Individualized dose of anti-thymocyte globulin based on weight and pre-transplantation lymphocyte counts in pediatric patients: a single center experience

Anti-thymocyte globulin (ATG) has become a standard in preventing GVHD in related and unrelated donor transplantation, but there is no consensus on the best administration schedule. The PARACHUTE trial reported excellent CD4 immune reconstitution (CD4 IR) using a dosing schedule based on the patient's weight and pre-conditioning absolute lymphocyte count (ALC). In 2015 we introduced the PARACHUTE dosing schedule for pediatric patients at our center. One hundred one patients were transplanted for malignant and non-malignant diseases. In this non-concurrent cohort CD4 IR+, defined by a single CD4 count >50/µL on day 90, was seen in 81% of patients. The incidence of grade II-IV and III to IV aGvHD was 26.6% and 15.3% and 5% for cGvHD with no severe cases. We found no difference in aGvHD between donor type and stem cell sources. Five-year EFS and OS were 77.5% and 83.5%. Grade III-IV GFRS was 75.2%. CD4 IR+ patients had better EFS (93.1% vs. 77.7%, p = 0.04) and lower non-relapse mortality (2.7% vs. 22.2%, p = 0.002). The PARACHUTE ATG dosing schedule individualized by weight and ALC results in good early immune reconstitution, low incidence of cGvHD, and favorable survival for patients with different disease groups, donor types, and stem cell sources.

Sexually transmitted infections in Spain: Current status

Sexually Transmitted Infections (STI) are a major public health problem. The problems inherent to their diagnosis, treatment and prevention have to do not only with their nature, but also with organizational issues and overlapping competencies of the different health authorities in Spain. The real situation of STI in Spain, at present, is poorly known. For this reason, the Scientific Committee on COVID and Emerging Pathogens of the Illustrious Official College of Physicians of Madrid (ICOMEM) has formulated a series of questions on this subject which were distributed, not only among the members of the Committee, but also among experts outside it. The central health authorities provide very high and increasing figures for gonococcal infection, syphilis, Chlamydia trachomatis infection and lymphogranuloma venereum (LGV). Both HIV infection and Monkeypox are two important STI caused by viruses in our environment, to which it should be added, mainly, Herpes simplex virus (HSV) and Human papillomavirus (HPV) infections. Emerging microorganisms such as Mycoplasma genitalium pose not only pathogenic challenges but also therapeutic problems, as in the case of N. gonohrroeae. The pathways that patients with suspected STI follow until they are adequately diagnosed and treated are not well known in Spain. Experts understand that this problem is fundamentally managed in public health institutions, and that Primary Care and Hospital Emergency Services, together with some institutions that deal monographically with this problem, are the recipients of most of these patients. One of the most serious difficulties of STI lies in the availability of the microbiological tests necessary for their diagnosis, particularly in this era of outsourcing of microbiology services. Added to this is the increased cost of implementing the latest generation of molecular techniques and the difficulties of transporting samples. It is clear that STI are not diseases to which the entire population is equally exposed and it is necessary to have a better knowledge of the risk groups where to focus the necessary interventions adapted to their characteristics. It should not be forgotten that STI are also a problem in the pediatric age group and that their presence can be a marker of sexual abuse with all that this implies in terms of health care and medicolegal activity. Finally, STI are infections that are associated with a high cost of care for which we have very little information. The possibility of expanding the automatic performance of laboratory tests for STI surveillance through laboratory routines is encountering ethical and legal problems that are not always easy to solve. Spain has created a ministerial area of specific attention to STI and there are plans to improve the diagnosis, treatment and prevention of these problems, but we still lack the necessary evidence on their impact. We cannot forget that these are diseases that transcend the individual and constitute a Public Health problem.

[Assessment of techniques and errors in the use of metered dose inhalers in the adult patient]

BACKGROUND

Not all the techniques for the correct use of metered dose inhalers are used by patients and health care professionals.

AIM

To assess the techniques and errors in the use of metered dose inhalers among patients and health care professionals.

MATERIAL AND METHODS

Evaluation of the inhaling technique, using a validated questionnaire, used by 68 patients, 30 physicians and 30 nurses working in a hospital at Concepción, Chile.

RESULTS

The "closed mouth" technique is used by 84% of patients, 40% of physicians and 73% of nurses. The rest uses the "open mouth" technique. The aerochamber is used by 12% of patients, 37% of physicians and 27% of nurses. The most frequent inhaling errors detected were not shaking the inhaler (26% of patients, 30% of physicians and 7% of nurses), not applying the puff at the start of inspiration (28% of patients, 7% of physicians and 13% of nurses), and not maintaining an apnea after the inhalation (41% of patients, 7% of physicians and 10% of nurses). Sixty percent of patients, 67% of physicians and 40% of nurses have not received instructions about the inhaler use.

CONCLUSIONS

There is a high frequency of errors in the use of inhalers and most users have not been trained in its use.

[Smoking among academics, non-academics and students of the Universidad de Concepción]

BACKGROUND

Effective smoking cessation campaigns require as baseline, precise estimations of smoking habits in different populations.

AIM

To assess the prevalence of smoking in academic, non-academics workers and student of the University of Concepción.

MATERIAL AND METHODS

In a random and stratified sample of 272 workers (including academics) and 1146 students, a previously validated, self administered questionnaire about smoking was applied. Daily smoking was defined as smoking seven or more cigarettes per week and occasional smoking as smoking less than seven cigarettes per week.

RESULTS

The prevalence of smoking was 23% among academics, 34% among non-academic workers and 44% among students. Nineteen percent of men and 16% of women were occasional smokers; 23% of men and 25% of women were daily smokers. Students started smoking at 15 +/- 2 years old and workers did so at 18 +/- 3 years old. The greater influence about smoking came from parents. Workers from the administrative services and from the natural sciences faculty had the higher prevalence of the habit. The total annual cost of smoking was $33,000,000 (US$62,000).

CONCLUSIONS

The prevalence of smoking at the University of Concepción is higher among students than workers. Quitting programs are urgently needed.

[Better at home: a continuous health care program for patients with advanced chronic respiratory disease]

The objective of this study was to analyze the effect of continuous health care on the frequency of readmissions of patients with advanced chronic respiratory disease. The study was prospective, enrolling 26 patients (16 with COPD, 7 with bronchiectasis and 3 with pachypleuritis) who had been admitted at least 3 times within the past year. The patients were assigned to 3 groups: group A was the ambulatory monitoring group, with 8 patients who were able to travel to the hospital for monthly outpatient checkups; group B was the ambulatory pulmonary rehabilitation group, with 10 patients who were able to travel to the hospital and who needed rebreathing training (one weekly group session); and group C was the home care group, with 8 patients who were unable to travel to the hospital and who received weekly or biweekly house calls. All patients had telephone contact with the program team. Mean lung function values for the whole population were FVC 40 (11)%, FEV1 23 (7)% of reference, PaO2 55 (7) and PaCO2 55 (10) mmHg. A significant decrease in number of admissions (79 versus 18, p < 0.0001) was observed in both the first and second halves of the year in all three treatment groups: A, 25 to 2; B, 28 to 8; and C, 26 to 8 (p < 0.001). The reduction in health care costs over the previous year's expenditure was calculated to be 22,751,402 pesetas. We conclude that specialized health care that is continuous and personalized reduces the number of hospital readmissions of patients with advanced chronic respiratory disease. Moreover, the overall cost of care, without the need to make house calls to all patients.

Galectin-1 from ovine placenta--amino-acid sequence, physicochemical properties and implications in T-cell death

In the present study we report the amino-acid sequence, carbohydrate specificity and overall biochemical and physicochemical properties of galectin-1, a beta-galactoside-binding lectin from ovine placenta. The complete amino-acid sequence, obtained by tryptic and chymotryptic digestion, revealed that this carbohydrate-binding protein shares all the absolutely preserved and critical residues found in other members of the mammalian galectin-1 subfamily. Moreover, conformational changes induced by protein interaction with its specific disaccharide were investigated by fourth-derivative spectral analysis, intrinsic tryptophan fluorescence measurements and circular dichroism. The first two methods indicated changes in the environment of aromatic residues, in agreement with the role of Trp in carbohydrate binding. The quenching of the fluorescence emission upon addition of lactose, allowed us to calculate the Kd for its interaction with the galectin, which was 0.157 +/- 0.02 mM. The far-ultraviolet CD spectra is consistent with the large extent of beta-sheet structure described for other galectins. Addition of lactose produced no significant changes, suggesting that it causes no modifications in the secondary structure of the lectin. In addition, we explored its potential cell-growth inhibitory activity and implications in T-cell death. Finally, we also provide evidence showing that antagonic properties of galectins-1 and -3 are reciprocally neutralized in a natural mixture of both proteins, suggesting that they could play an important role in the regulation of cell proliferation and death, according to physiological requirements at particular developmental stages of the placenta, thus allowing successful pregnancy to occur.

Regulated expression of a 16-kd galectin-like protein in activated rat macrophages

We investigated the presence of a galectin-like protein in rat mononuclear cells using a polyclonal antibody raised against a soluble lactose-binding lectin purified from adult chicken liver that immunoreacted strongly with a broad protein band of about 16 kd in Western blot assays. Immunochemical studies revealed a constitutive expression of this protein in mononuclear cells mainly in the macrophage (M phi) population. Subcellular localization was assessed by Western blot assays of the cytosolic and membrane fractions of different cell populations studied: (1) spleen mononuclear cells, (2) T cell-enriched, (3) B cell- and M phi-enriched populations, and (4) peritoneal cells, processed in the presence of lactose. In broad agreement with immunocytochemical studies of nonpermeabilized and permeabilized cells, Western blot assays suggest that this protein is localized mainly in the cytoplasmic compartment but also associated with the cell surface. By flow cytometric analyses we detected about a 14% of ED1 double-positive cells corresponding to macrophages that constitutively express this galectin-like protein associated with their cell surface. The cytosolic fraction obtained from the M phi-enriched cell population showed hemagglutinating activity specifically inhibited by beta-galactoside-related sugars. Moreover, this galectin-like protein was retained in a lactosyl-Sepharose matrix and specifically eluted with lactose. In this work, evidence is also provided to show that different stimuli are able to modulate the expression of the galectin-like protein. Expression was upregulated in inflammatory and activated macrophages, revealing a significant increase in phorbol ester- and formylmethionine oligopeptide-treated cells. Both stimuli involving protein kinase C activation pathway have been able not only to up-regulate the total expression of this protein but also to modulate its subcellular localization.

A dominant negative mutant of 2-5A-dependent RNase suppresses antiproliferative and antiviral effects of interferon

2-5A-dependent RNase is the terminal factor in the interferon-regulated 2-5A system thought to function in both the molecular mechanism of interferon action and in the general control of RNA stability. However, direct evidence for specific functions of 2-5A-dependent RNase has been generally lacking. Therefore, we developed a strategy to block the 2-5A system using a truncated form of 2-5A-dependent RNase which retains 2-5A binding activity while lacking RNase activity. When the truncated RNase was stably expressed to high levels in murine cells, it prevented specific rRNA cleavage in response to 2-5A transfection and the cells were unresponsive to the antiviral activity of interferon alpha/beta for encephalomyocarditis virus. Remarkably, cells expressing the truncated RNase were also resistant to the antiproliferative activity of interferon. The truncated RNase is a dominant negative mutant that binds 2-5A and that may interfere with normal protein-protein interactions through nine ankyrin-like repeats.

Investigation of human erythrocyte ghost membranes with intramolecular excimer probes

Human erythrocyte ghost membranes have been investigated using two intramolecular excimer probes, di(1-pyrenyl)propane and di(1-pyrenylmethyl) ether. Values for the viscosity of the direct probe environment in the ghost membranes range from 76 cP at 37 degrees C to 570 cP at 5 degrees C, as reported for di(1-pyrenyl(propane, with liquid paraffin as the reference solvent. For the activation energy of the excimer formation process, determined here mainly by the viscosity of the medium, a value of 37 kJ/mol is obtained. The other probe molecule reports a higher local viscosity, 133 cP at 37 degrees C, as well as a higher activation energy of excimer formation, 54 kJ/mol. Neither thermotropic phase transitions nor temperature hysteresis effects are observed within the temperature range (0 to 40 degrees C) studied. From the vibrational structure of the fluorescence spectrum of di(1-pyrenylmethyl) ether, a polarity of the probe environment close to that of hexanol (epsilon - 13.3) results for the erythrocyte ghost membranes. The polarity measured in egg phosphatidylcholine membranes and in multibilayers of dimyristoylphosphatidylcholine is slightly larger, comparable to that of butanol (epsilon = 17.5), whereas a polarity comparable to that of methanol (epsilon = 32.7) is observed for aqueous micellar solutions of sodium dodecyl sulphate. Further, from the wavelength shifts in the absorption spectrum of di(1-pyrenyl)propane and di(1-pyrenylmethyl) ether, the polarizability of the probe surroundings can be determined, leading to a surprisingly high value for the apparent refractive index. This is attributed to a high local density of the direct environment of the probe, for which a location between the membrane/water interface and the unpolar bilayer mid-plane is deduced.