Serum P-glycoprotein level: a potential biomarker of DMARD failure in patients with rheumatoid arthritis.

OBJECTIVES: To evaluate the utility of elevated serum P-glycoprotein (P-gp) as a risk marker of therapeutic response failure in rheumatoid arthritis (RA) patients treated with disease-modifying antirheumatic drugs (DMARDs). METHODS: A cross-sectional study was conducted in 151 RA patients. Patients were classified into two groups according to the response achieved in terms of the disease activity score (DAS)28 after ≥ 6 months: (1) patients with a therapeutic response to DMARDs, with DAS28 < 3.2; and (2) patients without a response to DMARDs, with persistent DAS28 ≥ 3.2. We explored a wide group of clinical factors associated with therapeutic resistance. Serum P-gp levels were measured by ELISA. The risk of P-gp elevation as a marker of failure to achieve a therapeutic response to DMARDs was computed using multivariate logistic regression. RESULTS: Serum P-gp levels were significantly higher in RA patients (n = 151) than in the controls (n = 30) (158.70 ± 182.71 ng/mL vs. 14.12 ± 8.97 ng/mL, p < 0.001). The P-gp level was correlated with the DAS28 score (r = 0.39, p < 0.001). RA patients with DMARD failure had higher serum P-gp levels than patients with a therapeutic response (206 ± 21.47 ng/mL vs 120.60 ± 15.70 ng/mL; p = 0.001). High P-gp levels increased the risk of DMARD failure (OR 3.36, 95% CI 1.54-7.27, p = 0.001). After adjusting for confounding variables, elevated P-gp remained associated with DMARD failure (OR 2.64, 95% CI 1.29-5.40, p = 0.01). CONCLUSION: Elevated serum P-gp is associated with DMARD failure. The P-gp level can be considered a clinical tool for evaluating the risk of DMARD failure in patients; however, future prospective studies should be performed to evaluate the utility of this marker in predicting long-term responses.

Developing Sustainable Cancer Education Programs: Training Public Health Students to Deliver Cancer 101 in Puerto Rico.

The use of promotores to educate Hispanic communities about different health topics has been proven successful, albeit with limitations in program sustainability. The goal of this study was to develop a sustainable train-the-trainer model to train graduate public health (PH) students to disseminate cancer education among communities in Puerto Rico (PR). Graduate students (n = 32) from Ponce Health Sciences University's (PHSU) PH program participated in a 2-day Cáncer 101 training, where they learned how to deliver nine cancer modules to the community. Cancer knowledge was assessed before and after the training via 54 items measuring discussed concepts. Participants also assessed the training's effectiveness by completing a training evaluation informed by social cognitive theory (SCT) constructs of self-efficacy, outcome expectations, facilitation, and observational learning. Participants were mainly female (78.1 %), 26.7 ± 3.9 years old, and enrolled in a Masters-level program (81.3 %). Participants reported an average 11.38-point increase in cancer knowledge after attending the training [t(31) = 14.88, p < .001]. Participants also evaluated the training favorably upon completion, reporting satisfactory comments in the open-ended responses and high scores on measured SCT constructs. The Cáncer 101 training program effectively prepared students to deliver cancer education to local communities. Training graduate PH students to educate communities about health issues is an innovative, and potentially sustainable, way to reach underserved populations.

Reproductive cycle and maternal-embryonic nutritional relationship of shovelnose guitarfish Pseudobatos productus in the Gulf of California.

Samples of the shovelnose guitarfish Pseudobatos productus were collected on board a vessel and at landings of artisanal commercial fisheries in the Gulf of California from May 2004 to June 2007. Samples of 650 females, 2047 embryos and 484 uterine eggs were examined. The reproductive cycle is annual, ovulation and parturition occur in July, the uterine eggs are in diapause for 9 months (July-March) before an accelerated growth of embryos of 3 months. Histological analyses of the uterine wall of pregnant females suggested that no secretions were used for embryo nourishment. The standard percentage of water content was 48·6% in fertilized eggs and 80·75% in full-term embryos. Dry mass loss during embryonic development was 16·3% and the chemical balance of development was 0·84. This indicates that P. productus is a strictly lecithotrophic, viviparous species, that makes no maternal contribution of nutrients during embryonic development.

Association between -174G/C and -572G/C interleukin 6 gene polymorphisms and severe radiographic damage to the hands of Mexican patients with rheumatoid arthritis: a preliminary report.

Several interleukin 6 gene (IL6) polymorphisms are implicated in susceptibility to rheumatoid arthritis (RA). It has not yet been established with certainty if these polymorphisms are associated with the severe radiographic damage observed in some RA patients, particularly those with the development of joint bone ankylosis (JBA). The objective of the present study was to evaluate the association between severe radiographic damage in hands and the -174G/C and -572G/C IL6 polymorphisms in Mexican Mestizo people with RA. Mestizo adults with RA and long disease duration (>5 years) were classified into two groups according to the radiographic damage in their hands: a) severe radiographic damage (JBA and/or joint bone subluxations) and b) mild or moderate radiographic damage. We compared the differences in genotype and allele frequencies of -174G/C and -572G/C IL6 polymorphisms (genotyped using polymerase chain reaction-restriction fragment length polymorphism) between these two groups. Our findings indicated that the -174G/C polymorphism of IL6 is associated with severe joint radiographic damage [maximum likelihood odds ratios (MLE_OR): 8.03; 95%CI 1.22-187.06; P = 0.03], whereas the -572G/C polymorphism of IL6 exhibited no such association (MLE_OR: 1.5; 95%CI 0.52-4.5; P = 0.44). Higher anti-cyclic citrullinated peptide antibody levels were associated with more severe joint radiographic damage (P = 0.04). We conclude that there is a relevant association between the -174G/C IL6 polymorphism and severe radiographic damage. Future studies in other populations are required to confirm our findings.

The -174G/C Interleukin-6 Gene Promoter Polymorphism as a Genetic Marker of Differences in Therapeutic Response to Methotrexate and Leflunomide in Rheumatoid Arthritis.

Objective. To evaluate the association of -174G/C IL-6 polymorphism with failure in therapeutic response to methotrexate (MTX) or leflunomide (LEF). This prospective, observational cohort included 96 Mexican-Mestizo patients with moderate or severe rheumatoid arthritis (RA), initiating MTX or LEF, genotyped for IL-6 -174G/C polymorphism by PCR-RFLP. Therapeutic response was strictly defined: only if patients achieved remission or low disease activity (DAS-28 < 3.2). Results. Patients with MTX or LEF had significant decrement in DAS-28 (p < 0.001); nevertheless, only 14% and 12.5% achieved DAS-28 < 3.2 at 3 and 6 months. After 6 months with any of these drugs the -174G/G genotype carriers (56%) had higher risk of therapeutic failure compared with GC (RR: 1.19, 95% CI: 1.07-1.56). By analyzing each drug separately, after 6 months with LEF, GG genotype confers higher risk of therapeutic failure than GC (RR = 1.56; 95% CI = 1.05-2.3; p = 0.003), or CC (RR = 1.83; 95% CI = 1.07-3.14; p = 0.001). This risk was also observed in the dominant model (RR = 1.33; 95% CI = 1.03-1.72; p = 0.02). Instead, in patients receiving MTX no genotype was predictor of therapeutic failure. We concluded that IL-6 -174G/G genotype confers higher risk of failure in therapeutic response to LEF in Mexicans and if confirmed in other populations this can be used as promissory genetic marker to differentiate risk of therapeutic failure to LEF.

Diagnostic reference levels and complexity indices in interventional radiology: a national programme.

OBJECTIVES: To propose national diagnostic reference levels (DRLs) for interventional radiology and to evaluate the impact of the procedural complexity on patient doses. METHODS: Eight interventional radiology units from Spanish hospitals were involved in this project. The participants agreed to undergo common quality control procedures for X-ray systems. Kerma area product (KAP) was collected from a sample of 1,649 procedures. A consensus document established the criteria to evaluate the complexity of seven types of procedures. DRLs were set as the 3rd quartile of KAP values. RESULTS: The KAP (3rd quartile) in Gy cm2 for the procedures included in the survey were: lower extremity arteriography (n = 784) 78; renal arteriography (n = 37) 107; transjugular hepatic biopsies (THB) (n = 30) 45; biliary drainage (BD) (n = 314) 30; uterine fibroid embolization (UFE) (n = 56) 214; colon endoprostheses (CE) (n = 31) 169; hepatic chemoembolization (HC) (n = 269) 303; femoropopliteal revascularization (FR) (n = 62) 119; and iliac stent (n = 66) 170. The complexity involved the increases in the following KAP factors from simple to complex procedures: THB x4; BD x13; UFE x3; CE x3; HC x5; FR x5 and IS x4. CONCLUSIONS: The evaluation of the procedure complexity in patient doses will allow the proper use of DRLs for the optimization of interventional radiology. KEY POINTS: • National DRLs for interventional procedures have been proposed given level of complexity • For clinical audits, the level of complexity should be taken into account. • An evaluation of the complexity levels of the procedure should be made.

When a Common Language Is Not Enough: Transcreating Cancer 101 for Communities in Puerto Rico.

In Puerto Rico (PR), cancer is the leading cause of death. Previous research has identified the need for cancer education in PR. Using culturally adapted cancer curricula to train local health educators may effectively increase cancer education and reduce health disparities. This article describes the three-phase process used to transcreate the Cancer 101 curriculum to train Master of Public Health (MPH) students to educate PR communities. First, an expert panel collaboratively reviewed the curriculum for content, legibility, utility, and colloquialisms. Recommendations included incorporating local references and resources, replacing words and examples with culturally relevant topics, and updating objectives and evaluation items. Subsequent focus groups with 10 MPH students assessed the adaptation's strengths, weaknesses, and utility for future trainees. Participants were satisfied with the curriculum's overall adaptation, ease of use, and listed resources; further improvements were suggested for all modules. Final expert panel revisions highlighted minor feedback, with the final curriculum containing nine transcreated modules. The transcreation process identified the need for changes to content and cultural translation. Changes were culturally and literacy-level appropriate, represented PR's social context, and were tailored for future trainees to successfully deliver cancer education. Findings highlight the importance of adapting Spanish educational materials across Hispanic sub-groups.

Mortality risk factors in critical post-surgical patients treated using continuous renal replacement techniques.

OBJECTIVE: To determine the influence of demographics, medical, and surgical variables on 30-day mortality in patients who need continuous renal replacement therapy (CRRT). MATERIALS AND METHODS: A retrospective-following study was conducted using the data of 112 patients admitted to the postoperative intensive care unit who required CRRT, between August 2006 and August 2011, and followed-up for 30 days. The following information was collected: age, gender, history of HBP, DM, cardiovascular disease, and CKD, urgent surgery, surgical speciality, organic dysfunction according to the SOFA scale, the number of organs with dysfunction, use of mechanical ventilation, diagnostic and origin of sepsis, type of CRRT, and 30-day mortality. General linear models were used for estimating the strength of association (relative risk [RR], and 95% confidence interval [CI] between variables and 30-day mortality. RESULTS: In the univariant analysis, the following variables were identified as risk factors for 30-day mortality: age (RR 1.04; 95% CI 1.01-1.06; P=.0005), and history of cardiovascular disease (RR 1.57; 95% CI 1.02-2.41; P=.039). Among the variables included in the multivariable analysis (age, history of cardiovascular disease, sepsis, and number of organs with dysfunction), only age was identified as an independent risk factor for 30-day mortality (RR 1.03; 95% CI 1.00-1.05; P=.007). CONCLUSION: Thirty-day mortality in postoperative, critically ill patients who require CRRT is high (41.07%). Age has been identified as an independent risk factor, with renal failure as the most common indication for the use of these therapies.

Metals in the caudal scutes of Morelet's crocodile (Crocodylus moreletii) from the southern Gulf of Mexico.

Caudal scutes were collected from 92 Morelet's crocodiles (Crocodylus moreletii) between May and August 2012, in three Wildlife Management and Use Units (UMAs, from its name in Spanish) and three wild sites in Campeche, Mexico. The UMAs are intensive, with an ex situ approach to manage crocodiles in captivity. The concentrations of arsenic, mercury, lead, nickel, cadmium and chromium were analyzed in each sample. As and Pb were detected in all samples, Hg in 86 and Ni in 74. The metal concentrations estimated were higher than most of the concentrations reported for skin, tail tip and caudal scutes in other crocodilians around the world. The concentration of As, Pb and Ni was significantly greater in the free-ranging groups than in the captive groups in UMAs (p < 0.05). Negative linear relationship was estimated between the snout-vent length and the concentration of Pb (in five groups) and Ni (in three groups). In this region C. moreletii is exposed to metals contamination and more studies are necessary to establish if represents a risk to their populations.

Strategic Plan for the Spanish Academy of Dermatology and Venerology (AEDV): FuturAEDV 2013-2017.

BACKGROUND: The Spanish Academy of Dermatology and Venereology (AEDV) has decided that a Strategic Plan is needed to help the association adapt to new circumstances and anticipate future developments. OBJECTIVES: 1) To position the AEDV as a medical association that can exert an influence in everything related to dermatology. 2) To contribute to the development of the specialty, strengthening the prestige and reputation of dermatology and dermatologists. 3) To establish a model for operating and strategic thinking that can be handed on to successive Boards of Directors and will enable the Academy to identify future challenges. METHODS: The approach used to develop the Strategic Plan was as follows: analysis of trends in the health care system; assessment of the current situation of AEDV and of dermatology in general through an internal analysis based on surveys and interviews with academics; analysis of strengths, weaknesses, opportunities, and threats; preparation of a mission statement; and identification, development, and implementation of a strategy map prioritizing strategic lines of action. RESULTS: The strategy map set out 16 general goals grouped into 4 main topics (achieving the vision, internal and external customers, internal processes, and innovation) and detailed in an action plan with 19 initiatives, each with specific actions. The plan will be monitored by the Strategic Plan Monitoring Committee, which is made up of the members of the Standing Committee and the chairs of the 9 Technical Committees responsible for implementing the initiatives. COMMENT: The Functional Plan should guide the management of AEDV until 2017, and its implementation will enable the association to contribute to the development and prestige of the specialty and position itself as a reference in terms of its functional model.

[Review of evidence of thalidomide and lenalidomide in different hematological diseases: chronic lymphocytic leukemia, primary amyloidosis, myelofibrosis and syndrome myelodysplastic]. / Revisión de la evidencia de talidomida y lenalidomida en diferentes enfermedades hematológicas: leucemia linfocítica crónica, amiloidosis primaria, mielofibrosis y síndrome mielodisplásico.

Lenalidomide is an immunomodulatory drug approved by the AEMPS and the EMA, in combination with dexamethasone, for the treatment of multiple myeloma in adult patients who have received at least one prior therapy. Moreover, it has recently been approved for the treatment of patients with transfusion-dependent anaemia due to low- or intermediate-1-risk myelodysplastic syndromes associated with an isolated deletion 5q cytogenetic abnormality when other therapeutic options are insufficient or inadequate. It has also shown to be active in other hematologic and no hematologic diseases. Growing evidence of its use entails a challenge when situating the drug in a cost-effective way to treat these diseases. On this article we review the available evidence on the use of lenalidomide in the second line treatment of patients with chronic lymphocytic leukemia, primary amyloidosis and primary myelofibrosis, and in the first line treatment of patients with myelodysplastic syndrome, and also the evidence of other immunomodulators. Different clinical practice guidelines and scientific evidence portals consider lenalidomide a valid alternative in the first-line treatment of patients with myelodysplastic syndromes, specially those with the deletion of 5q, and in second line for patients with chronic lymphocytic leukemia. However, the available evidence of lenalidomide in the treatment of patients with primary amyloidosis and primary myelofibrosis is limited, ant thus is not considered as the first choice treatment. In any case, the treatment of choice should consider the safety profile in each patient, the previous treatments that has received and the own therapeutic protocols of each center.

Lenalidomida es un fármaco inmunomodulador aprobado por la EMA y la AEMPS, en combinación con dexametasona, para el tratamiento de pacientes con mieloma múltiple refractario o en recaída que han recibido como mínimo un tratamiento previo. Recientemente también se ha aprobado para el tratamiento de pacientes con anemia dependiente de transfusiones debida a síndromes mielodisplásicos de riego bajo o intermedio-1 asociados a una anomalía citogenética de deleción 5q aislada, cuando otras opciones terapéuticas son insuficientes o inadecuadas. Además, ha mostrado ser activo en otras enfermedades hematológicas y no hematológicas. La evidencia creciente de su utilización supone un reto a la hora de posicionar el fármaco de forma coste-eficaz en el tratamiento de estas patologías. En el presente artículo se revisa la evidencia disponible del uso de lenalidomida en segunda línea en pacientes con leucemia linfocítica crónica, amiloidosis primaria y mielofibrosis primaria, y en primera línea en pacientes con un síndrome mielodisplásico, así como la evidencia de otros inmunomoduladores. Diferentes guías de práctica clínica y portales de evidencia científica consideran lenalidomida una alternativa válida en primera línea para el tratamiento de pacientes con síndromes mielodisplásicos, especialmente aquellos con la deleción del 5q-, y en segunda línea en leucemia linfocítica crónica. En cambio, la evidencia disponible de lenalidomida para el tratamiento de pacientes con amiloidosis primaria y mielofibrosis primaria es limitada, por lo que no se considera de primera elección. En cualquier caso, la elección del tratamiento debe tener en cuenta el perfil de seguridad en cada paciente, las líneas previas que haya recibido así como los protocolos internos de cada centro.

Pulmonary function in ankylosing spondylitis: association with clinical variables.

To evaluate the association between pulmonary function and clinical variables in ankylosing spondylitis (AS) and to compare the pulmonary function of patients with AS with that of healthy controls, 61 AS patients and 74 healthy controls were included. In AS, we assessed clinical disease indices (BASDAI, BASFI, BASG), morning stiffness, number of hypersensitive entheses, metrology measures, 6-min walking test, acute phase reactants, radiological presence of "bamboo spine," and severity of radiological involvement in sacroiliac and vertebral joints. AS and healthy controls had similar age and gender. All the parameters of pulmonary function were significantly diminished in AS than in healthy controls (p < 0.001), with a higher proportion of restrictive pattern (57.4 vs. 5.4 %). In AS, pulmonary function correlated negatively with BASDAI, BASFI, BASG, morning stiffness, number of hypersensitive entheses, occiput-wall distance, and ESR, and positively with 6-min walking test. There was no association between pulmonary function with radiological stage of vertebral joints and sacroiliac joints, "bamboo spine," disease duration, or chest expansion. A higher frequency of AS patients had a decreased pulmonary function and results of the 6-min walking test. These abnormalities in AS were more related with disease activity than with mobility limitation.

Antibody and cytokine responses in BALB/c mice immunized with the excreted/secreted proteins of Giardia intestinalis: the role of cysteine proteases.

The mechanisms involved in the induction of the immune response in humans or experimental hosts infected with Giardia intestinalis are not well understood. The results of previous studies indicate that the parasite induces a mixed Th1/Th2 response and that, in experimentally infected mice, the parasite's excreted/secreted (E/S) proteins contain cysteine proteases that are recognised by the murine immune system. In the present study, the possible effects of the E/S proteases of G. intestinalis on the host's humoral and cellular immune responses were investigated in BALB/c mice immunized with the parasite's E/S proteins. High titres of specific IgG(1), IgG(2a) and IgE antibodies were detected after immunization with native E/S proteins. Spleen cells stimulated with such proteins in vitro showed a significant antigen-specific proliferative response accompanied by the production of high concentrations of interleukin-4 (IL-4), interleukin-5 (IL-5) and interleukin-10 (IL-10) but little secretion of interferon-gamma (IFN-gamma). When, before use, the proteases in the E/S proteins were inhibited, by heat treatment or the addition of E-64, they elicited much lower titres of specific IgG(1) and IgE in mice while, in splenocytes in vitro, they triggered much lower production of IL-4, IL-5 and IL-10 and reduced antigen-specific proliferation. Since E-64 only inhibits cysteine proteases, these results indicate that the excreted/secreted cysteine proteases of G. intestinalis may be involved in the induction and regulation of a specific immune response in the infected host.

New rapid methods for determination of total LAS in sewage sludge by high performance liquid chromatography (HPLC) and capillary electrophoresis (CE).

Linear alkylbenzene sulfonates (LAS) are the most common synthetic anionic surfactant used in domestic and industrial detergents, with a global production of 2.4x10(6) t year(-1). After use and disposal, LAS may enter the environment by one of the several routes, including by direct discharge to surface water or discharge to water from sewage treatment plants. Sewage treatment plants break down LAS only partly: some of them remain in effluent and other fraction is adsorbed in sewage solid. New and rapid methods for determination of total LAS from sewage sludge based on microwave assisted extraction and HPLC-FL and CE-DAD determination are proposed. The extraction of total LAS is carried out by using microwaves energy, an extraction time of 10 min and 5 mL of methanol. For HPLC-FL determination, mobile phase acetonitrile-water was used, comprising 60% (v/v) from 0 to 1 min and a flow rate of 1 mL min(-1) programmed to 100% acetonitrile between 1 and 2 min and a flow rate of 2 mL min(-1). The final composition was maintained for a further 5 min. The determination of total LAS by CE-DAD was performed in a phosphate buffer (10 mM, pH 9). The separation voltage was 25 kV and the temperature of the capillary was 30 degrees C. Injections were performed in the pressure mode and the injection time was set at 12 s. The determination of total LAS is carried out in less than 5 min. The methods did not require clean-up or preconcentration steps. Detection limit for total LAS in the sludge was 3.03 mg kg(-1) using HPLC-FL and 21.0 mg kg(-1) using CE-DAD, and recoveries were >85% using both determination methods. Concentrations of total LAS obtained using both methods were compared with the sum of concentrations of homologues LAS C-10, LAS C-11, LAS C-12 and LAS C-13 obtained using microwaves assisted extraction and HPLC-FL and CE-DAD determination.

Optimization and validation of a new method for analysis of linear alkylbenzene sulfonates in sewage sludge by liquid chromatography after microwave-assisted extraction.

A new approach has been developed for the monitoring of linear alkylbenzene sulfonates (LAS) (C10-C13) in sewage sludge. It is based on microwave-assisted extraction (MAE) prior to high performance liquid chromatography coupled with diode array (HPLC-DAD) and fluorescence (HPLC-FL) detectors. Column Zorbax XDB-C8, 150 mm x 4.6 mm i.d., 5 microm particle size was used as well as acetonitrile-water containing 0.1 M NaClO4 (65:35) and isocratic elution. Compounds were isocratically eluted over 6 min runtime at a flow rate of 1 mL min(-1). Since polar interferences are eluted between 0 and 2 min, they do not interfere in the analysis. The column was thermostated at a temperature of 25 degrees C. For the determination of LAS, DAD-UV (lambda(ex) = 225 nm) and fluorescence (lambda(ex) = 225 nm, lambda(em) = 295 nm) detectors were employed. The main factors affecting the extraction efficiency (extractant volume, microwave power and irradiation time) were optimized using a compost sludge. The detection limit for total LAS in the sludge was < 5 mg kg(-1). The extraction of C10-C13 homologues is carried out by using an extraction time of 10 min and 5 mL of methanol; whereas Soxhlet needs a 12 h extraction. The method did not require clean-up or preconcentration steps. Concentration levels of LAS were between 13,037 mg kg(-1) for digested sludge and 2492 mg kg(-1) for compost sludge.

Initial poor function in the age of old donors: prognostic factors.

INTRODUCTION: The current donor selection criteria have changed from the past years. Primary nonfunction is a serious complication after liver transplantation, but initial poor function (IPF), which occurs from 2% to 23%, also has an increased morbidity and mortality. We analyzed prognostic factors associated with IPF. MATERIALS AND METHOD: This retrospective study of 551 liver transplants performed from January 2000 to December 2005 excluded retransplantations and transplants by classic surgery. The study cohort was attentified according to the presence or the absence of IPF. The variables included were (1) donor age, gender, cause of death, length of stay in Critical Care Medicine, noradrenaline use, sodium levels, and cardiorespiratory arrest, (2) from the standpoint of surgery: we included ischemia time (IT), intervention time, units of packet red cells (PRC), volume of blood autotransfusion (VBA), postreperfusion syndrome (PRS), and vasoactive drugs within the surgery procedure (VAD); (3) from the recipient's: view we examined age, gender, etiology, functional state, and covermittant pathology; (4) During the postoperative period we noted the presence of postoperative hemorrhage. Statistical analysis used chi-square test, Student t test, multiple logistic regression with significance set at P < .05. RESULTS: Differences were found in IT (P = .001), VBA (P = .001), PRS (P = .012), VAD (P = .03), fulminant hepatic failure as the cause the transplantation (P = .002), and chronic obstructive pulmonary disease (P = .007). A regression model retained the following variables: IT, VBA, PRS, fulminant hepatic failure, and chronic obstructive pulmonary disease. CONCLUSIONS: The prognostic factors for IPF need to be modified together with donor selection criteria in liver transplantation.

Nonlinear local electrovascular coupling. II: From data to neuronal masses.

In the companion article a local electrovascular coupling (LEVC) model was proposed to explain the continuous dynamics of electrical and vascular states within a cortical unit. These states produce certain mesoscopic reflections whose discrete time series can be reconstructed from electroencephalography (EEG) and functional magnetic resonance imaging (fMRI). In this article we develop a recursive optimization algorithm based on the local linearization (LL) filter and an innovation method to make statistical inferences about the LEVC model from both EEG and fMRI data, i.e., to estimate the unobserved states and the unknown parameters of the model. For a better understanding, the LL filter is described from a Bayesian point of view, providing the particulars for the case of hybrid data (e.g., EEG and fMRI), which could be sampled at different rates. The dynamics of the exogenous synaptic inputs going into the cortical unit are also estimated by introducing a set of Gaussian radial basis functions. In order to study the dynamics of the electrical and vascular states in the striate cortex of humans as well as their local interrelationships, we applied this algorithm to EEG and fMRI recordings obtained concurrently from two subjects while passively observing a radial checkerboard with a white/black pattern reversal. The EEG and fMRI data from the first subject was used to estimate the electrical/vascular states and parameters of the LEVC model in V1 for a 4.0 Hz reversion frequency. We used the EEG data from the second subject to investigate the changes in the dynamics of the electrical states when the frequency of reversion is varied from 0.5-4.0 Hz. Then we made use of the estimated electrical states to predict the effects on the vasculature that such variations produce.

Excreted/secreted glycoproteins of G. intestinalis play an essential role in the antibody response.

In the present work, glycoproteins in the excretory/secretory products of G. intestinalis were identified and the reactivity in serum of immunized mice with these molecules was evaluated by western blotting before and after chemical treatment or enzymatic deglycosylation. Glycoproteins of 58 and 63 kDa were revealed in E/S products after periodic acid-Schiff (PAS) stain. Studies of carbohydrate specificity using digoxigenin-labeled lectins, revealed the presence of O-glycans and N-glycans. Chemical treatment of excretory/secretory products with sodium meta-periodate or enzymatic deglycosylation with N-glycosidase F reduced the reactivity in serum for proteins of 36, 58 and 63 kDa, respectively. These results show the presence of glycoproteins in E/S products of G. intestinalis and suggest that the antibody response is directed against glycoepitopes. The expression of carbohydrate moieties in the E/S-G. intestinalis may play an essential role in the antibody response and may be a target for serodiagnosis or immune intervention in human giardiasis.

Minimally invasive distal limb bypasses. Techniques and results.

As endovascular procedures increasingly become the procedures of choice for limb salvage, a subset of patients remains that requires open arterial reconstruction due to anatomic or pathologic reasons. Traditional greater saphenous vein harvest performed during open bypass for peripheral occlusive arterial disease is associated with long surgical incisions, increased operative times devoted to wound closure, and wound complications such as infection and dehiscence. Endoscopic conduit harvest, used with excellent results in coronary artery bypass surgery, can also be used in minimally invasive arterial bypass for limb salvage with certain technical modifications. These approaches to complex limb salvage procedures may result in shortened operating room time, shorter length of stay, reduced readmissions for wound complications, and ultimately, decreased costs to the health care system. The treating surgeon must continue to stay up to date with these approaches and be aware of pertinent issues regarding open and minimally invasive arterial interventions, as well as endovascular approaches.

Temporal evolution of polycyclic aromatic hydrocarbons (PAHs) in sludge from wastewater treatment plants: comparison between PAHs and heavy metals.

This paper presents results on the presence and temporal variability of the 16 PAHs recommended by the EPA in primary, secondary and digested sewage sludge over a year. The sewage sludges originated from the Guadalete wastewater treatment plant (WWTP) site in Jerez de la Frontera (Cádiz, Spain). These organic pollutants have been extracted from the sewage sludge by microwave energy. High performance liquid chromatography coupled with diode array (HPLC-DAD) or fluorescence (HPLC-FL) detectors have been used. The results showed that total PAHs concentration varied between 1,945 ng g(-1) dry matter (DM) for primary sludges collected in March and 10,100 ng g(-1) DM for primary sludge collected in June. Generally, concentrations of PAHs were higher in compost and digested sludge than in fresh one. On the other hand, the highest concentration of PAHs were found on summer. This thing is associated to the traffic increase from inland zones to the coast (Jerez de la Frontera is very near to beaches). Finally, this paper present a comparative study of the American an European legislation concluding that the limits of concentrations established are not exceeded. In addition heavy metals were analysed. The origin of PAHs and heavy metals seems to be different.