[Long-term survival metastatic ovarian cancer elderly patient]. / Paziente anziana con carcinoma ovarico metastatico lungo-sopravvivente.

Ovarian cancer is the sixth diagnosed cancer among women worldwide, it has a high mortality and in most cases it's diagnosed in advanced stage (stage III-IV). Combination platinum-paclitaxel chemotherapy administered every 3 weeks is considered the gold standard for first-line treatment of patients with advanced ovarian cancer. Elderly patients with ovarian cancer represents a subgroup with poor prognosis because they are often treated less radically for comorbidities and age. In the present article, we report a case of a 85 year old woman who was diagnosed with stage IV ovarian carcinoma for the presence of peritoneal carcinomatosis ab initio, not radically debulked and then treated with weekly schedule platinum-based and paclitaxel. Despite not being able to complete the chemotherapy, the patient achieved excellent results and represents a case of long survival.

Two-stage phase II study of imatinib mesylate in subjects with refractory or relapsing neuroblastoma.

BACKGROUND: Cure rate for subjects with refractory or relapsing metastatic neuroblastoma is <5%. In the search for a novel therapy, continuous daily oral administration of imatinib mesylate was evaluated. PATIENTS AND METHODS: Twenty-four subjects were enrolled in a two-stage study. Imatinib was administered for the first 4 weeks (cycle) at 170 mg/sqm b.i.d. If no major toxicity occurred, the dose was escalated to 300 mg/sqm b.i.d. for a maximum of 12 cycles. Clinical response and toxicity were evaluated according to international criteria. Pharmacokinetics (PK) profiles and tyrosine hydroxylase (TH) mRNA expression were also determined in a subset of subjects. RESULTS: Five (21%) complete responses, with one subject still alive at 68 months, and 2 (8%) partial responses lasting up to 29 months were obtained. No grade 4 toxicity was observed. At steady-state, PK exposure (69.7 µg h/ml) was similar to that of adults receiving 1000 mg/die. Responses appear to correlate with the absence or presence of metastasis in the bone marrow (BM) alone, with low TH expression levels at study entry and low imatinib exposure. CONCLUSIONS: Imatinib mesylate was well-tolerated and effective in the subset of subjects with low BM infiltration as only site of metastasis. Study identifier EudraCT: 2005-005778-63.

Morphology and biometric of the vesicular and bulbourethralglands in castrated and non-castratedSanta Inesbreed sheep

Introduction: The purpose of this paper is to determine the topography, biometry and light microscopyimage of the vesicular and bulbourethral glands in order to analyze morphologic features of the accessorysexual glands in castrated and non-castrated animals.Materials and Methods:The morphology of theaccessory sexual glands was investigated in 14 adult Santa Inesbreed sheep, weighing 32 kg, on average.Six of them were castrated, and eight, non-castrated. For macroscopic study, the description of these twoglands was carried out, as well as dissection and biometry study. Moreover, weight, length, height andwidth measurements were evaluated. For histological analysis, the vesicular and bulbourethral glands weresampled.Results:The topography of the reproductive glands was similar to bovine species. However, lowermacroscopic measurements (p < 0,05) in the glands of the castrated sheep were evidenced when comparedwith the non-castrated ones. Characteristics such as shape of the glands, composition of the layer mucosa,the lamina propria, muscular, the excretory ducts and the adventitia were determined.Conclusion:Sheepcastration promoted changes in the biometric measures of the glands, which were lower in castrated animals.The morphological and biometric characteristics of the vesicular and bulbourethral glands in sheep weredetermined.

Emprego da microscopia eletrônica na avaliação pós-vacinal de epitélio traqueal de patos (Anas platyrhynchos) imunizados contra a doença de Newcastle / The use of scanning electron microscopy in post-vaccinal evaluation of tracheal epithelium in ducks (Anas platyrhynchos) imunized against Newcastle disease

Avaliou-se o emprego da microscopia eletrônica de varredura no estudo da reação respiratória pós-vacinal em epitélio traqueal de patos (Anas platyrhynchos) imunizados contra a doença de Newcastle. Foram utilizadas 48 aves, distribuídas em quatro grupos: T1 - grupo de aves-controle (não vacinadas), T2 - grupo de aves vacinadas com a estirpe Ulster 2C, T3 - grupo de aves vacinadas com a estirpe B1 e T4 - grupo de aves vacinadas com a estirpe LaSota. Independente do grupo experimental, as aves não apresentaram sinais clínicos detectáveis de reação respiratória pós-vacinal. Ao microscópio eletrônico de varredura, observou-se que os animais vacinados com as estirpes B1 e LaSota desenvolveram descamação epitelial da traqueia, enquanto os vacinados com a estirpe Ulster 2C não, mostrando um epitélio traqueal íntegro, semelhante ao do grupo-controle. Os patos vacinados com a estirpe B1 mostraram evidências de regeneração epitelial da traqueia decorridos 21 dias pós-vacinação, o que não ocorreu com os vacinados com a amostra LaSota.

Scanning electron microscopy was used in the study of the post-vaccinal respiratory reaction of the tracheal epithelium of ducks (Anas platyrhynchos) immunized against Newcastle disease. Forty-eight ducks were distributed into four groups: T1 - control birds (non-vaccinated); T2 - birds vaccinated with Ulster 2C strain; t3 - birds vaccinated with B1 strain; and t4 - birds vaccinated with LaSota strain. Regardless the experimental group, birds did not show detectable clinical signs of post-vaccinal respiratory reaction. Scanning electron microscopy showed that birds vaccinated with B1 and LaSota strains developed epithelial sloughing of the trachea, whereas those vaccinated with Ulster 2C strain did not develop this change, showing intact tracheal epithelium, similar to the control group. However, the birds vaccinated with B1 strain showed evidences of regeneration of tracheal epithelium 21 days post-vaccination, which did not happen with the ducks vaccinated with LaSota strain.

[Childhood cerebral tumors: morbidity and follow-up into adulthood]. / Tumeurs cérébrales de l'enfant: morbidité et suivi à l'âge adulte.

This chapter presents guidelines for the follow-up of children with brain tumors, whether benign or malignant, in their transition to adulthood. The consequences of their disease and its treatment overlap greatly. The complications and long-term follow-up are detailed based on the specialists involved.

Risk factors for hepatic veno-occlusive disease: a retrospective unicentric study in 116 children autografted after a high-dose BU-thiotepa regimen.

At our Institute, during the last decade, the incidence of hepatic veno-occlusive disease (HVOD) appears to be on the increase among pediatric patients treated with BU-thiotepa (BU-TTP)-conditioning regimen. We thus performed a retrospective analysis to identify the risk factors for HVOD, which could explain such a change. In total, 116 patients treated at Institut Gustave Roussy, between May 1998 and December 2005 were eligible for this study having received BU-TTP as their first high-dose chemotherapy regimen, followed by autologous hematopoietic SCT (AHSCT). According to McDonald's clinical criteria, HVOD was diagnosed in 31% of these children. Demographic, clinical, biological and therapeutic parameters were evaluated in uni- and multivariate analyses that showed a significant correlation between previous carboplatin therapy and risk of developing post transplant HVOD (P=0.028). Comparable results were found for etoposide (P=0.048). In addition, a correlation between HVOD and risk of post transplant death was linked to its association with other types of organ failure (P=0.029). This study demonstrates that previous VPCARBO administration in conventional chemotherapy significantly increases the risk of HVOD among brain tumor patients later consolidated with BU-TTP followed by AHSCT.

Dimorfismo sexual da traquéia e siringe de periquito (Touist sp. ) / Sexual dimorphism of the parakeet (Touist sp. ) trachea and syrinx

Investigaram-se as diferenças morfológicas da siringe do periquito Touist sp, cinco machos e cinco fêmeas. A traquéia e a siringe foram dissecadas com o auxílio de uma lupa estereoscópia e avaliaram-se o número de anéis, o comprimento da traquéia e da siringe e o comprimento e espessura do músculo traqueolateral. A traquéia do macho apresentou maior número de anéis e maior comprimento que a das fêmeas. O músculo traqueolateral dos machos é mais vigoroso e origina-se no 43º anel traqueal enquanto o das fêmeas origina-se no 30º anel traqueal e se insere no primeiro anel bronquial. A siringe do piriquito é constituída por anéis craniais, cinco nos machos e três nas fêmeas, anéis intermediários, com formato semelhante a uma bolha sulcada ventralmente, anéis caudais, quatro em ambos os sexos, e pessulo. O dimorfismo sexual está presente na morfometria da musculatura e das cartilagens, o que reflete no canto mais vigoroso dos machos

The morphologic differences of the trachea and syrinx of five male and five female Touist sp. parakeets were studied. Trachea and syrinx were dissected with the aid of a stereoscopic magnifying glass and the number of rings, the length of trachea and syrinx were evaluated, as well as the length and thickness of the tracheolateral muscle. Trachea of male parakeets had larger amount of rings and was lengther than the female. Tracheolateral muscle of the males was more vigorous and arised in the 43rd tracheal ring while in the females it originated in the 30th tracheal and inserted in first bronchi ring. The syrinx was constituted by cranial rings (five in males and three in females), intermediate rings (resembly a bubble furrowed ventrally), caudal rings (four in both sexes) and the pessule. Sexual dimorphism directly influenced on the syrinx, concerning the morfometry of the musculature and cartilages, making males sound more vigorously

Morphometric study of Rynchotus rufescens testis throughout the year

The research aimed to study the morphologic variation of the testis, seeking to promote the selection and genetic control of those that present appreciable spermatic production throughout the year. Testis morphology of the Rynchotus rufescens partridge was investigated, analyzing the testis weight, the seminiferous tubules diameter, the thickness of the seminiferous epithelium, the amount of meiotic figures and the thickness of the tunica albuginea. Sixty male partridges were used, divided in 12 groups, and one group per month had the testis collected for the histological routine and the sections were stained using the Hematoxilin-Eosin technique. For the histological sections analysis, morphometric measures were taken, with the aid of an Image Analyzer and the resulting data were submitted to analysis of variance and to Tukey's test. Based on the histological modifications of the seminiferous epithelium and the morphometric analysis, the partridge testis morphology could be divided in four successive phases throughout the year. The reproductive phase occurred in the spring, characterized by the complete spermatogenesis process. The regression phase occurred in the summer, with the involution of the seminiferous epithelium. The rest phase took place in the fall, with spermatogonias presence and some spermatocytes beginning the meiosis. The phase of recrudescence occurred in the winter, with the recovery of the seminiferous epithelium and absence of spermatozoa. In conclusion, the characteristics analyzed revealed a variation over the year, with greater production of spermatozoa in the spring and less in the winter.

O trabalho teve como objetivo estudar a variação morfológica do testículo, visando promover a seleção e o controle genético de exemplares que apresentem produção espermática apreciável ao longo do ano. A morfologia testicular de perdiz Rynchotus rufescens foi avaliada, analisando o peso do testículo, o diâmetro dos túbulos seminíferos, a espessura do epitélio seminífero, o número de figuras de meiose e a espessura da túnica albugínea. Foram utilizados 60 machos de perdizes, divididos em 12 grupos, sendo que um grupo por mês teve os testículos coletados para a rotina histológica e foram corados pela técnica de Hematoxilina-Eosina. Para a análise dos cortes histológicos, foram realizadas medidas morfométricas, com o auxílio de um Analisador de Imagem e os dados encontrados foram submetidos à análise de variância e teste de Tukey. Baseado nas modificações histológicas do epitélio seminífero e na análise morfométrica, a morfologia testicular da perdiz pôde ser dividida em quatro fases sucessivas ao longo do ano. A fase reprodutiva ocorreu na primavera, caracterizando-se pelo completo processo de espermatogênese. A fase de regressão aconteceu no verão, ocorrendo involução do epitélio seminífero. No outono ocorreu a fase de repouso, com a presença de espermatogônias e alguns espermatócitos em início de meiose, já a fase de recrudescência da perdiz aconteceu no inverno, com a recuperação do epitélio seminífero e ausência de espermatozóides. Em conclusão, as características analisadas revelaram uma variação durante o ano, com maior produção de espermatozóides na primavera e menor produção no inverno.

Wireless capsule endoscopy in the diagnostic of small intestine angiodysplasia in chronic uremic patient.

Gastroenteric bleeding due to angiodysplasia (AD) is a relatively common occurrence in patients with end-stage renal failure. Gastric and colon angiodysplasic lesions can be easily revealed by endoscopic procedures, whereas lesions of the small intestine are more difficult to detect. Imaging modalities used in the diagnostic imaging algorithm for the detection of small-bowel AD, include non-invasive methods like enema-helical computer tomography,(99m)Tc-labelled red blood cell scintigraphy, and angiography, and invasive methods such as intraoperative enteroscopy. We report the cases of 3 hemodialysis patients with recurrent episodes of gastrointestinal bleeding, caused by small-bowel AD diagnosed by means of wireless-capsule endoscopy. In all cases, previous gastroscopy and colonoscopy were unrevealing. Wireless-capsule endoscopy consists in swallowing a capsule endoscope (11 mmx27 mm) which contains a miniature video camera, a light source, batteries, and a radio transmitter. Video images are transmitted by means of radio telemetry to aerials taped to the body that allow images to be captured. Moving images from a period as long as 6 h are stored on a portable recorder. Wireless-capsule endoscopy may prove valuable in the assessment of gastrointestinal bleeding in uremic patients with unrevealing results at gastroscopy and colonoscopy.

[Russell's syndrome: a case of long-term survival and review of the literature]. / Sindrome di Russell: descrizione di un caso clinico a lunga sopravvivenza e revisione della letteratura.

We report the case of a two years old, normally eating child, affected by organic macies and severe dystrophy. After the negative response of blood and laboratory examinations let us exclude a malabsorption syndrome, only the performance of neuro-radiologic exams showed evidence of a subthalamic tumor as the cause of a "Diencephalic syndrome". Diencephalic syndrome or Russell's syndrome is a diencephalic tumor induced disease, which sets in the first time of life. The disease clinical markers are a severe emaciation with appetite preservation and absence or very scarce evidence of any telltale neurological sign. The tumoral histo-pathology most frequently shows a low grade of malignancy astrocytoma, whose eradication is very often difficult because of particular anatomic site. Treatment of choice includes an excisional biopsy with chemotherapy and radiotherapy. We report a clinical case of long-term survival and review of the literature.

One percent sodium carboxymethylcellulose prevents experimentally induced abdominal adhesions in horses.

OBJECTIVE: To evaluate the efficacy of 1% sodium carboxymethylcellulose (SCMC) for prevention of experimentally induced abdominal adhesions in horses. STUDY DESIGN: Prospective, controlled, experimental study. ANIMAL POPULATION: Twelve healthy adult horses. METHODS: The effect of 1% SCMC on adhesion formation was evaluated in 12 healthy horses by using an established model of serosal trauma to induce intraabdominal adhesions. After ventral median celiotomy, 2 separate areas of the jejunum were abraded, and three 2-0 chromic gut sutures were placed in each abraded area. Jejunal resection and end-to-end anastomosis was performed at 2 sites distant to the abrasion sites. In treated horses (n = 6), 2 L of 1% SCMC was applied to the intestine before and after intestinal manipulation. In control horses (n = 6), 2 L of saline solution were applied to the intestine before and after surgical manipulation. All horses were euthanatized 10 days after surgery, and the abdominal cavity was evaluated for adhesion formation. The frequency of intraabdominal adhesions between groups was compared with a chi-square test. Statistical significance was set at P <.05. RESULTS: All control horses had intraabdominal adhesions. Fibrous adhesions were associated with both jejunal abrasion sites in 5 control horses. Fibrous adhesions were also associated with 1 or both jejunal anastomotic sites in 5 control horses. Only 1 treated horse developed adhesions at the jejunal abrasion sites, and no adhesions were present at the anastomotic sites in the treated horses. There were significantly fewer adhesions in the SCMC treatment group compared with the control group (P <.05). CONCLUSION: In this experimental model, application of 1% SCMC reduced the frequency of intraabdominal adhesions at areas of serosal abrasion and at jejunal anastomotic sites. CLINICAL RELEVANCE: In horses at an increased risk for developing intraabdominal adhesions after intestinal surgery, the use of 1% SCMC during celiotomy may decrease the frequency of adhesion formation.

Biocompatibility and functional performance of a polyethylene glycol acid-grafted cellulosic membrane for hemodialysis.

In order to improve the biochemical reactivity of the cellulose polymer, which is mainly attributed to the presence of surface hydroxyl groups, derivatized cellulosic membranes have been engineered replacing or masking some or all of the hydroxyl groups in the manufacturing process of the membrane. The present study was set up to analyze both biocompatibility and functional performance of two different derivatized cellulosic membranes (cellulose diacetate; polyethylene glycol, PEG, acid-grafted cellulose) as compared to a synthetic membrane (polymethylmethacrylate, PMMA). Cellulose diacetate is prepared by substituting hydroxyl groups with acetyl groups; PEG cellulose is obtained by grafting PEG chains onto the cellulosic polymer with a smaller amount of substitution than cellulose diacetate. While the three dialyzers provided similar urea and creatinine removal, the dialyzer containing cellulose diacetate showed a reduced ability to remove 32-microglobulin compared to that containing PEG cellulose or PMMA. A transient reduction in leukocyte count was observed for both derivatized cellulosic membranes. The neutrophil and monocyte counts throughout the entire dialysis session showed a closer parallelism with the cellular expression of the adhesive receptor CD 15s (sialyl-Lewis x molecule) than with CD11b/CD18 expression. Platelet activation, as indicated by the percentage of cells expressing the activation markers CD62P (P-selectin) and CD63 (gp53), occurred with all membranes at 15 min of dialysis and also with PMMA at 30 min. An increased formation of platelet-neutrophil and platelet-monocyte coaggregates was found at 15 and 30 min during dialysis with cellulose diacetate and PMMA but not with PEG cellulose. Generally in concomitance with the increase in platelet-neutrophil coaggregates, an increased hydrogen peroxide production by neutrophils occurred. Our results indicate that derivatizing cellulose may represent a useful approach to improve the biocompatibility of the cellulose polymer, though some homeostatic reactions remain activated. Our results also indicate that there may be a great variability in the biocompatibility profile of derivatize cellulosic membranes which most likely stem from the different type of structural modification rather than from the degree of hydroxyl group replacement.

Effect of carboxymethylcellulose and a hyaluronate-carboxymethylcellulose membrane on healing of intestinal anastomoses in horses.

OBJECTIVE: To evaluate the effect of sodium carboxymethylcellulose (SCMC) or a hyaluronate-carboxymethylcellulose membrane (HA membrane) on healing of the small intestine in horses. ANIMALS: 18 healthy adult horses. PROCEDURE: Midline celiotomy and 2 jejunal resection-and-anastomosis surgeries were performed. In treated horses, SCMC (n = 6) or a HA membrane (6) was applied to the jejunum to cover the anastomosis. There were 6 untreated control horses. Horses were euthanatized 10 days after surgery. For each horse, 1 anastomosis was used for histologic examination, and the second was used to determine intestinal bursting strength. Intestinal bursting tension, serosal granulation tissue, serosal fibrin deposition, and width of the fibrous seal at the anastomosis were compared among groups. RESULTS: 3 control horses had adhesions associated with the anastomosis, but none of the treated horses had adhesions associated with the anastomosis. Mean thickness of fibrin deposited on the serosal surfaces for the SCMC and HA-membrane groups was significantly less than that for control horses. Mean thickness of serosal granulation tissue, width of fibrous seal between inverted musculature, inflammatory cell infiltrate scores, and bursting tension did not differ significantly among groups. CONCLUSIONS AND CLINICAL RELEVANCE: Use of SCMC or application of a HA membrane to small intestinal anastomoses in horses resulted in fewer adhesions and decreased fibrin deposition, and it did not adversely affect anastomotic healing. In horses at increased risk for intra-abdominal adhesions, SCMC or application of HA membranes may decrease the frequency of adhesions without adversely affecting healing of small intestinal anastomoses.

Evaluation of a bioresorbable hyaluronate-carboxymethylcellulose membrane for prevention of experimentally induced abdominal adhesions in horses.

OBJECTIVE: To evaluate the efficacy of a bioresorbable hyaluronate-carboxymethylcellulose membrane (HA-membrane) for prevention of experimentally induced abdominal adhesions in horses. STUDY DESIGN: Experimental study. ANIMAL POPULATION: Twelve healthy adult horses. METHODS: The effect of an HA-membrane on adhesion formation was evaluated in 12 healthy horses using an established model of serosal trauma to induce adhesions. A ventral median celiotomy and two jejunal resections and end-to-end anastomoses were performed. Two separate jejunal areas were abraded, and three 2-0 chromic gut sutures placed in the abraded areas. In treated horses (n = 6), HA-membranes were applied to the jejunum to completely cover the anastomoses and abraded areas of jejunum. Nontreated horses (n = 6) served as controls. All horses were killed 10 days after surgery. The abdominal cavity was evaluated for adhesion formation. The frequency of intra-abdominal adhesions between groups was compared with a chi2 test with statistical significance set at P < .05. RESULTS: All control horses had intra-abdominal adhesions; fibrous adhesions were associated with both jejunal abrasion sites in 5 horses. One treated horse developed adhesions. There were significantly fewer adhesions in the HA-membrane-treated group (P < .0034). CONCLUSIONS: In this experimental model, application of an HA-membrane to a localized area of serosal trauma reduced the frequency of intra-abdominal adhesion formation. CLINICAL RELEVANCE: Application of an HA membrane may decrease the frequency of adhesions in horses at an increased risk of postoperative adhesion formation.

Endoscopy as a tool for diagnosing and treating gastrointestinal angiodysplasia in haemodialysis patients.

Gastroenteric angiodysplasia is an important cause of haemorrhage in chronic renal failure patients. This paper reports on 2 patients on maintenance haemodialysis with upper gastrointestinal bleeding due to different manifestations of angiodysplasic lesions (sudden appearance of haematemesis and melaena in one case, progressive anaemia with apparent resistance to erythropoietin in the other case). Exploratory endoscope examination of the first digestive tract showed in both cases the presence of bleeding angiodysplasic lesions. Both patients were there and then submitted to surgical endoscopy, during which the bleeding angiodysplasic lesion was sclerosed with physiological salt solution plus adrenaline 1/10000 and 1% polydocanol. In one patient, bleeding occurred again ten days later, making renewed surgical endoscopy necessary. In the course of this an elastic ligature was made to the superangular angiodysplasia. A year later in both cases there were no direct or indirect signs of further bleeding; an endoscopic check-up showed the treated lesions to be sclerosed. Endoscopy offers the unique possibility of being used for both diagnostic and therapeutic purposes in a single session. In expert hands, endoscope therapy is effective and markedly reduces the risk of side effects.

[Possibilities of CT typing of liposarcomas]. / Possibilità di tipizzazione dei liposarcomi con TC.

Twenty-nine cases of liposarcomas were examined by CT; in 60% of them the CT finding was that of an ill defined, often large mass with content uniformly dishomogeneous and CT numbers ranging from -40 to +28 H.U. Diagnosis of liposarcoma is often possible when this finding is recognized in a mass of the thigh or retroperitoneum where these tumors frequently arise. Authors report differential diagnosis between liposarcomas and other lipomatous tumors such as angiomyolipoma of the kidney (when it is large and only attached to the kidney by an inconspicuous pedicle) and intramuscular lipomas (50% of them are located in the thigh).

[Changes in adenosinetriphosphatase activity in rat liver after CC14 poisoning]. / Variazioni delle attivita' adenosintrifosfatasiche nel fegato di ratto in seguito ad intossicazione con CCl4.

Our study shows evidences that CCl4 administration (at the dose of 2,5 ml/kg b.w. "per os") increased ATPase activities in rat liver plasmamembranes 1 and 2 hours after treatment. Conversely we found that CCl4 poisoning decreased ATPase activities in microsomal membranes of rat liver at the same tested times. Therefore we suggest that ATPase activities were differently influenced by CCl4 treatment with respect to different subcellular distribution of those enzymes.

[Changes in the adenosinetriphosphatase activity in plasma membranes incubated in vitro in the presence of 4-hydroxy-2,3-nonenal]. / Variazioni delle attivita' adenosintrifosfatasiche in plasma membrane incubate "in vitro" in presenza di 4-idrossi-2,3-nonenale.

Cation-dependent ATPase activities of rat liver plasmamembranes incubated "in vitro" with 4-hidroxy-2,3-nonenal (HNE, an aldehyde from peroxidative decomposition of biological membrane lipid moieties) are investigated. Mg++-ATPase activity is inhibited significantly by all the doses of HNE used (13,9, 4,1,1,2, 0,35 and 0,10 microM). Evidences for the inhibition of Mg++- Na+- K+- ATPase activity are also presented. Ca++- ATPase activity is strongly increased when rat liver plasmamembranes are incubated in presence of HNE 13,9 microM. Our results suggest that HNE may play a role in the control of intracellular cation levels acting directly on mechanisms of plasmamembranes ion transport.