Aortic pulse wave comparison between controls and triathletes in baseline conditions and in response to acute maximum exercise.

To determine the effects of intense training on aortic pulse wave variables and hemodynamic parameters at baseline and at recovery from maximal exercise testing (MaxET) in triathletes compared with sedentary individuals. In this prospective and experimental study, 21 triathletes and 21 sedentary individuals were recruited and evaluated prior and two minutes after the MaxET using the Mobil-O-Graph®, which estimates the aortic pulse wave from the brachial artery pressure. The augmentation index (AIx@75) was lower in triathletes after the MaxET compared to control group (16.34 ± 5.95 vs. 23.5 ± 8.53%, p = 0.001), while the pulse wave velocity (PWV) was similar between groups. The heart rate was significantly lower at baseline and after MaxET in triathletes group (55.70 ± 8.95 bpm 91.49 ± 11.39 bpm) compared with control group (62.11 ± 6.70 bpm; 102.08 ± 10.85 bpm). The stroke volume was significantly higher at baseline (96.08 ± 13.96 ml; 86.17 ± 11.24 ml) and after MaxET in triathletes group (69.15 ± 6.51 ml, 58.38 ± 6.99 ml) compared with control group. Triathetes show lower value of AIx@75 after MaxET in comparison with the control group. AIx@75, in addition to being an indirect measure of arterial stiffness, is also a measure of left ventricular afterload. Thus, the lower AIx@75 in triathletes may be due to their lower left ventricular afterload, lower myocardial oxygen demand, and greater coronary perfusion than sedentary individuals. The hemodynamic changes observed in triathletes at rest and during an acute exercise bout are distinctive characteristics of aerobic physical training.

Eye lens dose levels in interventional rooms using simple phantom simulation, dose management software and Monte Carlo method of uncertainty assessment.

This paper presents a fast method to estimate the annual eye lens dose levels for interventional practitioners applying the Monte Carlo method of uncertainty assessment. The estimation was performed by placing an anthropomorphic phantom in the typical working position, and applying the habitually employed protocol. No radiation protection devices were considered in the simulation. The results were compatible with the measurements performed during interventions by placing dosimeters in the vicinity of the eyes of two paediatric interventional cardiologists working with a fluoroscopic biplane system.

Eye lens dose correlations with personal dose equivalent and patient exposure in paediatric interventional cardiology performed with a fluoroscopic biplane system.

PURPOSE: To analyse the correlations between the eye lens dose estimates performed with dosimeters placed next to the eyes of paediatric interventional cardiologists working with a biplane system, the personal dose equivalent measured on the thorax and the patient dose. METHODS: The eye lens dose was estimated in terms of Hp(0.07) on a monthly basis, placing optically stimulated luminescence dosimeters (OSLDs) on goggles. The Hp(0.07) personal dose equivalent was measured over aprons with whole-body OSLDs. Data on patient dose as recorded by the kerma-area product (PKA) were collected using an automatic dose management system. The 2 paediatric cardiologists working in the facility were involved in the study, and 222 interventions in a 1-year period were evaluated. The ceiling-suspended screen was often disregarded during interventions. RESULTS: The annual eye lens doses estimated on goggles were 4.13±0.93 and 4.98±1.28mSv. Over the aprons, the doses obtained were 10.83±0.99 and 11.97±1.44mSv. The correlation between the goggles and the apron dose was R2=0.89, with a ratio of 0.38. The correlation with the patient dose was R2=0.40, with a ratio of 1.79µSvGy-1cm-2. The dose per procedure obtained over the aprons was 102±16µSv, and on goggles 40±9µSv. The eye lens dose normalized to PKA was 2.21±0.58µSvGy-1cm-2. CONCLUSIONS: Measurements of personal dose equivalent over the paediatric cardiologist's apron are useful to estimate eye lens dose levels if no radiation protection devices are typically used.

Parvicapsula pseudobranchicola (Myxosporea) in farmed Atlantic salmon Salmo salar. Tissue distribution, diagnosis and phylogeny.

Parvicapsula pseudobranchicola infections in farmed Atlantic salmon in Norway are associated with low-grade to significant mortalities. The parasite is found as mature spores in pseudobranchs, but has also been detected in the gills, liver and kidney. Diagnosis has relied on the detection of Parvicapsula spores, with the pseudobranch being the preferred organ. A better understanding of the epizootiology of this myxosporean is a prerequisite for appropriate management and control. Hence, early detection of infections and life cycle studies are needed. We sequenced the small subunit (ssu) rDNA (18S) from P. pseudobranchicola and developed a sensitive diagnostic PCR protocol. This allowed us to (1) identify appropriate tissues for diagnostic assays, (2) examine the intraspecific variation in ssu rDNA in the parasite's Norwegian range, (3) examine annelid potential primary hosts and (4) obtain additional ssu rDNA sequences of marine Parvicapsula species to perform a phylogenetic study. Primers were constructed targeting the ssu rDNA from P. minibicornis. With these we obtained a partial ssu sequence of the P. pseudobranchicola type isolate. A new set of primers (PCF3/PCR3) was constructed for diagnostic purposes. These were tested against DNA from the host and several myxozoan species infecting Norwegian salmon. The primers give a positive product of 203 bp and pick out P. pseudobranchicola in salmnonids. They also amplify the congeners P. unicornis and P. asymmetrica infecting unrelated fish. The PCR protocol developed showed a greater sensitivity than light microscopy. The pseudobranchs were always positive and are the recommended organ for PCR diagnostics. There was no sequence variation between geographic isolates from farmed salmon. Preliminary examinations of marine polychaetes and oligochaetes collected from farm sites with parvicapsulose problems were negative. A comparison of the sequence of the ssu rDNA from P. pseudobranchicola with that of other myxozoans shows that it groups closely together with P. unicornis and P. asymmetrica. The closest relative to this group is P. minibicornis.

Estimation of eye lens doses received by pediatric interventional cardiologists.

Maximum Hp(0.07) dose to the eye lens received in a year by the pediatric interventional cardiologists has been estimated. Optically stimulated luminescence dosimeters were placed on the eyes of an anthropomorphic phantom, whose position in the room simulates the most common irradiation conditions. Maximum workload was considered with data collected from procedures performed in the Hospital. None of the maximum values obtained exceed the dose limit of 20 mSv recommended by ICRP.

Novel continuous passive motion device for self-treatment of chronic lower back pain: a randomised controlled study.

OBJECTIVE: To evaluate the efficacy of a novel, angular, continuous passive motion device for self-treatment at home in patients with mild-to-moderate, non-specific, chronic low back pain (LBP). DESIGN: Prospective, randomised, waiting-list-controlled (WLC) trial. SETTING: Recruitment and assessment were conducted at the Koren Centre for Physical Therapy. Self-treatment was performed at home. PARTICIPANTS: Thirty-six patients with a score ≤6 on the numeric rating scale (NRS) for pain were enrolled. Twenty-eight patients completed treatment. INTERVENTIONS: Participants were randomised to receive the Kyrobak (Radiancy, Hod-hasharon, Israel) at enrolment [immediate treatment (IT) group] or 3 weeks later (WLC group). Self-treatment was prescribed for 10minutes, one to three times per day, for 3 weeks. The treatment period was followed by a 3-week follow-up period. MAIN OUTCOME MEASURES: Primary outcome was self-reported pain level (NRS). RESULTS: Three weeks of self-treatment with the Kyrobak reduced pain levels significantly in the IT group compared with the WLC group {mean [standard deviation (SD)] ΔNRS score from baseline to post-treatment: IT group, 1.4 (1.5), 95% confidence interval (CI) 0.5 to 2.3; WLC group, -0.1 (2.2), 95% CI -1.1 to 1.2; effect mean difference 1.5}. This benefit was maintained over the follow-up period [from baseline to end of follow-up, mean (SD) ΔNRS score 1.1 (1.8), 95% CI 0.4 to 1.8]. Multi-linear regression analysis found that higher baseline pain resulted in greater pain reduction (P=0.003). Eighty-three percent of participants with a baseline NRS score >4.35 (threshold determined by logistic regression, P=0.01) achieved the minimal important change criterion of ΔNRS score ≥2. Daily NRS score reduced gradually over the treatment period [regression slope -0.052 (0.01), 95% CI -0.07 to -0.03]. CONCLUSIONS: Preliminary evidence suggests that the Kyrobak may be beneficial for short-term relief of non-specific, chronic LBP, particularly in participants with a moderate level of pain. A longer treatment period may lead to a further reduction in pain.

Haemorrhagic smolt syndrome (HSS) in Norway: pathology and associated virus-like particles.

Atlantic salmon Salmo salar pre-smolt, smolt and post-smolt, with clinical signs of haemorrhagic smolt syndrome (HSS) have been found in several locations along the Norwegian coast (Rogaland to Troms). Affected fish had pale gills and bleeding at the fin bases, but seemed to be in good physical condition with no obvious weight loss. The internal organs and body cavity showed distinct bleedings. Petechiae were found on the gastrointestinal tract, swim bladder and peritoneum, visceral adipose tissue, heart and somatic musculature. The liver was bright yellow and sometimes mottled with petechiae and ecchymoses. Acitic fluid was found in the visceral cavity and fluid was also present in the pericardial cavity. Histological examination revealed haemorrhage in most organs. The glomeruli were degenerated and the renal tubules were filled with erythrocytes. The aims of this study were to describe the pathology and discover, if possible, the aetiology of the HSS. Tissues were collected for light and transmission electron microscopy (TEM), immunofluorescence (IFAT), reverse transcription (RT)-PCR diagnostics (screening for infectious salmon anaemia virus [ISAV], viral haemorrhagic septicaemia virus [VHSV], salmon pancreas disease virus [SPDV], sleeping disease virus [SDV] and infectious haematopoetic necrosis virus [IHNV]), and tissue homogenates (heart, liver, kidney and spleen) were sterile-filtered and inoculated into cell cultures. Homogenates made from several tissues were also injected intraperitoneally into salmon and rainbow trout Oncorhynchus mykiss. The diagnostic tests revealed no consistent findings of any pathogens, with the exception of TEM which showed 2 types of virus-like particles: Type I was 50 to 60 nm in diameter and Type II about 50 nm in diameter. These virus-like particles were found in salmon from all farms affected by HSS and screened by TEM. Several different cells, blood vessel endothelial cells, endocardial cells, heart myofibres, and leukocytes were associated with the 2 virus-like particles. The Type I particle seems to be an infectious pancreatic necrosis (IPN)-like virus, while (based on the number of target cells, particle morphology, budding and uptake into target cells) Type II particle could be a togavirus.

Failure of sentinel node identification following neo-adjuvant chemo-radiotherapy for locally advanced squamous cell carcinoma of the vulva.

A case of a 70-year-old patient with advanced local vulvar cancer is presented. Treatment with neo-adjuvant chemo-radiotherapy for two courses was administered and two weeks after completion of treatment the patient underwent wide local excision with bilateral inguino-femoral lymph node dissection through three separate incisions. Two methods for the evaluation of sentinel nodes--lymphoscintigraphy and intraoperative gamma hand-held probe and blue dye injection, did not detect any sentinel node on either side. Groin-node dissection revealed 23 negative nodes. It is our hypothesis that the non-visualization of sentinel nodes in this patient was due to post-irradiation damage to the lymph channels.

Ellagic acid and polyphenolics present in walnut kernels inhibit in vitro human peripheral blood mononuclear cell proliferation and alter cytokine production.

Tree nuts, including walnuts, are important elicitors of food allergy. We examined the ability of walnut kernel polyphenolics and purified ellagic acid (EA) to modulate cytokine production and cellular proliferation from stimulated human peripheral blood mononuclear cells (PBMC). IL-13 and TNF-alpha production decreased while no change was observed in IL-4 production. Paradoxically, EA and the walnut polyphenolics all significantly and dose-dependently inhibited stimulated [phytohemagglutin (PHA), alpha-CD3, and phorbol myristate acetate (PMA)/ionomycin] PBMC proliferation while simultaneously increasing IL-2 production. When added at time 0 min and 2 h, EA dose-dependently inhibited PHA-induced proliferation. However, at 30 min and 1 h, low doses of EA (10 and 1 muM) significantly increased proliferation above that of PHA alone, although higher doses led to inhibition. Our data do not support the hypothesis that walnut polyphenolics skew a cytokine response toward Th2 in an in vitro environment. However, immunomodulatory effects are present, including an inhibition of cellular proliferation despite no decrease in IL-4 or IL-2.

Isolation and culture of endocardial endothelial cells from Atlantic salmon (Salmo salar) and Atlantic cod (Gadus morhua).

This paper describes a procedure for establishing primary cultures of endocardial endothelial cells and morphologically characterizes the cultivated endothelial cells from Atlantic cod (Gadus morhua L.) and salmon (Salmo salar L.). Following incubation with collagenase and trypsin, the resulting cell suspension was seeded on substrates of fibronectin, collagen or gelatin. Cod and salmon endothelial cells attached firmly to these substrates within 24 and 5 h respectively, but did not attach to uncoated tissue-culture plastic. The contamination by non-endothelial cells was kept at a minimum by working out optimal combinations of serum concentration and growth substrate. The yield was about 3x10(6) and 1x10(6) cells per kg cod and salmon, respectively. Cultures could be maintained for several weeks but cells did not proliferate. Cultivated cod endocardial endothelial cells differed from salmon endocardial cells in having abundant cytoplasm with many vesicles and avidly taking up labelled collagen. The described method allows, for the first time, functional and morphological studies to be performed under controlled conditions on both a specialized scavenger type of endothelium from cod and a conventional flat endothelium from salmon.

Neovejiga ileal ostómica continente / Continent ostomic ileal neobladder

La neovejiga ileal ortotópica es una derivación urinaria ampliamente aceptada luego de una cistectomía radical por cáncer de vejiga. Cuando se necesita un reservorio ostómico se utilizan segmentos ileocecales para usar el apéndice cecal o el íleon terminal afinado como mecanismo de continencia, Los reservorios ileales ostómicos continentes como el Kock y Ghohein, son complejos. Se presenta la técnica quirúrgica de un reservorio ileal continente ostómico de simple realización, con el mecanismo de continencia basado en el principio de Nissen para la funduplicatura gástrica en hernia hiatal. La técnica ha sido efectuada en 2 pacientes con buenos resultados de continencia y fácil cateterismo.

Tasas de mortalidad por tumores malignos urológicos en la República Argentina / Mortality rates due to urologic malignant tumors in Republica Argentina

Se efectuó un análisis de los datos oficiales disponibles de mortalidad por neoplasias genitourinarias en la República Argentina, provenientes del Programa Nacional de Estadísticas de la Salud. Para una población estimda en 1996 de 35.219.612 personas, se graficó una pirámide desviada a lña izquierda que demuestra una población joven. La tasa de mortalidad global, sobre 268.715 fallecidos, fue de 7,6 por 1.000 habitantes. Las principales causa de muerte fueron las cardiopatías con 76.940 defunciones (28,6 por ciento), seguidas por los tumores malignos con 51.650 (19,2 por ciento). Fallecieron 5994 personas por cáncer urológicos: 3138 (52,3 por ciento) por tumores malignos de próstata, 1236 (20,6 por ciento) por tumores malignos de vejiga, 128 (2,1 por ciento) por tumores malignos de testículo y 1.492 (24,9 por ciento) por otros tumores malignos genitourinarios, donde se incluyen riñón, vías urinarias, pene y otros tumores menos frecuentes. El cáncer de próstata presentó el 11,1 por ciento del total de muertes por cáncer en hombres. el cáncer de vejiga el 2,4 por ciento del total de muertes por cáncer de testículo el 11,2 por cento de las muertes por cáncer en los varones de 15 a 34 años. La comparación con estadísticas intenacionales permite la validación de estos datos

Biopsia retroperitoneoscópica de tumores retroperitoneales / Retroperitoneoscopic biopsy of retroperitoneal tumors

Objetivos: Describir la técnica de la biopsia de tumores retroperitoneales por vía retroperitoneoscópica y analizar los resultados obtenidos en nuestro servicio. Material y método: Entro los años 1996 y 2003 se han realizado 18 biopsias de tumores retroperitoneales por vía retroperitoneoscópica en 16 pacientes ( en un paciente se realizó el procedimiento en 3 oportunidades). La técnica quirúrgica fue con el paciente en decúbito lateral intermedio con elevación del flanco y abordaje retroperitoneal. Se colocaron 2 trocares de 10 y 5mm, exposición del retroperitoneo, apertura de la fascia de Gerota, disección de la masa tumoral y biopsia incisional analizada por congelación. Resultados: se diagnosticaron 12 linfomas (11 no Hodgkin y1 Enfermedad de Hodgkin), 1 mesotelioma, 1 schwannoma, 1 metástasis ganflionar de cáncer de mama y metástasis adrenal de cáncer de pulmón. Se obtuvo diagnóstico anátomo-patológico en todos los pacientes biopsiados. El material permitió efectuar estudios citológicos por impronta, evaluación histológica e inmunofenotipo por citometria de flujo. No se registraron complicaciones y el tiempo de internación fue menor de 24 horas. Conclusiones: La técnica de biopsia de tumores retroperitoneales por retroperitoneoscopia propociona buenos resultados con baja morbilidad, permitiendo obtener el diagnóstico anátomo-patológico en todos los casos. En los kinfomas posibilitó la clasificación de subtipos y repetir la biopsia en caso necesario