Immunoglobulins in systemic sclerosis management. A large multicenter experience.

OBJECTIVE: To analyze the effectiveness and safety of intravenous immunoglobulin (IVIG) given in routine care to patients with systemic sclerosis (SSc). METHODS: A retrospective multicenter observational study was conducted in SSc patients treated with IVIG. We collected data on epidemiological parameters and clinical outcomes. Firstly, we assessed changes in organ manifestations during IVIG treatment. Secondly, we analyzed the frequency of adverse effects. The following parameters were collected from baseline to the last follow-up: the patient's weight, modified Rodnan Skin Score (mRSS), modified manual muscle strength scale (MRC), laboratory test(creatine kinase(CK), hemoglobin and protein levels), The University of California Los Angeles Scleroderma Clinical Trials Consortium gastrointestinal tract 2.0 (UCLA GIT 2.0) questionnaire, pulmonary function tests, and echocardiography. RESULTS: Data were collected on 78 patients (82% females; 59% with diffuse SSc). Inflammatory idiopathic myopathy was the most frequent concomitant overlap disease (41%). The time since Raynaud's phenomenon and SSc onset were 8.8 ± 18 and 6.2 ± 6.7 years respectively. The most frequent IVIG indication was myositis (38/78), followed by gastrointestinal (27/78) and cutaneous (17/78) involvement. The median number of cycles given were 5. 54, 53 and 9 patients have been treated previously with glucocorticoids, synthetic disease-modifying antirheumatic drugs and biologic therapies respectively. After IVIG use we found significant improvements in muscular involvement (MRC ≥ 3/5 92% IVIG, p = 0.001 and CK levels from 1149 ± 2026 UI to 217 ± 224 UI, p = 0.02), mRSS (15 ± 12.4 to 13 ± 12.5, p = 0.015) and improvement in total score of UCLA GIT 2.0 (p = 0.05). None Anti-RNA polymerase III patients showed an adequate response in gastrointestinal involvement (0/7) in comparison with other antibodies (0 vs. 25, p = 0,039). Cardiorespiratory involvement remained stable. A total of 12 adverse events were reported with only one withdrawn due to serious adverse effect. CONCLUSIONS: this study suggest that IVIG may improve myositis, gastrointestinal and skin involvement in SSc patients treated in routine care and seems to have a good safety profile.

Pan-atlantic analysis of the overlap of a highly migratory species, the leatherback turtle, with pelagic longline fisheries.

Large oceanic migrants play important roles in ecosystems, yet many species are of conservation concern as a result of anthropogenic threats, of which incidental capture by fisheries is frequently identified. The last large populations of the leatherback turtle, Dermochelys coriacea, occur in the Atlantic Ocean, but interactions with industrial fisheries could jeopardize recent positive population trends, making bycatch mitigation a priority. Here, we perform the first pan-Atlantic analysis of spatio-temporal distribution of the leatherback turtle and ascertain overlap with longline fishing effort. Data suggest that the Atlantic probably consists of two regional management units: northern and southern (the latter including turtles breeding in South Africa). Although turtles and fisheries show highly diverse distributions, we highlight nine areas of high susceptibility to potential bycatch (four in the northern Atlantic and five in the southern/equatorial Atlantic) that are worthy of further targeted investigation and mitigation. These are reinforced by reports of leatherback bycatch at eight of these sites. International collaborative efforts are needed, especially from nations hosting regions where susceptibility to bycatch is likely to be high within their exclusive economic zone (northern Atlantic: Cape Verde, Gambia, Guinea Bissau, Mauritania, Senegal, Spain, USA and Western Sahara; southern Atlantic: Angola, Brazil, Namibia and UK) and from nations fishing in these high-susceptibility areas, including those located in international waters.

Epidural vs. intravenous fentanyl during colorectal surgery using a double-blind, double-dummy design.

BACKGROUND: The overall therapeutic effectiveness of epidural fentanyl vs. the intravenous route is controversial. The present work describes a randomized, controlled, double-blind, double-dummy study of the intraoperative requirements of fentanyl administered by the intravenous or epidural routes during open colon surgery. METHODS: Thirty patients were randomized to receive intraoperative analgesia with boluses of fentanyl administered by either the epidural or intravenous route (2 µg/kg). The first fentanyl bolus was administered 10 min before incision, and repeated boluses were given when mean arterial pressure or heart rate increased more than 20% over basal values. General anaesthesia was maintained with a propofol infusion. Intraoperative fentanyl and propofol requirements, time to awakening, time to analgesia request, and incidence of adverse effects were recorded. RESULTS: Median [interquartile range (range)] fentanyl requirements in the epidural and intravenous groups were 0.81 [0.65 (0.47-2.61)] and 2.5 [1.08 (1.07-4.85)] µg/kg/h, respectively (P < 0.001). The epidural group had a shorter time to awakening, with a median of 8 min [4.5 (3-18)] compared with 20 min [12.5 (7-34)] for the intravenous group (P < 0.001). There were no significant differences in propofol requirements. The time to analgesia request was also delayed in the epidural group, with a median of 5 h [5.5 (1-16)] vs. 2 h [1 (1-5)] when fentanyl was administered intravenously (P < 0.001). The incidence of adverse effects was similar in both groups. CONCLUSION: During major abdominal surgery, epidural administration requires lower doses of intraoperative fentanyl when compared with the intravenous route. Epidural fentanyl also facilitates early awakening and residual analgesia without increasing adverse events.

The infectious hypodermal and haematopoietic necrosis virus: a brief review of what we do and do not know.

Given its high prevalence, its wide distribution and its remarkable capacity to cause severe mortality in shrimp, the infectious hypodermal and haematopoietic necrosis virus (IHHNV) may deserve far more attention than it has received, as it remains considered as one of the most serious problems plaguing the global shrimp farming industry. Furthermore, its real measurable impact over wild shrimp populations remains unknown. Undeniably, the progress that we have reached today on the knowledge of its geographical distribution, clinical signs, genetic diversity, transmission and virulence may help to identify and understand important aspects of its biology and pathogenesis. However, the information regarding the molecular events that occur during the infection process is scarce. Thus, it may not be surprising to find that there are no therapeutic options available for the prophylaxis or treatments to reduce the deleterious impact of this viral pathogen to date. The aim of this review is to integrate and discuss the current state of knowledge concerning several aspects of the biology of IHHNV and to highlight potential future directions for this area of research.

Allometry of hummingbird lifting performance.

Vertical lifting performance in 67 hummingbird species was studied across a 4000 m elevational gradient. We used the technique of asymptotic load-lifting to elicit maximum sustained muscle power output during loaded hovering flight. Our analysis incorporated direct measurements of maximum sustained load and simultaneous wingbeat kinematics, together with aerodynamic estimates of mass-specific mechanical power output, all within a robust phylogenetic framework for the Trochilidae. We evaluated key statistical factors relevant to estimating slopes for allometric relationships by performing analyses with and without phylogenetic information, and incorporating species-specific measurement error. We further examined allometric relationships at different elevations because this gradient represents a natural experiment for studying physical challenges to animal flight mechanics. Maximum lifting capacity (i.e. vertical force production) declined with elevation, but was either isometric or negatively allometric with respect to both body and muscle mass, depending on elevational occurrence of the corresponding taxa. Maximum relative muscle power output exhibited a negative allometry with respect to muscle mass, supporting theoretical predictions from muscle mechanics.

Helicobacter spp. from gastric biopsies of stranded South American fur seals (Arctocephalus australis).

Gastrointestinal lesions with uncertain etiology have been widely described among pinnipeds. The aim of our study was to investigate the presence of Helicobacter spp. in the gastric mucosa of South American fur seals (Arctocephalusaustralis). Gastric biopsies from thirteen seals, stranded on the shores of the Southwestern Atlantic Ocean in Argentina, were evaluated for the presence of Helicobacter spp. by PCR and DNA sequence analysis. Six gastric biopsies were positive for Helicobacter spp. Pairwise sequence comparisons showed less than 95% identity to novel Helicobacter spp. described from pinnipeds from North America and Australia. However, phylogenetic analysis revealed that the South American fur seal sequences clustered with 99-100% homology with H. cetorum, a species isolated from dolphins and whales. The presence of H. cetorum in pinnipeds, if confirmed by its isolation from the gastric mucosa of these mammals, demonstrates the wide host range of this bacterium in the marine environment.

Detection of Helicobacter and Campylobacter spp. from the aquatic environment of marine mammals.

The mechanism by which Helicobacter species are transmitted remains unclear. To examine the possible role of environmental transmission in marine mammals, we sought the presence of Helicobacter spp. and non-Helicobacter bacteria within the order Campylobacterales in water from the aquatic environment of marine mammals, and in fish otoliths regurgitated by dolphins. Water was collected from six pools, two inhabited by dolphins and four inhabited by seals. Regurgitated otoliths were collected from the bottom of dolphins' pools. Samples were evaluated by culture, PCR and DNA sequence analysis. Sequences from dolphins' water and from regurgitated otoliths clustered with 99.8-100% homology with sequences from gastric fluids, dental plaque and saliva from dolphins living in those pools, and with 99.5% homology with H. cetorum. Sequences from seals' water clustered with 99.5% homology with a sequence amplified from a Northern sea lion (AY203900). Control PCR on source water for the pools and from otoliths dissected from feeder fish were negative. The findings of Helicobacter spp. DNA in the aquatic environment suggests that contaminated water from regurgitated fish otoliths and perhaps other tissues may play a role in Helicobacter transmission among marine mammals.

[Usefulness of activated recombinant factor VII for controlling massive bleeding: 4 years' experience in a university hospital]. / Utilidad del factor VII recombinante para el control de la hemorragia masiva. Experiencia de cuatro años en un centro hospitalario universitario.

OBJECTIVE: Massive bleeding that cannot be controlled by the usual means, such as transfusion, is a serious medical problem with high associated mortality. Our aim was to assess the efficacy and safety of treatment with activated recombinant factor VII (rFVIIa) to control massive bleeding after the failure of other methods. PATIENTS AND METHODS: This was a retrospective study of all cases of rFVIIa-treated massive bleeding in patients without a history of coagulation disorder from January 2003 through June 2007. RESULTS: The prevalence of rFVIIa treatment for this indication was 1 in 5200 hospitalized patients. Thirty patients were treated. Bleeding was reduced or stopped in 80% and consumption of blood products was reduced after administration of rFVIIa. Mortality was 43% and death was due to continued bleeding in 5 cases. No deaths were due to thromboembolism. CONCLUSIONS: rFVIIa is efficacious for controlling bleeding and reducing transfusion requirements in cases of massive hemorrhage, but mortality unrelated to bleeding is high in patients experiencing this complication. Further study is needed to better assess the utility, dosing, and ideal timing in the use of this drug.

Utilidad del factor VII recombinante para el controlde la hemorragia masiva. Experiencia de cuatro añosen un centro hospitalario universitario / No disponible

OBJETIVO: La hemorragia masiva no controlada pese alas medidas terapéuticas habituales como el soporte transfusional,supone un grave problema médico y tiene unaelevada mortalidad. El objetivo del trabajo ha sido evaluarla eficacia y seguridad del tratamiento con factor VII activadorecombinante (rFVIIa) en el control de la hemorragiamasiva, cuando las demás medidas han fracasado.PACIENTES Y MÉTODOS: Estudio retrospectivo de todoslos casos de hemorragia masiva en pacientes sin transtornoprevio de la coagulación, que fueron tratados conrFVIIa en nuestro centro desde enero de 2003 a junio de2007.RESULTADOS: La prevalencia de uso de rFVIIa con estaindicación ha sido de 1/5.200 pacientes hospitalizados. Sehan tratado 30 pacientes de los cuales el sangrado se redujoo paró en el 80% de los casos, con una disminución deluso de hemoderivados tras la administración de rFVIIa.La mortalidad fue del 43%, 5 casos por persistencia delsangrado, pero ninguna muerte fue por proceso tromboembólico.CONCLUSIONES: El rFVIIa resulta eficaz en el control delsangrado y en reducir los requerimientos transfusionalesen la hemorragia masiva, pero la mortalidad en estospacientes por causa no hemorrágica es alta. Son necesariosmás estudios para evaluar mejor la utilidad, dosificación ymomento idóneo de administración de este fármaco (AU)

OBJECTIVE: Massive bleeding that cannot be controlledby the usual means, such as transfusion, is a seriousmedical problem with high associated mortality. Our aimwas to assess the efficacy and safety of treatment withactivated recombinant factor VII (rFVIIa) to controlmassive bleeding after the failure of other methods.PATIENTS AND METHODS: This was a retrospective studyof all cases of rFVIIa-treated massive bleeding in patientswithout a history of coagulation disorder from January2003 through June 2007.RESULTS: The prevalence of rFVIIa treatment for thisindication was 1 in 5200 hospitalized patients. Thirtypatients were treated. Bleeding was reduced or stopped in80% and consumption of blood products was reducedafter administration of rFVIIa. Mortality was 43% anddeath was due to continued bleeding in 5 cases. No deathswere due to thromboembolism.CONCLUSIONS: rFVIIa is efficacious for controllingbleeding and reducing transfusion requirements in cases ofmassive hemorrhage, but mortality unrelated to bleedingis high in patients experiencing this complication. Furtherstudy is needed to better assess the utility, dosing, and idealtiming in the use of this drug (AU)

[Effect of subinhibitory concentrations of various antimicrobials on insoluble glucan production, polystyrene adherence and bacterial surface hydrophobicity of Streptococcus sobrinus]. / Efecto de diferentes antimicrobianos a concentraciones subinhibitorias sobre la producción de glucano insoluble, adherencia al poliestireno ehidrofobicidad de superficie bacteriana de Streptococcus sobrinus.

The effect of subinhibitory concentrations (1/2, 1/4, 1/8 of the MIC) of amoxicillin, teicoplanin, clindamycin and erythromycin on the factors influencing the adherence and pathogenicity of Streptococcus sobrinus was evaluated. These factors included insoluble glucan, polystyrene adherence and bacterial surface hydrophobicity. Insoluble glucan was detected using a spectrophotometric method; polystyrene adherence was assessed using microtiter plates; and surface hydrophobicity was determined using a biphasic system (water/p-xiline). Amoxicillin and teicoplanin induced a statistically significant decrease in adherence at subinhibitory concentrations, and they also decreased the hydrophobicity. However, clindamycin and erythromycin were unable to decrease these parameters. The adherence and hydrophobicity of S. sobrinus was also dependent on the concentration of sucrose in the culture medium.

Malignant nasopharyngeal tumors: a neurological and neuroradiological view.

Four cases of nasopharyngeal tumors are presented. The neurological complications of these lesions are discussed. The importance of the neuroradiological examination in different stages of these processes, particularly computed tomography, is emphasized.