Allogeneic stem cell transplantation and CAR-T in B-cell Non-Hodgkin Lymphoma: a two-center experience and review of the literature

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is still a potentially curative option for B-cell Non-Hodgkin Lymphoma (B-NHL) in the modern immunotherapy era. The objective of this study was to analyze long-term outcomes of patients with B-NHL who received allo-HSCT. We analyzed overall survival (OS), progression-free survival (PFS) and graft versus host disease (GVHD) relapse-free survival (GRFS) in 53 patients undergoing allo-HSCT from two institutions. The median follow-up of the study was 72 months (range 29-115 months). The median number of lines of therapy before allo-HSCT was 3 (range 1-6) and twenty-eight patients (53%) had received a previous autologous transplant. The 3-year PFS, OS and GRFS were 55%, 63%, and 55%, respectively. One-year non-relapse mortality was 26%. Karnofsky Performance Scale < 90 was associated with worse OS in multivariable analysis. A non-comparative analysis of a cohort of 44 patients with similar characteristics who received chimeric antigen receptor T-cell therapy was done, showing a 1-year PFS and OS were 60% and 66%, respectively. Our data shows that allo-HSCT is still a useful option for treating selected patients with R/R B-NHL. Our retrospective analysis and review of the literature demonstrate that allo-HSCT can provide durable remissions in a subset of patients with R/R B-NHL.

Safety and effectiveness of direct-acting antiviral drugs in the treatment of hepatitis C in patients with inflammatory bowel disease

BACKGROUND AND AIMS

Hepatitis C virus (HCV) management in Inflammatory Bowel Disease (IBD) is uncertain. The ECCO guidelines 2021 recommended HCV treatment but warn about the risk of IBD reactivation. We aimed to evaluate 1) the effectiveness and safety of direct-acting antivirals (DAAs) in IBD; 2) the interaction of DAAs with IBD drugs.

METHODS

Multicentre study of IBD patients and HCV treated with DAAs. Variables related to liver diseases and IBD, as well as adverse events (AEs) and drug interactions, were recorded. McNemar's test was used to assess differences in the proportion of active IBD during the study period.

RESULTS

We included 79 patients with IBD and HCV treated with DAAs from 25,998 IBD patients of the ENEIDA registry. Thirty-one (39.2 %) received immunomodulators/biologics. There were no significant differences in the percentage of active IBD at the beginning (n = 11, 13.9 %) or at the 12-week follow-up after DAAs (n = 15, 19 %) (p = 0.424). Sustained viral response occurred in 96.2 % (n = 76). A total of 8 (10.1 %) AEs occurred and these were unrelated to activity, type of IBD, liver fibrosis, immunosuppressants/biologics, and DAAs.

CONCLUSIONS

We demonstrate a high efficacy and safety of DAAs in patients with IBD and HCV irrespective of activity and treatment of IBD.

Short-term recovery of soil and pine tree canopy after late prescribed burning in a semi-arid landscape

Climate change worsening due to global warming and progressive abandonment in rural areas mean that wildfires are increasing in extent and severity terms, and are one of the major disturbances in the Mediterranean Basin. To mitigate these disturbances, preventive management tools need to be used. Fire employment is being implemented, known as prescribed burnings, as forestry actions to change vegetation lines both vertically and horizontally to eliminate forest fuel load continuity. This study aimed to know the ecological effects of late prescribed burning treatments under mixed trees. Prescribed burns were carried out in October 2019 in the municipality of Ayna, Albacete (SE Spain). To assess the short-term (12-month) fire impact on soil, we measured soil respiration with a CO₂ flow chamber and analyzed soil physico-chemical properties. We also used minidisc infiltrometers to analyze soil repellency and soil hydraulic conductivity over a 1-year monitoring period. In addition, we evaluated the effects on tree strata by performing chemical nature analyses of fallen needles in Pinus pinaster after prescribed burning. According to our initial hypotheses, the results did not show significant changes in any parameter evaluated during the study period. However, some variables were affected in the first 3 months, needlefall and in microbiological activity, such as variations in soil physico-chemical properties, which can be due to long dry seasons combined with prescribed burning. This study attempts to observe and make known the effects that low-intensity prescribed burning has on soil and needlefall, which are relevant for updating forest management tools.

POS0501 SUSTAINED 2-YEAR REMISSION OF THE DISEASE IN A CLINIC OF EXCELLENCE IN RHEUMATOID ARTHRITIS. EXPERIENCE OF THE CLINICAL REGISTRY IN COLOMBIA

Background:

Rheumatoid arthritis (RA) is a chronic autoimmune disease with no cure, characterized by episodes of exacerbation and remission, which requires permanent use of medications. Clinics of excellence are multidisciplinary and centralized programs that improve adherence to treatments. Information on the benefits of these models of care has been published but is not definitive. In Colombia, the clinical registry of patients with RA is kept in the Cuenta de Alto Costo (CAC).

Objectives:

To demonstrate the difference in the percentages of sustained remission at 2 years, between an institution with non-centralized management or standard of care (Hospital Militar Central-HMC) compared to another institution with centralized management or clinic of excellence (BIOMAB-IPS) and determine if the results are determined by any of the intervention variables or by the program.

Methods:

The 2-year clinical records for the CAC were compared between an institution with non-centralized management (HMC) in comparison with another institution with centralized management (BIOMAB-IPS), performing a sociodemographic description, measuring control of the disease DAS28 clinimetry, Fisher’s test non-parametric bivariate analysis, multiple regression model, and population matching with Propensity score Matching (PSM).

Results:

Complete information was obtained from 2 years of follow-up, in centralized management 3457 patients and for the non-centralized unit 114 patients. Most of them corresponded to 2962 women (82%), with time of illness of 9.5 years and 10.2 years, respectively, without statistically significant differences. A difference was observed in the 2 programs to maintain remission at 2 years, in favor of the centralized program 54.7% vs 28.6.2% (p <0.00). With the binomial generalized linear regression model, it was confirmed that this difference was not explained by variables such as the use of biological therapy (RR = 0.77; 95% CI 0.69-0.86), use of DMARDs (RR = 0.71; 95% CI 0.62-0.82) and number of rheumatology consultations (RR = 0.97; 95% CI 0.92-1.02) in comparison with the centralized care model (RR = 2.32; 95% CI 1.58-3.35). Due to the biases between the groups due to the non-probability sampling, a PSM was performed, with a 1: 1 match, caliper of 0.065, obtaining a pseudo population with well-balanced covariates (see table 1). In the common support area, statistically significant differences were documented in sustained remission over 2 years, in favor of the centralized care group 45 vs 17.9% (p = 0.001).

Conclusion:

With the information from the clinical records, statistical strategies can be used to evaluate important differences in centralized care programs, observing favorable results of these types of care that are not related to isolated elements of the program, but to the overall effect of the program.

References:

[1]Austin PC. Double propensity-score adjustment: A solution to design bias or bias due to incomplete matching. Stat Methods Med Res. 2017;26(1):201–22.33333

Disclosure of Interests:

Juan Manuel Bello-Gualtero: None declared, Esperanza Peña: None declared, Pedro Iván Santos Moreno: None declared, Jasmin Vesga Gualdrón Employee of: Baxter, Ginna Saavedra: None declared, Clara Perez: None declared

Burning season and vegetation coverage influenced the community-level physiological profile of Mediterranean mixed-mesogean pine forest soils

Knowledge of forest soil ecology is necessary to assess vulnerability to disturbances, such as wildfires, and improve its microbial diversity and functional value. Soil microbiota play an important role in forest soil processes and are a key driver of postfire recovery, but they are very vulnerable to heat. According to future scenarios for climate and land-use change, fire regimes will undergo transformations in semiarid terrestrial ecosystems, mainly in the Mediterranean Basin. To develop tools for forest management in fire-prone areas, i.e., fire prevention, we assessed the impact of prescribed burnings on soil microorganisms in Mediterranean mixed pine forests. We hypothesised that low severity fire burns would not influence the functional diversity of soil microorganisms, although the burning season could influence that response due to seasonal variations in its vulnerability. We used the Biolog EcoPlate System to record soil biological indicators and assess the effect of the prescribed burning season (early or late season) on bacterial communities, including the soil-plant interphase. The soil microbiome response differed significantly according to vegetation coverage but prescribed burning season was not directly related. Burning increased the proportions of soil organic matter and soil organic carbon, and also promoted cation-exchange capacity and total phosphorus, which were higher following spring burns. Microbial richness and the Shannon-Weaver diversity index both showed a positive correlation with vegetation cover. However, microbial richness was triggered after burning uncovered patches of vegetation. We also noted differences in the usage pattern for the six substrate groups defined in our study: the use of carboxylic acids, amino acids and carbohydrates was higher in unburned plots and those subject to late burns, whereas amino acids did not predominate in early burn plots.

Development and Validation of a Novel Acute Myeloid Leukemia-Composite Model to Estimate Risks of Mortality

Question

Can a model incorporating patient-specific (comorbidities and age) and acute myeloid leukemia (AML)-specific features (cytogenetic and molecular alterations) predict mortality after AML treatment?

Findings

In a multicenter cohort study of 1100 patients, we demonstrated that (1) comorbidities had a significant impact on 1-year mortality after initial therapy for AML, (2) an augmented hematopoietic cell transplant–comorbidity index (HCT-CI) was the best suited index for comorbidity evaluation in AML, and (3) an AML composite model of augmented HCT-CI, age, and cytogenetic/molecular risks has a strong AUC of 0.76 for 1-year mortality.

Meaning

An AML composite model can guide decision-making about treatment of AML.

Importance

To our knowledge, this multicenter analysis is the first to test and validate (1) the prognostic impact of comorbidities on 1-year mortality after initial therapy of acute myeloid leukemia (AML) and (2) a novel, risk-stratifying composite model incorporating comorbidities, age, and cytogenetic and molecular risks.

Objective

To accurately estimate risks of mortality by developing and validating a composite model that combines the most significant patient-specific and AML-specific features.

Design, Setting, and Participants

This is a retrospective cohort study. A series of comorbidities, including those already incorporated into the hematopoietic cell transplantation–comorbidity index (HCT-CI), were evaluated. Patients were randomly divided into a training set (n = 733) and a validation set (n = 367). In the training set, covariates associated with 1-year overall mortality at a significance level of P < .10 constructed a multivariate Cox proportional hazards model in which the impact of each covariate was adjusted for that of all others. Then, the adjusted hazard ratios were used as weights. Performances of models were compared using C statistics for continuous outcomes and area under the curve (AUC) for binary outcomes.

Exposures

Initial therapy for AML.

Main Outcomes and Measures

Death within 1 year after initial therapy for AML.

Results

A total of 1100 patients, ages 20 to 89 years, were treated for AML between January 1, 2008, and December 31, 2012, at 5 academic institutions specialized in treating AML; 605 (55%) were male, and 495 (45%) were female. In the validation set, the original HCT-CI had better C statistic and AUC estimates compared with the AML comorbidity index for prediction of 1-year mortality. Augmenting the original HCT-CI with 3 independently significant comorbidities, hypoalbuminemia, thrombocytopenia, and high lactate dehydrogenase level, yielded a better C statistic of 0.66 and AUC of 0.69 for 1-year mortality. A composite model comprising augmented HCT-CI, age, and cytogenetic/molecular risks had even better predictive estimates of 0.72 and 0.76, respectively.

Conclusions and Relevance

In this cohort study, comorbidities influenced 1-year survival of patients with AML, and comorbidities are best captured by an augmented HCT-CI. The augmented HCT-CI, age, and cytogenetic/molecular risks could be combined into an AML composite model that could guide treatment decision-making and trial design in AML. Studying physical, cognitive, and social health might further clarify the prognostic role of aging. Targeting comorbidities with interventions alongside specific AML therapy might improve survival.

Estimating Concentration Response Function and Change-Point using Time-Course and Calibration Data

In this paper the problem of determining the functional relationship between time and the concentration of a chemical substance is studied. An intervention drug is administered on the experimental unit from which the chemical substance (specimen) is measured. This drug is hypothesized to cause a change in the concentration level of the chemical substance a certain lag-time after the intervention. However, the concentration value could not be directly measured, but rather a surrogate response can be measured. In the time-course study, this surrogate response is measured using different electrodes which possess varied behaviors. To utilize these surrogate measurements arising from the different electrodes (sensors), a calibration study is undertaken which measures the surrogate response for the different electrodes at known concentration levels. Based on the time-course and calibration data sets, a statistical procedure to estimate the signal function and the lag-time is proposed. Simulation studies indicate that the proposed procedure is able to reasonably recover the signal function and the lag-time. The procedure is then applied to the real data sets obtained during an analytical chemistry experiment.

Tissue factor variants induce monocyte transformation and transdifferentiation into endothelial cell-like cells

Essentials Monocytes (Mo) transdifferentiate into endothelial cell-like (ECL) cells. Mo induce tissue factor (TF) expression and secretion in microvascular endothelial cells (mECs). TF interacts with Mo in a paracrine fashion, inducing their transdifferentiation into ECL cells. TF generates a positive feedback crosstalk between Mo and mECs that promotes angiogenesis.

SUMMARY

Background Monocytes (Mo) increase neovascularization by releasing proangiogenic mediators and/or transdifferentiating into endothelial cell-like (ECL) cells. Recently, we have reported that Mo-microvascular endothelial cells (mECs) crosstalk induces mEC-tissue factor (TF) expression and promotes angiogenesis. However, the effect of TF on Mo remains unknown. Objective Here, we analyzed whether TF might exert angiogenic effects by inducing transdifferentiation of Mo. Methods Full-length TF (flTF) and alternatively spliced TF (asTF) were overexpressed in mECs, and their supernatants were added to Mo cultures. CD16 positivity and expression of vascular endothelial cell (VEC) markers in Mo were analyzed by fluorescence activated cell sorting. The capacity to form tube-like structures were visualized in three-dimensional cultures. Results In mECs flTF and asTF expression and release were increased in cultures with Mo-conditioned media. TF variants induced expansion of a CD16+ Mo subset and Mo transdifferentiation into ECL-cells expressing VEC markers that can form new microvessels. CD16+ Mo exposed to TF showed an increased expression of VE-cadherin, von Willebrand factor (VWF) and eNOS. Mo cultured with supernatants obtained from TF-silenced mECs did not transdifferentiate to ECL-cells or expressed VEC markers. Blocking β1-integrin in Mo significantly blocked the effects of the TF variants. Conclusions Mo induce mECs to express and release TF, which drives CD16- Mo to transform into CD16+ Mo and to transdifferentiate into ECL-cells that can form new microvessels. Our results reveal a TF-mediated positive feedback between mECs and Mo that stimulates Mo differentiation and induces angiogenesis.

Influence of a Commercial Antithrombotic Filter on the Caval Blood Flow During Neutra and Valsalva Maneuver

Anticoagulants are the treatment of choice for pulmonary embolism. When these fail or are contraindicated, vena cava filters are effective devices for preventing clots from the legs from migrating to the lung. Many uncertainties exist when a filter is inserted, especially during physiological activity such as normal breathing and the Valsalva maneuver. These activities are often connected with filter migration and vena cava damage due to the various related vein geometrical configurations. In this work, we analyzed the response of the vena cava during normal breathing and Valsalva maneuver, for a healthy vena cava and after insertion of a commercial Günther-Tulip® filter. Validated computational fluid dynamics (CFD) and patient specific data are used for analyzing blood flow inside the vena cava during these maneuvers. While during normal breathing, the vena cava flow can be considered almost stationary with a very low pressure gradient, during Valsalva the extravascular pressure compresses the vena cava resulting in a drastic reduction of the vein section, a global flow decrease through the cava but increasing the velocity magnitude. This change in the section is altered by the presence of the filter which forces the section of the vena cava before the renal veins to keep open. The effect of the presence of the filter is investigated during these maneuvers showing changes in wall shear stress and velocity patterns.

[Irritable bowel syndrome with constipation and functional constipation in adults: Treatment (Part 2 of 2)]

In this Clinical practice guide we examine the diagnostic and therapeutic management of adult patients with constipation and abdominal discomfort, at the confluence of the spectrum of irritable bowel syndrome and functional constipation. Both fall within the framework of functional intestinal disorders and have major personal, health and social impact, altering the quality of life of the patients affected. The former is a subtype of irritable bowel syndrome in which constipation and altered bowel habit predominate, often along with recurring abdominal pain, bloating and abdominal distension. Constipation is characterised by infrequent or hard-to-pass bowel movements, often accompanied by straining during defecation or the sensation of incomplete evacuation. There is no underlying organic cause in the majority of cases; it being considered a functional bowel disorder. There are many clinical and pathophysiological similarities between the two conditions, the constipation responds in a similar way to commonly used drugs, the fundamental difference being the presence or absence of pain, but not in an "all or nothing" way. The severity of these disorders depends not only on the intensity of the intestinal symptoms but also on other biopsychosocial factors: association of gastrointestinal and extraintestinal symptoms, degree of involvement, forms of perception and behaviour. Functional bowel disorders are diagnosed using the Rome criteria. This Clinical practice guide adapts to the Rome IV criteria published at the end of May 2016. The first part (96, 97, 98) examined the conceptual and pathophysiological aspects, alarm criteria, diagnostic test and referral criteria between Primary Care and Gastroenterology. This second part reviews all the available treatment alternatives (exercise, fluid ingestion, diet with soluble fibre-rich foods, fibre supplements, other dietary components, osmotic or stimulating laxatives, probiotics, antibiotics, spasmolytics, peppermint essence, prucalopride, linaclotide, lubiprostone, biofeedback, antdepressants, psychological treatment, acupuncture, enemas, sacral root neurostimulation and surgery), and practical recommendations are made for each.

[Clinical practice guidelines: Irritable bowel syndrome with constipation and functional constipation in adults: Concept, diagnosis, and healthcare continuity. (Part 1 of 2)]

In this Clinical practice guide, an analysis is made of the diagnosis and treatment of adult patients with constipation and abdominal discomfort, under the spectrum of irritable bowel syndrome and functional constipation. These have an important personal, health and social impact, affecting the quality of life of these patients. In irritable bowel syndrome with a predominance of constipation, this is the predominant change in bowel movements, with recurrent abdominal pain, bloating and frequent abdominal distension. Constipation is characterised by infrequent or difficulty in bowel movements, associated with excessive straining during bowel movement or sensation of incomplete evacuation. There is often no underling cause, with an intestinal functional disorder being considered. They have many clinical and pathophysiological similarities, with a similar response of the constipation to common drugs. The fundamental difference is the presence or absence of pain, but not in a way evaluable way; "all or nothing". The severity depends on the intensity of bowel symptoms and other factors, a combination of gastrointestinal and extra-intestinal symptoms, level of involvement, forms of perception, and behaviour. The Rome criteria diagnose functional bowel disorders. This guide is adapted to the Rome criteria IV (May 2016) and in this first part an analysis is made of the alarm criteria, diagnostic tests, and the criteria for referral between Primary Care and Digestive Disease specialists. In the second part, a review will be made of the therapeutic alternatives available (exercise, diet, drug therapies, neurostimulation of sacral roots, or surgery), making practical recommendations for each one of them.

[Clinical practice guidelines: Irritable bowel syndrome with constipation and functional constipation in adults: Concept, diagnosis, and healthcare continuity. (Part 1 of 2)]

In this Clinical practice guide, an analysis is made of the diagnosis and treatment of adult patients with constipation and abdominal discomfort, under the spectrum of irritable bowel syndrome and functional constipation. These have an important personal, health and social impact, affecting the quality of life of these patients. In irritable bowel syndrome with a predominance of constipation, this is the predominant change in bowel movements, with recurrent abdominal pain, bloating and frequent abdominal distension. Constipation is characterised by infrequent or difficulty in bowel movements, associated with excessive straining during bowel movement or sensation of incomplete evacuation. There is often no underling cause, with an intestinal functional disorder being considered. They have many clinical and pathophysiological similarities, with a similar response of the constipation to common drugs. The fundamental difference is the presence or absence of pain, but not in a way evaluable way; "all or nothing". The severity depends on the intensity of bowel symptoms and other factors, a combination of gastrointestinal and extra-intestinal symptoms, level of involvement, forms of perception, and behaviour. The Rome criteria diagnose functional bowel disorders. This guide is adapted to the Rome criteria IV (May 2016) and in this first part an analysis is made of the alarm criteria, diagnostic tests, and the criteria for referral between Primary Care and Digestive Disease specialists. In the second part, a review will be made of the therapeutic alternatives available (exercise, diet, drug therapies, neurostimulation of sacral roots, or surgery), making practical recommendations for each one of them.

Antidepressants in Parkinson's disease. Recommendations by the movement disorder study group of the Neurological Association of Madrid

INTRODUCTION

Although antidepressants are widely used in Parkinson's disease (PD), few well-designed studies to support their efficacy have been conducted.

DEVELOPMENT

These clinical guidelines are based on a review of the literature and the results of an AMN movement disorder study group survey.

CONCLUSIONS

Evidence suggests that nortriptyline, venlafaxine, paroxetine, and citalopram may be useful in treating depression in PD, although studies on paroxetine and citalopram yield conflicting results. In clinical practice, however, selective serotonin reuptake inhibitors are usually considered the treatment of choice. Duloxetine may be an alternative to venlafaxine, although the evidence for this is less, and venlafaxine plus mirtazapine may be useful in drug-resistant cases. Furthermore, citalopram may be indicated for the treatment of anxiety, atomoxetine for hypersomnia, trazodone and mirtazapine for insomnia and psychosis, and bupropion for apathy. In general, antidepressants are well tolerated in PD. However, clinicians should consider the anticholinergic effect of tricyclic antidepressants, the impact of serotonin-norepinephrine reuptake inhibitors on blood pressure, the extrapyramidal effects of antidepressants, and any potential interactions between monoamine oxidase B inhibitors and other antidepressants.

Microstructural quantification of collagen fiber orientations and its integration in constitutive modeling of the porcine carotid artery

BACKGROUND

Mechanical characteristics of vascular tissue may play a role in different arterial pathologies, which, amongst others, requires robust constitutive descriptions to capture the vessel wall's anisotropic and non-linear properties.Specifically, the complex 3D network of collagen and its interaction with other structural elements has a dominating effect of arterial properties at higher stress levels.The aim of this study is to collect quantitative collagen organization as well as mechanical properties to facilitate structural constitutive models for the porcine carotid artery.This helps the understanding of the mechanics of swine carotid arteries, being a standard in clinical hypothesis testing, in endovascular preclinical trials for example.

METHOD

Porcine common carotid arteries (n=10) were harvested and used to (i) characterize the collagen fiber organization with polarized light microscopy, and (ii) the biaxial mechanical properties by inflation testing.The collagen organization was quantified by the Bingham orientation density function (ODF), which in turn was integrated in a structural constitutive model of the vessel wall.A one-layered and thick-walled model was used to estimate mechanical constitutive parameters by least-square fitting the recorded in vitro inflation test results.Finally, uniaxial data published elsewhere were used to validate the mean collagen organization described by the Bingham ODF.

RESULTS

Thick collagen fibers, i.e.the most mechanically relevant structure, in the common carotid artery are dispersed around the circumferential direction.In addition, almost all samples showed two distinct families of collagen fibers at different elevation, but not azimuthal, angles.Collagen fiber organization could be accurately represented by the Bingham ODF (κ1,2,3=[13.5,0.0,25.2] and κ1,2,3=[14.7,0.0,26.6]; average error of about 5%), and their integration into a structural constitutive model captured the inflation characteristics of individual carotid artery samples.Specifically, only four mechanical parameters were required to reasonably (average error from 14% to 38%) cover the experimental data over a wide range of axial and circumferential stretches.However, it was critical to account for fibrilar links between thick collagen fibers.Finally, the mean Bingham ODF provide also good approximation to uniaxial experimental data.

CONCLUSIONS

The applied structural constitutive model, based on individually measured collagen orientation densities, was able to capture the biaxial properties of the common carotid artery. Since the model required coupling amongst thick collagen fibers, the collagen fiber orientations measured from polarized light microscopy, alone, seem to be insufficient structural information. Alternatively, a larger dispersion of collagen fiber orientations, that is likely to arise from analyzing larger wall sections, could have had a similar effect, i.e. could have avoided coupling amongst thick collagen fibers.

STATEMENT OF SIGNIFICANCE

The applied structural constitutive model, based on individually measured collagen orientation densities, was able to capture the biaxial and uniaxial properties of the common carotid artery. Since the model required coupling amongst thick collagen fibers, an effective orientation density that accounts for cross-links between the main collagen fibers has been porposed. The model provides a good approximation to the experimental data.

Sacral nerve stimulation versus percutaneous posterior tibial nerve stimulation in the treatment of severe fecal incontinence in men

BACKGROUND

Sacral nerve stimulation and percutaneous posterior tibial nerve stimulation have been described previously as effective treatments for fecal incontinence. Nevertheless, there does not exist any study that compares the efficiency of both. The aim of this study was to compare the use of SNS and PPTNS in males with FI.

METHODS

We conducted a prospective cohort study on men with FI treated with SNS or PTNS in the Coloproctology Unit of the University General Hospital of Elche and Reina Sofia of Murcia between January 2010 and December 2011. Preoperative assessment included physical examination, anorectal manometry, and anal endosonography. Anal continence was evaluated using the Wexner continence grading system. Quality of life was evaluated using the Fecal Incontinence Quality of life Scale.

RESULTS

Nineteen patients were included (ten patients SNS and nine PPTNS). SNS improved FI in nine of the ten patients. The mean Wexner score decreased significantly from a median of 14 (12-16) (preoperative) to 4 (1-8) (6-month revision) (p = 0.007). PTNS improved FI in seven of the nine patients. The mean Wexner score decreased significantly from a median of 12 (11-19) (preoperative) to 5 (4-7) (6-month revision) (p = 0.018). Both treatments produced symptomatic improvement without statistical differences between them.

CONCLUSIONS

Our study was nonrandomized with a relatively small number of patients. PPTNS had similar efficiency to the SNS in our men population. However, more studies are necessary to exclude selection bias and analyze long-term results.

Failure properties of vena cava tissue due to deep penetration during filter insertion

In this work, we use an in-vitro mechanical test to explore the resistance of biaxially stretched vena cava tissue against deep perforation and a methodology which integrates experimental and numerical modeling to identify constitutive fracture properties of the vena cava. Six sheep vena cava were harvested just after killing, and cyclic uniaxial tension tests in longitudinal and circumferential directions and biaxial deep penetration tests were performed. After that, we use a nonlinear finite element model to simulate in vitro penetration of the cava tissue in order to fit the fracture properties under penetration of the vena cava by defining a cohesive fracture zone. An iterative process was developed in order to fit the fracture properties of the vena cava using the previously obtained experimental results. The proposed solutions were obtained with fracture energy of 0.22 or 0.33 N/mm. In comparison with the experimental data, the simulation using [Formula: see text], [Formula: see text], and [Formula: see text] parameters ([Formula: see text]) is in good agreement with results from penetration experiments of cava tissue. It is noticeable that the parameter estimation process of the fracture behavior is more accurate than the estimation process of the elastic behavior for the toe region of the curve.

La relación de <i>Helicobacter pylori</i> con la displasia y el cáncer gástrico en Costa Rica

Se comparó la incidencia de labaéteria Hdicobacter pylori en un lugar pe baja incidencia de cáncer gástrico, Poás ( 15. 13%) y otro de incidencia muy alta, Puriscal (83. 53%) Se eligió a 185 adultos de cada cantón, similares en edad y sexo y se practicó un estudio serológico para buscar anticuerpos IgG para H. pylori, y una gastroscopía para tomar dos biopsias por caso. Los resultados no apoyan la existencia de una fuerte relación entre H. pylori y cáncer gástrico

Computational model of collagen turnover in carotid arteries during hypertension

It is well known that biological tissues adapt their properties because of different mechanical and chemical stimuli. The goal of this work is to study the collagen turnover in the arterial tissue of hypertensive patients through a coupled computational mechano-chemical model. Although it has been widely studied experimentally, computational models dealing with the mechano-chemical approach are not. The present approach can be extended easily to study other aspects of bone remodeling or collagen degradation in heart diseases. The model can be divided into three different stages. First, we study the smooth muscle cell synthesis of different biological substances due to over-stretching during hypertension. Next, we study the mass-transport of these substances along the arterial wall. The last step is to compute the turnover of collagen based on the amount of these substances in the arterial wall which interact with each other to modify the turnover rate of collagen. We simulate this process in a finite element model of a real human carotid artery. The final results show the well-known stiffening of the arterial wall due to the increase in the collagen content.

Short- and long-term biomechanical and morphological study of new suture types in abdominal wall closure

To perform an abdominal-wall closure, a continuous suture is the preferred method. The suture materials that are most commonly employed in abdominal surgery are polypropylene and polydioxanone. However, in recent times, new products have been marketed, such as non-absorbable polyurethane with elastic properties (Assuplus(®), Assut Europe, Italy) and absorbable barbed polydioxanone (Filbloc(®), Assut Europe, Italy). The purpose of this study was to compare the ability of those against the standard polypropylene (Surgipro(TM), Covidien, USA) and polydioxanone (Assufil(®), Assut Europe, Italy) to mimic the biomechanical behavior of the abdominal wall closure. Comparison of the sutures was made first with the materials alone and later in a laparotomy closure of a rabbit abdomen, used as an animal model. The biomechanical analysis consisted of uniaxial tensile tests of threads and sutured samples of the animal abdomen. In the latter case, results were analyzed at short- (21days) and long- (180days) term intervals after the surgery. The morphology studies and collagen expression of the samples were also investigated. The results determined that polydioxanone and polypropylene sutures showed a linear elastic behavior, with barbed polydioxanone as the most compliant suture and polyurethane as the stiffest. The sutured samples showed a statistically significant loss of resistance, measured as the load needed to perform a certain stretch, when compared with the corresponding control tissue. Analysis of the stress-stretch curves showed that elastic polyurethane was the only suture able to reproduce the mechanical behavior of healthy tissue in the short term, while the rest of the sutures remained less stiff. This coincides with the expression of type I collagen observed in this group at this point in the study. In the long term, there was no difference among the sutures, and none was able to mimic control behavior.

A structural approach including the behavior of collagen cross-links to model patient-specific human carotid arteries

In this work the mechanical response of the carotid arterial wall is studied. Some limitations of previous models of the arterial wall are overcomed and variability of the fitting problem is reduced. We review some experimental data from the literature and provide a constitutive model to characterize such data. A strain energy function is introduced including the behavior of cross-links between the main collagen fibers. With this function we are able to fit experimental data including information about the microstructure that previous models were not able to do. To demonstrate the applicability of the proposed model a patient-specific carotid artery geometry is reconstructed and simulated in a finite element framework, providing a microstructural description of the arterial wall. Our results qualitatively and quantitatively describe the experimental findings given in the literature fitting macroscopic mechanical tests and improving the features of previously developed models.

Atypical neurological symptoms associated with CGG expansions of the FMR1 gene

More than 40 CGG expansions in the 5’ noncoding region of the fragile X mental retardation 1 (FMR1) gene of the X chromosome give rise to several distinct clinical phenotypes, depending on the size of the expansion. First, more than 200 CGG expansions (full mutation) cause an inherited mental retardation called fragile X syndrome. Second, CGG expansions between 55 and 199 (premutation) cause a disorder called fragile X-associated tremor/ataxia syndrome (FXTAS) which typically includes intention tremor, ataxia and specific magnetic resonance imaging (MRI) findings. Indeed, it could develop parkinsonism although it usually shows features of postsynaptic parkinsonism. Finally, CGG expansions between 41 and 54 CGG (gray zone) are not consider normal but rarely develops abnormal neurological conditions. In this sense, the aim of this study is to report two atypical cases associated with CGG expansions of the FMR1 gene. First, a FMR1 premutation alleles carrier with an unusual phenotype, such as a presynaptic parkinsonism indistinguishable from Parkinson disease (PD) and a FMR1 gray zone alleles carrier presented with neurological features, namely hand tremor, parkinsonism and ataxia, usually described in FXTAS, as well as orthostatic tremor. We conclude that, on the one hand, FMR1 premutation alleles might cause two phenotypes of parkinsonism, such as a presynaptic phenotype, indistinguishable from PD, and a postsynaptic phenotype, associated with clinical features of FXTAS. On the other hand, although FMR1 gray zone alleles carriers were believed to have no abnormal neurological conditions, our study supports that they could develop FXTAS and other neurological disorders such as orthostatic tremor which has not been reported before associated with the FMR1 gene.

Monomerization of C-reactive protein requires glycoprotein IIb-IIIa activation: pentraxins and platelet deposition

BACKGROUND

Pentraxins are inflammatory mediators linked to cardiovascular disease; however, their role in thrombosis remains to be fully elucidated.

AIMS

We investigated the role of pentraxins in thrombus formation on different vascular substrates under flow conditions.

METHODS

Native C-reactive protein (nCRP) and serum amyloid P (SAP) effects on thrombosis were evaluated under flow conditions on substrates placed in flat perfusion chambers. nCRP and dissociated monomeric CRP (mCRP) distributions were visualized by use of confocal microscopy. The effects of nCRP on vascular substrates were tested in the Badimon chamber.

RESULTS

mCRP, but not nCRP, induced a significant activation in platelet deposition, whereas SAP induced an activation only on fibrinogen-coated substrates. The effects of CRP on platelet deposition were significantly reduced by statin treatment. mCRP resulting from recirculation of blood containing nCRP over a thrombogenic vessel wall induced increased platelet deposition. Blocking glycoprotein IIb-IIIa prevented the effects of CRP dissociation and significantly reduced platelet deposition. Annexin V treatment did not block monomerization of CRP on activated platelets.

CONCLUSIONS

Under flow conditions, platelet deposited on all tested biological substrates support nCRP dissociation into mCRP. The effect is dependent on the thrombogenic potency of the substrate to trigger initial platelet deposition. Exposure of glycoprotein IIb-IIIa in the platelet surface supports nCRP dissociation. CRP monomerization was not dependent on the aminophospholipid exposed on the surface of activated platelets. The dissociated mCRP is trapped in the growing platelet aggregate and stimulates further platelet deposition. SAP increases platelet deposition only on fibrin monolayers. Therefore, pentraxins induce a platelet activation effect linking inflammation and thrombosis.

Tissue factor induces human coronary artery smooth muscle cell motility through Wnt-signalling

BACKGROUND

Tissue factor (TF) is the most relevant physiological trigger of thrombosis contributing to the presentation of clinical ischemic events after plaque rupture. However, the role of human vascular smooth muscle cell (HVSMC) TF in vascular remodeling, restenosis and atherosclerosis is less known. We have hypothesized that TF contributes to atherosclerotic lesion formation, triggering smooth muscle cell migration through a specific yet unknown signaling pathway.

OBJECTIVES

The aim of this study has been to investigate the signal transduction mechanism by which TF may contribute to the transition of resident static contractile HVSMC into a migrating cell that promotes atherosclerotic plaque progression.

METHODS

We have used a system biology discovery approach with gene-engineered HVSMCs to identify genes/proteins involved in the TF-triggered effects in HVSMC obtained from the coronary arteries of human adult hearts.

RESULTS

Analysis of wild-type HVSMC (TF(+) ) and TF(-) silenced HVSMC (TF(-) ) showed that TF is involved in the regulation of Wnt signaling and in the expression of downstream proteins that affect the atherosclerotic process.

CONCLUSIONS

The 'in silico' analysis pointed to specific Wnt-pathway proteins that have been validated in cell culture and also have been found expressed in human advanced atherosclerotic plaques but not in early lesions. TF signals through Wnt to regulate coronary smooth muscle cell migration and vascular remodeling.

Treatment with botulinum toxin: An update

Botulinum neurotoxin (BoNT) is a potent toxin produced by the anaerobic bacterium clostridium botulinum. It causes flaccid, long-lasting, local and reversible paralysis. In addition, BoNT inhibits the secretion of the exocrine glands and could have properties in the control of pain. Thus, BoNT is useful in the treatment of many neuromuscular conditions where an increase of muscle tone is associated with the pathogenic mechanism. Furthermore, BoNT is recommended in the treatment of some hypersecretion disorders of the exocrine gland and could play a role in the treatment of migraine and other chronic pain conditions. In the BoNT therapy adverse effects are usually mild and reversible. However, repeated injections of BoNT can lead to the development of neutralizing antibodies that can subsequently inhibit the biological activity of the toxin. In this sense, many factors can influence the immunogenicity of the BoNT, such as product-related factors, the dose of BoNT used, the frequency of injection and the previous exposure to the toxin. In this review, we are going to discuss the current clinical applications of BoNT with a special focus on evidence, doses, injection technique and adverse effects for those applications more frequently used in neurology, namely spasticity, blepharospasm, hemifacial spasm, cervical dystonia and other focal dystonias, as well as chronic migraine, tremor, sialorrhea, facial palsy, neurogenic bladder and many other neurological condition.

Surgical lung biopsy for diffuse lung disease. Our experience in the last 15 years

INTRODUCTION

Surgical lung biopsy is a technique that presents a morbi-mortality rate of considerable importance. We analyze our experience with surgical lung biopsies for the diagnosis of diffuse lung disease and the effect produced on the indications for surgical biopsy in these pathologies after the publication of the consensus of the ATS (American Thoracic Society) and ERS (European Respiratory Society) for Idiopathic Pulmonary Fibrosis (IPF).

PATIENTS AND METHODS

We performed a retrospective review of 171 patients operated between January 1997 and December 2011. We divided the series into 2 groups: group 1 (operated between 1997 and 2002) and group 2 (operated between 2003 and 2011). Suspected preoperative diagnosis, respiratory status, pathological postoperative diagnoses, percentage of thoracotomies, mean postoperative stay and perioperative morbidity and mortality were analyzed.

RESULTS

Group 1 consisted of 99 patients and group two 72. The most frequent postoperative diagnoses were: usual interstitial pneumonia and extrinsic allergic alveolitis. There were ten (5.84%) deaths. Death was caused by progressive respiratory failure that was related to interstitial lung disease in 7 (70%) of 10 cases, alveolar haemorrhage in 2 (20%) and heart failure in 1 (10%).

CONCLUSIONS

Since the publication of the ATS and ERS consensus on the IPF, we have observed a noticeable decrease in the number of indications for surgical lung biopsy. This technique, though simple, has a considerable morbidity and mortality.

Short-term behavior of different polymer structure lightweight meshes used to repair abdominal wall defects

BACKGROUND

While lightweight (LW) polypropylene (PP) meshes are been used for hernia repair, new prosthetic meshes also of low-density and with large pores have recently been introduced composed of other polymer materials. This study compares the behavior in the short-term of two macroporous LW prosthetic materials, PP and non-expanded PTFE.

METHODS

Partial defects were created in the lateral wall of the abdomen in New Zealand White rabbits and then repaired using a LW PP mesh or a new monofile, LW PTFE mesh. At 14 days postimplant, shrinkage and tissue incorporation, gene and protein expression of neo-collagens (qRT-PCR/immunofluorescence), macrophage response (immunohistochemistry) and biomechanical strength were determined.

RESULTS

Both meshes induced good host tissue ingrowth, yet the macrophage response was significantly greater for the PTFE implants (p⟨0.05). Collagen 1/3 mRNA expression was greater for the PP mesh but differences lacked significance. Similar patterns of collagen I and III protein expression were observed in the neoformed tissue infiltrating the two meshes. After 14 days of implant, tensile strengths were also similar, while elastic modulus values were higher for the PTFE mesh (p⟨0.05).

CONCLUSIONS

In the short term, host collagen deposition and biomechanical performance seemed unaffected by the polymer structure of the implanted mesh. In contrast, the inflammatory response to mesh implant produced at this early time point was more intense for the PTFE.

Viscoelastic properties of the passive mechanical behavior of the porcine carotid artery: influence of proximal and distal positions

The viscoelastic properties of porcine carotid tissue are investigated in this work. Experimental uniaxial stress relaxation tests along the longitudinal and circumferential directions of the vessel were performed for carotid strips extracted from 10 vessels. Directional and local differences--distal versus proximal position--in the tissue behavior were investigated. The experimental tests reveal a highly anisotropic, non-linear viscoelastic response and local dependence of the samples. The carotid artery shows anisotropic relaxation behavior for both proximal and distal samples. The highest stress relaxation was found in the circumferential tensile test for the highest applied strain at the distal position. For the circumferential direction, the relaxation stress was higher than in the longitudinal being at its highest in the distal position. These facts show that the stress relaxation is higher in the distal than in the proximal position. However, there are no differences between both positions in the longitudinal direction. In addition, a constitutive law that takes into account the fundamental features, including non-linear viscoelasticity, of the arterial tissue is proposed. The present results are correlated with the purely elastic response and the microstructural analysis of the tissue by means of histological quantification presented in a previous study.

Subcellular localization of tissue factor and human coronary artery smooth muscle cell migration

BACKGROUND

Tissue factor (TF) is the most relevant physiological trigger of thrombosis. Additionally TF is a transmembrane receptor with cell signaling functions.

OBJECTIVES

The aim of this study was to investigate TF subcellular localization, function and signaling in human coronary artery smooth muscle cell migration.

METHODS

Coronary arteries and primary cultures of vascular smooth muscle cells (HVSMC) were obtained from human explanted hearts. Wound repair and Boyden chamber assays were used to measure migration in vitro. TF-pro-coagulant activity (TF-PCA) was measured in extracted cellular membranes. Analysis of TF distribution was performed by confocal microscopy. A nucleofector device was used for TF and protease activated receptor 2 (PAR2) silencing. mRNA levels were analyzed by RT-PCR.

RESULTS

In migrating HVSMC TF translocates to the leading edge of the cells showing an intense patch-like staining in the lamellipodia. In the migrating front TF colocalizes with filamin (FLN) in the polarized lipid rafts. TF-PCA was increased in migrating cells. Silencing of the TF gene inhibits RSK-induced FLN-Ser-2152 phosphorylation, down-regulates CDC42, RhoA, and Rac1 protein expression and significantly inhibits cell migration. Silencing PAR2 also inhibits cell migration; however, silencing both TF and PAR2 induces a significantly higher effect on migration. Smooth muscle cells expressing TF have been identified in non-lipid-rich human coronary artery atherosclerotic plaques.

CONCLUSIONS

TF translocates to the cell front in association with cytoskeleton proteins and regulates HVSMC migration by mechanisms dependent and independent of factor (F)VIIa/PAR2. These results extend the functional role of TF to smooth muscle cell trafficking in vessel wall remodeling.

Aggregated low-density lipoprotein induce impairment of the cytoskeleton dynamics through urokinase-type plasminogen activator/urokinase-type plasminogen activator receptor in human vascular smooth muscle cell

BACKGROUND

Urokinase-type plasminogen activator (UPA) regulates vascular smooth muscle cell (VSMC) functions relevant in vascular remodeling by facilitating proteolysis at the cell surface and inducing cell signaling pathways. Our previous results demonstrated that aggregated low-density lipoprotein (agLDL) impair cytoskeleton dynamics, a key event contributing to VSMC behavior during progression of atherosclerotic plaques.

OBJECTIVES

To investigate whether mechanisms underlying inhibition of cytoskeleton dynamics in lipid-loaded VSMC occurs through a UPA-mediated process.

METHODS

Adhesion assay was performed in lipid-loaded human VSMC after 16-h exposition to agLDL (100 μg mL(-1)). Protein subcellular localization and actin-fiber formation were assessed by confocal microscopy. For analysis of protein expression western blots were carried out. Co-immunoprecipitates of UPAR were examined by one-dimensional- or two-dimensional electrophoresis (1-DE or 2-DE), mass spectrometry MALDI-TOF and western blot.

RESULTS

agLDL induced UPA subcellular delocalization and significantly decreased UPA levels during attachment of VSMC. UPA (enhanced endogenous-expression or exogenous added) acting as a urokinase-type plasminogen activator receptor (UPAR)-ligand restored actin-cytoskeleton organization and adhesion capacity of lipid-loaded cells to control levels. UPAR co-immunoprecipitated with the unphosphorylated form of myosin regulatory light chain (MRLC) in lipid-loaded cells. The detrimental effects of agLDL on MRLC phosphorylation were reversed by high levels of UPA. The UPA effects on VSMC exposed to agLDL involved FAK phosphorylation.

CONCLUSIONS

The detrimental effects of atherogenic LDL on VSMC are mediated by a decrease and delocalization of the UPA-UPAR interaction that result in an impairment of cytoskeleton dynamics and adhesion capacity affecting cell phenotype and function.

Tissue factor-Akt signaling triggers microvessel formation

BACKGROUND

Tissue factor (TF) and its signaling mediators play a crucial role in angiogenesis. We have previously shown that TF-induced endothelial cell (EC) CCL2 release contributes to neovessel formation.

OBJECTIVE

In this study, we have investigated the signaling pathways involved in TF-induced EC tube formation.

METHODS

The human microvascular endothelial cell line (HMEC-1) cultured onto basement membrane-like gel (Matrigel) was used to study TF signaling pathways during neovessels formation.

RESULTS

Inhibition of endogenous TF expression in ECs using siRNA resulted in inhibition of a stable tube-like structure formation in three-dimensional cultures, associated with a down-regulation of Akt activation, an increased phosphorylation of Raf at Ser(259) with a subsequent reduction of Raf kinase and a reduction of ERK1/2 phosphorylation ending up in Ets-1 transcription factor inhibition. Conversely, overexpression of TF resulted in an increase in tube formation and up-regulation of Akt protein. Moreover, immunoprecipitation of Akt and western blotting of the immunoprecipitates with anti-TF antibody revealed a direct interaction between TF and Akt. The effects of silencing TF were partially reversed by a PAR2 agonist that rescued tube formation, indicating that the TF-Akt pathway induces PAR2-independent effector signaling. Finally, enforced expression of Akt in TF-silenced ECs rescued tube formation in a Matrigel assay and induced Ets-1 phosphorylation.

CONCLUSIONS

In EC, TF forms a complex with Akt activating Raf/ERK and Ets-1 signaling induces microvessel formation.