds*±Ds^∓, 0.654±0.072±0.065 for Bs0→Ds*+Ds*-, and 1.261±0.095±0.112 for the inclusive decay Bs0→Ds(*)+Ds(*)-, where the uncertainties are statistical and systematic. These results are the most precise single measurements to date and provide important constraints for indirect searches for nonstandard model physics in Bs0 mixing.

Search for a dark matter candidate produced in association with a single top quark in pp collisions at √[s]=1.96 TeV

We report a new search for dark matter in a data sample of an integrated luminosity of 7.7  fb-1 of Tevatron pp[over ¯] collisions at √[s]=1.96  TeV, collected by the CDF II detector. We search for production of a dark-matter candidate, D, in association with a single top quark. We consider the hadronic decay mode of the top quark exclusively, yielding a final state of three jets with missing transverse energy. The data are consistent with the standard model; we thus set 95% confidence level upper limits on the cross section of the process pp[over ¯]→t+D as a function of the mass of the dark-matter candidate. The limits are approximately 0.5 pb for a dark-matter particle with mass in the range of 0-150  GeV/c2.

Search for a low-mass standard model Higgs boson in the ττ decay channel in pp collisions at sqrt[s]=1.96 TeV

We report on a search for the standard model Higgs boson decaying into pairs of τ leptons in pp collisions produced by the Tevatron at sqrt[s]=1.96  TeV. The analyzed data sample was recorded by the CDFII detector and corresponds to an integrated luminosity of 6.0  fb(-1). The search is performed in the final state with one τ decaying leptonically and the second one identified through its semihadronic decay. Since no significant excess is observed, a 95% credibility level upper limit on the production cross section times branching ratio to the ττ final state is set for hypothetical Higgs boson masses between 100 and 150  GeV/c2. For a Higgs boson of 120  GeV/c2 the observed (expected) limit is 14.6 (15.3) the predicted value.