Evaluation of the water quality status of two surface water reservoirs in a Mediterranean island.

A 1-year monitoring study is presented on the chemical status of two surface water reservoirs in a decentralized Mediterranean island. Water samples were collected at varying depths in the two surface water reservoirs and different seasons between November 2015 and September 2016, covering both wet and dry periods of the year. Samples were analyzed in order to determine major chemical parameters and priority substances based on the EU Water Framework Directive (2000/60/EC) and the latest revision of the Priority Substances Policy Directive (2013/39/EU). Tested parameters in both reservoirs did not exceed the set limits. Increased pollutant concentrations were observed in the bottom samples. More than 200 pesticide active substances were determined but none of them was above the parametric trigger value (0.1 µg L-1). Toxic metals were not detected in the examined water samples, whereas the relatively high concentrations of Mn and Cu in the bottom samples are mainly attributed to geogenic background concentrations. Based on the results of the present study, it can be concluded that the chemical situation of both water reservoirs is considered acceptable; however, continuous monitoring should be implemented in the area.

Multi-residue analysis of pesticides, plant hormones, veterinary drugs and mycotoxins using HILIC chromatography - MS/MS in various food matrices.

One of the recent trends in Analytical Chemistry is the development of economic, quick and easy hyphenated methods to be used in a field that includes analytes of different classes and physicochemical properties. In this work a multi-residue method was developed for the simultaneous determination of 28 xenobiotics (polar and hydrophilic) using hydrophilic interaction liquid chromatography technique (HILIC) coupled with triple quadrupole mass spectrometry (LC-MS/MS) technology. The scope of the method includes plant growth regulators (chlormequat, daminozide, diquat, maleic hydrazide, mepiquat, paraquat), pesticides (cyromazine, the metabolite of the fungicide propineb PTU (propylenethiourea), amitrole), various multiclass antibiotics (tetracyclines, sulfonamides quinolones, kasugamycin and mycotoxins (aflatoxin B1, B2, fumonisin B1 and ochratoxin A). Isolation of the analytes from the matrix was achieved with a fast and effective technique. The validation of the multi-residue method was performed at the levels: 10 µg/kg and 100 µg/kg in the following representative substrates: fruits-vegetables (apples, apricots, lettuce and onions), cereals and pulses (flour and chickpeas), animal products (milk and meat) and cereal based baby foods. The method was validated taking into consideration EU guidelines and showed acceptable linearity (r ≥ 0.99), accuracy with recoveries between 70 and 120% and precision with RSD ≤ 20% for the majority of the analytes studied. For the analytes that presented accuracy and precision values outside the acceptable limits the method still is able to serve as a semi-quantitative method. The matrix effect, the limits of detection and quantification were also estimated and compared with the current EU MRLs (Maximum Residue Levels) and FAO/WHO MLs (Maximum Levels) or CXLs (Codex Maximum Residue Limits). The combined and expanded uncertainty of the method for each analyte per substrate, was also estimated.

Determination of mycotoxins in feedstuffs and ruminant's milk using an easy and simple LC-MS/MS multiresidue method.

Mycotoxin contamination is a common problem on feedstuffs, that can be formed on crops in the field, during harvest, storage, processing or feeding. The scope of the current study was to investigate the levels of Aflatoxin B1, Aflatoxin B2, Aflatoxin G1, Aflatoxin G2, Diacetoxyscirpenol, Ochratoxin A, Toxin HT-2, Toxin T-2 and zearalenone in a variety of feedstuffs (maize silage, alfalfa hay, cottonseed cake, corn grain and concentrates) fed to ruminants and the possible contamination of milk though consumption. For this purpose an easy and simple multiresidue LC-MS/MS method without any clean-up step was developed and successfully validated in feed and milk matrices. The LOQ of the method was set at 10 µg/kg for all analytes and 0.05 µg/kg for Aflatoxin M1 and Ochratoxin A in milk. The results showed that 7 cottonseed cake samples, out of 13 were contaminated with Aflatoxin B1 at a level higher than the maximum levels as set by EU Regulations and with Toxin T-2 with values ranging from 8 to 562 µg/kg. Nine maize silages and 6 alfalfa hay samples were contaminated with Aflatoxin G2 at levels higher than the maximum tolerance limit. No mycotoxins or their metabolites were found above the LOQ in any of the analyzed milk samples.

Development and validation of an easy multiresidue method for the determination of multiclass pesticide residues using GC-MS/MS and LC-MS/MS in olive oil and olives.

Olives and olive oil are two of the most important commodities produced in the Mediterranean region. Due to their significant economical importance, the usage of pesticides in their production is systematic, by using a wide range of plant protection products with a variety of modes of action. As a consequence, monitoring of their residue levels in this products is a necessity. In the present study a gas and liquid chromatography-tandem mass spectrometry multiresidue method, with a short sample preparation step, based on acetonitrile extraction is developed and validated according to the European Union guidelines (SANCO Doc. No. 12495/2011) in olives and olive oil, with a large scope that includes pesticides of different chemical classes. Good sensitivity and selectivity of the method were obtained with limits of quantification at 10 µg/kg. All pesticides had recoveries in the range of 70-120%, with relative standard deviation values less than 20-25%, at both validation levels. Excellent linearity was achieved with r≥0,99 for both matrices. The method is easy, with low consumption of reagents, is characterized by reliability, sensitivity and therefore is suitable for the monitoring the levels of multiclass pesticides residues in olives and olive oil. The method was applied to 262 samples of the Greek market, of which 7% were found positive for the present of pesticides. In some of the samples 2-8 different analytes were detected.

Increased epithelial permeability in pulmonary fibrosis in relation to disease progression.

Epithelial injury contributes to pathogenesis in idiopathic pulmonary fibrosis (IPF) but its role in the interstitial lung disease (ILD) of systemic sclerosis (SSc) is uncertain. We quantified the prognostic significance of inhaled technetium-99m ((99m)Tc)-labelled diethylene triamine pentacetate (DTPA) pulmonary clearance, a marker of the extent of epithelial injury, in both diseases. Baseline (99m)Tc-DTPA pulmonary clearance was evaluated retrospectively in patients with SSc-ILD (n = 168) and IPF (n = 97) against mortality and disease progression. In SSc-ILD, the rapidity of total clearance (hazard ratio (HR) 1.02, 95% CI 1.01-1.03; p = 0.001) and the presence of abnormally rapid clearance (HR 2.10; 95% CI 1.25-3.53; p = 0.005) predicted a shorter time to forced vital capcity (FVC) decline, independent of disease severity. These associations were robust in both mild and severe disease. By contrast, in IPF, delayed clearance of the slow component, an expected consequence of honeycomb change, was an independent predictor of a shorter time to FVC decline (HR 1.01, 95% CI 1.00-1.02; p<0.01). Epithelial injury should be incorporated in pathogenetic models in SSc-ILD. By contrast, outcome is not linked to the overall extent of epithelial injury in IPF, apart from abnormalities ascribable to honeycombing, suggesting that core pathogenetic events may be more spatially focal in that disease.

Pesticides residues in milks and feedstuff of farm animals drawn from Greece.

The objective of this study was to investigate if milk from dairy sheep and goats, fed mainly with supplementary feed during the winter months, was contaminated with pesticides residues. Tauwo hundred milk samples from sheep and goats were collected from 10 farms of each animals. The sheep and goats farms were selected from those which represent common conventional production and feeding systems in Greece. Milk and feed samples (alfalfa hay, wheat straw, shrubs, pasture and concentrates) were taken from each farm to analyze for pesticides residues. The results showed that the summation operatorendosulfan was the main pesticide residue which was detected in all the concentrates samples at a mean concentration of 5.36 mgkg(-1), which is much higher from the maximum residue level (MRL). In addition, the summation operatorendosulfan was also detected in all the alfalfa hay samples but at a mean concentration of 0.10 mgkg(-1) which is lower than the MRL. The mean concentrations of endosulfan alpha and beta were 2.82 and 2.39 mgkg(-1) in the concentrates samples and 0.08 and 0.02 mgkg(-1) respectively in alfalfa hay samples. In the wheat straw, shrubs and pasture samples no pesticides residues were detected. No pesticide residues were also detected in milk samples of sheep and goats. Thus, this milk from the farms sampled presents no human health risks as far as the contaminants analyzed concerned.

Cardiac valve surgery and myocardial damage: the role of cardiac troponin I.

AIM: The study investigated the release of cardiac Troponin I (cTnI) levels in heart valve surgery and in coronary artery bypass grafting (CABG). The aims of the research were 1) to evaluate the ability of cTnI to detect the myocardial damage; and 2) to demonstrate possible causative factors of the cTnI release after valve surgery. METHODS: A prospective, single-center study. Ninety consecutive patients were operated on for different types of cardiac surgery; 45 patients underwent cardiac valve surgery - The VALVE group. 45 patients underwent CABG surgery - the CABG group. CTnI levels were measured preoperatively, on the day of operation and the 7 days postoperatively. The diagnosis of damaged myocardium classically performed through the measurement of cTnI, twelve-lead electrocardiograms (ECG) and echocardiographics according to the protocol of the study. RESULTS: Although more elevated cTnI release was noticed in valve group early after operation, no occurrence of cardiac events was found in that group. Statistically significant occurrence of cardiac events was found in CABG group (P=0.015). No relationship was shown between the peak of cTnI and the presence of cardiac events in valve group. A statistically significant correlation was observed between cardiac events and peak cTnI in CABG group (P=0.05). Possible correlations were investigated between the peak of cTnI and perioperative parameters in both two groups. CONCLUSION: The absence of cardiac events and the association of valve surgery with higher early release of cTnI compared to CABG suggest that the type of surgery strongly affects the induction of myocardial damage.

Does hypothermic circulatory arrest or prolonged cardiopulmonary bypass time affect early outcome in reoperative aortic surgery?

AIM: Prolonged cardio-pulmonary bypass (CPB) time, usually necessary for reoperations, is known to increase mortality in coronary bypass procedures and aortic reoperations. We investigated if prolonged CPB time and arch reconstruction in reoperations of the thoracic aorta affect in-hospital outcome. METHODS: Twenty-nine patients underwent reoperations on the thoracic aorta. The reoperations performed were aortic root replacement with composite graft without aortic arch involvement in ten patients, isolated ascending aorta replacement in six patients, aortic arch replacement as a primary procedure in two patients, and aortic arch in conjunction with ascending or descending aorta replacement in 11 patients. RESULTS: Fourteen patients had aortic reoperation with deep hypothermic circulatory arrest (DHCA) and 15 without DHCA. The in-hospital mortality rate was 13.8%. The use deep hypothermic circulatory arrest or CPB time did not affect early outcome. Previous coronary artery bypass procedure was independent predictor of in-hospital mortality. Seven patients required re-exploration for bleeding. One patient suffered from stroke and finally five patients had prolonged ventilation, two requiring tracheostomy. There have been no deaths in the follow-up period. None of the patients has required repeat surgical intervention on the heart or the aorta. CONCLUSION: The use of DHCA or prolonged CPB time do not affect early outcome in reoperations of the thoracic aorta.

The systemic inflammatory response in coronary artery bypass grafting: what is the role of the very low ejection fraction (EF < or = 30%)?

AIM: Patients with depressed left ventricular function are more susceptible to develop postoperative complications after cardiac surgery. The aim of the present study was to examine the effect of severe left ventricular dysfunction on the activation of systemic inflammatory reaction during and after coronary artery bypass grafting (CABG). METHODS: Clinical prospective study; 32 selected patients underwent CABG; 16 patients had depressed left ventricular function before the operation (low ejection fraction [EF] <30%)--Low EF group (study group). Sixteen patients had normal left ventricular function (normal EF, >50%)--Normal EF group (control group). The levels of inflammatory mediators TNF-alpha, IL-6, IL-8 and IL-10 were measured preoperatively, during and after cardiopulmonary bypass (CPB) and 24 hours postoperatively. RESULTS: Higher levels of almost all of inflammatory mediators were detected in patients with depressed left ventricular function compared with patients of normal EF group. IL-6 levels were found statistically significant higher in Low EF group before the induction of anesthesia (P=0.039) and after the administration of protamine (P=0.02). IL-8 levels were found statistically significant higher in Low EF group before the induction of anesthesia (P=0.05), 30 min after the start of CPB (P=0.02), after the administration of protamine (P=0.015) and 24 hours after the end of the operation (P=0.05). No statistically significant differences were demonstrated between the 2 groups of study relative to TNF-alpha and IL-10. CONCLUSION: A greater activation of systemic inflammatory reaction occurred in patients with depressed left ventricular function than in patients with normal cardiac function when they underwent CABG with extracorporeal circulation.

Idiopathic gingival fibromatosis: a review of the literature and a case report.

Gingival fibromatosis is characterized by localized or generalized fibrous enlargement of the gingivae, mainly around permanent teeth. Gingival fibromatosis affects only the masticatory mucosa and does not extend beyond the muco-gingival junction. This article describes an unusual case of idiopathic gingival fibromatosis with delayed eruption of permanent teeth in an 8 year-old boy. The pathogenic mechanisms that bring about gingival fibromatosis are discussed.

Localized aggressive periodontitis associated with unusual gingival enlargement posing a diagnostic dilemma: a case report.

This is a case report of localized aggressive periodontitis associated with unusual gingival enlargement. There was difficulty both clinically and histologically in deciding whether the gingival enlargement was a pyogenic granuloma or a Kaposi sarcoma. The diagnosis of Kaposi sarcoma was eventually ruled out by the failure of immunohistopathological examination to demonstrate the presence of HHV-8 DNA markers, and by the clinical response of the lesions to antimicrobial agents. Once a definitive diagnosis was made, the patient was treated conventionally.

Enamel dysplasia with hamartomatous atypical follicular hyperplasia: review of the literature and report of a case.

This article documents an additional case of a rare syndrome, reported only in black persons in South Africa. It is characterised by hamartomatous atypical follicular hyperplasia with central odontogenic fibroma (WHO-type)-like features attached to multiple impacted teeth, and with generalized enamel dysplasia showing features of hypoplastic amelogenesis imperfecta. Other features associated with the syndrome, but not present in all reported cases, include open-bite malocclusion, gingival overgrowth, hypodontia, pulpal calcifications and aberrant root formation of the unerupted teeth. Our present case shows the additional feature of impacted supernumerary teeth. As we cannot find any reports in the literature of the occurrence of amelogenesis imperfecta-like enamel dysplasia associated with hamartomatous follicular hyperplasia showing the features of WHO-type central odontogenic fibroma, with or without the additional features mentioned above, we propose to name this syndrome Enamel Dysplasia with Hamartomatous atypical Follicular Hyperplasia (EDHFH) syndrome.

Does anemia affect outcome after lobectomy or pneumonectomy in early stage lung cancer patients who have not received neo-adjuvant treatment?

BACKGROUND: Preoperative anemia has been shown to be an ominous prognostic factor for survival in patients with early stage non small cell lung cancer. METHODS: Two hundred and fourteen patients underwent resection for early stage non small cell lung cancer between 2001 and 2006 without neo-adjuvant treatment. Patients were divided into four groups based on their admission hemoglobin (Hgb): group I: Hgb < or = 12 g/dl, group II: Hgb = 12.1 - 12.9 g/dl, group III: Hgb = 13.0 - 14.0 g/dl, and group IV: Hgb > 14 g/dl. Cox regression analysis was used to evaluate each variable's impact on midterm survival taking all causes and lung cancer-specific mortality into account. Kaplan-Meier survival plots were estimated. RESULTS: Preoperative hemoglobin (HR = 1.44, 95 % confidence intervals 1.08 - 1.94, P = 0.014) and pneumonectomy (HR = 3.58, 95 % confidence intervals 1.26 - 10.16, P = 0.017) were the only predictors of all-cause midterm mortality. Similarly, when only lung cancer-related mortality was considered, preoperative hemoglobin (HR = 1.81, 95 % confidence intervals 1.17 - 2.78, P = 0.007) and pneumonectomy (HR = 6.89, 95 % confidence intervals 2.29 - 20.73, P = 0.001,) were independent predictors. Age, gender, pulmonary function test results, tumor stage, and histology did not influence survival. CONCLUSIONS: Preoperative anemia and the type of resection in early stage non small cell lung cancer have an impact on midterm survival and lung cancer-specific mortality.

EANM/ESC guidelines for radionuclide imaging of cardiac function.

Radionuclide imaging of cardiac function represents a number of well-validated techniques for accurate determination of right (RV) and left ventricular (LV) ejection fraction (EF) and LV volumes. These first European guidelines give recommendations for how and when to use first-pass and equilibrium radionuclide ventriculography, gated myocardial perfusion scintigraphy, gated PET, and studies with non-imaging devices for the evaluation of cardiac function. The items covered are presented in 11 sections: clinical indications, radiopharmaceuticals and dosimetry, study acquisition, RV EF, LV EF, LV volumes, LV regional function, LV diastolic function, reports and image display and reference values from the literature of RVEF, LVEF and LV volumes. If specific recommendations given cannot be based on evidence from original, scientific studies, referral is given to "prevailing or general consensus". The guidelines are designed to assist in the practice of referral to, performance, interpretation and reporting of nuclear cardiology studies for the evaluation of cardiac performance.

Independent predictors for early and midterm mortality after thoracic surgery.

BACKGROUND: The purpose of the present study was to determine independent predictors for early and midterm mortality for the whole context of thoracic surgery. METHODS: We studied 1453 consecutive patients who underwent thoracic surgery between 2002 and 2005. Operations included lung resections (n = 504), mediastinal (n = 468), pleural and pericardial (n = 226), esophageal (n = 83), chest wall (n = 85), tracheal (n = 50) and other procedures (n = 37). Midterm survival data (mean follow-up 2.0 +/- 1.1 years) were obtained from the National Death Index. Multivariate logistic regression was used to assess in-hospital mortality. Independent predictors for midterm mortality were determined by multivariate Cox regression analysis. RESULTS: There were 47 (3.2 %) in-hospital and 312 (21.5 %) late deaths. Independent predictors for in-hospital mortality included Zubrod score (OR 2.72, P < 0.001), ASA score (OR 3.42, P < 0.001), pneumonectomy (OR 20.71, P = 0.001) and no history of cerebrovascular events (OR 0.27, P = 0.011). Independent predictors for midterm mortality included age (HR 1.03, P < 0.001), weight loss (HR 1.57, P = 0.005), Zubrod score (HR 1.47, P < 0.001), primary lung cancer (HR 1.98 P < 0.001), intrathoracic extrapulmonary metastases (HR 2.78, P < 0.001), primary chest wall tumor (HR 0.14, P = 0.008), diabetes requiring insulin (HR 1.71, P = 0.017), no preoperative renal failure (HR 0.57, P = 0.004), no comorbidities (HR 0.54, P = 0.009), ASA score (HR 1.69, P < 0.001), postoperative radiation treatment (HR 1.90, P = 0.016), pneumonectomy (HR 2.18, P = 0.040), reoperation for bleeding and/or postoperative transfusion (HR 3.10, P = 0.027) and postoperative pulmonary complications (HR 1.89, P = 0.013). CONCLUSIONS: We determined independent predictors for in-hospital and midterm mortality for the whole context of thoracic surgery. Zubrod and ASA scores affect both early and midterm mortality.

Acute heart failure: is there a role for surgery?

Many of the disorders and lesions leading to acute heart failure can be treated surgically. Modern surgical techniques like the off pump coronary surgery, newer techniques for the surgical treatment of the mechanical complications of acute MI and valvular reparative techniques have been added to the surgical armamentarium in recent years. Modern ventricular assist devices have started their career in the clinical arena promising to be less invasive. At the same time the spectrum of indications for mechanical circulatory support continues to witness a rapid expansion. Technical advances have led to an evolution of surgical strategies. Heart failure surgery is now in a position to offer improved outcomes, avoidance of recurrence of acute heart failure or the development of advanced chronic heart failure.

A report of oral extramedullary acute myeloid leukaemia (AML) in an 8-year-old girl with newly diagnosed AML-M4Eo.

Acute myeloid leukaemia (AML), characterized by proliferation of immature neoplastic myeloid cells, is uncommon in childhood. We present a case of an 8-year-old girl with AML-M4Eo who had an extramedullary leukaemic tumour in the oral cavity.

The importance of independent risk-factors for long-term mortality prediction after cardiac surgery.

The purpose of the present study was to determine independent predictors for long-term mortality after cardiac surgery. The European System for Cardiac Operative Risk Evaluation (EuroSCORE) was developed to score in-hospital mortality and recent studies have shown its ability to predict long-term mortality as well. We compared forecasts based on EuroSCORE with other models based on independent predictors. Medical records of patients with cardiac surgery who were discharged alive (n = 4852) were retrospectively reviewed. Their operative surgical risks were calculated according to EuroSCORE. Patients were randomly divided into two groups: training dataset (n = 3233) and validation dataset (n = 1619). Long-term survival data (mean follow-up 5.1 years) were obtained from the National Death Index. We compared four models: standard EuroSCORE (M1); logistic EuroSCORE (M2); M2 and other preoperative, intra-operative and post-operative selected variables (M3); and selected variables only (M4). M3 and M4 were determined with multivariable Cox regression analysis using the training dataset. The estimated five-year survival rates of the quartiles in compared models in the validation dataset were: 94.5%, 87.8%, 77.1%, 64.9% for M1; 95.1%, 88.0%, 80.5%, 64.4% for M2; 93.4%, 89.4%, 80.8%, 64.1% for M3; and 95.8%, 90.9%, 81.0%, 59.9% for M4. In the four models, the odds of death in the highest-risk quartile was 8.4-, 8.5-, 9.4- and 15.6-fold higher, respectively, than the odds of death in the lowest-risk quartile (P < 0.0001 for all). EuroSCORE is a good predictor of long-term mortality after cardiac surgery. We developed and validated a model using selected preoperative, intra-operative and post-operative variables that has better discriminatory ability.

Syphilitic periostitis in a newly diagnosed HIV-positive man.

A 36-year-old man presented for an HIV test, which answered positive. He gave a six-week history of headache and fever. His syphilis serology was also positive with a Venereal Disease Research Laboratory (VDRL) titre of 1:32, and positive Treponema pallidum particle agglutination (TPPA) assay and fluorescent treponemal antibody (FTA). When he attended for treatment of the syphilis, he had developed severe pain in both lower limbs. Plain radiographs were normal. An isotope bone scan showed multiple areas of increased uptake, consistent with syphilitic periostitis. Some of these lesions were asymptomatic. He was treated with benzathine penicillin and his pain resolved. The bone scan had normalized after six months. We review the previous literature regarding syphilitic bone pain and periostitis. We discuss the importance of considering syphilis in the differential diagnosis of any sexually active adult presenting with bone pain, and highlight the usefulness of isotope bone scans in clarifying the clinical picture.