Effects of Commercial Probiotics on Colonic Sensitivity after Acute Mucosal Irritation

Gastrointestinal pathologies associated with abdominal pain, such as irritable bowel syndrome or inflammatory bowel disease, lack sufficiently effective treatments. In our study we have used a rat model of visceral pain (72 animals; n = 8–13 per experimental group) to analyze the consequences of intracolonic administration of the irritant acetic acid on visceral sensitivity, histology of the colonic wall, and inflammatory response. Moreover, we have studied the possible beneficial effects of a pretreatment with a commercial probiotic (Actimel^®). Contrary to expectations, acetic acid application (7 cm proximal to the anus) decreased the nociceptive response to intracolonic mechanical stimulation, with a slight increase in the histological damage of colonic mucosa. The intensity of these changes depended on the concentration (4% or 0.6%) and the time of application (30 or 60 min). Pretreatment with probiotics (by daily gavage, for 1 week) normalized the values obtained in the visceral sensitivity test but revealed an increase in the number of macrophages. These results suggest a possible activation of inhibitory mechanisms early after colonic irritation, not previously described (which need further experimental confirmation), and the ability of probiotics to normalize the effects of acetic acid. In addition, pretreatment with probiotics has a direct effect on immune functions, stimulating macrophagic activity.

A child with resistant Kawasaki disease successfully treated with anakinra: a case report

Background

Kawasaki disease (KD) is an acute self-limited systemic vasculitis of unknown etiology. Intravenous immunoglobulin (IVIG) is an effective treatment and decreases the risk of cardiac complications to less than 5%. In spite of its effectiveness, some children do not respond to this therapy and still develop coronary aneurysms (CAA). The optimal treatment for IVIG non-responsive patients remains controversial although corticoids have been suggested to be an effective treatment in some patients. For those patients still resistant to IVIG and corticoids, interleukin-1 receptor antagonists (IL-1RA) such anakinra could be an alternative.

Case presentation

We present a 3 year-old Caucasian patient with KD without cardiac complications but with important resistance to treatment. After becoming resistant to IVIG and corticoids, anakinra proved to be an effective treatment.

Conclusions

To our knowledge, this is the first report of the utility of IL-1RA in refractory KD without coronary impairment. The patient fulfilled the classical criteria for KD and, after becoming resistant to first and second line treatments, anakinra proved to be an effective treatment. Further studies are required to determine if this is an effective treatment option for other cases of resistant Kawasaki disease.

[Recommendations for the use of methotrexate in patients with juvenile idiopathic arthritis]

OBJECTIVES

To develop a consensus document of recommendations for the use of methotrexate (MTX) in patients with juvenile idiopathic arthritis (JIA).

MATERIAL AND METHOD

A group of eleven experts proposed several clinical questions on the use of MTX in patients with JIA. A systematic review was conducted and the evidence and recommendations for each question were extracted. The results were discussed and validated by the experts in a work session to establish the final recommendations.

RESULTS

MTX is recommended as the first drug for inducing remission in JIA, and its indication should be made according to the clinical category of the patient. Prior to treatment, it is recommended to perform a complete blood count, including white cells, levels of liver enzymes, serum creatinine, and other analytical parameters according to specific risk factors. Treatment should be initiated with a dose of 10-15 mg/m(2)/week. In cases of uveitis or polyarthritis, an initial dose of 15 mg/m(2)/week should be considered. For a better bioavailability and tolerability, it is preferable to administer MTX parenterally if the dose is ≥15 mg/m(2)/week. It is necessary to periodically perform an analytical monitoring of the patient and to assess possible alterations in liver enzymes to make changes if necessary. Combinations with biological agents may be necessary, as well as the concomitant addition of folic or folinic acid.

CONCLUSIONS

This document describes the main recommendations for the appropriate use of MTX in JIA patients, according to scientific evidence and clinical experience.

Incontinentia pigmenti and bipolar aphthosis: an unusual combination

Incontinentia pigmenti (IP) is an uncommon X-linked dominant multisystem disorder, lethal in the majority of affected males in utero and variably expressed in females. The cutaneous manifestations are diagnostic and classically occur in four stages: vesicular, verrucous, hyperpigmented, and atrophic. The skin lesions are typically spread along the lines of Blaschko, and they are usually present at birth. It may be variably accompanied by dental, ocular, neurologic, bones and joints, and development anomalies. The genes IP has been mapped to Xq28. Mutations in the NEMO/IKKγ gene, located at Xq28, have been found to cause expression of the disease. Behçets disease is a multisystem disorder consisting of recurrent oral aphtae, genital ulcers, pustular skin eruption, and uveitis. Occasionally there are other articular, neurological, intestinal, or vascular abnormalities. This disease is rare in children. Here, we report a case of a 16-year-old female with the rare combination of incontinentia pigmenti and an aphthosis bipolar, and we discuss the probably relationship between these two diseases.

A new rapid desensitization protocol for chemotherapy agents

BACKGROUND

Desensitization has been used for some decades to treat patients with the allergenic drug when an alternative drug with similar efficacy and safety is not available. We present the results from a series of oncology patients desensitized at our hospital during the last 2 years.

OBJECTIVE

To assess the efficacy of a new desensitization protocol in patients allergic to chemotherapy drugs.

METHODS

We performed an observational retrospective study of 11 women (6 breast cancer and 5 ovarian cancer) who underwent our desensitization protocol. Four patients had immediate reactions to carboplatin, 3 to docetaxel, 3 to paclitaxel, and 1 to both docetaxel and paclitaxel. Premedication was administered in all cases. A 5-step protocol based on 5 different dilutions of the drugs was used.

RESULTS

We performed 39 desensitization procedures: 14 to carboplatin, 3 to oxaliplatin, 16 to docetaxel, and 6 to paclitaxel. Eight patients tolerated the full dose in 36 procedures. One patient suffered an anaphylactic reaction to carboplatin that reverted with treatment. One patient had dyspnea after a paclitaxel cycle. One patient experienced dyspnea due to chronic pulmonary thromboembolism related to her disease.

CONCLUSION

Desensitization is a useful procedure in patients who are allergic to their chemotherapy agents.

Incidence and prevalence of juvenile idiopathic arthritis in Catalonia (Spain)

OBJECTIVE

To ascertain the incidence and prevalence of juvenile idiopathic arthritis (JIA) in Catalonia (autonomous region in northeast Spain), examined according to the currently established disease subtypes.

METHODS

Before initiating the study, we conducted an educational programme on paediatric rheumatology, addressed to all general paediatricians in Catalonia. A 2-year (2004-2006), prospective, population-based study was then carried out to determine the incidence of JIA. Prospective and retrospective data retrieval was performed to calculate prevalence. The International League of Associations for Rheumatology (ILAR, Edmonton revision) classification criteria were applied.

RESULTS

Over the study period, 145 new cases of JIA were diagnosed. The mean annual incidence was 6.9/10⁵ children aged less than 16 years (range 5.8-8.1 years; 9.0 years for girls and 4.8 years for boys). On separate analysis of patients ≤ 6 and > 6 years, the distribution in younger children was found to be similar for both girls and boys, whereas in older children, most girls belonged to the oligoarthritis and polyarthritis subgroups, and boys to the enthesitis-related arthritis and undifferentiated subgroups. The calculated prevalence of JIA (31 October 2006) was 39.7 (36.1-43.7)/10⁵ children younger than 16. The relative risk of girls having JIA was 2.1 [95% confidence interval (CI) 1.7-2.7, p < 0.001]. In 70% of patients, the diagnosis was established before the age of 7. Subgroup distribution of prevalent cases mirrored that of incident cases.

CONCLUSION

This is the first population-based study on the epidemiology of JIA in Catalonia. Incidence and prevalence rates are lower than those reported for several areas in Nordic countries of Europe. Oligoarthritis was the most common subtype.

Risk factors associated to the prevalence of asthma in adolescence

The ISAAC project (International Study of Asthma and Allergies in Childhood) was developed with the purpose of determining the prevalence of asthma in schoool children, with the definition of two age groups: infancy, when asthma is more frequent, and adolescence, when mortality associated to asthma is greater. However, the study does not address the risk factors associated with this pathology. Our aim is to comparatively analyze the prevalence of respiratory symptoms and the asthma epidemiological factors in the two age groups and in both sexes. Since the results of ISAAC Phase I are available, we can study the variations in risk factors, relating them to the current prevalence of asthma. The prevalence of bronchial asthma in our adolescents is 10 % - this implying a significant increase with respect to the data corresponding to ISAAC Phase I. Likewise, the prevalence of wheezing in the last 12 months has also increased significantly with respect to the data corresponding to ISAAC Phase I. It can be affirmed that familial antecedents of asthma are significantly correlated to the fact of having experienced asthma at some point in time, or to wheezing in the previous 12 months. In the same way as for bronchial asthma, the increase in rhinitis has been significant. The presence of animals in the home is significantly associated to the fact of having experienced asthma at some point in time, though the presence of animals in the home has decreased significantly. An encouraging finding in our study is the fact that smoking has decreased significantly among adolescents in comparison with the previous data. However, the same does not apply to smoking among parents, which shows results similar to those recorded in the previous study - with an influence upon the same habit in the offspring. As in other studies, active smoker status is seen to be associated with the fact of having experienced asthma at some point in time. Although a common observation, the importance of hyper-responsiveness with exercise among adolescents is still not acknowledged, despite its significant correlation to the fact of having experienced asthma at some point in time, or wheezing in the previous 12 months.

[Allergic rhinitis and bronchial hyperreactivity]

BACKGROUND

Bronchial hyperreactivity (BHR) is a characteristic of bronchial asthma. Patients with allergic rhinitis who do not report symptoms of bronchial asthma on spirometry show BHR, which could indicate the presence of subclinical inflammation of the lower respiratory airway. The aim of this study was to investigate whether the patients diagnosed with allergic rhinitis in our unit without symptoms of bronchial asthma had bronchial hyperreactivity and to determine which allergens caused these symptoms in our patients.

METHODS AND RESULTS

We performed a retrospective, observational study of patients diagnosed with allergic rhinitis in our Allergy Unit between August 2000 and December 2001. The patients' medical records were reviewed and data on the following were gathered: demographic information, age, sex, rhinitis symptoms (perennial or seasonal), conjunctivitis, atopic dermatitis, bronchitis, sensitization (specific IgE, skin tests, nasal challenge tests), total IgE levels, spirometry performed through stress test (positive with a decrease of FEV1 > 15 % with stress or an increase of FEV1 of 12 % after bronchodilation) and family history of allergic disease. A total of 135 medical records of patients with allergic rhinitis were reviewed. Of these, 68 did not report symptoms of bronchial asthma (35 men and 33 women aged between 4 and 18 years). Most of our patients (50/68) reported perennial asthma and were sensitized to mites (44/68). In 14/68 spirometry was not performed at diagnosis. Stress test was positive in 13/54 (24 %). All patients who showed bronchial hyperreactivity were sensitized to mites and only one of these reported seasonal rhinitis.

CONCLUSIONS

According to the latest guidelines on the treatment and control of allergic rhinitis --The Allergic Rhinitis and its Impact on Asthma Workshop Report-- bronchial asthma and allergic rhinitis are distinct manifestations of a single airway and of the same disease. In view of our results, we recommend systematic evaluation of bronchial hyperreactivity in the study protocol of allergic rhinitis in patients who do not report symptoms of bronchial asthma.

Chromosome length polymorphism in Cryptococcus neoformans clinical and environmental isolates

A protocol for intact DNA preparation from the basidiomycetous yeast Cryptococcus neoformans has been developed and applied to karyotyping C. neoformans isolates displaying different degrees of capsule formation. A total of 46 strains have been analyzed: 23 (50%) isolated from environmental samples (pigeon droppings), all of them belonging to C. neoformans var. neoformans; and 23 (50%) from clinical samples (human and veterinarian) including 10 isolates of C. neoformans var. neoformans and 13 isolates of C. neoformans var. gattii. Our results showed a global genome size ranging from 14.2 to 20.9 Mb for variety neoformans and from 7.9 to 16.8 Mb for variety gattii. The karyotype diversity was very high for variety neoformans (29 different patterns for the 33 analyzed strains) and lower for variety gattii (six different patterns for 13 strains). No grouping among variety neoformans strains from the same origin was found indicating very high genome diversity for this variety, irrespectively of the origin of the strains.

Archaeal Biodiversity in Crystallizer Ponds from a Solar Saltern: Culture versus PCR

The culturable haloarchaeal diversity in a crystallizer pond from a solar saltern has been analyzed and compared with the biodiversity directly retrieved by analysis of rRNA genes amplified from the environment. Two different sets of culture conditions have been assayed: solid medium with yeast extract as carbon source and liquid media with either yeast extract or a mixture of fishmeal, Spirulina sp., and Artemia salina. Seventeen colonies grown on plates with yeast extract incubated at 30 degrees C were analyzed by 16S rDNA partial sequencing. Sixteen were closely related to haloarchaea of the genus Halorubrum; 13 of them to Halorubrum coriense, a haloarchaeon isolated from a solar saltern pond in Australia, which had not been previously isolated from the pond analyzed in this study; and one to Haloarcula marismortui. Liquid cultures were analyzed by ribosomal internal spacer analysis (RISA) and partial sequencing of the 16SrRNA genes. A total of 18 sequences were analyzed, 15 corresponding to RISA bands obtained from cultures, and 3 from the environmental sample used as inoculum. Thirteen sequences obtained from cultures were related to several Halorubrum species, and 2 to Haloarcula. One of the clones obtained directly from the environmental sample was distantly related to a Natronobacterium, whereas two were related to SPhT, the phylotype most frequently retrieved from this environment by culture independent techniques. Our results show an extremely low diversity for the haloarchaea retrieved by cultivation even when modifications to the standard technique are introduced.

Direct proof for the presence and expression of two 5% different 16S rRNA genes in individual cells of Haloarcula marismortui

A single-cell-derived pure culture of Haloarcula marismortui was obtained using the optical tweezers technique. Analysis of the 16S rRNA genes unambiguously demonstrated two 5% different 16S rRNA sequences. In addition, expression of both operons in the same cell was shown by fluorescence in situ hybridization with operon-specific probes.

Pulsed-field gel electrophoresis analysis of virus assemblages present in a hypersaline environment

A method for analyzing virus assemblages in aquatic environments was developed and used for studying the highest-salinity ponds (from 13.4 to 35% salinity) from a multi-pond solar saltern in Alicante, Spain. The protocol consisted of a series of concentration and purification steps including tangential flow filtration and ultracentrifugation, followed by the preparation of total viral nucleic acids that were subsequently separated by pulsed-field gel electrophoresis. For every sample analyzed, a characteristic DNA pattern was obtained, whose complexity was related to viral diversity. The comparison of our results with a similar analysis carried out with marine virus assemblages shows that, as expected, the viral diversity corresponding to the analyzed hypersaline environment is considerably lower than that of a marine environment.

Extremely halophilic bacteria in crystallizer ponds from solar salterns

It is generally assumed that hypersaline environments with sodium chloride concentrations close to saturation are dominated by halophilic members of the domain Archaea, while Bacteria are not considered to be relevant in this kind of environment. Here, we report the high abundance and growth of a new group of hitherto-uncultured Bacteria in crystallizer ponds (salinity, from 30 to 37%) from multipond solar salterns. In the present study, these Bacteria constituted from 5 to 25% of the total prokaryotic community and were affiliated with the Cytophaga-Flavobacterium-Bacteroides phylum. Growth was demonstrated in saturated NaCl. A provisional classification of this new bacterial group as "Candidatus Salinibacter gen. nov." is proposed. The perception that Archaea are the only ecologically relevant prokaryotes in hypersaline aquatic environments should be revised.

Prokaryotic diversity in Zostera noltii-colonized marine sediments

The diversity of microorganisms present in a sediment colonized by the phanerogam Zostera noltii has been analyzed. Microbial DNA was extracted and used for constructing two 16S rDNA clone libraries for Bacteria and Archaea. Bacterial diversity was very high in these samples, since 57 different sequences were found among the 60 clones analyzed. Eight major lineages of the Domain Bacteria were represented in the library. The most frequently retrieved bacterial group (36% of the clones) was delta-Proteobacteria related to sulfate-reducing bacteria. The second most abundant group (27%) was gamma-Proteobacteria, including five clones closely related to S-oxidizing endosymbionts. The archaeal clone library included members of Crenarchaeota and Euryarchaeota, with nine different sequences among the 15 analyzed clones, indicating less diversity when compared to the Bacteria organisms. None of these sequences was closely related to cultured Archaea organisms.

Fluorescence in situ hybridization analysis of the prokaryotic community inhabiting crystallizer ponds

A fluorescence in situ hybridization (FISH) protocol suitable for the identification of prokaryotes inhabiting hypersaline environments was developed and applied to several crystallizer ponds with salinities above 36% from a multipond solar saltern in Alicante, Spain. Two morphotypes were abundant in these environments: rods and square or square-like prokaryotes that could be affiliated to Bacteria and Archaea, respectively, by FISH with domain-specific probes. FISH with a newly designed probe proved that the archaeal 16S rDNA sequence most frequently recovered from the crystallizers, SPhT, originated from the dominant square-like prokaryotes. These uncultured prokaryotes have the morphology of Walsby's square bacteria. Additionally, FISH with a probe targeted to the genus Haloarcula, members of which are frequently isolated from this environment, indicated that this genus accounts for less than 0.1% of the total prokaryotic community.

Posttraumatic subgaleal hematoma: a case report and review of the literature

INTRODUCTION

A subgaleal hematoma or subaponeurotic hemorrhage occurs infrequently and is usually seen in pediatric patients, especially in the neonatal period. It may be associated with coagulation disorders.

CASE REPORT

We report on a previously healthy 19-month-old patient who presented with an extensive subgaleal hematoma and significant anemia secondary to a fall.

DISCUSSION

A literature review was conducted, and the etiology, diagnosis, and treatment of the subgaleal hematoma are discussed.

CONCLUSION

Conservative treatment, except in select severe cases, is recommended for this condition.

Structural studies on the acidic exopolysaccharide from Haloferax denitrificans ATCC 35960

The structure of a linear, acidic exopolysaccharide isolated from the Archaeon Haloferax denitrificans ATCC 35960 has been determined using NMR spectroscopy. The sugar residues in the repeating unit of the polysaccharide were identified as Gal and GlcA2,3NAc after the assignment of the 1H and 13C resonances using COSY, HOHAHA, HMQC and HMQC-TOCSY experiments. The sequence of the residues in the polysaccharide was established from the inter-residue connectivities observed in the HMQC-NOESY plot. The only sugar released on acid hydrolysis was shown to be D-Gal by GLC analysis, while the absolute configuration of the acidic sugars was shown to be D by comparison of the carbon chemical shifts with those of model compounds. Partial acid hydrolysis yielded a tetrasaccharide, terminated by D-Gal at the reducing end, whose structure confirmed that of the repeating unit of the polysaccharide as-->4)-beta-D-GlcpA2,3NAc-(1-->4)-beta-D-GlcpA2, 3NAc-(1-->4)-alpha-D-GlcpA2,3NAc-(1-->3)-alpha-D-Galp- (1-->, where D-GlcpA2,3NAc is 2,3-diacetamido-2,3-dideoxy-D-glucopyranosiduronic acid.

Diversity of free-living and attached bacteria in offshore Western Mediterranean waters as depicted by analysis of genes encoding 16S rRNA

In a previous study (S. G. Acinas, F. Rodríguez-Valera, and C. Pedrós-Alió, FEMS Microbiol. Ecol. 24:27-40, 1997), community fingerprinting by 16S rDNA restriction analysis applied to Mediterranean offshore waters showed that the free-living pelagic bacterial community was very different from the bacterial cells aggregated or attached to particles of more than about 8 micrometer. Here we have studied both assemblages at three depths (5, 50, and 400 m) by cloning and sequencing the 16S rDNA obtained from the same samples, and we have also studied the samples by scanning electron microscopy to detect morphology patterns. As expected, the sequences retrieved from the assemblages were very different. The subsample of attached bacteria contained very little diversity, with close relatives of a well-known species of marine bacteria, Alteromonas macleodii, representing the vast majority of the clones at every depth. On the other hand, the free-living assemblage was highly diverse and varied with depth. At 400 m, close relatives of cultivated gamma Proteobacteria predominated, but as shown by other authors, near the surface most clones were related to phylotypes described only by sequence, in which the alpha Proteobacteria of the SAR11 cluster predominated. The new technique of rDNA internal spacer analysis has been utilized, confirming these results. Clones representative of the A. macleodii cluster have been completely sequenced, producing a picture that fits well with the idea that they could represent a genus with at least two species and with a characteristic depth distribution.

The structure of the exocellular polysaccharide produced by the Archaeon Haloferax gibbonsii (ATCC 33959)

The structure of the neutral exocellular polysaccharide isolated from the Archaeon Haloferax gibbonsii (ATCC 33959) has been determined using acid hydrolysis, methylation analysis and NMR spectroscopy. The polysaccharide contained D-Man, D-Glc, D-Gal and L-Rha in the ratios 2:1:3:1. The substitution patterns of the sugar residues were deduced from the methylation analysis which indicated the polymer to be composed of a heptasaccharide repeating unit containing two branches. The 1H and 13C NMR resonances of the component sugars were assigned using COSY, HOHAHA, HMQC, and HMQC-TOCSY 2D NMR experiments and the sequence of the sugars in the repeating unit was determined from NOESY and HMBC experiments. The structure can be written as: [formula: see text]

Influence of diagnostic and treatment factors in the population pharmacokinetics of gentamicin

Using the NONMEM program, the population kinetics of gentamicin were retrospectively studied in a series of 51 patients with different pathologies undergoing treatment (single or three daily doses) with gentamicin whose serum gentamicin levels were being monitored. Renal function, the type of treatment and cancer proved to be the covariates which affected drug clearance, while patient weight was found to govern the distribution volume. The distribution coefficient of gentamicin in the patients was 0.37 litres/kg, justifying gentamicin doses higher than those used conventionally. The optimized population model allowed us to simulate drug serum levels at 8 and 12h, as well as the area under the curve of gentamicin and its variability in patients with high distribution volumes when dosage regimens based on a single daily dose administration are implemented.

Halobacterial megaplasmids are negatively supercoiled

Several covalently closed circular halobacterial megaplasmids (up to more than 500 kb) from different strains of Haloferax mediterranei, have been resolved by orthogonal-field alternating gel electrophoresis (OFAGE). These molecules seem to be negatively supercoiled in vivo, as deduced from the effect of intercalating agents affecting their topology and, therefore, their electrophoretic mobility. It has also been demonstrated that the topoisomerase II inhibitor novobiocin affects the native topological state of halobacterial megaplasmids impeding their migration in OFAGE under standard conditions for resolution of large supercoiled molecules.

Production of an Extracellular Polysaccharide by Haloferax mediterranei

The extremely halophilic archaebacterium Haloferax mediterranei produces an exocellular polymeric substance that gives the colonies a typical mucous character and is responsible for the appearance of a superficial layer in unshaken liquid medium. This exocellular polymeric substance can be obtained from the supernatant of shaken liquid cultures by cold ethanol precipitation, and yields as high as 3 mg/ml have been detected. The substance was produced under all the conditions tested and with all substrates assayed, although higher yields were obtained with sugars, particularly glucose, as carbon and energy source. The total exocellular polymeric substance produced was proportional to the total biomass. The polymer is a heteropolysaccharide containing mannose as the major component. Glucose, galactose, and another unidentified sugar were also present, as well as amino sugars, uronic acids, and a considerable amount of sulfate, which accounts for the acidic nature of the polymer. The infrared spectrum and specific assays showed the absence of acyl groups. The rheological properties of polymer solutions were studied, showing a pseudoplastic behavior and a high apparent viscosity at relatively low concentrations. Viscosity was remarkably resistant to extremes of pH, temperature, or salinity. These characteristics make this polymer interesting for enhanced oil recovery and other applications for which a very resistant thickening agent is required.