Use of rituximab as an induction therapy in anti-glomerular basement-membrane disease.

BACKGROUND: Anti-glomerular basement-membrane (anti-GBM) disease (or Goodpasture disease) is characterized by severe kidney and lung involvement. Prognoses have improved with treatments that combine plasma exchange and immunosuppressive drugs. However, patients with severe renal involvement can have poor renal outcomes and cyclophosphamide can cause significant complications. Anti-GBM antibodies have a direct pathogenic effect on the disease: thus, therapeutics that can decrease their production, such as rituximab, could be a good alternative. METHODS: The medical files of five patients that had received rituximab as a first-line therapy (instead of cyclophosphamide), plus plasma exchange and steroids, were reviewed. All patients had severe disease manifestations. RESULTS: Four patients required dialysis at diagnosis and remained dialysis-dependent over the mean follow-up of 15 months. Three patients had pulmonary involvement, but recovered even though mechanical ventilation was required. Anti-GBM antibodies became rapidly undetectable in all patients. One infectious and two hematological complications were observed. CONCLUSIONS: We report the outcomes of five patients with Goodpasture disease and treated with rituximab as a first-line treatment. This strategy was effective at treating pulmonary manifestations and was associated with a good biological response with no major serious adverse events. However, renal outcomes were not significantly improved.

High-purity biodiesel production from microalgae and added-value lipid extraction: a new process.

A new process was tested in order to produce and purify biodiesel from microalgae lipids and to recover unsaponifiable (added-value) lipids. This process is a two-step biodiesel production including a saponification reaction step followed by an esterification reaction step. The process includes a recovery of the unsaponified lipids between both reaction steps. Among the conditions tested, the following conditions were found to be the best: temperature for both steps (90 °C), saponification time (30 min), esterification time (30 min), sulfuric acid/potassium hydroxide (1.21, w/w), and methanol-lipid ratio (13.3 mL/g). Under these conditions, the fatty acid methyl ester (FAME) yield and the biodiesel purity were, respectively, 32% (g FAME/g lipid) and 77% (g FAME/g biodiesel). This study also showed that the two-step biodiesel process allows a FAME mass composition rich in palmitate (27.9-29.4 wt%), palmitoleate (24.9-26.0 wt%), elaidate (14.8-15.2 wt%), and myristate (12.1-13.0 wt%).

Coupled electronic and structural relaxation pathways in the postexcitation dynamics of Rydberg states of BaArN clusters.

We investigate, theoretically, the joint relaxation of orbital and structure in postexcitation dynamics of Rydberg states of cluster BaArN (N=250). Mixed quantum-classical dynamics is used to account for the nonadiabatic transitions among more than 160 electronic states, represented via a diatomics-in-molecules Hamiltonian. The simulation illustrates the complex multistep relaxation processes and provides detailed insight in the mechanisms contributing to the final-time experimental photoelectron spectrum.

[Benign prostatic hyperplasia : New and treatment-relevant aspects from the DGU guidelines]. / Benignes Prostatasyndrom : Neues und Praxisrelevantes aus den DGU-Leitlinien.

The diagnosis and treatment of lower urinary tract symptoms (LUTS) due to benign prostatic enlargement plays an important role in daily urological practice. Therefore, a targeted and resource-saving approach is essential. A rational base-line work-up of our patients provides the necessary information for obtaining the diagnosis and only needs to be expanded in individual cases. In addition to drug therapy, the modification of lifestyle and the possibility of watchful waiting must not be underestimated. Simple measures such as a timed fluid intake, double micturition in the case of residual urine development, but also bladder reconditioning can significantly improve the quality of life of our patients. Regarding surgical treatment, laser procedures have found their way into many departments and have established themselves in daily routine as a reference procedure in addition to transurethral resection of the prostate (TUR-P) and simple open prostatectomy. New, minimally invasive procedures-such as prostatic artery embolization (PAE), the Rezum™- (NxThera Inc., Maple-Grove, MN, USA) or the Aquabeam® (Procept, Redwood City, CA, USA) procedure, but also nonablative procedures such as iTind© (TIND, Medi-Tate, Or Akiva, Israel) or Urolift® (Neotract Inc., Pleasanton, CA, USA)-offer new treatment options to those affected, with the potential to maintain patient's sexual function. As a result, individual risk assessment and advice on the advantages and disadvantages of all available treatment options-even more than today-will be an important part of LUTS treatment. An individual approach, similar to that used in the treatment of oncological disease, will become standard also in the treatment of benign prostatic syndrome.

Conjugation in S. pombe: identification of a microtubule-organising centre, a requirement for microtubules and a role for Mad2.

During the G1 phase of the cell cycle, cells of the fission yeast Schizosaccharomyces pombe can be induced to mate by nitrogen starvation and the presence of mating pheromones. Polarised growth towards cells of the opposite mating type (P or M) leads to the formation of a projection tip and, upon contact, localised cell wall degradation results in conjugation and cell fusion [1]. Here, we have investigated the role of microtubules in this process. We describe a previously unidentified microtubule-organising centre (MTOC) that forms at projection tips upon cell-to-cell contact, before cells fuse. Treatment of mating cells with the microtubule-destabilising drug thiabendazole (TBZ) showed that microtubule integrity was required for mating at two distinct stages: during projection tip formation and cell fusion. Projection tip formation requires filamentous (F) actin function [2] and microtubules are required for the localisation of F actin to the projection tip. We also identify a role during mating for Mad2--a mitotic checkpoint protein that is required in all eukaryotes to maintain the mitotic state in response to microtubule depolymerisation [3]. S. pombe mad2 mutant cells were compromised in their ability to mate upon removal of TBZ, indicating that in fission yeast, in the absence of microtubules, Mad2 is also required to maintain mating competence.

NMDA-mediated activation of the medial amygdala initiates a downstream neuroendocrine memory responsible for pseudopregnancy in the female rat.

In female rats, genitosensory stimulation received during mating initiates twice-daily prolactin (PRL) surges, a neuroendocrine response that is the hallmark of early pregnancy or pseudopregnancy (P/PSP). Nocturnal and diurnal PRL surges are expressed repeatedly for up to 2 weeks after copulation, suggesting that a neuroendocrine memory for vaginocervical stimulation (VCS) is established at the time of mating. These studies investigated whether the processing and retention of VCS involves acute glutamatergic activation or de novo protein synthesis within the medial nucleus of the amygdala (MEA), a VCS-responsive brain site that is implicated in P/PSP initiation. Pharmacological activation of the MEA with the glutamate agonist, NMDA, initiated nocturnal PRL surges, causing a PSP state in females that had not received VCS. P/PSP initiation by mating was prevented by intra-amygdalar infusion of the NMDA receptor antagonist, 2-amino-5-phosphonopentanoic acid (AP-5), provided that it was administered before mating. AP-5 treatment also disrupted mating-induced c-fos expression in the principle bed nucleus of the stria terminalis and the ventrolateral division of the ventromedial hypothalamic nucleus, but not in the medial or anteroventral periventricular preoptic nuclei. Neither P/PSP nor downstream cellular activation was prevented when a protein synthesis inhibitor, anisomycin, was administered to the MEA. The results indicate that MEA cells are critical to the early processing of VCS through NMDA channel activation, rapidly conveying information to downstream hypothalamic cell groups that modulate neuroendocrine function.

Predicting gaseous emissions from small-scale combustion of agricultural biomass fuels.

A prediction model of gaseous emissions (CO, CO2, NOx, SO2 and HCl) from small-scale combustion of agricultural biomass fuels was developed in order to rapidly assess their potential to be burned in accordance to current environmental threshold values. The model was established based on calculation of thermodynamic equilibrium of reactive multicomponent systems using Gibbs free energy minimization. Since this method has been widely used to estimate the composition of the syngas from wood gasification, the model was first validated by comparing its prediction results with those of similar models from the literature. The model was then used to evaluate the main gas emissions from the combustion of four dedicated energy crops (short-rotation willow, reed canary grass, switchgrass and miscanthus) previously burned in a 29-kW boiler. The prediction values revealed good agreement with the experimental results. The model was particularly effective in estimating the influence of harvest season on SO2 emissions.

Volumetric quantitative computed tomography of the proximal femur: precision and relation to bone strength.

We have developed a three-dimensional computed tomography (CT) scanning and image analysis method for measurement of trabecular and integral bone mineral density (BMD) and geometry in automatically determined femoral-neck and trochanteric subregions of the proximal femur. We measured the correlation of the density and geometry variables to femoral strength assessed in vitro under loading simulating a single-limb condition and a fall to the side. While BMD alone accounted for 48%-77% of the variability in strength for the stance loading configuration, femoral neck cross-sectional area (minCSA) and femoral neck axis length (FNAL) also contributed independently to femoral strength, and a combination of BMD and geometry variables explained 87%-93% of the variance in the data. For the fall loading configuration, trochanteric trabecular BMD alone explained 87% of the variability of strength. The reproducibility in vivo of the technique was assessed in a group of seven postmenopausal women, who underwent repeat scans with repositioning. For trabecular BMD, the precision was 1.1% and 0.6% for the femoral neck and trochanteric subregions, respectively, compared to 3.3% and 1.6% for the corresponding integral envelopes. Thus, trabecular BMD measurements were reproducible and highly correlated to biomechanical strength measurements. These results support further exploration of quantitative CT for assessment of osteoporosis at the proximal femur.

The use of the covered Wallstent for the palliative treatment of inoperable tracheobronchial cancers. A prospective, multicenter study.

STUDY OBJECTIVE: To investigate the safety, efficacy, and tolerance of the covered Wallstent for the palliative treatment of inoperable tracheobronchial cancer. DESIGN: An 8-month prospective study employing either a rigid bronchoscope or a flexible delivery system for prosthesis insertion. SETTING: Multicentric setting involving four teaching hospitals in Switzerland and Germany. PATIENTS: Forty patients (29 men, 11 women), average age of 62 years, presenting with an inoperable tracheobronchial cancer. INTERVENTIONS: After partial airway recanalization with an Nd-YAG laser, the covered Wallstent was inserted 23 times using a rigid bronchoscope (Rigidstep device), and 27 times using a flexible delivery system (Telestep device) under fluoroscopic and endoscopic visualization. RESULTS: Clinical and endoscopic examination at 1, 30, and 90 days showed improvement in the bronchial lumen and in the dyspnea index. No serious complication (death, perforation, hemorrhage, inability to remove an improperly placed prosthesis) was observed during surgery. Late complications included migration (12%), inflammatory granulations or tumor regrowth at the tip of the prosthesis (36%), and symptomatic retention of secretion (38%). CONCLUSIONS: Compared with other tracheobronchial prostheses, notably the Dumon stent, the covered Wallstent presents the following advantages: insertion with visual guidance, treatment of extrinsic compressions and esophagobronchial fistulas, and little chance of migration when the prosthesis diameter is chosen correctly. The following disadvantages can be noted: high price; both repositioning and extraction of the released stent are more difficult, though certainly possible; and risk of granulations at the tips of the prosthesis and retention of secretions. Suggestions are made for potential improvements to the stent and insertion system that may result in a significant decrease in early and late complications.

Involvement of a cyclic-AMP pathway in group I metabotropic glutamate receptor responses in neonatal rat cortex.

3,5-Dihydroxyphenylglycine (DHPG), (S)-3-hydroxyphenylglycine and (S)-4-carboxy-3-hydroxyphenylglycine (S-4C3HPG) stimulated phosphoinositide hydrolysis in neonatal rat cortical slices, but with lower maximal effect, in comparison with 2S,1'S,2'S-2-(2'-carboxycyclopropyl)glycine (L-CCG I) or (1S,3R)-1-aminocyclo-pentane-1,3-dicarboxylic acid (1S,3R-ACPD). DHPG, 1S,3R-ACPD, and S-4C3HPG also evoked a rapidly desensitizing increase in [Ca2+]i in cortical layers of neonatal brain slices. (R,S)-alpha-methyl-4-tetrazolyl-phenylglycine (MTPG), and (R,S)-alpha-methyl-4-phosphono-phenylglycine (MPPG) inhibited the increase of phosphoinositide hydrolysis elicited by 1S,3R-ACPD but not that by R,S-DHPG. In contrast, the selective group II receptor agonist (1S,2S,5R,6S)-2-amino-bicyclo-[3.1.0]-hexane-2,6-dicarboxylate (LY 354740) potentiated the response of R,S-DHPG. Finally, 8-(4-chlorophenylthio)-cAMP, a membrane permeant analogue of cAMP, reversed the stimulatory effect of 1S,3R-ACPD and S-4C3HPG on phosphoinositide hydrolysis and [Ca2+]i mobilization, without affecting the response induced by R,S-DHPG. These data suggest that, in neonatal rat cortex, the activation of group II metabotropic glutamate receptors potentiates the phosphoinositide hydrolysis and [Ca2+]i responses mediated by group I metabotropic glutamate receptors.

Gaseous contaminant emissions as affected by burning scrap tires in cement manufacturing.

We studied the environmental impact (gaseous emissions) of using scrap tires as a fuel substitute at a cement plant that produces one million tons of cement per year. Using a combination of tires and coal as opposed to only coal caused variations in the pollutant emission rate. The study recorded a 37% increase in the rate of emission for CO, a 24% increase for SO2, an 11% decrease for NOx, and a 48% increase for HCl when tires were included. The rate of emission for metals increased 61% for Fe, 33% for Al, 487% for Zn, 127% for Pb, 339% for Cr, 100% for Mn, and 74% for Cu, and decreased 22% for Hg. On the other hand, the emission rate of organic compounds dropped by 14% for polycyclic aromatic hydrocarbons, 8% in naphthalene, 37% in chlorobenzene, and 45% in dioxins and furans. We used a Gaussian model of atmospheric dispersion to calculate the average pollutant concentration (1-h, 24-h, and annual concentrations) in the ambient air at ground level with the help of the ISC-ST2 software program developed by the USEPA. When tires were used, we observed (i) a 12 to 24% increase in particulate matter, this range considering the concentration variation depending on the average used (1-h, 24-h, and annual basis), 31 to 52% in CO, 22 to 34% in SO2, 39 to 52% in HCl, 12 to 27% in Fe, -3 to 8% in Al, 30 to 37% in Zn, and 270 to 885% in Pb; (ii) a decrease of 8 to 13% in NOx, 9 to 13% in polycyclic aromatic hydrocarbons, 6 to 7% in naphthalene, 32 to 39% in chlorobenzene, and 32 to 45% in dioxins and furans. The results obtained showed that the maximum ground-level concentrations were well within the environmental standards (for operation with only coal as well as for operation with a combination of coal and tires).

[Therapy of female urinary incontinence with the AMS 800 artificial sphincter. Indications, outcome, complications and risk factors]. / Therapie der weiblichen Harninkontinenz mit dem artifiziellen Sphinkter AMS 800. Indikationen, Ergebnisse, Komplikationen und Risikofaktoren.

Indications, results and complications of 144 women who have undergone implantation of the current model AMS 800 since 1983 and remained in continuous follow-up in our department are presented. Included are 70 patients suffering from stress urinary incontinence (SUI) type III after 208 previously unsuccessful incontinence procedures, 54 patients with incontinence due to neurogenic bladder dysfunction (NBD) and 20 patients with congenital or acquired internal sphincter weakness of other causes. In the NBD group, apart from sphincter implantation a total of 113 additional operations were necessary due to complex malfunctions of the urinary tract: augmentation ileocystoplasty in 51 patients, ureterocystoneostomy in 23 patients and 43 operations at the bladder neck. One hundred and twenty-six patients (86%) achieved total continence and 5 patients (3%) were significantly improved. In 9 females (6%) incontinence persisted, and 4 patients ultimately underwent urinary diversion into a Kock pouch. With the implanted artificial sphincter 116 patients (81%) are able to empty their bladder spontaneously, without residual urine and without the necessity of intermittent self catheterisation. Under the aforementioned conditions implantation of the artificial urinary sphincter AMS 800 is the most effective therapy for complex female incontinence.

[Anatomy and blood supply of the penis and urethra]. / Anatomie und Blutversorgung des Penis und der Harnröhre.

The exact knowledge of the topographic anatomy of the urethra as well as the macro- and microcirculation of the penis [6] are the basics of reconstructive urethral surgery. Adherence to the fundamentals and principles of tissue transfer [5] are necessary to fascilitate conditions for successful treatment of the various disorders of the male urethra. Mutural description of the anatomy of the male urethra in conjunction with external male genitals is necessary because of developmental similarities as well as the close anatomical relationship. The arterial and venous blood supply of the urethra and the penis have to be taken into account if vascularized flaps from the penile skin or the prepuce are used in urethral reconstruction. The dual arterial and venous vascularity of the genital skin is of fundamental importance to a successful outcome of the operative treatment. The purpose of this article is, to summarize the relevant anatomical knowledge of reconstructive urethral surgery.

Biofiltration of air contaminated with toluene.

In industrial activities, operation of air biofilters may be interrupted for a long period of time. In order to examine the effect of shut-down on the performance of biofilters, a pilot scale biofiltration unit was restarted up after a non-use duration of eight months. After a reacclimation period of eight days, the biofilter reached an elimination capacity of 35 g x m(-3) x h(-1) compared to 38 g x m(-3) x h(-1) before shut-down, for the same operating conditions. The results obtained indicate that the microorganism activity was completely restored and this was confirmed by the microbial count tests performed on filter bed material samples. The impact of varying the inlet concentration of toluene on biofilter performance was also investigated. A maximum elimination capacity of 120 g x m(-3) x h(-1) was achieved, compared to 135 g x m(-3) x h(-1) before shut-down. The biofilter removal efficiency exceeded 96% for inlet concentrations up to 1.8 g x m(-3). Temperature measurements revealed that the filter bed temperature depends strongly on the intensity of microbial activity and the biofilter effectiveness in eliminating toluene. Experimental data were compared with the calculations of a mathematical model. Comparison showed that the theoretical model was successful in predicting the performance of the biofiltration unit.

[Overweight and obesity in children and adolescents of Corrients city. Relationship with cardiovascular risk factors ]. / Sobrepeso y obesidad en niños y adolescentes de la ciudad de Corrientes. Asociación con factores de riesgo cardiovascular.

UNLABELLED: The prevalence of children's obesity is increasing all over the world. It has been related to an increment of all morbimortality causes in the mature age. To determine the prevalence of obesity and other cardiovascular risk factors in adolescence, and correlate them with each other, we designed a cross-sectional study. A survey was applied to 2115 secondary school students, 1212 (57.3%) females and 903 (42.7%) males; blood pressure (BP) and cholesterol level were measured. Mean age: 14.8 +/- 1.6.: Body Mass Index (BMI): 20.6 +/- 3.1, 1838 (86.9%) normal, 230 (10.9%) where overweight and 47 (2.2%) obese, higher in males (OR = 1.46; IC = 1.12-1.91; p = 0.03). Weekly physical activity: 3.9 +/- 2.9 hs. higher in males (p < 0.001). Sedentarism daily hours: 3.2 +/- 1.9. ANTECEDENTS: maternal obesity 282 (13.3%), paternal 311 (14.7%) and in both 116 (6.6%). Regular consumption of fatty foods: 1711 (80.9%). SBP: 107.8 +/- 13.6; DBP: 66.9 +/- 11.5; MBP: 80.5 +/- 10.1. We found hypertension in 64 (3%) prevalent in males (p = 0.002). Cholesterol: 161.9 +/- 29.2; desirable 1283 (60.7%); normal high 628 (29.5%) and high 208 (9.8%). BMI and MBP correlation was: r = 0.25; r2 = 0.06; CI 95%: 0.02-0.11; b coefficient 0.83. We found a positive correlation of BMI with MBP (0.83 mm Hg increment for each point of BMI increment). We found significant association between parental obesity and alcohol consumption and BMI increment. We did not find any association with dietary habits, physical activity or sedentarism.

[Stents in the tracheobronchial tree]. / Stents in den Atemwegen.

Interventional procedures in bronchoscopy such as tissue ablation by laser, bronchusdilatation, stenting, endobronchial radiotherapy have a firm established position as treatment modalities for severe tracheobronchial obstruction. They allow quick and effective treatment of sometimes life threatening tracheal and bronchial obstructions. This article focuses on stents in the airways. A brief description of historic development is given. Currently available and frequently used stents are shown. There advantages and disadvantages are discussed. Indications for Stent-insertion in particular and for interventional endoscopy are summarized and the different techniques for insertion outlined. Based on the published literature results and complication rates are discussed.

[Laser therapy of bronchial carcinoma]. / Lasertherapie des Bronchialkarzinoms.

Endobronchial laser-therapy is reviewed in perspective to other palliating modalities such as radio- and chemotherapy. Laser treatment is most suited for exophytic tumors of the trachea and larger bronchi. Favorable for reventilation of atelectases are: short duration of luminal obstruction patent peripheral bronchi as evidenced by computed tomography, exophytic growth in the main or intermediary bronchus. The intervention can be performed using either fiber optics or the rigid bronchoscope in one or more sessions. For processes in the trachea or the main bronchi the method of choice is a single treatment using the rigid instrument.

Performance and macrokinetic analysis of biofiltration of toluene and p-xylene mixtures in a conventional biofilter packed with inert material.

Interactions of toluene and p-xylene in air treatment biofilters packed with an inert filter media were studied. The effect of the inlet load of toluene, p-xylene and mixtures of both compounds on the biodegradation rate was analyzed in three lab-scale biofilters. A maximum elimination capacity (EC) of 26.5 and 40.3 gCm(-3)h(-1) for an inlet load (IL) of 65.6 and 57.8 gCm(-3)h(-1) was obtained for p-xylene and toluene biofilters, respectively. Inhibition of p-xylene biodegradation by the presence of toluene took place when the mixture was treated, whereas the presence of p-xylene had an enhancing effect on the toluene removal efficiency. Specific growth rates (µ) from 0.019 to 0.068 h(-1) were calculated in the mixed biofilter, where the highest values were similar to mixtures with lower p-xylene levels (IL(p-Xyl) 8.84 ± 0.29 gCm(-3)h(-1)). Michaelis-Menten and Haldane type models were fitted to experimental EC for p-xylene and toluene biofilters, respectively.