Prospective study of HDR brachytherapy (BT), external beam radiotherapy (EBRT) and androgen deprivation therapy (ADT): 10-years experience of an MRI-guided approach

OBJECTIVES

To evaluate the predictive factors for biochemical failure and distant metastases in a prospective cohort of patients with localized prostate cancer treated with the combination of HDR BT and EBRT.

METHODS AND MATERIALS

Patients with intermediate (IR) or high-risk (HR) prostate adenocarcinoma received a single fraction of HDR of 15 Gy combined with RT of 37.5 Gy in 15 fractions. ADT duration was used depending on risk-group. Descriptive analyses were performed. Univariate and multivariate Hazard Ratios were obtained. Finally, the Kaplan-Meier model was used to describe the survival of the events of interest.

RESULTS

309 patients were treated prospectively (199 were IR and 110 HR). Median age was 72 years; 58.3 % were MRI stage ≤ T2c, 34.1 % T3a and 7.6 % T3b; ISUP-grade 1-3 in 78.9 % and ISUP 4-5 in 21.1 %. 71.8 % of patients had ≤ 50 % positive-cores in biopsy and 28.2 % had > 50 %. Median pre-treatment PSA was 9.9 ng/mL. After a median follow-up of 88 months, 41 patients presented biochemical failure and 18 developed distant metastases. Multivariate cox-regression analyses found that MR-T3b Stage (HR 3.88, p = 0.001) and ADT use (HR 3.99, p = 0.03) were the only predictive factors for biochemical failure and the number of positive cores (>50 %) the only independent predictive factor of distant metastases (HR 4.36, p = 0.002).

CONCLUSIONS

Patients with mpMRI evidence of invasion of the SV and involvement of more than 50% of the cores in the prostate biopsy are patients with a higher risk of presenting a biochemical recurrence or developing metastasis due to their prostate cancer, respectively.

Influence of plasma kinetic energy during the pulsed laser deposition of borophene films on silicon (100)

Developing borophene films with good structural stability on non-metallic substrates to maximize their potential in photosensitivity, gas detection, photothermia, energy storage, and deformation detection, among others has been challenging in recent years. Herein, we succeeded in the pulsed laser deposition of multilayered borophene films on Si (100) with β12 or χ3 bonding by tuning the mean kinetic energy in the plasma during the deposition process. Raman and X-ray photoelectron spectroscopies confirm β12 and χ3 bonding in the films. Borophene films with β12 bonding were obtained by tuning a high mean kinetic energy in the plasma, while borophene with χ3 bonding required a relatively low mean kinetic energy. Atomic force microscopy (AFM) micrographs revealed a granular and directional growth of the multilayered borophene films following the linear atomic terraces from the (100) silicon substrate. AFM nanofriction was used to access the borophene surfaces and to reveal the pull-off force and friction coefficient of the films where the surface oxide showed a significant contribution. To summarize, we show that it is possible to deposit multilayered borophene thin films with different bondings by tuning the mean kinetic energy during pulsed laser deposition. The characterization of the plasma during borophene deposition accompanies our findings, providing support for the changes in kinetic energy.

An efficient nonstandard computer method to solve a compartmental epidemiological model for COVID-19 with vaccination and population migration

BACKGROUND AND OBJECTIVE

In this manuscript, we consider a compartmental model to describe the dynamics of propagation of an infectious disease in a human population. The population considers the presence of susceptible, exposed, asymptomatic and symptomatic infected, quarantined, recovered and vaccinated individuals. In turn, the mathematical model considers various mechanisms of interaction between the sub-populations in addition to population migration.

METHODS

The steady-state solutions for the disease-free and endemic scenarios are calculated, and the local stability of the equilibium solutions is determined using linear analysis, Descartes' rule of signs and the Routh-Hurwitz criterion. We demonstrate rigorously the existence and uniqueness of non-negative solutions for the mathematical model, and we prove that the system has no periodic solutions using Dulac's criterion. To solve this system, a nonstandard finite-difference method is proposed.

RESULTS

As the main results, we show that the computer method presented in this work is uniquely solvable, and that it preserves the non-negativity of initial approximations. Moreover, the steady-state solutions of the continuous model are also constant solutions of the numerical scheme, and the stability properties of those solutions are likewise preserved in the discrete scenario. Furthermore, we establish the consistency of the scheme and, using a discrete form of Gronwall's inequality, we prove theoretically the stability and the convergence properties of the scheme. For convenience, a Matlab program of our method is provided in the appendix.

CONCLUSIONS

The computer method presented in this work is a nonstandard scheme with multiple dynamical and numerical properties. Most of those properties are thoroughly confirmed using computer simulations. Its easy implementation make this numerical approach a useful tool in the investigation on the propagation of infectious diseases. From the theoretical point of view, the present work is one of the few papers in which a nonstandard scheme is fully and rigorously analyzed not only for the dynamical properties, but also for consistently, stability and convergence.

An optimal Bayesian threshold method for onset detection in electric biosignals

In this work, we consider the problem of identifying activity phases in electromyography signals, and various other potential types of electrical and non-electrical biological signals such as electroneurograms, electroencephalograms, voice and ultrasounds. The solution to this problem has been provided under relatively limited scenarios. The purpose of the present work is to propose an optimal Bayesian classifier to solve the problem of detecting bursts on biological signals. To that end, a parametrization of the distribution of samples in signals is presented. We propose a model based on a linear combination of normal distributions with mean equal to zero and different variances. The threshold criterion is expressed in a closed-form, and the use of morphology operators in the post-processing treatment leads to accurate results. Various comparisons are provided against other techniques available in the literature. In all of our experiments, we show that our present approach yields superior results.

LEACHING AND DEGRADATION OF 2,4-DICHLOROPHENOXIACETIC ACID, IN COLOMBIA RICE FLOODED SOIL

Rice is mostly cultivated on soil held under flooded conditions. Under these conditions pesticides undergo reductive transformations which are characteristic to rice fields and other anaerobic systems. The present study was undertaken to evaluate the mobility and persistence of 2,4-dichlorophenoxy acetic acid (2,4-D) under laboratory conditions for the rice crop in Espinal, Colombia. A displacement study was performed on a hand packed soil column 30 cm length. After leaching experiment, the soil from column was sliced into six successive sections (5 cm). Methanol acidified (H3PO4 0.25%) extraction was used to determine the herbicide residues in each section. 2,4-D experimental breakthrough curve was analyzed using Stanmod program (inverse problem) to obtain transport parameters. The non-equilibrium physical model fitted well the experimental breakthrough curve. The recovery percent of 2,4-D in leachates was 36.44% after 3.4 pore volumes, and retardation factor was 2.1, indicating low adsorption in that conditions. 2,4-D was rapidly degraded, with DT50 = 11.4 days. The results suggest that 2,4-D under flooded conditions have a high potential for leaching through the soil profile, although the elevated rate of degradation reduced the ground water contamination risk.

A computational method for the detection of activation/deactivation patterns in biological signals with three levels of electric intensity

In the present work, we develop a computational technique to approximate the changes of phase in temporal series associated to electric signals of muscles which perform activities at three different levels of intensity. We suppose that the temporal series are samples of independent, normally distributed random variables with mean equal to zero, and variance equal to one of three possible values, each of them associated to a certain degree of electric intensity. For example, these intensity levels may represent a leg muscle at rest, or active during a light activity (walking), or active during a highly demanding performance (jogging). The model is presented as a maximum likelihood problem involving discrete variables. In turn, this problem is transformed into a continuous one via the introduction of continuous variables with penalization parameters, and it is solved recursively through an iterative numerical method. An a posteriori treatment of the results is used in order to avoid the detection of relatively short periods of silence or activity. We perform simulations with synthetic data in order to assess the validity of our technique. Our computational results show that the method approximates well the occurrence of the change points in synthetic temporal series, even in the presence of autocorrelated sequences. In the way, we show that a generalization of a computational technique for the change-point detection of electric signals with two phases of activity (Esquivel-Frausto et al., 2010 [40]), may be inapplicable in cases of temporal series with three levels of intensity. In this sense, the method proposed in the present manuscript improves previous efforts of the authors.

First Report of Shoot Blight and Canker Caused by Diplodia coryli in Hazelnut Trees in Chile

Shoot blight, twig and branch cankers with grayish discoloration, roughened tissue, and dieback were observed in 5-year-old European hazelnut trees (Corylus avellana L.) cv. Barcelona at two commercial plantations in the Allipén locality, Region de La Araucanía (38° 59' 24.76″ S, 72° 29' 35.58″ W), Chile, during the 2011 to 2012 growing season. In addition, discoloration of the wood was observed in cross-sections. In order to isolate the causal agent, entire twigs and shoot fragments with cankers were sterilized in 0.5% sodium hypochlorite for 2 minutes, followed by two rinses with sterile distilled water. The tissues were then stored in a humid chamber. Sub-epidermal black pycnidia with sporulation were detected on the symptomatic tissue. Conidia were transferred to potato dextrose agar (PDA) (Difco, Lawrence, KS) and incubated at 25°C in the dark. The mycelia were black, creeping, and compact in appearance. The mature conidia were dark brown with a single septum, slightly constricted at the septum, and ovoid with a broadly rounded apex; some had a truncated base. Conidia had the following measurements: (20.0-) 23.1 ± 1.9 (-28.0) × (10-) 11.9 ± 1.2 (-15) μm with an average length/width ratio of 1.95 ± 0.17 (n = 50). These morphometric characteristics correspond to those of Diplodia coryli Fuckel (1870), teleomorph: Botryosphaeria sensu lato. The identity of the fungus was confirmed using internal transcribed spacer (ITS) rDNA sequencing completed at CABI, United Kingdom. The sequencing report indicated that the isolate (IMI-501235a) had 100% homology with a reference strain (CBS 242.51) in the CBS collection. The obtained sequence was deposited in GenBank (Accession No. JX163116). The anamorphs of Botryosphaeria have been divided into up to 18 genera (1), many of which are not clearly defined. Diplodia (3), including D. coryli (CBS 242.51) and D. juglandis (CBS 188.87), have been included within the genus Dothiorella (2), but the taxon names have not been formally changed. A pathogenicity test was conducted with one isolate (IMI-501235a) and four 1-year-old plants of hazelnut cultivar Barcelona. Plants were maintained in individual bags in greenhouse conditions (14/10 hours dark/light, 20°C; 70% RH). Prior to inoculation, plant tissues were externally disinfected with sodium hypochlorite (2%) and rinsed with sterile distilled water. Each plant was inoculated at fresh wound sites on two shoots and three twigs around each vegetative bud. The inoculum consisted of an agar plug with mycelia (5 mm) from the margin of an actively growing colony cultured on PDA media for 7 days. Each wound was covered with moistened cotton and sealed with Parafilm; a control plant was inoculated in the same way with agar only. After 3 months, fragments of necrotic and discolored vascular system tissues from inoculated shoots were removed and incubated on PDA. D. coryli was consistently recovered from these tissues, satisfying Koch's postulates. The control plant showed no symptoms of the disease. D. coryli has been reported to cause symptoms of dieback (dead branches) in Italy and Spain. To our knowledge, this is the first report of D. coryli on C. avellana cv. Barcelona in Chile. European hazelnut is an emerging crop in Chile, grown mainly for export, and management strategies for this disease will need to be developed. References: (1) S. Denman et al. Stud. Mycol. 45:129, 2000. (2) A. J. L. Phillips et al. Persoonia 21:29, 2008. (3) A. J. L. Phillips et al. Mycologia 97:513, 2005.

In silico discovery of a compound with nanomolar affinity to antithrombin causing partial activation and increased heparin affinity

The medical and socioeconomic relevance of thromboembolic disorders promotes an ongoing effort to develop new anticoagulants. Heparin is widely used as activator of antithrombin but incurs side effects. We screened a large database in silico to find alternative molecules and predicted d-myo-inositol 3,4,5,6-tetrakisphosphate (TMI) to strongly interact with antithrombin. Isothermal titration calorimetry confirmed a TMI affinity of 45 nM, higher than the heparin affinity (273 nM). Functional studies, fluorescence analysis, and citrullination experiments revealed that TMI induced a partial activation of antithrombin that facilitated the interaction with heparin and low affinity heparins. TMI improved antithrombin inhibitory function of plasma from homozygous patients with antithrombin deficiency with a heparin binding defect and also in a model with endothelial cells. Our in silico screen identified a new, non-polysaccharide scaffold able to interact with the heparin binding domain of antithrombin. The functional consequences of this interaction were experimentally characterized and suggest potential anticoagulant therapeutic applications.

Activity pattern detection in electroneurographic and electromyogram signals through a heteroscedastic change-point method

In this work, we propose a heteroscedastic method in the detection of activity patterns of electroneurographic and electromyogram signals involved in rhythmic activities of nerves and muscles, respectively. The electric behavior observed in such signals is characterized by phases of activity and silence. The beginning and the length of electrically active and electrically silent phases in a signal allow us to quantitatively analyze the changes and the effects on a rhythmic activity produced by experimental changes. In order to distinguish between these two phases, signals are assumed to be a sample of a time-dependent, normally distributed random variable with non-constant variance, and that the determination of the variance at each point allows us to determine in which phase is the signal. The parameters of the model are determined by means of an iterative process which maximizes the log-likelihood under the proposed model. Moreover, we apply our method to the determination of the activity phases and silence phases in sequences of experimental and synthetic electroneurographic and electromyogram signals. The results obtained with synthetic data show that the method performs well in the determination of these activity patterns. Finally, the study of particular signals simulated under a generalized autoregressive conditional heteroscedasticity model suggests the robustness of the method with respect to the assumption of independence.

14C tebuconazole degradation in Colombian soils

Tebuconazole is a fungicide used on onion crops (Allium Fistulosum L) in Colombia. Persistence of pesticides in soils is characterized by the half-life (DT50), which is influenced by their chemical structure, the physical and chemical properties of the soil and the previous soil history. Based on its structural and chemical properties, tebuconazole should be expected to be relatively persistent in soils. Laboratory incubation studies were conducted to evaluate persistence and bond residues of 14C tebuconazole in three soils, two inceptisol (I) and one histosol (H). Textural classifications were: loam (101), loamy sand (102) and loam (H03), respectively. Data obtained followed a first-order degradation kinetics (R2 > or = 0.899) with DT50 values between 158 and 198 days. The production of 14CO2 from the 14C-ring-labelled test chemicals was very low and increased slightly during 63 days in all cases. The methanol extractable 14C-residues were higher than aqueous ones and both decreased over incubation time for the three soils. The formation of bound 14C-residues increased with time and final values were 11.3; 5.55 and 7.87% for 101, 102 and H03 respectively. Soil 101 showed the lowest mineralization rate and the highest bound residues formation, which might be explained by the clay fraction content. In contrast, an inverse behavior was found for soils 102 and H03, these results might be explained by the higher soil organic carbon content.

Differential effects of quercetin, apigenin and genistein on signalling pathways of protease-activated receptors PAR(1) and PAR(4) in platelets

BACKGROUND AND PURPOSE

The modulation by flavonoids of platelet responses induced by thrombin has been little investigated, and the antiplatelet activity, as well as possible inhibitory mechanisms of these compounds on thrombin signalling, has not yet been elucidated. We explored whether flavonoids affect platelet signalling pathways triggered by thrombin and by the selective activation of its protease-activated receptors (PARs) 1 and 4, and analysed the antagonism of these polyphenols at thrombin receptors.

EXPERIMENTAL APPROACH

We investigated the effect of a range of polyphenolic compounds on platelet aggregation, 5-HT secretion, intracellular calcium mobilization, protein kinase activity and tyrosine phosphorylation, triggered by thrombin and PAR agonist peptides (PAR-APs). The ability of these flavonoids to bind to thrombin receptors was investigated by competitive radioligand binding assays using (125)I-thrombin.

KEY RESULTS

Quercetin, apigenin and genistein impaired platelet aggregation, as well as 5-HT release and calcium mobilization, induced by thrombin and PAR-APs. Quercetin and apigenin were inhibitors of protein kinases, but genistein exhibited a minimal ability to suppress platelet phosphorylation. Binding assays did not establish any kind of interaction between thrombin receptors and any of the flavonoids tested.

CONCLUSIONS AND IMPLICATIONS

Quercetin, apigenin and genistein did not inhibit thrombin responses by interacting with thrombin receptors, but by interfering with intracellular signalling. While inhibition by genistein may be a consequence of affecting calcium mobilization, subsequent platelet secretion and aggregation, for quercetin and apigenin, inhibition of kinase activation may also be involved in the impairment of platelet responses.

Effects of acrolein, a natural occurring aldehyde, on the anticoagulant serpin antithrombin

We studied the effect of acrolein, an alpha,beta-unsaturated aldehyde that causes adduct-modification of lysine, cysteine, and histidine residues, on antithrombin, a key anticoagulant serpin. Intrinsic fluorescence, functionality (anti-FXa and anti-IIa activity), heparin affinity and conformational features of plasma and purified antithrombin were evaluated. In vivo experiments were carried out in mice. Intrinsic fluorescence showed a two-step conformational change. Acrolein, even at low dose, impaired the anticoagulant function of purified antithrombin by affecting its heparin affinity. However, higher concentrations of acrolein and long incubations are required to cause mild functional effects on plasma antithrombin and mice.

In vivo relevance for platelet glycoprotein Ibalpha residue Tyr276 in thrombus formation

BACKGROUND

Platelet glycoprotein (GP) Ib-IX-V supports platelet adhesion on damaged vascular walls by binding to von Willebrand factor (VWF). For several decades it has been recognized that the alpha-subunit of GP (GPIbalpha) also binds thrombin but the physiological relevance, if any, of this interaction was unknown. Previous studies have shown that a sulfated tyrosine 276 (Tyr276) is essential for thrombin binding to GPIbalpha.

OBJECTIVES

This study investigated the in vivo relevance of GPIbalpha residue Tyr276 in hemostasis and thrombosis.

METHODS

Transgenic mouse colonies expressing the normal human GPIbalpha subunit or a mutant human GPIbalpha containing a Phe substitution for Tyr276 (hTg(Y276F)) were generated. Both colonies were bred to mice devoid of murine GPIbalpha.

RESULTS

Surface-expressed GPIbalpha levels and platelet counts were similar in both colonies. hTg(Y276F) platelets were significantly impaired in binding alpha-thrombin but displayed normal binding to type I fibrillar collagen and human VWF in the presence of ristocetin. In vivo thrombus formation as a result of chemical damage (FeCl(3)) demonstrated that hTg(Y276F) mice have a delayed time to occlusion followed by unstable blood flow indicative of embolization. In models of laser-induced injury, thrombi developing in hTg(Y276F) animals were also less stable.

CONCLUSIONS

The results demonstrate that GPIbalpha residue Tyr276 is physiologically important, supporting stable thrombus formation in vivo.

Adaptive monogenic filtering and normalization of ESPI fringe patterns

A technique is presented for filtering and normalizing noisy fringe patterns, which may include closed fringes, so that single-frame demodulation schemes may be successfully applied. It is based on the construction of an adaptive filter as a linear combination of the responses of a set of isotropic bandpass filters. The space-varying coefficients are proportional to the envelope of the response of each filter, which in turn is computed by using the corresponding monogenic image [Felsberg and Sommer, IEEE Trans. Signal Process. 49, 3136 (2001)]. Some examples of demodulation of real Electronic Speckle Pattern Interferometry (ESPI) images patterns are presented.

Flavonoids inhibit platelet function through binding to the thromboxane A2 receptor

BACKGROUND

Dietary flavonoids are known for their antiplatelet activity resulting in cardiovascular protection, although the specific mechanisms by which this inhibition occurs has not been fully established.

OBJECTIVE

The aim of this study was to investigate the interaction of nine flavonoids representative of various chemical classes, with platelet responses dependent on thromboxane A(2) (TxA(2)) generation and on receptor antagonism, and to analyze the structural requirements for such effects.

METHODS

The effect of several types of flavonoids on platelet aggregation, serotonin release, and TxA(2) generation was investigated. Competitive radioligand binding assays were used to screen for affinity of these compounds to TxA(2) receptors.

RESULTS

Flavones (apigenin and luteolin) and isoflavones (genistein) abrogated arachidonic acid and collagen-induced platelet responses, such as aggregation and secretion, with a less substantial effect on TxA(2) synthesis. These compounds were identified as specific ligands of the TxA(2) receptor in the micromol L(-1) range, this effect accounting for antiplatelet effects related to stimulation with those agonists. Tight binding of flavonoids to the human TxA(2) receptor relies on structural features such as the presence of the double bond in C2-C3, and a keto group in C4.

CONCLUSIONS

The inhibition by specific flavonoids of in vitro platelet responses induced by collagen or arachidonic acid seems to be related, to a great extent, to their ability to compete for binding to the TxA(2) receptor. Therefore, antagonism of this TxA(2) receptor may represent an additional mechanism for the inhibitory effect of these compounds in platelet function.

Evaluation of refrigerated platelet concentrates supplemented with low doses of second messenger effectors

With the goal of producing haemostatically effective platelet concentrates (PCs) with a longer shelf-life, we aimed to identify a simple combination of platelet inhibitors, with a low pharmacological load, which could avoid the unacceptable loss of platelets stored under refrigerated conditions. PCs stored with different combinations of second messenger effectors were analysed at days 5, 10 and 15 of storage and compared with those supplemented with ThromboSol--a combination of six platelet inhibitors that protects cells from cold damage. The following parameters were analysed: platelet counts, biochemical parameters (glucose, pH, bicarbonate, lactate), cell lysis (lactic dehydrogenase, LDH), membrane glycoproteins (GPs), platelet aggregation, fibrinogen binding and hypotonic shock response. We characterized the combination of amiloride and sodium nitroprusside (at 1/2 the dose included in ThromboSol). This was found to be similar to ThromboSol and superior to nontreated units in the prevention of cold-induced platelet aggregation at day 15 of storage (maintenance of 78% and 80% of initial platelet counts, respectively), preservation of GPIbalpha (11% and 12% better maintenance of mean fluorescence intensity compared with control units, respectively), and reduced cell lysis (13% and 11% decrease in supernatant LDH, respectively). The reduced pharmacological load with the identified solution compared with ThromboSol is an argument in favour of the potential use of these agents when designing strategies to improve PC storage.

Genetic variants of the extra-large stimulatory Gs protein alpha-subunit and risk of thrombotic and haemorrhagic disorders

A polymorphism of the gene encoding the extra-large stimulatory G-protein alpha-subunit (XLalphas), originally identified in three patients with a bleeding tendency, involved a 36-bp insertion and two missense changes. A paternally-inherited insertion displayed a moderate platelet Gsalpha over-expression, which lead to platelet hypo-reactivity. These data prompted us to investigate the genetic, functional and clinical relevance of this polymorphism in the Mediterranean population. We included 414 healthy subjects and three case/control studies: 263 consecutive patients with a first episode of primary intracerebral haemorrhage, 195 patients with deep venous thrombosis, and 104 patients with cerebrovascular disease. Controls were selected by approximating criteria to match selected risk factors to patients. Moreover, we performed studies of platelet function. We developed a simple method to determine the methylated allele, by digestion of genomic DNA with Sma I before polymerase chain reaction amplification. We identified two new rare variants, resulting from the loss of repeat units 7 and 5. The AB genotype was present in 3.6% of healthy population and the prevalence of the B allele was similar among cases and controls. Accordingly, the non-methylated B allele did not modify either the expression of platelet Gsalpha or the platelet response to Gs-agonists. Thus, our study suggests a minor functional role of XLalphas polymorphism in thrombotic or in haemorrhagic disorders.

Determination of linear alkylbenzenesulfonates in wastewater treatment plants and coastal waters by automated solid-phase extraction followed by capillary electrophoresis-UV detection and confirmation by capillary electrophoresis-mass spectrometry

Linear alkylbenzenesulfonates (LASs) were determined in wastewaters and coastal waters by solid-phase extraction, using two different sample preparation protocols depending on the sample treated, followed by capillary electrophoresis and ultraviolet detection (CE-UV). The linear range of the proposed method varied from 3 to 53 and from 25 to 495 microg/l, depending on the compound, with a limit of detection of 1 microg/l when 250 ml of coastal water was preconcentrated. [M-H]- ions were used for CE-MS confirmation after quantification by CE-UV. CE-MS diagnostic ions were the same ones used in LC-electrospray (ESI) MS and corresponded to m/z 297, 311, 325 and 339 for C10, C11, C12 and C13 LASs, respectively. LASs were determined in wastewater samples of the influent and effluent of three wastewater treatment plants (WWTPs), two of them using biological treatment with secondary settlement and receiving mainly domestic wastewaters whereas one of the plants was operated with physicochemical treatment and received mainly industrial wastewaters. LASs were also analyzed in two samples from coastal waters of the bay of Cadiz (Spain) receiving untreated domestic effluents. All samples were also analyzed by LC-ESI-MS and the results are compared with the CE-UV method developed in this work. The concentration levels of total LASs varied from 988 to 1309 microg/l in the influents of WWTPs, whereas in the effluents the concentrations varied from 136 to 197 microg/l. The levels of LASs in coastal wastewaters of the bay of Cadiz varied from 739 to 911 microg/l, indicating that the wastewaters discharged into the bay did not undergo any treatment at all.

Reproducibility of time-domain and three different frequency-domain techniques for the analysis of the signal-averaged electrocardiogram

Because time-domain (TD) analysis of the signal-averaged ECG (SAECG) has some limitations that limit its use, several frequency-domain analysis techniques were developed in an attempt to improve the diagnostic ability of the SAECG. However, it is not known how reliable these techniques are at detecting late potentials. This prospective study compares the short-term reproducibility of 4 analysis techniques: TD analysis, spectral temporal mapping (STM), spectral turbulence analysis (STA), and acceleration spectrum analysis (ASA), in a large series of normal patients and post-myocardial infarction (MI) patients. Two consecutive SAECGs were recorded in 634 patients that were divided into 3 groups: 117 remote MI patients undergoing programmed electrical stimulation for the inducibility of ventricular tachycardia (Group 1), 407 consecutive acute MI survivors (Group 2), and in 110 healthy volunteers (Group 3). The diagnostic reproducibility of the 4 techniques was evaluated by comparing rates of inconsistent results (1 normal and the other abnormal). The numeric reproducibility for each technique was assessed by comparing the normalized differences of each single SAECG parameter between the 2 recordings. Inconsistent results of diagnostic reproducibility were observed in 4.1%, 6.9%, 9.8%, and 18.0%, with TD, STA, ASA, and STM, respectively. Comparisons of these rates were significantly different (P < .05) except between STA and ASA (P = .07). The numeric reproducibility was highest for TD parameters, lowest for STM factors of normality, and intermediate for STA and ASA indices. TD analysis remains the most reproducible SAECG analysis technique, whereas STM showed the worst reproducibility, which limits its clinical applicability. STA and ASA provide an acceptable intermediate reproducibility, the former being slightly, although not significantly, more reproducible than the latter.

[Effects of 3 insecticide formulations in the removal and hatching of oothecae of Blatella germanica (Dictyoptera: Blattellidae)]

Different insecticide formulations used for the control of German Cockroach, Blatella germanica (L.) were studied to know their effects on the gravid females of this species. The insecticides assayed were baygon 20% EC, diazinon 60 EC, and licon 2.5% EC. Exposure to each insecticide showed an effect on the oothecal drop (p < 0.001). Gravid females treated with baygon had the highest percent of oothecae detached (71%); whereas diazinon caused the lowest percent (33.5%). Doses of baygon, diazinon, and icon used showed that among the oothecas detached hatching occurred only in 19.01%; 34.2% and 39.11%, respectively. Of the oothecas retained by treated females, the lowest hatching percent was produced by baygon (13.79%) compared with diazinon and icon insecticides, which presented the highest hatching percentages with 39.84 and 47.82, respectively. Therefore, the effects of insecticides on females bearing oothecas may be considered at the time of selecting an insecticide to control the German cockroach.

[Growth hormone and its effects on cholesterol and lipoprotein metabolism following surgical intervention (hGH and cholesterol metabolism during surgery)]

The objective of this work was to determine whether the increase in serum GH, IGF1, glucose and insulin levels caused by the administration of hGH modifies the normal response of cholesterol and lipoproteins to surgical aggression. A prospective, randomized, and double blind study is carried out in 28 patients operated for gallstones and diverticulitis. The control group (n = 15) was not given anything except conventional fluidtherapy in the postoperative period: the patients in the hGH (n = 13) group were also given 8 IU of hGH during the first five days after the intervention. The comparative study of the triglycerides, cholesterol, LDLc, HDL-c, and A-1 B apolipoproteins shows that in the group treated with hGH the normal response of cholesterol and lipoproteins to surgical aggression is attenuated.

Comparison of the new acceleration spectrum analysis with other time- and frequency-domain analyses of the signal-averaged electrocardiogram

AIM

To compare four analysis techniques of the signal-averaged-electrocardiogram, including time-domain, spectral temporal mapping, spectral turbulence analysis and the new acceleration spectrum analysis.

METHODS AND RESULTS

We studied 634 subjects (77 with bundle branch block) divided into three groups. Group 1 comprised 117 post-myocardial infarction patients tested for inducibility of sustained ventricular tachycardia, and which was induced in 54 of them. Group 2 comprised 407 consecutive acute myocardial infarction survivors, followed for 1 year; 29 of them had suffered major arrhythmic events: 15 were cases of sustained ventricular tachycardia, three resuscitated ventricular fibrillation and 11 sudden cardiac death. Group 3 comprised 110 control subjects. The different analysis techniques were compared by their likelihood ratio for the prediction of ventricular tachycardia inducibility (Group 1) or major arrhythmic events (Group 2). The likelihood ratios of spectral-turbulence-analysis, acceleration spectrum analysis, spectral temporal mapping and time-domain were 8.0, 3.3, 1.7, 1.3 in Group 1, and 3.8, 2.1, 1.5, 2.6, in Group 2, while the corresponding false-positive rates in Group 3 (control) were 0.9%, 10.0%, 4.5%, and 3.6%, respectively.

CONCLUSION

Spectral turbulence analysis was the most accurate technique for the prediction of either ventricular tachycardia inducibility or major arrhythmic events after myocardial infarction. It also showed the highest specificity among control subjects.

Can the use of growth hormone reduce the postoperative fatigue syndrome?

Convalescence after surgery is characterized by a period of fatigue (POF). If we assume that the POF syndrome has a multifactorial etiology, it is clear that the aim of therapeutic measures should be to reduce the response to surgical stress. The purpose of the present study was to determine if administering exogenous human growth hormone (hGH) can prevent the development or reduce the duration of the POF. We carried out a placebo-controlled randomized double-blind trial with 48 patients after elective cholecystectomy (placebo, or control group, n = 26; hGH-treated group, n = 22). Eligibility criteria were strict so as to introduce as few variables as possible. The results obtained in the study show that for moderate surgical injury (cholecystectomy in metabolically healthy subjects) the administering of low doses of hGH (8 IU/day) minimized the POF syndrome (Christensen score). Furthermore, a positive nitrogen balance was achieved in the hGH-treated group during the postoperative period from the first 24 hours onward. This finding correlates with the significant increase in serum levels of hGH (p < 0.05) and insulin-like growth factor 1 (IGF-1) (p < 0.001). On the other hand, anthropometric measurements in the hGH-treated group revealed a slight but continuous decrease in body weight and thickness of the triceps skinfold; however, arm muscle circumference did not significantly change during the postoperative period. These findings are related to the effects of the application of exogenous growth hormone, which preserves or increases lean body mass and reduces adipose tissue mass. The serum transferrin level proved to be a reliable biochemical indicator of POF.

[Postoperative pain in tonsillectomy in general anesthesia and local infiltration]

The aim of this study is to demonstrate that blockade by bupivacaine of nociceptors located at the same level than the anterior tonsillar pillar, can reduce the pain in the postoperative period following tonsillectomy, thus, making easier the recovery of these patients at home. For this purpose, fifty children aged 2 to 13 years old, are studied. A double blind study is performed distributing the children randomly in two groups. One group is infiltrated prior to surgery with 1 cm3 of bupivacaine 0.25% + epinephrine 1:200,000 in three points of the anterior tonsillar pilla, while the other group is infiltrated with normal saline. The pain in the immediate postoperative period (60 minutes) is classified in five categories by a visual pain scale (scored 1-10). Short term postoperative (7 days) is also classified in five categories by a scale (scored 1-10) based in the information provided by the mother. Statistical analyses of the data is performed considering the statistical significance of the correlations obtained from the Chi2 and Student's tests.

CONCLUSION

pre-incisional infiltration in the anterior tonsillar pillar with bupivacaine in the tonsillectomy will cause a remarkable reduction in the intensity of the postoperative pain.

Exogenous growth hormone: effects on the catabolic response to surgically produced acute stress and on postoperative immune function

The first purpose of the present prospective randomized study was to determine if the protein catabolic response after operation could be restrained by administration of hypocaloric parenteral nutrition (HPN) plus human growth hormone (hGH). Our second aim was to determine if the administration of hGH could improve the systemic host defenses, thereby reducing the risk of infection. We performed a placebo-controlled randomized double-blind trial in 180 patients after elective cholecystectomy with or without choledochoduodenostomy (placebo = control group, n = 93; hGH-treated group, n = 87). The results obtained in this study show that positive nitrogen balance can be achieved during the postoperative period from the first 24 hours onward, with a combination of HPN support (1.0-1.5 g protein/kg/day and 900 kcal/day) together with the administration of small doses (8 IU) of hGH. The potassium balance tended to follow the same positive balance as the nitrogen balance. Our study shows that in the control group, treated only with HPN, a significant decrease in serum levels of some acute-phase proteins (retinol-binding protein, transferrin, prealbumin), albumin, total proteins, and immunoglobulins occurs by the 5th postoperative day. In the GH group the values of all the above-mentioned proteins do not change or tend to rise if compared to preoperative levels. In the GH-treated group liver function appeared to improve at the start of the study. GH and somatomedin C levels were similar in the two groups and had not changed significantly in the control group by the 5th postoperative day.(ABSTRACT TRUNCATED AT 250 WORDS)

[Synergism of midazolam and propofol in the induction of anesthesia]

INTRODUCTION

The purpose of this study was to determine the possible interaction of midazolam and propofol in the induction of anesthesia.

METHODS

A double-blind study of 90 ASA I-II women undergoing elective general surgery and gynecology was performed. The patients were divided into three groups of 30 patients receiving midazolam, propofol and a combination of both as the anesthesia induction agent. As a test of anesthetic induction the response to the verbal order of opening their eyes was evaluated. The dose-response curves for each group were determined by a logistic regression procedure while isobolographic analysis compared the actions of both agents separately and together.

RESULTS

The ED50 in the propofol group was 1.56 mg.kg-1 and that of the midazolam group was 0.24 mg.kg-1. In the midazolam-propofol group the ED50 of midazolam was reduced approximately a quarter (0.068 mg.kg-1) when associated to the half of the ED50 of propofol anteriorly obtained. Isobolographic analysis revealed that the conjunctive action of both drugs was synergic (p = 0.04).

CONCLUSIONS

Propofol potentiates the action of midazolam in anesthetic induction. Although this synergism also reduces with the association of thiopental-midazolam, the mechanism of action is not demonstrated as the same. Thiopental increases the affinity of the benzodiazepines for the GABA complex receptors which has not been described for propofol.

[Effect of growth hormone and parenteral nutrition on the catabolic phase following major digestive surgery]

The purpose of the present study was to determine if the administration of a biosynthetic human growth hormone (bGH) was able to enhance the efficacy of total parenteral nutrition (PN). Patients (n = 38) who had undergone major gastrointestinal surgery were randomly divided in two groups. Group I (n = 20) treated only with PN and Group II (n = 18) treated as in Group I plus bGH (4 UI/daily). Our study shows that the administration of bGH produces a significant increase in serum levels of growth hormone and Somatomedin-C. It also caused a positive nitrogen balance from the first 24 hours on (p less than 0.01). In Group II on day 12 after operation a statistically significant increase in transferrin (p less than 0.05), albumin (p less than 0.01) and total proteins (p less than 0.02) was observed. Our study suggest that the administration of bGH produces, perhaps through Somatomedin-C as mediator, an increase in protein synthesis.

Effects of growth hormone in patients receiving total parenteral nutrition following major gastrointestinal surgery

The purpose of the present study was to determine whether the administration of a biosynthetic human growth hormone was capable of enhancing the efficacy of total parenteral nutrition. Patients (n = 38) who had undergone major gastrointestinal surgery were randomly divided into two groups. Group I (n = 20) treated only with PN, and Group II (n = 18) treated as in Group I plus human growth hormone (4 IU daily). Our study shows that the administration of human growth hormone produces a statistically significant increase in serum levels of growth hormone, somatomedin-C, transferrin, albumin and total proteins. It also causes a positive nitrogen balance from the first 24 hours onward. These findings suggest that the administration of human growth hormone produces an increase in protein synthesis, perhaps through somatomedin-C as mediator.

Efficacy of oral streptokinase-streptodornase in the treatment of ankle sprains

To evaluate the analgesic and antiinflammatory properties of oral streptokinase-streptodornase (SS) in cases of minor trauma, 190 patients with ankle sprains were studied. Subjects were randomly given an active drug or a placebo in doses of two tablets three times a day for eight days. A scoring system was used to rate the following symptoms: spontaneous pain, mobilization pain, wearing pain, articular disability, flaccidity, muscular spasm, edema, and hematoma. Each symptom was categorized as none (0), mild (1), moderate (3), or severe (4). Patients were evaluated at the beginning of the study and on the fourth and eighth days of treatment. At the end of the trial, the decrease in each symptom score was significantly greater in patients receiving SS than in patients receiving a placebo. Analgesic intake during the study was also noticeably lower in the SS group. The incidence of drug-induced side effects (mainly abdominal discomfort) was minimal. Oral SS ameliorates the inflammatory symptoms associated with ankle sprains and therefore may be used as an alternative to nonsteroidal antiinflammatory drugs.

[Intraoperative autotransfusion in massive hemorrhage following thoracic-abdominal trauma]

In the University Hospital of Granada (Spain), 359 surgical trauma patients underwent intraoperative autotransfusion. The patients were divided into 2 groups, according to their blood loss: group I (blood loss less than or equal to 2000 ml) and group II (blood loss greater than 2000 ml). Patients from group I did not require homologous blood transfusion. So the high risk involved in this type of transfusion was avoided. Macroscopic haemoglobinuria was only found in those patients where the Solcotrans, Viavae type of autotransfusion system was used; with the Bentley ATS system, no macroscopic haemoglobinuria was registered. With patients from group II, however, that is, those with a blood loss of more than 2000 ml, we had to fall back on homologous transfusion in addition to retransfusing autologous blood. When the transfusion exceeds 4000 ml there is increasing bleeding, which requires treatment with fresh frozen plasma, platelets and/or fibrinogen. The mortality rate of patients in group II was very high but the patients died from the severity of their injuries or from postoperative complications which were not due to autotransfusion in itself with the exception of 3 patients who underwent massive autotransfusion (12,000 to 25,000 ml) and died from acute renal failure. The main indication for intraoperative autotransfusion is without doubt abdominal and thoracic trauma which lead to high blood loss.

Giant diverticula of the colon

A case of a gas-filled intra-abdominal abscess cavity is reported. The literature is reviewed for similar cases and with reference to the cause and differential diagnosis of abdominal air cysts.

Intrahepatic vascular division in the pig: basis for partial hepatectomies

Transplantation of resected hepatic fragments, with the attendant vascular and biliary tract reconstruction, presents difficulties. We have studied the intraparenchymal vascular division in the pig with a view to performing partial hepatectomies with the greastest possible anatomical support. Forty-six molds of the various vascular territories were obtained from the 31 porcine livers. Each segment of the median lobe is dependent on the adjacent lateral lobe. Its intersegmental fissure is the obligatory site for parenchymal section to be continued through horizontal portion of portal vein, hepatic artery, and left hepatic duct. A right hemihepatectomy unfailingly results in the devitalization of the left side of the liver. If the goal of a hepatectomy is the transplantation of the resected fragment, it is recommended that the right side of the liver be utilized, as its more convenient extrahepatic vascular and biliary calibre will permit pedicular conservation and anastomosis.

Shortened small bowel syndrome. Mackby's operation

Intestinal infarction is a condition with a high rate of mortality. Progress in the fields of anesthesia, maintenance of electrolyte balance, and intensive postoperative care has made survival possible in a number of patients subjected to extensive resection of the small intestine. Many of these patients, however, later succumb to the effects of malabsorption. In this paper we report on a patient who has undergone massive intestinal resection, because of venous intestinal infarction, and Mackby's operation, with favorable results twelve months postoperatively.