Improved Process for the Continuous Acylation of 1,3-Benzodioxole.

The acylation of 1,3-benzodioxole was studied in a continuous process using a recyclable heterogeneous substoichiometric catalyst. In a short time period (30 min), at 100 °C, the conversion rate was 73%, with a selectivity of 62% of the desired acylated product; the reaction was run continuously for 6 h, showing excellent stability and selectivity. Moreover, the unreacted starting material, 1,3-benzodioxole, can be easily separated by distillation and recycled.

HIV-1 remission and possible cure in a woman after haplo-cord blood transplant.

Previously, two men were cured of HIV-1 through CCR5Δ32 homozygous (CCR5Δ32/Δ32) allogeneic adult stem cell transplant. We report the first remission and possible HIV-1 cure in a mixed-race woman who received a CCR5Δ32/Δ32 haplo-cord transplant (cord blood cells combined with haploidentical stem cells from an adult) to treat acute myeloid leukemia (AML). Peripheral blood chimerism was 100% CCR5Δ32/Δ32 cord blood by week 14 post-transplant and persisted through 4.8 years of follow-up. Immune reconstitution was associated with (1) loss of detectable replication-competent HIV-1 reservoirs, (2) loss of HIV-1-specific immune responses, (3) in vitro resistance to X4 and R5 laboratory variants, including pre-transplant autologous latent reservoir isolates, and (4) 18 months of HIV-1 control with aviremia, off antiretroviral therapy, starting at 37 months post-transplant. CCR5Δ32/Δ32 haplo-cord transplant achieved remission and a possible HIV-1 cure for a person of diverse ancestry, living with HIV-1, who required a stem cell transplant for acute leukemia.

Marker assisted selection for Varroa destructor resistance in New Zealand honey bees.

Varroa destructor is a honey bee (Apis mellifera) parasite identified as one of the leading causes of overwintering colony loss in New Zealand. It has been shown that a naturally occurring heritable trait, "Varroa Sensitive Hygiene" (VSH), confers an advantage to colonies by increasing behaviours that limit the survival and reproduction of Varroa mites. The SNP 9-9224292 is an adenine/guanine (A/G) polymorphism on chromosome 9 of Apis mellifera where the G allele was observed to be associated with VSH behaviour in North American honey bees. In this study, we sought to determine if selection for the G allele of SNP 9-9224292 could decrease Varroa mite infestation of New Zealand honey bee (Apis mellifera ligustica) colonies. We genotyped queens and tracked their colonies over summer before measuring Varroa levels at the point of autumn Varroa treatment. The mean Varroa population level in colonies headed by queens that carry two copies of VSH associated G allele of SNP 9-9224292 was 28.5% (P<0.05) lower compared with colonies headed by queens with two copies of non-VSH associated A alleles. Although a significant reduction in mite infestation was achieved in treatment colonies, conventional Varroa treatment was still required for adequate Varroa control. Considering the open mating of queens used and a lack of drift control in this study, this VSH SNP shows promise for marker assisted selection of New Zealand honey bees when aiming for innate Varroa control traits.

Sequential intensive chemotherapy followed by autologous or allogeneic transplantation for refractory lymphoma.

We evaluate the safety of bendamustine as a bridge to stem cell transplantation (SCT) in patients with relapsed/refractory lymphoma and residual disease after salvage therapy. Thirty-four subjects without complete responses (CR) received bendamustine 200 mg/m2/day for 2 days followed 14 days later by SCT. Sixteen subjects in partial remission (PR) with maximal FDG-PET SUVs ≤8 prior to bendamustine received autologous SCT, while 13 with suboptimal responses were allografted. Five subjects did not proceed to transplant. No bendamustine toxicities precluded transplantation and no detrimental effect on engraftment or early treatment-related mortality (TRM) was attributable to bendamustine. At 1 year, 75% of auto-recipients and 31% of allo-recipients were alive with CR. Two subjects in the autologous arm developed therapy-related myeloid neoplasia (t-MN). In conclusion, a bendamustine bridge to SCT can be administered without early toxicity to patients with suboptimal responses to salvage chemotherapy. However this approach may increase the risk of t-MN. (NCT02059239).Supplemental data for this article is available online at here.

Bio- and Biomimetic Receptors for Electrochemical Sensing of Heavy Metal Ions.

Heavy metals ions (HMI), if not properly handled, used and disposed, are a hazard for the ecosystem and pose serious risks for human health. They are counted among the most common environmental pollutants, mainly originating from anthropogenic sources, such as agricultural, industrial and/or domestic effluents, atmospheric emissions, etc. To face this issue, it is necessary not only to determine the origin, distribution and the concentration of HMI but also to rapidly (possibly in real-time) monitor their concentration levels in situ. Therefore, portable, low-cost and high performing analytical tools are urgently needed. Even though in the last decades many analytical tools and methodologies have been designed to this aim, there are still several open challenges. Compared with the traditional analytical techniques, such as atomic absorption/emission spectroscopy, inductively coupled plasma mass spectrometry and/or high-performance liquid chromatography coupled with electrochemical or UV-VIS detectors, bio- and biomimetic electrochemical sensors provide high sensitivity, selectivity and rapid responses within portable and user-friendly devices. In this review, the advances in HMI sensing in the last five years (2016-2020) are addressed. Key examples of bio and biomimetic electrochemical, impedimetric and electrochemiluminescence-based sensors for Hg2+, Cu2+, Pb2+, Cd2+, Cr6+, Zn2+ and Tl+ are described and discussed.

Diet effect on osmoregulation in the subterranean rodent Ctenomys talarum.

Water conservation requires osmoregulatory skills, sometimes limited by the environment and/or physiological and behavioral characteristics acquired along the evolutionary history of the species. Fossoriality had probably emerged as a survival mechanism to face increasing aridity, as suggested for Ctenomys, a genus that radiated to different environments. Ctenomys talarum (tuco-tuco) is an herbivorous subterranean rodent that lives in coastal grasslands inside humid burrows that reduce evaporation. However, their osmoregulatory mechanisms may be challenged by atmospheric variations when foraging aboveground and by the annual variability in dietary water and salt content. Then, it is of great interest to identify how much of this flexibility of C .talarum is attributed to physiological regulation. We analyzed the effect of water and salt content of diet on urinary, plasmatic, fecal and respiratory parameters. Tuco-tucos were not able to maintain their body weight under the offered monodiet, especially under the low hydrated diet, which explains its generalist and opportunistic foraging behavior. C. talarum mainly obtained water through food, whereas water metabolic production was negligible. Evaporative water loss did not vary between diets, but individuals under water restriction showed decreased fecal water loss and urine volume, high urine concentration but stable plasmatic osmolality and ionic concentration values. Under salt stress, urinary parameters remained relatively stable and high plasmatic osmolality was detected. Despite C. talarum produced more diluted urine than rodents from xeric environments, it is able to concentrate it 4 times above than the required at field even under the lowest water availability. This may be a characteristic associated with the evolutionary history of the species, which evolved in an arid context.

Case Report: Ocular Gnathostomiasis in Venezuela Most Likely Acquired in Texas.

A 69-year-old male dentist in Caracas, Venezuela, was referred to our Cornea Clinic with a history of pain, photophobia, and blurred vision on his left eye. Routine biomicroscopic examination with a slit lamp showed a worm in the corneal stroma of his left eye. The worm was surgically removed and was identified morphologically as Gnathostoma binucleatum.

Effect of ambient temperature on evaporative water loss in the subterranean rodent Ctenomys talarum.

Subterranean rodents face unique thermoregulatory challenges. Evaporative water loss (EWL) is a crucial mechanism for maintaining heat balance in endotherms subjected to heat stress but also leads to potential dehydration. EWL depends on gradients of temperature and humidity between the surface of the individual and the surrounding environment. Underground burrows generally provide a stable water vapor saturated atmosphere which may impede evaporative heat loss (EHL). This will mainly occur when ambient temperature exceeds the upper limit of individual's thermoneutral zone, or when body temperature rises as result of digging activities. Here we evaluate the effect of ambient temperature on EWL and energy metabolism in the subterranean rodent Ctenomys talarum (tuco-tucos), which inhabits sealed burrows, but makes an extensive use of the aboveground environment. We observed that EWL is increased when ambient temperature rises above thermoneutrality; below this point, evaporation remains stable. Though EWL contributes to total heat loss by increasing ∼1.3 times at 35°C, dry thermal conductance is raised four times. In tuco-tucos' burrows both non-evaporative and, to some extent, evaporative and behavioral mechanisms are essential for body temperature regulation, preventing overheating at high ambient temperatures in a water vapor-saturated atmosphere.

Assessing the energetic costs and trade-offs of a PHA-induced inflammation in the subterranean rodent Ctenomys talarum: immune response in growing tuco-tucos.

A traditional approach used to assess whether immune defense is costly is to explore the existence of trade-offs between immunity and other functions; however, quantitative studies of the energetic costs associated with the activation of the immune system are scarce. We assessed the magnitude of a PHA-triggered immune response and the associated energetic costs in 60-day old Ctenomys talarum. We expected that the magnitude of the macroscopic inflammatory response to PHA is lower in young tuco-tucos compared with that of adults, given the allocation of substantial energy to growth, and that the magnitude of the inflammation is lower in male pups compared to females, due to the higher investment in growth of the larger sex. Concomitantly, we expected that the pups challenged with PHA show an increase in oxygen consumption compared to control animals and that a positive association exists between magnitude of the PHA-induced inflammation and oxygen consumption. Contrary to what was expected, young tuco-tucos mounted a higher inflammatory response compared with adults and there were no differences in the magnitude of this response between sexes. The inflammatory response induced by a PHA injection did not represent a significant energetic cost for young tuco-tucos. There were no differences in oxygen consumption between PHA-injected and control animals, and tuco-tucos that mounted a higher inflammatory response to PHA did not show higher oxygen consumption. Energy expenditure, however, is not the only physiological cost involved in trade-offs between immune response and various functions of the organism, and other currencies are discussed.

Thermoregulatory development and behavior of Ctenomys talarum pups during brief repeated postnatal isolation.

In altricial mammals, the role of the mother and siblings throughout pup's early ontogeny is critical to determine "normal" development in neonates. It has been reported that variations in parental investment during pups' development affect thermoregulatory capacity, growth patterns, brain development and behavior during lifetime, such as spatial learning and memory in adults. Ctenomys talarum (tuco-tuco) is a solitary subterranean rodent, who inhabits complex burrows and exhibits developed spatial orientation abilities. Tuco-tuco's pups display an altricial development, spending more than 80% of the time in contact with the mother. Throughout weaning period, pups display active exploratory behavior and improvements in their spatial capabilities. Then, we determined the effect of repeated brief postnatal isolations on the acquisition of physiological thermoregulation and the development of spatial learning capabilities in tuco-tuco's pups. As it occurs in wild animals, daily brief isolations (30min) did not affect the acquisition of adult's body temperature nor resting metabolic rate's development pattern. Moreover, behavioral response and adult spatial abilities of isolated pups were similar to that observed in non-isolated ones. Then, during periods of mother's absence, minor physiological and behavioral adjustments, such as shivering and postural changes, are required to keep C. talarum pups within allostasis.

Protective ileostomy: complications and mortality associated with its closure.

INTRODUCTION: diverting loop ileostomies are widely used in colorectal surgery to protect low rectal anastomoses. However, they may have various complications, among which are those associated with the subsequent stoma closure. The present study analyses our experience in a series of patients undergoing closure of loop ileostomies. METHOD: retrospective study of all the patients undergoing ileostomy closure at our hospital between 2006-2010. There were 89 patients: 56 males (63%) and 33 females (37%) with a mean age of 55 (38-71) years. The most common indication for ileostomy was protection of a low rectal anastomosis, 81 patients (91%). The waiting time until stoma closure, type and frequency of the complications, length of hospital stay and mortality rate are analysed. RESULTS: waiting time before surgery was 8 (1-25) months. Forty-one patients (45,9%) developed some type of complication, three were reoperated (3.37%) and one patient died (1.12%). The most important complications were intestinal obstruction (32.6%), diarrhoea(6%), surgical wound infection (6%), enterocutaneous fistula (4.5%), rectorrhagia (3.4%) and anastomotic leak (1.12%). The mean length of patient stay was 7.54 (2-23) days. CONCLUSIONS: protective ostomies in low rectal anastomoses have proved to be the only preventive measure for reducing the morbidity and mortality rates for anastomotic leakage. However, creation means subsequent closure, which must not be considered a minor procedure but an operation with possibly significant complications, including death, as has been shown in publications on the subject and in our own series.

Ileostomías de protección: complicaciones y mortalidad asociadas a su cierre / Protective ileostomy: complications and mortality associated with its closure

Introducción: las ileostomías derivativas son ampliamente utilizadas para proteger anastomosis rectales bajas. Sin embargo no están desprovistas de inconvenientes, como la posibilidad de presentar distintas complicaciones, entre las cuales figuran las asociadas al cierre ulterior del estoma. Analizamos nuestra experiencia en una serie de pacientes sometidos a cierre de ileostomías derivativas. Método: estudio retrospectivo de los pacientes sometidos a cierre de ileostomías en nuestro hospital, en un periodo comprendido entre 2006-2010. En total son 89 pacientes; 56 hombres (63%) y 33 mujeres (37%), con una edad media de 55 (38-71) años. La indicación más frecuente para llevar a cabo la ileostomía fue la protección de una anastomosis rectal baja, en un total de 81 pacientes (91%). Se analiza el tiempo de espera hasta el cierre del estoma, el tipo y frecuencia de las complicaciones, la estancia hospitalaria y la mortalidad. Resultados: el tiempo medio de espera entre la elaboración de la ileostomía y su cierre fue de 8 (1-25) meses. Cuarenta y un pacientes (45,9%) desarrollaron algún tipo de complicación, 3 de los cuales (3,37%) fueron reintervenidos y uno fue éxitus (1,12%). Las complicaciones más importantes fueron: obstrucción intestinal (32,6%), diarrea (6%), infección de la herida quirúrgica (6%), fístula enterocutánea (4,5%), rectorragia (3,4%), y dehiscencia anastomótica (1,12%). La estancia media de los pacientes fue de 7,54 (2-23) días. Conclusiones: la realización de ostomías de protección en las anastomosis rectales bajas ha demostrado ser la única medida preventiva eficaz para disminuir la morbi-mortalidad de las dehiscencias de las mismas. Sin embargo su cierre no debe considerarse un procedimiento menor, sino una intervención con posibles e importantes complicaciones(AU)

Introduction: diverting loop ileostomies are widely used in colorectal surgery to protect low rectal anastomoses. However, they may have various complications, among which are those associated with the subsequent stoma closure. The present study analyses our experience in a series of patients undergoing closure of loop ileostomies. Method: retrospective study of all the patients undergoing ileostomy closure at our hospital between 2006-2010. There were 89 patients: 56 males (63%) and 33 females (37%) with a mean age of 55 (38-71) years. The most common indication for ileostomy was protection of a low rectal anastomosis, 81 patients (91%). The waiting time until stoma closure, type and frequency of the complications, length of hospital stay and mortality rate are analysed. Results: waiting time before surgery was 8 (1-25) months. Fortyone patients (45,9%) developed some type of complication, three were reoperated (3.37%) and one patient died (1.12%). The most important complications were intestinal obstruction (32.6%), diarrhoea (6%), surgical wound infection (6%), enterocutaneous fistula (4.5%), rectorrhagia (3.4%) and anastomotic leak (1.12%). The mean length of patient stay was 7.54 (2-23) days. Conclusions: protective ostomies in low rectal anastomoses have proved to be the only preventive measure for reducing the morbidity and mortality rates for anastomotic leakage. However, creation means subsequent closure, which must not be considered a minor procedure but an operation with possibly significant complications, including death, as has been shown in publications on the subject and in our own series(AU)

[Colorectal stents: efficacy and complications in our center]. / Prótesis de colon y recto: eficacia y complicaciones en nuestro centro.

BACKGROUND: in emergency surgery, colorectal mortality is very high compared with elective surgery. An alternative is placement of endoscopic stents to correct the bowel obstruction and then allow elective surgery. Moreover, it is possible to use stents in the palliative treatment of patients at high surgical risk or with unresecable tumors. The aim of this study is to evaluate the rates of technical and clinical success and complications of colorectal stent placement over the past 5 years. METHODS: retrospective study of 33 patients in which stents were placed since 2006 to 2011. Variables were analyzed: 1) the indication (palliation or "bridge to surgery"), 2) rates of technical success and clinical success, and 3) complications (perforation, migration, bleeding, and reocclusion). RESULTS: in 24 patients the prosthesis was placed as a palliative treatment (72.7%) and in 9 cases as a "bridge to surgery". The technical success rate was 87.87% and 82.14% clinical success. There were five cases of bowel perforation with high pneumoperitoneum and a case of microperforation (18.1%). Five patients had reocclusion (17.2%); there were 3 and 4 with bleeding and migration. Three patients died within 24 hours after endoscopic treatment. In 9 cases of "bridge to surgery," technical success was 100% and 77% clinical success. One patient required emergency surgery due to migration of the prosthesis and reocclusion and another colonic perforation. CONCLUSIONS: endoscopic treatment is a good option as a transitional step to elective surgery or palliative treatment. But serious complications such as perforation or reocclusion should be considered.

Gastrointestinal bleeding and bowel obstruction as a presentation of Bouveret syndrome.

BACKGROUND: Bouveret syndrome is a rare entity consisting of duodenal obstruction due to a gallstone from the gallbladder. CLINICAL CASES: We present two patients with very different ages and comorbidities whose conditions were resolved in two different ways: a 41-year-old female with right upper quadrant pain and vomiting who underwent surgical correction of obstruction and fistula, and an 81-year-old female with a high bowel obstruction, only treating the obstruction without intervention of the fistula. CONCLUSIONS: It is important to include high gastrointestinal obstruction in the differential diagnosis. Diagnosis can be made either by radiological or endoscopic techniques and therapeutic options are diverse, ranging from endoscopic removal to surgery (with the resolution of obstruction and fistula in the same surgical procedure). This condition usually affects elderly patients with high comorbidities and high surgical risk; therefore, most authors recommend using the most conservative possible treatment.

Evaluation of a clinical pathway to improve colorectal cancer outcomes.

The aims of this preintervention and postintervention study were to monitor and evaluate the clinical pathway (CP) for colorectal cancer (CRC) over a 5-year period and to compare 2 groups of patients (before and after the intervention) with regard to different variables of effectiveness. Group I comprised 68 patients who underwent planned surgery between January 2002 and January 2003. Group II comprised a sample of 202 patients who underwent surgery between January 2004 and December 2008. No significant differences were found in the majority of the parameters measured: postoperative stay, compliance with antibiotic prophylaxis, compliance with the staging study, mortality, rate of infection, and reoperations. The mean length of stay (±standard deviation) for patients without complications was reduced significantly (9.2 ± 3.6 in group I versus 7.7 ± 1.7 in group II, P = .031). The CP for CRC did not achieve most of the objectives for which it was designed.

Unnoticed small bowel perforation as a complication of lumbar discectomy.

BACKGROUND CONTEXT: Surgery for disc herniation is one of the most common traumas and neurosurgical procedures. Although discectomy has low morbidity, serious intra-abdominal complications can affect retroperitoneal structures, such as the large vessels, small intestine, and ureters. CASE REPORT: A 36-year-old woman in uncontrollable pain presented with left sciatic neuralgia in the L5 region. Magnetic resonance imaging revealed an extruded left paracentral hernia at L5-S1. With the patient in the decubitus prone position, trauma surgeons specializing in spine surgery performed an L5-S1 flavectomy and a simple discectomy. Intraoperative complications were not observed. About 4 hours after surgery, the patient reported sharp abdominal pain and had persistent hypotension. Emergency abdominal computed tomography showed hemoperitoneum in the pouch of Douglas and left parietocolic space. Laparoscopic exploration confirmed hemoperitoneum without visible cause, a seton perforation of the small intestine, and a few adhesions in the right iliac fossa that were consequences of previous appendectomy. A laparotomy was then performed. A lesion was discovered in the mesentery of the rectosigmoid junction coinciding with the S5-L1 space. A segmental bowel resection and mechanical side-to-side anastomosis, with drainage, were done. The patient recovered satisfactorily despite a surgical wound infection. DISCUSSION: Although bowel perforation after discectomy rarely occurs, spine surgeons must try to prevent them by being more cautious during surgery. General surgeons must be highly suspicious of the presence of an intra-abdominal complication when there are signs and symptoms of a postoperative acute abdomen.