Synthesis of novel magnetic hydroxyapatite-biomass nanocomposite for arsenic and fluoride adsorption.

A magnetic nanocomposite of hydroxyapatite and biomass (HAp-CM) was synthesized through a combined ultrasonic and hydrothermal method, aiming for efficient adsorption of arsenic (As) and fluoride (F-) from drinking water in natural environments. The characterization of HAp-CM was carried out using TG, FTIR, XRD, SEM, SEM-EDS, and TEM techniques, along with the determination of pHpzc charge. FTIR analysis suggested that coordinating links are the main interactions that allow the formation of the nanocomposite. XRD data indicated that the crystalline structure of the constituent materials remained unaffected during the formation of HAp-CM. SEM-EDS analysis revelated a Ca/P molar ratio of 1.78. Adsorption assays conducted in batches demonstrated that As and F- followed a PSO kinetic model. Furthermore, As adsorption fitting well to the Langmuir model, while F- adsorption could be explained by both Langmuir and Freundlich models. The maximum adsorption capacity of HAp-CM was found to be 5.0 mg g-1 for As and 10.2 mg g-1 for F-. The influence of sorbent dosage, pH, and the presence of coexisting species on adsorption capacity was explored. The pH significantly affected the nanocomposite's efficiency in removing both pollutants. The presence of various coexisting species had different effects on F- removal efficiency, while As adsorption efficiency was generally enhanced, except in the case of PO43-. The competitive adsorption between F- and As on HAp-CM was also examined. The achieved results demonstrate that HAp-CM has great potential for use in a natural environment, particularly in groundwater remediation as a preliminary treatment for water consumption.

Impact of substance use on the physical health of patients with bipolar disorder.

OBJECTIVE: To describe the impact of tobacco, alcohol and cannabis on metabolic profile and cardiovascular risk in bipolar patients. METHOD: Naturalistic, cross-sectional, multicenter Spanish study. Current use of tobacco, alcohol and cannabis was determined based on patient self-reports. Metabolic syndrome was defined using the National Health and Nutrition Examination Survey 1999-2000 and the American Heart Association/National Heart, Lung and Blood Institute criteria, and cardiovascular risk using the Framingham and the Systematic Coronary Risk Evaluation functions. RESULTS: Mean age was 46.6 years, 49% were male. Substance use: 51% tobacco, 13% alcohol and 12.5% cannabis. Patients who reported consuming any substance were significantly younger and a higher proportion was male. After controlling for confounding factors, tobacco was a risk factor for coronary heart disease (CHD) (unstandardized linear regression coefficient 3.47, 95% confidence interval 1.85-5.10). CONCLUSION: Substance use, mainly tobacco, was common in bipolar patients. Tobacco use negatively impacted CHD risk.

[Anesthetic and physiologic implications of neurophysiologic monitoring with evoked potentials during spinal surgery]. / Implicaciones anestésicas y fisiológicas de la monitorización neurofisiológica intraoperatoria con potenciales evocados en la cirugía vertebral y medular.

Neurophysiologic monitoring with somatosensory and motor evoked potentials in spinal surgery is now widely applied in order to reduce the risk of neural injury and facilitate intraoperative decision making. Most anesthetics affect such monitoring by altering both somatosensory and motor evoked responses and these effects may place constraints on the choice of anesthetic. Intraoperative management includes maintaining stable physiologic conditions, which involves adjusting hemodynamic parameters, maintaining normal blood flow to promote proper oxygen exchange, ensuring proper ventilation, and avoiding variations in temperature. Close collaboration between the anesthetist, the surgeon, and the neurophysiologist will ensure the success of intraoperative monitoring and make it possible to avoid neural injury by making timely changes in the surgical approach.

Transcutaneous stimulation of the posterior tibial nerve for treating refractory urge incontinence of idiopathic and neurogenic origin. / Estimulación transcutánea del nervio tibial posterior en el tratamiento de la incontinencia urinaria de urgencia refractaria, de origen idiopático y neurógenico.

OBJECTIVE: To assess the efficacy of treatment with transcutaneous posterior tibial nerve stimulation (TPTNS) in patients with urge urinary incontinence, of neurogenic or nonneurogenic origin, refractory to first-line therapeutic options. MATERIAL AND METHODS: We included 65 patients with urge urinary incontinence refractory to medical treatment. A case history review, a urodynamic study and a somatosensory evoked potentials (SEP) study were conducted before the TPTNS, studying the functional urological condition by means of a voiding diary. The treatment consisted of 10 weekly sessions of TPTNS lasting 30minutes. RESULTS: Some 57.7% of the patients showed abnormal tibial SEPs, and 42% showed abnormal pudendal SEPs. A statistically significant symptomatic improvement was observed in all clinical parameters after treatment with TPTNS, and 66% of the patients showed an overall improvement, regardless of sex, the presence of underlying neurological disorders, detrusor hyperactivity in the urodynamic study or SEP disorders. There were no adverse effects during the treatment. CONCLUSIONS: TPTNS is an effective and well tolerated treatment in patients with urge incontinence refractory to first-line therapies and should be offered early in the treatment strategy. New studies are needed to identify the optimal parameters of stimulation, the most effective treatment protocols and long-term efficacy, as well as its applicability to patients with a neurogenic substrate.

Imaging of mucormycosis skull base osteomyelitis.

Skull base osteomyelitis (SBO) is typically bacterial in origin and caused by Pseudomonas, although the fungus Aspergillus has also rarely been implicated. SBO generally arises from ear infections and infrequently complicates sinonasal infection. Rhinocerebral Mucor infection is characteristically an acute, fulminant, and deadly infection also affecting the orbits and deep face and is associated with intracranial complications. Bony involvement is uncommon because of the angioinvasive nature of the fungus. More recently, chronic invasive Mucor sinusitis has been described. We report the unusual clinical and imaging features of a patient with biopsy-proven invasive mucormycosis arising from chronic isolated sphenoid sinus disease, who presented with extensive SBO and a paucity of deep facial, orbital, or intracranial involvement.

The posterolateral neck dissection. Technique and results.

OBJECTIVE: To evaluate the effectiveness of the posterolateral neck dissection in providing regional control of metastatic disease to the posterior triangle from head and neck primary tumors as part of a multidisciplinary treatment approach. DESIGN: A case series review of 55 patients treated over a 10-year period form 1982 through 1991 with a minimum of 3 years of follow-up. Factors evaluated included site and histologic type of primary tumors, extent of surgery performed, other therapies provided, pathologic findings, and clinical outcome. SETTING: The University of Texas M.D. Anderson Cancer Center, Houston. PATIENTS: Forty-six male and nine female patients were studied. Three of them had bilateral dissections, for a total of 58 operations. Thirty-five were diagnosed as having melanoma; 10, squamous cell carcinoma, and 10, various other histologic types. INTERVENTION: All patients underwent a posterolateral neck dissection, either alone or as part of a multidisciplinary treatment plan. OUTCOME MEASURES: Factors reviewed were recurrence, either at the primary site or at a regional site, development of distant metastases, and surgical morbidity. RESULTS: Our review showed that, overall, disease was controlled at the site of the primary tumor in 89% of patients (94% of patients with melanoma) and that regional disease was controlled in 93% of patients (89% of patients with melanoma). Surgical morbidity was minimal. CONCLUSION: The "functional" posterolateral neck dissection as practiced at the University of Texas M.D. Anderson Cancer Center is effective surgical therapy that provides control of regional metastatic disease to the posterior neck from head and neck primary tumors.

Tracheal agenesis. A case report and literature review.

Tracheal agenesis (TA) is a rare congenital anomaly that is incompatible with prolonged life. It occurs in isolation or in association with other anomalies. The affected neonate presents with respiratory distress and is unable to produce an audible cry despite obvious physical effort. A difficult intubation ensues, and often only during a postmortem examination is the diagnosis of TA made. It is hoped that in addition to adding the 47th case of TA to the literature, this article will provide some insight into the pathogenesis, presentation, and management of this anomaly. It must be emphasized that as TA carries a fatal prognosis, great care must be taken in establishing the diagnosis. If the diagnosis is confirmed, complex reconstructive surgery is not recommended as it has not been shown to change the prognosis or clinical course of affected neonates.

Laryngeal stenosis after supracricoid partial laryngectomy.

The purpose of this study was to review the incidence, risks, management, and outcomes of nontumoral laryngeal stenosis after supracricoid partial laryngectomy (SCPL) in a case series of 376 consecutive SCPLs performed at 1 institution from 1975 to 1995 with a minimum of 3 years of follow-up. Post-SCPL nontumoral symptomatic laryngeal stenosis was defined as an inability to decannulate patients before the 60th postoperative day (group 1) or the development of dyspnea (in patients without local recurrence) after an initial period of prolonged, successful decannulation (group 2). Of 376 SCPLs performed, nontumoral symptomatic laryngeal stenosis developed in 14 (3.7%). There were 7 patients (1.85%) in group 1 and 7 patients (1.85%) in group 2. In univariate analysis, none of the following variables appeared to be statistically related to the risk of immediate stenosis (group 1): age, gender, comorbidity, diabetes mellitus, symptomatic gastroesophageal reflux, arteritis, preoperative radiotherapy, arytenoid cartilage disarticulation, type of reconstruction performed, and postoperative radiotherapy. A delayed laryngeal stenosis (group 2) was statistically more likely to occur if the reconstruction performed at the time of SCPL was a cricohyoidopexy (p = .01). Successful management of the laryngeal stenosis without permanent tracheostomy was achieved in 5 group 1 patients and 3 group 2 patients. We believe that stenosis in group I patients arose through technical error, whereas group 2 patients seemed to suffer from problems of healing, mainly cicatricial narrowing of the airway at the site of the cricohyoidal impaction, or pexis. As a result, whereas laryngeal stenosis in group 1 patients was usually more easily correctable through dilation, laser incision, or resection of redundant tissue or revision of the impaction, laryngeal stenosis in group 2 patients presented a more difficult and frustrating complication. The management and outcomes of these patients are presented.

Chemotherapy for skull base cancers.

This article focuses on treatment options for select skull base problems that have decreased post-treatment morbidity and, in many cases, improved survival. The select skull base cancers covered include nasopharyngeal carcinoma, squamous cell carcinoma of the paranasal sinuses, sinonasal undifferentiated carcinoma, neuroendocrine carcinoma, esthesioneuroblastoma, and salivary gland carcinoma.

[Respiratory polygraphy in the diagnosis of obstructive sleep apnea syndrome]. / Poligrafía respiratoria en el diagnóstico del síndrome de apneas obstructivas durante el sueño.

The traditional way of diagnosing obstructive sleep apnea syndrome (OSAS) is all-night polysomnographic recording. A proposed alternative is respiratory polygraphy, a simplified procedure that consists in nighttime monitoring of oxygen saturation, oronasal flow and respiratory movements. Our aim was to evaluate the efficacy of respiratory polygraphy in diagnosing OSAS in comparison with conventional polysomnography. We studied 101 patients (92 men and 9 women) who had undergone polysomnography. An apnea-hypopnea index (AHI) > or = 10 was considered to be the diagnostic criterion for OSAS. To assess the diagnostic validity of respiratory polygraphy we considered that an AHI per hour of recording > or = 10 and a desaturation index per hour of recording > or = 10 were consistent with a diagnosis of OSAS. Sixty patients were diagnosed of OSAS. The AHI per hour of recording was > or = 10 in 56 patients, with 4 false negatives (sensitivity 93.3% and specificity 100%). The desaturation index per hour of recording was > or = 10 in 65 patients, with 7 false positives and 2 false negatives (sensitivity 96.6% and specificity 82.9%). We conclude that respiratory polysomnography is a specific, highly sensitive method for diagnosing OSAS.

[Unilateral post-bilobectomy pulmonary edema originating from thrombosis of the pulmonary vein]. / Edema pulmonar unilateral posbilobectomía originado por trombosis de la vena pulmonar.

Foucart (1875) and Ortner (1899) were the first to describe unilateral pulmonary edema as a complication of drainage of hydrothorax. Although various causes have been reported for this entity, it continues to be rare. We report a case of right unilateral pulmonary edema due to thrombosis of the superior pulmonary vein that was detected while a patient was in the recovery room after bilateral lobectomy for pulmonary tumors. The possible pathophysiological mechanisms contributing to pulmonary edema are discussed.

[Influence of age, duration of smoking habit and cigarette consumption on keratinization indexes of the oral mucosa]. / Influencia de la edad, duración del hábito de fumar y consumo de cigarrillos sobre los indices de queratinización de la mucosa bucal.

In order to determine influence of habit of smoking black cigarettes on rhythm of cell maturity of the mucosa of palate and cheeks, cytologic samples of such regions were taken to 52 male individuals, who were smokers since more than five years ago, older than 40 years and who at the time of the clinical examination did not present evidences of any type of lesion. The samples were compared with those from a control group comprising non-smoker individuals, but with the same characteristics. The samples were obtained by scraping cheeks and palate with a wooden spatula, and were fixed with ethyl alcohol and stained by Papanicolaou's technique. Observations were performed at a light microscope. Microscopic fields for cell counting were selected at random. More than 300 cells per patient were evaluated taking into account their morphology and characteristics of staining affinity. Within the studied variables, that of smoking years was the most influencing on modifications of cell keratinization indexes in the buccal mucosa of healthy smokers (p less than 0.05).

[Denture stomatitis: epidemiological study of 6,302 patients with removable dental prostheses]. / Estomatitis subprotesis: estudio epidemiológico en 6,302 pacientes portadores de protesis dentales removibles.

This research was performed with the purpose of being acquainted with the frequency of onset of subprosthetic stomatitis in a large group of individuals and to determine some causal variables derivative of personal customs and habits of using prosthesis. The universe of study was represented by all the patients carrier of denture-plate for six months or more, who attended to 36 stomatologic clinics during a period of three uninterrupted weeks. A total of 6,302 individuals was examined and 2,952 of them were recorded as affected by subprosthetic stomatitis, for a rote of 46.84%; corresponding 50.47% to female sex and 39.96% to male sex. The most involved decade of life was that of 30 years, for 49.8%, and higher affection was observed in individuals using prosthesis with acrylic base, accounting for 48.45%. The largest amount of lesions, 63.04%, corresponded to clinical grade I. Of the individuals who estimated at the beginning of using fixed prosthesis, that such prosthesis were suitable and well fitted, 47.14% presented alterations. Of the individuals examined, 83.38% had the habit of sleeping with prosthesis, and 51.07% of them was affected by lesions.

A multimodal strategy for the treatment of patients with T2 invasive squamous cell carcinoma of the glottis.

BACKGROUND: The current conservative standard of care for T2 squamous cell carcinoma of the glottis is either partial laryngectomy or radiation therapy. METHODS: Based on an inception cohort of 100 patients with T2 squamous cell carcinoma of the glottis and a minimum of 3 years of follow-up, the present study documented the results achieved with a multimodal strategy using platinum-based induction chemotherapy and partial laryngeal surgery. Statistical analysis of survival and local control was based on the Kaplan-Meier actuarial life table method. Univariate analysis was performed to determine whether there was a correlation among various factors and toxicity, clinical response, histologic regression, local control, and survival. RESULTS: A complete clinical response and a partial response after induction chemotherapy was achieved in 24% and 58% of patients, respectively. Complete histologic regression was noted in 31%. A significant statistical relation (P < 0.0001) was noted between a complete clinical response after induction chemotherapy and a complete histologic regression. The 5-year actuarial survival estimate was 85.8%. The 5-year actuarial local control estimate was 95.7% (97.7% if the vocal cord was mobile and 93.8% if the motion of the vocal cord was impaired). Salvage treatment resulted in an overall 99% rate of local control and a 95% rate of laryngeal preservation. CONCLUSIONS: Because this represents a nonrandomized retrospective study, no definitive conclusions can be derived. However, when compared with the data reported in a large series using radiation therapy or partial laryngectomy alone, this 10-year experience suggests that, in patients with "early" invasive squamous cell carcinoma of the glottis, the use of platinum-based induction chemotherapy prior to a conventional conservative treatment modality should be investigated further.

Further experience with Botox injection for tracheoesophageal speech failure.

BACKGROUND: Some patients fail to acquire tracheoesophageal (TE) speech after laryngectomy because of pharyngeal constrictor hypertonicity. Botox injection relieves hypertonicity, but there are little objective data regarding outcomes, duration of effect, and reinjection rates. METHODS: Hypertonicity was identified by means of insufflation testing and confirmed videofluoroscopically in 23 unsuccessful TE speakers. Each patient received an EMG-guided Botox injection. Additional injections were offered if the first injection failed to produce fluent speech. RESULTS: Overall, 20 of 23 patients (87%) achieved fluent TE speech production after Botox injections; 5 after additional injections. Two patients declined further intervention, and 1 failed to achieve fluent TE speech production even after 3 Botox injections. The longest sustained effect was 37 months, the shortest was 5 months for 1 patient who required reinjection of Botox to maintain her TE speech production. CONCLUSIONS: Botox injection relieves constrictor hypertonicity in selected cases of TE speech failure with little need for reinjection to maintain long-term speech success.

A qualitative analysis of posttraumatic stress among Mexican victims of disaster.

In unstructured interviews, 24 Mexicans described survivors' responses to disasters in Guadalajara, Jalisco (n = 9), Homestead, Florida (n = 6), and Puerto Angel, Oaxaca (n = 9). This analysis assessed the extent to which symptom descriptions corresponded to the 17 criterion symptoms of PTSD. Nineteen participants (79%) mentioned from 1 to 9 criterion symptoms. Event-related distress, hypervigilance, recurrent recollections, and avoiding reminders were described most often. Only 3 criterion symptoms were never described. Twenty participants (83%) provided 109 separate expressions that could not be classified specifically as criterion symptoms. These phrases were sorted by 9 independent Mexican volunteers and cluster analyzed. Clusters composed of ataques de nervios, depression, lasting trauma, and somatic complaints provided the best description of the data.

Embryonic stem cells alone are able to support fetal development in the mouse.

The developmental potential of embryonic stem (ES) cells versus 3.5 day inner cell mass (ICM) was compared after aggregation with normal diploid embryos and with developmentally compromised tetraploid embryos. ES cells were capable of colonizing somatic tissues in diploid aggregation chimeras but less efficiently than ICMs of the same genotype. When ICM in equilibrium with tetraploid and ES in equilibrium with tetraploid chimeras were made, the newborns were almost all completely ICM- or ES-derived, as judged by GPI isozyme analysis, but tetraploid cells were found in the yolk sac endoderm and trophectoderm lineage. Investigation of ES contribution in 13.5 day ES in equilibrium with tetraploid chimeras by DNA in situ hybridization confirmed the complete tetraploid origin of the placenta (except the fetal blood and blood vessels) and the yolk sac endoderm. However, the yolk sac mesoderm, amnion and fetus contained only ES-derived cells. ES-derived newborns failed to survive after birth, although they had normal birthweight and anatomically they appeared normal. This phenomenon remains unexplained at the moment. The present results prove that ES cells are able to support complete fetal development, resulting in ES-derived newborns, and suggest a useful route for studying the development of genetically manipulated ES cells in all fetal lineages.