Imaging leachate runoff from a landfill using magnetotellurics: The Garraf karst case.

Electrical and active source electromagnetic geophysical methods have been traditionally employed to approach and tackle environmental problems, such as those caused by landfills. However, since these problems are more consequential and cover broader areas, it is necessary to use deeper penetration methods, such as magnetotellurics. In the Garraf Massif (Catalan Coastal Ranges, NE Spain), an urban waste disposal landfill had been in operation from 1974 to 2006, during which >26 million metric tons of garbage had been deposited. This landfill overlies karstic terrain, thus principally impacting groundwater circulation. Previous electrical resistivity tomography profiles had partially imaged the infill but were not able to penetrate below the base of the original landfill. During 2019 and 2020 we performed a magnetotelluric study over the landfill and its surrounding with the goals of characterizing the electrical resistivity of the infill and below it. The 2D and 3D resistivity models confirmed the highly conductive nature of the leachate and allowed us to identify its presence below the landfill base, which we quantified with maximum thicknesses of 90 m. This proved that landfill leachate had filtered through the original impermeable layer, enhanced by the karstic drainage structure.

[The morbidity and mortality review meetings in radiotherapy departments: Procedure, implementation and prospects of the "Proust" French national project]. / Revue de morbidité et mortalité en radiothérapie : procédure, implémentation et perspectives du projet national français « Proust ¼.

Radiation-induced acute and late toxicity depends on several parameters. The type, severity and duration of morbidity are mainly related to irradiated volume, total dose and its fractionation and the intrinsic radiosensitivity of the patients. The follow-up of these toxicities is essential. However, unlike many specialties, morbidity and mortality reviews procedures are not developed as part of quality governance programs in radiation therapy departments for the monitoring of toxicity which sometimes hinder the patients' quality of life. One French survey published within the framework of the project entitled Prospective Registration of Morbidity and Mortality, Individual Radiosensitivity and Radiation Technique (Proust), conclude that there was a lack of knowledge of morbidity and mortality reviews and considerable confusion between these reviews and other quality processes without perspective for the local morbidity and mortality reviews development in a large number of the participated centers. In this article, we will discuss the procedure of the "ideal morbidity and mortality reviews" and its implementation through a monocentric experience started in 2015. Thus, the Proust project is a unique opportunity to implement and standardize a national morbidity and mortality reviews implementation in radiation therapy departments by involving the French regions.

Congenital CLN8 disease of neuronal ceroid lipofuscinosis: a novel phenotype. / Enfermedad CLN8 congenita de lipofuscinosis neuronal ceroidea: un nuevo fenotipo.

INTRODUCTION: CLN8 disease is one of the thirteen recognized genetic types of neuronal ceroid lipofuscinosis, a group of neurodegenerative lysosomal storage disorders, most frequent in childhood. A putative 286 amino acids transmembrane CLN8 protein with unknown function is affected. Pathological variants in the CLN8 gene were associated with two different phenotypes: variant late-infantile in individuals from many countries worldwide, and epilepsy progressive with mental retardation, appearing in Finnish and Turkish subjects. CASE REPORT: The girl showed psychomotor delay and dementia since birth, tonic-clonic seizures, myoclonus, ataxia with cerebellar atrophy, and early death at 12 years old. Electron microscopy of the skin showed mixed GROD, curvilinear, fingerprint cytosomes and mitochondrial hypertrophy. Two pathological DNA variants in the CLN8 gene (exon 2 c.1A>G; p.?/ exon 3 c.792C>G; p.Asn264Lys) were found confirming a compound heterozygous genotype. CONCLUSION: This case is the Latin American index for a new congenital phenotype of the CLN8 disease. The congenital phenotype has to be added to the clinical spectrum of the CLN8 disease. The suspicion of CLN8 disease should be genetically sustained in challenging cases of a neurodegenerative syndrome with psychomotor delay since birth, speech difficulty and seizures. The course includes ataxia, cerebellar atrophy, and early death.

TITLE: Enfermedad CLN8 congenita de lipofuscinosis neuronal ceroidea: un nuevo fenotipo.Introduccion. La enfermedad CLN8 es uno de los 13 tipos geneticos reconocidos de lipofuscinosis neuronal ceroidea, un grupo de trastornos neurodegenerativos de acumulacion lisosomica, los mas frecuentes en la infancia. La causan mutaciones en la proteina transmembrana CLN8 de 286 aminoacidos, cuya funcion se desconoce. Las variantes patologicas en el gen CLN8 se asociaron con dos fenotipos diferentes: la variante infantil tardia en individuos de diversos paises alrededor del mundo, y la epilepsia progresiva con retraso mental, que aparece en pacientes finlandeses y turcos. Caso clinico. Niña que mostro retraso psicomotor y demencia desde el nacimiento, convulsiones tonicoclonicas, mioclonia, ataxia con atrofia cerebelosa y muerte temprana a los 12 años. La microscopia electronica de la piel mostro una mezcla de citosomas con patrones de depositos osmiofilicos granulares, curvilineos y de «huella digital¼, y mitocondrias hipertrofiadas. Se encontraron dos variantes patologicas de ADN en el gen CLN8 (exon 2 c.1A>G; p.?/ exon 3 c.792C>G; p.Asn264Lys), lo que confirmo un genotipo heterocigoto compuesto. Conclusion. Este es el caso indice en America Latina para el nuevo fenotipo congenito de la enfermedad CLN8. La sospecha de esta patologia deberia sustentarse geneticamente en casos de sindrome neurodegenerativo con retraso psicomotor desde el nacimiento, dificultad del habla y convulsiones. El curso clinico incluye ataxia, atrofia cerebelosa y muerte temprana.

Linfedema asociado al cáncer de mama: factores de riesgo, diagnóstico y tratamiento quirúrgico / Breast cancer related lymphedema: risk factors, diagnosis and surgical treatment

Resumen El linfedema asociado al cáncer de mama es una de las complicaciones más subestimadas y debilitantes del tratamiento de esta entidad. Ocurre como resultado de la interrupción del flujo linfático en asociación a otros factores. La incidencia varía dependiendo del tipo tratamiento recibido, existiendo mayor riesgo en los casos en los que se realiza mastectomía total, disección axilar, radioterapia, y en los pacientes en los cuales los ganglios están positivos para cáncer, hubo una mayor cantidad de linfonodos resecados, se utilizaron taxanos o padecen de obesidad. El diagnóstico clínico y a través de técnicas de imágenes es fundamental para evaluar el estado funcional del sistema linfático. Los objetivos principales en el manejo del linfedema son limitar la morbilidad del paciente, mejorar la funcionalidad y la calidad de vida. Existen procedimientos que buscan prevenir el desarrollo del linfedema asociado al cáncer de mama. Una vez establecido, el tratamiento puede ser conservador y quirúrgico. El tratamiento quirúrgico incluye procedimientos fisiológicos (reconstructivos) y resectivos. El éxito depende de una buena selección de los pacientes y la realización de un tratamiento individualizado. A continuación, se presenta una revisión en cuanto a la incidencia, factores de riesgo, estrategias diagnósticas y técnicas quirúrgicas con énfasis en el tratamiento microquirúrgico.

Breast cancer related lymphedema is one of the most underestimated and debilitating complications of the treatment of this entity. Occurs as result of the interruption of the lymphatic flow in association with other factors. The incidence varies depending on the type of treatment received; being a higher risk in cases in which total mastectomy, axillary dissection, radiotherapy are performed; and in patients in whom the lymph nodes are positive for cancer, there was a greater number of harvested lymph nodes, taxanes were used or in obese patients. Clinical diagnosis and imaging techniques are essential to assess the functional status of the lymphatic system. The main objectives in the management of lymphedema are to limit patient morbidity, improve functionality and quality of life. There are procedures that seek to prevent the development of breast cancer related lymphedema. Once established, the treatment can be conservative and surgical. Surgical treatment includes physiological (reconstructive) and excisional procedures. Success depends on a good selection of patients and the performance of an individualized treatment. The following is a review regarding the incidence, risk factors, diagnostic strategies and surgical techniques with emphasis on microsurgical treatment.

Increase in gonorrhoea among very young adolescents, Catalonia, Spain, January 2012 to June 2013.

Between January 2012 and June 2013, 27 sexually transmitted infections were reported in adolescents aged 13-15 years in Catalonia, Spain. In the first half of 2013, there were nine cases of gonorrhoea, while in the same period of 2012, there was one. In June 2013, two gonorrhoea cases aged 13-14 years, linked to a common source through a social network, were reported. The public health response should be adapted to this vulnerable population.

Epidemiology of cypress pollen allergy in Montpellier.

BACKGROUND: Cupressaceae pollen allergy is a worldwide winter pollinosis. Exposure to cypress pollen has increased enormously during recent decades, and cypress pollen allergy has become a major health problem, especially in Mediterranean countries. OBJECTIVES: We aimed to evaluate the prevalence of cypress pollen sensitization and allergy in the Montpellier area and the symptoms presented by sensitized patients. METHODS: We included all 6185 consecutive patients who were referred to our center for any allergic disorder during a 36-month period. For each patient, we evaluated skin prick test results, allergy symptoms, pulmonary function test results, and the need for allergen immunotherapy. RESULTS: We found that 20.7% of patients were sensitized to cypress pollen and 46.4% presented symptoms during the pollen season. The main symptoms were rhinoconjunctivitis and asthma. Oral allergy syndrome to peach was detected in 4% of sensitized and symptomatic patients. Allergen immunotherapy was necessary to control symptoms in 57.9% of cases. CONCLUSIONS: Cypress pollen allergy is one of the leading causes of respiratory allergy in the Montpellier area. Symptoms are often severe and include pollen-induced asthma. Moreover,many patients need allergen immunotherapy in order to achieve better control of their symptoms.

Nanoscale characterization of the dielectric charging phenomenon in PECVD silicon nitride thin films with various interfacial structures based on Kelvin probe force microscopy.

This work presents a novel characterization methodology for the dielectric charging phenomenon in electrostatically driven MEMS devices using Kelvin probe force microscopy (KPFM). It has been used to study plasma-enhanced chemical vapor deposition (PECVD) silicon nitride thin films in view of application in electrostatic capacitive RF MEMS switches. The proposed technique takes the advantage of the atomic force microscope (AFM) tip to simulate charge injection through asperities, and then the induced surface potential is measured. The impact of bias amplitude, bias polarity, and bias duration employed during charge injection has been explored. The influence of various parameters on the charging/discharging processes has been investigated: dielectric film thickness, SiN(x) material deposition conditions, and under layers. Fourier transform infrared spectroscopy (FT-IR) and x-ray photoelectron spectroscopy (XPS) material characterization techniques have been used to determine the chemical bonds and compositions, respectively, of the SiN(x) films being investigated. The required samples for this technique consist only of thin dielectric films deposited over planar substrates, and no photolithography steps are required. Therefore, the proposed methodology provides a low cost and quite fast solution compared to other available characterization techniques of actual MEMS switches. Finally, the comparison between the KPFM results and the discharge current transients (DCT) measurements shows a quite good agreement.

Nanoscale characterization of different stiction mechanisms in electrostatically driven MEMS devices based on adhesion and friction measurements.

In this work, for the first time different stiction mechanisms in electrostatic micro-electromechanical systems (MEMS) switches were studied. In these devices stiction can be caused by two main mechanisms: dielectric charging and meniscus formation resulting from the adsorbed water film between the switch bridge and the dielectric layer. The effect of each mechanism and their interaction were investigated by measuring the adhesive and friction forces under different electrical stress conditions and relative humidity levels. An atomic force microscope (AFM) was used to perform force-distance and friction measurements on the nanoscale. A novel technique was proposed to measure the induced surface potential over the dielectric surface and was used to explain the obtained adhesive and friction results. The evolution of adhesive force with time was monitored in order to study the charging/discharging processes in the dielectric film. The assessment methodology is employed for application in RF-MEMS switches and could be extended to other electrostatic MEMS devices. The study provides an in-depth understanding of different stiction mechanisms, and explanation for the literature reported device level measurements for electrostatic capacitive MEMS switches.

On the influence of environment gases, relative humidity and gas purification on dielectric charging/discharging processes in electrostatically driven MEMS/NEMS devices.

In this paper, we investigate the impact of environment gases and relative humidity on dielectric charging phenomenon in electrostatically actuated micro- and nano-electromechanical systems (MEMS and NEMS). The research is based on surface potential measurements using Kelvin probe force microscopy (KPFM). Plasma-enhanced chemical vapor deposition (PECVD) silicon nitride films were investigated in view of applications in electrostatic capacitive RF MEMS switches. Charges were injected through the atomic force microscope (AFM) tip, and the induced surface potential was measured using KPFM. Experiments have been performed in air and in nitrogen environments, both under different relative humidity levels ranging from 0.02% to 40%. The impact of oxygen gas and hydrocarbon contaminants has been studied for the first time by using different gas purifiers in both air and nitrogen lines. Voltage pulses with different bias amplitudes have been applied during the charge injection step under all investigated environmental conditions in order to investigate the effect of bias amplitude. The investigation reveals a deeper understanding of charging and discharging processes and could further lead to improved operating environment conditions in order to minimize the dielectric charging. Finally, the nanoscale KPFM results obtained in this study show a good correlation with the device level measurements for capacitive MEMS switches reported in the literature.

Trypanosoma cruzi: Cardiac mitochondrial alterations produced by different strains in the acute phase of the infection.

The parasite Trypanosoma cruzi is the causative agent of Chagas disease. T. cruzi invasion and replication in cardiomyocytes induce cellular injuries and cytotoxic reactions, with the production of inflammatory cytokines and nitric oxide, both source of reactive oxygen species. The myocyte response to oxidative stress involves the progression of cellular changes primarily targeting mitochondria. We studied the cardiac mitochondrial structure and the enzymatic activity of citrate synthase and respiratory chain CI-CIV complexes, in Albino Swiss mice infected with T. cruzi, Tulahuen strain and SGO Z12 isolate, in two periods of the acute infection. Changes in the mitochondrial structure were detected in both infected groups, reaching values of 71% for Tulahuen and 88% for SGO Z12 infected mice, 30 days post infection. The citrate synthase activity was different according to the evolution of the infection and the parasite strain, but the respiratory chain alterations were similar with either strain.

The use of computed tomography in radiotherapy treatment planning for breast cancer. How does conventional radiotherapy planning compare with virtual?

PURPOSE: To compare, in terms of ballistics and dosimetry, a conventional and a virtual simulation in 14 patients without changing the set-up. PATIENTS AND METHODS: 14 women with breast cancer were treated with postoperative radiotherapy from October 2003 to November 2004. Whole breast irradiation alone was indicated (50 Gy at International Committee on Radiation Units [ICRU] point in 25 fractions over 5 weeks) with, in some cases, an additional boost of 16 Gy to the tumor bed--that was not taken into account in this study. After CT scan, tangential fields were conventionally simulated using a Mecaserto Phebus-type simulator-CT scan. The planning target volume (PTV) was the clinical target volume (CTV) expanded with an additional margin of 1 cm in all directions but towards the skin. Both the lungs and the heart were delineated as organs at risk. Dosimetries were computed for the two beams arrangements i.e. 2D conventional and 3D virtual. RESULTS: The mean age of 14 women was 51.4 years (range 26-65). Laterality was the left breast for 6 patients and the right for 8. Few differences were noticeable in terms of gantry angles. The 3D medial fields were more medial with a mean of 8 mm (range 0-15). The 3D lateral fields were more posterior with a mean difference of 8 mm (range 0-25). The dosimetry analysis showed that, with regard to conventional simulations, at least 95% of the CTV received in all cases > 95% of the prescribed dose. However, in 8 out of 14 patients (57%), 15% of the PTV received < 95% of the prescribed dose. The ICRU 50 quality criterion that at least 95% of the PTV (PTV(95%)) should receive at least 95% of the prescribed dose was never met with conventional simulation. In the case of virtual simulation, the ballistics of the treatment were designed to meet the ICRU quality criterion and thus the PTV95% was higher here than with the conventional simulation by a mean of 17.6% +/- 9.7%. The percentage of CTV receiving a dose higher than 107% of the prescribed dose was 21.3% +/- 12% with conventional and 24% +/- 11% with virtual simulation. CONCLUSION: The high incidence of breast cancer, the essential role of radiotherapy in its treatment and the potential ensuing toxicity explain why so many studies are devoted to the improvements brought to the techniques of this treatment. The virtual planning of the treatment, however, comes up against many difficulties. The countering of the CTV is complex and necessitates a combination of clinical examination and imagery. The choice of margins around the CTV has not been standardised and is largely dependent both on the equipment used and the quality control methods.

[Comparison of classic simulation and virtual simulation in breast irradiation: prospective study on 14 patients]. / Comparaison simulation classique-simulation virtuelle au cours d'une irradiation mammaire: étude prospective sur 14 patientes.

PURPOSE: To compare conventional 2D simulation and virtual simulation on 14 patients with breast cancer. PATIENTS AND METHODS: Patients were simulated for treatment using standard procedure. They subsequently underwent CT scan in the treatment position. The CTV was defined as breast tissue. The PTV was obtained by adding a 3D margin of 1 cm around CTV. Organs at risk (lungs and heart) were outlined. Ballistics and dose distribution obtained with the two planning methods were compared. RESULTS: With conventional simulation, 95% of CTV received 95% of the dose prescribed. Virtual simulation significantly improved dosimetric coverage of PTV without increasing irradiation volume of lung and heart. In 2D simulation, using three slices allowed optimisation by adjusting wedge angle. The five-slice plan was a much better predictor of the maximum dose regions when compared to the three-slice plan. Using entire CT data didn't give any benefit. CONCLUSION: Variations in CTV delineation and PTV definition limit interest of virtual simulation. In classic simulation, a 5 CT slice-plan can be used to optimise dose distribution.

Trypanosoma cruzi infection induces microfilament depletion in human placenta syncytiotrophoblast.

Congenital Chagas disease, endemic in Latin America, is associated with premature labour, miscarriage, and placentitis. Metacyclic trypomastigotes adhere to specific receptors on the outer membrane of host cells as a prelude to intracellular invasion, causing calcium ion mobilization, rearrangement of host cell microfilaments, recruitment of lysosomes and parasite internalization. The actin cytoskeleton plays an important role in many cellular processes including the parasite invasion into mammalian cells. In order to observe if placental cytoskeleton is altered in the process of parasite invasion into placental villi, actin microfilaments were studied. Using immunohistochemical techniques, it was observed that the presence of actin in the syncytiotrophoblast was intense throughout the brush border in control placentae belonging to non-chagasic women. But after culture with the trypomastigote, this labelling disappeared, indicating that the parasite induced disassembly of the cortical actin cytoskeleton when the placenta was infected. As a control, placentae from chagasic women were studied, and no actin was found. The same results were obtained by the electron microscope. We confirmed that cortical actin rearrangements may be an early step in the Trypanosoma cruzi invasion mechanism into placental cells, in order to allow lysosomes access to the plasma membrane, and formation of the parasitophorous vacuole. The recruitment of lysosomes occurs directly beneath the invasion site, and this process is required for parasite internalization.

[Cardiovascular risk and glucose metabolism: agreements and discrepancies between the WHO-85 and ADA-97 classifications]. / Riesgo cardiovascular y metabolismo de la glucosa: acuerdos y discrepancias entre las clasificaciones OMS-85 y ADA-97.

UNLABELLED: AIM. To identify the differences between coronary heart disease risk in patients with altered basal glucemia (ABG), oral glucose intolerance (OGI) and type II diabetes mellitus according to the WHO-85 and ADA-97 diagnostic classifications, in an adult population at high risk for diabetes mellitus. DESIGN: Descriptive, cross-sectional, multicenter study.Setting. Seven primary health care centers in Spain.Patient. 970 persons considered the population at risk for type II diabetes mellitus. MEASURES: Participants were classified according to the criteria of the WHO-85 (normal, OGI, diabetes) and the ADA-97 system (normal, ABG, diabetes). The following variables were recorded: age, sex, smoking habit, body mass index, systolic blood pressure, diastolic blood pressure, basal glucemia, glucemia 2 h after an oral glucose tolerance test, HbA1c, microalbmuniuria, total cholesterol, HDL, LDL and triglycerides. Coronary heart disease risk was calculated with the 1998 table developed by Wilson et al. on the basis of the Framingham study. RESULTS: A total of 970 participants were studied. Mean age was 58.6 #+ 12.4 years; 453 were men (46.7%) and 517 were women (53.3%). Our analysis showed that cardiovascular disease risk factors were less frequent in normal subjects, and that their prevalence was higher in persons with diabetes (according to both WHO and ADA classifications). There were no significant differences in coronary heart disease risk or different risk factors between analogous groups in the two classification systems (normal, OGI/ABG or diabetes). Coronary heart disease risk in persons with different types of alterations in glucose metabolism was 11.3% in normal subjects, 14% in persons with OGI and 27.3% in persons with diabetes according to the WHO-85 system, and 11.4% in normal subjects, 15.7% in persons with ABG and 29.5% in persons with diabetes according to the ADA-97 system. CONCLUSIONS: The greater the alteration in carbohydrate metabolism, the greater the coexistence of risk factors and the estimated risk of coronary heart disease. There were no significant differences in the presence of cardiovascular risk factors, or in the relationship between carbohydrate metabolism and coronary heart disease risk, between analogous stages identified with one classification system or the other.

Riesgo cardiovascular y metabolismo de la glucosa: acuerdos y discrepancias entre las clasificaciones OMS-85 y ADA-97 / Cardiovascular disease risk and glucose metabolism: agreement and discrepancies between the WHO-85 and ADA-97 classifications

Objetivo. Conocer las diferencias entre el riesgo coronario de los sujetos con glucemia basal alterada (GBA), intolerancia oral a la glucosa (ITG) y diabetes mellitus tipo 2 según las clasificaciones diagnósticas de la OMS-85 y ADA-97 en una población adulta con un riesgo alto de presentar diabetes mellitus. Diseño. Estudio descriptivo, transversal, multicéntrico. Emplazamiento. Atención primaria, 7 centros de salud. Pacientes. Un total de 970 sujetos considerados población de riesgo para diabetes mellitus tipo 2.Mediciones. Se clasificaron los sujetos según los criterios OMS-85 (normales, ITG, diabetes) y según la ADA-97 (normales, GBA y diabetes). Se recogieron las siguientes variables: edad, sexo, consumo de tabaco, índice de masa corporal, tensión arterial sistólica, tensión arterial diastólica, glucemia basal, glucemia a las 2 horas de la PTOG, HbA1c, microalbuminuria, colesterol total, cHDL, cLDL, triglicéridos y se estimó el cálculo del riesgo coronario mediante la tabla de Wilson et al de 1998, basada en el estudio Framingham. Resultados. Se evaluó a 970 sujetos con una edad media de 58,6 ñ 12,4 años, 453 varones (46,7 por ciento) y 517 mujeres (53,3 por ciento). En el análisis de la presencia de factores de riesgo cardiovascular se observa que éstos son menos frecuentes en los sujetos normales y que su prevalencia es más elevada en los diabéticos (OMS y ADA). No existen diferencias significativas entre el riesgo coronario y los diversos factores de riesgo cuando se analizan grupos homónimos OMS-ADA (normales, ITG-GBA o diabéticos). Según la clasificación de la OMS-85, el riesgo coronario en los distintos tipos de alteraciones del metabolismo de la glucosa fue un 11,3 por ciento en sujetos normales, un 14 por ciento en ITG y un 27,3 por ciento en diabéticos, y según la ADA-97 un 11,4 por ciento en sujetos normales, un 15,7 por ciento en GBA y un 29,5 por ciento en diabéticos. Conclusiones. A mayor grado de patología hidrocarbonada, mayor coexistencia de factores de riesgo y mayor estimación del riesgo coronario. No hay diferencias importantes entre los estadios de las clasificaciones OMS y ADA ni en la presencia de factores de riesgo cardiovascular ni en relación al riesgo coronario (AU)

Epidemiological relationship of human and swine Streptococcus suis isolates.

Two cases of meningitis due to Streptococcus suis in humans are reported here. A butcher and an abattoir worker were referred to a health centre in Castellón (Spain) with fever and symptoms of meningitis. After adequate treatment, a slight hipoacusia persisted as sequelae in both cases. Colonies of S. suis group R, serotype 2 and phenotype MRP+EF+ were isolated from cerebroespinal fluid. Epidemiological studies showed that both workers had in common the handling of pork meat of slaughtered healthy pigs from three closed farms. A study of the tonsils from apparently healthy, slaughtered pigs was carried out. A total of 234 tonsillar samples were obtained and 81 strains of S. suis were isolated from them. Serotype 2 appeared to be the most frequent (50.6%), and the analysis for phenotype showed a high percentage of tonsillar strains with the phenotype MRP+EF+ (35.9%). The humans and 28 tonsillar swine strains showed a similar profile (S. suis group R, serotype 2 and phenotype MRP+EF+). A total of 26 of the swine isolates were analysed by ribotyping using EcoRI. The human strains showed the same six-band hybridization pattern that shared five bands with the pattern most frequently shown by most of the tonsillar N. suis group R, serotype 2 and phenotype MRP+EF+ strains, differing only in the lightest, faintest band which was slightly less anodical in human (> or = 1.8 kb) than in swine (approximately 1.8 kb). From these results, both groups of strains, humans and porcine, showed differences; how can these differences in the pattern of ribotyping be explained if they should have the same origin? Is it possible that they have undergone an adaptation to the new host or perhaps the modification is due to other unknown causes? Further studies in this area are required in order to answer these questions.

Executive summary: developing objectives, content, and competencies for the training of emergency medical technicians, emergency physicians, and emergency nurses to care for casualties resulting from nuclear, biological, or chemical incidents.

STUDY OBJECTIVE: The task force assessed the needs, demands, feasibility, and content of training for US civilian emergency medical responders (paramedics, nurses, and physicians) for nuclear/biological/chemical (NBC) terrorism. METHODS: A task force representing key professional organizations, stakeholders, and disciplines involved in emergency medical response conducted an iterated instructional-design analysis on the feasibility and content of such training with input from educational professionals. We then analyzed 6 previously developed training courses for their congruence with our recommendations. RESULTS: The task force produced descriptions of learning groups, content and learning objectives, and barriers and challenges to NBC education. Access to training and sustainment of learning (retention of knowledge) represent the significant barriers. The courses analyzed by the task force did not meet all objectives and challenges addressed. CONCLUSION: The task force recommends training programs and materials need to be developed to overcome the identified barriers and challenges to learning for these audiences. Furthermore, the task force recommends incorporating NBC training into standard training programs for emergency medical professionals.

Wound botulism associated with black tar heroin and lower extremity cellulitis.

Wound botulism is a rare and potentially fatal disease. The use of black tar heroin has spawned an increase in the incidence of the disease, with the majority of cases occurring in California. The use of botulism antitoxin and surgical debridement are recommended to decrease hospital stay. For this to be effective, the diagnosis of wound botulism first must be considered, followed by an aggressive search for any area of infection that may be debrided. This case report demonstrates several factors to consider in patients presenting with symptoms of botulism poisoning: occurrence away from the Mexico border, no obvious abscess, and the need for prolonged ventilatory support. This case report documents a prolonged hospital stay, possibly caused by delay in administration of antitoxin in a patient with cellulitis that was not considered appropriate for debridement.