Live biotherapeutic products and their regulatory framework in Italy and Europe.

In Italy and Europe, live microorganisms-containing products meant to be used by vulnerable or sick people for preventing or curing a disease are defined as live biotherapeutic products and are regulated as biological drugs. As such, they must undergo extensive quality, safety and efficacy testing and evaluation before receiving a marketing authorization. This review describes the regulatory framework of live biotherapeutic products with special focus on the European Pharmacopoeia monograph 3053 that set mandatory requirements for this kind of medicines, including verification of the number of live microorganisms and absence of certain contamination indicator microorganisms. The other product categories that may contain live microorganisms are also described, with brief references to the overlaps possibly occurring between the different categories.

Biological activity of native Myrtaceae fruits from Chile as a potential functional food.

Myrtaceae fruits (Myrceugenia obtusa, Luma apiculata, and Luma chequen) were used as food and medicine by Chilean indigenous people. This study aimed to evaluate the bioactive properties of these berry-type fruits. The antioxidant capacity determined by the FRAP assay varied between 10.4 and 646.9 mmol Fe+2/g, while the antibacterial activity against Staphylococcus aureus and Salmonella typhi was 0 - 33 mm and 0 - 7.33 mm, respectively. All the extracts were rich in polyphenols and showed low cytotoxicity. Overall, M. obtusa presented dissimilar results compared to those of L. apiculata and L. chequen, encouraging the use of these native fruits as food, nutraceutical, or pharmacological ingredients.

Growth alteration of Allium cepa L. roots exposed to 1.5 mT, 25 Hz pulsed magnetic field.

The response of plants to magnetic fields (MF) is not fully understood. This work studies the effects of pulsed MF on the germination and growth of Allium cepa roots. Onions were exposed to 25Hz, 1.5mT, 33h. Pulsed MF was generated by a Helmholtz-type equipment that generated rectangular voltage pulses. The results showed that fewer roots grew in the specimens exposed to pulsed MF (14±6 roots on day 1 to 21±8 on day 4) than in the control groups (32±17 to 48±23) (p<0.05 Friedman). Control specimens showed a root mean length of 7±4 mm (day 1) and 24±10 mm (day 4). The specimens treated with pulsed MF showed a length of 4±2 mm (day 1), reaching 18±9 mm on day 4 (p<0.001 ANOVA). In conclusion, the exposure of Allium cepa specimens to 25Hz, 1.5mT pulsed MF during 33h produces a decrease in the germination and growth of roots.

Antibacterial potential assessment of Nalca (Gunnera tinctoria Mol.) ethanolic extracts.

Nalca is an edible rhubarb-type plant from the southern of Chile; with studies focussing on petiole chemical and biological properties. This work evaluated for the first time the antibacterial capacities of three organs of nalca against Escherichia coli, Staphylococcus aureus and Pseudomonas aeruginosa. Petiole (P), root (R) and flower (F) ethanolic extracts at three different concentrations (25, 50, 100 mg/mL) were evaluated by means of agar diffusion assay and MIC. The result showed that antibacterial activities are bacteria and concentration dependent, with root having the highest antimicrobial activity of the organs plant studied. Compared to commercial antibiotics, nalca extracts show promising control over Ps. aeruginosa. The main polyphenolics of the extracts were identified by UPLC-MS/MS, observing for the first time caffeic, coumaric and gallic acids presence in all samples, with quercetin and rutin determined in petiole and flower extracts only. Our results contribute to better understanding of nalca attributes as potential source of antibacterial compounds to be used in nutraceutical, cosmetic and food industry.

Hepatoprotective species from the Chilean medicinal flora: Junellia spathulata (Verbenaceae).

ETHNOPHARMACOLOGICAL RELEVANCE: Chilean population relies on medicinal plants for treating a wide range of illnesses, especially those of the gastrointestinal system. Junellia spathulata (Gillies & Hook.) Moldenke var. spathulata (Verbenaceae), called as "verbena-azul-de-cordilleira", is a medicinal plant native to Argentina and Chile traditionally used for treating digestive disorders. Although the species of the genus are important as therapeutic resources for the Andean population, the plants are very scarcely studied. AIMS OF THE STUDY: The purpose of the present study was to find out the main constituents and investigate the protective effect of J. spathulata against oxidative stress induced by the potent oxidant 2,2'-azobis (2-amidinopropane) dihydrochloride (AAPH) in human hepatoblastoma cells. MATERIALS AND METHODS: The crude methanol extract of J. spathulata and an iridoid obtained by chromatographic processes were tested to access the hepatoprotective effect and cytotoxicity in HepG2 cell. In addition, the reducing power of the samples and their ability to scavenge free radicals were evaluated using FRAP and ORAC assay systems. RESULTS: The iridoid asperuloside, the main compound of the crude methanol extract of J. spathulata, was isolated and identified by means of NMR analysis. The crude methanol extract of J. spathulata and asperuloside protected HepG2 cells against oxidative damage triggered by AAPH-derived free radicals. This effect can be credited to the ability of the extract and asperuloside to protect the liver cells from chemical-induced injury, which might be correlated to their free radical scavenging potential. CONCLUSIONS: This study experimentally evidenced the ethnopharmacological usefulness of J. spathulata as a treatment of digestive disorders. Our result could stimulate further investigations of hepatoprotective agents in other Chilean Junellia species.

Inclusion of different levels of inulin on productive parameters and intestinal morphology in fattening guinea pigs (Cavia porcellus) / Efeito da inclusão de diferentes níveis de inulina nos parâmetros produtivos e na morfologia intestinal em cobaias de engorda (Cavia porcellus)

ABSTRACT: This study evaluated the effect of the three inulin levels (0.1%, 0.2%, 0.4%) supplemented as a substitute for an antibiotic growth promoter (AGP, zinc bacitracin) and control in guinea pigs raised for human consumption. Fifty 14-day-old male guinea pigs were used. Productive parameters (weight gain, total dry matter intake, and feed conversion ratio (FCR)) and intestinal morphology of the duodenum, jejunum, and ileum at slaughter (70 days of age) were evaluated. An inverse relationship was observed between inulin levels and FCR (linear effect; P = 0.006). There was no statistically significant effect of the treatments on total dry matter intake and weight gain (P > 0.05). A linear effect of the inulin level on the villi's length (VL), villi's width (VW), and length/depth ratio (VL/DC) in the duodenum; VW in the jejunum; and VL in the ileum (P <0 .05) was reported. In conclusion, a linear effect of the increasing doses of inulin was found on the FCR and the morphological parameters of the duodenum's integrity, and no differences in the effects of the inulin added to the diet and the treatment with AGP were found.

RESUMO: O objetivo do estudo foi avaliar o efeito da suplementação na dieta de cobaias com inulina, em níveis crescentes (0,1%, 0,2%, 0,4%) como substituto para um antibiótico promotor de crescimento (AGP, bacitracina de zinco) além do grupo controle (dieta padrão). Foram utilizados 50 porquinhos-da-índia machos com 14 dias de idade. Os parâmetros produtivos foram avaliados do desmame aos 70 dias de idade e os parâmetros morfológicos intestinais foram avaliados no duodeno, jejuno e íleo no momento do abate. Foi encontrado um efeito linear do nível de inulina sobre na taxa de conversão alimentar (FCR; P = 0,006), indicando que em níveis mais elevados de inulina o FCR diminui. Não houve diferença significativa entre os grupos quando avaliado o efeito dos diferentes tratamentos sobre o consumo de ração e ganho de peso corporal (P > 0,05). Um efeito linear do nível de inulina foi encontrado no comprimento das vilosidades (VL), na largura das vilosidades (VW) e na relação comprimento / profundidade (VL/DC) no duodeno, sobre a VW no jejuno; e no VL no íleo (P < 0,05). Em conclusão, um efeito linear do aumento do nível de inulina foi encontrado na taxa de conversão alimentar e nos parâmetros morfológicos da integridade do duodeno, além disso, não houve diferença entre a adição de inulina na dieta e o tratamento com um antibiótico promotor de crescimento.

Determining the Effect of Postharvest Cold Storage Treatment on the Survival of Immature Drosophila suzukii (Diptera: Drosophilidae) in Small Fruits.

We evaluated the effect of postharvest cold storage temperature (0.0-2.2°C) and duration (3-5 d) on pupal emergence of single life stage populations of laboratory-generated Drosophila suzukii (Matsumura) and mixed-age populations collected in the field from blackberries, blueberries, strawberries, and raspberries. For field-infested fruit, cold storage at any temperature and duration resulted in less pupal emergence compared with the control held at 20°C, but D. suzukii subjected to higher temperatures and shorter storage durations in caneberries had higher survival. When a single life stage of D. suzukii was exposed to cold storage, pupal emergence was significantly reduced across all fruit types held at 0°C and for most life stages and fruit types held at 1.5 and 2.2°C, dependent on the substrate. Freshly laid eggs exposed to cold storage produced the lowest pupal emergence. Our results suggest using cold storage treatment is an effective postharvest management strategy for small-fruit growers to use on-farm as part of an integrated program to manage D. suzukii infestation. An economic assessment was made to examine the profit implications of an investment in cold storage units to counter pest pressure. Results suggest that investment in a cold storage unit would breakeven in about 4 yr. On farms that already have cold storage installed, we estimated a $0.11/kg decrease in blueberry market price for holding fruit for 3 d. Together, this cost assessment will provide growers with the knowledge to make decisions based on infestation risk and the seasonal sale price of blueberries.

In Vivo Metabolic Regulation of Alternative Oxidase under Nutrient Deficiency-Interaction with Arbuscular Mycorrhizal Fungi and Rhizobium Bacteria.

The interaction of the alternative oxidase (AOX) pathway with nutrient metabolism is important for understanding how respiration modulates ATP synthesis and carbon economy in plants under nutrient deficiency. Although AOX activity reduces the energy yield of respiration, this enzymatic activity is upregulated under stress conditions to maintain the functioning of primary metabolism. The in vivo metabolic regulation of AOX activity by phosphorus (P) and nitrogen (N) and during plant symbioses with Arbuscular mycorrhizal fungi (AMF) and Rhizobium bacteria is still not fully understood. We highlight several findings and open questions concerning the in vivo regulation of AOX activity and its impact on plant metabolism during P deficiency and symbiosis with AMF. We also highlight the need for the identification of which metabolic regulatory factors of AOX activity are related to N availability and nitrogen-fixing legume-rhizobia symbiosis in order to improve our understanding of N assimilation and biological nitrogen fixation.

Histochemical Analysis of Anthocyanins, Carotenoids, and Flavan-3-ols/Proanthocyanidins in Prunus domestica L. Fruits during Ripening.

As a result of the high variability of fruit properties in the European plum Prunus domestica, a histochemical analysis of fruits at different stages of development was performed to understand the ripening process in cv. 'Colora' (yellow-red skinned) and cv. 'Topfive' (purple skinned). Histological analysis showed that carotenoids in the fruit had two different origins. In the fruit flesh, they derived from chloroplasts that turned into chromoplasts, whereas carotenoids in the fruit skin derived probably from proplastids. Flavan-3-ols and proanthocyanidins showed differential localization during ripening. They were visible in the vacuole in different fruit tissues or organized in tannosomes in the fruit flesh. Tanninoplasts were observed only in hypodermal cells of 'Colora'. Toward maturity, anthocyanins were detected in the epidermis and later in the hypodermis of both cultivars. The study forms a basis for the analysis of the biosynthesis of secondary metabolites in European plums and their biological effects.

The Influence of Health Messages in Nudging Consumption of Whole Grain Pasta.

Health messages may be an important predictor in the selection of healthier food choices among young adults. The primary objective of our study is to test the impact of labeling whole grain pasta with a health message descriptor displayed at the point-of-purchase (POP) on consumer choice in a campus dining setting. The study was conducted in a large US college dining venue during lunch service; data were collected during a nine-week period, for a total of 18 days of observation. Each day, an information treatment (i.e., no-message condition; vitamin message; fiber message) was alternated assigned to whole grain penne. Over the study period, the selection of four pasta options (white penne, whole grain penne, spinach fettuccine, and tortellini) were recorded and compiled for analysis. Logistic regression and pairwise comparison analyses were performed to estimate the impact of health messages on diners' decisions to choose whole grain penne among the four pasta types. Our results indicate that only the message about vitamin benefits had a significant effect on this choice, with a 7.4% higher probability of selecting this pasta than the no-message condition and 6.0% higher than the fiber message condition. These findings suggest that psychological health claims (e.g., reduction of fatigue) of whole grains seem more attractive than physiological health claims (e.g., maintaining a healthy weight) for university students. In line with the 2015-2020 Dietary Guidelines for Americans, our results suggest that small changes made at the POP have the potential to contribute to significant improvements in diet (e.g., achieving recommended levels of dietary fiber). These findings have important implications for food service practitioners in delivering information with the greatest impact on healthy food choices.

Prediction Model for Choosing Needle Length to Minimize Risk of Median Nerve Puncture With Dry Needling of the Pronator Teres.

OBJECTIVE: The aim of this study was to relate forearm anthropometric measures to ultrasound pronator teres depth to determine the necessary needle length to prevent median nerve (MN) injury during pronator teres dry needling. METHODS: We conducted a study employing a diagnostic accuracy prediction model (NCT03308279) at a Spanish university center. The study recruited 65 participants to predict the depth of the MN (measured with ultrasound) in the pronator teres using a decision tree algorithm to reduce the risk of MN puncture using 2 needle lengths (13 mm or 25 mm). The decision tree was developed by automatically selecting a cutoff for body mass index, forearm length and circumference, and pronator teres thickness. RESULTS: For forearm circumferences ≤27.5 cm, the predictive value for the 13-mm needle was 92%. For forearm circumferences >27.5 cm and forearm lengths ≤26.75 cm, the predictive value for the 25-mm needle was 100%. CONCLUSION: Based upon the findings of this study, we suggest that needle length should be selected according to forearm anthropometric measures to prevent MN injury during pronator teres dry needling.

Comparison of a Traditional and Novel Evoked Compound Action Potentials Recording Approach and Evoked Auditory Brainstem Responses in Pediatric Cochlear Implants Users.

OBJECTIVES: Electrically evoked compound action potentials (eCAP) recordings are widely used in functional evaluation and fitting of cochlear implants (CI) in clinics. We compared the results from two eCAP recording approaches (StandardART and FineGrain, MED-EL, Austria). The FineGrain method is more advanced than the Auditory Nerve Response Telemetry (StandardART) method in terms of the stimulation and algorithm for the eCAP threshold detection. To understand the benefits of these alterations, we compared the two methods on a larger scale in pediatric CI users alongside evoked auditory brainstem responses (eABR). MATERIALS AND METHODS: We collected the eCAP recordings obtained with both methods from a population of pediatric subjects with CI, either intra- or post-operatively. The eABR recordings were only collected post-operatively. For comparability reasons, we used the same stimulation rate and similar amplitude levels for all three approaches. RESULTS: Our results demonstrate that, although the success rates are similar, the FineGrain method outperforms traditional StandardART in terms of robustness and measurement duration. The eCAP recordings in general outperform the eABR in terms of speed. CONCLUSION: We conclude that the eCAP recordings are the method of choice for measuring the auditory neural activity, and FineGrain outperforms StandardART. From the three investigated approaches, we conclude that FineGrain performed best and should be the first-choice method in pediatric patients.

Effects of a strength protocol combined with electrical stimulation on patellar tendinopathy: 42 months retrospective follow-up on 6 high-level jumping athletes.

STUDY DESIGN: A retrospective study. INTRODUCTION: Patellar tendinopathy (PT) or jumper's knee (JK) in elite athletes is a challenging condition for sports medicine professionals. This study analyzes the development of a protocol using eccentric, isometric, concentric exercises, and electrostimulation to treat elite athletes suffering from JK. The semiannual strength protocol was completed during a total of 36 months by six high-level jumping athletes with chronic painful JK. Pain during patellar tendon loading activity was evaluated on a visual analogue pain scale (VAS). Upon protocol completion, promising clinical results were evidenced by significant pain reduction during tendon loading activity. MATERIAL AND METHODS: Six high level jumping athletes with chronic painful JK completed a semiannual strength program using eccentric, isometric, concentric and electrical stimulation exercises. The protocol was done 12 weeks in the winter pre-season and 10 weeks in the summer pre-season, for altogether 36 months, with an interruption of the protocol at 24 months for 6 months. Pain during patellar tendon loading activity was evaluated on a visual analogue pain scale (VAS), before the first session and then every 6 months, coinciding with the competitive phase, the time of maximum pain. RESULTS: There was a significant (p < 0.01) decrease in the VAS from start to the 18, 24 and 48 months follow-ups. CONCLUSIONS: In a small group of high level jumping athletes with chronic painful JK, a strength protocol combined with electrical stimulation showed promising clinical results with significant pain reduction during tendon loading activity.

Decoupling of soil nutrient cycles as a function of aridity in global drylands.

The biogeochemical cycles of carbon (C), nitrogen (N) and phosphorus (P) are interlinked by primary production, respiration and decomposition in terrestrial ecosystems. It has been suggested that the C, N and P cycles could become uncoupled under rapid climate change because of the different degrees of control exerted on the supply of these elements by biological and geochemical processes. Climatic controls on biogeochemical cycles are particularly relevant in arid, semi-arid and dry sub-humid ecosystems (drylands) because their biological activity is mainly driven by water availability. The increase in aridity predicted for the twenty-first century in many drylands worldwide may therefore threaten the balance between these cycles, differentially affecting the availability of essential nutrients. Here we evaluate how aridity affects the balance between C, N and P in soils collected from 224 dryland sites from all continents except Antarctica. We find a negative effect of aridity on the concentration of soil organic C and total N, but a positive effect on the concentration of inorganic P. Aridity is negatively related to plant cover, which may favour the dominance of physical processes such as rock weathering, a major source of P to ecosystems, over biological processes that provide more C and N, such as litter decomposition. Our findings suggest that any predicted increase in aridity with climate change will probably reduce the concentrations of N and C in global drylands, but increase that of P. These changes would uncouple the C, N and P cycles in drylands and could negatively affect the provision of key services provided by these ecosystems.

Subproductos de papa en la alimentación estratégica de ovinos durante la estación seca en el valle del Mantaro / Potato by products for sheep strategic feeding during the dry season in the Mantaro valley

Se evaluó el efecto de niveles crecientes de suplementación con subproducto de papa sobre la ganancia de peso vivo en ovinos. Se usó 120 ovinos Junín (69 hembras y 51 machos) en un arreglo factorial de 5 tratamientos x 2 sexos. Un tratamiento fue de solo pastoreo por 8 h y los otros cuatro fueron de 4 h/día de pastoreo más rastrojo de maíz amonificado (550 g/animal (día) con adición de 0, 200, 400 y 600 g/ovino/día de subproducto de papa para un periodo de engorde de 24 días. La respuesta en ganancia de peso a la suplementación con subproducto de papa fue mayor para ovinos machos (p<0.01), en los cuales el patrón de respuesta para los niveles crecientes de subproducto de papa fue de tipo cuadrático (p<0.05), y donde un nivel de 570 g de subproducto de papa dio ganancias de peso e índices económicos similares a los del sistema pastoril (8 h/día). Se concluye que la inclusión de subproducto de papa en niveles de 570 g/ovino/día a dietas de pastoreo restringido (4 h/día) más rastrojo de maíz amonificado es una estrategia de alimentación viable y económica para engordar ovinos machos durante la estación seca en la Sierra peruana.

The effect of increasing levels of supplementation with potato by-products on sheep body weight gain was evaluated. It was used 120 Junín sheep (69 female and 51 male) in a 2 x 5 factorial arrangement (two sexes x 5 feeding types). One treatment was 8 h/day ofgrazing and other four with addition of 0, 200, 400 and 600 g of potato by-products over ammoniated corn crop residue basal diet on 4-h a day grazing system for 24 days. Body weight gain was higher in males (p<0.01) in which the response pattern to the increasing levels of potato by-products supplementation was quadratic (p<0.01), and the level of570 g of potato by-products gave a biological and economic performance similar to the full (8-h a day) grazing system. Data suggested that the inclusion of 570 g of potato by-products on ammoniated corn crop residues is a practical and economical feeding strategyfor fattening male sheep on a 4-h a day restricted grazing regime during the dry season in the Peruvian highlands.

N-acetylcysteine, coenzyme Q10 and superoxide dismutase mimetic prevent mitochondrial cell dysfunction and cell death induced by d-galactosamine in primary culture of human hepatocytes.

D-Galactosamine (D-GalN) induces reactive oxygen species (ROS) generation and cell death in cultured hepatocytes. The aim of the study was to evaluate the cytoprotective properties of N-acetylcysteine (NAC), coenzyme Q(10) (Q(10)) and the superoxide dismutase (SOD) mimetic against the mitochondrial dysfunction and cell death in D-GalN-treated hepatocytes. Hepatocytes were isolated from liver resections. NAC (0.5 mM), Q(10) (30 microM) or MnTBAP (Mn(III)tetrakis(4-benzoic acid) porphyrin chloride (1mg/mL) were co-administered with D-GalN (40 mM) in hepatocytes. Cell death, oxidative stress, mitochondrial transmembrane potential (MTP), ATP, mitochondrial oxidized/reduced glutathione (GSH) and Q(10) ratios, electronic transport chain (ETC) activity, and nuclear- and mitochondria-encoded expression of complex I subunits were determined in hepatocytes. d-GalN induced a transient increase of mitochondrial hyperpolarization and oxidative stress, followed by an increase of oxidized/reduced GSH and Q(10) ratios, mitochondrial dysfunction and cell death in hepatocytes. The cytoprotective properties of NAC supplementation were related to a reduction of ROS generation and oxidized/reduced GSH and Q(10) ratios, and a recovery of mitochondrial complexes I+III and II+III activities and cellular ATP content. The co-administration of Q(10) or MnTBAP recovered oxidized/reduced GSH ratio, and reduced ROS generation, ETC dysfunction and cell death induced by D-GalN. The cytoprotective properties of studied antioxidants were related to an increase of the protein expression of nuclear- and mitochondrial-encoded subunits of complex I. In conclusion, the co-administration of NAC, Q(10) and MnTBAP enhanced the expression of complex I subunits, and reduced ROS production, oxidized/reduced GSH ratio, mitochondrial dysfunction and cell death induced by D-GalN in cultured hepatocytes.

Dual-stage peat beds in small community wastewater treatment.

In this study, the quality of water treated by two dual-stage peat bed systems was compared with a single-stage system, and a costs analysis was performed. The experiment was carried out on a pilot scale using pre-treated urban wastewater. The pilot setup consisted of a single-stage system with a hydraulic loading of 0.6 m(3)/m(2)d, and two dual-stage systems. The first of these worked with hydraulic loadings of 1.2 and 0.6 m(3)/m(2)d for the initial and second stages respectively. For the second dual-stage system hydraulic loadings were 1.8 and 0.9 m(3)/m(2)d. In comparison with the single-stage system, the dual-stage systems produced effluents with a substantial improvement in physicochemical quality (suspended solids, COD and BOD) and microbiological quality (faecal and total coliforms). Quality parameters were similar to a conventional system, meeting the legislative standards of European Union Directive 271/91 for wastewater treatment. Total costs of the peat-bed systems showed a reciprocal X-model regression depending on the average daily volume of urban wastewater to be treated, with a tendency towards convergence of costs between the single and dual-stage systems. The main problem with the dual-stage systems is the greater surface area required for their installation, which can be estimated by linear regression depending on the average volume of water to be treated per day.

Complicaciones físicas del consumo de drogas recreativas / Physical complications of recreational drug use

A lo largo de los últimos años se ha observado un aumento de las publicaciones en la literatura científica sobre las reacciones tóxicas, las complicaciones físicas y los fallecimientos asociados con el consumo de drogas recreativas, paralelo al aumento en la prevalencia de consumo de estas sustancias. Junto con las reacciones adversas que aparecen asociadas a la intoxicación aguda, el consumo de estas sustancias puede provocar complicaciones a nivel cardiovascular, accidentes cerebrovasculares, convulsiones, un cuadro de hiponatremia con edema cerebral o importantes alteraciones a nivel hepático. Sin embargo una de las complicaciones más graves que pueden desarrollarse es el de un síndrome hipertérmico que puede provocar coagulación intravascular diseminada, rabdomiolisis, e insuficiencia renal aguda. En el tratamiento de la intoxicación aguda o ante la ausencia de un antídoto específico el abordaje es fundamentalmente de tipo sintomático y de soporte (AU)

In recent years there has been an increase in the publications in the scientific literature on the toxic reactions, physical complications and deaths associated with “recreations drug” use, parallel to increase in the prevalence of this drug consumption. In addition to the adverse reactions that can be observed associated with acute intoxication, use of these substances may cause cardiovascular complications, cerebrovascular accidents, convulsions, hyponatremia leading to cerebral aedema, as well as important hepatotoxic effects. However, one of the most severe complications that may develop is a hyperthermic syndrome that may evolve to diseminated intravascular coagulation, rhabdomyolysis, and acute renal failure. The treatment of acute intoxication, in light of the absence of a specific antidote the management is primarily symptomatic and supportive (AU)

Estudio comparativo de la angioplastia coronaria en pacientes con diabetes: resultados clínicos y angiográficos inmediatos y evolución clínica en el primer año / Comparative study of coronary angioplasty in diabetic patients: clinical and angiographic results and clinical evolution at 1 year of follow up

Background: The success of revascularization procedures for coronary artery disease could be lower in diabetic patients. Aim: To report the results of coronary angioplasty in diabetic and non diabetic patients. Patients and methods: All angioplasty procedures performed between 1996 and 1999 were recorded. Demographic data, procedure details, hospital outcome and evolution at one year of follow up were analyzed. Results: During the study period, 358 patients were treated; of these, 79 were diabetics. Despite the greater severity of coronary lesions among diabetic patients the clinical success of the procedure was 92.4 percent in diabetics and 91.8 percent in non diabetics. Hospital mortality was 1.3 pecent in diabetics and 0.7 percent in non diabetics. Major complications occurred in 3.8 percent of diabetics and 3.2 percent in non diabetics. One year survival was 95.9 percent for diabetics and 98 percent in non diabetics. There were five late cardiac deaths among non diabetics and 3 among diabetics during the year of follow up. The frequency of new revascularization procedures was 4.3 percent in diabetics and 8.3 percent in non diabetics. Event-free survival was 95.6 percent in diabetics and 89.2 percent in non diabetics. Conclusions: Results of angioplasty were similar in diabetic and non diabetic patients in terms of hospital outcome and late follow-up

Implante de prótesis endovasculares (stents) en el tratamiento de la cardiopatía coronaria: resultados angiográficos, clínicos inmediatos y tardíos / Endovascular stent placing in the treatment of coronary artery disease: angiographic, immediate and late clinical results

Background: Coronary revascularization allows a better survival and quality of life in high risk patients with coronary artery disease. Aim: To report the experience in stent placement as treatment for obstructive atherosclerotic coronary artery disease. Patients and methods: A prospective analysis of 105 stent placements. A morphological and quantitative analysis of coronary angiograms, using an electronic caliper, was performed. Patients were followed during their hospital stay and after discharge. Results: In four of 112 coronary lesions, it was not possible to liberate the stent and in 108, it was successfully placed (48 in anterior descending, 19 in circumflex, 36 in right coronary arteries and 5 in saphenous aortocoronary by-pass. Lesions with stent implantation were type A in 11 percent, B1 in 30 percent, B2 in 44 percent and C in 15 percent. Reference diameter was 3.13 ñ 0.58 mm. After placement, luminal diameter increased from 0 95 ñ 0.43 to 2.99 ñ 0.46 mm, with a final stenosis of 7.2 ñ 10.1 percent. Angiographic success was obtained in 99 percent and procedure success in 98 percent. Hospital mortality was 0.98 percent. After a mean of eight months follow up, 91 percent of patients is free of major cardiac events. In 17 percent angina recurred and 5 percent required a new revascularization. There were no late cardiac deaths, acute stent thrombosis or infarction in relation to the treated lesion. Conclusions: In these patients, stent placement has had excellent immediate and late results