Nonclinical evaluation of chronic cardiac contractility modulation on 3D human engineered cardiac tissues

INTRODUCTION

Cardiac contractility modulation (CCM) is a medical device-based therapy delivering non-excitatory electrical stimulations to the heart to enhance cardiac function in heart failure (HF) patients. The lack of human in vitro tools to assess CCM hinders our understanding of CCM mechanisms of action. Here, we introduce a novel chronic (i.e., 2-day) in vitro CCM assay to evaluate the effects of CCM in a human 3D microphysiological system consisting of engineered cardiac tissues (ECTs).

METHODS

Cryopreserved human induced pluripotent stem cell-derived cardiomyocytes were used to generate 3D ECTs. The ECTs were cultured, incorporating human primary ventricular cardiac fibroblasts and a fibrin-based gel. Electrical stimulation was applied using two separate pulse generators for the CCM group and control group. Contractile properties and intracellular calcium were measured, and a cardiac gene quantitative PCR screen was conducted.

RESULTS

Chronic CCM increased contraction amplitude and duration, enhanced intracellular calcium transient amplitude, and altered gene expression related to HF (i.e., natriuretic peptide B, NPPB) and excitation-contraction coupling (i.e., sodium-calcium exchanger, SLC8).

CONCLUSION

These data represent the first study of chronic CCM in a 3D ECT model, providing a nonclinical tool to assess the effects of cardiac electrophysiology medical device signals complementing in vivo animal studies. The methodology established a standardized 3D ECT-based in vitro testbed for chronic CCM, allowing evaluation of physiological and molecular effects on human cardiac tissues.

AB0124 EFFECTS OF INHIBITOR K-CARRAGEENAN ON HAECs INFLAMMATORY RESPONSE TO LDLs ISOLATED FROM SLE PATIENTS

Background

Systemic Lupus Erythematosus (SLE) is an autoimmune disease with a high risk of atherosclerosis and cardiovascular events. It was previously reported by our group that low-density lipoprotein (LDL) particles isolated from SLE patients, during an active state of the disease (‘flare’), promoted an exaggerated inflammatory response in human aortic endothelial cells (HAECs). However, the molecular mechanisms underlying this response still remain elusive.

Objectives

The hypothesis of this study is that these SLE-LDLs would be using receptor LOX-1, associated with inflammatory conditions and altered lipoproteins, to generate the proatherogenic response in HAECs.

Methods

LOX-1 pharmacological inhibitor k-carrageenan was used before the stimulation of HAECs with LDLs isolated from healthy controls (10), non-active (13), or active-SLE patients (13). Gene expression, protein, and cell migration assays were performed to evaluate HAECs inflammatory response.

Results

LOX-1 inhibition with k-carrageenan significantly reduced the expression of vascular cell adhesion molecule 1 (VCAM-1) and restored the gene expression of endothelial nitric oxide synthase (eNOS) in HAECs incubated with non-active SLE LDLs.

Conclusion

While VCAM-1 down-regulation was expected, the immediate next step derived from the observed results will be a deeper understanding of how LOX-1 inhibition may restore the endothelial ability to synthetize NO in the presence of altered LDL. This will allow gaining insight not only on the development of atherosclerosis but also on the clue mechanisms involved in the pathogenesis of SLE.

Disclosure of Interests

None declared

Health and finance in the post-austerity context: the Portuguese experience

In March 2018, a Mission Structure (EMSPOS) was created in Portugal, under supervision of both Ministries of Health and Finance, to analyze the economic situation of the National Health Service (NHS), and propose recommendations to ensure its financial sustainability. The main concern was the recurrent cycles of overdue debt of NHS hospitals, which reached, in September 2018, more than 1.3 billion euros. These debts cycles, mainly to the pharmaceutical industry, were viewed as a combination of (i) under-budgeting during and following the Great Recession; (ii) expenditure growth related to population aging and new technologies; and (iii) a hospital financing and governance model that provided few incentives towards adequate management.

Hospitals' overdue debts limit their autonomy to assume investment compromises, while they deteriorate the NHS negotiation power vis-à-vis suppliers/creditors. Also, these debts were paid through financial bailouts, which shifted from punctual to predictable and regular, constituting an “indebtment reward” that destroyed any incentive towards efficiency and cost containment.

The challenge faced by EMSPOS was to ensure better budgets and autonomy to hospitals, both indispensable to face growing needs (the health sector claim), while providing the right monitoring and incentives to avoid new cycles of debt, inefficiencies, and unsustainable expenditure growth (the Ministry of Finance claim). This last request was reinforced by the Post-Program Surveillance (PPS), by the European Commission and Central Bank, that “measure Portugal's capacity to repay its outstanding loans”.

The EMSPOS proposed a new governance model that included better budgets with an efficiency-related performance component, a new management contract for hospitals' executive boards, and a path towards more investment autonomy, through the approval of “Activity and Budget Plans”. We will discuss the details of this new models and the challenges of its implementation.

Key messages

Portuguese NHS hospitals have been facing regular cycles of overdue debt, related to under-budgeting and inadequate governance models. Better budgets and hospital autonomy are needed to face growing needs (MoH claim), and right incentives are needed, to avoid inefficiencies and unsustainable expenditure growth (MoF claim).

Stream chemistry response to changing nitrogen and sulfur deposition in two mountain areas in the Iberian Peninsula

Sulfur (S) and nitrogen (N) increasing anthropogenic emissions in the last century has arisen wide concern on the ecological effects of S and N deposition. In this paper, we use bulk deposition and stream water measurements in the central Pyrenees (PYR-C and PYR-AT sites) and Montseny (MSY-TM0) covering different time lengths in the period 1983-2017 to investigate how these mountain environments respond to ongoing changes of regional emissions to the atmosphere. PYR-C, in spite of its position far away from urban and industrial areas, presented higher SO₄-S, NO₃-N and NH₄-N bulk deposition than the Montseny site closer to Barcelona and the inclusion of dry deposition only reversed this pattern for NO₃-N. This indicates that distance to pollution sources does not protect these mountain sites from a considerable impact of pollution. Time-trends in SO₄^2- and NO₃^- concentrations in bulk deposition were similar between sites: SO₄^2- monotonically decreased, while NO₃^- increased until the mid-2000 s and decreased thereafter. In the period 1983 to 2017, SO₂ emissions in Europe (EU-28) decreased by 95%, while in the SO₄^2- concentrations in bulk deposition declined by 35-50% in Pyrenees and Montseny respectively and SO₄^2- concentrations in the streams by 25-35%, respectively. Other sources of SO₄^2- (e.g. episodic African dust) may explain the different reduction rate between anthropogenic emissions and bulk deposition. Net S budget was positive for MSY-TM0 (indicating flushing from the catchment) and negative for the PYR-C site (indicating retention), while it was close to zero for the other Pyrenean site, but in the PYR-C site net retention showed a significant increasing trend tending to lower retention in recent years. Bulk N deposition in the Pyrenees was lower but stream concentrations and export was higher than at Montseny, this leading to less N retention in the Pyrenean sites. However, the MSY-TM0 site showed a trend towards less N retention in recent years. This was driven by higher exports during the wet months, which would correspond to a first stage of N saturation according Stoddard's classification.

Acute resveratrol supplementation in coronary artery disease: towards patient stratification

Objective: Resveratrol (RV) is a polyphenol with antioxidant, anti-inflammatory and cardio-protective properties. Our objective was to investigate whether acute supplementation with high doses of RV would improve flow-mediated dilation (FMD) and oxygen consumption (VO₂) kinetics in older coronary artery disease (CAD) patients. Design: We employed a placebo-controlled, single-blind, crossover design in which ten participants (aged 66.6 ± 7.8 years) received either RV or placebo (330 mg, 3× day^-1) during three consecutive days plus additional 330 mg in the morning of the fourth day with a seven-day wash-out period in-between. On the fourth day, FMD of the brachial artery and VO₂ on-kinetics were determined. Results: RV improved FMD in patients who had undergone coronary artery bypass grafting (CABG; -1.4 vs. 5.0%; p = .004), but not in those who had undergone percutaneous coronary intervention (PCI; 4.2 vs. -0.2%; NS). Conclusion: Acute high dose supplementation with RV improved FMD in patients after CABG surgery but impaired FMD in patients who underwent PCI. The revascularization method-related differential effects of RV may be due to its direct effects on endothelial-dependent dilator responses. Our findings have important implications for personalized treatment and stratification of older CAD patients.

Relative permittivity estimation of wheat starch: A critical property for understanding electrostatic hazards

Wheat starch is a widely used material in the food, pharmaceutical and entertainment industry not considered hazard but recently associated to dust explosions during processing and handling. How an insulating starch grain is charged and how its ability to be polarized is affected by environmental conditions such as temperature, humidity and frequency? are fundamental questions that must be explored in order to understand the dust explosion phenomena. Here we investigate the dependence of temperature, humidity and low-frequency on the relative permittivity of wheat starch. We characterized starch at the micro and macro scales using atomic force microscopy-based techniques and capacitive planar sensor-based measurements respectively. The results show high values of permittivity (˜80) at the microscale (single starch grains) compared to the low values (10-20) at the macroscale (20 mg of wheat starch). The differences are attributed to the Maxwell-Wagner-Sillars interfacial polarization process on individual grains and potential charge exchange between grains. Permittivity is a critical property to investigate starch electrostatic hazards.

Comparative study of equivalent circuit models for photoconductive antennas

Comparison of equivalent circuit models (ECM) for photoconductive antennas (PCA) represents a challenge due to the multiphysics phenomena involved during PCA operation and the absence of a standardized validation methodology. In this work, currently reported ECMs are compared using a unique set of simulation parameters and validation indicators (THz waveform, optical power saturation, and ECM voltages consistency). The ECM simulations are contrasted with measured THz pulses of an H-shaped 20μm gap PCA at different optical powers (20mW to 220mW). In addition, an alternative two-element ECM that accounts for both space-charge and radiation screening effects is presented and validated using the proposed methodology. The model shows an accurately reproduced THz pulse using a reduced number of circuital elements, which represents an advantage for PCA modeling.

Quantitative study on nitrogen deposition and canopy retention in Mediterranean evergreen forests

To assess the impact of nitrogen (N) pollutants on forest ecosystems, the role of the interactions in the canopy needs to be understood. A great number of studies have addressed this issue in heavily N-polluted regions in north and central Europe. Much less information is available for the Iberian Peninsula, and yet this region is home to mountain forests and alpine grasslands that may be at risk due to excessive N deposition. To establish the basis for ecology-based policies, there is a need to better understand the forest response to this atmospheric impact. To fill this gap, in this study, we measured N deposition (as bulk, wet, and throughfall fluxes of dissolved inorganic nitrogen) and air N gas concentrations from 2011 to 2013 at four Spanish holm oak (Quercus ilex) forests located in different pollution environments. One site was in an area of intensive agriculture, two sites were influenced by big cities (Madrid and Barcelona, respectively), and one site was in a rural mountain environment 40 km north of Barcelona. Wet deposition ranged between 0.54 and 3.8 kg N ha^-1 year^-1 for ammonium (NH₄⁺)-N and between 0.65 and 2.1 kg N ha^-1 year^-1 for nitrate (NO₃^-)-N, with the lowest deposition at the Madrid site for both components. Dry deposition was evaluated with three different approaches: (1) a canopy budget model based in throughfall measurements, (2) a branch washing method, and (3) inferential calculations. Taking the average dry deposition from these methods, dry deposition represented 51-67% (reduced N) and 72-75% (oxidized N) of total N deposition. Canopies retained both NH₄⁺-N and NO₃-N, with a higher retention at the agricultural and rural sites (50-60%) than at sites located close to big cities (20-35%, though more uncertainty was found for the site near Madrid), thereby highlighting the role of the forest canopy in processing N pollutant emissions.

Ecological impacts of atmospheric pollution and interactions with climate change in terrestrial ecosystems of the Mediterranean Basin: Current research and future directions

Mediterranean Basin ecosystems, their unique biodiversity, and the key services they provide are currently at risk due to air pollution and climate change, yet only a limited number of isolated and geographically-restricted studies have addressed this topic, often with contrasting results. Particularities of air pollution in this region include high O₃ levels due to high air temperatures and solar radiation, the stability of air masses, and dominance of dry over wet nitrogen deposition. Moreover, the unique abiotic and biotic factors (e.g., climate, vegetation type, relevance of Saharan dust inputs) modulating the response of Mediterranean ecosystems at various spatiotemporal scales make it difficult to understand, and thus predict, the consequences of human activities that cause air pollution in the Mediterranean Basin. Therefore, there is an urgent need to implement coordinated research and experimental platforms along with wider environmental monitoring networks in the region. In particular, a robust deposition monitoring network in conjunction with modelling estimates is crucial, possibly including a set of common biomonitors (ideally cryptogams, an important component of the Mediterranean vegetation), to help refine pollutant deposition maps. Additionally, increased attention must be paid to functional diversity measures in future air pollution and climate change studies to establish the necessary link between biodiversity and the provision of ecosystem services in Mediterranean ecosystems. Through a coordinated effort, the Mediterranean scientific community can fill the above-mentioned gaps and reach a greater understanding of the mechanisms underlying the combined effects of air pollution and climate change in the Mediterranean Basin.

Patterns of hypothalamic GnIH change over the reproductive period in starlings and rats

Gonadotropin inhibitory hormone (GnIH) exerts powerful inhibitory effects on various levels of the vertebrate hypothalamic-pituitary-gonadal (reproductive) axis, yet little is known of how it might change naturally over the course of reproduction. We characterized patterns of hypothalamic GnIH cell abundance over the reproductive period in two popular models used for the study of reproductive endocrinology: European starlings (Sturnus vulgaris) and Sprague-Dawley rats (Rattus norvegicus). We also examined the effects on an unpredictable change in the environment on GnIH cell abundance during the reproductive period, specifically during the period of parental care, by simulating a nest predation event and removing eggs/pups. In both species, we report changes in GnIH cell abundance are occurring at similar reproductive time points but are not always directionally parallel; this may be due to a difference in life histories and physiology mediating parental care. We discovered that cells immunoreactive for the GnIH peptide in male and female starlings are most highly abundant on the first day of incubation and the first day after the first chick hatches. Conversely in rats, GnIH cell abundance decreases in dams on the first day after pups are born. In both male and female starlings and female rats, GnIH cell abundance increases in response to egg/pup loss, indicating that GnIH responds to an unpredictable change in the environment in a potentially conserved fashion. These changes in GnIH cell abundance during the reproductive period inspire further investigation of its adaptive role in reproductive physiological events and behaviors, especially parental care.

Long-term effects of changing atmospheric pollution on throughfall, bulk deposition and streamwaters in a Mediterranean forest

The abatement programs implanted in Europe to reduce SO2, NO2 and NH3 emissions are here evaluated by analyzing the relationships between emissions in Spain and neighboring countries and atmospheric deposition in a Mediterranean forest in the Montseny mountains (NE Spain) for the last 3decades. A canopy budget model was applied to throughfall data measured during a period of high emissions (1995-1996) and a period of lower emissions (2011-2013) to estimate the changes in dry deposition over this time span. Emissions of SO2 in Spain strongly decreased (77%) and that was reflected in reductions for nssSO4(2-) in precipitation (65% for concentrations and 62% for SO4(2)-S deposition). A lower decline was found for dry deposition (29%). Spanish NO2 emissions increased from 1980 to 1991, remained constant until 2005, and decreased thereafter, a pattern that was paralleled by NO3(-) concentrations in bulk precipitation at Montseny. This pattern seems to be related to a higher share of renewable energies in electricity generation in Spain in recent years. However, dry deposition increased markedly between 1995 and 2012, from 1.3 to 6.7 kg ha(-1) year(-)(1). Differences in meteorology between periods may have had a role, since the recent period was drier thus probably favoring dry deposition. Spanish NH3 emissions increased by 13% between 1980 and 2012 in Spain but NH4(+) concentrations in precipitation and NH4(+)-N deposition showed a decreasing trend (15% reduction) at Montseny, probably linked to the reduction ammonium sulfate and nitrate aerosols to be scavenged by rainfall. NH4(+)-N dry deposition was similar between the compared periods. The N load at Montseny (15-17 kg ha(-1)y ear(-1)) was within the critical load range proposed for Mediterranean sclerophyllous forests (15-17.5 kg ha(-1) year(-1)). The onset of N saturation is suggested by the observed increasing N export in streamwaters.

Urinary neutrophil gelatinase-associated lipocalin after kidney transplantation: is it a good biomarker to assess delayed graft function?

Delayed graft function (DGF) is a common complication after transplantation. Its incidence is increased among patients receiving a graft from an expanded-criteria donor. Urinary neutrophil gelatinase-associated lipocalin (uNGAL), an acute kidney injury marker, could in the first days after transplantation be an early marker of DGF. We collected urine samples from 38 renal transplant recipients on days 1, 3, 6, and 10 post-transplantation, and months 1 and 6 creatinine to determine uNGAL, serum creatinine, Cystatin C, and albumin/creatinine ratio. We divided the patients into 2 groups, based on whether they developed DGF. We observed that mean uNGAL concentrations, Cystatin C, serum creatinine, and albumin/creatinine ratio were significantly lower in the non-DGF cohort on all measured days. uNGAL at day 3 showed a positive correlation with serum creatinine at day 10 (R = 0.58; P < .00) and day 30 (R = 0.57; P = .016) as well as with the length of hospital stay (r = 0.47; P < .00). Receiver operating characteristic analyses performed to assess the potential of uNGAL to predict DGF showed an area under the curve for day 3 of uNGAL of 0.917 (confidence interval [CI], 0.79-1.00; P = .00), with an optimal cutoff level of 124 ng/mL, sensitivity of 80% (CI, 62%-97%), and specificity of 83% (62%-104%; P = .001). In the first days after transplantation, uNGAL could be an early marker of DGF, providing additional information to standard biomarkers and potentially helping clinicians to take early measures to mitigate DGF.

ADAM17 is a survival factor for microglial cells in vitro and in vivo after spinal cord injury in mice

A disintegrin and metalloprotease 17 (ADAM17) is a sheddase with important substrates including tumor necrosis factor-α (TNF-α) and its receptors, the p75 neurotrophin receptor (p75NTR), and members of the epidermal growth factor family. The rationale of this study was to inhibit ADAM17-induced shedding of soluble TNF-α in order to reduce detrimental inflammation after spinal cord injury (SCI). However, using the specific ADAM17 blocker BMS-561392 in neuronal and glial cell cultures, we show that proper functioning of ADAM17 is vital for oligodendrocyte and microglia survival in a p44 MAPK-dependent manner. In contrast, genetic ablation of ADAM17 specifically increases microglial death. Surprisingly, although blocking ADAM17 in vivo does not substantially change the ratio between membrane-bound and soluble TNF-α, it increases expression of the pro-apoptotic marker Bax and microglial apoptosis while impairing functional recovery after SCI. These data suggest that ADAM17 is a key survival factor for microglial cells after SCI.

Double momentum spectrometer for ion-electron vector correlations in dissociative photoionization

We have developed a new momentum spectrometer dedicated to momentum vector correlations in the context of deep core photoionization of atomic and molecular species in the gas phase. In this article, we describe the design and operation of the experimental setup. The capabilities of the apparatus are illustrated with a set of measurements done on the sulphur core 1s photoionization of gas-phase CS2.

Cortisol hyporesponsiveness to the low dose ACTH test is a frequent finding in a pediatric population with type 1 diabetes mellitus

INTRODUCTION

In adults with type 1 diabetes mellitus (DM1), a 25% of risk of hypocortisolism has been found through a low dose ACTH test with negative antibodies suggesting other causes of hypothalamic-pituitary-adrenal axis dysfunction.

AIM

To evaluate adrenal function in pediatric patients with DM1 and correlate the results with the frequency of hypoglycemia and metabolic control.

METHODS

Sixty-nine patients were enrolled, age 12.3 (5.7-18.1); 50 boys and 19 girls. A 20% had additional autoimmune diseases. Mean hemoglobin A1c (HbA1c) was 8.1% and insulin dose was 1.14 U/kg/d. After an overnight fast, a low dose ACTH test (1 µg) was performed. Basal and stimulated cortisol concentrations, DHEAS, and plasma renin activity (PRA) were measured. A cortisol response post-ACTH below 18 µg/dL was considered abnormal.

RESULTS

58% of the tested patients had an abnormal response to ACTH test. These patients also had lower DHEAS concentrations, but were not different in diabetes duration, HbA1C, severe hypoglycemia, ACTH, or PRA concentrations compared to those who had a normal cortisol post-ACTH. One patient out of 59, had a positive anti-21-hydroxylase antibody (21OHA) and presented a poor response to ACTH.

CONCLUSIONS

We found a significant proportion of our patients having a subnormal cortisol response independent of the presence of anti-adrenal cell antibodies. We did not find a correlation with metabolic control, probably due to the good metabolic control of this group. The absence of 21OHA does not rule out subclinical hypocortisolism in this population. Our results suggest testing adrenal function in children with DM1.

Changes in atmospheric deposition and streamwater chemistry over 25 years in undisturbed catchments in a Mediterranean mountain environment

Surface water chemistry has changed in response to reduced atmospheric deposition of sulphur and acidity in many regions of Europe and North America. Most of these studies come from acidic or low-alkalinity surface waters under high acidic deposition. Mediterranean climates offer a different biogeochemical context, characterised by streamwaters of higher alkalinity and low acid inputs. In this paper, we use surveys of streamwater chemistry conducted in 1981-1984 and again in 2007 in the Montseny natural park (NE Spain) to test whether streamwaters of these well-buffered catchments respond to changes in atmospheric deposition, which has declined for S during the last decades in NE Spain while remaining about stable for nitrogen. The 23 sampled streams drained heathland, beech forests and evergreen oak forests in relatively undisturbed small catchments underlain by silicate bedrock. Bulk deposition of sulphate at Montseny decreased by 54% while nitrate bulk deposition increased (non-significantly) by 30% in this period. Total N deposition is estimated in the range 15-30 kg N ha(-1) y(-1) for NE Spain. This is well above threshold values (e.g. 10 kg N ha(-1) y(-1)) reported as starting nitrogen saturation symptoms in forest ecosystems in Europe. Baseflow sulphate concentrations decreased on average by 47 μeq L(-1) or 29% of early 1980s concentrations. Baseflow mean nitrate concentrations increased significantly but only from 5.5 to 8.9 μeq L(-1). Thus, despite decades of high N deposition, these ecosystems appear to be still far from N saturation. Baseflow alkalinity and base cation concentrations increased substantially, probably a combined result of decreased S deposition, enhanced silicate weathering under current higher temperatures, reduced plant cation uptake as vegetation matures, and slightly drier conditions in the survey of 2007. Overall, these well-buffered catchments have shown sizable changes in baseflow chemistry in response to changed atmospheric deposition and other environmental changes.

Nitrogen-doped anatase nanofibers decorated with noble metal nanoparticles for photocatalytic production of hydrogen

We report the synthesis of N-doped TiO(2) nanofibers and high photocatalytic efficiency in generating hydrogen from ethanol-water mixtures under UV-A and UV-B irradiation. Titanate nanofibers synthesized by hydrothermal method are annealed in air and/or ammonia to achieve N-doped anatase fibers. Depending on the synthesis route, either interstitial N atoms or new N-Ti bonds appear in the lattice, resulting in slight lattice expansion as shown by XPS and HR-TEM analysis, respectively. These nanofibers were then used as support for Pd and Pt nanoparticles deposited with wet impregnation followed by calcination and reduction. In the hydrogen generation tests, the N-doped samples were clearly outperforming their undoped counterparts, showing remarkable efficiency not only under UV-B but also with UV-A illumination. When 100 mg of catalyst (N-doped TiO(2) nanofiber decorated with Pt nanoparticles) was applied to 1 L of water-ethanol mixture, the H(2) evolution rates were as high as 700 μmol/h (UV-A) and 2250 μmol/h (UV-B) corresponding to photo energy conversion percentages of ∼3.6 and ∼12.3%, respectively.

Ambulatory blood pressure monitoring in renal transplant patients: should it be routinely performed?

INTRODUCTION

Arterial hypertension is common among kidney transplant patients. It increases cardiovascular risk and is a factor for progression of renal failure. Our objective was to perform ambulatory blood pressure monitoring (ABPM) in renal transplant patients with office hypertension.

METHODS

Patients were divided into 2 groups according to their mean ABPM blood pressures with treatment: well-controlled hypertension (blood pressure [BP] <130/85 mmHg), and poorly controlled hypertension (BP>130/85 mmHg). A "nondipper pattern" was defined as a decrease of <10% or an increase, and a "raiser pattern," in which mean blood pressure was greater during the nocturnal than the diurnal period. "White coat effect" was considered when the mean of 3 BP measurements in the clinic was >140/90 mmHg among well-controlled hypertensive patients as documented by ABPM.

RESULTS

ABPM was performed in 53 patients: 25 (47%) "well-controlled hypertensives" and 28 (53%) "poorly controlled hypertensives." Of the latter, 24 (85%) showed a nondipper or raiser pattern with only 4 revealing dipper patterns. We compared well-controlled with poorly controlled hypertensives. The latter cohort were older (54.4±9.3 vs 45.5±13.8 years; P=.009), received grafts from older donors (56.7±15.0 vs 45.8±17 years; P=.02); had worse renal function measured by serum creatinine (1.7±0.5 vs 1.4±0.4 mg/dL, P=.03) or the Modification of Diet in Renal Disease (MDRD)=4 formula (41.8±14.0 vs 55.4±20.5 mL/min/1.73 m2; P=.009), and displayed more proteinuria (0.30±0.33 vs 0.18±0.10 g/d, P=.08). Nondipper or raiser patients showed a higher mean body mass index (27.1 vs 21.7 kg/m2; P=.04). Among 25 well-controlled patients, 11 presented "white coat phenomenon."

CONCLUSION

We observed an important "white coat" effect, a large prevalence of uncontrolled nocturnal hypertension, and a small but important incident of "masked hypertension." Factors related to hypertension control were patient age, donor age, renal function, induction use, and proteinuria.

Source areas and long-range transport of pollen from continental land to Tenerife (Canary Islands)

The Canary Islands, due to their geographical position, constitute an adequate site for the study of long-range pollen transport from the surrounding land masses. In this study, we analyzed airborne pollen counts at two sites: Santa Cruz de Tenerife (SCO), at sea level corresponding to the marine boundary layer (MBL), and Izaña at 2,367 m.a.s.l. corresponding to the free troposphere (FT), for the years 2006 and 2007. We used three approaches to describe pollen transport: (1) a classification of provenances with an ANOVA test to describe pollen count differences between sectors; (2) a study of special events of high pollen concentrations, taking into consideration the corresponding meteorological synoptic pattern responsible for transport and back trajectories; and (3) a source-receptor model applied to a selection of the pollen taxa to show pollen source areas. Our results indicate several extra-regional pollen transport episodes to Tenerife. The main provenances were: (1) the Mediterranean region, especially the southern Iberian Peninsula and Morocco, through the trade winds in the MBL. These episodes were characterized by the presence of pollen from trees (Casuarina, Olea, Quercus perennial and deciduous types) mixed with pollen from herbs (Artemisia, Chenopodiaceae/Amaranthaceae and Poaceae wild type). (2) The Saharan sector, through transport at the MBL level carrying pollen principally from herbs (Chenopodiaceae-Amaranthaceae, Cyperaceae and Poaceae wild type) and, in one case, Casuarina pollen, uplifted to the free troposphere. And (3) the Sahel, characterized by low pollen concentrations of Arecaceae, Chenopodiaceae-Amaranthaceae, Cyperaceae and Poaceae wild type in sporadic episodes. This research shows that sporadic events of long-range pollen transport need to be taken into consideration in Tenerife as possible responsible agents in respiratory allergy episodes. In particular, it is estimated that 89-97% of annual counts of the highly allergenous Olea originates from extra-regional sources in southern Iberia and northern Africa.

Leuprolide acetate gonadotrophin response patterns during female puberty

OBJECTIVE

To assess normative data and the usefulness of spontaneous and LHRH analogue-stimulated serum LH and FSH levels measured by immunoradiometric assays (IRMA) in the evaluation of normal puberty.

DESIGN

Prospective. Healthy girls in Tanner I and Tanner II from the local community were invited to participate (n = 47).

METHODS

A leuprolide acetate test (500 mcg/m(2); sc) was performed. LH and FSH levels were determined using IRMA. Tanner II girls were assessed every 6 months until Tanner V. Girls who progressed from Tanner II to Tanner III in the next 6 months were called Tanner II-2; otherwise, they were called Tanner II-1.

RESULTS

The prepubertal upper limit (CI 95%) was 0.49 IU/l for basal LH and 5.1 IU/l for stimulated LH. Taking into account these LH cut-off limits, 72.2% and 66.7% of Tanner II-1 and 41.6% and 41.7% of Tanner II-2 subjects presented overlapping values for basal and stimulated LH, respectively, as compared with the Tanner I group. The cut-offs for basal and stimulated LH to predict progression from Tanner II to Tanner III in the next 6 months were a basal LH level > or =0.49 IU/l (Sensitivity = 0.58; 1-Specificity = 0.33) and a poststimulated LH level > or =4.75 IU/l (Sensitivity = 0.67; 1-Specificity = 0.44).

CONCLUSION

According to an IRMA, the basal and leuprolide acetate gonadotrophin response patterns during the beginning stages of puberty overlapped between Tanner I and Tanner II, and the cut-offs of basal and stimulated LH levels to predict progress from Tanner II to Tanner III had low sensitivities for the following 6 months.

Renal allografts from donors older than 70 years are useful for single transplantation

Kidney transplantation has been related in elderly recipients to a greater longevity compared with dialysis. Due to the scarcity of donors, transplantation of older patients depends on the acceptance of older donors. We compared the characteristics and evolution of transplants from donors >or=70 years (n = 53) with those from donors >55-<70 years (n = 201). Group D >or=70 included older recipients (65.37 +/- 4.9 vs 55.92 +/- 9.66 years; P = .000) and more women (62.3% vs 45.3%; P = .02), with more peripheral arterial disease (10.9% vs 2.4%; P = .011). No differences in donor characteristics were observed. Induction treatment with thymoglobulin or basiliximab was more common in D >or=70 (81.1% vs 57.3%; P = .006), with no differences in other immunosuppressive drugs. The incidence of delayed graft function (DGF) was similar (P = .82), with a trend to a lower incidence of acute rejection episodes among D>or=70 (11.8% vs 22.5%; P = 0.09). Serum creatinine and proteinuria levels did not differ during follow-up (P > .05). Patients in D >or=70 displayed more episodes of urinary sepsis (19.1% vs 6.4%; P = .008), but no differences were observed in cytomegalovirus (CMV) infection (P = .629), neoplasia (P = .118), ischemic cardiopathy (P = .642), or hospital readmission due to infections (P = .567). Graft survivals at 5 years were 70% and 75% (P = .279) among groups D >or=70 and D>55-<70, respectively, and patient survivals at 5 years were 88% and 88% (P = .63), respectively. In conclusion, our study showed that selected kidneys from donors older than 70 years were followed with excellent graft and patient survivals, permitting older patients on renal replacement therapy to benefit from renal transplantation.

Long-range transport of beech (Fagus sylvatica L.) pollen to Catalonia (north-eastern Spain)

Local and long-range transport of beech (Fagus sylvatica) pollen was analysed by using 23-year data (1983-2007) at six stations in Catalonia, Spain, and numerical simulations. Back trajectories and synoptic meteorology indicated a consistent north European provenance during beech pollen peak days. Specifically, the area from northern Italy to central Germany was the most probable source, as indicated by a source-receptor model based on back trajectories. For the event with the highest pollen levels (17 May 2004), back trajectories indicated a source in the Vosges (NE France) and the Schwarzwald (SW Germany) regions. By applying a mesoscale model (MM5) to this event, pollen transport could be further refined, allowing its entrance to Catalonia through the lower easternmost pass of the Pyrenees (the Alberes pass, 500 m a.s.l.) to be described. Hourly counts of Fagus pollen allowed the timing of pollen arrival during this episode to be matched with the model results regarding the above-mentioned passage. This study may help to interpret some results of modern beech genetic diversity and contribute to the understanding of paleopalynological records by taking long-range transport into consideration.

Risk factors and prognosis for proteinuria in renal transplant recipients

INTRODUCTION

Proteinuria in renal transplant recipients has been recognized as a risk factor of progression of chronic allograft nephropathy and for cardiovascular disease, the main causes of transplant failure.

PATIENTS AND METHODS

We analyzed the risk factors for persistent proteinuria (>0.5 g/day) among 337 kidney allograft recipients with a minimum follow-up of 6 months, among a series of 375 transplants performed during a decade, as well as their association with allograft and patient survivals. Patients with proteinuria greater than 0.5 g/d were treated with angiotensin-converting enzyme inhibitors (ACEI) and/or angiotensin-receptor blockers.

RESULTS

After a mean follow-up of 53.35 +/- 52.63 months, 68 patients (20.17%) had persistent proteinuria greater than 0.5 g/d. Female patients (P = .012), body mass index (BMI) >25 (P = .008), pretransplant HLA sensitization (P = .039), and delayed graft function (DGF; P = .001) were associated with proteinuria. Induction treatment with antithymocyte globulin (P = .030) and treatment with tacrolimus instead of cyclosporine (P = .046) were associated with an increased risk of proteinuria. Multivariate analysis confirmed the independent value of DGF (RR = 2.23; 95% confidence interval [CI] 1.22 to 4.07; P = .009) and BMI >25 (RR = 1.968; 95% CI 1.05 to 3.68; P = .035) to predict postransplant proteinuria. The mean values of serum creatinine (P = .000) and systolic blood pressure (P < .05) were persistently higher from the early stages after transplantation in the proteinuric group. Graft survival at 5 years was 69% among patients who developed proteinuria and 93% in those without proteinuria (P = .000), with no differences in patient survival (P = .062).

CONCLUSION

Proteinuria in renal transplant recipients was related to immunological and nonimmunological factors, some of which, such as hypertension and obesity could be modifiable. Proteinuria in renal transplant recipients predicted a worse allograft survival despite of intensive treatment of hypertension including ACEI/angiotensin-receptor blockers.

Migration of the painted lady butterfly, Vanessa cardui, to north-eastern Spain is aided by African wind currents

1. Thousands of records of migratory butterfly species such as Vanessa cardui flying just above ground-level on fixed compass bearings have led to the common belief that these insects migrate within the so-called 'flight-boundary layer', where movements are relatively independent of the wind. 2. Given the selective advantages of windborne migration and the existence of a number of observations of flights of V. cardui from the upper levels of the atmosphere, we tested the hypothesis that migration from North Africa to southern Europe in this species is influenced by synoptic-scale wind currents. 3. Even with modern technology, it is extremely difficult to observe high-altitude flights directly, so we rely on an indirect approach that examines whether or not arrival peaks in north-eastern Spain are associated with winds blowing from Africa. 4. Arrivals of V. cardui were determined for the spring period (1 March-27 June, 1997-2006) at 79 sites in the Catalan Butterfly Monitoring Scheme. Wind patterns were described on the basis of synoptic-scale maps, transport models and back-trajectories calculated for each day of the spring period. 5. We found a strong association between migration and winds from North Africa, both for the whole data set (1997-2006; chi(2) = 4.7, P = 0.03) and for a restricted data set that excludes years in which the species was very scarce (chi(2) = 7.26, P = 0.007). 6. Episodes of massive northward migration within the species' flight-boundary layer also coincided with spells of winds from North Africa, suggesting a connection between low-altitude (observational) and high-altitude flights (inferred from wind patterns). 7. Finally, on the assumption that migration in V. cardui is windborne, a source-receptor transport model applied to spring abundance data in north-eastern Spain enables us to identify the most probable population source areas in North Africa.

Comparison of leptin levels, body composition and insulin sensitivity and secretion by OGTT in healthy, early pubertal girls born at either appropriate- or small-for-gestational age

BACKGROUND

Small for gestational age (SGA) has been associated with decreased insulin sensitivity (IS). A possible mechanism is the postnatal development of a metabolically disadvantageous body composition (BC).

AIM

To determine whether there are differences between IS and BC in girls in early puberty who were SGA (birth weight < 10th percentile) or appropriate for gestational age (AGA, 10th-90th percentile).

METHODS

Age-matched (SGA/AGA) early pubertal girls (Tanner II) were recruited from local schools. We determined waist circumference (WC), the sum of four skinfolds (S4S), and per cent fat mass (fat %) by impedanciometry. Leptin and OGTT assays were performed. The insulinogenic index (I-In), HOMA-IR (homeostasis model assessment of insulin resistance) and WBISI (whole body insulin sensitivity) were calculated.

RESULTS

Median age (interquartile range) for 30 SGA and 35 AGA girls was 10.2 (1.1) vs. 9.8 (0.9), respectively (P = NS). BMI percentiles were 62.6 (56) vs. 67.4 (39); WC 60.5 (9.5) vs. 62.2 (6.5) cm; S4S 52 (30) vs. 52.2 (29.5) cm, and fat %[26.2 (6.7) vs. 28.5 (6.3)] was similar in both groups. SGA girls had higher leptin levels [15.4 (9.7) vs. 9.6 (11) ng/ml; P = 0.01] and I-In [2.05 (1.86) vs. 1.47 (1.27) microU/ml* mg/dl; P = 0.02]. No differences between HOMA-IR [2.07 (1.26) vs. 2.04 (1.4)] and WBISI [5.3 (3.3) vs. 5.1 (3.1)] were found between groups.

CONCLUSION

The higher leptin level and I-In in girls born SGA at the beginning of puberty may be early indicators of an underlying subtle degree of insulin resistance, despite similar BMI and BC to AGA girls.

[Primary pyomyositis caused by Streptococcus intermedius]

Pyomyositis is a sub-acute bacterial infection that affects the striated muscle and is usually accompanied by the formation of an abscess in this muscle. It was initially described as an endemic disease in the tropics and only in recent years has an increase been observed in the number of cases in countries with a temperate climate in relation to an increase of immuno-depressed patients. The causal germ is Staphylococcus aureus in more than 75% of cases. The most useful imaging test is magnetic resonance. Treatment consists of complete surgical draining of the abscess combined with a suitable antibiotic therapy. We present a case of primary pyomyositis of the quadriceps in a diabetic patient with a remote traumatic antecedent of the affected zone and caused by an unusual germ. A complete recovery was obtained, without sequels, following surgical draining and 4 weeks of endovenous antibiotic treatment.

Effect of Overweight on Kidney Transplantation Outcome

INTRODUCTION

Obesity is a prevalent problem in renal transplant recipients that is followed by reduced graft and patient survivals. Because the prevalence of overweight (OW) is increasing in the renal transplant population, we studied the influence of OW on graft and recipient evolution.

PATIENTS AND METHODS

We analyzed a series of 337 patients with renal allografts having a mean follow-up of 53.4 +/- 30.6 months. We excluded 39 patients obese at transplantation. We compared the evolution of 134 OW patients (45.5%), and 160 patients (54.4%) with a body mass index <25 (NW group).

RESULTS

OW patients were older (P = .000) with a higher prevalence of hypertension (P = .028), left ventricular hypertrophy (P = .014), and dyslipidemia (P = .001). They had received kidneys from older donors (P = .019). OW patients showed a higher incidence of acute tubular necrosis (ATN) (P = .006), without a higher incidence of acute rejection episodes (P = .756). Postransplant diabetes mellitus was more frequent (P = .000), and systolic blood pressure (P < .05), total cholesterol (P < .05), and tryglicerides were higher (P < .05) in the OW group. Serum creatinine at 6 months (P = .007) and proteinuria >0.5 g/24 hours, (P = .023) were higher among the OW group. Graft survival was not different between groups, but patient survival was lower in the OW group (P = .002). A logistic regression analysis showed that the recipient age (RR: 5.243) and the presence of OW (RR: 1.100) were independent prognostic factors for patient death.

CONCLUSIONS

OW was a common situation among renal transplant candidates. It was associated with worse cardiovascular and metabolic profiles. OW patients showed worse allograft function and lower patient survival. A major effort must be exerted to avoid excessive weight gain, particularly among those OW at transplantation.

[A new Spanish family with CADASIL associated with 346C>T mutation of NOTCH3 gene]

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an adult-onset inherited condition characterized by migraine, recurrent strokes, and subcortical dementia. Other manifestations as psychiatric disturbances, seizures, hypoacusia or learning disorders have been reported. CADASIL may be suspected based on clinical syndrome, a positive family history, and a typical cranial magnetic resonance image with T2/FLAIR hyperintense signals in the temporopolar white matter or the external capsule. Bilateral white matter abnormalities are invariably seen and often small subcortical infarcts are also present. Accumulation of the granular osmiophilic material on skin biopsy may help in diagnosis. Mutations in the NOTCH3 gene localized in chromosome 19 are involved in its pathogenesis. Only 11 families from Spain have been reported. Here we describe two members of a family with clinical symptoms and neuroimaging of CADASIL. The skin biopsy was negative. In both patients 346C>T mutation in exon 3 of NOTCH3 gene was found. There is the first Spanish family reported with CADASIL, caused by the 346C > T mutation in NOTCH3 gene which was frequently described in the European series.

Benefits Derivated From Late Steroid Withdrawal in Renal Transplant Recipients

Because corticosteroids have adverse metabolic effects, inducing bone-mineral imbalance and contributing to infections among renal transplant recipients, many withdrawal trials have been attempted to reduce adverse events and improve quality of life. We retrospectively analyzed the safety and efficacy of late steroid withdrawal, after the first posttransplant year, among a selected group of kidney allograft recipients. In 42 low immunological risk allograft recipients, among 382 patients transplanted during a decade, corticosteroids were progressively reduced and completely withdrawn. The evolution of clinical and biochemical parameters after the withdrawal were analyzed. Corticosteroid withdrawal was performed as a mean of 52.16 +/- 28.41 months posttransplant, with subsequent follow-up without steroid treatment of 18.13 +/- 16.11 months. Comparing the most recent evaluation with the data previous to steroid withdrawal, patients showed a significant decreases in diastolic pressure (P = .039), total cholesterol (P = .000), and low-density lipoprotein cholesterol levels (P = .039), but not in triglyceride levels (P = .33). Body weight did not change (P = .77), but increased fasting glucose levels were noted (P = .03), in absence of new diagnosed diabetes mellitus. A significant reduction in cyclosporine Neoral (P = .01) or tacrolimus doses were detected (P = .01). At the last visit, serum creatinine in the whole group remained stable (P = .06). Only five patients showed an increase in serum creatinine more than 20% (from 1.44 +/- 0.41 to 1.94 +/- 0.45 mg/dL P = .04) and proteinuria did not increase (P = .94). No patient was diagnosed with a rejection episodes or required corticosteroid resumption. Graft and patient survivals were 100% at the end of follow-up. In conclusion, our data showed that late corticosteroid withdrawal in renal transplant recipients of low immunological risk is safe and is followed by an improvement in their metabolic profile and in blood pressure.

Diffuse cutaneous leishmaniasis responds to miltefosine but then relapses

BACKGROUND

Diffuse cutaneous leishmaniasis (DCL), although rare, is profoundly incapacitating. At present there is no successful treatment for this progressive protozoan infection, which is associated with the absence of specific cell-mediated immunity (CMI) to Leishmania. This disease shares features with visceral leishmaniasis (VL), including specific CMI inactivity during active disease and a heavy parasitic burden, but VL responds well to treatment. Miltefosine is the first orally administered drug which has shown efficacy in the treatment of VL; it has not been adequately evaluated in the treatment of DCL.

OBJECTIVES

To evaluate the efficacy of miltefosine in the treatment of DCL, using clinical, parasitological, histopathological and immunological criteria.

METHODS

Sixteen patients with DCL were treated with miltefosine, 2.0-2.5 mg kg(-1) daily, for variable periods of time (75-218 days). Patients were hospitalized for the first month and evaluated every 2 weeks until the termination of treatment with routine laboratory chemistry, percentage clinical improvement, presence of parasites in skin smears, growth of parasites in culture medium and in hamsters, histopathological characteristics of the granulomas, adverse side-effects, and reactivity to leishmanin skin test antigen. Further cycles of treatment were given in some of these patients, particularly after suspension of treatment was followed by relapse.

RESULTS

Patients showed dramatic clinical improvement and reduction in the parasite burden by day 15 after the initiation of treatment, which continued while treatment was maintained. By day 45, 15 patients showed 80-90% clinical improvement. Nevertheless, suspension of treatment was followed by the development of new lesions in all but one patient. Inoculation in hamsters was observed to be the most sensitive technique to detect persisting parasites. Adverse events were very mild.

CONCLUSIONS

Miltefosine produced a dramatic clinical and parasitological response in patients with DCL and improvement continued during drug administration, but with a single exception all patients presented new lesions after suspension of treatment. There was no histological or skin test evidence to suggest the development of CMI during treatment, which may be an indispensable criterion for the evaluation of potentially effective drugs against DCL.

[Seasonal perodicity in vascular access thrombosis for haemodialysis]

Different studies have shown that some clinical events, particularly cardiovascular and thrombotic events, show a regularity in its appearance. The aim of our study was to analyse the possible existence of seasonal periodicity in the incidence of the vascular access thrombosis in patients on chronic haemodialysis. Prospectively, we collected information of 164 patients with 250 episodes of vascular access thrombosis referred to our hospital from january 1995 to december 1999. An ANOVA test for comparison of the means, and a time series analysis were performed. During the five year study the consecutive number of thrombosis were 43, 57, 55, 59 and 36. When the different seasons were analysed, the cumulative number of events in summer during the study period were 91, a significant increase compared to spring, autumn, and winter (54, 54, and 51, respectively; p<0.001). Time series analysis confirmed that thrombolic events during summer showed an increased incidence over the mean (p<0.001), and it occurred every year. The same results were obtained when the PTFE grafts were analyzed separetely (july RR 2.62, p=0.002; august, RR 2.37, p=0.04), but not with the arteriovenous fistulae. In conclusion, this study showed a seasonal periodicity of vascular access thrombosis, with a PTFE graft. Although the causes were unknown, these data alert us on the convenience of an increased attention to the vascular access during the summer months in order to prevent its thrombosis.

Erythropoietin treatment in the sixth posttransplant month as a prognostic factor for renal allograft survival

The purpose of this work was to assess the prognostic value of the need for erythropoietin (EPO) treatment at 6 months after transplantation. We retrospectively reviewed the outcomes of 143 consecutive cadaveric kidney transplants performed between January 2000 and April 2004, functioning at 6 months postransplantation. Patients were divided into two groups: group EPO6m (n = 24) received EPO treatment in the sixth month, and a control group (n = 119) did not receive EPO. Renal function deterioration (RFD) was considered to be a sustained decrease in creatinine clearance (CrCl) greater than 20% between the sixth month postransplant and the last visit. Mean follow-up was 38 +/- 16 months. The mean ages of the donor (57 +/- 9 vs 49 +/- 12 years; P = .001) and the recipient (59 +/- 12 vs 47 +/- 17 years; P = .000) were greater in the EPO6m group. Delayed graft function (83% vs 48%; P = .001) was more frequent in the EPO6m group. At 6 months after transplantation the EPO6m group showed lower hemoglobin (11.52 +/- 1.71 vs 13.32 +/- 1.69 g/dL; P = .000), higher serum creatinine (2.31 +/- 0.72 vs 1.65 +/- 0.53 mg/dL; P = .000), lower CrCl (33.53 +/- 10.83 vs 53.6 +/- 17.58 mL/min; P = .000), and similar proteinuria. RFD was more common in the EPO6m group (38% vs 10%; P = .026), with a different pattern of evolution of CrCl (-0.098 +/- 0.176 vs +0.093 +/- 0.396 mL/min/mo, P = .000). Multivariate analysis demonstrated that treatment with EPO at 6 months was the only predictor of RFD (RR 4.46; 1.58 to 12.58; P = .005). The need for EPO at 6 months postransplant was a good predictor of later renal allograft deterioration, more sensitive than serum creatinine or proteinuria.

Transplant Renal Artery Stenosis: Association With Acute Vascular Rejection

BACKGROUND

Transplant renal artery stenosis, the prevalence of which varies from 2% to 12%, is an important cause of hypertension and allograft dysfunction. We sought to determine the clinical characteristics of this disorder, assessing, predisposing factors, establishing treatment options, and examining patient outcomes.

PATIENTS AND METHODS

Among 321 renal allograft recipients between November 1996 and December 2004, six patients were identified with this finding. We analyzed their clinical data before and after treatment compared with the 315 recipients face of the disorder.

RESULTS

The six patients with the disorder were diagnosed within the first year (2 to 8 months; median 5.5 months). All patients displayed renal dysfunction, peripheral edema, and new-onset or uncontrolled hypertension at presentation. Abnormal Doppler findings were observed in 5 (83.3%) patients. The hemodynamically significant stenosis was successfully treated with percutaneous transluminal angioplasty (PTA) in all six. However, 3 (50%) patients displayed recurrent stenosis requiring a second PTA. The mean serum creatinine level decreased from a pre-PTA value of 4.4 +/- 1.8 mg/dL to a 1-month post-PTA value of 2.2 +/- 0.5 mg/dL (P = .027). Patients had no significant improvement in mean systolic and diastolic pressure. Vascular acute rejection episodes were more frequent among the affected than the control group (3/6; 50% vs 18/315; 5.7%; P < .001). No differences were found in age, sex, donor type, etiology of renal disease, immunosuppression, acute tubular necrosis, acute cellular rejection, cold ischemia time, or HLA matching.

CONCLUSION

Transplant renal artery stenosis is a common cause of hypertension and renal allograft dysfunction. Acute vascular rejection is associated with this disorder.

Comparison of clinical, ultrasonographic, and biochemical differences at the beginning of puberty in healthy girls born either small for gestational age or appropriate for gestational age: preliminary results

CONTEXT

There are limited and controversial data concerning puberty characteristics in girls born small for gestational age (SGA).

OBJECTIVE

The objective of the study was to document clinical, ultrasonographic, and biochemical characteristics at the beginning of puberty in matched healthy girls born either SGA or appropriate for gestational age (AGA) recruited from the community.

PATIENTS

Inclusion criteria were breast Tanner stage II and a body mass index between the 10th and 95th percentiles.

INTERVENTIONS

Recruited subjects underwent a complete physical exam, bone age, and ultrasound measurements of the internal genitalia. Hormonal assessment included fasting early morning dehydroepiandrosterone sulfate, androstenedione, SHBG, inhibin-B, FSH, LH, estradiol (E2), 17-hydroxyprogesterone (17OH Prog), and testosterone. Thereafter, a GnRH agonist test (leuprolide 500 microg, sc) was performed with FSH and LH at time 3 and 24 h for E2, 17OH Prog, and testosterone.

RESULTS

Sixty-five girls (35 AGA, 30 SGA) with a mean age of 9.9 +/- 1.03 (7.8-12.5) yr, similar bone age/chronological age (1.02 +/- 0.8 in AGA and 1 +/- 0.76 in SGA), median height of 1.35 +/- 0.06 cm, and similar waist to hip ratio were included. No differences in the presence of pubic hair, axillary hair, apocrine odor, or ultrasound measurements were found. SGA girls had increased baseline E2 as well as stimulated E2 and 17OH Prog.

CONCLUSIONS

In a preliminary sample of lean, healthy girls recruited from the community born either SGA or AGA, we observed slight hormonal differences at the beginning of puberty. Longitudinal follow-up of this cohort will allow us to understand whether these differences are maintained and have a clinical impact in their pubertal development.