Clinical validation of the European Panel on the Appropriateness of Gastrointestinal Endoscopy (EPAGE) II criteria in an open-access unit: a prospective study

BACKGROUND AND STUDY AIMS

The European Panel on the Appropriateness of Gastrointestinal Endoscopy (EPAGE I) criteria were recently updated (EPAGE II), but no prospective studies have used these criteria in clinical practice. The aim of the current study was to validate the EPAGE II criteria in an open-access endoscopy unit.

PATIENTS AND METHODS

A prospective observational study was conducted in an open-access endoscopy unit at a tertiary care referral center. Consecutive outpatients (n = 1004; mean age 58.9 ± 13.1 years; 45 % men) were referred for diagnostic colonoscopy between September 2009 and February 2010. The appropriateness of colonoscopy was assessed based on EPAGE II criteria, and the relationship between appropriateness and both referral doctor and detection of significant lesions was examined. The effectiveness of EPAGE II criteria in assessing appropriateness was measured by means of sensitivity, specificity, and positive and negative predictive values for detecting significant lesions.

RESULTS

Colonoscopic cecal intubation was achieved in 956 patients (95.2 %). Most referral doctors were gastroenterologists (58.0 %) and the most common indication was colorectal cancer (CRC) screening (35.2 %). EPAGE II criteria were applicable in 968 patients (96.4 %); of these patients, the indication was appropriate in 778 (80.4 %), inappropriate in 102 (10.5 %), and uncertain in 88 (9.1 %). Patients with appropriate or uncertain indications based on EPAGE II criteria had more relevant endoscopic findings than those with inappropriate indications (38.8 % vs. 24.5 %; OR 1.95, 95 %CI 1.22 - 3.13; P < 0.005). Sensitivity and negative predictive value of EPAGE II criteria for detecting significant lesions were 93.1 % (95 %CI 90 % - 96 %) and 75.5 % (95 %CI 67 % - 84 %), respectively, whereas for advanced neoplastic lesions these values were 98.0 % (95 %CI 95 % - 100 %) and 98.0 % (95 % CI 95 % - 100 %), respectively. Adherence to EPAGE II recommendations was an independent predictor of finding a significant lesion (OR 1.93, 95 %CI 1.20 - 3.11; P = 0.007).

CONCLUSIONS

EPAGE II is a simple, valid score for detecting inappropriate colonoscopies in clinical practice.

Improvement in chromatin maturity of human spermatozoa selected through density gradient centrifugation

A two-step gradient density centrifugation system has been set up to isolate two contrasting sperm populations of normozoospermic and oligoasthenoteratozoospermic (OAT) men. High- and low-density fractions were characterized by total and free thiol fluorescence as determined by monobromobimane-flow cytometry and by protamine/DNA ratios after protamine extraction and polyacrylamide acid-urea gel electrophoresis. Further chromatin characterization was performed through immunofluorescence (IF) with specific antibodies to nucleosomes, histone subtypes (H3.1/H3.2 and TH2B), histone modifications (KM-2 and H4K8ac) and precursor protamine 2. The native sperm samples from normozoospermic and OAT patients showed a biphasic distribution of total thiol levels, which changed in the sperm fractions obtained using the density isolation protocol presented here. Moreover, significant differences were detected in the protamine content in the different fractions of OAT and fertile donor samples. In addition, in the high-density fractions from OAT and normozoospermics, higher IF levels for H4K8ac and TH2B were seen. These results would be consistent with the intended beneficial effect on chromatin maturity of the density selection techniques currently being used in assisted fertilization procedures. However, most nucleosome and related proteins/modifications differ between OAT and normozoospermic men, even after gradient centrifugation, providing evidence for incomplete nuclear maturity in OAT patients.

Whole-chromosome aneuploidy analysis in human oocytes: focus on comparative genomic hybridization

The study of aneuploidy in human oocytes, discarded from IVF cycles, has provided a better understanding of the incidence of aneuploidy of female origin and the responsible mechanisms. Comparative genomic hybridization (CGH) is an established technique that allows for the detection of aneuploidy in all chromosomes avoiding artifactual chromosome losses. In this review, results obtained using CGH in single cells (1PB and/or MII oocytes) are included. The results of oocyte aneuploidy rates obtained by CGH from discarded oocytes of IVF patients and of oocyte donors are summarized. Moreover, the mechanisms involved in the aneuploid events, e.g. whether alterations occurred due to first meiotic errors or germ-line mitotic errors are also discussed. Finally, the incidence of aneuploid oocyte production due to first meiotic errors and germ-line mitotic errors observed in oocytes coming from IVF patients and IVF oocyte donors was assessed.

A regulatory perspective on the radiological impact of NORM industries: the case of the Spanish phosphate industry

Radioactive and chemical risks coexist in NORM industries although they are usually addressed separately by regulations. The European Union (EU) has developed extensive legislation concerning both matters, which has been diversely reflected in national policies. We consider the case of the Spanish phosphate industry and analyse to which extent regulatory mandates have reduced the historical and ongoing radiological impact on the environment of phosphate facilities. Although no specific radiological constraints on effluent monitoring and release or on waste disposal have yet been imposed on NORM industries in Spain, other environmental regulations have achieved a substantial reduction on the phosphate industry impact. Nevertheless, a more efficient control could be established by eliminating the current conceptual and practical separation of chemical and radioactive risks in NORM industries. We highlight research needs to accomplish so and propose shorter-term measures that require active cooperation among the regulatory bodies involved.

[Histopathological findings and biomarker analysis in cutaneous graft-versus-host disease ]

Graft-versus-host disease (GVHD) remains the greatest source of morbidity-mortality in allogenic transplant patients. Although in most cases the more easily obtainable clinical and laboratory test parameters suffice to confirm the diagnosis and establish the stage of the disease biopsies of the affected organ are sometimes needed. At present there is great Interest in the study of factors allowing a prognosis of the course and type of response to treatment in patients with CVHD. In this sense, It would be necessary to objectively Identify and validate biomarkers capable of predicting biological or pathological processes in patients with cVHD. To this effect we have performed serial analyses of skin tissue using peripheral blood and tissue biomarkers in a prospective observational study conducted in three transplant centers. The still preliminary results Indicate that certain histopathological findings classically attributed to CVHD ore also seen in patients not clinically affected by the disease--this probably being related to other physiopathological phenomena occurring during transplantation. The study of these findings, combined with biomarker analysis, will allow improved understanding of the underlying etiopathogenesis, as well as the definition of new diagnostic, prognostic and response-evaluating criteria.

Mutation update for the CSB/ERCC6 and CSA/ERCC8 genes involved in Cockayne syndrome

Cockayne syndrome is an autosomal recessive multisystem disorder characterized principally by neurological and sensory impairment, cachectic dwarfism, and photosensitivity. This rare disease is linked to mutations in the CSB/ERCC6 and CSA/ERCC8 genes encoding proteins involved in the transcription-coupled DNA repair pathway. The clinical spectrum of Cockayne syndrome encompasses a wide range of severity from severe prenatal forms to mild and late-onset presentations. We have reviewed the 45 published mutations in CSA and CSB to date and we report 43 new mutations in these genes together with the corresponding clinical data. Among the 84 reported kindreds, 52 (62%) have mutations in the CSB gene. Many types of mutations are scattered along the whole coding sequence of both genes, but clusters of missense mutations can be recognized and highlight the role of particular motifs in the proteins. Genotype-phenotype correlation hypotheses are considered with regard to these new molecular and clinical data. Additional cases of molecular prenatal diagnosis are reported and the strategy for prenatal testing is discussed. Two web-based locus-specific databases have been created to list all identified variants and to allow the inclusion of future reports (www.umd.be/CSA/ and www.umd.be/CSB/).

Memoirs of an insult: sperm as a possible source of transgenerational epimutations and genetic instability

Male transgenerational epigenetic effects have been discovered in the discipline of mouse radiation genetics, using genetic and non-genetic readouts. The mechanism to explain the origin of the transmission of epigenetic and genetic instability is still unknown. In a search for a hypothesis that could satisfy the data, we propose that regulation of chromosome structure in the germline, by the occupancy of matrix/scaffold associated regions, contains molecular memory function. The male germline is strikingly dynamic as to chromatin organization. This could explain why experience of irradiation stress leaves a persistent mark in the male germline only. To be installed, such memory requires both S-phase and chromatin reorganization during spermatogenesis and in the zygote, that likely also involves reorganization of loop domains. By this reorganization, another layer of information is added, needed to accommodate early embryonic development. Observations point at the involvement of DNA repair as inducer of transgenerational epigenetic modulation. Nuclear structure, chromatin composition and loop domain organization are aspects of human sperm variability that in many cases of assisted reproduction is increased due to inclusion of more incompletely differentiated/maturated sperm nuclei. Adjustment of loop domains in early embryo development can be anticipated and zygotic and cleavage stage S-phase repair activity will have to deal with potential paternal DNA lesions. Therefore, by changing male nucleus structure due to reproduction from impaired spermatogenesis, the transgenerational information content could be changed as well. We discuss aspects of male reproductive performance in the context of this hypothesis.

Results of liver transplantation at the Cuban Center for Medical and Surgical Research

From July 4, 1999, when a liver transplantation program was started in Cuba, to December 30, 2007, we performed 125 procedures in 115 patients. The most frequent reasons for transplantation were cirrhosis caused by hepatitis C virus (29%) and alcoholic cirrhosis (17.2%). Two patients received simultaneous liver-kidney transplants. Sixty-seven patients were males, and the patient ages ranged from 12 to 74 years. The average surgical time was 6 hours, and cold ischemia time was 4 to 14 hours. The average blood consumption was 1630 mL; 2900 mL of plasma and 8 units of platelets were used in 7 cases. Immunosuppression was mainly cyclosporine, mycophenolate mofetil, and prednisone. Acute cellular rejections were treated in almost all cases with 3 doses of methylprednisolone. The most frequent complications were biliary (15%), hepatic arterial thrombosis (6%), postsurgical bleeding (8%), acute cellular rejection (20%), and ductopenic rejection (2%). The overall 1-year survival was 74.7%.

The effect of acute fluid consumption on measures of impedance and percent body fat estimated using segmental bioelectrical impedance analysis

BACKGROUND/OBJECTIVES

To determine the effect of acute fluid consumption on measures of impedance and percent body fat (%BF) estimated using segmental bioelectrical impedance analysis (SBIA).

SUBJECTS/METHODS

Seventy-six healthy, recreationally active adults (41 women; 35 men) volunteered to participate in this study (mean+/-s.d.; age, 21.0+/-1.6 years; body mass index, 25.0+/-3.2 kg/m2). Subjects had their body composition assessed on three separate occasions. After a baseline measurement, subjects consumed 591 ml of water (H2O), a carbohydrate/electrolyte drink (CHOE) or received nothing (CON). Subjects were reassessed 20, 40 and 60 min following (POST) the baseline measure in each fluid condition.

RESULTS

Twenty minutes after drinking a H2O or CHOE beverage, %BF (1.1 and 1.2%), impedance (12 and 14 Omega) and body mass increased significantly (P<0.001). During the CON trial, %BF (0.3 and 0.5%) and impedance (7 and 11 Omega) also increased significantly above baseline values at 40 and 60 min POST. However, the normal hourly variability was significantly (P<0.009) less than the observed fluid-induced %BF alterations. The greatest %BF increases were observed in the lightest subjects, who were women. Fluid type had no effect on the magnitude of change POST.

CONCLUSIONS

Twenty minutes after drinking, %BF estimates increased approximately 1.0% due to elevations in impedance and body mass. As such, we recommend adhering to the pretest fluid restriction guideline to avoid fluid-induced alterations in SBIA body composition measures. In addition, use of a consistent testing schedule may minimize normal %BF variation over time.

Ultrasonic-assisted matrix solid-phase dispersion as an improved methodology for the determination of pesticides in fruits

An ultrasonic-assisted matrix solid-phase dispersion (UA-MSPD) method has been developed for extracting and cleaning-up 15 organophosphorus pesticides (OPPs) and 9 triazines in fruits. Using reversed phase octasilyl-derivatised silica (C8) as dispersant and ethyl acetate as extraction solvent, two sonication devices, an ultrasonic bath and a sonoreactor, were tested for speeding and increasing the efficiency of the MSPD process. A standard MSPD and a heating-assisted MSPD procedure were also done. Gas chromatography-mass spectrometry was used for analyte determination. 1-min sonication with the sonoreactor at 50% amplitude provided the best results, with reproducibilities below 15% for the pesticides studied. The general low detection limits (1-42microgkg(-1)) ensure proper determination at maximum allowed residue levels set in current legislations, except for dimethoate and disulfuton. The analytical performance of the method was evaluated for apples, pear and apricot, showing little or no matrix effect.