Evaluation of the anorectal motor response after percutaneous stimulation of the posterior tibial nerve in patients with fecal incontinence.

BACKGROUND: The effect of posterior tibial nerve stimulation (PTNS) on the mechanisms of anal continence has not been fully demonstrated. The aim of this study was to assess the anal manometric response after percutaneous PTNS in patients with fecal incontinence (FI). METHODS: This was a prospective study in patients with FI undergoing 1 weekly session of percutaneous PTNS for 8 weeks. A clinical assessment (Wexner scale) and a complete study of up to 22 manometric parameters were carried out prior to treatment and 2-4 weeks after the end of treatment. RESULTS: A total of 32 patients were evaluated. After therapy, there was a decrease in the average Wexner score [12.6 (± 5.2) to 9.5 (± 5.2) (P < 0.005)] and an increase in the "anal canal length at rest" [4.55 (± 0.60) to 4.95 (± 0.21) P = 0.004], without observing variations in other manometric parameters. The decrease in the Wexner score was significantly correlated with an increase in the "pressure at 5 cm at rest" after therapy (r = 0.464 P = 0.030). CONCLUSIONS: In our study, PTNS was associated with a significant decrease in the Wexner score and with an increase in the functional length of the anal canal at rest. The improvement in the Wexner scale was correlated with an increase in pressure at rest in the theoretical area of the anorectal junction.

Polychlorinated biphenyls (PCBs) and p,p'-dichlorodiphenyldichloroethylene (DDE) concentrations in maternal and umbilical cord serum in a human cohort from South Portugal.

Organochlorine compounds as polychlorinated biphenyls (PCBs) and pp'-dichlorodiphenyldichloroethylene (pp'DDE) are ubiquitous, resistant to degradation and lipophilic compounds, commonly found in the general population. Prenatal exposure to these compounds has been associated to adverse developmental effects. Levels of PCBs and pp'DDE were investigated in maternal and umbilical cord serum of 68 women/newborns pairs from Algarve, South Portugal. Mean sum PCBs congeners and pp'DDE concentrations were 1.62 ± 0.39 ng mL(-1)and 1.11 ± 0.69 ng mL(-1)-for maternal and 1.45 ± 0.25 ng mL(-1) and 0.85 ± 0.50 ng mL(-1)for cord serum, respectively. Congeners distribution pattern followed the order PCB 153>180>130, both for maternal and cord serum). Significant correlations (p<0.05) were found between maternal and cord serum concentrations. The umbilical cord/maternal serum ratio were 0.90 and 0.76, respectively for ΣPCB and pp'DDE Multivariate analyses relate women in urban centers with higher PCB levels, while higher pp'DDE relates to older primiparous women that live at rural areas. PCBs were also correlated to more portions of fat rich foods, while pp'DDE is associated to higher ingestion of vegetables and fruits. Smoking habits only correlated to maternal PCB. The present work provides, to our knowledge and for the first time, baseline human-biomonitoring data and establishes background ranges of PCB and pp'DDE levels in the maternal and umbilical cord serum in the Algarve region. These compounds exhibited the capacity to pass the placenta barrier and target the fetus. Even in non-industrialized areas, and in non-intensive agriculture areas, like the Southern Portugal, there is a need to take measures to eliminate or minimize the risk of organochlorine exposure during pregnancy.

Modeling fish biological responses to contaminants and natural variability in estuaries.

Understanding the factors that influence biological responses to contaminants has long been a major goal in marine environmental research. Seven estuarine sites along the Portuguese coast were sampled over a year, and different biological responses of Pomatoschistus microps and Atherina presbyter were determined: superoxide dismutase, catalase, ethoxyresorufin O-deethylase, glutathione S-transferase, metallothioneins, lipid peroxidation, RNA:DNA ratio and condition factor K. Generalized linear models (GLM) were developed for each biological variable per species in relation to sediment chemical characterization (metals and polycyclic aromatic hydrocarbons concentration) and environmental conditions (month, site, water temperature, salinity, depth and mud percentage in the sediment). GLM varied in explanatory power and in the set of predictor variables included in the models. Environmental factors were frequently selected as predictor variables. Individual metals concentration and sediment quality guidelines (integrating all metals) were the major contaminants explaining biological variability. Accordingly, models for metallothioneins and lipid peroxidation had highest explanatory power. Species-specific responses and dataset size were the basis of observed differences between GLM for the two species.

Assessment of essential and nonessential metals and different metal exposure biomarkers in the human placenta in a population from the south of Portugal.

The general population is exposed to metals as trace amounts of metallic compounds are present in air, water, and food. Information on background exposures and biomarker concentrations of environmental chemicals in the general Portuguese population is limited. Therefore, the purpose of this study was to determine the levels of important nonessential metals with recognized toxicity cadmium (Cd) and lead (Pb) and essential metals copper (Cu), nickel (Ni), chromium (Cr), and zinc (Zn) in placentas of mothers living in south Portugal (Algarve). Due to the difficulty in establishing the effects of chemicals in a complex and variable environment, this study also aimed to examine the response of biomarkers, such as biochemical changes that occurs at subcellular levels in the presence of contaminants. The investigated biomarkers in placentas indicative of metal exposure or damage included the metallothioneins (MT), delta-aminolevulinic acid dehydratase (ALAD) (specific for Pb), and lipid peroxidation (LPO) as an index of oxidative stress damage. Moreover, HJ-BIPLOT was applied in order to identify and categorize mothers vulnerable to environmental contamination in this region. Metal concentrations in the placenta were not excessive but within the range found in most European studies. In general, the biomarkers MT and LPO were positively correlated with metal levels, while with ALAD the opposite occurred, indicating the selected battery of biomarkers were suitable to study the effects of metals on human placenta. Further, the application of multivariate analysis with HJ-BIPLOT showed that most significant factors contributing to maternal and fetal exposures via placenta were dietary and smoking habits.

A multibiomarker approach in the clam Ruditapes decussatus to assess the impact of pollution in the Ria Formosa lagoon, South Coast of Portugal.

The Ria Formosa lagoon is an ecosystem whose water quality reflects the anthropogenic influence upon the surrounding areas. In this lagoon, the clam Ruditapes decussatus has a great economical importance and has been widely used as a biomonitor. A multibiomarker approach (δ-aminolevulinic acid dehydratase, metallothionein, lipid peroxidation, acetylcholinesterase, alkali-labile phosphates, DNA damage) was applied to assess the environmental quality of this ecosystem and the accumulation of contaminants and their potential adverse effects on clams. Clams were sampled in different shellfish beds in the period between July 2007 and December 2008 and abiotic parameters (temperature, salinity, pH and dissolved oxygen of seawater and organic matter in the sediment), condition index, metals (Cd, Cu, Zn, Ni, Pb), TBTs and PAHs concentrations were measured in clam tissues. Data was integrated using Principal Component Analyses and biomarker indices: IBR (Integrated Biomarker Response) and HSI (Health Status Index). This multibiomarker approach enabled discrimination of a time and space trend between sites with different degrees of anthropogenic contamination, identifying one of them (site 2) as the most stressful and summer months as the most critical period for clams due to an increase of environmental stress (anthropogenic pressure along with extreme environmental conditions, e.g. temperature, dissolved oxygen, organic matter in the sediments, etc). The selected biomarkers provided an integrated response to assess the environmental quality of the system, proving to be a useful approach when complex mixtures of contaminants occur.

Short-term variability of multiple biomarker response in fish from estuaries: Influence of environmental dynamics.

Short-term variability in biomarker responses and the effects of temperature and salinity variation were explored in three fish species (Dicentrarchus labrax, Solea senegalensis and Pomatoschistus microps) occurring in the Tejo estuary. Short-term variability in biomarkers was observed in all species although no pattern was discerned over time (days to weeks). Antioxidant enzymes activity (superoxide dismutase (SOD) and catalase (CAT)) showed low temporal variability, indicating some constancy or baseline level in antioxidant responses. Only CAT activity in S. senegalensis was correlated with temperature, suggesting that exposure to contaminants triggered antioxidant acclimation. Higher short-term variability was observed in xenobiotic biotransformation enzymes activity (phase I ethoxyresorufin O-deethylase (EROD) and phase II glutathione S-transferase (GST)). Yet a significant correlation between EROD and GST in D. labrax and S. senegalensis suggests a concomitant response to contaminants. Moreover the lack of correlation between xenobiotic biotransformation enzymes and abiotic variables on concordant time scales, suggest a high specificity of these biomarkers to chemical exposure, rather than high variability due to environmental dynamics.

Multi-biomarker responses to estuarine habitat contamination in three fish species: Dicentrarchus labrax, Solea senegalensis and Pomatoschistus microps.

Several biomarker responses were determined in three fish species, Dicentrarchus labrax, Solea senegalensis and Pomatoschistus microps, from two estuaries of the Portuguese coast, Ria de Aveiro and Tejo. Both estuaries have significant anthropogenic influences from multiple sources (industrial, agricultural and shipping activities), which was evident from sediment chemical characterization concerning metal (copper, zinc, nickel, lead and chromium) and polycyclic aromatic hydrocarbon (PAH) concentrations. Spatial variability in fish responses was observed across species for most biomarkers of exposure [the activities of superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), ethoxyresorufin O-deethylase (EROD) and glutathione S-transferase (GST), and metallothionein concentrations (MT)] and effect biomarkers [lipid peroxidation (LPO), RNA to DNA ratio (R:D), protein and lipid content]. In general, the interspecific differences in biomarker responses were greater than the spatial differences, due to differences in the behavior and habitat use of the species. Nevertheless, similarities were also observed considering both chemical load and biomarker responses. In highly polluted sites fish showed in general a significant antioxidant enzyme induction, associated with decreased R:D values, while fish from the least impacted site had little enzyme induction and better condition indices (high R:D and low LPO values). EROD activity was also higher for all species in the Tejo than Ria de Aveiro estuary, despite the generally higher total PAH measured in Ria de Aveiro, most likely due to a higher proportion of 4 and 6-ring PAHs, considered more toxic than low molecular weight PAHs, in the Tejo. In conclusion, this multi-biomarker approach considering multiple species provided improved understanding of the diverse responses and effects of exposure to contaminants and the effective risk it poses for different fish species.

Source and impact of lead contamination on δ-aminolevulinic acid dehydratase activity in several marine bivalve species along the Gulf of Cadiz.

Coastal areas and estuaries are particularly sensitive to metal contamination from anthropogenic sources and in the last few decades the study of space-time distribution and variation of metals has been extensively researched. The Gulf of Cadiz is no exception, with several rivers draining one of the largest concentrations of sulphide deposits in the world, the Iberian Pyrite Belt (IPB). Of these rivers, the Guadiana, one of the most important in the Iberian Peninsula, together with smaller rivers like the Tinto and Odiel, delivers a very high metal load to the adjacent coastal areas. The purpose of this work was to study the source and impact of lead (Pb) drained from historical or active mining areas in the IPB on the activity of a Pb inhibited enzyme (δ-aminolevulinic acid dehydratase, ALAD) in several bivalve species along the Gulf of Cadiz. Seven marine species (Chamelea gallina, Mactra corallina, Donax trunculus, Cerastoderma edule, Mytilus galloprovincialis, Scrobicularia plana and Crassostrea angulata) were collected at 12 sites from Mazagón, near the mouth of the rivers Tinto and Odiel (Spain), to Cacela Velha (Ria Formosa lagoon system, Portugal). Lead concentrations, ALAD activity and lead isotope ratios ((206)Pb/(204)Pb, (207)Pb/(204)Pb and (208)Pb/(204)Pb) were determined in the whole soft tissues. The highest Pb concentrations were determined in S. plana (3.50±1.09 µg g(-1) Pb d.w.) and D. trunculus (1.95±0.10 µg g(-1) Pb d.w.), while M. galloprovincialis and C. angulata showed the lowest Pb levels (<0.38 µg g(-1) Pb d.w.). In general, ALAD activity is negatively correlated with total Pb concentration. However this relationship is species dependent (e.g. linear for C. gallina ALAD=-0.36[Pb]+0.79; r=0.837; or exponential for M. galloprovincialis ALAD=2.48e(-8.3[Pb]); r=0.911). This indicates that ALAD activity has considerable potential as a biomarker of Pb and moreover, in marine bivalve species with different feeding habits. Lead isotope data showed significant seasonal and spatial changes in bivalve isotopic composition reflecting seasonal and geographic differences in bioaccumulation. Within the study area, Pb can be modelled as a mixing between geogenic Pb and mine-related, discharges of Pb from the IPB. For some sites at the mouth of the Guadiana River, the bivalves show contamination from other anthropogenic sources, such as leaded boat/aviation fuel and/or leaded paint. Finally, the study demonstrates convincingly the need to consider species-specific variation when using bivalve ALAD activity as a biomarker for Pb.

Biomarkers of exposure to metal contamination and lipid peroxidation in the benthic fish Cathorops spixii from two estuaries in South America, Brazil.

Biomarkers as lipid peroxidation, metallothionein and delta-aminolevulinic acid dehydratase were determined in Cathorops spixii to compare the biological responses of this fish from estuaries with distinct anthropogenic influence. Three areas were selected in two estuaries in accordance with the levels of contamination for the polluted (Santos/São Vicente) and with the hydrodynamic characteristics for the non-polluted (Cananéia) estuary. Water characteristics and mercury levels in C. spixii confirmed a high human influence in the polluted system. In general, the biomarkers showed differences between the estuaries, suggesting disturbances in the specific cell mechanisms due to the presence of multiple xenobiotics in the contaminated system. Therefore, these biomarkers are recommended to promote more accurate information about the exposure to pollutants. Additionally, the study of the effect of the multiple xenobiotics on resident species such as the benthic fish C. spixii can favor a better assessment of the environmental quality of these systems.

Long-term results of artificial bowel sphincter for the treatment of severe faecal incontinence. Are they what we hoped for?

OBJECTIVE: This study evaluates the long-term morbidity, functional results and quality of life (QOL) after treatment of severe faecal incontinence (FI) with the Acticon Neosphincter (American Medical Systems, Minneapolis, Minnesota, USA). METHOD: Between 1996 and 2002, 17 consecutive patients (14 female, 3 male; median age 46) underwent sphincter implantation. Clinical evaluation, incontinence severity and QOL were assessed. Anorectal manometry, endoanal ultrasound and pudendal nerve latency were performed preoperatively and at several stages of follow-up. The study was completed in December 2007. RESULTS: Mean follow-up was 68 months (range: 3-133). Morbidity occurred in 100% of patients from which 65% required at least one re-operation. After the first implant, 11 devices had to be removed (65%). Seven patients had a new implant. At the final stage, Acticon was activated in 9 cases (53%). Severity of FI improved from a median of 17.5 preoperatively to 9 (P = 0.005), 5.5 (P = 0.005) and 10 (P = 0.092) at 6, 12 months and at the end of follow-up, respectively. There was a significant improvement in QOL in all postoperative controls (P < 0.05). Severity of FI did not show a correlation with QOL in the preoperative period, but did at 6, 12 months and at the end of follow-up. Mean maximum resting pressure significantly increased with the full anal cuff. CONCLUSION: There is a high rate of morbidity, surgical re-interventions and explants after Acticon implant. Patients should be clearly informed about this before surgery. However, patients who have not had Acticon Neosphincter explanted, experience a significant improvement in anal continence and QOL.

[Postoperative analgesia in knee arthroplasty using an anterior sciatic nerve block and a femoral nerve block]. / Analgesia postoperatoria en la artroplastia de rodilla mediante los bloqueos ciático por vía anterior y femoral.

OBJECTIVE: To evaluate the efficacy of a nerve block as an alternative technique for analgesia after knee arthroplasty and to indicate the usefulness and advantages of the anterior approach to the sciatic nerve block. MATERIAL AND METHODS: Between April 2004 and March 2006, we studied a series of consecutive patients undergoing knee arthroplasty in which a subarachnoid block was used as the anesthetic technique and postoperative analgesia was provided by means of a combined peripheral femoral nerve block and an anterior sciatic nerve block. We evaluated the mean length of time free from pain, quality of analgesia, and length of stay in hospital. RESULTS: Seventy-eight patients were included in the study. The mean (SD) length of time free from pain for the group was 42.1 (3.9) hours. Patients reported mild pain after 34.8 (4.1) hours and moderate to severe pain after 42.4 (3.5) hours. By the third day, 62.8% of patients were able to bend the knee to 90 degrees. There were no complications resulting from the technique and the level of patient satisfaction was high. CONCLUSIONS: A combined femoral-sciatic nerve block is effective in knee arthroplasty. It controls postoperative pain and allows for early rehabilitation. The anterior approach to the sciatic nerve is relatively simple to perform without removing the pressure bandaging from the thigh after surgery. This approach also makes it unnecessary to move the patient.

Analgesia postoperatoria en la artroplastia de rodilla mediante losbloqueos ciático por vía anterior y femoral / Postoperative analgesia in knee arthroplasty using an anterior sciatic nerve block and a femoral nerve block

OBJETIVO: Valorar la eficacia de los bloqueos nerviososcomo técnica alternativa de analgesia postoperatoriaen las prótesis de rodilla, señalando la validez y ventajasdel abordaje por vía anterior del bloqueo ciático.MATERIAL Y MÉTODO: Estudiamos un grupo de pacientesconsecutivos, desde abril de 2004 a marzo de 2006,intervenidos de artroplastia de rodilla, utilizando el bloqueosubaracnoideo como técnica anestésica y los bloqueosperiféricos combinados femoral y ciático mediantesu abordaje anterior como técnica analgésicapostoperatoria. Valoramos el tiempo medio libre dedolor, calidad de la analgesia y estancia hospitalaria.RESULTADOS: Incluimos 78 pacientes. El intervalolibre de dolor del conjunto de todos los pacientes fue de42,1±3,9 h. Los pacientes que refirieron dolor leve, fue alas 34,8±4,1 h y dolor moderado-intenso a las 42,4±3,5 h.Alcanzaron 90º de flexión de la rodilla, al tercer día, el62,8% de los pacientes. No hubo complicación derivadade la técnica y el grado satisfactorio de los pacientes fuealto.CONCLUSIONES: El bloqueo combinado femoral y ciáticoen cirugía protésica de la rodilla es eficaz, controlael dolor postoperatorio, permite una rehabilitación precoz.El abordaje anterior del ciático es relativamentesencillo de realizar sin retirar el vendaje compresivo delmuslo tras la cirugía y además evita movilizar al paciente (AU)

OBJECTIVE: To evaluate the efficacy of a nerve block asan alternative technique for analgesia after kneearthroplasty and to indicate the usefulness and advantagesof the anterior approach to the sciatic nerve block.MATERIALAND METHODS: Between April 2004 and March2006, we studied a series of consecutive patients undergoingknee arthroplasty in which a subarachnoid block was usedas the anesthetic technique and postoperative analgesia wasprovided by means of a combined peripheral femoral nerveblock and an anterior sciatic nerve block. We evaluated themean length of time free from pain, quality of analgesia,and length of stay in hospital.RESULTS: Seventy-eight patients were included in thestudy. The mean (SD) length of time free from pain forthe group was 42.1 (3.9) hours. Patients reported mildpain after 34.8 (4.1) hours and moderate to severe painafter 42.4 (3.5) hours. By the third day, 62.8% ofpatients were able to bend the knee to 90°. There wereno complications resulting from the technique and thelevel of patient satisfaction was high.CONCLUSIONS: A combined femoral-sciatic nerve blockis effective in knee arthroplasty. It controls postoperativepain and allows for early rehabilitation. The anteriorapproach to the sciatic nerve is relatively simple toperform without removing the pressure bandaging fromthe thigh after surgery. This approach also makes itunnecessary to move the patient (AU)

Using biochemical and isotope geochemistry to understand the environmental and public health implications of lead pollution in the lower Guadiana River, Iberia: a freshwater bivalve study.

Lead is a natural component of aquatic ecosystems with no known biological role and is highly toxic. Its toxicity stems from its ability to mimic biologically important metals and to produce membrane damage through lipid peroxidation (LPO). Most lead poisoning symptoms are thought to occur by interfering with an essential enzyme, delta-aminolevulinic acid dehydratase (ALAD), the activity of which is markedly inhibited by lead. The purpose of this work was to study the levels and effects of lead pollution (responses of ALAD and oxidative stress biomarker LPO) in the freshwater bivalve Corbicula fluminea along the lower Guadiana River (Portugal and Spain); a major river system impacted by historic mining pollution and more recent anthropogenic inputs. The results show that the enzymatic activity of ALAD is negatively correlated with the total Pb concentration of the whole tissue suggesting that ALAD has considerable potential as a biomarker of lead exposure in C. fluminea. To identify the sources of lead to which bivalves have been exposed, high precision (206)Pb/(204)Pb, (207)Pb/(204)Pb, (208)Pb/(204)/Pb ratios for C. fluminea confirm that historical mining activities in the Iberian Pyrite Belt are the dominant source of lead pollution in the lower Guadiana River. The isotope patterns however exhibit marked seasonal and geographic variation in response to rainfall and river water management. Locally, other anthropogenic sources of lead have been detected in C. fluminea close to population centres, thus adding to its versatility as a freshwater bio-indicator. Overall, the study highlights the value of natural ecosystems as monitors of water quality and their importance for public health assessment and surveillance.

Variability of oil content and of major fatty acid composition in almond (Prunus amygdalus Batsch) and its relationship with kernel quality.

Oil content and fatty acid composition were determined for two years in the kernel oil of eight cultivars and 47 advanced self-compatible almond genotypes developed in an almond breeding program. Considerable variation between genotypes was found for all parameters. Oil content ranged from 48% to 67% of the total kernel dry weight but was consistent over the two years. Fatty acid composition was also very variable, with significant differences between genotypes, even in genotypes of the same progeny. Oleic acid, ranging from 63% to 78%, and linoleic acid, ranging from 12% to 27%, were the major fatty acids, showing higher values in some selections than in their parents. The large variability observed for all fatty acids and the presence of selections with higher oil and fatty acid contents than the commercial cultivars represents a very promising base to obtain new almond cultivars with oil of higher quality, satisfying the industrial and consumer sectors.

Comparative petroleum hydrocarbons levels and biochemical responses in mussels from hydrothermal vents (Bathymodiolus azoricus) and coastal environments (Mytilus galloprovincialis).

Aliphatic hydrocarbons and PAHs in the whole soft tissues of Bathymodiolus azoricus from three Mid-Atlantic Ridge hydrothermal vents (Menez-Gwen, Lucky Strike and Rainbow), and Mytilus galloprovincialis from three contaminated coastal sites in South Portugal were analysed, and its effects on the digestive gland microsomes mixed-function oxygenase system (MFO) were assessed. Aliphatic hydrocarbons levels were present in the same magnitude in both coastal and hydrothermal environments, while the UCM (unresolved complex mixture) for coastal mussels were higher than in vent mussels. In general, significantly higher PAHs concentrations were found in coastal mussels, compared to B. azoricus where low molecular weight PAHs (2-3 rings) represented the majority of PAHs contrarily to what was observed in M. galloprovincialis. The MFO components were present in both mussel species, and were detected in vent mussels for the first time. However this system seems to have different roles in species from these contrasting environments. In coastal mussels MFO responded to hydrocarbon contamination while response in hydrothermal organisms appeared to be related mainly to endogenous factors.

Metal concentrations in the shell of Bathymodiolus azoricus from contrasting hydrothermal vent fields on the Mid-Atlantic Ridge.

Specimens of Bathymodiolus azoricus were sampled along the Mid-Atlantic Ridge at the Menez Gwen, Lucky Strike and Rainbow hydrothermal fields. Individual shells (n = 51), through the weight range 0.62 to 15.70 g, were analyzed for their magnesium, strontium, iron, manganese, copper, zinc and cadmium concentrations. Amongst the marine molluscs the shell of B. azoricus is confirmed as being particularly impoverished in strontium (mean 943 microg g(-1)). Trace metal concentrations in the shells decreased in the order Fe> Mn> Zn> Cu> Cd. Despite originating from trace metal rich environments mean concentrations were low (37.9, 13.2, 10.7, 1.1 and 0.7 microg g(-1), respectively). Irrespective of geographical origin magnesium, strontium and copper concentrations were primarily dictated by shell weight. In contrast cadmium concentrations were elevated in shells from the Rainbow field and ambient seawater chemistry imparted site specific chemical fingerprints to the shells with respect to the iron to manganese ratio.