The use of blood in Anas clypeata as an efficient and non-lethal method for the biomonitoring of mercury.

Hg was analyzed in seven tissues of 52 common shoveler Anas clypeata collected from the coast of SE Gulf of California. Mean Hg concentrations were highest in the liver (2,885 ng g⁻¹) and lowest in the gizzard (621 ng g⁻¹); they followed the order: liver, feathers > muscle tissue and tissues of the circulatory system > digestive organs. Hg levels were similar or higher than birds of the same trophic level and feeding habits. Considering the relationships of Hg among tissues and blood we recommend the use of blood as an efficient method to monitor Hg.

A pilot study of the use of the oral and faecal microbiota for the diagnosis of ulcerative colitis and Crohn's disease in a paediatric population.

Crohn's disease (CD) and ulcerative colitis (UC) are chronic inflammatory bowel diseases (IBD) that affect the gastrointestinal tract. Changes in the microbiome and its interaction with the immune system are thought to play a key role in their development. The aim of this study was to determine whether metagenomic analysis is a feasible non-invasive diagnostic tool for IBD in paediatric patients. A pilot study of oral and faecal microbiota was proposed with 36 paediatric patients divided in three cohorts [12 with CD, 12 with UC and 12 healthy controls (HC)] with 6 months of follow-up. Finally, 30 participants were included: 13 with CD, 11 with UC and 8 HC (6 dropped out during follow-up). Despite the small size of the study population, a differential pattern of microbial biodiversity was observed between IBD patients and the control group. Twenty-one bacterial species were selected in function of their discriminant accuracy, forming three sets of potential markers of IBD. Although IBD diagnosis requires comprehensive medical evaluation, the findings of this study show that faecal metagenomics or a reduced set of bacterial markers could be useful as a non-invasive tool for an easier and earlier diagnosis.

Deposition chamber technology as building blocks for a standardized brain-on-chip framework.

The in vitro modeling of human brain connectomes is key to exploring the structure-function relationship of the central nervous system. Elucidating this intricate relationship will allow better studying of the pathological mechanisms of neurodegeneration and hence result in improved drug screenings for complex neurological disorders, such as Alzheimer's and Parkinson diseases. However, currently used in vitro modeling technologies lack the potential to mimic physiologically relevant neural structures. Herein, we present an innovative microfluidic design that overcomes one of the current limitations of in vitro brain models: their inability to recapitulate the heterogeneity of brain regions in terms of cellular density and number. This device allows the controlled and uniform deposition of any cellular population within unique plating chambers of variable size and shape. Through the fine tuning of the hydrodynamic resistance and cell deposition rate, the number of neurons seeded in each plating chamber can be tailored from a thousand up to a million. By applying our design to so-called neurofluidic devices, we offer novel neuro-engineered microfluidic platforms that can be strategically used as organ-on-a-chip platforms for neuroscience research. These advances provide essential enhancements to in vitro platforms in the quest to provide structural architectures that support models for investigating human neurodegenerative diseases.

[Degenerative diseases of the spine]. / Degenerative Erkrankungen der Wirbelsäule.

Degenerative alterations of the spine are among the most common causes of complaints of the musculoskeletal system. Imaging procedures are an established component of diagnostics and differential diagnoses. A reduction in height of the intervertebral space and sclerotization of the basal and covering plates are part of the first radiological alterations and in the further course can be accompanied by formation of spondylophytes, arthrosis of the intervertebral joints and degenerative vertebral surface gliding. However, early changes of the mobile segments can often not be visualized in x-ray images. Computed tomography (CT) and magnetic resonance imaging (MRI) substantially improve the diagnostic options. Using MRI the spinal column and the surrounding soft tissues can be visualized in 3-D and a differential diagnostic differentiation between inflammatory, traumatized or neoplastic processes is possible. A lack of correlation between the imaging findings and clinical symptoms remains problematic. A meaningful interpretation of x-ray images and MRI can only be made with the appropriate knowledge of the symptoms and possible diseases.

HCMV seroprevalence and associated risk factors in pregnant women, Havana City, 2007 to 2008.

OBJECTIVE: To prenatally identify pregnant women at risk of developing congenital infection due to human cytomegalovirus (HCMV). METHODS: One thousand one hundred and thirty-one pregnant women from three municipalities from Havana City were serologically screened for HCMV infection (IgM/IgG, IgG avidity) from January 2007 to January 2008. Demographical, epidemiological, and clinical variables were correlated to serologic status to identify predictors of seroconversion in pregnancy. RESULTS: The majority of women were seropositive to HCMV (92.6%); 27 women (2.4%) developed HCMV active infection during pregnancy, defined by the detection of IgG+ and IgM+ (7 women), IgM+ and IgG- (2 women), and IgG seroconversion (18 women). Susceptibility of active HCMV infection during pregnancy was associated with maternal age < 20 years and nulligravidity. Primary infection was detected in 20 pregnant women (1.8%), whereas 7 patients (0.6%) had active non-primary infection. CONCLUSION: Although pregnant women in Cuba have high seroprevalence rates for HCMV, those younger than 20 years and nulligravidae are at risk of acquiring infection during pregnancy.

[Arterial Hypertension register in private clinics in Venezuela: RHAVEN Study]. / Registro de Hipertensión Arterial en consultas privadas en Venezuela: Estudio RHAVEN.

INTRODUCTION: In Venezuela, no large studies have been conducted to determine the level of control of hypertension (HT). OBJECTIVE: The primary objective was to know the prevalence of controlled HT among hypertensive patients treated pharmacologically. MATERIALS AND METHODS: A cross-section study was conducted on patients 18years and older. RESULTS: A total of 4,320 patients were included. The prevalence of controlled hypertension was 52.6% (95%CI: 51.1-54.1%). The lack of control of HT was associated with diabetes (P<.001), hypertensive heart disease (P<.001), chronic kidney disease (P<.001), and peripheral arterial disease (P=.02). Non-compliance of treatment was also associated with uncontrolled HT (5.1% [117/2,274] in the controlled versus 43.2% [885/2,046] in the uncontrolled; (P<.001). CONCLUSION: The prevalence detected of controlled hypertension was 52.6%.

Detection of bovine viral diarrhoea virus (BVDV) nucleic acid and antigen in different organs of water buffaloes (Bubalus bubalis).

Bovine viral diarrhoea virus (BVDV) is a pestivirus that infects mainly bovine cattle. Nevertheless, there are several reports about infections in other members of the Artiodactyla order including serological studies, that indicate infection of BVDV in buffaloes. The aim of this article is to study the presence of BVDV in three young water buffaloes, displaying nonspecific clinical signs, compatible with the BVDV infection. Both immunohistochemistry and RT-PCR confirmed the presence of BVDV in the animals. The sequence analysis on RT-PCR amplicons revealed high identity with reference strains of genotypes 1a and 1b. Although BVDV was unequivocally identified in the sick animals, it has not been proved it is responsible for the clinical signs. Further studies are needed to clarify the pathogenic role of BVDV infection in this animal species, and the role of buffaloes in the epidemiology of BVDV infection.

Intraoperative radiotherapy in recurrent gynecological cancer.

A retrospective analysis to assess the feasibility and clinical tolerance of intraoperative radiotherapy (IORT) in the treatment of recurrent gynecologic cancer is reported. From February 1985 to September 1992, 26 patients with recurrent gynecologic tumors entered this trial. The clinical experience comprises two different categories of disease situations: tumors relapsing after full dose radiation therapy (group I) and recurrent disease to previous surgery (group II). Cervical carcinoma was the initial tumor site of involvement in 18 patients (69%). Treatment consisted in maximal surgical resection + IORT boost (10-25 Gy) to the high-risk areas for recurrence. Non previously irradiated patients also received external beam irradiation (EBRT) (+/- chemotherapy) pre- or postoperatively. IORT-related toxicity was one episode of motor neuropathy. Local control rates have been 33% and 77%, respectively in groups I and II. The 4-year actuarial overall survival in Group I is 7% and 6-year actuarial overall survival in Group II is 33%. The addition of IORT to surgical debulking achieves modest local control and long-term survival rates if tumor-free margins cannot be obtained in previously irradiated patients. Combined EBRT (+/- chemotherapy) maximal surgical resection plus IORT could render some long-term survivors among those surgical recurrent patients not candidates for radical surgery with curative intent.

Surgical repair of esophageal perforation in cirrhotic patients with varices.

A 51-year-old woman, a known alcohol abuser, had sclerotherapy for esophageal varices from portal hypertension. A perforation of the distal esophagus, diagnosed several days later, could not be closed primarily at thoracotomy due to extensive bleeding. The method of "exclusion and diversion in continuity" was modified by ligation of the esophagogastric junction with absorbable suture over a tube stent. The perforation healed and patency of the esophageal lumen was demonstrated 2 weeks later. This alternative life-saving procedure may be useful in chronic esophageal perforation, especially in cirrhotic or otherwise debilitated patients.

"Mini-sternotomy" for bilateral pulmonary wedge resections.

A mini-sternotomy is described that allows access to both thoracic cavities. This technique offers excellent exposure for lung resections from chest cavities without the invasiveness of a formal thoracotomy.

Esophageal carcinoma. The value of staging in long-term survival.

A three-stage study of 177 patients in Puerto Rico who had esophageal carcinoma is presented. Those surviving five or more years over a twenty-one-year period were located. Next, the experience at the San Juan City Hospital from 1968 to 1973 was examined. The information obtained from those two groups led to the last stage, a prospective study in which treatment was based on objective staging of the extent of the disease. Only 27% of these patients are really potentially curable upon admission to the hospital, and they should have aggressive therapy. Adequate palliation can be obtained with radiotherapy and chemotherapy in the remainder. The findings that nearly half of the five-year survivors had metastases or tumor extension and that some patients survived for prolonged periods without treatment emphasize the need for individualized treatment and research in tumor immunology.

Cardiac surgery in a small community: an eight-year experience.

Long-term results of 374 open-heart procedures performed over an eight-year period in a small community hospital are presented. Patients were followed up for an average of 49 months. The heart unit did not conform to the yearly volume of cases suggested by current national guidelines. Nonetheless, we obtained some interesting results. 1. The hospital mortality in nonemergency coronary artery bypass operations was 1.8%; in all types of bypass operation, 3.3%; and 5.1% for all types of cardiac operation. 2. The attrition rate was less than 1% per year for all types of patients with a total long-term survival of 92%. 3. Patients having coronary artery bypass had a yearly attrition rate of 0.66% and a total long-term survival of 94.2%. 4. The average hospital cost per patient having open-heart operation was $9,670 in 1978 and $11,073 in 1979. Case volume requirements for an open-heart-surgery unit in our area allowed an exception from the guidelines with emphasis on quality of results rather than quantity. This permitted comprehensive cardiac care especially for the poor and those with fixed incomes unable to afford the cost of traveling and associated expenses. Further similar reports may be valuable in the formulation of health policies for small communities that guarantee the health rights of all segments of the population.

Four multiple primary malignant neoplasms of the aerodigestive tract.

Multiple primary cancers of the head, neck, and upper aerodigestive tract have been documented in patients previously treated for oropharyngeal cancer. There generally is no causal relationship established between the different tumors. Two synchronous or metachronous cancers are common, three are unusual, and four are very unusual. We describe the treatment of a patient with tonsillar and synchronous esophageal and pulmonary cancers followed by a tongue cancer over a 6-year period.

Cisplatin, mitomycin, and vindesine followed by intraoperative and postoperative radiotherapy for stage III non-small cell lung cancer: final results of a phase II study.

Sixty-two patients with stage III non-small cell lung cancer (NSCLC) were treated with neoadjuvant chemotherapy consisting of cisplatin 120 mg/m2 day 1, mitomycin 8 mg/m2 day 1, and vindesine 3 mg/m2 days 1 and 14. Each cycle was repeated every 4 weeks for a total of 1 to 6 cycles (median, 3 cycles). Resection was attempted 4 to 5 weeks after the last course of chemotherapy. Intraoperative radiation therapy (IORT) (10-15 Gy) was delivered during surgery and postoperative external beam radiotherapy (EBRT) (46 Gy) was begun 4 weeks after surgery. Fifty-five patients (25 IIIA, 30 IIIB) were evaluable. Only partial responses occurred (64%), and 29 patients (53%) underwent resection. Complete resection rates were 85% (12/14) and 40% (6/15) in stage IIIA and IIIB, respectively (p = 0.01). In 3 of 29 patients (10%), no tumor was found in the resected specimen. There was one chemotherapy-related death and three postoperative-related deaths. The median survival time was 10 months, and the 5-year survival rate was 29 and 7% for stage IIIA and stage IIIB, respectively (p = 0.3). High complete resection rates and modest increase in 5-year survival have been observed in stage IIIA NSCLC. Although a number of stage IIIB patients can be made technically resectable, the low complete resectability rate reflects the lack of survival benefit in these patients.

Long-term survival of patients with carcinoma of the esophagus in Puerto Rico.

From 1950 to 1971 a total of 4,342 cases of carcinoma of the esophagus were reported to the Central Cancer Registry of the Puerto Rico Health Department. Fifty-eight patients with histologic proof of their diagnosis survived five or more years, for an absolute survival of 1.3 per cent. Neither location of the tumor or type of treatment made much difference in average survival. In fact, 20 of the 58 patients had metastasis or extension of the tumor to adjacent tissues at sometime in their clinical course.

Clinical spectrum of radiation induced pericarditis.

A series of seven patients diagnosed as having radiation induced pericarditis were reviewed and compared to those reported in the literature. They constituted 6.8 per cent of all patients with the diagnosis of pericarditis seen in a five-year period. These patients had the diagnosis proven by autopsy or by the absence of tumor cells from the pericardial fluid and/or surgical biopsy. The echocardiogram and cardiac catheterization were found to be specific diagnostic tools. Recommendations are made for a therapeutic approach to these patients. The diagnosis of this condition depends on a high index of suspicion, and close follow-up of patients who have received intense radiotherapy to the chest. Recommendations are made for prophylaxis. We challenge the pessimistic approach towards the cancer patient who develops recurrent pericardial fluid or pleural effusion due to radiation induced pericarditis. We advocate an aggressive diagnostic approach and therapy which should be related to the degree of hemodynamic impairment.

Glycerol and methylprednisolone in lung contusion.

An experimental model was developed in dogs that quantifies the amount of pulmonary trauma produced. The severity of thoracic trauma is related to mortality and to a presence or absence of bilateral pulmonary injury. Bilateral injury represents severe trauma, consistently alters blood gases and is associated with significant mortality when untreated. Both methylprednisolone and glycerol exerted beneficial effects on mortality from bilateral pulmonary contusion, and glycerol altered the blood gas pattern towards normal. Glycerol has been utilized extensively clinically to reverse the adverse effects of cerebral edema. It may prove to be of similar value when pulmonary injury is an important factor.

Early complications and long-term survival in severely obese coronary bypass patients.

Our objective was to describe the short-term morbidity of coronary artery bypass operations and the effect of surgery plus aggressive cardiac rehabilitation on the long-term prognosis of severely obese patients with coronary artery disease. We investigated an inception cohort of 28 consecutive severely obese patients with three-vessel coronary disease followed on average for 51 months. The patients' age, preoperative and postoperative weight, risk factors, and cholesterol were measured. We performed coronary artery bypass surgery, then began aggressive cardiac rehabilitation programs. We recorded intraoperative data, perioperative deaths, complications, readmissions, and lengths of stay. Also, New York Heart classifications and use of anti-anginal or cholesterol-lowering medications were noted. All patients were followed up. Despite high morbidity, long-term function and survival of severely obese CABG patients compares favorably with that of average patients. However, aggressive behavior modification fails to alter their postoperative weight or risk profile, placing them at risk for both second CABG procedures and continued obesity-related disease occurrences.

Acute reaction to protamine. Its importance to surgeons.

Three open heart surgery patients developed noncardiogenic pulmonary edema after administration of protamine following cardiopulmonary bypass. A catastrophic series of events are characteristic of this reaction: 1) sudden onset; 2) severe bronchoconstriction with early extreme difficulty in ventilation; 3) hyperinflation of the lungs; 4) pulmonary hypertension with normal pulmonary wedge or left atrial pressures; 5) progression to fulminant noncardiogenic pulmonary edema; 6) significant mortality; and 7) ventilatory perfusion abnormalities in survivors. Review of the literature reveals three types of reactions to protamine injection of varying severity: 1) brief hypotension; 2) anaphylactoid generalized reaction; and 3) high protein noncardiogenic pulmonary edema with cardiopulmonary collapse. The severity of the reaction had no relation to the dose of protamine. Previous protamine exposure was documented in 14 of 35 cases. Awareness of this reaction is essential for prompt treatment if fulminant pulmonary edema occurs. Administration of epinephrine, steroids, vasopressors, and potassium replacement may be required. Needless use of protamine sulfate should be discouraged.