Integrating ecotoxicity and chemical approaches to compare the effects of ZnO nanoparticles, ZnO bulk, and ZnCl2 on plants and microorganisms in a natural soil.

This work compared the toxicity of ZnO nanoparticles (ZnO-NPs), ZnO bulk, and ZnCl2 on microbial activity (C and N transformations and dehydrogenase and phosphatase activities) and their uptake and toxic effects (emergence, root elongation, and shoot growth) on three plant species namely wheat, radish, and vetch in a natural soil at 1000 mg Zn kg(-1). Additionally, plants were also tested at 250 mg Zn kg(-1). The effects of the chemical species on Zn extractability in soil were studied by performing single and sequential extractions. ZnCl2-1000 presented the highest toxicity for both taxonomic groups. For microorganisms, ZnO-NPs demonstrated adverse effects on all measured parameters, except on N transformations. The effects of both ZnO forms were similar. For plants, ZnO-NPs affected the growth of more plant species than ZnO bulk, although the effects were small in all cases. Regarding accumulation, the total Zn amounts were higher in plants exposed to ZnO-NP than those exposed to ZnO bulk, except for vetch shoots. The soil sequential extraction revealed that the Zn concentration in the most labile forms (water soluble (WS) and exchangeable (EX)) was similar in soil treated with ZnO (NP and bulk) and lower than that of ZnCl2-treated soil, indicating the higher availability of the ionic forms. The strong correlations obtained between WS-Zn fraction and the Zn concentrations in the roots, shoots, and the effects on shoot weight show the suitability of this soil extraction method for predicting bioavailable Zn soil for the three plant species when it was added as ZnO-NPs, ZnO bulk, or ZnCl2. In this work, the hazard associated with the ZnO-NPs was similar to ZnO bulk in most cases.

Tratamiento del cáncer de próstata en función de la esperanza de vida, la comorbilidad y las guías de práctica clínica / Treatment of prostate cancer according to life expectancy, comorbidity and clinical practice guidelines

Fundamento: Describir el tratamiento de pacientes con cáncer de próstata en función de esperanza de vida, riesgo y comorbilidad, explorar el grado de seguimiento de las guías de práctica clínica (GPC) y registrar los efectos secundarios tras un año. Método: Estudio retrospectivo de pacientes diagnosticados y tratados de cáncer de próstata en un hospital el 2011. Se recogieron variables sociodemográficas, comorbilidad (índice de Charlson), del tumor, del tratamiento y efectos secundarios. Se realizó análisis bivariante con Ji cuadrado. Resultados: Se identificaron 114 pacientes. El 92,1% tenía esperanza de vida mayor de 10 años; el 50% comorbilidad baja, el 36% media y el 14% alta. Se practicó cirugía en el 56,2%, más en pacientes de riesgo medio y comorbilidad baja; radioterapia en el 13,2%, más en pacientes de riesgo alto y comorbilidad baja; hormonoterapia en el 21,9%, más en comorbilidad media, y tratamiento diferido en el 12,3%. El no seguimiento de la GPC alcanzó el 38,6% y en riesgo alto el 58,1%. El 70% de los tratados con cirugía presentaron incontinencia urinaria y el 48,3% disfunción eréctil. De los tratados con hormonoterapia, un 17,15% presentó enfermedades cardiovasculares y un 32,5% agravamiento de factores de riesgo cardiovascular. Conclusiones: El tratamiento del cáncer de próstata tiene en cuenta el riesgo y la comorbilidad, pero el seguimiento de las GPC puede mejorarse, principalmente en pacientes de riesgo alto. Es necesario adoptar medidas preventivas para reducir efectos secundarios cardiovasculares en pacientes sometidos a hormonoterapia (AU)

Background: To describe the treatment of prostate cancer patients according to life expectancy, risk and comorbidity, to examine the degree to which Clinical Practice Guidelines (CPG) are followed, and to register secondary effects after one year. Methods: Retrospective study of patients diagnosed with prostate cancer in a hospital in 2011. Socio-demographic variables, as well as comorbidity (Charlson index), tumor characteristics, treatments and secondary effects were collected. A bivariate analysis was performed using the Chi square test. Results: One hundred and fourteen patients were identified. Life expectancy was higher than 10 years in 92.1%; 50% had low comorbidity, 36% medium and 14% high. Surgery was performed in 56.2%, more often in patients with intermediate-risk and low comorbidity; radiotherapy in 13.2%, more often in patients with high-risk and low comorbidity; hormonal therapy in 21.9%, more often in patients with medium comorbidity, and deferred treatment in 12.3%. CPG recommendations were not followed in 38.6%, especially in high-risk patients, 58.1%. Regarding adverse effects, 70% of patients treated with surgery presented urinary incontinence, and 48.3% erectile dysfunction. On the other hand, 17.15% of patients treated with hormonal therapy presented a cardiovascular disease, and 32.5% worsening of a cardiovascular risk factor. Conclusions: Treatment of prostate cancer takes into account risk and comorbidity, but there could be improvement in following CPG guidelines, especially in elderly patients. It is advisable to develop preventive strategies to avoid cardiovascular effects in patients with hormonal therapy (AU)

Toxicity of ZnO nanoparticles, ZnO bulk, and ZnCl2 on earthworms in a spiked natural soil and toxicological effects of leachates on aquatic organisms.

The present study assessed the uptake and toxicity of ZnO nanoparticles (NPs), ZnO bulk, and ZnCl2 salt in earthworms in spiked agricultural soils. In addition, the toxicity of aqueous extracts to Daphnia magna and Chlorella vulgaris was analyzed to determine the risk of these soils to the aquatic compartment. We then investigated the distribution of Zn in soil fractions to interpret the nature of toxicity. Neither mortality nor differences in earthworm body weight were observed compared with the control. The most sensitive end point was reproduction. ZnCl2 was notably toxic in eliminating the production of cocoons. The effects induced by ZnO-NPs and bulk ZnO on fecundity were similar and lower than those of the salt. In contrast to ZnO bulk, ZnO-NPs adversely affected fertility. The internal concentrations of Zn in earthworms in the NP group were greater than those in the salt and bulk groups, although bioconcentration factors were consistently <1. No relationship was found between toxicity and internal Zn amounts in earthworms. The results from the sequential extraction of soil showed that ZnCl2 displayed the highest availability compared with both ZnO. Zn distribution was consistent with the greatest toxicity showed by the salt but not with Zn body concentrations. The soil extracts from both ZnO-NPs and bulk ZnO did not show effects on aquatic organisms (Daphnia and algae) after short-term exposure. However, ZnCl2 extracts (total and 0.45-µm filtered) were toxic to Daphnia.

[Treatment of prostate cancer according to life expectancy, comorbidity and clinical practice guidelines]. / Tratamiento del cáncer de próstata en función de la esperanza de vida, la comorbilidad y las guías de práctica clínica.

BACKGROUND: To describe the treatment of prostate cancer patients according to life expectancy, risk and comorbidity, to examine the degree to which Clinical Practice Guidelines (CPG) are followed, and to register secondary effects after one year. METHODS: Retrospective study of patients diagnosed with prostate cancer in a hospital in 2011. Socio-demographic variables, as well as comorbidity (Charlson index), tumor characteristics, treatments and secondary effects were collected. A bivariate analysis was performed using the Chi square test. RESULTS: One hundred and fourteen patients were identified. Life expectancy was higher than 10 years in 92.1%; 50% had low comorbidity, 36% medium and 14% high. Surgery was performed in 56.2%, more often in patients with intermediate-risk and low comorbidity; radiotherapy in 13.2%, more often in patients with high-risk and low comorbidity; hormonal therapy in 21.9%, more often in patients with medium comorbidity, and deferred treatment in 12.3%. CPG recommendations were not followed in 38.6%, especially in high-risk patients, 58.1%. Regarding adverse effects, 70% of patients treated with surgery presented urinary incontinence, and 48.3% erectile dysfunction. On the other hand, 17.15% of patients treated with hormonal therapy presented a cardiovascular disease, and 32.5% worsening of a cardiovascular risk factor. CONCLUSIONS: Treatment of prostate cancer takes into account risk and comorbidity, but there could be improvement in following CPG guidelines, especially in elderly patients. It is advisable to develop preventive strategies to avoid cardiovascular effects in patients with hormonal therapy.

Metabolic alkalosis and induced hypokalaemia in the diagnosis of renovascular arterial hypertension

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Behavior of zinc from six organic fertilizers applied to a navy bean crop grown in a calcareous soil.

The objective of this study was to compare the mobility, leaching, availability, and relative effectiveness of Zn from Zn-polyhydroxyphenylcarboxilate (Zn-PHP), Zn-HEDTA (Zn-N-2-hydroxyethyl-ethylenediaminetriacetate), Zn-EDDHSA [Zn-ethylenediamine-di-(2-hydroxy-5-sulfophenylacetate)], Zn-EDTA (Zn-ethylenediaminetetraacetate), Zn-S,S-EDDS (Zn-ethylenediaminedisuccinate), and Zn-EDTA-HEDTA sources by applying different Zn rates (5 and 10 mg kg(-1)) to a calcareous soil under greenhouse conditions. A lysimeter experiment was carried out for 60 days and using navy bean (Phaseolus vulgaris L.) as an indicator plant. The Zn available to the plant and easily leachable Zn were determined in soil by different single extractions, while the distribution of Zn in the soil was assessed by sequential speciation. The utilization of applied Zn by the navy bean was greatest when the Zn treatments were Zn-EDTA, Zn-EDTA-HEDTA, Zn-HEDTA, and Zn-EDDHSA. Both total Zn in the plants and soluble Zn in the plant dry matter (extracted with 1 mM 2-morpholino-ethanesulfonic acid) were positive and significantly correlated with the following: the amounts of Zn extracted with the three single extractions used to estimate soil available Zn and the amounts of Zn in the water soluble plus exchangeable and organically complexed fractions. The Zn-HEDTA, Zn-EDDHSA, Zn-EDTA-HEDTA, Zn-S,S-EDDS, and Zn-EDTA sources significantly increased the mobility of micronutrients through the soil with respect to the control and Zn-PHP source. The maximum Zn concentration obtained in the leachate fractions was 65 mg L(-1) (13% of Zn applied) for the Zn-S,S-EDDS chelate applied at a rate of 10 mg Zn kg(-1) soil. In the course of the crop, the soil pH + pe parameter increased significantly with experimental time.

[Implantation of a hospital registry of hereditary nonpolyposis colorectal cancer]. / Implantación de un registro hospitalario de cáncer colorrectal hereditario sin poliposis.

INTRODUCTION: Identification of patients with hereditary nonpolyposis colorectal cancer (HNPCC) can allow colorectal cancer (CRC) prevention through colonoscopy and polypectomies. The purpose of this study was to report the clinical characteristics of HNPCC families in our registry. PATIENTS AND METHOD: HNPCC was identified using the Amsterdam criteria. Familial clustering of CRC and extracolonic cancers were investigated in families. Individuals at risk were offered annual colonoscopy, starting from the age of 25 years. RESULTS: Twelve HNPCC families were identified. There were 46 cases of CRC in 38 patients. The mean age at diagnosis of CRC was 45.4 +/- 12.7 years (range 25-73 years). In patients with documented disease, right-sided tumors predominated. Eleven patients with extracolonic cancer were identified (six tumors located in the endometrium). Of 43 at-risk individuals, 29 accepted surveillance. CONCLUSIONS: Our data confirm the importance of the family history in identifying HNPCC. This study confirms previously described characteristics in HNPCC, namely, early age at onset of CRC, right-sided predominance, multiple synchronous and metachronous neoplasms, and increased extracolonic cancers. This is the first study of clinical data in a Spanish HNPCC registry.

Implantación de un registro hospitalario de cáncer colorrectal hereditario sin poliposis / Implantation of a hospital registry of hereditary nonpolyposis colorectal cancer

Introducción: La identificación de los pacientes afectados de cáncer colorrectal hereditario sin poliposis (CCRHSP) hace posible la prevención del cáncer colorrectal (CCR), mediante el cribado endoscópico y las polipectomías endoscópicas. La finalidad de nuestro estudio es presentar los datos clínicos de las familias incluidas en nuestro registro de CCRHSP. Pacientes y método: El CCRHSP se identifica mediante los criterios de Ámsterdam. Se analiza la historia familiar de CCR y de neoplasias extracolónicas. Entre las familias identificadas, a los familiares en situación de riesgo se les ofrece la realización de cribado mediante colonoscopia anual, a partir de los 25 años de edad. Resultados: Se identifica a 12 familias que cumplen los criterios de Ámsterdam. En total se presentan 46 casos de CCR en 38 pacientes. La edad media en el momento del diagnóstico es de 45,4 ± 12,7 años, con un rango de entre 25 y 73 años. Entre los pacientes con histología documentada, predominan las lesiones del colon derecho. Se identifica a 11 pacientes con neoplasias extracolónicas (6 localizadas en el endometrio). En total, 29 de 43 familiares de riesgo aceptaron el cribado endoscópico. Conclusiones: Los datos confirman la importancia de la historia familiar para la identificación del CCRHSP. Este estudio confirma las características previamente descritas para el CCRHSP, como la edad temprana de presentación del CCR, la localización preferente en el colon derecho, la presencia de múltiples lesiones sincrónicas o metacrónicas y el incremento de las neoplasias extracolónicas. Éste es el primer estudio con datos clínicos de un registro de CCRHSP en España

Introduction: Identification of patients with hereditary nonpolyposis colorectal cancer (HNPCC) can allow colorectal cancer (CRC) prevention through colonoscopy and polypectomies. The purpose of this study was to report the clinical characteristics of HNPCC families in our registry. Patients and method: HNPCC was identified using the Amsterdam criteria. Familial clustering of CRC and extracolonic cancers were investigated in families. Individuals at risk were offered annual colonoscopy, starting from the age of 25 years. Results: Twelve HNPCC families were identified. There were 46 cases of CRC in 38 patients. The mean age at diagnosis of CRC was 45.4 ± 12.7 years (range 25-73 years). In patients with documented disease, right-sided tumors predominated. Eleven patients with extracolonic cancer were identified (six tumors located in the endometrium). Of 43 at-risk individuals, 29 accepted surveillance. Conclusions: Our data confirm the importance of the family history in identifying HNPCC. This study confirms previously described characteristics in HNPCC, namely, early age at onset of CRC, right-sided predominance, multiple synchronous and metachronous neoplasms, and increased extracolonic cancers. This is the first study of clinical data in a Spanish HNPCC registry

Review article: colorectal cancer surveillance in ulcerative colitis - what should we be doing?

Different societies have published guidelines for colorectal cancer (CRC) surveillance in ulcerative colitis (UC). While it would seem that most gastroenterologists and endoscopists agree with these guidelines, different studies have shown that in clinical practice, the concept of dysplasia is not fully understood, and therefore, the guidelines are not always followed. According to some studies, the reason why gastroenterologists do not follow the recommendations is inadequate education. The main advance in recent years in this subject is in endoscopic diagnosis of dysplasia. The magnification and chromoendoscopy allow targeted biopsies to be taken. Some studies indicate that nontargeted biopsies are not useful in ruling out dysplasia. It is also important to realize that most dysplasia is visible in conventional colonoscopy. In colonoscopy, it is not only significant to detect dysplasia-associated lesions or masses; the endoscopist should also be trained to detect, in the course of conventional exploration, subtle changes in colour or in mucosal surfaces that imply dysplasia. Adherence to guidelines had been extensively assessed in other disease conditions (asthma, hypertension, etc.). According to our knowledge there are no such data regarding CRC surveillance in UC. Some barriers that may affect physicians include: (i) knowledge (lack of awareness or lack of familiarity); (ii) attitudes (lack of agreement, lack of self-efficacy, lack of outcome expectancy, or the inertia of previous practice) and (iii) behaviour (external barriers). In conclusion, we need new guidelines for CRC surveillance in UC, which must take into account the advances in risk factors of dysplasia and new technologies to study colon dysplasia.

Recomendaciones sobre tuberculosis y tratamiento de la enfermedad inflamatoria intestinal con infliximab. Actualización 2006 / Recommendations on tuberculosis and treatment of inflammatory bowel disease with infliximab. 2006 update

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Documento de consenso en el uso de la granulocitoaféresis en pacientes con enfermedad inflamatoria intestinal / Consensus document on the use of granulocytapheresis in patients with inflammatory bowel disease

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Prevalence of HFE C282Y and H63D in Jewish populations and clinical implications of H63D homozygosity.

The frequencies of C282Y and H63D mutations of the HFE gene vary between different populations. A previous study showed an unexpectedly high H63D frequency in Chuetas (a population of Jewish descent). The present study addressed the question of the distribution of these mutations in Jewish populations from different origins and studied the possible causes of the high H63D frequency in Chuetas. Moreover, to improve the understanding of the controversial relationship between H63D homozygosity and iron overload, a group of patients with altered iron metabolism were studied. The high frequency of H63D mutation in Chuetas is not due to a high prevalence of this mutation in Sephardic Jews. Jewish populations have low C282Y and moderate H63D frequencies, suggesting slight gene flow from their surrounding populations. In accordance with historical and demographic data, genetic drift is the most probable cause for the singular H63D frequency in Chuetas. Clinically, this study of H63D homozygotes supports the conclusion that this genotype must be taken into account, because it confers an increased risk of iron overload and therefore genetic susceptibility to developing hereditary hemochromatosis or to aggravating other diseases.

Recomendaciones GETECCU-2005 para el uso de infliximab (Remicade®) en la enfermedad inflamatoria intestinal / GETECCU-2005 recommendations for the use of infliximab (Remicade®) in inflammatory bowel disease

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Granulocyteaphaeresis in steroid-dependent inflammatory bowel disease: a prospective, open, pilot study.

BACKGROUND: Uncontrolled studies suggest that granulocyteaphaeresis might be useful in the management of active ulcerative colitis. AIM: To assess the efficacy of granulocyteaphaeresis treatment in active steroid-dependent inflammatory bowel disease. METHODS: We conducted a multicentre, prospective, open, pilot study in patients with steroid-dependent inflammatory bowel disease. All patients were started on 60 mg/day of prednisone; after 1 week, a five-session programme of granulocyteaphaeresis (once per week) was started. The steroid dose was tapered weekly if there was clinical improvement. Remission was defined as an inactive clinical activity index together with complete withdrawal of steroids at week 6. The patients were followed up for at least 6 months or until disease relapse. RESULTS: Twenty-six patients (14 ulcerative colitis, 12 Crohn's disease) were included. More than a half had been previously treated with immunomodulators. Remission was achieved in 62 and 70% of ulcerative colitis and Crohn's disease, respectively. During a median follow-up of 12.6 months, six of eight ulcerative colitis patients maintained their clinical remission; however, only one Crohn's disease patient remained in remission after the first 6 months of follow-up. CONCLUSIONS: Granulocyteaphaeresis is a safe treatment option in inflammatory bowel disease. A five-session programme of granulocyteaphaeresis seems to be efficient in the treatment of steroid-dependent ulcerative colitis, but not in Crohn's disease.