Irrigation implementation promotes increases in salinity and nitrate concentration in the lower reaches of the Cidacos River (Navarre, Spain)

The shift from rainfed to irrigated agriculture is associated with a change in the fertilization rates due to increases in expected production and the fact of growing more N demanding crops. In addition, the circulation of irrigation return flows (IRF) mobilizes soluble salts stored in soils or geological materials. As a consequence, it implies severe modifications in the dynamics and total amount of soluble salts and nitrogen exported, especially in semi-arid watersheds. In this study, long-term data collected by the regional authorities was used to assess the effects of irrigation implementation on salinity (using electrical conductivity, EC, as a proxy) and nitrate concentration (NO₃^-) after the transformation of ca. 77 km² from rainfed to irrigated agriculture in the Cidacos River (CR) watershed. The results indicate that water quality in the lower reaches of the CR was significantly modified after the diffuse incorporation of IRF. In contrast, neither EC nor NO₃^- were different in those monitoring stations whose contributing watersheds did not include transformed area. In addition, the temporal dynamics in the analysed variables shifted from a rainfed land signal typical in the region to an irrigated land signal, and the hydrochemical type of the CR shifted from mixed-to-Na⁺-mixed-to-HCO₃^- to mostly Na⁺-mixed type, typical of waters affected by IRF in the region. Groundwater EC and NO₃^- also increased in those wells located within the irrigated area. Although there are great uncertainties in the actual amount of salt and N reaching the CR via IRF, the expected contribution of waste water spilled into the CR is minor in comparison to other sources, mostly agricultural sources in the case of N. The observed changes have promoted the designation of the lower reaches of the CR as "affected" by NO₃^- pollution, and the whole CR watershed as a Nitrate Vulnerable Zone, with the emergent question about whether irrigation implementation as carried out currently in Spain is against the environmental objectives of the Water Framework Directive.

LAM study: Effects of lacosamide on behaviour and quality of life in patients with epilepsy

INTRODUCTION

Psychiatric comorbidities are common in epileptic patients, and evaluating the impact of antiepileptic drugs on patients' moods is therefore essential. The aim of this study is to assess the effects of lacosamide on behaviour and quality of life in people with epilepsy.

METHODS

We conducted a multicentre prospective observational study of poorly-controlled epileptic patients who received lacosamide as an adjuvant treatment. Patients were evaluated on 4 occasions during a 12-month period. The impact of lacosamide on patients' mood and quality of life was assessed with the Quality of Life in Epilepsy Inventory-10 (QOLIE-10), the Hospital Anxiety and Depression Scale (HADS), and the Barratt Impulsiveness Scale (BIS-11). As a secondary objective, we evaluated the effectiveness and safety of lacosamide.

RESULTS

We included 55 patients with a mean age of 47.1±18.4 years. At baseline, 34.5% of the patients had psychiatric comorbidities; the mean number of crises in the previous month was 3.6±4.3. The QOLIE-10 and HADS scales revealed statistically significant improvements in patients with a poor baseline condition (anxiety, depression, and/or poor quality of life). The BIS-11 scale detected no impulsive behaviour during follow-up. After 12 months of treatment, 51.9% of the patients were seizure-free and 77.8% experienced a reduction of at least 50% in seizure frequency. Adverse effects were mild in most cases; lacosamide was discontinued in 10 patients (18.2%).

CONCLUSIONS

Lacosamide is a safe and effective treatment option for patients with epilepsy and psychiatric comorbidities.

Paraneoplastic dermatomyositis: a study of 12 cases

INTRODUCTION AND OBJECTIVES

Adult dermatomyositis presents as a paraneoplastic syndrome in up to 25% of cases, but no clinical, histologic, or laboratory markers completely specific for paraneoplastic disease in dermatomyositis have been identified to date. Furthermore, studies on adult dermatomyositis do not usually report the frequency of cutaneous features of dermatomyositis in patients with associated cancer. Our aim was to review the characteristics of paraneoplastic dermatomyositis in patients seen at our hospital.

MATERIAL AND METHODS

We studied 12 cases of paraneoplastic dermatomyositis and recorded patient age and sex, associated cancer, time between onset of dermatomyositis and cancer, emergent cutaneous manifestations, muscle involvement, dysphagia, lung disease, and levels of creatine phosphokinase and circulating autoantibodies.

RESULTS

The mean age of the patients was 61 years and the 2 most common malignancies were ovarian cancer and bladder cancer. The mean time between the diagnosis of cancer and dermatomyositis was 7 months and in most cases, the cancer was diagnosed first. Seven patients had amyopathic dermatomyositis. The most common cutaneous signs were a violaceous photodistributed rash sparing the interscapular area and a heliotrope rash, followed by Gottron papules and cuticle involvement. Superficial cutaneous necrosis was observed in 3 cases. Myositis-specific autoantibodies were not detected in any of the 6 patients who underwent this test.

CONCLUSIONS

Paraneoplastic dermatomyositis is often amyopathic. There are no specific cutaneous markers for malignancy in dermatomyositis. Myositis-specific antibodies are not associated with paraneoplastic dermatomyositis.

An RCT on the effects of topical CGP on surgical wound appearance and residual scarring in bilateral total-knee arthroplasty patients

OBJECTIVE

To test the hypothesis that topically applied calcium glycerophosphate (CGP) would improve the appearance of the wound following bilateral knee replacement.

METHOD

Healthy patients, aged 45-75 years, scheduled for bilateral total-knee replacement surgery were recruited into the study. One knee was randomly assigned to the treatment group, while the contralateral knee was designated the control (standard care). Subjects were instructed to apply a preparation of 10% CGP in an aqueous lotion to the treated knee once daily for 42 days, starting at the third postoperative day. Functional sealing and cosmetic appearance of the incision were evaluated by two surgeons by direct examination of the patient and then by two experienced assessors from photographs. The investigators qualitatively scored the intensity and extent of erythema along the incision and over the entire knee, the appearance of visible oedema along the incision and over the knee, and the overall clinical impression of wound healing. All four assessors were blinded to the subjects' allocation and the latter two assessors to the initial investigators' assessments. Subjects were also followed up for an additional 46 weeks, giving a total study duration of 12 months.

RESULTS

Twenty patients completed the study. Statistical analysis showed that both the area and intensity of erythema along the incision were significantly reduced in the treated vs untreated knee over the entire study period. The analysis further showed that treatment significantly reduced oedema, both along the incision and across the entire knee. The differences were most marked at the seventh postoperative day and diminished with time. No adverse effects were observed for any patient, in either treated or untreated knees.

CONCLUSION

These data demonstrate that postoperative application of 10% CGP could improve the appearance of the wound following total knee arthroplasty.

Integral valorization of tagasaste (Chamaecytisus proliferus) under hydrothermal and pulp processing

Tagasaste wood (Chamaecytisus proliferus L.F. ssp palmensis) was characterized, chemical and energy terms, and assessed its potential as a lignocellulosic raw material, and its integral fractionation by autohydrolysis and delignification with ethanol. The hydrothermal treatment of the raw material at 175-185 degrees C provided a liquor containing a substantially increased amount of oligomers (between 16.6% and 47.4% as percentages with respect to the content of the raw material in each polymer fraction). A cellulose pulp with autohydrolysis treatment increased yields (53-60%), reduced Kappa number (28.8-34.6) but also viscosity (755-857 mL/g), and decreased paper strength (2.97-5.22 kN m/kg). However, beating ethanol cellulose from tagasaste was found to improve its strength-related properties more markedly than in soda pulp from the same material (tensile index of 44 kN m/kg).

Integral valorization of two legumes by autohydrolysis and organosolv delignification

Two woody legumes species (Chamaecytisus proliferus L.F. ssp. palmensis and Leucaena diversifolia) were evaluated for integrally exploitation. The raw material was subjected to autohydrolysis under variable operating conditions which provided a liquid phase rich in hemicellulose oligomers and a solid phase that was used to obtain cellulose pulp and paper sheets by using organosolv procedures. The chemical properties of both C. proliferus and L. diversifolia allow their integral exploitation by using a hydrothermal treatment prior to their organosolv pulping with ethanol. The pulp yields obtained are quite high (40.3% for L. diversifolia and 58.2% for C. proliferus), and so are the sugar concentrations in the liquors from the thermal pretreatment (viz. 16.1 and 20.0 g oligomers/l in C. proliferus and L. diversifolia, respectively, and 1.5 and 1.1g xylose/l, respectively, in the two raw materials). The strength-related properties of the paper sheets obtained are acceptable (tensile index 7.76 and 10.77 kN m/kg for C. proliferus and L. diversifolia, respectively and kappa index 31 and 12.5 for C. proliferus and L. diversifolia, respectively), but somewhat worse than those provided by other raw materials such as eucalyptus; however, they can be improved by mechanical refining of the pulp.

The use of Tagasaste (Chamaecytisus proliferus) from different origins for biomass and paper production

In order to identify faster-growing non-woody species usable for biomass and paper production, four Tagasastes (Chamaecytisus proliferus) from different origins are tested. All the Tagasaste species (T. Huelva, T. Australia, T. New Zealand and T. La Palma island) show a good soil and climatic adaptation to Southwest Spain. The studied Tagasaste provenances shows biomass productivity ranges from 1.0 t ha(-1)yr(-1) to 3.4 th a(-1)yr(-1) (o.d.b.) and 25.3 t ha(-1)yr(-1) to 49.4 t ha(-1)yr(-1) under Mediterranean conditions for first and second year sprouts, respectively. The quantity of solubles and extractives shows similar values when compared with wood materials. A relatively lower lignin content in Tagasaste (from 13.7% to 17.1%) species has been found with respect to other vegetal species. The alpha-celullose contents (43.6-45.3%) were in the range of the normal values expected for the other non-wood raw materials. The study confirms the feasibility of the organocell yield pulping process to Tagasaste provenances. Organocell processes provide an efficient delignification (kappa index from 7.2 to 10.9 and pulp yield from 43.6% to 54.1%). The best results are obtained for the physical properties of paper sheets for Tagasaste from Australia in the second year, with values of tensile index of 16.0 kNm/kg, burst index of 1.12 MPa m2/kg and tear index of 0.55 Nm2/kg.

[B-cell pseudolymphoma caused by aluminium hydroxide following hyposensitization therapy]

Aluminium hydroxide is used as an adjuvant in vaccines. We describe the case of a patient who presented a persistent adverse local reaction to aluminium hydroxide due to hyposensitization therapy to dust mites. Multiple painful and pruriginous subcutaneous nodules were observed in both arms, along with hypertrichosis at the injection site. Histology revealed a pseudolymphomatous B cell reaction predominantly involving cells that were CD20 positive, did not express bcl-2, and did not display the t(14-18) translocation. The cells also exhibited polyclonal rearrangement of the immunoglobulin heavy chains. X-ray spectral microanalysis revealed deposits of inorganic aluminium in the granular histiocytes among the germinal centers. The patient was diagnosed with cutaneous B-cell pseudolymphoma due to aluminium hydroxide as a result of immunotherapy.

Thoracoscopic and laparoscopic repair of complicated Bochdalek hernia in adult

Bochdalek's hernia is a congenital defect of the diaphragm that occurs predominantly in children. Perforation or necrosis of the involved organ is a feared complication and surgical repair constitutes the gold standard of treatment. We present a case of a 42-year-old female patient who presented with a 3-month history of left-upper-quadrant abdominal pain, nausea, tachycardia, and early postprandial vomit. Physical exploration was remarkable for audible peristalsis in the left hemithorax. Total white blood count was elevated and chest X-rays showed images of intestines in the left hemithorax. Tomography with double contrast reported left colon herniated to thorax. Left thoracoscopy was practised, finding a Bochdalek's hernia with presence of herniated descendent colon with a necrotic area, which was perforated and sealed. The herniated content was returned back in place, the diaphragmatic defect was corrected, and colostomy by laparoscopy was simultaneously performed. Her postoperative recovery was uneventful and she was discharged from the hospital. Combined thoracoscopy and laparoscopic surgery is effective in complicated cases of Bochdalek's hernia in adults, lessening surgical trauma and postsurgical morbidity.

[Becker nevus syndrome]

Becker nevus is a hyperpigmented hamartoma with an irregular outline and often hairy. It is normally found on the shoulders and chest, although it can appear in other areas. Becker nevus is sometimes associated with other muscular, skeletal, or cutaneous abnormalities such as ipsilateral breast hypoplasia or scoliosis. This characteristic phenotype of Becker nevus associated with unilateral breast hypoplasia or other abnormalities is referred to as Becker nevus syndrome. Although the lesions usually become apparent during adolescence, they are present from birth and represent part of the spectrum of so-called epidermal nevus syndromes. We present 4 cases of Becker nevus syndrome in which Becker nevus was associated with ipsilateral breast hypoplasia and, less consistently, other abnormalities.

[Oral involvement in lymphomatoid papulosis]

Lymphomatoid papulosis is a cutaneous lymphoma with an indolent clinical behaviour characterized by chronic development of recurrent, self-limited lesions appearing as necrotic papules and with a pathology compatible with T cell lymphoma. Mucosal involvement by lymphomatoid papulosis is very rare but has been reported in the literature. It usually appears as ulcers in patients previously diagnosed of lymphomatoid papulosis. From a histological perspective it is characterized by an infiltrate of CD 30 positive atypical lymphocytes together with a mixed inflammatory infiltrate of eosinophils, neutrophils, histiocytes and plasma cells. We report the case of a man previously diagnosed of lymphomatoid papulosis that developed two ulcerated lesions in the tongue whose biopsy confirmed the diagnosis of oral involvement by lymphomatoid papulosis.

Nevos plantares múltiples posquimioterapia

The induction of multiple melanocytic nevi in children after chemotherapy has been documented in the literature. This situation apparently has more to do with the state of immunosuppression that is produced than with any specific agent used. We present the case of a 12-year-old girl who presented with multiple plantar melanocytic nevi after multidrug chemotherapy for acute lymphocytic leukemia. None of the lesions showed any alarming clinical signs. Although the degeneration of post-chemotherapy melanocytic nevi to melanoma has not been documented in any of the cases described, the presence of a high number of melanocytic nevi is an accepted risk factor for melanoma; thus, close clinical follow-up of these patients seems advisable.

Clinical, dermoscopy and histological correlation study of melanotic pigmentations in excision scars of melanocytic tumours

BACKGROUND

Melanotic pigmentations in scars consecutive to the excision of melanocytic tumours can be secondary to a reactive phenomenon related to the scar tissue or to a recurrence of the melanocytic lesion excised in the first case. Recurrent naevi may sometimes adopt unusual features that make them difficult to differentiate from a melanoma.

OBJECTIVES

To describe the clinical, dermoscopic and histological features of melanotic pigmentations in scars consecutive to the excision of melanocytic tumours, and to correlate the histological diagnosis with the dermoscopic features.

METHODS

This was a prospective cohort study using macrophotography, dermoscopy and histopathological study. Ninety-five melanotic pigmentations (77 patients) in scars secondary to the excision of melanocytic tumours were prospectively collected in the Department of Dermatology at the Instituto Valenciano de Oncología in Valencia, Spain. Histopathological study was performed in 57 scars.

RESULTS

Thirteen dermoscopic structures were identified. Four criteria allowed a differentiation between reactive and specific melanocytic pigmentations. Presence of globules and presence of heterogeneous pigmentation were features associated with specific melanocytic pigmentations (P < 0.0001). Presence of a regular network and presence of streaks were more frequently found in reactive pigmentations (P = 0.023 and 0.026, respectively).

CONCLUSIONS

Dermoscopic examination of melanotic pigmentations in excision scars of melanocytic tumours provides useful information about the origin of that pigmentation. Based on such information, recurrent naevi can be differentiated from reactive pigmentations in most cases. Excision and histopathological diagnosis continue to be imperative in some cases of recurrent naevi with atypical clinical features.

Development of a cortical visual neuroprosthesis for the blind: the relevance of neuroplasticity

Clinical applications such as artificial vision require extraordinary, diverse, lengthy and intimate collaborations among basic scientists, engineers and clinicians. In this review, we present the state of research on a visual neuroprosthesis designed to interface with the occipital visual cortex as a means through which a limited, but useful, visual sense could be restored in profoundly blind individuals. We review the most important physiological principles regarding this neuroprosthetic approach and emphasize the role of neural plasticity in order to achieve desired behavioral outcomes. While full restoration of fine detailed vision with current technology is unlikely in the immediate near future, the discrimination of shapes and the localization of objects should be possible allowing blind subjects to navigate in a unfamiliar environment and perhaps even to read enlarged text. Continued research and development in neuroprosthesis technology will likely result in a substantial improvement in the quality of life of blind and visually impaired individuals.

Lupus vulgar de 50 años de evolución

Lupus vulgaris is the most frequent form of cutaneous tuberculosis in industrialized countries. It is a chronic and benign form of cutaneous tuberculosis that usually occurs in patients previously sensitized to Mycobacterium tuberculosis. The histopathological study shows tuberculoid granulomas that usually contain Langhans-type giant cells. Caseous necrosis is not normally found. The culture is negative in most patients. On the other hand, the Mantoux test is usually highly positive. We present the case of a 58-year-old male who developed lupus vulgaris on the left cheek over a nine-year period, and who had another similar lesion on the edge of a residual scar on the left forearm from a probable scrofuloderma suffered during childhood.

Mapping of the human visual cortex using image-guided transcranial magnetic stimulation

We describe a protocol using transcranial magnetic stimulation (TMS) to systematically map the visual sensations induced by focal and non-invasive stimulation of the human occipital cortex. TMS is applied with a figure of eight coil to 28 positions arranged in a 2x2-cm grid over the occipital area. A digitizing tablet connected to a PC computer running customized software, and audio and video recording are used for detailed and accurate data collection and analysis of evoked phosphenes. A frameless image-guided neuronavigational device is used to describe the position of the actual sites of the stimulation coils relative to the cortical surface. Our results show that TMS is able to elicit phosphenes in almost all sighted subjects and in a proportion of blind subjects. Evoked phosphenes are topographically organized. Despite minor inter-individual variations, the mapping results are reproducible and show good congruence among different subjects. This procedure has potential to improve our understanding of physiologic organization and plastic changes in the human visual system and to establish the degree of remaining functional visual cortex in blind subjects. Such a non-invasive method is critical for selection of suitable subjects for a cortical visual prosthesis.