Biometric and corneal characteristics in marfan syndrome with ectopia lentis

PURPOSE

To describe the biometric and corneal characteristics of patients with Marfan Syndrome (MFS) and ectopia lentis.

STUDY DESIGN

Observational, descriptive, prospective study. Subjects Individuals with MFS with ectopia lentis (EL).

METHODS

Fourty-four eyes of 23 patients underwent Scheimpflug analysis using the Pentacam (Oculus, Wetzlar, Germany), axial length (AL) using the IOL master 700 (Carl Zeiss AG, Oberkochen, Germany), endothelial cell count (ECC) using the CEM-350 (NIDEK, Maihama, Japan) and corneal biomechanics evaluation with the Ocular Response Analyzer: ORA (Reichert Ophthalmic Instruments, Buffalo, New York, USA) and Corvis (Oculus, Wetzlar, Germany). Statistical analysis was performed using IBM SPSS Statistics 25.0.

RESULTS

The direction of lens subluxation was most frequently supero-nasal 40.9% (18/44). Mean keratometry (Km) was 40.22±1.76 Diopters (D); mean corneal astigmatism was 1.68±0.83 D; total corneal aberrometric root mean square (RMS) was 2.237±0.795μm; higher-order aberrations (HOAs) RMS were 0.576±0.272μm; mean AL was 25.63±3.65mm; mean ECC was 3315±459cell/mm2; mean CBI was 0.13±0.24, mean TBI was 0.31±0.25, mean posterior elevation was 4.3±4.5μm; mean total corneal densitometry was 16.0±2.14 grayscale units (GSU).

CONCLUSION

Increased axial length, flatter and thicker corneas with higher regular astigmatism, normal densitometry, normal corneal biomechanical indices and normal posterior elevation were observed in Marfan patients with EL.

Methods for Using Race and Ethnicity in Prediction Models for Lung Cancer Screening Eligibility

Importance

Using race and ethnicity in clinical prediction models can reduce or inadvertently increase racial and ethnic disparities in medical decisions.

Objective

To compare eligibility for lung cancer screening in a contemporary representative US population by refitting the life-years gained from screening-computed tomography (LYFS-CT) model to exclude race and ethnicity vs a counterfactual eligibility approach that recalculates life expectancy for racial and ethnic minority individuals using the same covariates but substitutes White race and uses the higher predicted life expectancy, ensuring that historically underserved groups are not penalized.

Design, Setting, and Participants

The 2 submodels composing LYFS-CT NoRace were refit and externally validated without race and ethnicity: the lung cancer death submodel in participants of a large clinical trial (recruited 1993-2001; followed up until December 31, 2009) who ever smoked (n = 39 180) and the all-cause mortality submodel in the National Health Interview Survey (NHIS) 1997-2001 participants aged 40 to 80 years who ever smoked (n = 74 842, followed up until December 31, 2006). Screening eligibility was examined in NHIS 2015-2018 participants aged 50 to 80 years who ever smoked. Data were analyzed from June 2021 to September 2022.

Exposure

Including and removing race and ethnicity (African American, Asian American, Hispanic American, White) in each LYFS-CT submodel.

Main Outcomes and Measures

By race and ethnicity: calibration of the LYFS-CT NoRace model and the counterfactual approach (ratio of expected to observed [E/O] outcomes), US individuals eligible for screening, predicted days of life gained from screening by LYFS-CT.

Results

The NHIS 2015-2018 included 25 601 individuals aged 50 to 80 years who ever smoked (2769 African American, 649 Asian American, 1855 Hispanic American, and 20 328 White individuals). Removing race and ethnicity from the submodels underestimated lung cancer death risk (expected/observed [E/O], 0.72; 95% CI, 0.52-1.00) and all-cause mortality (E/O, 0.90; 95% CI, 0.86-0.94) in African American individuals. It also overestimated mortality in Hispanic American (E/O, 1.08, 95% CI, 1.00-1.16) and Asian American individuals (E/O, 1.14, 95% CI, 1.01-1.30). Consequently, the LYFS-CT NoRace model increased Hispanic American and Asian American eligibility by 108% and 73%, respectively, while reducing African American eligibility by 39%. Using LYFS-CT with the counterfactual all-cause mortality model better maintained calibration across groups and increased African American eligibility by 13% without reducing eligibility for Hispanic American and Asian American individuals.

Conclusions and Relevance

In this study, removing race and ethnicity miscalibrated LYFS-CT submodels and substantially reduced African American eligibility for lung cancer screening. Under counterfactual eligibility, no one became ineligible, and African American eligibility increased, demonstrating the potential for maintaining model accuracy while reducing disparities.

Assessing discards in an illegal small-scale fishery using fisher-led reporting

About a third of all marine fish in the world are caught in Small-Scale Fisheries (SSF). SSF are increasingly recognised as essential for food security and livelihoods for vulnerable and economically fragile communities globally. Although individual SSF vessels are usually perceived as having little impact on the ecosystem, the cumulative impact of gear type and number of vessels may be substantial. Bottom trawling is a common fishing method that can greatly influence the marine ecosystem by damaging the seafloor and generating high levels of discards. However, appropriate sampling coverage using on-board observer programmes to collect these data from SSF are rare, as they are expensive and pose logistical constraints. A mobile App was used to assess whether self-reporting by fishers could provide reliable fine-scale information on fishing effort and discards over time in an illegal shrimp trawling fishery in northern Peru. Maps depicting the spatial distribution of trawling effort and the proportion of discards from observers and fishers were compared using the Similarity in Means (SIM) Index, which ranges from 0 when spatial patterns differ completely to 1 when spatial patterns are very similar. High levels of agreement between spatio-temporal patterns of effort (SIM Index = 0.81) and discards (0.96) were found between fisher and observer maps. Moreover, far greater spatial coverage was accomplished by fishers, suggesting that self-reporting via an App represents a useful approach to collect reliable fisheries data as an initial step for effective monitoring and management of these fisheries.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s11160-022-09708-9.

Cutibacterium acnes: An emerging pathogen in culture negative bacterial prosthetic valve infective endocarditis (IE)

Cutibacterium acnes (previously known as Propionibacterium) infections are reportedly increasing in patients with implanted foreign material. Though it is a rare cause of bacterial endocarditis, patients with implanted prosthetic valves and devices have potential increased risk. Cutibacterium species are an ubiquitous environmental surface contaminant and typically difficult to culture, in case of high suspicion for infective endocarditis extended duration incubation of blood or any tissue sample and 16S RNA sequencing of any tissue sample is helpful for a microbiological identification. We report a case of a 50 year old male with culture negative prosthetic valve endocarditis in which the pathogen was identified by molecular testing 16S RNA gene sequencing.

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Prosthetic valve endocarditis.

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Cutibacterium acnes.

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16S gene sequencing.

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Management challange for prostetic valve endocarditis.

Diagnostic accuracy of transvaginal sonography for detecting parametrial involvement in women with deep endometriosis: systematic review and meta-analysis

OBJECTIVE

To evaluate the accuracy of transvaginal sonography (TVS) for detecting parametrial deep endometriosis, using laparoscopy as the reference standard.

METHODS

A search was performed in PubMed/MEDLINE and Web of Science for studies evaluating TVS for detecting parametrial involvement in women with suspected deep endometriosis, as compared with laparoscopy, from January 2000 to December 2020. The Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool was used to evaluate the quality of the studies. Pooled sensitivity, specificity and positive and negative likelihood ratios for TVS in the detection of parametrial deep endometriosis were calculated, and the post-test probability of parametrial deep endometriosis following a positive or negative test was determined.

RESULTS

The search identified 134 citations. Four studies, comprising 560 patients, were included in the analysis. The mean prevalence of parametrial deep endometriosis at surgery was 18%. Overall, the pooled estimated sensitivity, specificity and positive and negative likelihood ratios of TVS in the detection of parametrial deep endometriosis were 31% (95% CI, 10-64%), 98% (95% CI, 95-99%), 18.5 (95% CI, 8.8-38.9) and 0.70 (95% CI, 0.46-1.06), respectively. The diagnostic odds ratio was 26 (95% CI, 10-68). Heterogeneity was high. Visualization of a lesion suspected to be parametrial deep endometriosis on TVS increased significantly the post-test probability of parametrial deep endometriosis.

CONCLUSION

TVS has high specificity but low sensitivity for the detection of parametrial deep endometriosis. © 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Inter and intraobserver variability in the echocardiographic measurement of vegetations in infective endocarditis

Introduction and objectives

The indication for surgery to prevent embolism in infective endocarditis includes four clinical scenarios and three different echocardiographic measurements of the maximal vegetation diameter. These cut-off points are completely arbitrary and not evidence-based. Our hypothesis is that the vegetation diameter is not an appropriate surgical criterium. The goal of the study is to analyze the inter and intra-observer variability in this measurement and to compare the surgical indications agreement based on these parameters.

Methods

Two trained echocardiographers have measured the maximal vegetation diameter by transesophageal echocardiogram in 67 consecutive patients with definite infective endocarditis in an off-line workstation. The inter- and intra-observer variability was calculated by the interclass correlation coefficient and with the Bland-Altman analysis. The relationship between the strength of agreement for the cut-off points of 10 and 15 mm was also calculated.

Results

Intra and inter-observer interclass correlation coefficient in the measurement of the maximal longitudinal diameter of the vegetations were 0.872 (0.805–0.917) and 0.757 (0.642–0.839) respectively. The strength of agreement of the intra and inter-observer analysis for the cut-off point of 10 mm were 0.674 (0.485–0.862) and 0.533 (0.327–0.759). For the cut-off point of 15 mm they were 0.696 (0.530–0.862) and 0.475 (0.270–0.679).

Conclusions

The variability in the measurements of the maximal longitudinal diameter by transesophageal echocardiogram between two experimented echocardiographers is good. Nonetheless, surgical indications based on the cut-off points recommended in the European guidelines would have changed in an unacceptable high proportion of patients. Therefore, we suggest that these indications should be revised in the light of our results.

Funding Acknowledgement

Type of funding source: None

The 3 noes right-sided infective endocarditis: a unrecognized type of right-sided endocarditis

Introduction

The “3 noes right-sided infective endocarditis” (3no-RSIE: no left-sided, no drug users, no cardiac devices) was depicted for the first time more than a decade ago. We describe the largest series to date to characterize its clinical, microbiological, echocardiographic and prognostic profile.

Methods

Eight tertiary centers with surgical facilities participated in this study. Patients with right-sided endocarditis without left involvement, absence of antecedents of drug use and no intracardiac electronic devices were retrospectively included in a multipurpose database. A total of 53 variables were analysed in every patient. We performed a univariate analysis of in-hospital mortality to determine variables associated with worse prognosis.

Results

A total of 100 patients (mean age 54.1±20 years, 65% male) with definite 3no-RSIE were included (16.7% of all the right-sided endocarditis of the series). Most of the episodes were community-acquired (72%), congenital cardiopathies were frequent, fever was the main manifestation at admission (85%). The microbiological profile is led by Staphylococci spp. Vegetations were detected in 92% of the patients. Global in-hospital mortality was 19% (5.7% in patients operated and 26% in patients who received only medical treatment, p<0.001). Non community-acquired infection, diabetes mellitus, right heart failure, septic shock and acute renal failure were more common in patients who died.

Conclusions

The clinical profile of 3no-RSIE is closer to other types of RSIE than to LSIE, but mortality is higher than that reported on for other types of RSIE. Surgery plays an important role in improving outcome.

Funding Acknowledgement

Type of funding source: None

P6292Role of CXCL12gamma isoform and its interactions with heparan-sulfates in post-ischemic cardiac remodeling

Introduction

Myocardial infarction (MI) is a severe ischemic disease precipitating long-term adverse remodeling and heart failure. The chemokine CXCL12/SDF-1 is essential for cardiovascular system development and plays a prominent role in physio-pathological processes such as inflammation, angiogenesis and tissue fibrosis. In addition to the binding to its cognate receptors CXCR4 and CXCR7, CXCL12 interacts with heparan-sulfates (HS) which coordinate its biological activity. We have previously highlighted the essential role of CXCL12/HS interactions in vascular growth and remodeling in the setting of critical limb ischemia. In addition, studies in experimental model of MI revealed a protective role for the CXCL12α isoform, through the regulation of cardiomyocyte survival and recruitment of inflammatory cells. However, in mice, three CXCL12 isoforms (α, β and γ) have been identified and, among them, the CXCL12γ isoform shows an unchallenged ability to cooperate with HS, suggesting a putative pivotal role in tissue repair.

Objectives

The aim of the study is to analyze the role of CXCL12γ isoform and the importance of CXCL12/HS interactions in post-ischemic cardiac remodeling in an acute model of MI.

Methods

MI was induced by permanent ligation of the left ascending coronary artery in mice carrying a Cxcl12 gene mutation that precludes interactions with HS (Cxcl12Gagtm) and in Cxcl12γ knock-in animals (Cxcl12γ-KI) harboring CXCL12γ deficiency. Alternatively, the impact of CXCL12γ overexpression and the importance of its interactions with HS was also evaluated in wild-type (WT) mice receiving transcutaneous echo-guided injections of adenovirus encoding WT Cxcl12γ or HS-binding-disabled Cxcl12γ in cardiac tissue. Cardiac function and remodeling have been assessed through echocardiography analysis, evaluation of infarct size, interstitial fibrosis, vascular growth (capillary and arteriole densities) and inflammatory cell infiltration into the cardiac tissue.

Results

After MI, Cxcl12Gagtm and Cxcl12γ-KI animals exhibit reduction in cardiac function and adverse left ventricular remodeling when compared to their respective WT littermates. Interestingly, overexpression of CXCL12γ in WT mice cardiac restored cardiac function by reducing the size of the infarcted area, interstitial fibrosis and promoting vascular growth. In sharp contrast, HS–binding disabled CXCL12gamma mutants failed to improve cardiac function and to abrogate adverse left ventricular remodeling.

Conclusion

We show that CXCL12γ isoform plays an important role in the regulation of post-ischemic cardiac function and remodeling and that its interactions with HS are essential for adequate cardiac repair in the setting of acute MI.

P6598MicroRNA 21 and Hypoxia Inducible Factor 1 synchronize the impact of B lymphocytes on cardiac function after acute myocardial infarction

Background

Myocardial infarction (MI) is a severe ischemic disease responsible for heart failure and sudden death. Mature B lymphocytes have been shown to exacerbate tissue injury and deterioration of cardiac function after MI. However, the cellular and molecular mechanisms governing B cell deleterious effects in the ischemic milieu remain to be defined.

Purpose

In this study, we speculate that endogenous activation of the miR21/HIFα-related pathways mediates the effect of B lymphocytes on post-ischemic cardiac remodeling.

Methods

Acute MI was induced by permanent ligation of the left anterior descending artery in mice. Cardiac function and remodeling was determined by echocardiography and immunohistochemistry. Inflammatory cell number and phenotype were defined by FACS analysis. To evaluate the role of HIFα isoforms in B cells, we generated mice with B cell lineage specific (Cd79aCre/+) conditional deletion of HIF1α (HIF1αflox/flox), HIF2α (HIF2αflox/flox), or both isoforms (HIF1α-HIF2αflox/flox).

Results

Acute MI increased miR21 levels in B cells. miR21 deficient mice showed reduced B cell numbers in the spleen, blood and subsequently in the injured cardiac tissue. Transplantation of bone marrow derived cells isolated from miR21-deficient mice (miR21−/−) improved cardiac function and remodeling when compared to administration of wild-type (WT) bone marrow cells. Similarly, in Rag1−/− immunodeficient mice with acute MI, re-supplementation with miR21−/− B lymphocytes restored cardiac repair and function when compared to injection of WT B cells. miR21 abrogated PTEN contents and subsequently enhanced HIF1α levels in cultured B cells. B cell deletion of HIF1α, but not that of HIF2α, reduced B cell accumulation and improved cardiac function after MI. Mice, which were equally deficient in HIF1α and HIF2α, also exhibited abrogation of adverse ventricular remodeling and showed recovery of cardiac function after MI. Toll like receptor agonist, CpG, fostered the release of the monocyte chemo-attractant protein, Ccl7, in cultured WT B cells but not in miR21- or HIF1α- deficient B cells. Ccl7 circulating levels were also reduced in miR21−/− and Cd79aCre/+/HIF1α flox/flox animals after acute MI. Ccl7 down-regulation hampered Ly6Chigh monocyte infiltration in the ischemic myocardium, leading to decreased infarct size and interstitial fibrosis, supporting cardiac repair.

Conclusion

This work reveals a novel function for miR21/HIF1α related pathways in B lymphocyte dependent effect on cardiac function and remodeling in the setting of acute MI.

Plattenepithelkarzinom der Schilddrüse ausgehend von einer Ductus thyreoglossus Zyste

Es wird über eine 73jährige Patientin mit dem sehr seltenen Fall eines Karzinoms berichtet, das sich in einer Ductus thyreoglossus-Zyste innerhalb einer Struma diffusa et nodosa entwickelt hatte. Zusätzlich bestand eine Immunthyreopathie Typ Basedow. Sonographische, röntgenologische, szintigraphische und histologische Befunde werden vorgestellt.

Schilddrüsenvolumina und Jodversorgung 6- bis 17jähriger Schüler

In Österreich wurde 1963 eine gesetzlich vorgeschriebene Speisesalzjodierung mit 10 mg KJ/kg eingeführt. Dennoch zeigten Untersuchungen zur Jodversorgung zwischen 1982 und 84 nach wie vor einen Jodmangel Grad I bis II. Dies führte 1990 zur Anhebung der Speisesalzjodierung auf 20 mg KJ/kg Vollsalz. Ziel der Untersuchung war es, die Jodversorgung und die Schilddrüsenvolumina von Schülern 3 Jahre nach Einführung der erhöhten Jodsalzprophlyaxe zu überprüfen. Durchgeführt wurde eine stichprobenartige Untersuchung an 734 Schülern der 1. bis 12. Schulstufe. Der Mittelwert der Harnjodidausscheidung betrug 121 ug/g Kr; dies bedeutet gebenüber den Voruntersuchungen von 1984 einen deutlichen Anstieg der Jodversorgung. Gegenüber den Vergleichsdaten zeigten die entsprechenden Altersgruppen geringere mittlere Schilddrüsenvolumina.

Diagnostik der SDAT mittels HMPAO-SPECT und Serumvitamin-B12-Spiegel

Die alleinige klinische Abklärung dementieller Zustandsbilder, so auch der senilen Demenz vom Alzheimertyp (SDAT), ist schwierig. Durch die Kombination von 99mTc-HMPAO-Gehirn-SPECT und Serumvitamin-B12-Bestimmung erwarteten wir eine Beschleunigung und Verbesserung der Diagnostik der SDAT. Von 116 Patienten, die in 4 Gruppen, entsprechend ihrem 99mTc-HMPAO-Verteilungsmuster eingeteilt worden waren, konnten bei 17 klinisch sehr wahrscheinlichen SDAT-Patienten bei 15 Auffälligkeiten mit Hinweis auf SDAT im Gehirn SPECT gefunden werden. Ein Teil der Patienten wies einen niedrig-normalen bzw. pathologisch niedrigen Vitamin-B12-Spiegel auf. Andere Untersuchungen würden durch die Kombination von Gehirn-SPECT und Serumvitamin-B12-Bestimmung nicht überflüssig werden, obwohl beide Untersuchungen Informationen lieferten, die die Zuordnung zur Diagnose SDAT erleichterten. Die zusätzliche Serumvitamin-B12-Bestimmung stellt keinen wesentlichen Mehraufwand dar.

Tc-99m-Tetrofosmin Scintimammography: A Prospective Study in Primary Breast Lesions

Despite low specificity routine mammography is the method of choice to screen women for breast cancer. In addition high frequency ultrasonography (US) or magnetic resonance imaging (MRI) can improve breast cancer diagnosis. However there is a lack of conventional imaging to improve the high rate of false positive results that make biopsy or surgery necessary. Aim: The purpose of our study was to evaluate prospectively the sensitivity, specificity, PPV and NPV of scintimammography with a new cationic complex Tc-99m-tetrofosmin. Methods: Fourtyeight patients in whom mammography and/or high resolution ultrasonography (10MHz) revealed suspicious breast lesions were studied with Tc-99m-tetrofosmin scintimammography. In thirtyfour of them biopsy and/or surgery was performed for histological evaluation. After intravenous injection of 555 MBq Tc-99m-tetrofosmin dynamic images over three minutes (1 frame/10 sec.) planar images in anterior and lateral projections (5 min. p.i.) and SPECT imaging including 3-D-reconstruction (20 min. p.i.) were performed. Scintimammography was evaluated as negative, equivocal (+), probably (++) or definitely (+++) positive. Results: Scintimammography with Tc-99m-tetrofosmin was negative in 18 patients (17 t.n.; 1 f.n.) and positive in 16 patients (10 t.p., 6 f.p.). The false negative scintimammography was observed in a patient with infiltrating ductal carcinoma pT1, the false positive result in a patient with fibrocystic disease; all of the five fibroadenomas were also “false” positive. Sensitivity of Tc-99m-tetrofosmin scintimammography in this prospective study was 91 %, specificity 74%, PPV 63% and NPV 94%. Scintimammographic results in patients with suspicious breast lesion show, that Tc-99m-tetrofosmin accumulates in breast cancer as well as in fibroadenoma. However the high NPV of 94 % excludes breast cancer in suspicious mammographie lesions in a very high degree and therefore reduces the need of biopsy and/or surgery in most of these patients. Conclusion: Our first results show that scintimammography with Tc-99m-tetrofosmin might play a role as further diagnostic step before surgery for women in whom mammography and/or ultrasonography show suspicious lesions.

Tc-99m ciprofloxacin in clinically selected patients suspected for peripherial osteomyelitis, spondylodiscitis and fever of unknown origin: preliminary results

Aim: Retrospective evaluation of Tc-99m ciprofloxacin (infecton) scintigraphy consecutively performed in a series of patients clinically suspected for peripheral osteomyelitis (OM), spondylodiscitis (SD) and fever of unknown origin (FUO). Methods: A total of 20 patients clinically suspected for OM (n = 12), SD (n = 3) and FUO (n = 5) were included in our retrospective analysis. The additional criterion was a positive 3-phase bone scan for OM, or a 2-phase bone scan in case of SD. Planar whole body scans and static acquisitions were performed 1 and 4 h after application of 370 MBq Tc-99m ciprofloxacin. In 10 patients with suspected OM, additional immunoscintigraphy using Tc-99m labelled monoclonal antibodies (Mab BW 250/183) was performed and the correlation of infecton to bloodpool and antigranulocyte scintigraphy was analysed. Results: OM: Bacterial infection was confirmed in 8 of 15 lesions. Infecton demonstrated true positive (TP) results in 7 of 8, true negative (TN) results in 2 of 7, false positive (FP) results in 5 of 7 patients and one false negative (FN) result. A strong correlation could be demonstrated between T/NT ratios of infecton and bloodpool Tc-99m medronate imaging (r = 0.84, 0.88) and between infecton and BW 250/183 (r = 0.92, 0.90). Using a threshold of 2.0 for T/NT ratio, only TP results could be observed whereas a T/NT in the range of 1.0-2.0 could not discriminate between septic and aseptic inflammation. Concordant results with Mab BW 250/183 could only be observed in 5 of 10 patients (4 TP, 1 TN) by showing 4 FP and 1 FN lesions with IF. Conclusion: Non-specific uptake of infecton can be observed in a variety of clinical situations with moderate uptake, by showing a strong correlation with blood-pool imaging. Nevertheless, intense uptake may be specific for septic inflammation.

Psychotherapeutic Iinterventions in Transition Unit

Introduction.

The In-patient units are very closed and highly controlled healthcare resource and then patients have to join the community rapidly, and in sometimes feeling unprotected and with their needs non covered. We created a transition unit with a program of psychotherapeutic intervention, to offer an adequate transition between the acute episode and the incorporation to the community.

Objective.

We describe the characteristics of the psychotherapeutic group, the aims and the results of the interventions.

Methods.

Psychotherapeutic transition unit was created to offer intensive attention and control demand that is not possible to control in the community. The objects are to prevent re-admissions and relapse because of abandonment of treatment in patient with personality disorder and suicide attempts, and first episode, affective or psychotic. Patients are selected from the in-patients unit with inclusion criteria, and start going from the unit before discharge. The intervention is once per week, with a duration between 60–90 minutes. There is not a number of sessions, and we have approximately 10 patients per sessions.

Results.

Since the beginning of the psychotherapeutic interventions, re-admissions have been decreased in patients with diagnosis of personality disorder (most histrionic and borderline disorder) with multiple admissions because of suicide attempt, some had been discharged. In another group of patient we have prevented relapses.

Conclusions.

Psychotherapeutic interventions will be effective in patients with high risk of re-admissions and relapses. It is early to have solid conclusions, but the preliminary results encourage the continuation of the program.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

EEG feature variations under stress situations

The goal of this study is to identify EEG parameters and electrode positions with the highest significant values to differentiate between tasks and relax periods. Different signals were recorded as 12 subjects are doing arithmetic and memory tasks under stress condition. The test consisted of an initial and final 5-minute relax periods and three 4-minute performance phases with increased stress level. θ and α bands concentrated mainly features whose variation were significant, and F3 and P4 were the best positions to distinguish between performed tasks and arousal level.

The role of prostaglandin E2 in human vascular inflammation

Prostaglandins (PG) are the product of a cascade of enzymes such as cyclooxygenases and PG synthases. Among PG, PGE2 is produced by 3 isoforms of PGE synthase (PGES) and through activation of its cognate receptors (EP1-4), this PG is involved in the pathophysiology of vascular diseases. Some anti-inflammatory drugs (e.g. glucocorticoids, nonsteroidal anti-inflammatory drugs) interfere with its metabolism or effects. Vascular cells can initiate many of the responses associated with inflammation. In human vascular tissue, PGE2 is involved in many physiological processes, such as increasing vascular permeability, cell proliferation, cell migration and control of vascular smooth muscle tone. PGE2 has been shown to contribute to the pathogenesis of atherosclerosis, abdominal aortic aneurysm but also in physiologic/adaptive processes such as angiogenesis. Understanding the roles of PGE2 and its cognate receptors in vascular diseases could help to identify diagnostic and prognostic biomarkers. In addition, from these recent studies new promising therapeutic approaches like mPGES-1 inhibition and/or EP4-antagonism should be investigated.

PGE(2) receptor (EP(4)) agonists: potent dilators of human bronchi and future asthma therapy?

BACKGROUND

Asthma and chronic obstructive pulmonary disease are characterized by inappropriate constriction of the airway smooth muscle. In this context, the physiological response of the human airways to selective relaxant agonists like PGE(2) is highly relevant. The aim of this study was thus to characterize the PGE(2) receptor subtypes (EP(2) or EP(4)) involved in the relaxation of human bronchial preparations.

METHODS

Human bronchial preparations cut as rings were mounted in organ baths for isometric recording of tension and a pharmacological study was performed using selective EP(2) or EP(4) ligands.

RESULTS

In the presence of a thromboxane TP receptor antagonist and indomethacin, PGE(2) induced the relaxation of human bronchi (E(max) = 86 ± 04% of papaverine response; pEC(50) value = 7.06 ± 0.13; n = 6). This bronchodilation was significantly blocked by a selective EP(4) receptor antagonist (GW627368X, 1 and 10 μmol/L) with a pK(B) value of 6.38 ± 0.19 (n = 5). In addition, the selective EP(4) receptor agonists (ONO-AE1-329; L-902688), but not the selective EP(2) receptor agonist (ONO-AE1-259), induced potent relaxation of bronchial preparations pre-contracted with histamine or anti-IgE.

CONCLUSION

PGE(2) and EP(4) agonists induced potent relaxations of human bronchial preparations via EP(4) receptor. These observations suggest that EP(4) receptor agonists could constitute therapeutic agents to treat the increased airway resistance in asthma.

Differential reactivity of human mammary artery and saphenous vein to prostaglandin E(2) : implication for cardiovascular grafts

BACKGROUND AND PURPOSE

Human internal mammary arteries (IMA) and saphenous veins (SV) are frequently used for coronary artery bypass graft surgery. Intra- and postoperatively, the bypass grafts are exposed to inflammatory conditions, under which there is a striking increase in the synthesis of prostaglandin E(2) (PGE(2) ). In this context, the physiological response of these vascular grafts to PGE(2) is highly relevant. The aim of this study was thus to characterize the PGE(2) receptor subtypes (EP(1) , EP(2) , EP(3) or EP(4) ) involved in modulation of the vascular tone in these two vessels.

EXPERIMENTAL APPROACH

Rings of IMA and SV were prepared from 48 patients. The rings were mounted in organ baths for isometric recording of tension, and a pharmacological study was performed, together with associated reverse transcriptase PCR and immunohistochemistry experiments.

KEY RESULTS

PGE(2) induced contractions of IMA (E(max) = 1.43 ± 0.20 g; pEC(50) = 7.50 ± 0.10); contractions were also observed with the EP(3) receptor agonists, sulprostone, 17-phenyl-PGE(2) , misoprostol or ONO-AE-248. In contrast, PGE(2) induced relaxation of the precontracted SV (E(max) =-0.22 ± 0.02 g; pEC(50) = 7.14 ± 0.09), as did the EP(4) receptor agonist, ONO-AE1-329. These results were confirmed by the use of selective EP receptor antagonists (GW627368X, L-826266, ONO-8713, SC-51322) and by molecular biology and immunostaining.

CONCLUSIONS AND IMPLICATIONS

PGE(2) induced potent and opposite effects on the human vascular segments used for grafting, namely vasoconstriction of the IMA and vasodilatation of the SV via EP(3) and EP(4) receptors respectively. These observations suggest that EP(3) and EP(4) receptors could constitute therapeutic targets to increase vascular graft patency.

EPAS1 mRNA in plasma from colorectal cancer patients is associated with poor outcome in advanced stages

The presence of free nucleic acids in plasma has been detected in cancer patients and is associated with poor prognosis. In the present study, the mRNA levels of three genes (EPAS1, KIAA0101 and UBE2D3) in plasma from colorectal cancer patients were analyzed. These genes were selected from a previous study of genomic profiles, discriminating between healthy controls and colorectal cancer patients. mRNA levels were analyzed by real-time PCR in the plasma of 154 patients with colorectal cancer. The association of plasma mRNA levels with clinicopathological parameters and patient survival were analyzed. High levels of EPAS1 in the plasma were associated with patients aged over 50 years, relapse of disease and patient mortality. When patients were divided into two groups, early (I and II) and advanced (III and IV) stages, an association was observed between high levels of EPAS1 mRNA and worse disease-free and overall survival in advanced stages. The expression of KIAA0101 and UBE2D3 was not associated with poor prognosis. Thus, our results suggest that EPAS1 mRNA levels may be an indicator of poor prognosis in colorectal cancer patients at advanced stages, obtained by a non-invasive method.

Microwave Processing Applied to Ceramic Reactions

The necessary energy for processing ceramics usually comes from gas firing or electricity. With gas firing, ceramics processing is conducted at relative low temperatures. In the case of electric arc furnace, temperatures are high enough to smelt the material and the reaction takes place in a liquid state. In this work we use microwave radiation for conducting reactions between oxides to produce ceramic materials, mainly spinels. The microwave energy was supplied using an 800W magnetron operating at 2.45 GHz. The microstructure and the mineral composition were studied by means of SEM and X-Ray diffractometer respectively.

Heterogeneous Dopamine Neurochemistry in the Striatum: The Fountain-Drain Matrix

In contrast to the relatively high attention paid to the structural heterogeneity of striatal dopamine (DA) innervation, little attention has been focused on the possible striatal heterogeneity for release and uptake of DA. By using amperometric methods, we found striatal regions showing a DA decrease during the medial forebrain bundle stimulation (drain areas) near to other zones that showed an increase in DA concentration (fountain areas). Both areas were intermixed to form a tridimensional matrix to regulate DA concentration throughout the striatum (fountain-drain matrix). The response to electrical stimuli of different amplitudes and durations and to different drugs (alpha-methyl-l-tyrosine, cocaine, gamma-butyrolactone, and haloperidol) suggests that regional differences for both DA release/DA uptake and DA cell firing autoregulation are behind the striatal fountain-drain matrix. The high diversity of DA activity observed in the striatum is a new framework for analyzing experimental and clinical phenomena.

Evaluation of composted sewage sludge as nutritional source for horticultural soils

Water deficit and soil degradation have become some of the major problems for crop production in semi-arid regions, as it is the South East of Spain. As a matter of fact, considerable productivity loss and risk of erosion have to be taken into account in these areas, especially those with an horticultural use (Davis, 1989). Utilization of sewage sludge in agriculture. Agricultural Progress 64, 72-80]. Horticultural soils are highly vulnerable and prone to erosion, as vegetables are generally fast-growing species under intensive exploitation regimes. High-rate chemical inputs contribute to horticultural soil degradation and have a dramatic effect on soil microbial population and nutrient balance whilst, at the same time, have a counter-effect on price competitiveness of the vegetables to be commercialized. In this paper we monitored variations in physical, chemical and biological properties of a cauliflower plot where four increasing quantities of compost were applied. We carried out a three-stage sampling schedule in order to check the effect of compost applications doses. We conclude that a 2 kg compost/m2 application had a positive effect on physical and biological properties of the soil and provides a supply of nutrients to grow cauliflowers on its surface under intensive exploitation regimes without loss in biomass yield.

Modulation Factors of Oxidative Status in Stable Renal Transplantation

Reactive oxygen species (ROS) trigger a biomolecular alteration that causes functional and structural changes. In renal transplantation, there is an increase in oxidative phenomena related to endothelial dysfunction, inflammation, and atherosclerosis, the main cause of cardiovascular complications and chronic allograft failure. The present study was designed to assess the oxidative state of transplant patients with stable renal function, in order to establish differences in oxidative, biochemical, and clinical parameters between patients treated with tacrolimus versus cyclosporine. We studied 67 stable kidney transplant patients treated with calcineurin inhibitors who were not receiving cholesterol-lowering therapy, and 14 healthy subjects. Data were collected on biochemical parameters: lipid profile (apoA, apoB, total cholesterol and fractions, and triglycerides); urea; and creatinine; oxidative parameters: malondialdehyde (MDA) as a lipid peroxidation marker, glutathione peroxidase (GPx), catalase, superoxide dismutase (SOD), glutathione reductase (GR), and antibodies against oxidized LDL; and clinical variables. Transplanted patients showed a higher oxidative status (MDA increase and GPx decrease) than healthy subjects. The oxidative status did not differ between the cyclosporine and tacrolimus cohorts. Some factors during the posttransplant period, such as delayed graft function, cytomegalovirus infection, and microalbuminuria, which may damage renal function, produce a decreased antioxidant capacity (lower GPx).

Single amino acid mutations in the cadherin receptor from Heliothis virescens affect its toxin binding ability to Cry1A toxins

Bacillus thuringiensis Cry protein exerts its toxic effect through a receptor-mediated process. Both aminopeptidases and cadherin proteins were identified as putative Cry1A receptors from Heliothis virescens and Manduca sexta. The importance of cadherin was implied by its correlation with a Cry1Ac resistant H. virescens strain (Gahan, L. J., Gould, F., and Heckel, D. G. (2001) Science 293, 857-860). In this study, the Cry1Ac toxin-binding region in H. virescens cadherin was mapped to a 40-amino-acid fragment, from amino acids 1422 to 1440. This site overlaps with a Cry1Ab toxin-binding site, amino acids 1363-1464 recently reported in M. sexta (Hua, G., Jurat-Fuentes, J. L., and Adang, M. J. (2004) J. Biol. Chem. 279, 28051-28056). Further, feeding of the anti-H. virescens cadherin antiserum or the partial cadherins, which contain the toxin-binding region, in combination with Cry1Ab/Cry1Ac reduced insect mortality by 25.5-55.6% to first instar H. virescens and M. sexta larvae, suggesting a critical function for this cadherin domain in insect toxicity. Mutations in this region, to which the Cry1Ac binds through its loop 3, resulted in the loss of toxin binding. For the first time, we show that the cadherin amino acids Leu(1425) and Phe(1429) are critical for Cry1Ac toxin interaction, and if substituted with charged amino acids, result in the loss of toxin binding, with a K(D) of < 10(-5) m. Mutation of Gln(1430) to an alanine, however, increased the Cry1Ac affinity 10-fold primarily due to an increase on rate. The L1425R mutant can result from a single nucleotide mutation, CTG --> CGG, suggesting that these mutants, which have decreased toxin binding, may lead to Cry1A resistance in insects.

T cells from elderly persons respond to neoantigenic stimulation with an unimpaired IL-2 production and an enhanced differentiation into effector cells

We analysed the capacity of T cells from young and elderly persons to produce IL-2 and IFN-gamma after in vitro stimulation with two neoantigens, namely inactivated rabies virus and recombinant Etr protein of tick-borne encephalitis virus (TBEV). Soluble antigens should per definition primarly stimulate CD4(+) naïve T cells. Cytokine production was analysed by ELISPOT technology. T cells from elderly and young donors produced similar amounts of IL-2 after priming with both neoantigens. In contrast, IFN-gamma production was induced earlier and at lower antigenic concentrations in T cells from elderly persons than from young controls indicating an enhanced capacity of primed T cells to differentiate into effector cells. In both age groups the response pattern to neoantigenic stimulation was the same whether unfractionated blood mononuclear cells or purified CD4(+)CD45RA(+) T cells with autologous DC as APC were used. The magnitude of the response was, however slightly lower in isolated cells. Autologous DC still induced an MLR in purified CD4(+)CD45RA(+) cells, which was more pronounced in the young than in the elderly group. Our results demonstrate that the ability of CD4(+) T cells from elderly persons to respond to neoantigenic stimulation is intact and that their capacity to differentiate into effector cells is even enhanced. This is in good agreement with earlier reports on alterations in the homing receptor pattern of naïve T cells in old age. Rapid generation of effector cells from naïve cells may at least partly counterbalance the decreasing size of the naïve T cell pool in elderly persons.

Characterization of Tick-Borne Encephalitis Virus–Specific Human T Lymphocyte Responses by Stimulation with Structural TBEV Proteins Expressed in a Recombinant Baculovirus

Very little information is available on human T cell responses following exposure to tick-borne encephalitis virus (TBEV) proteins, largely because the virus is a dangerous pathogen and relatively large amounts of purified antigen would be required for the functional characterization of cellular immune responses. We have produced recombinant TBEV proteins using the baculovirus expression system and tested them for their capacity to stimulate T cells in vitro. T lymphocytes from TBEV vaccinated individuals were characterized. The recombinant E and C proteins triggered CD4+ but not CD8+ cells to proliferate and to produce IFN-gamma and IL-5. T cell responses against recombinant NS3 protein were not detected. T cell lines with specificity for the E protein were also established. These lines were CD4+ and had a TH0 cytokine production pattern. Our results demonstrate the utility of recombinant viral proteins to study the generation and characterization of TBEV specific T cell responses.

Changes in the expression of CD31 and CXCR3 in CD4+ naïve T cells in elderly persons

So far, very few studies exist on the naïve T cell population of elderly persons. Only recently an increase in the percentage of long lived CD4(+)CD31(-) naïve T cells has been claimed to occur with aging. We, therefore, characterised CD31(+) and CD31(-) CD45RA(+) CD4(+) T cells in young and healthy elderly persons. The production of IL-2 and IFN-gamma by the different subpopulations was studied following stimulation with PMA and Ionomycin. The expression of CD28, CD11a, CD62L, CXCR3 and CCR7 was also analysed. The results of this study demonstrate a pronounced increase in the percentage of CD31(-) CD45RA(+) T cells within the CD4 subpopulation of elderly persons. Both, CD31(-) and CD31(+) CD45RA(+) cells expressed CD28, CD62L, were CD11a (dim) and produced IL-2 but no IFN-gamma. This phenotype confirms that they were naïve T cells. IL-2 production by naïve T cells was not impaired in elderly persons. Interestingly, CD31(+) as well as CD31(-) naïve T cells contained a subpopulation of CXCR3(+) cells in elderly individuals, but not in young ones. In spite of expressing this chemokine receptor that enables the cells to migrate into inflammatory tissues, they were still CCR7(+) and CD62L(+). We speculate that due to previous contact with local environmental factors, this subset of naïve T cells acquires a different chemokine receptor phenotype, resulting in an altered migratory capacity in old age. Aberrant contact with antigen and effector cell differentiation in unorthodox locations may be the consequence. This could also affect Th1/Th2 polarisation, which is known to be impaired in elderly persons.