Diagnostic utility of canine cerebrospinal fluid preserved by 10% buffered formalin.

OBJECTIVES: To examine the diagnostic utility of canine cerebrospinal fluid samples collected into tubes containing ethylenediaminetetraacetic acid (EDTA) with and without the addition of 10% buffered formalin analysed within 6 to 20 hours. MATERIALS AND METHODS: Inclusion criteria were dogs presenting to a referral hospital with neurological signs and having cerebrospinal fluid analysis performed. Samples were submitted to an external laboratory in tubes containing ethylenediaminetetraacetic acid as paired-samples; one with the addition of one drop of 10% buffered formalin and the other without formalin. Cytology report, total nucleated cell counts, and protein concentration were reviewed. Three different categories of cell preservation were defined: diagnostic, non-diagnostic and unclassified. Each sample was included in one of these categories depending on cytological features, and the diagnostic quality between samples was compared. Samples were further divided in two groups depending on protein concentration using 50 mg/dL as cut-off value and the diagnostic quality between samples was compared. RESULTS: 254 samples from 127 dogs were included. 47% of samples without formalin were non-diagnostic, 46% diagnostic and 6% unclassified. In the formalin group, 2% samples were non-diagnostic, 92% diagnostic and 6% unclassified. Samples with formalin preservation were statistically more likely to be diagnostic than samples without formalin preservation. In both protein groups (≥50 and <50 mg/dL) formalin samples were statistically more likely to be diagnostic as well. CLINICAL SIGNIFICANCE: The addition of one drop of 10% formalin is a simple, widely available method which can help to improve the accuracy of cytological assessment in canine cerebrospinal fluid by preserving cellular morphology when analysis is performed within 6 to 20 hours.

Imerslund-Grasbeck syndrome in a cross-breed dog.

Imerslund-Gräsbeck syndrome is an autosomal recessive disease reported only in certain pure-breed dogs. An 18-month-old, male neutered beagle cross-breed was presented for evaluation of severe lethargy, progressive weakness and anorexia. Main clinicopathological findings included low body condition score (2.5/9), severe muscle atrophy, several neurological abnormalities, mild normochromic, normocytic, non-regenerative anaemia, severe hypocobalaminemia and mild proteinuria. Extensive diagnostic tests ruled out most of differential diagnoses for the aforementioned clinicopathological abnormalities and genetic evaluation showed that the dog was heterozygous for two previously described mutations affecting the CUBN gene, the beagle and the border collie variants. The dog showed an excellent clinical response to oral cobalamin supplementation with no relapse after 4 months. In conclusion, this case creates awareness that Imerslund-Gräsbeck syndrome should be considered even in mixed-breed dogs with compatible clinical signs and that two different pathogenic CUBN mutations in compound heterozygosity can lead to a typical Imerslund-Gräsbeck syndrome phenotype.

Contaminación microbiológica en humidificadores de sistemas de oxigenoterapia de alto y bajo flujo: una revisión sistemática / Microbiological contamination in high and low flow oxygen humidifiers: A systematic review

Objetivo: Determinar el riesgo de contaminación microbiológica de los humidificadores de burbujeo para oxigenoterapia de alto o bajo flujo de uso hospitalario. Métodos: Revisión sistemática de la literatura a través de 6 bases de datos bibliográficas. Se seleccionaron estudios observacionales o experimentales publicados entre 1990 y 2016, en inglés o español, que analizaban la contaminación microbiana de los humidificadores de burbujeo de los dispositivos de oxigenoterapia hospitalaria de alto y bajo flujo. Resultados: Se incluyeron 12 artículos: 4 analizaron el agua de humidificadores reutilizables, 4 de desechables y otros 4 compararon muestras procedentes de ambos modelos. Se observó la presencia de contaminación microbiana en todos los estudios que evaluaron humidificadores reutilizables (generalmente bacterias habituales de la flora cutánea). En 2 de ellos se notificaron aislamientos de especies potencialmente patogénicas. No se aisló contaminación microbiana en las muestras procedentes de modelos desechables, independientemente de si fueron utilizados por un único paciente o por varios de forma consecutiva a lo largo del tiempo. Conclusión: Parece existir bajo riesgo de contaminación en humidificadores desechables durante las primeras semanas de uso, pudiendo reutilizarse entre pacientes distintos sin riesgo de contaminación cruzada. Por otro lado, cabe destacar que la manipulación de los humidificadores reutilizables de forma no aséptica puede aumentar la probabilidad de contaminación, por lo que la sustitución de humidificadores reutilizables por modelos desechables podría ser la opción más segura

Aim: To determine the risk of microbiological contamination with hospital use high- and low-flow bubbling humidifiers. Methods: A systematic literature review was carried out in 6 databases. Observational or experimental studies published between 1990 and 2016 were selected, written in English or Spanish, and in which microbiological contamination with hospital use high- and low-flow bubbling humidifiers was investigated. Results: A total of 12 articles were included: 4 analyzed the water from reusable humidifiers, 4 analyzed the water from prefilled system humidifiers, and the rest compared samples from both models. Microbial contamination was observed in all studies in which reusable humidifiers were evaluated, usually involving common bacteria from the skin flora, while potential pathogenic species were notified in 2 studies. No microbial contamination was isolated from reusable humidifiers, regardless of whether they had been consecutively used over time by a single patient or by several patients. Conclusion: On one hand, there seems to be a low risk of contamination during the first weeks of use of prefilled humidifiers, which allows multiple use in different patients, without a risk of cross-contamination. On the other hand, it should be underscored that handling reusable humidifiers without correct aseptic measures can increase the risk of contamination; replacing reusable humidifiers with prefilled models therefore could be the safest option

Microbiological contamination in high and low flow oxygen humidifiers: A systematic review. / Contaminación microbiológica en humidificadores de sistemas de oxigenoterapia de alto y bajo flujo: una revisión sistemática.

AIM: To determine the risk of microbiological contamination with hospital use high- and low-flow bubbling humidifiers. METHODS: A systematic literature review was carried out in 6 databases. Observational or experimental studies published between 1990 and 2016 were selected, written in English or Spanish, and in which microbiological contamination with hospital use high- and low-flow bubbling humidifiers was investigated. RESULTS: A total of 12 articles were included: 4 analyzed the water from reusable humidifiers, 4 analyzed the water from prefilled system humidifiers, and the rest compared samples from both models. Microbial contamination was observed in all studies in which reusable humidifiers were evaluated, usually involving common bacteria from the skin flora, while potential pathogenic species were notified in 2 studies. No microbial contamination was isolated from reusable humidifiers, regardless of whether they had been consecutively used over time by a single patient or by several patients. CONCLUSION: On one hand, there seems to be a low risk of contamination during the first weeks of use of prefilled humidifiers, which allows multiple use in different patients, without a risk of cross-contamination. On the other hand, it should be underscored that handling reusable humidifiers without correct aseptic measures can increase the risk of contamination; replacing reusable humidifiers with prefilled models therefore could be the safest option.

New concepts on carbon redirection in wastewater treatment plants: A review.

Wastewater treatment plants (WWTPs) are no longer considered pollution removal systems but rather resources (nutrients and energy) recovery plants. Legislation imposing more stringent effluent requirements and the need energy self-sufficient or even energy-positive plants are the main drivers for the research and development of new WWTP configurations. While a lot of effort has been focused on developing new processes for nutrient recovery, limited efforts have been allocated to maximizing energy recovery from the organic load. Within this context, high-rate activated sludge (HRAS) is the most promising alternative technology to redirect carbon (organic compounds) towards energy as biogas. This is a critical review of the last decade's development of new alternatives for carbon redirection to improve the energy balance of WWTPs on both the laboratory and the industrial scale.

Recovery of ammonia from domestic wastewater effluents as liquid fertilizers by integration of natural zeolites and hollow fibre membrane contactors.

The integration of up-concentration processes to increase the efficiency of primary sedimentation, as a solution to achieve energy neutral wastewater treatment plants, requires further post-treatment due to the missing ammonium removal stage. This study evaluated the use of zeolites as a post-treatment step, an alternative to the biological removal process. A natural granular clinoptilolite zeolite was evaluated as a sorbent media to remove low levels (up to 100mg-N/L) of ammonium from treated wastewater using batch and fixed bed columns. After being activated to the Na-form (Z-Na), the granular zeolite shown an ammonium exchange capacity of 29±0.8mgN-NH4+/g in single ammonium solutions and 23±0.8mgN-NH4+/g in treated wastewater simulating up-concentration effluent at pH=8. The equilibrium removal data were well described by the Langmuir isotherm. The ammonium adsorption into zeolites is a very fast process when compared with polymeric materials (zeolite particle diffusion coefficient around 3×10-12m2/s). Column experiments with solutions containing 100mgN-NH4+/L provide effective sorption and elution rates with concentration factors between 20 and 30 in consecutive operation cycles. The loaded zeolite was regenerated using 2g NaOH/L solution and the rich ammonium/ammonia concentrates 2-3g/L in NaOH were used in a liquid-liquid membrane contactor system in a closed-loop configuration with nitric and phosphoric acid as stripping solutions. The ammonia recovery ratio exceeded 98%. Ammonia nitrate and di-ammonium phosphate concentrated solutions reached up to 2-5% wt. of N.

Two-step partial nitritation/Anammox process in granulation reactors: Start-up operation and microbial characterization.

A two-stage Partial Nitritation (PN)/Anammox process was carried out at lab-scale conditions to treat reject water from a municipal WWTP. PN was achieved in a granular SBR obtaining an effluent with a NH4(+)-N/NO2(-)-N molar ratio around 1.0. The microbial characterization of this reactor revealed a predominance of Betaproteobacteria, with a member of Nitrosomonas as the main autotrophic ammonium oxidizing bacterium (AOB). Nitrite oxidizing bacteria (NOB) were under the detection limit of 16S rRNA gene pyrosequencing, indicating their effective inhibition. The effluent of the PN reactor was fed to an Anammox SBR where stable operation was achieved with a NH4(+)-N:NO2(-)-N:NO3(-)-N stoichiometry of 1:1.25:0.14. The deviation to the theoretical stoichiometry could be attributed to the presence of heterotrophic biomass in the Anammox reactor (mainly members of Chlorobi and Chloroflexi). Planctomycetes accounted for 7% of the global community, being members of Brocadia (1.4% of the total abundance) the main anaerobic ammonium oxidizer detected.

Intensive care practices in brain death diagnosis and organ donation.

We conducted a multicentre study of 1844 patients from 42 Spanish intensive care units, and analysed the clinical characteristics of brain death, the use of ancillary testing, and the clinical decisions taken after the diagnosis of brain death. The main cause of brain death was intracerebral haemorrhage (769/1844, 42%), followed by traumatic brain injury (343/1844, 19%) and subarachnoid haemorrhage (257/1844, 14%). The diagnosis of brain death was made rapidly (50% in the first 24 h). Of those patients who went on to die, the Glasgow Coma Scale on admission was ≤ 8/15 in 1146/1261 (91%) of patients with intracerebral haemorrhage, traumatic brain injury or anoxic encephalopathy; the Hunt and Hess Scale was 4-5 in 207/251 (83%) of patients following subarachnoid haemorrhage; and the National Institutes of Health Stroke Scale was ≥ 15 in 114/129 (89%) of patients with strokes. Brain death was diagnosed exclusively by clinical examination in 92/1844 (5%) of cases. Electroencephalography was the most frequently used ancillary test (1303/1752, 70.7%), followed by transcranial Doppler (652/1752, 37%). Organ donation took place in 70% of patients (1291/1844), with medical unsuitability (267/553, 48%) and family refusal (244/553, 13%) the main reasons for loss of potential donors. All life-sustaining measures were withdrawn in 413/553 of non-donors (75%).

Determination of the optimal tolerance for MLC positioning in sliding window and VMAT techniques.

PURPOSE: Several authors have recommended a 2 mm tolerance for multileaf collimator (MLC) positioning in sliding window treatments. In volumetric modulated arc therapy (VMAT) treatments, however, the optimal tolerance for MLC positioning remains unknown. In this paper, the authors present the results of a multicenter study to determine the optimal tolerance for both techniques. METHODS: The procedure used is based on dynalog file analysis. The study was carried out using seven Varian linear accelerators from five different centers. Dynalogs were collected from over 100,000 clinical treatments and in-house software was used to compute the number of tolerance faults as a function of the user-defined tolerance. Thus, the optimal value for this tolerance, defined as the lowest achievable value, was investigated. RESULTS: Dynalog files accurately predict the number of tolerance faults as a function of the tolerance value, especially for low fault incidences. All MLCs behaved similarly and the Millennium120 and the HD120 models yielded comparable results. In sliding window techniques, the number of beams with an incidence of hold-offs >1% rapidly decreases for a tolerance of 1.5 mm. In VMAT techniques, the number of tolerance faults sharply drops for tolerances around 2 mm. For a tolerance of 2.5 mm, less than 0.1% of the VMAT arcs presented tolerance faults. CONCLUSIONS: Dynalog analysis provides a feasible method for investigating the optimal tolerance for MLC positioning in dynamic fields. In sliding window treatments, the tolerance of 2 mm was found to be adequate, although it can be reduced to 1.5 mm. In VMAT treatments, the typically used 5 mm tolerance is excessively high. Instead, a tolerance of 2.5 mm is recommended.

Neuronal activity in the visual cortex reveals the temporal order of cognitive operations.

Most mental processes consist of a number of processing steps that are executed sequentially. The timing of the individual mental operations can usually only be estimated indirectly, from the pattern of reaction times. In vision, however, many processing steps are associated with the modulation of neuronal activity in early visual areas. Here we exploited this association to elucidate the time course of neuronal activity related to each of the self-paced mental processing steps in complex visual tasks. We trained monkeys to perform two tasks, search-trace and trace-search, which required performing a sequence of two operations: a visual search for a specific color and the mental tracing of a curve. We used multielectrode recording techniques to monitor the representations of multiple visual items in area V1 at the same time and found that the relevant curve as well as the target of visual search evoked enhanced neuronal activity with a timing that depended on the order of operations. This modulation of neuronal activity in early visual areas could allow these areas to (1) act as a cognitive blackboard that permits the exchange of information between successive processing steps of a sequential visual task and to (2) contribute to the orderly progression of task-dependent endogenous attention shifts that are driven by task structure and evolve over hundreds of milliseconds.

Effects of histamine H3 receptor ligands in experimental models of anxiety and depression.

Histamine H3 receptor ligands have been proposed to be of potential therapeutic interest for the treatment of different central nervous system disorders; however, the psychopharmacological properties of these drugs have not been studied extensively. In this work, we investigated the possible involvement of histamine H3 receptor function in experimental models of anxiety (elevated plus-maze) and depression (forced swimming test). Male Sprague-Dawley rats were treated i.p. with the histamine H3 receptor agonist R-alpha-methylhistamine (10 mg/kg) or the histamine H3 receptor antagonist thioperamide (0.2, 2 and 10 mg/kg) and 30 min afterwards the time spent in the open arms of an elevated plus-maze was registered for 5 min. The immobility time of male OF1 mice in the forced swimming test was recorded for 6 min, 1 h after the i.p. administration of R-alpha-methylhistamine (10 and 20 mg/kg), thioperamide (0.2, 2, 10 and 20 mg/kg) or another histamine H3 receptor antagonist, clobenpropit (5 mg/kg). The locomotor activity of mice was checked in parallel by means of an activity meter. Both saline controls and active drug controls were used in all the paradigms. Neither thioperamide nor R-alpha-methylhistamine significantly changed animal behaviour in the elevated plus-maze. R-alpha-methylhistamine and the higher dose of thioperamide assayed (20 mg/kg) were also inactive in the forced swimming test. By contrast, thioperamide (0.2-10 mg/kg) dose-dependently decreased immobility, the effect being significant at 10 mg/kg (33% reduction of immobility); clobenpropit produced an effect qualitatively similar (24% reduction of immobility). None of these histamine H3 receptor antagonists affected locomotor activity. These preliminary results suggest that the histamine H3 receptor blockade could be devoid of anxiolytic potential but have antidepressant effects. Besides, the stimulation of these receptors does not seem to be followed by changes in the behavioural parameters studied.

[Electroconvulsive therapy in Parkinson disease. Description of three cases]. / Terapia electroconvulsiva en la enfermedad de Parkinson. Descripción de 3 casos.

Electroconvulsive therapy (ECT) has demonstrated to be useful in psychiatric patients with parkinsonism as well as patients with Parkinson's disease (PD) without associated psychopathology. We prospectively evaluated three patients with PD and major depression in whom ECT proved to be efficacious. These patients experimented a marked improvement measured by the Unified Parkinson's Rating Scale (UPDRS). In two cases the ECT allowed for a reduction in their drug treatment, and in one case complex fluctuations disappeared. In the two patients who continued with ECT fortnightly, the improvement observed inicially has remained. Since ECT has shown a good tolerance, we conclude that this therapy should be considered as an alternative approach for PD patients with a poor answer to conventional treatment.

[Parapharyngeal carcinoma of the larynx: current clinical and pathological aspects and reports of a clinical case]. / Schwanoma parafaríngeo: aspectos clinicopatológicos actuales y exposición de un caso clínico.

Schwannomas (neurilemmomas) are benign tumors of the nerve sheath arising from the Schwann cells in the neural sheath of cranial and spinal nerves. The most frequent sites are the peripheral nerves of the head and neck and the flexor surfaces of the upper extremities. Parapharyngeal schwannomas are rare, which makes them interesting for ear, nose and throat specialists. A new case of schwannoma of the parapharyngeal space is reported. Our experience with the clinical management and surgical treatment of cervical schwannomas is discussed and the literature is reviewed.

Evaluation of AutoDELFIA and access automated immunoassay systems for third generation assays for thyrotropin.

We evaluated the technical performance of two new commercial automated immunoassay systems of third-generation assays for thyrotropin. The interassay CV was 2.8% for AutoDELFIA and 3.25% for Access at thyrotropin concentrations of approximately 1.3 mIU/l. The lower detection limits of the assays were 0.023 mIU/l for AutoDELFIA and 0.0096 mIU/l for Access, and the functional sensitivity for a CV of 20% was 0.027 mIU/l and 0.028 mIU/l, respectively. Sample to sample carry over was negligible (0.0016% for AutoDELFIA and 0.005% for Access). The range of linearity was acceptable for Access (102-115%) but not for low thyrotropin concentrations in AutoDELFIA (143% for a thyrotropin value of 0.48 mIU/l). Correlation between AutoDELFIA and Access was adequate (r = 0.999). We conclude that both automated immunoassays offer good reliability, practicability and performance characteristics.