[Reply to "Nutritional Risk and Malnutrition in Paediatrics: From Anthropometric Assessment to STRONGkids® Screening Tool"]

N/D.

Insights into environmental caffeine contamination in ecotoxicological biomarkers and potential health effects of Danio rerio

Caffeine (CAF) exposures have been shown to cause several pharmacological and biological effects in target and non-target organisms. Although there are already several ecotoxicological studies with CAF in non-target organisms, they are focused on marine organisms, with relevant concentrations in these ecosystems, therefore, less ecologically relevant to freshwater ecosystems (the main ecoreceptor of this type of anthropogenic contaminant). The present study aimed to assess the chronic effects (28 days) of sub-lethal and environmentally relevant concentrations of CAF (0.16, 0.42, 1.09, 2.84, 7.40, 19.23, and 50 μg/L) in Danio rerio. Biochemical endpoints as biomarkers of antioxidant defense, biotransformation, lipid peroxidation, energy sources, and neurotransmission were assessed. CAF exposure induced alterations in antioxidant defenses (superoxide dismutase and glutathione reductase activities, and glutathione content) preventing lipid peroxidation. Lactate dehydrogenase activity decreased in all the concentrations tested, while acetylcholinesterase activity was only affected by the highest concentrations tested (19.23 and 50 μg/L). We also utilized a multi-biomarker approach (Integrated Biomarker Response version 2, IBRv2) to investigate the effects of CAF in the dispersion scope of individual biochemical responses of D. rerio. IBRv2 showed that the concentration of 50 μg/L promotes the highest stress. However, the results showed that CAF induced disturbances in the metabolic pathways studied in D. rerio. These results demonstrated the toxic effects of CAF on freshwater fish, compromising their physiological functions and evidencing the need for monitoring the residues of CAF released into the inland aquatic environments. Furthermore, this research evidence that phylogenetically and physiologically different species may present different biological responses with concern for ecologically relevant environmental conditions. In this sense, the present study generated ecotoxicologically relevant data, that can be considered by environment regulators, since the here-endpoints evaluated showed sensitivity and consistency in the evaluation of caffeine risks in freshwater environments.

Incidental Liver Lesions in children: A practical and evidence-based approach

Incidental liver lesions are increasingly being discovered in the context of the increased use of ultrasound studies and the majority are benign. In children, although individually rare, the differential diagnosis is broad and therefore a systematic approach is of utmost importance to reduce the radiological and disease burden in children and their families. This review article collected current evidence and provides fundamental information for the clinician regarding specific differential diagnoses and unique imaging features of benign liver lesions in children. Ultimately, we propose a practical stepwise approach mainly involving clinical and radiological workup. Laboratory tests and histopathological examination may be necessary in the presence of red flags or in indeterminate lesions.

0804 Sleep Bruxism, Awake Bruxism and Sleep Related Breathing Disorders in Adults With Down Syndrome

Introduction

To our knowledge, no studies have accessed theawake bruxism (AB) and stage by stage sleep bruxism (SB) in adults with Down syndrome. Recent works have shown that portable PSG systems are accurate for SB assessment even in the absence of audio-video recording. We aimed to evaluate the prevalence of awake bruxism, stage-by-stage sleep bruxism and Sleep Related Breathing Disorders (SRBD) in adults with Down syndrome.

Methods

Twenty-three adults with Down Syndrome (DS) were enrolled in this study. General health, dental status, parafunctional habits and temporomandibular symptoms were assessed. The history of SB/AB was taken from a questionnaire to the caregivers. A portable PSG type II system (Embla Embletta MPR+PG ST+Proxy, Natus, California-USA) was used to perform a full-sleep study at patients’ home. RMMA activity was defined as low (>1 and <2 episodes/h of sleep), moderate (>2 and <4 episodes/h of sleep), or high (>4 episodes/h of sleep). PSG diagnose of SB was assumed if RMMA index was >2 episodes/h of sleep.

Results

According to caregiver’s report, AB was present in all patients whereas only 13.1% had SB. PSG records showed a SB prevalence of 91.3%, with a mean RMMA index 40.0±30.0/h. Only 2 (8,7%) showed RMMA index of 0.0/h. SB episodes were predominant in N3 and REM sleep stage in 14 and 9 patients, respectively. All but one (95,7%) patient (isolated snoring) presented with OSA (AHI=32.8±28.6). A unique TMD symptom (pain on palpation) was present in 8,7% of the global sample.

Conclusion

The high prevalence of “definitive SB” together with the high prevalence of OSA and snoring point in favor to the recommendation of routine PSG in adults with DS. Furthermore, the low sensitivity of parent-oriented questionnaires reinforces the need of more accurate assessment tools in order to get a better standard of care in this particular group of patients.

Support

State of Sao Paulo Research Support Foundation - FAPESP grant number: 2017/06835-8

0657 Impact of Treatment With Mandibular Advancement Oral Appliance on Respiratory Parameters, Sleep and Cardiometabolic Risk Factors of CPAP Non-Adherent Patients With Severe Obstructive Sleep Apnea

Introduction

Obstructive sleep apnea (OSA) may trigger systemic changes linked to important cardiometabolic risk factors such as hypertension, stroke and diabetes II. As a life-threatening, multifactorial disorder, OSA demands a multiprofessional approach. The most common worldwide treatments are Continuous Positive Airway Pressure (CPAP) and Mandibular Advancement Oral Appliance (OAm). The aim of this study was to evaluate the impact of OAm treatment on CPAP non-adherent patients with severe OSA, comparing objective and subjective data between baseline and follow up.

Methods

A prospective study was carried out including non-adherent severe OSA patients, which were referred to OAm therapy evaluation. Patients presenting with snoring, gasping/choking during sleep, fatigue and daily sleepiness were evaluated by a sleep medicine specialist and the diagnosis of severe OSA with a basal polysomnography (PSG). All the patients were treated with a standard OAm (PMPositioner®). Baseline and Follow up (6 months) sleep parameters (PSG and Epworth Sleepiness Scale - ESS) were compared to assess treatment efficacy.

Results

Seventeen patients (9 with hypertension and 8 with hypertension + diabetes) met the inclusion criteria and 13 finished the protocol. After treatment with OAm the following parameters improved significantly: OSA severity (44.5±13.5 to 9.0±4.3, p≤0.001), ODI (46.8±11.6 to 12.1±9.1(p<0.05)), REM (18.4± 4.8 to 21.5± 2.9 (p<0.05)) and SaO2nadir (75.7± 9.4 to 87.0±3.6, p<0.001), ESS (p<0.005). Ten patients (58%) reported a reduction either in systolic and diastolic blood pressure with 3 of them (30%) reduced the hypertensive drug dose.

Conclusion

Our findings show that OAm is a safe and effective treatment option to CPAP non-adherent severe OSA patients. Furthermore OAm therapy had also a positive impact on cardiometabolic risk factors which are particularly relevant outcomes in OSA patients.

Support

State of Sao Paulo Research Support Foundation (FAPESP).

Quantifying steatosis in the liver and pancreas with MRI in patient with chronic liver disease

AIM

To compare pancreatic and hepatic steatosis quantified by proton density fat fraction (PDFF) on magnetic resonance imaging (MRI) in patients with chronic liver disease.

MATERIAL AND METHODS

This cross-sectional study included 46 adult patients who underwent liver biopsy for chronic viral hepatitis (n=19) or other chronic non-alcoholic liver diseases (NALD) (n=27). Liver biopsy was used as the gold standard for diagnosing and grading hepatic steatosis. All patients underwent clinical evaluation and MRI with a multi-echo chemical shift-encoded (MECSE) gradient-echo sequence for liver and pancreas PDFF quantification. We used Spearman's correlation coefficient to determine the degree of association between hepatic PDFF and steatosis grade, and between pancreatic PDFF and steatosis grade and hepatic PDFF. To compare the chronic viral hepatitis group and the NALD group, we used t-tests for continuous or ordinal variables and chi-square tests for categorical variables.

RESULTS

Hepatic PDFF measurements correlated with steatosis grades (R_S=0.875, p<0.001). Pancreatic PDFF correlated with hepatic steatosis grades (R_S=0.573, p<0.001) and hepatic PDFF measurements (R_S=0.536, p<0.001). In the subgroup of patients with chronic NALD, the correlations remained significant between pancreatic PDFF and hepatic PDFF (R_S=0.632, p<0.001) and between pancreatic PDFF and liver steatosis (R_S=0.608, p<0.001); however, in the subgroup of patients with viral hepatitis these correlations were no longer significant.

CONCLUSION

Pancreatic fat deposition correlates with hepatic steatosis in patients with chronic NALD, but not in those with chronic viral hepatitis.

Uptake and effects of different concentrations of spherical polymer microparticles on Artemia franciscana

Artemia cysts have a huge economic importance for the aquaculture sector due to the fact that they are used as live feed for larviculture. Microplastics (MPs) are common and emergent pollutants in the aquatic environments, with unknown and potential long-term effects on planktonic species such as Artemia spp. When used as live feed, Artemia could transfer contaminants to fish along the food chain, with possible adverse effects on human health through their consumption. This study aims to assess the uptake of different concentrations of spherical polymer microparticles (FRM) (1-5 μm diameter) and their associated chronic effects on feeding, growth, mortality, and reproductive success from juvenile to adult stage of brine shrimp Artemia franciscana. Individuals were exposed for 44 days to 0.4, 0.8 and 1.6 mg.L^-1 of FRM. No significant detrimental effects on growth, ingestion and mortality rates of A. franciscana were observed in all tested conditions. However, reproductive success was strongly affected by the increase of MP concentrations. The results of the present study showed that A. franciscana juveniles and adults were able to survive different experimental MP concentrations, but their reproductive success and progeny were significantly impacted by exposure to FRM particles.

Lymnaea stagnalis as a freshwater model invertebrate for ecotoxicological studies

Lymnaea stagnalis, also referred to as great or common pond snail, is an abundant and widespread invertebrate species colonizing temperate limnic systems. Given the species importance, studies involving L. stagnalis have the potential to produce scientifically relevant information, leading to a better understanding of the damage caused by aquatic contamination, as well as the modes of action of toxicants. Lymnaea stagnalis individuals are easily maintained in laboratory conditions, with a lifespan of about two years. The snails are hermaphrodites and sexual maturity occurs about three months after egg laying. Importantly, they can produce a high number of offspring all year round and are considered well suited for use in investigations targeting the identification of developmental and reproductive impairments. The primary aims of this review were two-fold: i) to provide an updated and insightful compilation of established toxicological measures determined in both chronic and acute toxicity assays, as useful tool to the design and development of future research; and ii) to provide a state of the art related to direct toxicant exposure and its potentially negative effects on this species. Relevant and informative studies were analysed and discussed. Knowledge gaps in need to be addressed in the near future were further identified.

Escherichia coli's water load affects zebrafish (Danio rerio) behavior

Traditional physico-chemical sensors are becoming an obsolete tool for environmental quality assessment. Biomonitoring techniques, such as biological early warning systems present the advantage of being sensitivity, fast, non-invasive and ecologically relevant. In this work, we applied a video tracking system, developed with zebrafish (Danio rerio), to detect microbiological contamination in water. Using the fishs' behavior response, the system was able to detect the presence of a non-pathogenic environmental strain of Escherichia coli, at three different levels of contamination: 600, 1800 and 5000 CFU/100 mL (colony forming units/100 mL). Data was collected during 50 min of exposure and analyzed with the artificial neural networks Self-organizing Map and Multi-layer Perceptron. The behavior of exposed fish was more erratic, with pronounced and rapid changes on movement direction and with significant less exploratory activity. The accuracy, sensitivity and specificity values regarding the detection capability (distinction between presence or absence of contamination) ranged from 89 to 100%. Regarding the classification capability (distinction between experimental conditions), the values ranged from 67 to 89%. This research may be a valuable contribution to improve water monitoring and management strategies, by taking as reference the effects on biosensors, without a biased anthropocentric perspective.

Effect of calcitriol on in vitro whole blood cytokine production in critically ill dogs

Hypovitaminosis D has been identified as a predictor of mortality in human beings, dogs, cats and foals. However, the immunomodulatory effects of vitamin D in critically ill dogs has not been evaluated. The aim of this study was to evaluate the effect of calcitriol on cytokine production from whole blood collected from critically ill dogs in vitro. Twelve critically ill dogs admitted to a veterinary intensive care unit (ICU) were enrolled in a prospective cohort study. Whole blood from these dogs was incubated with calcitriol (2×10^-7M) or ethanol (control) for 24h. Subsequent to this incubation, lipopolysaccharide (LPS)-stimulated whole blood production of tumor necrosis factor (TNF)-α, interleukin (IL)-6 and IL-10 were measured using a canine-specific multiplex assay. Calcitriol significantly increased LPS-stimulated whole blood production of IL-10 and decreased TNF-α production without significantly altering IL-6 production. There was no significant difference in whole blood cytokine production capacity between survivors and non-survivors at the time of discharge from the ICU or 30days after discharge. These data suggests that calcitriol induces an anti-inflammatory phenotype in vitro in whole blood from critically ill dogs.

Immune Function in Critically Ill Dogs

Background

People with critical illness (CI) commonly develop various forms of immune dysfunction, however, there is limited information concerning immune dysfunction in dogs with CI.

Hypothesis

The immune response in CI dogs differs from that of healthy dogs.

Animals

Immunologic variables were compared between 14 dogs with CI, defined as APPLE_fast score of >20 points, admitted to the University of Missouri Veterinary Health Center Small Animal Clinic Intensive Care Unit and healthy controls (n = 15).

Methods

Cohort study evaluating constitutive and lipopolysaccharide (LPS)‐stimulated TNF‐α, IL‐6, and IL‐10 production, phagocytosis of opsonized E. coli and respiratory burst capacity after opsonized E. coli or phorbol 12‐myristate 13‐acetate (PMA) stimulation, peripheral blood lymphocyte phenotype, and monocyte expressions of HLA‐DR and TLR‐4.

Results

Lipopolysaccharide‐stimulated leukocyte TNF‐α (median, Q1, Q3; CI, 49, 49, 120; control, 655, 446, 1174 pg/mL; P = < 0.001), IL‐6 (median, Q1, Q3; CI, 49, 49, 64; control, 100, 49, 166 pg/mL; P = 0.029), and IL‐10 (CI, 49, 49, 56; control, 96, 49, 203 pg/mL; P = 0.014) production and both E. coli (median, Q1, Q3; CI, 60.5, 43, 88.5; control, 86.6, 81, 89.2%; P = 0.047) and PMA (CI, 40, 11.7, 70; control, 93, 83, 97.6%; P = < 0.001)‐stimulated respiratory burst capacity significantly decreased in CI dogs. Percentage of monocytes expressing TLR‐4 greater in the CI dogs (median, Q1, Q3; CI, 46.9, 24.3, 64.2; control, 16.4, 9.4, 26.2%; P = 0.005).

Conclusion

These findings suggest dogs with CI develop immune system alterations that result in reduced respiratory burst function and cytokine production despite upregulation of TLR‐4.

Evaluation of the sensitivity spectrum of a video tracking system with zebrafish (Danio rerio) exposed to five different toxicants

The aim of this study was to develop a biological early warning system for the detection of aquatic toxicity and test it with five toxicants with distinct chemical nature. This was done in order to verify the spectrum of sensitivities of the proposed system, as well as the potential identification capability of the tested contaminants, using only the analysis of zebrafish's behavior. Six experimental conditions were tested: negative control and five toxicants (bleach, lindane, tributyltin, mercury, and formaldehyde). The exposure time was 45 min, and the concentrations used corresponded to 9% of LC₅₀'s-96 h for the tested compounds, to ensure ecologically relevant results. A total of 108 fish were used, with each individual experimental condition being tested 18 times. A statistical model of diagnosis was used, combining self-organizing map and correspondence analysis. The values of sensitivity, specificity, accuracy, false positive, false negative, positive predictive value (PPV), and negative predictive value (NPV) were calculated. The objectives of the work were accomplished and the system showed a good overall diagnostic performance with 79% in accuracy, 77% in sensitivity, and 88% in specificity. The lowest result of the predictive values was 78% (lindane and mercury), in the case of the NPV, and 86% (bleach and lindane), in the case of the PPV. The best result of the predictive values was 100% (bleach and tributyltin), for the NPV, and 89% (tributyltin), for the PPV. Regarding the five tested toxicants, the system was able to correctly identify the agent responsible for the contamination in 40% of the positive diagnoses.

Molecular mechanism of dynein recruitment to kinetochores by the Rod-Zw10-Zwilch complex and Spindly

The dynein motor is recruited to the kinetochore to capture spindle microtubules and control the spindle assembly checkpoint. Gama et al. reveal the molecular mechanism of how the Rod–Zw10–Zwilch complex and Spindly mediate dynein recruitment in Caenorhabditis elegans and human cells.

The molecular motor dynein concentrates at the kinetochore region of mitotic chromosomes in animals to accelerate spindle microtubule capture and to control spindle checkpoint signaling. In this study, we describe the molecular mechanism used by the Rod–Zw10–Zwilch complex and the adaptor Spindly to recruit dynein to kinetochores in Caenorhabditis elegans embryos and human cells. We show that Rod’s N-terminal β-propeller and the associated Zwilch subunit bind Spindly’s C-terminal domain, and we identify a specific Zwilch mutant that abrogates Spindly and dynein recruitment in vivo and Spindly binding to a Rod β-propeller–Zwilch complex in vitro. Spindly’s N-terminal coiled-coil uses distinct motifs to bind dynein light intermediate chain and the pointed-end complex of dynactin. Mutations in these motifs inhibit assembly of a dynein–dynactin–Spindly complex, and a null mutant of the dynactin pointed-end subunit p27 prevents kinetochore recruitment of dynein–dynactin without affecting other mitotic functions of the motor. Conservation of Spindly-like motifs in adaptors involved in intracellular transport suggests a common mechanism for linking dynein to cargo.

Evaluation of fibrosis and inflammation in diffuse liver diseases using intravoxel incoherent motion diffusion-weighted MR imaging

PURPOSE

The purpose of the study was to evaluate the role of intravoxel incoherent motion (IVIM) diffusion model for the assessment of liver fibrosis and inflammation in diffuse liver disorders, also considering the presence of liver steatosis and iron deposits.

METHODS

Seventy-four patients were included, with liver biopsy and a 3 Tesla abdominal magnetic resonance imaging examination, with an IVIM diffusion-weighted sequence (single-shot spin-echo echo-planar sequence, with gradient reversal fat suppression; 6 b-values: 0, 50, 200, 400, 600, and 800 s/mm²). Histological evaluation comprised the Ishak modified scale, for grading inflammation and fibrosis, plus steatosis and iron loading classification. The liver apparent diffusion coefficient (ADC) and IVIM parameters (D, D*, f) were calculated from the IVIM images. The relationship between IVIM parameters and histopathological scores were evaluated by ANOVA and Spearman correlation tests. A test-retest experiment assessed reproducibility and repeatability in 10 healthy volunteers and 10 randomly selected patient studies.

RESULTS

ADC and f values were lower with higher fibrosis stages (p = 0.009, p = 0.006, respectively) and also with higher necro-inflammatory activity grades (p = 0.02, p = 0.017, respectively). Considered together, only fibrosis presented a significant effect on ADC and f measurements (p < 0.05), whereas inflammation had no significant effect (p > 0.05). A mild correlation was found between ADC and f with fibrosis (R _S = -0.32 and R _S = -0.38; p < 0.05) and inflammation (R _S = -0.31 and R _S = -0.32, p < 0.05; respectively). The AUROC for ADC and f measurements with the different dichotomizations between fibrosis or inflammation grades were only fair (0.670 to 0.749, p < 0.05). Neither D nor D* values were significantly different between liver fibrosis or inflammation grades. D measurements were significantly different across histologic grades of steatosis (p < 0.001) and iron overload (p < 0.001), whereas f measurements showed significant differences across histologic steatosis grades (p = 0.005). There was an excellent agreement between the different readers for ADC, f, and D.

CONCLUSIONS

Although fibrosis presented a significant effect on ADC and f, IVIM measurements are not accurate enough to stage liver fibrosis or necro-inflammatory activity in diffuse liver diseases. D values were influenced by steatosis and iron overload.

Stress test of a biological early warning system with zebrafish (Danio rerio)

The aim of this work was to develop a novel methodology to stress test the diagnostic capability of a video tracking system with zebrafish (Danio rerio), against two pre-established disturbances. Eight different treatments were tested varying the presence or absence of a toxicant (NaOCl) and two disturbances: the passing of a shadow (mimicking a predator) and entrapment of the fish. The concentration tested corresponded to a sublethal (1 % 24 h-LC₅₀) and short term exposure (2 h). A total of 56 organisms were tested resulting in 112 diagnoses (before and after the contamination). A statistical model of diagnosis was developed using Self-organizing Map (SOM) and Correspondence Analysis (CA). Sensitivity, specificity, accuracy, false positive and false negative values were calculated to evaluate the diagnostic performance. The disturbances did not negatively affect the capability of the model. In the presence of at least one of these variables, the diagnostic performance was similar or even superior to the baseline results without disturbances. Furthermore, the system produced a large number of correct diagnoses, at an ecologically relevant concentration of exposure, in a non-invasive way.

Resilience assessment of a biological early warning system based on the locomotor behavior of zebrafish (Danio rerio)

With the development of new tools such as biological early warning systems, it becomes extremely important to test their reliability and detection capability. This work aimed at testing the sturdiness of a video tracking system by determining whether the detection capability does not deteriorate over time, after successive exposures of the zebrafish to three different toxicants, namely sodium hypochlorite, bisphenol A, and ethanol. Zebrafish were exposed to the three tested compounds separately (one fish, one toxicant) once a day, for 1 h and 30 m over 9 days, to 9 % of the 96 h LC50 of the respective toxicant. The behavior analysis was based on nine movement descriptor parameters of the fish, namely: angular velocity; linear velocity; spatial dispersion; linear acceleration; and angular acceleration. A statistical method was developed using self-organizing map (SOM), correspondence analysis, and linear and orthogonal multiple regression models. The results indicated that the system was able to successfully detect the three toxicants. With ethanol, the detection capability was maintained, but in the case of the sodium hypochlorite and bisphenol A, a deterioration of the detection capability occurred over the 9 days. This effect may be due to the induction of detoxification mechanisms and physiological acclimation, or due to the accumulation of adverse effects caused by the repeated exposure to the toxicants. Future works, especially those focusing on the application of similar early warning systems in real-world scenarios, should regularly exchange the sentinel organisms, to avoid degradation of the detection capability, as verified with two of the three tested compounds.

Video-tracking of zebrafish (Danio rerio) as a biological early warning system using two distinct artificial neural networks: Probabilistic neural network (PNN) and self-organizing map (SOM)

Biological early warning systems (BEWS) are becoming very important tools in ecotoxicological studies because they can detect changes in the behavior of organisms exposed to toxic substances. In this work, a video tracking system was fully developed to detect the presence of commercial bleach (NaOCl) in water in three different concentrations (0.0005%; 0.0010% and 0.0020% (v/v)) during one hour of exposure. Zebrafish was selected as the test organism because it is widely used in many different areas and studies. Two distinct statistical models were developed, using probabilistic neural network (PNN) and correspondence analysis associated with self-organizing map (SOM-CA). The diagnosis was based only in the analysis of a few behavioral components of the fish, namely: mean angular velocity, mean linear velocity, spatial dispersion, mean value of the X coordinate and mean value of the Y coordinate. Both models showed good results in their diagnosis capabilities. However, the overall performance (accuracy) was always superior in the PNN model. The worst result was with the SOM-CA model, at the lowest concentration (0.0005% v/v), achieving only 65% of correct diagnosis. The best result was with the PNN model, at the highest concentration (0.0020% v/v), achieving 94% of correct diagnosis.

Possibility of nonexistence of hot and superhot hydrogen atoms in electrical discharges

Recently, the existence of extremely energetic hydrogen atoms in electrical discharges has been proposed in the literature with large controversy, from the analysis of the anomalous broadening of hydrogen Balmer lines. In this paper, the velocity distribution of H atoms and the profiles of the emitting atom lines created by the exothermic reaction H2++H{2}→H{3}{+}+H+ΔE are calculated, as a function of the internal energy defect ΔE . The shapes found for the non-Maxwell-Boltzmann distributions resulting in non-Gaussian line profiles raise serious arguments against the existence of hot and superhot H atoms as it has been proposed, at least with those temperatures.

Occupancy of rotational population in molecular spectra based on nonextensive statistics

The procedure to obtain gas temperature in plasmas is to fit the experimental rotational spectrum to a theoretical one based on the Boltzmann distribution. For many systems a single distribution fails to account for the occupation of the levels. Researchers have improved the fitting by coupling two distributions and obtaining two distinct temperatures. They assigned the lowest temperature to the gas. Here, we show that these systems should be described by Tsallis nonextensive statistics and its unique associated temperature. Experimental and simulated spectra are tested and excellent agreement is obtained.

Expression, mutation and copy number analysis of platelet-derived growth factor receptor A (PDGFRA) and its ligand PDGFA in gliomas

BACKGROUND

Malignant gliomas are the most prevalent type of primary brain tumours but the therapeutic armamentarium for these tumours is limited. Platelet-derived growth factor (PDGF) signalling has been shown to be a key regulator of glioma development. Clinical trials evaluating the efficacy of anti-PDGFRA therapies on gliomas are ongoing. In this study, we intended to analyse the expression of PDGFA and its receptor PDGFRA, as well as the underlying genetic (mutations and amplification) mechanisms driving their expression in a large series of human gliomas.

METHODS

PDGFA and PDGFRA expression was evaluated by immunohistochemistry in a series of 160 gliomas of distinct World Health Organization (WHO) malignancy grade. PDGFRA-activating gene mutations (exons 12, 18 and 23) were assessed in a subset of 86 cases by PCR-single-strand conformational polymorphism (PCR-SSCP), followed by direct sequencing. PDGFRA gene amplification analysis was performed in 57 cases by quantitative real-time PCR (QPCR) and further validated in a subset of cases by chromogenic in situ hybridisation (CISH) and microarray-based comparative genomic hybridisation (aCGH).

RESULTS

PDGFA and PDGFRA expression was found in 81.2% (130 out of 160) and 29.6% (48 out of 160) of gliomas, respectively. Its expression was significantly correlated with histological type of the tumours; however, no significant association between the expression of the ligand and its receptor was observed. The absence of PDGFA expression was significantly associated with the age of patients and with poor prognosis. Although PDGFRA gene-activating mutations were not found, PDGFRA gene amplification was observed in 21.1% (12 out of 57) of gliomas. No association was found between the presence of PDGFRA gene amplification and expression, excepting for grade II diffuse astrocytomas.

CONCLUSION

The concurrent expression of PDGFA and PDGFRA in different subtypes of gliomas, reinforce the recognised significance of this signalling pathway in gliomas. PDGFRA gene amplification rather than gene mutation may be the underlying genetic mechanism driving PDGFRA overexpression in a portion of gliomas. Taken together, our results could provide in the future a molecular basis for PDGFRA-targeted therapies in gliomas.

Lorazepam-induced Heightened Sexual Desire

Introduction:

Drug-induced increased libido has been reported mainly with dopaminergic agents. Although benzodiazepines may cause behavioural dishinibition, they were rarely related to sexual undesired urges.

Case:

A 62-year-old woman was seen for breast mucinous carcinoma. Besides mild hypertension and initial insomnia she was otherwise previously healthy. She was chronically medicated with ramipril and diazepam 5mg id. Tumour ressection was carried out and chemotherapy with FEC-T was began. One week after, in a follow-up visit, she complained having difficulties on sleep onset. Lorazepam 1mg at the bedtime was prescribed. After the first dose she felt an overwhelming sexual desire, the urge making her to repeatedly open and close her legs, feeling even the physical intercourse. This sensation fade gradually over the next few hours. On the following day she decided to take another lorazepam pill to be sure it was the cause of that strange feelings. The symptoms of the previous night were completely reproduced. She has now completed the chemotherapy and proposed to adjuvant radiotherapy. She never felt those symptoms again and did not take another lorazepam.

Conclusion:

It is believed that dopaminomimetic drugs can heighten sexual desire by increasing dopamine concentration on the mesolimbic pathway. In this way, benzodiazepines, as GABA enhancers, would inhibit dopamine release leading to reduced libido. On the other hand, GABA also inhibits serotoninergic-mediated vigilance and impulse control, leading to dishinibition and impulsivity. In our patient, lorazepam has caused a “virtual intercourse” as previously found in electric and mechanic stimulation of septal region and amygdala.

Multicentre evaluation of the VITEK 2 Advanced Expert System for interpretive reading of antimicrobial resistance tests

Interpretive reading analyses the complete resistance profiles of bacteria to multiple antibiotics and infers the resistance mechanisms present; it aids therapeutic choice and enhances surveillance data. We evaluated the Advanced Expert System (AES), which interprets MICs generated by the VITEK 2. Ten European laboratories tested 42 reference strains and 76-106 of their own strains, representing important resistance genotypes. Interpretive reading by the VITEK 2 AES achieved full agreement with genotype data for 88-89% of strains, with the correct mechanism identified as one of two possibilities for a further 5-6%. Mechanisms inferred with 90% agreement with reference data included methicillin resistance in staphylococci, glycopeptide resistance in enterococci, quinolone resistance in staphylococci and Enterobacteriaceae, AAC(6')-APH(2")-mediated aminoglycoside resistance in Gram-positive cocci, erm-mediated macrolide resistance in pneumococci, extended-spectrum beta-lactamases (ESBLs) in Enterobacteriaceae and Pseudomonas aeruginosa, and acquired penicillinases in Enterobacteriaceae. VanA, VanB and VanC phenotypes of enterococci were distinguished reliably, and ESBL production was accurately inferred in AmpC-inducible species as well as Escherichia coli and Klebsiella spp. Mechanisms identified, but only as possibilities among several, included IRT-type beta-lactamases and individual aminoglycoside-modifying enzymes in Enterobacteriaceae. Most disagreements with reference data concerned pneumococci found to have high-level penicillin resistance by the VITEK 2 AES but previously determined, phenotypically, to have intermediate resistance. When ESBL production was inferred in E. coli and klebsiellae, the VITEK 2 AES edited susceptible results for cephalosporins (except cefoxitin) to resistant; when an acquired penicillinase was inferred in Enterobacteriaceae, piperacillin results were edited to resistant; and when staphylococci were found methicillin resistant, resistance was reported for all beta-lactams. Further editing may be desirable (e.g. of cephalosporin results for salmonellas inferred to have ESBLs).

[The assessment of functional status in the elderly. The application of a Portuguese version of the COOP/WONCA charts]

INTRODUCTION

The outcomes of medical care can be measured in terms of health or functional status. Several outcomes measures have been developed in the last years but, there are several difficulties with cross-cultural adaptations. This study is mainly an application exercise to a group of old people of a Portuguese version of the COOP/WONCA charts.

METHODS

A descriptive cross-sectional study with a component of qualitative analysis was done. Population basis was the elderly registered in the lists of five family doctors in two Portuguese health centres (Lumiar and Costa da Caparica) in the Lisbon region. A random sample of 189 patients (aged 65 and over) was interviewed. The studied variables were: gender, age, civil status, literacy, co-morbidity and dimensions of the COOP/WONCA charts. Univariate and bivariate analysis was done. A qualitative analysis was also performed to approach relevancy and acceptability of the charts to the elderly.

RESULTS

23% of the elderly had important limitations (values 4 and 5 of the charts) in physical fitness, 25% had unfavourable repercussions in feelings (values 4 and 5), 12% had important difficulties (value 4 and 5) in every-day life activities and 7% had important limitations in social life. 66% had no changes in their health in the last two weeks, 18% got better and 16% got worse. 21% valued their overall health as fair or poor, 47% as good and 24% as very good or excellent. Moderate to severe pain in the last two weeks was reported by 55% of the patients. Female reported in general worse scores than males. Statistical significance was found in the association between the number of the co-existent health problems in the same person (co-morbidity) and the values of some dimensions of the COOP/WONCA charts. In the half of the cases where the Katz index was measured there were non-concordance with the measures of the daily life of the COOP/WONCA charts. The charts had good acceptability and applicability but also some difficulties for illiterate elderly.

DISCUSSION

Although the use of COOP/WONCA charts could be difficult with elderly patients the present study showed its applicability and utility in the everyday clinical practice. The charts open new possibilities for international comparisons on functional status assessment.