Failure of talc seromadesis for the treatment of subcutaneous chronic seromas after incisional hernia surgery.

BACKGROUND AND AIM: Talc poudrage has been used since many years for sclerosing chronic pleural effusion. Several reports have shown good results managing chronic seromas after breast, vascular, and incisional hernia surgeries. The purpose of this study is to determine the utility of talc seromadesis for the management of chronic seromas after incisional hernia surgery. MATERIALS AND METHODS: Multicentric prospective observational study including patients diagnosed of chronic seromas after incisional hernia surgery. Under local anesthesia and ultrasonographic control, two percutaneous trocars were placed in the seroma, washing the seroma cavity with 0.9% saline solution and aspirating the remaining liquid. A sample of 4 g of talcum powder was introduced in the seroma cavity, and a 15-F drain was left in place. Patients were followed each week during at least 4 weeks after drainage removal. RESULTS: Between January 2013 and December 2016, a total of six patients were enrolled in the study. Talc poudrage was performed without any complications. Drains were pulled out in a mean time of 3 (range: 2-4) weeks. One case of the chronic seromas was efficiently sclerosed with talc without recurrence in time. In three cases, the seroma recurred, and the final solution was surgical decortication of the seroma. In the other two cases, seroma also recurred and were managed with instillation of ethanol and iodine povidone. CONCLUSION: In our experience, the management of chronic seromas after incisional hernia repair with talc seromadesis is ineffective and is associated with a high rate of seroma recurrence.

Combining anterior and posterior component separation for extreme cases of abdominal wall reconstruction.

PURPOSE: The closure of midline in abdominal wall incisional hernias is an essential principle. In some exceptional circumstances, despite adequate component separation techniques, this midline closure cannot be achieved. This study aims to review the results of using both anterior and component separation in these exceptional cases. METHODS: We reviewed our experience using the combination of both anterior and posterior component separation in the attempt to close the midline. Our first step was to perform a TAR and a complete extensive dissection of the retromuscular preperitoneal plane developed laterally as far as the posterior axillary line. When the closure of midline was not possible, an external oblique release was made. A retromuscular preperitoneal reinforcement was made with the combination of an absorbable mesh and a 50 × 50 polypropylene mesh. RESULTS: Twelve patients underwent anterior and posterior component separation. The mean hernia width was 23.5 ± 5. The majority were classified as severe complex incisional hernia and had previous attempts of repair. After a mean follow-up of 27 months (range 8-45), no case of recurrence was registered. Only one patient (8.33%) presented with an asymptomatic bulging in the follow-up. European Hernia Society's quality of life scores showed a significant improvement at 2 years postoperatively in the three domains: pain (p = 0.01), restrictions (p = 0.04) and cosmetic (p = 0.01). CONCLUSIONS: The combination of posterior and anterior component separation can effectively treat massive and challenging cases of abdominal wall reconstruction in which the primary midline closure is impossible to achieve despite appropriate optimization of surgery.

Long-term outcomes after prophylactic use of onlay mesh in midline laparotomy.

BACKGROUND: The prevalence of incisional hernias (IHs) is still high after midline laparotomy (ML). There is an increasing body of evidence that prophylactic mesh placement (PMP) can be safe and efficient in the short-term outcomes, but there still are some concerns about the potential long-term complications of these meshes. This study describes our long-term PMP experience. METHODS: Observational and prospective study including all patients undergoing the use of prophylactic onlay large-pore polypropylene meshes for the closure of ML since 2008 to 2014. Outcome measures included demographics, perioperative details, wound complications, recurrences, reoperations and chronic complications. RESULTS: A cohort of 172 patients was analysed: 75% elective surgery, 25% emergency cases. Mean age was 68 years with mean body mass index (BMI) of 28.6 kg/m2. Wound classification: 6.4% clean; 85% clean-contaminated; 1.2% contaminated and 8.1% dirty. Follow-up of patients was up to 8 years (mean: 5 ± 1.6). Two meshes were removed due to chronic infection in first six postoperative months. Of the 13 patients (9.02%) who developed IH, 5 of them have been reoperated for IH repair without any difficulty related to previous mesh. During follow-up, 8 patients have been reoperated for other reasons and the integrity of abdominal wall was also checked. After the comparative study, higher BMI and emergency surgery were still risk factors for IH despite PMP. CONCLUSIONS: In our setting, the use of polypropylene prophylactic meshes in MLs is safe, efficient and durable.

Temporal and spatial variation of trace elements in atmospheric deposition around the industrial area of Puchuncaví-Ventanas (Chile) and its influence on exceedances of lead and cadmium critical loads in soils.

Fractionation of elemental contents in atmospheric samples is useful to evaluate pollution levels for risk assessment and pollution sources assignment. We present here the main results of long-term characterization of atmospheric deposition by using a recently developed atmospheric elemental fractionation sampler (AEFS) for major and trace elements monitoring around an important industrial complex located in Puchuncaví region (Chile). Atmospheric deposition samples were collected during two sampling campaigns (2010 and 2011) at four sampling locations: La Greda (LG), Los Maitenes (LM), Puchuncaví (PU) and Valle Alegre (VA). Sample digestion and ICP-MS gave elements deposition values (Al, As, Ba, Cd, Co, Cu, Fe, K, Mn, Pb, Sb, Ti, V and Zn) in the insoluble fraction of the total atmospheric deposition. Results showed that LG location, the closest location to the industrial complex, was the more polluted sampling site having the highest values for the analyzed elements. PU and LM were the next more polluted and, finally, the lowest elements concentrations were registered at VA. The application of Principal Component Analysis and Cluster Analysis identified industrial, traffic and mineral-crustal factors. We found critical loads exceedances for Pb at all sampling locations in the area affected by the industrial emissions, more significant in LG close to the industrial complex, with a trend to decrease in 2011, whereas no exceedances due to atmospheric deposition were detected for Cd.

Safety and efficacy of intraurethral alprostadil in patients with erectile dysfunction refractory to treatment using phosphodiesterase-5 inhibitors.

INTRODUCTION: Phosphodiesterase-5 inhibitors (PDE5i) are the first choice for treating erectile dysfunction (ED) but are not always effective. The aim of this study was to present our experience in treating patients with ED, refractory to treatment with PDE5i, using intraurethral alprostadil (MUSE). MATERIAL AND METHODS: We conducted a review of 82 patients with ED and no response to PDE5i, from March 2013 to October 2014. Forty-seven patients (57%) had hypertension (AHT), 24 (29%) had diabetes (DM) and 20 (24%) had AHT and DM. Additionally, 19 (23%) had undergone radical prostatic (RP) surgery. The patients were evaluated after the treatment was applied and at 4 weeks using the following validated questionnaires: International Index of Erectile Function (IIEF-5/SHIM), Global Assessment Questionnaire (GAQ), Sexual Encounter Profile (SEP) and Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS). RESULTS: The mean patient age was 60.5 years (40-80), and the mean follow-up was 11.3 months (1-20). Sixty-eight percent of the treated patients responded to MUSE(®) (74% in the AHT group, 65% in the AHT+DM group, 62.5% in the DM group and 58% in the RP group). The mean IIEF-5 score was 11.7±4.7, which increased to 18.6±4.9 after MUSE was administered (P=.027). The mean EDITS score at 4 weeks was 61.6 (6-81.9). The most common adverse effect was urethral burning, which occurred in 24 patients (29%). There were no cases of urinary tract infection, syncope or priapism. CONCLUSIONS: Intraurethral alprostadil is an effective treatment and has a broad safety profile for treating patients with erectile dysfunction refractory to oral treatment with PDE5i.

Fractionation of trace elements in total atmospheric deposition by filtrating-bulk passive sampling.

We have developed and validated a new simple and effective methodology for fractionation of soluble and insoluble forms of trace elements in total atmospheric deposition. The proposed methodology is based on the modification of a standard total deposition passive sampler by integrating a quartz fiber filter that retains the insoluble material, allowing the soluble fraction to pass through and flow to a receiving bottle. The quartz filter containing the insoluble fraction and the liquid containing the soluble fraction are then separately assayed by standardized ICP-MS protocols. The proposed atmospheric elemental fractionation sampler (AEFS) was validated by analyzing a Coal Fly Ash reference material with proper recoveries, and tested for field fractionation of a set of 10 key trace elements in total atmospheric deposition at the industrial area of Puchuncaví-Ventanas, Chile. The AEFS was proven useful for pollution assessment and also to identify variability of the soluble and insoluble fractions of the selected elements within the study area, improving the analytical information attainable by standard passive samplers for total deposition without the need of using sophisticated and high cost wet-only/dry only collectors.

U1 snRNP control of 3'-end processing and the therapeutic application of U1 inhibition combined with RNA interference.

U1 snRNP (U1 small nuclear ribonucleoprotein) is a well-characterized splicing factor. Besides, when U1 snRNP binds close to a putative polyadenylation site, mostly located in introns, it prevents premature cleavage and polyadenylation and controls the length of most cellular mRNAs. On the other hand, U1 snRNP binding close to the 3'-end of some mRNAs, inhibits polyadenylation and, therefore, gene expression. The inhibition of polyadenylation by U1 snRNP is the basis of U1i (U1 snRNP-based inhibition), a technique used to inhibit gene expression. U1i consists of the expression of a U1 snRNP modified to interact with a target mRNA and inhibit target gene expression. U1i has been used to inhibit the expression of reporter or endogenous genes both in tissue culture and in animal models. Furthermore, combination of U1i and RNA interference (RNAi) results in synergistic increased inhibitions which allow the dose of inhibitors to be decreased whilst at the same time obtaining good inhibitions with fewer unwanted secondary effects. The combination of RNAi and U1i is of special interest for antiviral therapy, as a functional decrease of the expression of replicative viral RNAs may require high inhibition and the combination of two or more inhibitors should decrease the possibility of escape mutants resistant to treatment. In fact, a therapy with U1i combined with RNAi is currently being developed for the treatment of HBV infections. We believe that this review will clarify the hallmarks of U1i technology and will encourage many laboratories to use U1i for functional studies and therapeutic applications.

Miniaturized voltammetric stripping on screen printed gold electrodes for field determination of copper in atmospheric deposition.

The applicability of commercial screen-printed gold electrodes (SPGEs) connected to a portable potentiostat and a laptop has been explored to optimize a new square wave anodic stripping voltammetric method for on-site determination of soluble Cu(II) in atmospheric deposition samples taken around an industrial complex. Electrode conditioning procedures, chemical and instrumental variables have been optimized to develop a reliable method capable of measuring dissolved copper with a detection limit of 3.7 ng mL(-1), useful for pollution monitoring or screening purposes. The proposed method was tested with the SLRS-5 River Water for Trace Metals (recoveries 109.9-113.1%) and the SPS-SW2 Batch 121 Elements in Surface Waters (recoveries 93.2-97.6%). The method was applied to soluble Cu(II) measurement in liquid samples taken by a total atmospheric deposition collector modified with a quartz filter for soluble and insoluble elemental speciation. The voltammetric measurements on field samples were tested in the lab by a reference ICP-MS method, with good agreement. The proposed method proved capability for field operation during a two weeks monitoring campaign.

Somatic mosaicism in a case of apparently sporadic Creutzfeldt-Jakob disease carrying a de novo D178N mutation in the PRNP gene.

Transmissible spongiform encephalopathies (TSEs) are a group of rare fatal neurodegenerative disorders. Creutzfeldt-Jakob disease (CJD) represents the most common form of TSE and can be classified into sporadic, genetic, iatrogenic and variant forms. Genetic cases are related to prion protein gene mutations but they only account for 10-20% of cases. Here we report an apparently sporadic CJD case with negative family history carrying a mutation at codon 178 of prion protein gene. This mutation is a de novo mutation as the parents of the case do not show it. Furthermore the presence of three different alleles (wild type 129M-178D and 129V-178D and mutated 129V-178N), confirmed by different methods, indicates that this de novo mutation is a post-zygotic mutation that produces somatic mosaicism. The proportion of mutated cells in peripheral blood cells and in brain tissue was similar and was estimated at approximately 97%, suggesting that the mutation occurred at an early stage of embryogenesis. Neuropathological examination disclosed spongiform change mainly involving the caudate and putamen, and the cerebral cortex, together with proteinase K-resistant PrP globular deposits in the cerebrum and cerebellum. PrP typing was characterized by a lower band of 21 kDa. This is the first case of mosaicism described in prion diseases and illustrates a potential etiology for apparently sporadic neurodegenerative diseases. In light of this case, genetic counseling for inherited and sporadic forms of transmissible encephalopathies should take into account this possibility for genetic screening procedures.

Characterization of novel CAPN3 isoforms in white blood cells: an alternative approach for limb-girdle muscular dystrophy 2A diagnosis.

Limb-girdle muscular dystrophy type 2A (LGMD2A) is an autosomal recessive disorder caused by mutations in the CAPN3 gene. Its definitive diagnosis is laborious, since the clinical phenotype is often similar to other types of muscular dystrophy and since the CAPN3 gene encompasses a large genomic region with more than 300 pathogenic mutations described to date. In fact, it is estimated that nearly 25% of the cases with a phenotype suggestive of LGMD2A do not have mutations in the CAPN3 gene and that, in up to 22% of the cases, only one mutation is identified. In the present work, we have characterised CAPN3 messenger RNA (mRNA) expression in peripheral blood, and we have performed a retrospective diagnostic study with 26 LGMD2A patients, sequencing a transcript of CAPN3 present in white blood cells (WBCs). The 25% of the mutations presented in this paper (7/28) act modifying pre-mRNA splicing of the CAPN3 transcript, including the first deep-intronic mutation described to date in the CAPN3 gene. Our results determine that the sequencing of CAPN3 transcripts present in WBCs could be applied as a new approach for LGMD2A diagnosis. This method improves and simplifies diagnosis, since it combines the advantages of mRNA analysis in a more accessible and rapidly regenerated tissue. However, the lack of exon 15 in the CAPN3 isoforms present in blood, and the presence of mRNA degradation make it necessary to combine mRNA and DNA analyses in some specific cases.

Genes related to iron metabolism and susceptibility to Alzheimer's disease in Basque population.

Alzheimer's disease (AD) is the most common dementing disorder and presents with a progressive and irreversible cognitive decline of gradual onset. To date, several reports have involved iron in AD physiopathology. In this study, we have analysed TFC2 variant and HFE mutations (H63D and C282Y) in 211 AD patients and 167 controls recruited from an area of the Basque Country. Furthermore, we have studied APOE genotype as it is a well-known risk factor for AD. APOE epsilon 4 allele was associated with an increased risk of AD and an earlier age at onset, whereas no association was found between TFC2 or HFE C282Y mutation and disease susceptibility. The frequency of H63D mutation was higher in control population (29.9%) than in AD patients (18%), suggesting a protective role of this allele on AD either due to the presence of the mutation itself or through the effect of other related genes in the ancestral haplotype in which it is included.

CD24 V/V is an allele associated with the risk of developing multiple sclerosis in the Spanish population.

The allele C in the CD24 gene has been related to multiple sclerosis (MS). In this work we check this single nucleotide polymorphism (SNP) in a population of 135 patients and 285 controls. Our results confirm the association between the V/V genotype at aa 57 of this gene and MS and highlight the importance of taking into account the origin of the subjects to avoid a population bias.

Apolipoprotein E epsilon4 allele in familial and sporadic Parkinson's disease.

Parkinson's disease (PD) is the second most common age-related neurodegenerative disease after Alzheimer's disease (AD). Common risk factors for both diseases have been explored to study potential etiologic interactions between these two neurodegenerative disorders. The APOE epsilon4 allele, previously associated with AD, has also been associated with risk of PD and with the presence of some clinical features in PD patients. However, the role of APOE epsilon4 allele in risk of PD remains unclear. We studied the distribution of APOE alleles in 276 unrelated familial and sporadic PD patients and in 212 controls. Patients and controls were classified by ethnicity. No genetic heterogeneity between Basques and people from other regions of Spain was found. No significant differences in APOE allele distribution between PD patients and controls were found; however, lower epsilon4 allele frequency was observed when the sporadic PD group was analyzed separately. By contrast, an increase in epsilon4 allele frequency was found in familial PD patients with cognitive decline. We conclude that the APOE epsilon4 allele may be associated with the risk of developing PD in isolated cases and that it is linked to the presence of cognitive decline in familial PD in our sample.