Radiological predictors of final infarct volume in patients with proximal vascular occlusion

INTRODUCTION

Various clinical and radiologic variables impact the neurologic prognosis of patients with ischemic cerebrovascular accidents. About 30% of ischemic cerebrovascular accidents are caused by proximal obstruction of the anterior circulation; in these cases, systemic thrombolysis is of limited usefulness. CT angiography is indicated in candidates for endovascular treatment. Various radiologic factors, including the grade of leptomeningeal collateral circulation, as well as the length, density, and extension of the thrombus, have been identified as predictors of neurologic prognosis after anterior ischemic cerebrovascular accidents due to proximal vascular obstruction. Final infarct volume correlations with mortality and long-term functional outcome in these patients. This study aimed to determine the best predictors of final infarct volume on CT angiography in patients with ischemic cerebral accidents due to proximal occlusion.

MATERIALS AND METHODS

This retrospective observational study included adults with ischemic cerebrovascular accidents due to obstruction of the anterior circulation diagnosed by CT angiography in the period comprising June 2009 through December 2019. We measured the length and density of the thrombus in unenhanced CT images, and we used the clot burden score to record the grade of leptomeningeal collateral circulation and the extension of the thrombus. Then we measured the final infarct volume on follow-up CT and analyzed the correlations among these radiologic factors in the infarct volume.

RESULTS

We included 54 patients [mean age, 82 y; 41 (75%) women] with ischemic cerebrovascular accidents due to proximal occlusion. About 60% of the cerebrovascular accidents affected the right cerebral hemisphere, and the most commonly affected vessel was the M1 segment of the medial cerebral artery (40.7%). Final infarct volume correlated with the grade of leptomeningeal collateral circulation (p=0.03) and with the clot burden score (p=0.01). Neither the length nor the density of the thrombus correlated with final infarct volume.

CONCLUSION

The final infarct volume can be estimated on the initial CT angiogram. Nevertheless, we found no useful predictive factors in unenhanced CT images. The best independent radiologic predictors of the final infarct volume are the grade of collateral circulation and the clot burden score, especially in patients who did not undergo mechanical thrombectomy, because mechanical thrombectomy improves outcomes. These factors are important for decision making in the management of patients with ischemic cerebrovascular accidents due to proximal occlusion.

Deficits in coordinated neuronal activity and network topology are striatal hallmarks in Huntington's disease

Background

Network alterations underlying neurodegenerative diseases often precede symptoms and functional deficits. Thus, their early identification is central for improved prognosis. In Huntington’s disease (HD), the cortico-striatal networks, involved in motor function processing, are the most compromised neural substrate. However, whether the network alterations are intrinsic of the striatum or the cortex is not fully understood.

Results

In order to identify early HD neural deficits, we characterized neuronal ensemble calcium activity and network topology of HD striatal and cortical cultures. We used large-scale calcium imaging combined with activity-based network inference analysis. We extracted collective activity events and inferred the topology of the neuronal network in cortical and striatal primary cultures from wild-type and R6/1 mouse model of HD. Striatal, but not cortical, HD networks displayed lower activity and a lessened ability to integrate information. GABA_A receptor blockade in healthy and HD striatal cultures generated similar coordinated ensemble activity and network topology, highlighting that the excitatory component of striatal system is spared in HD. Conversely, NMDA receptor activation increased individual neuronal activity while coordinated activity became highly variable and undefined. Interestingly, by boosting NMDA activity, we rectified striatal HD network alterations.

Conclusions

Overall, our integrative approach highlights striatal defective network integration capacity as a major contributor of basal ganglia dysfunction in HD and suggests that increased excitatory drive may serve as a potential intervention. In addition, our work provides a valuable tool to evaluate in vitro network recovery after treatment intervention in basal ganglia disorders.

Morphologic Features on MR Imaging Classify Multifocal Glioblastomas in Different Prognostic Groups

BACKGROUND AND PURPOSE

Multifocal glioblastomas (ie, glioblastomas with multiple foci, unconnected in postcontrast pretreatment T1-weighted images) represent a challenge in clinical practice due to their poor prognosis. We wished to obtain imaging biomarkers with prognostic value that have not been found previously.

MATERIALS AND METHODS

A retrospective review of 1155 patients with glioblastomas from 10 local institutions during 2006-2017 provided 97 patients satisfying the inclusion criteria of the study and classified as having multifocal glioblastomas. Tumors were segmented and morphologic features were computed using different methodologies: 1) measured on the largest focus, 2) aggregating the different foci as a whole, and 3) recording the extreme value obtained for each focus. Kaplan-Meier, Cox proportional hazards, correlations, and Harrell concordance indices (c-indices) were used for the statistical analysis.

RESULTS

Age (P < .001, hazard ratio = 2.11, c-index = 0.705), surgery (P < .001, hazard ratio = 2.04, c-index = 0.712), contrast-enhancing rim width (P < .001, hazard ratio = 2.15, c-index = 0.704), and surface regularity (P = .021, hazard ratio = 1.66, c-index = 0.639) measured on the largest focus were significant independent predictors of survival. Maximum contrast-enhancing rim width (P = .002, hazard ratio = 2.05, c-index = 0.668) and minimal surface regularity (P = .036, hazard ratio = 1.64, c-index = 0.600) were also significant. A multivariate model using age, surgery, and contrast-enhancing rim width measured on the largest foci classified multifocal glioblastomas into groups with different outcomes (P < .001, hazard ratio = 3.00, c-index = 0.853, median survival difference = 10.55 months). Moreover, quartiles with the highest and lowest individual prognostic scores based on the focus with the largest volume and surgery were identified as extreme groups in terms of survival (P < .001, hazard ratio = 18.67, c-index = 0.967).

CONCLUSIONS

A prognostic model incorporating imaging findings on pretreatment postcontrast T1-weighted MRI classified patients with glioblastoma into different prognostic groups.

Prevalence and distribution of hepatitis C virus genotypes in Spain during the 2000-2015 period (the GEHEP 005 study)

We report the largest study on the prevalence and distribution of HCV genotypes in Spain (2000-2015), and we relate them with clinical, epidemiological and virological factors. Patients from 29 hospitals in 10 autonomous communities (Andalusia, Aragon, Castilla-Leon, Catalonia, Galicia, Canary Islands, Madrid Community, Valencian Community, Murcia Region and Basque Country) have been studied. Annual distribution of HCV genotypes and subtypes, as well as gender, age, transmission route, HIV and/or HBV coinfection, and treatment details were recorded. We included 48595 chronically HCV-infected patients with the following characteristics: median age 51 years (IQR, 44-58), 67.9% male, 19.1% HIV-coinfected, 23.5% HBV-coinfected. Parenteral transmission route was the most frequent (58.7%). Genotype distribution was 66.9% GT1 (24.9% subtype 1a and 37.9% subtype 1b), 2.8% GT2, 17.3% GT3, 11.4% GT4 and 0.1% GT5 and 0.02% GT6. LiPA was the most widely HCV genotyping test used (52.4%). HCV subtype 1a and genotypes 3 and 4 were closely associated with male gender, parenteral route of infection and HIV and HBV coinfection; in contrast, subtype 1b and genotype 2 were associated with female gender, nonparenteral route and mono-infection. Age was related to genotype distribution, and different patterns of distribution and biodiversity index were observed between different geographical areas. Finally, we describe how treatment and changes in transmission routes may have affected HCV genotype prevalence and distribution patterns. We present the most recent data on molecular epidemiology of hepatitis C virus in Spain. This study confirms that genotype distributions vary with age, sex, HIV and HBV coinfection and within geographical areas and epidemiological groups.

Immunologic responses to the major allergen of Olea europaea in local and systemic allergic rhinitis subjects

OBJECTIVE

To evaluate the in vivo and in vitro responses to nOle e 1 in allergic rhinitis (AR) and local allergic rhinitis (LAR) patients sensitized to olive tree pollen (OL) confirmed by nasal allergen provocation test (NAPT).

METHODS

Twelve subjects with AR, 12 with LAR and 12 subjects as control group (CG) were selected. Skin testing and NAPT with nOle e 1 were performed. Eosinophilic cationic protein (ECP) and tryptase were measured in nasal lavages before and after NAPT. Serum IgE to OL allergens was measured by ELISA. Basophil activation tests (BAT) with OL and nOle e 1 and dendritic cell maturation/proliferation studies were carried out.

RESULTS

All AR (12/12) and 10/12 (83%) of LAR had a +NAPT to nOle e 1. ECP levels in nasal lavages were significantly increased after NAPT in both AR and LAR compared with CG at 15 min (P < 0.05). Serum IgE was positive only in AR. All AR had +BAT responses to OL and 10/12 to nOle e 1 (83%); 8/12 LAR (66.6%) had a +BAT to OL and 4/12 (33%) to nOle e 1, with only one subject of the CG with a +BAT to both OL and nOle e 1 (8%). Dendritic cell proliferation to nOle e 1 was increased in AR compared to LAR and CG (P = 0.019 and P = 0.001, respectively).

CONCLUSION

Both AR and LAR had a similar in vivo response to nOle e 1 with release of inflammatory mediators. Specific basophil activation with OL and nOle e 1 was observed in LAR confirming previous data obtained with dust mites.

Diazoxide enhances excitotoxicity-induced neurogenesis and attenuates neurodegeneration in the rat non-neurogenic hippocampus

Diazoxide, a well-known mitochondrial KATP channel opener with neuroprotective effects, has been proposed for the effective and safe treatment of neuroinflammation. To test whether diazoxide affects the neurogenesis associated with excitotoxicity in brain injury, we induced lesions by injecting excitotoxic N-methyl-d-aspartate (NMDA) into the rat hippocampus and analyzed the effects of a daily oral administration of diazoxide on the induced lesion. Specific glial and neuronal staining showed that NMDA elicited a strong glial reaction associated with progressive neuronal loss in the whole hippocampal formation. Doublecortin immunohistochemistry and bromo-deoxyuridine (BrdU)-NeuN double immunohistochemistry revealed that NMDA also induced cell proliferation and neurogenesis in the lesioned non-neurogenic hippocampus. Furthermore, glial fibrillary acidic protein (GFAP)-positive cells in the injured hippocampus expressed transcription factor Sp8 indicating that the excitotoxic lesion elicited the migration of progenitors from the subventricular zone and/or the reprograming of reactive astrocytes. Diazoxide treatment attenuated the NMDA-induced hippocampal injury in rats, as demonstrated by decreases in the size of the lesion, neuronal loss and microglial reaction. Diazoxide also increased the number of BrdU/NeuN double-stained cells and elevated the number of Sp8-positive cells in the lesioned hippocampus. These results indicate a role for KATP channel activation in regulating excitotoxicity-induced neurogenesis in brain injury.

Periodic nanostructures on unpolished substrates and their integration in solar cells

We present a novel fabrication process based on laser interference lithography, lift-off and reactive ion etching, which allows us to fabricate periodic nanostructures on photovoltaic substrates with an average root mean square (RMS) roughness of 750 nm. We fabricate nanostructures on unpolished crystalline silicon substrates, which reduces their reflectance 30% as fabricated. When an additional passivation layer is deposited, the light trapping grows, achieving a reflectance reduction of 60%. In addition, we have successfully integrated the nanostructured substrates in silicon wafer-based solar cells following standard processes, achieving a final efficiency of 15.56%.

Diazoxide attenuates autoimmune encephalomyelitis and modulates lymphocyte proliferation and dendritic cell functionality

Activation of mitochondrial ATP-sensitive potassium (KATP) channels is postulated as an effective mechanism to confer cardio and neuroprotection, especially in situations associated to oxidative stress. Pharmacological activation of these channels inhibits glia-mediated neuroinflammation. In this way, diazoxide, an old-known mitochondrial KATP channel opener, has been proposed as an effective and safe treatment for different neurodegenerative diseases, demonstrating efficacy in different animal models, including the experimental autoimmune encephalomyelitis (EAE), an animal model for Multiple Sclerosis. Although neuroprotection and modulation of glial reactivity could alone explain the positive effects of diazoxide administration in EAE mice, little is known of its effects on the immune system and the autoimmune reaction that triggers the EAE pathology. The aim of the present work was to study the effects of diazoxide in autoimmune key processes related with EAE, such as antigen presentation and lymphocyte activation and proliferation. Results show that, although diazoxide treatment inhibited in vitro and ex-vivo lymphocyte proliferation from whole splenocytes it had no effect in isolated CD4(+) T cells. In any case, treatment had no impact in lymphocyte activation. Diazoxide can also slightly decrease CD83, CD80, CD86 and major histocompatibility complex class II expression in cultured dendritic cells, demonstrating a possible role in modulating antigen presentation. Taken together, our results indicate that diazoxide treatment attenuates autoimmune encephalomyelitis pathology without immunosuppressive effect.

Systematic review and meta-analysis of performance of second-trimester nasal bone assessment in detection of fetuses with Down syndrome

OBJECTIVE

To review systematically the literature on diagnostic tests and performance of second-trimester sonographic assessment of nasal bone (NB) in identifying fetuses affected by Down syndrome.

METHODS

A search of studies involving screening tests for NB evaluation and measurements was carried out in the main international bibliographic databases (MEDLINE, EMBASE and CINAHL). Those considered to be relevant were then subjected to critical reading, following Critical Appraisal Skills Programme (CASP) criteria, by at least three independent observers. All data were extracted and tabulated by two independent investigators. A statistical synthesis of sensitivity, specificity and likelihood ratios was performed using specific software (Meta-DiSc).

RESULTS

From an initial list of 852 articles referring to ultrasound markers for Down syndrome, 207 relevant papers were selected. Following exclusions, 21 studies were included in the quantitative synthesis. The pooled estimates of positive and negative likelihood ratios were 40.08 (95% CI, 18.10-88.76) and 0.71 (95% CI, 0.64-0.79), respectively, for absent NB and 15.15 (95% CI, 8.15-28.16) and 0.47 (95% CI, 0.34-0.64), respectively, for hypoplastic NB. No relevant differences were found between the various means of defining nasal hypoplasia (multiples of the median (MoM) or percentiles). The biparietal diameter/nasal bone length (BPD/NBL) ratio showed somewhat higher sensitivity but lower specificity with a threshold effect.

CONCLUSIONS

NB absence or hypoplasia show high specificity and low but acceptable sensitivity in identifying fetuses with Down syndrome. Screening performance is better with NB measurements as a function of MoM or percentiles rather than as the BPD/NBL ratio. Classification of women into various risk groups for Down syndrome does not affect diagnostic performance.

[Functional echocardiography in neonatal intensive care: 1 year experience in a unit in Spain]

INTRODUCTION

Several publications highlight the usefulness of functional echocardiography (FnECHO) in neonatal intensive care. Data is lacking on its use in units neonatal in Spain.

OBJECTIVES

To evaluate frequency of use, patient characteristics, indications, measurements, and impact on patient management of FnECHO in a neonatal intensive care unit (NICU) in Spain over a 1 year period.

METHODS

A retrospective study conducted in NICU patients during 1 year.

VARIABLES

gestational age, birthweight, admission criteria, days of life at examination, indication for FnECHO, parameters assessed, and treatment modifications.

RESULTS

168 echocardiographic studies were performed in 50 patients (mean 3,4. SD 2,83). The most frequent indication was patent ductus (PDA) assessment (58.3%), followed by hemodynamic instability (22.2%). The results of FnECHO modified treatment in 62 cases (36.9%). In 17.4% of them treatment with ibuprofen was initiated, and in 1.2% it was discontinued. In 10.8% of the cases, the results of FnECHO modified hemodynamic support. Echocardiographic evaluation included: assessment of presence/hemodynamic significance of PDA (100%); myocardiac function: ejection fraction/shortening fraction (EF/SF) 23.8%, left ventricular output 24.4%, right ventricular output 21.4%, systemic blood flow 42.3%; and signs of pulmonary hypertension 7.7%.

CONCLUSIONS

FnECHO is frequently used in the NICU, and in many cases it guides treatment. PDA assessment and hemodynamic instability are the most frequent indications. It still needs to be elucidated if the use of FnECHO modifies patient outcomes.

ATP-dependent potassium channel blockade strengthens microglial neuroprotection after hypoxia-ischemia in rats

Stroke causes CNS injury associated with strong fast microglial activation as part of the inflammatory response. In rat models of stroke, sulphonylurea receptor blockade with glibenclamide reduced cerebral edema and infarct volume. We postulated that glibenclamide administered during the early stages of stroke might foster neuroprotective microglial activity through ATP-sensitive potassium (K(ATP)) channel blockade. We found in vitro that BV2 cell line showed upregulated expression of K(ATP) channel subunits in response to pro-inflammatory signals and that glibenclamide increases the reactive morphology of microglia, phagocytic capacity and TNFα release. Moreover, glibenclamide administered to rats 6, 12 and 24h after transient Middle Cerebral Artery occlusion improved neurological outcome and preserved neurons in the lesioned core three days after reperfusion. Immunohistochemistry with specific markers to neuron, astroglia, microglia and lymphocytes showed that resident amoeboid microglia are the main cell population in that necrotic zone. These reactive microglial cells express SUR1, SUR2B and Kir6.2 proteins that assemble in functional K(ATP) channels. These findings provide that evidence for the key role of K(ATP) channels in the control of microglial reactivity are consistent with a microglial effect of glibenclamide into the ischemic brain and suggest a neuroprotective role of microglia in the early stages of stroke.

Overexpression of TMPRSS4 in non-small cell lung cancer is associated with poor prognosis in patients with squamous histology

Background:

Mortality rates in lung cancer patients have not decreased significantly in recent years, even with the implementation of new therapeutic regimens. One of the main problems is that a large proportion of patients present local or distant metastasis at the time of diagnosis. The need for identification of novel biomarkers and therapeutic targets for a more effective management of lung cancer led us to investigate TMPRSS4, a protease reported to promote tumour growth and metastasis.

Material and methods:

In all, 34 lung cancer cell lines were used to evaluate the TMPRSS4 expression. Cell migration and clonogenic assays, and an in-vivo lung metastasis model were used for functional analysis of the TMPRSS4 downregulation in H358, H441 and H2170 cell lines. The TMPRSS4 expression analysis in normal and malignant lung tissue samples was performed by qPCR. Five different microarray-based publicly available expression databases were used to validate our results and to study prognosis.

Results:

The TMPRSS4 knock down in H358, H441 and H2170 cells resulted in a significant reduction in proliferation, clonogenic capacity and invasion. A significant (P<0.05) decrease in the lung colonisation and growth was found when mice were injected with TMPRSS4-depleated H358-derived clones, as compared with controls. Expression of TMPRSS4 showed a >30-fold increase (P<0.001) in tumours in comparison with non-malignant samples. Levels in tumours with squamous cell carcinoma (SCC) histology were found to be significantly higher (P<0.001) than those with adenocarcinoma (AC) histology, which was confirmed in data retrieved from the microarrays. Kaplan–Meier curves demonstrated that high levels of TMPRSS4 were significantly associated (P=0.017) with reduced overall survival in the patients with SCC histology, whereas no correlation was found for the AC histology.

Conclusion:

Our results demonstrate that TMPRSS4 has a role in the lung cancer development. The potential use of TMPRSS4 as a biomarker for lung cancer detection or as a predictor of patient's outcome warrants further investigation.

Isolated cardiomyopathy caused by a DMD nonsense mutation in somatic mosaicism: genetic normalization in skeletal muscle

X-linked dilated cardiomyopathy is a pure cardiac dystrophinopathy phenotype mainly caused by DMD mutations that present a specific transcription effect in cardiac tissue. We report a 26-year-old male who presented with severe dilated cardiomyopathy and high creatine kinase. The patient did not complain of skeletal muscle weakness. A muscle biopsy showed mild dystrophic changes and a low proportion of dystrophin-negative fibres. A molecular study identified a nonsense DMD mutation (p.Arg2098X) in somatic mosaicism. The ratio of mutant versus normal allele in blood and skeletal muscle suggests selective pressure against mutant muscle cells, a process known as genetic normalization. We hypothesize that this process may have mitigated skeletal muscle symptoms in this patient. This is the second report of a DMD somatic mosaic with evidence of genetic normalization in muscle. Somatic DMD mutations should be considered in patients presenting with idiopathic dilated cardiomyopathy.

In search of clinical truths: equine and comparative studies of anatomy

The importance of correlating anatomical studies with diagnostic and therapeutic approaches in practice has long been recognised. Such studies in the horse have, until recently, lagged behind this discipline in human medicine and surgery. Clinical techniques by which this correlation is achieved include radiography, ultrasound, computed tomography and magnetic resonance imaging. This review presents published literature on the subject and, in addition, describes the part played by plastination, a recently developed technique for the preservation of biological specimens. In this, tissue fluids and part of the lipids are replaced by certain polymers yielding specimens that can be handled without gloves, do not smell or decay, and even retain microscopic properties of the original sample. The technique has proved to be a useful tool to correct previously presented anatomical descriptions and is one now favoured by human surgeons. Studies of the horse employing this technique include those of the temporomandibular joint and tarsus. The aim of the review is to stimulate further correlations of anatomical structure and equine medical and surgical procedures, thereby advancing knowledge and understanding in practice and teaching.

Anatomy of the equine temporomandibular joint: study by gross dissection, vascular injection and section

REASONS FOR PERFORMING STUDY

The minute anatomy of the temporomandibular joint (TMJ) in horses is poorly documented in the literature.

OBJECTIVES

To examine in detail the anatomy of the normal equine TMJ and the relationship of the joint to adjacent structures.

METHODS

The anatomy of the TMJ was examined in 12 equidae using dissections, synovial and vascular injections and frozen and plastinated sections. Relevant structures were photographed.

RESULTS

Rostral and caudal compartments were identified in the dorsal and ventral synovial pouches of the TMJ. Lateral and caudal ligaments were identified and attachments of the masticatory muscles over the TMJ were documented. Direct relationships between the TMJ and components of the ear were found, and the vascular supply described.

CONCLUSIONS

This joint is related to some components of the ear as in man, and has its own peripheral vascular supply.

POTENTIAL RELEVANCE

A knowledge of the detailed anatomy of the equine TMJ is a prerequisite to interpreting the imaging techniques, and will enable improved diagnosis of TMJ pathologies.

First Report of Crenate Broomrape (Orobanche crenata) on Lentil (Lens culinaris) and Common Vetch (Vicia sativa) in Salamanca Province, Spain

Broomrapes (Orobanche spp.) are obligate parasites that infect roots of dicotyledonous plants. Orobanche species are particularly important in southern and eastern Europe, the Middle East, and North Africa. O. crenata (crenate broomrape) has been known to threaten legume crops since antiquity. This parasitic weed is mainly restricted to the Mediterranean Basin, southern Europe, and the Middle East and is an important pest in grain and forage legumes as well as in some Apiaceous crops such as carrot and celery (2,3). In Spain, O. crenata is a well-known problem on grain legumes in the south (Andalucía and Extremadura regions) and along the entire east coast north to the border with France. However, it has never been reported as a problem in central Spain. Castilla-León is the major pea-, vetch-, and lentil-producing area of Spain and was believed to be free of O. crenata. However, widespread and heavy infections of O. crenata (as many as 20 broomrapes per m²) were identified in the spring of 2007 on lentil and common vetch growing in several fields in Salamanca Province, between La Vellés, Palencia de Negrilla, and Aldeanueva de Figueroa, covering an area of approximately 80 km². Infection of lentil and vetch plants was confirmed by digging up the plants to verify the attachment of the broomrape plant to the lentil or vetch roots. Morphology was typical of O. crenata (2), i.e., large erect plants with single, nonbranched spikes that may reach a height of up to 1 m, bearing many flowers of diverse pigmentation from yellow through white to pink and violet. The calyx is 13 to 18 mm with segments free and bidentate. The corolla is 18 to 28 mm, glandular pubescent, the lips often with lilac veins, lips divergent, large, and not ciliate. The anthers are brown, glabrous, or subglabrous. The filaments insert 2 to 3 mm above the base of the corolla and are hairy at the base with glandular hair at the apex. Voucher specimens were deposited at the Herbarium of the Botanic Department of the University of Córdoba. The heavy and widespread level of infection observed in several fields is most likely explained by an inadvertent introduction of O. crenata seed mixed with seed of lentil and vetch. To our knowledge, this is the first report of O. crenata infecting lentil and common vetch in Salamanca Province and is relevant because the area was considered free of the plant. Remarkably, a recent modeling study suggested that O. crenata might become a problem in central and northern Spain (1) since climatic conditions are suitable for its establishment. The spread of this infestation should be monitored because it could represent a major constraint on legume production in this region. References: (1) J. H. Grenz and J. Sauerborn. Agric. Ecosyst. Environ.122:275, 2007. (2) D. M. Joel et al. Biology and Management of Weedy Root Parasites. Page 267 in: Horticultural Reviews. Vol. 33. John Wiley and Sons, Inc. Hoboken, NJ, 2007. (3) D. Rubiales et al. Euphytica 147:187, 2006.

[Susceptibility to antimicrobial agents of rapidly growing mycobacteria]

Rapidly growing mycobacteria are often associated with human diseases. We investigated the in vitro susceptibilities of 40 isolates to six antimicrobial agents: 17 Mycobacterium fortuitum, 11 M. chelonae and 12 M. abscessus isolated from several human sources: 29 respiratory secretions, 5 cutaneous abscesses, 4 corneal ulcers and 2 urine samples of patients treated at "Hospital Puerta del Mar" (Cádiz). Susceptibility studies were determined by the broth microdilution method for amikacin, clarithromycin, ciprofloxacin, levofloxacin, imipenem and cefoxitin. Results suggest that amikacin is the most effective antimicrobial agent for treating infections due to rapidly growing mycobacteria. Clarithromycin and imipenem show good activity against M. fortuitum and M. abscessus, but not against M. chelonae. Quinolones are only effective against M. fortuitum. It's important to identify, in rapidly growing mycobacteria infections, the etiologic agent to determine correct treatment.

Cost-effectiveness analysis of pregabalin versus gabapentin in the management of neuropathic pain due to diabetic polyneuropathy or post-herpetic neuralgia

OBJECTIVE

To estimate the cost-effectiveness of branded pregabalin (PGB) versus generic gabapentin (GBP) in patients with neuropathic pain (NeP) due to painful diabetic polyneuropathy (DPN) or post-herpetic neuralgia (PHN) in Spain.

METHODS

Using stochastic simulation, we estimated the cost-effectiveness of PGB 150-600 mg/d vs. GBP 900-3600 mg/d in a hypothetical cohort of 1000 patients. The model used data from three randomized controlled clinical trials. Pain was evaluated using a 0-10 scale. Mean baseline pain was 6.9 in both treatment groups. The model assigned untreated pain scores over 84 days. Treated scores were calculated using weekly changes in pain scores from trials. Outcomes included the numbers of days with no or mild pain (score < 4), days with >or= 30% and >or= 50% reductions in pain intensity, quality-adjusted life-years (QALYs), and estimated health costs.

RESULTS

Compared with GBP, PGB yielded an estimated mean of 8 (standard error, 0.4) additional days with no or mild pain, 6 (0.4) days with >or= 30% reduction in pain intensity, 9 (0.5) days with >or= 50% reduction in pain intensity, and a gain of 0.1186 (0.0002) QALYs for 12 weeks. The estimated total health costs of therapies were euro 1049 (euro 35) for PGB and euro 951 (euro 38) for GBP, respectively. Incremental cost-effectiveness ratio (ICER) for PGB versus GBP were a mean of euro 12 (95% confidence interval, euro 1-24) per additional day with no or mild pain, euro 431 (dominant-euro 876) per additional patient with no or mild pain, and euro 20 535 (euro 1607-40 345) per QALY gained.

CONCLUSIONS

According with data used in this modeling in patients with NeP due to DPN and/or PHN, PGB was shown to be more cost-effective than generic gabapentin in Spain.

Manejo del dolor del anciano en Atención Primaria (Estudio ADA)

OBJECTIVE

The main purpose of this study is to obtain information concerning type, clinical evaluation and therapeutic management of pain in elderly people in a Primary Care setting.

METHODOLOGY

Observational prospective study, conducted in the Primary Care setting in elderly patients, who were attended in the doctor's office with pain as main or secondary symptom. A total of 213 physicians and 1120 patients have participated in the study. Demographic data and clinical characteristics, pain intensity (as measured by Visual Analogical Scale -VAS-), diagnostic methods, treatments and sanitary resources used have been collected.

RESULTS

Pain was the main reason for visiting the physician in 86.2% of patients. The main characteristics of pain were: nociceptive pain (80.8%), lower limbs location (43.5%), degenerative etiology (71.8%) and chronic (67,7%). Pain intensity, as measured by VAS, was 7.1 +/- 1.3. Degree of satisfaction with previous analgesic treatments was good/very good in 30% of patients. The analgesics most frequently prescribed in this study were paracetamol (87.4%) and NSAID (51.2%).

DISCUSSION

Chronic nociceptive pain of degenerative etiology, and not very satisfactory response with previous treatments are the main characteristics of the elderly patient with pain that were attended by the Primary Care physician.

[Ischemic stroke secondary to left atrial myxoma]

We present the case of a 43-year-old-woman with history of ictal episodes who was admitted to the hospital after suffering a stroke affecting the left middle cerebral artery territory. After initial evaluation, an echocardiography identified a left atrial myxoma as aetiology of the stroke. In view of the surgical need, we asked for a cardiac magnetic resonance in order to obtain further anatomical information about the atrial mass. In the present article we review the neurological manifestations of the cardiac myxoma, considering the ischemic cerebrovascular disease as the most frequent presentation, just as this case illustrates.

[Anesthetic management for scheduled peritonectomy and hyperthermic intraperitoneal chemotherapy in 20 patients]

OBJECTIVE

The aim of this study was to describe our protocol for the anesthetic management for peritonectomy and hyperthermic intraperitoneal chemotherapy and to report the results from a series of 20 patients.

METHODS

The patients were diagnosed with peritoneal carcinomatosis and classified ASA 1-3. A thoracic epidural catheter was inserted for invasive monitoring. We recorded duration of surgery, hemodynamic changes and the use of vasoconstrictors, requirement for intraoperative fluid replacement or blood product transfusion, diuresis, and use of diuretics.

RESULTS

Twenty patients were studied. Peritonectomy could not be performed in 3 patients and their data was excluded in order to avoid skewing. The mean (SD) duration of the intervention was 543 (98) minutes. Vasoconstrictors were used in 7 out of 17 patients (41%). Diuretics were used in 10 out of 17 patients (58%). Fluids infused during surgery were a mean of 7.9 (2) L of crystalloid solution and 2.3 (0.6) L of colloid solution. Packed red blood cells were transfused in 9 cases and only 1 patient required fresh frozen plasma. The temperature rose from 1-1.5 degrees C during administration of the hyperthermic chemotherapy and was controlled without complications with the infusion of cold liquids and a heating blanket set at 32-34 degrees C. Extubation inside the operating room was possible in 41% of the cases. Two patients developed postoperative respiratory problems and 1 patient, renal failure. One patient was reoperated for bleeding.

CONCLUSIONS

The described anesthetic management protocol allowed the intervention to be carried out without complications other than hypotension, which responded to vasoconstrictor therapy.

In vivo co-ordinated interactions between inhibitory systems to control glutamate-mediated hippocampal excitability

We present an overview of the long-term adaptation of hippocampal neurotransmission to cholinergic and GABAergic deafferentation caused by excitotoxic lesion of the medial septum. Two months after septal microinjection of 2.7 nmol alpha-amino-3-hydroxy-5-methylisoxazole-4-propionate (AMPA), a 220% increase of GABA(A) receptor labelling in the hippocampal CA3 and the hilus was shown, and also changes in hippocampal neurotransmission characterised by in vivo microdialysis and HPLC. Basal amino acid and purine extracellular levels were studied in control and lesioned rats. In vivo effects of 100 mm KCl perfusion and adenosine A(1) receptor blockade with 1,3-dipropyl-8-cyclopentylxanthine (DPCPX) on their release were also investigated. In lesioned animals GABA, glutamate and glutamine basal levels were decreased and taurine, adenosine and uric acid levels increased. A similar response to KCl infusion occurred in both groups except for GABA and glutamate, which release decreased in lesioned rats. Only in lesioned rats, DPCPX increased GABA basal level and KCl-induced glutamate release, and decreased glutamate turnover. Our results evidence that an excitotoxic septal lesion leads to increased hippocampal GABA(A) receptors and decreased glutamate neurotransmission. In this situation, a co-ordinated response of hippocampal retaliatory systems takes place to control neuron excitability.

Clonal plasma cells from monoclonal gammopathy of undetermined significance, multiple myeloma and plasma cell leukemia show different expression profiles of molecules involved in the interaction with the immunological bone marrow microenvironment

The immunological bone marrow (BM) microenvironment plays a major role in controlling growth and survival of clonal plasma cells (PC); this might translate into different patterns of expression of molecules involved in immune responses on PC from different types of monoclonal gammopathies (MG). We have studied the expression of a group of nine such molecules on both BMPC and the plasma of 61 newly diagnosed MG patients (30 MG of undetermined significance (MGUS), 27 multiple myeloma (MM) and four plasma cell leukemia (PCL)) and five normal individuals. Clonal PC from all MG displayed significantly increased levels of CD56, CD86 and CD126, and decreased amounts of CD38 (P<0.001). Additionally, HLA-I and beta2-microglobulin were abnormally highly expressed in MGUS, while CD40 expression was decreased in MM and PCL (P<0.05). Interestingly, a progressive increase in the soluble levels of beta2-microglobulin was found from MGUS to MM and PCL patients (P=0.03). In contrast, all groups showed similar surface and soluble amounts of CD126, CD130 and CD95, except for increased soluble levels of CD95 observed in PCL. Overall, those phenotypic differences are consistent with increased antigen presentation and costimulatory capacities in MGUS, which progressively deteriorate in malignant MG (MM and PCL).

Effect of a Simple Dose-Escalation Schedule on Tramadol Tolerability

OBJECTIVE

To assess the effect of a very simple dose-escalation schedule on tramadol tolerability in clinical practice. This schedule consists of starting treatment with sustained-release tramadol 50mg twice daily, and escalating the dose around 7 days later to 100mg twice daily.

METHODS

Data from 1925 outpatients with non-malignant chronic pain were collected in this multicentre, prospective, comparative, non-randomised, open, observational study.

RESULTS

A total of 1071 patients (55.6%) were included in the dose-escalation group (50mg group) and 854 patients (44.4%) in the control group (sustained-release tramadol 100mg twice daily; 100mg group). The proportion of patients who interrupted tramadol treatment due to the occurrence of adverse reactions was significantly lower in the 50mg group (5.6%) than in the 100mg group (12.6%) [p = 0.001]. In line with this, the proportion of patients who experienced at least one adverse reaction was significantly lower in the 50mg group (18.4%) than in the 100mg group (30.4%) [p = 0.001] and, interestingly, the two most frequently reported adverse reactions, nausea and dizziness, were found with a significantly lower frequency in the 50mg group (p < 0.001). Multivariate analysis showed that the risk of safety-related treatment cessations was 2.3 times higher in the 100mg group than in the 50mg group, and 2.2 times higher in females than in males. The two treatments were equally effective in reducing pain intensity (p = 0.121), measured as a reduction in pain score obtained by means of a visual analogue scale.

CONCLUSION

The instauration of tramadol treatment, starting with sustained-release 50mg capsules twice daily and escalating the dose some days later to 100mg twice daily, was shown to be an effective and easy way to improve tramadol tolerability in clinical practice, whilst maintaining its analgesic efficacy.

Putative glucosensing property in rat and human activated microglia

Microglial cells involved in the pathogenesis of many neurodegenerative diseases acquire the features of cytotoxic and phagocytic cells in response to certain pathogens and inflammatory signals. K(ATP) channels are energy sensors of ATP availability that link the cell's metabolic state to its membrane excitability. In pancreatic beta cells, they promote glucose-dependent insulin secretion, and in neurones, hyperpolarization that protects against hypoxic damage. This study analyses activated microglia in an in vivo rat neurodegenerative model based on acute hippocampal glutamate receptor overactivation and in postmortem samples from patients with Alzheimer's disease. We demonstrate that in activated microglia the K(ATP) channel components SUR-1 or SUR-2 are present together with glucokinase. Our results indicate that, according to glucose availability, these channels may modify microglia membrane potential. The functional relevance of these channels is seen as a new mechanism modulating the effects of external signals on microglia.

Epidemiology of chronic inflammatory bowel disease in the Northern area of Huelva

OBJECTIVE

To know the different epidemiologic aspects of chronic inflammatory bowel disease (IBD) in the Northern area of the province of Huelva.

MATERIAL AND METHODS

we carried out a retrospective (1980-1996) and prospective (1996-2003) study of all patients diagnosed with IBD in the Northern area of Huelva, with 77,856 inhabitants. The distribution of Crohn s disease (CD) and ulcerative colitis (UC) was analyzed, as well as sex, age and smoking habit at the time of diagnosis, familial aggregation, appendicectomy rate, phenotype (anatomical site and clinical types), extraintestinal manifestations, and immunosuppressive therapy or surgical requirements.

RESULTS

70 patients with IBD were studied, 40 with UC and 30 with CD. Sex distribution was 39 (55.7%) males (55% with CD vs 56.6% with UC; NS) and 31 (44.3%) females (45% with CD vs 43.3% with UC; NS). Mean age at presentation was 44.7 +/- 19.32 years in UC vs 32.3 +/- 16.43 in CD; p < 0.001. Familial association was 7.1%. Previous appendicectomy was referred in 2.5% of patients with UC vs 36.7% of those with CD (p < 0.001), and the percentage of smokers was also higher in CD 66.7% vs CU 12.5% (p < 0.001). Anatomical site in UC was: proctitis, 20%; proctosigmoiditis/left colon, 42.5%; extensive colitis, 25%; and pancolitis, 12.5%; in CD was: terminal ileum, 43.3%; colon, 20%; and ileo-colon, 36.7%. The disease patterns were: inflammatory 56.7%, obstruction 26.7%, and fistulization 16.7%. Extraintestinal manifestations were diagnosed in 7.5% of patients with UC vs 16.6% patients with CD; surgery was performed in one patient with UC vs 10 with CD, and one patient with UC required immunosuppressive treatment vs 12 with CD. A multivariant analysis showed that younger age and smoking habit were risk factors for CD vs advanced age in UC, in which case, the smoking habit was a protective factor. The mean incidence rate of IBD starting from 1996 and expressed in cases/100,000 inhabitants/year was 5.2 for UC and 6.6 for CD.

CONCLUSIONS

The mean incidence of UC in our area was 5.2 cases/100,000/inhabitants/year, and 6.6 for CD. Patients presenting with CD are diagnosed at a significantly younger age that those with UC; the smoking habit is a risk factor for CD while it protects from UC. The characteristics of IBD in our geographical area do not differ substantially from those in other regions of Spain.

Nonfatal splenic haematoma and pancytopenia in an ass

This report describes a case of nonfatal idiopathic splenic haematoma and pancytopenia in a female ass, a condition that has not been previously reported in this species. A 12-year-old female ass weighing 225 kg was presented with signs of anorexia, depression and prominent abdominal distension. At the onset of clinical signs there was evidence of anaemia, leucopenia and thrombocytopenia. A large mass was palpated per rectum. The mass was confluent with the spleen and extended across the entire width of the abdomen. Percutaneous transabdominal ultrasonography and laparoscopy under general anaesthesia confirmed the diagnosis of splenic haematoma. The ass was treated initially with intravenous polyionic fluids; vitamins, trace elements and aminoacids; clanobutin; and penicillin and gentamicin, and was transfused with whole blood. After 5 days of hospitalisation the ass appeared brighter, and after 10 days the animal was discharged to recuperate at pasture. Six months later the animal's demeanour and appetite had improved. Repeat ultrasonographic examination showed persistence of the mass, but its thickness had decreased by 2 to 3 cm. A small mineralised area suggesting organisation of the haematoma was also detected. The haematological parameters had returned to normal values and the ass was clinically normal.

In vivo neuroprotective adaptation of the glutamate/glutamine cycle to neuronal death

Synaptic increase of glutamate level, when not coupled to a heightened energy production, renders neurons susceptible to death. Astrocyte uptake and recycling of synaptic glutamate as glutamine is a major metabolic pathway dependent on energy metabolism, which inter-relationships are not fully understood and remain controversial. We examine how the glutamate-glutamine cycle and glucose metabolism are modified in two in vivo models of severe and mild brain injury. Graded reductions of glutaminase, the glutamate synthetic enzyme, were evidenced combined with increases in glutamine synthetase, the inactivating glutamate enzyme. Increased lactate dhydrogenase (LDH) activity was only present after a more severe injury. These results indicate an in vivo adaptation of the glutamate-glutamine cycle in order to increase the net glutamine output, reduce glutamate excitotoxicity, and avoid neuronal death. We conclude that the graded modification of the glutamate-glutamine correlation and neuronal lactate availability may be key factors in the apoptotic and necrotic neuronal demise, whose control may prove highly useful to potentiate neuronal survival.

The Clinical Global Impression-Schizophrenia scale: a simple instrument to measure the diversity of symptoms present in schizophrenia

OBJECTIVE

To describe the development and validation of the Clinical Global Impression-Schizophrenia (CGI-SCH) scale, designed to assess positive, negative, depressive and cognitive symptoms in schizophrenia.

METHOD

The CGI-SCH scale was adapted from the CGI scale. Concurrent validity and sensitivity to change were assessed by comparison with the Positive and Negative Symptom Severity (PANSS) and Global Assessment of Functioning (GAF) scales. To evaluate inter-rater reliability, all patients were assessed by two clinicians.

RESULTS

Symptoms were assessed in 114 patients. Correlation coefficients between the CGI-SCH and the GAF and PANSS scores were high (most above 0.75), and were highest for positive and negative symptoms. Reliability was substantial (intraclass correlation coefficient, ICC > 0.70) in all but one dimension (depressive dimension, ICC = 0.64).

CONCLUSION

The CGI-SCH scale is a valid, reliable instrument to evaluate severity and treatment response in schizophrenia. Given its simplicity, brevity and clinical face validity, the scale is appropriate for use in observational studies and routine clinical practice.

[Treatment of allergy to mushrooms]

The treatment of patients with respiratory allergy is based on environmental control measures, pharmacological and immunotherapy treatment. The third cause of allergic respiratory disease in our environment is mushrooms, the most frequently involved being the Alternaria class. However, due to the great difficulties in their diagnosis and specific treatment, there are few controlled studies on immunotherapy with mushroom extracts. A clinical test was carried out with a suitable, biologically standardized extract for the diagnosis and treatment of patients allergic to Alternaria. A second phase determined the maximum tolerated dosage of this extract administered through immunotherapy, in depot preparation and in conventional dosage, which was 0.1 mg/ml of Alt a I. This dosage was established as the maintenance dosage in the following phase (double blind test controlled with placebo), in which the efficacy and safety of the immunotherapy with this extract was determined, administered in immunotherapy to the mentioned maintenance dosage, to 28 patients with rhinitis and/or asthma due to allergy to Alternaria. All the patients reached the pre-established maintenance dosage of 1670 BSU. The treatment proved efficient, producing an improvement in the symptoms, respiratory function, subjective evaluation of patient and doctor, and severity of the disease. The immunological response supported the clinical efficacy, with an increase in the IgG and a fall in the IgE over the course of the study. Tolerance to the treatment was excellent, with only two light systemic reactions registered in the 711 dosages administered (0.28% reactions/dosages administered).

MAO-A and MAO-B localisation in human lung and spleen

Localisation of MAO-A and -B in human lung and spleen was studied by immunohistochemistry. The primary antibodies used were mouse monoclonal anti-human MAO-A (6G11/E1) and anti-human MAO-B (3F12/G10/2E3). Samples of lung and spleen were obtained from 6 routine autopsy cases. Both immunoreactivities showed a homogeneous distribution in lung, where all cell types had both MAO-A and -B staining. In spleen MAO-A and -B showed a very weak immunoreactivity, which was restricted to smooth muscle cells and reticular cells of the white pulp. These data represent the most comprehensive study of MAO-A and -B localisation in the two tissues.

Initial bacterial colonization in patients admitted to a respiratory intensive care unit: bacteriological pattern and risk factors

BACKGROUND

Colonization is an important risk factor for consecutive infection, but little is known about incidence and initial pattern on admission to respiratory intensive care units (RICU).

OBJECTIVE

To study the bacterial colonization during the first 24 h after admission to a RICU.

METHODS

Endotracheal aspirates, gastric juice, and pharyngeal and rectal swabs of 55 consecutive patients were cultured (45 men, age 66 +/- 14 years, APACHE II 20.1 +/- 5.6, no parenchymal infection). All samples were taken within the first 24 h after admission to a RICU. Potentially pathogenic microorganisms were grouped as community (c-PPM) and hospital acquired (h-PPM), and risk factors for colonization of each body site as well as for overall colonization (all sites excluding rectum) were identified by logistic regression analysis.

RESULTS

The trachea was colonized in 18% of the intubated patients with c-PPMs and in 11% with h-PPMs. Candida spp. were the most frequent c-PPMs isolated from trachea, pharynx, and stomach (excluding rectal swabs), and Pseudomonas aeruginosa was the most frequently isolated h-PPM in trachea. The incidence of overall colonization was 49% for c-PPMs (predominantly Escherichia coli) and 18% for h-PPMs (predominantly P. aeruginosa). Admission to the hospital > or = 48 h before ICU admission was an independent risk factor of colonization with h-PPMs in univariate (33 vs. 7%, p = 0.015) and multivariate analyses (odds ratio 7.2, 95% CI 1.4-38.3; p = 0.0197).

CONCLUSIONS

Colonization of the trachea with c-PPMs was already present in every 5th and with h-PPMs in every 10th intubated patient during the first 24 h of RICU admission even in the absence of parenchymal infections. Hospitalization more than 48 h prior to RICU admission was a risk factor of colonization with h-PPMs.

Cellular localization of monoamine oxidase A and B in human tissues outside of the central nervous system

We studied the localization of monoamine oxidase (MAO) A and B in human heart, liver, duodenum, blood vessels and kidney by immunohistochemistry. The primary antibodies used were mouse monoclonal anti-human MAO-A (6G11/E1) and anti-human MAO-B (3F12/G10/2E3). Samples were obtained from six routine autopsy cases and fixed in 2% paraformaldehyde. All cardiomyocytes and hepatocytes showed MAO-A and MAO-B immunoreactivity. In the duodenum, both immunoreactivities were present in all cells of the villi, Lieberkühn crypts, muscularis mucosae and muscular layers, whereas Brunner glands were devoid of MAO-A and MAO-B staining. Endothelial cells of lymphatic vessels showed MAO-A but no MAO-B immunoreactivity, whereas arteries and veins presented MAO-A and MAO-B staining in muscular layers and fibroblasts but not in endothelial cells. In the kidney, renal tubuli showed MAO-A and MAO-B immunoreactivities, whereas collecting ducts and the Bowman's capsule showed only MAO-A staining. These data represent the first study of the cellular distribution of MAO-A and MAO-B in these human tissues. They show that both enzymes have a widespread distribution in the human body with a matching pattern in many, but not all tissues, and with strong differences from the pattern of distribution in rodents.

Increase in AMPA receptors in aged memory-impaired rats is not associated with increase in monoamine oxidase B levels

Aged rats may be behaviorally classified as either cognitively impaired or unimpaired based upon their performance in the Morris water maze task. In aged Long-Evans rats, emergence of functional deficits has been related to the increase in the alpha-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid (AMPA) receptor subtype in most hippocampal subfields, not observed in other brain structures. As AMPA receptors expressed in astrocytes may participate in the delayed and long-term glial response to injury, we investigated whether astrocytes participate in the increase of AMPA receptor observed in these aged rats. To this end, distribution of monoamine oxidase B, used as an astroglial marker, was characterized by quantitative autoradiography in the hippocampus and septum of young adults (six months) and aged (24-25 months) rats using [3H]lazabemide. Specific binding to brain sections of young, aged unimpaired, and aged impaired animals were calculated densitometrically. Compared to young animals, all hippocampal subfields in the aged unimpaired group showed a significant age-related increased labeling, which was not present in the aged impaired group. This contrasts with the increased glial transcription described in this last group. We propose that increase in AMPA receptors in the aged memory-impaired animals may be related to an atypic astrocytic reactivity.

Efficacy and safety of dipyrone versus tramadol in the management of pain after hysterectomy: a randomized, double-blind, multicenter study

BACKGROUND AND OBJECTIVES

We assessed the efficacy and safety of dipyrone in comparison with tramadol in the relief of early postoperative pain following abdominal hysterectomy.

METHODS

A total of 151 women between 18 and 60 years of age undergoing abdominal hysterectomy during general anesthesia participated in a randomized, double-blind, controlled, multicenter study. Seventy-three patients received dipyrone and 78 received tramadol. Patients received an intravenous loading dose of the study drug immediately after operation followed by intravenous (IV) maintenance infusion and IV on-demand boluses up to a maximum number of predetermined doses/day of 8 g dipyrone and 500 mg tramadol. The duration of the study was 24 hours.

RESULTS

The mean (SD) number of boluses in the dipyrone group was 3.8 (2.4) and 3.5 (2.5) in the tramadol group (95% confidence interval, -0.455 to 1.175), and the percentage of patients requiring rescue IV morphine (dipyrone 26.9%, tramadol 26.8%) was not statistically significant. Other analgesic efficacy parameters, such as pain intensity differences, sum of pain intensity differences, pain relief assessed by the patient, or patients who required the maximum number of demand doses, were not different between treatment groups. A significantly higher percentage of adverse gastrointestinal effects was found in patients given tramadol (42.1%) than in patients given dipyrone (20.2%) (P <.05). Also, a significantly higher number of tramadol-treated patients required ondansetron to control nausea and vomiting at 1 hour (19% v 7%), 2 hours (26% v 11%), and 24 hours (46% v 29%) (P <.05) after surgery. Patients and the investigators reported similar tolerability for both study arms.

CONCLUSIONS

Dipyrone and tramadol showed similar efficacy for early pain relief after abdominal hysterectomy. Nausea and vomiting, possibly caused by the tramadol, occurred more frequently in those patients. In this group, the need of the antiemetic drug ondansetron was also higher.

Molecular characterization of acute myeloblastic leukemia according to the new WHO classification: a different distribution in Central-West Spain

BACKGROUND AND OBJECTIVES

Molecular analysis has contributed to the identification of several non-random chromosomal translocations, such as t(15;17), t(8:21), inv(16)/t(16;16) and 11q23 abnormalities, typically associated with acute myeloid leukemia (AML). The identification of these chromosomal abnormalities helps not only to define different AML subtypes with distinct prognoses and treatments but also to monitor the disappearance of malignant cells after treatment. Recent reports suggest that the frequency of these alterations may differ according to geographic distribution. However, most of these reports focus on just one or two genetic alterations, which may lead to some selection bias. Appropriate epidemiological studies should be based on unselected consecutive series of patients in which all relevant genes are simultaneously analyzed. The aim of the present study was to explore whether or not the incidence of genetic lesions in Spanish AML patients differs from that reported in other countries.

DESIGN AND METHODS

In a series of 145 consecutive un-selected adult patients with AML we simultaneously analyzed the presence of 4 genetic abnormalities, PML/RARalpha for t(15;17), AML1/ETO for t(8;21), CBFbeta/MYH11 for inv(16)/t(16;16) and rearrangements of the MLL gene for 11q23 abnormalities. AML were classified using the new World Health Organization (WHO) classification for hematologic malignancies. The techniques used were standardized according to the recommendations of the European BIOMED-1 Concerted Action.

RESULTS

The PML/RARalpha transcript was present in 34 patients (23.4%) (23 were bcr1, 2 bcr2 and 9 bcr3). The AML1/ETO fusion transcript was detected in only 2 cases (1.4%) both with M2 morphology, but 29 other cases with M2 morphology were negative. CBFbeta/MYH11 transcript was present in 9 cases (6.2%) eight of them displaying M4Eo morphology. Finally, 5 cases (3.5%) showed rearrangements of theMLL gene. Our results differ from those reported from the United States and North/Central Europe, particularly regarding the incidence of t(15;17) and t(8;21) translocations. In Spain the frequency of t(15;17) is higher while that of t(8;21) is lower.

INTERPRETATION AND CONCLUSIONS

These data add epidemiological information about geographic heterogeneity of such chromosome aberrations in AML and would contribute to the design of specific screening strategies adapted to the incidence in each country.

Tissue activity and cellular localization of human semicarbazide-sensitive amine oxidase

Semicarbazide-sensitive amine oxidase (SSAO), widely distributed in highly vascularized mammalian tissues, metabolizes endogenous and xenobiotic aromatic and aliphatic monoamines. To assess whether its physiological role in humans is restricted to oxidation, we used an immunohistochemical approach to examine the cellular localization of SSAO in human peripheral tissues (adrenal gland, duodenum, heart, kidney, lung, liver, pancreas, spleen, thyroid gland, and blood vessels) and also analyzed its subcellular localization. The results are in agreement with the specific activities also determined in the same samples and are discussed with reference to the tissue distribution of monoamine oxidase A and B. Together with the oxidative deamination of monoamines, SSAO cellular localization indicates that, in most human peripheral tissues, it might participate in the regulation of physiological processes via H(2)O(2) generation. (J Histochem Cytochem 49:209-217, 2001)

Perinatal human hypoxia-ischemia vulnerability correlates with brain calcification

Deregulation of intracellular calcium homeostasis is widely considered as one of the underlying pathophysiological mechanisms of hypoxic-ischemic brain injury. Whether this alteration can result in cerebral calcification was investigated in basal ganglia, cerebral cortex, and hippocampus of human premature and term neonates together with glial reaction. In all samples nonarteriosclerotic calcifications were observed, their number and size were area-specific and increased in term neonates. Basal ganglia always presented the highest degree of calcification and hippocampus the lowest, located mainly in the CA1 subfield. In all cases, neuronal damage was associated with astroglial reaction and calcium precipitates, with microglial reaction only in basal ganglia and cerebral cortex, and argues for the participation of excitatory amino acid receptors in hypoxia-ischemia damage. These data correlate with hypoxia-ischemia vulnerability in the perinatal period. The clinical relevance of these precipitates and the neuroprotective interest of non-NMDA receptor manipulation are discussed in the light of our results.

In vivo and in vitro effects of (p)ppGpp on the sigma(54) promoter Pu of the TOL plasmid of Pseudomonas putida

The connection between the physiological control of the sigma(54)-dependent Pu promoter of the TOL plasmid pWW0 of Pseudomonas putida and the stringent response mediated by the alarmone (p)ppGpp has been examined in vivo an in vitro. To this end, the key regulatory elements of the system were faithfully reproduced in an Escherichia coli strain and assayed as lacZ fusions in various genetic backgrounds lacking (p)ppGpp or overexpressing relA. Neither the responsiveness of Pu to 3-methyl benzylalcohol mediated by its cognate activator XylR nor the down-regulation of the promoter by rapid growth were affected in relA/spoT strains to an extent which could account for the known physiological control that governs this promoter. Overexpression of the relA gene [predicted to increase intracellullar (p)ppGpp levels] did, however, cause a significant gain in Pu activity. Since such a gain might be the result of indirect effects, we resorted to an in vitro transcription system to assay directly the effect of ppGpp on the transcriptional machinery. Although we did observe a significant increase in Pu performance through a range of sigma(54)-RNAP concentrations, such an increase never exceeded twofold. The difference between these results and the behavior of the related Po promoter of the phenol degradation plasmid pVI150 could be traced to the different promoter sequences, which may dictate the type of metabolic signals recruited for the physiological control of sigma(54)-systems.

Excitatory amino acids and neurodegeneration: a hypothetical role of calcium precipitation

Activation of excitatory amino acid (EAA) receptors can induce neurodegeneration by two major mechanisms of excitotoxicity, one related to the influx of Na(+), Cl(-) and water, and the other to the increase in intracellular calcium concentration ([Ca(2+)](i)). Thus, acute microinjection of EAAs in several areas of the central nervous system (CNS) has been used to produce neurodegenerative models. We studied the excitotoxic pattern associated with acute microinjection of AMPA in rat hippocampus, medial septum-diagonal band of Broca (MS-DBB), prefrontal cortex and retina. In all cases progressive neuronal loss, glial reaction and development of intra- and extracellular calcium concretions were observed. However, a CNS-area differential vulnerability was revealed, as shown by the specific atrophy of MS-DBB and its limited calcification. Whether calcium deposits are a defensive mechanism against the massive increment of free cytoplasmatic calcium is discussed on the basis of ultrastructural data and previous results.

Localization of monoamine oxidase A and B in human pancreas, thyroid, and adrenal glands

We studied monoamine oxidase (MAO) A and B localization in human pancreas, thyroid gland, and adrenal gland by immunohistochemistry. The primary antibodies used were mouse monoclonal anti-human MAO-A (6G11/E1) and anti-human MAO-B (3F12/G10/2E3). Samples were obtained from six routine autopsy cases and fixed in 2% paraformaldehyde. Exocrine pancreas showed a widespread distribution of MAO-A, whereas MAO-B was present only in centroacinar cells and epithelial cells of pancreatic ducts. In endocrine pancreas, MAO-A was observed in around 50% of islet cells, whereas MAO-B was less abundant and was restricted to the periphery of islets. Thyroid gland showed strong MAO-A immunoreactivity in all cell types and was MAO-B-negative. In adrenal gland, the capsule displayed MAO-A but not MAO-B immunoreactivity, whereas the cortex showed widespread MAO-A staining but was MAO-B-negative in interstitial cells. Finally, in the medulla only a few scattered cells showed either MAO-A or MAO-B immunoreactivity. To our knowledge, these data represent the first study of the cellular distribution of MAO-A and MAO-B in the three human tissues included.

Reliability of low-avidity IgG and of IgA in the diagnosis of primary infection by rubella virus with adaptation of a commercial test

The detection of IgA and low-avidity IgG and antibodies in serum is a potentially useful marker of recent infection by a microorganism. We studied the reliability of IgG avidity and presence of IgA for the diagnosis of recent acute infection by rubella virus. Low-avidity IgG (Avy-EIA test) was determined with a modified commercial test using 8 molar urea (indirect ELISA, DiaSorin, Italy) and IgA was determined with a homemade indirect ELISA test. Twenty-five patients with recent primary infection by rubella virus (group I) and 50 healthy subjects (group II) were studied. In group I low-avidity IgG varied between 100 and 0% (67.3+/-21.8%); IgA was present in 24 patients (96%). In group II low-avidity IgG varied from 50.4 to 0% (19.8+/-16.9%). IgA was present in 2 subjects (4%). The sensitivity of the Avi-EIA and the IgA test was 92 and 96%, respectively; specificity was 100 and 96%, respectively. We conclude that both low-avidity IgG and IgA tests are helpful and reliable for the diagnosis of recent primary infection.

Severe limb girdle muscular dystrophy in Spanish gypsies: further evidence for a founder mutation in the gamma-sarcoglycan gene

Limb-girdle muscular dystrophy type 2C (LGMD2C) is an autosomal recessive muscular dystrophy with primary gamma-sarcoglycan deficiency, generally associated with a severe clinical course. gamma-sarcoglycan, a 35kDa dystrophin-associated protein, is encoded by a single gene on chromosome 13q12. Six different mutations have been described in that gene, and it has been proved they are the origin of the disease. One of these mutations (C283Y), a G-->A transition in codon 283, was recently and exclusively identified in Gypsy patients from different European countries. We report the study of 11 LGMD2C unrelated Gypsy families (nine Spanish and two Portugese). The muscle biopsies of these patients showed a drastically decreased immunostaining with alpha and gamma-sarcoglycan antibodies. All the patients were homozygous for C283Y missense mutation, and all affected chromosomes (patients and heterozygous relatives) carried the allele 5 (112 bp) of the intragenic microsatellite D13S232. Unexpectedly, this allele is most frequent in the Caucasian population but not in the normal Gypsy population. The clinical severity of all patients demonstrates that the C283Y missense mutation in a homozygous state causes a severe LGMD2C (DMD-like). The elevated number of families ascertained let us assume that LGMD2C is prevalent in the Gypsy population, and that all the families have inherited a founding mutation.

A home telecare management system

The increasing tendency to discharge chronic patients from hospital, as well as the growing expectation of improved quality of life for elderly and disabled people at home, was the original motivation for the development of a home telecare management system. The system allows a service centre to perform remote monitoring of biological signals and other data via the public telephone network, as well as to manage different emergency situations arising at home. The system is part of the FU-funded EPIC project (European Prototype for Integrated Care). It was tested in Belfast (Northern Ireland) and is currently being installed in Torre del Mar (Spain). This paper describes the system design and preliminary evaluation. The results indicate that the system operators find it highly acceptable in terms of efficiency, effectiveness, helpfulness, control and learnability. Integration of home telecare data with community-care information systems is essential if data captured at home are to be incorporated into the care process effectively.

[Influence of hematopoietic growth factors on transfusion support following autologous bone marrow transplantation]

PURPOSE

To determine the effect of haematopoietic growth factors (HGFs) (G-CSF and GM-CSF) on supporting platelet and red blood cell (RBC) transfusions in patients undergoing autologous bone marrow transplantation.

PATIENTS AND METHODS

We retrospectively evaluated the transfusion requirements of 44 patients over three months post-transplant. Ten of these patients received recombinant human G-CSF and ten received GM-CSF. This group was compared with the control group, formed of 24 patients who did not received HGFs. The patients receiving HGFs did not differ significantly from those who did not receive growth factor with regard to age, sex, diagnosis, number of bone marrow cells infused and clinical factors affecting the efficacy of platelet and/or RBC transfusion (fever, infection, amphotericin B treatment, bleeding episodes). Statistical analysis of the results was made using the Mann-Whitney U test, with a p value significant at the 0.05 level.

RESULTS

No significant effect of HGFs on platelet cell recovery was observed, but there was a trend for the time taken to recovery to increase. The median time of duration of platelet support dependence in the HGFs treated group was 19 days (range 7-100), compared with 15 days (range 3-65) in the control group. The number of platelet transfusions was 8.5 (2-43) and 7.5 (1-33) respectively. The treated patients received a median of 57 units of platelets (range 12-363), compared with 49 in the controls (range 7-206). In NHL there was a reduced need for platelet transfusions in HGFs group. In HD, HGFs increased platelet usage considerably (p < 0.05), although these groups were formed by only 5 and 7 patients respectively. The median RBC usage was the same between both patient groups (6 units of packed red cells).

CONCLUSION

In our patients, the administration of HGFs has no beneficial effect on blood product requirements.