Combined effects of acute exercise and hypoxia on memory.

No previous studies have evaluated the potential combined effects of acute exercise and acute hypoxia exposure on memory function, which was the purpose of this study. Twenty-five participants (Mage = 21.2 years) completed two laboratory visits in a counterbalanced order, involving 1) acute exercise (a 20-min bout of moderate-intensity exercise) and then 30 min of exposure to hypoxia (FIO2 = 0.12), and 2) exposure to hypoxia alone (FIO2 = 0.12) for 30 min. Following this, participants completed a cued-recall and memory interference task (AB/AC paradigm), assessing cued-recall memory (recall 1 and recall 2) and memory interference (proactive and retroactive interference). For cued-recall memory, we observed a significant main effect for condition, with Exercise + Hypoxia condition having significantly greater cued-recall performance than Hypoxia alone. Memory interference did not differ as a function of the experimental condition. This experiment demonstrates that engaging in an acute bout of exercise prior to acute hypoxia exposure had an additive effect in enhancing cued-recall memory performance.

Draft Genome Sequence of Streptomyces sp. Strain C8S0, Isolated from a Highly Oligotrophic Sediment.

Streptomyces spp. are prolific bacteria producing bioactive metabolites. We present the draft genome sequence of Streptomyces sp. strain C8S0, which was isolated from a highly oligotrophic sediment from the Cuatro Cienegas Basin (Mexico). The whole-genome assembly comprised 6,898,902 bp, with 18 biosynthetic gene clusters, including those for nonconventional terpenes, nonribosomal peptides, and polyketides.

Cardiac surgery in infective endocarditis and predictors of in-hospital mortality. / Cirurgia cardíaca na endocardite infeciosa e preditores da mortalidade intra­hospitalar.

INTRODUCTION: Infective endocarditis (IE) is a serious disease with significant in-hospital mortality (15-30%) despite advances in medical and surgical therapy. AIMS: To perform a clinical characterization of patients undergoing cardiac surgery for IE and to identify factors that predict in-hospital mortality. METHODS: We retrospectively analyzed 145 patients with IE admitted between January 2006 and October 2017. RESULTS: The median age was 72 years. IE was acquired mainly in the community (69%), and involved the native aortic valve in 54% of patients, biological prosthetic valves in 22.1% and mechanical valves in 10.3%. Staphylococcus spp. (31.0%) were the most frequent etiological agents. Cardiac surgery was emergent in 29 patients, urgent in 108, and elective in eight. The main indications were heart failure (57.9%), large vegetations (20%), systemic embolism (17.2%) and valve dysfunction (15.2%). Overall, biological valves were implanted in 62.1% of patients and mechanical valves in 37.2%. A total of 19 patients (13.1%) died. Predictors of mortality were preoperative atrial fibrillation and lower left ventricular ejection fraction, postoperative severe valve regurgitation associated with cardiogenic shock, sepsis, septic shock associated with cardiogenic shock, cardiac tamponade, need for renal replacement therapy and, although without statistical significance, emergent surgery. CONCLUSIONS: There is a need for better indicators to enable early identification of surgical candidates for IE, implementation of a heart team, and better surgical strategies, including more rapid intervention, more specific postoperative care, and optimal antibiotic therapy.

Hypothesized mechanisms through which acute exercise influences episodic memory.

Emerging research demonstrates that exercise is favorably associated with several cognitive outcomes, including episodic memory function. The majority of the mechanistic work describing the underlying mechanisms of this effect has focused on chronic exercise engagement. Such mechanisms include, e.g., chronic exercise-induced neurogenesis, gliogenesis, angiogenesis, cerebral circulation, and growth factor production. Less research has examined the mechanisms through which acute (vs. chronic) exercise subserves episodic memory function. The purpose of this review is to discuss these potential underlying mechanisms, which include, e.g., acute exercise-induced (via several pathways, such as vagus nerve and muscle spindle stimulation) alterations in neurotransmitters, synaptic tagging/capturing, associativity, and psychological attention.

Collagen type IV-related nephropathies in Portugal: pathogenic COL4A3 and COL4A4 mutations and clinical characterization of 25 families.

Pathogenic mutations in genes COL4A3/COL4A4 are responsible for autosomal Alport syndrome (AS) and thin basement membrane nephropathy (TBMN). We used Sanger sequencing to analyze all exons and splice site regions of COL4A3/COL4A4, in 40 unrelated Portuguese probands with clinical suspicion of AS/TBMN. To assess genotype-phenotype correlations, we compared clinically relevant phenotypes/outcomes between homozygous/compound heterozygous and apparently heterozygous patients. Seventeen novel and four reportedly pathogenic COL4A3/COL4A4 mutations were identified in 62.5% (25/40) of the probands. Regardless of the mutated gene, all patients with ARAS manifested chronic renal failure (CRF) and hearing loss, whereas a minority of the apparently heterozygous patients had CRF or extrarenal symptoms. CRF was diagnosed at a significantly younger age in patients with ARAS. In our families, the occurrence of COL4A3/COL4A4 mutations was higher, while the prevalence of XLAS was lower than expected. Overall, a pathogenic COL4A3/COL4A4/COL4A5 mutation was identified in >50% of patients with fewer than three of the standard diagnostic criteria of AS. With such a population background, simultaneous next-generation sequencing of all three genes may be recommended as the most expedite approach to diagnose collagen IV-related glomerular basement membrane nephropathies.

Collagen type IV-related nephropathies in Portugal: pathogenic COL4A5 mutations and clinical characterization of 22 families.

Alport syndrome (AS) is caused by pathogenic mutations in the genes encoding α3, α4 or α5 chains of collagen IV (COL4A3/COL4A4/COL4A5), resulting in hematuria, chronic renal failure (CRF), sensorineural hearing loss (SNHL) and ocular abnormalities. Mutations in the X-linked COL4A5 gene have been identified in 85% of the families (XLAS). In this study, 22 of 60 probands (37%) of unrelated Portuguese families, with clinical diagnosis of AS and no evidence of autosomal inheritance, had pathogenic COL4A5 mutations detected by Sanger sequencing and/or multiplex-ligation probe amplification, of which 12 (57%) are novel. Males had more severe and earlier renal and extrarenal complications, but microscopic hematuria was a constant finding irrespective of gender. Nonsense and splice site mutations, as well as small and large deletions, were associated with younger age of onset of SNHL in males, and with higher risk of CRF and SNHL in females. Pathogenic COL4A3 or COL4A4 mutations were subsequently identified in more than half of the families without a pathogenic mutation in COL4A5. The lower than expected prevalence of XLAS in Portuguese families warrants the use of next-generation sequencing for simultaneous COL4A3/COL4A4/COL4A5 analysis, as first-tier approach to the genetic diagnosis of collagen type IV-related nephropathies.

Novel Fuzzy Logic Controller based on Time Delay Inputs for a Conventional Electric Wheelchair / Controlador Difuso basado en Entradas Obtenidas por Retardos en el Tiempo para una Silla de Ruedas Eléctrica

This work proposes a Dynamic fuzzy logic Controller for the navigation problem of an electric wheelchair. The controller uses present data from three ultrasonic sensors as the main source of information from the environment. However other inputs, named as "dynamic time delay", are obtained from past samples of those static data and are used to design the rule base. Although fuzzy logic controllers with static inputs could solve basic navigation problems, the proposed structure with dynamic inputs gets an excellent performance for more complex navigation problems. There were designed static and dynamic navigation strategies, which were first deployed in software just to evaluate their behavior. They were tested in a maze and their trajectories were compared to select the best. For improving its response, the dynamic fuzzy logic strategy was deployed in hardware. The paper presents a comparison between the software and hardware applications to illustrate the possibility of implementing the proposed methodology in different platforms. The dynamic fuzzy logic controller led the electric wheelchair without colliding against walls, and is a high performance navigation system. Moreover, this controller could solve the sensor limitations.

En este trabajo se presenta un controlador dinámico con lógica difusa para el problema de navegación de una silla de ruedas. El controlador usa datos presentes de tres sensores ultrasónicos como la principal fuente de información del entorno. Sin embargo, a partir de valores pasados se obtienen otras entradas designadas como "retrasos dinámicos'' para la base de reglas. A pesar de que los controladores de lógica difusa con entradas estáticas pueden resolver problemas básicos de navegación, la estructura propuesta con entradas dinámicas tiene un excelente desempeño para problemas de navegación más complejos. Se diseñaron estrategias de navegación estáticas y dinámicas, las cuales fueron implementadas primero en software para evaluar su desempeño. Se usó un laberinto y sus trayectorias fueron comparadas para seleccionar el mejor. Para mejorar su respuesta, la estrategia dinámica fue implementada en hardware. Este artículo presenta una comparación entre las aplicaciones de hardware y software para ilustrar la posibilidad de implementar la metodología en diferentes plataformas. El controlador dinámico de lógica difusa dirigió la silla eléctrica sin colisionar contra los muros, y es un sistema de navegación de alto desempeño. Así mismo, este controlador podría resolver las limitaciones del sensor.

Co-simulación del Diseño Biomecánico para un Exoesqueleto Robótico del Miembro Inferior / Co-simulation of Biomechanical Design for a Robotic Exoskeleton for the Lower Limb

Este trabajo muestra como la co-simulación incrementa las ventajas y decrementa las desventajas para el diseño del exoesqueleto. La metodología propuesta tiene tres estados: el diseño de la parte biomecánica, el diseño mecánico y el sistema de control Para el análisis biomecánico, OpenSim® resuelve el sistema musculo-esquelético e incluye modelos para diferentes condiciones que pueden ser usados en el diseño de procesos. SolidWorks® que es aplicado en diseños asistidos por computadora evalúa la parte mecánica y Matlab® resuelve el sistema de control del exoesqueleto. Esto permite conseguir un diseño personalizado, que simula los movimientos de una marcha completa cubriendo las restricciones cinemáticas para lograr un movimiento natural y las limitaciones del usuario cuando tienen algún problema para caminar. El resultado muestra como es aplicada la co-simulación para hacer un prototipo virtual, como se unen y dependen los programas uno del otro. Aunque la simulación convencional de cada programa puede ahorrar dinero y tiempo, estos no resuelven completamente los problemas de diseño del exoesqueleto; por lo tanto la co-simulación es una excelente opción para la biomecánica, la mecánica y los sistemas de control que necesitan exactitud y rapidez en cada parte del proceso de diseño.

This work shows how the co-simulation increases the advantages and decreases the drawbacks for exoskeleton design. The proposed methodology has three stages: the design of a biomechanical part, the mechanical design and the control system. For the biomechanical analysis, OpenSim ® solves the muscle-skeleton system and includes models for different conditions that can be used in the design process. SolidWorks® that is applied in assistive computer design evaluates the mechanical part of the exoskeleton and Matlab® solves the control system that takes over the exoskeleton. It allows getting a personalized design which simulates the complete walking movements, covering the kinematic restrictions to achieve a natural human movement and the user limitations when they have any problem for to walk. The results show how the co-simulation is applied to complete a virtual prototype and the programs are linked hand in hand. Although conventional simulation by one program can save money and time, it cannot solve the entire exoskeleton design problem; as a result the co-simulation is an excellent option in biomechanical, mechanical and control systems that need accurate and swift results in each part of the design process.

Methodology to Weight Evaluation Areas from Autism Spectrum Disorder ADOS-G Test with Artificial Neural Networks and Taguchi Method / Metodología para ponderar áreas de evaluación de la herramienta ADOS-G en trastorno del espectro autista con redes neuronales artificiales y método de Taguchi

Autism diagnosis requires validated diagnostic tools employed by mental health professionals with expertise in autism spectrum disorders. This conventionally requires lengthy information processing and technical understanding of each of the areas evaluated in the tools. Classifying the impact of these areas and proposing a system that can aid experts in the diagnosis is a complex task. This paper presents the methodology used to find the most significant items from the ADOS-G tool to detect Autism Spectrum Disorders through Feed-forward Artificial Neural Networks with back-propagation training. The number of cases for the network training data was determined by using the Taguchi method with Orthogonal Arrays reducing the sample size from 531,441 to only 27. The trained network provides an accuracy of 100% with 11 different cases used only for validation, which provides a specificity and sensitivity of 1. The network was used to classify the 12 items from the ADOS-G tool algorithm into three levels of impact for Autism diagnosis: High, Medium and Low. It was found that the items "Showing", "Shared enjoyment in Interaction" and "Frequency of vocalization directed to others", are the areas of highest impact for Autism diagnosis. The methodology here presented can be replicated to different Autism diagnosis tests to classify their impact areas as well.

El diagnóstico del autismo requiere del uso de herramientas de diagnóstico validadas internacionalmente que son utilizadas por los profesionales de la salud expertos en trastornos del espectro autista, lo cual requiere de procesamiento de mucha información y un entendimiento técnico de cada una de las áreas evaluadas en ellas. La clasificación del impacto que tienen cada una de estas áreas, así como la propuesta de un sistema que pueda ayudar a los expertos en el diagnóstico, es una tarea compleja, por lo que en este artículo se presenta una metodología utilizada para encontrar los elementos más significativos de la herramienta de diagnóstico de autismo ADOS-G a través de redes neuronales artificiales entrenadas con retropropagación del error. El número de casos para entrenamiento de la red se seleccionó utilizando el método de Taguchi con arreglos ortogonales, reduciendo el tamaño de la muestra de 531,441 a solo 27 casos. La red entrenada tiene una exactitud del 100% validada con 11 casos diferentes de niños evaluados para diagnóstico de trastorno del espectro autista con lo que se obtuvo una especificidad y sensibilidad de 1. La red neuronal artificial se utilizó para clasificar los 12 elementos del algoritmo de la herramienta ADOS-G en tres niveles de impacto: Alto, Medio y Bajo. Se encontró que los elementos "Mostrar", "Placer compartido durante la interacción" y "Frecuencia de vocalizaciones dirigidas a otros" son las áreas de mayor impacto para el diagnóstico de autismo. La metodología presentada puede ser replicada para diferentes herramientas de diagnóstico de autismo para clasificar sus áreas de mayor impacto también.

Morphophysiology of the Zuckerkandl's paraganglion: effects of dexamethasone and aging.

The extra-adrenal Zuckerkandl's paraganglion is used as a source of chromaffin cells for transplantation in parkinsonian animals. Aging can affect its viability, and this tissue needs further characterization for improving grafting procedures. The objectives were: (i) to compare the main morpho-functional characteristics of prepubertal and old Zuckerkandl's paraganglion (ZP), and (ii) to discern phenotypic changes after sub-chronic dexamethasone treatment in extra-adrenal tissue of prepubertal rats. For these purposes, immunostaining methods, stereology, voltammetry, cell culture, Western blotting, and ELISA were employed. The findings revealed that all paraganglia were composed of mesenchymal tissue and chromaffin cells. In prepubertal rats, chromaffin cells are arranged as large or small clusters. Large clusters (also known as "cell nests") contain densely packed chromaffin cells, and they are seen as fascicles in longitudinal sections. In old paraganglia, cell nests disappear, and chromaffin cells are found to be arranged as small cell clusters or dispersed throughout the mesenchyma. Paraganglionic chromaffin cells possess a rounded morphology with diameter ranging from 12 to 15 µm, with intracytoplasmic granules (100-500 nm in diameter) containing catecholamines. Prepubertal and old ZP chromaffin cells are mostly noradrenergics, and a few of them are dopaminergics. Aging reduces the amount of chromaffin tissue (28% in adult rats vs. 11% in old animals, both in relation to total volume of the paraganglion), and induces the presence of adrenergic cells and adrenaline. Both prepubertal and old cells express the neurotrophic factors GDNF and TGF-ß1, aging leading to reduced levels of both growth factors. Dexamethasone (50 µg/kg daily, 5 days) leads to the expression of phenylethanolamine-N-methyl-transferase in prepubertal paraganglia, and to a higher content and release of adrenaline.

Angiotensin-converting enzyme inhibitors after renal transplantation.

The blockade of the renin-angiotensin-aldosterone system may limit the progression of graft dysfunction in patients receiving kidney transplantations. We retrospectively evaluated the safety and efficacy of angiotensin-converting enzyme inhibitors (ACEI) in renal allograft recipients. Fifty-seven cadaveric kidney recipients (58% of recipients), were prescribed an ACEI (lisinopril). The indications for ACEI were isolated proteinuria (1 patient), erythrocytosis (6 patients), and arterial hypertension (50 patients). The choice of an ACEI for blood pressure control was due to presence of left ventricular hypertrophy (2 patients), mild proteinuria (4 patients), and high hemoglobin (4 patients). There was a significant reduction in the mean arterial pressure after 1 month (P = .0004) and 1 year (P = .0002) of therapy. Overall, the estimated glomerular filtrate rate (eGFR), calculated using the Cockcroft-Gault equation, remained unchanged. Among patients who had serum creatinine values above 2.0 mg/dL at the beginning of ACEI therapy, there was a significant rise in eGFR from 39.3 +/- 13.2 to 44.1 +/- 16.8 mL/min after 6 months (P = .01), and 43.3 +/- 17.3 mL/min after 1 year (P = .04). In patients with erythrocytosis, the hemoglobin showed a significant and sustained reduction after 1 month (P = .004) and 1 year (P = .001). Six patients suspended ACEI owing to adverse events: cough (n = 4), worsening of graft function (n = 1), and hypotension (n = 1). Six patients required erythropoiesis-stimulating agents. No patient suspended treatment owing to hyperkalemia. In conclusion, ACEI were well tolerated, safe, and effective antihypertensive agents in kidney graft recipients. They seemed to have some beneficial effect in preserving GFR in patients with worse graft function.

Evaluation of segmentation algorithms for coronary angiography.

This paper presents an evaluation technique based on ROC analysis to compare four segmentation algorithms in coronary angiography images. We have implemented four algorithms and we have optimized their parameters; then, we have compared their performances. Both steps are done by means of a ROC analysis. Experimental results are presented on simulated data and real images.

Increased use of catheters as vascular access: is it justified by patients' clinical conditions?

BACKGROUND: Over the last years many technical improvements have been made in hemodialysis treatment. Vascular access (VA) still remains an important problem. Although the use of indwelling vascular catheters is discouraged, in Europe there is an increasing use of them. The K/DOQI Guidelines recommend a native arteriovenous fistula (AVF) as VA of choice. As reported by DOPPS, there is considerable geographic variation in the distribution of type of VA used amongst hemodialysis patients. The aim of this study was to evaluate the time patients in four European countries have to wait before undergoing their first surgery for VA (AVF or graft). METHODS: All incident patients admitted to HD clinics located in Turkey, Italy, the UK and Portugal of the European FME clinics network between October 1, 2002 and September 30, 2004 were considered. Data were gained from the Clinical Database EuCliD. RESULTS: 2,152 patients (males 55.9%, mean age 62.5+/-15.7 years, diabetics 27%) were selected. Italy and Portugal had a higher proportion of elderly patients. At time of admission, the proportion of patients starting dialysis with AVF ranged between 23% and 60% from Turkey to Italy respectively. Patients with an indwelling catheter at admission are expected to undergo VA surgery as soon as possible. After 3 months of follow-up, about 75% of all patients had undergone surgery, however in the UK less than 50% of the patients had had a VA procedure. Overall, males have significantly higher probability of undergoing surgery, whilst elderly patients have a lower probability (27% and 14% respectively). CONCLUSION: Significant differences exist between countries in the time interval from referral to creation of VA. Health care system related problems seem to be the major reason to explain such differences. Patients in the UK have longer waiting times than the other countries studied.

[Two-years experience with the use of radial artery in coronary revascularization surgery]. / Dois anos de experiência uso da artéria radial em cirurgia coronária.

INTRODUCTION: Among several other factors, in coronary surgery the results depend on the quality and durability of the grafts. Revascularization employing arterial conduits, namely the radial artery, has been playing a growing role, with the aim of replacing the autologous saphenous vein. The benefits and risks of this strategy is still a matter of controversy. The goal of the present study was the evaluation of the incidence of early complications related to the use of radial artery in the revascularization surgery of the myocardium. METHODS: A series of consecutive patients who underwent coronary revascularization surgery in the CHVNGaia using radial artery, from January 2000 to December 2001, was retrospectively analyzed. Data were obtained through the revision of the clinical charts and hospital database. The major end-point assessed was the 30-day or intra hospital postoperative death; furthermore, acute myocardial infarction, stroke, renal failure, prolonged ventilation and reoperations for acute graft occlusion, bleeding and mediastistinitis were also evaluated. RESULTS: During that period of time, 656 patients underwent coronary revascularization surgery, but the radial artery was used in only 230 (35%). Mean age was 60.2+/- 9.1 years and 42 (18.3%) were female. Two hundred and four patients (88.6%) were operated on under extracorporeal circulation. The average number of grafts was 2.6+/- 0.6 per patient. Mean duration of orotraqueal intubation was 2.4 +/- 6 hours. Thirty patients (14,3 %) developed atrial fibrillation and ten (4.3%) had postoperative bleeding. Perioperative myocardial infarction occurred in five cases (2.2%). Two patients (0.8%) underwent reoperation for mediastinitis and one patient (0.4%) was reoperated on for acute occlusion of the graft. The overall postoperative mortality was 1.3% (3 patients). CONCLUSION: The use of radial artery in coronary revascularization did not caused morbidity and mortality, out of the usual context of coronary surgery. The results of our experience suggest that radial artery can be successfully used in myocardial revascularization surgery, enlarging the possibilities of utilization of arterial autografts.

Early extubation does not increase complication rates after coronary artery bypass graft surgery with cardiopulmonary bypass.

BACKGROUND: With the evolution of anesthesia and surgical procedures, fast track extubation has gained an increased interest, mainly based on the possibility of reducing health costs seemingly without compromising patient care. AIM: To compare two groups of patients submitted to a non-fast track extubation and a fast track extubation protocol after coronary artery bypass graft surgery with cardiopulmonary bypass, regarding their times of ventilation and intubation and their complication rates in the postoperative period. METHODS: During the year of 1998, 323 sequential patients scheduled for isolated coronary artery bypass graft surgery with cardiopulmonary bypass were enrolled in the study. Fifty-nine patients were excluded due to preoperative use of emergent mechanical and/or inotropic hemodynamic support, low body mass index (< or =18-20 kg/m(2)), reoperations for acute surgical complications, off-pump coronary artery bypass graft surgery, severe respiratory disease, recent myocardial infarction (< or =7 days) and absence of relevant data. Previous myocardial infarction (> or =7 days), prophylactic intraaortic balloon pump and use of postoperative vasoactive drugs were not exclusion criteria. We compared 76 patients sequentially submitted to anesthesia by one of the authors with a fast track extubation protocol and 188 patients sequentially submitted to anesthesia by others in the same period and using a conventional anesthetic protocol. RESULTS: Demographic data, previous medical and cardiac history, preoperative medication and operative data were all similar between the two groups. The mean ventilation and intubation times were significantly shorter in the fast track extubation group than in the non-fast track extubation patients (30 min vs. 7 h and 50 min vs. 8 h, respectively). Forty-two percent of patients in the fast track extubation group were extubated on arrival at the intensive care unit. Morbidity and mortality were similar in both groups. CONCLUSIONS: The study shows that a very fast track extubation protocol may be safely implemented in patients submitted to coronary artery bypass graft surgery with cardiopulmonary bypass.

Vascular access for dialysis in the elderly.

Although not taken in consideration as a special issue in current guidelines, vascular access in the elderly deserve specific recommendations as they are quickly enlarging as a group, with particularly high vascular access morbidity and failure rate. Hemodynamic and endothelial mechanisms of access failure are reviewed and tentative strategies to increase the prevalence of durable native arteriovenous fistulas are analysed.

Diffuse axonal injury with or without an evacuated intracranial hematoma in head injured patients. Are they different lesions?

The general classification of head injury proposed by Marshall et al., based on admission CT scan findings, might mask a group of patients who have Diffuse Brain Injury (DI) in addition to intracranial haematomas. The aim of this study was to assess possible differences in outcome with respect to the level of intracranial pressure (ICP) and cerebral perfusion pressure (CPP) between a group of patients with DI: III-IV (Marshall's classification) after the evacuation of an intracranial haematoma (group A) and another group with DI: III-IV in the absence of a mass lesion (group B). We prospectively studied 129 patients with isolated and closed severe head injury (GCS < 9). In group A (n = 61), the median percentage of hours with ICP > 20 mmHg and CPP < 70 mmHg was 42.8 and 18, respectively and 17 (28%) survived with GOS 4-5. In group B (n = 68), median values of 20 and 5.5 hours were obtained for ICP > 20 and CPP < 70 respectively, whilst 39 (57.3%) survived with favourable outcomes. When we analysed the effects of the DI: III-IV in both groups of patients, we found that the differences in percentage of time with ICP > 20 and CPP < 70 were statistically significant (p < 0.01) and patients in group A had a higher morbidity and mortality (p < 0.05). This study has demonstrated that the levels of ICP, morbidity and mortality in patients with DI: III-IV and an evacuated mass lesion were higher than in patients with DI: III-IV without a mass lesion.

Iron supplementation in haemodialysis--practical clinical guidelines.

BACKGROUND: The aim of this prospective study was to test a new protocol for iron supplementation in haemodialysis patients, as well as to assess the utility of different iron metabolism markers in common use and their 'target' values for the correction of iron deficiency. METHODS: Thirty-three of 56 chronic haemodialysis patients were selected for long-term (6 months) i.v. iron therapy at 20 mg three times per week post-dialysis based on the presence of at least one of the following iron metabolism markers: percentage of transferrin saturation (%TSAT) <20%; percentage of hypochromic erythrocytes (%HypoE) > 10% and serum ferritin (SF) <400 microg/l. Reasons for patient exclusion were active inflammatory or infectious diseases, haematological diseases, psychosis, probable iron overload (SF > or =400 microg/l) and/or acute need of blood transfusion mostly due to haemorrhage and change in renal replacement treatment. RESULTS: More than half (51.8%) of the patients of our dialysis centre proved to have some degree of iron deficiency in spite of their regular oral iron supplementation. At the start of the study the mean haemoglobin was 10.8 g/dl and increased after the 6 months of iron treatment to 12.8 g/dl (P<0.0001). The use of erythropoietin decreased from 118 units/kg/week to 84 units/kg/week. The criterion for iron supplementation with the best sensitivity/specificity relationship (100/87.9%) was ferritin <400 microg/l. Patients with ferritin < 100 [microg/l and those with ferritin between 100 microg/l and 400 microg/l had the same increase in haemoglobin but other parameters of iron metabolism were different between the two groups. CONCLUSIONS: Routine supplementation of iron in haemodialysis patients should be performed intravenously. Target ferritin values should be considered individually and the best mean haemoglobin values were achieved at 6 months with a mean ferritin of 456 microg/l (variation from to 919 microg/l). The percentage of transferrin saturation, percentage of hypochromic erythrocytes and ferritin <100 microg/l, were not considered useful parameters to monitor routine iron supplementation in haemodialysis patients. No significant adverse reactions to iron therapy were observed.

Gliomatosis cerebri: findings with computed tomography and magnetic resonance imaging.

Gliomatosis cerebri (GC), is a rare neoplastic disease (less than 150 cases reported in the literature) with a diffuse, widespread proliferation of neoplastic glial cells in the brain, generally affecting both hemispheres and involving the gray and white matter [1-3]. Less commonly, the cerebellum, the brain stem and the medulla can be affected. Histologic evaluation reveals neoplastic astrocytes with varying levels of differentiation. Perineuronal and perivascular spread of tumor infiltration is observed. Demyelination can be found in the affected areas. A well-preserved underlying neuroanatomic architecture is considered characteristic [2]. Clinical signs vary and are non-specific, including changes in the mental state and headaches, followed by focal motor deficits and convulsive episodes [4]. The prognosis is poor, ranging from weeks to some years after the manifestation of the symptoms. Steroids may be useful in the short term, but chemotherapy is of little value and radiotherapy of questionable benefit. The literature was reviewed and the radiological pattern of three new cases of GC is reported. In two cases the diagnosis was achieved ante-mortem.