Repeated pancreatic resection for pancreatic metastases from renal cell Carcinoma: A Spanish multicenter study (PANMEKID)

BACKGROUND AND OBJECTIVES

Recurrent isolated pancreatic metastasis from Renal Cell Carcinoma (RCC) after pancreatic resection is rare. The purpose of our study is to describe a series of cases of relapse of pancreatic metastasis from renal cancer in the pancreatic remnant and its surgical treatment with a repeated pancreatic resection, and to analyse the results of both overall and disease-free survival.

METHODS

Multicenter retrospective study of patients undergoing pancreatic resection for RCC pancreatic metastases, from January 2010 to May 2020. Patients were grouped into two groups depending on whether they received a single pancreatic resection (SPS) or iterative pancreatic resection. Data on short and long-term outcome after pancreatic resection were collected.

RESULTS

The study included 131 pancreatic resections performed in 116 patients. Thus, iterative pancreatic surgery (IPS) was performed in 15 patients. The mean length of time between the first pancreatic surgery and the second was 48.9 months (95 % CI: 22.2-56.9). There were no differences in the rate of postoperative complications. The DFS rates at 1, 3 and 5 years were 86 %, 78 % and 78 % vs 75 %, 50 % and 37 % in the IPS and SPS group respectively (p = 0.179). OS rates at 1, 3, 5 and 7 years were 100 %, 100 %, 100 % and 75 % in the IPS group vs 95 %, 85 %, 80 % and 68 % in the SPS group (p = 0.895).

CONCLUSION

Repeated pancreatic resection in case of relapse of pancreatic metastasis of RCC in the pancreatic remnant is justified, since it achieves OS results similar to those obtained after the first resection.

Pancreatic metastases from renal cell carcinoma. Postoperative outcome after surgical treatment in a Spanish multicenter study (PANMEKID)

BACKGROUND

Renal Cell Carcinoma (RCC) occasionally spreads to the pancreas. The purpose of our study is to evaluate the short and long-term results of a multicenter series in order to determine the effect of surgical treatment on the prognosis of these patients.

METHODS

Multicenter retrospective study of patients undergoing surgery for RCC pancreatic metastases, from January 2010 to May 2020. Variables related to the primary tumor, demographics, clinical characteristics of metastasis, location in the pancreas, type of pancreatic resection performed and data on short and long-term evolution after pancreatic resection were collected.

RESULTS

The study included 116 patients. The mean time between nephrectomy and pancreatic metastases' resection was 87.35 months (ICR: 1.51-332.55). Distal pancreatectomy was the most performed technique employed (50 %). Postoperative morbidity was observed in 60.9 % of cases (Clavien-Dindo greater than IIIa in 14 %). The median follow-up time was 43 months (13-78). Overall survival (OS) rates at 1, 3, and 5 years were 96 %, 88 %, and 83 %, respectively. The disease-free survival (DFS) rate at 1, 3, and 5 years was 73 %, 49 %, and 35 %, respectively. Significant prognostic factors of relapse were a disease free interval of less than 10 years (2.05 [1.13-3.72], p 0.02) and a history of previous extrapancreatic metastasis (2.44 [1.22-4.86], p 0.01).

CONCLUSIONS

Pancreatic resection if metastatic RCC is found in the pancreas is warranted to achieve higher overall survival and disease-free survival, even if extrapancreatic metastases were previously removed. The existence of intrapancreatic multifocal compromise does not always warrant the performance of a total pancreatectomy in order to improve survival.

Ovum pick-up interval in buffalo (Bubalus bubalis) managed under wetland conditions in Argentina: Effect on follicular population, oocyte recovery, and in vitro embryo development

The excellent adaptation of water buffalo (Bubalis bubalis) to swampy environments means that animals are frequently managed in areas with restricted access for reproductive procedures. The objective of this study was to evaluate the effect of the ovum pick-up (OPU) interval on follicular population, oocyte recovery, oocyte quality and in vitro embryo production. Twelve Murrah buffaloes were subjected to two consecutive dominant follicle reductions, and randomly assigned to either 7-day (n=6) or 14-day (n=6) OPU interval groups. Although there was no significant difference in the average number of small (<3mm) and large (>8mm) diameter follicles available per OPU, a higher proportion of medium-sized follicles (3-8mm) were observed in the 14-day interval group (5.129 vs 3.267; p<0.05). The number of recovered oocytes per donor was also significantly higher (4.51 vs. 2.8; p<0.05) in the 14-day interval group, although this was attributed to an increase in the proportion of lower quality oocytes (grades III and IV). After in vitro fertilization, embryo developmental competence from grade I and II oocytes was superior to that from grade III and IV oocytes, irrespective of OPU interval group. There was no significant difference in the proportion of grade I and II oocytes cleaved after sperm co-incubation; however, there was a higher proportion of blastocysts produced in 14-day interval group (28 vs. 6%, p<0.05). No blastocysts were produced from grade III and IV oocytes. This study indicates it is possible to use a 14-day interval for oocyte collection in water buffalo; this approach could be considered as an alternative when access to animals is restricted.

Commentary on Pharmacometrics for Immunotherapy

This commentary provides an overview of recent examples of pharmacometrics applied during the clinical development of two antagonists of the programmed death‐1 (PD‐1) cell surface receptor, pembrolizumab and nivolumab. Despite the remarkable achievements obtained in predicting the correct dosing schedule from different quantitative approaches, data indicated a great degree of heterogeneity in tumor response. To achieve therapeutic goals the search for predictive biomarkers associated with a lack of response and mechanism‐based combination studies are warranted.

Phylogeography and bindin evolution in Arbacia, a sea urchin genus with an unusual distribution

Among shallow water sea urchin genera, Arbacia is the only genus that contains species found in both high and low latitudes. In order to determine the geographical origin of the genus and its history of speciation events, we constructed phylogenies based on cytochrome oxidase I and sperm bindin from all its species. Both the mitochondrial and the nuclear gene genealogies show that Arbacia originated in the temperate zone of the Southern Hemisphere and gave rise to three species in the eastern Pacific, which were then isolated from the Atlantic by the Isthmus of Panama. The mid-Atlantic barrier separated two additional species. The bindin data suggest that selection against hybridization is not important in the evolution of this molecule in this genus. Metz et al. in a previous publication found no evidence of selection on bindin of Arbacia and suggested that this might be due to allopatry between species, which obviated the need for species recognition. This suggestion formed the basis of the conclusion, widely spread in the literature, that the source of selection on sea urchin bindin (where it does occur) was reinforcement. However, the range of Arbacia spatuligera overlaps with that of two other species of Arbacia, and our data show that it is hybridizing with one of them. We found that even in the species that overlap geographically, there are no deviations from selective neutrality in the evolution of bindin.

Efficacy of neutral electrolyzed water to inactivate Escherichia coli, Listeria monocytogenes, Pseudomonas aeruginosa, and Staphylococcus aureus on plastic and wooden kitchen cutting boards

This study evaluated the efficacy of neutral electrolyzed water (NEW; 64.1 mg/liter of active chlorine) to reduce populations of Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus, and Listeria monocytogenes on plastic and wooden kitchen cutting boards. Its effectiveness was compared with that of a sodium hypochlorite solution (NaClO; 62.3 mg/liter of active chlorine). Inoculated portions of cutting boards were rinsed in either NEW or NaClO solutions, or deionized water (control). Plastic boards were rinsed for 1 min and wooden boards for 1 and 5 min. After each treatment, the surviving population of each strain was determined on the surface and in the soaking water. No significant difference (P > or = 0.05) was found between the final populations of each strain with regard to the treatment solutions (NEW or NaClO). However, a significant difference (P < or = 0.05) was revealed between surface materials after 1 min of washing. Whereas in plastic boards the initial bacterial populations were reduced by 5 log CFU/50 cm2, in wooden cutting boards they underwent a reduction of <3 log CFU/50 cm2. A 5-min exposure time yielded reductions of about 4 log CFU/50 cm2. The surviving populations of all bacteria in NEW and NaCIO washing solutions were <1 log CFU/ml after soaking both surfaces. This study revealed that NEW treatment is an effective method for reducing microbial contamination on plastic and wooden cutting boards. NEW efficacy was comparable to that of NaCIO, with the advantage of having a larger storage time.

Inactivation of Escherichia coli, Listeria monocytogenes, Pseudomonas aeruginosa and Staphylococcus aureus on stainless steel and glass surfaces by neutral electrolysed water

AIM

To ascertain the efficacy of neutral electrolysed water (NEW) in reducing Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus and Listeria monocytogenes on glass and stainless steel surfaces. Its effectiveness for that purpose is compared with that of a sodium hypochlorite (NaClO) solution with similar pH, oxidation-reduction potential (ORP) and active chlorine content.

METHODS AND RESULTS

First, the bactericidal activity of NEW was evaluated over pure cultures (8.5 log CFU ml-1) of the abovementioned strains: all of them were reduced by more than 7 log CFU ml-1 within 5 min of exposure either to NEW (63 mg l-1 active chlorine) or to NaClO solution (62 mg l-1 active chlorine). Then, stainless steel and glass surfaces were inoculated with the same strains and rinsed for 1 min in either NEW, NaClO solution or deionized water (control). In the first two cases, the populations of all the strains decreased by more than 6 log CFU 50 cm-2. No significant difference (P<or=0.05) was found between the final populations of each strain with regard to the treatment solutions (NEW or NaClO solution) or to the type of surface.

CONCLUSIONS

NEW was revealed to be as effective as NaClO at significantly reducing the presence of pathogenic and spoilage bacteria (in this study, E. coli, L. monocytogenes, P. aeruginosa and S. aureus) on stainless steel and glass surfaces.

SIGNIFICANCE AND IMPACT OF THE STUDY

NEW has the advantage of being safer than NaClO and easier to handle. Hence, it represents an advantageous alternative for the disinfection of surfaces in the food industry.

Enumeration of Clostridium perfringens spores in groundwater samples: comparison of six culture media

In order to investigate the ability of Fluorocult-supplemented TSC agar (TSCF (Fluorocult supplemented TSC-agar): prepared from Tryptose Sulfite Cycloserine Agar Base (Merck), D-cycloserine (Fluka Chemika, USA), and fluorocult TSC-Agar supplement (Merck)) for detecting spores of Clostridium perfringens in water, we analyzed groundwater samples, pretreated by heating to 80 degrees C/5 min, using this fluorogenic medium together with five other media: mCP agar (Panreac; Cultimed), TSC agar (Merck, Germany), TSN agar (Merck), and SPS agar (BBL, USA) by the membrane filtration technique, and Wilson-Blair agar (WB) following the still-in-force Spanish official method. Variance analysis of the data obtained shows statistically significant differences in the counts obtained between media employed in this work. The C. perfringens spore counts on mCP agar were significantly lower (P<0.05) than the corresponding values of TSC, TSCF, SPS, and WB media. No statistically significant differences were found between C. perfringens spore counts on TSCF compared with those of other methods used. On the other hand, the identification of typical and atypical colonies isolated from all media demonstrated that fluorogenic TSC agar was the most specific medium for C. perfringens spore recovery in groundwater samples. Additionally, the results obtained indicate that mCP agar, which is the reference method in the European Union, is not suitable medium for recovering C. perfringens spores from groundwater samples.

[Neuropsychological deficits in alcoholics: some implications for road safety]

AIM

There are various published studies showing that chronic alcoholics present cognitive deficit. In this conference we would like to review the most actual studies focusing on the neuropsychological alterations as consequences of the long and abusive alcohol intake. We also will analyse the involvement of these deficit in a complex task as driving.

DEVELOPMENT

The long and abusive alcohol intake produces an affectation of the central nervous system. We could observe its consequences both in short and long term. Attention and memory deficit and a slowness of information processing are very common. However, complete neuropsychological assessment and rehabilitation programs are convenient. This is an important topic if we consider the high number of traffic accidents in which alcohol intake is one of the possible causes. Therefore, it is necessary to pay attention to the persons working daily with a car, such as taxi or bus drivers, especially those of them who are alcoholics in abstinence, chronic alcoholics and people who suffer from alcohol abuse.

CONCLUSION

The control of this situation and the publicity about neuropsychological sequels of alcoholism could contribute in an efficient way towards safety in road.

Inactivation of Escherichia coli O157:H7, Salmonella enteritidis and Listeria monocytogenes on the surface of tomatoes by neutral electrolyzed water

AIMS

To determine the efficacy of neutral electrolyzed water (NEW) in killing Escherichia coli O157:H7, Salmonella enteritidis and Listeria monocytogenes, as well as nonpathogenic E. coli, on the surface of tomatoes, and to evaluate the effect of rinsing with NEW on the organoleptic characteristics of the tomatoes.

METHODS AND RESULTS

The bactericidal activity of NEW, containing 444 or 89 mg l(-1) of active chlorine, was evaluated over pure cultures (8.5 log CFU ml(-1)) of the above-mentioned strains. All of them were reduced by more than 6 log CFU ml(-1) within 5 min of exposure to NEW. Fresh tomatoes were surface-inoculated with the same strains, and rinsed in NEW (89 mg l(-1) of active chlorine) or in deionized sterile water (control), for 30 or 60 s. In the NEW treatments, independent of the strain and of the treatment time, an initial surface population of about 5 log CFU sq.cm(-1) was reduced to <1 log CFU sq.cm(-1), and no cells were detected in the washing solution by plating procedure. A sensory evaluation was conducted to ascertain possible alterations in organoleptic qualities, yielding no significant differences with regard to untreated tomatoes.

SIGNIFICANCE AND IMPACT OF THE STUDY

Rinsing in NEW reveals as an effective method to control the presence of E. coli O157:H7, S. enteritidis and L. monocytogenes on the surface of fresh tomatoes, without affecting their organoleptic characteristics. This indicates its potential application for the decontamination of fresh produce surfaces.

Demographic history of Diadema antillarum, a keystone herbivore on Caribbean reefs

The sea urchin Diadema antillarum was the most important herbivore on Caribbean reefs until 1983, when mass mortality reduced its populations by more than 97%. Knowledge of its past demography is essential to reconstruct reef ecology as it was before human impact, which has been implicated as having caused high pre-mortality Diadema abundance. To determine the history of its population size, we sequenced the ATPase 6 and 8 region of mitochondrial DNA from populations in the Caribbean and in the eastern Atlantic (which was not affected by the mass mortality), as well as from the eastern Pacific D. mexicanum. The Caribbean population harbours an order of magnitude more molecular diversity than those of the eastern Pacific or the eastern Atlantic and, despite the recent mass mortality, its DNA sequences bear the genetic signature of a previous population expansion. By estimating mutation rates from divergence between D. antillarum and D. mexicanum, that were separated at a known time by the Isthmus of Panama, and by using estimates of effective population size derived from mismatch distributions and a maximum likelihood coalescence algorithm, we date the expansion as having occurred no more recently than 100 000 years before the present. Thus, Diadema was abundant in the Caribbean long before humans could have affected ecological processes; the genetic data contain no evidence of a recent, anthropogenically caused, population increase.

Mutagenic potential of bisphenol A diglycidyl ether (BADGE) and its hydrolysis-derived products in the Ames Salmonella assay

The mutagenicity of bisphenol A diglycidyl ether (BADGE), its first and second hydrolysis products (the diol epoxide and bis-diol of BADGE, respectively) and the bis-chlorohydrin of BADGE were investigated using the Ames Salmonella assay with strains TA98, TA100, TA1535 and TA1537. The assays were performed in the absence and presence of various concentrations of rat liver S9 fraction. The results obtained confirm the mutagenic power of BADGE in strains TA100 and TA1535 and show a positive response to the diol epoxide of BADGE in these strains, although the latter compound was approximately 10 times less potent than the former. A lack of mutagenic activity of the bis-diol of BADGE and the chlorohydrin under study is also shown. These findings suggest that BADGE and, to a much lesser extent, the diol epoxide of BADGE may constitute a genotoxic hazard, but not the bis-diol or bis-chlorohydrin of BADGE.

Detection of Sorghum yellow banding virus Infecting Grain Sorghum in Venezuela

Naturally infected grain sorghum plants (Sorghum bicolor) in Maracay, Aragua State, showed yellow speckles, streaks and bands with chlorosis, stunting, and necrosis. A virus was mechanically transmitted to 3 to 10% of inoculated sorghum cvs. Atlas and Himeca-303 plants in the greenhouse. They developed symptoms similar to those in the field within 20 days after inoculation. The virus infected a narrow range of the gramineous species. It was not transmitted by Rhopalosiphum maidis, Schizaphis graminum, Peregrinus maidis, Dalbulus maidis, nor Hortensia similis, nor by sorghum seed. The virus was purified three times from fresh infected tissue giving yields as high as 14.7 mg/100 g. The A₂₆₀/ A₂₈₀ was 1.55. The virions were isometric, 25 nm in diameter, and contained a single capsid protein with a molecular weight of approximately 29 kDa. The virus was highly stable in sap. The virus was not serologically related to eight small isometric viruses that infect Gramineae species but did react in agar double-diffusion tests with antiserum (supplied by R. W. Toler) to Sorghum yellow banding virus (SYBV), a virus that affects sorghum and sorghum × sudangrass hybrids in Texas and California (1). Based on the above characteristics, the virus is considered to be SYBV. This disease has not been found in other states in Venezuela. This is the first report of SYBV infecting grain sorghum in Venezuela. Reference: (1) V. A. Klaassen and B. W. Falk. Phytopathology 79:646, 1989.

Evaluation of Coli-ID and MUG Plus media for recovering Escherichia coli and other coliform bacteria from groundwater samples

Several chromogenic media for detecting coliform bacteria in water are commercially available including Coli ID medium (ID) (bioMérieux) and MUG Plus cefsulodin agar (MP) (Laboratorios Microkit, S.L.). Since little is known about the performance of these media, we have evaluated their usefulness for recovering Escherichia coli and other coliform organisms in groundwaters used for direct human consumption. Variance analysis of obtained data showed that no statistically significant differences in counts of E. coli and other coliforms on ID and MP media compared with reference methods. However, the evaluation of sensitivity and recovery efficiency of both media showed that the two chromogenic media were more sensitive and significantly more efficient (P = < 0.05) than reference medium for detecting coliforms in groundwater. However, the identification of 400 typical and atypical colonies isolated from ID and MP media demonstrated a higher specificity when using ID for coliforms and E. coli. In summary, the two chromogenic media evaluated could be used as alternative methods to reference media for detecting and recovering coliform bacteria in groundwater samples. MP agar was more sensitive and efficient than ID agar whereas the latter was more specific and selective.

Evaluation of fluorogenic TSC agar for recovering Clostridium perfringens in groundwater samples

Clostridium perfringens is widely recognised as a reliable water pollution indicator. Since several media can be employed for the membrane filtration enumeration of this microorganism, the main aim of this work was to investigate the ability of fluorocult-supplemented TSC-agar (Merck) for recovering Cl. perfringens from public springs used for direct human consumption. Cl. perfringens recovery was also performed on mCP agar (Cultimed) according to Directive 98/83 as well as on TSC-Agar (Merck), TSN-Agar (Merck) and SPS-Agar (BBL) media. Variance analysis of data obtained showed no statistically significant differences in the counts obtained among all media employed in this work. However, the Cl. perfringens recovery efficiencies with TSC and fluorogenic TSC agars were significantly greater (P = < 0.05) than the corresponding values of mCP and TSN media. On the other hand, the identification of typical and atypical colonies isolated from all media demonstrated that fluorogenic TSC agar was the most specific medium for Cl. perfringens recovery in groundwater samples (85.3% of typical colonies and 82.8% of atypical colonies confirmed). In summary, the membrane filtration technique with fluorogenic TSC agar showed the best performance characteristics of all the media tested as judged by their recovery efficiency and specificity in these water samples.

Modeling of the in vivo antinociceptive interaction between an opioid agonist, (+)-O-desmethyltramadol, and a monoamine reuptake inhibitor, (-)-O-desmethyltramadol, in rats

The pharmacokinetic-pharmacodynamic (pk-pd) characterization of the in vivo antinociceptive interaction between (+)-O-desmethyltramadol [(+)-M1] and (-)-O-desmethyltramadol [(-)-M1], main metabolites of tramadol, was studied in three groups of rats. (+)-M1 and (-)-M1, both with different pd properties, were studied under steady-state and nonsteady-state conditions, depending on the group. Plasma drug concentration and antinociception were simultaneously measured in each animal by using an enantioselective analytical assay and the tail-flick test, respectively. Respiratory depression also was evaluated in another series of experiments according to the same experimental conditions. The pk behavior was similar for both enantiomers and no significant (P >.05) interaction between two compounds was found at this level. However, a significant (P <.01) potentiation in the antinociceptive effect elicited by (+)-M1 was found during and after (-)-M1 administration. The pd model used to describe the time course of the antinociception in the presence of (+)-M1, (-)-M1, or both is based on previous knowledge of the compounds and includes the following: 1) an effect compartment model to account for the opioid effect of (+)-M1, and 2) an indirect response model accounting for the release of noradrenaline (NA) caused by (+)-M1, and the inhibition of the NA reuptake due to the action of (-)-M1. The model predicts a positive contribution to antinociception of the predicted increasing levels of NA. No significant (P >.05) respiratory effects were seen during or after (+)-M1 and (-)-M1 administration.

Pharmacokinetic-pharmacodynamic modeling of the antinociceptive effects of main active metabolites of tramadol, (+)-O-desmethyltramadol and (-)-O-desmethyltramadol, in rats

The pharmacokinetics and pharmacodynamics of the two main metabolites of tramadol, (+)-O-desmethyltramadol and (-)-O-desmethyltramadol, were studied in rats. Pharmacodynamic endpoints evaluated were respiratory depression, measured as the change in arterial blood pCO(2), pO(2), and pH levels; and antinociception, measured by the tail-flick technique. The administration of 10 mg/kg (+)-O-desmethyltramadol in a 10-min i.v. infusion significantly altered pCO(2), pO(2), and pH values in comparison with baseline and lower-dose groups (P <.05). However, 2 mg/kg administered in a 10-min i.v. infusion was enough to achieve 100% antinociception without respiratory depression. Moreover, the beta-funaltrexamine pretreatment completely eliminated the antinociception of the 2-mg/kg dose, suggesting that such an effect is due to mu-opioid receptor activation. To describe and adequately characterize the in vivo antinociceptive effect of the drug, (+)-O-desmethyltramadol was given at different infusion rates of varying lengths (10-300 min). Pharmacokinetics was best described by a two-compartmental model. The time course of response was described using an effect compartment associated with a linear pharmacodynamic model. The estimates of the slope of the effect versus concentration relationship were significantly decreased (P <. 05) as the length of infusion was increased, suggesting the development of tolerance. Doses of up to 8 mg/kg (-)-O-desmethyltramadol given in 10-min i.v. infusion did not elicit either antinociception in the tail-flick test or respiratory effects. These in vivo results are in accordance with the opiate and nonopiate properties reported for these compounds in several in vitro studies.

Alpha 1-acid glycoprotein (AAG) and serum protein binding of methadone in heroin addicts with abstinence syndrome

OBJECTIVE

To quantify serum protein levels and protein-binding of methadone in vitro in heroin-addicted patients showing objective signs of heroin abstinence.

SUBJECTS AND METHODS

Serum samples were obtained from patients (n = 27) hospitalized to participate in a methadone detoxification program and from healthy volunteers (n = 21). The severity of the abstinence syndrome was assessed before blood sampling using a standardized scale. Concentrations of both albumin and alpha1-acid glycoprotein (AAG) were measured in all serum samples. The protein-binding of alpha1-methadone was determined by the ultrafiltration technique and the unbound concentration was measured by liquid scintillation counting.

RESULTS

The mean of the AAG concentrations was significantly increased in patients showing signs of withdrawal while the albumin concentrations did not change. Also, the unbound methadone was significantly decreased in this group when compared to the control. A positive correlation (Pearson r = 0.48; p < 0.005) indicates that AAG levels rise during abstinence as the score of withdrawal symptoms increases. Additionally, pooled data from all individuals show the binding of methadone to be related to AAG (r = 0.46; p < 0.05) levels and not to albumin.

CONCLUSIONS

The observed changes in protein-binding in abstinence individuals suggest the need for increased dosages of methadone when such patients are treated. Levels of AAG or protein-binding appear to be components of the interindividual variance observed in the response to methadone treatment, hence these variables could be included in future kinetic and dynamic studies.

Methadone: a review of its pharmacokinetic/pharmacodynamic properties

During the past decades the use of methadone has been increased as a result of the interest of optimizing its therapeutics in opioid addicts, one of the groups with higher risk for AIDS infection. However standard dose of methadone are far from being the appropriate for relief pain or prevent withdrawal signs in maintenance programs in many patients. To achieve an optimal dose regimen for an individual, the knowledge of the relationship between the pharmacokinetics/pharmacodynamics (pk/pd) drug properties and the demographic and physiopathological characteristics of the subject is required. Unfortunately, there is a lack of studies dealing with the population pk/pd properties of methadone. In the current study, a review of the pk/pd properties of methadone is presented with the aim of understanding the sources of variability in response. This will help in the design of prospective pk/pd studies; in particular, individual data including sex, weight, alpha(1)-acid glycoprotein levels in plasma, concomitant medications, time after starting treatment with methadone and previous exposure to other opioids should be requested. In addition, designs for drug administration should allow the characterization of the plasma-versus-biophase distribution and the development of tolerance processes. Because methadone is usually administered as a racemic mixture, the use of enantioselective techniques to determine both enantiomers in plasma is also highly recommended.

Altered plasma and brain disposition and pharmacodynamics of methadone in abstinent rats

The pharmacokinetics and pharmacodynamics of methadone were investigated in control and abstinent rats. Minipumps filled with saline (control group) or saline-morphine (abstinent group) solutions were used to induce physical dependence. Solutions were delivered continuously by minipumps for 6 days. The physical dependence was evaluated 12 h after minipump removal by measuring specific withdrawal signs. Animals from the abstinent group showed clear withdrawal signs such as hostility on handling and weight loss. Plasma and brain disposition and pharmacodynamics of methadone were evaluated after a 0.35 mg/kg i.v. bolus dose administered 12 h after minipump removal. Plasma clearance, distribution clearance, and volume of distribution at steady-state were significantly decreased (P < 0.05) in the abstinent group. Plasma levels of alpha1-acid glycoprotein and plasma protein binding were significantly increased (P < 0.05) in the abstinent group. The estimates of pharmacokinetic parameters based on unbound plasma concentrations did not differ between groups, with the sole exception of the unbound apparent volume of distribution. The access of methadone to the brain was significantly faster (P < 0.05) in the abstinent group, although the extent of distribution in the brain was diminished in comparison with the control group. Analgesia recorded with tail-flick was used as the pharmacodynamic endpoint. Analgesic response and effect compartment concentrations of methadone were related by the sigmoidal Emax model. Estimates of C50 [steady-state plasma concentrations eliciting half of maximum effect (Emax)]] based on unbound concentrations did not differ between groups. On the other hand, the estimate of Emax had decreased by 65% in the abstinent group.

Pharmacokinetic-pharmacodynamic modeling of mivacurium in rats

The pharmacokinetic (PK) and pharmacodynamic (PD) characteristics of the neuromuscular blocking agent mivacurium were evaluated separately in two groups of rats receiving 0.6 mg kg-1 of mivacurium in a 2.5-min intravenous continuous (iv) infusion. The PK parameters for mivacurium were determined in the first group. A two-compartment model describes the kinetics of mivacurium in plasma. The estimates of the apparent volume of distribution at steady-state and plasma clearance [mean(SE)] were 650 (123) mL kg-1 and 9.9 (0.75) mL min-1 kg-1, respectively. In the second group, the evoked tibialis anterior muscle tension was monitored. The PK parameters derived from the first group were used to compute mivacurium plasma concentrations (C) at the times the PD measurements were recorded in the second group. The concentration-neuromuscular effect [% depression of initial twitch tension (E)] relationship was analyzed by two approaches. (1) The relationship of estimated effect site concentrations versus E; a sigmoidal Emax model described the effect compartment concentrations versus E relationship. The estimate [mean(SE)] of Cess50 (steady-state plasma concentration eliciting half of maximum E) was 0.65 (0.01) microgram mL-1. The value [mean-(SE)] of Keo (rate constant of equilibration between plasma and effect site) was estimated at 0.32 (0.03) min-1. (2) The relationship of descending limb C versus E; a sigmoidal Emax model described such relationship. The estimate [mean(SE)] of C50 (post-infusion C eliciting half of maximum E) was 0.57(0.03) microgram mL-1. The PD properties of mivacurium were also evaluated in another two groups of animals receiving either 5- or 10-min continuous iv infusion; PK and PD parameters obtained from the 2.5-min infusion experiments were used to predict the time course of E in the groups receiving 0.6 mg kg-1 of mivacurium in 5- and 10-min infusions; simulations using the estimated parameters adequately describe the time course of E in those groups. The effect of mivacurium on the mean arterial blood pressure (MAP) was also investigated; a 10% nonsignificant decrease (p > 0.05) in MAP was found in all groups.

The effect of changes in gastric pH induced by omeprazole on the absorption and respiratory depression of methadone

The effect of omeprazole (2 mg kg-1 i.v.) on respiratory depression induced in rats by acute oral methadone administration (5 mg kg-1) was examined and compared with control animals that only received methadone. Quantitative assessments of arterial Pco2,Po2, pH, and respiratory rate were employed as criteria for evaluation. Intragastric pH was measured in each rat immediately before and 2 h after methadone. Plasma concentration of methadone was measured for 3 h. The relationship between drug effect and the systemic bioavailability of methadone, measured as the area under the plasma concentration-time curve (AUC0-180), was also evaluated. The intensity of the methadone-induced respiratory depression was significantly greater in the omeprazole group than in control rats. A significant variation (p < 0.01) in all respiratory parameters was detected from 30 to 120 min after methadone. Omeprazole caused a significant increase in methadone levels (Cmax = 156 +/- 6.5 ng mL-1 against 51 +/- 5.8 ng mL-1 in control; p < 0.05). AUC0-180 was higher (p < 0.05) after omeprazole treatment (18.6 +/- 1.4 micrograms mL-1 min) than in control (6.8 +/- 0.6 microgram mL-1 min). Two hours after treatment with omeprazole, intragastric pH values were significantly elevated (4.7 +/- 0.1 against 2.2 +/- 0.04) and continued increasing, being 6.4 +/- 0.1 at the end of the experiment. Correlation was observed between intragastric pH and the area under the effect- (respiratory depression-) time curve (r = 0.74; p < 0.001). A relationship between plasma methadone levels at 120 min and gastric pH (r = 0.92; p < 0.001) was detected. A significant correlation between the area under the effect-time curve (0-120 min) and AUC0-180 has been also observed (r = 0.90; p < 0.01). These pharmacokinetic and pharmacodynamic changes could be gastric pH dependent because they were mimicked when gastric pH was experimentally modified by bicarbonate whereas opposite results were obtained with acidic pH2 solution.

Influence of plasma-protein binding on analgesic effect of methadone in rats with spontaneous withdrawal

The effect of spontaneous withdrawal on alpha 1-acid glycoprotein (AAG) levels and methadone protein binding has been studied in the rat. Animals were made physically dependent on morphine by providing morphine HCl in drinking water for three weeks. The natural opiate withdrawal was induced in rats by substituting the morphine solution with drinking water. The severity of the abstinence syndrome was assessed at various time intervals. After 12 h of withdrawal, the animals showing abstinence signs and low morphine levels were injected with intravenous methadone (0.35 mg kg-1) and the analgesic effect was measured by the tail-flick method and compared with animals receiving water. The oral administration of morphine produced an increase in AAG levels from 0.64 +/- 0.05 g L-1 in control animals to 1.47 +/- 0.92 g L-1 in experimental animals at the point of withdrawal and 1.21 +/- 0.09 g L-1 24 h after withdrawal. The percentage of methadone unbound was significantly lower in morphine-treated than in control animals. A significant correlation between AAG levels and percentage of methadone bound was observed. A parallel analgesic effect after intravenous methadone, as measured by AUC in the tail-flick test, was less in abstinence animals than in control (287.6 +/- 24.8 compared with 401.0 +/- 37.06s min). We suggest that in the withdrawal syndrome an adjustment of methadone dose may be necessary because of changes in protein binding.

Altered methadone analgesia due to changes in plasma protein binding: role of the route of administration

1. The effect of experimental inflammation on methadone analgesia was evaluated in rats, by the tail-flick test, after single intravenous (0.35 mg/kg) and subcutaneous (3 mg/kg) doses. 2. After i.v. administration a significant decrease (P < 0.05) in the area under the methadone time-response curve was seen in rats with experimental inflammation, when compared with control. However, no differences in the analgesic response to methadone were detected between control rats and rats with inflammation when the drug was administered by s.c. injection. 3. Plasma mucoprotein levels were significantly increased (P < 0.001) and methadone free fraction was significantly decreased in rats with inflammation (P < 0.05). In addition, after i.v. methadone a decrease in brain uptake in rats with inflammation was detected. A significant correlation between brain uptake index and plasma free fraction was also observed. 4. These results suggest that a decreased immediate response to i.v. methadone may occur in circumstances in which there is an increase in alpha 1 acid glycoprotein, but that this is not likely to be observed when the absorption is not instantaneous.

Underestimation of Fecal Coliform Counts in Shellfish-Growing Waters by the Spanish Official Method

We compared two tube fermentation methods for the enumeration of fecal coliforms in mussels: the APHA method and the Spanish official method (CP method). In the study area (Galicia, northwest Spain), the regional authorities have proposed that the CP method be adopted as standard. Results showed that the APHA method gave significantly higher counts (P < 0.01) than the CP method. The mean difference between APHA-method counts and CP-method counts was particularly high when only those samples containing less than 500 fecal coliforms per 100 g (as determined by either method) were considered. A significantly higher number of samples were classified as unacceptable (more than 300 fecal coliforms per 100 g) by the APHA method than by the CP method. These results suggest that the CP method is inappropriate for the enumeration of fecal coliforms in mussels.

[Characterization of propofol binding to plasma proteins and possible interactions]

OBJECTIVES

a) To study the binding of propofol to proteins in plasma samples from healthy volunteers and in solutions of albumin and alpha 1-acid glycoprotein (AGA); b) to describe the nature of the bond and possible interactions with other substances that are potential displacers: salicylate, phenylbutazone, sulfisoxazole, tolbutamide, sodium valproate, sodium oleate and penbutolol; c) to assess the effect of propofol on the binding of specific markers and possible binding sites in the following proteins: 14C-warfarin, 3H-diazepam, 3H-midazolam, 3H-imidazole, 3H-penbutolol and 3H-morphine.

MATERIAL AND METHODS

The free fraction was obtained in all samples by ultrafiltration and measurement of the free concentration of propofol by liquid chromatography and of the markers by scintillation spectrometry.

RESULTS

The free fraction of propofol in plasma was 0.98 +/- 0.12% and binding was not saturable. Albumin seems to play an important role (95% bound), whereas the participation of AGA was low (54% bound). Propofol did not affect the binding of any of the markers studied. Nor did the presence of other drugs at therapeutic plasma concentrations affect the binding of propofol.

CONCLUSIONS

The binding of propofol to plasma proteins seems unlikely to cause drug interactions in clinical practice.

Estradiol-induced effects on glutathione metabolism in rat hepatocytes

Glutathione plays an important role in the intracellular protection against oxidative stress and damage in the liver. It is generally assumed that the toxic potential of estrogens is linked to reactive metabolites generated during their enzymatic oxidation in hepatic microsomes. In the present study, the effects of pharmacological doses of estradiol on glutathione metabolism using isolated rat hepatocytes are described. Estradiol (0.1-1.5 mM) produced a dose-dependent depletion of cellular reduced glutathione (GSH), whereas it did not alter the glutathione disulfide (GSSG) excretion into the medium. The viability of cells exposed to the estrogen did not change even when conditions of exacerbated toxicity (addition of either 1 mM diethylmaleimide or 30 microM dicoumarol) were used. In addition, estradiol was shown to exert protective effects against the spontaneous lipid peroxidation in liver cells. In rat liver microsomes, estradiol (5-50 microM) significantly interacted with GSH only when an NADPH-regenerating system was incorporated into the medium.

[Incidence of bacterial contamination in the Ares-Betanzos estuary (NW Spain)]

The presence of bacterial indicators of fecal pollution and V. parahaemolyticus in the estuary of Ares-Betanzos (ría de Ares-Betanzos, NW of Spain) was investigated. Resistance patterns of coliform bacteria to eight antibacterial agents were also determined. In general, high numbers of indicator bacteria were found; for instance, heterotrophic bacteria ranged between 1.82 x 10(2) to 1.9 x 10(4) CFU/ml and up to 4.6 x 10(3)/100 ml fecal coliforms in surface waters and 1.2 x 10(4)/100 ml fecal streptococci in sediment could be found. Surface waters of sampling points 2 and 7, located at the inner part of the estuary, were more polluted than the corresponding ones in the mouth (sampling points, 1, 3, 4 and 9), whereas the sediment showed just the opposite distribution. An 88.5% of isolated coliforms were resistant to one or more antibacterial agents. The MAR index points to urban wastewaters as the probable origin of pollution. The low incidence of V. parahaemolyticus and the lack of correlation with any of the fecal indicator bacteria determined, discard its use as indicative of fecal pollution in marine environments.

[Intestinal parasitoses in the Galician population]

To evaluate the relative importance of the different intestinal parasites in Galicia, we report the results of the investigation of 6,554 samples of feces in the Microbiology Service of the Hospital General de Galicia (Santiago) from 1983 to 1987. The results indicate that the yearly frequency of parasitism has been reduced from 27.8% of the investigated samples en 1983 to 12.1% in 1987. The mean value for the study period was 16.8% (15.6% simple parasitism and 1.2% multiple parasitism). There were no differences in incidence depending on sex. The enteric parasites most commonly found were G. lamblia, T. trichiura, A. lumbricoides and E. coli.

Preparation of beta-aminomethyl-beta-benzoylpropionic acids and related cis beta-aminomethyl-gamma-phenyl-gamma-butyrolactones as potential antibacterial agents

The synthesis of beta-aminomethyl-beta-benzoylpropionic acids (V) and beta-aminomethyl-gamma phenylbutyrolactones (VI) is described. The cis stereochemistry of compounds VI was unambiguously established by NOE experiments carried out with Vla. Antibacterial activity was studied; MIC of each derivate was determined by agar dilution in Muller-Hinton medium and application of Steers' replicator.

The effect of the intestinal worms and migrating L1 larvae of Trichinella spiralis on the production of antiparasitic IgE antibodies

The effect of the adult worms and migrating L1 larvae of Trichinella spiralis on the production of specific IgE antibodies was determined in BCF1 mice. To achieve this, we combined the effect of two anthelminthics: thiabendazole, to produce chemosterilization of adult females, and napthalophos, to expel adult worms from the intestine of infected mice on the desired day. Our results demonstrate that when the natural route of infection is used the production of IgE antibodies is not dependent on the infection dose or the number of migrating L1 larvae, and that both intestinal worms and migrating L1 larvae contribute to the production of reaginic antibodies. In addition to this, an extended period of antigenic stimulation (10-12 days) is required for the induction of a detectable, specific IgE response by adult worms. Finally, our results seem to indicate that although the effects of adult worms and migratory L1 larvae on the IgE production are not additive, the presence of adult worms in the intestine of mice may stimulate a secondary exposure to common antigens released by the migrating L1 larvae.

[Taxonomic study of epiphyte lactic bacteria in grapes in Galicia]

A taxonomic analysis of the malolactic microflora present in nine grape samples from different zones of Galicia, was carried out. Nineteen strains were isolated and identified as Lactobacillus plantarum (42%), L. brevis (10.6%), L. casei (5.25%), L. hilgardii (5.25%), Streptococcus cremoris (5.25%), Leuconostoc lactis (5.25%), L. oenos (10.6%), and Pediococcus acidilactici (15.8%).

Biotyping and phage typing of coagulase-negative staphylococci from blood cultures of neonates

One hundred coagulase-negative staphylococci isolated from blood cultures of neonates have been biotyped and phage typed. These results have been compared with previous reports. The susceptibility of the strains to antimicrobial drugs has also been examined and a rise in resistance rates towards the end of the study was documented. The possible causes of this finding are discussed.

Antimicrobial susceptibility of clinical isolates of Serratia marcescens

The in vitro susceptibilities of 242 isolates of Serratia marcescens to 17 antibacterial drugs have been determined. Oxolinic acid, nalidixic acid, cefoxitin, and amikacin were the most active drugs. Ampicillin, kanamycin, and cephalothin were among the least active. A 4-year study showed that resistance of S. marcescens to dibekacin, tobramycin, sisomycin, and gentamicin has increased at least one order of magnitude in that period, whereas resistance to amikacin showed but a twofold increase.

Characterisation of the reaginic response to sulphonamides in mice

Reaginic responses were induced in immunised mice with either 4-sulphanilamidobenzoic acid (4-SABA) or sulphamethoxazole (SMX) coupled to chicken gamma-globulin (CGG). The former was coupled through the carboxylic group of benzoic acid and the latter through the diazo derivative of the sulphanilamide group. The specificity of the reaginic responses obtained was assessed in each case by inhibition of passive cutaneous anaphylaxis in the rat. Immunisation with 4-SABA-CGG resulted in antibodies which recognised the sulphanilamide group as immunodominant and, therefore, they cross-reacted strongly with other sulphonamides. In contrast, SMX-CGG-induced IgE antibodies directed primarily to the methoxazole end of the molecule and cross-reactivity with other sulphonamides could not be demonstrated. This model may be useful for a more comprehensive study of allergic reactions induced by sulphonamides.

The use of hapten-polysaccharide conjugates for the induction of B-cell tolerance involving IgE responses. II. Specific tolerance induced by sulphonamide-substituted levan in the mouse

Normal and sulphonamide-sensitised mice were made tolerant with 4-sulphanilamido-benzoic-diaminopropyl-carboxymethyl-levan (4-SABA-Le). The tolerance was demonstrably specific for the sulphanilamide moiety of the hapten and extended to related compounds sharing this determinant. Mice sensitised with a 4-SABA-chicken gamma-globulin conjugate developed fatal anaphylactic shock after the injection of sulphanilamide or 4-SABA-ovalbumin, whereas allergic mice subsequently tolerised with 4-SABA-Le did not. The tolerance induced was long lasting since mice were still tolerant 7 months after an injection of an optimal dose of tolerogen. Suppressor cells play little or no part in the maintenance of this unresponsive state since even a 10-fold excess of splenic cells from tolerant animals failed to inhibit the responsivenss of 4-SABA-primed cells when they were transferred together into irradiated recipients.

The use of hapten-polysaccharide conjugates for the induction of B-cell tolerance involving IgE responses. III. Specific tolerance induced by sulphonamide-substituted levan in the guinea pig

Inbred strain 2 and (strain 2 x strain 13)F1 guinea pigs were made allergic by intraperitoneal injections of sulphonamide-chicken gamma-globulin (CGG) conjugates. Two sulphonamides were used: 4-sulphanilamide benzoic acid (4-SABA) and sulphamethoxazole (SMX). 4-SABA was coupled to CGG through its carboxylic group and SMX was coupled following diazotization of its sulphanilamide group. The anti-4-SABA and anti-SMX reaginic antibodies formed did not show any cross-reactivity with each other. Injection of 4-SABA coupled to native levan effectively suppressed the allergic responses of these guinea pigs when given either prior to or after immunization with 4-SABA-CGG. This treatment is specific as it did not affect anti-SMX or anti-CGG reaginic responses. Guinea pigs seem more sensitive to the regime used for tolerance induction than correspondingly sensitized mice in that less tolerogen is required on a body weight basis.