Bladder irrigation with amphotericin B and fungal urinary tract infection-systematic review with meta-analysis

Background: Candiduria is a hospital-associated infection and a daily problem in the intensive care unit. The treatment of asymptomatic candiduria is not well established and the use of amphotericin B bladder irrigation (ABBI) is controversial. The aim of this systematic review was to determine the best place for this therapy in practice. Methods: The databases searched in this study included MEDLINE, EMBASE, Web of Science, and LILACS (January 1960-June 2007). We included manuscripts with data on the treatment of candiduria using ABBI. The studies were classified as comparative, dose-finding, or non-comparative. Results: From 213 studies, nine articles (377 patients) met our inclusion criteria. ABBI showed a higher clearance of the candiduria 24 hours after the end of therapy than fluconazole (odds ratio (OR) 0.57, 95% confidence interval (CI) 0.32-1.00). Fungal culture 5 days after the end of both therapies showed a similar response (OR 1.51, 95% CI 0.81-2.80). The evaluation of ABBI using an intermittent or continuous system of delivery showed an early candiduria clearance (24 hours after therapy) of 80% and 82%, respectively (OR 0.87, 95% CI 0.52-1.36). Candiduria clearance at >5 days after the therapy showed a superior response using continuous bladder irrigation with amphotericin B (OR 0.52, 95% CI 0.29-0.94). The use of continuous ABBI for more than 5 days showed a better result (88% vs. 78%) than ABBI for less than 5 days, but without significance (OR 0.55, 95% CI 0.34-1.04). Conclusion: Although the strength of the results in the underlying literature is not sufficient to allow the drawing of definitive conclusions, ABBI appears to be as effective as fluconazole, but it does not offer systemic antifungal therapy and should only be used for asymptomatic candiduria. (C) 2008 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Urinary bladder washings in autopsies. A cytopathologic study of 63 cases

The sediment from urinary bladder washings from 63 consecutive autopsies was cytologically studied in order to achieve a better understanding of the changes in urothelial cells collected from hospital populations. The observed alterations were correlated with alterations in the urinary system and with therapy preceding death. The specimens obtained were of good quality. In 39.7% of the cases, the sediment contained giant superficial multinucleated cells. Three of nine cases previously subjected to radiation or chemotherapy showed atypical urothelial cells. In three cases with immunosuppression, there was cytologic evidence of subclinical infection by polyomavirus, and virus particles were identified by electron microscopy of the vesical mucosa. The study of the smear background offered additional information: the sediment contained hyaline or hematic or hyaline-cellular casts in 17.4% of the cases, in all of which there were renal tubulopathies when the kidney sections were studied. The method is useful for a good evaluation of the autopsy as well as for training in urinary cytopathology.

A Microleakage Study Of Gutta-percha/ah Plus And Resilon/real Self-etch Systems After Different Irrigation Protocols.

The development and maintenance of the sealing of the root canal system is the key to the success of root canal treatment. The resin-based adhesive material has the potential to reduce the microleakage of the root canal because of its adhesive properties and penetration into dentinal walls. Moreover, the irrigation protocols may have an influence on the adhesiveness of resin-based sealers to root dentin. The objective of the present study was to evaluate the effect of different irrigant protocols on coronal bacterial microleakage of gutta-percha/AH Plus and Resilon/Real Seal Self-etch systems. One hundred ninety pre-molars were used. The teeth were divided into 18 experimental groups according to the irrigation protocols and filling materials used. The protocols used were: distilled water; sodium hypochlorite (NaOCl)+eDTA; NaOCl+H3PO4; NaOCl+eDTA+chlorhexidine (CHX); NaOCl+H3PO4+CHX; CHX+eDTA; CHX+ H3PO4; CHX+eDTA+CHX and CHX+H3PO4+CHX. Gutta-percha/AH Plus or Resilon/Real Seal Se were used as root-filling materials. The coronal microleakage was evaluated for 90 days against Enterococcus faecalis. Data were statistically analyzed using Kaplan-Meier survival test, Kruskal-Wallis and Mann-Whitney tests. No significant difference was verified in the groups using chlorhexidine or sodium hypochlorite during the chemo-mechanical preparation followed by eDTA or phosphoric acid for smear layer removal. The same results were found for filling materials. However, the statistical analyses revealed that a final flush with 2% chlorhexidine reduced significantly the coronal microleakage. A final flush with 2% chlorhexidine after smear layer removal reduces coronal microleakage of teeth filled with gutta-percha/AH Plus or Resilon/Real Seal SE.

Intravesical Bacillus Calmette-guérin Efficiently Reduces P70s6k1 But Not 4e-bp1 Phosphorylation In Nonmuscle Invasive Bladder Cancer.

We characterized the functional consequences of intravesical bacillus Calmette-Guérin on the molecular mechanism of the AKT/mTOR signaling pathway in nonmuscle invasive bladder cancer. To our knowledge this has not been reported previously. At age 7 weeks female Fischer 344 rats received 1.5 mg/kg MNU intravesically every other week for 6 weeks. They were randomized at 10 per group to MNU (0.2 ml vehicle), bacillus Calmette-Guérin (10(6) cfu Connaught strain), rapamycin (15 μg/ml) and bacillus Calmette-Guérin plus simultaneous rapamycin, each intravesically for 6 weeks. At week 15 the bladders were collected for histopathology, immunohistochemistry and immunoblot to determine p-AKT, Rictor, Raptor, p-4E-BP1, p-p70S6K1, p-AMPK-α, p-mTOR and p-p53. Papillary carcinoma (pTa) and high grade intraepithelial neoplasia (pTis) predominated in the MNU group while normal urothelium, papillary and flat hyperplasia were more common in treated groups. Nonmuscle invasive bladder cancer treated with bacillus Calmette-Guérin showed suppression of p70S6K1 but not 4E-BP1 phosphorylation. This suggests that 4E-BP1 is regulated differently than p70S6K1, escaping the bacillus Calmette-Guérin action that occurs in a mTOR independent manner. The association of bacillus Calmette-Guérin with rapamycin but not rapamycin monotherapy affected p70S6K1 and 4E-BP1 phosphorylation with no features of in situ carcinoma (pTis). The activation status of p70S6K1 and 4E-BP1 might be used to stratify patients who could benefit from targeting such molecular elements with multitarget/multidrug intravesical therapy. In the future 4E-BP1 might be a worthwhile new target for bacillus Calmette-Guérin refractory nonmuscle invasive bladder cancer.

Effectiveness of different final irrigation protocols in removing debris in flattened root canals

This study evaluated in vitro the capacity of debris removal from the apical third of flattened root canals, using different final irrigation protocols. Thirty human mandibular central incisors with a mesiodistal flattened root were prepared using rotary instrumentation by Endo-Flare 25.12 and Hero 642 30.06, 35.02, 40.02 files, irrigated with 2 mL of 1% NaOCl after each file. The specimens were randomly distributed into 5 groups according to the final irrigation of root canals: Group I: 10 mL of distilled water (control), Group II: 10 mL of 1% NaOCl for 8 min, Group III: 2 mL of 1% NaOCl for 2 min (repeated 4 times), Group IV: 10 mL of 2.5% NaOCl for 8 min, and Group V: 10 mL of 2.5% NaOCl for 2 min (repeated 4 times). The apical thirds of the specimens were subjected to histological processing and 6-μm cross-sections were obtained and stained with hematoxylin-eosin. The specimens were examined under optical microscopy at ×40 magnification and the images were subjected to morphometric analysis using the Scion image-analysis software. The total area of root canal and the area with debris were measured in square millimeters. Analysis of variance showed no statistically significant difference (p>0.05) among the groups GI (2.39 ± 3.59), GII (2.91 ± 2.21), GIII (0.73 ± 1.36), GIV (0.95 ± 0.84) and GV (0.51 ± 0.22). In conclusion, the final irrigation protocols evaluated in this study using the Luer syringe presented similar performance in the removal of debris from the apical third of flattened root canals.

Immunomodulatory effects of recombinant BCG expressing pertussis toxin on TNF-alpha and IL-10 in a bladder cancer model

Background: Since successful treatment of superficial bladder cancer with BCG requires proper induction of Th1 immunity, we have developed a rBCG-S1PT strain that induced a stronger cellular immune response than BCG. This preclinical study was designed to compare the modulatory effects of BCG and rBCG-S1PT on bladder TNF-alpha and IL-10 expression and to evaluate antitumour activity. Methods: For Experiment I, the MB49 bladder cancer cell line was used in C57BL/6 mice. Chemical cauterization of the bladder was performed to promote intravesical tumor implantation. Mice were treated by intravesical instillation with BCG, rBCG-S1PT or PBS once a week for four weeks. After 35 days the bladders were removed and weighed. TNF-bladder weight reduction, compared to the BCG and control group. There were increases in TNF-alpha in the BCG-treated group, as well as increases in TNF-alpha and IL-10 mRNA in the rBCG-S1PT group. Conclusion: These data indicate a significant reduction of bladder tumor volume for the rBCG group, compared to the BCG and PBS groups. This suggests that rBCG could be a useful substitute for wild-type BCG and that the potential modulation between TNF-alpha and IL-10 cytokine productions may have therapeutic value.

Evaluation of the Incidence of Bladder Perforation After Transurethral Bladder Tumor Resection in a Residency Setting

Purpose: To evaluate prospectively the actual bladder perforation incidence during transurethral resection of bladder tumor (TURB) performed by residents and to identify possible predisposing factors to such condition. Patients and Methods: Thirty-four patients with bladder tumor were submitted to TURB in our academic institution in April 2006, and were prospectively studied. Procedures were all done by senior residents under an attending direct supervision. All patients had a cystograms performed after the procedure by the injection of 400 mL of saline-diluted contrast solution with low-pressure infusion through the Foley catheter. The cystograms were evaluated blindly by a single radiologist. All patients were examined by cystoscopy and/or CT every 3 months for the first 2 years postoperatively. Results: The cystogram showed contrast leaking compatible with bladder perforation in 17 (50%) cases. None of the perforations were recognized intraoperatively by the surgeon. All perforations were extraperitoneal and managed conservatively. There was no significant correlation between the incidence of bladder perforation and the patient age (p = 0.508), the tumor stage (p = 0.998), the tumor grade (p = 0.833), the number of lesions (p = 0.394), and the tumor size (p = 0.651). The only factor that had impact on the development of bladder perforation was tumor localization at the bottom of the bladder (p = 0.035; OR, 6750; 95% CI, 1.14, 39.8). Conclusion: Asymptomatic perforations of the bladder wall occur very frequently after a TURB procedure performed by residents in training and, most of the time, are not noticed by the surgeon. Localization of the tumor at bladder dome was the only factor that negatively influenced perforation rates.

Tabasco pepper production with CO(2) application using drip irrigation

Tabasco pepper production with CO(2) application using drip irrigation. Application of CO(2) through water reduces the soil solution pH, causing variations in nutrient mobility and consequent effects on the absorption. The objective of this study was to analyze the effects of carbon dioxide rates supplied by drip irrigation in the production of Capsicum frutescens L. crop. A randomized block design with four treatments and eight replications was used. The treatments were four rates of CO(2): 0 (T1), 451.95 (T2); 677.93 (T3) and 903.92 (T4) kg ha(-1). The fruits were counted and weighed; the length and the diameter were obtained from an average of 20 fruits per plant, randomly taken, from each treatment in the plot. The quadratic effect (p < 0.01) occurred for CO(2) on the yield and there was quadratic effect (p < 0.05) of the rates on the number of fruits. There were no effects of CO(2) rates on the green matter, dry matter and fruit length and diameter. The T2 treatment provided greater yield and higher number of fruits per plant with an increase of 16 and 26%, respectively in relation to T1 (without CO(2)). CO(2) application favored the increase in the yield because of the greater number of fruits per plant in the Tabasco pepper crop.

Distribution and storage characterization of soil solution for drip irrigation

The increased use of marginal quality water with drip irrigation requires sound fertigation practices that reconcile environmental concerns with viable crop production objectives. We conducted experiments to characterize dynamics and patterns of soil solution within wet bulb formed by drip irrigation. Time-domain reflectometry probes were used to monitor the distribution of potassium nitrate (KNO(3)) and water distribution from drippers discharging at constant flow rates of 2, 4 and 8 L h(-1) in soil-filled containers. Considering results from different profiles, we observed greater solute storage near the dripper decreasing gradually towards the wetting front. About half of the applied KNO(3) solution (48%) was stored in the first layer (0-0.10 m) for all experiments, 29% was stored in the next layer (0.10-0.20 m). Comparing different dripper flow rates, we observed higher solution storage for 4 L h(-1), with 45, 53 and 47% of applied KNO(3) solution accumulating in the first layer (0-0.10 m) for dripper flow rates of 2, 4 and 8 L h(-1), respectively. The results suggest that based on the volume and frequency used in this experiment, it would be advantageous to apply small amounts of solution at more frequent intervals to reduce deep percolation losses of applied water and solutes.

Economic feasibility of cowpea irrigation in Piaui State

The objective of this work was to evaluate the economic feasibility of cowpea irrigation in Piaui State Brazil. Water balances were carried out on a daily basis using the Thornthwaite and Mather (1955) method, for 165 sites, considering twelve sowings dates and available water capacity in the soil of 20, 40 and 60 mm. The net revenues were estimated with a probability of occurrence of 75%, later being spatialized to Piaui State. Cowpea irrigation was shown to economically viable for all sowing dates, irrespective of the available water capacity. Net revenues varied among several regions of the State, in function of the sowing date and available water capacity in the soil. Considering a planning strategy for Piaui State, sowing on February, I was shown to be most favorable, because it enabled higher net revenue values, covering larger areas of the State.

Optimal irrigation depth for bean crops considering water constraints and farmer`s risk aversion level

Nowadays, the rising competition for the use of water and environmental resources with consequent restrictions for farmers should change the paradigm in terms of irrigation concepts, or rather, in order to attain economical efficiency other than to supply water requirement for the crop. Therefore, taking into account the social and economical role of bean activity in Brazil, as well as the risk inherent to crop due to its high sensibility to both deficit and excessive water, the optimization methods regarding to irrigation management have become more interesting and essential. This study intends to present a way to determine the optimal water supply, considering different combinations between desired bean yield and level of risk, bringing as a result a graph with the former associated with the latter, depending on different water depths.

Flow rate sprinkler development for site-specific irrigation

Due to the rapid depletion of water resources, water must be used more efficiently in agriculture to maintain current levels of yield in irrigated areas. The efficiency of irrigation systems can be increased by adjusting the amount of water applied to specific conditions of soil and crop, which may vary in a field. Taking into account spatial and temporal variability, it is evident that an equipment capable of providing different irrigation levels is necessary to meet the water requirement of the soil. This work aims to develop and evaluate a flow rate sprinkler to be used in center pivots or linear moving irrigation systems, with potential for utilization in irrigation scheduling. A prototype was developed by duplicating its calibrations, and discharge coefficient adjustment was carried out in the laboratory. To predict the flow rate, a successful model that represented the operation of the flow rate sprinkler was established. The calibration of the flow rate sprinkler prototype showed satisfactory statistical and technical results. Automation of the prototype was achieved by driving a step motor using communication from the parallel port of a microcomputer, which was controlled by a software developed for this purpose. The results were satisfactory and technically feasible.

Irrigation requirements and transpiration coupling to the atmosphere of a citrus orchard in Southern Brazil

Crop evapotranspiration (ETc) was measured as evaporative heat flux from an irrigated acid lime orchard (Citrus latifolia Tanaka) using the aerodynamic method. Crop transpiration (T) was determined by a stem heat balance method. The irrigation requirements were determined by comparing the orchard evapotranspiration (ETc) and T with the reference evapotranspiration (ETo) derived from the Penman-Monteith equation, and the irrigation requirements were expressed as ETc/ETo (Kc) and T/ETo (Kcb) ratios. The influence of inter-row vegetation on the ETc was analyzed because the measurements were taken during the summer and winter, which are periods with different regional soil water content. In this study, the average Mc values obtained were 0.65 and 0.24 for the summer and winter, respectively. The strong coupling of citrus trees to the atmosphere and the sensitivity of citrus plants to large vapor pressure deficits and air/leaf temperatures caused variations in the Kcb in relation to the ETo ranges. During the summer, the Kcb value ranged from 0.34 when the ETo exceeded 5 mm d(-1) to 0.46 when the ETo was less than 3 mm d(-1). (C) 2011 Elsevier B.V. All rights reserved.

Microbial Metabolic Potential Affected by Surplus Wastewater Irrigation in Tropical Soil Cultivated with Tifton 85 Bermuda Grass (Cynodon dactylon Pers. X C. niemfuensis Vanderyst)

Agricultural reuse of treated sewage effluent (TSE) is an environmental and economic practice; however, little is known about its effects on the characteristics and microbial function in tropical soils. The effect of surplus irrigation of a pasture with TSE, in a period of 18 months, was investigated, considering the effect of 0% surplus irrigation with TSE as a control. In addition, the experiment consisted of three surplus treatments (25%, 50%, and 100% excess) and a nonirrigated pasture area (SE) to compare the soil microbial community level physiological profiles, using the Biolog method. The TSE application increased the average substrate consumption of the soil microbial community, based on the kinetic parameters of the average well color development curve fitting. There were no significant differences between the levels of surplus irrigation treatments. Surplus TSE pasture irrigation caused minor increases in the physiological status of the soil microbial community but no detectable damage to the pasture or soil.

Analysis of soil wetting and solute transport in subsurface trickle irrigation

The increased use of trickle or drip irrigation is seen as one way of helping to improve the sustainability of irrigation systems around the world. However, soil water and solute transport properties and soil profile characteristics are often not adequately incorporated in the design and management of trickle systems. In this paper, we describe results of a simulation study designed to highlight the impacts of soil properties on water and solute transport from buried trickle emitters. The analysis addresses the influence of soil hydraulic properties, soil layering, trickle discharge rate, irrigation frequency, and timing of nutrient application on wetting patterns and solute distribution. We show that (1) trickle irrigation can improve plant water availability in medium and low permeability fine-textured soils, providing that design and management are adapted to account for their soil hydraulic properties, (2) in highly permeable coarse-textured soils, water and nutrients move quickly downwards from the emitter, making it difficult to wet the near surface zone if emitters are buried too deep, and (3) changing the fertigation strategy for highly permeable coarse-textured soils to apply nutrients at the beginning of an irrigation cycle can maintain larger amounts of nutrient near to and above the emitter, thereby making them less susceptible to leaching losses. The results demonstrate the need to account for differences in soil hydraulic properties and solute transport when designing irrigation and fertigation management strategies. Failure to do this will result in inefficient systems and lost opportunities for reducing the negative environmental impacts of irrigation.