Evidence of waste management impacting severe diarrhea prevalence more than WASH: An exhaustive analysis with Brazilian municipal-level data.

Adequate housing protects from diarrhea, which is a substantial health concern in low- and middle-income countries. The purpose of this study was to quantify the relationship between severe diarrhea and housing features at the municipal level to help in public health planning. Regression analyses were performed on annual (2000-2012) datasets on Brazilian municipalities (5570) in six household feature categories (e.g., waste management) and four severe diarrhea outcomes (e.g., diarrhea deaths of under-5 children). Household data were not available elsewhere of this magnitude and granularity, highlighting the scientific value-add of this study. Municipalities were clustered prior to regression analysis because of data heterogeneity. The compositional household feature data were also subjected to principal component analysis to diminish feature variable multicollinearity. The highest explanatory power was found for diarrhea deaths of under-5 children (R2 = 10-22 %), while those in the over-5 population were the least best explained (R2 = 0.3-7 %). Household features predicted diarrhea outcomes more accurately in the "advanced" housing municipality cluster (R2 = 16-22 %) than in the "mid-level" (R2 = 7-20 %) and "basic" (R2 = 6-12 %) ones (over-5 diarrhea deaths excluded). Under-5 children's diarrhea death prevalence was three times higher in the "basic" cluster than in the "advanced" cluster. Importantly, the impact of waste management was overall the largest of all household features, even larger than those of WASH, i.e., water supply, sanitation, and household drinking water treatment. This is surprising in the context of existing literature because WASH is generally regarded as the most important household factor affecting gastrointestinal health. In conclusion, public health interventions could benefit from customizing interventions for diarrhea outcomes, municipality types, and household features. Waste management's identified stronger association with diarrhea compared to WASH may have important implications beyond the water field and Brazil.

Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for peritoneal metastasis of non-primary origin.

PURPOSE: The objective of this study was to analyze the role of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy that has developed in the treatment of patients with peritoneal metastasis of non-primary origin. METHODS: Patients who underwent treatment for secondary gastrointestinal and ovarian malignancies over a 20-year period were reviewed. Survival curves were estimated by the Kaplan-Meier product limit method and the log-rank test was used to assess differences between subgroups. RESULTS: The study included 293 patients. The most common histology was ovarian cancer (56.3%). Median PCI was 16 and CC0-1 resection was obtained in 88.1% of cases. Grade III and IV complications occurred in 12 patients (4.1%) and 47 patients (16%), respectively. The 30- and 60-day mortality rate was 1.3% (4 patients) and 2.4% (7 patients). Five-year OS was 21.7%, 73.6%, 42.1%, and 0 for colorectal, appendiceal, ovarian, and gastric cancer (p = < 0.0001), respectively, whereas 5-year DFS was 12.4%, 48.4%, 24.3%, and 0 (p = < 0.0001), respectively. Survival outcomes were significantly higher for CC0 in each subgroup of patients. CONCLUSION: Despite being a complex procedure, cytoreductive surgery with hyperthermic intraperitoneal chemotherapy should be considered a safe treatment with acceptable postoperative morbidity and mortality rates, if performed in high-volume centers. Good survival outcomes have been increasingly obtained in selected patients with peritoneal metastasis of non-primary origin.

Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Carcinomatosis from Epithelial Ovarian Cancer: A 20-Year Single-Center Experience.

Despite improvement in treatments, the peritoneum remains the primary site of relapse in most ovarian cancer cases. Patients who underwent cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis from epithelial ovarian cancer were reviewed. Kaplan-Meier curves and multivariate Cox analyses were used to identify survival rates and prognostic factors. This study included 158 patients. The procedure was mostly performed for recurrent disease (46.8%) and high-grade serous carcinoma (58.2%). The median peritoneal cancer index was 14, and complete cytoreduction was obtained in 87.9% of cases. Grade IV morbidity occurred in 15.2% of patients, mostly requiring surgical reoperation, and one patient (0.6%) died within 90 days. The median follow-up was 63.5 months. The Kaplan-Meier 5-year overall survival (OS) and disease-free survival (DFS) rates were 42.1% and 24.3%, respectively. Multiple regression logistic analyses demonstrated that the completeness of cytoreduction (CC) score (p ≤ 0.0001), pancreatic resection (p ≤ 0.0001) and number of resections (p = 0.001) were significant factors influencing OS; whereas the CC score (p ≤ 0.0001) and diaphragmatic procedures (p = 0.01) were significant for DFS. The addition of hyperthermic intraperitoneal chemotherapy to standard multimodality therapy may improve outcomes in both primary and recurrent epithelial ovarian cancer without impairing early postoperative results, but the exact timing has not yet been established. Prospective randomized studies will clarify the role and indications of this approach.

Leprosy in the North and Northeast regions of Brazil: an integrated spatiotemporal approach.

OBJECTIVE: To analyse the spatiotemporal patterns of leprosy occurrence in the North and Northeast regions of Brazil from 2001 to 2017. METHODS: Mixed population-based ecological study with spatial and temporal trend analysis of epidemiological indicators based on new cases reported to the Information System for Notifiable Diseases of the Ministry of Health occurring in individuals residing in North and Northeast states of Brazil. RESULTS: A total of 396 987 new cases were analysed; 9.2% of these involved children <15 years of age, and 5.4% involved individuals with grade 2 disability (G2D). The Northeast region recorded 66.4% of the new cases. Most cases involved males between 15 and 59 years of age and of brown race/colour. The temporal trend showed a reduction in most of the indicators and study variables. The G2D rate did not have trends over time in the Northeast Region, in individuals 0-14 years of age, or in municipalities with 'very high' social vulnerability indexes. The spatial and spatiotemporal analysis showed the presence of hyperendemic foci with high detection risk involving municipalities in the states of Tocantins, Pará and Maranhão. CONCLUSION: Leprosy in the North and Northeast regions of Brazil persists as a critical public health problem. Temporal and spatiotemporal patterns identified in this study confirm that leprosy remains epidemiologically relevant in vulnerable areas. Surveillance and control interventions are needed in municipalities with low detection in the general population, in children and in individuals with G2D, to reduce late diagnosis.

OBJECTIF: Analyser les profils spatiotemporels de l'apparition des cas de lèpre dans les régions du nord et du nord-est du Brésil de 2001 à 2017. MÉTHODES: Etude écologique mixte basée sur la population avec analyse des tendances spatiales et temporelles des indicateurs épidémiologiques sur la base des nouveaux cas rapportés dans le Système d'Information sur les Maladies à Déclaration Obligatoire du Ministère de la Santé, survenant chez des individus résidant dans les Etats du nord et du nord-est du Brésil. RÉSULTATS: 396.987 nouveaux cas ont été analysés; 9,2% d'entre eux concernaient des enfants de moins de 15 ans et 5,4% concernaient des personnes avec un handicap de grade 2 (G2D). La région du nord-est a enregistré 66,4% des nouveaux cas. La plupart des cas concernaient des hommes âgés de 15 à 59 ans et de race/couleur noire. La tendance temporelle a montré une réduction dans la plupart des indicateurs et des variables de l'étude. Le taux de G2D n'a pas évolué au cours du temps dans la région du nord-est, chez les individus de 0 à 14 ans ou dans les municipalités avec des indices de vulnérabilité sociale "très élevés". L'analyse spatiale et spatiotemporelle a montré la présence de foyers hyper endémiques à risque élevé de détection impliquant des municipalités dans les Etats de Tocantins, Pará et Maranhão. CONCLUSION: La lèpre dans les régions du nord et du nord-est du Brésil persiste comme problème critique de santé publique. Les schémas temporels et spatiotemporels identifiés dans cette étude confirment que la lèpre reste épidémiologiquement importante dans les zones vulnérables. Des interventions de surveillance et de contrôle sont nécessaires dans les municipalités à faible détection dans la population générale et chez les enfants, ainsi que chez les personnes atteintes de G2D, afin de réduire le diagnostic tardif.

[Mortality from leprosy in highly endemic contexts: integrated temporal-spatial analysis in BrazilMortalidad por lepra en zonas de alta endemicidad: análisis espacio-temporal integrado en Brasil]. / Mortalidade por hanseníase em contextos de alta endemicidade: análise espaço-temporal integrada no Brasil.

OBJECTIVE: To describe temporal trends and spatial patterns of leprosy-related mortality in the North and Northeast of Brazil from 2001 to 2017. METHODS: This population-based, mixed ecological study employed secondary data obtained from the Health Ministry's Mortality Information System. Death certificates were examined for extraction of information on leprosy as underlying or contributing cause of death. RESULTS: In the period of interest, 4 907 leprosy-related deaths were recorded. In 59.3%, leprosy was a contributing cause. "Leprosy, unspecified" (ICD-10 A30.9) was the most common cause recorded (72.7% as underlying cause; 76.1% as contributing cause). Increased risk of mortality by leprosy was observed in males, age ≥ 60 years and brown or black race/color. Joinpoint regression analysis of time trends revealed an increased overall mortality trend in the Northeast and in the states of Tocantins, Maranhão, Alagoas, and Bahia, as well as in the male sex. Regarding the spatial distribution of mortality rates adjusted by age and sex, as well as the analysis of moving spatial means and standardized mortality ratio, patterns that were above the mean for the area under study were identified for the states of Acre and Rondônia, the southern part of Pará, Tocantins, Maranhão, Piauí, south of Ceará, and north and south of Bahia. CONCLUSIONS: Leprosy mortality in the Brazilian North and Northeast is expressive and persistent, with a focal pattern of distribution in more vulnerable territories and populations. Comprehensive leprosy care must be strengthened in the Unified Health System in these regions.

OBJETIVO: Describir las tendencias temporales y los patrones espaciales de la mortalidad relacionada con la lepra en las regiones norte y nordeste de Brasil del 2001 al 2017. MÉTODOS: Estudio ecológico mixto basado en la población, con análisis de las tendencias temporal y espacial, hecho a partir de datos secundarios tomados de las declaraciones de defunción del Sistema de Información de Mortalidad (SIM) del Ministerio de Salud. Dichas declaraciones se examinaron para extraer los registros de lepra como causa básica y asociada de defunción. RESULTADOS: Se registraron 4 907 defunciones relacionadas con la lepra en el período de interés, en 59,3% de las cuales se la citó como causa asociada. La "lepra no especificada" (A30.9) fue la causa más citada en las declaraciones de defunción (causa básica: 72,7%; causa asociada: 76,1%). Se verificó un mayor riesgo de mortalidad por lepra en personas de sexo masculino, mayores de 60 años y de raza o de piel negra o morena. La tendencia temporal por análisis de puntos de inflexión (joinpoints) mostró un incremento en la tendencia general de la mortalidad en la región nordeste y en los estados de Tocantins, Maranhão, Alagoas y Bahía, así como en personas de sexo masculino. En lo referente a la distribución espacial de las tasas de mortalidad ajustadas por edad y sexo, así como a los análisis de las medias móviles espaciales y de la razón de mortalidad normalizada, se identificaron patrones superiores a la media de la zona de estudio en Acre, Rondônia, el Sur del estado de Pará, Tocantins, Maranhão, Piauí, el Sur de Ceará y las regiones del Norte y Sur de Bahía. CONCLUSIONES: La mortalidad por lepra en las regiones norte y nordeste es significativa y persistente, con un patrón focal de incidencia en los territorios y poblaciones con mayor vulnerabilidad. Se hace hincapié en la necesidad de fortalecer la atención integral a esta enfermedad en la red de atención del Sistema Único de Salud de esas regiones.

Mortalidade por hanseníase em contextos de alta endemicidade: análise espaço-temporal integrada no Brasil

[RESUMO]. Objetivo. Descrever as tendências temporais e os padrões espaciais da mortalidade relacionada à hanseníase nas regiões Norte e Nordeste do Brasil de 2001 a 2017. Métodos. Estudo ecológico misto de base populacional, de tendência temporal e espacial, baseado em dados secundários de declarações de óbito (DO) do Sistema de Informação de Mortalidade do Ministério da Saúde (SIM). As DO foram examinadas para extração dos registros de hanseníase como causa básica e associada de morte. Resultados. Foram registrados 4 907 óbitos relacionados à hanseníase no período de interesse, 59,3% como causa associada. A hanseníase não especificada (A30.9) foi a causa mais citada nas declarações de óbito (causa básica: 72,7%; causa associada: 76,1%). Verificou-se risco acrescido de mortalidade por hanseníase em pessoas do sexo masculino, com idade ≥60 anos e de raça/cor preta ou parda. A tendência temporal por análise de pontos de inflexão (joinpoints) apresentou incremento na tendência geral da mortalidade na região Nordeste e nos estados de Tocantins, Maranhão, Alagoas e Bahia, assim como no sexo masculino. Para a distribuição espacial das taxas de mortalidade ajustadas por idade e sexo, assim como para as análises das médias móveis espaciais e da razão de mortalidade padronizada, padrões acima da média da área de estudo foram identificados para Acre, Rondônia, sul do estado do Pará, Tocantins, Maranhão, Piauí, sul do Ceará e regiões do norte e sul da Bahia. Conclusões. A mortalidade por hanseníase nas regiões Norte e Nordeste é expressiva e persistente, com padrão focal de ocorrência em territórios e populações com maior vulnerabilidade. Ressalta-se a necessidade de fortalecer a atenção integral à hanseníase na rede de atenção do Sistema Único de Saúde dessas regiões.

[ABSTRACT]. Objective. To describe temporal trends and spatial patterns of leprosy-related mortality in the North and Northeast of Brazil from 2001 to 2017. Methods. This population-based, mixed ecological study employed secondary data obtained from the Health Ministry’s Mortality Information System. Death certificates were examined for extraction of information on leprosy as underlying or contributing cause of death. Results. In the period of interest, 4 907 leprosy-related deaths were recorded. In 59.3%, leprosy was a contributing cause. “Leprosy, unspecified” (ICD-10 A30.9) was the most common cause recorded (72.7% as underlying cause; 76.1% as contributing cause). Increased risk of mortality by leprosy was observed in males, age ≥ 60 years and brown or black race/color. Joinpoint regression analysis of time trends revealed an increased overall mortality trend in the Northeast and in the states of Tocantins, Maranhão, Alagoas, and Bahia, as well as in the male sex. Regarding the spatial distribution of mortality rates adjusted by age and sex, as well as the analysis of moving spatial means and standardized mortality ratio, patterns that were above the mean for the area under study were identified for the states of Acre and Rondônia, the southern part of Pará, Tocantins, Maranhão, Piauí, south of Ceará, and north and south of Bahia. Conclusions. Leprosy mortality in the Brazilian North and Northeast is expressive and persistent, with a focal pattern of distribution in more vulnerable territories and populations. Comprehensive leprosy care must be strengthened in the Unified Health System in these regions.

[RESUMEN]. Objetivo. Describir las tendencias temporales y los patrones espaciales de la mortalidad relacionada con la lepra en las regiones norte y nordeste de Brasil del 2001 al 2017. Métodos. Estudio ecológico mixto basado en la población, con análisis de las tendencias temporal y espacial, hecho a partir de datos secundarios tomados de las declaraciones de defunción del Sistema de Información de Mortalidad (SIM) del Ministerio de Salud. Dichas declaraciones se examinaron para extraer los registros de lepra como causa básica y asociada de defunción. Resultados. Se registraron 4 907 defunciones relacionadas con la lepra en el período de interés, en 59,3% de las cuales se la citó como causa asociada. La “lepra no especificada” (A30.9) fue la causa más citada en las declaraciones de defunción (causa básica: 72,7%; causa asociada: 76,1%). Se verificó un mayor riesgo de mortalidad por lepra en personas de sexo masculino, mayores de 60 años y de raza o de piel negra o morena. La tendencia temporal por análisis de puntos de inflexión (joinpoints) mostró un incremento en la tendencia general de la mortalidad en la región nordeste y en los estados de Tocantins, Maranhão, Alagoas y Bahía, así como en personas de sexo masculino. En lo referente a la distribución espacial de las tasas de mortalidad ajustadas por edad y sexo, así como a los análisis de las medias móviles espaciales y de la razón de mortalidad normalizada, se identificaron patrones superiores a la media de la zona de estudio en Acre, Rondônia, el Sur del estado de Pará, Tocantins, Maranhão, Piauí, el Sur de Ceará y las regiones del Norte y Sur de Bahía. Conclusiones. La mortalidad por lepra en las regiones norte y nordeste es significativa y persistente, con un patrón focal de incidencia en los territorios y poblaciones con mayor vulnerabilidad. Se hace hincapié en la necesidad de fortalecer la atención integral a esta enfermedad en la red de atención del Sistema Único de Salud de esas regiones.

Effects of Six Months Training on Physical Capacity and Metaboreflex Activity in Patients with Multiple Sclerosis.

Patients with multiple sclerosis (MS) have an increased systemic vascular resistance (SVR) response during the metaboreflex. It has been hypothesized that this is the consequence of a sedentary lifestyle secondary to MS. The purpose of this study was to discover whether a 6-month training program could reverse this hemodynamic dysregulation. Patients were randomly assigned to one of the following two groups: the intervention group (MSIT, n = 11), who followed an adapted training program; and the control group (MSCTL, n = 10), who continued with their sedentary lifestyle. Cardiovascular response during the metaboreflex was evaluated using the post-exercise muscle ischemia (PEMI) method and during a control exercise recovery (CER) test. The difference in hemodynamic variables such as stroke volume (SV), cardiac output (CO), and SVR between the PEMI and the CER tests was calculated to assess the metaboreflex response. Moreover, physical capacity was measured during a cardiopulmonary test till exhaustion. All tests were repeated after 3 and 6 months (T3 and T6, respectively) from the beginning of the study. The main result was that the MSIT group substantially improved parameters related to physical capacity (+5.31 ± 5.12 ml·min-1/kg in maximal oxygen uptake at T6) in comparison with the MSCTL group (-0.97 ± 4.89 ml·min-1/kg at T6; group effect: p = 0.0004). However, none of the hemodynamic variables changed in response to the metaboreflex activation. It was concluded that a 6-month period of adapted physical training was unable to reverse the hemodynamic dys-regulation in response to metaboreflex activation in these patients.

Cardio-metabolic responses during horse riding at three different speeds.

PURPOSE: The purpose of the present investigation was to study the metabolic demand and cardiovascular response during a typical horse riding session. METHODS: To this aim, 19 (9 male, 10 female) riders, regularly participating in competitions, were enrolled. They underwent a preliminary, incremental exercise test on a cycle-ergometer to assess their anaerobic threshold (AT) and VO2max. Then, participants underwent a riding training session, which comprised periods of walking, trotting, and cantering for a total of 20 min. Oxygen uptake (VO2), carbon dioxide production (VCO2), and heart rate (HR) were obtained throughout the preliminary and riding test by means of a portable metabolic system. Moreover, excess of CO2 production (CO2excess) and oxygen pulse (OP) were also calculated to obtain an estimate of anaerobic glycolysis and stroke volume. RESULTS: The main result was that all collected parameters remained below the AT level throughout the riding session, with the exception of HR that approached the AT level only during cantering. In detail, during cantering, average VO2, VCO2, HR, CO2excess, and OP values were 1289 ± 331 mL min(-1), 1326 ± 266 mL min(-1), 158 ± 22 bpm, 215 ± 119 mL min(-1), and 7.8 ± 1.6 mL/bpm, respectively. CONCLUSIONS: It was concluded that riding imposes only light to moderate stress on the aerobic and anaerobic energy systems. Moreover, cardiovascular reserve is only moderately recruited in terms of inotropism, while chronotropism can be stimulated more.

Nitrous Oxide Production at a Fully Covered Wastewater Treatment Plant: Results of a Long-Term Online Monitoring Campaign.

The nitrous oxide emissions of the Viikinmäki wastewater treatment plant were measured in a 12 month online monitoring campaign. The measurements, which were conducted with a continuous gas analyzer, covered all of the unit operations of the advanced wastewater-treatment process. The relation between the nitrous oxide emissions and certain process parameters, such as the wastewater temperature, influent biological oxygen demand, and ammonium nitrogen load, was investigated by applying online data obtained from the process-control system at 1 min intervals. Although seasonal variations in the measured nitrous oxide emissions were remarkable, the measurement data indicated no clear relationship between these emissions and seasonal changes in the wastewater temperature. The diurnal variations of the nitrous oxide emissions did, however, strongly correlate with the alternation of the influent biological oxygen demand and ammonium nitrogen load to the aerated zones of the activated sludge process. Overall, the annual nitrous oxide emissions of 168 g/PE/year and the emission factor of 1.9% of the influent nitrogen load are in the high range of values reported in the literature but in very good agreement with the results of other long-term online monitoring campaigns implemented at full-scale wastewater-treatment plants.

Metaboreflex activity in multiple sclerosis patients.

PURPOSE: The muscle metaboreflex activation has been shown essential to reach normal hemodynamic response during exercise. It has been demonstrated that patients with multiple sclerosis (MS) have impaired autonomic functions and cardiovascular regulation during exercise. However, to the best of our knowledge, no previous research to date has studied the metaboreflex in MS patients. The purpose of this study was to investigate the hemodynamic response to metaboreflex activation in patients with MS (n = 43) compared to an age-matched, control group (CTL, n = 21). METHODS: Cardiovascular response during the metaboreflex was evaluated using the post-exercise muscle ischemia (PEMI) method and during a control exercise recovery (CER) test. The difference in hemodynamics between the PEMI and the CER test was calculated and this procedure allowed for the assessment of the metaboreflex response. Hemodynamics was estimated by impedance cardiography. RESULTS: The MS group showed a normal mean blood pressure (MBP) response as compared to the CTL group (+6.5 ± 6.9 vs. +8 ± 6.8 mmHg, respectively), but this response was achieved with an increase in systemic vascular resistance, that was higher in the MS with respect to the CTL group (+137.6 ± 300.5 vs. -14.3 ± 240 dyne · s(-1) cm(-5), respectively). This was the main consequence of the MS group's incapacity to raise the stroke volume (-0.65 ± 10.6 vs. +6.2 ± 12.8 ml, respectively). CONCLUSION: It was concluded that MS patients have an impaired capacity to increase stroke volume (SV) in response to low level metaboreflex, even if they could sustain the MBP response by vasoconstriction. This was probably a consequence of their chronic physical de-conditioning.

Accelerated isotope fine structure calculation using pruned transition trees.

A fast and memory-efficient calculation of theoretical isotope patterns is crucial for the routine interpretation of mass spectrometric data. For high-resolution experiments, calculations must procure the exact masses and probabilities of relevant isotopologues over a wide range of polyisotopic compounds, while pruning low-probable ones. Here, a novel albeit simple treelike structure is introduced to swiftly derive sets of relevant subisotopologues for each element in a molecule, which are then combined to the isotopologues of the full molecule. In contrast to existing approaches, transitions via single replacements of the most abundant isotope per element are used in separable tree branches to derive subisotopologues from each other. Moreover, the underlying transition trees prevent redundant replacements and permit the detection of the most probable isotopologue in a first phase. A relative threshold can then be exploited in a second parallelized phase for a precise prepruning of large fractions of the remaining subisotopologues. The gain in performance from such early pruning and the lower variation in the distortion of simulated data with use of relative rather than absolute thresholds were validated in a large-scale benchmark simulation, unprecedentedly comprising several thousand molecular formulas. Both the algorithm and a wealth of related features are freely available as R-package enviPat and as a user-friendly Web interface.

Scenario simulations of future salinity and ecological consequences in the Baltic Sea and adjacent North Sea areas-implications for environmental monitoring.

Substantial ecological changes occurred in the 1970s in the Northern Baltic during a temporary period of low salinity (S). This period was preceded by an episodic increase in the rainfall over the Baltic Sea watershed area. Several climate models, both global and regional, project an increase in the runoff of the Northern latitudes due to proceeding climate change. The aim of this study is to model, firstly, the effects on Baltic Sea salinity of increased runoff due to projected global change and, secondly, the effects of salinity change on the distribution of marine species. The results suggest a critical shift in the S range 5-7, which is a threshold for both freshwater and marine species distributions and diversity. We discuss several topics emphasizing future monitoring, modelling, and fisheries research. Environmental monitoring and modelling are investigated because the developing alternative ecosystems do not necessarily show the same relations to environment quality factors as the retiring ones. An important corollary is that the observed and modelled S changes considered together with species' ranges indicate what may appear under a future climate. Consequences could include a shift in distribution areas of marine benthic foundation species and some 40-50 other species, affiliated to these. This change would extend over hundreds of kilometres, in the Baltic Sea and the adjacent North Sea areas. Potential cascading effects, in coastal ecology, fish ecology and fisheries would be extensive, and point out the necessity to develop further the "ecosystem approach in the environmental monitoring".

Biochemical characterization of Helicobacter pylori α-1,4 fucosyltransferase: metal ion requirement, donor substrate specificity and organic solvent stability.

The effect of metal ions on the activity, the donor substrate specificity, and the stability in organic solvents of Helicobacter pylori α-1,4 fucosyltransferase were studied. The recombinant enzyme was expressed as soluble form in E. coli strain AD494 and purified in a one step affinity chromatography. Its activity was highest in cacodylate buffer at pH 6.5 in the presence of 20 mM Mn2+ ions at 37°C. Mn2+ ions could be substituted by other metal ions. In all cases, Mn2+ ions proofed to be the most effective (Mn2+ > Co2+ > Ca2+ > Mg2+ > Cu2+ > Ni2+ > EDTA). The enzyme shows substrate specificity for Type I disaccharide (1) with a KM of 114 µM. In addition, the H. pylori α-1,4 fucosyltransferase efficiently transfers GDP-activated L-fucose derivatives to Galß1-3GlcNAc-OR (1). Interestingly, the presence of organic solvents such as DMSO and methanol up to 20% in the reaction medium does not affect significantly the enzyme activity. However, at the same concentration of dioxane, activity is totally abolished.

Laparoscopic intestinal derotation: original technique.

The intestinal derotation technique, introduced by Cattel and Valdoni 40 years ago, is carried out using a laparoscopic procedure, which is described here for the first time. The method is effective in the treatment of malign lesions of the III and IV duodenum and during laparoscopic subtotal colectomy with anastomosis between the ascending colon and the rectum. Ultimately, the procedure allows for the verticalization of the duodenal C and the anterior positioning of the mesenteric vessels, facilitating biopsy and resection of the III and IV duodenal portions and allowing anastomosis of the ascending rectum, avoiding both subtotal colectomy and the risk of torsion of the right colic loop. Although the procedure calls for extensive experience with advanced video-laparoscopic surgery, it is both feasible and repeatable. In our experience we have observed no mortality or morbidity.