Volatilome Analysis of Soursop Fruits for the Determination of Kairomone Components That Attract the Annonaceae Fruit Weevil (Optatus palmaris Pascoe).

Soursop possesses the largest fruit size of the Annona genus. However, this species is threatened by the Annonaceae fruit weevil (Optatus palmaris), which can cause the destruction of whole soursop fruits. Recently, the potential of semiochemicals for the management of this insect is highlighted, and its aggregation pheromone has been elucidated. This pheromone works well only when mixed with soursop volatiles. Thus, the aim of this research was to determine specific kairomone components to potentiate the aggregation pheromone of this Annonaceae fruit weevil. This task was carried out via volatilome analysis of soursop fruits, which was correlated with the biological activity of the identified volatiles. The GC-MS analysis of aroma collections of mature soursop fruits and flowers, determined using multivariate data analysis, confirmed a volatile differentiation between these organs. The volatile variation between fruits and flowers was reflected in weevils' preference for mature fruits instead of flowers. Moreover, weevils' response to soursop fruits increased with more mature fruits. This was correlated with volatile changes throughout the phenological stages of soursop fruits. The two volatiles most correlated with weevils' attraction were benzothiazole and (E)-ß-caryophyllene. These volatiles only evoked a response when mixed and potentiated the attraction of the aggregation pheromone. Thus, these two volatiles are active kairomone components with the potential for being used in combination with the aggregation pheromone of Annonaceae fruit weevils in field trials.

Direct costs of a home parenteral nutrition programme.

BACKGROUND & AIMS: Home parenteral nutrition (HPN) is a lifesaving treatment for people with chronic intestinal failure and its cost has been reported to be very high. The purpose of the present paper was to study the direct healthcare and non-healthcare costs associated with the HPN programme managed by a tertiary hospital. METHODS: Observational, retrospective study of all adult patients on HPN from 11.1.2014 to 10.31.2015 treated at Gregorio Marañón University Hospital (Madrid, Spain). An economic evaluation was undertaken to calculate the direct healthcare (HPN provision, outpatient monitoring and management of complications) and non-healthcare costs (transportation process) of the HPN programme. The variables were collected from medical records, the dispensary and the hospital's financial services. The unit costs were taken from official price lists. RESULTS: Thirty-two patients met the inclusion criteria. Total direct healthcare and non-healthcare costs amounted to €13,363.53 per patient (€124.02 per patient per day). The direct healthcare costs accounted for 98.32% of overall costs, while the non-healthcare costs accounted for the remaining 1.68%. HPN provision accounted for the majority of the costs (74.25%), followed by management of complications (21.85%) and outpatient monitoring (2.23%). CONCLUSIONS: The direct healthcare costs accounted for the majority of HPN expenditure, specifically HPN provision was the category with the highest percentage.

Efectos de la musicoterapia sobre el nivel de ansiedad del adulto cardiópata sometido a resonancia magnética / Effects of music-therapy on the level of anxiety of the heart-ill adult undergoing magnetic resonance / Efeitos da musicoterapia sobre o nível de ansiedade do adulto cardiopata submetido à ressonância magnética

Introducción: La resonancia magnética es un método de imagen ideal para el diagnóstico de enfermedades cardiovasculares; sin embargo, la mayoría de los pacientes refieren enfrentarse a un ambiente desconocido, lo cual les provoca ansiedad y cambios en sus constantes vitales. Objetivo: Comparar el nivel de ansiedad (NA) del adulto cardiópata posterior a una intervención de musicoterapia, en un estudio de resonancia magnética. Material y métodos: Estudio comparativo, prospectivo y transversal. Muestra probabilística aleatoria simple (N = 31) para dos grupos: G1 n = 14 y G2 n = 17; incluyó pacientes >15 años, ambos sexos. Se aplicó el instrumento STAI antes y después de musicoterapia; 10 ítems para datos demográficos, signos vitales y sintomatología; 20 ítems para NA con respuesta tipo Likert: nada = 0 hasta mucho = 3 puntos; bajo NA <24, NA medio 24-38 y alto NA >38 puntos. Intervención musical: G1 escuchó música clásica y G2 de su preferencia por 30 minutos entre 15 y 24 decibeles antes del estudio y el tiempo que duró este (> 20 minutos). Datos analizados con estadística descriptiva, prueba Pearson, Spearman, U Mann Whitney, t de Student y T pareada, p <0.05 significativo. Resultados: La musicoterapia reduce la frecuencia cardiaca (74.36 vs. 69.07, p = 0.01), frecuencia respiratoria (16.29 vs. 12.93, p = 0.001) y tensión arterial sistólica (127.21 vs. 117.21, p = 0.01), tanto en el G1 como en el G2. Los pacientes del G2 mostraron mayor disminución del NA comparado con el G1 (26.88 vs. 23.24, p=0.037). Conclusiones: La musicoterapia seleccionada por el paciente sometido a resonancia magnética ha mostrado ser una intervención efectiva para conseguir un cambio específico en el estado fisiológico, emocional y conductual.

Introduction: Magnetic resonance is an ideal imaging method in the diagnosis of cardiovascular diseases; however, the majority of patients refer this process as if they were in an unknown environment which provokes them anxiety, resulting in constant changes in their vitals. Objective: To compare the level of anxiety (AL) of the heart-ill adult after an intervention with music-therapy following a magnetic resonance study. Materials and methods: This is a comparative, prospective and transversal study, with a simple aleatory probabilistic sample (N = 31) divided in two groups: G1 with n = 14, and G2 with n = 17, including patients >15 years old of both sexes. The STAI instrument was applied before and after the music-therapy session using 10 items for demographic data, vital signs, and symptomatology, and 20 items to estimate the AL, with answers based on a Likert-type scale with: 0 = not at all, to 3 = a lot, and a total scale score where, <24 = low level of anxiety, 24-38 = medium level of anxiety, and >28 = high level of anxiety. The group G1 listened to classical music, while the group G2 listened to the music of their choice for 30 minutes the sound level was kept between 15 and 24 decibels before the study and the duration of the study (> 20 minutes). Data were analyzed using descriptive statistics, and Pearson, Spearman, U Mann Whitney, Student's t, and paired T test, p < .05. Results: Music-therapy reduced the cardiac frequency (74.36 vs. 69.07, p = .01), the respiratory frequency (16.29 vs. 12.93, p = .001), and the systolic arterial tension (127.21 vs. 117.21, p = .01), in both groups. Patients in G2 showed a greater AL reduction compared to those in G1 (26.88 vs. 23.24, p = .037). Conclusions: Selected music-therapy in patients undergoing magnetic resonance has shown to be an effective intervention method to modify specific physiological, emotional, and behavioral states of these patients.

Introdução: A ressonância magnética (RM) é um método de imagem ideal para o diagnóstico de doenças cardiovasculares, porém, a maioria dos pacientes descrevem enfrentar-se a um ambiente desconhecido, o que lhes produz ansiedade e mudanças nos seus signos vitais. Objetivo: Comparar o nível de ansiedade (NA) do adulto cardiopata posterior a uma intervençãode musicoterapia em um teste de ressonância magnética. Material e métodos: Estudo comparativo, prospetivo e transversal. Amostra probabilística aleatória simples (N=31) para dois grupos: G1 n=14 y G2 n=17, incluiu pacientes >15 anos, ambos os sexos. Aplicou-se o instrumento STAI antes e depois de musicoterapia, 10 itens para dados demográficos, signos vitais e sintomatologia, 20 itens para NA com resposta tipo Likert: nada =0 até muito=3 pontos, sob NA <24, NA médio 24-38 e alto NA >38 pontos. Intervenção musical: G1 escutou música clássica e G2 de sua preferência por 30 minutos entre 15 e 24 decibéis antes do teste e o tempo que durou este (>20 minutos). Dados analisados com estatística descritiva, prova Pearson, Spearman, U Mann Whitney, T de Student e T pareada, p <0.05 significativo. Resultados: A musicoterapia reduz a frequência cardíaca (74.36 vs 69.07, p=0.01), frequência respiratória (16.29 vs 12.93, p=0.001) e tensão arterial sistólica (127.21 vs 117.21, p=0.01), tanto no G1 quanto no G2. Os pacientes do G2 mostraram maior diminuição do NA comparado com o G1 (26.88 vs 23.24, p=0.037). Conclusões: A musicoterapia selecionada pelo paciente submetido a RM mostrou ser uma intervenção efetiva para conseguir um cambio específico no estado fisiológico, emocional e comportamental.

A mild carbon-boron bond formation from diaryliodonium salts.

The direct metal-free borylation of diaryliodonium salts with diboron reagents is now demonstrated to be a feasible process toward formation of aryl boronic esters without any additive or catalysts, and it can be extended to a two-step C-C coupling of both aryl groups of the initial diaryliodonium reagent.

Percutaneous Endopyelotomy over High Pressure Balloon for Recurrent Ureteropelvic Junction Obstruction in Children.

PURPOSE: We analyzed results of percutaneous endopyelotomy for treatment of recurrent ureteropelvic junction obstruction in children with failed primary pyeloplasty. MATERIALS AND METHODS: We retrospectively studied all patients treated at our department for recurrent ureteropelvic junction obstruction between 2009 and 2013. All procedures were performed using a 12Fr miniperc approach with the patient in the supine position. A high pressure balloon was inflated at the ureteropelvic junction obstruction. To improve the exposure of the cutting area, the ureteropelvic junction was introduced into the renal pelvis by pushing the high pressure balloon. Modified percutaneous endopyelotomy was done with monopolar electrocautery over it to avoid damaging nearby structures. Medical data and imaging studies before and after the first surgery and percutaneous endopyelotomy were reviewed. RESULTS: Seven boys and 2 girls (mean ± SD age 5.8 ± 4.9 years) with recurrent ureteropelvic junction obstruction were treated at our hospital between July 2009 and July 2013. Three patients had a solitary kidney. Three children had previously undergone 2 procedures. Mean ± SD operative time was 61.0 ± 17.9 minutes, postoperative hospital stay was 3.8 ± 1.9 days and followup after modified percutaneous endopyelotomy was 39.3 ± 25.2 months. All patients were rendered symptom-free. Postoperative ultrasound and renogram revealed that modified percutaneous endopyelotomy was successful in 7 renal units. In 2 patients hydronephrosis improvement was not significant. Three patients suffered postoperative complications, consisting of hematuria, obstruction of Double-J® stent and paralytic ileus in 1 each. CONCLUSIONS: Modified percutaneous endopyelotomy is a fairly effective technique to treat recurrent ureteropelvic junction obstruction after failed pyeloplasty in children. However, in some cases potentially serious complications can occur.

Dilatación con balón de alta presión como tratamiento del ureterocele ortotópico / High-Pressure Balloon Dilatation for Treatment of Orthotopic Ureterocele

Objetivo: La punción o destechamiento endoscópico es el tratamiento más utilizado en la actualidad tanto para los ureteroceles ortotópicos como para los ectópicos. Sin embargo, tiene una elevada incidencia de reflujo vesicoureteral secundario y de procedimientos quirúrgicos posteriores en ambos grupos. Presentamos una nueva técnica de tratamiento de los ureteroceles ortotópicos. Material y métodos: Analizamos 4 pacientes con ureteroceles ortotópicos de edad 9,7±6,2 meses tratados mediante dilatación del meato del ureterocele. Ningún caso presentaba sistemas duplicados ni reflujo vesicoureteral. La indicación fue pionefrosis en 2 niños y empeoramiento progresivo de la hidronefrosis en otros 2. La dilatación fue realizada con balón de alta presión de 5 o 6mm tras tutorizar el ureterocele con guía de 0,014”. Resultados: No hubo complicaciones intraoperatorias ni post-operatorias, siendo el tiempo quirúrgico de 24±9min. Todos los pacientes fueron dados de alta a las 24 h post-operatorias. En todos los niños desapareció la ureterohidronefrosis y permanecen asintomáticos tras 35±22,5 meses de seguimiento. No hubo ningún caso de reflujo vesicoureteral secundario y la gammagrafía renal se mantuvo sin cambios tras el tratamiento. Conclusiones: La dilatación con balón de alta presión del meato del ureterocele en los casos ortotópicos es una técnica rápida, segura y con buenos resultados a largo plazo. No encontramos en nuestra serie ningún caso de reflujo vesicoureteral secundario ni de procedimientos quirúrgicos posteriores, por lo que consideramos que podría ofertar importantes beneficios respecto a la punción en este tipo de pacientes (AU)

Objective: Transurethral puncture or endoscopic unroofing is the best treatment currently used for both orthotopic and ectopic ureteroceles. However, they have a high incidence of secondary vesicoureteral reflux and subsequent procedures in both groups. We present a new technique for treatment of orthotopic ureterocele. Material and methods: We have analyzed 4 patients with orthotopic ureterocele (9.7±6.2 months old) treated by dilatation of the meatus of the ureterocele. No patient had vesicoureteral reflux or duplicate systems. The indication was pyonephrosis in 2 children and progressive worsening of hydronephrosis in 2. Dilatation was performed with 5 or 6mm high-pressure balloon after inserting a stent with guidewire of 0.014” to the ureterocele. Results: There were no intraoperative or postoperative complications, surgical time being 24±9minutes. All patients were discharged at 24 postoperative hours. Ureterohydronephrosis disappeared in all the children and they continue asymptomatic after 35±22.5 months of follow-up. There were no cases of secondary vesicoureteral reflux and renal scan was unchanged after treatment. Conclusions: High pressure balloon dilatation of the meatus in cases of orthotopic ureterocele is a fast, safe and successful surgical technique. We did not find any cases of secondary vesicoureteral reflux or subsequent procedures in our series, so we believe this may offer significant benefits over the transurethral puncture in such patients (AU)

[High-pressure balloon dilatation for treatment of orthotopic ureterocele]. / Dilatación con balón de alta presión como tratamiento del ureterocele ortotópico.

OBJECTIVE: Transurethral puncture or endoscopic unroofing is the best treatment currently used for both orthotopic and ectopic ureteroceles. However, they have a high incidence of secondary vesicoureteral reflux and subsequent procedures in both groups. We present a new technique for treatment of orthotopic ureterocele. MATERIAL AND METHODS: We have analyzed 4 patients with orthotopic ureterocele (9.7 ± 6.2 months old) treated by dilatation of the meatus of the ureterocele. No patient had vesicoureteral reflux or duplicate systems. The indication was pyonephrosis in 2 children and progressive worsening of hydronephrosis in 2. Dilatation was performed with 5 or 6mm high-pressure balloon after inserting a stent with guidewire of 0.014" to the ureterocele. RESULTS: There were no intraoperative or postoperative complications, surgical time being 24 ± 9minutes. All patients were discharged at 24 postoperative hours. Ureterohydronephrosis disappeared in all the children and they continue asymptomatic after 35 ± 22.5 months of follow-up. There were no cases of secondary vesicoureteral reflux and renal scan was unchanged after treatment. CONCLUSIONS: High pressure balloon dilatation of the meatus in cases of orthotopic ureterocele is a fast, safe and successful surgical technique. We did not find any cases of secondary vesicoureteral reflux or subsequent procedures in our series, so we believe this may offer significant benefits over the transurethral puncture in such patients.

Fish meal supplementation increases bovine plasma and luteal tissue omega-3 fatty acid composition.

The objective of this experiment was to determine if dietary inclusion of fish meal would increase plasma and luteal tissue concentrations of eicosapentaenoic and docosahexaenoic acids. Seventeen nonlactating Angus cows (2 to 8 yr of age) were housed in individual pens and fed a corn silage-based diet for approximately 60 d. Diets were supplemented with fish meal at 5% DMI (a rich source of eicosapentaenoic acid and docosahexaenoic acid; n = 9 cows) or corn gluten meal at 6% DMI (n = 8 cows). Body weights and jugular blood samples were collected immediately before the initiation of supplementation and every 7 d thereafter for 56 d to monitor plasma n-3 fatty acid composition and BW. Estrous cycles were synchronized using 2 injections of PGF(2α) administered at 14-d intervals. The ovary bearing the corpus luteum was surgically removed at midcycle (between d 10 and 12) after estrus synchronization, which corresponded to approximately d 60 of supplementation. The ovary was transported to the laboratory, and approximately 1.5 g of luteal tissue was stored at -80°C until analyzed for n-3 fatty acid content. Initial and ending BW did not differ (P > 0.10) between cows supplemented with fish meal and those with corn gluten meal. Plasma eicosapentaenoic acid was greater (P < 0.05) beginning at d 7 of supplementation and docosahexaenoic was greater (P < 0.05) beginning at d 14 of supplementation for cows receiving fish meal. Luteal tissue collected from fish meal-supplemented cows had greater (P < 0.05) luteal n-3 fatty acids and reduced (P < 0.05) arachidonic acid and n-6 to n-3 ratio as compared with tissue obtained from cows supplemented with corn gluten meal. Our data show that fish meal supplementation increases luteal n-3 fatty acid content and reduces available arachidonic acid content, the precursor for PGF(2α). The increase in luteal n-3 fatty acids may reduce PGF(2α) intraluteal synthesis after breeding resulting in increased fertility in cattle.

Toxina botulínica en el fracaso del cierre de derivaciones urinarias altas / Botulinum toxin in the failure of high urinary diversion closure

Introducción: El cierre de las derivaciones urinarias realizadas en la edad neonatal tiene un no despreciable porcentaje de fracasos en pacientes con patología vesical. Presentamos el uso de toxina botulínica como alternativa útil y mínimamente invasiva para el tratamiento en estos pacientes. Material y métodos: Presentamos dos pacientes monorrenos con valvas de uretra posterior (VUP) en los que fue necesario realizar ureterostomía por insuficiencia renal severa. En ambos pacientes fracasó el intento posterior de cierre de la derivación. Con 4 y 10 años de edad presentaban vejigas conocidas comúnmente como «vejigas secas», con baja capacidad (20 y 110ml), mala acomodación (1,5 y 3,1ml/ cm H2O) y altas presiones de apertura del detrusor. Se realizó punción en el detrusor de toxina botulínica-A 10 UI/ kg en una y dos ocasiones respectivamente previas al cierre de la derivación. Resultados: En ninguno de los pacientes hubo empeoramiento clínico ni ecográfico tras el cierre de la derivación, permaneciendo la función renal sin cambios respecto a la previa tras uno y 4 años de seguimiento, respectivamente. La videourodinámica al año de la intervención muestra una gran mejoría de la capacidad vesical (451 y 250ml), de la acomodación (20,4 y 81,9ml/ cm H2O) y de la presión de apertura del detrusor. Conclusiones: El cierre de las derivaciones urinarias altas tiene un porcentaje de fracasos elevado en niños con vejigas patológicas con presiones elevadas. La toxina botulínica puede ser útil como tratamiento vesical previo al cierre de la derivación, especialmente en pacientes monorrenos (AU)

Introduction: The closure of urinary diversions performed on newly born infants has a notable failure percentage in patients with bladder disease. We present the use of botulinum toxin as a useful and minimally invasive alternative to treat these patients. Material and methods: We present two patients with a single kidney and with posterior urethral valves (PUV), in whom it was necessary to perform a ureterostomy due to chronic kidney disease. In both patients, the subsequent attempt to close the diversion failed. Aged 4 and 10years respectively, they presented bladders commonly known as “dry bladders”, with a low capacity (20 and 110ml), bad adaptation (1.5 and 3.1ml/ cm H2O) and high opening detrusor pressure. A 10 UI/Kg botulinum toxin A puncture was applied in the detrusor on one and two occasions respectively, prior to the closure of the diversion. Results: Neither of the patients suffered clinical or ecographic worsening after the closure of the diversion and their kidney function continued without change with respect to the first diversion after one and four years of follow-up respectively. One year after the surgical procedure, video urodynamics showed a significant improvement in bladder capacity (451 and 250ml), in adaptation (20.4 and 81.9ml/cmH2O) and in the opening detrusor pressure. Conclusions: The closure of high urinary diversions has a high failure percentage in infants with pathological high-pressure bladders. Botulinum toxin may be useful as bladder treatment prior to closure of the diversion, especially in patients with a single kidney (AU)

[Botulinum toxin in the failure of high urinary diversion closure]. / Toxina botulínica en el fracaso del cierre de derivaciones urinarias altas.

INTRODUCTION: The closure of urinary diversions performed on newly born infants has a notable failure percentage in patients with bladder disease. We present the use of botulinum toxin as a useful and minimally invasive alternative to treat these patients. MATERIAL AND METHODS: We present two patients with a single kidney and with posterior urethral valves (PUV), in whom it was necessary to perform a ureterostomy due to chronic kidney disease. In both patients, the subsequent attempt to close the diversion failed. Aged 4 and 10 years respectively, they presented bladders commonly known as "dry bladders", with a low capacity (20 and 110 ml), bad adaptation (1.5 and 3.1 ml/ cm H(2)O) and high opening detrusor pressure. A 10 UI/Kg botulinum toxin A puncture was applied in the detrusor on one and two occasions respectively, prior to the closure of the diversion. RESULTS: Neither of the patients suffered clinical or ecographic worsening after the closure of the diversion and their kidney function continued without change with respect to the first diversion after one and four years of follow-up respectively. One year after the surgical procedure, video urodynamics showed a significant improvement in bladder capacity (451 and 250 ml), in adaptation (20.4 and 81.9 ml/ cmH(2)O) and in the opening detrusor pressure. CONCLUSIONS: The closure of high urinary diversions has a high failure percentage in infants with pathological high-pressure bladders. Botulinum toxin may be useful as bladder treatment prior to closure of the diversion, especially in patients with a single kidney.

Es la inyección de Toxina botulínica-A en el detrusor una alternativa a la ampliación vesical en niños / Injection of Botulinum Toxin (BTX-A) in Children with Bladder Dysfunction due to Detrusor Overactivity

Introducción: la disfunción vesical causa incontinencia urinaria y daño renal en niños. Cuando el tratamiento con anticolinérgicos y cateterismo vesical intermitente fracasa, la alternativa terapéutica es la ampliación vesical. Pacientes y métodos: entre 2005 y 2009 se ha realizado un estudio prospectivo con Botox® inyectado en el detrusor de niños por disfunción vesical con alta presión, a pesar del tratamiento anticolinérgico. Se valora la evolución urodinámica, clínica y radiológica, antes y a las 4 semanas, 6 meses y un año tras la inyección (10 U/kg de peso hasta 300 U). La reinyección se indicó ante el empeoramiento clínico o urodinámico. Se empleó el test de Wilcoxon para el análisis estadístico de los parámetros urodinámicos. Resultados: se trataron 12 pacientes, 11 de causa neurógena (91,7%) y uno por válvulas de uretra posterior (8,4%). La mediana de edad fue 12,6 (4,3-17,8) años y el seguimiento 40,8 (16,9-45,7) meses. A las 4 semanas se produjo mejoría en la capacidad vesical, acomodación y presión del detrusor en todos los pacientes salvo en dos (16,7%). Esta mejoría fue disminuyendo a partir de 6 meses, aunque inyecciones sucesivas produjeron cambios similares. Un paciente (8,3%) recibió una dosis, 6 (50%) dos y 5 (41,7%) tres. En 8 pacientes (66,7%) la mejoría clínica y urodinámica permitió evitar ampliación vesical. Conclusiones: la inyección de toxina botulínica repetida en el detrusor es una herramienta terapéutica frente a disfunciones vesicales con alta presión y baja acomodación en niños. Puede sustituir a la ampliación vesical en algunos casos, pero se necesitan estudios con largo seguimiento para evaluar apropiadamente su seguridad y eficacia (AU)

Introduction: bladder dysfunction causes urinary incontinence and kidney damage in children. When treatment with anticholinergics and intermittent bladder catheterization fails, the alternative therapy is bladder augmentation. Patients and methods: between 2005 and 2009, a prospective study was carried out with Botox® injected into the detrusor of children suffering from high-pressure bladder despite anticholinergic treatment. We assessed their urodynamic, clinical and radiological evolution prior to and at 4 weeks, 6 months and 1 year after the injection (10 u/kg of weight up to 300 u). Reinjection was indicated in the event of clinical or urodynamic worsening. We employed the Wilcoxom test to statistically analyze the urodynamic parameters. Results: 12 patients were treated, 11 with neurogenic bladder (91.7%) and 1 with posterior urethral valves (8.4%). The mean age was 12.6 (4.3-17.8) years and follow-up took place after 40.8 (16.9-45-7) months. Bladder capacity, detrusor accommodation and pressure improved after 4 weeks in all the patients except in 2 (16.7%). This improvement decreased after 6 months, although successive injections produced similar changes. One patient (8.3%) received 1 dose, six (50%) two doses and five (41.7%) received three. Clinical and urodynamic improvement in 8 patients (66.7%) prevented bladder augmentation. Conclusions: repeated botulinum toxin injection in the detrusor is a therapeutic instrument for high pressure and low accommodation bladders in children. It could replace bladder augmentation in some cases, however further studies with long-term follow-up care are required to appropriately evaluate its safety and effectiveness (AU)

[Injection of botulinum toxin (BTX-A) in children with bladder dysfunction due to detrusor overactivity]. / Es la inyección de Toxina botulínica-A en el detrusor una alternativa a la ampliación vesical en niños.

INTRODUCTION: bladder dysfunction causes urinary incontinence and kidney damage in children. When treatment with anticholinergics and intermittent bladder catheterization fails, the alternative therapy is bladder augmentation. PATIENTS AND METHODS: between 2005 and 2009, a prospective study was carried out with Botox(®) injected into the detrusor of children suffering from high-pressure bladder despite anticholinergic treatment. We assessed their urodynamic, clinical and radiological evolution prior to and at 4 weeks, 6 months and 1 year after the injection (10 u/kg of weight up to 300 u). Reinjection was indicated in the event of clinical or urodynamic worsening. We employed the Wilcoxom test to statistically analyze the urodynamic parameters. RESULTS: 12 patients were treated, 11 with neurogenic bladder (91.7%) and 1 with posterior urethral valves (8.4%). The mean age was 12.6 (4.3-17.8) years and follow-up took place after 40.8 (16.9-45-7) months. Bladder capacity, detrusor accommodation and pressure improved after 4 weeks in all the patients except in 2 (16.7%). This improvement decreased after 6 months, although successive injections produced similar changes. One patient (8.3%) received 1 dose, six (50%) two doses and five (41.7%) received three. Clinical and urodynamic improvement in 8 patients (66.7%) prevented bladder augmentation. CONCLUSIONS: repeated botulinum toxin injection in the detrusor is a therapeutic instrument for high pressure and low accommodation bladders in children. It could replace bladder augmentation in some cases, however further studies with long-term follow-up care are required to appropriately evaluate its safety and effectiveness.

Determination of trace metals in urine with an on-line ultrasound-assisted digestion system combined with a flow-injection preconcentration manifold coupled to flame atomic absorption spectrometry.

A flow analysis method with on-line sample digestion/minicolumn preconcentration/flame atomic absorption spectrometry is described for the determination of trace metals in urine. First, urine sample was on-line ultrasound-assisted digested exploiting the stopped-flow mode, and then the metals were preconcentrated passing the pre-treated sample through a minicolumn containing a chelating resin. A home-made minicolumn of commercially available imminodiacetic functional group resin, Chelite Che was used to preconcentrate trace metals (Cu, Fe, Mn and Ni) from urine. The proposed procedure allowed the determination of the metals with detection limits of 0.5, 1.1, 0.8 and 0.8microgL(-1), for Cu, Fe, Mn and Ni, respectively. The precision based on replicate analysis was less than +/-10.0%, and the enrichment factor obtained was between 21.3 (Mn) and 44.1 (Ni), for sample volumes between 2.5 and 5.0mL, and an eluent volume of 110microL. This procedure was applied for determination of metals in urine of workers exposed to welding fumes and urine of unexposed persons (urine control).

Description of electrophoretic and chromatographic hemoglobin profile of Rhinoclemmys punctularia.

Studies of the hemoglobin pattern in Brazilian reptiles are important for determining ecological and phylogenetic relationships, but they are scarce. Peripheral blood samples were obtained from 7 males and 18 females of Rhinoclemmys punctularia. The hematological profile was based on the total hemoglobin and hematocrit values. The hemoglobin profile was obtained using electrophoretic procedures at different pH, isoelectric focusing, globin chain electrophoresis, and HPLC. The hematocrit (31 +/- 2%) and total hemoglobin (7.5 +/- 0.2 g/dL) values did not indicate gender variations. Alkaline pH electrophoresis of the total blood samples treated with 1% saponin demonstrated the presence of four well-defined hemoglobin fractions, one major component (fraction I), showing cathodic migration and three others faster than fraction I with anodic migration. When the samples were precipitated with chloroform, only two hemoglobin fractions were observed, similar to fractions I and III from the first procedure. Isoelectric focusing and HPLC showed the same pattern. With acid and neutral pH electrophoresis, two fractions with anodic migration were observed. The globin chain identification at alkaline pH showed two fractions, but four fractions were observed at acidic pH, suggesting that different polypeptide chains are involved in the hemoglobin molecule. The chromatographic separation of the total blood sample demonstrated that the major fraction comprised 81.9% and the minor 18.1%. The results obtained demonstrated a similarity between these hemoglobin components and those of some Chelidae reported in the literature for both land and aquatic animals, reflecting the adaptation to environmental conditions.

Flow injection determination of lead and cadmium in hair samples from workers exposed to welding fumes.

A flow injection procedure involving continuous acid leaching for lead and cadmium determination in hair samples of persons in permanent contact with a polluted workplace environment by flame atomic absorption spectrometry is proposed. Variables such as sonication time, nature and concentration of the acid solution used as leaching solution, leaching temperature, flow-rate of the continuous manifold, leaching solution volume and hair particle size were simultaneously studied by applying a Plackett-Burman design approach. Results showed that nitric acid concentration (leaching solution), leaching temperature and sonication time were statistically significant variables (confidence interval of 95%). These last two variables were finally optimised by using a central composite design. The proposed procedure allowed the determination of cadmium and lead with limits of detection 0.1 and 1.0 microgg(-1), respectively. The accuracy of the developed procedure was evaluated by the analysis of a certified reference material (CRM 397, human hair, from the BCR). The proposed method was applied with satisfactory results to the determination of Cd and Pb in human hair samples of workers exposed to welding fumes.

Fast ultrasound-assisted extraction of copper, iron, manganese and zinc from human hair samples prior to flow injection flame atomic absorption spectrometric detection.

A dynamic ultrasound-assisted extraction procedure utilizing diluted nitric acid was developed for the determination of copper, iron, manganese and zinc in human hair taken from workers in permanent contact with a polluted environment. The extraction unit of the dynamic ultrasound-assisted extraction system contains a minicolumn into which a specified amount of hair (5-50 mg) is placed. Once inserted into the continuous manifold, trace metals were extracted at 3 mL min(-1) with 3 mol L(-1) nitric acid under the action of ultrasound for 2 min for zinc and 3 min for copper, iron and manganese determination, and using an ultrasonic water-bath temperature of 70 degrees C for zinc and 80 degrees C for copper, iron and manganese determination. The system permits the direct analysis of hair and yields concentrations with relative standard deviations of <3% (n = 11). The applicability of the procedure was verified by analysing human hair samples from workers exposed to welding fumes, and its accuracy was assessed through comparison with a conventional sample dissolution procedure and the use of a certified reference material (BCR 397, human hair).

Description of electrophoretic and chromatographic hemoglobin profile of Rhinoclemmys punctularia

Studies of the hemoglobin pattern in Brazilian reptiles are important for determining ecological and phylogenetic relationships, but they are scarce. Peripheral blood samples were obtained from 7 males and 18 females of Rhinoclemmys punctularia. The hematological profile was based on the total hemoglobin and hematocrit values. The hemoglobin profile was obtained using electrophoretic procedures at different pH, isoelectric focusing, globin chain electrophoresis, and HPLC. The hematocrit (31 +/- 2%) and total hemoglobin (7.5 +/- 0.2 g/dL) values did not indicate gender variations. Alkaline pH electrophoresis of the total blood samples treated with 1% saponin demonstrated the presence of four well-defined hemoglobin fractions, one major component (fraction I), showing cathodic migration and three others faster than fraction I with anodic migration. When the samples were precipitated with chloroform, only two hemoglobin fractions were observed, similar to fractions I and III from the first procedure. Isoelectric focusing and HPLC showed the same pattern. With acid and neutral pH electrophoresis, two fractions with anodic migration were observed. The globin chain identification at alkaline pH showed two fractions, but four fractions were observed at acidic pH, suggesting that different polypeptide chains are involved in the hemoglobin molecule. The chromatographic separation of the total blood sample demonstrated that the major fraction comprised 81.9% and the minor 18.1%. The results obtained demonstrated a similarity between these hemoglobin components and those of some Chelidae reported in the literature for both land and aquatic animals, reflecting the adaptation to environmental conditions.

Acute transverse myelitis in a 7-month-old boy after diphtheria-tetanus-pertussis immunization.

STUDY DESIGN: Case report of a 7-month-old boy, who developed acute transverse myelitis after diphtheria-tetanus-pertussis immunization. OBJECTIVES: To describe the clinical course of acute transverse myelitis in an infant and to review the literature regarding the association of acute transverse myelitis and vaccinations. SETTING: Department of Pediatrics, University of Kentucky, Lexington, Kentucky, USA. METHODS: Case report. RESULTS: Magnetic resonance imaging (MRI) on admission demonstrated diffuse spinal cord edema with increased signal on T-2 weighted images and faint enhancement with gadolinium infusion. Urologic symptoms improved with steroids but motor function was never fully regained. Repeat MRI of the spinal cord several months later showed diminution of cord diameter with resolution of edema and signal abnormality. CONCLUSION: Based on the clinical course and MRI findings, the daignosis of acute transverse myelitis was made. The association of previously received DPT immunization and the genesis of transverse myelitis is explored.

[Role of peritoneal drainage in very low birth weight with enterocolitis]. / Papel del drenaje peritoneal en la enterocolitis del prematuro crítico.

UNLABELLED: Peritoneal drainage (PD) has been proposed as a temporizing procedure for perforated necrotizing enterocolitis (NEC) in very low birth weight neonates. This operation was designed for patients considered too unstable to undergo laparotomy (LAP). Since the introduction of PD some investigators have suggested that it may serve as a definitive therapy. The aim of our study is to determine the efficacy of PD for the stabilization of patients with complicated NEC and its utility as a definitive surgical treatment. METHODS: We review the clinical records from all the patients treated in our unit because of NEC that required surgical therapy. We analyze the mean blood pressure, cardiac and respiratory rate, inspired oxygen concentration, mean airway pressure, diuresis, and arterial blood gases measured 6 and 12 hours after the initial surgical treatment. We divide patients in two different groups according to the initial surgical procedure, peritoneal drainage (PD) or laparotomy group (LAP). Data is shown as media +/- standard deviation, statistical analyses were performed using analysis of variance (ANOVA) for repeated measures and Mann-Withney test. RESULTS: From January 1997 to January 2001 we treated 13 patients with necrotizing enterocolitis that required surgical treatment. Among this group 6 patients were managed initially with PD and 7 with LAP. The gestational age media was 29.07 +/- 3.81 weeks and the birth weight mean 1199.76 +/- 521 gr., without any significant differences between the two groups DP and LAP. All patients improved haemodynamically and respiratory 6 and 12 hours after the surgical treatment. Nevertheless, the mean blood pressure improved even more in the DP group (p<0.005). The DP group showed an improvement in all parameters 6 hours after the drainage was placed, but this effect wasn't maintained for the next 12 hours onwards. From the 12 hours after PD all patients suffered a steady worsening that required further surgical procedures. The overall mortality was 3 patients (23%), without differences between the two groups. The surgical techniques performed (bowel resection, diversion) were similar for both groups. DISCUSSION: DP allows the stabilization for very critically ill patients with complicated NEC. However, this stabilization is temporary. This improvement lasts for a few hours providing a better status for the definitive surgical treatment for the perforated NEC. In our experience DP could not be considered as a definitive surgical treatment.