The association of acute kidney injury on outcomes in cancer patients receiving immune checkpoint inhibitor therapy: a systematic review and meta-analysis

Background

Immune checkpoint inhibitors (ICPIs) are a novel therapeutic approach to cancer treatment that has changed the landscape of cancer therapy but also has some considerable drawbacks. Acute kidney injury (AKI) is one of these potential complications that may have effects on patient outcomes. In this review, we assessed the effect of AKI on mortality outcomes in cancer patients receiving this immunotherapy.

Materials and methods

We performed a systematic review and meta-analysis of prospective, retrospective, randomized, and non-randomized studies, which examined the effects of AKI in cancer patients receiving immune checkpoint inhibitors. We searched through PubMed, Medline, Web of Science, Scopus, and Cochrane Library databases.

Results

7 studies were included in the final analysis, with a total number of patients of 761. Overall, the risk of death was higher in patients that developed AKI during ICPI treatment (HR 1.42, 95% CI 1.05 to 1.92, P = 0.02; heterogeneity χ2 = 11.68, I2 = 66%, P = 0.02) compared to patients that did not develop AKI. In addition, there was a trend to a better survival in those with less severe AKI patients compared to those with more severe AKI (HR 1.35, 95% CI 0.99 to 1.83, P = 0.05). Lastly, it was seen that patients with persistent kidney dysfunction (non-recovery) had an increased risk for all-cause mortality (HR 2.93, 95% CI 1.41 to 6.08, P = 0.004; heterogeneity χ2 = 0.53, I2 = 0%, P = 0.47).

Conclusions

Development of AKI in patients with cancer receiving immune checkpoint inhibitors is associated with increased risk of mortality.

MO102: Lean Tissue, as Assessed by Bioimpedance Spectroscopy, Is Dependent on Renal Function in Patients with HFREF

BACKGROUND AND AIMS

Despite impressive improvements in treatment strategies, heart failure (HF) morbidity and mortality remain substantially high worldwide. Muscle wasting is common and is associated with increased morbidity and mortality in patients with HF. The aim of the study was to determine muscle mass, by bioimpedance spectroscopy (BIS), and to identify factors associated with decreased muscle mass in this population.

METHOD

This was a prospective observational study of outpatient adults referred for clinically indicated transthoracic echocardiograms at an academic hospital between 2016 and 2018. A left ventricular ejection fraction below 45% was required for inclusion (HFrEF).

Muscle mass was assessed using BIS (with the body composition monitor—BCM® device).

RESULTS

Our study included 151 patients. The mean age and eGFR values of the population at baseline were 67.1 years and 66.5 mL/min/1.73 m2. The median levels for lean tissue index (LTI, lean tissue mass/height2) were 11.3 (IQR 9.4–12.9) kg/m2.

LTI was positively associated with eGFR and negatively associated with uric acid, ST-2 and galectin-3 levels. Including all these variables in a stepwise multivariable regression only eGFR and ST-2 remained independently associated with LTI (see Table 1).

Based on the LTI median value, we also divided the patients into two groups—group 1 (LTI ≤ 11.3 kg/m2) and group 2 (LTI > 11.3 kg/m2). In the univariable logistic regression age, using the haemoglobin, eGFR and ST-2 levels predicted the group appurtenance. Including all these variables in a stepwise multivariable logistic regression, only eGFR and eGFR remained independently associated with LTI groups (see Table 2).

CONCLUSION

A better understanding of the factors associated with decreased muscle mass is needed to develop preventive strategies for muscle wasting in patients with HF. Muscle mass, as measured by the BCM and expressed as the LTI, is strongly associated with eGFR.

UPLC-MS/MS method for the quantification of MCI-77, a novel sigma-1 receptor ligand, and its application to pharmacokinetic studies

Sigma-1 receptors are involved in pain modulation, particularly in cases of nerve injury and neuropathic pain. High-affinity ligands with improved pharmacokinetic profiles are needed to further investigate the properties of these receptors and their potential as a therapeutic target. The novel compound MCI-77 is one such selective sigma-1 receptor ligand, and the purpose of this study was to characterize its preclinical pharmacokinetic parameters. An ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) method was developed and validated to quantify MCI-77 in mouse plasma and brain homogenate. The method was validated for sensitivity, selectivity, linearity, accuracy, precision, stability, and dilution integrity. The method has a linearity range of 2-200 ng/mL, a short run-time of 3.2 min, and requires a low sample volume of 25 µL. A simple protein precipitation procedure was used for compound extraction. Samples were run on an Acquity UPLC BEH C18 column (1.7 μm, 2.1 × 50 mm) following a gradient elution method using a mobile phase consisting of water containing 0.1% (v/v) formic acid and acetonitrile. The method was applied to the analysis of plasma and brain homogenate samples from preclinical pharmacokinetic studies in CD-1 mice. MCI-77 exhibited high systemic clearance (8.5 ± 0.3 L/h/kg) and extensive tissue distribution indicated by a high volume of distribution (20.1 ± 0.3 L/kg). The concentration levels were consistently higher in brain samples than in plasma (brain/plasma AUC ratio 2.9), indicating its ability to cross the blood-brain barrier.

MO146RENAL FUNCTION MEDIATES THE EFFECT OF FLUID EXCESS ON LUNG CONGESTION IN PATIENTS WITH HFREF

Background and Aims

Despite impressive improvements in treatment strategies, heart failure (HF) morbidity and mortality remain substantially high worldwide. Pulmonary congestion is considered the leading cause for hospital admissions and death among patients with HF. The aim of this study is to investigate if the effect of fluid status, as assessed by bioimpedance spectroscopy (BIS) on lung congestion is mediated by renal function, inflammation or cardiac function.

Method

This was a prospective observational study of outpatient adults referred for clinically indicated transthoracic echocardiograms at an academic hospital between 2016 and 2018. A left ventricular ejection fraction (LVEF) below 45% was required for inclusion (HFrEF).

Mediation is the process through which an exposure causes disease. We hypothesized that some of the total effect of extracellular water (ECW) to intracellular water (ICW) (as assessed by bioimpedance) ratio on lung congestion (as assessed by lung ultrasonography) is mediated by C-reactive protein (CRP), left atrium volum index (LAVI) or estimated glomerular filtration rate (eGFR) – the mediators.

Results

Our study included 153 patients. The mean age and eGFR values of the population at baseline were 67.1 years and 66.5 ml/min/1.73m2. The mean median value for CRP was 25.6 (IQR 9.0-56.4) mg/L.

Figure 1 depicts the structural equation models with the calculated magnitude of the direct and indirect effects of ECW/ICW on the B-lines number in our population. In this model, the fluid status has both direct and indirect effects on lung congestion. Specifically, it has a direct effect on LAVI and eGFR, which in turn have a direct effect on the number of B-lines. Therefore, the indirect effect mediated by LAVI and eGFR accounts for a significant proportion of 27.6% of the total effect of ECW/ICW on lung congestion

Although ECW/ICW has a direct effect on inflammation, this doesn’t have any effect on renal function or lung congestion.

Conclusion

We show that eGFR and LAVI partly mediate the effect of ECW/ICW on lung congestion in patients with HFrEF. While the deleterious effects of fluid overload on lung congestion have long been recognized, this study provides evidence for a relationship of significant magnitude linking fluid overload with decreased eGFR and increased LAVI, which in turn lead to elevations in the B-lines number.

This work was supported by a grant of the Ministery of Research and Innovation, CNCS-UEFISCDI, project number PN-III-P1-1.1-PD-2016-0287, within PNCDI III and by a grant of the “Grigore T. Popa” University of Medicine and Pharmacy, contract number 27505/2018.

Pharmacokinetics of Eleven Kratom Alkaloids Following an Oral Dose of Either Traditional or Commercial Kratom Products in Rats

Kratom, Mitragyna speciosa Korth., is being widely consumed in the United States for pain management and the reduction of opioid withdrawal symptoms. The central nervous system (CNS) active alkaloids of kratom, including mitragynine, 7-hydroxymitragynine, and numerous additional compounds, are believed to derive their effects through opioid receptor activity. There is no literature describing the systemic exposure of many of these alkaloids after the consumption of kratom. Therefore, we have developed and validated a bioanalytical method for the simultaneous quantitation of 11 kratom alkaloids (mitragynine, 7-hydroxymitragynine, corynantheidine, speciogynine, speciociliatine, paynantheine, corynoxine, corynoxine-B, mitraphylline, ajmalicine, and isospeciofoline) in rat plasma. The validated method was used to analyze oral pharmacokinetic study samples of lyophilized kratom tea (LKT) and a marketed product, OPMS liquid shot, in rats. Among the 11 alkaloids, only mitragynine, 7-hydroxymitragynine, speciociliatine, and corynantheidine showed systemic exposure 8 h postdose, and the dose-normalized systemic exposure of these four alkaloids was higher (1.6-2.4-fold) following the administration of the commercial OPMS liquid. Paynantheine and speciogynine levels were quantifiable up to 1 h postdose, whereas none of the other alkaloids were detected. In summary, the method was successfully applied to quantify the exposure of individual kratom alkaloids after an oral dose of traditional or commercial products. This information will contribute to understanding the role of each alkaloid in the overall pharmacology of kratom and elucidating the pharmacokinetic differences between traditional and commercial kratom products.

Regulatory sampling of industrial hemp plant samples (Cannabis sativa L.) using UPLC-MS/MS method for detection and quantification of twelve cannabinoids

Background

In 2018, the Farm Bill mandated the United States Department of Agriculture to develop regulations governing the cultivation, processing, and marketing of industrial hemp. Industrial hemp is defined as Cannabis sativa L. with a total Δ-9-tetrahydrocannabinol (Δ-9-THC) content ≤0.3%. Therefore, for hemp to become an agricultural commodity, it is important to regulate production by developing standard methods for sampling and testing of the plant material.

Methods

An ultra-performance liquid chromatography-tandem mass spectrometry analytical method for the quantification of twelve cannabinoids was developed. The method was applied to a regulatory sampling trial of three hemp varieties cultivated for cannabidiol (CBD) production. Two samples were taken from 28 plants with one sample being flower only while the other was a composite sample that included flowers, leaves, and stems.

Results

The assay method was validated for specificity, range, repeatability, reproducibility, and recovery in accordance with all applicable standards for analytical methods. The results of the regulatory study indicated a significant decrease in the concentration of total Δ-9-THC and total CBD of 0.09% and 1.32%, respectively, between a flower only and a composite sample.

Conclusions

There are many factors that may influence reported total Δ-9-THC content in industrial hemp. A robust analytical method was developed to analyze hemp samples in a trial regulatory study. The results indicate that the way hemp is sampled and analyzed may influence the legality of a crop, which could have negative economic and legal consequences.

Bioanalytical method development and pharmacokinetics of MCI-92, a sigma-1 receptor ligand

Sigma-1 receptors are found throughout the nervous system and play a role in regulating nociception. They are highly expressed in nerve injury, making them a potential target for the treatment of neuropathic pain. Although sigma-1 receptor antagonists have been shown to have anti-nociceptive and anti-allodynic effects, improved selectivity of these ligands is needed to further investigate their potential to treat neuropathic pain. MCI-92 is a novel, selective sigma-1 receptor ligand developed to address this need. A sensitive and rapid ultra-performance liquid chromatography tandem mass spectrometry (UPLC-MS/MS) method was developed and validated for the quantification of MCI-92 in mouse plasma and brain homogenate. A structural analog of the analyte, MCI-147, was used as the internal standard (IS). The chromatographic separation was achieved on an Acquity UPLC BEH C18 column using a mobile phase consisting of water acidified with 0.1 % v/v formic acid and acetonitrile with gradient elution over 3.2 min. The method was linear over a concentration range of 1-200 ng/mL. Multiple reaction monitoring in the positive ionization mode was used for the mass spectrometric quantitation using m/z transitions 369.2 > 126.0 for MCI-92 and 448.9 > 350.1 for the IS. The method was successfully applied to the analysis of plasma and brain samples obtained in the course of oral and intravenous pharmacokinetic studies in CD-1 mice. MCI-92 showed a high volume of distribution (11.3 ± 0.6 L/kg) and rapid clearance (6.1 ± 0.8 L/h/kg) from systemic circulation. The concentration of the MCI-92 was higher in the brain than in plasma throughout all terminal time points, indicating high blood-to-brain partitioning and slow brain clearance.

Preclinical pharmacokinetic study of speciociliatine, a kratom alkaloid, in rats using an UPLC-MS/MS method

Speciociliatine is a minor indole alkaloid found in kratom, a southeast Asian medicinal plant, used for centuries to increase energy, enhance mood, and mitigate pain and opioid dependence. An ultra-performance liquid chromatography tandem mass spectrometry method was developed and validated to quantify speciociliatine in rat plasma. The quantitation range was 3-600 ng/mL. The validated method was applied to a preclinical pharmacokinetic study in male Sprague-Dawley rats after 2.5 mg/kg intravenous (I.V.) and 20 mg/kg oral (P.O.) dosing. The plasma was analyzed to obtain concentration-time profiles and results were subjected to non-compartmental analysis to determine pharmacokinetic parameters including volume of distribution (6.2 ± 2.3 L/kg I.V.), clearance (0.7 ± 0.2 L/hr/kg), and absolute oral bioavailability (20.7 %). Speciociliatine had higher systemic exposure and lower clearance compared to the other kratom alkaloids mitragynine and corynantheidine. The speciociliatine pharmacokinetic parameters described here will help to better understand the overall effects reported with kratom product use.

P1473THE EFFECT OF SERUM C-REACTIVE PROTEIN AND FERRITIN LEVELS ON ALL-CAUSE AND CARDIOVASCULAR MORTALITY IN HAEMODIALYSIS PATIENTS

Background and Aims

Ferritin, is commonly used as a surrogate marker of iron storage in haemodialysis (HD) patients. However, besides being an indicator of iron storage, serum ferritin levels are closely influenced by non-iron related factors, such as systemic inflammation.

The aim of this study is to assess the combined effect of serum ferritin and C-reactive protein (CRP) levels on all-cause and cardiovascular (CV) mortality in a large national cohort of HD patients.

Method

This is a retrospective study which included all patients that were on standard HD therapy in 34 Romanian Fresenius dialysis units at January 1st 2014. The main outcomes were all-cause and CV mortality. Patients were censored at December 31st 2016.

Results

Our study included 1255 patients. The mean age of the population at baseline was 59 years. The median values for CRP and ferritin levels were 4.8 (IQR 1.9-11.0) mg/dL and 696.0 (IQR 448.5-996.8) ng/mL, respectively.

Using the tertiles categories for CRP (<2.7, 2.7-8.1, and >8.1 mg/dL) and ferritin (<536.6, 536.6-876.1, and >876.1 ng/mL) our population was categorized into 9 groups of patients:

Group 1

CRP<2.7 mg/dL, ferritin<536.6 ng/mL;

Group 2

CRP<2.7 mg/dL, ferritin 536.6-876.1ng/mL;

Group 3

CRP 2.7-8.1mg/dL, ferritin >876.1 ng/mL;

Group 4

CRP 2.7-8.1 mg/dL, ferritin<536.6 ng/mL;

Group 5

CRP 2.7-8.1 mg/dL, ferritin 536.6-876.1ng/mL;

Group 6

2.7-8.1 mg/dL, ferritin >876.1 ng/mL;

Group 7

CRP>8.1 mg/dL, ferritin<536.6 ng/mL;

Group 8

CRP>8.1 mg/dL, ferritin 536.6-876.1ng/mL;

Group 9

CRP>8.1 mg/dL, ferritin >876.1 ng/mL;

During the follow-up (mean 1.75, median 1.94 years), 204 patients (16.25%) died with 103 (8.21%) from CV disease.

The central point of our investigation was to assess the combined effect of CRP and ferritin levels on the two outcomes (Table 1). For the all-cause mortality, after adjustment for different demographic, clinical and biological risk factors, only patients with CRP levels in the highest tertile (CRP>8.1 mg/dL), irrespectively of ferritin levels (Groups 7, 8 and 9), remained significantly associated with this outcome.

When considering the CV mortality, in the adjusted analysis, only patients from Groups 4 (2nd tertile CRP, 1st tertile ferritin) and 7 (3rd tertile CRP, 1st tertile ferritin) remained associated with a higher risk for the outcome as compared with patients from Group 1.

Conclusion

We show that increased levels of CRP are associated with an increased risk for all-cause mortality in the HD population, irrespective of ferritin levels. However, increasing CRP levels are associated with CV mortality only for the lowest tertile of ferritin levels.

This work was supported by a grant of the Ministery of Research and Innovation,  CNCS-UEFISCDI, project number PN-III-P1-1.1-PD-2016-0287, within PNCDI III and by grants of the “Grigore T. Popa” University of Medicine and Pharmacy, contract numbers  27495/2018 and 27505/2018.

Changes in the histological spectrum of glomerular diseases in the past 16 years in the North-Eastern region of Romania

BACKGROUND

The aim of this study was to describe the findings of renal biopsies from a large nephrology center in Iasi, Romania, performed between 2005 and 2010. We compared these findings with our previous ones, from 1995 to 2004, as well as with similar reports.

METHODS

We studied retrospectively 239 renal biopsies. The indications for renal biopsy were categorized into: nephrotic syndrome, acute nephritic syndrome, asymptomatic urinary abnormalities, acute kidney injury, and chronic kidney disease of unknown etiology.

RESULTS

During the past 16 years, a gradual increase in the annual number of renal biopsies/per million population (p.m.p.)/year was observed, although this incidence remained lower than in other European countries. Nephrotic syndrome was the indication for renal biopsy in over 50% of cases. Glomerulonephritis (GN) was the main histological diagnosis in 91% of cases, of which 56% were primary GN and 35% were secondary GN. The frequency of various types of primary GN was: membranoproliferative GN (MPGN) - 29.3%, membranous nephropathy (MN) -27.5%, focal segmental glomerulosclerosis (FSGS) - 17.2%, mesangial GN (including IgAN) -13.7%, crescentic GN - 9.4%, and minimal change disease (MCD) - 2.5%. Compared to the previously reported period (1994-2004), we observed a significant decrease in the frequency of MPGN and significant increases in the frequency of FSGS and, particularly MN - which more than doubled.

CONCLUSION

We report significant changes in the histological spectrum of GN in North-Eastern Romania in 2005-2010, compared to the previously reported 10-yrs. These changes seem to be following a trend that has also been observed in Western countries a few decades ago, and which may have a socioeconomic explanation.

Parastomal hernia mesh repair, variant of surgical technique without stoma relocation

RATIONALE

Due to the improvement of prognosis through adjuvant therapy, the life expectancy of neoplasia patients is continuously increasing, which, in conjunction with the progressive occurrence of parastomal hernias during the disease evolution, explains the growing number of reported parastomal hernias affecting patients with permanent colostomy. Conventional techniques of local repair are inappropriate considering the high recurrence rate, and the decision of stoma relocation depends on the associated pathology, which may counter-indicate general anesthesia, and on previous surgical interventions that are usually followed by a dense peritoneal adhesion syndrome.

OBJECTIVE

The purpose of this article is to make known a variant of alloplastic technique, without translocation, with a low degree of invasiveness, which can be performed successfully under spinal anesthesia, followed by a reduced period of hospitalization.

METHODS AND RESULTS

The study group consisted of 6 patients with permanent left iliac anus who underwent these interventions one to three years prior to the occurrence of parastomal hernia. Patients were followed at 1 year and 2 years postoperatively and the results were favorable, with no recurrence and improved quality of life through proper prosthesis of the stoma.

DISCUSSION

We suggest that this technique variation is applied to small and medium parastomal hernias, in case of patients with permanent left iliac anus, with the declared intent of minimal invasiveness.

Europeanization in making policies against domestic violence in Central and Eastern Europe

This article looks at how Europe matters in the development of policies against domestic violence, a gender equality field outside the core European Union (EU) conditionality criteria. By analyzing the concrete workings and uses of Europe's domestic violence policy-making in five Central and Eastern European countries, it identifies three mechanisms of Europeanization in the field and shows how together they work to expand the reach of the EU to this policy realm. The findings point toward an understanding of Europeanization based on social learning and dynamic, interactive processes of constructing what membership in the EU means in terms of domestic violence policy processes.

Entrance effects at nanopores of nanocapsules functionalized with poly(ethylene glycol) and their flow through nanochannels

We studied the effect of poly(ethylene glycol) (PEG) on the extrusion of large, multilamellar nanocapsules (also called liposomes or vesicles) through nanochannels with a length of 6 microm. For the generation of the nanocapsules, we used a lipid mixture with lecithin consisting of saturated and unsaturated fatty acids (dipalmitoylphosphatidylcholine (DPPC) and dioleoylphosphatidylcholine (DOPC)), cholesterol, and 2-8 mol % PEG linked to a lipid anchor (distearoylphosphatidylethanolamine (DSPE)) or the plain lipid anchor without PEG. An increase in PEG leads to a decrease of the critical tension for nanocapsule rupture (lysis tension) between 20-30%, whereas the pure lipid anchor does not produce any differences. We interpret these findings to be produced by a partial intrusion of the polymeric chain into the phospholipid bilayer of the nanocapsule which weakens its tensile strength. We evaluate statistically the discrepancies of lysis tensions found for different channels widths (50-100 nm) and two or four channels in series. Comparing our results on the flow resistance of either nanocapsules or pure water with lubrication theory, we find that the calculated viscous forces are not sufficient to account for the measured friction of nanocapsules. This shows that the nanocapsules are decelerated in the nanochannels by van der Waals interactions between channel and capsule walls and the intermediate water layer. The strength of these forces is 24 times higher for PEG and 94 times higher for the pure lipid anchor than the respective calculated viscous forces alone, showing that nanocapsule flow in nanochannels cannot be considered under the classical continuum assumption of the intermediate water layer.

[Oral and perioral endogenous pigmented lesions]

Pigmented lesions are commonly found in the mouth. Such lesions represent a variety of clinical entities, ranging from physiologic changes to manifestations of systemic illnesses and malignant neoplasms. Two groups of pigmented lesions of the oral mucosa are recognized: 1) endogenous lesions, including racial pigmentations, melanotic macules, melanocytic nevi, malignant melanoma and 2) exogenous lesions (e.g., blood-related pigmentations, metallic pigmentations). The etiology, differential diagnosis, clinical and histopathological features and management of endogenous pigmented lesions is discussed and the current literature is reviewed. In this article, pigmented lesions are described to allow practitioner to elaborate a positive diagnosis of endogenous pigmented lesions and to facilitate an early detection of these lesions particularly the malignant ones.

Usage of venous grafts in aorto-iliac reconstructive surgery

The authors present their clinical experience utilizing venous grafts (greater saphenous vein and superficial femoral vein) in the aorto-femoral position.

MATERIALS AND METHODS

Span of study is five years. The situations when these techniques were implemented are as follows:-(A). Infected synthetic prosthesis and (B). aorto-iliac occlusive disease in younger patients. A. In synthetic prosthetic infections there are 2 situations: (1) IMMEDIATE INFECTION. Observed in 10 cases, from which 2 cases where of severe infection and 8 cases of superficial infection--localized in the postoperative wound--Scarpa triangle region (7 cases) and left para-rectal (1 case). Superficial infections were treated successfully by daily dressings, excision of necrotic debris, antibiotic-therapy according to local antibiogram (only cases involving local invasion), and of course secondary wound closure at a later on date. The 2 cases of severe graft infection required harvesting of the superficial femoral vein and its usage in the aorto-femoral position. (2) LATE INFECTIONS. 3 patients were diagnosed with late infection of the synthetic prosthesis. In 2 cases, the infection was localized in the Scarpa triangle region, and the third in the abdomen (at the level of the aortic anastomosis). B. Aorto-iliac occlusive disease in younger patients--2 cases benefited from an aorto-bifemoral bypass reconstruction using the superficial femoral vein, and 5 cases where the greater saphenous vein was used in the iliac position.

RESULTS

Only 1 patient with severe prosthetic infection died due to multiple organ dysfunctions after the operation; the rest survived without any major amputation.

CONCLUSIONS

the harvesting and usage of these venous grafts is sometimes the final solution for patients with synthetic prosthesis infection.

Total body irradiation prior to bone marrow transplantation--the experience of the Institute of Oncology Prof. Dr. Al. Trestioreanu Bucharest

PURPOSE

To present the technique of total body irradiation (TBI), applied for the first time in Romania, at the Institute of Oncology Bucharest, as part of stem cell transplantation for hematological malignancies.

PATIENTS AND METHODS

The total dose administered was 12 Gy at the reference point, 2 Gy/fraction, one fraction per day, 6 consecutive days, with a total dose of 8 - 11.4 Gy delivered to the lung, using Mevatron Primus linear accelerator (6 MV & 15 MV, 200-300 cGy/min in isocenter), in vivo dosimetry detectors and equipment for the reference dosimetry, personalized blocks for lung shielding sustained by polymethylmethaacrylate (PPMA) plate, Simulix HP simulator, and computer tomographic (CT) scans. Techniques used were: a) two parallel opposed anteroposterior / posteroanterior (AP/PA) fields with the patient in prone and supine position; b) two parallel opposed lateral fields with the patient placed on a lateral table, at 320 cm from the source. The percentage depth dose, tissue maximum ratio (TMR), off axis ratio (OAR) and the reference dose rate were measured for every patient's geometrical characteristics, with an uncertainty of +/- 2.2% and were used to calculate monitor units and to evaluate the dose in organs at risk (lungs, gonads, eyes etc).

RESULTS

5 patients (3 with the AP/PA technique and 2 with the lateral technique) were irradiated. All patients completed their irradiation in good clinical condition. The acute side effects were minimal (WHO grade 1: nausea/ vomiting--all patients; diarrhea--1 patient; headache--2 patients; photophobia and diplopia--1 patient; head and neck skin erythema--all patients). Because of the short follow-up period no safe evaluation of late side effects can be done. However, during this period one patient developed a non-aggressive form of chronic liver graft vs. host disease (GVHD) and one patient died due to acute GVHD.

CONCLUSION

TBI as part of stem cell transplantation for hematological malignancies was successfully realized at our Institute, with favorable clinical results. This technique is easy to carry out and reproducible.

Iron-magnesium silicate bioweathering on Earth (and Mars?)

We examined the common, iron-magnesium silicate minerals olivine and pyroxene in basalt and in mantle rocks to determine if they exhibit textures similar to bioweathering textures found in glass. Our results show that weathering in olivine may occur as long, narrow tunnels (1-3 microm in diameter and up to 100 microm long) and as larger irregular galleries, both of which have distinctive characteristics consistent with biological activity. These weathering textures are associated with clay mineral by-products and nucleic acids. We also examined olivine and pyroxene in martian meteorites, some of which experienced preterrestrial aqueous alteration. Some olivines and pyroxenes in the martian meteorite Nakhla were found to contain tunnels that are similar in size and shape to tunnels in terrestrial iron-magnesium silicates that contain nucleic acids. Though the tunnels found in Nakhla are similar to the biosignatures found in terrestrial minerals, their presence cannot be used to prove that the martian alteration features had a biogenic origin. The abundance and wide distribution of olivine and pyroxene on Earth and in the Solar System make bioweathering features in these minerals potentially important new biosignatures that may play a significant role in evaluating whether life ever existed on Mars.

[Therapeutical options in partial infected aorto- bifemoral prosthetic grafts]

PURPOSE

To asses the use of synthetic or autologous conduits for the reconstruction of iliofemural sector in the cases of partial, limited infections of aortobifemural prosthetic grafts.

METHOD

We present two cases, both of them with infection recognized at the groin; the first one by a vascular fistula bleeding intermittently, the second by a draining groin sinus with fever and leukocytosis.

RESULTS

The PTFE conduit was the material utilized at the first case and the superficial femoral vein in the second case. The patients presented completed resolution of the infectious signs and symptoms and the revascularisation of the legs was successfully done. Evan with an extra-anatomical bridge or an autogenous material, sometimes is possible to resolve a regional infection of the aortobifemural graft only with a partial resection of one leg of the prosthesis and replacing with another sterile material.

Thoracoscopic sympathectomy for upper limb ischemic disease

We treated in 2001 in our clinic two patients with upper limb ischemic disease. Both patients had chronic pain and cyanosis of the fingers, with trophic disorders and partial amputations of distal phalanges. They were previously submitted to medical treatment with no result. We present the technique used, resectional thoracoscopic sympathectomy including T2 and T3 ganglia. First of the patients was operated on bilaterally in two successive operations, the second one only on the right side. There was an uneventful postoperative evolution with good immediate and short term results.

Localization of nitric oxide synthase isoforms in the human cochlea

The location of nitric oxide (NO) in the structures of the cochlea is a topical issue. Nitric oxide synthase (NOS) has been detected previously in mammalian cochleae, but information on its presence in the human cochlea is still sparse. The location of NOS isoforms I, II and III in substructures of the human cochlea was studied by immunohistochemistry (fluorescein isothiocyanate technique) using monoclonal antibodies to NOS I, II and III. NOS I was the predominant isoform and staining could be observed in cells of the spiral ganglion (SG), in nerve fibres and in the outer hair cells (OHC). Furthermore, the supporting cells of the organ of Corti and the stria vascularis showed a fluorescent reaction to NOS I. Staining for NOS III was less intense and was located in the OHC, supporting cells and SG cells, while the stria vascularis remained unstained. By contrast, NOS II showed weak staining in a few neuron fibres only. The results imply that NO in the human cochlea could act as a neurotransmitter/neuromodulator at the level of neural cells and may be involved in the physiology of the supporting cells and stria vascularis. Moreover, because NO is both a mediator of excitotoxicity and a non-specifically toxic radical, it may also play a role in neurotoxicity of the human cochlea.

Pharmacological models for inner ear therapy with emphasis on nitric oxide

Nitric oxide (NO)-mediated neurotoxicity may be an appropriate pathophysiological model with which to explain a variety of inner ear diseases characterized by acute or progressive hearing loss, tinnitus and vertigo. The localization of NO synthase (NOS) isoforms was examined in the inner ear of the pigmented guinea pig after intratympanic injection of 1 mg lipopolysaccharide (LPS) or 5 mg gentamicin (GM) using an immunohistochemical method, revealing the expression of NOS II in the inner ear. Production of NO in the isolated organ of Corti and utricle or in the isolated vestibular and cochlear hair cells after stimulation with L-arginine, glutamate, GM and LPS was investigated using the fluorescence indicator 4,5-diaminofluorescein diacetate. The fluorescence intensity of the sensory cells was augmented by stimulation with L-arginine, glutamate, GM and LPS. A significant increase in NO production was also noted in the LPS-treated animals. These findings imply that NO from constitutive NOS may mediate ototoxicity in the early phase, whereas NO from NOS II may contribute to the late phase of tissue damage in the inner ear. Based on this hypothesis, reduction of glutamatergic excitotoxicity and inhibition of NOS, scavenging superoxide and scavenging peroxynitrite are thought to attenuate NO-mediated otoneurotoxicity.

Discrimination among iron sulfide species formed in microbial cultures

A quantitative method for the study of iron sulfides precipitated in liquid cultures of bacteria is described. This method can be used to quantify and discriminate among amorphous iron sulfide (FeS(amorph)), iron monosulfide minerals such as mackinawite or greigite (FeS(min)), and iron disulfide minerals such as pyrite or marcasite (FeS(2min)) formed in liquid cultures. Degradation of iron sulfides is performed using a modified Cr(2+) reduction method with reflux distillation. The basic steps of the method are: first, separation of FeS(amorph); second, elimination of interfering species of S such as colloidal sulfur (S(c) degrees ), thiosulphate (S(2)O(3)(2-)) and polysulfides (S(x)(2-)); third, separation of FeS(min); and fourth, separation of FeS(2min). The final product is H(2)S which is determined after trapping. The efficiency of recovery is 96-99% for FeS(amorph), 76-88% for FeS(min), and >97% for FeS(2min). This method has a high reproducibility if the experimental conditions are rigorously applied and only glass conduits are used. A well ventilated fume hood must be used because of the toxicity and volatility of several reagents and products. The advantage relative to previously described methods are better resolution for iron sulfide species and use of the same bottles for both incubation of cultures and acid degradation. The method can also be used for Fe/S stoichiometry with sub-sampling and Fe analysis.

Alpha and beta subunits of acetylcholine receptors in the human inner ear

The localization and distribution of nicotinic acetylcholine receptors (n-ACh-r) was characterized by studying alpha and beta subunits in the adult human inner ear by FITC fluorescence technique. In the cochlea, distinct fluorescence staining occurred for beta subunits in outer hair cells (OHCs), but no alpha subunits were identified. Beta subunits differ quantitatively between the three rows of OHCs, decreasing along a base-to-apex gradient in the cochlea. Both alpha and beta subunits were identified on spiral ganglion cells, adjacent nerve fibres and in vestibular hair cells (HCs). It would appear that they form an active complex in n-ACh-r at these locations.

Otoprotectant minimizes hearing defects caused by Pseudomonas aeruginosa exotoxin A

Exotoxin A, produced by Pseudomonas aeruginosa (PaExoA), penetrates from the middle ear in to the cochlea and causes sensorineural hearing loss (SNHL). In this investigation we studied electrophysiological changes in the albino rat following instillation of PaExoA and N(G)-nitro-L-arginine methyl ester (L-NAME), a known inhibitor of nitric oxide synthesis, into the middle ear. Hearing thresholds were measured by auditory brainstem response (ABR) technique. Latency/intensity curves were constructed to distinguish between cochlear and conductive components of hearing loss. PaExoA caused damage to cochleae and SNHL, mainly at high frequencies. This impairment was blocked by (L-NAME). It would appear that nitric oxide may be a significant link in the mechanism of SNHL caused by bacterial toxin. L-NAME acts as an otoprotectant against the deleterious action of PaExoA.

Lipopolysaccharide-induced expression of inducible nitric oxide synthase in the guinea pig organ of Corti

The purpose of the investigation was to ascertain whether inoculation of bacterial lipopolysaccharide (LPS) into the cochlea of the guinea pig could elicit formation of inducible nitric oxide synthase (iNOS). Immunohistochemical study revealed that immunoreactivity to iNOS was seen below outer hair cells representing nerve fibers and synaptic nerve endings. iNOS-staining could also be observed in phalangeal dendrites of Deiter's cells pointing to the cuticular membrane, Hensen's cells and on stria vascularis 48 h after inoculation with LPS. Immunohistochemical investigation with a specific anti-nitrotyrosine antibody also revealed intense immunoreactivity identical to that of iNOS, suggesting formation of peroxynitrite in the organ of Corti by the reaction of NO with O(2)(-). On the basis of these findings, it can be concluded that NO together with O(2)(-), which form the more reactive peroxynitrite, are the most important pathogenic agents in LPS-induced damage of cochlea in the guinea pig.

Localization of soluble guanylate cyclase activity in the guinea pig inner ear

The aim of this study was to characterize the nitric oxide (NO) receptor soluble guanylate cyclase (sGC), to determine the cells targeted by NO and to elucidate the function of the NO/cGMP pathway in the inner ear. sGC activity in the inner ear was localized by immunohistochemical detection of NO-stimulated cGMP. Soluble guanylate cyclase activity in the cochlea was detected in the nerve endings underneath the outer and inner hair cells, supporting cells, stria vascularis and vessels. In the vestibular organs, sGC activity was detected in the cytoplasm of sensory cells, nerve fibres, dark cells and transitional cells and vessels. These findings suggest that the NO/cGMP pathway may be involved in regulatory processes in neurotransmission, blood flow and inner ear fluid homeostasis.

Free radicals in the guinea pig inner ear following gentamicin exposure

The purpose of this study was to investigate the occurrence of free radicals, nitric oxide (NO), superoxide (O-2) and peroxynitrite, in the inner ear of the guinea pig following intratympanic injection with 5 mg of gentamicin (GM). Forty-eight hours after GM injection, varying degrees of degeneration of the inner ear were observed. Immunohistochemical study revealed immunoreactivity to NO synthase II (which generates NO) and to xanthine oxidase (which generates O-2) in both the vestibular organ and the organ of Corti. Immunohistochemical investigation, using a specific antinitrotyrosine antibody, also showed intense staining, suggesting formation of peroxynitrite in the inner ear through the reaction of NO with O-2. Scanning electron-microscopic study showed that the ototoxic effects could be blocked with N-nitro-L-arginine methylester, a competitive inhibitor of NO synthase, with superoxide dismutase, an O-2 scavenger, and with ebselen, a scavenger of peroxynitrite. On the basis of these findings, it can be concluded that NO together with O-2, which form more reactive peroxynitrite, play an important role in GM ototoxicity in the guinea pig.

[The prevalence of viral hepatitis markers in patients hospitalized in infectious disease wards with a diagnosis of acute viral hepatitis]

According with Romanian public health surveillance system, the acute viral hepatitis is nominal reportable disease for what hospital admission is compulsory (Ord. MS 638/1978 and Ord. MS 386/1985); that why, for this condition controlling purpose, only the hospital admitted cases are reported. The acute viral hepatitis statistics do not reflect the morbidity in general population but in hospitalized population; these statistics are very dependent if ill people are hospitalized or not, and in the same time by the lack possibilities of laboratory diagnosis. The objective's study were: a) to describe the structure of laboratory-based diagnostics (using ELISA kits), b) to compare this one with diagnostics established for admitted ill people in infectious wards or clinics, using electroimmunodiffusion (EID) test. The most important findings reveal that from a total of 121 cases about three quarters has been identified as type B viral hepatitis, 20% as type A viral hepatitis and 8.3% were neither type A nor type B viral hepatitis (ELISA kits for hepatitis C diagnosis there was not available for us). According with our findings we think EID technique as etiologic diagnosis for acute viral hepatitis, have to be changed. We need instead a more sensitive and timeliness test; in the same time this has to be permissive from the financial point of view.

[The prevalence of viral hepatitis B in pregnant women in an area of southern Romania]

In Romania, the acute hepatitis B virus (HBV) infections are considered to be a public health problem. One of the most effective routes of transmission is from infected mothers to newborns both perinatal and in early childhood. That for, this study objective was to estimate the prevalence of hepatitis B în pregnant women. We used the cluster sampling method with a sample size of 1356 pregnant women. Finally our study was based on 1298 blood samples coming from 19 clusters (obstetrics wards/hospitals) selected from those 108 obstetrics wards/hospitals in the south of Romania. Overall, 31.8% (95% C.I. 27.3%-36.4%) of pregnant women admitted for birth in southern Romania had the evidence of past or current HBV infection (anti HBc, AgHBs). In a study done in 1990, Bradley A. Woodruff et al. has reported a prevalence of past or current HBV infection of 36.7% among pregnant women in northeastern Romania.

Possible involvement of free radicals in lipopolysaccharide-induced labyrinthitis in the guinea pig: a morphological and functional investigation

Intratympanic injection of bacterial lipopolysaccharide impaired caloric responses and caused severe and widespread morphological damage to vestibular end organs and the endolymphatic sac in the guinea pig. These effects could be blocked with N-nitro-L-arginine methylester, a competitive inhibitor of nitric oxide synthase, with superoxide dismutase, an O2 scavenger, with dexamethasone, and with ebselen, a scavenger of peroxynitrite. These observations indicate that enhanced nitric oxide and superoxide production, resulting in formation of peroxynitrite, is probably an important factor responsible for the pathological damage to vestibuli. If this is so, we may have found a way to study vestibular pathogenesis in inner ear disease.

Lipopolysaccharide-induced expression of reactive oxygen species and peroxynitrite in the guinea pig vestibular organ

The purpose of this study was to investigate the occurrence of reactive oxygen species and peroxynitrite in the vestibular organ of the guinea pig following inoculation with bacterial lipopolysaccharide (LPS). The animals were injected transtympanically with 1 mg of LPS 24 h after the intraperitoneal injection of 0.1 mg LPS. Forty-eight hours after the inoculation, varying degrees of degeneration of the vestibular end organs were observed. Immunohistochemical study revealed immunoreactivity to xanthine oxidase (which generates O-2) in the vestibular organ after inoculation with LPS. Immunohistochemical investigation with a specific antinitrotyrosine antibody also showed intense staining of sensory epithelium, fluid transporting cells and the endolymphatic sac, suggesting formation of peroxynitrite in the vestibular organ through the reaction of NO with O-2. On the basis of these data, it can be concluded that NO together with O-2, which form more reactive peroxynitrite, may be the most important pathogenic agents in LPS-induced labyrinthitis in the guinea pig.

Effect of percutaneous absorption of fluocinolone acetonide on the activity of superoxide dismutase and total antioxidant status in patients with psoriasis

This study defines a modification of antioxidant systems by percutaneous absorption of fluocinolone acetonide. Total antioxidant status (TAS) provides an overall indication of antioxidant status. Superoxide dismutase (SOD), a primary antioxidant, accelerates the dismutation of the toxic superoxide radical produced during the oxidative energy processes into the less harmful molecules, hydrogen peroxide and molecular oxygen. We monitored the level of SOD and TAS in 7 males with psoriasis and 6 control subjects before and after a single application of fluocinolone acetonide 0.025% ointment to 90% of the body. The results showed that the plasma level of TAS was significantly increased (p < 0.02) at 24 h posttreatment. The erythrocytic level of SOD was significantly decreased (p < 0.01) only at 12 h after glucocorticosteroid application. The level of TAS and SOD in patients with psoriasis was also significantly increased (p < 0.01 for both situations) as compared to healthy controls. Our study suggests that fluocinolone acetonide as a therapeutic agent may play a role in the oxidative stress in skin diseases.