Impact of microbial inoculum storage on dark fermentative H2 production.

Complex organic substrates represent an important and relevant feedstock for producing hydrogen by Dark Fermentation (DF). Usually, an external microbial inoculum originated from various natural environments is added to seed the DF reactors. However, H2 yields are significantly impacted by the inoculum origin and the storage conditions as microbial community composition can fluctuate. This study aims to determine how the type and time of inoculum storage can impact the DF performances. Biochemical Hydrogen Potential tests were carried out using three substrates (glucose, the organic fraction of municipal solid waste, and food waste), inocula of three different origins, different storage conditions (freezing or freeze-drying) and duration. As a result, H2 production from glucose with the differently stored inocula was significantly impacted (positively or negatively) and was inoculum-origin-dependent. For complex substrates, hydrogen yields with the stored inocula were not statistically different from the fresh inocula, offering the possibility to store an inoculum.

Intake of alcohol-free red wine modulates antioxidant enzyme activities in a human intervention study.

Wine intake affects the antioxidant enzyme activities that contribute to the overall antioxidant properties of wine. The purpose of this study is to evaluate whether alcohol-free wine has any effect on antioxidant enzymes. The study was a randomized cross-over human intervention. A low phenolic diet (LPD) was designed to prevent interference from polyphenols in other food sources. In the first period, the volunteers ate only this low phenolic diet; in the second, they ate this diet and also drank 300 mL of alcohol-free wine. The enzymes under study were: superoxide dismutase, catalase, glutathione peroxidase and glutathione reductase. The activities of glutathione reductase, superoxide dismutase and catalase decreased during the LPD period and increased in the LPD+dealcoholized wine period. On the third day of intervention, significant changes were observed in glutathione reductase and superoxide dismutase activity for both intervention periods under study. Catalase activity changed significantly on the seventh day of intervention. Antioxidant enzymes modulated their activity more easily than the endogenous antioxidants, which did not undergo any changes. Our results show for the first time that the increase in the activity of the antioxidant enzymes is not due to the alcohol content in wine but to the polyphenolic composition. Therefore, alcohol-free wine could be an excellent source of antioxidants to protect people suffering from oxidative stress (cancer, diabetes, alzheimer, etc.) who should not consume alcohol.

Visual follow-up in peroxisomal-disorder patients treated with docosahexaenoic Acid ethyl ester.

Purpose. To assess the possible beneficial effects of docosahexaenoic acid (DHA) ethyl ester on visual function in DHA-deficient patients with peroxisome biogenesis disorders (PBDs). Methods. A total of 23 patients were studied, of whom 2 had classic Zellweger syndrome and 1 had a D-bifunctional protein (DBP) deficiency. Most of the PBD patients could be followed up, but for only nine of them was there ophthalmic baseline data to enable a full evaluation of the visual effects of the treatment. A daily dose of 200 mg of DHA ethyl ester was given to all patients. Clinical examination, visual evoked potentials (VEPs), and electroretinogram (ERG) were obtained in all cases. Results. Nystagmus disappeared very quickly in all the patients. The retinal appearance remained stable in all but one. Visual acuity was maintained without deterioration in all the patients. The electrophysiological examination showed a general improvement in retinoneural function, better documented in those patients who had undergone a baseline examination, but also in two children whose ERG continued to improve many years after the treatment was initiated. Conclusions. The visual improvement obtained with DHA therapy emphasizes the deleterious role that a DHA deficiency plays on the retina, especially in PBD patients, with retinas virtually devoid of DHA. These data, together with those reported previously, indicate that the DHA deficiency is an important pathogenic factor in peroxisomal disorders and should always be corrected. Treatment with DHA ethyl ester, given as early as possible, is strongly recommended, before the damage becomes irreversible.

Empirical antifungal therapy in selected patients with persistent febrile neutropenia.

Universal empirical antifungal therapy (EAT) in patients with unexplained persistent febrile neutropenia (PFN) is the standard of care, but EAT could be applied in selected patients on the basis of clinical criteria and risk factors. A prospective interventional study was carried out to analyse the incidence and related mortality of invasive fungal infection (IFI) in patients with PFN according to whether or not EAT was indicated. EAT was indicated according to the following criteria: (a) severe sepsis or septic shock; (b) focused infection: lung, central nervous system, sinus, abdominal or skin; (c) individualized clinical decision in patients at high risk. Sixty-six (19%) of 347 episodes of febrile neutropenia fulfilled PFN criteria, 97% with a haematological malignancy. Just 26 (39.4%) were treated with EAT. The overall IFI incidence was 4.5%. In the group that received EAT, three patients developed IFI (11.5%), in comparison with none in the group that did not receive it (P=0.04, RR 2.7:1.9-3.8). IFI-related mortality was null in the group that did not receive EAT and 8% (two of 26 patients) in the group that received EAT. These data suggest that in patients with PFN, EAT in selected patients may be safe and avoid unnecessary antifungal therapy.

Detección de episodios de hipoxia tisular isquémica mediante la monitorización neurofisiológica intraoperatoria combinada con la monitorización de la oxigenación tisular en la cirugía aneurismática / Detection of episodes of ischemic tissue hypoxia by means of the combined intraoperative neurophysiologic monitoring with the tissue oxygenation monitoring in aneurysm surgery

Introducción. La neuromonitorización intraoperatoria en la cirugía aneurismática puede ser de gran utilidad para determinar posiciones inadecuadas del clip que ocasionen un compromiso parcial o completo del flujo sanguíneo cerebral en los territorios vasculares irrigados por las arterias relacionadas con el aneurisma. La visualización directa de estas arterias tras la aplicación del clip quirúrgico puede ser insuficiente para detectar esta situación potencialmente deletérea. El conocimiento precoz de esta circunstancia permitiría al neurocirujano corregirla y evitar así la hipoxia tisular cerebral isquémica. Mostramos, con el ejemplo de un caso clínico, la utilidad de la monitorización intraoperatoria de la presión tisular de oxígeno (PtiO2) y de los potenciales evocados somato sensoriales (PESS) para la detección de estas situaciones. Caso clínico. Presentamos el caso de una mujer de 62 años de edad, que debutó con una hemorragia subaracnoidea de origen aneurismático. La arteriografía cerebral demostró la existencia de un aneurisma de la arteria comunicante posterior izquierda que fue tratado inicialmente por vía endovascular con exclusión parcial del aneurisma. Por este motivo se decidió completar el tratamiento mediante cirugía programada. La paciente fue monitorizada intraoperatoriamente con un sensor de PtiO2 situado en el área de riesgo y con PESS. Tras la colocación del clip se produjo una rápida caída de la presión parcial de oxígeno, así como disminución de la amplitud del potencial cortical del nervio tibial posterior izquierdo. El conocimiento de esta situación, permitió detectar un atrapamiento de la arteria comunicante posterior. Tras corregir esta situación reposicionando el clip quirúrgico, ambas variables recuperaron sus valores basales. Conclusiones. La monitorización intraoperatoria dela PtiO2 combinada con la monitorización neurofisiológica durante la cirugía aneurismática ofrece, de una forma rápida y fiable, la detección precoz de fenómenos isquémicos ocasionados por mal posicionamiento del clip quirúrgico

Introduction. Intraoperative neuromonitoring in aneurysm surgery can be very useful to determine inadequate positions of the vascular clip that cause partial or complete compromise of the cerebral sanguineous flow in the vascular territories irrigated by the arteries related to aneurysm. The direct visualization of these arteries after the application of the surgical clip can be insufficient in detecting this potentially detrimental situation. Knowing this circumstance on the onset would allow the neurosurgeon to correct it and to avoid, therefore, cerebral ischemic tissue hypoxia. We show the utility of the intraoperative monitoring of the oxygen tissue pressure (PtiO2) and the somato sensorial evoked potential (SSEP) for the detection of these situations with the example of a clinical case. Clinical case. We present the case of a 62 year-old woman, that presented with subarachnoid hemorrhage of aneurysmal origin. The cerebral arteriography demonstrated the existence of an aneurysm of the posterior communicating artery that was treated initially by endovascular procedure with partial exclusion of the aneurysm. For this reason it was decided to complete the treatment with a programmed surgery. The patient was put on an intraoperative monitoring system with a PtiO2 sensor located in the risk area and with SSEP. After positioning the surgical clip the partial oxygen pressure decreased rapidly, as well as the amplitude of the cortical potential of the left posterior tibial nerve. The knowledge of this situation allowed the detection of a trapped posterior communicating artery. After correcting this situation by replacing the surgical clip, both variables recovered to their basal values. Conclusions. The intraoperative PtiO2 monitoring, combined with neurophysiologic monitoring during aneurysm surgery offers a fast and trustworthy form ofearly detection of ischemic phenomena caused by bad positioning of the surgical clip

[Outcomes of surgical treatment in 100 patients with arteriovenous malformations of the brain]. / Resultados del tratamiento quirúrgico en 100 pacientes con malformaciones arteriovenosas cerebrales.

AIM: To conduct a descriptive analysis of a series of patients with arteriovenous malformations (AVM) that had been treated surgically. PATIENTS AND METHODS: Of a total of 189 adult patients with AVM evaluated consecutively in our hospital, 100 patients who had undergone surgical treatment were selected; a number of demographic, clinical and radiological aspects were then analysed, together with data concerning any associated vascular lesions, the type of surgical treatment, angiographic results and clinical outcomes. RESULTS: The mean age was 34 years (range: 15-71 years). The most common presenting symptom was intracranial haemorrhage, which occurred in 60 cases (60%). The AVM were located in the supratentorial convexity in 79% of cases, 8% were deep and 13% were situated in the cerebellum. The most frequent degree, according to the Spetzler and Martin scale, was grade III. Seventeen patients had other associated lesions and it should be noted that eight patients had aneurysms. Most of the patients (78%) underwent elective surgery and, in two cases, post-embolisation. Surgical treatment (salvage surgery) was performed in 13 patients (13%) when other therapeutic options failed and seven patients were submitted to emergency operations because of brain haemorrhages. The postoperative angiographic study showed complete removal of the AVM in 98% of cases. The clinical outcomes were as follows: 75%, good recovery; 20%, moderate incapacity; and 5%, an important degree of incapacity. CONCLUSION: Surgery is the best therapeutic option for patients with AVM, if they are selected in an appropriate manner.

Resultados del tratamiento quirúrgico en 100 pacientes con malformaciones arteriovenosas cerebrales / Outcomes of surgical treatment in 100 patients with arteriovenous malformations of the brain

Objetivo. Análisis descriptivo de una serie de pacientes con malformaciones arteriovenosas (MAV) tratados quirúrgicamente. Pacientes y métodos. De un total de 189 pacientes adultos con MAV evaluados consecutivamente en nuestro hospital, se han seleccionado los 100 pacientes tratados quirúrgicamente y se han analizado diversos aspectos demográficos, clínicos, radiológicos, lesiones vasculares asociadas, tipo de tratamiento quirúrgico, resultados angiográficos y resultados clínicos. Resultados. La edad media fue de 34 años (rango: 15-71 años). La forma de presentación más frecuente fue la hemorragia intracraneal, en 60 casos (60%). El 79% de las MAV estaban localizadas en la convexidad supratentorial, el 8% profundas y el 13% en el cerebelo. El grado más frecuente, según la escala de Spetzler y Martin, fue el grado III. Diecisiete pacientes tenían otras lesiones asociadas y destacaban ocho pacientes con aneurismas. En la mayoría de los pacientes, el 78%, se practicó una cirugía electiva y en dos casos, postembolización. En 13 pacientes (13%) se recurrió al tratamiento quirúrgico (cirugía de rescate) cuando fracasaron otras opciones terapéuticas y siete pacientes se operaron de urgencia debido a la hemorragia cerebral. El estudio angiográfico postoperatorio demostró en el 98% de los casos la extirpación completa de la MAV. Los resultados clínicos fueron los siguientes: el 75%, buena recuperación; el 20%, moderada incapacidad, y el 5%, gran incapacidad. Conclusión. Con una apropiada selección, la cirugía es la mejor opción terapéutica para los pacientes con una MAV

Aim. To conduct a descriptive analysis of a series of patients with arteriovenous malformations (AVM) that had been treated surgically. Patients and methods. Of a total of 189 adult patients with AVM evaluated consecutively in our hospital, 100 patients who had undergone surgical treatment were selected; a number of demographic, clinical and radiological aspects were then analysed, together with data concerning any associated vascular lesions, the type of surgical treatment, angiographic results and clinical outcomes. Results. The mean age was 34 years (range: 15-71 years). The most common presenting symptom was intracranial haemorrhage, which occurred in 60 cases (60%). The AVM were located in the supratentorial convexity in 79% of cases, 8% were deep and 13% were situated in the cerebellum. The most frequent degree, according to the Spetzler and Martin scale, was grade III. Seventeen patients had other associated lesions and it should be noted that eight patients had aneurysms. Most of the patients (78%) underwent elective surgery and, in two cases, post-embolisation. Surgical treatment (salvage surgery) was performed in 13 patients (13%) when other therapeutic options failed and seven patients were submitted to emergency operations because of brain haemorrhages. The postoperative angiographic study showed complete removal of the AVM in 98% of cases. The clinical outcomes were as follows: 75%, good recovery; 20%, moderate incapacity; and 5%, an important degree of incapacity. Conclusion. Surgery is the best therapeutic option for patients with AVM, if they are selected in an appropriate manner

Detección intraoperatoria de hipoxia cerebral isquémica mediante sensores de presión tisular de oxígeno / Intraoperative detection of ischemic brain hypoxia using oxygen tissue pressure microprobes

Objetivo e Importancia: La detección de los eventos isquémicos intraoperatorios puede contribuir a la resolución de su causa y a la prevención del establecimiento definitivo de un infarto postquirúrgico. Queremos ilustrar las posibilidades que ofrece la monitorización intraoperatoria de la presión tisular de oxígeno (Pti02) en áreas críticas durante un procedimiento neuroquirúrgico vascular, resaltando su fiabilidad e inmediatez en la obtención de información sobre el estado de oxigenación tisular como marcador de isquemia del territorio vascular expuesto a riesgo. Presentación clínica: Presentamos el caso de un varón de 32 años con una malformación arteriovenosa (MAV) profunda situada en la región insular. El paciente había sido tratado inicialmente mediante radiocirugía sin resultado satisfactorio.Intervención: La exéresis de la MAV se realizó a través de un abordaje transilviano transinsular. La Ptio2 se monitorizó en el polo temporal (área de referencia) y en la región temporal posterior (área de riesgo). Ambas mantuvieron niveles de oxigenación tisular parejos hasta la fase final de la resección de la MAV en la que, durante la hemostasia de un supuesto vaso aferente, se produjo una brusca caída de la tensión de oxígeno en la región temporal posterior. En el postoperatorio se observó un infarto isquémico en este área. Conclusión: La monitorización de la Pti02 tiene una alta fiabilidad en la detección de hipoxia tisular intraoperatoria. Los datos que nos proporciona pueden servir para identificar precozmente estos acontecimientos y, en la medida de lo posible, solventar la situación creada para prevenir la instauración definitiva de un infarto isquémico (AU)

[Intraoperative detection of ischemic brain hypoxia using oxygen tissue pressure microprobes]. / Detección intraoperatoria de hipoxia cerebral isquémica mediante sensores de presión tisular de oxígeno.

OBJECTIVE AND IMPORTANCE: Detection of intraoperative ischemic events could lead to the resolution of their cause and to the prevention of the definitive establishment of a postoperative infarct. We want to illustrate the possibilities that intraoperative monitoring of oxygen tissue pressure (PtiO2) in critical areas during a neurosurgical vascular procedure offers, enhancing its reliability and immediacy in obtaining information about tissue oxygenation status as a marker of ischemia in the vascular territory at risk. CLINICAL PRESENTATION: We report the case of a 32 year-old male with a deep arteriovenous malformation (AVM) localised in the insular region. The patient had been previously treated with radiosurgery without achieving a satisfactory result. INTERVENTION: AVM removal was performed through a transylvian transinsular approach. PtiO2 was monitorised at the temporal pole (reference area) and at the posterior temporal region (risk area). Both probes maintained close tissue oxygenation levels until the last stage of the AVM resection when, during the coagulation of a supposed afferent vessel, a brisk fall of the oxygen tissue pressure in the posterior temporal region was detected. An ischemic infarct in this area was observed postoperatively. CONCLUSIONS: PtiO2 monitoring has a high reliability in the detection of intraoperative tissue hypoxia. Data obtained could lead to early identification of these events and, whatever possible, to resolve this situation preventing the definitive establishment of an ischemic infarct.

[The use of moderate hypothermia in the treatment of patients with severe craniocerebral trauma]. / Reflexiones sobre el uso de la hipotermia moderada en el tratamiento del paciente con un traumatismo craneoencefálico grave.

Traumatic brain injury initiates several metabolic processes that can increase the primary injury. It is well established that in severe head injuries, posttraumatic secondary insults, such as brain hypoxia, hypotension or anemia, exacerbate neuronal injury and lead to a poorer outcome. Experimental and clinical evidence suggests that moderate hypothermia (32-34 degrees C), may limit some of these deleterious secondary metabolic responses. Recent laboratory studies and prospective controlled clinical trials of induced moderate hypothermia for relatively short periods (24-48 h) in patients with severe head injury, have demonstrated good intracranial pressure control and better outcome when compared with patients maintained in normothermia and given conventional treatment. Despite its proven clinical role in neuroprotection, hypothermia research has been inconstantly followed for various reasons. In this paper we review the mechanisms of neuroprotection in hypothermia, the different preclinical and clinical studies that favor its use as a neuroprotector in severe head injury or in patients in whom high intracranial pressure is refractory to first tier measures. The evidence that favors hypothermia is discussed. We also discuss the negative results of the still unpublished multicentre trial on prophylactic moderate hypothermia developed in the USA. The main problem with moderate hypothermia is the lack of a systematic methodology to induce and maintain it. Also, optimal duration of its use and the methodology and timing for rewarming have not been determined. Consequently, the results of different trials are difficult to analyze and compare. However, most evidence suggests that hypothermia provides remarkable protection against the adverse effects of neuronal damage that is exacerbated by secondary injury. Further prospective controlled trials with clearly defined methodology are needed before this method is implemented in daily clinical practice. The most important task for the years to come may be to focus on refining this procedure, defining the optimal time of cooling and rewarming and to optimize the methods of rapidly inducing and maintaining low temperature. It is also essential to define the most appropriate method and velocity of the rewarming phase, in which many successfully controlled patients deteriorate and die.

Mouthrinses: a comparative microbiological study.

This study was performed in order to evaluate the efficacy of different mouthrinses whose use is extended in Spain. Six different antiseptic mouthrinses were studied by means of determination of Minimal Inhibitory Concentration (MIC) values against Klebsiella pneumoniae, Serratia marcescens, Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus, Salmonella typhimurium, Bacillus subtilis, Streptococcus mutans, Prevotella intermedia, Porphyromonas gingivalis and Actinobacillus actinomycetemcomitans. Also in vivo experiments were carried out in volunteers by the use of mouthrinses and evaluation of bacterial populations before and after the treatment. Finally, the kinetics of bacterial death was determined. Results suggested that the determination of MIC values is not a reliable method to evaluate the antibacterial effect of such products. On the other hand those rinsing solutions based on the effect of oxygen, such as those containing carbamide peroxide have a greater efficacy against anaerobic bacteria compared with rinses whose active molecule is a disinfectant. Finally, the kinetics of bacterial death demonstrates that the essential oil rinse kills bacteria much faster. All tested mouthrinses were active as antibacterial although those based on oxygen production or essential oils were more active than solutions based on chlorhexidine and Triclosan.

[Orthotopic liver transplant for giant cavernous hemangioma and Kasabach-Merritt syndrome]. / Trasplante hepático ortotópico por hemangioma cavernoso gigante y síndrome de Kasabach-Merritt.

We describe the case of a 42-year-old woman with giant cavernous hemangioma and Kasabach-Merritt syndrome. The patient presented with consumption coagulopathy due to intravascular, intratumoral coagulation as revealed by low platelet levels, fibrinogenopenia and an increase in fibrinolysis with high levels of fibrinogen degradation products. She was scheduled to receive an orthotopic liver transplant because of three factors: respiratory distress caused by compression of the diaphragm by the giant tumor; the risk of bleeding caused by spontaneous rupture or trauma; and the presence of Kasabach-Merritt syndrome due to consumption coagulopathy. Before surgery fibrinogen deficit was corrected with 4 units of cryoprecipitates and low platelet level was treated with 10 units of platelets. Coagulopathy during surgery was corrected with fresh plasma (17 units), cryoprecipitates (6 U), aprotinin (1 x 10(6) U/kg) and antithrombin 3 (2000 U). Blood loss was compensated for with 9 units of packed red blood cells. This report describes the procedures used for anesthesia, for prevention of accidental bleeding during surgery, hemodynamic control and preoperative coagulation testing.

Intraspinal baclofen in the treatment of severe spasticity and spasms.

Ten patients with severe spasticity were evaluated according to a standardized protocol in order to be treated by intraspinal baclofen. Entry criteria in the protocol were the following: 1) Stable central nervous system lesion, 2) Severe spasticity and/or flexo-extensor spasms not controllable by oral treatment, 3) Normal CSF circulation and 4) Informed consent. All patients received a test dose of twenty-five micrograms of baclofen injected intrathecally. At intervals of at least one day, doses were increased in 10-25 microgram steps until total abolition of spontaneous spasms was achieved in complete spinal cord lesions. In patients with residual motor function, doses were titrated until the optimal dose was found that reduced spasms and enabled performance of maximum daily life activities according to the patient's neurological level. In nine patients a multidose reservoir was implanted to deliver intrathecal baclofen. Effective dosage was 60 +/- 31 micrograms in the entire group. Ashworth score was reduced from 4.6 +/- 0.7 to 1.2 +/- 0.4 (mean +/- SD) (p less than 0.0001) and spasms from 3.2 +/- 0.8 to 0.2 +/- 0.4 (p less than 0.0001). Follow-up of the nine patients in whom a reservoir was implanted has been 18 +/- 9 months. Initial dosage requirements and tolerance were significantly different in complete (Frankel's A grade) or incomplete lesions (Frankel's B, C and D grades). Complete spinal cord lesions required a greater initial dose (156 +/- 43) than incomplete lesions (44 +/- 24), these differences being statistically significant (Student's t-test, p less than 0.05). Tolerance was observed only in patients with complete motor and complete sensory lesions. In incomplete lesions, dose increase was insignificant.