Isolation of pectin-enriched products from red beet (Beta vulgaris L. var. conditiva) wastes: composition and functional properties.

The present work was dedicated to the development of an extraction process for red beet (Beta vulgaris L. var. conditiva) by-products that preserves the high molecular weight of the macromolecules with the primary aim of waste upgrading. Our study concerns the extraction of pectin-enriched products with potential thickening properties for their usage in food formulation, as well as with some healthy physiological effect, by using citrate buffer (pH = 5.2) either alone or with enzymes (hemicellulase or cellulase) active on cell wall polysaccharide networks. Considering that red beet tissue contains ferulic acid, which cross-links pectin macromolecules through arabinose residues to anchor them into the cell wall, an alkaline pretreatment was also evaluated in order to perform polysaccharide hydrolysis in the cell wall network to accomplish higher renderings. Chemical composition and yield, as well as the in vitro glucose retention exerted by the isolated fiber products were finally analyzed.

B cells from Patients with Rheumatoid Arthritis Show Conserved CD39-Mediated Regulatory Function and increased CD39 Expression After Positive Response to Therapy.

Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by progressive joint destruction associated with increased pro-inflammatory mediators. In inflammatory microenvironments, exogenous ATP (eATP) is hydrolyzed to adenosine, which exerts immunosuppressive effects, by the consecutive action of the ectonucleotidases CD39 and CD73. Mature B cells constitutively express both ectonucleotidases, converting these cells to potential suppressors. Here, we assessed CD39 and CD73 expression on B cells from treated or untreated patients with RA. Neither the frequency of CD73+CD39+ and CD73-CD39+ B cell subsets nor the levels of CD73 and CD39 expression on B cells from untreated or treated RA patients showed significant changes in comparison to healthy controls (HC). CpG+IL-2-stimulated B cells from HC or untreated RA patients increased their CD39 expression, and suppressed CD4+ and CD8+ T cell proliferation and intracellular TNF-production. A CD39 inhibitor significantly restored proliferation and TNF-producing capacity in CD4+ T cells, but not in CD8+ T cells, from HC and untreated RA patients, indicating that B cells from untreated RA patients conserved CD39-mediated regulatory function. Good responder patients to therapy (R-RA) exhibited an increased CD39 but not CD73 expression on B cells after treatment, while most of the non-responder (NR) patients showed a reduction in ectoenzyme expression. The positive changes of CD39 expression on B cells exhibited a negative correlation with disease activity and rheumatoid factor levels. Our results suggest modulating the ectoenzymes/ADO pathway as a potential therapy target for improving the course of RA.

Evaluation of the validity of the Quality of Well-being Scale in Trinidad and Tobago.

Both developing countries in the Caribbean and developed countries face resource allocation challenges. However, cost-effectiveness analysis instruments that may assist in allocation of resources have not been tested in Caribbean countries. Trinidad and Tobago is an advantageous location to test an instrument for potential use in the Caribbean. It has a single payer healthcare system and a literate population. Due to historical and current migration from other Caribbean countries, the population might be a fair representation of English-speaking Caribbean nations. We tested the validity of the Quality of Well-being Scale (QWB) on a sample of the non-institutionalized general population in Trinidad. The survey included reports of chronic conditions and items from the Trinidad and Tobago National Health Interview Survey. Data were analyzed using a multivariable regression model. One adult from each of 235 households consented to the interview. The results are consistent with results obtained in the United States of America. Being older female, more chronic conditions and more symptoms/problems were significantly associated with lower mean QWB scores. These results suggest that the QWB with US-derived weights show evidence of validity in Trinidad and Tobago. Thus, health decision makers can use the QWB to compare the effects of different health conditions and health interventions. In addition, investigators can make cross-cultural comparisons of QWB scores for diseases or health conditions.

[Clinical-pathology relationship in bladder cancer]. / Relación clinico-patólogica en cáncer vesical.

OBJECTIVES: Analyze the role of the Computerized Axial Tomography (TAC) like image study of pre-surgery stadification, in the subjected patients to radical cystectomy, for the treatment of muscle infiltrate bladder cancer. METHODS: Retrospective study of cohorts on 63 subjected patients to radical cystectomy for bladder cancer, in oneself service, between january of 1995 and december of 2.005. The capacity of the TAC was determined for the stadification bladder (pT), node (pN) and the results were compared, with the obtained ones in the pathological anatomy after the radical cystectomy, acording to TNM clasification. The possible impact of this image technique was evaluated in the change of surgical attitude in these patients. RESULTS: The estimate of bladder affectation with TAC was correct in 28.6%, sub-estadificate in 50.8%, and up-estadificate in 20.6%. The TAC for the bladder possesses a lower sensibility the more outpost it is this affectation. It specificity is higher the more advanced locally is the cancer, oscillating among 44% in the pT2 and 94% in the pT4. Regarding the estadification node, it is correct in 73.5% of all cases, although this percentage depends almost exclusively on the patients with negative node (N -). These data offer us a sensibility of 28%, specificity of 55%, positive predictive value of 68% and negative predictive of 67%. SUMMARY: The impact of the TAC in the clinical estadification of the infiltrate bladder cancer is relatively low. The biggest benefit is obtained in patient with suspicion of advanced illness. Its limitation to this group would suppose a significant reduction of costs, with low risk of an inappropriate surgical handling.

[Renal artery aneurysm. Laparoscopic nephrectomy, ex-vivo reconstruction and autotrasplantation]. / Aneurisma de arteria renal. Nefrectomía laparoscópica, reconstrucción en banco y autotrasplante.

We report a case of severe hypertensive patient with poor response regardless 5 drugs, that is diagnosed with right renal artery aneurysm, during the study of his HTN. Conservative surgery was performed by extracting laparoscopic kidney graft,ex-vivo pedicle reconstruction, followed by transplant in right iliac fossa utilizing the ilioinguinal incision used for the extraction, without need for two incisions. We perform a brief discussion of surgery indications of surgery in these patients.

[Early biochemical failure after radical prostatectomy for prostate cancer. Impact factors?]. / Recidiva bioquímica precoz tras prostatectomía radical retropúbica por cáncer de próstata. Factores implicados. Influye el tiempo de espera entre biopsia y cirugía?

UNLABELLED: Does delay from biopsy to surgery have any influence? OBJECTIVES: To determine wether WT may impact on the EBF (before one year) alter RRP in our series, and to study other factors that may impact on this issue. MATERIAL AND METHODS: We study 310 RRP. Inclusion criteria are: one year follow up, no hormonal manipulation neither previous radiotherapy. Patients are divide in two groups attending WT. Group A < 90 days (n: 148), Group B > 90 days (n: 162). We study EBF (2 or more PSA determinations >= 0.2 ng/ml), and the impact of previous PSA, biopsy Gleason, Gleason of the specimen (G), pT stage (pT), and WT. T of Student or W of Wilcoxon are used to determine the homogeneity of the two groups. Chi Square of Pearson to compare the two group's EBF and pT attending to WT and EBF attending to pT. U of Mann Whitney is used to study EBF attending to G. Multivariate logistic regresion (LR) is used to study the impact of the variables on EBF. RESULTS: There are no differences between the two groups in age (p<0.129), PSA (p<0.479), biopsy's Gleason (p<0.913). There are no differences in EBF nor in pT attending to WT. Significant statystical differences are founded in EBF attending to pT and G. T3 tumors have more chance of recurrence than T2. EBF is more frecuent as G increases. In logistic regresion of the global serie, independent variables for progression are: Previous PSA and pT. Nor biopsy's Gleason nor specimen's Gleason, nor WT, impact on the EBF. CONCLUSIONS: Biopsy Gleason and WT do not impact on EBF. WT do not impact on pT. In our serie differences on EBF are lead by previous PSA and pT. Also Gleason of the especimen seems to impact on EBF, but in lower proportion, with no significance in multivariate analysis.

Alfonso de la Peña Pineda and the Urology exchange by correspondence. / Alfonso de la Peña Pineda y el Intercambio urológico por correspondencia.

INTRODUCTION: In 1943, the brothers Alfonso and Emilio de la Peña Pineda proposed creating a communication system by correspondence as in North America, an idea welcomed by Spanish urologists, a system that was named the Urology Exchange by Correspondence. MATERIAL AND METHODS: A thorough reading and detailed analysis was conducted of content from 1944 to 1953, with an average of 3 pages of folio size of each copy. RESULT: A total of 105 issues containing 234 urological presentations were sent, signed by 67 Spanish urologists, 2 Portuguese urologists and 1 general surgeon. Thirty-nine of these presentations were translations of a similar U.S. publication. The subject matter corresponded to curious or rare personal cases, concerning conditions or problems of the most common urological diseases in that era, of which only 20 of those articles stand out. In general, the content is of little use and interest, which prompted the gradual decline in the collaboration until it disappeared. CONCLUSION: The proposal was answered mostly by those who had a professional relationship with the chair of Urology of the Faculty of Medicine of Madrid directed by Alfonso de la Peña. The subject matter of the personal case studies, most of which lacked importance, lead to the gradual decline in the contribution of presentations until its eventual end. Only a few articles stand out. The study's major value consists of collecting and analysing the content of what is highly likely the only complete collection in existence, given that it was not edited for printing and was distributed only as correspondence and cannot therefore be found in public libraries.

[Bladder neoplasm after nephroureterectomy for upper urinary tract tumor. Does distal ureter surgery influx on the evolution?]. / Neoplasia vesical tras nefroureterectomía por tumores de urotelio superior. La cirugía del uréter distal influye en la evolución?

OBJECTIVE: To compare evolution in patients with urothelial upper tract tumor (UUTT) in whom we performed the classic open approach to the distal ureter with those in whom whe performed the endoscopic approach. We study the bladder recurrences in each group and the factors which may influx on the evolution. MATERIAL AND METHODS: Retrospective review of nephroureterectomies in our department in the last 20 years. Group A (n:24): double incision (lumbar and pelvic incision), Group B (n:29): endoscopical approach of the distal ureter and classic lumbar incision. A descriptive study is first performed in which we review: sex, and patients age, background transuretral resection of bladder tumor (TURBT), UUTT side, and UUTT location (calices, pelvis or urether). Pathological stage and tumor grade are also exposed. Secondly, a review of the bladder recurrences in each group is performed. In order to find differences between de groups we used the Fisher's Exact test. RESULTS: We observed that in terms of bladder recurrence there is a statistically significant difference between the two groups favoring Group B (p < 0.036), which means that there are less bladder recidives when perform endoscopic approach of distal ureter. Noneless due to the groups inhomogeneity in tumor stage, grade, and location, this differences seem to be associated to these sigues, more than to the approach to the ureter as an independant variable. In that concerning to the eventual relationship between bladder recidive and background of previous TURBT, we have not found any differences between the two groups but there are statystically significant difference in the global series. The small number of recurrences (13) does not allow us to establish a well based conclusion on this issue, but it seems that the background of previous TURBT is an important factor that may influx in posterior bladder recurrences. CONCLUSIONS: In our results, endoscopic approach of distal ureter in nephroureterectomy for UUTT does seems to positively influx in the posterior chance of bladder recurrences. But the studied sample is small and the two groups have not been aleatorized because of ethical reasons. May the low number of cases affect the test's statistical potency. It seems that previous TURBT may conditionate these recurrences, as we show in global serie. It should be necessary a prospective and statistically analised multicenter trial to understand if distal ureter approach influx on the evolution of these tumors.

The effect of household poverty on tuberculosis.

pSETTING: Households in Malawi, Mongolia, Myanmar, the Philippines, Rwanda, Tanzania, Viet Nam and Zambia.OBJECTIVE To assess the relationship between household socio-economic level, both relative and absolute, and individual tuberculosis (TB) disease. DESIGN: We analysed national TB prevalence surveys from eight countries individually and in pooled multicountry models. Socio-economic level (SEL) was measured in terms of both relative household position and absolute wealth. The outcome of interest was whether or not an individual had TB disease. Logistic regression models were used to control for putative risk factors for TB disease such as age, sex and previous treatment history. RESULTS: Overall, a strong and consistent association between household SEL and individual TB disease was not found. Significant results were found in four individual country models, with the lowest socio-economic quintile being associated with higher TB risk in Mongolia, Myanmar, Tanzania and Viet Nam. CONCLUSIONS: TB prevalence surveys are designed to assess prevalence of disease and, due to the small numbers of cases usually detected, may not be the most efficient means of investigating TB risk factors. Different designs are needed, including measuring the SEL of individuals in nested case-control studies within TB prevalence surveys or among TB patients seeking treatment in health care facilities.

Comparison of histologic stains for use in PCR analysis of microdissected, paraffin-embedded tissues.

We evaluated the effect of six different histologic stains on the productivity of PCR amplification of DNA isolated from paraffin-embedded tissue samples. The tissue was collected from glass slides by microdissection techniques, whereby tiny portions of tissue are visually identified through a microscope and selectively resected for subsequent DNA extraction and PCR amplification. We found that the success of PCR amplification depended on the type of histologic stain that was used to facilitate microscopic visualization of the undeparaffinized tissue section. The best results were obtained with methyl green and nuclear fast red, while Wright's stain yielded less PCR product. Two other stains, Evans blue and light-green SF yellowish (also known as the counterstain for geomori methenamine silver stain) yielded sufficient PCR products; however, their staining characteristics did not afford satisfactory visualization of nuclear chromatin to discriminate between benign and malignant cells. Our most significant finding was that a commonly used histologic stain, hematoxylin, failed to produce DNA templates that could be consistently amplified by PCR. In conclusion, it is prudent to avoid hematoxylin stains when preparing tissues as starting material for PCR. Among the remaining five stains that were evaluated, the best choice depends on the differential staining characteristics of the cells to be dissected.

[Pyelocaliceal diverticuli]. / Divertículos pielocalicilares.

Pyelocalyceal diverticula are eventrations of the upper collector system in an intraparenchymatous location which communicate with the main collector system through a narrow channel. They have a thin wall and are lined with a transitional cells epithelium and surrounded by a muscle layer. Although these are non-secretory cavities they contain urine as a result of a passive filling from the adjacent collector system. The large majority of these lesions have less than 1 cm in diameter. Many are asymptomatic and are frequently found incidentally during elimination urography for other reasons. They rarely require treatment but may cause symptoms related to size or associated complications (infection or lithiasis). A number of years ago, definite treatment of complicated calyceal diverticulum was open surgery, but this has been defeated lately by less invasive techniques such as shock wave and percutaneous nephrolythotomy.

[Study of urinary outflow in pregnancy]. / Análisis de los valores uroflujométricos durante la gestación.

Anatomical and physiological changes in the urinary tract develop during pregnancy. These changes may affect the urinary outflow. Urinary symptoms may develop during pregnancy in previously asymptomatic patients. Most of these symptoms will vanish after delivery. Some of them remain and others will become worse in consecutive pregnancies. A study was designed to compare if there was any difference in the urinary outflow between pregnant and non-pregnant women. Changes in the urinary outflow at different gestacional ages were studies too. In general, the urinary volume is higher in pregnant than in non-pregnant patients. Having said this, during the pregnancy this volume decrease in the third trimester. Peak urinary outflow is higher in pregnancy, being statically significant during the second and third trimester. Opposite to the non-pregnant patient, peak urinary outflow does not decrease with urinary volumes over 500 ml in pregnant patients. Significant differences were not found in the mean urinary outflow in both groups.

[Renal adenocarcinoma with multicystic pattern]. / Adenocarcinoma renal con patrón multiquístico.

One growth pattern of renal carcinomas is the multicystic of multilocular cysts one, of which few cases have been published but which according to Hartman represent 15% of total cases. This variant of the renal tumour arouses great diagnostic and therapeutical uncertainties with multicystic kidney, biopsy after surgery being the test which provides true diagnosis. Presentation of two clinical cases and review of this condition.

[Vesico-uterine fistula, a rare complication of cesarean section]. / Fístula vésicouterina, una rara complicación del parto por cesárea.

We present the case of a vesicouterine fistula secondary to a caesarean section indicated due to the disproportion the pelvis and the head of the baby. This kind of fistula is due fundamentally to obstetric causes, especially to caesarean sections in developed countries and to prolonged labour in developing countries. The commonest clinical presentation is urinary incontinence in the form of continuous or intermittent urinary leaks. Surgical treatment is generally the therapy of choice, although, in the case of small fistulas, conservative treatment is feasible. The best form of prevention is correct indication of caesarean section and careful surgical technique.

[Endoscopic resolution of complications caused by urethrovesical suspension]. / Resolución endoscópica de complicaciones en suspensión uretrovesical.

We presented a total of ten women which referred a varied syntomatology secondary to a bladder foreign body due to the suture employed in the stress incontinence surgery in which urethrovesical suspension techniques were performed. In these patients, to six a Marshall-Marchetti-Krantz technique was practised, to three modified Burch procedure and to the left a suspension according to Raz method. It is described the varied clinic they presented, the necessity of endoscopic study to confirm and the results after solving the 90% of these cases using endoscopic techniques. It is concluded that is not mandatory the employment of non absorbable suture to perform the suspension techniques and in the opposite of the usual tendency of the authors recurring to open surgery, this complication can be solved endoscopically and in ambulatory regime in the most of these cases.

[Urinary bilharziasis. Comments on 10 cases]. / Bilharziosis urinaria. Comentarios sobre 10 casos.

Urinary bilharziasis is a parasitic disease caused by Schistosome haematobium which is prevalent in several African and Middle East countries. The closeness of the Canary Islands to the African continent and a greater population mobility have allowed us to diagnose and treat ten patients, all of them natural of this region. This paper outlines the case-reports, and reviews this parasitic disease which seriously affects the urinary tract and which must be specifically contemplated both in emigrants and occasional visitors from endemic regions.

[Ureteroscopy with pseudoanalgesia in the treatment of ureteral lithiasis]. / La ureteroscopia con sedoanalgesia en el tratamiento de la litiasis ureteral.

Presentation of the results obtained in 35 patients with ureteral lithiasis treated over a two-year interval by means of ureteroscopy with pseudoanalgesia at the Hospital Insular, with a 89% success rate. We conclude that in selected cases, the use of peg ureteroscopy or pneumatic lithotrite is a valid therapeutical option since it is well-tolerated and has the benefit of a short or null hospitalization.

[Enterocystoplasty in the treatment of interstitial cystitis]. / La enterocistoplastia en el tratamiento de la cistitis intersticial.

OBJECTIVE: To evaluate supratrigonal cystectomy and enterocystoplasty in patients with interstitial cystitis. METHODS: We reviewed four women with interstitial cystitis with infructuos conservative treatment and performed supratrigonal cystectomy and enterocystoplasty. All the patients fulfilled the NHI criteria with increased voiding frequency by night (mean 7.3 times). In 3 cases urodynamic study was available. We used is the four patients ileon as segment for the enterocystoplasty. RESULTS: Mean postoperative follow up was 60 months. In all cases the suprapubic pain disappeared and night voiding frequency reduced (mean 2.2 times). We don't have mayor complications. One patient needs self catheterism 3 years after surgery. CONCLUSION: In patients with interstitial cystitis to be operated supratrigonal cystectomy and enterocystoplasty is the most effective method.

[A fibroepithelial myxoid polyp of the renal pelvis in a patient with horseshoe kidneys. Apropos a case]. / Pólipo fibroepitelial mixoide de la pelvis renal en paciente con riñones en herradura. A propósito de un caso.

Tumours of the renal pelvis are usually urothelial carcinomas. The benign tumors are extremely rare. Fibroepithelial polyps are the most common mesodermal tumors of the upper urinary tract. They are found most commonly in the ureter but several have been reported in the renal pelvis. Patients usually present with pain and less commonly hematuria. Grossly, these polypoid structures are smooth nodules or filiform projections varying is size from a few millimeters to several centimetres. Histologically, they consist of a thick fibrous stalk with numerous vascular channels covered by a layer of normal or hyperplastic transitional epithelium. The etiology of these tumors is unknown but congenital, obstruction, allergy and trauma have been implicated. Conservative treatment is recommended when the diagnosis is certain. To our knowledge, this is the first report of fibroepithelial polyp of the renal pelvis in a patient with horseshoe kidney.

[Bladder paraganglioma. Report of a case and review of the Spanish literature]. / Paraganglioma vesical. Presentación de un caso y revisión de la literatura española.

Paragangliomas are rare tumours of the bladder accounting for 0.06% of all vesical tumours. This paper reports one case of vesical paraganglioma in a young female patient that has the singularity of being associated to melanin pigmentation. A review is made of cases treated in Spain, adding some comments on the signs and symptoms presented, as well as the diagnostic and therapeutical methods used in this unusual condition.