Conjugate treatment with high concentration normobaric oxygen and hyaluronic acid for vaginal atrophy: a prospective study.

OBJECTIVE: Vulvovaginal atrophy is a condition closely related to low circulating estrogen levels, with post-menopause being the main cause. However, patients of childbearing age may also present with these symptoms due to treatments that reduce estrogen production. Local estrogen therapy is the causal treatment of local symptoms, but it is not always accepted and is often abandoned by patients. In recent years, alternative therapies have been proposed: fractional CO2 laser or the conjugate treatment with normobaric oxygen and hyaluronic acid, the latter being the subject of this study. The study aimed to evaluate the effectiveness of conjugate topical treatment with normobaric oxygen and hyaluronic acid. PATIENTS AND METHODS: 50 patients were evaluated and treated with 5 applications of 15 minutes each, every 15 days, with Caressflow®. All patients presented at least one of the symptoms related to vulvovaginal atrophy: dryness, burning, and dyspareunia. In all cases, vulvoscopy, colposcopy, and cervicovaginal cytology were performed. The patients were interviewed with an analogic scale (VAS) concerning the severity of symptoms before and after the treatment. Colposcopy and PAP-smear were assessed by mean of Vaginal Health Index Score (VHI) at baseline and at the end of the treatment. RESULTS: All patients completed the treatment scheme and presented with a significant improvement in subjective symptoms. The colposcopy and PAP-smear performed 10 days after the end of the last treatment showed a significant improvement in the appearance and elasticity of the vaginal epithelium and the cytological picture, which showed, in the sample taken after treatment, hyaluronic acid vesicles within the cell cytoplasm. CONCLUSIONS: This study corroborates the data presented in the latest published papers on the effectiveness of treatment with normobaric O2 and hyaluronic acid on vaginal atrophy. Efficacy has been confirmed both in terms of subjective symptoms reported by the patients and objective improvement at colposcopy and PAP-smear cytology.

Strengthening preparedness against global health threats: A paradigm shift based on One Health approaches.

The implementation of preparedness strategies to prevent and mitigate the impact of global health threats poses several challenges. It should promptly identify cross-cutting drivers of pandemic threats, assess context-specific risks, engage multiple stakeholders, and translate complex data from multiple sources into accessible information for action. This requires a coordinated, multidisciplinary and multisectoral effort engaging systems that, most of the time, work in isolation. The One Health (OH) approach promotes the collaboration and communication among different disciplines and sectors, and could be applied across the preparedness phases at national and international level. We discuss here gaps and needs in preparedness strategies, which can benefit from the OH approach, and a set of actionable recommendations, as shared with the G20-2021 with a dedicated Policy Brief. The discussion adds to the current debate about OH operationalization and promotes a paradigm shift towards coordinated prevention and preparedness strategies for early assessment and management of global health threats.

Litotricia por ondas de choque con música: un tratamiento menos doloroso y más satisfactorio / Shockwave lithotripsy with music: Less painful and more satisfactory treatment

Introducción: El objetivo del estudio fue determinar si escuchar música durante una sesión de litotricia extracorpórea por ondas de choque (LEOC) mejora el dolor de los pacientes. Material y método: Se realizó una aleatorización simple y oculta de pacientes con litiasis renales o ureterales que acudieron por vez primera a una sesión de LEOC de 7.000 ondas, entre septiembre y diciembre de 2014. Un grupo recibió música mientras que el otro no. Se registraron la edad, sexo, localización de la litiasis (renal/ureteral) y 2 cuestionarios pre-LEOC (cuestionario A) y post-LEOC (cuestionario B). Cada cuestionario contiene una pregunta sobre ansiedad y otra sobre dolor en escala Likert (0 al 10). El B, además, contiene otra sobre satisfacción y otra sobre comodidad (Likert 0 al 10). Otras variables fueron la frecuencia cardiaca, respiratoria, tensión arterial sistólica y diastólica en la onda 2.000, 5.000 y 7.000, causa de interrupción del procedimiento, petidina total (mg), analgesia secundaria, energía (J) y frecuencia (Hz). Se realizó un análisis bivariante con t de Student, X2/Fisher y un modelo de regresión lineal múltiple. Resultados: La muestra incluyó a 95 pacientes, con una media de edad de 52 años (±13), 35 mujeres (36,84%), 60 hombres (63,2%); 25 para litiasis ureterales (26,3%) y 70 (26,3%) para renales (73,7%). Un total de 42 pacientes (44,2%) pacientes recibieron música. No hubo diferencias entre las variables demográficas ni en las puntuaciones del cuestionario A. La satisfacción y el dolor fueron mejores en el cuestionario B con música. Conclusión: La música es capaz de disminuir el dolor y mejorar la satisfacción del paciente en los tratamientos con LEOC. Más estudios son necesarios para comprobar este efecto

Introduction: The objective of this study was to determine whether listening to music during a session of extracorporeal shockwave lithotripsy (ESWL) improves patients' pain. Material and method: A simple, blind randomisation was undertaken of patients with kidney and ureter stones attending an ESWL session of 7,000 waves for the first time, between September and December 2014. One group was given music and the other was not. The age, gender, location of stones (kidney/ureter) were recorded and 2 questionnaires: pre ESWL (questionnaire A) and postESWL (questionnaire B). Each questionnaire contained a question about anxiety and another question on pain on the Likert scale (0-10). Questionnaire B also had a question on satisfaction and comfort (Likert 0-10). Other variables included heart rate, respiratory rate, systolic and diastolic blood pressure on wave 2,000, 5,000 and 7,000, reason for halting the procedure, total pethidine (mg), secondary analgesia, energy (J) and frequency (Hz). Bivariate analysis using the Student's t-test, X2/Fisher test and a multiple linear regression model. Results: The sample comprised 95 patients, with a mean age of 52 (±13) years, 35 (36.84%) females, 60 (63.2%) males. A total of 25 (26.3%) ureter stones and 70 (73.7%) kidney stones. A number of 42 (44.2%) patients were given music. There were no differences between the demographic variables or questionnaire A scores. Satisfaction and pain were better on questionnaire B with music. Conclusion: Music can reduce pain and improve patient satisfaction in ESWL treatment. More studies are required to confirm this effect

Shockwave lithotripsy with music: Less painful and more satisfactory treatment. / Litotricia por ondas de choque con música: un tratamiento menos doloroso y más satisfactorio.

INTRODUCTION: The objective of this study was to determine whether listening to music during a session of extracorporeal shockwave lithotripsy (ESWL) improves patients' pain. MATERIAL AND METHOD: A simple, blind randomisation was undertaken of patients with kidney and ureter stones attending an ESWL session of 7,000 waves for the first time, between September and December 2014. One group was given music and the other was not. The age, gender, location of stones (kidney/ureter) were recorded and 2questionnaires: pre ESWL (questionnaire A) and postESWL (questionnaire B). Each questionnaire contained a question about anxiety and another question on pain on the Likert scale (0-10). Questionnaire B also had a question on satisfaction and comfort (Likert 0-10). Other variables included heart rate, respiratory rate, systolic and diastolic blood pressure on wave 2,000, 5,000 and 7,000, reason for halting the procedure, total pethidine (mg), secondary analgesia, energy (J) and frequency (Hz). Bivariate analysis using the Student's t-test, X2/Fisher test and a multiple linear regression model. RESULTS: The sample comprised 95 patients, with a mean age of 52 (±13) years, 35 (36.84%) females, 60 (63.2%) males. A total of 25 (26.3%) ureter stones and 70 (73.7%) kidney stones. A number of 42 (44.2%) patients were given music. There were no differences between the demographic variables or questionnaire A scores. Satisfaction and pain were better on questionnaire B with music. CONCLUSION: Music can reduce pain and improve patient satisfaction in ESWL treatment. More studies are required to confirm this effect.

Dietary lipids differentially modulate the initiation of experimental breast carcinogenesis through their influence on hepatic xenobiotic metabolism and DNA damage in the mammary gland.

Breast cancer is the most common malignancy among women worldwide. In addition to reproductive factors, environmental factors such as nutrition and xenobiotic exposure have a role in the etiology of this malignancy. A stimulating and a potentially protective effect on experimental breast cancer has been previously described for high corn oil and high extra-virgin olive oil diets, respectively. This work investigates the effect of these lipids on the metabolism of 7,12-dimethylbenz(a)anthracene (DMBA), a polycyclic aromatic hydrocarbon that can initiate carcinogenesis and its consequences in an experimental rat breast cancer model. The PUFA n-6-enriched diet increased expression of Phase I enzymes prior to DMBA administration and raised the activity of CYP1s in the hours immediately after induction, while reducing the activity of Phase II enzymes, mainly NQO1. The levels of reactive metabolites measured in plasma by GC-MS and DMBA-DNA adducts in the mammary gland of the animals fed the high corn oil diet were also higher than in the other groups. On the other hand, the high extra-virgin olive oil diet and the control low-fat diet exhibited better coordinated Phase I and Phase II activity, with a lower production of reactive metabolites and less DNA damage in the mammary gland. The concordance between these effects and the different efficacy of the carcinogenesis process due to the dietary treatment suggest that lipids may differently modify mammary gland susceptibility or resistance to cancer initiation over the exposure to environmental carcinogens. SUMMARY: Dietary lipids influence the initiation of DMBA-induced mammary cancer through the modulation of liver xenobiotic metabolism, formation of reactive metabolites and subsequent DNA damage in the target tissue.

Diets high in corn oil or extra-virgin olive oil differentially modify the gene expression profile of the mammary gland and influence experimental breast cancer susceptibility.

PURPOSE: Nutritional factors, especially dietary lipids, may have a role in the etiology of breast cancer. We aimed to analyze the effects of high-fat diets on the susceptibility of the mammary gland to experimental malignant transformation. METHODS: Female Sprague-Dawley rats were fed a low-fat, high-corn-oil, or high-extra-virgin olive oil (EVOO) diet from weaning or from induction. Animals were induced with 7,12-dimethylbenz[a]anthracene at 53 days and euthanized at 36, 51, 100 and 246 days. Gene expression profiles of mammary glands were determined by microarrays. Further molecular analyses were performed by real-time PCR, TUNEL and immunohistochemistry. Carcinogenesis parameters were determined at 105 and 246 days. RESULTS: High-corn-oil diet increased body weight and mass when administered from weaning. The EVOO diet did not modify these parameters and increased the hepatic expression of UCP2, suggesting a decrease in intake/expenditure balance. Both diets differentially modified the gene expression profile of the mammary gland, especially after short dietary intervention. Corn oil down-regulated the expression of genes related to immune system and apoptosis, whereas EVOO modified the expression of metabolism genes. Further analysis suggested an increase in proliferation and lower apoptosis in the mammary glands by effect of the high-corn-oil diet, which may be one of the mechanisms of its clear stimulating effect on carcinogenesis. CONCLUSIONS: The high-corn-oil diet strongly stimulates mammary tumorigenesis in association with modifications in the expression profile and an increased proliferation/apoptosis balance of the mammary gland.

Determination of trace element concentrations and stable lead, uranium and thorium isotope ratios by quadrupole-ICP-MS in NORM and NORM-polluted sample leachates.

This work focuses on the monitoring of the potential pollution in scenarios that involve NORM-related industrial activities (environmental or in-door scenarios). The objective was to develop a method to determine extent and origin of the contamination, suitable for monitoring (i.e. simple, fast and economical) and avoiding the use of too many different instruments. It is presented a radiochemical method that allows the determination of trace element concentrations and 206Pb/207Pb/208Pb, 238U/234U and 232Th/230Th isotope ratios using a single sample aliquot and a single instrument (ICP-QMS). Eichrom UTEVA® extraction chromatography minicolumns were used to separate uranium and thorium in sample leachates. Independent ICP-MS determinations of uranium and thorium isotope ratios were carried out afterwards. Previously a small aliquot of the leachate was used for the determination of trace element concentrations and lead isotope ratios. Several radiochemical arrangements were tested to get maximum performances and simplicity of the method. The performances of the method were studied in terms of chemical yields of uranium and thorium and removal of the potentially interfering elements. The established method was applied to samples from a chemical industry and sediments collected in a NORM-polluted scenario. The results obtained from our method allowed us to infer not only the extent, but also the sources of the contamination in the area.

Uranium pollution in an estuary affected by pyrite acid mine drainage and releases of naturally occurring radioactive materials.

After the termination of phosphogypsum discharges to the Huelva estuary (SW Spain), a unique opportunity was presented to study the response of a contaminated environmental compartment after the cessation of its main source of pollution. The evolution over time of uranium concentrations in the estuary is presented to supply new insights into the decontamination of a scenario affected by Naturally Occurring Radioactive Material (NORM) discharges. The cleaning of uranium isotopes from the area has not taken place as rapidly as expected due to leaching from phosphogypsum stacks. An in-depth study using various techniques of analysis, including (234)U/(238)U and (230)Th/(232)Th ratios and the decreasing rates of the uranium concentration, enabled a second source of uranium contamination to be discovered. Increased uranium levels due to acid mine drainage from pyrite mines located in the Iberian Pyrite Belt (SW Spain) prevent complete uranium decontamination and, therefore, result in levels nearly twice those of natural background levels.

Diets high in corn oil or extra-virgin olive oil provided from weaning advance sexual maturation and differentially modify susceptibility to mammary carcinogenesis in female rats.

Based on the importance of early-life events in breast cancer risk, we have investigated the effects of high-fat diets on maturation, mammary gland development, and its susceptibility to transformation. Female Sprague-Dawley rats were fed a lowfat (LF), high corn oil (HCO), or high extra-virgin olive oil (HOO) diet from weaning and gavaged with 7,12-dimethylbenz[a]anthracene. Body weight and mass increased in the HCO group compared to the LF group. The vaginal opening was advanced in both high-fat groups, especially in the HCO group. This HCO group also had increased body weight around puberty, more corpora lutea at post-puberty, and tended to have higher kisspeptin levels in the hypothalamus. Both high-fat diets induced subtle modifications in the morphology of the mammary gland, with no changes on ß-casein or hormone receptors expression in the gland. The HCO diet had a clearly stimulating effect of carcinogenesis, inducing the earliest appearance of tumors and the highest tumor incidence and yield, whereas the HOO diet seemed to have a weak enhancing effect, increasing tumor yield. Our data suggest a strong influence of the HCO diet in sexual maturation and mammary cancer risk, while rats fed the HOO diet were more similar to the controls.

Contamination and restoration of an estuary affected by phosphogypsum releases.

The Huelva Estuary in Huelva, Spain, has been one of the most studied environmental compartments in the past years from the point of view of naturally occurring radioactive material (NORM) releases. It has been historically affected by waste releases, enriched in radionuclides from the U-decay series, from factories located in the area devoted to the production of phosphoric acid and phosphate fertilizers. Nevertheless, changes in national regulations forced a new waste management practice in 1998, prohibiting releases of phosphogypsum into the rivers. The input of natural radionuclides from phosphate factories to rivers was drastically reduced. Because of this there was a unique opportunity for the study of the response of a contaminated environmental compartment, specifically an estuary affected by tidal influences, after the cessation of the contaminant releases to, in this case, the Huelva Estuary (henceforth referred to as the Estuary). To investigate the environmental response to this new discharge regime, the specific activities of radionuclides 226Ra and 210Pb in water and sediment samples collected in four campaigns (from 1999 to 2005) were determined and compared with pre-1998 values. From this study it is possible to infer the most effective mechanisms of decontamination for the Estuary. Decontamination rates of 210Pb and 226Ra in the sediments and water have been calculated using exponential fittings and corresponding half-lives have been deduced from them. The cleaning half-life in the whole area of the Estuary is about 6 and 3.5 years for 226Ra and 210Pb respectively. The observed trend clearly shows that contamination of the Estuary by natural radionuclides is now decreasing and radioactive levels in waters and sediments are approaching the natural background references. This work attempts to evaluate whether it can be expected that the decontamination of the enhanced levels of natural radioactivity in the Estuary can be performed via natural processes.

Food allergies, cross-reactions and agroalimentary biotechnologies.

The discrepancy between what the general public and specialist in allergic diseases regard as a true food allergy can in part depend on the frequent evidence of subjects in whom clinical symptoms elicited by a given food allergen are frequently not reproducible: this suggests the existence of allergens variably present in certain foods. In adults and older children common is a form of food allergy associated with inhaled allergens, especially pollens. In this allergic form pollens and various vegetal food often cross react but the underlying scientific rationale is largely unclear. From the study of the "latex-fruits allergic syndrome" and the "oral allergic syndrome" emerged that the cross reactivity depends on epitopes of pollens and vegetables belonging to one of the 14 classes of the "pathogenesis related proteins" (PRPs). Vegetables produce PRPs in response to infection or after plant injury or application of chemicals: long-term conservation and methods used for rapid artificial ripening of vegetables can cause plant to produce PRPs or other allergens. A genetic selection of vegetables "protecting themselves against infection and infestation" by mean of PRPs production is practiced in agroalimentary biotechnology. We deem it urgent that the two realms, Medical Science (Allergology) and Agricultural Biotechnology begin to communicate openly in order to produce food as efficiently as possible but without harming the large part of the population which is predisposed to allergy and react to PRPs.

[Comparative study between tobramicin and tobramicin plus ciprofloxacin in transrectal prostate biopsy prophylaxis]. / Estudio comparativo entre tobramicina y tobramicina más ciprofloxacino como profilaxis para la biopsia transrectal de próstata.

INTRODUCTION AND OBJECTIVES: To compare the efficacy of tobramicin and tobramicin + ciprofloxacin for prevention of transrectal prostatic biopsy infectious complications. We revised our complications, microorganism most common in the infectious complications, and their sensibility. MATERIAL AND METHODS: Prospective and randomized study in 153 patients with 157 prostatic biopsies. The 71 patients in group A were treated with intramuscular tobramicin 100 mg, one dose 30 minutes before biopsy and another one 8 hours afterwards. The 85 patients in group B were treated with the same tobramicin doses and oral ciprofloxacin 500 mg, one dose 30 minutes before biopsy and afterwards they continue with the ciprofloxacin every 12 hours during 3 days. RESULTS: we did 71 biopsies in group A and 86 in group B. 50 (31,8%) patients had hematuria, 20 (12,7%) fever, 15 (9,5%) hemospermia, 7 (4,4%) perineal pain, one (1,2%) orchiepididymitis and another one (1,2%) urinary retention. The patients who had fever were 15 of the group A and 5 of the group B (p=0,004). A total of 15 (21,1%) patients with fever of the group A needed to be treated in the hospital and 3 patients (3,5%) of the group B (p=0,0006). E. coli growthed in 67% of the blood cultures and amoxicillin-clavulanic, tobramicin and third generation of cephalosporins were the antibiotics more eficacious. CONCLUSIONS: Prophylaxis scheme with tobramicin plus ciprofloxacin was more efficacy that tobramicina alone in transrectal prostatic biopsy. Hematuria was the most common complication. E. coli was the microorganism most frequent in infectious complications after prostatic biopsy and amoxicillin-clavulanic, tobramicin and third generation of cephalosporins the most effective antibiotics in our hospital.

Estudio comparativo entre tobramicina y tobramicina más ciprofloxacino como profilaxis para la biopsia transrectal de próstata / Comparative study between tobramicin and tobramicin plus ciprofloxacin in transrectal prostate biopsy prophylaxis

Introducción y Objetivos: Estudio de eficacia en la prevención de complicaciones infecciosas tras biopsia transrectal de próstata. Revisión de las complicaciones infecciosas y microorganismo implicados. Material y métodos: Estudio prospectivo y aleatorizado en 153 pacientes en los que se realizaron 157 biopsias de próstata. El Grupo A (71 pacientes) recibieron tobramicina 100 mg una dosis intravenosa media hora antes de la biopsia y otra intramuscular a las 8 horas de la primera, y los del Grupo B (85 pacientes) recibieron el mismo esquema de tobramicina y añadiendo ciprofloxacino oral 500 mg media hora antes de la biopsia continuando luego con una dosis cada 12 horas durante tres días. Resultados: en el Grupo A se realizaron 71 biopsias y en el Grupo B 86. 50 pacientes (31,8%) presentaron hematuria, 20 (12,7%) fiebre, 15 (9,5%) hemospermia, 7 (4,4%) dolor perineal, uno (1,2%) orquiepididimitis y otro (1,2%) retención urinaria. De los pacientes con fiebre 15 pertenecen al grupo A y 5 al grupo B (p=0,004). Ingresaron por fiebre 15 (21,1%) pacientes del grupo A y 3 (3,5%) del grupo B (p=0,0006). En el 67% de los hemocultivos se aisló E. Coli. Conclusiones: La pauta profiláctica consistente en tobramicina más ciprofloxacino resultó ser más eficaz en la prevención de ingresos por fiebre post-biopsia que la tobramicina sola. La complicación más frecuente fue la hematuria. El microorganismo más frecuentemente fue E. Coli sensible, en nuestro hospital, a amoxicilina-clavulánico, tobramicina y cefalosporinas de tercera generación

Introduction and objectives: To compare the efficacy of tobramicin and tobramicin + ciprofloxacin for prevention of transrectal prostatic biopsy infectious complications. We revised our complications, microorganism most common in the infectious complications, and their sensibility. Material and methods: Prospective and randomized study in 153 patients with 157 prostatic biopsies. The 71 patients in group A were treated with intramuscular tobramicin 100 mg, one dose 30 minutes before biopsy and another one 8 hours afterwards. The 85 patients in group B were treated with the same tobramicin doses and oral ciprofloxacin 500 mg, one dose 30 minutes before biopsy and afterwards they continue with the ciprofloxacin every 12 hours during 3 days. Results: we did 71 biopsies in group A and 86 in group B. 50 (31,8%) patients had hematuria, 20 (12,7%) fever, 15 (9,5%) hemospermia, 7 (4,4%) perineal pain, one (1,2%) orchiepididymitis and another one (1,2%) urinary retention. The patients who had fever were 15 of the group A and 5 of the group B (p=0,004). A total of 15 (21,1%) patients with fever of the group A needed to be treated in the hospital and 3 patients (3,5%) of the group B (p=0,0006). E. coli growthed in 67% of the blood cultures and amoxicillin-clavulanic, tobramicin and third generation of cephalosporins were the antibiotics more eficacious. Conclusions: Prophylaxis scheme with tobramicin plus ciprofloxacin was more efficacy that tobramicina alone in transrectal prostatic biopsy. Hematuria was the most common complication. E.coli was the microorganism most frequent in infectious complications after prostatic biopsy and amoxicillin-clavulanic, tobramicin and third generation of cephalosporins the most effective antibiotics in our hospital

Chromatographic and electrochemical determination of quercetin and kaempferol in phytopharmaceuticals.

An NP-HPLC method both with diode-array (DAD) and electrochemical detection (ED) was developed and validated for the determination of quercetin and kaempferol, the principal active constituents in phytopharmaceuticals of Ginkgo Biloba. Calculated retention of the two flavonoids was contrasted with experimental values in five different reversed phase columns for methanol-water, acetonitrile-water, THF-water and dioxane-hexane binary mixtures as mobile phases. The capacity factor k, selectivity alpha and asymmetry factor F were evaluated and compared in DAD-RP-HPLC, DAD-NP-HPLC, ED-RP-HPLC and ED-NP-HPLC. The methods were used for the quantitative analysis of acid hydrolyzed extracts of tablet phytopharmaceuticals. Calibration curves were linear within the range 10 and 40 microg ml(-1) for the DAD and 10-270 microg ml(-1) for the ED, whereby limits of detection ranged from 0.5 microg ml(-1) (quercetin) to 0.1 microg ml(-1) (kaempferol). The electrochemical method based on differential pulse voltammetry (DPV) with a C-PVC electrode resolved the quercetin and kaempferol peaks and exhibited a two orders higher sensitivity in comparison with a carbon fiber electrode. DPV calibration curves were linear within the range 96-300 microg ml(-1) for quercetin and 68-960 microg ml(-1) for kaempferol. The respective oxidation peaks appeared at 462 and 518+/-2 mV and were used in the direct determination of quercetin in extracts of commercial phytopharmaceuticals.

[Bone complications of renal transplantation. How to identify and prevent them]. / Le complicanze ossee del trapianto renale. Come identificarle e prevenirle.

Bone disease is a very frequent complication after renal transplantation (RTx). The main features of transplant bone disease include the osteopenic-osteoporotic syndrome, often complicated by fractures, avascular osteonecrosis of bones, bone pain syndrome and growth retardation in the children. The bone loss is greater during the first 12 months after RTx and can reach the osteoporotic range in above 40% of patients, with a fracture rate of 2-3% per year. The story of bone disease over the long pre-uremic and uremic period is one of the main causal factors. After RTx, glucocorticoid therapy seems to play the major causal role. Much more disputed is the role of the other immunosuppressive drugs, of persistent secondary hyperparathyroidism, and age. Hypophosphatemia and some genetic factors could also affect bone loss after RTx. Diabetic patients are particularly prone to develop bone disease after RTx. The main prophylactic interventions consist in the optimal control of hyperparathyroidism during the pre-transplant period, prescribing parathyroidectomy for autonomous hyperparathyroidism, not-responding to medical therapy. After RTx, both bisphosphonate and vitamin D metabolites, variably associated with calcium supplementation, have been demonstrated to have some beneficial effect on bone loss, at least in the first year after RTx. However, there are no data about the possible efficacy of these treatments on fracture rate.

Gender difference in the pancreatic trypsinogen response to ethanol withdrawal in rat pups.

This study was designed to examine the effects of ethanol withdrawal on offspring rats that consumed ethanol during gestation and lactation, in order to examine whether there was an improvement in pancreatic trypsinogen and lipase activities at 2 months postpartum with respect to offspring that fed on ethanol until death. A second purpose for our study was to determine if a folic acid supplement during gestation and lactation was sufficient or insufficient to reverse the negative effects of ethanol consumption. Both genders were used with the aim of investigating any differential pancreatic behaviour. The animals were randomized into five groups: the control group (CG) received water and a basic rat diet during pregnancy, lactation and growth; the ethanol group (EG) was fed an ethanol diet during pregnancy, the suckling period and growth until death; the ethanol-water group's (E+WG) ethanol was eliminated after lactation; The ethanol-folic acid group (E+FG) received a folic acid supplemented diet during pregnancy and the suckling period and in the ethanol+folic acid group (E+FG+FG) this supplementation continued during growth. Our results showed that ethanol administration or ethanol withdrawal did not significantly alter lipase activity in the pancreas. Ethanol administration decreased trypsinogen levels in the pancreas of males and females. However, in males, as opposed to females, the withdrawal of ethanol did not recover the values of pancreatic trypsinogen content, nor did a folic acid supplementation significantly alter the parameters we studied. Our treatment produced no effect on lipase levels. There was a gender-related difference in pancreatic trypsinogen content, the implication being that in future all results on exocrine pancreas function in male and female animals should be analysed separately.

Esophagogastric dissociation versus fundoplication: Which is best for severely neurologically impaired children?

PURPOSE: Neurologically impaired children (NIC) often have swallowing difficulties, severe gastroesophageal reflux, recurrent respiratory infections, and malnutrition. Bianchi proposed esophagogastric dissociation (EGD) as an alternative to fundoplication and gastrostomy. The authors compared these 2 approaches. METHODS: Twenty-nine consecutive symptomatic NIC refractory to medical therapy were enrolled in a prospective study and divided into 2 groups: A (n = 12), NIC who underwent fundoplication and gastrostomy; B (n = 14), NIC who underwent EGD. Three were excluded because of previous fundoplication. Anthropometric (percentage of the 50th percentile/age of healthy children) and biochemical parameters, respiratory infections per year, hospitalization (days per year), feeding time (minutes), and "quality of life" (parental psychological questionnaire, range 0 to 60), were analyzed (t test and Mann-Whitney test) preoperatively and 1 year postoperatively. Complications were recorded. RESULTS: Compared with group A, group B presented a statistically significant increase of all anthropometric and nearly all biochemical parameters with a statistical difference in terms of respiratory infections, hospital stay, feeding time, and psychological questionnaire. In group A, 2 bowel obstructions, 1 tight fundoplication, 1 dumping syndrome, and 3 failures of fundoplication occurred. Group B presented 1 anastomotic stricture, 1 paraesophageal hernia, and 1 bowel obstruction. CONCLUSIONS: Compared with fundoplication and gastrostomy, EGD offered better nutritional rehabilitation, reduction in respiratory infections, and improved quality of life. EGD can be rightfully chosen as a primary procedure.

Bacillary disease and health seeking behavior among Filipinos with symptoms of tuberculosis: implications for control.

SETTING: Urban and rural communities and urban poor settlements in the Philippines. OBJECTIVE: To determine bacillary disease and action taking among individuals with symptoms of tuberculosis (TB), and to analyze their implications for TB control. STUDY DESIGN AND METHOD: Subjects aged 20 years and older were interviewed in the 1997 nationwide stratified multi-cluster survey. Sputum acid-fast smears and cultures were done in subjects with abnormal screening chest radiographs. RESULTS: Individuals with TB symptoms comprised 18.1% of the population studied. The prevalence of bacillary disease was 39/1000 in symptomatic subjects compared to 13/1000 in asymptomatic subjects. Symptom screening had a 14.3% positive predictive value and a 91.4% negative predictive value for bacillary disease. Significantly more symptomatic than asymptomatic subjects attended chest radiographic screening during the survey. However, in response to their symptoms, the majority (43.0%) took no action or self medicated (31.6%), while 11.8% consulted a private practitioner, 7.5% a public health center, 4.4% a hospital, and 1.7% a traditional healer. CONCLUSION: Sputum smear examination after symptom screening was acceptable for case finding. The health seeking behavior of subjects with TB symptoms was inappropriate. A health education program and public-private collaboration in directly observed therapy, short course (DOTS) are essential for TB control in the Philippines.

In vitro photoinhibition by psoralen and ultraviolet A radiation of human hematopoietic progenitors.

The in vitro sensitivity of human hematopoietic progenitors to PUVA, 8-MOP and UVA alone was investigated. 8-MOP alone at final concentrations of 150, 200, 600 and 1,000 ng/ml did not modify colony growth of circulating and bone marrow erythroid (BFU-E), myeloid (CFU-GM) and immature (CFU-GEMM) hematopoietic progenitors obtained from normal controls. The exposure of the same progenitors to increasing doses of UVA, up to 12 J/cm2, progressively decreased hematopoietic colony growth (with estimated 50% inhibition occurring at about 5 J/cm2). In vitro PUVA treatment (8-MOP 200 ng/ml followed by UVA 5 J/cm2) caused 90% growth inhibition of circulating and bone marrow hematopoietic progenitors. In addition, the treatment completely inhibited the formation of spontaneous erythroid colonies, obtained from 5 polycythemic patients, that are considered to be a marker of this neoplastic disease. PUVA cytotoxicity was assessed by the colorimetric MTT assay. The percentage of cell death after PUVA exposure was 29 +/- 10% for both peripheral and bone marrow mononuclear cells. Our findings indicate that 8-MOP alone is not toxic to hematopoietic progenitors whereas UVA treatment determines in vitro a dose-dependent inhibition of the clonogenic capacity of normal hematopoietic cells. PUVA treatment enhances this effect, causing a quite complete inhibition of hematopoietic progenitors colony formation from normal donors and spontaneous BFU-E colony formation from polycythemic patients.