Correction to: PANLAR consensus statement on biosimilars.

The two co-authors of the mentioned above article were incorrect. The correct are authors should have been "P. A. Beltrán" instead of "P. A. B. Roa" and "J. F. Diaz-Coto" instead of "L. Diaz Soto".

PANLAR consensus statement on biosimilars.

INTRODUCTION: Biologics have improved the treatment of rheumatic diseases, resulting in better outcomes. However, their high cost limits access for many patients in both North America and Latin America. Following patent expiration for biologicals, the availability of biosimilars, which typically are less expensive due to lower development costs, provides additional treatment options for patients with rheumatic diseases. The availability of biosimilars in North American and Latin American countries is evolving, with differing regulations and clinical indications. OBJECTIVE: The objective of the study was to present the consensus statement on biosimilars in rheumatology developed by Pan American League of Associations for Rheumatology (PANLAR). METHODS: Using a modified Delphi process approach, the following topics were addressed: regulation, efficacy and safety, extrapolation of indications, interchangeability, automatic substitution, pharmacovigilance, risk management, naming, traceability, registries, economic aspects, and biomimics. Consensus was achieved when there was agreement among 80% or more of the panel members. Three Delphi rounds were conducted to reach consensus. Questionnaires were sent electronically to panel members and comments about each question were solicited. RESULTS: Eight recommendations were formulated regarding regulation, pharmacovigilance, risk management, naming, traceability, registries, economic aspects, and biomimics. CONCLUSION: The recommendations highlighted that, after receiving regulatory approval, pharmacovigilance is a fundamental strategy to ensure safety of all medications. Registries should be employed to monitor use of biosimilars and to identify potential adverse effects. The price of biosimilars should be significantly lower than that of reference products to enhance patient access. Biomimics are not biosimilars and, if they are to be marketed, they must first be evaluated and approved according to established regulatory pathways for novel biopharmaceuticals. KEY POINTS: • Biologics have improved the treatment of rheumatic diseases. • Their high cost limits access for many patients in both North America and Latin America. • Biosimilars typically are less expensive, providing additional treatment options for patients with rheumatic diseases. • PANLAR presents its consensus on biosimilars in rheumatology.

X-ray microtomography system for small and light samples using a flat panel detector.

A low-cost system able to perform microtomography of samples such as teeth, insects, or other small materials and low atomic numbers is presented. For this, a small flat panel type sensor was used. The process of characterization of the detector is detailed, as well as its main characteristics. The electromechanical control and the software used are also described. The advantages, some limitations, and comparisons with commercial systems are presented along with some three-dimensional volumetric reconstruction of different materials that served as samples during the development of the system.

Melatonin suppresses nitric oxide production in glial cultures by pro-inflammatory cytokines through p38 MAPK inhibition.

Melatonin has been shown to down-regulate inflammatory responses and provide neuroprotection. However, the mechanisms underlying the anti-inflammatory properties of melatonin are poorly understood. In the present work, we studied the modulatory effect of melatonin against pro-inflammatory cytokines in glial cell cultures. Treatment with pro-inflammatory cytokines mainly tumor necrosis factor-alpha, interleukin 1-beta, and interferon-gamma induces an increase in inducible nitric oxide synthase (iNOS) expression and nitric oxide (NO) production. Pre-treatment with melatonin produced an inhibitory effect on iNOS expression and NO production. The biochemical studies revealed that cytokine treatment favors the activation of several pathways, such as mitogen-activated protein kinases (MAPKs), STAT1, and STAT3; however, the anti-inflammatory effect of melatonin was accompanied only by a decrease in p38 MAPK activity. Likewise, SB203580 a p38 kinase inhibitor inhibits NO production. These data indicate that the anti-inflammatory action of melatonin in glial cells after stimulation with pro-inflammatory cytokines may be in part, attributable to p38 inhibition which down-regulates iNOS expression and NO production.

The SHARON process in the treatment of landfill leachate.

The purpose of this paper was to study the partial nitrification of the nitrogen present in a landfill leachate applying the SHARON process in order to obtain a suitable effluent to the ANAMMOX process. As a first step, the SHARON reactor was fed anaerobically pre-treated leachate at an ammonium concentration of 2,000 mg N/L (1.1 kg N/m(3) d). In such conditions, the average ammonium and nitrite concentrations in the effluent were 775 mg N/L and 1,225 mg N/L, respectively. During this period the COD removal was very low since most of the biodegradable organic matter was removed in the anaerobic pre-treatment. Afterwards, the SHARON reactor was fed leachate without a previous treatment and the efficiency of the partial nitritation diminished. As well, the COD removal increased, achieving a percentage around 28%.

[Pituitary adenoma apoplexy after spinal anaesthesia. Report of two cases and review of the literature]. / Apoplejía de adenoma hipofi sario no funcionante tras anestesia espinal. A propósito de dos casos.

Two cases of pituitary apoplexy occurring after spinal anaesthesia are described. Both presented with headache and III par palsy, one of them with additional visual disturbance and hyponatremia. A bibliographical review has been done, looking for early diagnostic keys. We propose the arterial hypotension as a possible pathogenetic mechanism of pituitary adenoma apoplexy.

Apoplejía de adenoma hipofi sario no funcionante tras anestesia espinal. A propósito de dos casos / Pituitary adenoma apoplexy after spinal anaesthesia. Report of two cases and review of the literature

Se presentan dos casos clínicos de apoplejía hipofisaria tras anestesia espinal, ambos con cefalea y unaparálisis del III par craneal. Uno de ellos con alteraciónvisual adicional e hiponatremia. Se revisa la bibliografíaen busca de las claves para un diagnóstico precozy se propone la hipotensión arterial como mecanismopatogénico de la apoplejía (AU)

Two cases of pituitary apoplexy occurring afterspinal anaesthesia are described. Both presented withheadache and III par palsy, one of them with additionalvisual disturbance and hyponatremia. A bibliographicalreview has been done, looking for early diagnostickeys. We propose the arterial hypotension as a possiblepathogenetic mechanism of pituitary adenoma apoplexy (AU)

Effect of phenol on the biological treatment of wastewaters from a resin producing industry.

The effect of phenol on the biological treatment of wastewaters from a resin producing industry was analyzed in a pre-denitrification system. First, the effect of phenol overloads on the removal of organic matter and nitrogen compounds was studied. During the overloads (from 250 to 4000 mg/L), phenol was detected in the effluent of the anoxic reactor but the system recovered fast after stopping the overloads. The total organic carbon (TOC) removal remained unchanged during phenol addition (91.9% at 0.20 kg TOC/m3 d), except for the highest overload. With regard to total Kjeldahl nitrogen (TKN), its mean removal (87.9% at 0.08 kg TKN/m3 d) was not affected by the phenol overloads. Afterwards, the effect of different phenol concentrations on the biological treatment of these wastewaters was analyzed. Phenol concentrations from 250 to 4000 mg/L were added to the feed. Phenol was completely removed despite the presence of other carbon sources in the wastewater. In spite of the presence of phenol, a TOC removal around 91.3% was achieved at an average organic loading rate of 0.11 kg TOC/m3 d. The mean applied nitrogen loading rates were 0.05 and 0.08 kg TKN/m3 d, obtaining TKN removals around 85.8% and 87.1%, respectively. Therefore, the biological treatment of wastewaters from a resin producing industry in a pre-denitrification system was not affected by the presence of phenol.

Depresión vascular con síntomas melancólicos: respuesta a terapia electroconvulsiva / Vascular depression with melancholic symptoms: response to electroconvulsive therapy

El concepto de depresión vascular hace referencia a casos de depresión de inicio tardío, con infartos cerebrales en técnicas de imagen y factores de riesgo cardiovascular, con déficit cognitivos y pobre respuesta a fármacos antidepresivos. Se presenta el caso de una mujer de 71 años, sin antecedentes psiquiátricos y con factores de riesgo vascular, que reingresa en una unidad de hospitalización psiquiátrica por depresión melancólica con síntomas psicóticos. La resonancia magnética de la paciente mostró un infarto lacunar subcortical y una ligera leucoaraiosis y presentó déficit cognitivos en las pruebas neuropsicológicas. En los ingresos previos fue refractaria a psicofármacos, respondiendo únicamente a terapia electroconvulsiva (TEC). En este ingreso se aplicó TEC, con remisión de la sintomatología, incluyéndose en programa de TEC de mantenimiento. El concepto de depresión vascular podría explicar las especiales características y evolución del caso

The concept of vascular depression includes cases of late-onset depression, with cerebral infarction observed in imaging modalities and cardiovascular risk factors, with cognitive disabilities and poor response to antidepressant drugs. A case of a 71 year-old woman with no psychiatric background and with vascular risk factors who was re-admitted to a psychiatric hospitalization unit for melancholic depression with psychotic symptoms is presented. The magnetic resonance imaging showed a subcortical lacunar lesion and mild leukoaraiosis lesions and the neuropsychological examinations showed mild cognitive impairments. In the previous admissions the symptoms were refractory to several psychopharmacology strategies, responding only to electroconvulsive therapy (ECT). In this admission she received ECT, with remission of the symptoms, and was included in an ECT maintenance program. The vascular depression concept would explain the special features and outcome of this case

Vascular depression with melancholic symptoms: response to electroconvulsive therapy.

The concept of vascular depression includes cases of late- onset depression, with cerebral infarction observed in imaging modalities and cardiovascular risk factors, with cognitive disabilities and poor response to antidepressant drugs. A case of a 71 year-old woman with no psychiatric background and with vascular risk factors who was re-admitted to a psychiatric hospitalization unit for melancholic depression with psychotic symptoms is presented. The magnetic resonance imaging showed a subcortical lacunar lesion and mild leukoaraiosis lesions and the neuropsychological examinations showed mild cognitive impairments. In the previous admissions the symptoms were refractory to several psychopharmacology strategies, responding only to electroconvulsive therapy (ECT). In this admission she received ECT, with remission of the symptoms, and was included in an ECT maintenance program. The vascular depression concept would explain the special features and outcome of this case.

Formaldehyde biodegradation and its effect on the denitrification process.

Simultaneous formaldehyde biodegradation and denitrification in batch assays and in a continuous lab-scale reactor were studied. In batch assays, initial biodegradation rates between 0.7 and 3.3 g CKH2O g VSS(-1) d(-1) were obtained at formaldehyde concentrations between 300 and 2150 mg l(-1). The denitrification process was affected by the presence of formaldehyde. The nitrite accumulation increased with the initial formaldehyde concentration. In the continuous reactor, removal efficiencies above 98.5% were obtained at formaldehyde loading rates between 0.37 and 2.96 kg COD m(-3) d(-1) (625-5000 mg CH2O l(-1)). Formaldehyde removal led to the appearance of methanol and formic acid in the medium. Denitrification process was almost complete (around 99.7%) at nitrogen loading rates up to 0.44 kg N-NO3- m(-3) d(-1). Nitrite occasionally appeared in the effluent at concentrations less than 2.9 mg l(-1). The composition of the biogas indicated that denitrification and methanogenesis occurred simultaneously in the same unit.

[Spinal cord tethering in myelomeningocele and lipomeningocele patients: the second operation]. / Reanclaje medular en pacientes con mielomeningocele y lipomeningocele: la segunda operación.

BACKGROUND: Spinal cord rethetering can occur after the primary surgical repair of myelomeningoceles (MMC) and lipomeningoceles (LMC) and produce devastating physical and psychological consequences. The inadvertent introduction of skin elements at the time of the initial surgery can lead to the growth of intraspinal epidermoid or dermoid cysts. OBJECTIVES: To review the incidence of spinal cord tethering following surgery for open and occult spinal dysraphism and to analyze factors that might influence the appearance of this complication. We also aimed to search technical measures at the time of the primary operation that might prevent the occurrence of symptomatic cord retethering. MATERIAL AND METHODS: We reviewed the medical records of patients submitted to surgical repair of MMC (n=162) or occult spinal dysraphism (n= 54) during the period 1975-2005 who developed symptomatic tethered cord syndrome. RESULTS: Eleven of 162 (6.79%) patients with MMC and 2 of 54 (3.7%) with LMC developed clinical symptoms and signs of spinal cord tethering after intervals ranging from 2 to 37 years after the initial surgical repair of their back lesions. Indications for surgical re-exploration were based mainly on clinical grounds. Postoperative fibrosis was a constant finding in all instances. Other surgical findings included inclusion tumors of cutaneous origin (n=3), lumbar canal stenosis (n= 2), foreign body reactions (n= 2), residual lipoma (n= 1), and a tight hyalinized filum (n=1). Interestingly, 3 of 162 (or 1.85%) myelomeningoceles were found to harbor an intradural epidermoid tumor at the time of spinal cord dethetering, accounting for an incidence of cutaneous inclusion tumors of 27% in cases of post- MMC repair tethering. After a mean follow-up time of 5.5 years, eight patients were improved, two were unchanged and one was worsened. CONCLUSIONS: Neurological deterioration is not a necessary consequence of the natural history of patients with MMC or LMC. Early or late clinical deterioration can be due to spinal cord re-tethering and deserves timely investigation and surgical exploration. Results of surgical intervention were rewarding as 92% of the patients showed improvement or stabilization in their otherwise deteriorating condition. We also report two infrequent causes of spinal cord deterioration: lumbar canal stenosis and intense foreign-body reactions to implanted materials.

Reanclaje medular en pacientes con mielomeningocele y lipomeningocele: la segunda operación / Spinal cord tethering in myelomeningocele and lipomeningocele patients: the second operation

Antecedentes. La médula espinal puede fijarse tras la reparación inicial en pacientes operados demielomeningocele (MMC) y lipomeningocele (LMC), produciendo graves lesiones físicas y psicológicas. Asimismo, la introducción accidental de restos cutáneos durante la reparación de estas lesiones puede dar lugar al desarrollo de tumores intraespinales de estirpe cutánea. Objetivos. Averiguar la incidencia del anclaje medular tras la cirugía de MMC y LMC y analizar los factores que puedan explicar su aparición. También, investigamos las maniobras técnicas durante la operación primaria susceptibles de evitar la aparición del síndrome de médula fijada. Pacientes y métodos. Revisión retrospectiva de las historias de los pacientes operados de MMC (n=162) y de espina bífida oculta (n=54) en el período 1975-2005 que desarrollaron cuadros de anclaje medular sintomático. Resultados. Once pacientes con MMC (6,79%) y dos con LMC (3,7%) presentaron manifestaciones de anclaje medular tras intervalos de 2 a 37 años después de la reparación primaria. Las indicaciones de reintervención se basaron fundamentalmente en criterios clínicos. Un hallazgo constante fue la fibrosiscicatricial que estuvo presente en todos los casos. Otros hallazgos operatorios causantes de la fijación medular consistieron en tumores cutáneos de inclusión (n=3),reacciones de cuerpo extraño (n=2), estenosis del canal lumbar (n=2), restos de lipoma (n=1), y filumhialinizado (n=1). En 3 casos de MMC se encontróademás un quiste epidermoide intradural (1,85% delos MMC), lo que supone una tasa de epidermoides en la reintervención de MMC de 27%. El periodo medio de seguimiento fue de 5,5 años y los resultados fueron: mejoría en 8, dos no experimentaron cambios, y uno sufrió empeoramiento. Conclusiones. El deterioro neurológico de los pacientes operados de MMC o LMC no constituye una consecuencia obligada o parte de la historia natural de estos procesos. El deterioro, precoz o tardío, puede estar motivado por el anclaje posquirúrgico de la médula espinal. Ello hace necesario realizar un seguimiento periódico de estos pacientes, acompañado de los oportunos estudios de neuroimagen y, en su caso, de exploración quirúrgica. Los resultados fueron satisfactorios, ya que el 92% de los pacientes reoperados experimentaron mejoría o estabilización de su enfermedad. Se describen además dos causas infrecuentemente descritas de deterioro tardío: la estenosis del canal y las reacciones fibrosas de cuerpo extraño a materiales implantados

Background. Spinal cord rethetering can occur after the primary surgical repair of myelomeningoceles (MMC) and lipomeningoceles (LMC) and produced evastating physical and psychological consequences.The inadvertent introduction of skin elements at the time of the initial surgery can lead to the growth of intraspinal epidermoid or dermoid cysts. Objectives. To review the incidence of spinal cord tethering following surgery for open and occult spinaldys raphism and to analyze factors that might influence the appearance of this complication. We also aimed to search technical measures at the time of the primary operation that might prevent the occurrence of symptomatic cord retethering. Material and methods. We reviewed the medical records of patients submitted to surgical repair of MMC (n=162) or occult spinal dysraphism (n= 54) during the period 1975-2005 who developed symptomatic tethered cord syndrome. Results. Eleven of 162 (6.79%) patients with MMCand 2 of 54 (3.7%) with LMC developed clinical symptoms and signs of spinal cord tethering after intervals ranging from 2 to 37 years after the initial surgical repair of their back lesions. Indications for surgical re-exploration were based mainly on clinical grounds. Postoperative fibrosis was a constant finding in all instances. Other surgical findings included inclusion tumors of cutaneous origin (n=3), lumbar canal stenosis(n= 2), foreign body reactions (n= 2), residual lipoma (n= 1), and a tight hyalinized filum (n=1). Interestingly,3 of 162 (or 1.85%) myelomeningoceles were found to harbor an intradural epidermoid tumor at the time of spinal cord dethetering, accounting for an incidence of cutaneous inclusion tumors of 27% in cases of post-MMC repair tethering. After a mean follow-up time of 5.5 years, eight patients were improved, two were unchanged and one was worsened. Conclusions. Neurological deterioration is not a necessary consequence of the natural history of patients with MMC or LMC. Early or late clinical deterioration can be due to spinal cord re-tethering and deserves timely investigation and surgical exploration. Results of surgical intervention were rewarding as 92% of the patients showed improvement or stabilization in their otherwise deteriorating condition. We also report two infrequent causes of spinal cord deterioration: lumbar canal stenosis and intense foreign-body reactions to implanted materials

A selective retinoid X receptor agonist bexarotene (LGD1069, targretin) inhibits angiogenesis and metastasis in solid tumours.

The present study determined the influence of a retinoid X receptor agonist bexarotene on angiogenesis and metastasis in solid tumours. In the experimental lung metastasis xenograft models, treatment with bexarotene inhibited the development of the lung tumour nodule formation compared to control. In vivo angiogenesis assay utilising gelfoam sponges, bexarotene reduced angiogenesis in sponges containing vascular endothelial growth factor, epidermal growth factor and basic fibroblast growth factor to various extent. To determine the basis of these observations, human breast and non-small-cell lung cancer cells were subjected to migration and invasion assays in the presence of bexarotene. Our data showed that bexarotene decrease migration and invasiveness of tumour cells in a dose-dependent manner. Furthermore, bexarotene inhibited angiogenesis by directly inhibiting human umbilical vein endothelial cell growth and indirectly inhibiting tumour cell-mediated migration of human umbilical vein endothelial cells through Matrigel matrix. Analysis of tumour-conditioned medium indicated that bexarotene decreased the secretion of angiogenic factors and matrix metalloproteinases and increased the tissue inhibitor of matrix metalloproteinases. The ability of bexarotene to inhibit angiogenesis and metastasis was dependent on activation of its heterodimerisation partner peroxisome proliferator-activated receptor gamma. Collectively, our results suggest a role of bexarotene in treatment of angiogenesis and metastasis in solid tumours.

Effects of type of physical exercise and leisure activities on the depression scores of obese Brazilian adolescent girls.

Several studies have indicated that depressive states may lead to hypokinesia with diminished metabolic rate and energy use. Hypokinesia associated with certain eating behaviors may lead to an unfavorable energy balance that can contribute to the emergence and prevalence of obesity among children and adults. The purpose of the present study was to examine the possibility of reducing depression inventory scores in female adolescents with third-degree obesity while testing the effectiveness of different exercise programs in reducing anxiety and depression scores. The sample consisted of 40 female subjects (mean age 16 +/- 1.56 years) divided into 4 groups (aerobic training, anaerobic training, leisure activities, and control). Subjects had a body mass index of 95% or more in relation to the 50th percentile. The aerobic program consisted of three ergometric bicycle sessions per week over a 3-month period (12 weeks) and the activities were prescribed after determining the anaerobic ventilatory threshold (VO2 threshold). Anaerobic training was based on the Wingate anaerobic power test. The leisure program consisted of a varied range of activities (games, exercises, etc.). A nutritionist interviewed the members of these two groups and the control group every week in order to adapt them to the nutritional guidelines proposed for the study. The study showed that all three programs (aerobic exercise, anaerobic exercise and leisure activities) were effective in reducing body mass. However, we found a significant reduction when analyzing the depression scores only for aerobic exercise (18.9 +/- 9.33 to 10.6 +/- 9.56 or 43.9%) but no significant alterations for anaerobic exercise (11.36 +/- 5.23 to 9.63 +/- 4.78 or 15.22%) and leisure (17.28 +/- 7.55 to 15.07 +/- 7.54 or 12.78%), thus indicating that in principle this type of activity could be included to improve emotional well-being of obese adolescent girls.

Effects of type of physical exercise and leisure activities on the depression scores of obese Brazilian adolescent girls

Several studies have indicated that depressive states may lead to hypokinesia with diminished metabolic rate and energy use. Hypokinesia associated with certain eating behaviors may lead to an unfavorable energy balance that can contribute to the emergence and prevalence of obesity among children and adults. The purpose of the present study was to examine the possibility of reducing depression inventory scores in female adolescents with third-degree obesity while testing the effectiveness of different exercise programs in reducing anxiety and depression scores. The sample consisted of 40 female subjects (mean age 16 ± 1.56 years) divided into 4 groups (aerobic training, anaerobic training, leisure activities, and control). Subjects had a body mass index of 95 percent or more in relation to the 50th percentile. The aerobic program consisted of three ergometric bicycle sessions per week over a 3-month period (12 weeks) and the activities were prescribed after determining the anaerobic ventilatory threshold (VO2 threshold). Anaerobic training was based on the Wingate anaerobic power test. The leisure program consisted of a varied range of activities (games, exercises, etc.). A nutritionist interviewed the members of these two groups and the control group every week in order to adapt them to the nutritional guidelines proposed for the study. The study showed that all three programs (aerobic exercise, anaerobic exercise and leisure activities) were effective in reducing body mass. However, we found a significant reduction when analyzing the depression scores only for aerobic exercise (18.9 ± 9.33 to 10.6 ± 9.56 or 43.9 percent) but no significant alterations for anaerobic exercise (11.36 ± 5.23 to 9.63 ± 4.78 or 15.22 percent) and leisure (17.28 ± 7.55 to 15.07 ± 7.54 or 12.78 percent), thus indicating that in principle this type of activity could be included to improve emotional well-being of obese adolescent girls.

Biodegradation and effect of formaldehyde and phenol on the denitrification process.

Formaldehyde and phenol biodegradation during the denitrification process was studied at lab-scale, first in anoxic batch assays and then in a continuous anoxic reactor. The biodegradation of formaldehyde (260 mgl(-1)) as single carbon source and at phenol concentrations ranging from 30 to 580 mgl(-1) was investigated in batch assays, obtaining an initial biodegradation rate around 0.5g CH(2)OgVSS(-1)d(-1). With regard to phenol, its complete biodegradation was only observed at initial concentrations of 30 and 180 mgl(-1). The denitrification process was inhibited at phenol concentrations higher than 360 mgl(-1). Studies were also done using a continuous anoxic upflow sludge blanket reactor in which formaldehyde removal efficiencies above 99.5% were obtained at all the applied formaldehyde loading rates, between 0.89 and 0.14g COD (CH(2)O)l(-1)d(-1). The phenol loading rate was increased from 0.03 to 1.3g COD (C(6)H(6)O)l(-1)d(-1). Phenol removal efficiencies above 90.6% were obtained at phenol concentrations in the influent between 27 and 755 mgl(-1). However, when the phenol concentration was increased to 1010 mgl(-1), its removal efficiency decreased. Denitrification percentages around 98.4% were obtained with phenol concentrations in the influent up to 755 mgl(-1). After increasing phenol concentration to 1010 mgl(-1), the denitrification percentage decreased because of the inhibition caused by phenol.

Partial nitrification of wastewater from an aminoplastic resin producing factory.

Nitrification via nitrite was studied in two aerobic reactors treating wastewater from an aminoplastic resin producing factory at HRT varying between 1.37-1.89 and 2.45-3.63 days. Both eactors were fed with concentrations of 366, 450, 1099 and 1899 mg N-NH4+/L. In general in the reactor operated at a lower HRT, the nitritation percentage decreased from 87.2 to 21.6%, while the nitratation percentage remained always lower than 2.5% (except in the last period) when the ammonium concentration was increased. This behaviour could be due to the inhibition of the ammonium and nitrite oxidation produced by high free ammonia concentrations up to 179.3 mg N-NH3/L. In the reactor operated at a higher HRT, the nitritation percentage decreased and the nitratation percentage increased from 88.6 to 39.6% and from 0.65 to 35.7%, respectively, due to an increase of the dissolved oxygen concentration from 0.76 to 1.02 mg O2/L. However, when ammonium was fed at a concentration of 1898.7 mg N-NH4+/L, the nitritation increased and the nitratation decreased, probably as a result of the accumulation of free ammonia up to 2.04 mg N-NH3/L, meaning that nitrite oxidizers were inhibited. Nitrite build-up was observed after each modification of ammonium concentration in the feed.

Malignant mixed Mullerian tumor of the uterine cervix with neuroendocrine differentiation.

Malignant mixed Mullerian tumors (MMMTs) are rare neoplasms. We report the clinical, pathologic, and immunohistochemical features of an MMMT primary of uterine cervix. This lesion was composed of a poorly differentiated epithelial component (cytokeratin positive) and a spindle cell component (vimentin positive) with heterologous (myoblastic) differentiation (focal 1A4 positive). There were also cells with neuroendocrine features that expressed S-100 and chromogranin A. Along with a brief review of this amazing neoplasm, some histogenetic concepts relevant to this case are discussed. To our knowledge this is the first report of a malignant mixed Mullerian tumor of the uterine cervix with neuroendocrine differentiation.