On-site extraction using a 3D printed device coated with Zn/Co-ZIF-derived carbon followed by an on-line SIA-HPLC-FL system for fluoroquinolones determination in wastewater.

A 3D printed device covered with Zn/Co-ZIF-derived carbon allows the on-site extraction of fluoroquinolones (FQs) from wastewater, avoiding the sample transportation to the laboratory, and the subsequent elution, separation and determination using an on-line flow system based on sequential injection analysis (SIA) coupled to HPLC-FL. Several parameters that affect the extraction efficiency and desorption were optimized including the sorption phase immobilization technique on the 3D device, extraction time, pH effect, sample volume as well as the type of eluent, eluent volume, and flow rate. Under optimum conditions, detection limits of 3-9 ng L-1 were achieved for norfloxacin, ciprofloxacin, danofloxacin, enrofloxacin and difloxacin. The precision expressed as relative standard deviation (%RSD, n = 3), showed intraday and interday ranges of 1.5-5.3% and 2.8-5.7%, respectively, demonstrating a good precision of the proposed methodology. To assess matrix effects and accuracy of the proposed method in real samples, recovery studies were performed without and with FQs spiked at different concentrations (0.5-10 µg L-1) to wastewater samples, showing good recoveries in the range of 91-104%. The results allow to confirm the applicability of MOF-derived carbons as adsorbents for on-site extraction, and the satisfactory separation and quantification of FQs by a SIA-HPLC-FL on-line system after their desorption with small eluent volumes.

Proprotein convertase subtilisin/kexin type 9 inhibitors in secondary prevention of vascular events in patients with stroke: Consensus document and practice guidance.

INTRODUCTION: Patients with history of stroke or transient ischaemic attack present considerable risk of future vascular events. Reducing levels of low-density lipoprotein (LDL) cholesterol decreases the incidence of new vascular events, although in a substantial number of patients, the currently available lipid-lowering therapies fail to achieve the therapeutic goals recommended in clinical guidelines. The aim of this consensus statement is to provide updated information on the role of the proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors alirocumab and evolocumab in the secondary prevention of vascular events in patients with history of ischaemic stroke. METHODS: A literature review was performed to identify the main evidence on the use of PCSK9 inhibitors in these patients and the recommended therapeutic targets of LDL cholesterol. The results were discussed in 2 consensus meetings that constituted the basis for the drafting of the document. CONCLUSIONS: PCSK9 inhibitors are effective in reducing vascular risk in secondary prevention; evolocumab specifically has achieved this reduction in patients with history of ischaemic stroke. Moreover, both alirocumab and evolocumab present good safety profiles, even in patients achieving LDL cholesterol levels < 20 mg/dL, and no signs of cognitive impairment have been observed in patients treated with evolocumab who achieved very low levels of LDL cholesterol. In the light of this evidence, we provide practical recommendations about the use of PCSK9 inhibitors in secondary prevention of vascular events in patients with history of ischaemic stroke and follow-up of these patients.

Proprotein convertase subtilisin/kexin type 9 inhibitors in secondary prevention of vascular events in patients with stroke: Consensus document and practice guidance. / Inhibidores de la proproteína convertasa subtilisina/kexina tipo 9 (iPCSK9) en la prevención secundaria de episodios vasculares en pacientes con ictus isquémico: Documento de consenso y aplicaciones prácticas.

INTRODUCTION: Patients with history of stroke or transient ischaemic attack present considerable risk of future vascular events. Reducing levels of low-density lipoprotein (LDL) cholesterol decreases the incidence of new vascular events, although in a substantial number of patients, the currently available lipid-lowering therapies fail to achieve the therapeutic goals recommended in clinical guidelines. The aim of this consensus statement is to provide updated information on the role of the proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors alirocumab and evolocumab in the secondary prevention of vascular events in patients with history of ischaemic stroke. METHODS: A literature review was performed to identify the main evidence on the use of PCSK9 inhibitors in these patients and the recommended therapeutic targets of LDL cholesterol. The results were discussed in 2 consensus meetings that constituted the basis for the drafting of the document. CONCLUSIONS: PCSK9 inhibitors are effective in reducing vascular risk in secondary prevention; evolocumab specifically has achieved this reduction in patients with history of ischaemic stroke. Moreover, both alirocumab and evolocumab present good safety profiles, even in patients achieving LDL cholesterol levels <20 mg/dL, and no signs of cognitive impairment have been observed in patients treated with evolocumab who achieved very low levels of LDL cholesterol. In the light of this evidence, we provide practical recommendations about the use of PCSK9 inhibitors in secondary prevention of vascular events in patients with history of ischaemic stroke and follow-up of these patients.

Indwell times, complications and costs of open vs closed safety peripheral intravenous catheters: a randomized study.

BACKGROUND: Catheter-related infections (CRIs) caused by peripheral intravenous catheters (PIVCs) are an increasingly common iatrogenic complication. To prevent this, recommended timelines for routine replacement of PIVCs have increased from 48 h to 72 h and subsequently to 96 h, despite a lack of supporting scientific evidence. AIM: To compare closed-system (COS) PIVCs with open-system (MOS) PIVCs. METHODS: This prospective, randomized controlled trial compared the indwell time of COS PIVCs without complications with that of MOS PIVCs, removed only by clinical indication. In total, 1199 PIVCs (642 inpatients) were randomized and 283 PIVCs were cultured. Sixteen catheters (11 patients) were lost to the study after randomization. FINDINGS: In total, 104,469 catheter-hours (54,173 h in 584 COS and 50,296 h in 599 MOS) were recorded. The median dwell time was 137.1h for COS PIVCs and 96 h for MOS PIVCs (P = 0.001). Among PIVCs in place for ≥ 24 h, the median dwell time was 144.5h for COS PIVCs [95% confidence interval (CI) 123.4-165.6] and 99 h for MOS PIVCs (95% CI 87.2-110.8). Use of COS PIVCs reduced phlebitis rates by 29% (31 vs 45 cases/1000 catheter-days; P = 0.004). The probability that a MOS PIVC would last for 96 h was 79.9%, and the probability that a COS PIVC would last for 144 h was 80.4%. There were no significant differences in rates of bacterial colonization per 1000 catheter-days (51.1 COS vs 54.1 MOS) or CRI (5.76 COS vs 6.65 MOS). Nevertheless, there was a 20% relative risk reduction in CRI. CONCLUSION: Use of COS PIVCs reduced episodes of phlebitis and risk of infection at a cost of only € 0.09/day. When PIVCs are replaced based on clinical indication, COS PIVCs last for up to 144 h and MOS PIVCs last for up to 96 h without increased risk and with significant cost savings (€ 786,257/year/1000 beds).

[Withdrawal of assisted ventilation in the home: making decisions in paediatric palliative care]. / Retirada de asistencia respiratoria en domicilio: toma de decisiones en cuidados paliativos pediátricos.

End-of-life care is of growing interest in Paediatrics. The number of children with diseases being treated using high-technology as palliative treatment has also increased. The creation of multidisciplinary care teams with 24/7 hours home care may prevent prolonged hospital stays in these patients. To adapt the treatment in order to avoid new hospital admissions and to obtain a better quality of life is a desirable objective. The taking of decisions and subsequent withdrawal of mechanical ventilation in the home is presented, along with the underlying disease and the acute event that led to the worsening of the patient. The decision-making and clinical management until the death of the patient is then discussed and reviewed.

Contribution of 18F-sodium fluoride PET/CT to the study of the carotid atheroma calcification.

AIM: To assess the calcification process of the carotid plaque by (18)F-sodium fluoride PET/CT imaging. MATERIAL AND METHODS: A prospectively designed study including 15 patients in whom an atheroma plaque was detected by contrast enhanced CT scan during a neurological work-up was performed. A total of 29 plaques, 19 asymptomatic and 10 symptomatic, were studied. An (18)F-sodium fluoride PET/CT scan was acquired 180min after the i.v. injection of 370 MBq of (18)F-sodium fluoride in all the patients. The images obtained were analyzed visually according to the intensity of the uptake. RESULTS: All the plaques showed (18)F-sodium fluoride uptake, regardless of the intensity. However, the plaques of the symptomatic group showed a level of 2 or greater intensity while the intensity in 6 of the 19 in the asymptomatic group was lower than 2. CONCLUSIONS: Although the study is limited by the small number of cases, the results show the feasibility of the technique to study the calcification of the atheroma using (18)F-sodium fluoride and suggest an association between symptomatology and higher uptake of (18)F-sodium fluoride. Thus, these results encourage us to continue this study, with the inclusion of a larger number of patients.

[Talking about death to children with cancer]. / Hablar de la muerte al final de la vida: el niño con cáncer en fase terminal.

INTRODUCTION: Paediatric cancer treatment includes a multidisciplinary intervention in all treatment phases, and particularly in the palliative phase. One of the main skills is information. This study tries to explore the level of information that children on palliative care have about their own death. SAMPLE AND METHODS: We retrospectively collected the psychosocial variables of 45 oncology patients who died as inpatients in the Hospital Niño Jesús Hospital (HNJS) between 2006 and 2007. The concept of death is analysed according to each child development stage. RESULTS: We found a relationship between the age of the children and the information they have about their own death, as well as a statistical significance between the information that the child has and the information received from their parents. Children between 3 to 6 years old have more information about their own death than children between 7 to 11 years old. CONCLUSIONS: Our results confirmed that the older age group had more information on their imminent death. However children between 3 to 6 years old have more information than children between 7 to 11 years old. Probably as children between 3 to 6 years old have a magical concept of death, it makes it easier to talk about their terminal phase. Over-protection and the difficulty to talk about death shows differences between what children know and what parents tell them about their palliative phase.

Postmortem biochemical behavior of giant squid (Dosidicus gigas) mantle muscle stored in ice and its relation with quality parameters.

Several freshness and spoilage indicators were monitored to characterize the postmortem biochemistry of giant squid (Dosidicus gigas) mantle muscle. Squid samples were obtained directly from the sea and kept at 0 degrees C during a 15-d storage period. Data at zero time were obtained from cryogenically frozen samples at time of capture. The adenosine 5'-triphosphate (ATP) degradation followed a different pattern as compared with that from fish species. ATP was almost completely depleted at 24-h postcatch from 6.54 to <1 micromol/g, while at the same time Hx was the predominant catabolite with a concentration of 4 mumol/g, reaching 6.85 micromol/g at day 15. K-value data followed a logarithmic pattern with time instead of a linear one, with no change after day 3, thus reducing its suitability as a freshness index. The coefficient Hx/AMP seems to be an adequate alternative for this purpose due to its constant increment with time. The high NH4Cl content in mantle muscle (461.3 +/- 24.5 mg of NH4(+)/100 g) derived from its physiological importance for the species compromises the use of the distillation step of the TVB-N analysis commonly used as a spoilage index. This fact explains why the initially high value of TVB-N detected in mantle muscle (243.7 mg N/100 g) did not correlate with the initial low TMA-N content (1.5 +/- 0.1 mg/100 g of muscle). The results suggested that under the experimental conditions the shelf life of squid exceeds 15 d.

Dosimetric evaluation of MRI-based treatment planning for prostate cancer.

The purpose of this study is to evaluate the dosimetric accuracy of MRI-based treatment planning for prostate cancer using a commercial radiotherapy treatment planning system. Three-dimensional conformal plans for 15 prostate patients were generated using the AcQPlan system. For each patient, dose distributions were calculated using patient CT data with and without heterogeneity correction, and using patient MRI data without heterogeneity correction. MR images were post-processed using the gradient distortion correction (GDC) software. The distortion corrected MR images were fused to the corresponding CT for each patient for target and structure delineation. The femoral heads were delineated based on CT. Other anatomic structures relevant to the treatment (i.e., prostate, seminal vesicles, lymph notes, rectum and bladder) were delineated based on MRI. The external contours were drawn separately on CT and MRI. The same internal contours were used in the dose calculation using CT- and MRI-based geometries by directly transferring them between MRI and CT as needed. Treatment plans were evaluated based on maximum dose, isodose distributions and dose-volume histograms. The results confirm previous investigations that there is no clinically significant dose difference between CT-based prostate plans with and without heterogeneity correction. The difference in the target dose between CT- and MRI-based plans using homogeneous geometry was within 2.5%. Our results suggest that MRI-based treatment planning is suitable for radiotherapy of prostate cancer.

Ultrasound-based stereotactic guidance in prostate cancer--quantification of organ motion and set-up errors in external beam radiation therapy.

OBJECTIVE: A mobile transabdominal ultrasound-based targeting system (BAT(R)) has been developed which can stereotactically localize the position of the prostate each treatment day and directly integrate this information into the treatment planning system. Daily target verification facilitates a marked reduction in planning treatment margins by correcting potential organ-motion and set-up errors. Previous studies have been performed to establish the precision of ultrasound localization. This report quantifies the magnitude of the patient isocenter shift parameters encountered during clinical implementation of this system. MATERIAL AND METHODS: After five weeks of conformal external beam radiation therapy, 54 patients underwent a second CT simulation. Prostate-only fields based on this scan were created with no PTV margin beyond the CTV. For each of the final conedown treatments (2-4 fractions), patients underwent ultrasound-based stereotactic prostate localization at the treatment machine. The portable system, which electronically imports the CT simulation target-contour and isocenter information, is situated adjacent to the treatment couch. Transverse and sagittal suprapubic ultrasound images are captured, and the system electronically couples this data to the baseline isocenter. The CT contours are maneuvered in three dimensions by a touch-screen menu to visually overlay the ultrasound images. The system then displays the three-dimensional (3D) couch shifts required to produce field alignment. RESULTS: One hundred and eighty-nine daily ultrasound prostate position shifts were recorded for 54 patients. The isocenter field misalignment between the baseline CT and ultrasound ranged from -26.8 to 33.8 mm in the anterior/posterior (A/P) dimension, -10.2 to 30.9 mm in the lateral dimension, and -24.6 to 9.0 mm in the superior/inferior (S/I) dimension. The corresponding directed average disagreements were -3.0 mm (SD 8.3 mm) A/P, 1.86 mm (SD 5.7 mm) lateral, and -2.6 mm (SD 6.5 mm) S/I. The magnitudes of undirected misalignments were frequently larger than 5 mm (51% of A/P, 31% of lateral, and 35% of superior measurements) and oftentimes larger than 10 mm (21% of A/P, 7% of lateral, and 12% of superior measurements). CONCLUSIONS: Organ motion and set-up uncertainties limit optimization of 3D treatment planning by expanding the width of PTV margins required to ensure target coverage. Transabdominal ultrasound-based stereotactic guidance is a safe and direct method for correcting patient positioning. Our experience with the BAT system in a large cohort of prostate cancer patients revealed that substantial daily isocenter corrections were encountered in a large percentage of cases. This data would suggest that daily clinical isocenter misalignments are greater than would be expected from published data on organ motion and set-up variations encountered in the study setting.

[Meningococcal meningitis:descriptive study of 76 cases in a pediatric hospital]. / Meningitis meningocócica: estudio descriptivo de 76 casos en un hospital pediátrico.

BACKGROUND: One of the principal causes of bacterial meningitis (BM) in children older than one month is Neisseria meningitidis (Nm). A quick diagnosis and an immediate treatment are considered essential for a good outcome. We propose this study with the purpose of evaluating the clinical and epidemiological characteristics of the patients with BM caused by Nm and analyzing the effect on the presentation and incidence of sequelae and/or complications of the time elapsed since the starting of symptoms and the beginning of the treatment. METHODS: We performed a retrospective analysis of the clinical registers of 76 patients diagnosed as BM caused by Nm entered in the Hospital de Pediatria Pedro de Elizalde, Buenos Aires, Argentina, during the years 1992 and 1993. We investigated age, sex, date of entrance, first symptoms, biochemistry of cerebrospinal fluid (CSF), nutritional status, convulsions and/or complications, length of internation and conditions at discharge. Processing was done with Epi-info 5.0. Differences between qualitative variables were analyzed with chi 2 and differences between means with z-test. RESULTS: Boys were majority; fever was the most frequent initial symptom; petechiae were less frequently found, specially among infants. 79% of the patients had CSF of purulent characteristics; 32.9% of the patients had complications during their evolution; its incidence raised up to 48% in infants. Lethality was 1.3%, 6.5% of the children had sequelae at the moment of discharge. The average time of internment was 13 days. There were no significant differences when different groups were compared according to their prior evolution time. CONCLUSIONS: 1) Petechiae and vomits were significantly less frequent in infants; 2) the incidence of complications was significantly higher in this last group; 3) no greater incidence of complications or sequelae was observed in patients whose previous period of evolution was longer than 48 hours; 4) in all groups of age we found insidious forms of starting, and 5) there were patients with CSF of normal biochemical characteristics in all groups considered independently of the time of evolution elapsed.

Dissociation of the reproductive and prolactin photoperiodic responses in male golden hamsters.

The response of prolactin (PRL) and that of the pituitary-testicular axis to inhibitory photoperiods were compared in immature and young adult hamsters. In the first experiment, 14-day-old hamsters were transferred from 14L:10D to 12L:12D or 8L:16D. At 21, 28, 35, and 49 days of age, body weights, testes weights, and plasma LH were similar in all groups. In contrast, the levels of PRL were lower in animals on 8L:16D or 12L:12D than in those on 14L:10D and 49 days of age. In a second experiment, 80-day-old hamsters were transferred from 14L:10D to either 12L:12D or 8L:16D. At 5-wk intervals, they were weighed and bled by cardiocentesis and the length of the testes was measured. Photoperiods of 12L:12D and 8L:16D induced testicular regression, which was complete by 15 wk. Thereafter, augmented levels of FSH preceded spontaneous recrudescence of the testes in animals on both photoperiods. Serum PRL levels were significantly depressed within 5 wk after transfer to either 8L:16D or 12L:12D. After 15 wk as the testes were increasing in size in both groups, circulating PRL levels increased in animals exposed to 8L:16D, whereas in animals exposed to 12L:12D, PRL remained at or below the sensitivity of the assay. In a final experiment, on the day before parturition, pregnant hamsters were transferred to either 6L:18D, 6L:30D, 6L:42D, or 6L:54D or were held on 14L:10D. There were no differences in testicular weights, plasma LH, or plasma thyroxine (T4) of the pups from these dams at 21, 36, or 48 days of age.(ABSTRACT TRUNCATED AT 250 WORDS)

[Spontaneous bladder rupture secondary to urinary tuberculosis]. / Rotura vesical espontánea secundaria a tuberculosis urinaria.

Atraumatic spontaneous vesical fracture is an uncommon occurrence. Here we present the case of a female patient with spontaneous vesical fracture secondary to urinary tract tuberculosis. A review of current literature showed another published case similar to ours. A brief comment is made on presentation signs and symptoms and picture evolution, as well as a discussion on the predisposing factors of spontaneous vesical fracture and its treatment.

[Intravesical foreign body. Post-traumatic migration of autologous bone fragment]. / Cuerpo extraño endovesical. Migración postraumática de fragmento óseo autólogo.

We report on a 24-year-old female patient with posttraumatic migration of a bony fragment from the site of the fracture to the bladder. The foreign body was removed from the bladder by endoscopy. The etiopathogenic mechanism, clinical signs, diagnostic method and therapeutic management are discussed.

[Wunderlich syndrome secondary to the rupture of an aneurysm of the renal artery. Review of the literature]. / Síndrome de Wunderlich secundario a rotura de aneurisma de la arteria renal. Revisión de la literatura.

We report a case of Wunderlich's syndrome secondary to spontaneous rupture of a renal artery aneurysm. Wunderlich's syndrome, also called spontaneous perirenal hematoma, may arise from several causes, the most common being renal tumors, particularly angiomyolipoma and hypernephroma. Spontaneous perirenal hematoma secondary to a ruptured renal artery aneurysm is rare and very few cases have been reported in the literature. We discuss the usefulness of the different noninvasive imaging techniques (US, CT and arteriography), our therapeutic approach and those advocated by others.

[Calcified gastric adenocarcinoma]. / Adenocarcinoma gástrico calcificado.

A case of calcified gastric adenocarcinoma is presented. It is of clinical interest because of its rareness. Histologically a mucus-secreting adenocarcinoma with lakes of intercellular mucin was found. The need to take this lesion into account in the differential diagnosis of the calcifications in the upper left quadrant, is emphasized.