Predictive value of ankle-brachial index and PAI-1 in symptomatic intracranial atherosclerotic disease recurrence.

BACKGROUND AND PURPOSE: We prospectively examine the single and combined predictive value of biological and clinical markers in recurrent strokes related to intracranial atherosclerotic disease (ICAD). METHODS: In 73 ICAD first-ever stroke patients, ankle-brachial index (ABI) was assessed three months after TIA or stroke together with CRP, Lp-PLA2, ICAM-1, E-selectin and PAI-1 measurements. Appearance of new TIA/stroke was assessed every 6 months. RESULTS: After a median follow-up of 22.4 months, 13 patients (17.8%) suffered a new stroke or TIA. Risk of new cerebrovascular events (CVEs) was associated with lowered ABI (p=0.011), baseline PAI-1>22.52 ng/ml (<0.001), E-selectin>24.75 ng/ml (p = 0.008) and ICAM-1>205 ng/ml (p = 0.029). The combination of PAI-1 with ABI or ESRS reclassified 55.4% (p<0.005) and 48.3% (p<0.05) of patients between low, high and very high-risk categories. CONCLUSIONS: This tentative study shows that ABI and PAI-1 are associated with the risk of new CVEs in symptomatic ICAD patients, and their combination might improve identification of patients at higher risk.

[Safety study of long-term video-electroencephalogram monitoring]. / Estudio de seguridad en la monitorización por vídeo-electroencefalograma prolongado.

INTRODUCTION: The increased morbidity and mortality and poorer quality of life associated with drug-resistant epilepsy justify admitting patients to epilepsy monitoring units (EMU). These units employ methods that promote the occurrence of seizures, which involves a risk of secondary adverse events. The aim of our study is to characterise and quantify these adverse events in a Spanish EMU. MATERIALS AND METHODS: A descriptive, longitudinal and retrospective study of patients admitted consecutively to our EMU. Patients admitted due to status epilepticus, clusters of seizures, or as participants in a clinical trial were excluded. RESULTS: We included 175 patients, of whom 92.1% (161) did not suffer any adverse events. Status epilepticus was present in 3.4% (6); 1.7% (3) had traumatic injury, 1.7% (3) had interictal or postictal psychosis, and 1.1% (2) had cardiorespiratory impairment. There were no risk factors associated with these adverse events. CONCLUSIONS: The most frequently-identified adverse events were status epilepticus, traumatic injury, interictal or postictal psychosis, and cardiorespiratory disorders. The frequency of these adverse events was similar to that seen in international literature. The complications detected do not contraindicate VEEGM.

Post-authorisation study of eslicarbazepine as treatment for drug-resistant epilepsy: preliminary results.

INTRODUCTION: Eslicarbazepine acetate (ESL) is a new antiepileptic drug (AED) and an analogue to carbamazepine (CBZ) and oxcarbazepine (OXC). In this study, we evaluate initial therapeutic response to ESL and events in the change from CBZ and OXC. METHODS: We evaluated 61 patients with a broad spectrum of drug-resistant epilepsies in a cross-sectional study. The switch from CBZ and OXC to ESL was carried out in a single night at ratios of 1:1.3 and 1:1mg respectively. RESULTS: The most common form of epilepsy was temporal lobe epilepsy (62.3%). The most common aetiology was mesial temporal sclerosis (26.2%). Mean follow-up time was 4.7±3.2 months. In 40 patients with a minimum follow-up period of 3 months, monthly median seizure frequency dropped by 63.6% (P<.001) and a reduction of 80% or more was recorded in 30%. Adverse events (AEs) occurred in 54%; all appeared during the titration phase. They were more frequent at doses in excess of 800mg (73.9% vs. 47.4%; P=.042). The most common AE was dizziness (34.4%), which was commonly associated with VPA, LTG and/or LCS consumption (19.2% vs. 45.7%; P=.031). The retention rate at 3 months was 75.4%. A total of 25 patients replaced CBZ or OXC treatment with ESL; any AEs were transient (69.2% for CBZ and 33% for OXC; P=.073). At 3 months after the treatment change, median seizure frequency had decreased by 20% (P<.075). CONCLUSIONS: ESL is effective in the treatment of focal epilepsies and its early retention rate is > 70%. AEs occurred during the titration phase and corresponded to associated AEDs. A rapid change from CBZ and OXC to ESL treatment can be safely performed.

Decreased levels of angiogenic growth factors in intracranial atherosclerotic disease despite severity-related increase in endothelial progenitor cell counts.

BACKGROUND: Intracranial atherosclerotic disease (ICAD) is an important cause of ischemic stroke (IS) and endothelial dysfunction plays a critical role in its onset and progression. Endothelial progenitor cells (EPCs) and endothelial production of angiogenic growth factors (AGFs) may play an essential role in this process. This study investigated the association of EPCs and AGFs with ICAD severity. METHODS: A total of 42 patients who had experienced a transient ischemic attack (TIA) or IS attributable to symptomatic ICAD were included. Clinical and neurosonological evaluations were conducted between 2.4 and 8.7 years after the initial cerebrovascular event. Severe ICAD was defined as the presence of at least 1 severe intracranial stenosis, and extensive ICAD as 3 or more intracranial stenoses. Blood samples were obtained to determine EPC levels using flow cytometry (CD34+KDR+ cells), and the plasma levels of several growth factors were assessed with a protein array (Searchlight(®)). Twenty-two individuals without cerebrovascular disease and with normal ultrasonographic examination were also included. RESULTS: No difference in the count of circulating EPCs was found between patients and controls, and a moderate increase in the number of EPCs/ml was noted in patients with extensive ICAD (p = 0.05). Patients presented decreased levels of fibroblast growth factor (FGF), vascular endothelial growth factor (VEGF) and platelet-derived growth factor (PDGF-BB) compared with controls (p = 0.002, p = 0.079 and p = 0.061, respectively). Higher levels of FGF, VEGF and PDGF-BB were found in patients with severe ICAD (p = 0.007, p = 0.07 and p = 0.07, respectively), but there was no correlation between any AGFs and EPCs. CONCLUSIONS: Symptomatic ICAD patients have decreased levels of AGFs with no correlation to the number of circulating EPCs, while patients with severe ICAD have higher levels of EPCs, FGF, VEGF and PDGF-BBs. This suggests that reduced EPC and proangiogenic factor production capacity is implicated in ICAD pathogenesis, while the more severe forms of chronic brain hypoperfusion in ICAD patients might stimulate EPC mobilization and AGF production.

Biodegradation of phytosanitary products in biological wastewater treatment.

Agricultural activity generates two types of waste: firstly, biodegradable organic effluents generally treated by biological processes and, secondly, phytosanitary effluents which contain residues of plant protection products. The latter are collected and treated. Current technological solutions are essentially based on concentration or physical-chemical processes. However, recent improvements in the biodegradability of pesticides open the way to the consideration of alternative, biological, treatment using mixed liquor from wastewater plant activated sludge. The feasibility of the biological treatment of viticultural effluents has been evaluated by the application of pesticides to activated sludge. The necessity for selection of a pesticide-resistant biomass has been highlighted. The elimination of the phytosanitary products shows the potential of a resistant biomass in the treatment of pesticides. The aerated biological storage ponds at three wineries, followed by a sand or reed-bed filter, were used for the treatment of the total annual volume of the viticulture effluents and validate the laboratory experiments. The results show that the biological purification of pesticides by activated sludge is possible by allowing approximately 8 days for biomass adaptation. Stability of purification occurs between 20 and 30 days.

Co-epuration of winery and pesticides effluents, activated sludge with tertiary nanofiltration, two new technologies for pesticides effluents treatment.

Wine-related activities produce significant volumes of wastewater characterized by high concentrations in organic matter. The term of pesticides effluents defines the water coming from the emptying and the rinsing of the equipment used to pulverize the phytosanitary products on the vines. Pesticide pollution of surface waters from vineyards applications represents a considerable hazard for the aquatic environment. The nature of these wastes is very variable, indeed more than 150 active molecules can be employed. So, the main characteristic of these effluents is their toxicity towards the environment. In this study, an approach was developed to estimate the possibility of developing two biological wastewater treatment process for pesticides effluents treatment. The first one is particulary designed for small vineyard and is a co-epuration process combining winery wastewater treatment with pesticides effluents treatment. The second one is an activated sludge with tertiary nanofiltration and is particularly suited for large vineyards or regroupings of wine growers.

[Use of the "Steritest" apparatus for testing the sterility of antibiotic preparations]. / Ispol'zovanie apparata "Steritest" dlia ispytaniia steril'nosti preparatov antibiotikov.

The efficiency of determining microbial contamination of artificially infected preparations of 8 antibiotics in ampoules and bottles and erythromycin eye ointment with the use of apparatus "Steritest" and "Millipore" was compared. It was found that "Steritest" had a number of advantages as compared to "Millipore" because of elimination of operations for preparing the apparatus for the assay, which prevented contamination of the apparatus with microorganisms from the environment. The time required for the assay with the use of "Steritest" was 2 times shorter and the amount of the tioglycol medium was 2 times lower.