[Fish oil containing lipid emulsions in critically ill patients: Critical analysis and future perspectives]. / Emulsiones lipídicas con aceite de pescado en el paciente crítico: análisis crítico y perspectivas futuras.

Third-generation lipid emulsions (LE) are soybean oil sparing strategies with immunomodulatory and antiinflammatory effects. Current evidence supporting the use of intravenous (i.v) fish oil (FO) LE in critically ill patients requiring parenteral nutrition or receiving enteral nutrition (pharmaconutrient strategy) mainly derives from small phase ii clinical trials in heterogenous intensive care unit patient's population. Over the last three years, there have been published different systematic reviews and meta-analyses evaluating the effects of FO containing LE in the critically ill. Recently, it has been demonstrated that i.v FO based LE may be able to significantly reduce the incidence of infections as well as mechanical ventilation days and hospital length of stay. Nonetheless, more robust evidence is required before giving a definitive recommendation. Finally, we strongly believe that a dosing study is required before new phase iii clinical trials comparing i.v FO containing emulsions versus other soybean oil strategies can be conducted.

Hyponatremia in the neurocritical care patient: An approach based on current evidence.

In the neurocritical care setting, hyponatremia is the commonest electrolyte disorder, which is associated with significant morbimortality. Cerebral salt wasting and syndrome of inappropriate antidiuretic hormone have been classically described as the 2 most frequent entities responsible of hyponatremia in neurocritical care patients. Nevertheless, to distinguish between both syndromes is usually difficult and useless as volume status is difficult to be determined, underlying pathophysiological mechanisms are still not fully understood, fluid restriction is usually contraindicated in these patients, and the first option in the therapeutic strategy is always the same: 3% hypertonic saline solution. Therefore, we definitively agree with the current concept of "cerebral salt wasting", which means that whatever is the etiology of hyponatremia, initially in neurocritical care patients the treatment will be the same: hypertonic saline solution.

[Pharmaconutrition with parenteral selenium in sepsis]. / Farmaconutrición parenteral con selenio en la sepsis.

Critical illness is characterized by oxidative stress which leads to multiple organ failure, and sepsis-related organ dysfunction remains the most common cause of death in the intensive care unit. Over the last 2 decades, different antioxidant therapies have been developed to improve outcomes in septic patients. According to recent evidence, selenium therapy should be considered the cornerstone of the antioxidant strategies. Selenium given as selenious acid or sodium selenite should be considered as a drug or pharmaconutrient with prooxidant and cytotoxic effects when a loading dose in intravenous bolus form is administered, particularly in the early stage of severe sepsis/septic shock. To date, several phase ii trials have demonstrated that selenium therapy may be able to decrease mortality, improve organ dysfunction and reduce infections in critically ill septic patients. The effect of selenium therapy in sepsis syndrome must be confirmed by large, well designed phase iii clinical trials. The purpose of this review is to discuss current evidence on selenium pharmaconutrition in sepsis syndrome.

Maternal periconceptional exposure to drinking water disinfection by-products and neural tube defects in offspring.

BACKGROUND: Associations between maternal periconceptional exposure to disinfection by-products (DBPs) in drinking water and neural tube defects (NTDs) in offspring are inconclusive, limited in part by exposure misclassification. METHODS: Maternal interview reports of drinking water sources and consumption from the National Birth Defects Prevention Study were linked with DBP concentrations in public water system monitoring data for case children with an NTD and control children delivered during 2000-2005. DBPs analyzed were total trihalomethanes, the five most common haloacetic acids combined, and individual species. Associations were estimated for all NTDs combined and selected subtypes (spina bifida, anencephaly) with maternal periconceptional exposure to DBPs in public water systems and with average daily periconceptional ingestion of DBPs accounting for individual-level consumption and filtration information. Mixed effects logistic regression models with maternal race/ethnicity and educational attainment at delivery as fixed effects and study site as a random intercept were applied. RESULTS: Overall, 111 case and 649 control children were eligible for analyses. Adjusted odds ratios for maternal exposure to DBPs in public water systems ranged from 0.8-1.5 for all NTDs combined, 0.6-2.0 for spina bifida, and 0.7-1.9 for anencephaly; respective ranges for average daily maternal ingestion of DBPs were 0.7-1.1, 0.5-1.5, and 0.6-1.8. Several positive estimates (≥1.2) were observed, but all confidence intervals included the null. CONCLUSIONS: Using community- and individual-level data from a large, US, population-based, case-control study, we observed statistically nonsignificant associations between maternal periconceptional exposure to total and individual DBP species in drinking water and NTDs and subtypes.

Urban-rural residence and the occurrence of neural tube defects in Texas, 1999-2003.

Neural tube birth defects (NTDs) affect more than 4000 pregnancies in the US annually. The etiology of NTDs is believed to be multifactorial, but much remains unknown. We examined the pattern and magnitude of urban-rural variation in anencephaly, spina bifida without anencephaly, and encephalocele in Texas in relation with urban-rural residence for the period 1999-2003. There was no evidence that urban-rural residence was associated with changes in the rate of anencephaly or spina bifida without anencephaly in unadjusted or adjusted analyses. In contrast, rates of encephalocele were statistically significantly higher in areas classified as suburban or more rural compared to urban areas using four different urban-rural residence indicators.

The population-based prevalence of achondroplasia and thanatophoric dysplasia in selected regions of the US.

There have been no large population-based studies of the prevalence of achondroplasia and thanatophroic dysplasia in the United States. This study compared data from seven population-based birth defects monitoring programs in the United States. We also present data on the association between older paternal age and these birth defects, which has been described in earlier studies. The prevalence of achondroplasia ranged from 0.36 to 0.60 per 10,000 livebirths (1/27,780-1/16,670 livebirths). The prevalence of thanatophoric dysplasia ranged from 0.21 to 0.30 per 10,000 livebirths (1/33,330-1/47,620 livebirths). In Texas, fathers that were 25-29, 30-34, 35-39, and > or =40 years of age had significantly increased rates of de novo achondroplasia among their offspring compared with younger fathers. The adjusted prevalence odds ratios were 2.8 (95% CI; 1.2, 6.7), 2.8 (95% CI; 1.0, 7.6), 4.9 (95% CI; 1.7, 14.3), and 5.0 (95% CI; 1.5, 16.1), respectively. Using the same age categories, the crude prevalence odds ratios for de novo cases of thanatophoric dysplasia in Texas were 5.8 (95% CI; 1.7, 9.8), 3.9 (95% CI; 1.1, 6.7), 6.1 (95% CI; 1.6, 10.6), and 10.2 (95% CI; 2.6, 17.8), respectively. These data suggest that thanatophoric dysplasia is one-third to one-half as frequent as achondroplasia. The differences in the prevalence of these conditions across monitoring programs were consistent with random fluctuation. Birth defects monitoring programs may be a good source of ascertainment for population-based studies of achondroplasia and thanatophoric dysplasia, provided that diagnoses are confirmed by review of medical records.

Data on processing of Ti-25Nb-25Zr ß-titanium alloys via powder metallurgy route: Methodology, microstructure and mechanical properties.

The data presented in this article are related to the research article entitled "Cyclic Shear behavior of conventional and harmonic structure-designed Ti-25Nb-25Zr ß-titanium alloy: Back-stress hardening and twinning inhibition" (Dirras et al., 2017) [1]. The datasheet describes the methods used to fabricate two ß-titanium alloys having conventional microstructure and so-called harmonic structure (HS) design via a powder metallurgy route, namely the spark plasma sintering (SPS) route. The data show the as-processed unconsolidated powder microstructures as well as the post-SPS ones. The data illustrate the mechanical response under cyclic shear loading of consolidated alloy specimens. The data show how electron back scattering diffraction(EBSD) method is used to clearly identify induced deformation features in the case of the conventional alloy.

Retroclavicular approach vs infraclavicular approach for plexic bloc anesthesia of the upper limb: study protocol randomized controlled trial.

BACKGROUND: The coracoid approach is recognized as the simplest approach to perform brachial plexus anaesthesia, but needle visualization needs to be improved. With a different needle entry point, the retroclavicular approach confers a perpendicular angle between the ultrasound and the needle, which theoretically enhances needle visualization. This trial compares these two techniques. The leading hypothesis is that the retroclavicular approach is comparable to the infraclavicular coracoid approach in general aspects, but needle visualization is better with this novel approach. METHODS: We designed a multicentre, randomized, non-inferiority trial. Patients eligible for the study are older than 18 years, able to consent, will undergo urgent or elective upper limb surgery distal to the elbow and are classified with American Society of Anaesthesiologists risk score (ASA) I-III. They will be excluded if they meet contraindicated criteria to regional anaesthesia, have affected anatomy of the clavicle or are pregnant. Randomization will be done by a computer-generated randomization schedule stratified for each site and in 1:1 ratio, and concealment will be maintained with opaque, sealed envelopes in a locked office. The primary outcome, the performance time, will be analyzed using non-inferiority analysis while secondary outcomes will be analyzed with superiority analysis. Needle visualization will be ranked on a Likert scale of 1-5 that is subjective and represents a pitfall. Two separate persons will rank needle visualization to compensate this pitfall. According to previous studies, 49 patients per group are required for statistical power of 0.90 and one-sided type I error of 0.05. DISCUSSION: The conduct of this study will bring clear answers to our questions and, if our hypothesis is confirmed, will confer an anatomic alternative to difficult coracoid infraclavicular brachial blocks or could even become a standard for brachial plexus anaesthesia. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02913625 . Registered on 12 September 2016.

Speed of sound measurements of the third metacarpal bone in young exercising thoroughbred racehorses.

The purpose of this longitudinal in-field study was to evaluate the influence of exercise, age, and gender on superficial cortical bone of the third metacarpal bone (MC III) in young Thoroughbreds by measuring speed of sound (SOS) values with an axial transmission technique (Omnisense, Sunlight Ltd, Israel). Both MC III of 75 racehorses, 2 to 4 years old, were monitored with SOS measurements in 5- to 7-week intervals during a 9- month physical exercise period. Medical data and training programs (slow gallop, canter, and high-speed work) of each horse were recorded. SOS measurements began before 2-year-old horses started high-speed training. SOS values of the dorsal aspect of MC III were significantly lower in comparison with values obtained at the lateral and the medial aspect of MC III, and SOS values were inversely correlated with measurement cycles. Significant limb-associated differences in dorsal MC III SOS values were observed at measurement cycles 2, 3, and 4. SOS values obtained at the lateral and medial aspect of MC III increased with age. SOS values obtained at the dorsal aspect of MC III, decreased with age. Mares had significantly higher SOS values at the dorsal aspect of MC III, when compared with corresponding values in stallions. In 2-year-old Thoroughbreds SOS values of the dorsal MC III were significantly different between cycles 1 and 2, between cycles 3 and 4, and between cycles 4 and 5. Three-year-old horses showed significant differences between SOS values of the dorsal MC III obtained at cycles 3 and 4. Training intensities did not significantly influence SOS values. The results indicate that young exercising Thoroughbred racehorses have age-, gender-, and measurement-cycle-dependent variations in SOS values of MC III, which probably reflect adaptive variations in superficial cortical bone properties of MC III.

Detection of the terminal complement complex in patient plasma following acute myocardial infarction.

The mechanisms of inflammation responsible for the myocardial tissue damage seen after an acute myocardial infarction (AMI) have not been clearly identified. Recent lines of evidence, demonstrating depressed sera levels of individual complement components in patients after myocardial infarction, have suggested involvement of the complement (C) system in micro- and macrovascular injury subsequent to AMI. The present study assessed the role of complement as a mediator of myocardial inflammation by quantifying products of complement activation including, the terminal complement complex (TCC) the cytolytic component of the complement system, C1rC1s-C1 inhibitor complex and C3bBbP complex, formed following activation of the classical and alternative pathway, respectively, and anaphylatoxins C3a and C5a in 41 patients following AMI. Plasma TCC and C1rC1s-C1 inhibitor complex concentrations increased up to 32-fold (P less than 0.001) and 8-fold (P less than 0.001), respectively, while the C3bBbP complex, C3a des-Arg and C5a des-Arg each increased over 2-fold (P less than 0.001) 16 h after AMI, and were only minimally detectable during non-inflammatory myocardial conditions. Furthermore, TCC concentrations increased over 150% (P less than 0.001) one day after patients reinfarcted, subsequent to hospitalization for a primary AMI. These results demonstrate activation of complement after AMI and suggest that inflammatory mediators of the complement system may contribute to myocardial tissue damage during the infarction process.

Assessing exposure to disinfection by-products in women of reproductive age living in Corpus Christi, Texas, and Cobb county, Georgia: descriptive results and methods.

We conducted a field study in Corpus Christi, Texas, and Cobb County, Georgia, to evaluate exposure measures for disinfection by-products, with special emphasis on trihalomethanes (THMs). Participants were mothers living in either geographic area who had given birth to healthy infants from June 1998 through May 1999. We assessed exposure by sampling blood and water and obtaining information about water use habits and tap water characteristics. Two 10-mL whole blood samples were collected from each participant before and immediately after her shower. Levels of individual THM species (chloroform, bromodichloromethane, dibromochloromethane, and bromoform) were measured in whole blood [parts per trillion (pptr)] and in water samples (parts per billion). In the Corpus Christi water samples, brominated compounds accounted for 71% of the total THM concentration by weight; in Cobb County, chloroform accounted for 88%. Significant differences in blood THM levels were observed between study locations. For example, the median baseline blood level of bromoform was 0.3 pptr and 3.5 pptr for participants in Cobb County and Corpus Christi, respectively (p = 0.0001). Differences were most striking in blood obtained after showering. For bromoform, the median blood levels were 0.5 pptr and 17 pptr for participants in Cobb County and Corpus Christi, respectively (p = 0.0001). These results suggest that blood levels of THM species vary substantially across populations, depending on both water quality characteristics and water use activities. Such variation has important implications for epidemiologic studies of the potential health effects of disinfection by-products.

Differential transferrin receptor density in human colorectal cancer: A potential probe for diagnosis and therapy.

Transferrin receptor density was investigated in human colorectal surgical specimens. Crude membranes were prepared from 23 cancer tumors (adenocarcinoma or malignant villous tumor) and 3 non-cancer tumors (polyadenoma or villous tumor) and 26 adjacent control mucosa. Contrary to non-cancer tumors, Scatchard analysis of 125I-transferrin binding data evidenced higher maximal transferrin binding capacity and lower dissociation constant in cancer tissues (Bmax cancer 1.828+/-0.320 nmol/g, Kd 24.1+/-4.7 nM), as compared to paired control colonic mucosa (Bmax contol 0.851+/-0.182 nmol/g, Kd 30.7+/-7.3 nM), paired t-tests: Bmax p<0.001, Kd p<0.05). As the cancer/control Bmax ratio was 2.6+/-0.4,transferrin carrier constructs should be proposed for cancer imaging or therapy.

A synthetic aragonite-based bioceramic: influence of process parameters on porosity and compressive strength.

We investigate the influence of process parameters such as weight fraction and particle size of pore-former, and isostatic pressure, on porosity and compressive strength of non-sintered porous calcium carbonate biomaterials compacted at high pressure in uniaxial or isostatic mode. Experiment design and results analysis are performed according to a two-level 2k factorial design method (FDM). Results indicate that only the weight fraction of pore-former (wt fpf) influences significantly the porosity and the compressive strength. The porosity P, is described by a linear function of wt fpf, and the compressive strength sigma(comp), by an exponential one. For materials compacted under uniaxial pressing: P (vol%) = 33.7 + 85.4 (wt fpf) and sigma(comp) (MPa) = 28.8e(-9.2(wt fpf)) with 0.1 < or = wt fpf < or = 0.3. For materials compacted in isostatic mode: P (vol%) = 33.9 + 82.1 (wt fpf) and sigma(comp) (MPa) = 24.0e(-7.0(wt fpf)) with 0.15 < or = wt fpf < or = 0.35. The pore-former particle size has no significant influence on both properties. The increase in isostatic pressure provides slightly lower porosity and better compressive strength. For a fixed fraction of pore-former, isostatic pressing leads to a better compressive strength than uniaxial pressing. This study indicates that, for a constant amount of pore former, the size of macropores can be adjusted to reach optimal bone-ingrowth without change in compressive strength.

Iron chelators: in vitro inhibitory effect on the liver stage of rodent and human malaria.

The activity of desferrioxamine (Desferal) and desferrithiocin (a newly developed oral iron chelator) was evaluated against the liver stage of Plasmodium yoelii and P. falciparum in the rodent and the human hepatocyte in vitro culture system. The two iron chelators were found to inhibit the liver schizogony of both the rodent and the human Plasmodium species at concentrations achievable in vivo. P. falciparum proved to be more sensitive (ic 95% below 20 micromol/l than P. yoelii (ic 95% 50-100 micromol/l). As assessed by electron microscopy, drug administration was associated with focal clarification of the cytoplasm thought to be reversible. As desferrioxamine and desferrithiocin are known to be equally active on the blood stage of rodent and human plasmodia, iron chelators are deserving of further investigation as potential alternative candidates to existing drugs for radical cure of malaria.

Diurnal variation in responses to influenza vaccine.

Data from two field trials of influenza vaccine were examined for an association between vaccination time and subject response. Both were conducted on adults and involved the same antigens and dose via intramuscular injection. In one study (Princeton) a diurnal pattern in antibody response to the antigen A/Philippines, but not to A/Chile or B/USSR, was detected after the first vaccination administered during summer 1984, but not after the second revaccination given during summer 1985. In a second study (Houston) conducted during autumn 1985, no diurnal pattern in antibody response was detected for any of the antigens assessed. No diurnal pattern in systemic reactions was observed. Previously vaccinated subjects of both studies more commonly experienced local reactions of arm redness, hardness, and soreness after afternoon versus morning (p < 0.05) injection upon revaccination, both before and after adjustment for possible confounders of age and gender.

Temporal patterns of reported single-vehicle car and truck accidents in Texas, U.S.A. during 1980-1983.

Reported single car and truck accidents due specifically to driver 'fatigue' for the 4-year span of 1980-1983 were analyzed for 24-hr, 7-d and 1-yr patterns. Three types of data were examined: (1) accidents in rural Texas, (2) accidents only in San Antonio, the fourth largest city in Texas and (3) accident ratio (number of accidents per time interval divided by traffic volume for the interval) in this city. A statistically significant seasonal variation of relatively low amplitude with peaks in May and July was detected only for accidents in rural areas. High-amplitude periodicities of 7 d were evident in all the data sets, with a peak on the weekend. A very prominent 24-hr pattern was detected as well, with the acrophase determined by single cosinor around 0300. A slight secondary peak in accidents, around 1500, was evident in the data from the rural areas. This secondary peak represented a 12-hr rhythm in addition to the 24-hr. Overall, features of the temporal patterns in accidents over 24 hr and over the year in urban and rural areas differed only slightly. Accident ratios yielded results similar to accident frequencies. However, with regard to the rural data, the shape of the 24-hr temporal pattern varied with driver age; older drivers exhibited a flatter curve with a more pronounced afternoon rather than early morning (around 0300) peak.

The National Birth Defects Prevention Study.

The National Birth Defects Prevention Study was designed to identify infants with major birth defects and evaluate genetic and environmental factors associated with the occurrence of birth defects. The ongoing case-control study covers an annual birth population of 482,000 and includes cases identified from birth defect surveillance registries in eight states. Infants used as controls are randomly selected from birth certificates or birth hospital records. Mothers of case and control infants are interviewed and parents are asked to collect buccal cells from themselves and their infants for DNA testing. Information gathered from the interviews and the DNA specimens will be used to study independent genetic and environmental factors and gene-environment interactions for a broad range of birth defects. As of December 2000, 7,470 cases and 3,821 controls had been ascertained in the eight states. Interviews had been completed with 70% of the eligible case and control mothers, buccal cell collection had begun in all of the study sites, and researchers were developing analysis plans for the compiled data. This study is the largest and broadest collaborative effort ever conducted among the nation's leading birth defect researchers. The unprecedented statistical power that will result from this study will enable scientists to study the epidemiology of some rare birth defects for the first time. The compiled interview data and banked DNA of approximately 35 categories of birth defects will facilitate future research as new hypotheses and improved technologies emerge.

Accentuated complement activation in patient plasma during the adult respiratory distress syndrome: a potential mechanism for pulmonary inflammation.

The adult respiratory distress syndrome (ARDS) represents an acute inflammatory lung disorder, characterized by both refractory hypoxemia and a mortality rate approaching 95%. Researchers have proposed that activation of the complement (C) system may play a role in the development of the pulmonary inflammation associated with ARDS. The purpose of this investigation was to determine whether complement activation occurs to a greater extent in patients with ARDS than in patients without ARDS, thereby providing a potential mechanism for the acute inflammation seen in ARDS. In this study, we assessed plasma complement activation by measuring complement activation by-products: C1rC1s-C1 inhibitor complex and C3b-P complex, generated subsequent to activation of the classical and alternative pathways, respectively, and also the terminal complement complex, formed after activation of either the classical or alternative complement pathway. Multivariate discriminant analysis revealed that these three complement activation complexes could distinguish patients with ARDS from those without ARDS (p less than 0.04). Furthermore, these three complexes provided a more sensitive discriminator of ARDS than did plasma levels of C3a desarginine (p greater than 0.30), C5a desarginine (p greater than 0.41) and total hemolytic complement activity (CH50) (p greater than 0.72). We conclude that a temporal association exists between the complement activation and the development of ARDS. Therefore, we suggest that complement activation by-products be included in the armamentarium for ARDS.

Toronto tap water: perception of its quality and use of alternatives.

A cross-sectional telephone survey determined attitudes of City of Toronto residents toward the quality of their tap water, and their usage of alternative drinking water sources. Overall, 49% of households rated the water as good or very good, although 73% felt that it contained some or a lot of chemical pollutants. An alternative to tap water was used by 40.5% of households; 35% were 'regular' users, obtaining at least 50% of their consumed water this way. In terms of specific alternatives, 22.5% of households consumed bottled water, 11% treated tap water additionally with a home device, and 12% boiled their water. For 'regular users', the proportions were 19.5%, 10% and 10% respectively. This surprisingly high and probably increasing usage of alternatives may have implications for regulation.

A comparison of the health status of Riverdale residents with residents of the rest of Toronto based on the Toronto Community Health Survey.

OBJECTIVES: To compare the health status of Riverdale residents with residents of the rest of Toronto. DESIGN: Cross-sectional telephone survey. SETTING: Toronto. TIME FRAME: October 1988-June 1989. PARTICIPANTS: Four hundred and fourteen residents of Riverdale, a residential-industrial area of Toronto, and 866 residents of the rest of Toronto, age 15 years and older in households with telephones. MAIN RESULTS: Respondents in Riverdale compared to respondents in the rest of Toronto were more likely to speak languages other than English, have less formal education, and be of Oriental ethnic origin. Perceived health status varied between the two areas, but no significant difference existed in diagnosed morbidity. Riverdale respondents were much more aware of food and soil contamination than respondents from the rest of Toronto.