Is COPD a Progressive Disease? A Long Term Bode Cohort Observation

Background

The Global Initiative for Obstructive Lung Diseases (GOLD) defines COPD as a disease that is usually progressive. GOLD also provides a spirometric classification of airflow limitation. However, little is known about the long-term changes of patients in different GOLD grades.

Objective

Explore the proportion and characteristics of COPD patients that change their spirometric GOLD grade over long-term follow-up.

Methods

Patients alive for at least 8 years since recruitment and those who died with at least 4 years of repeated spirometric measurements were selected from the BODE cohort database. We purposely included the group of non survivors to avoid a “survival selection” bias. The proportion of patients that had a change (improvement or worsening) in their spirometric GOLD grading was calculated and their characteristics compared with those that remained in the same grade.

Results

A total of 318 patients were included in the survivor and 217 in the non-survivor groups. Nine percent of survivors and 11% of non survivors had an improvement of at least one GOLD grade. Seventy one percent of survivors and non-survivors remained in the same GOLD grade. Those that improved had a greater degree of airway obstruction at baseline.

Conclusions

In this selected population of COPD patients, a high proportion of patients remained in the same spirometric GOLD grade or improved in a long-term follow-up. These findings suggest that once diagnosed, COPD is usually a non-progressive disease.

Time to culture conversion in smokers with pulmonary tuberculosis

Background and objective. It has been reported that tobacco smoking slows the sterilisation of sputum culture in pulmonary tuberculosis, but the factors that could delay culture conversion in patients who smoke are not known. Our aim is to identify the factors influencing sputum culture conversion in smokers with pulmonary tuberculosis. Methods. Ninety-nine patients with a smoking history and diagnosed with pulmonary tuberculosis were analysed retrospectively. The relationship between sputum culture status at the second month and the following variables: age, gender, pack-years index, comorbid diseases, number acid-fast bacilli (AFB) in sputum smear examination, radiological findings (cavitary, extensive or limited disease), drug susceptibility pattern and initial treatment, was analysed. The Student t-test, chi-square test and logistic regression model with forward stepwise conditional methods were used for statistical analysis. A p value of <0.05 was considered to be statistically significant. Results. Twenty six patients (26.2%): 18 males (22.2%) and 8 females (44%) were sputum culture positive at the end of the second month of treatment. In univariate analysis, culture conversion time was significantly associated with female gender and extensive disease, but in a logistic regression analysis was only correlated with female gender (OR=5.63 95% CI 1.21-20.64-p=0.02). Conclusion. In current smokers with pulmonary tuberculosis, the ‘time to culture’ conversion relates only to the female gender.

Differential Effect of Modified Medical Research Council Dyspnea, COPD Assessment Test, and Clinical COPD Questionnaire for Symptoms Evaluation Within the New GOLD Staging and Mortality in COPD

OBJECTIVE

The modified Medical Research Council (mMRC) dyspnea, the COPD Assessment Test (CAT), and the Clinical COPD Questionnaire (CCQ) have been interchangeably proposed by GOLD (Global Initiative for Chronic Obstructive Lung Disease) for assessing symptoms in patients with COPD. However, there are no data on the prognostic value of these tools in terms of mortality. We endeavored to evaluate the prognostic value of the CAT and CCQ scores and compare them with mMRC dyspnea.

METHODS

We analyzed the ability of these tests to predict mortality in an observational cohort of 768 patients with COPD (82% men; FEV1, 60%) from the COPD History Assessment in Spain (CHAIN) study, a multicenter observational Spanish cohort, who were monitored annually for a mean follow-up time of 38 months.

RESULTS

Subjects who died (n = 73; 9.5%) had higher CAT (14 vs 11, P = .022), CCQ (1.6 vs 1.3, P = .033), and mMRC dyspnea scores (2 vs 1, P < .001) than survivors. Receiver operating characteristic analysis showed that higher CAT, CCQ, and mMRC dyspnea scores were associated with higher mortality (area under the curve: 0.589, 0.588, and 0.649, respectively). CAT scores ≥ 17 and CCQ scores > 2.5 provided a similar sensitivity than mMRC dyspnea scores ≥ 2 to predict all-cause mortality.

CONCLUSIONS

The CAT and the CCQ have similar ability for predicting all-cause mortality in patients with COPD, but were inferior to mMRC dyspnea scores. We suggest new thresholds for CAT and CCQ scores based on mortality risk that could be useful for the new GOLD grading classification.

TRIAL REGISTRY

ClinicalTrials.gov; No.: NCT01122758; URL: www.clinicaltrials.gov.

Rapid, Fully Automated Digital Immunoassay for p24 Protein with the Sensitivity of Nucleic Acid Amplification for Detecting Acute HIV Infection

BACKGROUND

Nucleic acid testing (NAT) has become the standard for high sensitivity in detecting low levels of virus. However, adoption of NAT can be cost prohibitive in low-resource settings where access to extreme sensitivity could be clinically advantageous for early detection of infection. We report development and preliminary validation of a simple, low-cost, fully automated digital p24 antigen immunoassay with the sensitivity of quantitative NAT viral load (NAT-VL) methods for detection of acute HIV infection.

METHODS

We developed an investigational 69-min immunoassay for p24 capsid protein for use on a novel digital analyzer on the basis of single-molecule-array technology. We evaluated the assay for sensitivity by dilution of standardized preparations of p24, cultured HIV, and preseroconversion samples. We characterized analytical performance and concordance with 2 NAT-VL methods and 2 contemporary p24 Ag/Ab combination immunoassays with dilutions of viral isolates and samples from the earliest stages of HIV infection.

RESULTS

Analytical sensitivity was 0.0025 ng/L p24, equivalent to 60 HIV RNA copies/mL. The limit of quantification was 0.0076 ng/L, and imprecision across 10 runs was <10% for samples as low as 0.09 ng/L. Clinical specificity was 95.1%. Sensitivity concordance vs NAT-VL on dilutions of preseroconversion samples and Group M viral isolates was 100%.

CONCLUSIONS

The digital immunoassay exhibited >4000-fold greater sensitivity than contemporary immunoassays for p24 and sensitivity equivalent to that of NAT methods for early detection of HIV. The data indicate that NAT-level sensitivity for acute HIV infection is possible with a simple, low-cost digital immunoassay.

COPD comorbidities network

Multimorbidity frequently affects the ageing population and their co-existence may not occur at random. Understanding their interactions and that with clinical variables could be important for disease screening and management.

In a cohort of 1969 chronic obstructive pulmonary disease (COPD) patients and 316 non-COPD controls, we applied a network-based analysis to explore the associations between multiple comorbidities. Clinical characteristics (age, degree of obstruction, walking, dyspnoea, body mass index) and 79 comorbidities were identified and their interrelationships quantified. Using network visualisation software, we represented each clinical variable and comorbidity as a node with linkages representing statistically significant associations.

The resulting COPD comorbidity network had 428, 357 or 265 linkages depending on the statistical threshold used (p≤0.01, p≤0.001 or p≤0.0001). There were more nodes and links in COPD compared with controls after adjusting for age, sex and number of subjects. In COPD, a subset of nodes had a larger number of linkages representing hubs. Four sub-networks or modules were identified using an inter-linkage affinity algorithm and their display provided meaningful interactions not discernible by univariate analysis.

COPD patients are affected by larger number of multiple interlinked morbidities which clustering pattern may suggest common pathobiological processes or be utilised for screening and/or therapeutic interventions.

Comorbidity Distribution, Clinical Expression and Survival in COPD Patients with Different Body Mass Index

Rationale: Contrary to the general population, in patients with chronic obstructive pulmonary disease (COPD) a low body mass index (BMI) is associated with excess mortality, while obesity appears protective (obesity paradox). We hypothesized that BMI is associated with a distinct number and expression of comorbidities in patients with COPD. The type of comorbidity may relate to mortality variability. Objectives and Methods: We followed 1659 COPD patients for a median of 51 months [IQR 27-77] with detailed comorbidity records and tracking pulmonary function, exercise capacity, dyspnea, health status, and cause of death. The cohort was categorized into the 5 National Heart Lung and Blood Institute (NHLBI) BMI groups with determination made about each group's relationship to specific comorbidities, clinical parameters and risk for death. Results: Whereas osteoporosis, substance abuse, abdominal aortic aneurism and peripheral arterial disease were more prevalent in patients with low BMI, metabolic and cardiac problems were more frequent in those with high BMI. The BMI was inversely related to the ratio of forced expiratory volume in 1 second (FEV₁) to forced vital capacity (FVC)(FEV₁ %), BODE (Body mass index, airway Obstruction, Dyspnea, Exercise capacity) index and hyperinflation, had a "U" shape with dyspnea and the St. George's Respiratory Questionaire (SGRQ) score and an inverse "U" with exercise capacity. The crude mortality rate was 60%, 43%, 37%, 36% and 28% from the lowest to highest BMI groups (p<.0001). More respiratory deaths were observed in the lowest BMI group even though they had a lower number of comorbidities. Conclusions: Different BMI categories are associated with distinct clinical expressions of COPD and comorbidity patterns. The relationship between BMI and mortality in patients with COPD remains an unresolved paradox.

Disease progression in young patients with COPD: rethinking the Fletcher and Peto model

Chronic obstructive pulmonary disease (COPD), although frequent in older individuals, can also occur at younger age; this latter population has not been well described. We reviewed the functional progression of 1708 patients with COPD attending pulmonary clinics. Those with three or more annual spirometries were divided into those who, at enrolment, were ≤ 55 (n = 103) or ≥ 65 (n = 463) years of age (younger and older COPD, respectively). Baseline and annual changes in lung function (forced expiratory volume in 1 s (FEV1)) and BODE (body mass index, airflow obstruction, dyspnoea, exercise capacity) score were recorded and compared between both groups. Severity distribution by Global Initiative for Chronic Obstructive Lung Disease and BODE scores were similar in both groups, except for mild obstruction, which was higher in the younger group. Mean FEV1 decline was 38.8 and 40.6 mL · year(-1), while BODE scores increased 0.19 and 0.23 units per year, for younger and older COPD, respectively. Both groups had similar proportion of FEV1 rapid decliners (42% and 46%, respectively). The severity distribution and progression of disease in younger patients with COPD is similar to that of patients of older age. This observation suggests that younger individuals presenting with COPD develop the disease from an already compromised pulmonary and systemic status, complementing the model of steeper decline of lung function proposed by Fletcher and Peto.

210 FACTORS AFFECTING SUPEROVULATION RESPONSE IN CATTLE: A RETROSPECTIVE STUDY

Superovulation, embryo collection, and transfer allow for genetic improvement resulting in more rapid enhancement of production traits. Despite these advantages, variability in the response to superovulation has been observed between and within individual animals, becoming a costly inconvenience of these techniques. The purpose of this study was to evaluate the factors that influenced the superovulatory response and the resulting quantity and quality of the ova/embryos collected during embryo flushing in the study group, with cow as the experimental unit. A retrospective study was conducted, evaluating superovulation records from 794 embryo donors collected for the first time. Individual information was classified as breed (Angus or Holstein), parity (heifers or dry cow), body condition score (BCS; 5, 6, or 7 was considered optimal and BCS <5 or >7 was considered not optimal; in a 1 to 9 scale), hormonal dose used (375 or 500 IU of FSH), ovarian response (presence of more than one corpus luteum), collection (abnormal: blood or <80% fluid recovered or normal: bicornual >80% fluid recovered) and season at collection (summer, fall, winter, spring) to determine their predictive value for the total number of ova/embryos collected: number of transferable embryos, degenerated embryos, and unfertilized oocytes (UFOs) according to the IETS standards for classification. Variables were evaluated and transformed when needed to establish normality. Binary logistic regression was used to identify predictors of ovarian response or nonresponse. A model was built for each of these dependent variables using a general linear model (GLM). Tukey's post hoc test was used to compare adjusted means between groups when there were significant factors identified by the GLM. The study found a significant difference (P = 0.024) in the percentage of cows responding to superovulation treatment in summer compared with spring (91.5% v. 98.4%). From the 755 donors that responded, the mean number (±s.e.m.) of ova/embryos collected from donors with optimal BCS was higher (P = 0.052) than those from donors with nonoptimal BCS (9.8 ± 0.37 v. 8.4 ± 0.42). The mean numbers of total ova/embryos obtained from normal collections was higher (P < 0.001) than the mean from those collections classified as abnormal (10.25 ± 0.30 v. 6.60 ± 0.62). The mean number of viable embryos from responding donors was 5.66 ± 0.18 per collection. Donors with BCS classified as optimal had significantly higher (P = 0.034) mean number (±s.e.m.) of viable embryos compared with donors with nonoptimal BCS (5.95 ± 0.23 v. 5.18 ± 0.29). For the present study, the percentage of cows treated that responded and were collected decreased in summer. The effect of ambient temperature may be reduced by evaporative cooling of donors or by avoiding collections during the hottest days of the summer. Complications during the collection are rare and can be partially avoided by using experienced technicians only. Results may improve when donors are in an appropriate nutrition status, either by supplementing those animals with low body scores or by restricting diets for those that are overweight, to improve the efficiency of the technique.

G-CSF activation of AKT is not sufficient to prolong neutrophil survival

Neutrophils play an important role in the innate immune response against bacterial and fungal infections. They have a short lifespan in circulation, and their survival can be modulated by several cytokines, including G-CSF. Previous studies have implicated AKT as a critical signaling intermediary in the regulation of neutrophil survival. Our results demonstrate that G-CSF activation of AKT is not sufficient to prolong neutrophil survival. Neutrophils treated with G-CSF undergo apoptosis, even in the presence of high levels of p-AKT. In addition, inhibitors of AKT and downstream targets failed to alter neutrophil survival. In contrast, neutrophil precursors appear to be dependent on AKT signaling pathways for survival, whereas high levels of p-AKT inhibit proliferation. Our data suggest that the AKT/mTOR pathway, although important in G-CSF-driven myeloid differentiation, proliferation, and survival of early hematopoietic progenitors, is less essential in G-CSF suppression of neutrophil apoptosis. Whereas basal AKT levels may be required for the brief life of neutrophils, further p-AKT expression is not able to extend the neutrophil lifespan in the presence of G-CSF.

The role of biologically active peptides in tissue repair using umbilical cord mesenchymal stem cells

The role of bioactive compounds in wound repair is critical. The preliminary work described herein includes the study of the effects of second degree burns in a Rex rabbit model and the action of human umbilical cord cells on the regulation and secretion of bioactive compounds. When applied on blood scaffolds as heterograft matrices, fibroblasts proliferate from these primary cultures and release biologically active peptides under tight control. Our work in progress indicates that mesenchymal stem cell (MSC)-mediated therapy provides better quality and more efficient burn reepithelialization of injured tissues by controlling the release of these peptides. Improvement of wound aesthetics is achieved in less time than without MSC-mediated therapy. Well-organized epidermal regeneration and overall better quality of reepithelialization, with no rejection, can be demonstrated consistently with periodic biopsies. Our studies indicate that MSCs have the capacity to produce, regulate, and deliver biologically active peptides that result in superior regeneration, compared with conventional treatments.

Comorbidities and risk of mortality in patients with chronic obstructive pulmonary disease

RATIONALE

Patients with chronic obstructive pulmonary disease (COPD) are afflicted by comorbidities. Few studies have prospectively evaluated COPD comorbidities and mortality risk.

OBJECTIVES

To prospectively evaluate COPD comorbidities and mortality risk.

METHODS

We followed 1,664 patients with COPD in five centers for a median of 51 months. Systematically, 79 comorbidities were recorded. We calculated mortality risk using Cox proportional hazard, and developed a graphic representation of the prevalence and strength of association to mortality in the form of a "comorbidome". A COPD comorbidity index (COPD specific comorbidity test [COTE]) was constructed based on the comorbidities that increase mortality risk using a multivariate analysis. We tested the COTE index as predictor of mortality and explored whether the COTE index added predictive information when used with the validated BODE index.

MEASUREMENTS AND MAIN RESULTS

Fifteen of 79 comorbidities differed in prevalence between survivors and nonsurvivors. Of those, 12 predicted mortality and were integrated into the COTE index. Increases in the COTE index were associated with an increased risk of death from COPD-related (hazard ratio [HR], 1.13; 95% confidence interval, 1.08-1.18; P < 0.001) and non-COPD-related causes (HR, 1.18; 95% confidence interval, 1.15-1.21; P < 0.001). Further, increases in the BODE and COTE were independently associated with increased risk of death. A COTE score of greater than or equal to 4 points increased by 2.2-fold the risk of death (HR, 2.26-2.68; P < 0.001) in all BODE quartile.

CONCLUSIONS

Comorbidities are frequent in COPD and 12 of them negatively influence survival. A simple disease-specific comorbidities index (COTE) helps assess mortality risk in patients with COPD.

Tidal volume is a major determinant of cyclic recruitment-derecruitment in acute respiratory distress syndrome

BACKGROUND

Overdistension and cyclic recruitment-derecruitment contribute to ventilator-induced lung injury. High tidal volumes are thought to increase mortality mainly by inducing overdistension. However, experimental evidence suggests that tidal volume (VT) may also influence cyclic recruitment-derecruitment. Our main goal was to determine whether high tidal volumes increase cyclic recruitment-derecruitment in acute respiratory distress syndrome (ARDS) patients, as measured by dynamic computed tomography (CT).

METHODS

We studied 9 ARDS patients with diffuse attenuations on CT who underwent a protocol including 2 ventilatory modes: (a) VT 6 mL/kg, respiratory rate 30/min, PEEP 9 cmH2O, (b) VT 12 mL/kg, respiratory rate 15/min, PEEP 9 cmH2O. A dynamic computed tomography of 8 seconds on a fixed transverse region was performed during each ventilator mode. Cyclic recruitment-derecruitment was determined as non-aerated tissue variation between inspiration and expiration and was expressed as % of lung tissue weight.

RESULTS

VT 12 mL/kg exhibited less non-aerated tissue at expiration compared to VT 6 ml/kg (40.15 [35.94-56.00] and 45.31 [37.95-59.32], respectively, P<0.05). However, VT 12 ml/kg increased cyclic recruitment-derecruitment compared to VT 6 mL/kg (7.32 [6.58-9.29] mL/kg vs. 4.51 [3.42-5.75] mL/kg, P<0.01). Tidal hyperinflation was also larger at VT 12 mL/kg (0.55 [0.27-2.24] vs. 0.24 [0.18-0.83], P<0.01).

CONCLUSION

High tidal volume is a major determinant of cyclic recruitment-derecruitment in ARDS patients with diffuse attenuations.

Caracterización sanitaria y nutricional de colonias de abejas melíferas en forestaciones de Eucalyptus grandis

En Uruguay muchos apicultores trasladan sus colonias a las forestaciones de Eucalyptus grandis al final del verano y en otoño obteniendo importantes cosechas de miel. Sin embargo, cuando finaliza la floración las colonias se encuentran muy debilitadas, sobreviniendo una elevada mortalidad. Problemas nutricionales y sanitarios podrían explicar el debilitamiento de las colonias. Para averiguar las causas del debilitamiento se llevaron colonias de igual tamaño a una forestación de E. grandis, separadas en tres grupos diferenciados por la disponibilidad de polen. A lo largo del periodo de floración se registró: el origen botánico y el contenido de proteína cruda del polen que ingresaba en las colmenas, la proteína corporal de las abejas, la infección por Nosema ceranae y la infestación por Varroa destructor, el área de cría y la producción de miel. Los resultados más importantes hallados fueron: i) la sostenida disminución de la diversidad botánica del polen a medida que transcurría el periodo de floración de E. grandis hasta quedar únicamente el polen de esta especie; ii) el polen de E. grandis presentó valores de proteína bruta cercanos al 30%, pero fue disminuyendo paulatinamente hasta alcanzar un valor inferior a 20% al final de la floración; iii) las colonias que contaban inicialmente con reservas de polen presentaron abejas con mayor proteína corporal pocos días después de llegar a la forestación y menor infestación de N. ceranae durante la mayor parte del periodo de floración; iv) la disponibilidad de polen no incidió en la infestación de V. destructor, el área de cría y la producción de miel. El déficit nutricional de las abejas durante la floración de E. grandis podría generar las condiciones adecuadas para la multiplicación de N. ceranae. Al final de la floración del eucalipto las colonias presentaron promedialmente más del 90% de las abejas pecoreadoras infectadas con N. ceranae y 12% de V. destructor en las abejas adultas. La incidencia de ambos patógenos sobre las abejas debilitadas podría explicar la pérdida de colonias.

Whole-blastocyst culture followed by laser drilling technology enhances the efficiency of inner cell mass isolation and embryonic stem cell derivation from good- and poor-quality mouse embryos: new insights for derivation of human embryonic stem cell lines

The optimization of human embryonic stem (hES) cell line derivation methods is challenging because many worldwide laboratories have neither access to spare human embryos nor ethical approval for using supernumerary human embryos for hES cell derivation purposes. Additionally, studies performed directly on human embryos imply a waste of precious human biological material. In this study, we developed a new strategy based on the combination of whole-blastocyst culture followed by laser drilling destruction of the trophoectoderm for improving the efficiency of inner cell mass (ICM) isolation and ES cell derivation using murine embryos. Embryos were divided into good- and poor-quality embryos. We demonstrate that the efficiency of both ICM isolation and ES cell derivation using this strategy is significantly superior to whole-blastocyst culture or laser drilling technology itself. Regardless of the ICM isolation method, the ES cell establishment depends on a feeder cell growth surface. Importantly, this combined methodology can be successfully applied to poor-quality blastocysts that otherwise would not be suitable for laser drilling itself nor immunosurgery in an attempt to derive ES cell lines due to the inability to distinguish the ICM. The ES cell lines derived by this combined method were characterized and shown to maintain a typical morphology, undifferentiated phenotype, and in vitro and in vivo three germ layer differentiation potential. Finally, all ES cell lines established using either technology acquired an aneuploid karyotype after extended culture periods, suggesting that the method used for ES cell derivation does not seem to influence the karyotype of the ES cells after extended culture. This methodology may open up new avenues for further improvements for the derivation of hES cells, the majority of which are derived from frozen, poor-quality human embryos.

Socio-economic gradient in food selection and diet quality among 70-year olds

OBJECTIVE

The aim of this study was to assess social disparities in food choices and diet quality in a population of 70-year old Swedes.

DESIGN

Cross-sectional study among participants in the 2000 Gerontological and Geriatric Population Studies in Goteborg.

PARTICIPANTS

A representative population of men (n=233) and women (n=321) from Goteborg, a city on the south western coast of Sweden.

METHODS

One hour diet history interviews were performed and 35 specific foods and food groups were identified; in addition a diet quality index (DQI) was calculated. Differences in food choices and diet quality scores were tested across educational and socio-economic index categories (SEI).

RESULTS

Men with higher education and SEI had higher diet quality scores than those with lower socio-economic status, while no differences in DQI were noted in women. Further analysis of women based on their husband's occupational group also yielded no differences in diet quality. When studying individual foods, socio-economic differences were observed in women and men.

CONCLUSIONS

Selection of food varies by education and occupational status in both sexes although socio-economic disparities in diet quality were observed in men only.

Detection and analysis of somatic mutations at a lacZ reporter locus in higher organisms: application to Mus musculus and Drosophila melanogaster

Methods to detect and analyze somatic mutations in higher organisms are critically important in view of their causal role in cancer, heritable diseases, and, possibly, aging. Here, we describe detailed protocols for the use of a mutational reporter system based on lacZ-containing plasmids integrated in the germline of Mus musculus and Drosophila melanogaster. Plasmids containing the bacterial lacZ gene integrated at one or more chromosomal sites can be excised, purified and recovered in suitable Escherichia coli hosts allowing the positive selection of mutant lacZ genes and their further molecular characterization. This system is capable of detecting a broad range of mutational events, varying from small mutations in the lacZ reporter gene to large genome rearrangements with one breakpoint in lacZ and the other breakpoint elsewhere in the genome.

Human Papillomavirus Associated with Papillary Squamous Cell Carcinoma of the Oropharynx in a Renal Transplant Recipient

The papillary squamous cell carcinoma (PSCC) is a rare variant of the head and neck squamous cell carcinoma. Established etiological factors can include tobacco smoking and heavy alcohol abuse. Moreover, human papillomavirus infection can be involved in the pathogenesis of PSCC. This tumor is more frequent in patients with immunosuppression including those who have received a transplant. Most of the cases are produced by genotype HPV-6 and HPV-16, although there is a possibility of infection by other HPV subtypes. We present a case report of a PSCC and papilloma with oropharyngeal location in which high-risk HPV type 16 and low-risk HPV type 6, respectively, were identified by PCR in a renal transplant patient.

General safety guidances in stem cell bank installations

The use of cell cultures in research and in regenerative medicine programs has increased in the past few years, and control of the risks inherent to these procedures should be increased. People who work in stem cell bank installations should be aware of the risks implied in their work and take necessary self-protection measures for the known and unidentified risks. Work in stem cell bank installations is subject to different types of risks, such as toxicologic, carcinogen and, mainly, infectious risks. Different types of safety measurements should be distinguished and secured, for example for protection of personnel, protection of the cell cultures and protection in general of humans and the environment.

Organ-Specific Increase in Mutation Accumulation and Apoptosis Rate in CuZn-Superoxide Dismutase–Deficient Mice

Reactive oxygen species have been implicated as a cause of cancer and aging in mammals. Mice deficient for the antioxidant enzyme CuZn-superoxide dismutase (Sod1) have a decreased life span and an elevated incidence of liver cancer. To test the hypothesis that the cancer-prone phenotype in such mice is due to accelerated spontaneous mutation accumulation, we crossed these mutants with mice harboring a neutral lacZ mutation reporter gene. At 2 months of age, the lacZ mutation frequency in the liver of the hybrid animals was already twice as high as in littermate controls of the same age. This difference in mutation frequency increased to >3-fold at 6 months of age, after which it did not increase any further. Characterization of the mutation spectra in liver of the Sod1-null mice indicated mainly GC-to-TA transversions and GC-to-AT transitions, signature mutations of oxidative stress. The accelerated mutation accumulation in liver was accompanied by an increased frequency of apoptotic cells, as indicated by an increase in both terminal deoxyribonucleotidyl transferase-mediated dUTP nick end labeling- and caspase 3-stained cells at 6 and 12 months of age. In kidney, an elevated mutation frequency above controls of approximately 2.5-fold was found not earlier than at 6 months. No increased mutation accumulation was observed in brain or spleen. These results support the hypothesis, that oxidative stress is an important causal factor of cancer in mammals.

Prescribed daily doses and 'risk factors' associated with the use of benzodiazepines in primary care

OBJECTIVE

To assess the extent, characteristics and determinants of benzodiazepine prescription in outpatient Primary Health Care.

METHODS

A clinical audit of a stratified random sample of Primary Health Care Centres in the seven islands and 1.6 million inhabitants region of 'Canarias' in Spain was carried out. From those centres, a random sample of 1045 clinical records was reviewed and information on diagnosis, prescription and prescribed dosages was collected in a structured questionnaire. A multivariate logistic regression analysis was performed in order to determine the 'risk factors' for the use of benzodiazepines.

RESULTS

Benzodiazepine prescription was recorded in 23.4% of all clinical records; 87.7% of these were for benzodiazepines classified as anxiolytics (N05B) and 12.3% for hypnotics (N05C2). Benzodiazepine prescription was more common for women, elderly, widowed, divorced, low educational background, housewives and retired people. Using multivariate logistic regression, the probability of benzodiazepine prescription was found to be closely related to age, gender and employment status, but not with educational level. Prescribed Daily Doses were lower than Defined Daily Doses (DDD) in 77.1% of all anxiolytic prescriptions, but were in agreement with DDD in 90% of hypnotic prescriptions. The duration of treatment recorded in the clinical records was 25+/-21 months, with a range of 1 and 144 months. General Practitioners were responsible for 67% of all benzodiazepine prescription. Anxiolytics were prescribed as a single daily dose in 57% of the cases, and only 'at supper' in 48.6%.

CONCLUSION

In the general population attending Primary Health Care Centres of the Canary Islands Health System the prescription of benzodiazepines is higher for women and the elderly, and the most common use is chronic, with a duration of over 2 years in most cases. Anxiolytics are prescribed in doses which are much lower than those used as DDD and were used only 'at night' in almost half of the cases. This could represent an overlapping of the indications with hypnotics, and explain part of the huge difference in the use of anxiolytics in Spain compared with other figures in Europe. This fact must also be taken into account when making inferences of benzodiazepine use from sales statistics, which are very imprecise measures of drug use.

Self-reported stress levels predict subsequent breast cancer in a cohort of Swedish women

The association between stress and breast cancer has been studied, mostly using case-control designs, but rarely examined prospectively. The purpose of this paper is to describe the role of stress as a predictor of subsequent breast cancer. A representative cohort of 1,462 Swedish women aged 38-60 years were followed for 24 years. Stress experience at a baseline examination in 1968-69 was analysed in relation to incidence of breast cancer with proportional hazards regression. Women reporting experience of stress during the five years preceding the first examination displayed a two-fold rate of breast cancer compared with women reporting no stress (age-adjusted relative risk 2.1; 95% CI [1.2-3.7]). This association was independent of potential confounders including reproductive and lifestyle factors. In conclusion, the significant, positive relationship between stress and breast cancer in this prospective study is based on information that is unbiased with respect to knowledge of disease, and can be regarded as more valid than results drawn from case-control studies.

Ascorbic acid in diet supplements: loss in the manufacturing process and storage

The ascorbic acid content was determined in 25 different diet supplements commercially available to the consumer in two pharmaceutical forms (pills and ampoules). These products are widely consumed by several population groups (elderly people, sportsmen, adolescents, children, etc.). High-performance liquid chromatography was used as the analytical technique. The proposed method has been validated with good linearity, reproducibility, recovery and accuracy, and can be used in routine analyses and in quality control. The ascorbic acid content in pills ranged from 15.62 to 50.16 mg/g, and in that ampoules from 2.12 to 8.83 mg/ml. Depending on the dosage rates, these levels would represent approximately 20-50% of the daily dietary intake recommended by the National Research Council. Possible losses in the manufacturing process and stability during storage for 30 days at 40 +/- 2 degrees C without light, were tested. In relation to the ascorbic acid concentrations stated on the labels, a loss of 12.0-21.9% in pills and of 11.7-18.0% in ampoules was detected. In relation to the stability conditions, the losses are of 1.8-24.8% in pills and of 10.4-19.3% in ampoules. The pasteurisation and sterilisation processes produced a mean loss of ascorbic acid in ampoules of 2.1 and 1.4%, respectively. A statistically significant direct correlation was observed between ascorbic acid loss and content in proteins, humidity, ash, and fructose. The influence of the pharmaceutical form was also tested. Data revealed that the control of losses during the manufacturing and commercialisation process of these products is necessary to ensure the intake of vitamin C from these products by the consumer.

Interleukin-7 in plasma correlates with CD4 T-cell depletion and may be associated with emergence of syncytium-inducing variants in human immunodeficiency virus type 1-positive individuals

Human immunodeficiency virus type 1 (HIV-1) primary infection is characterized by the use of CCR5 as a coreceptor for viral entry, which is associated with the non-syncytium-inducing (NSI) phenotype in lymphoid cells. Syncytium-inducing (SI) variants of HIV-1 appear in advanced stages of HIV-1 infection and are characterized by the use of CXCR4 as a coreceptor. The emergence of SI variants is accompanied by a rapid decrease in the number of T cells. However, it is unclear why SI variants emerge and what factors trigger the evolution of HIV from R5 to X4 variants. Interleukin-7 (IL-7), a cytokine produced by stromal cells of the thymus and bone marrow and by keratin, is known to play a key role in T-cell development. We evaluated IL-7 levels in plasma of healthy donors and HIV-positive patients and found significantly higher levels in HIV-positive patients. There was a negative correlation between circulating IL-7 levels and CD4(+) T-cell count in HIV-positive patients (r = -0.621; P < 0.001), suggesting that IL-7 may be involved in HIV-induced T-cell depletion and disease progression. IL-7 levels were higher in individuals who harbored SI variants and who had progressed to having CD4 cell counts of lower than 200 cells/microl than in individuals with NSI variants at a similar stage of disease. IL-7 induced T-cell proliferation and up-regulated CXCR4 expression in peripheral blood mononuclear cells in vitro. Taken together, our results suggest a role for IL-7 in the maintenance of T-cell regeneration and depletion by HIV in infected individuals and a possible relationship between IL-7 levels and the emergence of SI variants.

Chromium in basic foods of the Spanish diet: seafood, cereals, vegetables, olive oils and dairy products

In the present study, graphite furnace atomic absorption spectrometry (GFAAS) was used to determine the content of total chromium in some basic foods of the Spanish diet. The seafood samples, vegetables and olive oils were mineralized previously with HNO3 and V2O5. A procedure of slurries with Triton X-100 was applied to dairy products. The temperature-time program was optimized for every type of sample. An assessment of the analytical characteristics of the method verifies their reliability. The content of Cr ranged between 0.004 and 0.079 microg/g in seafood (fresh wt.), from 0.007 to 0.456 microg/g in cereals and vegetables (fresh wt.), between not detectable and 0.625 microg/g in dairy products and between not detectable and 0.040 microg/g in olive oils. The high consumption of these products conditions the fact that they should be significant sources of Cr in the diet.

[Use of procholinergics in the prevention of postoperative delirium in hip fracture surgery in the elderly. A randomized controlled trial]

INTRODUCTION

40 to 50% of elderly with hip fracture present delirium. The morbimortality increase in patients whose presented delirium.

OBJECTIVE

To study the use of citicoline (CDP choline) in the prevention of delirium in elderly under hip fracture surgery.

PATIENTS AND METHODS

A randomized control trial. The patients with hip fracture without dementia or an other organic brain illness. The medication were administered 24 hours before and during 4 days after surgery. The doses was 1.2 g/day. The primary outcome measure was percentage of patients with delirium measured with Abbreviated Mental Test (AMT) and Confusion Assessment Method (CAM). The Mini Mental State (MMS) was used before and 4 days after surgery. All treatment comparation was considered statistically significant at p< 0.05 calculating chi square and Wilcoxon test.

RESULTS

The sample size was 81 patients (46 placebo and 35 citicoline). The mean age was 79.45 for tested group and 79.97 for placebo. There was no statistically significant difference between groups with respect to ASA class of anesthesia. The incidence of delirium was 17.39% in placebo and 11.76% in citicoline group (p= 0.6). CAM and AMT at 1, 2, 3, 4 days post surgery was not significant in placebo and citicoline group (p= 0.8 and p= 0.34).

CONCLUSION

In the present study the citicoline did not prevent or reduce the incidence of delirium in hip fracture surgery in elderly.

Socioeconomic status and mortality in Swedish women: opposing trends for cardiovascular disease and cancer

We examined relations between socioeconomic status and cardiovascular disease, cancer, and diabetes mellitus in a 24-year prospective study of 1,462 Swedish women. Two socioeconomic indicators were used: the husband's occupational category for married women and a composite indicator combining women's educational level with household income for all women. The husband's occupational category was strongly associated with cardiovascular disease and cancer mortality in opposite directions, independent of age and other potential confounders. Women with husbands of lower occupational categories had an increased risk of cardiovascular disease mortality [relative risk (RR) = 1.60; 95% confidence interval (95% CI) = 1.09-2.33] while experiencing lower rates of all-site cancer mortality (RR = 0.69; 95% CI = 0.50-0.96). A similar relation was seen with the composite variable: women with low socioeconomic status had an increased risk of cardiovascular disease (RR = 1.37; 95% CI = 1.01-1.84) but a somewhat lower risk for cancer of all sites (RR = 0.86; 95% CI = 0.66-1.11). Finally, morbidity data (diabetes mellitus, stroke, and breast cancer) yielded results that were consistent with the mortality trends, and breast cancer appeared to account for a major part of the association between total cancer and high socioeconomic status. In summary, higher socioeconomic status was associated with decreased cardiovascular disease mortality and excess cancer mortality, in such a way that only a weak association was seen for all-cause mortality.

Daily dietary intake of chromium in southern Spain measured with duplicate diet sampling

We measured daily dietary Cr intake in southern Spain by sampling duplicate diets for seven consecutive days in different population groups. Cr was determined by electrothermal atomization-atomic absorption spectrometry. The samples were mineralized in a digestion block with HNO(3), HClO(4) and V(2)O(5). A total of 161 duplicate diets from twenty-three subjects were analysed, and mean levels of Cr intake ranged from 9.39 to 205.16 microg/d. Mean Cr intake (100 microg/d) was similar to levels found for most other countries, and was within the range recommended by the National Research Council for a safe and adequate daily intake (50-200 microg/d). Chromium intake correlated significantly with energy, protein and carbohydrate intake, and with the daily intake of Zn, Fe, Mg, K, Na, Ca and nicotinic acid in the diets analysed.

CD4(+) and CD8(+) T cell death during human immunodeficiency virus infection in vitro

We have evaluated the death of CD4(+) and CD8(+) T cells during in vitro human immunodeficiency virus (HIV) infection of peripheral blood mononuclear cells (PBMC) and tonsilar tissue. Acute infections with several X4 and R5 HIV isolates induced a decrease in cell viability that was higher in infections with X4 viruses and correlated with an increased rate of CD4(+) T-cell death. In CD4(+) T cells, the primary X4 isolate AOM induced higher levels of death than the laboratory X4 isolates IIIB and NL4-3 or the R5 isolates BaL and MDM. An effect on CD8(+) T-cell viability was exclusively observed in infections by X4 viruses, including the NL4-3 strain, in both PBMC and tonsilar tissue. This effect was dependent on the env gene of the infecting isolate and required productive HIV replication in CD4(+) but not in CD8(+) T cells. Our results suggest that X4 and R5 HIV isolates depleted CD4(+) T cells to a different extent and that CD8(+) T-cell viability may also be affected by mechanisms other than those acting in CD4(+) T cells.

Estimation of chromium bioavailability from the diet by an in vitro method

An in vitro method was used to study the dialysable fraction of chromium (Cr) from the diet which simulates human gastric and intestinal digestion. The percentage of dialysed Cr was used to assess the bioavailability. The duplicate diet approach was used to obtain ten different sets of samples each representative of the normal diet consumed in southern Spain. In each case triplicate analysis of Cr was carried out by electrothermal atomization-atomic absorption spectrometry in acid-mineralized samples. The Cr dietary intake ranged from 16 to 117 microg/day, and the dialysable Cr fraction ranged from 0.4% to 1.6%. The Cr absorption was higher for low levels of daily dietary intake of Cr (< 40 microg) than for levels of 40-80 microg; for high levels (> 80 microg) there was an increase in the dialysable fraction. The energy and nutrient intake of these diets was also evaluated.

A catalytic antibody against cocaine attenuates cocaine's cardiovascular effects in mice: a dose and time course analysis

The murine monoclonal antibody 15A10 (mAb 15A10), elicited by a transition-state analog for cocaine hydrolysis, has previously been shown to metabolize cocaine in vitro and in vivo. The present experiments were designed to evaluate further the in vivo effectiveness of mAb 15A10 in blocking cardiovascular effects of acute cocaine administration. Balb/c mice were implanted with a femoral artery catheter utilized for mean arterial pressure (MAP) monitoring, and administered intravenous (i.v.) pretreatments of either mAb 15A10 (10, 32, 100 and 300 mg/kg) or vehicle prior to cocaine injection (100 mg/kg, i.p.). A time course analysis for mAb 15A10's effect was also conducted, for which either vehicle or 100 mg/kg mAb 15A10 was infused 1, 3, 10 and 30 days prior to cocaine treatment. During the cardiovascular recording sessions, mice were awake and freely moving within a limited area. Increases in MAP (approximately 25 mm Hg) following cocaine injection were dose-dependently attenuated by mAb 15A10. The antibody-attenuated cocaine-induced increases in MAP at 1- and 3-day pretreatment times, and reduced mortality at some of the time points studied. With 100 mg/kg antibody, plasma cocaine levels were significantly decreased early in the recording session, whereas levels of ecgonine methyl ester increased significantly. Although 10-fold greater quantities of antibody are required to observe significant effects in mouse, compared to our previous studies in rats, the present mouse model provides a convenient paradigm for investigating catalytic and non-catalytic antibodies.

Aluminium levels in spices and aromatic herbs

We evaluated the levels of aluminium in a total of 72 samples of 17 different spices and aromatic herbs that are widely consumed in Spain, and in the Mediterranean diet, in general. Aluminium was determined in the samples mineralized with HNO3 and V2O5, using electrothermal atomization atomic absorption spectroscopy as the analytical technique. The accuracy and precision of the proposed method was verified against an NBS-certified reference material. Precision, expressed as relative standard deviation, ranged from 1.10 to 4.07%. The results obtained from recovery studies were of 97.90 +/- 1.20. Aluminium concentrations ranged from 3.74 to 56.50 microg/g (dry wt.). The presence of this metal was detected in all the samples we analysed.

Anti-human immunodeficiency virus activity of novel aminoglycoside-arginine conjugates at early stages of infection

Conjugates of L-arginine with aminoglycosides have already been described as potent in vitro inhibitors of the HIV-1 Tat-trans-activation responsive element interaction. The polycationic nature of these agents leads us to suggest that they may be active against HIV-1 replication by inhibiting earlier stages of the virus life cycle. We have found that R4K and R3G, kanamycin A, and gentamicin C, conjugated with arginine, inhibited HIV-1 NL4-3 replication at EC50 values of 15 and 30 microM for R3G and R4K, respectively, without a detectable tonic effect on MT-4 cells at concentrations higher than 4000 and about 1000 microM, respectively. Both compounds inhibited the binding of a monoclonal antibody (12G5) directed to CXCR4 as well as the intracellular Ca2+ signal induced by the chemokine SDF-1alpha on CXCR4+ cells, suggesting that aminoglycoside-arginine conjugates interact with CXCR4, the coreceptor used by T-tropic, X4 strains of HIV-1. On the other hand, CB4K, a conjugate of kanamycin A with gamma-guanidinobutyric acid, structurally similar to R4K, failed to display any anti-HIV activity of CXCR4 antagonist activity. An HIV-1 strain that was made resistant to the known CXCR4 antagonist AMD3100 was cross-resistant to both R4K and R3G. However, unlike SDF-1alpha and R4K, R3G inhibited the binding of HIV-1 to MT-4 cells. Aminoglycoside-arginine conjugates inhibit HIV replication by interrupting the early phase of the virus life cycle, namely virus binding to CD4 cells and interaction with CXCR4. R3G and R4K may serve as prototypes of novel anti-HIV agents and should be further studied.

Chromium levels in spices and aromatic herbs

We determined the presence of chromium in a total of 72 samples of 17 different spices and aromatic herbs. Electrothermal atomization atomic absorption spectrometry (ETA-AAS) was used to determine Cr content in the samples mineralized with HNO3 and V2O5. The analytical characteristics of the proposed method were tested, and the accuracy and precision was also verified against an NBS-certified reference material. Chromium concentrations ranged from not detectable to 1.42 micrograms/g (dry wt.) and Cr presence was detected in 95% of samples. Spices and aromatic herbs are widely consumed in the Spanish diet and in the Mediterranean diet, in general.

Optimized determination of iron in grape juice, wines, and other alcoholic beverages by atomic absorption spectrometry

This paper describes a study of the different methods of sample preparation for the determination of iron in grape juice, wines, and other alcoholic beverages by atomic absorption spectrometry with electrothermal atomization; results are also reported for the practical application of these methods to the analysis of commercial samples produced in Spain. The methods examined include dealcoholization and dry and wet mineralization treatment using different acids and/or mixtures of them, both with and without heating. The sensitivity, detection limit, accuracy, precision, and selectivity of each method were established. The best results were obtained for wet mineralization with heated acid (HNO3-H2SO4); the results for table wines had an accuracy of 97.5-101.6%, a relative standard deviation of 3.51%, a detection limit of 19.2 micrograms/L, and a determination limit of 32.0 micrograms/L. The method was also sufficiently sensitive and selective. It was applied to the determination of iron in grape juice, different types of wines, and beverages with high alcoholic content, all of which are produced and widely consumed in Spain. The values obtained ranged from 3.394 +/- 2.15 mg/L for the juice, 2.938 +/- 1.47 mg/L for the white wines, 19.470 +/- 5.43 mg/L for the sweet wines, 0.311 +/- 0.07 mg/L for the brandies, and 0.564 +/- 0.12 mg/L for the anisettes. Thus, the method is useful for routine analysis in the quality control of these beverages.

Resistance of the human immunodeficiency virus to the inhibitory action of negatively charged albumins on virus binding to CD4

Negatively charged albumins (NCAs) have been identified as potent inhibitors of HIV-1 replication in vitro. Time of addition studies suggest that succinylated and aconitylated human serum albumin (Suc-HSA and Aco-HSA) act at an early stage of the virus life cycle, and surface plasmon resonance (BIAcore) experiments have confirmed a direct interaction of NCAs with HIV-1 gp120. Resistance to Suc-HSA and Aco-HSA was analyzed by characterizing HIV-1 variants that were selected in cell culture after serial passage of the NL4-3 strain in the presence of the compounds. After 24 passages (126 days) we isolated variants that were resistant to Suc-HSA (>27-fold) and Aco-HSA (37-fold), as compared with the wild-type NL4-3 virus. The binding of the NCA-resistant HIV strains to CD4+ MT-4 cells could no longer be inhibited by either Suc- or Aco-HSA. The emergence of mutations in the envelope gp120 of the resistant virus paralleled the emergence of the resistant phenotype. The Suc-HSA-resistant strain was 100-fold cross-resistant to the G quartet-containing oligonucleotide AR177 (Zintevir, an HIV-binding inhibitor), and partially cross-resistant to dextran sulfate, but remained sensitive to the bicyclam AMD3100 and the chemokine SDF-1alpha, which block HIV replication by interaction with the chemokine receptor CXCR4. Furthermore, neither Suc-HSA nor Aco-HSA inhibited the binding of monoclonal antibodies 12G5 and 2D7 (directed to CXCR4 and CCR5, respectively) in SUPT-1 cells or THP-1 cells. These results confirm that NCAs bind primarily to gp120 and do not interact directly with the HIV chemokine receptor but block the binding of the virus particles (through gp120) with CD4+ cells.

Trace element determination in different milk slurries

We have studied the contents of trace elements of nutritional or toxicological interest in 90 samples of whole, low-fat, skim, condensed, evaporated and powdered milks. Slurries of the samples were prepared with Triton X-100 and analysed using electrothermal atomic absorption spectrometry. The temperature-time programme of the graphite oven was optimized for each element, and the accuracy, precision, selectivity and sensitivity of the method were verified. Concentrations of the trace elements we investigated were: Pb 0-0.211 microgram/g, Cd 0-28.985 ng/g, Al 0.528-4.025 micrograms/g, Cu 0.041-0.370 microgram/g, Cr 0-0.177 microgram/g, Mn 0.024-0.145 microgram/g, Se 0-23.333 ng/g, Zn 0.297-0.827 microgram/g and Ni 0.058-1.750 micrograms/g. (A value of zero indicates that the element was undetectable by our methods.) Concentrations of the pairs of elements Cu-Cd, Mn-Cd, Mn-Cu, Zn-Mn, Ni-Cu, Ni-Mn and Ni-Zn were significantly correlated (P < 0.001). Linear discriminant analysis confirmed the separation between the six types of milk analyzed.