Facile, one-pot biosynthesis and characterization of iron, copper and silver nanoparticles using Syzygium cumini leaf extract: As an effective antimicrobial and aflatoxin B1 adsorption agents.

In this study, a facile, ecological and economical green method is described for the fabrication of iron (Fe), copper (Cu) and silver (Ag) nanoparticles (NPs) from the extract of Syzygium cumini leaves. The obtained metal NPs were categorized using UV/Vis, SEM, TEM, FTIR and EDX-ray spectroscopy techniques. The Fe-, Cu- and Ag-NPs were crystalline, spherical and size ranged from 40-52, 28-35 and 11-19 nm, respectively. The Ag-NPs showed excellent antimicrobial activities against methicillin- and vancomycin-resistance Staphylococcus aureus bacterial strains and Aspergillus flavus and A. parasiticus fungal species. Furthermore, the aflatoxins (AFs) production was also significantly inhibited when compared with the Fe- and Cu-NPs. In contrast, the adsorption results of NPs with aflatoxin B1 (AFB1) were observed as following order Fe->Cu->Ag-NPs. The Langmuir isotherm model well described the equilibrium data by the sorption capacity of Fe-NPs (105.3 ng mg-1), Cu-NPs (88.5 ng mg-1) and Ag-NPs (81.7 ng mg-1). The adsorption was found feasible, endothermic and follow the pseudo-second order kinetic model as revealed by the thermodynamic and kinetic studies. The present findings suggests that the green synthesis of metal NPs is a simple, sustainable, non-toxic, economical and energy-effective as compared to the others conventional approaches. In addition, synthesized metal NPs might be a promising AFs adsorbent for the detoxification of AFB1 in human and animal food/feed.

Microbiota facilitates the formation of the aminated metabolite of green tea polyphenol (-)-epigallocatechin-3-gallate which trap deleterious reactive endogenous metabolites.

The in vivo mechanism of tea polyphenol-mediated prevention of many chronic diseases is still largely unknown. Studies have shown that accumulation of toxic reactive cellular metabolites, such as ammonia and reactive carbonyl species (RCS), is one of the causing factors to the development of many chronic diseases. In this study, we investigated the in vivo interaction between (-)-epigallocatechin-3-gallate (EGCG), the most abundant polyphenol in tea leaves, and ammonia and RCS. We found that EGCG could be oxidized to EGCG quinone in mice, and then rapidly react with ammonia to generate the aminated EGCG metabolite, 4'-NH2-EGCG. Both EGCG and its aminated metabolite could further scavenge RCS, such as methylglyoxal (MGO), malondialdehyde (MDA), and trans-4-hydroxy-2-nonenal (4-HNE), to produce the RCS conjugates of EGCG and the aminated EGCG. Both the aminated and the RCS conjugated metabolites of EGCG were detected in human after drinking four cups of green tea per day. By comparing the levels of the aminated and the RCS conjugated metabolites in EGCG exposed germ-free (GF) mice and specific-pathogen-free (SPF) mice, we demonstrated that gut microbiota facilitate the formation of the aminated metabolite of EGCG, the RCS conjugates of EGCG, and the RCS conjugates of the aminated EGCG. By comparing the trapping capacities of EGCG and its aminated metabolite under aerobic and anaerobic conditions, we found that oxygen is not essential for the trapping of reactive species by EGCG and 4'-NH2-EGCG suggesting that EGCG and its aminated metabolite could scavenge RCS in the GI track and in the circulation system. Altogether, this study provides in vivo evidences that EGCG has the capacity to scavenge toxic reactive metabolic wastes. This finding opens a new window to understand the underlying mechanisms by which drinking tea could prevent the development of chronic diseases.

Sorption technique as a tool for reduction of genotoxicity.

In the present study, the Allium cepa root chromosomal aberration assay was used to determine the genotoxic effects of copper and cadmium ions solutions before and after sorption processes. The sorption process was carried out using unmodified Dendrocalamus strictus charcoal powder, nitrilotriacetic acid (NTA)-modified D. strictus charcoal powder, and Saccharomyces cerevisiae. The frequency of total chromosomal aberrations was observed to be 24.30-45.13% for copper and 13.16-45.14% for cadmium at different concentrations (1-500 mg/l) before the sorption process. Both metal ions solutions resulted in significant reduction of chromosomal aberrations after all the modes of the sorption processes. However, the order of reduction of percentage chromosomal aberrations for copper and cadmium solutions was found to be 45.29-70.04% and 47.80-84.57%, respectively (NTA-modified D. strictus charcoal powder); >44.53-54.32% and 37.10-79.40%, respectively (unmodified D. strictus charcoal powder); >15.59-48.51% and 13.63-21.50%, respectively (S. cerevisiae).

[Apheresis Techniques]. / Tecniche di Aferesi.

Apheresis therapies play an important role in the treatment of many pathologies, both as first-line and rescue therapies after drug failure or drug toxicity and, furthermore, when it is important to reach a therapeutic goal in a short time. Apheresis devices have evolved at an astounding rate over the last decades. Therapeutic apheresis are usually part of a treatment plan, so, a patient-centered approach to select the most appropriate treatment for each patient, balancing personal preferences, medication interferences and technological availability can significantly influence the choice of the protocol to be used. But, if the wide diversity of apheresis treatments may offer a tailored-patient approach, it can also create concerns on the right decision about the most appropriate protocol. Therapeutic apheresis - whose purpose is to cure diseases due to abnormality of blood cells or to toxicity of plasma substances - and, productive apheresis - whose purpose is to produce autologous or allogeneic therapeutic hemocomponents - are widely known as plasma-treatments and cytapheresis. The elementary techniques in apheresis are well represented by three physical separation methods of blood components: 1. differential centrifugation; 2. membrane filtration; 3. adsorption of proteins or cells, from whole blood or from plasma already separated. Starting from these three processes, several apheretic techniques have been developed to ensure, in expert hands, excellent therapeutic efficacy together with a low profile of adverse events.

Effectiveness of Fractionated Plasma Separation and Absorption as a Treatment for Amanita Phalloides Poisoning.

BACKGROUND Fractionated plasma separation and absorption (FPSA) is an extracorporeal liver support method that detoxifies accumulated toxins. There are limited data of its use in the treatment of Amanita phalloides intoxication. The objective of this study was to investigate whether FPSA before liver transplantation improves patients' short-term post liver transplantation survival in Amanita phalloides poisoning. MATERIAL AND METHODS The study population consisted of ten patients who had liver transplantation (LT) due to acute liver failure (ALF) caused by Amanita phalloides poisoning. Six patients were treated with FPSA before liver transplantation. All the patients who were started on FPSA were also placed on the liver transplantation list according to emergent liver transplantation criteria. RESULTS Patients treated with FPSA were in a more severe clinical condition presenting in higher mean MELD, total bilirubin, INR and ammonia along with more frequent hypoglycemia and hepatic encephalopathy grade 3/4. FPSA group had longer mean waiting time on the recipient list (3.5 vs. 1.25 days) but inferior thirty-day survival rate (16.5% vs. 100%). CONCLUSIONS When conservative medical modalities are ineffective, the only treatment for Amanita phalloides poisoning is a liver transplant. Although FPSA treated patients had inferior post-LT survival, FPSA was found to prolong the pre surgical waiting time for critically ill patients, consequently giving a chance of life-saving procedure.

Zeolite: «the magic stone»; main nutritional, environmental, experimental and clinical fields of application / Zeolita: «la piedra mágica»; principales campos nutricionales, ambientales, experimentales y clínicos de la aplicación

Introduction: zeolites (clinoptilolites) are a family of alluminosilicates and cations clustered to form macro aggregates by small individual cavities. In the medical area they are involved in detoxification mechanisms capturing ions and molecules into their holes. Actually, we classify about 140 types of natural and 150 synthetic zeolites, for specific and selective use. Clinoptilolite is a natural zeolite and it is the most widespread compound in the medical market. Objective: this review analyzes the main fields of zeolite utilization. Methods: we searched Pubmed/Medline using the terms «zeolite» and «clinoptilolite». Results and discussion: in zoothechnology and veterinary medicine zeolite improves the pets' fitness, removes radioactive elements, aflatoxines and poisons. Zeolite displays also antioxidant, whitening, hemostatic and anti-diarrhoic properties, projected in human care. However very scanty clinical studies have been run up to now in immunodeficiency, oncology after chemotherapy and radiotherapy as adjuvants. Conclusions: further clinical investigations are urgently required after this review article publication which updates the state of the art (AU)

Introducción: las zeolitas (clinoptilolitas) son una familia de aluminosilicatos y cationes agrupada para formar agregados macro de pequeñas cavidades individuales. En el área médica están involucrados en los mecanismos de desintoxicación y en capturar iones y moléculas en sus agujeros. En realidad, clasificamos cerca de 140 tipos de zeolitas naturales y 150 sintéticas, para usos específicos y selectivos. La clinoptilolita es una zeolita natural y es el compuesto más extendido en el mercado médico. Objetivo: esta revisión analiza los principales campos de utilización de la zeolita. Métodos: se realizaron búsquedas en Pubmed/Medline usando los términos «zeolita» y «clinoptilolita». Resultados y discusión: en zootecnología y medicina veterinaria la zeolita mejora la condición de la mascota, elimina los elementos radiactivos, las aflatoxinas y los venenos. En el cuidado humano, la zeolita también muestra propiedades antioxidantes, de blanqueamiento, homeostáticas y antidiarreicas. Sin embargo, los estudios clínicos que se han llevado a cabo hasta ahora como adyuvante en inmunodeficiencia y tras la quimioterapia y la radioterapia en oncología son muy escasos. Conclusiones: se requieren con urgencia otras investigaciones clínicas después de esta publicación del artículo que actualicen el estado de la técnica (AU)

[HEALTH-IMPROVING REMEDIES ON THE BASIS OF SMECTITE®].

The review is devoted to the issues of using smectites in medicine. Modern information concerning smectite composition, structure, physico-chemical properties and reasonability of using them with health-improving purposes is presented. Special attention is given to smectite sorbtional and ionic properties and their unique mineral composition. Characterization is given to modern preparation based on smectites, including developed in Ukraine dietary additives of the series Smectovit®.

Inhibition of cadmium- induced genotoxicity and histopathological changes in Nile tilapia fish by Egyptian and Tunisian montmorillonite clay.

Cadmium (Cd) is an important inorganic toxicant widely distributed in the environment because of its various industrial uses. The aims of the current study were to investigate the efficacy of purified Egyptian and Tunisian montmorillonite clays (EMC and TMC) to inhibit genotoxicity and histological alterations induced by cadmium chloride (CdCl2) utilizing the Nile tilapia fish as an in vivo model. Chromosomal aberrations (CAs), micronucleus (MN) frequencies and DNA fingerprinting profile were genotoxic end points and histopathological changes that were used in this investigation. Six groups of fish were treated for 2 weeks and included control group, CdCl2-treated group and groups treated with EMC or TMC alone or in combination with CdCl2. The present results revealed that, treatment of fish with CdCl2 exhibited significant increased in the number of micronucleated erythrocytes (MnRBCs), frequency of CAs and instability of genomic DNA. Treatment of EMC and TMC in combination with CdCl2 significantly reduced the frequency of MnRBCs by the percentage of 53.28% and 60.77% and the frequency of CAs by 43.91% and 52.17% respectively. As well as, normalized DNA fingerprinting profile and significantly improved histopathological picture induced by Cadmium treatment. It is worth mention that both clays have the ability to tightly bind CdCl2 and decreased its cytotoxicity and genotoxicity; however, Tunisian clay was more efficient in binding with the CdCl2 than Egyptian clay.

Experience of Treatments of Amanita phalloides-Induced Fulminant Liver Failure with Molecular Adsorbent Recirculating System and Therapeutic Plasma Exchange.

Ingestion of the mushroom containing Amanita phalloides can induce fulminant liver failure and death. There are no specific antidotes. Blood purifications, such as molecular adsorbent recirculating system (MARS) and therapeutic plasma exchange (TPE), are potential therapies. However, the extent to which these technologies avert the deleterious effects of amatoxins remains controversial; the optimal intensity, duration, and initiation criteria have not been determined yet. This study aimed to retrospectively observe the effects of MARS and TPE on nine patients with A. phalloides-induced fulminant liver failure. The survival rate for the nine patients was 66.7%. Both TPE and MARS might remove toxins and improve liver functions. However, a single session of TPE produced immediately greater improvements in alanine aminotransferase (-60% vs. -16.3%), aspartate aminotransferase (-47.6% vs. -15.4%), and total bilirubin (-37.3% vs. -17.1%) (compared with the values of pretreatment, all p < 0.05) than MARS compared with MARS. Early intervention may be more effective than delayed therapy. Additionally, the presence of severe liver failure and renal failure indicated worse outcome. Although these findings are promising, additional case-controlled, randomized studies are required to confirm our results.

[Comparative estimation of efficacy of the immunecorrecting combined three- level cytokino- and ozonotherapy in complex treatment of extended peritonitis].

The results of surgical treatment of 211 patients, suffering extended peritonitis (EP) of various etiology, were analyzed. The peritonitis severity was graded in accordance to Mannheim's index of peritonitis (MIP). The patients were divided on two groups. In 60 patients (group of comparison) the basic treatment was conducted, without immunocorrection. The patients of the main group were divided on three subgroups. To the patients of the first subgroup (43) 400 ml of ozonated isotonic solution (OIS) of sodium chloride was infused intravenously additionally in the contents of basic therapy, as well as peritoneal-enteral detoxication using OIS was conducted. In a second subgroup a regional intraabdominal endolymphatic ozonotherapy (OTH) was conducted to 57 patients with OIS and peritoneal-enteral sanation using medical ozone. In the 3d subgroup in 51 patients additionally were applied intravenous infusion of OIS and peritoneal-enteral sanation with medical ozone. To these patients cytokinotherapy was conducted, when splenopid was applied intravenously, intraperitoneally and enterally simultaneously. The indices of the T- and B-immunity links, phagocytic activity of neutrophils, including phagocytic index, phagocytic number, the completeness of phagocytosis index, as well as the content of the tumor necrosis factor alpha (TNF-alpha), gamma-interferon (IFN-gamma) and interleukins (IL) - IL-1, IL-2, IL-4, IL-6, IL-10 were estimated in the blood serum in dynamics. The combined staged three-level (systemic, intraperitoneal and enteral) application of natural cytokins and medical ozone have promoted mutual potentiating of their action, significant efficacy of the immunemodulating therapy in comparison with such systemic and local OTH.

Treatment of Amanita phalloides intoxication by fractionated plasma separation and adsorption (Prometheus®).

OBJECTIVE: To investigate the effectiveness and safety of extracorporeal detoxification using the fractionated plasma separation and adsorption system (FPSA, Prometheus® 4008H, Fresenius Medical Care, Germany) in patients suffering from acute liver failure due to intoxication with Amanita phalloides (AP) toxin. METHODS: The study population consisted of 20 patients with proven AP intoxication (FPSA treatment group n=9, control group n=11). Urinary amanitin toxin concentration was measured by the Amanitin ELISA Kit (Bühlmann Laboratories, Germany, cut off level 1.5 ng/ml). All patients received standard medical treatment with activated charcoal, i.v. crystalloid fluids, silibinine and N-acetylcysteine. Additionally 9 patients underwent treatment with FPSA until undetectable amanitin levels. RESULTS: Mean urinary amanitin levels were significantly reduced by FPSA with 42.5 +/- 21.9 ng/ml before and 1.2 +/- 0.31 ng/ml after treatment (p=0.04). No hemodynamic, respiratory or hematological complications were observed. None of the patients had to undergo liver transplantation. All patients in the treatment group survived and were discharged fully recovered. One patient in the control group died due to shock and lactic acidosis; one patient remained dialysis dependent. Mean duration of hospital stay was 7.1 days in the treatment group and 11.7 days in the control group (p=0.30). CONCLUSIONS: Use of liver support therapy by fractionated plasma separation and adsorption (Prometheus®) offers a safe way for elimination of Amanita toxin with the potential to avoid the need for liver transplantation.

Prevention of cytogenetic, histochemical and biochemical alterations in Oreochromis niloticus by dietary supplement of sorbent materials.

The current study was conducted to evaluate the ability of Egyptian bentonite (EB) and montmorillonite (EM) for the prevention of genotoxicity, histochemical and biochemical changes induced by aflatoxin B(1) (AFB(1)) using the micronucleus (MN) assay, chromosomal aberrations and DNA fragmentation analysis in Tilapia fish. Six groups of fish were treated for 3 weeks and included the control group, AFB(1)-treated group and the groups treated with EB or EM alone or in combination with AFB(1). At the end of experiment period, blood samples were collected for MN, testosterone and biochemical assays. Chromosomal aberrations were determined in kidney tissues, DNA fragmentation test was determined in liver and testis, whereas histochemical study was carried out on liver, testis and gills. The results indicated that a significant decrease in total protein, albumin, globulin, testosterone and DNA content in liver, gills and testis accompanied with a significant increase in number of micronucleated erythrocytes (MnRBCs), total chromosomal aberrations in kidney and DNA fragmentation in testis and liver of fish received AFB(1) alone. Fish treated with EB or EM alone were comparable to the control regarding the biochemical parameters except testosterone in EB-treated group which was significantly decreased. Both clays did not induce any significant differences in number of MnRBCs, chromosomal aberrations in the kidney, DNA fragmentation in testis, but not in liver of EB-treated group. The combined treatment with AFB(1) and EB or EM succeeded to improve all the tested parameters towards the control values although it did not normalize them. Moreover, the improvement was pronounced in the group received EM plus AFB(1). It could be concluded that EB and EM have the ability to tightly bind AFB(1) in the gastrointestinal tract of fish resulting in decreasing its bioavailability. Moreover, the two tested clays were safe and can be used as potential aflatoxin binders in animal feed.

Efficacy of fractionated plasma separation and adsorption system (Prometheus) for treatment of liver failure due to mushroom poisoning.

BACKGROUND/AIMS: Consuming wild mushrooms is an ordinary habit in late summer and autumn in our region. Every year, several cases of hepatic toxicity secondary to mushroom poisoning are observed because of poor identification of the mushrooms. Unfortunately some of them are fatal. Prometheus system is a newly developed extracorporeal liver support device for fractionated plasma separation and adsorption (FPSA) that enables removal of albumin-bound and water-soluble toxins. Therefore, it may be a promising treatment option for patients with liver failure due to mushroom poisoning. METHODOLOGY: We studied 8 patients with mushroom poisoning. All patients underwent 1 to 4 consecutive FPSA (Prometheus)-system in addition to medical and supportive treatment such as fluid replacement, Penicillin G, N-acetylcysteine (NAC) and silymarin. A variety of clinical and biochemical parameters were assessed. RESULTS: We had improvement of the biochemical parameters after first treatment with FPSA-system. Seven of 8 patients survived and were discharged to resume an independent life. One patient who had grade III encephalopathy when admitted to hospital died. No major adverse events were observed during the application of this therapy modality. CONCLUSIONS: FPSA-system may be a safe and effective treatment option for patient with mushroom poisoning. Early hospitalization is essential in order to be successful. Controlled studies are needed to evaluate the efficacy of this new treatment choice on survival of patients with acute liver failure (ALF) due to mushroom poisoning.

Human detoxification of perfluorinated compounds.

There has been no proven method thus far to accelerate the clearance of potentially toxic perfluorinated compounds (PFCs) in humans. PFCs are a family of commonly used synthetic compounds with many applications, including repelling oil and stains on furniture, clothing, carpets and food packaging, as well as in the manufacturing of polytetrafluoroethylene - a non-stick surfacing often used in cookware (e.g. Teflon(r)). Some PFCs remain persistent within the environment due to their inherent chemical stability, and are very slowly eliminated from the human body due, in part, to enterohepatic recirculation. Exposure to PFCs is widespread and some subpopulations, living in proximity to or working in fluorochemical manufacturing plants, are highly contaminated. PFC bioaccumulation has become an increasing public health concern as emerging evidence suggests reproductive toxicity, neurotoxicity and hepatotoxicity, and some PFCs are considered to be likely human carcinogens. A case history is presented where an individual with high concentrations of PFCs in serum provided: (1) sweat samples after use of a sauna; and (2) stool samples before and after oral administration of each of two bile acid sequestrants - cholestyramine (CSM) and saponin compounds (SPCs). Stool samples before and after use of a cation-exchange zeolite compound were also examined. PFCs found in serum were not detected in substantial quantities in sweat or in stool prior to treatment. Minimal amounts of perfluorooctanoic acid, but no other PFCs, were detected in stool after SPC use; minimal amounts of perfluorooctanesulfonate, but no other PFCs, were detected in stool after zeolite use. All PFC congeners found in serum were detected in stool after CSM use. Serum levels of all PFCs subsequently declined after regular use of CSM. Further study is required but this report suggests that CSM therapy may facilitate gastrointestinal elimination of some PFCs from the human body.

Sorption and desorption of phosphorus by shale: batch and column studies.

Constructed wetland systems have gained attention as attractive solutions for wastewater treatment. Wetlands are not efficient to treat wastewater with high concentrations of phosphorus (P). In order to remove high soluble P loads by wetland, sorbent beds can be added prior to the discharge of wastewater into wetlands. Sorption by sorbent materials is identified as a method for trapping excess P in wastewaters. In the present investigation, shale has been identified as a sorbent material for removal of phosphate (PO(4)-P) due to the cost effectiveness, stability and possibility of regeneration. The study focuses on the removal of PO(4)-P from wastewater using shale and the feasibility of using the P-sorbed material as slow-release fertilizer. Phosphorus sorption experiments were conducted by using shale (2 mm and 2-4.7 mm). Results indicate that Shale I (particle size = 2 mm) showed the highest sorption of PO(4)-P (500 +/- 44 mg kg(-1)). Breakthrough point was reached within 10 h in columns with flow rates of 2 and 3 ml min(-1). Lower flow rate of 1 ml min(-1) showed an average residence time of about 2 h while columns with a higher flow rate of 3 ml min(-1) showed a residence time of about 40 minutes. Variation in flow rate did not influence the desorption process. Since very low concentrations of PO(4)-P are released, Shale saturated with PO(4)-P may be used as a slow nutrient release source of P or as a soil amendment. The sorbent can also be regenerated by removing the sorbed PO(4)-P by using 0.1 N HCl.

Is MARS system enough for A. phalloides-induced liver failure treatment?

Patients with Amanita phalloides-induced liver failure (LF) have a high mortality, despite significant advances in intensive care management. Our study evaluated the effect of Molecular Absorbents Recirculating System (MARS) comparative with optimal intensive care (OIC) in adults with this condition, in the absence of liver transplantation (LT). Six consecutive patients (women, range 16-61 years) affected by A. phalloides-induced LF were treated with OIC (3 patients) and MARS (3 patients). Laboratory parameters and hepeatic encephalopaty were evaluated 15 min before and 24 hours following each MARS treatment. Three 6-hour sessions per patient were performed in MARS group, with a statistically significant decrease in ammonia (p value 0.011), alaninaminotransferase (ALT) and prothrombin time (PT) (p value 0.004). Two patients had a significant rebound in bilirubin (+116%; p value 0. 04) 24 hours following MARS. Mortality in MARS group was 66.7%. Survival rate in OIC was 0%. Negative prognostic markers: lack of PT and hepatic encephalopaty improvement, rebound in bilirubin, and delay of MARS therapy initiation. No significant adverse reactions occurred during MARS. MARS is an effective depurative therapy in adults with A. phalloides-induced LF, but alone is not enough. Survival is predicted by the results of the initial MARS, amount of mushroom consumed, and time from toxin exposure.

[Application of low-intensity laser radiation and endotoxin-binding preparations to the treatment of female infertility].

A total of 38 women of reproductive age (from 20 to 45 years) with chronic inflammatory gynecological diseases including 7 with primary and 9 with secondary infertility were examined by standard clinical, instrumental, and laboratory methods. In addition, variations of such important characteristics as serum endotoxin level and activity of antiendotoxin immunity were measured. The study has demonstrated participation of chronic aggression of endotoxins (of intestinal origin) in pathogenesis of the disorders of interest. Inclusion of the "antiendotoxic component" in the combined therapy allowed the efficacy of the treatment of chronic inflammation and female infertility to be greatly enhanced. It suggests the important (if not decisive) role of bacterial lipopolysacchardides in the pathogenetic mechanism underlying the problems considered in this study.

[Objectivization of the diagnostics and control of treatment of paresis of the gastrointestinal tract in diffuse peritonitis].

The work is devoted to objectivization of the diagnostics and control of treatment of paresis of the gastrointestinal tract in diffuse peritonitis. The method of selective electrogastroenterocolonography after digitization of the data makes it possible to characterize the functioning of the gastrointestinal tract in figures which can be compared with quantitative characteristics of endogenous intoxication. So the direct relation between the degree of the gastrointestinal tract paresis and endogenous intoxication was proved. The method of selective electrogastroenterocolonography allowed an objective control of the treatment using sorption technologies, low amplitude electrostimulation and parenteral feeding with Dipeptiven. Its success was proved by a less number of complications (from 45% to 27%) and less lethality (from 21.2% to 16.6%).