Degradation activity of fungal communities on avocado peel (Persea americana Mill.) in a solid-state process: mycobiota successions and trophic guild shifts.

To explore the capability of soil mycobiota to degrade avocado peel waste and identify relevant successions and trophic guild shifts, fungal communities from three environments with different land uses were evaluated in a solid-state process. Soil samples used as inoculum were collected from a pristine mature tropical forest, a traditionally managed Mayan land, and an intensively managed monospecific avocado plantation. Soil-substrate mixes were evaluated for 52 weeks to evaluate organic matter decay and the carbon-to-nitrogen ratio. Amplicon-based high-throughput sequencing from internally transcribed spacer (ITS) analysis revealed significant differences in fungal communities widely dominated by Fusarium sp. and Clonostachys sp.; however, less represented taxa showed relevant shifts concomitantly with organic matter content drops. Trophic guild assignment revealed different behaviors in fungal communities between treatments over the 52 weeks, suggesting distinct preconditioning of fungal communities in these environments. Overall, the results lead to the identification of promising degradation moments and inoculum sources for further consortia enrichment or bioprospecting efforts.

FESAEI: a fuzzy rule-based expert system for the assessment of environmental impacts : A fuzzy logic approach to impact assessment.

Currently, the method mostly used by practitioners of environmental impact assessment (EIA) is the "crisp numbers" method. Nevertheless, this arithmetic method is far away of giving correct values due to its rigidity and the lack of consideration of important aspects as the imprecision and incompleteness of data and the uncertainty that usually pervade our knowledge of environment. A more flexible model that considers uncertainty of knowledge and imprecision of data is necessary. Among the different approaches for the assessment of environmental impacts, the fuzzy logic-based one takes account of the aspects said before; this was our primal assumption. On this paper, we explain the structure and performance of the fuzzy rule-based inference model we built, how it works, and what can be obtained when used to assess environmental impacts. Our fuzzy expert system for the assessment of environmental impacts (FESAEI) is built as the combination of five subsystems, using a total of 120 fuzzy rules, and being the output and input for the next subsystem. We assessed the parameters of rarity, robustness, quality, recoverability, intrinsic value, extension, intensity, persistence, impact_character, cumulativeness, transmissivity, and impact prevalue in four subsystems. The fifth subsystem gives the definitive impact value corresponding to the impact type of "compatible," "moderate," "severe," and "critical." The model is verified and statistically validated. Weighted Cohen's kappa shows an almost perfect concordance among experts and FESAEI's evaluations.

Bacillus subtilis with endocellulase and exocellulase activities isolated in the thermophilic phase from composting with coffee residues.

The goal of this study was to isolate, select and characterize bacteria with cellulolytic activity from two different coffee residue composting piles, one of which had an internal temperature of 57°C and pH 5.5 and the other, a temperature of 61°C, and pH 9.3. Culture media were manipulated with carboxymethylcellulose and crystalline cellulose as sole carbon sources. The enzyme activity was assessed by hydrolysis halo formation, reducing sugar production and zymograms. Three out of twenty isolated strains showed higher enzymatic activity and were identified as Bacillus subtilis according to their morphological, physiological, biochemical characteristics and based on the sequence analysis of 16S rDNA regions. The enzymatic extracts of the three selected strains showed exocellulase and endocellulase maximum activity of 0.254 and 0.519 U/ml, respectively; the activity of these enzymes was maintained even in acid pH (4.8) and basic (9.3) and at temperatures of up to 60°C. The enzymatic activities observed in this study are within the highest reported for cellulose produced by bacteria of the genus Bacillus. Endocellulase activity was shown in the zymograms from 24h until 144h of incubation. Furthermore, the pH effect on the endocellulase activity is reported for the first time by zymograms. The findings in this study entail the possibility to use these enzymes in the procurement of fermentable substrates for the production of energy from the large amount of residues generated by the coffee agroindustry.

[Ligninolytic enzyme production by white rot fungi during paraquat (herbicide) degradation]. / Producción de enzimas ligninolíticas durante la degradación del herbicida paraquat por hongos de la pudrición blanca.

Paraquat is a widely used herbicide in agriculture. Its inappropriate use and wide distribution represents a serious pollution problem for soil and water. White rot fungi are capable of degrading pollutants having a similar structure to that of lignin, such as paraquat. This study evaluated the degradation effect of paraquat on the production of ligninolytic enzymes by white rot fungi isolated from the South of Mexico. Six fungal strains showed tolerance to the herbicide in solid culture. Three of the six evaluated strains showed levels of degradation of 32, 26 and 47% (Polyporus tricholoma, Cilindrobasidium laeve and Deconica citrispora, respectively) after twelve days of cultivation in the presence of the xenobiotic. An increase in laccase and manganese peroxidase (MnP) activities was detected in the strains showing the highest percentage of degradation. Experiments were done with enzyme extracts from the extracellular medium with the two strains showing more degradation potential and enzyme production. After 24hours of incubation, a degradation of 49% of the initial paraquat concentration was observed for D. citrispora. These results suggest that paraquat degradation can be attributed to the presence of extracellular enzymes from white rot fungi. In this work the first evidence of the biodegradation potential of D. citrispora and Cilindrobasidium leave is shown.

Bone neo-formation and mineral degradation of 4Bone.(®) Part II: histological and histomorphometric analysis in critical size defects in rabbits.

OBJECTIVE: To carry out the histological and histomorphometric plus radiological analysis of biphasic ceramic. MATERIALS AND METHOD: In this study, porous HA/ßTCP (4Bone(®) ) ceramic material was tested for the bone repairing capacity and osteoinductive potential in a New Zealand rabbit model. The ratio of the ceramic's components HA/ßTCP was 60/40 (in wt%). RESULTS: The 4Bone(®) showed significantly more bone formation in the pores and in the periphery of the graft than the control group. Histomorphometric analysis revealed that the ceramic material (66.43% ± 0.29) produced higher values of bone-to-implant contact (BIC) percentages (higher quality, closer contact); moreover, defect closure was significative higher in relation with control group (64.15% ± 3.52). CONCLUSIONS: 4Bone(®) is a biocompatible, partially resorbable and osteoconductive grafting material. Biphasic graft material of HA/ßTCP with a porosity of 95% without loading favors new bone formation.

Novel hybrid drilling protocol: evaluation for the implant healing--thermal changes, crestal bone loss, and bone-to-implant contact.

OBJECTIVES: To evaluate a new hybrid drilling protocol, by the analysis of thermal changes in vitro, and their effects in the crestal bone loss and bone-to-implant contact in vivo. MATERIALS AND METHODS: Temperature changes during simulated osteotomies with a hybrid drilling technique (biologic plus simplified) (test) versus an incremental drilling technique (control) were investigated. One hundred and twenty random osteotomies were performed (60 by group) in pig ribs up to 3.75-mm-diameter drill to a depth of 10 mm. Thermal changes and time were recorded by paired thermocouples. In a parallel experiment, bilateral mandibular premolars P2, P3, P4, and first molar M1 were extracted from six dogs. After 2-month healing, implant sites were randomly prepared using either of the drilling techniques. Forty eight implants of 3.75 mm diameter and 10 mm length were inserted. The dogs were euthanized at 30 and 90 days, and crestal bone loss (CBL) and bone-to-implant contact (BIC) were evaluated. RESULTS: The control group showed maximum temperatures of 35.3 °C ± 1.8 °C, ΔT of 10.4 °C, and a mean time of 100 s/procedure; meanwhile, the test group showed maximum temperatures of 36.7 °C ± 1.2 °C, ΔT of 8.1 °C, and a mean time of 240 s/procedure. After 30 days, CBL values for both groups (test: 1.168 ± 0.194 mm; control: 1.181 ± 0.113 mm) and BIC values (test: 43 ± 2.8%; control: 45 ± 1.3%) were similar, without significant differences (P > 0.05). After 90 days, CBL (test: 1.173 ± 0.187 mm; control: 1.205 ± 0.122 mm) and BIC (test: 64 ± 3.3%; control: 64 ± 2.4%) values were similar, without significant differences (P > 0.05). The BIC values were increased at 90 days in both groups compared with the 30-day period (P < 0.05). CONCLUSIONS: Within the limitations of this study, the new hybrid protocol for the preparation of the implant bed without irrigation, increase the temperature similarly to the incremental conventional protocol, and requires twice the time for the completion of the drilling procedure in vitro. Crestal bone loss and bone-to-implant contact in the hybrid drilling protocol are comparable with the conventional drilling protocol and do not affect the osseointegration process in vivo.

Enhanced bone regeneration with a novel synthetic bone substitute in combination with a new natural cross-linked collagen membrane: radiographic and histomorphometric study.

OBJECTIVES: 4Bone is a fully synthetic bioactive bone substitute composed of 60% hydroxyapatite (HA) and 40% beta-tricalcium phosphate (ß-TCP). This study aimed to investigate the effect of resorbable collagen membranes (RCM) on critical size defects in rabbit tibiae filled with this novel biphasic calcium phosphate at 15, 30, 45, and 60 days by radiological and histomorphometric analysis. MATERIAL AND METHODS: Three critical size defects of 6 mm diameter were created in both tibiae of 20 New Zealand rabbits and divided into three groups according to the filling material: Group A (4Bone), Group B (4Bone plus RCM), and Group C (unfilled control group). At each of the four study periods, five rabbits were sacrificed. Anteroposterior and lateral radiographs were taken. Samples were processed for observation under light microscopy. RESULTS: At the end of treatment, radiological analysis found that cortical defect closure was greater in Group B than Group A, and radiopacity was clearly lower and more heterogeneous in Group A cortical defects than in Group B. There was no cortical defect closure in Group C. Histomorphometric evaluation showed significant differences in newly formed bone and cortical closure in Group B compared with Groups A and C, with the presence of higher density newly formed bone in cortical and medullar zones. CONCLUSIONS: Biphasic calcium phosphate functioned well as a scaffolding material allowing bone ingrowth and mineralization. The addition of absorbable collagen membranes enhanced bone gain compared with non-membrane-treated sites. This rabbit study provides radiological and histological evidence confirming the suitability of this new material for guided tissue regeneration of critical defects.

Narrow- versus mini-implants at crestal and subcrestal bone levels. Experimental study in beagle dogs at three months.

OBJECTIVE: The objective of this study was to evaluate the osseointegration and crestal bone loss (CBL) in two implant designs with different diameters (Mini Sky® and Narrow Sky®) implants, placed at different vertical levels at healed canine ridges. MATERIAL AND METHODS: The second, third, and fourth mandibular premolars of six Beagle dogs were extracted bilaterally. After 2 months healing, four implants divided into two groups according to their diameters (i.e., Narrow Sky® and Mini Sky®) were placed in each hemi-mandible at the level of the bone crest or 2 mm subcrestally. The animals were euthanized at 12 weeks and undecalcified samples were processed for histology. Histomorphometric analysis was carried out to compare bone-to-implant contacts (BIC) and crestal bone loss (CBL). RESULTS: There were not significant differences in CBL between groups when the implants were placed at subcrestal bone level (p > 0.05), meanwhile the CBL was significantly higher for both groups when the implants were inserted at crestal level (p < 0.05). All implants were osseointegrated presenting a minimum BIC percentage of 56%. The major percentages of BIC were found for both groups at subcrestal level (p < 0.05). CONCLUSIONS: Within the limitations of this experimental study may be concluded that the implant diameter does not affect the CBL. BIC values are affected by implant diameter and design been higher for narrow implants compared to mini-implants. Subcrestal insertion of both implants favors crestal bone preservation but crestal insertion of both designs is associated with crestal bone loss CLINICAL RELEVANCE: The study shows that narrow implants protect peri-implant crestal bone.

Influence of biphasic ß-TCP with and without the use of collagen membranes on bone healing of surgically critical size defects. A radiological, histological, and histomorphometric study.

OBJECTIVES: The aim of this study was to investigate, by means of radiological and histomorphometric analysis, the effect of resorbable collagen membranes on critical size defects (CSD) in rabbit tibiae filled with biphasic calcium phosphate. MATERIALS AND METHODS: Three CSD of 6 mm diameter were created in both tibiae of 20 New Zealand rabbits and divided into three groups according to the filling material: Group A (Ossceram), Group B (Ossceram plus Alveoprotect membrane), and Group C (unfilled control group). Five animals from each group were sacrificed after 15, 30, 45, and 60 days. Anteroposterior and lateral radiographs were taken. Samples were processed for observation under light microscopy. RESULTS: At the end of treatment, radiological analysis found that cortical defect closure was greater in Group B than Group A, and radiopacity was clearly lower and more heterogeneous in the Group A cortical defects than in Group B. There was no cortical defect closure in Group C. Histomorphometric evaluation showed significant differences in newly formed bone and cortical closure in Group B compared with Groups A and C, with the presence of higher density newly formed bone in cortical and medullar zones. There was no cortical defect closure or medullar bone formation in Group C. CONCLUSIONS: Biphasic calcium phosphate functioned well as a scaffolding material allowing mineralized tissue formation. Furthermore, the addiction of absorbable collagen membranes enhanced bone gain compared with non-membrane-treated sites.

[Antimicrobial susceptibility testing of anaerobic bacteria]. / Estudios de sensibilidad en bacterias anaerobias.

The anaerobic bacteria resistance to antibiotics is increasing, and even has appeared against the most active of those, like metronidazol and carbapenems. This fact forces to make and periodical sensibility tests -at least in the most aggressive and virulent species, in cases that they are isolated from life locations and in the absence of therapeutic response- to check the local sensibility and to establish suitable empiric therapies, all based on multicentric studies carried out in order to this or well to check the activity of new antibiotics. For the laboratory routine, the easiest sensibility method is the E-test/MIC evaluator. Another alternative is microdilution, that's only normalized for Bacteroides. There are preliminary facts that allow the use of disc diffusion method in some species of Bacteroides and Clostridium. For the temporal and multicentric studies, the procedure is dilution in agar plate, the reference method.

1H-NMR Metabolomic Study of the Mushroom Pleurotus djamor for the Identification of Nematocidal Compounds.

Due to the increasing populations of anthelmintic-resistant gastrointestinal nematodes and as a consequence of the adverse effects of synthetic drugs, this study focuses on the search for secondary metabolites with nematocidal activity from the edible mushroom Pleurotus djamor using The proton nuclear magnetic resonance (1H-NMR) metabolomics. The highest activity was shown by the ethyl acetate fractions of mycelium (EC50 290.8 µg/mL) and basidiomes (EC50 282.7 µg/mL). Principal component analysis (PCA) and hierarchical data analysis (HCA) of the 1H-NMR metabolic profiles data showed that the ethanolic extracts, the ethyl acetate, butanol, and water fractions from mycelium have different metabolic profiles than those from basidiomes, while low polarity (hexane) fractions from both stages of fungal development show similar profiles. Orthogonal partial least squares discriminant analysis (OPLS-DA) allowed the identification of signals in the 1H-NMR metabolic profile associated with nematocidal activity. The signals yielded via OPLS-DA and bidimensional NMR analysis allowed the identification of uracil as a component in the ethyl acetate fraction from basidiomes, with an EC50 of 237.7 µg/mL. The results obtained showed that chemometric analyses of the 1H-NMR metabolic profiles represent a viable strategy for the identification of bioactive compounds from samples with complex chemical profiles.

Biodegradation of agave Comiteco bagasse by Pleurotus spp.: a source of cellulases useful in hydrolytic treatment to produce reducing sugars.

This study aimed to determine the production parameters of five strains of Pleurotus spp. during their cultivation on agave Comiteco bagasse, as well as the feasibility of using cellulolytic extracts to produce reducing sugars in the same bagasse. After cultivation, the basidiome production parameters varied between 41.2 and 65.7% (biological efficiency), 0.17 and 0.30 (yield), 0.60 and 0.90% (production rate), 16.4 and 41.1% (Bioconversion) and 9.4 and 21.3 g (mean mushroom weight). At day 15 of growth, P. djamor showed the highest ß-glucosidase activity (43.95 ± 4.5 IU/g); on day 33. The same strain had the highest endoglucanase activity (21.12 ± 0.5 IU/ml). Both extracts were partially purified, and the kinetic parameters Vmax and Km were estimated (20.83 µmole/ml sec and 232.01 µmole/ml for ß-glucosidase and 685.01 µmole/ml sec and 1,240.34 µmole/ml for endoglucanase). In the enzymatic hydrolysis assay, the highest concentration of reducing sugars (43.13 ± 1.09 g/L; 0.21 g/g bagasse) was obtained by a mixture of the two partially purified extracts acting synergistically after 48 h and with a pH adjustment. The results suggest that the use of agave Comiteco bagasse for cultivating edible mushrooms while obtaining cellulolytic extracts is an alternative treatment for waste reduction and valorization of agro-industrial by-products.

Use of spent substrate after Pleurotus pulmonarius cultivation for the treatment of chlorothalonil containing wastewater.

Lignocellulosic materials are used as substrate for the cultivation of the edible mushroom Pleurotus pulmonarius. After two or three flushes of mushrooms, the spent substrate is discarded although it still has an important enzymatic activity that can be used for several purposes. In this study, we sought to determine the technical feasibility of using spent substrate from P. pulmonarius to degrade chlorothalonil. Reaction mixture was prepared with 6 ml of pesticide aqueous solution (2 mg active ingredient/l) and 3 ml of enzymatic extract obtained from spent P. pulmonarius substrate. The enzymatic reaction (27 °C, pH 7.4) was conducted for 1 h with sampling at 15 min intervals. The effect of storage time and temperature (freezing or refrigerating) of spent substrate and enzymatic extract, respectively, on the activity over chlorothalonil was determined. Freshly obtained spent substrate extract was able to reduce 100% of the initial concentration of chlorothalonil (2 mg/l) after 45 min of reaction. Storage time had a negative effect on the stability of the enzymatic activity: with spent substrate stored for a week, chlorothalonil concentration was reduced in 49.5% after 1 h reaction and with substrate stored for two and three weeks, the degradation efficiency decreased to 9.15% and 0%, respectively. Cooling and freezing the spent substrate extract also had a negative effect on chlorothalonil degradation.

Nematocidal activity of hydroalcoholic extracts of spent substrate of Pleurotus djamor on L3 larvae of Haemonchus contortus.

The objective of this study was to evaluate and compare the in vitro lethal effect of the hydroalcoholic extract of the spent substrate of Pleurotus djamor ECS-123, obtained at 15 days of colonization (SPS) and at the first (SPS1) and second (SPS2) harvests, against infective larvae L3 of Haemonchus contortus. The in vitro lethal effect was evaluated by the L3 larval mortality test (LM) using six concentrations: 1.25, 2.5, 5, 10, 20, and 40 mg/mL, with ivermectin and thiabendazole (5 mg/mL) as controls. The first harvest extract (SPS1) of strain ECS-123 was subjected to liquid-liquid bipartition, which resulted in two fractions: aqueous (PdAcO) and ethyl acetate (PdAct). The chemical fractionation of PdAct with the highest mortality rate (80.11 %) was carried out with open-column chromatography, giving a total of 13 fractions, which were analyzed by thin-layer chromatography (TLC) and grouped into 5 mixtures (R1;1-3, R2;4-7, R3;8-9, R4;10-11 and R5;12-13). Subsequently, the mixtures were evaluated against H. contortus L3 larvae. Finally, the components of the mixtures with the highest nematocidal effects were evaluated by gas chromatography coupled to mass spectrometry (GC-MS). The data were analyzed with a completely randomized design through ANOVA using the generalized linear model (GLM) with the "R" program. The purification and characterization of R4 and R5 by GC-MS revealed the presence of the following compounds: veratryl alcohol, 4-hydroxy-3,5,5 trimethyl-4-[3-oxo-1-butenyl]-2- cyclohexen-1-one, caffeine and 5,6-dimethoxy-1(3 H) isobenzofuranone. This information allowed for the identification of nematocidal compounds in the degraded substrate of P. djamor, an activity that had not been reported previously.

Edible Mushroom Protein Content and Antioxidant Capacity Increase the Longevity of Anastrepha ludens Fruit Flies.

This study aimed to determine the effect of the protein and antioxidant contents of edible mushrooms on the longevity of the fruit fly (Anastrepha ludens). The contents of protein (Bradford assay), antioxidants (DPPH and ABTS assays), total phenols, and flavonoids in nine strains of different edible mushroom species were determined. Freeze-dried and finely ground complete mushroom fruiting bodies were used to feed the flies, with a concentration of 0.5% in the diet. Male and female fruit flies, both fertile and sterile, were used in this study. Two controls were used: the standard fly diet and a diet supplemented with cinnamon as a food rich in antioxidants. Differences in protein and antioxidant contents were found among the evaluated strains. Differences were also observed in the responses of female and male flies as well as between the responses of fertile and sterile flies. Overall, the sterile flies lived longer. The addition of mushrooms in the diet resulted in greater longevity than in the controls. The use of sterile flies allowed observation of the effect of proteins and antioxidants on reproduction and the subsequent effect of reproduction on longevity.

Nematicidal Effect of Shiitake (Lentinula edodes) Extracts Against Haemonchus contortus.

During the previous decades, the indiscriminate use of anthelmintics for the control of gastrointestinal nematodes has generated anthelmintic resistance in different parts of the world. It is necessary to search for new sustainable control alternatives, such as the use of extracts from plants and edible mushrooms. Therefore, the aim of the present study was to evaluate the nematicidal activity of extracts and fractions of the edible mushroom Lentinula edodes against Haemonchus contortus eggs and infective larvae. The basidiomata of L. edodes ECS-401 were provided by the Tropical Fungi Laboratory of El Colegio de la Frontera Sur and were extracted with ethyl acetate, methanol, and water. Fractionation of the most active extract was carried out by open column chromatography. The bioassays were performed in 96-well microtiter plates using 100 eggs/larvae, a final volume of 100 µL, and different concentrations of extracts/fractions (n = 4). Bioassay readings were taken at 48 h for egg hatching inhibition (EHI) and at 24, 48 and 72 h for larval mortality (LM). The ethyl acetate extract exhibited the highest percentage of EHI (100%). For the LM bioassay, the aqueous extract was the most active (69%), but its fractions did not show larvicidal activity. The chemical profile of the aqueous extract was analyzed by high-performance liquid chromatography, which showed the presence of phenols, flavonoids, and terpenes. L. edodes extracts showed ovicidal and/or larvicidal activity.

In Vitro and In Vivo Nematicide Effect of Extract Fractions of Pleurotus djamor Against Haemonchus contortus.

Sheep haemonchosis is a disease that causes anemia, diarrhea, weight loss, low production, and even death of young animals. This represents a negative economic impact on the livestock sector. For decades, chemicals have been used to control this parasitic disease; however, cases of anthelmintic resistance have increased around the world. For this reason, the search for control alternatives is necessary. Several studies have shown that edible mushrooms of Pleurotus genus have different medicinal properties, including nematicidal activity. In this study, the chromatographic fractionation of the hydroalcoholic extract of fruiting bodies Pleurotus djamor was carried out to identify and isolate the metabolites responsible for nematicidal activity. From the fractionation of the extract, the fraction PdR2 and the subfraction PdB were obtained, which were evaluated against Haemonchus contortus under in vitro conditions. The nematicidal effect of the fraction PdB in gerbils infected artificially with H. contortus was evaluated. Finally, the analysis of the PdB fraction by gas chromatography-mass spectrometry and nuclear magnetic resonance was carried out. The results showed that the PdB had 100% of egg hatching inhibition from 5 mg/mL. Regarding larvicidal activity, it presented >97.2% from 24 h to 20 mg/mL. The in vivo evaluation of the PdB fraction showed a reduction of H. contortus larvae of 92.56%. The compounds present in this fraction were the mixture of allitol and an unidentified terpene in a ratio of 9:1. The PdB fraction is a potential alternative for the control of H. contortus, where allitol and a terpene could be responsible for nematicidal activity.

Efficacy of peritoneal ultrafiltration in the treatment of refractory congestive heart failure.

BACKGROUND: Heart failure (HF) is a major health problem in developed countries. HF is a progressive, lethal disorder, even with adequate treatment. There exists a vicious circle in the pathophysiology of HF that perpetuates and magnifies the problem. Concomitant fluid accumulation may worsen the congestive HF, it is responsible for numerous hospitalizations and it is an important cause of mortality. In this situation, any means of fluid removal may aid in the management of these patients. The objective of this study was to evaluate the efficacy of peritoneal dialysis (PD) in the treatment of refractory HF in terms of functional status, hospitalization and mortality. We also determined the improvement in health-related quality of life with the use of PD, and examined the economic consequences of its use. METHODS: We conducted a single centre, prospective, non-randomized study involving patients showing symptoms and signs of congestive HF refractory to maximum tolerable drug treatment. All of them were treated with PD. We analysed physical and biochemical determinations, functional status (according to the NYHA classification) and echocardiogram parameters. Also, to determine the efficacy of the technique we compared the perceived state of health (measured by the EQ5D) to PD patients respect to those reported with conservative therapies. Finally, we carried out a cost-utility evaluation measured by the incremental cost-utility ratio between these two options. RESULTS: Seventeen patients (65% men, 64 +/- 9 years) were included in the study, and 12 were still undergoing PD treatment at the end of the follow-up period (15 +/- 9 months). All patients improved their NYHA functional status (65% two classes; the rest, one; P < 0.001), with an important improvement in their pulmonary artery systolic pressure (44 +/- 12 versus 27 +/- 9 mmHg; P = 0.007), but no changes in left ventricular ejection fraction. Hospitalization rates underwent a dramatic reduction (from 62 +/- 16 to 11 +/- 5 days/patient/year; P = 0.003) before and after PD treatment. PD treatment raised life expectancy of 82% after 12 months of treatment, and 70% and 56% after 18 and 24 months, respectively, much better outcomes than those reported about conservative therapies, which only use diverse diuretic regimens. PD was associated with a higher perception state of health than the conservative therapy (0.6727 versus 0.4305; P < 0.01). Finally, we found that PD is cost-effective compared with the conservative therapy. CONCLUSIONS: We demonstrate that congestive HF programmes should consider offering PD in hope of seeing better functional status, reduced morbidity and mortality, better quality of life as well as reduced health care costs.