Carbon and nitrogen isotopic similarity between the endangered Darwin's fox (Lycalopex fulvipes) and sympatric free-ranging dogs in Chiloé Island, Chile.

Darwin's fox is an opportunistic omnivorous predator native to Chile classified as endangered by the IUCN Red List. Habitat use by Darwin's foxes can be negatively affected by the presence of free-ranging dogs that range freely across native and non-native habitats and can be a source of fox mortality. The objective of this study was to analyze the isotopic similarity of Darwin's fox and sympatric free-ranging dogs in Chiloé Island to determine the impact of anthropogenic environmental alterations on wild predators. We use hair samples to characterise and compare their δ13C and δ15N values and to evaluate isotopic similarity and isotope niches overlap. A generalised linear model was used to associate the isotope value with landscape variables (forest cover and vegetation type) and distance to the nearest house. We found no significant differences in δ13C or δ15N values between foxes and dogs, and a marginally significant isotope niche overlap (59.4 %). None of the selected variables at landscape and site scale were related to isotope values. Although our study is not a probe of direct contact between foxes and free-ranging dogs, the high isotopic similarity highlights the risk of pathogen spillover from free-ranging dogs to Darwin's foxes.

A serosurvey for spotted fever group Rickettsia and Coxiella burnetii antibodies in rural dogs and foxes, Chile.

Antibodies against Spotted Fever Group (SFG) Rickettsia and Coxiella burnetii, investigated through indirect antibody immunofluorescence tests, were detected in serum samples from 3.1% and 0% of 358 rural dogs, respectively, and in none of 32 wild foxes tested. SFG Rickettsia seropositive dogs were only detected in the Mountain Desert (8%) and the Steppe-Mediterranean (9%) regions. Exposure in the Mountain Desert, where no ticks and fleas were found on any dog, could correspond to a new SFG Rickettsia sp. recently described in soft ticks or to a related agent. Our survey confirms low endemicity in the country of C. burnetii, as observed in recent serosurveys in humans.

Marked host association and molecular evidence of limited transmission of ticks and fleas between sympatric wild foxes and rural dogs.

Wild and domestic carnivores share ectoparasites, although molecular evidence is lacking. The goals of this study were to describe tick and flea infestation in sympatric free-ranging dogs Canis lupus familiaris (Linnaeus, 1758) (Carnivora: Canidae) and Andean foxes Lycalopex culpaeus (Molina, 1782) (Carnivora: Canidae) and to determine whether interspecific transmission occurs. Fleas and ticks retrieved from 79 foxes and 111 dogs in the human-dominated landscapes of central Chile were identified and a subset of specimens characterized by PCR and amplicon sequencing. Each ectoparasite species was clearly associated with a host: abundance and occurrence of Rhipicephalus sanguineus (Latreille 1806) (Acari: Ixodidae) and Ctenocephalides spp. (Siphonaptera: Pulicidae) were significantly higher in dogs than in foxes, whereas the opposite was true for Amblyomma tigrinum (Koch, 1844) (Acari: Ixodidae) and Pulex irritans (Linnaeus, 1758) (Siphonaptera: Pulicidae). Genetic analyses of a subset of ectoparasites revealed that dogs and foxes shared a limited number of nucleotide sequence types, suggesting that the interspecific transmission of these ectoparasites happens infrequently. Data also indicated that the ecological association and biological cycles of ticks and fleas determine the ectoparasite fauna of sympatric carnivores. In conclusion, our study shows that cross-species transmission should be assessed at a molecular level.

Pregnancy following Mustard or Senning correction of transposition of the great arteries: a retrospective study.

OBJECTIVE: To determine pregnancy outcome in women with atrial switch repair for transposition of the great arteries (TGA) and to compare follow up with a control group of childless women with the same repair. DESIGN: Retrospective cohort study. SETTING: Tertiary care medical centre. POPULATION: About 21 patients compared with 15 controls. METHODS: Review of records from joint cardiac-obstetric clinic 1993-2013. MAIN OUTCOME MEASURES: Occurrence of cardiovascular events: maternal death, heart failure, arrhythmia, thromboembolic events, worsening systemic ventricular function, worsening tricuspid valve regurgitation and newly detected baffle problems. RESULTS: There were 34 pregnancies in 21 women. Mean follow up was 100 months. No deaths or recurrence occurred. Events (few arrhythmias, thromboembolic events and baffle issues) were common in both groups: 13 (62%) patients and eight (53%) controls (P = 0.736). Worsening of ventricular function was similar in both groups: six (29%) patients and four (27%) controls (P = 0.899). Worsening tricuspid regurgitation was more common in patients [11 (52%)] than controls (0)] (P < 0.001). Labour was induced in 76% cases: 32% for cardiac deterioration, 37% to control timing of delivery, and 26% for intrauterine growth restriction. Delivery was vaginal in 84% cases. Median gestational age was 37 (30-40) weeks, median birthweight 2525 g (1460-3530). In all, 38% babies were premature and 38% were small-for-gestational-age. CONCLUSIONS: Cardiac events after atrial repair for TGA are equally common in pregnant women and non-pregnant controls, although worsening tricuspid regurgitation occurs more frequently in pregnancy. Induction of labour is to be expected but vaginal delivery is achievable in most cases. Infants are likely to be premature and small-for-gestational-age. TWEETABLE ABSTRACT: Pregnancy in atrial repair for TGA: cardiac events similar to controls, prematurity and small babies likely.

Coronary artery problems and disease in adults with congenital heart disease: how to evaluate, how to prevent, how to treat.

There are a wide variety of coronary artery anomalies and disease in adults with congenital heart disease (CHD). In fact, the increasing burden of acquired coronary artery disease (CAD) has to be considered in addition to congenital abnormalities of the coronary arteries, isolated or associated to other congenital diseases. This is largely a consequence of the increasing number of patients reaching older age. Due to complex underlying cardiac anatomy, previous surgery and comorbidities, treatment can be challenging. Individualized and multidisciplinary management involving congenital heart cardiologists, cardiac surgeons, coronary interventionists and imaging specialists is essential. This review gives an overview of coronary artery involvement in adults with CHD, summarizes the current literature and focuses on prevention, diagnosis and treatment. The potential role of cardiovascular risk factors for CAD is also discussed.

Emotional reactivity in bipolar depressed patients.

OBJECTIVE: Emotional reactivity in bipolar affective disorders has received increased attention as a relevant issue with regard to the ability to respond to emotional external stimuli for individual real world adaptation. We investigated emotional reactivity using the International Affective Picture System (IAPS) paradigm in bipolar patients during the depressive phase compared to healthy controls. METHOD: Twenty-three bipolar patients with a major depressive episode without manic symptoms and 27 healthy control subjects were recruited. They were asked to judge their emotional reactivity while viewing 90 pictures selected from the IAPS. Their ratings were categorized according to the emotional valence and arousal in response to pleasant, neutral, and unpleasant stimuli. RESULTS: The patients showed lower valence ratings for neutral pictures compared to healthy subjects. No significant between-group differences were found for the pleasant and unpleasant pictures. Higher activation for patients to all emotional stimuli was seen. CONCLUSION: Patients during the depressive phase gave more negative valence to neutral images. This can suggest that they are more pessimistic in the way they perceive the environment as more reactive to emotional cues.

Preoperative diagnosis of THYR 3 versus follicular lesion: malignant postoperative ratio.

AIM: In the evaluation of nodular thyroid lesions, cytology is the main diagnostic instrument, associated with ultrasound examination. METHODS: We prospectively categorized into a dedicated database, 612 patients submitted to thyroidectomy from January 2009 to December 2011. We selected two groups of patients: the cases with "follicular lesions" and the cases classified as "THYR 3" using Bethesda Classification. RESULTS: Of 612 patients submitted to TT, in 68 cases, 8 males (M) and 60 females (F), we recorded a preoperative cytological diagnosis compatible with THYR 3 class. In 56 cases, 82.4% of the patients (5 M, 51 F), we performed a thyroidectomy with Conventional technique (CT) and in 12 cases, 12.6% of the patients (3M, 9F) with video-assisted technique (MIVAT). In 39 cases (57.1%) of the THYR 3 patients treated, a benign disease was found while in the other 29 cases (42.9%) a differentiated thyroid cancer (DTC) were found. In patients with nodules classified as "follicular proliferation", treated in the same period and by the same surgical team, we recorded 97 cases (79 F, 18 M). The patients were treated with TT in 72 cases, with MIVAT in 22 cases; in 3 cases we performed a HT with traditional technique. Adenomatous hyperplasia was found in 51; DTC was found in 21 cases and adenoma in 25 cases. The analysis of the incidence of benign versus malignant disease between the 2 groups showed a P<0.0001. CONCLUSION: In our experience, we recommend surgery, TT or HT, for THYR 3 nodules analyzed for the first time by FNAB with sonographic pattern suspicious for malignancy.

Effect of physiological exercise on osteocalcin levels in subjects with adrenal incidentaloma.

AIM: In the present study, we have evaluated whether physical exercise affect low osteocalcin concentrations observed in patients with subclinical hypercortisolism. SUBJECTS AND METHODS: Sixteen patients (10 men and 6 women, age 38-55 yr) with adrenal incidentaloma were studied. Fifteen healthy volunteers matched for age (range 35-47 yr) were used as controls. Subjects were submitted to a 8-week exercise-training program with cycle-ergometer for 1 h/day 3-4 days/week at 60% of their individual VO2 max. Before and after this period, resting venous serum osteocalcin and GH concentrations were measured in the same batch. The blood sampling after 8 weeks of the training program were performed after resting for one day. All patients and controls underwent also the following endocrine evaluation: serum cortisol, plasma ACTH. RESULTS: Our results demonstrate a significant increase of osteocalcin after physical exercise and a positive correlation between osteocalcin and GH. This later might suggest a role of GH in the increased osteocalcin secretion. CONCLUSIONS: The data of the present study suggest a positive effect of physical exercise on bone metabolism in patients with adrenal incidentaloma.

Use of oxidized and regenerated cellulose in thyroid surgery: a prospective analysis as cause of postoperative hypocalcemia on 485 patients consecutively treated.

AIM: The intraoperative hemorrage determines an higher risk of parathyroid glands lesions, and laryngeal nerve injuries. We have examined if the use of oxidized and regenerated cellulose could be a cause of postoperative hypocalcemia because of the compression on the parathyroid glands or for tissue adhesions METHODS: From June 2009 to December 2010 we have examined 485 patients consecutively treated with total thyroidectomy. The cases examined were divided in two groups on the use of ionized cellulose (group A and B). 24 hours after surgical procedure, all patients were submitted to serum calcium evaluation. The data were analyzed with χ2 test and t-student test; P<0.05 was statistically significant. RESULTS: We have selected 372 cases out of 485 examined. We have registered after 10 hours from surgical procedure a case of hemorrhage with reintervention in group B (no use of cellulose). The cost of ionized cellulose is € 46; we have used this device in 212 cases on 372 patients undergone to total thyroidectomy, with a cost of € 9 752. The mean value of the serum calcium was statistically different between pre- and postoperative evaluation in all cases (P<0.0001) divided both on gender and on the use of hemostatic devices. CONCLUSION: In our experience, there isn't a statistically significant difference on incidence of postoperative hypocalcemia, related to use of ionized and regenerated cellulose on mean surgical time in all patients either treated with traditional surgery or with video-assisted procedure.

Inhibitory effect of somatostatin on the NPY response to insulin-induced hypoglycemia and the role of endogenous opioids.

The present study was undertaken in order to establish whether somatostatin (SRIH) is able to modify the neuropeptide Y (NPY) response to insulin-induced hypoglycemia during insulin tolerance test (ITT) in man. In addition, the possible involvement of opioid peptides in the mediation of hypoglycemia and/or SRIH action was investigated. Subjects were injected intravenously with 0.15IU/kg insulin alone (control test) or with SRIH (4.1µg/min/90min), naloxone (10mg in an iv bolus) or the combination of the two substances. Plasma NPY concentrations rose significantly during ITT. The NPY response was significantly reduced by the treatment with SRIH. The administration of naloxone did not modify NPY levels whereas when both SRIH and naloxone were given, NPY response to hypoglycemia did not differ from that observed in the control test. These data demonstrate that SRIH inhibits the NPY response to hypoglycemia. Naloxone-sensitive endogenous opiates do not seem to be involved in the control of hypoglycemia-induced NPY release. In contrast, since naloxone reversed the inhibiting effect of SRIH, an involvement of opioid peptides in the SRIH action may be supposed.

Somatostatin reduces neuropeptide Y rise induced by physical exercise.

The effect of an i. v. infusion of somatostatin (SRIH) 4.1 µg/min×90 min on the basal secretion of NPY and on the NPY response to physical exercise was studied in normal men. Basal NPY secretion was not modified by SRIH infusion, whereas the NPY response to physical exercise was significantly lower in the presence of SRIH. These data suggest the involvement of a somatostatinergic mechanism in the regulation of NPY response to physical exercise.

Can misdiagnosis in pre-operative FNAC of thyroid nodule influence surgical treatment?

BACKGROUND: Pre-operative cytology in thyroid disease remains the most appropriate diagnostic test for defining the nature of a thyroid nodule before surgical excision. MATERIALS AND METHODS: We selected the most recent 825 surgical thyroid procedures performed in our institution from January 2004 to June 2007; 776 were total thyroidectomies, 23 were lobe-isthmectomies, and 26 were radical neck dissections. We distributed the data based on pre-operative cytology. Each cytological diagnosis was compared to results obtained by definitive histology. Tumors were called incidentalomas if they consisted of a neoplastic focus with a low grade of aggressiveness, as demonstrated by dimension <5 mm, non-aggressive histological subtype. RESULTS: Of the 541 cases of benign disease, 417 were confirmed as benign. The other 124 cases are listed as follows: 29 follicular adenoma; 76 papillary carcinoma (35 found as incidentalomas), and 19 follicular carcinoma (3 incidentalomas). Cytology suggestive of papillary carcinoma was correct in 95.2% of cases (119/125). The 135 tumors termed "follicular neoplasm" were staged on pathology thus: 56 adenoma (41.4%), 26 carcinoma (19.2%), 13 (9.6%) absence of follicular proliferation, 38 (28.1%) papillary follicular variant, 2 (1.4%) undifferentiated cells. Medullary carcinomas were both confirmed. The "suspicious group" exhibited no malignancy on fine needle aspiration cytology (12 of 21; 57%). CONCLUSIONS: Cytology has good reliability in malignant lesions. Incidental tumors occurring in benign disease have little impact on clinical and surgical management; "follicular neoplasm" posed two problems - the impossibility of identifying the nature of the tumor, as well as the newer difficulty in distinguishing papillary follicular subtype.

Systemic oxytocin administration modulates NPY response to insulin-induced hypoglycemia in man.

The present study was undertaken to establish whether oxytocin (OT) is able to modify the NPY response to insulin-induced hypoglycemia in man. At 8:00 AM of 2 different days at least 1 week apart, 10 normal men were tested with insulin (0.15 IU/kg) and with the administration of OT (infused from time -15-60 min, at a constant rate of 2 mIU/ml) or placebo. Plasma NPY concentrations rose significantly during insulin tolerance test (ITT). Oxytocin treatment significantly reduced the NPY response to hypoglycemia. The finding demonstrates for the first time in humans that the systemic administration of OT exerts an inhibitory effect on the NPY rise caused by insulin-induced hypoglycemia.

Preoperative PTH as a marker of risk for post-thyroidectomy hypocalcemia.

AIM: There are no common guidelines to identify the population at risk to develop hypocalcemia preoperatively or early in the postoperative course in thyroidectomized patients, therefore the authors suggest to examine the PTH value preoperatively. METHODS: We divided 391 patients in two groups according to the preoperative PTH level (normal, ≤ 72 pg/mL vs. increased >73 pg/mL). RESULTS: In 92/391 cases (23.52%) preoperative PTH was increased (mean PTH level 112.4+/-24.8 pg/mL; normal range 12-72 pg/mL). Out of these, 43 (46.7%) had hypocalcaemia postoperatively. In 18 out of the 43 patients clinical hypocalcemia also developed. The mean follow-up was of 148+/-13 days. Of the 299 patients with normal preoperative PTH, 127 (42.47%) developed postoperative hypocalcemia (mean calcium level 7.4+/-0.33 mg/dL). In 30 patients it was also clinically evident. The difference in terms of incidence of symptomatic hypocalcemia was statistically significant (increased preoperative PTH 19.5% vs. normal preoperative PTH 10.03% , P=0.036). CONCLUSION: All candidates to thyroidectomy should be investigated for preoperative PTH abnormalities.

Incorporación de un componente espiritual religioso en el tratamiento de pacientes terminales de una unidad del dolor en un hospital general / Inclusion of a religious spiritual component in the treatment of terminally ill patients in a general hospital pain unit

La presente investigación describe y compara creencias religiosas en 200 pacientes con enfermedad oncológica avanzada, un grupo de 200 pacientes sin patología oncológica evidente y un equipo de 100 profesionales de la salud pública de un hospital general en Santiago de Chile. Se utiliza el cuestionario de religiosidad de la encuesta CNAP de Barber y OQ-45.2 de Lambert, validado en Chile por De la Parra y Von Bergen. Los pacientes con enfermedad oncológica avanzada presentan un 95,5 por ciento de adherencia a una religión, en comparación a un 86,7 por ciento de los profesionales que los atienden. Los pacientes sin enfermedad oncológica avanzada presentan un 79 por ciento de adherencia religiosa, en comparación con los profesionales que los atienden 92,5 por ciento. No se observan diferencias significativas entre pacientes adherentes y no adherentes, con respecto a OQ-45.2 para los dos grupos de pacientes. Se describe observancia religiosa tanto en pacientes con enfermedad oncológica avanzada, como en pacientes sin patología oncológica evidente, y en profesionales de la salud pública de un hospital general y diferencias de religiosidad en cuanto a datos sociodemográficos.

This research describes and compares religious believes in 200 final stage cancer patients, a group of 200 patients who show no evident signs of cancer, and team of 100 professionals working in public health in a general hospital in Santiago de Chile. We applied the PUC-Adimark GFK religion questionnaire used in the CNAP Barber survey and the CNAP of Lambert OQ-45.2 that De la Parra and Von Bergen validated in Chile. 95,5 percent of final stage of cancer patients adhere to a religion compared to 86,7 percent of the professionals that take care of them. With respect to OQ-45.2, we observed no significant differences between both groups of patients, religious and no religious. Final stage cancer patients and those with no evident signs of cancer and public health professionals working in a general hospital have religious believes, however, there are differences in terms of socio-demographic data.

Automated segmentation of tissue images for computerized IHC analysis.

This paper presents two automated methods for the segmentation of immunohistochemical tissue images that overcome the limitations of the manual approach as well as of the existing computerized techniques. The first independent method, based on unsupervised color clustering, recognizes automatically the target cancerous areas in the specimen and disregards the stroma; the second method, based on colors separation and morphological processing, exploits automated segmentation of the nuclear membranes of the cancerous cells. Extensive experimental results on real tissue images demonstrate the accuracy of our techniques compared to manual segmentations; additional experiments show that our techniques are more effective in immunohistochemical images than popular approaches based on supervised learning or active contours. The proposed procedure can be exploited for any applications that require tissues and cells exploration and to perform reliable and standardized measures of the activity of specific proteins involved in multi-factorial genetic pathologies.

Achieving the way for automated segmentation of nuclei in cancer tissue images through morphology-based approach: a quantitative evaluation.

In this paper we address the problem of nuclear segmentation in cancer tissue images, that is critical for specific protein activity quantification and for cancer diagnosis and therapy. We present a fully automated morphology-based technique able to perform accurate nuclear segmentations in images with heterogeneous staining and multiple tissue layers and we compare it with an alternate semi-automated method based on a well established segmentation approach, namely active contours. We discuss active contours' limitations in the segmentation of immunohistochemical images and we demonstrate and motivate through extensive experiments the better accuracy of our fully automated approach compared to various active contours implementations.

Effect of serotonergic system on AVP secretion induced by physical exercise.

The present study was undertaken in order to establish the possible involvement of serotonergic receptors in the control of physical exercise-stimulated vasopressin secretion. Twenty-one healthy men (divided in three groups of seven) underwent bicycle-ergometer tests until exhaustion: exercise control test (n=21), exercise plus ondansetron, selective 5-HT3 antagonist (n=7), exercise plus buspirone, selective 5-HT1A receptor agonist (n=7), exercise plus sumatriptan, selective 5-HT1D receptor agonist (n=7). AVP levels, physiological and biochemical variables were measured and compared during tests. Results showed that exercise-induced AVP rise did not change after the administration of buspirone and sumatriptan. In contrast, the administration of ondansetron significantly reduced physical exercise-induced AVP rise. Mean peak levels during physical exercise were 4.9 times higher than basal values in the control test and 2.6 times higher than basal values in the ondansetron plus exercise test. These data demonstrate that 5-HT3 serotonergic receptors at least partially mediate the AVP response to physical exercise. On the other hand, 5-HT1A and 5-HT1D serotonergic receptors do not appear to be involved in the control of AVP secretion during exercise.

Can we use ionized calcium in the evaluation of post-thyroidectomy hypocalcemia?

AIM: The postoperative hypocalcaemia has the higher incidence as complications related to thyroidectomy. METHODS: From 1 June 2006 to 30 June 2008, we examined 492 patients operated on consecutively in our unit with a total thyroidectomy for thyroid disease. We evaluated the values of ionized calcium in all the cases, matching these with the preoperative and postoperative values of serum calcium. The pre- and postoperative (24 hours after treatment) data for ionized calcium and serum calcium were examined statistically with the Student's t-test; results with a P-value <0.05 were considered to be statistically significant. RESULTS: Two-hundred-and-twenty-three of the 492 patients (45.2%) treated with total thyroidectomy had preoperative values of ionized calcium lower than 1.13 mmol/L (normal values 1.13-1.32 mmol/L), while the ionized calcium values were lower than 1.10 mmol/L in 154 of the 223 patients. The mean value of ionized calcium in all 223 cases was 1.04+/-0.07 mmol/L. The mean serum calcium value in these patients was 9.13+/-0.291 mg/dL (normal values 8.3-10.5 mg/dL). In the other 259 cases, the values of ionized calcium and serum calcium were 1.21+/-0.03 mmol/L and 9.1+/-0.29 mg/dL, respectively. In 75 cases on 223 with symptomatic hypocalcemia, the mean value of ionized calcium was 0.88+/-0.05 mmol/L, while, in the remaining 148 cases, the mean value was equal to 0.97+/-0.08 mmol/L (P<0.001). We compared this, in both groups, with the values of postoperative serum calcium; in the 75 cases with clinical hypocalcemia, the value of serum calcium was 7.32+/-0.35 mg/dL, while the value was equal to 8.4+/-0.34 mg/dL in the other cases (P<0.001). CONCLUSIONS: The values of ionized calcium must not be used as marker of hypocalcemia but must be seen as a diagnostic aid linked to others laboratory values, such as serum calcium.

The role of cetuximab in pre-treated refractory patients with metastatic colorectal cancer: outcome study in clinical practice.

We carried out a multicentric retrospective study on cetuximab + chemotherapy in pre-treated refractory patients outside clinical protocols, by registering the main clinical and pathological parameters. We evaluated 144 pre-treated patients. Cetuximab was administered usually in combination with irinotecan (93.8%). A 45% disease control rate (complete plus partial responses plus stable disease) was obtained in 55 patients and was related to absence of weight loss (p<0.0001) and high grade (> or =2) skin toxicity (p<0.0001). Median time to progression (TTP) was 4 months (95%CI 2.7-5.3) and median overall survival (OS) was 11.8 months (95%CI 8.5-15.1). Performance status << or =1, no weight loss and high grade (>or =22) skin toxicity were related both to a longer TTP (p=0.035, p=0.035, p=0.0017) and OS (p<0.0001, p<0.0001, p=0.006). According to multivariate analysis, the absence of weight loss was related to longer TTP (HR 0.331, p=0.004) and OS (HR 0.176, p<0.0001), and EGFR over-expression (3+) to longer TTP (HR 0.402, p=0.020).