A gas cloud on its way towards the supermassive black hole at the Galactic Centre.

Measurements of stellar orbits provide compelling evidence that the compact radio source Sagittarius A* at the Galactic Centre is a black hole four million times the mass of the Sun. With the exception of modest X-ray and infrared flares, Sgr A* is surprisingly faint, suggesting that the accretion rate and radiation efficiency near the event horizon are currently very low. Here we report the presence of a dense gas cloud approximately three times the mass of Earth that is falling into the accretion zone of Sgr A*. Our observations tightly constrain the cloud's orbit to be highly eccentric, with an innermost radius of approach of only ∼3,100 times the event horizon that will be reached in 2013. Over the past three years the cloud has begun to disrupt, probably mainly through tidal shearing arising from the black hole's gravitational force. The cloud's dynamic evolution and radiation in the next few years will probe the properties of the accretion flow and the feeding processes of the supermassive black hole. The kilo-electronvolt X-ray emission of Sgr A* may brighten significantly when the cloud reaches pericentre. There may also be a giant radiation flare several years from now if the cloud breaks up and its fragments feed gas into the central accretion zone.

[Early statin therapy in acute myocardial infarction]. / Tratamiento precoz con estatinas en el infarto agudo de miocardio.

OBJECTIVES: To evaluate the effects of the early administration of statins during acute myocardial infarction (MI). DESIGN: A retrospective cohort study was carried out. SETTING: National (Spain). PATIENTS OR PARTICIPANTS: Patients included in the ARIAM registry from January 1999 to December 2008 with a diagnosis of MI. INTERVENTIONS: None. MAIN VARIABLES: We used logistic regression analysis and propensity scoring to determine whether the administration of statins during the first 24h of MI acts as a protective factor against: 1) mortality, 2) the incidence of lethal arrhythmias, or 3) cardiogenic shock. RESULTS: A total of 36 842 patients were included in the study. Statins were administered early in 50.2% of the patients. Statin administration was associated with younger patients with known previous dyslipidemia, obesity, a history of ischemic heart disease, heart failure, presence of sinus tachycardia, use of beta-blockers, angiotensin-converting enzyme inhibitors, thrombolysis and percutaneous coronary intervention. Mortality was 8.2% (13.2% without statin versus 3% with statin, P<.001). Multivariate analysis demonstrated that statin administration acted as a protective factor against mortality (adjusted OR 0.518, 95%CI 0.447 to 0.601). Continued use of statins was associated with a reduction in mortality (adjusted OR 0.597, 95%CI 0.449 to 0.798), and the start of treatment was a protective factor against mortality (adjusted OR 0.642, 95%CI 0.544 -0.757). Statin therapy also exerted a protective effect against the incidence of lethal arrhythmias and cardiogenic shock. CONCLUSIONS: These results suggest that early treatment with statins in patients with MI is associated with reduced mortality.

Descriptive study of sensitization to methylchloroisothiazolinone and methylisothiazolinone in a skin allergy unit.

BACKGROUND: Methylchloroisothiazolinone (MCI) and methylisothiazolinone (MI) are heterocyclic compounds used as preservatives in cosmetic and industrial products. They continue to be common allergens, causing positive patch test reactions in 2% to 4% of patients tested. MATERIAL AND METHODS: We searched the database at our skin allergy unit for all cases of sensitization to MCI/MI and MI diagnosed between January 1980 and March 2013. RESULTS: Patch tests were performed with MCI/MI in 8705 patients and with MI in 404 patients. In total, 222 patients (2.55%) were sensitized to MCI/MI and 21 (5.19%) were sensitized to MI. The incidence of MCI/MI cases peaked between 1998 and 2005 and again between 2009 and 2013. Of the 222 patients with MCI/MI sensitization, 142 were women (64%) and 49 were men (36%); the mean age was 43 years. The most frequently affected areas were the hands (54% of cases), the arms (36%), and the face (35%); 75.67% of cases were due to cosmetics and 2.25% were due to paint. Of the 21 patients with MI sensitization (mean age, 50 years), 12 were women (57%) and 9 were men (43%). The most common site of involvement in this group was the face (71% of cases), followed by the arms (38%) and the hands (29%). All the cases were due to cosmetics. CONCLUSIONS: Our data show that sensitization to the combination of MCI and MI and MI alone has increased in recent years. It would appear to be necessary to add MI to the baseline patch test series, although the test concentration has yet to be determined.

Build up of off-diagonal long-range order in microcavity exciton-polaritons across the parametric threshold.

We report an experimental study of the spontaneous spatial and temporal coherence of polariton condensates generated in the optical parametric oscillator configuration, below and at the parametric threshold, and as a function of condensate area. Above the threshold we obtain very long coherence times (up to 3 ns) and a spatial coherence extending over the entire condensate (40 µm). The very long coherence time and its dependence on condensate area and pump power reflect the suppression of polariton-polariton interactions by an effect equivalent to motional narrowing.

[Protein contact dermatitis: review of 27 cases]. / Dermatitis de contacto por proteínas. Revisión de 27 casos.

BACKGROUND: Protein contact dermatitis (PCD) is a rare and underdiagnosed condition that many dermatologists fail to recognize. Nevertheless, increasing awareness of the condition and the substances responsible has led to a rise in the number of published cases in recent years. OBJECTIVE: To determine the clinical characteristics and allergens implicated in PCD in our setting. MATERIAL AND METHODS: A retrospective observational study of all patients diagnosed with PCD in the last 10 years was undertaken in the Skin Allergies Unit of the Department of Dermatology at Hospital General Universitario in Valencia, Spain. All patients were assessed by skin-prick test with the standard GEIDAC allergen panel and by prick-by-prick test with foods or other products that were linked to immediate skin symptoms following handling. RESULTS: Twenty-seven patients (8 men and 19 women) were diagnosed with PCD, and 26 of the cases were occupational in origin. The mean age of the patients was 32.3 years and 51.8% had a history of atopy. The latency period varied from 2 months to 27 years. The most commonly affected areas were the backs of the hands and the forearms. Four patients had an oral allergy syndrome. In order of frequency, the substances responsible for PCD were fish (9 patients, 33.3%), latex (8 patients, 29.6%), potato (4 patients, 14.8%), chicken (3 patients, 11.1%), flour (3 patients, 11.1%), alpha amylase (2 patients, 7.4%), aubergine (2 patients, 7.4%), pork (1 patient, 3.7%), garlic (1 patient, 3.7%), and Anisakis (1 patient, 3.7%). CONCLUSIONS: PCD is a clinically relevant condition that dermatologists should include in the differential diagnosis of chronic dermatitis affecting the hands or forearms in patients at high occupational risk, particular those in the food preparation industry.

[Anesthesia for electroconvulsive therapy: clinical experience]. / Anestesia en terapia electroconvulsiva. Experiencia clínica.

OBJECTIVE: To assess the utility of propofol and succinylcholine in obtaining optimal convulsions and assuring patient safety during electroconvulsive therapy. PATIENTS AND METHODS: This was a prospective observational study of patients undergoing electroconvulsive therapy under general anesthesia with propofol and succinylcholine. We recorded patient characteristics, doses of propofol and succinylcholine, electroencephalographically-recorded duration of convulsions, and complications. Descriptive statistics were compiled and the data were subjected to analysis of correlations, comparison with the Student t test for independent samples, the Mann-Whitney U test, and analysis of variance. RESULTS: We studied 108 patients, 62% women and 38% men, 80% classified as ASA 1 and 20% as ASA 2. The patients underwent 844 sessions of electroconvulsive therapy; their mean (SD) age was 39.95 (18.09) years. The doses of propofol and succinylcholine were 1.34 (0.32) mgxkg(-1) and 1.35 (0.26) mgxkg(-1), respectively. The mean recorded duration of the first convulsion (29.87 [22.42] seconds) was negatively correlated with age (r = -0.12) and unrelated to propofol dose (r = 0.06) or body weight (r = 0.02). Male and schizophrenic patients had longer-lasting convulsions (P < .01). Cardiovascular complications occurred in 2.4% and psychomotor agitation in 1.4%; there were no respiratory complications, musculoskeletal injuries, nausea, or vomiting. CONCLUSIONS: Electroconvulsive therapy can be safely applied in an operating room or similar space undergeneral anesthesia and with a neuromuscular blockade in order to prevent psychological or musculoskeletal trauma. Propofol did not affect the convulsions at the dosages administered.

Peripartum cardiomyopathy: a case series.

OBJECTIVES: We describe our experience with peripartum cardiomyopathy. DESIGN AND SETTING: A case series in intensive care units (ICU) of a district hospital and a referral center. PATIENTS: Six patients who required admission to an ICU after the onset of peripartum cardiomyopathy. RESULTS: Five of the six patients survived, with total recovery of ventricular function. After 1 year of follow-up all five survivors were symptom free with a normal ventricular function. CONCLUSIONS: There is a low rate of ICU admissions for peripartum cardiomyopathy, which has a potentially fatal prognosis. However, this disease can be detected by echocardiography among patients without the semiology.

Efficacy of thrombolysis in patients with acute myocardial infarction requiring cardiopulmonary resuscitation.

OBJECTIVE: To evaluate the efficacy and safety of systemic thrombolysis administered to resuscitated patients after cardiac arrest (CA) due to an acute myocardial infarction (AMI), through a study of their mortality and haemorrhagic complications. DESIGN: We studied a retrospective cohort of patients with ischaemic heart disease gathered from the database of the Spanish multi-centre project "Analysis of Delay in AMI" (ARIAM). SETTING: Intensive care (ICU) and coronary care (CCU) units of 77 Spanish hospitals. PATIENTS AND PARTICIPANTS: The study period was from 1 January 1995 to 1 January 2000, when 22,922 patients were included in the ARIAM database register; 13,704 were diagnosed with AMI and we studied 303 of these AMI patients admitted after resuscitation for CA. MEASUREMENTS AND RESULTS: Of the 303 patients studied, 228 were male (75.25%); the mean age was 64.57 +/- 12.48 years. Systemic thrombolysis was administered to 67 patients (group I) and the remaining 236 patients were managed without this treatment (group II). The ICU/CCU mortality rate of the series was 39.93 % (121 patients); that of group I was 17.91% (12 patients) and that of group II 46.18% (109 patients) (P < 0.00001). Group I required less mechanical ventilation (group I, 42.85% vs group II, 80.76 %; P < 0.00001) and fewer cardiopulmonary resuscitation attempts (33.34% vs 60.98%, P < 0.0001). Group I also showed a lower incidence of cardiogenic shock (14.28% vs 39.01%, P < 0.0001) and anoxic encephalopathy (8.62% vs 39.89% P = 0.006). There were no fatal haemorrhagic complications in either group. Logistic regression analysis showed the administration of thrombolysis to be an independent variable that protected against mortality. CONCLUSIONS: The administration of thrombolysis to patients with AMI who require resuscitation may be efficacious in reducing mortality and is safe, with no increase in haemorrhagic complications.

Disseminated Candida infection syndrome in heroin addicts--dominance of a single Candida albicans biotype.

Among 21 intravenous heroin abusers with cutaneous and ocular manifestations of disseminated Candida infection, a single C. albicans strain type (serotype A, biotype 153/7) was isolated from skin lesions in 14 cases. This suggests that central contamination of the heroin with C. albicans is less likely to be the source of infection than an endogenous source, and that one particular strain type is either better adapted than others to grow in the lemon juice used as a heroin solvent, or more likely than others to cause the specific pathology seen in these patients.

UV detection of triazine herbicides and their hydroxylated and dealkylated degradation products in well water.

The aim of this work was to develop a simple method to confirm the presence of hydroxytriazine products (hydroxyatrazine, hydroxysimazine, hydroxyethylterbutyltriazine and hydroxydiaminotriazine) in water and to apply it to well water samples. The hydroxytriazines were concentrated on a Sep-Pak C18 cartridge. Analysis was performed by HPLC using an RP8-DB column with phosphate buffer (pH 4.7)-acetonitrile (72:28, v/v) as the mobile phase and photodiode-array detection at 233 nm. Hydroxyatrazine, hydroxysimazine and hydroxyethylterbutyltriazine were detected at ppb levels in samples from two shallow wells under a very sandy soil citrus orchard taken at three different times in a 1-year period.

Dissipation of some citrus selective residual herbicides in an irrigation well.

The aim of this work was to study the behaviour of some of the main citrus selective residual herbicides in the water of an irrigation well. The chemicals used were: atrazine, simazine, terbuthylazine, terbutryn, terbumeton, bromacil and diuron. The simetric triazines and bromacil were analyzed by gas chromatography and diuron by HPLC. The mentioned pesticides were introduced in the well in order to simulate a point-source contamination. Levels of contamination of the well due to herbicide application were about 1 mg/l, however, dissipation of the herbicides was almost complete 8 days after application, except for bromacil and diuron which persisted longer than the s-triazines.

Actinobacillus pleuropneumoniae: virulence and gene cloning.

Actinobacillus pleuropneumoniae is the causal agent of porcine contagious pleuropneumonia (PCP). The infection produces important economic losses in porciculture due to its high morbidity and mortality. Survivors are asymptomatic carriers infectious to other pigs and have low alimentary conversion. The causative agent possesses several virulence factors: adhesion fimbriae, lipopolysaccharide of the outer membrane, capsule, and cytolysins. In addition, our group has reported secretion proteases of a wide pH range of activity. These proteases degrade different substrates such as porcine gelatin, hemoglobin and IgA, and bovine or human hemoglobin. To control PCP dissemination, farmers require serodiagnostic tests which detect carriers and discriminate between vaccinated and infected animals. Bacterines used as immunogens are serotype specific and do not prevent the infection. Genes have been cloned that codify a cohemolysin, cytolysins, and an iron-binding protein. We have cloned A. pleuropneumoniae genes using the expression plasmids pUC19 and Bluescript, in Escherichia coli Q358 and DH5 alpha; the screening for antigen production was made in four groups of pigs (vaccinated, experimentally infected, naturally infected, and from slaughterhouses); two E. coli clones expressed polypeptides recognized by sera from all the groups.

Thrombolysis with recombinant tissue plasminogen activator during cardiopulmonary resuscitation in fulminant pulmonary embolism. A case series.

OBJECTIVE: To describe our outcomes using thrombolysis during the cardiopulmonary resuscitation (CPR) of patients in cardiorespiratory arrest (CA) caused by fulminant pulmonary embolism (FPE). DESIGN: A case series. SETTING: Intensive care units of a district hospital and a referral centre. PATIENTS: Six patients that suffered CA secondary to an FPE. INTERVENTIONS: Administration of recombinant tissue plasminogen activator during usual CPR manoeuvres when there was a strong suspicion of FPE. Permission for the thrombolytic therapy was sought from family members in all cases. RESULTS: Four out of the six patients survived and remain symptom-free. The thrombolysis was not associated with any fatal complications. CONCLUSIONS: Early thrombolysis during CPR manoeuvres for CA apparently caused by an FPE may reduce the mortality rate among these patients.

Liquid chromatographic determination of five benzoylurea insecticides in fruit and vegetables.

A liquid chromatographic (LC) method was developed to determine 5 benzoylureas--diflubenzuron, hexaflumuron, teflubenzuron, flufenozuron, and lufenuron--in peppers, tomatoes, eggplants, cucumbers, and oranges. Preparation of samples involve extraction with acetone and partitioning into dichloromethane-petroleum ether. A portion of this extract is cleaned up with a solid-phase extraction aminopropyl disposable column. With LC analysis using an RP-8-DB microbore column, acetonitrile-water (70 + 30, v/v) as mobile phase, and photodiode array detection at 254 nm, recovery and repeatability data were collected for the 5 benzoylureas on 4 vegetables and citrus in the range 0.04-2.0 mg/kg. Validated limits of detection and quantitation were 0.01 and 0.04 mg/kg, respectively. The method is reliable for routine analysis of vegetables and fruits.

Technetium-99m-HMPAO-labeled leukocyte imaging in patients with seronegative spondyloarthropathies.

OBJECTIVE: Gut inflammation is frequent among patients with seronegative spondyloarthropathies (SSp). The purpose of this study was to evaluate the presence of positive abdominal findings in patients with SSp who did not have clinical symptoms or signs of inflammatory bowel disease (IBD). This represents a new indication for abdominal 99mTc-HMPAO-labeled leukocyte scintigraphy. METHODS: Eighty-six patients (59 with SSp and 27 controls) were prospectively imaged with 99mTc-HMPAO-labeled leukocytes. RESULTS: Leukocyte imaging was positive in 33 patients with SSp (56%), 27 of these patients scored between 2+ and 4+ (51%). Four (15%) control patients also had positive findings. CONCLUSION: These findings provide evidence linking SSp with intestinal inflammation. SSp may be an important new indication for 99mTc-HMPAO-labeled autologous leukocyte scintigraphy.

[Cutaneous sensitivity to mercury and its compounds]. / Sensibilisation cutanée au mercure et à ses composés.

We present the results of a study, spread over a 12-year period, concerning the frequency of skin sensitization to mercury and some of its compounds in a Spanish community. Among 2,592 subjects suspected of allergic contact dermatitis, 3.5 p. 100 had a positive test to metallic mercury 0.5 p. 100 in petroleum jelly. The pertinence of the test was regarded as "present" or "fast" in 63.9 p. 100 of the cases, and the dermatitis was found to be related to antiseptic Mercurochrome (merbromin) solutions, cosmetics containing ammoniated mercury and inhalation of mercury after breaking of thermometers. We consider that in children metallic mercury should be tested at a concentration not exceeding 0.1 p. 100. Among 2,154 subjects suspected of allergic contact dermatitis, 109 (5 p. 100) had a positive test to thiomersal 0.1 p. 100 in petroleum jelly. The pertinence of the test was regarded as "present" or "past" in 53.8 p. 100 of the cases, and the dermatitis was attributed to antiseptic solutions, eye drops, cosmetics and shoes. There was no cross-reaction between thiomersal and mercury, except in those cases where mercury chloride was the allergic determinant responsible for sensitization to thiomersal (39.4 p. 100 of the cases). Fifteen patients consulted for photoallergy to piroxicam, and all had a positive test to thiosalicylic acid which is the compound most frequently responsible for sensitization to thiomersal (51.6 p. 100 of our cases) and for cross-reaction between thiomersal and piroxicam.

[Pseudomonas aeruginosa folliculitis after depilation]. / Folliculites à pseudomonas aeruginosa secondaires à une épilation.

INTRODUCTION: Pseudomonas aeruginosa is usually the responsible agent for epidemics of folliculitis acquired in swimming pools and whirlpools. Sporadic cases of Pseudomonas folliculitis after epilation of the legs are well known by dermatologists, but unfrequently reported in the literature. CASE REPORT: We report the case of a 18-year-old female affected of folliculitis of the legs caused by Pseudomonas aeruginosa, after depilation. A meticulous investigation of contaminant sources was performed, and the responsible was the sponge used to wash the legs after depilation. DISCUSSION: Pseudomonas aeruginosa folliculitis after depilation is more frequent than usually reported. A meticulous study of the concomitant source of contamination is essential to avoid recurrent episodes.

[Histopathological aspects of chromium ulcers]. / Aspectos histopatológicos de las úlceras por cromo.

The authors describe two cases of "cromeholes". Both patients were working in electroplating. The pathology of these lesions demonstrate that it refers to caustic ulcers with necrosis of the epidermis and superficial dermis, with tendency to hyperplasia of neighbouring epidermis and important infiltration of the vessels and specially of the sweat glands.