Standardising personalised diabetes care across European health settings: A person-centred outcome set agreed in a multinational Delphi study

OBJECTIVE

Standardised person-reported outcomes (PRO) data can contextualise clinical outcomes enabling precision diabetes monitoring and care. Comprehensive outcome sets can guide this process, but their implementation in routine diabetes care has remained challenging and unsuccessful at international level. We aimed to address this by developing a person-centred outcome set for Type 1 and Type 2 diabetes, using a methodology with prospects for increased implementability and sustainability in international health settings.

METHODS

We used a three-round questionnaire-based Delphi study to reach consensus on the outcome set. We invited key stakeholders from 19 countries via purposive snowball sampling, namely people with diabetes (N = 94), healthcare professionals (N = 65), industry (N = 22) and health authorities (N = 3), to vote on the relevance and measurement frequency of 64 previously identified clinical and person-reported outcomes. Subsequent consensus meetings concluded the study.

RESULTS

The list of preliminary outcomes was shortlisted via the consensus process to 46 outcomes (27 clinical outcomes and 19 PROs). Two main collection times were recommended: (1) linked to a medical visit (e.g. diabetes-specific well-being, symptoms and psychological health) and (2) annually (e.g. clinical data, general well-being and diabetes self management-related outcomes).

CONCLUSIONS

PROs are often considered in a non-standardised way in routine diabetes care. We propose a person-centred outcome set for diabetes, specifically considering psychosocial and behavioural aspects, which was agreed by four international key stakeholder groups. It guides standardised collection of meaningful outcomes at scale, supporting individual and population level healthcare decision making. It will be implemented and tested in Europe as part of the H2O project.

Which diabetes specific patient reported outcomes should be measured in routine care? A systematic review to inform a core outcome set for adults with Type 1 and 2 diabetes mellitus: The European Health Outcomes Observatory (H2O) programme

OBJECTIVES

The objective was to identify candidate patient reported outcomes with potential to inform individual patient care and service development for inclusion in a digital outcome set to be collected in routine care, as part of an international project to enhance care outcomes for people with diabetes.

METHODS

PubMed, COSMIN and COMET databases were searched. Published studies were included if they recommended patient reported outcomes that were clinically useful and/or important to people with diabetes. To aid selection decisions, recommended outcomes were considered in terms of the evidence endorsing them and their importance to people with diabetes.

RESULTS

Twenty-seven studies recommending 53 diabetes specific outcomes, and patient reported outcome measures, were included. The outcomes reflected the experience of living with diabetes (e.g. psychological well-being, symptom experience, health beliefs and stigma) and behaviours (e.g. self-management). Diabetes distress and self-management behaviours were most endorsed by the evidence.

CONCLUSIONS

The review provides a comprehensive list of candidate outcomes endorsed by international evidence and informed by existing outcome sets, and suggestions for measures.

PRACTICE IMPLICATIONS

The review offers evidence to guide clinical application. Integrated measurement of these outcomes in care settings holds enormous potential to improve provision of care and outcomes in diabetes.

The effect of waterfowl signals and Pseudocorynosoma enrietti infection on the behaviour of the amphipod Hyalella patagonica

In the present study, we sought to determine whether i) a waterfowl signal induces avoidance behaviour of the amphipod Hyalella patagonica, ii) infection by the acanthocephalan Pseudocorynosoma enrietti affects the behaviour of the amphipod, and iii) the parasite interferes with the amphipod response to waterfowl. We evaluated amphipod behaviour experimentally by measuring activity levels, phototaxis, geotaxis, and clinging behaviour. The main findings of this study indicate that uninfected amphipods show avoidance behaviour by reducing their activity in the presence of a predator signal. Secondly, infected amphipods show altered behaviour, such as swimming in bright areas near the water surface, which makes them more visible to predators in nature. Lastly, the presence of predatory cues causes infected amphipods to drop to the bottom, which increases their visibility to predators. The present research allows us to perceive the intricate interplay among predators, parasites, and their intermediate hosts and advance our understanding of these complex ecological dynamics.

Outcomes of Patients with Severe Obesity and Cirrhosis with Portal Hypertension Undergoing Bariatric Surgery: a Systematic Review

PURPOSE

Thus far, little attention has been paid to bariatric surgery (BS) in patients with severe obesity (SO) and cirrhosis with portal hypertension (PH). To address this knowledge gap, we systematically reviewed the available literature and evidence about BS in patients with SO and cirrhosis with PH. We inform on the perioperative and long-term outcomes of this intervention.

MATERIALS AND METHODS

Articles were identified in MEDLINE, SCOPUS, LILACS, and SCIELO, and included if they analyzed SO patients with clinically significant PH and reported the characteristics and outcomes of BS.

RESULTS

Six articles, including 32 patients, were included. The most frequent type of BS was sleeve gastrectomy performed in 27 patients. Perioperative transfusions were often not required, with only one case report describing the use of 1 unit of packed red blood cells post-operatively. Neither intraoperative nor post-op deaths were reported. All patients reported significant weight loss with improvements in comorbidities during the follow-up periods. Overall, 27 out of 29 patients had T2DM resolution, and 13 out of 23 had arterial hypertension resolution. One study reported improvements in the parameters of fibroscan.

CONCLUSION

This systematic review described the outcomes of BS among patients with SO with cirrhosis and PH. Performing this kind of surgery among these patients appears safe and associated with acceptable perioperative and long-term outcomes. However, further studies are required to provide evidence-based, strong recommendations.

Effects of Naringin on Cardiomyocytes From a Rodent Model of Type 2 Diabetes

Diabetic cardiomyopathy (DCM) is a primary disease in diabetic patients characterized by diastolic dysfunction leading to heart failure and death. Unfortunately, even tight glycemic control has not been effective in its prevention. We have found aberrant diastolic Ca2+ concentrations ([Ca2+]d), decreased glucose transport, elevated production of reactive oxygen species (ROS), and increased calpain activity in cardiomyocytes from a murine model (db/db) of type 2 diabetes (T2D). Cardiomyocytes from these mice demonstrate significant cell injury, increased levels of tumor necrosis factor-alpha and interleukin-6 and expression of the transcription nuclear factor-κB (NF-κB). Furthermore, decreased cell viability, and reduced expression of Kir6.2, SUR1, and SUR2 subunits of the ATP-sensitive potassium (KATP) channels. Treatment of T2D mice with the citrus fruit flavonoid naringin for 4 weeks protected cardiomyocytes by reducing diastolic Ca2+ overload, improving glucose transport, lowering reactive oxygen species production, and suppressed myocardial inflammation. In addition, naringin reduced calpain activity, decreased cardiac injury, increased cell viability, and restored the protein expression of Kir6.2, SUR1, and SUR2 subunits of the KATP channels. Administration of the KATP channel inhibitor glibenclamide caused a further increase in [Ca2+]d in T2D cardiomyocytes and abolished the naringin effect on [Ca2+]d. Nicorandil, a KATP channel opener, and nitric oxide donor drug mimic the naringin effect on [Ca2+]d in T2D cardiomyocyte; however, it aggravated the hyperglycemia in T2D mice. These data add new insights into the mechanisms underlying the beneficial effects of naringin in T2D cardiomyopathy, thus suggesting a novel approach to treating this cardiovascular complication.

Mortality in patients treated for COVID-19 in the emergency department of a tertiary care hospital during the first phase of the pandemic: Derivation of a risk model for emergency departments

OBJECTIVES

To develop a risk model to predict 30-day mortality after emergency department treatment for COVID-19.

MATERIAL AND METHODS

Observational retrospective cohort study including 2511 patients with COVID-19 who came to our emergency department between March 1 and April 30, 2020. We analyzed variables with Kaplan Meier survival and Cox regression analyses.

RESULTS

All-cause mortality was 8% at 30 days. Independent variables associated with higher risk of mortality were age over 50 years, a Barthel index score less than 90, altered mental status, the ratio of arterial oxygen saturation to the fraction of inspired oxygen (SaO2/FIO2), abnormal lung sounds, platelet concentration less than 100 000/mm3, a C-reactive protein concentration of 5 mg/dL or higher, and a glomerular filtration rate less than 45 mL/min. Each independent predictor was assigned 1 point in the score except age, which was assigned 2 points. Risk was distributed in 3 levels: low risk (score of 4 points or less), intermediate risk (5 to 6 points), and high risk (7 points or above). Thirty-day risk of mortality was 1.7% for patients who scored in the low-risk category, 28.2% for patients with an intermediate risk score, and 67.3% for those with a high risk score.

CONCLUSION

This mortality risk stratification tool for patients with COVID-19 could be useful for managing the course of disease and assigning health care resources in the emergency department.

Endogenous cortisol excess confers a unique lipid signature and metabolic network

Chronic cortisol excess induces several alterations on protein, lipid and carbohydrate metabolism resembling those found in the metabolic syndrome. However, patients exposed to prolonged high levels of cortisol in Cushing syndrome (CS) present exceeding cardiometabolic alterations not reflected by conventional biomarkers. Using 3 ultra-high-performance liquid chromatography-tandem mass spectrometry (UHPLC-MS) platforms, we aimed to characterise the serum metabolome of 25 patients with active endogenous CS and 25 control subjects matched by propensity score (sex, BMI, diabetes mellitus type 2 (T2D), high blood pressure (HBP) and dyslipidaemia) to search for potential disease-specific biomarkers and pathways associated to the clinical comorbidities. A total of 93 metabolites were significantly altered in patients with CS. Increased levels of sulfur amino acids (AA), triacylglycerols, glycerophospholipids, ceramides and cholesteryl esters were observed. Contrarily, concentrations of essential and non-essential AA, polyunsaturated fatty acids, conjugated bile acids and second messenger glycerolipids were decreased. Twenty-four-hour urinary free cortisol (24h-UFC) independently determined the concentration of 21 lipids and 4 AA. A metabolic signature composed by 10 AA and 10 lipid metabolites presented an AUC-ROC of 95% for the classification of CS patients. Through differential network analysis, 152 aberrant associations between metabolites involved in the Lands cycle and Kennedy pathway were identified. Our data indicates that chronic hypercortisolemia confers a unique lipidomic signature and several alterations in numerous AA even when compared to patients with similar metabolic comorbidities providing novel insights of the increased cardiometabolic burden of CS. KEY MESSAGES: • Cortisol excess induces metabolic alterations beyond conventional biomarkers. • The hypercortisolism extent determines the concentration of 21 lipids and 5 aa. • Cortisol excess confers a unique metabolic signature of 20 metabolites. • Kennedy and Lands cycle are profoundly disturbed by cortisol excess.

Factors associated with revisits by patients with SARS-CoV-2 infection discharged from a hospital emergency department

OBJECTIVES

To analyze emergency department (ED) revisits from patients discharged with possible coronavirus disease 2019 (COVID-19).

MATERIAL AND METHODS

Retrospective observational study of consecutive patients who came to the ED over a period of 2 months and were diagnosed with possible COVID-19. We analyzed clinical and epidemiologic variables, treatments given in the ED, discharge destination, need to revisit, and reasons for revisits. Patients who did or did not revisit were compared, and factors associated with revisits were explored.

RESULTS

The 2378 patients included had a mean age of 57 years; 49% were women. Of the 925 patients (39%) discharged, 170 (20.5%) revisited the ED, mainly for persistence or progression of symptoms. Sixty-six (38.8%) were hospitalized. Odds ratios (ORs) for the following factors showed an association with revisits: history of rheumatologic disease (OR, 2.97; 95% CI, 1.10-7.99; P = .03), digestive symptoms (OR, 1.73; 95% CI, 1.14-2.63; P = .01), respiratory rate over 20 breaths per minute (OR, 1.03; 95% CI, 1.0-1.06; P = .05), and corticosteroid therapy given in the ED (OR, 7.78; 95% CI, 1.77-14.21, P = .01). Factors associated with hospitalization after revisits were age over 48 years (OR, 2.57; 95% CI, 1 42-4.67; P = .002) and fever (OR, 4.73; 95% CI, 1.99-11.27; P = .001).

CONCLUSION

Patients under the age of 48 years without comorbidity and with normal vitals can be discharged from the ED without fear of complications. A history of rheumatologic disease, fever, digestive symptoms, and a respiratory rate over 20 breaths per minute, or a need for corticosteroid therapy were independently associated with revisits. Fever and age over 48 years were associated with a need for hospitalization.

Aplicaciones de la tecnología de membranas en la industria alimentaria/Applications of membrane technology in the food industry

Membrane technology has emerged as a useful tool for separations in the food industry over the last two decades. Ultrafiltration (UF), reverse osmosis (RO) and cross flow microfiltration (CFMF) are already well established technologies in the dairy industry. To a lesser extent the above unit opera tions are used in tomato juice concentration and clarification of juices and wine. Other important potential applications concern aroma recovery from fruit juices using pervaporation, treatment of food industry waste effluents such as brine/blanching/osmotic solution using nanofiltration and other unit operations and finally recovery of valuable compounds from food wastes aiming at their transformation to products of medical importance, using bioreactors coupled with unit operations. In addition to the applications, the limiting factors and guidelines for modelling are also given.

Syndromic surveillance system based on near real-time cattle mortality monitoring

Early detection of an infectious disease incursion will minimize the impact of outbreaks in livestock. Syndromic surveillance based on the analysis of readily available data can enhance traditional surveillance systems and allow veterinary authorities to react in a timely manner. This study was based on monitoring the number of cattle carcasses sent for rendering in the veterinary unit of Talavera de la Reina (Spain). The aim was to develop a system to detect deviations from expected values which would signal unexpected health events. Historical weekly collected dead cattle (WCDC) time series stabilized by the Box-Cox transformation and adjusted by the minimum least squares method were used to build the univariate cycling regression model based on a Fourier transformation. Three different models, according to type of production system, were built to estimate the baseline expected number of WCDC. Two types of risk signals were generated: point risk signals when the observed value was greater than the upper 95% confidence interval of the expected baseline, and cumulative risk signals, generated by a modified cumulative sum algorithm, when the cumulative sums of reported deaths were above the cumulative sum of expected deaths. Data from 2011 were used to prospectively validate the model generating seven risk signals. None of them were correlated to infectious disease events but some coincided, in time, with very high climatic temperatures recorded in the region. The harvest effect was also observed during the first week of the study year. Establishing appropriate risk signal thresholds is a limiting factor of predictive models; it needs to be adjusted based on experience gained during the use of the models. To increase the sensitivity and specificity of the predictions epidemiological interpretation of non-specific risk signals should be complemented by other sources of information. The methodology developed in this study can enhance other existing early detection surveillance systems. Syndromic surveillance based on mortality monitoring can reduce the detection time for certain disease outbreaks associated with mild mortality only detected at regional level. The methodology can be adapted to monitor other parameters routinely collected at farm level which can be influenced by communicable diseases.

Nonlinear analyses of cell proliferation in the central nervous system reveal stochastic and deterministic components

This paper analyzes the dynamics of cell proliferation in the developing central nervous system. Three different algorithms, Fano factor, Allan factor and detrended fluctuations analysis, are used to estimate de scaling exponent of space numerical series obtained by recording the number and position of proliferating cells along the cephalic-caudal axis of the system. It can be concluded that the dynamics of proliferation involves two component: (a) a random noncorrelated stochastic component representing a basal proliferating activity uniformly distributed along the cephalic-caudal axis and (b) a deterministic nonstationary component that imposes a defined global trend to the process. The deterministic nonstationary trend can be interpreted as the effect of a controlling influence operating along the cephalic-caudal axis. This result indicates that the proliferative activity is spatially organized along the cephalic-caudal axis of the system.

Bronchial hyperresponsiveness and analysis of induced sputum cells in Crohn's disease

With the aim of investigating the presence of latent inflammatory process in the lungs of patients with Crohn's disease, 15 patients with Crohn's disease were evaluated by spirometry, the methacholine challenge test, induced sputum, and skin tests for inhaled antigens. Serum IgE, erythrocyte sedimentation rate and hematocrit were also determined. The patients were compared with 20 healthy controls by the Mann-Whitney and Fisher exact tests. Their respiratory physical examination was normal. None had a personal or family history of clinical atopy. None had a previous history of pulmonary disease, smoking or toxic bronchopulmonary exposure. None had sinusitis, migraine, diabetes mellitus, or cardiac failure. Four (26.6%) of the patients with Crohn's disease had a positive methacholine challenge test whereas none of the 20 controls had a positive methacholine test (P = 0.026, Fisher exact test). Patients with Crohn's disease had a higher level of lymphocytes in induced sputum than controls (mean 14.59%, range 3.2-50 vs 5.46%, 0-26.92%, respectively; P = 0.011, Mann-Whitney test). Patients with Crohn's disease and a positive methacholine challenge test had an even higher percentage of lymphocytes in induced sputum compared with patients with Crohn's disease and a negative methacholine test (mean 24.88%, range 12.87-50 vs 10.48%, 3.2-21.69%; P = 0.047, Mann-Whitney test). The simultaneous findings of bronchopulmonary lymphocytosis and bronchial hyperresponsiveness in patients with Crohn's disease were not reported up to now. These results suggest that patients with Crohn's disease present a subclinical inflammatory process despite the absence of pulmonary symptoms.

An Ectosymbiotic Flatworm, Temnocephala chilensis, as Second Intermediate Host for Echinoparyphium megacirrus (Digenea: Echinostomatidae) in Patagonia (Argentina)

During a survey of parasites of the Patagonian freshwater crab Aegla neuquensis neuquensis, its ectosymbiont Temnocephala chilensis was found parasitized with an echinostomatid metacercaria with 43 collar spines. Of the 414 T. chilensis collected, 106 were parasitized with metacercariae of Echinoparyphium sp. Ovigerous adults of E. megacirrus were obtained from domestic chicks experimentally infected with metacercariae obtained from temnocephalans. This is the first record of temnocephalans being parasitized by digeneans.

Steganoderma szidati n. sp. (Trematoda: Zoogonidae) from Galaxias maculatus (Jenyns) and G. platei Steindachner in Patagonia, Argentina

Steganoderma szidati n. sp. is described from the intestine of two freshwater fishes, Galaxias maculatus and G. platei (Galaxiidae), from Andean lakes in Patagonia, Argentina. This freshwater zoogonid species fits in the genus Steganoderma (sensu Bray, 1987) because of the length of the caeca and the position of the vitelline follicles. The new species is characterised by possessing 6-13 vitelline follicles situated between the anterior margin of the ventral sucker and the posterior margin of the testis. The gonads are in the anterior hindbody and the ovary is anterior to the right testis. The cirrus has two conspicuous spines at its distal end, and the seminal vesicle always exhibits a constriction. The excretory vesicle never reaches the level of the posterior margin of the testes.

Proteases with plasminogen activator activity in hamster oviduct

At present the physiological role of most oviductal proteins remains unknown. In this work, we present evidence that the oviductal secretion as well as the crude oviductal tissue-extract show proteolytic-like esterase and amidase activity. The proteolytic activity of the oviductal enzymes was higher in the oviducts of superovulated hamster females than in those of normal ones, indicating that gonadotrophic hormones would stimulate the synthesis and secretion of these enzymes. Some of their properties were analyzed in the 15,600-g supernatant of both oviductal tissue extracts (OE) and oviductal fluid (OF). The enzymatic activity toward the synthetic substrates p-tosyl-l-arginine methyl ester-HCl (TAME) and alpha-N-benzoyl-dl-arginine-p-nitroanilide HCl (BAPNA) was activated by calcium ions, reached a maximum at pH 7.5, and was inhibited by soybean trypsin inhibitor (SBTI), N-alpha-p-tosyl-l-lysine chloromethyl ketone HCl (TLCK), phenyl methyl sulfonyl fluoride (PMSF), and benzamidine. The OE glycoprotein fraction recognized by WGA-Sepharose affinity columns (37% total proteins) showed proteolytic activity with properties similar to the OE and OF enzymes. The protease activity could be ascribed to a plasminogen activator (PA) detected in the Triton X-100 treated tissue crude membrane fraction (Triton-CMF) and in the oviductal secretion of the superovulated females. In the Triton-CMF fraction, 100% of the proteolytic activity was plasminogen-dependent. The use of amiloride, a selective urokinase-type plasminogen activator (uPA) inhibitor, shows that 90% of this activity was due to a tissue-type plasminogen activator (tPA) and 10% to uPA whereas in the uterus 100% of the activity was tPA. Only a small percentage of the OF proteolytic activity was plasminogen-dependent, probably due to the presence of PA inhibitors in this medium.

Blue filter amblyopia treatment protocol for strabismic amblyopia: a prospective comparative study of 50 cases

PURPOSE

Previous studies of monochromatic visual evoked potentials confirm the strong suppression of (the cortical representation of) paracentral retinal areas of functionally amblyopic eyes, by a flat response to a blue stimulus. A clinical trial stimulating these areas with blue light was encouraging, and justified a prospective comparison of this treatment with conventional classic treatment.

SUBJECTS AND METHODS

In 50 strabismic children with amblyopia, the blue filter treatment protocol (flash stimulation with, and the wearing of, a blue filter during occlusion of the better eye for one hour daily) was compared with the classical treatment (full time total occlusion by patch) in a prospective matched and randomized study. Patients 3 to 7 years old without previous treatment and a visual acuity up to 0.3 were admitted to the study. Visual acuity and fixation behavior were used as the parameters of comparison. Visual Evoked Potentials by monochromatic flashes were also studied. Results of treatment were compared after 6 months.

RESULTS

The visual acuity outcome for the blue filter treatment was "statistically significantly" better (p=0.005). The greatest improvement was seen in the subgroup of children with eccentric fixation (p=0.01). Fixation behavior also showed a better outcome from the blue filter treatment (p=0.05) favoring especially children between 3 and 5 years. In children of this age with a visual acuity better than 0.1 we found a very "statistically significant" difference between the two treatments (p=0.004). In children 3 to 5 years old with poorer visual acuity we also found a "statistically significant" difference in the two treatments (p=0.04). The interocular difference of amplitude on the Visual Evoked Potentials also demonstrated more improvement in children treated with the blue filter. This treatment improved especially the cortical response to blue flash stimulation, correlating to paracentral retinal areas.

CONCLUSIONS

The blue filter treatment protocol provided better results for treating amblyopia than the conventional classic occlusion treatment method. We propose that stimulation of these paracentral retinal areas triggers a better disinhibition of a functionally amblyopic eye.

Developmental pattern of plasminogen activator activity in chick brain hemispheres

Plasminogen activators play key roles in several developmental events. In previous works we demonstrated the existence of typical developmental patterns of protease activity in the chick optic lobe and cerebellum. The aim of this work is to study the temporal pattern of development of plasminogen activator activity in the brain hemispheres. Plasminogen activator activity was assayed in soluble fractions derived by ultracentrifugation from Triton X-100 treated membrane fractions by using a radial fibrinolytic assay. Employing different inhibitors and anti-plasminogen activators antibodies we showed that developing brain hemispheres express only one type of enzyme which corresponds to the urokinase-type. Other results indicate that the protease activity displays a temporal pattern which completely differs from those of general parameters of development. This suggests that the plasminogen activator activity is developmentally regulated and could display specific functions during particular stages of development.

Cutaneous aspergillosis: a report of six cases

Skin invasion by Aspergillus is infrequent. We here describe six immunocompromised patients with skin manifestations caused by Aspergillus. A heart transplant recipient developed a primary cutaneous aspergillosis; two patients (one with chronic granulomatous disease and another treated with a high dose of corticosteroids) presented with nodular lesions secondary to haematogenous dissemination; and three patients with acute myelogenous leukaemia had skin dissemination by contiguity from orbit and sinus invasion. A. flavus was isolated in the three cases of leukaemia; the infection was due to A. fumigatus in the transplant recipient; A. fumigatus and A. versicolor were isolated in the patients with the secondary aspergillosis. In most cases, amphotericin B was useful, with clinical and mycological remission in four patients. A patient with leukaemia died without undergoing treatment, and a child carrier of chronic granulomatous disease died after only 12 days of treatment.

Temporal pattern of plasminogen activator activity in the developing chick cerebellum

Plasminogen activators are considered to be involved in several developmental events. The present work aims at characterizing the developmental pattern of expression of plasminogen activators in the chick cerebellum. Soluble fractions derived by ultracentrifugation from Triton X-100 treated membrane fractions were used for determination of the enzyme activity with a radial fibrinolytic assay. By using specific inhibitors and different anti-plasminogen activators antibodies it is shown that only one type of the enzyme, the urokinase-type plasminogen activator, is expressed during the cerebellum ontogeny. Our results show the existence of a bimodal pattern of enzyme activity with two peaks that temporally coincide with the processes of massive neuronal migration, neurite outgrowth and synapse formation and plasticity. It is proposed that plasminogen activator could play a role in these developmental events and that its pattern of variability is developmentally regulated.

Developmental pattern of plasminogen activator activity in chick optic lobe

Plasminogen activators are serine proteases which play a key role in morphogenesis and tissue remodelling. Two different molecular types, tissue-type and urokinase-type, were identified and they were postulated to play a role in neural development. The developing chick optic lobe plays a central role in processing visual information. In previous studies we demonstrated the occurrence of high levels of plasminogen activator activity in this model. The aim of the present paper is to study the temporal pattern of expression of this activity and characterize the type of plasminogen activator expressed in the developing optic lobe. Using soluble fractions derived by ultracentrifugation from Triton X-100-treated membrane fractions we measured the protease activity with a radial fibrinolytic assay. Employing different inhibitors of fibrinolytic activity and a zymographic assay, we showed that the developing optic lobe expresses only one type of plasminogen activator which corresponds to an urokinase-type of 70 kDa. Our results indicate that peaks of protease activity temporally correlate with massive neuronal migration, neurite outgrowth and synapse formation and maturation. This suggests that a plasminogen activator could play a role in these developmental events. This consistent pattern of variability strongly suggests that it is developmentally regulated and, if so, it could be a reliable parameter to study neural plastic changes induced by modifications in the environmental stimulation.

[Contribution to the morphological description of Tylodelphys barilochensis and Tylodelphys crubensis (Trematoda, Diplostomidae) encephalon parasites of Galaxias maculatus (Teleostei, Galaxiidae)]

Taxonomic characteristics, for species identification, of metacercarie of T. barilochensis and T. crubensis found in the encephalon of the fish Galaxias maculatus, not included in the original descriptions, particularly those concerning to the excretory system, are described.

Evidence for heme-heme excitonic coupling in the Soret circular dichroism of hemoglobin

In order to study interdimer heme-heme electronic interactions in human hemoglobin, the Soret circular dichroism spectrum of the carboxy adduct is measured as a function of protein concentration, the spectrum at the highest concentration representing primarily that of alpha2beta2 tetramers (93%) and the lowest concentration representing primarily alphabeta dimers (68%). The tetramer-dimer difference spectrum, obtained using singular value decomposition and linear least squares fitting from a matrix of CD spectra measured at ten concentrations, is roughly conservative, with a larger negative lobe at shorter wavelengths and a peak-to-trough magnitude that is 18% of the tetramer's maximum Soret CD magnitude. It is tentatively assigned to heme-heme excitonic interactions on the basis of theoretical predictions by R. W. Woody [(1985) in Optical Properties and Structure of Tetrapyrroles (Blauer, G., and Sund, H., Eds.), pp. 239-256, Walter de Gruyter, New York].

Development of the laminated pattern of the chick tectum opticum

Several ontogenetic studies have been devoted to the structural organization of the developing tectum opticum. They disagree in many respects because they are based on histological preparations performed with differently oriented planes of section. According to our results the differences found in the literature mainly result from the fact that the developmental gradient axis undergoes remarkable positional changes with respect to both optic lobe and neural tube longitudinal anatomical axes during the early stages of development. The present work is a dynamic description of the tectum opticum lamination based on sections coinciding with the developmental gradient. Since this latter displays a curved disposition, several slightly modified planes of section had to be used to obtain a complete picture along the developmental gradient. The development of the tectal architecture proceeds from a relatively simple organization through increasingly complex multilaminated patterns. A dynamic interpretation of successive images of a particular region observed at increasing developmental stages or of images observed at a particular stage along the entire length of the developmental gradient axis, allows us to propose that embryonic laminae are only transient spatial arrangements of cells actively migrating from the sites where they were generated to those where they will definitively reside. These considerations led us to define a nomenclature that establishes clear correlations between the early transient organizations and the definitive one of the fully developed optic tectum. This type of nomenclature could be usefully applied to describe dynamically the development of structures displaying multilaminated patterns such as other cortical zones of the central nervous system.

Development of serotonergic innervation of the chick embryo tectum opticum

This paper describes the development of the serotonergic innervation of the chick tectum opticum as revealed by an immunohistochemical methodology. The development of this innervation was previously described simply as the formation of an irregular network of serotonergic fibers that gradually invades the organ and increases in density. Our results show that the developmental pattern of serotonergic innervation differs significantly through the distinct tectal layers and that it progresses through a characteristic temporospatial pattern related to the lamination process. These findings support the idea that the concept of laminar segregation can be applied to describe the development of the serotonergic innervation. On the other hand, it is clear that the existence of a typical ordered developmental pattern of innervation makes it possible to detect embryonic or post-hatching alterations. Thus, the tectal serotonergic innervation could be used as a suitable model to investigate possible plastic changes in experimental conditions.

Current Triton X-100 treatments do not allow a complete plasminogen activator extraction from developing nervous tissue

Determinations of plasminogen activator (PA) activity are usually performed in Triton X-100-treated tissue homogenates or crude membrane fractions. Such preparations usually involve a single Triton X-100 treatment. In the present paper we describe the pattern of variability of PA activity measured in different fractions obtained from the developing chick CNS by a repetitive procedure of Triton X-100 treatment and ultracentrifugation. To further characterize this PA activity we have also performed zymographic analyses during the embryonic development and the early postnatal life. Our results show that: a) a single Triton X-100 treatment does not completely extract the enzyme and this lead to an underestimation of the total PA activity; b) the PA activity is associated with the particulate component of the total tissue homogenate requiring its complete solubilization more drastic Triton X-100 treatments; c) better estimations of total and specific activities are obtained by using soluble fractions derived by ultracentrifugation from Triton X-100-treated membrane fractions; d) the developing chick optic lobe expresses only one kind of PA molecule along the entire development; e) the level of PA activity vary characteristically during the ontogeny and the early postnatal life indicating the existence of a developmentally regulated mechanism of PA expression.

Methods for removing endogenous factors from CNS membrane preparations: differences in [3H]GABA binding parameters and developmental-related effects

The present report describes a systematic study comparing and combining methods currently used for the removal of endogenous factors known to affect the interaction of GABA with its receptor. The effects of these methods were analyzed by performing [3H]GABA binding studies, and by measuring the amount of residual GABA left in the different membrane preparations. The effectiveness of these methods were also applied to different developmental stages. The results show that: 1) an exhaustive buffer washing procedure is necessary to accurately measure the maximal binding capacity (Bmax) of the low-affinity GABA binding site, and 2) the use of more drastic methods, including freeze-thawing and Triton treatment allows a clear demonstration of receptor heterogeneity and a precise measurement of the Bmax of the high-affinity GABA binding site as well as increases the affinity of the low-affinity site. The analysis of the Bmax values obtained with these different procedures in relation to the values of GABA removal, strongly indicates that the exhaustive washing procedure removes some unknown endogenous substances required for Triton treatment to exhibit its maximal effectiveness. Finally, a detailed analysis of Kd and Bmax values obtained with these three methods in the developing nervous tissue shows the existence of significant differences with regard to their effectiveness in removing endogenous substances when applied in different developmental stages.

Ultra-short topical treatment of pityriasis versicolor with 2.5% bifonazole cream

The therapeutic efficacy of a preparation containing 2.5% bifonazole was investigated by comparing three different treatment modalities--A, B, and C. Group A used bifonazole only on Days 1, 2 and 3, and the Group C on Days 1, 3 and 5. Of the patients in Group A 56% had a negative mycological examination at the end of the study. The results obtained in Groups B and C were not significantly different: 92% of the patients had a negative mycological examination at the end of the study. Electron microscope (EM) studies showed morphological alterations such as loss of cytoplasmic organization with shrinkage and folding of the cell membranes after 1 week of treatment only in Groups B and C. We conclude that 2.5% bifonazole is a highly effective treatment for Pityrosporum ovale infection when applied using a 3-day schedule.

Serotoninergic reinnervation of regenerating tentacular sensory organs in a pulmonate snail, Cryptomphalus aspersa

Several ontogenetic studies performed in different species suggest a developmental role for 5-HT neurons. The 5-HT system interconnecting the CNS and the tentacular sensory organs in pulmonates is a suitable model for studying the postulated developmental role of 5-HT neurons. In this paper we describe the behavior of the 5-HT fibers during the early stages of blastema reinnervation, primordium formation and differentiation of regenerating tentacular sensory organs in the pulmonate snail Cryptomphalus aspersa. Our results show that the regeneration process allows the development of a normal pattern of 5-HT innervation of the regenerated sensory organs and suggest that 5-HT could be involved in reciprocal developmental interactions with regenerating tentacular tissues.

Fibre size and type adaptations to spinal isolation and cyclical passive stretch in cat hindlimb

Impulse activity is known to have a strong influence in determining the characteristics that distinguish skeletal muscle fibres into types. The control of muscle proteins by the neural systems that innervate the muscles, however, is not complete (Edgerton et al. 1985, 1990). The purpose of the present study, therefore, was to determine the effects of inactivity for 6 months on the size and fibre type composition of selected cat hindlimb muscles. Inactivity was produced by isolating the lumbar region of the spinal cord, i.e. transecting the cord at T12-T13 and again at L7-.S1 and then performing a bilateral dorsal rhizotomy between the transection sites (SI). In each SI cat, one hindlimb was passively manipulated for 30 min per day through a range of motion at the ankle mimicking a step cycle. SI resulted in an atrophic response in most muscles, with predominantly slow extensors showing the largest effect. In general, the predominant fibre type, which also had the largest mean size, in each muscle atrophied the most. The mean fibre size of all fibre types were similar after SI, suggesting that there may be a minimal size for inactive intact fibres. In comparison with control animals, all muscles in the SI cats had a higher proportion of fast fibres. Further, the relative contribution of the slow fibres to the total cross-sectional area of the muscle was decreased following SI. Some slow fibres in each muscle, however, were resistant to change. These data demonstrate the extent to which size and myosin type of mammalian muscle fibres are independent of activation characteristics.

The postnatal development of benzodiazepine receptor sites in the chick optic lobe is modulated by environmental lighting

The present paper describes the ability of benzodiazepine receptor sites to undergo light mediated-plastic changes during the early postnatal development of the chick optic lobe. The postnatal development pattern of these receptors was studied under different levels of light stimulation, i.e. normal-, light-and dark-rearing. At hatching the specific binding of [3H]Flunitrazepam was 0.23 +/- 0.01 pmol/mg protein. The developmental profile shows a sharp and transient peak of receptor overexpression between the 1st and the 2nd postnatal day in three experimental groups. Between the 2nd and the 6th day significant differences were found between the three groups, being this difference maximal during the peak of overexpression. In fact, on the 2nd day the specific [3H]Flunitrazepam binding showed an increase of 17% (P < 0.0005) and a decrease of 34% (P < 0.0005) for light- and dark-reared animals as compared with normally-reared ones. The changes in receptor density were transient since from the 6th day onward they gradually disappeared, being almost identical in the three groups by the day 15. At this moment the number of benzodiazepine receptor sites stabilized at the adult level. Scatchard analysis at the 2nd postnatal day revealed that the differences observed in the high affinity benzodiazepine binding sites between the three groups were due to modifications in the total number of binding sites while the affinity remained unchanged. The maximal number of binding sites were: 2.76 +/- 0.03, 3.40 +/- 0.01 and 1.46 +/- 0.11 pmol/mg protein in normally-, light- and dark-reared chicks, respectively; while the apparent dissociation constants were unaffected.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of a simple visual pattern on the early postnatal development of GABA receptor sites in the chick optic lobe

It is known that manipulation of the visual environment results in changes in the developmental pattern of several neurotransmitter receptors and that the GABA receptor shows a high degree of plasticity in differential illumination experiments. In the present paper we investigated whether exposure to a visual pattern has a developmental effect on GABA receptor expression during early postnatal life. Two groups of newly hatched chicks were used: one was exposed to a simple and specific visual pattern and the other was deprived of any visual pattern. GABA receptors at each developmental stage were determined by binding experiments performed in a crude membrane fraction. Saturation studies were carried out in a fraction enriched in synaptic membranes. The developmental pattern of both high and low affinity GABA binding sites was affected by the visual pattern. This effect displays its maximal expression by the end of the first postnatal week. The modification in receptor expression was due to a change in the receptor density while the affinity was not affected. The change in receptor density induced by the presence of a visual pattern was highest at the end of the first postnatal week suggesting that at that time there is a brief period of higher plasticity for GABA receptor expression in the visual system than at other times. Our results also suggest that variations in GABA receptor density could be instrumental in adaptative changes in the visual system in response to variations in the environmental stimulation.

Influence of 7 days of hindlimb suspension and intermittent weight support on rat muscle mechanical properties

Unloading the rat hindlimb results in a decrease in mass, especially in those muscles that normally have a load-bearing function. The present study was designed to evaluate the effect of intermittent periods of weight support in ameliorating this atrophic response. Adult male Sprague-Dawley rats were assigned to either a control (CON), a hindlimb suspended (HS), or a hindlimb suspended plus intermittent weight support (HS-WS) group. HS-WS rats were walked slowly on a treadmill at 0.2 m/s and a 19% incline for 10 min, every 6 h. After 7 d, the in situ mechanical properties of the soleus (Sol) and medial gastrocnemius (MG) were studied. Body weights of HS and HS-WS rats were 9 and 13% lower than CON. The SOl weight relative to body weight was 21 and 9% lower in HS and HS-WS than CON. Maximum tetanic tension relative to muscle mass was significantly lower in HS than CON, whereas HS-WS had values similar to CON. The MG weight relative to body weight was significantly lower in both suspended groups. The maximum tetanic tension relative to muscle weight was significantly elevated in HS-WS compared to CON, suggesting that weight support may have preferentially maintained the contractile protein component of the muscle. Contraction times were 25% faster (p less than 0.05) in the Sol and unchanged in teh MG of HS rats. For each muscle, the fatigue properties were similar in all groups. These data indicate that a low-force, short-duration exercise regime results in a significant functional recovery in the "slow" Sol, whereas the "fast" MG is less affected.(ABSTRACT TRUNCATED AT 250 WORDS)

Cutaneous ulcers due to Candida albicans in an immunocompromised patient--response to therapy with itraconazole

The patient, a 68-year-old female, with chronic anaemia and a previous history of carcinoma of the breast treated surgically, had been receiving therapy with methyl prednisone, in addition to gold, for pemphigus vulgaris. She developed deep cutaneous ulcers on the lower leg. All had well-defined edges and were covered with purulent and serosanguinous exudates. On histopathology the ulcers were deeply infiltrated with yeasts and mycelium and Candida albicans was isolated on culture. There was no evidence of systemic candidosis. Complete healing was obtained using itraconazole in a dose of 200 mg daily for 45 days: treatment with prednisone was continued throughout. The response to antifungal therapy alone suggests that Candida was largely, if not wholly responsible, for this unusual clinical condition.

Immunocytochemical study of the postnatal development of 5-HT-containing neurons and fibers in the cerebroid ganglia of Cryptomphalus aspersa

In this work we have studied the organization of the serotonergic system in new-hatched snails and the developmental changes that occur postnatally. The serotonergic system of the new-hatched snail is not completely developed. Tracts previously described in the adult were already present at hatching; however immunoreactivity of these tracts was somewhat less intense than that in adults, but, their location was practically the same. At hatch the pro- and postcerebral serotonergic plexi were poorly developed, while the mesocerebral one was nearly absent. The procerebral plexus occupied only the caudal half of the procerebral neuropile. Growth cone profiles were found in all plexi. The paired giant dorsal serotonergic neurons were the only stained neurons constantly found at hatching; they were symmetrically located. The paired medium-sized neurons were not found in all brains examined. Sometimes only one of them was present at hatching; it was located either in the right or in the left ganglion. The small neurons were absent in most cases. They gradually appeared during the first three postnatal months. Following hatching the procerebral plexus had undergone an intense growth. By the third postnatal month it innervated completely the procerebral neuropile. At hatching the area innervated by the procerebral plexus was 4500 micron 2, by the third month this area was about 58,000 micron 2 and in the adult was 80,000 micron 2. The postnatal development of the procerebral serotonergic plexus proceeds through two different modalities of neuritic growth: expansive growth is mediated by centrifugal elongation of terminal branches while the increase in fiber density within the plexus results from lateral sprouting.(ABSTRACT TRUNCATED AT 250 WORDS)