Interspecific differences in the bioaccumulation of arsenic of three Patagonian top predator fish: Organ distribution and arsenic speciation.

Interspecific differences in arsenic bioaccumulation and organ distribution (muscle, liver, kidney and gills) in three predator fish (creole perch, rainbow trout and brown trout) from a Patagonian lake impacted by volcanic eruptions were studied. Arsenic in fish organs were compared analyzing: 1) temporal (before and after volcanic eruption) and spatial (near and far from the volcano) influence of Puyehue-Cordón Caulle volcanic complex activity on arsenic concentrations; 2) the influence of growth (as total length), organ type and their interactions over arsenic accumulation; and 3) arsenic speciation and total arsenic relationship with carbon to nitrogen ratios (C:N), as a proxy of lipid presence, in fish muscle. In general, total arsenic concentrations in creole perch organs were 2-7 times higher than those recorded in the corresponding organs of salmonids. Arsenic was preferentially accumulated in liver and kidney in the three fish species. The influence of the volcanic activity over arsenic concentrations was more evident in creole perch: organs from creole perch captured closest to the volcano exhibited higher arsenic concentrations. Temporal variations were not so consistent. No clear relationship between arsenic and fish length was observed. Positive and linear relationship between arsenic in all pair of organs was found in creole perch, while rainbow trout showed a quadratic relationship between muscle and the remaining organs, indicating different arsenic assimilation-elimination relationships between organs and fish. The arsenic liver:muscle ratio in the three fish species was greater than 1, suggesting some level of arsenic stress. Arsenobetaine (AB) and dimethylarsinic acid (DMA) were the dominant arsenic species in muscle of these fish, having creole perch 3-4 times higher AB than rainbow trout. A positive relationship between C:N ratio and total arsenic concentrations was found, with higher C:N in creole perchs near the volcano. In terms of food safety, no inorganic arsenic compound were detected, therefore arsenic levels in fish from Lake Nahuel Huapi does not represent any health risk to consumers.

Surgery in ovarian cancer - Brazilian Society of Surgical Oncology consensus.

Surgical management in epithelial ovarian cancer (EOC) has a significant impact in overall survival and progression-free survival. The Brazilian Society of Surgical Oncology (BSSO) supported a taskforce of experts to reach a consensus: experienced and specialised trained surgeons, in cancer centres, provide the best EOC surgery. Laparoscopic and/or radiological staging prognosticates the possibility of complete cytoreduction (CC0) and helps to reduce unnecessary laparotomies. Surgical techniques were reviewed. Multidisciplinary input is essential for treatment planning. Quality assurance criteria are proposed and require national consensus. Genetic testing is mandatory. This consensus states the final recommendations from BSSO for management of EOC. TWEETABLE ABSTRACT: Brazilian Society of Surgical Oncology consensus for surgery in epithelial ovarian cancer patients.

The evolving contribution of non-communicable diseases to maternal mortality in Jamaica, 1998-2015: a population-based study.

OBJECTIVE: To describe trends in indirect cause-specific pregnancy-related mortality from 1998 to 2015. DESIGN: Secondary analysis of annual, national cross-sectional database of maternal and late maternal deaths, identified through active surveillance of deaths among women aged 10-50 years. SETTING: Jamaica, a middle-income Caribbean country. POPULATION: Maternal and late maternal deaths. METHODS: Descriptive trend analyses of demographic and cause-specific maternal and pregnancy-related mortality ratios undertaken comparing the periods 1998-2003, 2004-2009 and 2010-2015. Multivariate logistic regression was used to confirm changes in risk of indirect death. MAIN OUTCOME MEASURES: Maternal, pregnancy-related, direct, indirect and cause-specific mortality ratios (deaths/100 000 live births). RESULTS: Maternal deaths from indirect conditions increased between the first two periods (P = 0.004) and stabilised in the third (P = 0.085). Associated with upward movement in cardiovascular deaths (P[trend] = 0.003), women under 25 years were at elevated risk (odds ratio 1.44, 95% CI 1.00-2.08; P = 0.052). Haematological/immunological conditions (69% sickle cell disease) ranked second but did not vary with time. Health service utilisation was similar across age, parity, health region and major cause categories (non-communicable diseases, non-obstetric infections, direct), however women with indirect conditions spent more time in hospital (median 5 days versus 3 days) and more often died after the puerperium. CONCLUSIONS: Medical conditions, especially cardiovascular disease, are increasingly associated with maternal and late maternal mortality. Middle-income countries need to simultaneously improve management of indirect conditions, while redoubling efforts to reduce direct deaths. Postpuerperal medical services should be integrated into routine infant health services to improve continuity of care during this high-risk period. TWEETABLE ABSTRACT: Maternal survival (SDG 3.1) in LMICs requires better care for women with both non-communicable diseases and obstetric conditions.

Myxoid onychomatricoma: an unusual variant of a rare nail unit tumor.

A 57-year-old woman presented with a 3-year history of a thickened, yellowed, over-curved nail plate of the left second toe. The proximal nail fold had an associated nodule. When observed head-on, the distal nail plate demonstrated multiple circular perforations. Avulsion of the nail plate revealed a 0.7 cm pale white mass within the proximal nail matrix, which was excised. Histologic sections of the nail plate showed longitudinal cystic spaces associated with papillary projections of nail matrix epithelium. The parenchyma of the lesion demonstrated bland-appearing spindled cells in a prominent myxoid stroma with abundant mast cells. The spindled cells were focally positive for CD34 and factor XIIIa and negative for S100, pan-cytokeratin, desmin, smooth muscle actin, epithelial membrane antigen, and MART-1. Onychomatricoma (OM) is a rare nail unit biphasic fibroepithelial tumor with multiple radiating digitations lined by papillomatous matrix epithelium. The epithelial component is consisted of matrix cells that generate the thickened nail plate, and the digitations cause characteristic "wormwood" perforations of the nail plate. A fibrous stroma is characteristic with staining positive for CD34 and negative for CD99, epithelial membrane antigen, and S100. This case is unique with the presence of a prominent myxoid stroma associated with the fibrous component of the OM. Only 1 previous report of OM highlights a related finding of a myxocollagenous stroma. This purely myxoid variant represents a new distinct form of OM. Clinicopathologic correlation is essential to avoid confusion with other myxoid tumors such as a superficial acral myxoma, superficial angiomyxoma, or a digital myxoid cyst.

CD30 positive atypical lymphocytes in perniosis: a potential histopathologic pitfall in a benign condition.

In classical clinical perniosis (chilblains), the presence of atypical lymphocytes with immunohistochemical staining positive for CD30 is unusual and rarely reported. Here we report 2 cases of clinical perniosis, one in a 16-year-old girl and another in a 67-year-old woman. The biopsies revealed lymphocytic infiltrates, papillary dermal edema, and atypical cells highlighted with a CD30 immunohistochemical stain. Our cases demonstrate the importance of clinicopathologic correlation in the assessment of CD30 positive lymphocytes in benign nonneoplastic conditions. Dermatopathologists must be aware of this potential histologic pattern in perniosis to prevent misdiagnosis and overtreatment of this condition.

Arsenic, cobalt and chromium food web biodilution in a Patagonia mountain lake.

Mussels, Diplon chilensis, from Lake Moreno, a double-basined mountain lake in southern Argentina, is known to have elevated concentrations of chromium (Cr, > 25 µg g⁻¹ dry weight DW) and arsenic (As, 35 µg g⁻¹ DW), attributed to untreated sewage. To further understand the trophodynamics of Cr, As and cobalt (Co), we investigated concentrations and transfer throughout the food web in each basin of Lake Moreno. Each basin differs in morphology in that the gently-sloping Lake Moreno West has more littoral habitat than deeper Lake Moreno East with its higher proportion of pelagic habitat. Despite the morphological differences, both basins share similar water quality parameters and species assemblages. As a result, Lake Moreno provides an exceptional opportunity to compare trophodynamics of elements that enable us to hypothesize pelagic-littoral habitat coupling in response to lake morphology as the underlying factor influencing both Cr pathway and Co and As trophodynamic modeling. Using stable isotopes of nitrogen (δ¹5N) and carbon (δ¹³C) to characterize metals trophodynamics in each basin, biodilution of As, Cr and Co were indicated by negative regressions. This is confirmed by elevated As, Co and Cr concentrations in phytoplankton (11.3±5.7, 7.4±4.9, 44.5±40.7 µg g⁻¹ DW respectively), while zooplankton and biofilm had the next elevated concentrations. Those elevated concentrations are in contrast with lower concentrations in sport fish such as rainbow trout (0.5±0.5, 0.2±0.3, 1.8±1.2 µg g⁻¹ DW). Higher concentrations of Cr in fish were associated with higher proportion of benthic/littoral prey items in western basin, and were confirmed by significant correlation with δ¹³C values. Arsenic, Co and Cr concentrations in fish, while elevated, do not post health risks to human or wildlife consumers.

Trophodynamics and distribution of silver in a Patagonia mountain lake.

Silver (Ag) ions are among the most toxic metallic ions to aquatic biota. In southern Argentina, fish from Patagonian lakes have liver Ag concentrations [Ag] among the highest ever reported globally. Silver concentration in phytoplankton from Lake Moreno (1.82±3.00µgg(-1) dry weight, DW) was found to be significantly higher than [Ag] in zooplankton (0.25±0.13µgg(-1)). Values in snails and decapods (0.60±0.28µgg(-1) and 0.47±0.03µgg(-1) respectively), were higher than in insect larvae (0.28±0.39µgg(-1) for Trichoptera). We examined trophic transfer of Ag in the biota using stable nitrogen and carbon isotopes ratios (δ(15)N and δ(13)C respectively). Silver concentrations in the biota of Lake Moreno were not associated with any particular C source, as assessed by δ(13)C. Hepatic [Ag] significantly increased with trophic position, as measured by δ(15)N, within the brook trout sample set. Biodilution of Ag was observed between primary producers and small forage fish when whole body [Ag] was analyzed. Nevertheless, when considering whole food web biomagnification and hepatic [Ag] of top predator fish, a significant positive regression was found between [Ag] and trophic position, as measured by δ(15)N. The importance of species-specific and tissue-specific considerations to obtain more information on Ag trophodynamics than that usually presented in the literature is shown. To the best of our knowledge, this is the first study in assessing Ag trophodynamics and tissue-specific biomagnification in a whole freshwater food web.

Effect of different surfactants on pulmonary group B streptococcal infection in premature rabbits.

OBJECTIVES: To evaluate the effects of different surfactants on pulmonary infection with group B streptococci in premature rabbits and to examine the effects of different surfactants on pulmonary alveolar macrophage function of newborn rabbits. MODEL: Preterm and term rabbit pups. METHODS: Rabbit pups were infected with GBS aerosols followed by intratracheal administration of either calf lung surfactant extract, minced porcine lung surfactant (Curosurf), synthetic surfactant (Exosurf Neonatal), minced bovine lung surfactant (Survanta), human amniotic fluid-derived surfactant, rabbit surfactant, saline vehicle, or no treatment. Intrapulmonary clearance of GBS was determined by comparing bacterial counts in left lungs cultured immediately after aerosol infection with similarly infected lungs analyzed 4 hours after surfactant therapy. Phagocytosis of streptococci was ascertained by microscopic examination of the right lungs fixed in situ at 4 hours. For comparison, an in vitro method was used to measure growth of GBS in the different surfactants. RESULTS: Preterm animals had a sixfold increase in pulmonary bacterial growth compared with a slight decrease in intrapulmonary GBS in term animals when all were delivered by cesarean section (p < 0.05). In premature rabbits, GBS proliferation was lowest in animals treated with Exosurf Neonatal and highest in animals receiving Curosurf and human amniotic fluid-derived surfactant (p < 0.05). None of the surfactants promoted accelerated growth of GBS in comparison with control animals. Similar growth of GBS was seen in in vitro cultures. Intrapulmonary phagocytosis of GBS in premature pups was not altered by any of the surfactants. In term rabbit pups, the following measures of macrophage population kinetics remained normal at 1 and 24 hours after surfactant administration: viability, cell numbers based on lung lavage, and in vivo incorporation of thymidine. CONCLUSIONS: Surfactants used in clinical practice do not accelerate the in vivo growth of group B streptococci in the lungs of preterm rabbits. Some surfactants inhibit streptococcal proliferation. The effects of different surfactants are not explained by changes in macrophage function.

Tracking of blood pressure and anthropometric measures in Nigerian children.

Persistence in ranks (tracking) for blood pressure and anthropometric measures over a one year period was examined in 208 Nigerian children (age 6-17 years). Systolic blood pressure tracked better than diastolic blood pressure (r = 0.52 to 0.72) and r = 0.25 to 0.55, respectively). For systolic blood pressure, 56.5%-70.6% of the Nigerian children remained in the top tertile after one year compared with 45.5%-69.2% for diastolic blood pressure. Weight showed the strongest correlation over the one year period (r = 0.88 to 0.97), whereas skinfolds demonstrated the weakest association (r = 0.54 to 0.82). The association between anthropometric measures at baseline and blood pressure one year later revealed for both males and females that height and weight were positively and significantly correlated with blood pressure.

Significance of seizures associated with extracorporeal membrane oxygenation.

We previously reported a predominance of left focal motor seizures in infants receiving extracorporeal membrane oxygenation (ECMO), raising concerns about possible ischemia resulting from the right common carotid artery ligation. We therefore evaluated the neurologic and psychologic outcome at 2 years of age of all infants with ECMO-related seizures. Although 8 of 12 infants had left focal seizures in infancy, there was no lateralization of motor findings at 2 years of age; left hemiparesis was present in three of the infants and right hemiparesis in three. The developmental quotient was normal in 6 of 12 infants, low-average in three, borderline in two, and in the mentally handicapped range in one. We conclude that any ischemia resulting from carotid ligation is not great enough to produce long-term lateralizing findings but that seizures during ECMO are a risk factor for later cerebral palsy or developmental delay.

Physical activity, stress, and type A behavior in blacks.

We assessed the relationship between potential risk factors for coronary heart disease, including type A behavior, leisure time physical activity, and stress in a young black adult population. The study population consisted of 192 black college freshmen at the University of Pittsburgh. The mean age of male subjects was 18.4; the mean age of female subjects was 18.5 years. No significant sex differences were noted for body mass index, type A behavior, stress, or physical activity levels. For both men and women, type A (Framingham) was positively correlated with stress. Only among women was there a positive association between type A (Bortner) and physical activity.

Right common carotid artery ligation in extracorporeal membrane oxygenation.

The effect of right common carotid artery ligation required for arteriovenous extracorporeal membrane oxygenation (ECMO) was investigated in 35 infants. Their neonatal course was reviewed for evidence of right-sided ischemia of the brain, as suggested by the presence of focal seizures, hemiparesis, focal abnormalities on electroencephalography, or infarct or hemorrhage demonstrable on neuroimaging studies. A significant incidence of left focal seizures (9/35) versus right focal seizures (2/35) was noted, suggesting an effect of the carotid ligation on right hemisphere function. Computed tomographic scans (20/35 infants), electroencephalograms (18/35), ultrasound scans (31/35), and neurologic examinations did not reveal an increased incidence of right hemisphere abnormalities. These data suggest that systematic evaluation of the effects of right common carotid ligation should proceed as discussion continues on expanding the use of ECMO.

Prevention of pulmonary alveolar macrophage proliferation in newborn rabbits by hyperoxia.

As a test of the hypothesis that hyperoxia might hinder the growth of nascent lung macrophages, term newborn rabbits were treated with room air or increasing oxygen concentrations (40%, 80%, or greater than or equal to 95%) for 96 hours after birth. After 24, 48, 72, and 96 hours of environmental exposure, pulmonary alveolar macrophage population kinetics were determined by three methods: (1) bronchoalveolar lavage cell yields, (2) thymidine incorporation by macrophages, and (3) assessment of macrophage cell division by mitotic indices. Newborn rabbits kept in room air or 40% inspired O2 showed a steady increase of macrophages in lung lavage, but pups treated with 80% or greater than or equal to 95% oxygen showed no rise of macrophage yield in lung washings after 96 hours of exposure (P less than 0.02). The diminished macrophage yield noted in pups treated with 80% or greater than or equal to 95% oxygen was explained by rates of thymidine uptake and macrophages replication (mitotic indices) that were greater than 12-fold lower than values seen in rabbit pups housed in room air or 40% inspired O2 for 96 hours (P less than 0.05). These findings could not be attributed to malnutrition caused by oxygen toxicity because all groups appeared well and gained weight equally during the period of exposure. We conclude that acute hyperoxia impedes the intraalveolar proliferation of lung macrophages, an observation that may have implications regarding host defense and for repair and growth of the lung in neonates needing respiratory support.