A comprehensive analysis of factors related to carmustine/bevacizumab response in recurrent glioblastoma.

PURPOSE: Patients with recurrent glioblastoma (rGBM) have a poor prognosis, with survival ranging from 25 to 40 weeks. Antiangiogenic agents are widely used, showing a variable response. In this study, we explored the efficacy of carmustine plus bevacizumab (BCNU/Bev) for treating rGBM. METHODS/PATIENTS: In this study, we assessed 59 adult patients with histologically confirmed rGBM who were treated with BCNU/Bev as second-line regimen. The response rate (RR), progression-free survival (PFS) and overall survival (OS) were evaluated according to their molecular expression profile, including CD133 mRNA expression, MGMT methylation (pMGMT), PDGFR amplification, YKL40 mRNA expression, IDH1/2 condition, p53 and EGFRvIII mutation status. RESULTS: Median follow-up was 18.6 months, overall RR to the combination was 56.3%, and median PFS was 9.0 months (95% CI 8.0-9.9). OS from time of diagnosis was 21.0 months (95% CI 13.2-28.7) and from starting BCNU/Bev it was 10.7 months (95% CI 9.5-11.8). IDH1/2 mutations were found in 30.5% of the patients, pMGMT in 55.9% and high CD133 mRNA expression in 57.6%. Factors which positively affected PFS included performance status (p = 0.015), IDH+ (p = 0.05), CD133 mRNA expression (p = 0.009) and pMGMT+ (p = 0.007). OS was positively affected by pMGMT+ (p = 0.05). Meanwhile, YKL40 negatively affected PFS (p = 0.01) and OS (p = 0.0001). Grade ≥ 3 toxicities included hypertension (22%) and fatigue (12%). CONCLUSIONS: BCNU/Bev is a safe and tolerable treatment for rGBM. Patients with MGMT+/IDH+ derive the greatest benefit from the treatment combination in the second-line setting. Nonetheless, high YKL40 expression discourages the use of antiangiogenic therapy.

Textrode functional straps for bioimpedance measurements--experimental results for body composition analysis.

BACKGROUND/OBJECTIVES: Functional garments for physiological sensing purposes have been used in several disciplines, that is, sports, firefighting, military and medicine. In most of the cases, textile electrodes (textrodes) embedded in the garment are used to monitor vital signs and other physiological measurements. Electrical bioimpedance (EBI) is a non-invasive and effective technology that can be used for the detection and supervision of different health conditions.EBI technology could make use of the advantages of garment integration; however, a successful implementation of EBI technology depends on the good performance of textrodes. The main drawback of textrodes is a deficient skin-electrode interface that produces a high degree of sensitivity to signal disturbances. This sensitivity can be reduced with a suitable selection of the electrode material and an intelligent and ergonomic garment design that ensures an effective skin-electrode contact area. SUBJECTS/METHODS: In this work, textrode functional straps for total right side EBI measurements for body composition are presented, and its measurement performance is compared against the use of Ag/AgCl electrodes. Shieldex sensor fabric and a tetra-polar electrode configuration using the ImpediMed spectrometer SFB7 in the frequency range of 3-500 kHz were used to obtain and analyse the impedance spectra and Cole and body composition parameters. RESULTS: The results obtained show stable and reliable measurements; the slight differences obtained with the functional garment do not significantly affect the computation of Cole and body composition parameters. CONCLUSIONS: The use of a larger sensor area, a high conductive material and an appropriate design can compensate, to some degree, for the charge transfer deficiency of the skin-electrode interface.

Cerebral fat embolism detection with susceptibility-weighted images in sickle cell disease.

Cerebral fat embolism is a known but feared complication of sickle cell disease, which leads to significant morbidity. Although trauma-related fat embolism is more frequent and its diagnosis is straightforward, fat embolism secondary to bone infarcts after vaso-occlusive events can be unrecognized. Lack of criteria make the clinical diagnosis of sickle cell disease related fat embolism challenging. The neuroimaging findings are helpful to support the clinical diagnosis. Magnetic resonance imaging findings of fat embolism have been described including those seen on susceptibility-weighted imaging. Even though susceptibility-weighted imaging has been used for the diagnosis of cerebral fat embolism due to trauma, to the best of our knowledge its use has not been described in patients with sickle cell disease. We report an uncommon case of a 60-year-old woman with sickle cell disease who developed cerebral fat embolism and in which the findings on susceptibility-weighted imaging were characteristic and established the diagnosis.

Skin-electrode contact area in electrical bioimpedance spectroscopy. Influence in total body composition assessment.

Electrical Bioimpedance Spectroscopy (EBIS) has been widely used for assessment of total body composition and fluid distribution. (EBIS) measurements are commonly performed with electrolytic electrodes placed on the wrist and the ankle with a rather small skin-electrode contact area. The use of textile garments for EBI requires the integration of textrodes with a larger contact area surrounding the limbs in order to compensate the absence of electrolytic medium commonly present in traditional Ag/AgCl gel electrodes. Recently it has been shown that mismatch between the measurements electrodes might cause alterations on the EBIS measurements. When performing EBIS measurements with textrodes certain differences have been observed, especially at high frequencies, respect the same EBIS measurements using Ag/AgCl electrodes. In this work the influence of increasing the skin-electrode area on the estimation of body composition parameters has been studied performing experimental EBIS measurement. The results indicate that an increment on the area of the skin-electrode interface produced noticeable changes in the bioimpedance spectra as well as in the body composition parameters. Moreover, the area increment showed also an apparent reduction of electrode impedance mismatch effects. This influence must be taken into consideration when designing and testing textile-enable EBIS measurement systems.

Spontaneous internal carotid artery pseudoaneurysm in a patient with behçet disease.

We describe the uncommon case of a patient with Behçet disease who developed a giant spontaneous cervical internal carotid artery pseudoaneurysm confirmed at surgery. We also discuss the implications of this rare complication.

Textile electrode straps for wrist-to-ankle bioimpedance measurements for Body Composition Analysis. Initial validation & experimental results.

Electrical Bioimpedance (EBI) is one of the non-invasive monitoring technologies that could benefit from the emerging textile based measurement systems. If reliable and reproducible EBI measurements could be done with textile electrodes, that would facilitate the utilization of EBI-based personalized healthcare monitoring applications. In this work the performance of a custom-made dry-textile electrode prototype is tested. Four-electrodes ankle-to-wrist EBI measurements have been taken on healthy subjects with the Impedimed spectrometer SFB7 in the frequency range 5 kHz to 1 MHz. The EBI spectroscopy measurements taken with dry electrodes were analyzed via the Cole and Body Composition Analysis (BCA) parameters, which were compared with EBI measurements obtained with standard electrolytic electrodes. The analysis of the obtained results indicate that even when dry textile electrodes may be used for EBI spectroscopy measurements, the measurements present remarkable differences that influence in the Cole parameter estimation process and in the final production of the BCA parameters. These initial results indicate that more research work must be done to in order to obtain a textile-based electrode that ensures reliable and reproducible EBI spectroscopy measurements.

Textile electrodes in Electrical Bioimpedance measurements - a comparison with conventional Ag/AgCl electrodes.

Work has been intensified around the integration of textile and measurement technology for physiological measurements in the last years. As a result nowadays it is possible to find available commercial products for cardiovascular personal healthcare monitoring. Most of the efforts have been focused in the acquisition of EKG for cardiovascular monitoring where textile electrodes have shown satisfactory performance. Electrical Bioimpedance is another type of physiological measurement that can be used for personal healthcare monitoring where the integration and the performance of the textile electrodes has not been investigated that thoroughly. In this work, the influence of the textile electrodes on the measurements and on the estimation of the Cole (R(0), R(infinity), f(C) and alpha) and body composition (TBW, ICW, ECW and FFM) parameters has been especially addressed. Complex Spectroscopy 4-electrode wrist-to-ankle electrical bioimpedance measurements taken with conventional Ag/AgCl and textile-electrodes on customized bracelets have been compared and analyzed in the frequency range 3 to 500 kHz. The obtained results suggest that the use of textile electrodes do not influence remarkably on the complex spectral measurements neither in the estimation of Cole nor body composition parameter. In any case any possible effect introduced by the use of textile is smaller than the effect of preparing the skin by the using abrasive conductive paste.

Effect of a second bloodmeal on the oesophagus colonization by Leishmania mexicana complex in Lutzomyia evansi (Diptera: Psychodidae).

Migration and colonization of the oesophagus by Leishmania mexicana parasites were enhanced after digestion of a second bloodmeal intake in Lutzomyia evansi. This event has epidemiological significance since it affects the infection susceptibility of this sand fly species, which is a proven vector of L. chagasi in Colombian and Venezuelan visceral leishmaniasis foci. Also, it may explain the host seeking behaviour displayed by some partially bloodfed flies found inside houses.

[Extrapelvic endometriosis involving the perineum]. / Endometriosis extrapelviana de ubicación perineal.

The ectopic endometriosis in the perineum is very rare (0.2% of ectopic endometriosis). We studied 16 cases of vaginoperineal endometriosis. Fifteen of them were localized in the site of an episiotomy scar and in one there was another focus of a severe endometriosis of multiple localizations. All the patients were submitted to anamnesis, physical, gynecologic and proctologic examination, surgical excition, histopathologic study of the lesion and control. All the patients are asymptomatic after treatment. To cure definitively the disease it is necessary to make a complete ablation of the endometrial lesion. Eventually, hormonal treatments could be use in case there were other endometrial localizations besides the vaginoperineal one.

Leishmania braziliensis spp. in the nasal mucosa of guinea pigs inoculated in the tarsi.

Two lots of 20 young male guinea pigs were inoculated subcutaneously in the tarsi with 10(4) amastigotes of Leishmania braziliensis braziliensis or L. b. guyanensis to study the susceptibility of this Neotropical hystricomorph rodent the autochthonous parasites. Almost 50% of the animals showed lesions in the inoculation site and had parasitizations that were infective to hamsters, as shown by inoculating homogenates of the dermal lesion, of the spleen, of the liver, and of the nasal mucosa into hamsters at 20, 40, 60, and 120 days after inoculation of the guinea pig. Smears of the above organs showed the presence of amastigotes. Parasites inoculated into the tarsi were detected early in the skin, spleen, and liver of the guinea pig host. Blood cultures made by cardiopuncture on sacrifice of the guinea pigs were uniformly negative. The nasal mucosa of nearly all animals positive in the skin or viscera was invaded early by the parasites, although with greater frequency between 60 and 120 days post-inoculation. The use of this model for the study of mucocutaneous parasitism by L. braziliensis is discussed, together with the phenomena of parasitism at a distance from the inoculation site, the temperature of the body regions affected, and the possible genetic influence on susceptibility of the guinea pig to L. braziliensis.

[Septic shock in obstetrics]. / Choque séptico en obstetricia.

Septic shock in obstetrics is a major cause of mortality. Postpartum endometritis is often the first step of bacterial colonization inside the uterus which becomes the nidus of infection. Rapid spread into general circulation is favoured by hemodynamics patterns of pregnancy. Bacteremia would result in cardiovascular collapse and a myocardial depressant factor has been proposed to explain the fall in cardiac output. Later, endotoxin activates the substances of malignant intravascular inflammation and multiple systems organ failure may be observed in uncontrolled sepsis. Eight cases are reported hospitalized at Morelia's General Hospital, SSA, with septic shock and MSOF. Presumably because of aggressive acute resuscitation nobody succumbed during acute cardiac failure and hypotensive episode but two patients died later with multiple system organ failure. The mortality was 25%. Fluid, resuscitation, and vasoactive drugs are the most effective way to reduce mortality. Antibiotics, specific treatment of MSOF and taking away the nidus of infection are critical components of therapy.

Enhanced spectrofluorimetric determination of the pesticide warfarin by means of the inclusion complex with beta-cyclodextrin.

The warfarin-beta-cyclodextrin inclusion complex alters the luminescent properties of warfarin. This feature allows the use of a spectrofluorimetric method for its determination that gives improved analytical performance. The spectral changes associated with the inclusion process allowed a value of 160 l mol-1 to be obtained for the complexation constant. Fluorescence intensity is linearly related to warfarin concentration for a quantification limit of from 0.2 to 4 micrograms ml-1. The relative standard deviation at the 1.5 microgram ml-1 level is 3.5%. The method was applied satisfactorily to the determination of warfarin in irrigation water.