Combining multi-isotopic and molecular source tracking methods to identify nitrate pollution sources in surface and groundwater.

Nitrate (NO3-) pollution adversely impacts surface and groundwater quality. In recent decades, many countries have implemented measures to control and reduce anthropogenic nitrate pollution in water resources. However, to effectively implement mitigation measures at the origin of pollution,the source of nitrate must first be identified. The stable nitrogen and oxygen isotopes of NO3- (ẟ15N and ẟ18O) have been widely used to identify NO3- sources in water, and their combination with other stable isotopes such as boron (ẟ11B) has further improved nitrate source identification. However, the use of these datasets has been limited due to their overlapping isotopic ranges, mixing between sources, and/or isotopic fractionation related to physicochemical processes. To overcome these limitations, we combined a multi-isotopic analysis with fecal indicator bacteria (FIB) and microbial source tracking (MST) techniques to improve nitrate origin identification. We applied this novel approach on 149 groundwater and 39 surface water samples distributed across Catalonia (NE Spain). A further 18 wastewater treatment plant (WWTP) effluents were also isotopically and biologically characterized. The groundwater and surface water results confirm that isotopes and MST analyses were complementary and provided more reliable information on the source of nitrate contamination. The isotope and MST data agreed or partially agreed in most of the samples evaluated (79 %). This approach was especially useful for nitrate pollution tracing in surface water but was also effective in groundwater samples influenced by organic nitrate pollution. Furthermore, the findings from the WWTP effluents suggest that the use of literature values to define the isotopic ranges of anthropogenic sources can constrain interpretations. We therefore recommend that local sources be isotopically characterized for accurate interpretations. For instance, the detection of MST inferred animal influence in some WWTP effluents, but the ẟ11B values were higher than those reported in the literature for wastewater. The results of this study have been used by local water authorities to review uncertain cases and identify new vulnerable zones in Catalonia according to the European Nitrate Directive (91/676/CEE).

Advances in the pathophysiology of primary immune thrombocytopenia.

OBJECTIVES: Classically, immune thrombocytopenia (ITP) was thought to be caused by the destruction and insufficient production of platelets, as mediated by autoantibodies. More recently other immune mechanisms that contribute to the disease have been discovered. This review attempts to address the main unresolved questions in ITP. METHODS: We review the most current knowledge of the pathophysiology of ITP. Immunological effects of available therapies are also described. DISCUSSION: The trigger may be a loss of tolerance due to molecular mimicry with cross-reaction of antibodies arising from infectious agents or drugs, genetic factors, and/or platelet Toll receptors. This loss of tolerance activates autoreactive effector B and T lymphocytes, which in turn initiates platelet destruction, mediated by cytotoxic T lymphocytes and the release of pro-inflammatory cytokines (IL-2/IL-17) by T helper (Th) cells (Th1/Th17). Th2 (anti-inflammatory) and regulatory B (Breg) and Treg cells are also inhibited (with decrease in IL-10/TGF-ß), which leads to the disease becoming chronic. Some isotypes of autoantibodies may increase the bleeding risk. Corticosteroids, rituximab, and thrombopoietin receptor agonists (A-TPOs) all increase levels of Tregs and TGF-ß. The A-TPOs also increase Breg levels, which could explain why complete remission has been seen in some cases. CONCLUSION: A better understanding of the immunomodulatory effects of each ITP therapy is needed to best manage the disease.

Tratamiento con Montelukast. Eficacia en adultos mayores / Treatment with M ontelukast. Effectiveness in elders

Se realizó un estudio observacional, descriptivo y transversal en 20 adultos mayores con diagnóstico de asma bronquial persistente de la consulta de alergia del Hospital Celia Sánchez Manduley en el municipio de Manzanillo de la provincia de Granma, de enerohasta abril del 2011, con el objetivo de determinar la eficacia del tratamiento con Montelukast. Entre las variables estudiadas figuraron: edad, sexo, procedencia, síntomas y signos, uso de medicamentos y control del asma. Para la recolección de la información se confeccionó una planilla de vaciamiento de datos y como método estadístico el de números absolutos y porcientos. En el estudio predominaron los adultos mayores asmáticos de 60-69 años de edad, del sexo femenino y procedencia rural; los pacientes mejoraron los síntomas y signos a los tres meses de aplicado el tratamiento con montelukast; se logró reducir el uso de los esteroides y broncodilatadores posterior al tratamiento; se controló el mayor porciento de los pacientes asmáticos tratados con montelukast(AU)

It was carried out an observational, descriptive and traverse study in 20 elders with diagnostic of persistent bronchial asthma in the Allergy consultation of the Hospital Celia Sánchez Manduley in the municipality of Manzanillo, Granma province, sinceJanuary to April of the 2011, with the objective of determining the effectiveness of the treatment with Montelukast. Among the studied variables we had: age, sex, origin, symptoms and signs, use of medications and the control of asthma. For the gathering of the information it was made a schedule of data emptying and the statistical method was related to the absolute numbers and percents. In the study prevailed the females asthmatic elders of 60-69 years old of rural origin; the patients improved the symptoms and signs after three months of the application of the treatment with montelukast; it was possible to reduce the use of steroids and bronchodilatorsafter the treatment. It was controlled the greatest percent of asthmatic patients treated with montelukast(EU)

Histology assessment of bipolar coagulation and argon plasma coagulation on digestive tract.

AIM: To analyze the effect of bipolar electrocoagulation and argon plasma coagulation on fresh specimens of gastrointestinal tract. METHODS: An experimental evaluation was performed at Hospital das Clinicas of the University of São Paulo, on 31 fresh surgical specimens using argon plasma coagulation and bipolar electrocoagulation at different time intervals. The depth of tissue damage was histopathologically analyzed by single senior pathologist unaware of the coagulation method and power setting applied. To analyze the results, the mucosa was divided in superficial mucosa (epithelial layer of the esophagus and superficial portion of the glandular layer of the stomach and colon) intermediate mucosa (until the lamina propria of the esophagus and until the bottom of the glandular layer of the stomach and colon) and muscularis mucosa. Necrosis involvement of the layers was compared in several combinations of power and time interval. RESULTS: Involvement of the intermediate mucosa of the stomach and of the muscularis mucosa of the three organs was more frequent when higher amounts of energy were used with argon plasma. In the esophagus and in the colon, injury of the intermediate mucosa was frequent, even when small amounts of energy were used. The use of bipolar electrocoagulation resulted in more frequent involvement of the intermediate mucosa and of the muscularis mucosa of the esophagus and of the colon when higher amounts of energy were used. In the stomach, these involvements were rare. The risk of injury of the muscularis propria was significant only in the colon when argon plasma coagulation was employed. CONCLUSION: Tissue damage after argon plasma coagulation is deeper than bipolar electrocoagulation. Both of them depend on the amount of energy used.

Four-year advanced monitoring program of polar pesticides in groundwater of Catalonia (NE-Spain).

Pesticide contamination of groundwater is of paramount importance because it is the most sensitive and the largest body of freshwater in the European Union. In this paper, an isotopic dilution method based on on-line solid phase extraction-liquid chromatography (electrospray)-tandem mass spectrometry (SPE-LC(ESI)-MS/MS) was used for the analysis of 22 pesticides in groundwater. Results were evaluated from monitoring 112 wells and piezometers coming from 29 different aquifers located in 18 ground water bodies (GWBs), from Catalonia, Spain, for 4 years as part of the surveillance and operational monitoring programs conducted by the Catalan Water Agency. The analytical method developed allows the determination of the target pesticides (6 triazines, 4 phenylureas, 4 organophosphorous, 1 anilide, 2 chloroacetanilides, 1 thiocarbamate, and 4 acid herbicides) in groundwater with good sensitivity (limits of detection <5 ng/L), accuracy (relative recoveries between 85 and 116%, except for molinate), and repeatability (RSD<23%), and in a fully automated way. The most ubiquitous compounds were simazine, atrazine, desethylatrazine and diuron. Direct relation between frequency of detection of each target compound and Groundwater Ubiquity Score index (GUS index) is observed. Desethylatrazine and deisopropylatrazine, metabolites of atrazine and simazine, respectively, presented the highest mean concentrations. Compounds detected in less than 5% of the samples were cyanazine, molinate, fenitrothion and mecoprop. According to the Directive 2006/118/EC, 13 pesticides have individual values above the requested limits (desethylatrazine, atrazine and terbuthylazine lead the list) and 14 samples have total pesticide levels above 500 ng/L. The GWB with the highest levels of total pesticides is located in Lleida (NE-Spain), with 9 samples showing total pesticide levels above 500 ng/L. Several factors such as regulation of the use of pesticides, type of activities in the area, and irrigation were discussed in relation to the observed levels of pesticides.

Determination of glyphosate in groundwater samples using an ultrasensitive immunoassay and confirmation by on-line solid-phase extraction followed by liquid chromatography coupled to tandem mass spectrometry.

Despite having been the focus of much attention from the scientific community during recent years, glyphosate is still a challenging compound from an analytical point of view because of its physicochemical properties: relatively low molecular weight, high polarity, high water solubility, low organic solvent solubility, amphoteric behaviour and ease to form metal complexes. Large efforts have been directed towards developing suitable, sensitive and robust methods for the routine analysis of this widely used herbicide. In the present work, a magnetic particle immunoassay (IA) has been evaluated for fast, reliable and accurate part-per-trillion monitoring of glyphosate in water matrixes, in combination with a new analytical method based on solid-phase extraction (SPE), followed by liquid chromatography (LC) coupled to tandem mass spectrometry (MS/MS), for the confirmatory analysis of positive samples. The magnetic particle IA has been applied to the analysis of about 140 samples of groundwater from Catalonia (NE Spain) collected during four sampling campaigns. Glyphosate was present above limit of quantification levels in 41% of the samples with concentrations as high as 2.5 µg/L and a mean concentration of 200 ng/L. Good agreement was obtained when comparing the results from IA and on-line SPE-LC-MS/MS analyses. In addition, no false negatives were obtained by the use of the rapid IA. This is one of the few works related to the analysis of glyphosate in real groundwater samples and the presented data confirm that, although it has low mobility in soils, glyphosate is capable of reaching groundwater.

Application of fully automated online solid phase extraction-liquid chromatography-electrospray-tandem mass spectrometry for the determination of sulfonamides and their acetylated metabolites in groundwater.

The present study describes an automated methodology based on a liquid chromatography-electrospray, tandem mass spectrometry method combined with online solid phase extraction (online SPE-LC-ESI-MS/MS) for the simultaneous analysis of 16 sulfonamides (SAs) and five of their acetylated metabolites in groundwater. The evaluation of the degree of SA pollution in groundwater was made through the analysis of a total of 39 samples taken in seven groundwater bodies of Catalonia (Spain). Recovery values obtained ranged from 34.3% (N (4)-acetylsulfadiazine) to 134.4% (sulfabenzamide). The method limits of detection for all the analytes were 0.09-11 ng L(-1). Sulfamethoxazole was the SA detected more frequently (56.4% of the samples), with an average concentration of 2.3 ng L(-1), followed by sulfadimethoxine, present in 54% of the samples with an average concentration of 0.2 ng L(-1). It should be highlighted that the acetylated metabolites were ubiquitous in the different samples, with frequencies of detection up to 36% and maximum concentrations of 18 ng L(-1) (N (4)-acetylsulfamerazine).

Endobronchial ultrasound application for diagnosis of tracheobronchial tree invasion by esophageal cancer.

INTRODUCTION: Esophageal cancer staging has been performed through bronchoscopy, computerized tomography (CT), positron emission tomography (PET), and endoscopic ultrasound (EUS). Whereas CT and PET scan provide assessments of distant metastasis, bronchoscopy importantly diagnoses tracheobronchial involvement, complementing chest CT findings. EUS is the most accurate examination for T and N staging but is technically limited when tumoral stenoses cannot be traversed. Endobronchial ultrasound (EBUS) appears to present greater accuracy than EUS, CT, and bronchoscopy for assessing tracheobronchial wall involvement. EBUS has been recently associated with EUS for esophageal cancer staging in our unit. OBJECTIVE: To compare EBUS findings in esophageal cancer patients without evident signs of tracheobronchial invasion on conventional bronchoscopy with EUS and CT. METHODS: Fourteen patients with esophageal cancer underwent CT, conventional bronchoscopy, EUS, and EBUS for preoperative staging. All patients underwent EBUS and EUS with an Olympus(R) MH-908 echoendoscope at 7.5 MHz. Seven patients were eligible for the study according to the inclusion criteria. RESULTS: The echoendoscope could not traverse tumoral esophageal stenosis to perform EUS in two patients, and invasion was effectively diagnosed by EBUS. In 4 (57%) of 7 patients EBUS revealed additional information to staging. In the remaining 3 cases the invasion findings were the same under both EUS and EBUS. CONCLUSION: EBUS showed signs of tracheobronchial invasion not observed by conventional bronchoscopy, adding information to staging in most of the cases when compared with CT and EUS.

Endobronchial ultrasound application for diagnosis of tracheobronchial tree invasion by esophageal cancer

INTRODUCTION: Esophageal cancer staging has been performed through bronchoscopy, computerized tomography (CT), positron emission tomography (PET), and endoscopic ultrasound (EUS). Whereas CT and PET scan provide assessments of distant metastasis, bronchoscopy importantly diagnoses tracheobronchial involvement, complementing chest CT findings. EUS is the most accurate examination for T and N staging but is technically limited when tumoral stenoses cannot be traversed. Endobronchial ultrasound (EBUS) appears to present greater accuracy than EUS, CT, and bronchoscopy for assessing tracheobronchial wall involvement. EBUS has been recently associated with EUS for esophageal cancer staging in our unit. OBJECTIVE: To compare EBUS findings in esophageal cancer patients without evident signs of tracheobronchial invasion on conventional bronchoscopy with EUS and CT. METHODS: Fourteen patients with esophageal cancer underwent CT, conventional bronchoscopy, EUS, and EBUS for preoperative staging. All patients underwent EBUS and EUS with an Olympus® MH-908 echoendoscope at 7.5 MHz. Seven patients were eligible for the study according to the inclusion criteria. RESULTS: The echoendoscope could not traverse tumoral esophageal stenosis to perform EUS in two patients, and invasion was effectively diagnosed by EBUS. In 4 (57%) of 7 patients EBUS revealed additional information to staging. In the remaining 3 cases the invasion findings were the same under both EUS and EBUS. CONCLUSION: EBUS showed signs of tracheobronchial invasion not observed by conventional bronchoscopy, adding information to staging in most of the cases when compared with CT and EUS.

[Endoscopic placement of a "plug" made of acellular biomaterial: a new technique for the repair of gastric leak after Roux-en-Y gastric bypass]. / Experiência inicial no tratamento endoscópico de fístulas gastrocutâneas pós-gastroplastia vertical redutora através da aplicação de matriz acelular fibrogênica.

BACKGROUND: Roux-en-Y gastric bypass is one of the most commonly performed bariatric surgeries in Brazil. Gastric leaks are relatively uncommon and potentially dangerous complications. The initial management of gastric leaks consists in adequate drainage, nutritional support, antibiotics and acid suppression. In almost 30% of the cases the fistula will become chronic. AIM: A novel peroral endoscopic treatment of gastric leaks in Roux-en-Y gastric bypassed patients is presented. METHODS: An acellular biomaterial was endoscopically placed in the fistulous orifice in order to promote healing and avoid surgery in 25 patients. The time between fistula diagnosis and endoscopic treatment varied from 4 to 25 weeks (median: 7 weeks). RESULTS: Endoscopic treatment was successful in 20 (80%) patients. Fistula closure was obtained after one, two and three sessions in 6 (30%), 11 (55%) and 3 (15%) patients, respectively. No procedure related complications were observed. CONCLUSION: Endoscopic repair of gastric leak after Roux-en-Y gastric bypass by using an acellular biomaterial is safe and effective. However two or three endoscopic sessions are usually needed.

Experiência inicial no tratamento endoscópico de fístulas gastrocutâneas pós-gastroplastia vertical redutora através da aplicação de matriz acelular fibrogênica / Endoscopic placement of a plug made of acellular biomaterial: a new technique for the repair of gastric leak after Roux-en-Y gastric bypass

RACIONAL: A gastroplastia redutora à Capella, que combina técnicas restritiva e disabsortiva, é o procedimento bariátrico mais realizado no Brasil. Uma das complicações mais temidas desta operação é a fístula gastrocutânea que ocorre na linha de grampeamento vertical da neocâmara. O tratamento inicial consiste em drenagem adequada, suporte nutricional, bloqueio da produção de ácido e antibioticoterapia. Em 20 por cento a 30 por cento dos casos, a fístula tomará curso crônico. Nestes casos, vários tratamentos endoscópicos têm sido sugeridos. OBJETIVO: Descrever a técnica e os resultados do tratamento endoscópico das fístulas gastrocutâneas decorrentes de operações bariátricas através da aplicação de matriz acelular fibrogênica. MÉTODOS: Nesta série de casos, descrevem-se 25 pacientes com esta complicação tratados de maneira pioneira através da aplicação endoscópica de matriz acelular fibrogênica. O tempo entre o diagnóstico da fístula e a primeira sessão do tratamento endoscópico variou de 4 a 25 semanas, mediana: 7 semanas). RESULTADOS: Dos 25 pacientes, 20 (80 por cento) tiveram a fístula fechada pelo método. Seis deles com uma única sessão (30,0 por cento), 11 necessitaram de duas aplicações (55,0 por cento) e 3 pacientes, de uma terceira sessão (15,0 por cento) para a obliteração do trajeto fistuloso. Não houve complicações relacionadas ao procedimento. CONCLUSÃO: O uso de matriz fibrogênica para o tratamento endoscópico da fístula gástrica após operação de Capella é método seguro e eficaz, sendo sua principal limitação o número de sessões necessárias.

BACKGROUND: Roux-en-Y gastric bypass is one of the most commonly performed bariatric surgeries in Brazil. Gastric leaks are relatively uncommon and potentially dangerous complications. The initial management of gastric leaks consists in adequate drainage, nutritional support, antibiotics and acid suppression. In almost 30 percent of the cases the fistula will become chronic. AIM: A novel peroral endoscopic treatment of gastric leaks in Roux-en-Y gastric bypassed patients is presented. METHODS: An acellular biomaterial was endocopically placed in the fistulous orifice in order to promote healing and avoid surgery in 25 patients. The time between fistula diagnosis and endoscopic treatment varied from 4 to 25 weeks (median: 7 weeks). RESULTS: Endoscopic treatment was successful in 20 (80 percent) patients. Fistula closure was obtained after one, two and three sessions in 6 (30 percent), 11 (55 percent) and 3 (15 percent) patients, respectively. No procedure related complications were observed. CONCLUSION: Endoscopic repair of gastric leak after Roux-en-Y gastric bypass by using an acellular biomaterial is safe and effective. However two or three endoscopic sessions are usually needed.