The effect of antimalarials on the safety and persistence of treatment with biologic agents or Janus kinase inhibitors in rheumatoid arthritis

OBJECTIVES

To test the association of use of antimalarials with the overall safety of treatment in RA patients receiving one or multiple courses of biologic (b)DMARDs or a Janus kinase inhibitor (JAKi).

METHODS

BiobadaBrasil is a multicentric registry-based cohort study of Brazilian patients with rheumatic diseases starting their first bDMARD or JAKi. The present analysis includes RA patients recruited from January 2009 to October 2019, followed up over one or multiple (up to six) courses of treatment (latest date, 19 November 2019). The primary outcome was the incidence of serious adverse events (SAEs). Total and system-specific adverse events (AEs) and treatment interruption served as secondary outcomes. Negative binomial regression with generalized estimating equations (to estimate multivariate incidence rate ratios, mIRR) and frailty Cox proportional hazards models were used for statistical analyses.

RESULTS

The number of patients enrolled was 1316 (2335 treatment courses, 6711 patient-years [PY]; 1254.5 PY on antimalarials). The overall incidence of SAEs was 9.2/100 PY. Antimalarials were associated with reduced risk of SAEs (mIRR: 0.49; 95% CI: 0.36, 0.68; P < 0.001), total AEs (0.68; 95% CI: 0.56, 0.81; P < 0.001), serious infections (0.53; 95% CI: 0.34, 0.84; P = 0.007) and total hepatic AEs (0.21; 95% CI: 0.05, 0.85; P = 0.028). Antimalarials were also related to better survival of treatment course (P = 0.003). There was no significant increase in the risk of cardiovascular AEs.

CONCLUSION

Among RA patients on treatment with bDMARDs or JAKi, concomitant use of antimalarials was associated with reduced the incidence of serious and total AEs and with longer treatment course survival.

Effects of Sequential Combination of Moderate Pressure and Ultrasound on Subsequent Thermal Pasteurization of Liquid Whole Egg

As an alternative to commercial whole egg thermal pasteurization (TP), the sequential combination of moderate pressure (MP) and/or ultrasound (US) pre-treatments prior to a shorter TP was evaluated. The use of US alone or in combination with MP or TP resulted in an inactivation that was far from that of commercial TP. Nevertheless, when these three technologies were combined (MP-US-TP, 160 MPa/5 min-50% amplitude/1 min-60 °C/1.75 min), a safety level comparable to that of commercial TP was established. This was likely due to a decrease in the thermal resistance of Salmonella Senftenberg 775/W caused by MP and US pre-treatments. Regarding liquid whole egg (LWE) properties, using raw LWE as a reference, TP and MP treatments each decreased protein solubility (7-12%), which was accompanied by a viscosity increment (41-59%), whereas the US-only and MP-US-TP treatments improved protein solubility (about 4%) and reduced viscosity (about 34%). On average, all treatments lowered the emulsifying properties of LWE by 35-63%, with the MP-US-TP treatment having a more dramatic impact than commercial TP. In addition, the US-only, MP-only, and MP-US-TP treatments had the greatest impact on the volatile profile of LWE, lowering the concentration of the total volatile components. In comparison to commercial TP, LWE treated with MP-US-TP exhibited greater protein solubility (19%), lower viscosity (56%), and comparable emulsifying stability, but with a decreased emulsifying capacity (39%) and a lower total volatile compounds content (77%). Considering that a combined treatment (MP-US-TP) is lethally equivalent to commercial TP, but the latter better retained the quality properties of raw LWE, including volatiles, the application of MP followed by US pre-treatments before a shorter TP did not demonstrate significant advantages on quality parameters in comparison to commercial TP.

Uncovering the Bioactivity of Aurantiochytrium sp.: a Comparison of Extraction Methodologies

Aurantiochytrium sp. is an emerging alternative source of polyunsaturated fatty acids (PUFAs), docosahexaenoic acid (DHA), and squalene, playing an important role in the phasing out of traditional fish sources for these compounds. Novel lipid extraction techniques with a focus on sustainability and low environmental footprint are being developed for this organism, but the exploration of other added-value compounds within it is still very limited. In this work, a combination of novel green extraction techniques (high hydrostatic pressure extraction (HPE) and supercritical fluid extraction (SFE)) and traditional techniques (organic solvent Soxhlet extraction and hydrodistillation (HD)) was used to obtain lipophilic extracts of Aurantiochytrium sp., which were then screened for antioxidant (DPPH radical reduction capacity and ferric-reducing antioxidant potential (FRAP) assays), lipid oxidation protection, antimicrobial, anti-aging enzyme inhibition (collagenase, elastase and hyaluronidase), and anti-inflammatory (inhibition of NO production) activities. The screening revealed promising extracts in nearly all categories of biological activity tested, with only the enzymatic inhibition being low in all extracts. Powerful lipid oxidation protection and anti-inflammatory activity were observed in most SFE samples. Ethanolic HPEs inhibited both lipid oxidation reactions and microbial growth. The HD extract demonstrated high antioxidant, antimicrobial, and anti-inflammatory activities making, it a major contender for further studies aiming at the valorization of Aurantiochytrium sp. Taken together, this study presents compelling evidence of the bioactive potential of Aurantiochytrium sp. and encourages further exploration of its composition and application.

Immunofluorescent Verification of Silencing Estrogen Receptor α with siRNA in the Intact Rodent Brain

The ability to silence the expression of gene products in a chemically, spatially, and temporally specific manner in the brains of animals has enabled key breakthroughs in the field of behavioral neuroscience. Using this technique, estrogen receptor alpha (ERα) has been specifically implicated in a multitude of behaviors in mice, including sexual, aggressive, locomotor, and maternal behaviors, in a variety of brain regions, including the medial preoptic area, ventromedial hypothalamus, and amygdala. In this chapter, we describe the techniques involved in the generation of the small hairpin RNAs (shRNAs) specifically designed to silence ERα, the construction of the adeno-associated viral (AAV) vector for delivery of the shRNA, the procedures to confirm the silencing of ERα (in vitro and in vivo) and in vivo delivery of the shRNAs to the brains of animals.

Biocompatibility of self-adhesive resin cement with fibroblast cells

STATEMENT OF PROBLEM

Dental cements that release monomers that negatively impact adjacent oral soft tissues may adversely affect clinical outcomes. However, in vitro studies evaluating the cytotoxic and genotoxic potential of substances released from dental cements are lacking.

PURPOSE

The purpose of this in vitro study was to define and compare the cytotoxicity and genotoxicity of the eluates of a self-adhesive resin cement (RelyX Unicem 2 Automix) autopolymerized and light polymerized with 2 other types of luting cements: a glass ionomer cement (Ketac Cem Easymix) and a resin-modified glass ionomer cement (Ketac Cem Plus).

MATERIAL AND METHODS

The eluates were prepared, and 3T3 mouse fibroblast cells were exposed for 24 hours to serial eluate dilutions of the 3 types of cement. Cytotoxicity was determined by using a cell viability assessment through 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) and crystal violet assays. Genotoxic effects were determined by using the cytokinesis-block micronucleus assay.

RESULTS

Cell viability was higher in the presence of the glass ionomer cement eluate than of the resin-modified glass ionomer cement and resin cement eluates. A pronounced decrease in viability was found when the cells were exposed to undiluted samples of resin-modified glass ionomer cement (around 50%) or resin cement (around 80% to 90%). No significant difference in cell viability was found between autopolymerized and light-polymerized resin cements. All cements induced a dose-dependent response of mononucleated cell formation. However, only the resin cements showed double strand breaks significant differences in the deoxyribonucleic acid (DNA) molecules against the basal DNA lesions that occurred spontaneously.

CONCLUSIONS

The glass ionomer cement was not found to be cytotoxic or genotoxic, whereas the eluates derived from the resin-modified glass ionomer cement and resin cement, independently of the polymerization method, were cytotoxic in fibroblast cells. Maximum cytotoxicity was observed in the presence of resin cement, which also showed genotoxicity, independently of being light polymerized.

Early resynchronization of non-pregnant beef cows based in corpus luteum blood flow evaluation 21 days after Timed-AI

The study aimed to verify whether a hormone protocol started at Day 13 (D13) after Timed Artificial Insemination (TAI) influences the conception rate. Nelore cows (primiparous and multiparous) from two commercial beef farms (n = 1,431) were first TAI (D0). Timed AI was performed in lots (TAI Lots) ranging from 187 to 346 cows. On D13, regarding the TAI lot, cows were assigned for either receiving (Resynch group, n = 1,002) or not (Control group, a subset of approximately 30%, n = 429) another hormone protocol for resynchronization. The same hormone protocol was used for the first TAI and for the resynchronization, except for 1 mg instead of 2 mg of estradiol benzoate (EB) at the begging of the protocol. Eight days later (D21), the Resynch group was checked for corpus luteum blood flow by color Doppler ultrasonography, and in those detected as non-pregnant, the protocol was completed and a 2nd TAI was performed at D23. Pregnancy diagnosis was later (D30) performed by B-mode ultrasonography in the control group and confirmed in the presumptive pregnant cows from the 1st TAI of the Resynch group. The remaining cows were checked for pregnancy 30 days after the 2nd TAI (experimental Day 53). The statistical model to explain conception rate considered the effects of Group (Control or Resynch), Farm, Parity (primiparous or multiparous), Sire, Technician (who perform AI), TAI Lot and pertinent interactions (Group*Parity, Group*Farm and Group*TAI Lot). The statistical analyses of the model were performed using the Proc Glimmix (SAS virtual University Edition). The conception rate for the 1st TAI was similar (P > 0.4) between Control (50.3%, 216/429) and Resynch group (52.6%, 527/1002). The positive predictive diagnostic on D21 showed high relation with PD30 (90.7%, 527/581). In Resynch group, non-pregnant cows (n = 421, 1002 minus 581) were re-inseminated. The conception rate of the 2nd TAI (42.8%, 180/421) was affected (P < 0.002) by side effects of the Farm (48.5 vs. 33.1%) and Parity (51.2 vs. 40.3%, for multiparous vs. primiparous, p < 0.001). Nevertheless, after the 2 TAIs of the Resynch group, the cumulative conception rate was 70.5% (707/1002). In conclusion, the early resynchronization of cows with a low (1 mg) EB dose and progesterone device at D13 after TAI can be used as a strategy to reduce conception interval in beef cattle, and thus to increase the number of pregnant cows from artificial insemination after the breeding season.

Naive and Stem Cell Memory T Cell Subset Recovery Reveals Opposing Reconstitution Patterns in CD4 and CD8 T Cells in Chronic Graft vs. Host Disease

The success of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in the treatment of hematological malignancies remains hampered by life-threatening chronic graft vs. host disease (cGVHD). Although multifactorial in nature, cGVHD has been associated with imbalances between effector and regulatory T cells (Treg). To further elucidate this issue, we performed a prospective analysis of patients undergoing unrelated donor allo-HSCT after a reduced intensity conditioning (RIC) regimen containing anti-thymocyte globulin (ATG) and the same GVHD prophylaxis, at a single institution. We studied T cell subset homeostasis over a 24-month follow-up after HSCT in a comparative analysis of patients with and without cGVHD. We also quantified naive and memory T cell subsets, proliferation and expression of the apoptosis-related proteins Bcl-2 and CD95. Finally, we assessed thymic function by T cell receptor excision circle (TREC) quantification and T cell receptor (TCR) diversity by TCRVβ spectratyping. While the total number of conventional CD4 (Tcon) and CD8 T cells was similar between patient groups, Treg were decreased in cGVHD patients. Interestingly, we also observed divergent patterns of Naive and Stem Cell Memory (SCM) subset recovery in Treg and Tcon compared to CD8. Patients with cGVHD showed impaired recovery of Naive and SCM Tcon and Treg, but significantly increased frequencies and absolute numbers of Naive and SCM were observed in the CD8 pool. Markedly increased EMRA CD8 T cells were also noted in cGVHD. Taken together, these results suggest that Naive, SCM and EMRA CD8 play a role in the emergence of cGHVD. Reduced Naive and recent thymic emigrant Tcon and Treg in cGVHD was likely due to impaired thymic output, as it was accompanied by decreased CD4 TREC and TCR diversity. On the other hand, CD8 TCR diversity was similar between patient groups. Furthermore, no correlation was observed between CD8 TREC content and Naive CD8 numbers, suggesting limited thymic production of Naive CD8 T cells in patients after transplant, especially in those developing cGVHD. The mechanisms behind the opposing patterns of CD4 and CD8 subset cell recovery in cGVHD remain elusive, but may be linked to thymic damage associated with the conditioning regimen and/or acute GVHD.

Extension of raw watermelon juice shelf-life up to 58days by hyperbaric storage

Hyperbaric storage (HS) of raw watermelon juice, at 50, 62.5 and 75MPa, at temperatures of 10, 15 and ≈25°C (room temperature, RT), was studied to evaluate shelf-life comparatively to refrigeration (RF, 4°C). Generally, RF caused an increase of microbial loads to values ≥6.0logCFU/mL after 7days of storage. Contrarily, HS at 62.5/75MPa (15°C) showed a reduction of initial loads, by at least 2.5logCFU/mL, up to 58days, while pH and colour values did not changed under these HS conditions. Additionally, the combination of a lower temperature with HS has beneficial effects to control microbial development, particularly for the lower pressure studied (50MPa/10°C). In conclusion, HS increased watermelon juice shelf-life for at least 58days, indicating a great potential for future RF replacement.

Silencing Estrogen Receptor-α with siRNA in the Intact Rodent Brain

The ability to silence the expression of gene products in a chemically, spatially, and temporally specific manner in the brains of animals has enabled key breakthroughs in the field of behavioral neuroscience. Using this technique, estrogen receptor alpha (ERα) has been specifically implicated in a multitude of behaviors in mice, including sexual, aggressive, locomotor, and maternal behaviors. ERα has been identified in a variety of brain regions, including the medial preoptic area, ventromedial hypothalamus, and amygdala. In this chapter we describe the techniques involved in the generation of the small hairpin RNAs (shRNAs) specifically designed to silence ERα, the construction of the adeno-associated viral (AAV) vector for delivery of the shRNA, the procedures to confirm the silencing of ERα (in vitro and in vivo) and in vivo delivery of the shRNAs to the brains of animals.

Edge effects on the blowfly fauna (Diptera, Calliphoridae) of the Tijuca National Park, Rio de Janeiro, Brazil

In this contribution we examine the diversity, abundance and species richness of Calliphoridae in the Tijuca National Park, Rio de Janeiro, RJ. Specimens were collected monthly between September 2009 and August 2010, using sardines as bait, in three points: A, on the forest edge (22°56'846"S 43°17'496"W), B, 700 m from it (22°57'073"S 43°17'832"W) and C, 1,200 m into the forest (22°57'321"S 43°18'031"W), evaluating the indicator species at each point and the anthropogenic influences and abiotic factors that determine species distribution. A total of 16,364 Calliphoridae were collected and 17 species were identified. Species abundance was strongly positively correlated with temperature. The greatest number of flies was collected at A, but in this point, diversity was lower and most individuals collected belonged to the dominant species. Point C, conversely, had the lower abundance and the highest diversity. Chrysomya megacephala, an urban and synanthropic species, was dominant at point A, whereas Laneela nigripes and Mesembrinella peregrina, typically forest species, were considered indicators at points B and C, respectively, showing that the anthropogenic influence is more intense at the forest edge.

Microbial composition of atherosclerotic plaques

OBJECTIVE

The association of infections such as periodontitis with atherosclerotic diseases is well documented. In spite of the high diversity of the human oral microbiota, and its close contact with the circulatory system, few oral species were detected in atherosclerotic plaques. Thus, we attempted to evaluate the microbial diversity of atherosclerotic plaques from patients with different periodontal conditions, submitted to endarterectomy by a broad-range microbial method.

MATERIALS AND METHODS

Patients indicated for aorta endarterectomy due to myocardial infarction were recruited for periodontal clinical examination. The microbial diversity of atherosclerotic plaques (n = 35) was evaluated by sequence analysis of bacterial 16S rRNA libraries.

RESULTS

Bacterial DNA was detected in 12 endarterectomy specimens (34.3%). Twenty-three bacterial species/phylotypes were identified. Proteobacteria and Firmicutes comprised 78.3% and 21.7% of the identified taxa, respectively. Fifteen (60.9%) phylotypes were reported as yet uncultivable or as yet uncharacterized species. Two uncultured phylotypes were previously detected in the human mouth. The periodontopathogen Aggregatibacter actinomycetemcomitans was detected in seven samples (20%), followed by Pseudomonas species. There was no association between periodontal parameters and detection of A. actinomycetemcomitans or other phylotypes in atherosclerotic plaques.

CONCLUSION

Our results suggest a role of the oral microbiota in the development of inflammation in atherogenesis, particularly of A. actinomycetemcomitans.

Short and long-term immunogenicity and safety following the 23-valent polysaccharide pneumococcal vaccine in juvenile idiopathic arthritis patients under conventional DMARDs with or without anti-TNF therapy

OBJECTIVES

To assess immunogenicity and safety of the 23-valent polysaccharide pneumococcal vaccine (PPV23) in juvenile idiopathic arthritis (JIA) patients under conventional DMARDs with or without anti-TNF therapy. The influences of demographic data, disease activity and treatment on immune response and the potential deleterious effects of vaccine on disease itself were also evaluated.

METHODS

17 JIA patients immediately pre-etanercept (Group 1) and 10 JIA patients on stable dose of methotrexate (Group 2) received one dose of PPV23. All patients were evaluated pre-vaccination, 2 months and 12 months post-vaccination for seven pneumoccocal serotypes. Serology was performed by enzyme immunoassay and the immunogenicity endpoints included seroprotection (SP), seroconversion (SP) and geometric mean concentration of antibodies(GMC). Clinical and laboratorial parameters of JIA were evaluated before and after vaccination.

RESULTS

Groups 1 and 2 were comparable regarding age, gender, disease duration and other DMARDs use (p>0.05). Pre-immunization SP and GMC were alike in patients with and without anti-TNF therapy (p>0.05). The frequencies of patients achieving adequate vaccine response (seroconversion in ≥50% of all serotypes) at 2 months (53 vs. 30%, p=0.424) and 12 months (36 vs. 40%, p=1.0) were similar in JIA patients with and without anti-TNF therapy. Further comparison of patients with and without adequate response at 2 months revealed no influence of demographic, clinical and laboratorial JIA parameters (p>0.05). Serious adverse events were not observed.

CONCLUSIONS

Anti-TNF therapy in JIA patients does not seem to have an additional deleterious effect on short/long-term PPV23 immunogenicity compared to MTX alone and no influence on disease parameters was observed with this vaccine.

Are vicilins another major class of legume lectins?

Legume lectins comprise a structurally related, Ca/Mn-dependent, widespread, abundant and well characterized lectin family when compared to the large number of lectins from other sources described in the literature. Strangely enough, no specific function has been assigned to them aside from a possible role in storage and/or defense. Using a recent and fine-tuned methodology capable of specific lectin identification, β-conglutin, Vicia faba vicilin and β-lathyrin, the vicilin storage globulins from Lupinus albus, V. faba and Lathyrus sativus, respectively, were shown to be capable of affinity binding to thoroughly washed erythrocyte membranes and of specific elution with appropriate sugars. Based on this evidence and on sparse data published in the literature, a second family of legume lectins is proposed: the 7S family of storage proteins from leguminous seeds, or family II of legume lectins. These lectins are also structurally related, widespread and well characterized. In addition, they self-aggregate in a Ca/Mg, electrostatic dependent manner and are even more abundant than the family I of legume lectins. Using the same evidence, reserve and defense roles may be attributed to family II of legume lectins.

Proton and deuterium nuclear spin relaxation study of the SmA and SmC* phases of BP8Cl-d17 : a self-consistent analysis

A self-consistent analysis of proton and deuterium nuclear spin relaxation times in the smectic phases of a partially deuterated smectogen is presented here. Proton spin-lattice relaxation times T(1Z) were measured as a function of Larmor frequency over a range of 1 kHz to 300 MHz at selected temperatures. Deuterium spin relaxation times T(1Z) and T(1Q) were measured as a function of temperature at two different magnetic fields in the smectic A phase. The deuterium data provide dynamic parameters such as rotational diffusion constants and internal jump rates as well as the nematic order parameter S. The proton data are analyzed using a number of relaxation mechanisms, one of which is the molecular reorientation. It is found helpful in these latter analyses to use the nematic order parameter and to fix the contribution from molecular reorientations determined by the deuterium spin relaxation. The fits to the proton T(1) frequency and temperature dispersions by the remaining relaxation mechanisms such as layer undulations and translational self-diffusion will be discussed for the smectic A and chiral smectic C phases.

Immunogenicity and safety of two doses of a non-adjuvanted influenza A H1N1/2009 vaccine in young autoimmune rheumatic diseases patients

Objectives

The aim of this study was to evaluate the immunogenicity and safety of the influenza A H1N1/2009 vaccine in children under 9 years old with autoimmune rheumatic diseases (ARD).

Methods

Thirty-eight ARD patients and 11 healthy children received two doses of non-adjuvanted influenza A/California/7/2009 (H1N1) virus-like vaccine. Subjects were evaluated before and 21 days after vaccination. Seroprotection (SP) and seroconversion (SC) rates, geometric mean titers (GMT) and factor increases (FI) in GMT were calculated.

Results

Mean ages were comparable between patients and controls. Pre-vaccination SP and GMT were similar in patients and controls ( p > 0.05). Three weeks after immunization, SP (81.6% vs. 81.8%, p = 1.0), SC (81.6% vs. 90.9%, p = 0.66), GMT (151.5 vs. 282.1, p = 0.26) and the FI in GMT (16.7 vs. 36.3, p = 0.23) were similar in patients and controls, with both groups achieving an adequate response, according to the European Medicines Agency and Food and Drug Administration standards. Analysis of the possible factors influencing SC showed no difference in demographic data, leukocyte/lymphocyte counts or immunosuppressant use between seroconverted and non-seroconverted patients ( p > 0.05). The vaccine demonstrated a satisfactory safety profile in this population.

Conclusions

Two doses of influenza A H1N1/2009 vaccination induced an effective antibody response and caused adverse events in rare instances, suggesting this vaccine is appropriate and can be recommended for this age group.

Adsorbed fibrinogen leads to improved bone regeneration and correlates with differences in the systemic immune response

Designing new biomaterials that can modulate the inflammatory response instead of attempting just to reduce it constitutes a paradigm change in regenerative medicine. This work aimed to investigate the capacity of an immunomodulatory biomaterial to enhance bone regeneration. For that purpose we incorporated a molecule with well-established pro-inflammatory and pro-healing roles, fibrinogen, in chitosan scaffolds. Two different incorporation strategies were tested, leading to concentrations of 0.54±0.10mg fibrinogen g(-1) scaffold immediately upon adsorption (Fg-Sol), and 0.34±0.04mg fibrinogen g(-1) scaffold after washing (Fg-Ads). These materials were implanted in a critical size bone defect in rats. At two months post-implantation the extent of bone regeneration was examined by histology and the systemic immune response triggered was evaluated by determining the percentages of myeloid cells, T and B lymphocytes in the draining lymph nodes. The results obtained indicate that the fibrinogen incorporation strategy conditioned the osteogenic capacity of biomaterials. Fg-Ads scaffolds led to more bone formation, and the presence of Fg stimulated angiogenesis. Furthermore, animals implanted with Fg-Ads scaffolds showed significant increases in the percentages of B lymphocytes and myeloid cells in the draining lymph nodes, while levels of T lymphocytes were not significantly different. Finally, a significant increase in TGF-β1 was detected in the plasma of animals implanted with Fg-Ads. Taken together the results presented suggest a potential correlation between the elicited immune response and biomaterial osteogenic performance.

Abatacept and reduced immune response to pandemic 2009 influenza A/H1N1 vaccination in patients with rheumatoid arthritis

OBJECTIVE

To evaluate the influence of abatacept (ABA) and associated contributing factors on pandemic 2009 influenza A/H1N1 vaccine immunogenicity in rheumatoid arthritis (RA) patients.

METHODS

The response to a nonadjuvanted monovalent pandemic 2009 influenza A/H1N1 killed virus vaccine was analyzed in 11 RA patients using ABA (RA-ABA), most with concomitant nonbiologic disease-modifying antirheumatic drugs (DMARDS), and compared to 33 age-matched RA patients on methotrexate (MTX) and 55 healthy controls, all without previous seroprotection. Clinical and laboratory evaluations were performed before and 21 days after vaccination. Anti-influenza antibody titers were measured by hemagglutination inhibition assay. Seroprotection (antibody titers ≥1:40) and the factor increase (FI) in the geometric mean titers (GMTs) were calculated. Prevaccination lymphocyte counts and gammaglobulin levels were determined.

RESULTS

Sex distribution, disease duration, and the Disease Activity Score in 28 joints were similar in the RA groups (P > 0.05). After vaccination, seroprotection was significantly reduced in RA-ABA patients compared to RA-MTX patients (9% versus 58%; P = 0.006) and controls (69%; P ≤ 0.001). FI-GMT was severely reduced in RA-ABA patients compared to RA-MTX patients (1.8 [1.4-2.3] versus 8.7 [5.2-17.4]; P < 0.001) and controls (11.5 [8.0-16.7]; P ≤ 0.001). Lymphocyte counts were comparable in RA groups (P > 0.05), but RA-ABA patients had slightly lower gammaglobulin levels than RA-MTX patients (0.9 gm/dl [0.6-1.8] versus 1.2 gm/dl [0.8-1.7]; P = 0.03), although almost all were within the normal range values.

CONCLUSION

The current study established that ABA, in association with traditional DMARDs, significantly reduces the humoral response to pandemic 2009 influenza A/H1N1 vaccine in RA patients. The results suggest an influence of costimulatory modulation in humoral response to this vaccine.

The domain Archaea in human mucosal surfaces

Archaea present distinct features from bacteria and eukaryotes, and thus constitute one of the branches of the phylogenetic tree of life. Members of this domain colonize distinct niches in the human body, arranged in complex communities, especially in the intestines and the oral cavity. The diversity of archaea within these niches is limited to a few phylotypes, constituted in particular by methane-producing archaeal organisms. Although they are possibly symbionts, methanogens may play a role in the establishment of mucosal diseases by favouring the growth of certain bacterial groups.

Contrasting effects of leptin on food anticipatory and total locomotor activity

Obese, leptin deficient obob mice have profoundly decreased activity and increased food seeking behavior. The decreased activity has been attributed to obesity. In mice, we tested the hypothesis that leptin increases total locomotor activity but inhibits food anticipatory activity. We also sought to determine if leptin induced increases in total locomotor activity are independent of changes in body weight and obesity. We studied obob mice and also created a novel transgenic mouse where leptin is over-expressed in a tetracycline-off system and can be abruptly and non-invasively suppressed by doxycycline within few hours. The studies were performed using two independent behavioral assays: home cage activity (HCA) and running wheel activity (RWA). Systemic administration of leptin (150 ng/hr) to obob mice produced a 122%±30% (mean ± SEM) increase (p≤0.01) in locomotor activity within 2 days In addition, cerebroventricular administration of leptin (5 ng/hr) also produced an early and progressive increase in total locomotor activity beginning on the 1st day (+28±8%; p≤0.05) and increasing to +69±23% on day 3 without a decrease in body weight during this time. The increase in activity was restricted to the dark phase. Conversely, in a tet-off transgenic obob mouse line, acute leptin suppression reduced spontaneous locomotor activity. To further define activities that are leptin regulated, we assayed food anticipatory activity (FAA) and found that it was markedly augmented in obob mice compared to wild type mice (+38±6.7 in obob vs +20±6.3% in wild type at peak; mean ± SEM; p≤0.001) and abolished by leptin. Although melanocortin-3 receptors (MC3R) reportedly mediate FAA, we found augmented FAA and preserved inhibitory effects of leptin on FAA in MC3R-/-obob mice. In summary, this study demonstrates that total activity and FAA are regulated independently by leptin. Leptin, acting in the central nervous system and at physiologic levels, produces early increases in locomotor activity before substantial weight loss. In contrast, leptin suppresses augmented food anticipatory activity in obob mice.

Theoretical consequences of fluctuating versus constant liganding of oestrogen receptor-alpha in neurones

A theory is put forward that emphasises differences in neuronal responses to fluctuations in steroid hormone levels compared to constant hormone levels. We propose that neuronal functions that regulate gonadotrophin release from the anterior pituitary tend to be more sensitive to rapid increases in the levels of oestrogens than they are to constant oestrogen levels. By contrast, neurones that control certain behavioral functions are affected just as well by constant oestrogen levels as by positively accelerating levels of oestrogen. In addition to providing examples of data from recent experiments that examine actions of the long-term effects of oestrogen on mouse behaviour, we illustrate the behavioural effects of microinjections of adeno-associated viral vectors of small interfering RNA directed against the mRNA for oestrogen receptor-alpha (ERalpha). This manipulation provides for a long-term loss of ERalpha function in a neuranatomically specific manner. The theoretical distinction between temporal features of oestrogen sensitivity of neuroendocrine versus behavioural function is not absolute, but is intended to stimulate new experimentation that examines temporal features of oestrogen administration.

Phase structure and molecular dynamics of liquid-crystalline side-on organosiloxane tetrapodes

X-ray diffraction and proton NMR relaxation measurements were carried out on two liquid-crystalline organosiloxane tetrapodes with side-on mesogenic groups, exhibiting nematic and smectic- C phases, and on a monomeric analog. Packing models for the mesophases exhibited by these systems are proposed on the basis of x-ray diffraction data. As a consequence of microsegregation, the aromatic cores are packed in between two sublayers formed by a mixture of interdigitated aliphatic and siloxane chains. The mixed sublayers are characteristic for the tetrapodes with side-on mesogenic groups presented in this work and have not been observed in tetrapodes with terminally attached mesogens. The tilt angle in the smectic- C phase is found very large, i.e., approximately 61 degrees -62 degrees . Notably, smectic- C clusters are present also in the whole temperature range of the nematic phase. NMR relaxometry yields T(1)-1 dispersions clearly different from those of conventional calamitics. The influence of molecular tendency to form interdigitated structures is evidenced by frequency-dependent relaxation rate in the isotropic phase-indicating the presence of ordered clusters far above the phase transition-and by the diminished role of molecular self-diffusion in ordered phases. Nematiclike director fluctuations are the dominating relaxation mechanism whereas the translational displacements are strongly hindered by the interdigitation of dendrimer arms.

Relationship of arousal to circadian anticipatory behavior: ventromedial hypothalamus: one node in a hunger-arousal network

The mechanisms by which animals adapt to an ever-changing environment have long fascinated scientists. Different forces, conveying information regarding various aspects of the internal and external environment, interact with each other to modulate behavioral arousal. These forces can act in concert or, at times, in opposite directions. These signals eventually converge and are integrated to influence a common arousal pathway which, depending on all the information received from the environment, supports the activation of the most appropriate behavioral response. In this review we propose that the ventromedial hypothalamic nucleus (VMN) is part of the circuitry that controls food anticipation. It is the first nucleus activated when there is a change in the time of food availability, silencing of VMN ghrelin receptors decreases food-anticipatory activity (FAA) and, although lesions of the VMN do not abolish FAA, parts of the response are often altered. In proposing this model it is not our intention to exclude parallel, redundant and possibly interacting pathways that may ultimately communicate with, or work in concert with, the proposed network, but rather to describe the neuroanatomical requirements for this circuit and to illustrate how the VMN is strategically placed and connected to mediate this complex behavioral adaptation.

Colocalization of connexin 36 and corticotropin-releasing hormone in the mouse brain

BACKGROUND

Gap junction proteins, connexins, are expressed in most endocrine and exocrine glands in the body and are at least in some glands crucial for the hormonal secretion. To what extent connexins are expressed in neurons releasing hormones or neuropeptides from or within the central nervous system is, however, unknown. Previous studies provide indirect evidence for gap junction coupling between subsets of neuropeptide-containing neurons in the paraventricular nucleus (PVN) of the hypothalamus. Here we employ double labeling and retrograde tracing methods to investigate to what extent neuroendocrine and neuropeptide-containing neurons of the hypothalamus and brainstem express the neuronal gap junction protein connexin 36.

RESULTS

Western blot analysis showed that connexin 36 is expressed in the PVN. In bacterial artificial chromosome transgenic mice, which specifically express the reporter gene Enhanced Green Fluorescent Protein (EGFP) under the control of the connexin 36 gene promoter, EGFP expression was detected in magnocellular (neuroendocrine) and in parvocellular neurons of the PVN. Although no EGFP/connexin36 expression was seen in neurons containing oxytocin or vasopressin, EGFP/connexin36 was found in subsets of PVN neurons containing corticotropin-releasing hormone (CRH), and in somatostatin neurons located along the third ventricle. Moreover, CRH neurons in brainstem areas, including the lateral parabrachial nucleus, also expressed EGFP/connexin 36.

CONCLUSION

Our data indicate that connexin 36 is expressed in subsets of neuroendocrine and CRH neurons in specific nuclei of the hypothalamus and brainstem.

Biaxial nematic order and phase behavior studies in an organosiloxane tetrapode using complementary deuterium NMR experiments

The biaxial nematic phase was recently observed in different thermotropic liquid crystals, namely bent-core compounds, side-chain polymers, bent-core dimers, and organosiloxane tetrapodes. In this work, a series of experiments with a nematic organosiloxane tetrapode where nuclear magnetic resonance (NMR) spectra are collected while the sample is continuously rotating around an axis perpendicular to the magnetic field, are discussed in conjunction with the analysis of a deuterium NMR experiment on the same system reported earlier. The sample used is a mixture of a deuterated probe with the tetrapode. The mixture exhibits a nematic range between -40 degrees C and 37 degrees C. The results of the two independent, but complementary deuterium NMR experiments confirm the existence of a biaxial nematic phase for temperatures below 0 degrees C with high values of the asymmetry parameter at low temperatures. The presence of slow movements of the tetrapode mesogenic units in the low-temperature regime could also be detected through the analysis of the NMR spectra. Simulations indicate that these movements are mainly slow molecular reorientations of the mesogenic units associated with the presence of collective modes in the nematic phases of this compound. In the case of tetrapodes, recent investigations attribute the origin of biaxiality to the hindering of reorientations of the laterally attached mesogenic units which constitute the tetrapode. This study relates the molecular movements with the nematic biaxial ordering of the system.

Relations between mechanisms of CNS arousal and mechanisms of stress

In the centennial year of the birth of Hans Selye, this review compares his classical concepts of stress with a modern approach to mechanisms of CNS arousal. Relations between the two concepts are described. Neuroanatomical, neurophysiological, and functional genomic mechanisms underlying CNS arousal are briefly reviewed. Controls over stress responses and arousal are compared to particular concepts of control system engineering. Understanding these two systems is of crucial importance because their dysregulation is associated with large numbers of disease states.

Structure and molecular dynamics of the mesophases exhibited by an organosiloxane tetrapode with strong polar terminal groups

The polymorphism of a new organosiloxane tetrapode compound with cyano terminal polar groups was characterized by means of polarizing optical microscopy and x-ray diffraction. The compound exhibits smectic- A and smectic- C phases with a partial bilayer arrangement due to a certain degree of head-to-head association of the mesogenic units through their cyano end groups. On the basis of x-ray diffraction results, evidencing the microsegregation of polyphilic molecules, packing models for the smectic- A and smectic- C phases are proposed. A high degree of smectic positional order and a relatively low value of the tilt angle in the smectic- C phase are indicated. Molecular dynamics of the studied compound was investigated by means of proton NMR relaxometry. The frequency dispersions of the spin-lattice relaxation time (T1) show that the relaxation is induced by three rotational modes of individual dendrimer arms with frequencies between 10;{6} and 10;{9}Hz . In the smectic phases, the effect of individual rotations is overwhelmed by a well expressed contribution of layer undulations at Larmor frequencies below approximately 10MHz . The appearance of this relaxation mechanism over the frequency range of three decades is so far unique in the case of thermotropic liquid crystals. The analysis of the layer undulations contribution supports the microsegregation model of the smectic phases by revealing a slowing-down of translational diffusion and the lack of interactions among the sublayers formed by the mesogenic groups.

Deuterium nuclear-magnetic-resonance study of a chiral smectic-C{*} phase

This study reports deuterium nuclear-magnetic-resonance (NMR) spectra collected at 61.4MHz in the chiral smectic- C phase of liquid crystal 4{'}(octyloxy)-d{17} biphenyl-4- yl2 -chloro-3-methylpentanoate (BP8Cl). By using a goniometer probe, the oriented sample was rotated to collect spectra at different rotation (theta) angles. These spectra were simulated to gain information on solitonlike distortions in the helical superstructure. The Landau theory was adopted to study the distortion of the helix by the NMR magnetic field. Deuterium two-dimensional exchange experiments were also used on the aligned sample at theta=15 degrees to obtain dynamic parameters through the spectral simulation. The interlayer diffusion constants in the SmC{*} phase were estimated from a proton T(1) dispersion study. The pitch length of BP8Cl is estimated to be circa 2-3 microns at one temperature.

Frustrated structure of an anticlinic-like smectic-C phase

We present a polarising optical microscopy study of the low-temperature anticlinic-like tilted mesophase of the liquid-crystal compound octylphenyl-2-chloro-4-(p-cyano-benzoyloxy) (DB8Cl). This mesophase has been described as a bilayer smectic structure in which the molecules within each layer are organised in an anticlinic way. The optical textures observed in samples with planar orientation show a double stripe pattern, with the lines aligned parallel to the rubbing direction, characteristic of a double periodic modulation of the refractive index of the material. The long-period modulation is temperature dependent and disappears for thin sample cells (< 5 microm). The short-period modulation is nearly independent of the thickness of the cells. The experimental results are analysed in terms of a model which considers that there is a special distribution of the principal optical axis which may be in or out of the polariser-analyser plane. The observed periodic variation of the principal optical axis could not be interpreted in terms of the original structure proposed for this phase. DB8Cl presents a structure formed by dimers that can be viewed as flexible bent-core-like molecules, showing similarities with phases found in banana-like systems, but exhibiting a much more complex structure.

Field-cycling NMR relaxometry of a liquid crystal above in mesoscopic confinement

We measured the proton spin-lattice relaxation times in the isotropic phase of liquid crystal 4-n-pentyl-4-cyanobiphenyl (5CB) confined into porous glass (CPG) with the average pore diameter approximately 72 nm. The analysis of T1(-1) frequency dispersions, spanning over four decades, shows that the main relaxation mechanism induced by the ordered surface layer are molecular reorientations mediated by translational displacements (RMTD). The RMTD contribution to T1(-1) is proportional to the inverse square root of Larmor frequency, a consequence of the equipartition of diffusion modes along the surface. Low and high frequency cutoffs of the RMTD mechanism clearly reveal that the surface alignment of liquid crystal is random planar with the size of uniformly oriented patches approximately 5 nm, depending on the treatment of the CPG matrix. According to the size of the uniformly oriented patches varies also the thickness of the ordered surface layer and its temperature behavior. The surface-induced order parameter is found to be temperature independent and determined by the local short range surface interactions.

The effects of intracerebroventricular application of 8-Br-cGMP and LY-83,583, a guanylyl cyclase inhibitor, on sleep-wake activity in rats

Cyclic GMP is the second messenger that mediates most of the neuronal effects of nitric oxide (NO). Several lines of evidence suggest that NO-ergic mechanisms play an integral role in the regulation of vigilance. In the present study, we tested the effects of the activation of cGMP-receptive mechanisms and the inhibitor of guanylyl cyclase (GC), LY-83,583, on sleep in rats. Rats were injected intracerebroventricularly (icv) with 0.16, 4, 100, and 500 microg or 2.5 mg 8-Br-cGMP, a membrane-permeable analogue of cGMP, or 1 and 100 microg LY-83,583. Administration of 4 microg-2.5 mg 8-Br-cGMP increased wakefulness and suppressed rapid-eye-movement sleep (REMS) and non-REMS (NREMS) in rats when given before dark onset but not when given before the light period. The GC inhibitor LY-83,583 strongly promoted NREMS and suppressed REMS during the light period of the day. Furthermore, LY-83,583 induced striking increases in the delta-wave activity of the electroencephalogram (EEG) during NREMS, whereas EEG activity above the 4.5 Hz wave range was suppressed in all vigilance states. Our finding that cGMP has an arousal-promoting activity is in line with the hypothesis that NO/cGMP signaling pathway is involved in the regulation of vigilance.

NMR relaxation study of molecular dynamics in columnar and smectic phases of a PAMAM liquid-crystalline co-dendrimer

We present the first results obtained by proton ((1)H) nuclear magnetic relaxation studies of molecular dynamics in a supermolecular liquid-crystal dendrimer exhibiting columnar rectangular and smectic-A phases. The (1)H spin-lattice relaxation time (T(1)) dispersions are interpreted using two relaxation mechanisms associated with collective motions and local molecular reorientations of the dendritic segments in the low- and high-frequency ranges, respectively. The T(1) values show a drop around 2.3 MHz that is attributed to a contribution coming from cross-relaxation between (1)H and nitrogen nuclear spins. In the high-frequency range the motions appear to be of similar nature in both mesophases and are ascribed to reorientations of dendritic segments (belonging to the core and/or to the mesogenic units) characterized by two correlation times. Notable differences in the dynamics between the columnar and layered phases are observed in the low-frequency range. Depending on the mesophase they are discussed in terms of elastic deformations of the columns and layer undulations. In this study we find that the dendritic core influences the dynamics of the mesogenic units both for local and collective motions. These results can be understood in terms of spatial constraints imposed by the dendritic architecture and by the supermolecular arrangement in the mesophases.

Day- and nighttime injection of a nitric oxide synthase inhibitor elicits opposite sleep responses in rats

Previous studies suggest that nitric oxide (NO) may play a role in sleep regulation, particularly in the homeostatic process. The present studies were undertaken to compare the sleep effects of injecting a NO synthase (NOS) inhibitor when homeostatic sleep pressure is naturally highest (light onset) or when it is at its nadir (dark onset) in rats. Sleep, electroencephalogram delta-wave activity during nonrapid eye movement sleep (NREMS), also known as slow-wave activity (SWA), and brain temperature responses to three doses of the NOS inhibitor Nω-nitro-l-arginine methyl ester (l-NAME; 5, 50, and 100 mg/kg) injected intraperitoneally at light or dark onset were examined in rats ( n = 6 to 8). The effects of 5 mg/kg l-NAME were determined in both normal and vagotomized (VX) rats. Light onset administration of 50 mg/kg l-NAME decreased NREMS amounts and suppressed SWA and increased rapid eye movement sleep (REMS) amounts. At dark onset, l-NAME injection also dose dependently suppressed SWA; however, unlike light onset injections, both NREMS and REMS amounts were increased after all three doses. Sleep responses to 5 mg/kg l-NAME were not different in control and VX rats, suggesting that the sleep effects of l-NAME are not mediated through the activation of sensory vagal mechanisms. The present findings suggest that timing of the injection is a major determinant of the sleep responses observed after systemic l-NAME injection in rats.

Deuterium NMR investigation of the biaxial nematic phase in an organosiloxane tetrapode

Deuterium NMR is used to examine the molecular order exhibited by an organosiloxane tetrapode giving the first experimental evidence, using a bulk sample, for the existence of a biaxial nematic phase in this type of compounds. The temperature dependence of the averaged quadrupolar coupling constant and asymmetry parameter was determined in the compound's nematic phase. Two distinct regimes could be identified, one with a vanishing asymmetry parameter corresponding to a uniaxial nematic phase and another with a significant temperature dependent asymmetry parameter, corresponding to a biaxial nematic phase. The high values obtained for the asymmetry parameter at the lower end of the nematic range are well above experimental error and constitute a definite proof of the biaxial nature of the nematic phase exhibited by the studied compound for those temperatures.

Characterization of globulins from common vetch (Vicia sativa L.)

The proteins from Vicia sativa L. (common vetch) seeds were investigated. Protein comprises approximately 11.4% of the seed fresh weight, >50.8% of which is composed by globulins and 43.6% by albumins. The globulins may be fractionated into two main components, which were named alpha-vicinin (comprising 73% of the total globulin fraction, and hence >37% of the total seed protein) and beta-vicinin. Two minor globulin components are also present, gamma-vicinin and delta-vicinin. alpha-Vicinin, the legumin-like globulin, with a sedimentation coefficient of 10.6 S, is a nonglycosylated, disulfide-bond-containing globulin, composed of a group of subunits with molecular masses ranging from 50 to 78 kDa. Upon reduction, each of these subunits releases a heavy polypeptide chain (34-66 kDa) and a light polypeptide chain (21-23 kDa). beta-Vicinin, the vicilin-like globulin, with a sedimentation coefficient of 7.7 S, is a nonglycosylated globulin that contains no disulfide bonds and consists of two major polypeptides with molecular masses of 58 and 66 kDa. gamma-Vicinin is a minor, glycosylated, disulfide-bond-containing globulin. In the reduced form, it comprises six polypeptide chains with molecular masses of 12, 19, 21, 22, 23, and 31 kDa. Finally, delta-vicinin is a minor, highly glycosylated globulin that exhibits hemagglutinating activity. It is composed of a major 47 kDa polypeptide and two minor (33 and 38 kDa) polypeptides. N-terminal sequencing of the delta-vicinin 47 kDa polypeptide revealed no homology to any other known storage protein.

Novel pulsed switched power supply for a fast field cycling NMR spectrometer

In this paper, we outline the operating principles of a pulsed switched power supply for a fast field-cycling nuclear magnetic resonance spectrometer. The power supply uses a variant of a four-quadrant chopper with a duty cycle that defines the average output current. With this topology only two semiconductors are necessary to drive hundreds of amperes with an output power of several kilowatts. The output current ripple has a well-defined shape that can be reduced to acceptable values by a careful design of the semiconductors' controlling circuits and drivers. A power supply prototype was tested with a home build air-core magnet operating with fields between 0 and 0.21 T. The system is computer controlled using pulse generator and data acquisition PC cards, and specific user-friendly home-developed software. A comparative proton relaxometry study in two well-known liquid crystal compounds 5CB and MBBA was performed to check the reproducibility of the T1 measurements.

Rectangular to hexagonal columnar phase transition exhibited by a biforked mesogen

We present the structural study of a biforked compound exhibiting a Colr-Colh phase transition. This study was performed by means of DSC, optical microscopy, X-ray diffraction, dilatometry and molecular modelling. The molecular packing within the two columnar mesophases of this compound is discussed. For the first time, it is shown that the clusters of adjacent molecules which form the elementary section of a column are tilted with respect to the columnar axis in the rectangular mesophase. From the whole set of experimental data, the number of molecules in a columnar section is found to be about 5 in the rectangular mesophase, and 4 in the hexagonal one. The transition between the two columnar mesophases is discussed with respect to its slow kinetics.

Polymorphous low-grade adenocarcinoma of the salivary glands with transformation to high-grade carcinoma

AIMS

Polymorphous low-grade adenocarcinoma of the minor salivary glands is an infiltrative neoplasm characterized by bland-looking tumour cells arranged in diverse architectural patterns. It is considered to be of low-grade malignant potential in that nodal metastases are seen in only a minority, and distant spread is rare. Even more unusual is the transformation of polymorphous low-grade adenocarcinoma to a histologically high-grade carcinoma, i.e. dedifferentiation. In this paper, we describe the clinicopathological and immunohistochemical findings in two further examples.

METHODS AND RESULTS

Two patients presented each with a tumour of the palate. Histopathological examination showed the typical morphological, cytological and immunohistochemical features of a polymorphous low-grade adenocarcinoma. In one case there was a second component of high-grade carcinoma showing nuclear atypia, markedly increased mitotic activity and MIB1 index, as well as prominent zones of necrosis. It expressed epithelial markers and androgen receptors, and thus resembled salivary duct carcinoma. Similar tumour tissue was observed in one of the cervical nodal metastases, which was biopsied at the same time as the palate. In the second patient, a high-grade component was discovered when the tumour recurred in the palate 13 years after the initial biopsy. Whilst morphologically similar to that in first case, there were significant immunohistochemical differences such as retention of some of the polymorphous low-grade adenocarcinoma profile and absence of androgen receptor expression.

CONCLUSIONS

Polymorphous low-grade adenocarcinoma was first described relatively recently, and as experience with it continues to accumulate, it is becoming clear that late recurrences and metastases, whilst still infrequent, may not be quite as rare as previously thought. Reports of histological transformation are even scarcer, and most occurred at least 13 years after the polymorphous low-grade adenocarcinoma was initially recognized. It is a real possibility that this phenomenon, like clinical progression, may also be encountered more often as time passes. Therefore, we believe that, whilst polymorphous low-grade adenocarcinoma is certainly far less aggressive than, for example, adenoid cystic carcinoma, it nevertheless remains a true malignancy with a potential to prove fatal in a minority of patients.

Inflammatory myofibroblastic tumor involving the pterygopalatine fossa

SUMMARY

Inflammatory myofibroblastic tumors (IMT) comprise a rare group of lesions characterized histologically by acute and chronic inflammatory cells with a variable degree of fibrous stroma. Occurrence in the extracranial head and neck in children is unusual, and involvement in the pterygopalatine fossa has not, to our knowledge, been reported as occurring in this age group. We present the CT findings of an IMT of the pterygopalatine fossa in a 6-year-old female patient with a 2-week history of fever and a painless swelling of the left cheek. The diagnosis of IMT should be included in the differential diagnosis of a child presenting with an aggressive mass associated with systemic features such as fever, elevated sedimentation rate, and leukocytosis.

Human leukocyte antigen DR markers as predictors of progression to liver transplantation in patients with chronic hepatitis C

OBJECTIVE

Because many patients with chronic viral hepatitis do not progress to end-stage liver disease, it is possible that host factors such as human leukocyte antigen (HLA) differences are important. Our aims were to determine HLA marker-specific rates of progression to liver transplantation among patients with chronic hepatitis C; and to determine if polymerase chain reaction (PCR)-based HLA DRB1 typing can be performed on stored serum samples.

METHODS

Forty-two hepatitis C virus RNA-positive liver transplant patients and 87 untransplanted patients were included in a Cox proportional hazards model to test whether the occurrence of certain HLA DRB1 markers were associated with progression to liver transplantation. HLA DRB1 typing was performed on stored serum samples using a PCR method.

RESULTS

There were no differences among the HLA DRB1 markers with regard to the HLA marker-specific rate of progression to transplantation among patients with chronic hepatitis C.

CONCLUSIONS

HLA DRB1 markers do not appear to be associated with progression of disease in chronic viral hepatitis C. It is possible to perform PCR-based HLA DRB1 typing on stored frozen serum samples.

[Clinical findings of sensitivity to analgesics and nonsteroidal antiinflammatory drugs]

BACKGROUND

Analgesics (ANA) and nonsteroidal antiinflammatory drugs (NSAID) may simulate an allergic reaction or aggravate asthma and urticaria.

OBJECTIVE

The aim of this study was the analysis of the clinical findings in patients sensitive to ANA/NSAID.

METHODS AND SUBJECTS

The charts of 183 patients with history of reacting to these drugs were retrospectively analysed.

RESULTS

There were 93 (51%) females and 90 (49%) males; 63 (34%) were aged 15 years or less. Females predominate in the age group older than 15 years (p = 0,02). The age by the time of the first reaction varied from 7 months to 65 years (median 15 years). Skin tests to inhalant allergens were positive to at least one antigen in 100/138 patients (72%). Clinical presentation was angioedema (86%); urticaria (39%); systemic reaction (30%); nasal and ocular (15%); and asthma (14%). The frequency of symptoms was not related to age. Family history of ANA/NSAID sensitivity was present in 3.8% of patients. Associated diseases were rhinitis (55%), chronic urticaria (47%), asthma (37%) and conjuntivitis (18%). Among asthmatics 16 (23,5%) had had attacks with ANA/NSAID. Nine non asthmatics (7.7%) had had bronchospasm as clinical presentation. This difference was statistically significant. Repeated reactions occurred in 107 (58%) patients.

CONCLUSIONS

Sensitivity to ANA/NSAID was frequent in atopics; children and adults responded similarly; reactions were more common in adult females; palpebral angioedema was the most frequent clinical presentation; bronchosphasm was usually seen in asthmatics and most patients reacted repeatedly to different drugs.

Systemic injection of a nitric oxide synthase inhibitor suppresses sleep responses to sleep deprivation in rats

We hypothesized that nitric oxide (NO) may play a role in homeostatic sleep regulation. To test this hypothesis, we studied the sleep deprivation (SD)-induced homeostatic sleep responses after intraperitoneal administration of an NO synthase inhibitor, Nomega-nitro-L-arginine methyl ester (L-NAME, a cumulative dose of 100 mg/kg). Amounts and intensity of sleep were increased in response to 8 h of SD in control rats (n = 8). Sleep amounts remained above baseline for 16 h after SD followed by a negative rebound. Rapid eye movement sleep (REMS) and non-REMS (NREMS) intensities were elevated for 16 and 4 h, respectively. L-NAME treatment (n = 8) suppressed the rebound increases in NREMS amount and intensity. REMS rebound was attenuated by L-NAME in the first dark period after SD; however, a second rebound appeared in the subsequent dark period. REMS intensity did not increase after SD in L-NAME-injected rats. The finding that the NO synthase inhibitor suppressed rebound increases in NREMS suggests that NO may play a role as a signaling molecule in homeostatic regulation of NREMS.

Susceptibility of Nectomys rattus (Pelzen, 1883) to experimental infection with Schistosoma mansoni (Sambon, 1907): a potential reservoir in Brazil

The aim of the present research was to evaluate the potential of Nectomys rattus, the "water rat", to develop Schistosoma mansoni infection. Comparison with N. squamipes was carried out. Both species of rodents were submitted to transcutaneous infection using different infective cercariae loads: 50, 100 or 500. N. rattus showed high susceptibility to S. mansoni, with an infection rate of 71%. Rodents were able to excrete viable eggs of S. mansoni in the faeces during all infection period. For both species, the small intestine, followed by the liver and the large intestine, presented the highest concentration of eggs among the surveyed organs. Infection caused no animal death. Moreover, N. rattus accomplished the parasite's life cycle, by infecting the snails Biomphalaria glabrata and later Mus musculus. These evidences indicate that both N. rattus, as for N. squamipes are potential reservoirs for schistosomiasis in Brazil. Considering the fact that N. rattus and N. squamipes exist in the same natural ecosystems of S. mansoni, we suggest that these rodents must be regarded as influential factors in epidemiology surveys.

Esophageal manometry: a comparison of findings in younger and older patients

OBJECTIVE

We sought to determine the utility of esophageal manometry in an older patient population.

METHODS

Consecutively performed manometry studies (470) were reviewed and two groups were chosen for the study, those > or = 75 yr of age (66 patients) and those < or = 50 years (122 patients). Symptoms, manometric findings (lower esophageal sphincter [LES], esophageal body, upper esophageal sphincter [UES]) and diagnoses were compared between the groups.

RESULTS

Dysphagia was more common (60.6% vs 25.4%), and chest pain was less common (17.9 vs 26.2%) in older patients. In the entire group, there were no differences in LES parameters. Older patients with achalasia had lower LES residual pressures after deglutition (2.7 vs 12.0 mm Hg), but had similar resting pressures (31.4 vs 35.2 mm Hg) compared with younger achalasia patients. Duration and amplitude of peristalsis were similar in both groups, whereas peristaltic sequences were more likely to be simultaneous in the older group (15% vs 4%). The UES had a lower resting pressure in the older patients (49.6 vs 77.6 mm Hg) and a higher residual pressure (2.0 vs -2.7 mm Hg). The older patients were less likely to have normal motility (30.3% vs 44.3%) and were more likely to have achalasia (15.2% vs 4.1%) or diffuse esophageal spasm (16.6% vs 5.0%). When only patients with dysphagia were analyzed, achalasia was still more likely in the older group (20.0% vs 12.9%).

CONCLUSION

When older patients present with dysphagia, esophageal manometry frequently yields a diagnosis to help explain their symptoms.