Publications by authors named "Enrique Perez"

70 Publications

Removal of bacterial dextran in sugarcane juice by Talaromyces minioluteus dextranase expressed constitutively in Pichia pastoris.

J Biotechnol 2021 Apr 24;333:10-20. Epub 2021 Apr 24.

Grupo Tecnología de Enzimas, Dirección de Investigaciones Agropecuarias, Centro de Ingeniería Genética y Biotecnología (CIGB), Ave 31 entre 158 y 190, Apartado Postal 6162, Habana, 10600, Cuba. Electronic address:

A gene construct encoding the mature region of Talaromyces minioluteus dextranase (EC 3.2.1.11) fused to the Saccharomyces cerevisiae SUC2 signal sequence was expressed in Pichia pastoris under the constitutive glyceraldehyde 3-phosphate dehydrogenase promoter (pGAP). The increase of the transgene dosage from one to two and four copies enhanced proportionally the extracellular yield of the recombinant enzyme (r-TmDEX) without inhibiting cell growth. The volumetric productivity of the four-copy clone in fed batch fermentation (51 h) using molasses as carbon source was 1706 U/L/h. The secreted N-glycosylated r-TmDEX was optimally active at pH 4.5-5.5 and temperature 50-60 °C. The addition of sucrose (600 g/L) as a stabilizer retained intact the r-TmDEX activity after 1-h incubation at 50-60 °C and pH 5.5. Bacterial dextran in deteriorated sugarcane juice was completely removed by applying a crude preparation of secreted r-TmDEX. The high yield of r-TmDEX in methanol-free cultures and the low cost of the fed batch fermentation make the P. pastoris pGAP-based expression system appropriate for the large scale production of dextranase and its use for dextran removal at sugar mills.
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http://dx.doi.org/10.1016/j.jbiotec.2021.04.006DOI Listing
April 2021

The Price of Otologic Procedures: Variation in Markup by Surgical Procedure and Geography in the United States.

Otol Neurotol 2021 Mar 26. Epub 2021 Mar 26.

Department of Otolaryngology, Icahn School of Medicine at Mount Sinai Department of Otolaryngology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York.

Objective: To characterize and analyze variation in price markup of seven common otologic surgeries by procedure and geographic region.

Study Design: Retrospective Analysis of the Centers for Medicare and Medicaid Services database of 2017 Medicare Provider Utilization and Payment Public File.

Setting: Inpatient and outpatient centers delivering Medicare-reimbursed services.

Patients: Full sample of patients undergoing procedures with Medicare fee-for-service final action claims during 2017.

Interventions: Seven procedures (myringotomy, tympanoplasty, mastoidectomy, tympanomastoidectomy stapedotomy/stapedectomy, cochlear implant, bone-anchored hearing aid).

Main Outcome Measures: Markup ratio (MUR) is defined as the ratio of total charges to Medicare-allowable-costs; Variation in MUR was measured using coefficient of variation (CoV).

Results: Among all providers, the median MUR was 2.4 (interquartile range: 1.9-3.1). MUR varied significantly by procedure, from 2.3 for myringotomy to 8.7 for mastoidectomy (p < 0.01). MUR also varied significantly within procedure, with the least variation found in myringotomy (CoV = 0.46), and the greatest in cochlear implants (CoV = 0.92). Using the national average as baseline, MUR varied 71% between states, ranging from 1.75 to 6.24. Within the same state, significant variation was also noted, varying by 4% (CoV = 0.04) in Montana compared with 138% (CoV = 1.38) in Pennsylvania. MUR was not significantly correlated with patient comorbidity or Centers for Medicare and Medicaid Services risk scores.

Conclusions: There was significant variation in the price of otologic surgery across geographic regions and procedures. The MUR for otology is lower or comparable to that reported in other surgical fields.
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http://dx.doi.org/10.1097/MAO.0000000000003151DOI Listing
March 2021

Risk of development of brain metastases according to the IASLC/ATS/ERS lung adenocarcinoma classification in locally advanced and metastatic disease.

Lung Cancer 2021 May 27;155:183-190. Epub 2021 Jan 27.

Catalan Institute of Oncology, Germans Trials i Pujol Research Institute and Hospital Campus Can Ruti, Barcelona, Spain.

Introduction: Brain metastases (BM) are frequent among lung cancer patients, affecting prognosis and quality of life. The International Association for the Study of Lung Cancer (IASLC), American Thoracic Society (ATS) and European Respiratory Society (ERS) lung adenocarcinoma (LADC) classification (IASLC/ATS/ERS) has prognostic impact in early-stage disease; however, its role in the advanced setting is not precise. This study aims to determine the correlation between the predominant histological subtype and the risk of developing brain metastases (BM) in locally advanced and metastatic (stages IIIB-IV) LADC.

Methods: A total of 710 patients with LADC were treated at our institution from January 2010 to December 2017. After excluding patients with brain metastases at diagnoses (n = 151), they were categorized according to the IASLC/ATS/ERS LADC classification to estimate the risk of developing brain metastases. A competing risk analysis was employed, considering death a competing risk event.

Results: From 559 patients, the mean age was 59 ± 13.2 years, women (52.4 %), and clinical-stage IV (79.2 %). LADC subtypes distribution was lepidic (11.6 %), acinar (37.9 %), papillary (10.2 %), micropapillary (6.8 %), and solid (33.5 %). A total of 27.0 % of patients developed BM, 32.9 % died without brain affection, and 40.0 % did not progress. The predominantly solid subtype showed the greatest probability of all subtypes for developing BM [HR 4.0; 95 % CI (1.80-8.91), p = 0.0006], followed by micropapillary [HR1.11; 95 % CI (0.36-3.39), p = 0.85). The solid subtype, moderately differentiated tumors, age, and ECOG PS (>2) were associated with increased hazards in the multivariate analysis.

Conclusion: According to the IASLC/ATS/ERS classification, the predominantly solid pattern was significantly associated with an increased risk of developing BM in patients with locally advanced and metastatic LADC. Its prognostic value might help explore novel clinical approaches, modify monitoring for earlier detection, prevent complications, and reduce morbidity.
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http://dx.doi.org/10.1016/j.lungcan.2021.01.023DOI Listing
May 2021

The utility of augmented reality in lateral skull base surgery: A preliminary report.

Am J Otolaryngol 2021 Jan 29;42(4):102942. Epub 2021 Jan 29.

Icahn School of Medicine at Mount Sinai, Department of Otolaryngology-Head and Neck Surgery, United States of America; New York Eye and Ear Infirmary of Mount Sinai, Department of Otolaryngology, United States of America.

Objective: To discuss the utility of augmented reality in lateral skull base surgery.

Patients: Those undergoing lateral skull base surgery at our institution.

Intervention(s): Cerebellopontine angle tumor resection using an augmented reality interface.

Main Outcome Measure(s): Ease of use, utility of, and future directions of augmented reality in lateral skull base surgery.

Results: Anecdotally we have found an augmented reality interface helpful in simulating cerebellopontine angle tumor resection as well as assisting in planning the incision and craniotomy.

Conclusions: Augmented reality has the potential to be a useful adjunct in lateral skull base surgery, but more study is needed with large series.
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http://dx.doi.org/10.1016/j.amjoto.2021.102942DOI Listing
January 2021

Mutations Found in the Gene That Confer Susceptibility to the AAL-Toxin in Ancestral Tomatoes from Peru and Mexico.

Plants (Basel) 2020 Dec 28;10(1). Epub 2020 Dec 28.

Bio-Applications and Systems Engineering-BASE, Tokyo University of Agriculture and Technology (TUAT), Fuchu, Tokyo 183-8509, Japan.

Tomato susceptibility/resistance to stem canker disease caused by f. sp. and its pathogenic factor AAL-toxin is determined by the presence of the gene. Several cultivars of commercial tomato ( var. , ) are reported to have a mutation in , resulting in their susceptibility to AAL-toxin. We evaluated 119 ancestral tomato accessions including (), var. () and var. "jitomate criollo" () for AAL-toxin susceptibility. Three accessions, PER018805, PER018894, and M5-3, were susceptible to AAL-toxin. PER018894 and M5-3 had a two-nucleotide deletion (nt 854_855del) in identical to that found in cv. Aichi-first. Another mutation (nt 931_932insT) that may confer AAL-toxin susceptibility was identified in PER018805. In the phylogenetic tree based on the 18 COSII sequences, a clade (S3) is composed of , including the AAL-toxin susceptible PER018805, and . AAL-toxin susceptible PER018894 and M5-3 were in Clade S2 with cultivars. As is thought to be the ancestor of , and is an intermediate tomato between and , s with/without the mutation seem to have been inherited throughout the history of tomato domestication and breeding.
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http://dx.doi.org/10.3390/plants10010047DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7824085PMC
December 2020

Enhanced recovery after low- and medium-risk liver transplantation. A single-center prospective observational cohort study.

Int J Surg 2021 Jan 15;85:46-54. Epub 2020 Dec 15.

Hepatopancreatobiliary Surgery and Liver Transplantation, General University Hospital of Alicante (HGUA), And Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain.

Background & Aims: Few studies have fully applied an enhanced recovery after surgery (ERAS) protocol to liver transplantation (LT). Our aim was to assess the effects of a comprehensive ERAS protocol in our cohort of low- and medium-risk LT patients.

Methods: The ERAS protocol included pre-, intra-, and post-operative steps. During the five-year study period, 181 LT were performed in our institution. Two cohorts were identified: low risk patients (n = 101) had a laboratory model for end-stage liver disease (MELD) score of 20 points or less at the time of LT, received a liver from a donor after brain death, and had a balance of risk score of 9 points or less; medium-risk patients (n = 15) had identical characteristics except for a higher MELD score (21-30 points). In addition, we analyzed the remaining patients (n = 65) who were transplanted over the same study period separately using the ERAS protocol.

Results: The low-risk cohort showed a low need for packed red blood cells transfusion (median: 0 units) and renal replacement therapy (1%), as well as a short length of stay both in the intensive care unit (13 h) and in the hospital (4 days); morbidity during one-year follow-up, and probability of surviving to one year (89.30%) and five years (76.99%) were in line with well-established reference data. Similar findings were observed in the medium-risk cohort.

Conclusions: This single-center prospective observational cohort study provides evidence that ERAS is feasible and safe for low- and medium-risk LT.
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http://dx.doi.org/10.1016/j.ijsu.2020.12.003DOI Listing
January 2021

Multimorbidity and psychotropic polypharmacy among participants with autism spectrum disorder with intellectual disability.

Psychiatry Res 2020 10 22;292:113321. Epub 2020 Jul 22.

Neuropharmacology on Pain (NED) group, Alicante Institute for Health and Biomedical Research (ISABIAL Foundation), Alicante, Spain; Clinical Pharmacology Unit, Department of Health of Alicante - General Hospital, Alicante, Spain.

Nowadays, adults with autism spectrum disorder (ASD) experience several comorbidities whose treatment implies a wide range of psychotropic prescriptions. This study aimed to evaluate medication-related safety, drug-drug interactions, and psychotropics prescription trends. We conducted an observational and multicentric pharmacovigilance study in subjects with ASD and Intellectual disability (ID, n = 83). Clinical information (diagnoses, ongoing medications, comorbidities [multimorbidity ≥ 4 chronic health conditions]) and psychotropic prescriptions (polypharmacy ≥ 4 chronic drugs, daily drug doses, co-prescription) were registered. Ethical approval for this study was obtained. Participants (30±10 years old, 86% men, BMI 27±6 kg/m2) displayed 37% multimorbidity (mean of 3, IQR 2-4), and 57% polypharmacy (13% out of dose recommended range). Most drugs prescribed were psychotropic risperidone which is related to nervous system comorbidities (18% epilepsy, 16% insomnia, and 14% psychotic agitations). Risperidone and quetiapine were co-prescribed in 60% of the cases without any monitoring adverse event routine. The rates of multimorbidity and polypharmacy, among our young adults with ASD and ID, are concerning. Data suggest the need to develop a pharmacovigilance monitoring system to evaluate prescription accuracy, long-term safety of ongoing medications, and the fixed doses in this autistic population with associated ID.
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http://dx.doi.org/10.1016/j.psychres.2020.113321DOI Listing
October 2020

COVID-19 sampling from the middle ear and mastoid: A case report.

Am J Otolaryngol 2020 Sep - Oct;41(5):102577. Epub 2020 Jun 2.

Icahn School of Medicine at Mount Sinai, Department of Otolaryngology-Head and Neck Surgery, United States of America; New York Eye and Ear Infirmary of Mount Sinai, Department of Otolaryngology-Head and Neck Surgery, United States of America.

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http://dx.doi.org/10.1016/j.amjoto.2020.102577DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7264918PMC
September 2020

2-Octyl cyanoacrylate to prevent salivary fistula formation following oral cavity microvascular reconstruction: A prospective trial.

Am J Otolaryngol 2020 Sep - Oct;41(5):102552. Epub 2020 May 28.

Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, NY, New York, USA.

Background: Salivary fistulas remain a significant problem in patients undergoing major head and neck reconstructive surgery. Surgical sealants have become increasingly used in cutaneous and non-cutaneous wound closure, providing a barrier to fluids/gases and promoting healing. The purpose of this study was to determine the efficacy of a common surgical sealant, 2-Octyl Cyanoacrylate (2-OCA, Dermabond®), in the prevention of salivary fistulas following free flap reconstruction of the oral cavity.

Methods: In this non-randomized, single arm prospective trial, patients undergoing free flap reconstruction of gravity-dependent oral cavity defects were recruited. Application of 2-OCA was performed along flap inset suture lines at the time of surgery. Prospectively collected trial data were propensity score matched to a control cohort to compare outcomes. Data collected include demographics, medical co-morbidities, previous treatments, primary tumor site, and subsites reconstructed. The primary outcome measure was rate of salivary fistula formation. Secondary outcomes were time to development of leak and percentage of patients tolerating oral feeding at one month post-operatively.

Results: In the 46 propensity score matched pairs, eight (17.4%) out of 46 patients in the 2-OCA prospective cohort and seven (15.2%) out of 46 patients in the control cohort developed postoperative salivary fistulas within the one-month study interval (p = 1.00). The average time to postoperative leak in the 2-OCA group was 12.5 days versus 7.1 days in the control cohort (p = 0.10). In the 2-OCA group, 30 (65.2%) patients were tolerating regular diet at one month post-operatively compared to 33 (71.7%) in the control cohort (p = 0.65).

Conclusion: Salivary fistula rates after application of a 2-OCA surgical sealant were not improved compared to a control cohort in this single institutional trial. There are several surgical sealants available, each with varying elasticity and adhesiveness. Future studies are needed to identify surgical sealants that are able to provide sufficient strength and adhesion to seal closures and combat corrosive saliva, but elastic enough to handle motion related tension during swallowing and post-operative movements in the head and neck.
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http://dx.doi.org/10.1016/j.amjoto.2020.102552DOI Listing
November 2020

Temporal Bone Encephaloceles: Utility of Preoperative Imaging.

Otolaryngol Head Neck Surg 2020 09 28;163(3):577-581. Epub 2020 Apr 28.

Department of Otolaryngology and Head and Neck Surgery, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA.

Objective: To determine the diagnostic efficacy and clinical value of preoperative computed tomography (CT) and magnetic resonance imaging (MRI) among patients with suspected temporal bone encephaloceles (TBE).

Study Design: Retrospective chart review from 2006 to 2018.

Setting: Tertiary referral center.

Subjects And Methods: The subjects underwent surgery for a clinically suspected TBE or cerebrospinal fluid (CSF) leak. Preoperative imaging test characteristics of CT and MRI, including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), were calculated for TBE scans and compared with intraoperative findings.

Results: Fifty-seven subjects with otorrhea, middle ear effusion, hearing loss, and/or meningitis with suspected TBE or CSF leak were identified. All had preoperative CT scans, and 61% (35/57) had preoperative MRI scans. Intraoperatively, 37 of 57 patients (65%) were found to have a TBE. CT scans (17% sensitivity, 100% specificity, 100% PPV, 46% NPV) were less sensitive than MRI (58% sensitivity, 100% specificity, 100% PPV, 24% NPV) for detecting TBEs. Furthermore, the time from initial scan to operative repair was significantly longer in those who had a CT followed by MRI scan compared with CT alone or a fused CT-MRI scan (mean = 68 vs 15 days, respectively; = .004).

Conclusion: CT and MRI provide complementary information that may aid surgical planning. However, imaging cannot always rule out TBE. In cases with high clinical suspicion, surgical confirmation is often required for definitive diagnosis and treatment. The cost of an additional preoperative study should be considered before its use.
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http://dx.doi.org/10.1177/0194599820918566DOI Listing
September 2020

Surveillance of Salmonella enterica serovar  Typhi in Colombia, 2012-2015.

PLoS Negl Trop Dis 2020 03 10;14(3):e0008040. Epub 2020 Mar 10.

Cambridge Institute of Therapeutic Immunology & Infectious Disease (CITIID), The University of Cambridge, Cambridge, United Kingdom.

Salmonella Typhi (S. Typhi) is the causative agent of typhoid fever; a systemic disease affecting ~20 million people per year globally. There are little data regarding the contemporary epidemiology of typhoid in Latin America. Consequently, we aimed to describe some recent epidemiological aspects of typhoid in Colombia using cases reported to the National Public Health Surveillance System (Sivigila) between 2012 and 2015. Over the four-year reporting period there were 836 culture confirmed cases of typhoid in Colombia, with the majority (676/836; 80.1%) of reported cases originated from only seven departments. We further characterized 402 S. Typhi isolates with available corresponding data recovered from various departments of Colombia through antimicrobial susceptibility testing and molecular subtyping. The majority (235/402; 58.5%) of these typhoid cases occurred in males and were most commonly reported in those aged between 10 and 29 years (218/402; 54.2%); there were three (0.74%) reported fatalities. The overwhelming preponderance (339/402; 84.3%) of S. Typhi were susceptible to all tested antimicrobials. The most common antimicrobial to which the organisms exhibited non-susceptibility was ampicillin (30/402;7.5%), followed by nalidixic acid (23/402, 5.7%). Molecular subtyping identified substantial genetic diversity, which was well distributed across the country. Despite the diffuse pattern of S. Typhi genotypes, we identified various geographical hotspots of disease associated with local dominant genotypes. Notably, we found limited overlap of Colombian genotypes with organisms reported in other Latin American countries. Our work highlights a substantial burden of typhoid in Colombia, characterized by sustained transmission in some regions and limited epidemics in other departments. The disease is widely distributed across the country and associated with multiple antimicrobial susceptible genotypes that appear to be restricted to Colombia. This study provides a current perspective for typhoid in Latin America and highlights the importance of pathogen-specific surveillance to add insight into the limited epidemiology of typhoid in this region.
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http://dx.doi.org/10.1371/journal.pntd.0008040DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7083327PMC
March 2020

Practical Guidance for Interventions in Adults with Metabolic Syndrome: Diet and Exercise vs. Changes in Body Composition.

Int J Environ Res Public Health 2019 09 18;16(18). Epub 2019 Sep 18.

Department of Nutrition and Dietetics, Faculty of Health Sciences, University of Atacama, Avda. Copayapu 2862, III Region, Copiapó 1530000, Chile.

(1) Objective: to establish practical guidance for the design of future clinical trials in MS (metabolic syndrome) patients aged 18 and older, based on a systematic review of randomized clinical trials connecting diet, physical exercise and changes in body composition. (2) Method: this systematic review of randomized clinical trials (RCT) is based on the guidelines recommended by PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses). Criteria of selection: ≥18 years of age; patients diagnosed with MS; intervention programs including diet, physical exercise and/or modifications in the style of life as treatment, as well as the magnitude of changes in body composition (BC); randomized clinical trial published between 2004 and 2018. (3) Results: the multidisciplinary interventions describe major changes in BC, and the recurring pattern in these clinical trials is an energy reduction and control in the percentage of intake of macronutrients along with the performance of regularly structured exercise; the most analyzed parameter was waist circumference (88.9% of the trials), followed by body weight (85.2%), BMI (77.8%) and body fat (55.6%). (4) Conclusions: The analysis of the information here reported sheds light for the design of future clinical trials in adults with MS. The best anthropometric parameters and units of measurement to monitor the interventions are related to dietary and physical exercise interventions. A list of practical advice that is easy to implement in daily practice in consultation is here proposed in order to guarantee the best results in changes of body composition.
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http://dx.doi.org/10.3390/ijerph16183481DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6765968PMC
September 2019

Anatomical Correlates and Surgical Considerations for Localized Therapeutic Hypothermia Application in Cochlear Implantation Surgery.

Otol Neurotol 2019 10;40(9):1167-1177

Department of Otolaryngology.

Hypothesis: Application of localized, mild therapeutic hypothermia during cochlear implantation (CI) surgery is feasible for residual hearing preservation.

Background: CI surgery often results in a loss of residual hearing. In preclinical studies, local application of controlled, mild therapeutic hypothermia has shown promising results as a hearing preservation strategy. This study investigated a suitable surgical approach to deliver local hypothermia in patients utilizing anatomical and radiologic measurements and experimental measurements from cadaveric human temporal bones.

Methods: Ten human cadaveric temporal bones were scanned with micro-computed tomography and anatomical features and measurements predicting round window (RW) visibility were characterized. For each bone, the standard facial recess and myringotomy approaches for delivery of hypothermia were developed. The St. Thomas Hospital (STH) classification was used to record degree of RW visibility with and without placement of custom hypothermia probe. Therapeutic hypothermia was delivered through both approaches and temperatures recorded at the RW, RW niche, over the lateral semicircular canal and the supero-lateral mastoid edge.

Results: The average facial recess area was 13.87 ± 5.52 mm. The introduction of the cooling probe through either approach did not impede visualization of the RW or cochleostomy as determined by STH grading. The average temperatures at RW using the FR approach reduced by 4.57 ± 1.68 °C for RW, while using the myringotomy approach reduced by 4.11 ± 0.98 °C for RW.

Conclusion: Local application of therapeutic hypothermia is clinically feasible both through the facial recess and myringotomy approaches without limiting optimal surgical visualization.
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http://dx.doi.org/10.1097/MAO.0000000000002373DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6750193PMC
October 2019

Adsorption Properties of β- and Hydroxypropyl-β-Cyclodextrins Cross-Linked with Epichlorohydrin in Aqueous Solution. A Sustainable Recycling Strategy in Textile Dyeing Process.

Polymers (Basel) 2019 Feb 2;11(2). Epub 2019 Feb 2.

Dpto. de Ciencias de la Salud., Universidad Católica San Antonio de Murcia (UCAM), Avenida de los Jerónimos s/n, 30107 Guadalupe, Murcia, Spain.

β-cyclodextrin (β-CD) and hydroxypropyl-β-cyclodextrin (HP-β-CD) were used to prepare insoluble polymers using epichlorohydrin as a cross-linking agent and the azo dye Direct Red 83:1 was used as target adsorbate. The preliminary study related to adsorbent dosage, pH, agitation or dye concentration allowed us to select the best conditions to carry out the rest of experiments. The kinetics was evaluated by Elovich, pseudo first order, pseudo second order, and intra-particle diffusion models. The results indicated that the pseudo second order model presented the best fit to the experimental data, indicating that chemisorption is controlling the process. The results were also evaluated by Freundlich, Langmuir and Temkin isotherms. According to the determination coefficient (²), Freunlich gave the best results, which indicates that the adsorption process is happening on heterogeneous surfaces. One interesting parameter obtained from Langmuir isotherm is (maximum adsorption capacity). This value was six times higher when a β-CDs-EPI polymer was employed. The cross-linked polymers were fully characterized by nuclear magnetic resonance (NMR), Fourier transform infrared spectroscopy (FTIR), thermal gravimetric analysis (TGA). Also, morphology and particle size distribution were both assessed. Under optimized conditions, the β-CDs-EPI polymer seems to be a useful device for removing Direct Red 83:1 (close 90%), from aqueous solutions and industrial effluents. Complementarily, non-adsorbed dye was photolyzed by a pulsed light driven advanced oxidation process. The proposed methodology is environmental and economically advantageous, considering the point of view of a sustainable recycling economy in the textile dyeing process.
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http://dx.doi.org/10.3390/polym11020252DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6419267PMC
February 2019

Engineered thermostable β-fructosidase from Thermotoga maritima with enhanced fructooligosaccharides synthesis.

Enzyme Microb Technol 2019 Jun 6;125:53-62. Epub 2019 Feb 6.

Grupo Tecnología de Enzimas, Dirección de Investigaciones Agropecuarias, Centro de Ingeniería Genética y Biotecnología (CIGB), Ave 31 entre 158 y 190, Apartado Postal 6162, Habana, 10600, Cuba.

The thermostable β-fructosidase (BfrA) from the bacterium Thermotoga maritima converts sucrose into glucose, fructose, and low levels of short-chain fructooligosaccharides (FOS) at high substrate concentration (1.75 M) and elevated temperatures (60-70 °C). In this research, FOS produced by BfrA were characterized by HPAE-PAD analysis as a mixture of 1-kestotriose, 6-kestotriose (neokestose), and to a major extent 6-kestotriose. In order to increase the FOS yield, three BfrA mutants (W14Y, W14Y-N16S and W14Y-W256Y), designed from sequence divergence between hydrolases and transferases, were constructed and constitutively expressed in the non-saccharolytic yeast Pichia pastoris. The secreted recombinant glycoproteins were purified and characterized. The three mutants synthesized 6-kestotriose as the major component of a FOS mixture that includes minor amounts of tetra- and pentasaccharides. In all cases, sucrose hydrolysis was the predominant reaction. All mutants reached a similar overall FOS yield, with the average value 37.6% (w/w) being 3-fold higher than that of the wild-type enzyme (12.6%, w/w). None of the mutations altered the enzyme thermophilicity and thermostability. The single mutant W14Y, with specific activity of 841 U mg, represents an attractive candidate for the continuous production of FOS-containing invert syrup at pasteurization temperatures.
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http://dx.doi.org/10.1016/j.enzmictec.2019.02.002DOI Listing
June 2019

The PRIDE database and related tools and resources in 2019: improving support for quantification data.

Nucleic Acids Res 2019 01;47(D1):D442-D450

European Molecular Biology Laboratory, European Bioinformatics Institute (EMBL-EBI), Wellcome Trust Genome Campus, Hinxton, Cambridge CB10 1SD, UK.

The PRoteomics IDEntifications (PRIDE) database (https://www.ebi.ac.uk/pride/) is the world's largest data repository of mass spectrometry-based proteomics data, and is one of the founding members of the global ProteomeXchange (PX) consortium. In this manuscript, we summarize the developments in PRIDE resources and related tools since the previous update manuscript was published in Nucleic Acids Research in 2016. In the last 3 years, public data sharing through PRIDE (as part of PX) has definitely become the norm in the field. In parallel, data re-use of public proteomics data has increased enormously, with multiple applications. We first describe the new architecture of PRIDE Archive, the archival component of PRIDE. PRIDE Archive and the related data submission framework have been further developed to support the increase in submitted data volumes and additional data types. A new scalable and fault tolerant storage backend, Application Programming Interface and web interface have been implemented, as a part of an ongoing process. Additionally, we emphasize the improved support for quantitative proteomics data through the mzTab format. At last, we outline key statistics on the current data contents and volume of downloads, and how PRIDE data are starting to be disseminated to added-value resources including Ensembl, UniProt and Expression Atlas.
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http://dx.doi.org/10.1093/nar/gky1106DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6323896PMC
January 2019

Modeling the two- and three-dimensional displacement field in Lorca, Spain, subsidence and the global implications.

Sci Rep 2018 10 3;8(1):14782. Epub 2018 Oct 3.

CommSensLab, Dep. Signal Theory and Communications, Universitat Politècnica de Catalunya (UPC), D3-Campus Nord-UPC, C. Jordi Girona 1-3, 08034, Barcelona, Spain.

Land subsidence associated with overexploitation of aquifers is a hazard that commonly affects large areas worldwide. The Lorca area, located in southeast Spain, has undergone one of the highest subsidence rates in Europe as a direct consequence of long-term aquifer exploitation. Previous studies carried out on the region assumed that the ground deformation retrieved from satellite radar interferometry corresponds only to vertical displacement. Here we report, for the first time, the two- and three-dimensional displacement field over the study area using synthetic aperture radar (SAR) data from Sentinel-1A images and Global Navigation Satellite System (GNSS) observations. By modeling this displacement, we provide new insights on the spatial and temporal evolution of the subsidence processes and on the main governing mechanisms. Additionally, we also demonstrate the importance of knowing both the vertical and horizontal components of the displacement to properly characterize similar hazards. Based on these results, we propose some general guidelines for the sustainable management and monitoring of land subsidence related to anthropogenic activities.
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http://dx.doi.org/10.1038/s41598-018-33128-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6170491PMC
October 2018

Transmastoid Repair of Spontaneous Cerebrospinal Fluid Leaks.

J Neurol Surg B Skull Base 2018 Oct 11;79(5):451-457. Epub 2018 Jan 11.

Department of Otolaryngology Head and Neck Surgery, Mount Sinai Hospital, New York, New York, United States.

 Determine the efficacy of using a purely transmastoid approach for the repair of spontaneous cerebrospinal fluid (CSF) leaks and further elucidate the relationship of elevated body mass index (BMI) and skull base thickness in our patient population.  We conducted a retrospective chart review of patients treated for spontaneous temporal bone CSF leaks at our tertiary care institution from the years 2006 to 2015. Cases were categorized as primary or secondary. We analyzed success rates, length of stay, use of lumbar drains, BMIs, and rates of meningitis. Skull base thickness was compared with BMI in each case.  We identified 26 primary operations for spontaneous CSF leaks and 7 secondary operations. Twenty-three of 33 repairs were performed via the transmastoid approach alone with an 87% success rate (20/23). Of the10 repairs including a middle cranial fossa (MCF) or combined MCF-transmastoid approach, 2 failed for an 80% success rate (8/10). Five transmastoid repairs underwent placement of a lumbar drain versus all 10 repairs employing an intracranial exposure. Average length of stay for those undergoing a transmastoid approach (1.7 days) was significantly shorter than for patients undergoing a MCF repair (6.3 days). Four patients presented with meningitis. Average BMI was 35.3. No correlation was established between BMI and skull base thickness (  = 0.00011).  The transmastoid approach is effective in the majority of cases and prevents the need for an intracranial operation, resulting in lower morbidity and a shorter length of stay. We believe that this is the preferred primary approach in most patients with spontaneous CSF leaks.
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http://dx.doi.org/10.1055/s-0037-1617439DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6133665PMC
October 2018

Fluorescent Detection of Merlin-deficient Schwann Cells and Primary Human Vestibular Schwannoma Cells Using Sodium Fluorescein.

Otol Neurotol 2018 09;39(8):1053-1059

Department of Otolaryngology.

Hypothesis: Merlin-deficient Schwann cells (MD-SC) and primary human vestibular schwannoma (VS) cells exhibit selective uptake of sodium-fluorescein (SF), allowing for fluorescent detection and improved visualization of tumor cells, when compared with Schwann cells (SC).

Background: SF is a fluorescent compound used for fluorescence-guided resection of gliomas. The utility of SF for VS surgery has not been assessed.

Methods: Mouse MD-SCs and rat SCs were cultured on 96-well plates at different cell densities and treated with SF at several drug concentrations and durations. Relative fluorescence units (RFU) were measured using a fluorometer to determine optimal treatment parameters in vitro. Subsequently, a four-point Likert scale for fluorescence visualization of pelleted cells was created and validated. Blinded observers rated SF-treated primary human VS and SC cultures, which were developed from deidentified specimens obtained from live and cadaveric donors, respectively.

Results: In contrast to SCs that showed low levels of fluorescence, MD-SCs demonstrated dose-dependent increases in RFUs when treated with incremental dosages of SF as well as longer treatment and fluorescent excitation times. In addition, RFUs were higher at greater MD-SC densities. The Likert scale for fluorescence visualization was validated using nine blinded observers and there were excellent inter- and intrarater reliabilities (intraclass coefficients of 0.989 and >0.858, respectively). Using the Likert scale, human VS treated with SF received higher scores than human SCs (p < 0.001).

Conclusion: Mouse MD-SC and human VS cells demonstrate preferential uptake of SF when compared with normal primary SCs. Observers detected differences in fluorescence using the validated Likert scale. Further investigations into the utility of SF-guidance in VS surgery are warranted.
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http://dx.doi.org/10.1097/MAO.0000000000001895DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6095714PMC
September 2018

Fructooligosaccharides production by Schedonorus arundinaceus sucrose:sucrose 1-fructosyltransferase constitutively expressed to high levels in Pichia pastoris.

J Biotechnol 2018 Jan 12;266:59-71. Epub 2017 Dec 12.

Grupo Tecnología de Enzimas, Dirección de Investigaciones Agropecuarias, Centro de Ingeniería Genética y Biotecnología (CIGB), Ave 31 entre 158 y 190, Apartado Postal 6162, Habana, 10600, Cuba.

The non-saccharolytic yeast Pichia pastoris was engineered to express constitutively the mature region of sucrose:sucrose 1-fructosyltransferase (1-SST, EC 2.4.1.99) from Tall fescue (Schedonorus arundinaceus). The increase of the transgene dosage from one to nine copies enhanced 7.9-fold the recombinant enzyme (Sa1-SSTrec) yield without causing cell toxicity. Secretion driven by the Saccharomyces cerevisiae α-factor signal peptide resulted in periplasmic retention (38%) and extracellular release (62%) of Sa1-SSTrec to an overall activity of 102.1 U/ml when biomass reached (106 g/l, dry weight) in fed-batch fermentation using cane sugar for cell growth. The volumetric productivity of the nine-copy clone PGFT6x-308 at the end of fermentation (72 h) was 1422.2 U/l/h. Sa1-SSTrec purified from the culture supernatant was a monomeric glycoprotein optimally active at pH 5.0-6.0 and 45-50 °C. The removal of N-linked oligosaccharides by Endo Hf treatment decreased the enzyme stability but had no effect on the substrate and product specificities. Sa1-SSTrec converted sucrose (600 g/l) into 1-kestose (GF) and nystose (GF) in a ratio 9:1 with their sum representing 55-60% (w/w) of the total carbohydrates in the reaction mixture. Variations in the sucrose (100-800 g/l) or enzyme (1.5-15 units per gram of substrate) concentrations kept unaltered the product profile. Sa1-SSTrec is an attractive candidate enzyme for the industrial production of short-chain fructooligosaccharides, most particularly 1-kestose.
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http://dx.doi.org/10.1016/j.jbiotec.2017.12.008DOI Listing
January 2018

Malignant external otitis: The shifting treatment paradigm.

Am J Otolaryngol 2018 Jan - Feb;39(1):41-45. Epub 2017 May 25.

Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.

Importance: Malignant external otitis (MEO) is an aggressive infection occurring in immunocompromised hosts. Increasing antimicrobial resistance is making the disease more difficult to treat.

Objective: Determine if there has been a shift in the microbiology and outcomes of MEO.

Design: A retrospective case series at a tertiary care institution.

Setting: Inpatient and outpatient tertiary care hospital.

Participants: 12 cases of recent MEO were reviewed.

Main Outcomes And Measures: The primary outcome was progression of disease. Secondary outcomes were drug resistance and complications of MEO.

Results: Only 4 patients were cured of MEO. Four patients expired during the study period and at least one of these deaths was a direct result of the MEO. 7 patients developed Cranial nerve palsies, and 3 patients developed abscesses.

Conclusions: Select cases of MEO now require multi-drug and long-term parenteral antibiotic therapy with extended hospital stays.
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http://dx.doi.org/10.1016/j.amjoto.2017.05.010DOI Listing
August 2018

Reduction of Ochratoxin A in Oat Flakes by Twin-Screw Extrusion Processing.

J Food Prot 2017 10;80(10):1628-1634

1 School of Food Science, University of Idaho, 875 Perimeter Drive, MS 2312, Moscow, Idaho 83844-2312.

Ochratoxin A (OTA) is one of the most important mycotoxins owing to its widespread occurrence and toxicity, including nephrotoxicity and potential carcinogenicity to humans. OTA has been detected in a wide range of agricultural commodities, including cereal grains and their processed products. In particular, oat-based products show a higher incidence and level of contamination. Extrusion cooking is widely used in the manufacturing of breakfast cereals and snacks and may reduce mycotoxins to varying degrees. Hence, the effects of extrusion cooking on the stability of OTA in spiked (100 μg/kg) oat flake was investigated by using a laboratory-scale twin-screw extruder with a central composite design. Factors examined were moisture content (20, 25, and 30% dry weight basis), temperature (140, 160, and 180°C), screw speed (150, 200, and 250 rpm), and die size (1.5, 2, and 3 mm). Both nonextruded and extruded samples were analyzed for reductions of OTA by high-performance liquid chromatography, coupled with fluorescence detection. The percentage of reductions in OTA in the contaminated oat flakes upon extrusion processing were in the range of 0 to 28%. OTA was partially stable during extrusion, with only screw speed and die size having significant effect on reduction (P < 0.005). The highest reduction of 28% was achieved at 180°C, 20% moisture, 250 rpm screw speed, and a 3-mm die with 193 kJ/kg specific mechanical energy. According to the central composite design analyses, up to 28% of OTA can be reduced by a combination of 162°C, 30% moisture, and 221 rpm, with a 3-mm die.
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http://dx.doi.org/10.4315/0362-028X.JFP-16-559DOI Listing
October 2017

PulseNet International: Vision for the implementation of whole genome sequencing (WGS) for global food-borne disease surveillance.

Euro Surveill 2017 06;22(23)

The members of the FWD-NEXT Expert Panel are listed at the end of the article.

PulseNet International is a global network dedicated to laboratory-based surveillance for food-borne diseases. The network comprises the national and regional laboratory networks of Africa, Asia Pacific, Canada, Europe, Latin America and the Caribbean, the Middle East, and the United States. The PulseNet International vision is the standardised use of whole genome sequencing (WGS) to identify and subtype food-borne bacterial pathogens worldwide, replacing traditional methods to strengthen preparedness and response, reduce global social and economic disease burden, and save lives. To meet the needs of real-time surveillance, the PulseNet International network will standardise subtyping via WGS using whole genome multilocus sequence typing (wgMLST), which delivers sufficiently high resolution and epidemiological concordance, plus unambiguous nomenclature for the purposes of surveillance. Standardised protocols, validation studies, quality control programmes, database and nomenclature development, and training should support the implementation and decentralisation of WGS. Ideally, WGS data collected for surveillance purposes should be publicly available, in real time where possible, respecting data protection policies. WGS data are suitable for surveillance and outbreak purposes and for answering scientific questions pertaining to source attribution, antimicrobial resistance, transmission patterns, and virulence, which will further enable the protection and improvement of public health with respect to food-borne disease.
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http://dx.doi.org/10.2807/1560-7917.ES.2017.22.23.30544DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5479977PMC
June 2017

The price of free tissue transfer after tongue reconstruction: quantifying the risks.

Laryngoscope 2017 07 20;127(7):1551-1557. Epub 2017 Jan 20.

Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Medical Center, New York, New York, U.S.A.

Objectives/hypothesis: To evaluate the preoperative variables, mean operative time, morbidity, and mortality associated with reconstruction of partial glossectomy defects.

Study Design: Retrospective data analysis.

Methods: The National Surgical Quality Improvement Program database was queried for patients having undergone glossectomy procedures. The study sample was split into two groups based on the lack or presence of a flap reconstruction. A total of 1,012 glossectomy patients were identified, with 805 undergoing nonflap reconstruction and 207 undergoing free flap reconstruction. Variables evaluated included wound complications, major and minor morbidity, return to the operating room, mortality, and mean operative time.

Results: Patients undergoing free flap reconstruction experienced significantly longer mean operative times (482.1 vs. 183.0 minutes, P < .001), were more likely to return to the operating room (odds ratio [OR] = 2.39, 95% confidence interval [CI] = 1.33-4.29, P = .003), and had higher likelihood of wound complications (OR = 5.78, 95% CI = 2.72-12.26, P < .001), major morbidity (OR = 12.39, 95% CI = 7.02-21.85, P < .001), and minor morbidity (OR = 4.20, 95% CI = 2.12-8.33, P < .001). There was no difference in mortality between groups (OR = 8.62, 95% CI = 0.53-141.7, P = .131).

Conclusions: Free flap reconstruction of glossectomy defects involving up to half of the tongue is associated with increased morbidity and operative time when compared with nonflap reconstruction. Currently available functional outcomes data for tongue reconstruction are poor. Possible functional impairment must be weighed against the associated morbidity when deciding which defects require reconstruction, and the decision to reconstruct should not be taken lightly.

Level Of Evidence: 4. Laryngoscope, 127:1551-1557, 2017.
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http://dx.doi.org/10.1002/lary.26461DOI Listing
July 2017

Comparison of packing material in an animal model of middle ear trauma.

Am J Otolaryngol 2016 Jul-Aug;37(4):323-9. Epub 2016 Mar 2.

University of Miami, Miller School of Medicine, Department of Otolaryngology, Miami, Florida.

Purpose: To compare the performance of absorbable gelatin sponge (AGS) with polyurethane foam (PUF) as middle ear packing material after mucosal trauma.

Materials And Methods: Using a randomized, controlled and blinded study design fifteen guinea pigs underwent middle ear surgery with mucosal trauma performed on both ears. One ear was packed with either PUF or AGS while the contralateral ear remained untreated and used as non-packed paired controls. Auditory brainstem response (ABR) thresholds were measured pre-operatively and repeated at 1, 2, and 6weeks postoperatively. Histological analysis of middle ear mucosa was done in each group to evaluate the inflammatory reaction and wound healing. Another eighteen animals underwent middle ear wounding and packing in one ear while the contralateral ear was left undisturbed as control. Twelve guinea pigs were euthanized at 2weeks postoperatively, and six were euthanized at 3days post-operatively. Mucosal samples were collected for analysis of TGF-β1 levels by enzyme-linked immunosorbent assay.

Results: ABR recordings demonstrate that threshold level changes from baseline were minor in PUF packed and control ears. Threshold levels were higher in the AGS packed ears compared with both control and PUF packed ears for low frequency stimuli. Histological analysis showed persistence of packing material at 6weeks postoperatively, inflammation, granulation tissue formation, foreign body reaction and neo-osteogenesis in both AGS and PUF groups. TGF-β1 protein levels did not differ between groups.

Conclusion: PUF and AGS packing cause inflammation and neo-osteogenesis in the middle ear following wounding of the mucosa and packing.
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http://dx.doi.org/10.1016/j.amjoto.2016.02.009DOI Listing
October 2017

Origanum vulgare and Thymbra capitata Essential Oils from Spain: Determination of Aromatic Profile and Bioactivities.

Nat Prod Commun 2016 Jan;11(1):113-20

Oregano (Thymbra capitata and Origanum vulgare) essential oils (EOs), cultivated and extracted in the South-East of Spain, were analysed by GC/MS to determine their composition. (E)-β-Caryophyllene (0.5-4.9%), thymol (0.2-5.8%), p-cymene (3.8-8.2%), γ-terpinene (2.1-10.7%) and carvacrol (58.7-77.4%) were determined as the main molecules. This characterisation was completed with enantioselective gas chromatography, where (-)-(E)-β-caryophyllene, (+)-a- pinene and (+)-β-pinene were determined as the main enantiomers. Antioxidant activity was evaluated positively by several methods, accounting for activity against free radicals and reducing power. Important inhibitory activity on lipoxygenase (LOX) and acetylcholinesterase (AChE) was observed supporting potential anti-inflammatory, anti-Alzheimer and insecticidal activities, mainly due to carvacrol. These properties support the potential use of oregano EOs as natural cosmetic and natural pharmaceutical ingredients.
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January 2016

Electrode array-eluted dexamethasone protects against electrode insertion trauma induced hearing and hair cell losses, damage to neural elements, increases in impedance and fibrosis: A dose response study.

Hear Res 2016 07 15;337:12-24. Epub 2016 Feb 15.

Cochlear Implant Research Program, University of Miami Ear Institute, Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL, USA. Electronic address:

We evaluated the effects of dexamethasone base (DXMb) containing electrode arrays in a guinea pig model of cochlear implantation to determine if eluted DXMb could protect the cochlea against electrode insertion trauma (EIT)-induced: 1) loss of hair cells; 2) disruption of neural elements; 3) increases in hearing thresholds; 4) increased electrical impedance and 5) fibrosis. A guinea pig model of EIT-induced hearing and hair cell losses was used to test silicone electrode arrays that contained either 10%, 1%, 0.1%, or 0% levels of micronized DXMb. These four types of electrode arrays were implanted into the scala tympani via basal turn cochleostomies and left in place for 3 months. Hearing thresholds were determined by ABR and CAP recordings in response to a series of defined pure tone stimuli (i.e. 16-0.5 kHz). Changes in impedance were measured between the implant electrode and a reference electrode. Hair cell counts and neural element integrity were determined by confocal microscopy analyses of stained organ of Corti whole mounts obtained from 90 day post-implantation animals. Fibrosis was measured in Masson trichrome stained cross-sections through the organ of Corti. The results showed that either 10% or 1.0% DXMb eluting electrode arrays protected; hearing thresholds, hair cells, and neural elements against EIT-induced losses and damage. Electrode arrays with 0.1% DXMb only partial protected against EIT-induced hearing loss and damage to the cochlea. Protection of hearing thresholds and organ of Corti sensory elements by electrode-eluted DXMb was still apparent at 3 months post-EIT. All three concentrations of DXMb in the electrode arrays prevented EIT-induced increases in impedance. EIT-initiated fibrosis was significantly reduced within the implanted cochlea of the two DXMb concentrations tested. In conclusion, DXMb eluting electrodes protected the cochlea against long term increases in hearing thresholds, loss of hair cells, damage to neural elements and increases in impedance and fibrosis that result from EIT-initiated damage. The protection achieved by DXMb-eluting electrodes was dose dependent. Establishing a significant level of trauma induced elevation in hearing thresholds was important for the determination of the otoprotective effects of array-eluted DXMb.
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http://dx.doi.org/10.1016/j.heares.2016.02.003DOI Listing
July 2016

High intensity focused ultrasound ablation for atrial fibrillation: results from the National Spanish Registry.

Minerva Cardioangiol 2016 Oct 26;64(5):501-6. Epub 2015 May 26.

Department of Cardiovascular Surgery, Hospital Universitario de La Princesa, Madrid, Spain -

Background: A National Spanish Registry to compile all patients treated with high intensity focused ultrasound (HIFU) energy for atrial fibrillation (AF) was created to evaluate the safety and efficacy of AF surgical ablation.

Methods: A national Spanish registry was created, and ten hospitals using HIFU to ablate AF joined it. A total of 412 patients undergoing cardiac surgery between 2006 and February 2013 were included. AF was divided between paroxysmal AF (33%) and persistent AF (67%) with a mean AF duration of 29.3±108.2 months. Mean left atrial diameter was 51.2±6.5 mm. Mean underlying heart disease were aortic valve disease (49.3%), ischemic disease (25.2%) and mitral disease (33.2%) Clinical follow-up of patients and a 6 months postoperative echocardiogram were performed in all patients.

Results: A pacemaker implantation was needed in 4.9% of patients with a perioperative stroke in 2.5%. Rhythm at discharge from hospital was sinus rhythm in 58%, AF in 35.9% and atrial flutter in 0.8% of patients. Sinus rhythm restoration at 6, 12, 24 and 36 months follow-up was achieved in 66.1%, 63.8%, 63.9% and 45.9% of patients respectively. Multivariate analysis showed paroxysmal AF and sinus rhythm restoration in the operating theatre as factors related to sinus rhythm long term restoration.

Conclusions: The Spanish national registry showed an efficacy of AF ablation with the HIFU Epicor system of 66.1%, 63.8%, 63.9% and 45.9% at 6, 12, 24 and 36 months follow-up. There were no device-related complications.
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October 2016

Outcomes in aortic and mitral valve replacement with intervalvular fibrous body reconstruction.

Ann Thorac Surg 2015 Mar 9;99(3):838-45. Epub 2015 Jan 9.

Cardiac Surgery Department, Hospital Universitario 12 de Octubre, Madrid, Spain.

Background: Surgery for intervalvular fibrous body reconstruction in aortic and mitral valve replacement is a complex operation, although mandatory in some circumstances. The long-term result of this operation remains unknown. The objective of this study was to analyze the outcomes of this technique.

Methods: A descriptive and retrospective study was carried out to analyze operative morbidity and mortality in fibrous body reconstruction with the "David technique" and to evaluate the midterm and long-term results regarding durability and survival.

Results: A total of 40 consecutive patients underwent the David technique between 1997 and 2014. The mean age was 58 ± 15 years and 62.5% were male. The indications were active endocarditis with paravalvular and fibrous body abscesses in 26 patients (group A) and massive calcification of the intervalvular fibrous body in 14 patients (group B). Mean European system for cardiac operative risk evaluation I predicted risk of mortality was 36 ± 24 and 16 ± 15, respectively. The hospital mortality rate was 15.3% in group A and 7.1% in group B. Survival rate after 1, 5, and 10 years was 65.4%, 57.7%, and 50% for group A and 92.9%, 85.7%, and 78.6% for group B. Freedom from reoperation at 1, 5, and 10 years was 92.3%, 84.6%, and 76.9% for group A and 90.9%, 90.9%, and 90.9% for group B. Mean follow-up was 53 ± 8 months.

Conclusions: Although this complex operation is associated with high perioperative mortality, the long-term results are acceptable in patients where there are not suitable alternative procedures.
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http://dx.doi.org/10.1016/j.athoracsur.2014.09.052DOI Listing
March 2015

Magnitude, distribution, and estimated level of underreporting of acute gastroenteritis in Jamaica.

J Health Popul Nutr 2013 Dec;31(4 Suppl 1):69-80

Jamaica is the third largest island in the Caribbean. The epidemiology of acute gastroenteritis (AGE) is important to Jamaica, particularly in the areas of health, tourism, and because of the potential impact on the local workforce and the economy. Data collected by the National Surveillance Unit on the prevalence of AGE transmitted by food are not accurate. To determine the true magnitude, risk factors, and the extent of underreporting of AGE in Jamaica, we conducted a cross-sectional, population-based retrospective survey during the periods of 21 February-7 March and 14-27 June 2009, corresponding to high- and low-AGE season respectively. Of the total 1,920 persons selected randomly by a multistage cluster-sampling process, 1,264 responded (response rate 65.8%). Trained interviewers administered a standardized, validated questionnaire during face-to-face interviews. The overall prevalence of self-reported AGE was 4.0% (95% CI 2.9-5.1) at a rate of 0.5 episodes/per person-year. The highest monthly prevalence of AGE (14.6%) was found among the 1-4 year(s) age-group and the lowest (2.1%) among the 25-44 years age-group. Of the 18 cases (36%) who sought medical care, 11% were hospitalized, 33% were treated with antibiotics, and 66.7% received oral rehydration fluids. Only 2 cases who sought medical care reportedly submitted stool specimens. The mean duration of diarrhoea was 3.1 days, which resulted in a mean loss of 4 productive days, with over half of the cases requiring someone to care for them. The burden of syndromic AGE for 2009 was extrapolated to be 122,711 cases, showing an underreporting factor of 58.9. For every laboratory-confirmed AGE case, it was estimated that 383 more cases were occurring in the population. This research confirms that the prevalence of AGE is underreported in Jamaica and not being adequately detected by the current surveillance system. The components of the integrated surveillance system for AGE in Jamaica, particularly the laboratory aspect, need to be strengthened.
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December 2013