Evaluation of the dose-response and fate in the lung and pleura of chrysotile-containing brake dust compared to chrysotile or crocidolite asbestos in a 28-day quantitative inhalation toxicology study.

This study provides an understanding of the biokinetics and potential toxicology in the lung and pleura following inhalation of brake-dust (brakes manufactured with chrysotile). The design included a 28-day repeated multi-dose inhalation exposure (6 h/d, 5 d/wk, 4 wks) followed by 28-days without exposure. Fiber control groups included a similar grade chrysotile as used in the brakes and a commercial crocidolite asbestos. Aerosol fiber distributions of the chrysotile and crocidolite were similar (fiber-length > 20 µm/cm3: Chrysotile-low/high 42/62; Crocidolite-low/high 36/55; WHO-fibers/cm3: Chrysotile-low/high 192/219; Crocidolite-low/high 211/255). The total number of aerosol particles/cm3 in the brake-dust was similar to that in the chrysotile (Brake-dust 710-1065; Chrysotile 532-1442). Brake-dust at particle exposure levels equal to or greater than chrysotile or crocidolite caused no indication of microgranulomas, epithelial hyperplasia, or fibrosis (Wagner score < 1.7) or changes in bronchoalveolar lavage (BAL) indices from the air control. Chrysotile BAL indices did not differ from the air control. Pathologically, there was low level of inflammation and epithelial hyperplasia, but no fibrosis (Wagner score ≤ 3). Crocidolite induced elevated neutrophils and cell damage (BAL), persistent inflammation, microgranulomas, and fibrosis (Wagner scores 4) which persisted through the post exposure period. Confocal microscopy of snap-frozen chestwalls showed no difference between control, brake-dust and chrysotile-HD groups or in thickness of visceral or parietal pleural. The crocidolite exposure resulted in extensive inflammatory response, collagen development and adhesions between the visceral and parietal surfaces with double the surface thickness. These results provide essential information for the design of a subsequent subchronic study.

Evaluation of the fate and pathological response in the lung and pleura of brake dust alone and in combination with added chrysotile compared to crocidolite asbestos following short-term inhalation exposure.

This study was designed to provide an understanding of the biokinetics and potential toxicology in the lung and pleura following inhalation of brake dust following short term exposure in rats. The deposition, translocation and pathological response of brake-dust derived from brake pads manufactured with chrysotile were evaluated in comparison to the amphibole, crocidolite asbestos. Rats were exposed by inhalation 6h/day for 5 days to either brake-dust obtained by sanding of brake-drums manufactured with chrysotile, a mixture of chrysotile and the brake-dust or crocidolite asbestos. The chrysotile fibers were relatively biosoluble whereas the crocidolite asbestos fibers persisted through the life-time of the animal. This was reflected in the lung and the pleura where no significant pathological response was observed at any time point in the brake dust or chrysotile/brake dust exposure groups through 365 days post exposure. In contrast, crocidolite asbestos produced a rapid inflammatory response in the lung parenchyma and the pleura, inducing a significant increase in fibrotic response in both of these compartments. Crocidolite fibers were observed embedded in the diaphragm with activated mesothelial cells immediately after cessation of exposure. While no chrysotile fibers were found in the mediastinal lymph nodes, crocidolite fibers of up to 35 µm were observed. These results provide support that brake-dust derived from chrysotile containing brake drums would not initiate a pathological response in the lung or the pleural cavity following short term inhalation.

[Consensus on evaluation and management of apparent life-threatening events in infancy (ALTE)]. / Consenso sobre el manejo de eventos de aparente amenaza a la vida del lactante (ALTE). Comisión de Sueño, Sociedad Chilena de Neumología Pediátrica 2013.

Apparent life threatening events are defined as an acute episode in which the observer fears an infant < 1 year may die. ALTE is characterized by some combination of apnea, color or muscle tone change, chocking and has to be followed by cardiorespiratory reanimation. The present consensus paper reviews international and national evidence concerning diagnosis, etiologies, hospitalization criteria and indications for home monitoring.

[Decision rules to schedule patient appointments]. / Reglas de decisión para la selección de sistemas de citas basadas en características del paciente y de la institución de salud.

BACKGROUND: Outpatient scheduling has a significant impact on the perceived quality of service by the users and the efficient use of resources in the health system. There are mathematical methods that assist in solving this problem, but are seldom applied. AIM: To propose decision rules that are based on the own conditions of each institution and indicate which appointment system is the most suitable for the decision makers. MATERIAL AND METHODS: Through computer simulation, the effect of a wide range of decision and environmental factors over the appointment systems performance was assessed, in order to determine how these factors affect them. RESULTS: Considering performance indicators associated to the patient's satisfaction and resources utilization, scheduling shorter length patients (e.g. check-up patients) in the beginning of the working day resulted to be in the efficient solutions frontier, as well as scheduling patients in one person blocks (shifting to multiple patient blocks only if resources utilization indicators are prioritized). CONCLUSIONS: Performance indicators are more sensitive to the sequence used to schedule different length patients, rather than the number of patients scheduled per block. Moreover, decision rules based on the institution priorities are proposed, which are quite robust to environmental factors.

Early manifestations of autism spectrum disorders. Experience of 393 cases in a paediatric neurology.

INTRODUCTION: Autism spectrum disorders are group of conditions characterised by qualitative impairments in social communication, interaction, and imagination, and by a restricted range of interests and typical repetitive behaviours. Frequently, there is a delay in the age of detection, and therefore in starting multidisciplinary evaluations and interventions, which may result in a poorer prognosis and reduced quality of life for both children and parents. The aim of our study was to describe clinical and epidemiological data including the age of detection and main initial complaints present in children with autism disorders referred to a paediatric neurology centre. PATIENTS AND METHODS: A total of 393 medical records of consecutive cases diagnosed with an autism spectrum disorder were reviewed. RESULTS: Autism was diagnosed in 82.1% of the cases, unspecified pervasive disorder in 9.9%, Asperger syndrome in 4.8%, and Rett syndrome in 3%. Sixty percent of autistic children presented with a language disorder as their main complaint. The average age of detection was 4 years. CONCLUSIONS: Compared with other countries, age of detection is delayed. Primary care-based screening and surveillance are required in order to improve prognosis and quality of life of children with an autism spectrum disorder.

[Clinical characteristics of acute pancreatitis in Mexico]. / Características clínicas de la pancreatitis aguda en México.

BACKGROUND: Acute pancreatitis (AP) etiology and frequency vary in relation to geographic region. AIMS: To determine the etiology, frequency, and mortality of AP in a Mexican population. PATIENTS AND METHODS: We carried out a prospective study of first episode AP patients over a period of 6 years. RESULTS: A total of 605 patients with a mean age of 40 years were included in the study. Sixty-four percent of them presented with overweight and/or obesity determined through BMI. Etiology was biliary in 66.60%, it was due to alcohol consumption in 15.90%, hypertriglyceridemia in 7.80%, it was post-endoscopic retrograde cholangiopancreatography (ERCP) in 2.10%, and was undetermined in 7.20%. Pancreatic infection was suspected in 70 patients and they underwent CT-guided fine needle aspiration. Thirty-two of those patients were diagnosed with pancreatic infection in which Staphylococcus spp was the most common microorganism. Overall mortality was 5.00% (2.60% < 30 years and 10.00% > 70 years). Necrosis, pancreatic infection, and mortality were more frequent in the cases in which etiology was due to alcohol ingestion. CONCLUSIONS: The most frequent AP etiology was biliary, but that caused by alcohol presented with more complications. Overall mortality was 5.00% and was higher in the elderly patients.

Quantification of the pathological response and fate in the lung and pleura of chrysotile in combination with fine particles compared to amosite-asbestos following short-term inhalation exposure.

The marked difference in biopersistence and pathological response between chrysotile and amphibole asbestos has been well documented. This study is unique in that it has examined a commercial chrysotile product that was used as a joint compound. The pathological response was quantified in the lung and translocation of fibers to and pathological response in the pleural cavity determined. This paper presents the final results from the study. Rats were exposed by inhalation 6 h/day for 5 days to a well-defined fiber aerosol. Subgroups were examined through 1 year. The translocation to and pathological response in the pleura was examined by scanning electron microscopy and confocal microscopy (CM) using noninvasive methods. The number and size of fibers was quantified using transmission electron microscopy and CM. This is the first study to use such techniques to characterize fiber translocation to and the response of the pleural cavity. Amosite fibers were found to remain partly or fully imbedded in the interstitial space through 1 year and quickly produced granulomas (0 days) and interstitial fibrosis (28 days). Amosite fibers were observed penetrating the visceral pleural wall and were found on the parietal pleural within 7 days postexposure with a concomitant inflammatory response seen by 14 days. Pleural fibrin deposition, fibrosis, and adhesions were observed, similar to that reported in humans in response to amphibole asbestos. No cellular or inflammatory response was observed in the lung or the pleural cavity in response to the chrysotile and sanded particles (CSP) exposure. These results provide confirmation of the important differences between CSP and amphibole asbestos.

Selection of LED lighting systems for the reduction of the biodeterioration of speleothems induced by photosynthetic biofilms in the Nerja Cave (Malaga, Spain).

Electrical lighting favours the development of photosynthetic biofilms in caves which can induce biodeterioration in the colonized substrates. The use of specific lights as a limiting factor for biofilm growth could be effective in their control and represents an alternative to chemical methods since they can damage the substrate. However, studies about lighting and the photosynthetic activity of organisms in caves are scarce. In order to select the most effective LED light source in reducing photosynthesis and therefore, in reducing the growth rates of microalgae and cyanobacteria, four biofilms in the Nerja Cave were illuminated by several light emitted diodes (LEDs) with different spectral compositions and the photobiological responses were measured both by empirical and theoretical methodologies. The empirical approach was based on the photosynthetic efficiency, by measuring the in vivo chlorophyll a (Chl a) fluorescence and the theoretical approach was based on the photonic assimilation performance related to the proportion of the light quality used for photosynthesis, according to the action spectra for photosynthesis available in the literature. The photobiological responses showed differences between the empirical and theoretical approach mainly in biofilms dominated by cyanobacteria and red algae, probably because the available action spectra were not useful for monitoring these Nerja Cave biofilms. However, the expected spectral responses of photosynthesis were observed in green microalgal biofilms with maximum photosynthetic efficiency in red and blue light although the green light was also unexpectedly high. The high photosynthetic efficiency in green light could be explained by the predictable high chlorophyll content due to a very dark environment. The results were not conclusive enough for all the biofilm types to be able to recommend a specific lighting system for the photocontrol of biofilm expansion. Therefore, new action spectra for photosynthesis of the extremophile organisms of the Nerja Cave are required. This approach, based on theoretical and empirical methodologies, is a useful tool to obtain information to allow the design of the most adequate lighting systems to reduce photosynthetic activity and favour the conservation of the caves.

The pathological response and fate in the lung and pleura of chrysotile in combination with fine particles compared to amosite asbestos following short-term inhalation exposure: interim results.

The pathological response and translocation of a commercial chrysotile product similar to that which was used through the mid-1970s in a joint compound intended for sealing the interface between adjacent wall boards was evaluated in comparison to amosite asbestos. This study was unique in that it presents a combined real-world exposure and was the first study to investigate whether there were differences between chrysotile and amosite asbestos fibers in time course, size distribution, and pathological response in the pleural cavity. Rats were exposed by inhalation 6 h/day for 5 days to either sanded joint compound consisting of both chrysotile fibers and sanded joint compound particles (CSP) or amosite asbestos. Subgroups were examined through 1-year postexposure. No pathological response was observed at any time point in the CSP-exposure group. The long chrysotile fibers (L > 20 microm) cleared rapidly (T(1/2) of 4.5 days) and were not observed in the pleural cavity. In contrast, a rapid inflammatory response occurred in the lung following exposure to amosite resulting in Wagner grade 4 interstitial fibrosis within 28 days. Long amosite fibers had a T(1/2) > 1000 days and were observed in the pleural cavity within 7 days postexposure. By 90 days the long amosite fibers were associated with a marked inflammatory response on the parietal pleural. This study provides support that CSP following inhalation would not initiate an inflammatory response in the lung, and that the chrysotile fibers present do not migrate to, or cause an inflammatory response in the pleural cavity, the site of mesothelioma formation.

Cellular target of isoquercetin from Passiflora ligularis Juss for glucose uptake in rat soleus muscle.

Quercetin 3-O-beta-d-glucopyranoside (isoquercetin) is one of the most frequent metabolites of the Passiflora ligularis Juss. The purpose of this study was to investigate the effect of the aqueous extract and ethanol fraction from P. ligularis Juss leaves on glycaemia and the mechanism of action of isoquercetin on glucose uptake. In the glucose tolerance test, the aqueous extract and ethanol fraction from P. ligularis Juss (125 mg/kg to 500 mg/kg o. g.) reduced glycaemia and increased the hepatic and muscular glycogen content. Phytochemical analysis evidenced the dominant presence of isoquercetin in the extract and fraction from leaves of P. ligularis Juss. Isoquercetin mediates the stimulatory effect on glucose uptake independent of insulin receptor activation but, involve PI3K, MAPK, MEK/ERK pathways and de novo protein synthesis to GLUT-4 translocation. Overall findings revealed that isoquercetin and aqueous extract and ethanol fraction of P. ligularis Juss leaves might be a promising functional food or medicine for the treatment or prevention of diabetes.

Antibody and inflammatory responses in laying hens with experimental primary infections of Ascaridia galli.

Ascaridia galli, an intestinal nematode that affects hens and other domestic and wild birds, causes economic losses in avian exploitations. The present work shows that A. galli stimulates a strong antibody response as well as an intense inflammatory reaction, in the intestinal mucous of experimentally infected Lohmann Brown laying hens. IgG antibodies against soluble extracts of A. galli embrionated eggs and adult worms, were detected in both blood and yolks eggs from infected hens during a period of 105 days after the infection. This indicates that hens transfer to their offspring a part of the IgG antibodies produced when they become infected. The antigens responsible for the stimulation of specific IgG were molecules of 30-34, 44-54 and 58-90 kDa, while in the yolk eggs of infected hens a reactivity directed against antigens of molecular weight (M(w)) lower than 50 kDa was detected. Histology revealed traumatic lesions with leukocyte infiltration, and inflammation of the intestinal wall of the infected hens after 105 days of initial infection. The possible influence of the immune and inflammatory response on the population dynamics of the parasite is discussed.

[Resembling peritoneal tuberculois and gastric carcinoma with peritoneal carcinomatosis. Case report.]. / Tuberculosis gástrica y peritoneal semejando carcinoma gástrico con carcinomatosis peritoneal; informe de un caso.

We report the case of a woman with peritoneal and gastric tuberculosis who presented with clinical and radiologic features mimicking an advanced gastric neoplasia. We emphasize the relevance of including tuberculosis in the differential diagnosis of patients with gastric wall thickness.

High prevalence of clarithromycin resistance and effect on Helicobacter pylori eradication in a population from Santiago, Chile: cohort study and meta-analysis.

Helicobacter pylori (H. pylori) eradication using standard triple therapy (STT) with proton pump inhibitors (PPI), amoxicillin and clarithromycin (CLA) has been the standard in Latin America. However, CLA resistance is a rising problem affecting eradication rates. Genetic polymorphisms of CYP2C19, a PPI metabolizer may also affect eradication. The primary aims of this study were to evaluate the effect of clarithromycin resistance on H. pylori eradication in a population from Santiago, and to establish the pooled clarithromycin resistance in Santiago, Chile. Symptomatic adult patients attending a tertiary hospital in Santiago were recruited for this study. CLA resistance and the polymorphisms of CYP2C19 were determined on DNA extracted from gastric biopsies, using PCR. The STT was indicated for 14 days and eradication was determined by a urea breath test 4-6 weeks after therapy. A meta-analysis of CLA resistance studies among adult residents in Santiago was performed. Seventy-three out of 121 consecutive patients had positive rapid urease test (RUT) and received STT. Sixty-nine patients (95%) completed the study. The H. pylori eradication rate was 63% and the prevalence of CLA resistance was 26%. According to the CYP2C19 polymorphisms, 79.5% of the RUT-positive patients were extensive metabolizers. Multivariable analyses showed that only CLA resistance was significantly and inversely associated with failure of eradication (OR: 0.13; 95% confidence interval [95% CI], 0.04-0.49). A meta-analysis of two previous studies and our sample set (combined n = 194) yielded to a pooled prevalence of CLA resistance of 31.3% (95% CI 23.9-38.7). Our study shows that CLA resistance is associated with failure of H. pylori eradication. Given the high pooled prevalence of CLA resistance, consideration of CLA free therapies in Santiago is warranted. We could recommend bismuth quadruple therapy or high-dose dual therapy, according to bismuth availability. Further studies need to evaluate the best therapy.

A multinational study of treatment failures in asthma management.

SETTING: Emergency rooms. OBJECTIVE: To assess quality of care and its determinants for asthma patients before emergency room treatment. DESIGN: Consecutive patients with acute severe asthma attending emergency rooms were questioned about the severity of their disease and treatment in the previous 4 weeks. Prescriptions of inhaled corticosteroids were recorded. Other outcomes included self-reported adherence to treatment and loss of work. RESULTS: Thirteen centres in 11 countries recruited 1156 patients. Only 36% of patients with persistent asthma had been prescribed an adequate dose of inhaled corticosteroids. This percentage improved in those receiving regular care from the same doctor (OR 2.86, 95%CI 1.38-5.96), and was at least as good for the 10% of patients receiving 'private' health care (OR 3.08, 95%CI 1.69-5.62). Forty-four per cent of patients had health insurance covering some asthma medications. These patients were more likely to be receiving adequate inhaled corticosteroids (OR 1.74, 95%CI 1.17-2.58), and reported better adherence than those without insurance (OR 3.00, 95%CI 1.64-5.50). Of those on adequate inhaled corticosteroids, 18% had lost work in each of the 4 previous weeks compared with 59% among those more than one treatment step below the recommended dose. CONCLUSIONS: Access to adequate treatment is critical for better management of asthma.

Silastic band erosion in the bypassed stomach after Fobi-Pouch operation for obesity: Case report.

INTRODUCTION: Worldwide, one of the most commonly performed bariatric surgeries is the laparoscopic Roux-en-Y gastric bypass (LRYGP). Access to the bypassed stomach in patients who have undergone this procedure, for evaluation and/or management in different clinical situations remains a challenge for the physician. In order to facilitate the entrance to the gastric remnant, a silastic marker is left in place during the Fobi-Pouch operation, a modified laparoscopic gastric bypass surgery technique. PRESENTATION OF CASE: We present the case of a 56-year old female who presented 10 years after a Fobi-pouch operation, complaining of severe upper gastrointestinal bleeding. An enteroscopy revealed several marginal ulcers and erosion of the silastic ring marker in the excluded stomach. A partial gastric sleeve resection including the silastic ring was performed without any complications, preventing further bleeding due to the eroded ring. DISCUSSION: Physicians must be familiarized with the different bariatric procedures in order to associate the patient's symptomatology and possible surgery-related complications. Gastric ulceration and bleeding related to the presence of a foreign body have been previously described; however, to the best of our knowledge this is the first article reporting the concomitant erosion and bleeding of the silastic marker in the excluded stomach. CONCLUSION: Silastic marker erosion in the bypassed stomach is a rare but possible complication not reported in the literature before. Different approaches for this complication are possible including laparoscopic management, with excellent results.

Occurrence of volatile organic compounds (VOCs) in Liverpool Bay, Irish Sea.

Surface seawater samples were collected in the Irish Sea and Liverpool Bay area from the R.V. Prince Madog during the period of 25-31 of March 2006. VOCs were purged with nitrogen, pre-concentrated on a SPME fibre and analysed immediately on a GC-MS. Target compounds quantified were halogenated (0.2-1400 ng L(-1)), BTEXs and mono-aromatics (1.5-2900 ng L(-1)), aliphatic hydrocarbons and others (0.6-15,800 ng L(-1)). Day and night sampling was performed at a single station and suggested that factors such as sunlight and tide affect the presence of many of these compounds. Sample variability was high due to the variable weather conditions at the station. Poor correlations were found between marine phytopigments and selected VOCs. Principal component analysis (PCA) analysis showed that chlorinated compounds such as 1,2-dichloroethane, 1,1,1-trichloroethane, trichloroethene, tetrachloroethene and carbon tetrachloride, predominantly from anthropogenic sources, originated from the River Mersey. Other brominated and iodinated compounds quantified were more likely to be from biogenic sources including novel marine compounds such as 2-chloropropane, 1-bromoethane and 1-chlorobutane.

Niveles séricos de la isoenzima creatina quinasa-MB y lactato deshidrogenasa como indicadores de daño miocárdico en perros con enfermedad valvular degenerativa / Serum levels of the isoenzyme creatine kinase-MB and lactate dehydrogenase as indicators of myocardial damage in dogs with degenerative valve disease

RESUMEN Se analizaron los niveles séricos de creatina quinasa-MB (CK-MB) y lactato deshidrogenasa (LDH) en 10 perros diagnosticados con enfermedad valvular degenerativa y en seis perros clinicamente sanos, con el objetivo de evaluar si sus niveles séricos indican daño miocárdico. Las muestras de suero se analizaron mediante el método UV. Se utilizó la prueba de diferenciación de medias para determinar diferencias entre medias, y la prueba de correlación de Pearson para determinar si existe correlación entre los niveles séricos de ambas enzimas. Los valores de CK-MB y de LDH fueron significativamente diferentes entre los dos grupos de pacientes. Los niveles de CK-MB y LDH tuvieron correlación positiva, pero no significativa.

ABSTRACT Serum levels of creatine kinase-MB (CK-MB) and lactate dehydrogenase (LDH) were analyzed in 10 dogs diagnosed with degenerative valvular disease and in six clinically healthy dogs with the objective of evaluating whether their serum levels indicate myocardial damage. Serum samples were analyzed by UV method. The mean differentiation test was used to determine differences between means and the Pearson correlation test was performed to determine if there was a correlation between the serum levels of both enzymes. The CK-MB and LDH values were significantly different between the two groups of patients. The levels of CK-MB and LDH had a positive but not significant correlation.

What can adaptive optics do for a scanning laser ophthalmoscope ?

By compensating for the aberrations in the eye that cause blur, the adaptive optics scanning laser ophthalmoscope (AOSLO) yields high-magnification, high-resolution, real-time images of the living human retina. Features as small as single cone photoreceptors can be resolved, single leukocytes are recorded in real time as they pass through the smallest retinal capillaries, and the optical sectioning capability can be used to visualize independent layers of the retinal tissue ranging from the nerve fiber layer, through the blood vessels to the photoreceptors. The use of AO technology not only enhances the breadth of applications of conventional SLOs, but it facilitates a host of new applications. Here we provide an overview of AOSLO performance and its applications, including two clinical examples. Finally, we preview two novel applications; one where the AOSLO is used to present AO-corrected stimuli directly onto the retina while simultaneously recording their exact retinal position, and a second application where AOSLO videos are used to provide very precise, high-frequency measures of eye movements.

[Usefulness of transesophageal echocardiography during myocardial revascularization surgery without extracorporeal circulation]. / Utilidad de la ecocardiografía transesofágica intraoperatoria durante revascularización miocárdica sin circulación extracorpórea.

OBJECTIVE: Intraoperative transesophageal echocardiography can be a highly useful monitoring technique during myocardial revascularization surgery when extracorporeal circulation (ECC) is not being used. Transesophageal echocardiography provides real-time images on both volume status and segmental myocardial contractility without interfering with the surgical field. PATIENTS AND METHODS: A total of 25 patients undergoing myocardial revascularization by sternotomy without ECC were monitored by transesophageal echocardiography during surgery. RESULTS: The 18 men and 7 women studied had a mean (SD) age of 71.3 (8) years. A third of them had hypertension and diabetes, 3 had suffered a cerebrovascular accident, and 2 had renal failure. Nine patients had a history of acute myocardial infarction and 3 had undergone angioplasty. Baseline echocardiograms on all patients established that 6 had a low ejection fraction (<30%). Twelve had altered segmental contractility, which was transient in 11 cases. Six patients had improved ejection fraction at the final assessment. Transesophageal electrocardiography also monitored volume status and the effects of inotropic drugs and beta-blockers in 83% of the patients. CONCLUSION: Transesophageal electrocardiography is a minimally invasive, safe, and precise way to directly monitor the beating heart in real time during myocardial revascularization without ECC. Image quality is good.