Listeria monocytogenes in ready-to-eat (RTE) delicatessen foods: Prevalence, genomic characterization of isolates and growth potential.

This study investigated Listeria monocytogenes prevalence and count in 132 ready-to-eat (RTE) delicatessen samples belonging to different categories (starters with/without mayonnaise pasta/rice-based courses, meat/fish-based main courses) produced by an Italian industry. Whole Genome Sequencing characterized the isolates to map the pathogen circulation. Moreover, the growth potential of L. monocytogenes in the most contaminated product was investigated by a challenge test. L. monocytogenes was detected in 23 samples, giving an estimated prevalence of 17.4 %. Starters with mayonnaise showed a very high prevalence (56.7 %), showing the role of the sauce in the diffusion of the pathogen within the plant. A total of 49 isolates were obtained; they belonged to two different serogroups, IIb and IIa, and were related to two clonal complexes (CCs) and sequence types (STs) (CC288-ST330 and CC121-ST717), suggesting the possible persistence and circulation of the pathogen within the plant. The results of the challenge test showed a limited ability to grow in the selected product thanks to the presence of lactic microflora.

Postmortem PF4 antibodies confirm a rare case of thrombosis thrombocytopenia syndrome associated with ChAdOx1 nCoV-19 anti-COVID vaccination.

We report a case of cerebral venous sinus thrombosis, bilateral adrenal hemorrhage, and thrombocytopenia in a 70-year-old man found dead. He had previously received the ChAdOx1 nCoV-19 vaccine (Vaxzevria®, AstraZeneca) 18 days before, and had since developed unspecific and undiagnosed characteristics of what proved to be a rare case of vaccine-associated thrombocytopenia with thrombosis syndrome (TTS). He was found dead 1 week after the beginning of symptoms (day 25 post-vaccine). Autopsy yielded venous hemorrhagic infarction with the presence of thrombi within dural venous sinuses, and extensive hemorrhagic necrosis of the central part of the adrenal glands. Antibodies against platelet factor 4 (PF4) were strongly positive in postmortem fluids, as measured with an enzyme-linked immunosorbent assay (ELISA). This difficult diagnosis is usually made during the patient's lifetime. After eliminating differential diagnoses, we concluded on a fatal case of vaccine-induced immune TTS with positive anti-PF4 antibodies in cadaveric blood, 3 weeks after ChAdOx1 nCoV-19 vaccination. Specific search for anti-PF4 antibodies in cadaveric blood appears therefore paramount to assess postmortem cases of TTS associated with anti-COVID vaccines.

Piloting an ICU follow-up clinic to improve health-related quality of life in ICU survivors after a prolonged intensive care stay (PINA): study protocol for a pilot randomised controlled trial.

BACKGROUND: Intensive care unit (ICU) survivors often suffer from cognitive, physical and mental impairments, known as post-intensive care syndrome (PICS). ICU follow-up clinics may improve aftercare of these patients. There is a lack of evidence whether or which concept of an ICU follow-up clinic is effective. Within the PINA study, a concept for an ICU follow-up clinic was developed and will be tested in a pilot randomised controlled trial (RCT), primarily to evaluate the feasibility and additionally the potential efficacy. METHODS/DESIGN: Design: Pilot RCT with intervention and control (usual care) arms plus mixed-methods process evaluation. PARTICIPANTS: 100 ICU patients (50 per arm) of three ICUs in a university hospital (Regensburg, Germany), ≥ 18 years with an ICU stay of > 5 days, a sequential organ failure assessment (SOFA) score > 5 during the ICU stay and a life expectancy of more than 6 months. INTERVENTION: The intervention will contain three components: information, consultation and networking. Information will be available in form of an intensive care guide for patients and next of kin at the ICU and phone support during follow-up. For consultation, patients will visit the ICU follow-up clinic at least once during the first 6 months after discharge from ICU. During these visits, patients will be screened for symptoms of PICS and, if required, referred to specialists for further treatment. The networking part (e.g. special referral letter from the ICU follow-up clinic) aims to provide a network of outpatient care providers for former ICU patients. Feasibility Outcomes: Qualitative and quantitative evaluation will be used to explore reasons for non-participation and the intervention´s acceptability to patients and caregivers. Efficacy Outcomes: Health-related quality of life (HRQOL) will be assessed as primary outcome by the physical component score (PCS) of the Short-Form 12 Questionnaire (SF-12). Secondary outcomes encompass further patient-reported outcomes. All outcomes are assessed at 6 months after discharge from ICU. DISCUSSION: The PINA study will determine feasibility and potential efficacy of a complex intervention in a pilot RCT to enhance follow-up care of ICU survivors. The pilot study is an important step for further studies in the field of ICU aftercare and especially for the implementation of a pragmatic multi-centre RCT. TRIAL REGISTRATION: ClinicalTrials.gov , NCT04186468 . Submitted 2 December 2019.

Growth of Listeria monocytogenes in ready-to-eat "shrimp cocktail": Risk assessment and possible preventive interventions.

The present study investigated the presence, growth potential, and public health risk posed by Listeria monocytogenes in a ready-to-eat "shrimp cocktail". The pathogen was detected in 4 out of the 104 samples, and there were no counts above the enumeration limit (1 Log colony-forming unit (CFU)/g); the product was a suitable substrate for pathogen growth owing to its chemical/physical properties. A stochastic quantitative microbial risk assessment (QMRA) was performed to estimate the expected number of invasive listeriosis cases caused by the consumption of 10,000 servings of the product on the last day of its shelf life, considering a population comprising healthy consumers, those susceptible, and transplant recipients. The model predicted no cases for this scenario. Uncertainties were included by considering alternative scenarios; even when considering an increased mean bacterial concentration (up to 3-4 Log CFU/g), no cases were estimated. Following a producer's demand, the exposure assessment model was also used to estimate the probability of the product exceeding the threshold of 2 log CFU/g during the shelf life. The possibility of Listeria growth in the product could not be avoided. Therefore, a modification of the production process was tested to re-classify the product as unsuitable for Listeria growth (EC Reg. 2073/2005). The shrimps were conditioned in three different organic acid solutions comprising: acetic acid (1500 ppm) (A); benzoic acid (1500 ppm) + acetic acid (500 ppm) + lactic acid (750 ppm) (BLA); and lactic acid (4500 ppm) + sodium acetate (2500 ppm) (LSA). Testing was conducted over various treatment durations (1 day-5 days). Treatment for 2 days in the LSA solution was selected based on efficacy, the absence of consumer-perceptible sensorial modifications, and the producers' production rate requirements. The concentration of L. monocytogenes decreased when the new process was applied, which confirmed the usefulness and effectiveness of the treatment relative to the traditional process. Thus, the product obtained by the modified production process did not support the growth of L. monocytogenes.

Potential growth of Listeria monocytogenes in Italian mozzarella cheese as affected by microbiological and chemical-physical environment.

In the present study, 33 brands of mozzarella cheese (pasteurized cow milk mozzarella obtained by direct acidification through the addition of food-grade citric acid or obtained by natural acidification through the addition of thermophilic starter cultures, mozzarella for pizza mainly obtained by addition of citric acid, and pasteurized buffalo milk mozzarella obtained by adding microbial rennet) were characterized for the factors potentially influencing the growth of Listeria monocytogenes (microbial populations, moisture, pH, and organic acids). Then, the growth potential of L. monocytogenes in mozzarella was investigated by challenge tests performed at different temperatures. The presence of heterogeneous microflora (lactobacilli, streptococci, Pseudomonas spp., and, for buffalo mozzarella, yeasts) was evidenced. Almost all the product typologies were classified as high-moisture mozzarella cheese because moisture was >52%. Moreover, pH varied from 5.32 to 6.43 depending on the manufacturing methodology applied. Organic acid concentrations too showed great variability depending on the mozzarella production method, with values ranging from less than limit of detection (LOD; 16 mg/kg) to 14,709 mg/kg, less than LOD (216 mg/kg) to 29,195 mg/kg, and less than LOD (47 mg/kg) to 1,725 mg/kg in the water phase of lactic, citric, and acetic acids, respectively. Despite this presence, the concentration of undissociated acids was lower compared with the minimum inhibitory concentrations estimated for L. monocytogenes by other authors. This was confirmed by the results of the challenge tests conducted inoculating the pathogen in mozzarella produced with the addition of citric acid, as the microorganism grew fast at each temperature considered (4, 9, 15, and 20°C). Good hygiene practices should be strictly applied, especially with the aim of avoiding postproduction contamination of mozzarella, as the presence of organic acids and microflora is insufficient to prevent L. monocytogenes growth.

Effect of dairy product environment on the growth of Bacillus cereus.

pH is one of the most important parameters to manage bacterial replication in foodstuffs. In this study, the ability of 2 Bacillus cereus strains, 1 clinical human isolate (GPe2) and 1 isolate from a dairy product (D43), were investigated for in vitro growth at different pH values (from 3.5 to 7.5) at 2 temperatures (15 and 37°C), showing their ability to grow from 5.5 to 7.5 and from 5.0 to 7.5, respectively. The ability of spores of these 2 microorganisms to germinate in different typologies of dairy products (unflavored yogurt, Taleggio cheese, mascarpone cheese, and raw and pasteurized milk) was also investigated by inoculating the spores and maintaining the products at 15°C. No growth was observed in yogurt, likely due to the combined effect of low pH (<5) and the presence of natural microflora. An inhibitory action of the natural microflora on the growth of B. cereus was also hypothesized for Taleggio cheese and raw milk, as these substrates were characterized by a high natural lactic acid bacteria population and permissive pH values (5.8/6.8 in Taleggio cheese, >7 in raw milk). In pasteurized milk and mascarpone cheese, where pH was not restrictive for B. cereus growth and where no significant natural microflora was present, growth occurred rapidly up to loads close to 7 log cfu/g.

Former food products safety: microbiological quality and computer vision evaluation of packaging remnants contamination.

The use of alternative feed ingredients in farm animal's diets can be an interesting choice from several standpoints, including safety. In this respect, this study investigated the safety features of selected former food products (FFPs) intended for animal nutrition produced in the framework of the IZS PLV 06/14 RC project by an FFP processing plant. Six FFP samples, both mash and pelleted, were analysed for the enumeration of total viable count (TVC) (ISO 4833), Enterobacteriaceae (ISO 21528-1), Escherichia coli (ISO 16649-1), coagulase-positive Staphylococci (CPS) (ISO 6888), presumptive Bacillus cereus and its spores (ISO 7932), sulphite-reducing Clostridia (ISO 7937), yeasts and moulds (ISO 21527-1), and the presence in 25 g of Salmonella spp. (ISO 6579). On the same samples, the presence of undesired ingredients, which can be identified as remnants of packaging materials, was evaluated by two different methods: stereomicroscopy according to published methods; and stereomicroscopy coupled with a computer vision system (IRIS Visual Analyzer VA400). All FFPs analysed were safe from a microbiological point of view. TVC was limited and Salmonella was always absent. When remnants of packaging materials were considered, the contamination level was below 0.08% (w/w). Of note, packaging remnants were found mainly from the 1-mm sieve mesh fractions. Finally, the innovative computer vision system demonstrated the possibility of rapid detection for the presence of packaging remnants in FFPs when combined with a stereomicroscope. In conclusion, the FFPs analysed in the present study can be considered safe, even though some improvements in FFP processing in the feeding plant can be useful in further reducing their microbial loads and impurity.

Microbiological shelf life at different temperatures and fate of Listeria monocytogenes and Escherichia coli inoculated in unflavored and strawberry yogurts.

Three different trials were performed on unflavored and strawberry yogurts produced in a small-scale dairy plant. In the first trial, the microbiological shelf life of the products was evaluated at 4, 8, and 20°C. At 4°C the product showed low total viable counts until the end of the trial (d 35=3.0±0.7 and 1.5±0.0 log cfu/g in unflavored and strawberry yogurt, respectively). The loads were lower in strawberry yogurt at 4°C compared with unflavored yogurt because of the antimicrobial activity exerted by potassium sorbate present in the fruit puree added. Yeasts were confirmed to be the specific spoilage agents of this product, reaching rapidly high loads with thermal abuse (5.9-7.4 log cfu/g at d 18). In the second trial, Escherichia coli and especially Listeria monocytogenes added at 2 concentrations (2 and 5 log cfu/g) showed a rapid decrease in both types thanks to the acidic conditions provided by the products, but L. monocytogenes was very resistant; its presence was always detected until the end of the period considered (d 68). In the third trial, no statistically significant differences were detected between wild and acid-adapted strains of L. monocytogenes added to the products, due to the quick adaptation that probably occurred after inoculation.

Complications in thyroid resurgery: a single institutional experience on 233 patients from a whole series of 4,752 homogeneously treated patients.

The aim of this study was to examine a homogeneous, consecutive recent series of patients who underwent reoperation on the thyroid bed to assess the incidence of the complications commonly correlated with resurgery. We reviewed clinical charts of 233 patients who underwent resurgery taken from a total of 4,752 patients previously operated on for benign and malignant thyroid diseases from 2006 to 2010 by the same surgical team. We evaluated the incidence of postoperative hemorrhage, hypoparathyroidism, and recurrent laryngeal nerve (RLN) palsy. Analyses were done separately in relation to the type of the type of resurgery adopted: (A) monolateral completion; (B) bilateral completion, after monolateral (B1) or bilateral prior surgery (B2); and (C) lymph node dissection. We also separately analyzed patients according to their final histological diagnosis of benign or malignant disease. Regarding hemorrhage, 6/233 patients (2.5 %) underwent surgical revision of the thyroid within 12 h for postoperative hemorrhage. They included 2 (1.5 %) of the 129 monolateral reoperations (A), 3 (4 %) of the 74 bilateral reoperations (B), and 1 (3.3 %) of the 30 central dissections for nodal relapse (C). Transient and definitive postoperative hypoparathyroidism was recorded in 78 (36.4 %) and 7 (3.3 %) of the 214 eligible patients. Transient RLN palsy occurred in 21 RLNs at risk (7 %) and definitive RLN palsy in 5 (1.7 %). Elective total thyroidectomy cannot always be supported as an effective policy for preventing recurrences in patients with a single, benign node: lobectomy, preferably with extemporaneous histological examination, unquestionably represents the best minimal approach to thyroid resection.

Analgesia pós-operatória com metadona em gatos: administração epidural e intramuscular / Postoperative analgesia of methadone in cats: epidural and intramuscular administration

Compararam-se os efeitos analgésico, sedativo e neuroendócrino decorrentes da administração epidural e intramuscular da metadona em gatas submetidas à ovariossalpingoisterectomia (OSH). Todos os animais foram tranquilizados com acepromazina, 0,1mg kg-1 IM, seguindo-se a indução e manutenção anestésica com tiopental sódico, 12mg kg-1 IV, e halotano, respectivamente. Após a estabilização anestésica, os animais foram distribuídos em três grupos, com oito animais cada, tratados com metadona pela via epidural (EP) ou intramuscular (IM) 0,2mg kg-1, respectivamente, ou com solução salina (S) 0,2mL kg-1. Foram avaliados: graus de analgesia e de sedação, necessidade de analgesia de resgate, efeitos adversos e concentração sérica de cortisol. Os graus de analgesia e de sedação e o cortisol não diferiram entre os tratamentos. Analgesia de resgate foi administrada quatro, nove e 11 vezes nos tratamentos EP, IM e S, respectivamente. Nos tratamentos IM e S, a suplementação analgésica foi necessária a partir da primeira hora pós-cirúrgica, enquanto no tratamento EP, somente a partir da terceira hora após a OSH. Conclui-se que a administração de metadona pela via epidural resulta em menor quantidade do analgésico pós-operatório, e que a analgesia é mais prolongada quando comparada à obtida pela via intramuscular, em gatas submetidas à OSH.

The aim of this study was to investigate the analgesic, sedative and neuroendocrine effects of epidural (EP) and intramuscular (IM) methadone in cats submitted to ovariohysterectomy. The pre-anesthetic medication was acepromazine (0.1mg kg-1, IM) followed by induction of anesthesia with intravenous thiopental, 12mg kg-1, and anesthesia maintenance with halothane. After anesthesia stabilization the cats were randomly assigned to three groups of eight animals each and received EP or IM methadone, 0.2mg kg-1 diluted with saline to 0.2mL kg-1, EP and IM, respectively, or a saline placebo (S), 0.2mL kg-1. Pain measurements, degree of sedation, rescue analgesia requirements, adverse effects and serum cortisol concentration were recorded. Cortisol, pain and sedation scores did not differ among the groups. Rescue analgesia was administered 4, 9 and 11 times in the EP, IM and S treatment, respectively. In the IM and S rescue analgesia treatments were required early (first hour postoperative), whereas in the EP treatment, additional analgesics were required after the third hour postoperative. In conclusion, methadone epidural reduced the postoperative analgesic requirements and produced longer analgesia when compared to intramuscular administration in cats undergoing ovariohysterectomy.

Gluten-free bread formulated with Prosopis ruscifolia (vinal) seed and corn flours.

Vinal (Prosopis ruscifolia) is a wild leguminous tree found widely in the north of Argentina. Like other Prosopis, vinal can grow under extreme temperatures, in poor soils and can tolerate high saline conditions. Taking into account the high protein and gums contents of vinal seeds, a gluten-free bread was developed including them and corn flour. A central composite design involving vinal seed flour/corn starch ratio (X1) and corn flour/corn starch ratio (X2) was used, and second-order models for specific volume (Y1) and bread score (Y2), evaluated by an expert panel, were employed to generate response surfaces. In the optimum zone of response surfaces, a product with higher protein content (5.2 g/100 g) than gluten-free breads found in local commercial markets was obtained. Also, an interesting antioxidant activity (115 mg ascorbic acid equivalent/100 g) was found in optimized gluten-free bread.

Lumbar spinal osteoblastoma mimicking a dumbbell radicular schwannoma.

Spinal dumbbell tumors originate from nerve roots, usually growing within the spinal canal, the neural foramen and the extraforaminal compartment in the paraspinal region. We report a case of a 20-year-old man who presented with back pain radiating to his left lower limb mostly when in a supine position. Magnetic resonance imaging of the lumbar spine showed a dumbbell lesion at the L5-S1 neural foramen, with enlargement of the foramen and extension into the left paraspinal compartment. Although MR imaging studies were strongly suggestive of a dumbbell radicular schwannoma, the histological diagnosis was an osteoblastoma of the lumbar spine originating from the left L5 pedicle with intracanalicular, intraforaminal and extracanalicular extension. The presentation, imaging studies, intervention, pathology and differential diagnosis are described.

Transcriptional profiles in melanocytes from clinically unaffected skin distinguish the neoplastic growth pattern in patients with melanoma.

BACKGROUND: It is generally accepted that sunlight may contribute to the development of melanoma. OBJECTIVES: To analyse gene expression of melanocytes obtained from clinically unaffected skin of patients with melanoma and healthy controls before and after exposure to ultraviolet B radiation. METHODS: Using GeneChip array technology, the gene expression of melanocytes obtained from the two donor groups was profiled, in order to identify transcriptional differences affecting susceptibility to melanoma. RESULTS: The data collected did not show any difference between the expression profiles of melanocytes purified from normal donors and from patients with melanoma that was able to give a statistically significant class separation. However, by means of unsupervised clustering our data could be divided into two main classes. The first class included the transcriptome profiles of melanocytes obtained from skin samples of patients with a vertical growth phase (VGP) melanoma, while the second class included the transcriptome profiles of melanocytes obtained from skin samples of patients with a radial growth phase (RGP) melanoma. CONCLUSIONS: These data suggest that melanocytes in patients with VGP and RGP melanomas show significant differences in gene expression profiles, which allow us to classify patients with melanoma also from clinically unaffected skin.

New thymidylate synthase inhibitors induce apoptosis in melanoma cell lines.

Malignant melanoma is particularly resistant to conventional chemotherapy and radiotherapy. For this reason in the past years a huge variety of new compounds has been developed with potential chemotherapeutic activity which needs to be tested in vitro and in vivo. We investigated the in vitro action of three new experimental antifolate substances (MR7, MR21 and MR36) with a critical target for thymidylate synthase (TS), an essential enzyme for DNA synthesis. The response of two melanoma cell lines (SK-MEL-2 derived from malignant melanoma metastasis and SK-MEL-28 derived from primary malignant melanoma) was examined after treatment with these substances. The antifolate agents induced apoptosis in SK-MEL-2 and SK-MEL-28 cells as confirmed by the TUNEL technique and Comet Assay. Western-blot analysis showed a down-regulation of Bcl-2 protein level and PARP cleavage, otherwise p53 and Bax expressions were not modulated. Moreover, these antifolate-induced apoptosis was accompanied by both pro-caspase-9 and -8 activations. These results were supported by the use of the pan-caspases inhibitor Z-VAD-FMK that almost completely decreased the amount of apoptosis in both the melanoma cell lines treated with antifolate. In conclusion our results show that TS inhibitors are able to induce apoptosis through a caspase-mediated pathway, but without the involvement of the p53/Bax signalling.

Formulation and sensory evaluation of Prosopis alba (Algarrobo) pulp cookies with increased iron and calcium dialyzabilities.

Prosopis alba (algarrobo) is an important indigenous specie, which fruits are used as food and feed since ancient times. Cookies containing algarrobo pulp (AP) with increased iron and calcium availabilities were formulated and sensory evaluated. AP is preferred as food ingredient because of its high sugar content and pleasant flavour. Formulated cookies mean proximal composition was 8.9 g/100 g protein, 7.2 g/100 g dietary fiber, 25 g/100 g total sugar, and 18.5 g/100 g crude fat with iron and calcium contents 30 ppm and 340 ppm, respectively. Ascorbic (AA) and citric (CA) acids at different mM acid: mM Fe were added in order to increase mineral availabilities being evaluated by an in vitro method. Those ratios were 5:1 and 10:1 for AA:Fe whereas for CA:Fe were 50:1 and 100:1 and combinations of them. After chosen the best AA:Fe and CA:Fe ratios (5:1 and 50:1, respectively), sensory evaluation with trained sensory panel and a consumer acceptability test with one hundred and seventy untrained judges were carried out. Acceptability test showed that 77.65% of the people (< 25 years old 41.76%, 25-50 years old 20.00% and > 50 years old 15.89%) tasting final formulated cookies indicated that they "like very much" or "moderately like" and there were not consumers rejecting them.

[Farmacoeconomic impact of anti-TNF-alpha]. / Impatto farmacoeconomico degli anti-TNF-alpha.

The anti-TNF-alpha are undoubtedly an efficacious cure in the treatment of rheumatoid arthritis, but their costs are so high that a thorough pharmacoeconomical evaluation is needed in order to identify the specific conditions in which their use is to be considered convenient. For this reason there are related the most important experiences that have studied the cost-efficacy and cost-utility relationships of anti-TNF-alpha drugs, which have been made marketable in Italy. The data available, unfortunately, are too various to allow a final settlement of the chart of convenience between the different therapeutic alternatives. Moreover the socio-medical reality in Italy is so much different from the ones in other countries that it is impossible to try and use the foreign experiences. In a country of high social commitment like Italy, a fair judgment can thereafter be made only when the issue is considered related to our society, taking in account the summation of the medical costs endured by the National Health System, the patient's expenses and the ones that are a consequence of the loss of productivity.

Use of ascorbic and citric acids to increase dialyzable iron from vinal (Prosopis ruscifolia) pulp.

Vinal (Prosopis ruscifolia) is an ecologically important wild leguminous tree that grows spontaneously in Argentine deforested lands, the fruit of which is consumed by humans and animals. Because considerable iron content with low to intermediate availability has been previously reported in vinal pulps, its enhancement would be of interest. Iron availability was determined as iron dialyzability using an in vitro technique. Response surface methodology was used to evaluate iron availability increase after adding ascorbic and/or citric acids to vinal pulp at different mM acid/mM Fe ratios. Those ratios ranged from 0.05:1 to 9.95:1 and from 0.5:1 to 99.5:1 for ascorbic acid/Fe (AA:Fe) and citric acid/Fe (CA:Fe), respectively. The obtained second- and first-order polynomial equations showed that AA:Fe and CA:Fe molar ratios linear terms had a significant effect on iron dialyzability increase (P < or = 0.05). It was possible to enhance iron availability to a maximum of 4.6 times. Additional confirmatory experiments were made adding the same organic acids to different vinal pulps and to a traditional cake prepared with vinal pulp called "patay." There were no significant differences (p > 0.05) between predicted values obtained by the model and experimental results.

Geostatistics as a tool to improve sampling and statistical analysis in wetlands: a case sudy on dynamics of organic matter distribution in the Pantanal of Mato Grosso, Brazil

The Pantanal of Mato Grosso presents distinct landscape units: permanently, occasionally and periodically flooded areas. In the last ones, sampling is especially difficult due to the high heterogeneity occurring inter and intrastratas. This paper presents a comparison of different methodological approaches showing that they can influence decisively the knowledge of distribution organic matter dynamics. In such an area in order to understand the role of the flood pulse in the distribution dynamics of organic matter in a wetland at the Pantanal, we considered that there is spatial dependence between points. This consideration contradicts the classical statistic principle that focuses on the aleatority, and allowed the obtainment of a larger volume of information from a minor sampling effort, which means better performance, with time and money economy

Bone alterations in patients with idiopathic hypercalciuria and calcium nephrolithiasis.

OBJECTIVES: To verify whether alterations in bone density and turnover in patients with calcium nephrolithiasis and hypercalciuria are observable in various subgroups of patients divided according to the pathogenesis of the hypercalciuria. METHODS: Seventy patients with calcium nephrolithiasis and idiopathic hypercalciuria, 19 to 64 years old, were assessed for spine and femur mineral metabolism and bone density using a Dexa evaluation system. After a low calcium diet, the subjects were classified into two groups: fasting hypercalciuria (FH, 39 patients) and absorptive hypercalciuria (AH, 31 patients). RESULTS: Only in the patients with FH was the lumbar spine bone density lower than in the controls (P <0.001). Also, only the patients with FH had higher bone alkaline phosphatase and urinary hydroxyproline levels than the control group (P <0.005 and <0.015, respectively). The blood pH levels were lower, even though within the normal range, in the hypercalciuric patients than in the controls (P <0.01). There was a negative correlation between the urinary hydroxyproline level and lumbar spine and femoral neck density in patients with FH (P <0.001 and <0.005, respectively), and the blood pH correlated positively with the lumbar spine bone density. CONCLUSIONS: Altered bone metabolism and overall bone loss were found only in the patients with FH. Overloading of acid valences, perhaps of dietary origin, could be the pathogenic factor responsible.