In vitro nematicidal activity of two ferrocenyl chalcones against larvae of Haemonchus contortus (L3) and Nacobbus aberrans (J2).

The main goal of this work was to evaluate the in vitro biological activity of two ferrocenyl chalcones (FcC-1 and FcC-2) against Haemonchus contortus (third-stage larvae (L3)) and Nacobbus aberrans (second-stage juveniles (J2)). Both compounds were synthesized and characterized by usual spectroscopic methods and their molecular structures were confirmed by single-crystal X-ray diffractometry. Nematode strains were examined in terms of percentage mortality of H. contortus (L3) by the action of FcC-1, which showed an effectivity of 100% at a concentration of 342 µM in 24 h, with EC50 = 20.33 µM and EC90 = 162.76 µM, whereas FcC-2 had an effectivity of 72% at a concentration of 342 µM in 24 h, with EC50 = 167.39 µM and EC90 = 316.21 µM. The effect of FcC-1 against nematode phytoparasite N. aberrans showed a better percentage of 95% at a concentration of 342 µM, with EC50 = 7.18 µM and EC90 = 79.25 µM, whereas the effect of FcC-2 was 87% at 342 µM, with EC50 = 168 µM and EC90 = 319.56 µM at 36 h. After treatment, the scanning electron micrographs revealed deformities in the dorsal flank and posterior part close to the tail of H. contortus L3. They showed moderate in vitro nematicidal activity against H. contortus L3 and N. aberrans J2.

[Hypopituitarism after traumatic brain injury]. / Hipopituitarismo postraumatismo encefalocraneano: revisión de la literatura y algoritmo de estudio y abordaje terapéutico.

Hypopituitarism after moderate or severe traumatic brain injury (TBI) is usually underdiagnosed and therefore undertreated. Its course can be divided in an acute phase during the first 14 days after TBI with 50 to 80% risk of hypopituitarism, and a chronic phase, beginning three months after the event, with a prevalence of hypopituitarism that ranges from 2 to 70%. Its pathophysiology has been addressed in several studies, suggesting that a vascular injury to the pituitary tissue is the most important mechanism during the acute phase, and an autoimmune one during chronic stages. In the acute phase, there are difficulties to correctly interpret pituitary axes. Hence, we propose a simple and cost-effective algorithm to detect and treat a potential hypothalamic-pituitary-adrenal axis impairment and alterations of sodium homeostasis, both of which can be life-threatening. In the chronic phase, post-concussion syndrome is the most important differential diagnosis. Given the high prevalence of hypopituitarism, we suggest that all pituitary axes should be assessed in all patients with moderate to severe TBI, between 3 to 6 months after the event, and then repeated at 12 months after trauma by a specialized team in pituitary disease.

Mortality attributable to high temperatures over the 2021-2050 and 2051-2100 time horizons in Spain: Adaptation and economic estimate.

BACKGROUND: In recent years, a number of studies have been conducted with the aim of analysing the impact that high temperatures will have on mortality over different time horizons under different climate scenarios. Very few of these studies take into account the fact that the threshold temperature used to define a heat wave will vary over time, and there are practically none which calculate this threshold temperature for each geographical area on the assumption that there will be variations at a country level. OBJECTIVE: To analyse the impact that high temperatures will have on mortality across the periods 2021-2050 and 2051-2100 under a high-emission climate scenario (RCP8.5), in a case: (a) where adaptation processes are not taken into account; and (b) where complete adaptation processes are taken into account. MATERIAL AND METHODS: Based on heat-wave definition temperature (Tthreshold) values previously calculated for the reference period, 2000-2009, for each Spanish provincial capital, and their impact on daily mortality as measured by population attributable risk (PAR), the impact of high temperatures on mortality will be calculated for the above-mentioned future periods. Two hypotheses will be considered, namely: (a) that Tthreshold does not vary over time (scenario without adaptation to heat); and, (b) that Tthreshold does vary over time, with the percentile to which said Tthreshold corresponds being assumed to remain constant (complete adaptation to heat). The temperature data were sourced from projections generated by Coupled Model Intercomparison Project (CMIP5) climate models adapted to each region's local characteristics by the State Meteorological Agency (Agencia Estatal de Meteorología/AEMET). Population-growth projections were obtained from the National Statistics Institute (Instituto Nacional de Estadística/INE). In addition, an economic estimate of the resulting impact will be drawn up. RESULTS: The mean value of maximum daily temperatures will rise, in relation to those of the reference period (2000-2009), by 1.6°C across the period 2021-2050 and by 3.3°C across the period 2051-2100. In a case where there is no heat-adaptation process, overall annual mortality attributable to high temperatures in Spain would amount to 1414 deaths/year (95% CI: 1089-1771) in the period 2021-2050, rising to 12,896 deaths/year (95% CI: 9852-15,976) in the period 2051-2100. In a case where there is a heat-adaptation process, annual mortality would be 651 deaths/year (95% CI: 500-807) in the period 2021-2050, and 931 deaths per year (95% CI: 770-1081) in the period 2051-2100. These results display a high degree of heterogeneity. The savings between a situation that does envisage and one that does not envisage an adaptive process is €49,100 million/year over the 2051-2100 time horizon. CONCLUSION: A non-linear increase in maximum daily temperatures was observed, which varies widely from some regions to others, with an increase in mean values for Spain as a whole that is not linear over time. The high degree of heterogeneity found in heat-related mortality by region and the great differences observed on considering an adaptive versus a non-adaptive process render it necessary for adaptation plans to be implemented at a regional level.

Will there be cold-related mortality in Spain over the 2021-2050 and 2051-2100 time horizons despite the increase in temperatures as a consequence of climate change?

INTRODUCTION: Global warming is resulting in an increase in temperatures which is set to become more marked by the end of the century and depends on the accelerating pace of greenhouse gas emissions into the atmosphere. Yet even in this scenario, so-called "cold waves" will continue to be generated and have an impact on health. OBJECTIVES: This study sought to analyse the impact of cold waves on daily mortality at a provincial level in Spain over the 2021-2050 and 2051-2100 time horizons under RCP4.5 and RCP 8.5 emission scenarios, on the basis of two hypotheses: (1) that the cold-wave definition temperature (T threshold) would not vary over time; and, (2) that there would be a variation in T threshold. MATERIAL AND METHODS: The results of a retrospective study undertaken for Spain as a whole across the period 2000-2009 enabled us to ascertain the cold-wave definition temperature at a provincial level and its impact on health, measured by reference to population attributable risk (PAR). The minimum daily temperatures projected for each provincial capital considering the above time horizons and emission scenarios were provided by the State Meteorological Agency. On the basis of the T threshold definition values and minimum daily temperatures projected for each province, we calculated the expected impact of low temperatures on mortality under the above two hypotheses. Keeping the PAR values constant, it was assumed that the mortality rate would vary in accordance with the available data. RESULTS: If T threshold remained constant over the above time horizons under both emission scenarios, there would be no cold-related mortality. If T threshold were assumed to vary over time, however, then cold-related mortality would not disappear: it would instead remain practically constant over time and give rise to an estimated overall figure of around 250 deaths per year, equivalent to close on a quarter of Spain's current annual cold-related mortality and entailing a cost of approximately €1000 million per year. CONCLUSION: Given that cold waves are not going to disappear and that their impact on mortality is far from negligible and is likely to remain so, public health prevention measures must be implemented to minimise these effects as far as possible.

Short-term association between environmental factors and hospital admissions due to dementia in Madrid.

BACKGROUND: Spain has one of the highest proportions of dementia in the world among the population aged 60 years or over. Recent studies link various environmental factors to neurocognitive-type diseases. This study sought to analyse whether urban risk factors such as traffic noise, pollutants and heat waves might have a short-term impact on exacerbation of symptoms of dementia, leading to emergency hospital admission. MATERIAL AND METHODS: We conducted a longitudinal ecological time-series study, with the dependent variable being the number of daily dementia-related emergency (DDE) hospital admissions to Madrid municipal hospitals (ICD-10 codes 290.0-290.2, 290.4-290.9, 294.1-294) from 01 to 01-2001 to 31-12-2009, as obtained from the Hospital Morbidity Survey (National Statistics Institute). The measures used were as follows: for noise pollution, Leqd, equivalent diurnal noise level (from 8 to 22h), and Leqn, equivalent nocturnal noise level (from 22 to 8h) in dB(A); for chemical pollution, mean daily NO2, PM2.5, PM1 as provided by the Madrid Municipal Air Quality Monitoring Grid; and lastly, maximum daily temperature (°C), as supplied by the State Meteorological Agency. Scatterplot diagrams were plotted to assess the type of functional relationship existing between the main variable of analysis and the environmental variables. The lags of the environmental variables were calculated to analyse the timing of the effect. Poisson regression models were fitted, controlling for trends and seasonalities, to quantify relative risk (RR). RESULTS: During the study period, there were 1175 DDE hospital admissions. These admissions displayed a linear functional relationship without a threshold in the case of Leqd. The RR of DDE admissions was 1.15 (1.11-1.20) for an increase of 1dB in Leqd, with impact at lag 0. In the case of maximum daily temperature, there was a threshold temperature of 34°C, with an increase of 1°C over this threshold posing an RR of 1.19 (1.09-1.30) at lag 1. The only pollutant to show an association with DDE hospital admissions was O3 at lag 5, with an RR of 1.09 (1.04-1.15) for an increase of 10µg/m3 CONCLUSIONS: Diurnal traffic noise, heat waves and tropospheric ozone may exacerbate the symptoms of dementia to the point of requiring emergency admission to hospital. Lowering exposure levels to these environmental factors could reduce dementia-related admissions in Madrid.

Spatial variability in threshold temperatures of heat wave mortality: impact assessment on prevention plans.

Spain's current heat wave prevention plans are activated according to administrative areas. This study analyses the determination of threshold temperatures for triggering prevention-plan activation by reference to isoclimatic areas, and describes the public health benefits. We subdivided the study area - the Madrid Autonomous Region (MAR) - into three, distinct, isoclimatic areas: 'North', 'Central' and 'South', and grouped daily natural-cause mortality (ICD-10: A00-R99) in towns of over 10,000 inhabitants (2000-2009 period) accordingly. Using these three areas rather than the MAR as a whole would have resulted in a possible decrease in mortality of 73 persons (38-108) in the North area, and in aborting unnecessary activation of the plan 153 times in the Central area and 417 times in the South area. Our results indicate that extrapolating this methodology would bring benefits associated with a reduction in attributable mortality and improved effectiveness of public health interventions.

Is some better than none: are TEG and TGA profiles different in severe FVIII-deficient patients with inhibitors?

Severe factor VIII (FVIII)-deficient patients with and without FVIII inhibitors cannot be distinguished using FVIII levels. The FVIII assay is sensitive to detect factor levels below 1%. While severe FVIII-deficient, non-inhibitor patients have FVIII < 1%, they may retain unmeasurable residual factor activity. In contrast, inhibitor patients have a FVIII antibody that presumably fully eliminates FVIII activity. It is unknown whether thromboelastography (TEG) and thrombin generation assay (TGA) can differentiate between patients with FVIII < 1% with and without the presence of FVIII inhibitors. The primary objective was to discern whether TEG and TGA could differentiate between severe FVIII-deficient patients with and without the presence of FVIII inhibitors. A secondary objective was to correlate TEG and TGA to annualized bleeding rates. This observational study performed TEG and TGA in healthy volunteers (N = 15), severe FVIII-deficient (N = 15) and severe FVIII-deficient patients with inhibitors (N = 15). Kaolin-activated TEG was better at differentiating reaction time (31.3 vs. 120 min respectively, P = 0.004) and kinetics time (6.1 vs. 23.1 min respectively, P = 0.028) between the non-inhibitor and inhibitor patients. TEG activated by tissue factor in plasma-containing corn trypsin inhibitor failed to differentiate groups. The TGA failed to differentiate peak thrombin, endogenous thrombin potential and lag time between groups. There was no correlation between TEG and TGA with annualized bleeding rates. Kaolin-activated TEG, but not TGA, differentiated between severe FVIII-deficient patients with and without inhibitors. These assays did not find a correlation to annualized bleeding rate.

Comparison of the effects of extreme temperatures on daily mortality in Madrid (Spain), by age group: The need for a cold wave prevention plan.

A number of studies have shown that there is a time trend towards a reduction in the effects of heat on mortality. In the case of cold, however, there is practically no research of this type and so there is no clearly defined time trend of the impact of cold on mortality. Furthermore, no other specific studies have yet analysed the time trend of the impact of both thermal extremes by age group. We analysed data on daily mortality due to natural causes (ICD-10: A00-R99) in the city of Madrid across the period 2001-2009 and calculated the impact of extreme temperatures on mortality using Poisson regression models for specific age groups. The groups of age selected coinciding with the pre-existing age-groups analyzed in previous papers. For heat waves the groups of age used were: <10 years, 10-17 years, 18-44 years, 45-64 years, 65-74 years and over-75 years. For cold waves the groups of age used were: <1 year; 1-5 years, 6-17 years, 18-44 years, 45-64 years, 65-74 years and over-75 years. <1, 1-17, 18-44, 45-66, 65-74 and over-75 years. We controlled for confounding variables, such as air pollution, noise, influenza, pollen, pressure and relative humidity, trend of the series, as well as seasonalities and autoregressive components of the series. The results of these models were compared to those obtained for the same city during the period 1986-1997 and published in different studies. Our results show a lightly reduction in the effects of heat, especially in the over-45-year age group. In the case of cold, the behaviour pattern was the opposite, with an increase in its effect. Heat adaptation and socio-economic and public-health prevention and action measures may be behind this amelioration in the effects of heat, whereas the absence of such actions in respect of low temperatures may account for the increase in the effects of cold on mortality. From a public health point of view, the implementation of cold wave prevention plans covering all age groups is thus called for.

[Survival among renal allograft recipients from non related living donors]. / Resultados a 10 años en trasplantes renales con donantes vivos no relacionados: Experiencia de 22 años.

BACKGROUND: There is a gap between the number of patients requiring a renal allograft and the number of potential deceased donors (DD). One alternative is using allografts from non-related living donors (NRLD). AIM: To compare survival and complications of renal allograft recipients from DD, related living donors (RLD) and NRLD. MATERIAL AND METHODS: Observational study of a cohort of renal allograft recipients. Of 253 transplants performed in a Chilean region between 1981 and 2003, 20 patients received and allograft from a NRLD. Graft and patient survival of these patients were compared with those of 93 patients receiving an allograft from a related living donor and 140 receiving it from a DD. Patients were followed for 10 years or until death or dialysis requirement. RESULTS: No significant differences between groups in graft and patient survival, deaths with a functioning graft or return to dialysis were observed. Receptors of DD had more hospital admissions during the first years after receiving the graft, usually due to infections. Also a delayed graft function was more common among them. Glomerular filtration rate ten years after the graft was similar among the three groups. CONCLUSIONS: No differences in graft or patient survival was observed between patients receiving a renal allograft from NRLD, RLD or DD.

Aripiprazole as protector against COVID-19 mortality.

The relation of antipsychotics with severe Coronavirus Disease 19 (COVID-19) outcomes is a matter of debate since the beginning of the pandemic. To date, controversial results have been published on this issue. We aimed to prove whether antipsychotics might exert adverse or protective effects against fatal outcomes derived from COVID-19. A population-based retrospective cohort study (January 2020 to November 2020) comprising inpatients (15,968 patients) who were at least 18 years old and had a laboratory-confirmed COVID-19 infection. Two sub-cohorts were delineated, comprising a total of 2536 inpatients: individuals who either had no prescription medication or were prescribed an antipsychotic within the 15 days preceding hospitalization. We conducted survival and odds ratio analyses to assess the association between antipsychotic use and mortality, reporting both unadjusted and covariate-adjusted results. We computed the average treatment effects, using the untreated group as the reference, and the average treatment effect on the treated, focusing solely on the antipsychotic-treated population. Among the eight antipsychotics found to be in use, only aripiprazole showed a significant decrease in the risk of death from COVID-19 [adjusted odds ratio (OR) = 0.86; 95% CI, 0.79-0.93, multiple-testing adjusted p-value < 0.05]. Importantly, these findings were consistent for both covariate-adjusted and unadjusted analyses. Aripiprazole has been shown to have a differentiated beneficial effect in protecting against fatal clinical outcome in COVID-19 infected individuals. We speculate that the differential effect of aripiprazole on controlling immunological pathways and inducible inflammatory enzymes, that are critical in COVID19 illness, may be associated with our findings herein.

[Decrease in hospitalizations due to polyvalent medical day hospital]. / Ingresos evitados por el hospital de día médico polivalente.

INTRODUCTION: The day hospital is an alternative to hospitalization. This alternative improves accessibility and comfort of the patients, and avoids hospitalizations. Nevertheless, the efficacy of the polyvalent medical day hospital in avoiding hospitalizations has not been evaluated. OBJECTIVE: To analyze hospital stays avoided by the polyvalent medical day hospital of a university hospital of the Andalusian Health Service. METHODS: An observational prospective study of the patients studied and/or treated in the polyvalent medical day hospital of the Hospital Universitario Puerto Real over a one year period. RESULTS: A total of 9640 patients were attended to, with 1413 procedures and 4921 i.v. treatments. There were 3182 visits to the priority consultation of the polyvalent medical day hospital. The most frequent consultation complaints were constitutional symptoms (15.9%) and anemia (14.5%). After the first visit, 21.5% of the patients were discharged and fewer than 3% were hospitalized. Hospitalization was avoided in 16.8% of the patients, there being a 6.0% decrease in the need for hospital beds (5.0% reduction in the internal medicine unit). Inadequate hospitalizations and 30-day readmissions decreased 93.3% and 4.2%, respectively. The most frequent diagnosis was neoplasm (26.0%), and most of the beds freed up were generated by patients diagnosed of neoplasm (26.7%). CONCLUSION: With this type of polyvalent medical day hospital, we have observed improved efficiency of health care, freeing up hospital beds by reducing hospitalizations, inadequate hospitalizations and re-admissions in the medical units involved.

Triggered electromyography (tEMG) in the lumbar spine It́s reliable? Correlation of tEMG with postoperative CT images in lumbar instrumentation. / Electromiografía evocada (tEMG) en la columna lumbar. ¿Es confiable? Correlación de tEMG con imágenes de TC posoperatorias en la instrumentación lumbar.

INTRODUCTION: Instrumentation with pedicle screws (PS) can compromise the adjacent neural structures. Triggered electromyography (tEMG) is a modality of intraoperative neuromonitoring, used to assist in the placement of these. The objective of the present study is to evaluate the reliability of this tool. METHOD: Retrospective review of patients underwent posterior lumbar fusions from January 2017 to December 2019, correlating postoperative CT images (postop CT) with tEMG results for each PS with a threshold of 10mA, establishing sensitivity and specificity of this tool. Diagnostic test and receiver operating characteristic curve were performed to evaluate the area under the curve. RESULT: A total of 275 PS were evaluated between L1 to S1; 5 PS showed concordance for an inadequate trajectory, while 10PS, with tEMG <10mA, were correctly positioned. The postoperative CT identified 17 pedicle gaps not noticed by the tEMG. Sensitivity and specificity were 23% (95% CI: 8-45) and 96% (95% CI: 93-98), respectively, with a PPV of 33.3% and a NPV of 93.6%. The area under the curve was 0.74 (95% CI: 0.62-0.86) with a cut-off point of 24mA, showing a sensitivity of 77% (95% CI: 0.55-0.92) and specificity of 69% (95% CI: 0.63-0.75). CONCLUSION: Given its low sensitivity, we do not recommend tEMG as the sole test in the verification of PS. We recommend using a cut-off point ≤8mA as it demonstrated the highest levels of sensitivity and specificity. We do not recommend using high thresholds to increase sensitivity.

Peritoneal repairing cells: a type of bone marrow derived progenitor cells involved in mesothelial regeneration.

The peritoneal mesothelium exhibits a high regenerative ability. Peritoneal regeneration is concomitant with the appearance, in the coelomic cavity, of a free-floating population of cells whose origin and functions are still under discussion. We have isolated and characterized this cell population and we have studied the process of mesothelial regeneration through flow cytometry and confocal microscopy in a murine model lethally irradiated and reconstituted with GFP-expressing bone marrow cells. In unoperated control mice, most free cells positive for mesothelin, a mesothelial marker, are green fluorescent protein (GFP). However, 24 hrs after peritoneal damage, free mesothelin(+)/GFP(+) cells appear in peritoneal lavages. Cultured lavage peritoneal cells show colocalization of GFP with mesothelial (mesothelin, cytokeratin) and fibroblastic markers. Immunohistochemical staining of the peritoneal wall also revealed colocalization of GFP with mesothelial markers and with procollagen-1 and smooth muscle α-actin. This was observed in the injured area as well as in the surrounding not-injured peritoneal surfaces. These cells, which we herein call peritoneal repairing cells (PRC), are very abundant 1 week after surgery covering both the damaged peritoneal wall and the surrounding uninjured area. However, they become very scarce 1 month later, when the mesothelium has completely healed. We suggest that PRC constitute a type of monocyte-derived cells, closely related with the tissue-repairing cells known as 'fibrocytes' and specifically involved in peritoneal reparation. Thus, our results constitute a synthesis of the different scenarios hitherto proposed about peritoneal regeneration, particularly recruitment of circulating progenitor cells and adhesion of free-floating coelomic cells.

The embryonic epicardium: an essential element of cardiac development.

The epicardium has recently been identified as an active and essential element of cardiac development. Recent reports have unveiled a variety of functions performed by the embryonic epicardium, as well as the cellular and molecular mechanisms regulating them. However, despite its developmental importance, a number of unsolved issues related to embryonic epicardial biology persist. In this review, we will summarize our current knowledge about (i) the ontogeny and evolution of the epicardium, including a discussion on the evolutionary origins of the proepicardium (the epicardial primordium), (ii) the nature of epicardial-myocardial interactions during development, known to be essential for myocardial growth and maturation, and (iii) the contribution of epicardially derived cells to the vascular and connective tissue of the heart. We will finish with a note on the relationships existing between the primordia of the viscera and their coelomic epithelial lining. We would like to suggest that at least a part of the properties of the embryonic epicardium are shared by many other coelomic cell types, such that the role of epicardium in cardiac development is a particular example of a more general mechanism for the contribution of coelomic and coelomic-derived cells to the morphogenesis of organs such as the liver, kidneys, gonads or spleen.

Study of the olfactory epithelium in the developing sturgeon. Characterization of the crypt cells.

In acipenserids, crypt cells (CCs) have only been observed in juvenile specimens, and it has not been clarified whether they differentiate along with olfactory receptor neurons (ORNs) during the lecithotrophic stage or during later development stages. Furthermore, no detailed optical microscopy (OM) or electron microscopy study on the development of CCs has been published to date. In the present study, we used OM and electron microscopy to follow the development of CCs in Acipenser naccarii from hatching to the establishment of exogenous feeding. Based on these observations, we can affirm that CCs are present from the first few posthatching (PH) days. CCs appear with their nucleus close to the basal lamina of the epithelium and enveloped by supporting cells. In addition, from the beginning of day 2 PH, we observed cells with highly similar characteristics to those of CCs (absence of knob, abundant mitochondria and filamentous material in apical cytoplasm, numerous microtubules, and envelopment by supporting cells) but with cilia still remaining on their noninvaginated apical surface. We conclude that these cells may correspond to immature CCs in which the crypt, the final feature of their morphological differentiation, has not yet formed.

Time trends in the impact attributable to cold days in Spain: Incidence of local factors.

BACKGROUND: While numerous studies have shown that the impact of cold waves is decreasing as result of various processes of adaptation, far fewer have analysed the time trend shown by such impact, and still fewer have done so for the different provinces of a single country, moreover using a specific cold waves definition for each. This study thus aimed to analyse the time trend of the impact of cold days on daily mortality in Spain across the period 1983-2003. METHODS: For study purposes, we used daily mortality data for all natural causes except accidents in ten Spanish provinces. The time series was divided into three subperiods. For each period and province, the value of Tthreshold was obtained via the percentile corresponding to the cold day's definition for that province obtained in previous studies. Relative Risks (RRs) and Population Attributable Fraction (PARs) were calculated using Generalised Linear Models (GLMs) with the Poisson regression link. Seasonalities, trends and autoregressive components were controlled. Global RRs and ARs were calculated with the aid of a meta-analysis with random effects for each of the periods. RESULTS: The results show that the RRs for Spain as a whole were 1.12 (95% CI: 1.08 1.16) for the first period, 1.15 (95% CI: 1.09 1.22) for the second and 1.18 (95% CI: 1.10 1.26) for the third. The impact of cold days has risen slightly over time, though the differences were not statistically significant. These findings show a clearly different behaviour pattern to that previously found for heat. CONCLUSION: The results obtained in this study do not show a downward trend for colds days. The complexity of the biological mechanisms involved in cold-related mortality and the lack of robust results mean that more research must be done in this particular field of public health.

Norovirus recovery from floors and air after various decontamination protocols.

BACKGROUND: The dispersal of airborne norovirus (NoV) particles from the floor after contamination with faeces or vomit is a challenge for infection control, as this pathogen is infectious at low doses. Therefore, it is imperative to establish a safe protocol for floor decontamination. AIM: To assess the presence of residual NoV-GII particles on floors and airborne particles following various floor decontamination procedures. METHODS: Two types of floor (vinyl and granite) were contaminated intentionally with 10% human faeces, positive for NoV-GII. Two decontamination protocols were implemented: cleaning followed by disinfection using 1% sodium hypochlorite, and cleaning followed by disinfection using a manual ultraviolet C (UV-C) light device. Swab samples were taken from the floors, and air samples were obtained using an air sampler. The TaqMan method for real-time reverse transcription-quantitative polymerase chain reaction was employed for analysis. FINDINGS: The disinfection protocol using 1% sodium hypochlorite after cleaning proved to be more effective than cleaning followed by UV-C light exposure (P<0.001). Viral particles were detected in 27 of 36 air samples after cleaning, with no significant difference between the two floor types. On average, 617 genome copies/sample were identified in air samples after cleaning, but the number decreased gradually after disinfection. CONCLUSION: NoV-GII can be aerosolized during floor cleaning, and its particles may be inhaled and then swallowed or can settle on surfaces. Therefore, residual viral particles on floors must be fully eliminated. Cleaning followed by 10 min of 1% sodium hypochlorite disinfection proved to be the superior decontamination protocol.

Wt1 and retinoic acid signaling are essential for stellate cell development and liver morphogenesis.

Previous studies of knock-out mouse embryos have shown that the Wilms' tumor suppressor gene (Wt1) is indispensable for the development of kidneys, gonads, heart, adrenals and spleen. Using OPT (Optical Projection Tomography) we have found a new role for Wt1 in mouse liver development. In the absence of Wt1, the liver is reduced in size, and shows lobing abnormalities. In normal embryos, coelomic cells expressing Wt1, GATA-4, RALDH2 and RXRalpha delaminate from the surface of the liver, intermingle with the hepatoblasts and incorporate to the sinusoidal walls. Some of these cells express desmin, suggesting a contribution to the stellate cell population. Other cells, keeping high levels of RXRalpha immunoreactivity, are negative for stellate or smooth muscle cell markers. However, coelomic cells lining the liver of Wt1-null embryos show decreased or absent RALDH2 expression, the population of cells expressing high levels of RXRalpha is much reduced and the proliferation of hepatoblasts and RXRalpha-positive cells is significantly decreased. On the other hand, the expression of smooth muscle cell specific alpha-actin increases throughout the liver, suggesting an accelerated and probably anomalous differentiation of stellate cell progenitors. We describe a similar retardation of liver growth in RXRalpha-null mice as well as in chick embryos after inhibition of retinoic acid synthesis. We propose that Wt1 expression in cells delaminating from the coelomic epithelium is essential for the expansion of the progenitor population of liver stellate cells and for liver morphogenesis. Mechanistically, at least part of this effect is mediated via the retinoic acid signaling pathway.

Thoracoscopic and laparoscopic repair of complicated Bochdalek hernia in adult.

Bochdalek's hernia is a congenital defect of the diaphragm that occurs predominantly in children. Perforation or necrosis of the involved organ is a feared complication and surgical repair constitutes the gold standard of treatment. We present a case of a 42-year-old female patient who presented with a 3-month history of left-upper-quadrant abdominal pain, nausea, tachycardia, and early postprandial vomit. Physical exploration was remarkable for audible peristalsis in the left hemithorax. Total white blood count was elevated and chest X-rays showed images of intestines in the left hemithorax. Tomography with double contrast reported left colon herniated to thorax. Left thoracoscopy was practised, finding a Bochdalek's hernia with presence of herniated descendent colon with a necrotic area, which was perforated and sealed. The herniated content was returned back in place, the diaphragmatic defect was corrected, and colostomy by laparoscopy was simultaneously performed. Her postoperative recovery was uneventful and she was discharged from the hospital. Combined thoracoscopy and laparoscopic surgery is effective in complicated cases of Bochdalek's hernia in adults, lessening surgical trauma and postsurgical morbidity.