Laboratory study of rotationally inelastic collisions of CO2 at low temperatures

The rotational relaxation of CO2 by inelastic collisions has been studied in three supersonic jets. The jets were probed by means of Raman spectroscopy with high spectral and spatial resolutions, measuring the rotational populations and the total number density. The time evolution of the rotational populations was analyzed by means of a kinetic master equation, with the help of the energy-corrected sudden power law to relate the numerous state-to-state rate (STS rates) coefficients. In the thermal range investigated, 60-260 K, the STS rates decrease with increasing temperature and with increasing change in the rotational quantum number. Other quantities of interest for fluid dynamics, such as the rotational collision number, the relaxation cross section, and the bulk viscosity, have been derived from the STS rates.

Urinary pH and antibiotics, choose carefully. A systematic review

Uncomplicated urinary tract infection (UTI) is the most common bacterial infection in women. Since 1948, the relationship between urinary pH and antibiotics (ABs) has been established. We aimed to search for the best urinary pH for each family of antibiotics and to assess whether pH changes bacterial susceptibility to them. We included in vitro research and in vivo studies including one or more bacterial species and tested the effect of one or more ABs at different pH values. We also included randomized controlled clinical trials (RCTs) in uncomplicated UTI (EAU guidelines 2019 definition), choosing the ABs based on urinary pH or using an antibiotic plus urinary pH modifiers (L-methionine, vitamin C…) vs. an antibiotic and a placebo. Quadas-2 tool was used as a quality assessment of the studies and PRISMA set of items for systematic reviews. Two authors independently screened and evaluated the papers, while two additional authors individually repeated the search. A fifth researcher acted as an arbiter, and another author collaborated as a hospital pharmaceutical consultant. Alkaline-friendly antibiotics are most fluoroquinolones, aminoglycosides, trimethoprim. Acidic-friendly antibiotics are fosfomycin, tetracycline, nitrofurantoin and some β-lactams. We suggest performing urine cultures with antibiogram tests, in both acidic and alkaline media, to define the bacterial susceptibility profile. There is insufficient in vivo evidence to support whether choosing an antibiotic based on a patient's urinary pH or adding urinary pH modifiers will lead to a higher cure rate.

Guselkumab effectiveness and survival in patients with psoriasis and psoriatic arthritis: Multicenter analysis in daily clinical practice by the Spanish Psoriasis Group

INTRODUCTION

Guselkumab is a monoclonal antibody that selectively blocks the p19 subunit of interleukin 23 and has been approved for the treatment of moderate to severe psoriasis and active psoriatic arthritis in adult patients due to its efficacy in different clinical trials. Therefore, it is important to know the behavior of guselkumab in this setting of patients in clinical practice given that a high percentage of them are not represented in these studies.

OBJECTIVE

to evaluate the effectiveness and tolerability of guselkumab in clinical practice in the first patients with psoriasis and psoriatic arthritis treated since the date of its approval for psoriasis in Spain, in joint dermatology-rheumatology clinics.

MATERIAL AND METHODS

a multicenter retrospective data collection was carried out, in which 14 hospitals participated, including a total of 90 patients with psoriatic arthritis confirmed by a rheumatologist. Data collection was recorded at baseline and at weeks 12, 24, and 52 for both the articular and cutaneous domains.

RESULTS

Ninety PsA patients started treatment with guselkumab and therefore were included in this study. 93% of them had already failed to at least to one biologic therapy prior guselkumab prescription. The median age was 55 years, 61% were female and 46% had a BMI ≥ 30 kg/m² . Sixty-nine percent suffered from peripheral arthritis, and in 34% an axial involvement was also detected; dactylitis or enthesitis were present in 24% and 29% respectively. Guselkumab was effective in controlling both articular and skin manifestations of PsA patients. Absolute PASI significantly decreased from 10.5 to 4.8, 1.9 and 1.3 at weeks 12, 24 and 52 respectively. In 29 out of 61 (48%) of cases DAPSA was moderate or high, and patient showed a significant reduction in DAPSA at 12, 24 and 52 weeks of treatment (mean DAPSA values at baseline were 29, 20, 16 and 14, respectively). Patients with DAPSA in low activity or in remission at the time of initiation of Guselkumab maintained a response at the end of the study period. No new safety concerns were detected. Seventy-eight out of 90 patients (84.4%). Nine out of ten patients persisted after two years follow up.

CONCLUSIONS

Our experience suggests that guselkumab is an effective drug for PsA and PsO patients in clinical practice with good tolerability and no additional safety signals, making it a new therapeutic alternative for the treatment of these combine domains of the disease. These are one of the first and large data from routine clinical practice in patients with PsO and PsA. This article is protected by copyright. All rights reserved.

Clinical experience with integrase inhibitors in HIV-2-infected individuals in Spain

BACKGROUND

HIV-2 is a neglected virus despite estimates of 1-2 million people being infected worldwide. The virus is naturally resistant to some antiretrovirals used to treat HIV-1 and therapeutic options are limited for patients with HIV-2.

METHODS

In this retrospective observational study, we analysed all HIV-2-infected individuals treated with integrase strand transfer inhibitors (INSTIs) recorded in the Spanish HIV-2 cohort. Demographics, treatment modalities, laboratory values, quantitative HIV-2 RNA and CD4 counts as well as drug resistance were analysed.

RESULTS

From a total of 354 HIV-2-infected patients recruited by the Spanish HIV-2 cohort as of December 2017, INSTIs had been given to 44, in 18 as first-line therapy and in 26 after failing other antiretroviral regimens. After a median follow-up of 13 months of INSTI-based therapy, undetectable viraemia for HIV-2 was achieved in 89% of treatment-naive and in 65.4% of treatment-experienced patients. In parallel, CD4 gains were 82 and 126 cells/mm3, respectively. Treatment failure occurred in 15 patients, 2 being treatment-naive and 13 treatment-experienced. INSTI resistance changes were recognized in 12 patients: N155H (5), Q148H/R (3), Y143C/G (3) and R263K (1).

CONCLUSIONS

Combinations based on INSTIs are effective and safe treatment options for HIV-2-infected individuals. However, resistance mutations to INSTIs are selected frequently in failing patients, reducing the already limited treatment options.

Microbe-Dependent Induction of IL-9 by CLA+ T Cells in Psoriasis and Relationship with IL-17A

IL-9 is present in psoriatic lesions and is produced by lymphocytes. However, it is not known whether this cytokine is induced by relevant pathogenic triggers of psoriasis, such as Streptococcus pyogenes. Here we addressed the production of IL-9 in response to various pathogens in a psoriatic ex vivo model. Extracts of S. pyogenes and Candida albicans triggered the production of IL-9 and also IL-17A and IFN-γ. This induction was dependent on the interaction between CLA⁺ T cells and epidermal cells. Neutralization of IL-9 reduced S. pyogenes-induced IL-17A production by CLA⁺ T cells but had no effect on IFN-γ production. Also, IL-9 increased the survival of circulating psoriatic CLA⁺ T cells. Co-cultures from patients with guttate or plaque psoriasis with S. pyogenes produced similar amounts of IL-9. High cytokine responses in streptococcal-driven guttate patients paralleled peaks in Psoriasis Area Severity Index and anti-streptolysin O levels. Our results confirm that IL-9 promotes inflammation in psoriasis by up-regulating IL-17A production and support the clinical association of the immune response by streptococcal-sensitized CLA⁺ T cells with this cytokine, especially in guttate psoriasis.

Experimental study of the mechanical stabilization of electric arc furnace dust using fluid cement mortars

This article shows the results of an experimental study carried out in order to determine the maximum amount of electric arc furnace dust (EAFD) that can be incorporated into fluid cement-based mortars to produce mechanically stable monolithic blocks. The leaching performance of all mixes was studied in order to classify them according to the EU Council Decision 2003/33/EC. Two mortars were used as reference and three levels of EAFD incorporation were tested in each of the reference mortars. As the incorporation ratio of EAFD/cement increases, the mechanical strength decreases. This is due to the greater EAFD/cement and water/cement ratios, besides the presence of a double-hydrated hydroxide of Ca and Zn (CaZn₂(OH)₆·2H₂O) instead of the portlandite phase (Ca(OH)₂) in the mixes made with EAFD, as well as non-hydrated tricalcium silicate. A mass ratio of 2:1 (EAFD: cement-based mortar) can be added maintaining a stable mechanical strength. The mechanical stabilization process also reduced the leaching of metals, although it was not able to reduce the Pb concentration below the limit for hazardous waste. The high amount of EAFD mechanically stabilized in this experimental study can be useful to reduce the storage volume required in hazardous waste landfills.

Occupational eye lens doses in interventional cardiology. A multicentric study

New European regulation regarding radiological protection of workers and more specifically the new occupational dose limit for the eye lens recently reduced to 20 mSv yr(-1) may affect interventional cardiologists. This paper presents a set of measurements of occupational doses performed in five interventional cardiology centres and then compared with the new dose limit. The measurement of occupational doses was performed over the apron at chest level using electronic dosemeters recording H p(10). In one of the centres, scatter dose at goggles was also measured with optically stimulated luminescence dosemeters calibrated in terms of H p(0.07). An average H p(10) over the apron of 46 μSv/procedure was measured for cardiologists. Lower doses were noted in other professionals like second cardiologists, nurses or anaesthetists. Procedures for valvular and other structural heart diseases involved the highest occupational doses, averaging over 100 μSv/procedure. Important differences in occupational doses among centres may be indicative of different radiation protection habits. The new occupational dose limit for the eye lens is likely to be exceeded by those among the interventionalists who do not use protection tools (ceiling suspended screen and/or goggles) even with standard workloads.

Current concepts on microscopic colitis: evidence-based statements and recommendations of the Spanish Microscopic Colitis Group

BACKGROUND

Microscopic colitis (MC) is an underdiagnosed inflammatory bowel disease.

AIM

To develop an evidence-based clinical practice guide on MC current concepts.

METHODS

Literature search was done on the Cochrane Library, EMBASE and MEDLINE electronic databases, which were consulted covering the period up until March 2015. Work groups were selected for each of the reviewed topics, with the purpose of drafting the initial statements and recommendations. They subsequently underwent a voting process based on the Delphi method. Each statement/recommendation was accompanied by the result of the vote the level of evidence, and discussion of the corresponding evidence. The grade of recommendation (GR) using the GRADE approach was established for diagnosis and treatment recommendations.

RESULTS

Some key statements and recommendations are: advancing age increases the risk of developing MC, mainly in females. The symptoms of MC and IBS-D may be similar. If MC is suspected, colonoscopy taking biopsies is mandatory. Treatment with oral budesonide is recommended to induce clinical remission in patients with MC. Oral mesalazine is not recommended in patients with collagenous colitis for the induction of clinical remission. The use of anti-TNF-alpha drugs (infliximab, adalimumab) is recommended for the induction of remission in severe cases of MC that fail to respond to corticosteroids or immunomodulators, as an alternative to colectomy.

CONCLUSIONS

This is the first consensus paper on MC based on GRADE methodology. This initiative may help physicians involved in care of these patients in taking decisions based on evidence.

Radiation Doses in Patient Eye Lenses during Interventional Neuroradiology Procedures

BACKGROUND AND PURPOSE

Eye lenses are among the most sensitive organs to x-ray radiation and may be considered at risk during neurointerventional radiology procedures. The threshold dose to produce eye lens opacities has been recently reduced to 500 mGy by the International Commission on Radiologic Protection. In this article, the authors investigated the radiation doses delivered to patients' eyes during interventional neuroradiology procedures at a university hospital.

MATERIALS AND METHODS

Small optically stimulated luminescence dosimeters were located over patients' eyes during 5 diagnostic and 31 therapeutic procedures performed in a biplane x-ray system. Phantom measurements were also made to determine the level of radiation to the eye during imaging runs with conebeam CT.

RESULTS

The left eye (located toward the lateral C-arm x-ray source) received a 4.5 times greater dose than the right one. The average dose during embolization in the left eye was 300 mGy, with a maximum of 2000 mGy in a single procedure. The patient who received this maximum eye dose needed 6 embolization procedures to treat his high-volume AVM. If one took into account those 6 embolizations, the eye dose could be 2-fold. Sixteen percent of the embolizations resulted in eye doses of >500 mGy.

CONCLUSIONS

A relevant fraction of patients received eye doses exceeding the threshold of 500 mGy. A careful optimization of the procedures and follow-up of these patients to evaluate potential lens opacities should be considered.

A safer disposal of hazardous phosphate coating sludge by formation of an amorphous calcium phosphate matrix

Phosphate coating hazardous wastes originated from the automotive industry were efficiently encapsulated by an acid-base reaction between phosphates present in the sludge and calcium aluminate cement, yielding very inert and stable monolithic blocks of amorphous calcium phosphate (ACP). Two different compositions of industrial sludge were characterized and loaded in ratios ranging from 10 to 50 wt.%. Setting times and compressive strengths were recorded to establish the feasibility of this method to achieve a good handling and a safe landfilling of these samples. Short solidification periods were found and leaching tests showed an excellent retention for toxic metals (Zn, Ni, Cu, Cr and Mn) and for organic matter. Retentions over 99.9% for Zn and Mn were observed even for loadings as high as 50 wt.% of the wastes. The formation of ACP phase of low porosity and high stability accounted for the effective immobilization of the hazardous components of the wastes.

Mixing effects in the crystallization of supercooled quantum binary liquids

By means of Raman spectroscopy of liquid microjets, we have investigated the crystallization process of supercooled quantum liquid mixtures composed of parahydrogen (pH2) or orthodeuterium (oD2) diluted with small amounts of neon. We show that the introduction of the Ne impurities affects the crystallization kinetics in terms of a significant reduction of the measured pH2 and oD2 crystal growth rates, similarly to what found in our previous work on supercooled pH2-oD2 liquid mixtures [Kühnel et al., Phys. Rev. B 89, 180201(R) (2014)]. Our experimental results, in combination with path-integral simulations of the supercooled liquid mixtures, suggest in particular a correlation between the measured growth rates and the ratio of the effective particle sizes originating from quantum delocalization effects. We further show that the crystalline structure of the mixtures is also affected to a large extent by the presence of the Ne impurities, which likely initiate the freezing process through the formation of Ne-rich crystallites.

Reduction of occupational radiation dose in staff at the cardiac catheterisation laboratory by protective material placed on the patient

Reducing occupational radiation dose in cardiac catheterisation laboratories is one of the objectives of the radiation protection system because the procedures performed involve high levels of radiation compared with others in health care. Recommendations on protection methods used are referred to different structural types and personal protection tools. In this work, the effectiveness of a shielding drape above the patient in different geometric shapes for a standard procedure in interventional cardiology was evaluated. Values of personal dose equivalent Hp(10) obtained simultaneously with three active electronic semiconductor dosemeters located at the usual position of staff and at the C-arm have been used to show the usefulness of the shielding drape.

Brain radiation doses to patients in an interventional neuroradiology laboratory

BACKGROUND AND PURPOSE

In 2011, the International Commission on Radiologic Protection established an absorbed-dose threshold to the brain of 0.5 Gy as likely to produce cerebrovascular disease. In this paper, the authors investigated the brain doses delivered to patients during clinical neuroradiology procedures in a university hospital.

MATERIALS AND METHODS

The radiation dose delivered to the brain was investigated in 99 diagnostic and therapeutic interventional neuroradiology procedures. Brain doses were calculated in a mathematic model of an adult standard anthropomorphic phantom by using the technical and radiation dose data of an x-ray biplane system submitted to regular quality controls and calibration programs.

RESULTS

For cerebral embolizations, brain doses resulted in a maximum value of 1.7 Gy, with an average value of 500 mGy. Median and third quartile resulted in 400 and 856 mGy, respectively. For cerebral angiography, the average dose in the brain was 100 mGy.

CONCLUSIONS

This work supports the International Commission on Radiologic Protection recommendation on enhancing optimization when doses to the brain could be higher than 0.5 Gy. Radiation doses should be recorded for all patients and kept as low as reasonably achievable. For pediatric patients and young adults, an individual evaluation of brain doses could be appropriate.

Treatment of toxic metal aqueous solutions: encapsulation in a phosphate-calcium aluminate matrix

Polyphosphate-modified calcium aluminate cement matrices were prepared by using aqueous solutions polluted with toxic metals as mixing water to obtain waste-containing solid blocks with improved management and disposal. Synthetically contaminated waters containing either Pb or Cu or Zn were incorporated into phosphoaluminate cement mortars and the effects of the metal's presence on setting time and mechanical performance were assessed. Sorption and leaching tests were also executed and both retention and release patterns were investigated. For all three metals, high uptake capacities as well as percentages of retention larger than 99.9% were measured. Both Pb and Cu were seen to be largely compatible with this cementitious matrix, rendering the obtained blocks suitable for landfilling or for building purposes. However, Zn spoilt the compressive strength values because of its reaction with hydrogen phosphate anions, hindering the development of the binding matrix.

Solidification/stabilization of toxic metals in calcium aluminate cement matrices

The ability of calcium aluminate cement (CAC) to encapsulate toxic metals (Pb, Zn and Cu) was assessed under two curing conditions. Changes in the consistency and in the setting time were found upon the addition of the nitrates of the target metals. Both Pb and Cu caused a delay in CAC hydration, while Zn accelerated the stiffening of the mortar. Compressive strengths of the metal-doped mortars, when initially cured at 60 °C/100% RH, were comparable with that of the free-metal mortar. Three different pore size distribution patterns were identified and related to the compounds identified by XRD and SEM. Sorbent capacities of CAC for the toxic metals were excellent: a total uptake was achieved for up to 3 wt.% loading of the three metals. In this way, CAC mortars were perfectly able to encapsulate the toxic metals, allowing the use of CAC for waste management as proved by the leaching tests.

Dynamic model of microalgal production in tubular photobioreactors

A dynamic model for microalgal culture is presented. The model takes into account the fluid-dynamic and mass transfer, in addition to biological phenomena, it being based on fundamental principles. The model has been calibrated and validated using data from a pilot-scale tubular photobioreactor but it can be extended to other designs. It can be used to determine, from experimental measurements, the values of characteristic parameters. The model also allows a simulation of the system's dynamic behaviour in response to solar radiation, making it a useful tool for design and operation optimization of photobioreactors. Moreover, the model permits the identification of local pH gradients, dissolved oxygen and dissolved carbon dioxide; that can damage microalgae growth. In addition, the developed model can map the different characteristic time scales of phenomena inside microalgae cultures within tubular photobioreactors, meaning it is a valuable tool in the development of advanced control strategies for microalgae cultures.

Encapsulation, solid-phases identification and leaching of toxic metals in cement systems modified by natural biodegradable polymers

Cement mortars loaded with Cr, Pb and Zn were modified by polymeric admixtures [chitosans with low (LMWCH), medium (MMWCH) and high (HMWCH) molecular weight and hydroxypropylchitosan (HPCH)]. The influence of the simultaneous presence of the heavy metal and the polymeric additive on the fresh properties (consistency, water retention and setting time) and on the compressive strength of the mortars was assessed. Leaching patterns as well as properties of the cement mortars were related to the heavy metals-bearing solid phases. Chitosan admixtures lessened the effect of the addition of Cr and Pb on the setting time. In all instances, chitosans improved the compressive strength of the Zn-bearing mortars yielding values as high as 15 N mm(-2). A newly reported Zn phase, dietrichite (ZnAl(2)(SO(4))(4)·22H(2)O) was identified under the presence of LMWCH: it was responsible for an improvement by 24% in Zn retention. Lead-bearing silicates, such as plumalsite (Pb(4)Al(2)(SiO(3))(7)), were also identified by XRD confirming that Pb was mainly retained as a part of the silicate network after Ca ion exchange. Also, the presence of polymer induced the appearance and stabilization of some Pb(IV) species. Finally, diverse chromate species were identified and related to the larger leaching values of Cr(VI).

Production cost of a real microalgae production plant and strategies to reduce it

The cost analysis of a real facility for the production of high value microalgae biomass is presented. The facility is based on ten 3 m3 tubular photobioreactors operated in continuous mode for 2 years, data of Scenedesmus almeriensis productivity but also of nutrients and power consumption from this facility being used. The yield of the facility was close to maximum expected for the location of Almería, the annual production capacity being 3.8 t/year (90 t/ha·year) and the photosynthetic efficiency being 3.6%. The production cost was 69 €/kg. Economic analysis shows that labor and depreciation are the major factors contributing to this cost. Simplification of the technology and scale-up to a production capacity of 200 t/year allows to reduce the production cost up to 12.6 €/kg. Moreover, to reduce the microalgae production cost to approaches the energy or commodities markets it is necessary to reduce the photobioreactor cost (by simplifying its design or materials used), use waste water and flue gases, and reduce the power consumption and labor required for the production step. It can be concluded that although it has been reported that production of biofuels from microalgae is relatively close to being economically feasible, data here reported demonstrated that to achieve it by using the current production technologies, it is necessary to substantially reduce their costs and to operate them near their optimum values.

Interaction of carboxymethylchitosan and heavy metals in cement media

The performance of an etherified chitosan, carboxymethylchitosan (CMCH), when added to cement mortars doped with heavy metals, was assessed. In the presence of heavy metals (Cr, Pb, Zn) strong modifications of the fresh-state properties were evaluated. The addition of the polymer was seen to be useful in minimising some of these modifications, as those related to the setting time. A competitive mechanism for adsorption between the oxoanionic form of the metals and the carboxylate groups of the chitosan derivative was established. Studies on the metal chelating ability of the polymer and leaching from the hardened specimens showed scarce complexation under alkaline conditions, pointing to physical entrapment based on metal adsorption. However, significant chelation of metals was proved at near-neutral pH, suggesting the potential usefulness of the polymer as an agent for removing heavy metals from polluted waters and subsequently immobilizing them in cement mortars. Leaching tests carried out on polymer-metal complex-bearing samples showed a reduction in the amount of released Pb and Zn.

Visual and numerical methods to measure patient skin doses in interventional procedures using radiochromic XR-RV2 films

Radiochromic XR-RV2 films are considered as one of the best dosemeters to measure patient skin doses in fluoroscopy-guided interventional procedures. To fulfil this purpose, they need to be calibrated with diagnostic energies and doses beyond several Gray. The vendor provides a visual calibration strip to estimate the absorbed dose. Differences between visual dose estimation versus film digitisation were investigated. The influence of backscatter radiation on film sensitivity was also investigated and the sources of uncertainty were analysed when skin doses were measured with these films. When based on the visual comparison with the strip, the estimation of the dose resulted in an error of 50 % (2 Gy in the region around 4 Gy). However, when using numerical methods after film digitisation, the uncertainty in dose measurement fell to 7-14 % in the dose range of interest. Calibration under backscatter conditions demonstrates that the  'in air' calibration underestimates the doses by 7 %. When the dose was measured with a calibration method based on 16 bits grey digitisation, uncertainty was twice higher than when the red channel from red, green, blue digitised images was used.

Increases in patient doses need to be avoided when upgrading interventional cardiology systems to flat detectors

The aim of this study was to evaluate patient doses in two interventional cardiology laboratories over a period of 1 y in which the imaging devices were changed from image intensifier (II) to flat detector (FD). Dosimetric data from a total of 1040 coronary angiography (CA) procedures and 1087 percutaneous transluminal coronary angioplasty (PTCA) procedures were gathered. During the period studied with II imaging, median values of dose area product were 28 Gy cm(2) for CA and 57 Gy cm(2) for PTCA. In the first half of the year with FD imaging, median values were 37 Gy cm(2) for CA and 89 Gy cm(2) for PTCA. A significant increase in patient doses was noticed in the early stages of use of FD technology for imaging IC procedures, while fluoroscopy time and number of images remained similar. A careful setting of the X-ray systems, after upgrading the imaging system, is essential to avoid unjustified increases in patient doses.

A national programme for patient and staff dose monitoring in interventional cardiology

A national programme on patient and staff dose evaluation in interventional cardiology made in cooperation with the haemodynamic section of the Spanish Society of Cardiology has recently been launched. Its aim is to propose a set of national diagnostic reference levels (DRLs) for patients as recommended by the International Commission on Radiological Protection and to initiate several optimisation actions to improve radiological protection of both patients and staff. Six hospitals have joined the programme and accepted to submit their data to a central database. First to be acquired were the quality control data of the X-ray systems and radiation doses of patients and professionals. The results from 9 X-ray systems, 1467 procedures and staff doses from 43 professionals were gathered. Provisional DRLs resulted in 44 Gy cm(2) for coronary angiography and 78 Gy cm(2) for interventions. The X-ray systems varied up to a factor of 5 for dose rates in reference conditions. Staff doses showed that 50 % of interventional cardiologists do not use their personal dosemeters correctly.

Study of matrix metalloproteinases and their inhibitors in prostate cancer

BACKGROUND

Extracellular matrix metalloproteases (MMPs) have raised an extraordinary interest in cancer research because of their potential role in basal membrane and extracellular matrix degradation, consequently facilitating tumour invasion and metastases development.

METHODS

An immunohistochemical study was performed using tissue arrays and specific antibodies against MMPs 1, 2, 7, 9, 11, 13, 14, and their tissue inhibitors, TIMPs 1, 2 and 3. More than 2600 determinations on cancer specimens from 133 patients with clinically localised prostate carcinoma, 20 patients with prostatic intraepithelial neoplasia and 50 patients with benign prostate hyperplasia and controls, were performed.

RESULTS

When compared with benign pathologies, prostate carcinomas had higher expression of all MMPs and TIMPs. Dendogram shows a first-order division of tumours into two distinct MMPs/TIMPs molecular profiles, one of them with high MMPs/TIMs expression profile (n=70; 52.6%). Tumours with high expression of MMP-11 or -13, or cluster thereof, were significantly associated with higher probability of biochemical recurrence.

CONCLUSION

The expression of MMPs and TIMPs seems to have an important role in the molecular biology of prostate carcinomas, and their expression by tumours may be of clinical interest to used as indicators of tumour aggressiveness.

[Neuroprotection in Parkinson's disease: analysis though group of experts' methodology]

INTRODUCTION

Currently used antiparkinsonian drugs neither stop nor slow-down the progressive nature of the disease. The final phase of PD is characterized by the presence of symptoms and signs resistant to dopaminergic agents, such as depression, dementia, freezing and falls. Therefore, it is urgent to develop therapies able to positively modify this outcome. Despite neuroprotection is a research priority in PD, no effective strategies have been found so far.

METHOD

A key informants study was conducted. A group of experts in PD fulfilled a questionnaire of 10 questions to explore the most important topics related to neuroprotection. Afterwards a consensus about the current situation of neuroprotection in PD was established and future directions of development were suggested.

RESULTS

Most of the answers emphasized the need of new concepts, the limitations of animal models and the difficulties in the difficulties in demonstrating a neuroprotective effects in humans owing to a lack of biomarkers. Some of the experts believe that we are already exerting a disease modifying effect.

CONCLUSIONS

The concept of neuroprotection should be widened. Animal models should be improved. A reliable biomarker to start neuroprotective therapies long before the appearance of motor symptoms and to evaluate the neuroprotective effect of any therapy should be urgently developed.

Spanish growth studies 2008. New anthropometric standards

Cross-sectional and longitudinal growth studies have recently been conducted in Spain. These studies have allowed neonatal anthropometry in premature and term neonates and postnatal growth in children and adolescents to be evaluated. Moreover, a longitudinal study that allows pubertal growth to be evaluated for distinct groups according to maturation has also been published. Between 1999 and 2002, birth weight and vertex-heel length were evaluated in 9,362 newborns (4,884 boys and 4,478 girls), with a gestational age of 26-42 weeks. An increase in these values compared with previous Spanish studies (1987-1992) and sexual dimorphism were observed. Between 2000 and 2004, height, weight and body mass index (BMI) were evaluated in 32,064 individuals (16,607 males, 15,457 females) aged 0-24 years. An increasing secular trend was observed compared with data obtained 20 years previously. Increases in BMI exceeded those in height for BMI values above the 50th percentile. A longitudinal growth study of 458 healthy individuals (223 boys, 235 girls) born between 1978 and 1982 yielded pubertal growth and maturity standards for each of the five pubertal maturity groups. In addition, data on skinfolds, bone mass and intellectual development from birth to adulthood were also provided. Adult height in both studies was similar to that reported by European and American studies, but was lower than that reported for German, Swedish and Dutch populations. In males, BMI was higher than in other European populations and was close to that of the US population. In females, BMI was similar to that in European populations and was lower than that in the US population.

[Cystic bulbar hemangioblastoma]

INTRODUCTION

Hemangioblastomas are neoplasm of vascular type having benign characteristics. They represent between 2-3% of brain tumors and 7-12% of neoformative processes in the posterior fossa. The first description of the disease goes back to the year 1904, when Eugene von Hippel made the description of retinal haemangioblastoma.

CASE REPORT

A male patient of 41 years-old who went to his doctor after three weeks of having intermittent episodes of hiccups. In the neurological examination the presence of left thoracic-abdominal hypoesthesia was shown. Brain tumor was diagnosed by neuroimage techniques. It was well defined, cystic and placed in bulbar region. Surgical approach was carried out by means of suboccipital craniectomy, with the complete removal of the lesion. The histological study confirmed the hemangioblastoma diagnosis. The patient evolved satisfactory, without presenting new neurological symptoms.

CONCLUSION

The most frecuent localization of hemangioblastomas is in vermix and cerebellum hemispheres. The bulbar localization is infrequent (which represents less percentage than 5% of cerebral hemangioblastomas) likewise the clinical manifestation though hiccups.

[Fibromuscular dysplasia. Asymptomatic dissection and occlusion of the basilar artery]

INTRODUCTION

Historically, basilar artery occlusive disease has been considered to convey a poor prognosis and a high mortality rate. In contrast, recently prospective studies have shown a better prognosis. The basilar artery is most commonly affected by atherosclerosis, but may also be affected by embolisms, dissections, aneurysms, and other conditions like fibromuscular dysplasia.

CASE REPORT

The case of a 46 year-old male who was admitted after suffering a transient episode of ataxic gait and dysarthria is reported. Transcranial Doppler showed a stenotic flow in the basilar artery with distal embolic signals. Magnetic resonance (MR) angiography demonstrated an isolated fibromuscular dysplasia of the basilar artery that caused a > 50% stenosis without parenchymal lesions. Oral anticoagulation treatment was initiated. The control MR angiography performed ten months later, and although the patient was asymptomatic, showed a dissection which evolved into a complete occlusion of the basilar artery. Its distal portion was filled via a reverse flow from both posterior communicating arteries. Anticoagulation treatment was discontinued.

DISCUSSION

Fibromuscular dysplasia of the basilar artery is a rare and usually asymptomatic disease. It may develop into a dissection, but the usual clinical presentation is stenosis-related ischemic stroke. Intracranial artery dissections may be further complicated by subarachnoid hemorrhage. Many authors have recommended anticoagulant therapy for fibromuscular dysplasia. Basilar artery occlusion, as this case shows, does not always convey a poor prognosis. This is determined, at least partially, by the presence of good collateral circulation.

Low-temperature inelastic collisions between hydrogen molecules and helium atoms

Inelastic H(2):He collisions are studied from the experimental and theoretical points of view between 22 and 180 K. State-to-state cross sections and rates are calculated at the converged close-coupling level employing recent potential energy surfaces (PES): The MR-PES [J. Chem. Phys. 100, 4336 (1994)], and the MMR-PES and BMP-PESs [J. Chem. Phys. 119, 3187 (2003)]. The fundamental rates k(2-->0) and k(3-->1) for H(2):He collisions are assessed experimentally on the basis of a master equation describing the time evolution of rotational populations of H(2) in the vibrational ground state. These populations are measured in the paraxial region of supersonic jets of H(2)+He mixtures by means of high-sensitivity and high spatial resolution Raman spectroscopy. Good agreement between theory and experiment is found for the k(2-->0) rate derived from the MR-PES, but not for the BMP-PES. For the k(3-->1) rate, which is about one-third to one-half of k(2-->0), the result is less conclusive. The experimental k(3-->1) rate is compatible within experimental error with the values calculated from both PESs. In spite of this uncertainty, the global consistence of experiment and theory in the framework of Boltzmann equation supports the MR-PES and MMR-PESs, and the set of gas-dynamic equations employed to describe the paraxial region of the jet at a molecular level.

Complexing capacity profiles of naturally occurring ligands in Tempranillo wines for Cu and Zn

Complexing capacity of naturally occurring ligands in Vitis vinifera (Tempranillo variety) wines has been studied with respect to two target metals (Cu and Zn) by differential pulse anodic stripping voltammetry (DPASV). Eight commercial wines of two certified brands of origin (CBO) and a young wine along its vinification process were monitored. Conditional stability constants and total complexing ligand(s) concentration(s) have been calculated for both metals. Discussion of the particular electrochemical responses for Cu and Zn for all samples is presented. A follow-up of the Cu stripping response allowed differentiating a commercial wine from one under processing related to the cupric casse phenomenon. Interaction of Cu with two molecular forms of cyanidin has been theoretically modeled at natural wine pH.

The majority of cases of neonatal diabetes in Spain can be explained by known genetic abnormalities

BACKGROUND

Neonatal diabetes is a rare disease characterized by hyperglycaemia within the first 3 months of life and requiring insulin treatment; it can either be transient (TNDM) or permanent (PNDM). Alterations at band 6q24 and heterozygous activating mutations in KCNJ11, the gene encoding the pore-forming subunit of the KATP channel, can cause neonatal diabetes. Aims We screened the 6q24 region, KCNJ11, GCK, FOXP3 and IPF1 genes for mutations in families with PNDM or TNDM to establish a phenotype-genotype correlation.

METHODS

Twenty-two patients with neonatal diabetes were recruited. Inclusion criteria were insulin-treated diabetes diagnosed within the first 3 months and insulin treatment for at least 15 days. Clinical data were recorded in a questionnaire.

RESULTS

We identified 17 genetic alterations in our patients: six alterations at the 6q24 band associated with TNDM and nine mutations in KCNJ11, five of which were novel. The analysis for a phenotype-genotype correlation showed that patients with 6q24 alterations had a lower birth weight and were diagnosed earlier than patients with KCNJ11 mutations. At follow-up of the TNDM patients with genetic alterations, 43% developed diabetes or impaired glucose tolerance in later life (one with 6q24 duplication and two with N48D and E227K mutations at KCNJ11 gene). Furthermore, half the first-degree relatives who carried a genetic alteration but who had not suffered from neonatal diabetes were diagnosed with diabetes or impaired glucose tolerance before the age of 30 years.

CONCLUSIONS

KCNJ11 mutations are common in both TNDM and PNDM and are associated with a higher birth weight compared with patients with 6q24 abnormalities. Patients with TNDM should be screened for abnormalities in glucose metabolism in adult life.

Rotranslational state-to-state rates and spectral representation of inelastic collisions in low-temperature molecular hydrogen

Inelastic collisions in natural H2 are studied from the experimental and theoretical points of view between 10 and 140 K. Rotational populations and number densities measured by Raman spectroscopy along supersonic expansions of H2 provide the link between experimental and theoretical rotranslational state-to-state rate coefficients of H2 in the vibrational ground state. These rates are calculated in the close-scattering approach with the MOLSCAT code employing a recent ab initio H2-H2 potential. The calculated rates are assessed by means of a master equation describing the time evolution of the experimental rotational populations. The feasibility for obtaining the rates on the sole basis of the experiment is discussed. The dominant processes j(1)j(2)-->j'(1)j'(2) in the investigated thermal range are found to be 21-->01 >30-->12 >31-->11, proving the importance of double processes such as 30-->12. Good agreement is found between theory and experiment, as well as with earlier ultrasonic measurements of relaxation times. A spectral representation is proposed in order to visualize quantitatively the collisional contributions in any nonequilibrium time evolving process.

Six years experience in intracoronary brachytherapy procedures: patient doses from fluoroscopy

Typical patient dose levels during intracoronary brachytherapy (ICB) procedures using beta sources were determined across a sample of 221 treatments. Dose-area product values, fluoroscopy time and number of frames per procedure, with median values of 62 Gy cm2, 17.0 min and 1493 images, respectively, resulted in a 20% to 50% increase in the values measured for percutaneous transluminal coronary angioplasty procedures in the same medical centre (median values 41 Gy cm2, 14.3 min and 1078 images). Likely reasons for this increase include the additional complexity of ICB, the need for recording and reporting every step of the treatment, getting the essential parameters for the volume determination of the lesion and therapeutic radiation dose calculation and, finally, the learning curve for this kind of procedure. A high concentration skin dose distribution during ICB procedures was measured and in 12% of the patients peak skin doses higher than 1.5 Gy were confirmed. 10 patients were submitted to clinical follow-up and skin injuries were not identified.

[Acquired neuromuscular syndrome in critically ill patients]

AIMS

To analyse the causes and signs of the muscle weakness that critically ill patients develop during their stay in the ICU and to review the literature.

DEVELOPMENT

In the early 80s, Bolton reported a mixed axonal polyneuropathy that he called 'polyneuropathy in critically ill patients'. Clinically it was characterised by muscle weakness that varied in intensity and caused quadriplegia and/or the need for assisted ventilation in its severest forms. It is currently considered to be the most common neurological disorder among critically ill patients. Many patients made a complete recovery after a few months or even a year. Running almost parallel to this, he also described 'acute myopathy in intensive care' among asthmatic patients who were hospitalised in the ICU due to exacerbation of their illness. It was later observed how other types of patients also had this myopathy, for instance, those who had undergone a transplant, sepsis or burns. Some authors consider acute myopathy in intensive care to be the primary cause of muscle weakness in the ICU.

CONCLUSIONS

On many occasions 'polyneuropathy of critically ill patients' and 'acute myopathy in intensive care' can be differentiated and to do so neurophysiological and, if necessary, muscle biopsy studies are a valuable aid. Although some authors prefer to group these conditions under the name 'polyneuromyopathy', we propose the general term 'acquired neuromuscular syndrome in critically ill patients' -a more descriptive expression that does not presuppose a particular mechanism or a single aetiology.

[Bickerstaff's encephalitis]

INTRODUCTION

The clinical and radiological findings in a case of Bickerstaff encephalitis are described and the relationship with Miller Fisher and Guillain Barré syndromes are discussed.

CLINICAL CASE

Subsequently to a respiratory infection,a 44-year-old male developed external ophthalmoplegia and cerebellar-like ataxia; his condition deteriorated and he suffered consciousness disturbances and absent tendon reflexes were noted. An MRI scan was performed showing a lesion affecting the brainstem. The cerebrospinal fluid (CSF) revealed albuminocytologic dissociation and the presence of oligoclonal bands. He received high doses of intravenous immunoglobulins and five months later, he had completely recovered. A follow up MRI scan demonstrated complete resolution of the lesion.

CONCLUSIONS

The initial condition was diagnosed as Bickerstaff brainstem encephalitis (BBE) with overlapping peripheral nervous system semiology. The presence during the acute phase of oligoclonal bands in CSF, which decreased with the clinical improvement, supports the hypothesis than an autoimmune mechanism may function in its pathogenesis. Our case suggests that intravenous immunoglobulins therapy should be considered in patients with BBE.

Autosomal dominant congenital fibre type disproportion: a clinicopathological and imaging study of a large family

Congenital fibre type disproportion (CFTD) is considered a non-progressive or slowly progressive muscle disease with relative smallness of type 1 fibres on pathological examination. Although generally benign, CFTD has a variable natural course and severe progression has been observed in some patients. The pathogenesis of the disorder is unknown and many authors consider CFTD a syndrome with multiple aetiologies rather than a separate clinical entity. A positive family history has been reported in about 40% of cases, but the inheritance pattern is not clear. Both autosomal recessive and dominant modes of inheritance have been suggested. The present paper describes a large, multigenerational kindred that has an inherited myopathy fulfilling the histological criteria of CFTD, with autosomal dominant transmission and high penetrance. The clinical picture, remarkably similar in all affected family members, started in early infancy with mild limb muscle weakness. There was slow progression of symptoms into adulthood, with moderate to severe, mainly proximal, muscle weakness without loss of ambulation. Muscle biopsy from two affected individuals demonstrated predominance of small type 1 muscle fibres without other significant findings. Nerve conduction studies were normal and needle electromyography showed a myopathic pattern. MRI examination performed on three patients from successive generations showed involvement of proximal limb and paraspinal muscles. The clinical and pathological homogeneity in the present family, together with the lack of additional histological abnormalities after decades of disease progression in two affected individuals, supports this being a distinct myopathy with fibre type disproportion. Whether the disease in this family can be regarded as a form of the congenital myopathy known as CFTD or rather a unique condition sharing histological features with CFTD needs further investigation. This is, to our knowledge, the largest kindred with muscle fibre type disproportion reported to date. Our data confirm autosomal dominant inheritance, and this is the first MRI document of this disorder.

Inelastic collisions in para-H2: translation-rotation state-to-state rate coefficients and cross sections at low temperature and energy

We report an experimental determination of the k(00-->02) rate coefficient for inelastic H(2):H(2) collisions in the temperature range from 2 to 110 K based on Raman spectroscopy data in supersonic expansions of para-H(2). For this purpose a more accurate method for inverting the master equation of rotational populations is presented. The procedure permits us to reduce the measured k(00-->02) rate coefficient to the corresponding sigma(00-->02) cross section in the range of precollisional energy from 360 to 600 cm(-1). Numerical calculations of sigma(00-->02) carried out in the frame of the coupled channel method are also reported for different intermolecular potentials of H(2). A good agreement is found between the experimental cross section and the numerical one derived from Diep and Johnson's potential [J. Chem. Phys. 112, 4465 (2000)].

Comparison between experimental and calculated vehicle idle emission factors for Madrid fleet

Experimental vehicle idle emission factors have been compared with calculated factors for 100 vehicles in Madrid. The vehicles were selected according to the distribution (by age and fuel type) of the official, national car fleet (up to 31 December 1997). They were then clustered following the criteria of the Computer Programme to Calculate Emissions from Road Transport (COPERT III) category classification. NO(x) and CO idle emission factors show a wide range of values in each category and an important deviation between the experimental values and the corresponding parameterised ones. Fifteen percent of tested vehicles in this study have been identified as gross emitters generating approximately 50% of the total CO emission volume.

Long-term results of high-dose chemotherapy and autologous stem cell rescue for high-risk neuroblastoma patients: a report of the Spanish working party for BMT in children (Getmon)

The authors retrospectively analyzed the long-term outcome of 67 patients over 1 year of age at diagnosis with high-risk neuroblastoma (stage 4 or stage 3 with N-myc amplification) who were treated with megatherapy and stem cell rescue from 1984 to 1998. Median age at transplant was 4 years (range 1.6-15 years). The source of cells was peripheral stem cells in 29 and bone marrow in 38 patients. In 12 patients, an in vitro purging of bone marrow harvest was performed. Most patients were conditioned with melphalan, BCNU, and VM-26. After transplant 19 patients received complementary treatment with IL-2 (16) or 13-cis-retinoic acid (3). Six patients (8%) died from transplant-related toxicity and 39 from disease progression. Three patients were alive with active disease at the time of analysis. Nineteen patients are alive and disease-free at a median follow-up of 104 months. Five-year event-free survival is 0.30. Survival of patients who received a purged graft was not significantly better than the rest. Post-transplant complementary treatment significantly improved overall and event-free survival (p = .01 and p = .04, respectively).

Raman spectroscopy of small para-H2 clusters formed in cryogenic free jets

Small para-H2 clusters (pH2)N with N=2,...,8 have been identified by Raman spectroscopy in cryogenic free jets of the pure gas, near the Q(0) Raman line of the H2 monomer. The high resolution in space, time, and number size makes it possible to follow their growth kinetics with distance from the orifice. At lower source temperatures liquid clusters appear early in the expansion and then undergo a gradual phase transition to the solid state. The technique is very promising for exploring superfluidity in pure (pH2)N clusters.

[First non-autologous vascular access for hemodialysis: PTFE fistula]

INTRODUCTION

Since 1999 to 2003 we have tried to perform an antebraquial "loop" PTFE fistula (PTFEa) as first vascular access for hemodialysis in patients without suitable superficial venous system.

MATERIAL AND METHODS

We have performed a prospective study to analyze the results (permeability and complications) with this approach.

RESULTS

We could perform 44 PTFEa in 46 consecutive patients (in two cases we used the axillary vein as return vessel). Early failure was 0%. One year primary and secondary permeability were 66% and 90% respectively.

CONCLUSIONS

PTFEa is a good solution as first vascular access in patients without a suitable superficil venous system.

[Bone scintigraphy and somatostatin receptor scintigraphy in pediatric patients with bone involvement in Langerhans cell histiocytosis]

Langerhans cell histiocytosis (LCH) is a granulomatous disease which can involve multiples sites of the body. Diagnostic imaging is of utmost importance in the management of these patients. Up to now radiographic skeletal survey and bone scintigraphy (BS) have been used to assess bone involvement (both with low specificity). Magnetic resonance imaging (MRI) and CT have been used to assess visceral involvement but with the limitation that they cannot give information about the functional status. Recently somatostatin receptor scintigraphy (SSRS) has been proposed to detect active lesions and to monitor response to treatment. The aim of this study is to assess bone and somatostatin receptor scintigraphy in the detection of bone involvement in LCH in children. Twenty scintigraphies (12 SSRS and 8 BS) were performed in seven patients (3 girls and 4 boys) aged at diagnosis: 18 month-12 years (mean age 6 years). The findings obtained in the scintigraphies were compared with clinical evolution and other imaging techniques. Bone scintigraphy detected all the LCH bone lesions, and discovered one unknown lesion. SSRS scintigraphy visualised the active lesions in 3 patients (clinical and other imaging techniques were also positive). SSRS was negative in one patient classified as disease free and another in clinical remission. SSRS detected 2 new unknown bone lesions, but could not detect LCH bone lesions confirmed in other imaging techniques in 2 patients. Somatostatin receptor and Bone scintigraphy can be used to detect active LCH bone lesions in children and can help to monitor response to treatment. Further studies with more patients are needed to confirm the diagnostic usefulness of these techniques.

Pre-test prediction models of BRCA1 or BRCA2 mutation in breast/ovarian families attending familial cancer clinics

OBJECTIVE

To test whether statistical models developed to calculate pre-test probability of being a BRCA1/2 carrier can differentiate better between the breast/ovarian families to be referred to the DNA test laboratory.

STUDY DESIGN

A retrospective analysis was performed in 109 Spanish breast/ovarian families previously screened for germline mutations in both the BRCA1 and BRCA2 genes. Four easy to use logistic regression models originally developed in Spanish (HCSC model), Dutch (LUMC model), Finnish (HUCH model), and North American (U Penn model) families and one model based on empirical data of Frank 2002 were tested. A risk counsellor was asked to assign a subjective pre-test probability for each family. Sensitivity, specificity, negative and positive predictive values, and areas under receiver operator characteristics (ROC) curves were calculated in each case. Correlation between predicted probability and mutation prevalence was tested. All statistical tests were two sided.

RESULTS

Overall, the models performed well, improving the performances of a genetic counsellor. The median ROC curve area was 0.80 (range 0.77-0.82). At 100% sensitivity, the median specificity was 30% (range 25-33%). At 92% sensitivity, the median specificity was 42% (range 33.3-54.2%) and the median negative predictive value was 93% (range 89.7-98%). BRCA1 families tended to score higher risk than BRCA2 families in all models tested.

CONCLUSIONS

All models increased the discrimination power of an experienced risk counsellor, suggesting that their use is valuable in the context of clinical counselling and genetic testing to optimise selection of patients for screening and allowing for more focused management. Models developed in different ethnic populations performed similarly well in a Spanish series of families, suggesting that models targeted to specific populations may not be necessary in all cases. Carrier probability as predicted by the models is consistent with actual prevalence, although in general models tend to underestimate it. Our study suggests that these models may perform differently in populations with a high prevalence of BRCA2 mutations.

Minimal Residual Disease in Neuroblastoma: To GAGE or not to GAGE

We assessed the utility of GAGE gene expression as a marker of minimal residual disease (MRD) in neuroblastoma. The GAGE gene family shows a high degree of homology (>90%), clustering into two subgroups. GAGE-1, -2, and -8 form one subset, almost identical among themselves, while GAGE-3 to -7 constitute the other subset. The entire GAGE family (GAGE-1-8) was studied by RT-PCR followed by Southern blotting to increase both the sensitivity and specificity of the technique. Surprisingly, expression of GAGE was detected in 59% of peripheral blood samples from normal controls (20/35) as well as in a similar proportion from neuroblastoma patients with localized disease (stages 1 and 2). The study of GAGE-1, -2, and -8 with specific primers lowered this percentage to 28% (10/35), of which only two (6%) showed a high level of expression (directly visualized after RT-PCR). We conclude that GAGE genes can show a variable, usually low level of illegitimate expression in normal blood cells, and therefore their use as MRD markers should be taken with caution.

[Renal lithiasis due to indinavir]

Indinavir sulphate is a protease inhibitor that has been found to be extremely effective in increasing CD4+ cell counts and in decreasing HIV-RNA titers in patients with HIV and AIDS. However, patients receiving indinavir also have been noted to have a significant risk of developing urolithiasis. Indinavir has high urinary excretion with poor solubility in a physiologic pH solution. The typical symptoms of indinavir urolithiasis are similar to other forms of urolithiasis. Indinavir urolithiasis is unique in that computed tomography, which was once thought to be efficacious in identifying all urinary calculi, is not useful in imaging stones that are composed of pure indinavir. Indinavir urolithiasis generally responds to a conservative regimen of hydration, pain control, and temporary discontinuation of the medication. Only a minority of patients need surgical intervention.