Availability of endovascular therapies for cerebrovascular disease at primary stroke centers.

Background Endovascular therapies (EVTs) are useful for treating cerebrovascular disease. There are few data about the availability of such services at primary stroke centers (PSCs). Our hypothesis was that some of these services may be available at some PSCs. Methods We conducted an internet-based survey of hospitals certified as PSCs by the Joint Commission. The survey inquired about EVTs such as intra-arterial (IA) lytics, IA mechanical clot removal, coiling of aneurysms, and cervical arterial stenting, physician training, coverage models, hospital type, and outcomes. Chi-square analyses were used to detect differences between academic and community PSCs. Results Data were available from 352 PSCs, of which 75% were community hospitals, 23% academic medical centers, and 80% were non-profit; almost half (48%) see 300 or more patients annually with ischemic stroke. A majority (60%) provided some or all EVTs on site, while 29% had none on site and no plans to add them. Among the respondents offering EVTs, 95% offered stenting of neck vessels, 86% IA lytics, 80% IA mechanical, and 74% aneurysm coiling. The majority (>55%) that did offer such services provided them 24/7/365. Most endovascular coverage was provided by interventional neuroradiologists (60%), fellowship trained endovascular neurosurgeons (42%), and interventional radiologists (41%). The majority of hospitals (81%) did not participate in an audited national registry. Conclusions A variety of EVT services are offered at many PSCs by interventionalists with diverse types of training. The availability of such services is clinically relevant now with the proven efficacy of mechanical thrombectomy for ischemic stroke.

[Monitoring the success of veterinary treatment in rehabilitated and released birds of prey using radiotelemetry]. / Monitoring rehabilitierter und ausgewilderter Greifvögel mittels Telemetrie als Erfolgskontrolle.

OBJECTIVE: Free-ranging birds of prey brought to veterinary practice should only be treated after thorough diagnostics. Before their release back into the wild, specific training - including falconry techniques - may be necessary, depending on raptor species and age. Rehabilitated birds of prey were monitored using radiotelemetry after release back into the wild. The success of veterinary therapy and the prognosis of treated diseases/injuries in free-ranging birds were evaluated. In addition, the use of radiotelemetry as a simple technique for surveillance was evaluated. The project was undertaken in cooperation with schools as a contribution to environmental education. MATERIAL UND METHODS: Three common buzzards (Buteo buteo) and one kestrel (Falco tinnunculus)were treated and released with a radio transmitter attached to a tail feather. They were tracked daily (by car or plane), observed using binoculars and their GPS coordinates were documented. RESULTS: One transmitter was lost early, making monitoring of the bird impossible. Three birds were monitored over a period of more than 14 days. These birds were successfully reintroduced into the wild, as documented from courtship displays and mating. The longest flight distance achieved was 44 km. CONCLUSIONS: Veterinary treatment aimed at rehabilitating feral birds can be successful. Radiotelemetry is a suitable tool to monitor free-ranging birds. The application of this technique is performed readily by laypeople (school students). CLINICAL RELEVANCE: Being in agreement with other studies, this data should motivate veterinarians to treat wild birds of prey for rehabilitation.

The antidepressant drug carbamazepine induces differential transcriptome expression in the brain of Atlantic salmon, Salmo salar.

Concerns are being expressed recently over possible environmental effects of human pharmaceuticals. Although the likelihood of acute toxicity is low, the continuous discharge of pharmaceuticals into the aquatic environment means that sublethal effects on non-target organisms need to be seriously considered. One-year-old Atlantic salmon parr were exposed to 7.85±0.13µgL(-1) of the antidepressant drug Carbamazepine (CBZ) for five days to investigate changes of mRNA expression in the brain by means of a custom 17k Atlantic salmon cDNA microarray. The selected concentration is similar to upper levels that can be found in hospital and sewage treatment plant effluents. After treatment, 373 features were differently expressed with 26 showing up- or down-regulation of ≥2-fold (p≤0.05). Among the mRNAs showing the highest change were the pituitary hormones encoding features somatolactin, prolactin and somatotropin, or growth hormone. Functional enrichment and network analyses of up- and down-regulated genes showed that CBZ induced a highly different gene expression profile in comparison to untreated organisms. CBZ induced expression of essential genes of the focal adhesion and extracellular matrix - receptor interaction pathways most likely through integrin alpha-6 (itga6) activation. Negative regulation of apoptotic process, extracellular matrix organization and heme biosynthesis were the most enriched biological process related GO-terms, with the simultaneous enrichment of collagen and extracellular region related cellular component GO-terms, and extracellular matrix structural constituent, hormone activity and chromatin binding molecular function related GO-terms. These results show that relatively low doses of CBZ may affect brain physiology in exposed salmon parr, targeting similar processes as in human, indicating a high degree of conservation of targets of CBZ action. However, and since the mRNAs showing most changes in expression are critical for adaptation to different stressors and life history transitions in Atlantic salmon, more research should be undertaken to assess CBZ effects to avoid impairment of normal development and maintenance of natural populations.

Behaviour of Au-citrate nanoparticles in seawater and accumulation in bivalves at environmentally relevant concentrations.

The degree of aggregation and/or coalescence of Au-citrate nanoparticles (AuNPs, mean size 21.5 ± 2.9 nm), after delivery in simulated seawater, are shown to be concentration-dependent. At low concentrations no coalescence and only limited aggregation of primary particles were found. Experiments were performed in which the marine bivalve (Ruditapes philippinarum) was exposed to AuNPs or dissolved Au and subsequently, bivalve tissues were studied by Scanning and Transmission Electron Microscopy and chemical analyses. We show that the bivalve accumulates gold in both cases within either the digestive gland or gill tissues, in different concentrations (including values of predicted environmental relevance). After 28 days of exposure, electron-dense deposits (corresponding to AuNPs, as proven by X-ray microanalysis) were observed in the heterolysosomes of the digestive gland cells. Although non-measurable solubility of AuNPs in seawater was found, evidence is presented of the toxicity produced by Au(3+) dissolved species (chloroauric acid solutions) and its relevance is discussed.

Suitability of the marine prosobranch snail Hydrobia ulvae for sediment toxicity assessment: A case study with the anionic surfactant linear alkylbenzene sulphonate (LAS).

Individuals of the mudsnail Hydrobia ulvae (Pennant) (Mollusca: Prosobranchia) were exposed to sediments spiked with increasing concentrations (1.59-123.13mgkg(-1) dry weight) of the anionic surfactant linear alkylbenzene sulphonate (LAS) which is employed in the formulation of laundry powders and liquids, as well as hand dishwashing products. The suitability of the selected organism, H. ulvae for routine sediment toxicity testing was evaluated by measuring acute toxicity recording survival. Sublethal toxicity was evaluated as total number of produced veliger larvae per treatment throughout the test (9d). Mortality has shown to be a reliable and reproducible indicator of acute toxicity. LC(50) values were comprised between 203.4 (48h) and 94.3mgkg(-1) (9d) dry weight. As sublethal endpoint, the total number of produced larvae showed to be a useful indicator of toxicity for this organism. The number of produced larvae increased at lower exposure concentrations, whereas at the highest LAS concentration, the number of produced larvae decreased. This is the first report of acute and sublethal toxicity of sediment associated LAS for this species.

Environmental levels of Linear alkylbenzene Sulfonates (LAS) in sediments from the Tagus estuary (Portugal): environmental implications.

Sediments from the Tagus estuary (Portugal) were collected at 40 stations in July and December 2004. Total LAS concentrations ranged between 0.03 and 17.76 mg LAS.kg(-1) dry weight in July, and between 0.09 and 9.57 mg LAS.kg(-1) in December. Highest LAS concentrations were found at the upper northern part of the estuary, coincident with the localisation of an important waste water treatment station. According to the Predicted No Effect Concentration (PNEC) of 8.1 mg.kg(-1) derived for this compound, Environmental Risk Assessment (ERA) identified a hazard for the ecosystem at the station with the highest LAS concentration, and similar results are obtained by Equilibrium Partitioning Method (EPM). Nevertheless, LAS concentrations decreased significantly between samplings in the stations with the highest LAS concentrations in July, whereas increased LAS concentrations at adjacent stations were found in December. In the remaining stations, LAS concentrations were up to three orders of magnitude lower, representing no hazard for the sediment community.

Effects of sediment sorbed linear alkylbenzene sulphonate on juveniles of the Senegal sole, Solea senegalensis: toxicity and histological indicators.

Many synthetic organic substances, including surfactants, tend to be sorbed on suspended solids and to accumulate finally on bottom sediments, where benthic communities may be exposed to them. Concentrations of Linear Alkylbenzene Sulphonates (LAS) have been detected in estuarine and coastal sediments, presenting wide concentration ranges depending on the presence of treatment facilities, hydrodynamic conditions, organic matter content etc. Senegal sole, Solea senegalensis, larvae (40 days posthatching; dph) were exposed to increasing concentrations of LAS spiked sediments, comprised between 0.37 and 880.78 mg LAS x kg(-1) during 30 days. The obtained results showed that survival of exposed larvae was not significantly affected at environmentally relevant concentrations, the LC50 value being obtained after 30 days 876.46 mg x kg(-1). However, the histological and histopathological analyses carried out in target organs revealed, that first alterations from the normal pattern were observed at concentrations of 222.66 mg x kg(-1), presenting effects such as blood extravasation and hyperplasy of the lamellar epithelium in gills, increase of inter-myotomal spaces of the skeletal musculature and edematous separation of the skin from epidermis. At the highest exposure concentrations (755.27 and 880.78 mg LAS x kg(-1)), shrinkage of hepatocytes, nuclear pycnosis and blood stagnation are observed in the liver, degeneration of pancreatic cells, reduction of hemocytopoietic tissue in the kidney and vacuolisation of intestinal enterocytes was observed at histological level, as well as severe separation of the epidermis from the underlying tissues. Simultaneously, a significant increase of the wet weight with exposure concentration was observed in the test organisms.

Derivation of predicted no effect concentrations (PNEC) for marine environmental risk assessment: application of different approaches to the model contaminant Linear Alkylbenzene Sulphonates (LAS) in a site-specific environment.

Four sediment-dwelling marine organisms were exposed to sediments spiked with increasing concentrations of Linear Alkylbenzene Sulphonate (LAS). The selected endpoint mortality was reported daily and acute LC(50) (96 h), as well as final LC(10) values were calculated for the derivation of environmentally safe predicted no effect concentrations (PNEC) for the sediment compartment. PNECs were estimated by both application of assessment factors (AF) and the equilibrium partitioning method (EPM) as proposed by the EU TGD. Finally, environmental risk assessment in a site-specific environment, the Sancti Petri Channel, South Iberian Peninsula, was carried out at three different sampling stations with known environmental LAS concentrations. PNECs obtained by the assessment factor approach with acute toxicity data were one to two orders of magnitude lower than those from the equilibrium partitioning method. On the other hand, when applying lower AFs to the estimated LC(10) values, the PNECs obtained by both approaches were more similar. Environmental risk assessment carried out with the estimated PNECs in a site specific environment with known sediment LAS concentrations revealed that PNECs obtained with acute toxicity data were over conservative whereas those obtained with AF=10 on LC(10) data and EPM produced more realistic results in accordance with field observations carried out in the study area.

Sublethal effects of linear alkylbenzene sulphonate on larvae of the seabream (Sparus aurata): histological approach.

Neonate (< 24 h) larvae of the seabream, Sparus aurata, were exposed to sublethal concentrations (0.1-1.0 mg x L(-1)) of the anionic surfactant Linear Alkyl-benzene Sulphonate (LAS) for 72 h under laboratory conditions. The first histopathological changes, such as peri-yolk sac edema, were observed at concentrations of 0.2 mg x L(-1). Higher exposure concentrations provoked disorganisation of the nervous system, trunk musculature and trophoblastic sincitium as well as in the digestive epithelium. Immunohystochemical CYP1A analysis, however, was not shown to be an adequate indicator of sublethal effects produced by exposure to this type of anionic surfactant

Sediment toxicity tests using benthic marine microalgae Cylindrotheca closterium (Ehremberg) Lewin and Reimann (Bacillariophyceae).

A new method for sediment toxicity testing using marine benthic pennate noncolonial diatom (Cylindrotheca closterium, formerly Nitzschia closterium) has been developed. This microalgae showed a good growth rate during the experimental period, even when low enriched media were used. Sediment spiked with heavy metals [cadmium (Cd), copper (Cu), and lead (Pb)] was employed to determine the EC(50) values, using microalgal growth inhibition as the endpoint. The obtained results were as follows: Three heavy metals (Cd, Cu, and Pb), previously spiked on experimental sediment, were separately assayed in toxicity tests. The EC(50) values for these heavy metals in microalgal growth inhibition tests resulted to be 79 mg kg(-1) for Cd, 26 mg kg(-1) for Cu, and 29 mg kg(-1) for Pb (in experimental sediment). The influence of sediment granulometry on the growth of microalgal population was also studied, finding that the growth of the microalgal population on media containing sediment with a relation sand-size:silt size of 9:1 was not different from optimal growth (occurring in media containing 100% sand-sized sediment). The diatom C. closterium proved to be a suitable organism for sediment toxicity tests, due to its sensitivity and fast growth even in poorly enriched media.

Toxicity of linear alkylbenzene sulfonate and one long-chain degradation intermediate, sulfophenyl carboxylic acid on early life-stages of seabream (sparus aurata).

Seabream embryos (Sparus aurata) were exposed to various concentrations (0.05 to 10.0 mg L-1) of different homologues (C10 to C14) and a commercial mixture of linear alkylbenzene sulfonates (LAS), as well as one long-chain degradation intermediate, sulfophenyl carboxylic acid (SPC C11), to study the acute toxicity of these compounds. LAS homologues of higher chain length (C13 and C14) were proved to be more toxic than shorter species (C10, C11, and C12). LAS C13 and C14 provoked 100% lethality at concentrations of 0.1-0.25 mg L-1. On the other hand, shorter LAS homologues (chain length) did not produce any lethal effect at concentrations up to 5 mg L-1. In this work, results on the toxicity of a long-chain degradation intermediate of LAS, SPC C11, are presented. This compound did not produce any mortality at all the concentration ranges chosen.

Can early life-stages of the marine fish Sparus aurata be useful for the evaluation of the toxicity of linear alkylbenzene sulphonates homologues (LAS C10-C14) and commercial LAS?

Most commercial household cleaning agents and personal care products contain the anionic surfactant linear alkylbenzene sulphonates (LAS) as the active compound. After their use they are discharged, theoretically after adequate wastewater treatment, into receiving waters finally reaching estuaries and coastal waters. Laboratory toxicity tests are useful tools in determining at which concentration a certain wastewater compound becomes hazardous for an existing group of organisms. Early life-stage toxicity tests include exposure during the most sensitive development period of the organism. In fish, this type of assay has shown to predict accurately maximum acceptable toxicant concentration (MATC) values (comprised in the range defined by the NOEC and LOEC) in fish early life-stage tests. For this reason, larvae of the seabream, Sparus aurata, were exposed to increasing concentrations of LAS homologues (C10-C14) and commercial LAS. Obtained LC50 values ranged between 0.1 and 3.0 mg l(-1) and were compared with LC50 values of previous hatching experiments with the same species. Larvae proved to be more sensitive to LAS exposure of individual homologues than eggs, except in the case of commercial LAS. LC50 values can be directly employed to determine their potential risk in a concrete environment with known pollutant concentrations. Dividing the LC50 value with the found homologue concentration and extrapolating with certain security factors proposed by different environmental organisms, potentially hazardous pollutant concentrations may be detected. Average estuarine or coastal LAS concentrations are generally below toxicity limits for this kind of organism, considering that the average alkyl chain length of commercial LAS is 11.6 carbon atoms.

Acute toxicity of LAS homologues in marine microalgae: esterase activity and inhibition growth as endpoints of toxicity.

The toxicity of two linear alkylbenzene sulfonate (LAS) homologues (C(10) and C(13)) was evaluated in four marine microalgae (Nannochloropsis gaditana, Tetraselmis suecica, Rhodomonas salina, and Isocrysis galbana), using growth inhibition rate and esterase activity (measured by flow cytometry) as endpoints. The inhibitor effect was higher for the C(13) LAS homologue than for C(11), in both responses analyzed. When both endpoints were compared, the growth inhibition rate was between 2 and 5 times more sensitive than esterase activity. Among microalgae species, R. salina exhibited the highest sensitivity.

Marine microalgae toxicity test for linear alkylbenzene sulfonate (LAS) and alkylphenol ethoxylate (APEO).

Different microalgal species have been used in growth-inhibition tests to determine the toxic concentrations of anionic and non-ionic surfactants to phytoplankton. The species used were selected from different taxonomic groups, all of considerable ecological relevance to marine environments. The toxicity of the C13 LAS homologue to the microalgal species selected was usually one order of magnitude greater than that of the C11 homologue. The toxicity of a commercial LAS mixture to different microalgal species was also checked. For this material and C. gracilis, cellular counting by means of a Neubauer chamber and by use of a flow cytometer were compared; differences between the two methods were insignificant. The toxicity of decaethoxylated nonylphenol non-ionic surfactant to C. gracilis was also checked; the EC50 value for this compound was 1.0 mg L(-1).

Assessing quality in nursing home dementia special care units: a pilot test of the Joint Commission protocol.

Dementia is a serious and growing public health problem in the United States. Nearly 60% of nursing home residents are estimated to be cognitively impaired. Currently about 10% of nursing homes have special care units for residents with serious dementia including Alzheimer's disease. This research evaluates a protocol developed by the Joint Commission on Accrediation of Healthcare Organizations to assess the capability of special care units to provide quality care. The protocol was pilot tested through the use of two separate evaluations of diverse special care units in metropolitan Chicago. In comparing the two separate surveys from each site, data analysis revealed a high rate of correlation between these two evaluations at three distinct levels. The standards used, their intent, and the survey process were considered sound by those who tested the protocol and by those who were evaluated by it.

The levels of corticosterone-binding proteins in rat milk and coincidental serum, and the dissociation rates of the corticosterone.protein complexes.

The corticosterone-binding protein present in rat whey was further characterized by determining, with the aid of a dextran-coated charcoal procedure, the apparent rate of dissociation of the corticosterone.protein complex. The half-time values for the dissociation of the corticosterone.protein complexes in rat whey and serum were compared and found to be identical, i.e. 23 min at 0 C, when the measurements were made over a period of 40 min. The possible presence in small amounts of a corticosterone.protein complex in whey with the much slower dissociation rate characteristic of mammary glucocorticoid receptor could not be detected even when the dissociation was followed over a much longer period. The charcoal adsorption method also provided independent estimates of the molar concentrations of the corticosterone-binding proteins in rat serum and whey. The mean concentration of corticosterone-binding protein in whey was found to be 15% of that in coincidental serum during early lactation. The serum levels of corticosterone-binding protein decline markedly at parturition and then rise from day 2 to day 6 of lactation in rats with small litters. The results of this and a previous study suggest that the corticosterone-binding protein in whey is probably derived from that in serum. The mode of transport of the corticosterone-binding protein from the bloodstream across the mammary epithelium into milk as well as the concentrations of the corticosterone-binding proteins in serum and whey may be factors influencing the uptake of the glucocorticoid by its target cells.