Single-nucleus and spatial landscape of the sub-ventricular zone in human glioblastoma

The sub-ventricular zone (SVZ) is the most well-characterized neurogenic area in the mammalian brain. We previously showed that in 65% of patients with glioblastoma (GBM), the SVZ is a reservoir of cancer stem-like cells that contribute to treatment resistance and emergence of recurrence. Here, we built a single-nucleus RNA-sequencing-based microenvironment landscape of the tumor mass (T_Mass) and the SVZ (T_SVZ) of 15 GBM patients and 2 histologically normal SVZ (N_SVZ) samples as controls. We identified a mesenchymal signature in the T_SVZ of GBM patients: tumor cells from the T_SVZ relied on the ZEB1 regulatory network, whereas tumor cells in the T_Mass relied on the TEAD1 regulatory network. Moreover, the T_SVZ microenvironment was predominantly characterized by tumor-supportive microglia, which spatially co-exist and establish heterotypic interactions with tumor cells. Lastly, differential gene expression analyses, predictions of ligand-receptor and incoming/outgoing interactions, and functional assays revealed that the IL-1β/IL-1RAcP and Wnt-5a/Frizzled-3 pathways are therapeutic targets in the T_SVZ microenvironment. Our data provide insights into the biology of the SVZ in GBM patients and identify specific targets of this microenvironment.

[Reliability and validity of the SPAF questionnaire and the Stunkard rating scale amongst elderly Spanish people]

BACKGROUND

The aim of the study was to identify the reliability and validity of the SPAF questionnaire and the Stunkard rating scale in determining self-perceived physical appearance and the degree of body dissatisfaction in a group of elderly Spanish people.

METHODS

Both instruments were adapted to Spanish people and were administered twice to a group of 86 elderly people. Their reliability and validity were assessed by means of the intraclass correlation coefficient (ICC), Cronbach's alpha and Spearman's rho coefficient, from the physical fitness level of the participants and their body mass index (BMI). ANOVA test was carried out to compare the variables with normal distribution.

RESULTS

The questionnaire and the Stunkard rating scale showed a good test-retest reliability (ICC?=?0.78 and ICC?=?0.8, respectively). SPAF and fitness level showed a significant, albeit weak, association (rho?=?0.424), while the association between self-perception of body composition and BMI was moderately strong (rho?=?0.727). The self-perceived physical appearance of 59.5?% of the sample was acknowledged to be normal, 11.4?% perceived it as bad and 29.1?% as good. Only 27.1?% were satisfied with their body image, while the other participants showed a desire to lose the equivalent weight of one (47.06?%), two (22.35?%) or three or more (3.5?%) points in the Stunkard scale.

CONCLUSION

The versions of both instruments adapted to Spanish persons showed reliability and validity, and showed that it was possible to determine that a large part of the sample was dissatisfied with their body image. BMI had a significant influence in this regard.

Intrinsic Rashba coupling due to hydrogen bonding in DNA

We present an analytical model for the role of hydrogen bonding on the spin-orbit coupling of a model DNA molecule. Here, we analyze in detail the electric fields due to the polarization of the hydrogen bond on the DNA base pairs and derive, within a tight binding analytical band folding approach, an intrinsic Rashba coupling which should dictate the order of the spin active effects in the chiral-induced spin selectivity effect. The coupling found is ten times larger than the intrinsic coupling estimated previously and points out to the predominant role of hydrogen bonding in addition to chirality in the case of biological molecules. We expect similar dominant effects in oligopeptides, where the chiral structure is supported by hydrogen-bonding and bears on orbital carrying transport electrons.

[Analysis of the convergent validity of the Spanish short version of the Minnesota Leisure Time Physical Activity Questionnaire (VREM) and the Spanish version of the International Physical Activity Questionnaire in elderly people (IPAQ-E)]

BACKGROUND

In our country the Spanish short version of the Minnesota Leisure Time Physical Activity Questionnaire (VREM) and the International Physical Activity Questionnaire in elderly people (IPAQ-E) are considered useful tools for estimating the amount of physical activity (PA) performed by the geriatric population. However, few studies have been carried out on their psychometric properties. Therefore, this research aims to provide information on their convergent validity by analysing the degree of association that both questionnaires show with physical fitness level.

MATERIAL AND METHODS

A total of 105 people (mean age: 76.77 (SD=6.01) years; 84.8% women), answered both questionnaires and performed the Senior Fitness Test (SFT), in order to assess their physical fitness level.

RESULTS

Significant correlations were found between the SFT and the VREM items related to energy expenditure derived from walking (r=0.227) or from performing sports activities or dancing (r=0.235), and the estimated total energy expenditure (r=0.314). The IPAQ-E did not establish significant associations with any of the variables analysed. Although a certain a priori correlation was observed between the VREM and the IPAQ-E (r=0.447, p<0.001) and the mean difference between both parameters was nil (p=0.553), it was considered that the questionnaires showed a lack of agreement due to the great width found in the range of differences.

CONCLUSIONS

The use of the VREM questionnaire is recommended for estimating the amount of PA performed by the geriatric population, as it shows a certain degree of association, albeit weak, with the level of physical fitness.

Obstetrical providers' preferred mode of delivery and attitude towards non-medically indicated caesarean sections: a cross-sectional study

OBJECTIVE

To describe obstetrical providers' delivery preferences and attitudes towards caesarean section without medical indication, including on maternal request, and to examine the association between provider characteristics and preferences/attitudes.

DESIGN

Cross-sectional study.

SETTING

Two public and two private hospitals in Argentina.

POPULATION

Obstetrician-gynaecologists and midwives who provide prenatal care and/or labour/delivery services.

METHODS

Providers in hospitals with at least 1000 births per year completed a self-administered, anonymous survey.

MAIN OUTCOME MEASURES

Provider delivery preference for low-risk women, perception of women's preferred delivery method, support for a woman's right to choose her delivery method and willingness to perform caesarean section on maternal request.

RESULTS

168 providers participated (89.8% coverage rate). Providers (93.2%) preferred a vaginal delivery for their patients in the absence of a medical indication for caesarean section. Whereas 74.4% of providers supported their patient's right to choose a delivery method in the absence of a medical indication for caesarean section and 66.7% would perform a caesarean section upon maternal request, only 30.4% would consider a non-medically indicated caesarean section for their own personal delivery or that of their partner. In multivariate adjusted analysis, providers in the private sector [odds ratio (OR) 4.70, 95% CI 1.19-18.62] and obstetrician-gynaecologists (OR 4.37, 95% CI 1.58-12.09) were more willing than either providers working in the public/both settings or midwives to perform a caesarean section on maternal request.

CONCLUSIONS

Despite the ethical debate surrounding non-medically indicated caesarean sections, we observe very high levels of support, especially by providers in the private sector and obstetrician-gynaecologists, as aligned with the high caesarean section rates in Argentina.

TWEETABLE ABSTRACT

Non-medically indicated c-section? 74% of sampled Argentine OB providers support women's right to choose.

Influence of cognitive impairment on the freezing of gait in non demented people with Parkinson's disease

INTRODUCTION

Freezing of gait (FOG) is a motor disturbance usually appearing in advanced Parkinson's disease (PD). Cognitive and executive function seems to play an important role in this phenomenon.

AIM

To investigate if cognitive and kinematic parameters correlate with FOG in PD patients without dementia.

PATIENTS AND METHODS

We conducted an observational cross-sectional study. Participants were classified in two groups: freezers and non-freezers. Clinical information was obtained by Hoehn and Yahr scale, Unified Parkinson's Disease Rating Scale and balance test of Short Physical Performance Battery. Cognitive function was evaluated using Minimental Examination and the Fuld Object Memory Evaluation; executive function was assessed with the Frontal Assessment Battery test. Battery kinematic parameters were assessed by means of gait speed, cadence, stride length and stride time.

RESULTS

Twenty-five participants with PD without dementia completed the evaluation. Statistical significant differences between freezers and non-freezers were found in global cognition (p = 0,02), memory (p = 0,04), executive function (p = 0,04), cadence (p = 0,02), stride length (p = 0,04) and stride time (p = 0,01).

CONCLUSION

Cognitive parameters may have an important contribution to the manifestation of freezing of gait in PD. These results may have important clinical implications for developing future non-pharmacological and cognitive interventions strategies targeted to PD patients with FOG.

Phase II study of first-line biweekly docetaxel and cisplatin combination chemotherapy in advanced gastric cancer

PURPOSE

Previous studies have shown that docetaxel and cisplatin, as single agents, are effective and relatively well tolerated in patients with advanced gastric cancer. The aim of this study was to assess efficacy and toxicity of a biweekly regimen of docetaxel plus cisplatin in patients with advanced gastric cancer.

PATIENTS/METHODS

Fifty-five patients with histologically proven advanced gastric cancer with at least 1 measurable lesion and ECOG PS ≤ 2 were enrolled. Patients received docetaxel 50 mg/m(2) and cisplatin 50 mg/m(2) every 2 weeks until progression disease, unbearable toxicity or a maximum of 12 cycles.

RESULTS

In total, 426 cycles were administered (median 8.5 cycles) to 52 evaluable patients. One patient (1.9 %) showed a complete response, while 21 (40.4 %) had partial responses. The objective response rate was 42.3 % (95 % CI 28.9-55.7), the median time to progression was 5.5 months (95 % CI 4.0-7.0), and the median overall survival was 8.9 months (95 % CI 6.0-11.9). The most common grade 3-4 toxicities per cycle were haematological [neutropenia (5.9 %)].

CONCLUSIONS

Biweekly administration of docetaxel and cisplatin in advanced gastric cancer has a manageable toxicity profile and shows a promising antitumour activity as a first-line therapy.

Maintenance treatment with cetuximab in a series of patients treated with standard chemotherapy and cetuximab in metastatic colorectal cancer

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Background: New strategies are needed to improve outcomes and reduced toxicities of currently treatments for patients with advanced colorectal cancer. Nowadays maintaining treatment until disease progression is the standard option for these patients. Cetuximab is a recombinant humanized monoclonal antibody that neutralizes epidermal growth factor receptor and it has shown benefit not only in combination with standard chemotherapy in first- and second-line treatment or as a single agent in progression to standard chemotherapy in KRAS wild-type metastatic colorectal cancer (mCRC).

Methods: This data describes patients who received standard chemotherapy with cetuximab every two weeks. For patients with response or stable disease, cetuximab was continued until disease progression or unacceptable toxicity.

Results: Twelve patients are reported, nine were male (75%). The median age was 62 years (range, 46 to 78 years). All patients had stage IV, and liver was the most common location (75%). The majority of patients (75%) received FOLFOX VI as a first-line treatment in combination with cetuximab; only two patients were treated with FOLFIRI. Cetuximab was maintained after the first line of treatment in the 75% of patients. The median of cycles of chemotherapy and cetuximab was 12. Best response achieved in this setting was complete response (58.3%, 7/12). Median of monotherapy with cetuximab treatment was 7.5 cycles (range 3 to 12). At the moment of this analysis seven of twelve patients continued with the maintenance. In the rest of patients the treatment was followed until progression (33%, 3/12). No grade 3-4 toxicities were seen during maintenance cetuximab. The most common adverse effect during maintenance was cutaneous toxicity but the majority of patients had minor toxicity (50% grade 1).

Conclusions: Cetuximab has significant antitumor activity not only as a single agent or in combination with standard chemotherapy but may also when it is used as maintenance therapy after a complete or partial response to first or second line based chemotherapy in mCRC. Maintenance cetuximab is feasible, safe, and worthy of future study in advanced colorectal cancer.

No significant financial relationships to disclose.

Batteries assessing health related fitness in the elderly: a brief review

Evaluation of physical functioning is a key issue in clinical geriatrics and in aging research. In recent years, different physical performance batteries in which individuals are asked to perform several tasks and are evaluated using different criteria have been designed and used in elderly populations. These batteries include different types of test which range from basic motor abilities to relevant everyday activities, depending on the construct area in the domain of physical function that must be measured. This paper reviews and classifies the main physical functioning batteries that can be found in the scientific field of aging research in order to provide knowledge on selection, administration, and interpretation of this indispensable assessment tools.

House dust mite species and allergen levels in Galicia, Spain: a cross-sectional, multicenter, comparative study

BACKGROUND AND OBJECTIVES

Mites are important sources of allergens in Galicia, Spain. The objective of this study were to identify the main mite species and to determine allergen levels in mattresses from different locations in Galicia.

MATERIAL AND METHODS

Dust samples were collected with a portable vacuum cleaner for 2 minutes from 2 m2 of the surface of the mattress used by mite allergic patients and controls. After collection, samples were immediatel frozen. Mite species were collected, identified, and counted, and the results expressed as mites per gram of dust. Mite allergen levels (Der p 1 and Der f 1) were measured using monoclonal antibodies. All individuals answered a questionnaire about the characteristics of their homes.

RESULTS

A total of 332 dust samples were collected (112 from mite allergic patients and 220 from controls). Thirty-two species were identified. The mean age +/-SD of all the participants was 32.4 +/- 20.8 years and of the mattresses 7.6 +/- 5.9 years. The geometric mean of the total mite counts was 910.2 mites per gram (896.2 mites per gram in the mattresses of mite allergic patients and 917.3 in the mattresses of control subjects; P > .05). The main species was Dermatophagoides pteronyssinus, which was present in 97.6% of the samples (geometric mean, 584.7 mites per gram). The geometric mean level of Der p 1 was 13.1 microg/g of dust: 11.9 in the mattresses of mite allergic patients and 13.8 in the mattresses of control subjects. The geometric mean level of Der f1 was 1.1 microg/g: 1.5 in the mattresses of mite allergic patients and 0.8 in the mattresses of control subjects. Environmental risk factors associated with high mite counts included obvious signs of humidity in the bedroom and the age of the mattress.

CONCLUSIONS

The mite fauna in Galicia is comprised of many species, several of which are known to be of allergologic importance. The total population is exposed to very high levels of mite allergens.

Characteristics of pollinosis caused by Betula in patients from Ourense (Galicia, Spain)

A retrospective study was performed to describe the features of the pollinosis caused by Betula in the area of Ourense, Spain. The pollen count was carried out with a Lanzoni volumetric Hirts spore trap (1993-2000). The Betula pollen represented 5% over the annual total (annual mean quantity: 965 grains). It was present in the air from March to mid-May. The highest peaks took place in April (maximum values mean: 131 grains/m3). The medical records of 222 patients (mean age 25.66 years) diagnosed with pollinosis (1998-2000), who lived at less than 30 km. from the spore trap, were reviewed. In all of them, the skin-prick test (SPT) was carried out with pollen allergens. The percentages of positive SPT were: Lolium perenne, 91.89% (16.6% monosensitized); Plantago lanceolata, 71.17% (1.26% monosensitized); Betula alba, 41.89% (10.75% monosensitized); Platanus hybrida, 34.95%; Olea europea, 10.36%; and Parietaria judaica, 6.3%. The mean age of Betula monosensitized patients was 44.7 years. The majority of them had symptoms in March-April, 40% had asthma symptoms, 80% had lived in Central Europe, and 30% of them presented an oral allergy syndrome to fruits. There were 41.93% of the patients with positive SPT to Betula pollen who had asthma symptoms, in comparison with 23.25% of the patients with negative SPT to Betula (p = 0.0034). There were 20.28% of the patients with positive SPT to Betula pollen, who had lived in Central Europe, in comparison with 4.27% of the patients with negative SPT to Betula, p: 0.00049. The relative risk of sensitization was 2.05.

CONCLUSIONS

Betula pollen was the second cause of clinical pollinosis in our patients, after grass, being responsible of the symptoms in the early spring, in a small number of the patients in their forties. The presence of asthma was higher in Betula sensitized patients, and the residence in Central Europe was a sensitization risk factor.

[Diabetes mellitus induced by olanzapine. A case report]

Atypical antipsychotics are widely used in psychotic disorders, refractory to conventional neuroleptic agents. They induce minimal extra pyramidal side effects, probably due to their greater affinity for certain dopaminergic receptors. However, this polyreceptor affinity may be responsible for the development of other side effects. We report a 48 years old male drinker and addicted to cocaine, that after two months of Olanzapine use, developed a severe diabetes mellitus with fasting blood glucose values reaching 514 mg/dl. When he was admitted to the hospital, physical examination was normal and his body mass index was 28 kg/m2. Olanzapine was discontinued and blood glucose values gradually returned to normal. After two months of follow up, the patient is on dietary treatment and with a fasting glucose of 132 mg/dl.

[Focal atrial fibrillation treated with radiofrequency]

Atrial fibrillation is usually thought to be due to multiple circulating reentrant wavelets. From previous studies, a focal mechanism is considered to be very unlikely. This focal source could be successfully treated by radiofrequency catheter ablation. We report a patient without structural heart disease, but with multiple episodes of syncope and palpitations related to atrial tachycardia and atrial fibrillation. Electrophysiological study demonstrated that all atrial arrhythmias were due to one focus located in the left atrium at the ostium of the left superior pulmonary vein that was successfully treated with the use of a mean of three radiofrequency pulses, without complications. The pulmonary veins are an important source of ectopic beats, initiating frequent paroxysm of atrial fibrillation. These foci respond to treatment with radiofrequency ablation.

Platanus pollen as an important cause of pollinosis

OBJECTIVE

The existence of Platanus pollinosis is not generally accepted despite the production of very large quantities of airborne Platanus pollen in many cities of the United States and Europe. The aim of this study was to investigate if Platanus pollen really contributes to the symptoms of the patients with pollinosis in the Madrid area.

METHODS

We carried out systematic skin prick testing with Platanus pollen extract on 47 patients seen in our allergy center with spring-summer pollinosis symptoms. Each patient maintained symptom score diaries before, during, and after the Platanus pollination season. The average symptom scores were calculated and compared with the Platanus pollen counts. Measurements of specific IgE by ELISA and immunoblotting also were performed in each patient.

RESULTS

The Platanus skin tests were positive in 33 of the 39 patients first seen with seasonal symptoms during Platanus pollen season and only in three of the eight patients without symptoms during Platanus exposure (Fisher's exact test; p < 0.05). Twenty-two of the 33 Platanus-positive skin test patients also had a positive ELISA result. Furthermore, the average 24-hour rhinitis symptom scores of the 39 patients first seen with seasonal symptoms during March through April showed significant correlation with Platanus pollen counts (r(s) = 0.57, p < 0.05). The immunoblot results suggest that a 17 kd pollen protein could be a major allergen in patients with Platanus pollinosis.

CONCLUSIONS

Platanus pollen is an important cause of pollinosis in Madrid. A protein with a molecular weight of 17 kd appeared to be its major allergen.

Allergenic pollen pollinosis in Madrid

OBJECTIVE

A 15-year pollen count was performed in the atmosphere of Madrid, Spain, to determine the months in which the highest concentrations of allergenic pollens occur.

METHODS

Pollen counts were done with a Burkard spore trap (Burkard Manufacturing, Rickmansworth, Herst., U.K.). The results were subsequently compared with results of skin tests in patients with pollinosis born and living in and around Madrid.

RESULTS

The highest airborne presence (percent of total yearly pollen counts, mean of counts from 1979 to 1993) was for Quercus spp. (17%); followed by Platanus spp. (15%), Poaceae (15%), Cupressaceae (11%), Olea spp. (9%), Pinus spp. (7%), Populus spp. (4%), and Plantago spp. (4%). The most predominant pollens from January to April are tree pollens (Cupressaceae, Alnus, Fraxinus, Ulmus, Populus, Platanus, and Morus), although these are also abudant in May and June (Quercus, Olea, and Pinus spp.). The grass pollination period shows a double curve: the first peak occurs from February to April (8% of yearly grasses), and the second peak occurs from May to July (90% of yearly grasses). Among allergenically significant weeds, the most notable is Plantago; in contrast, Rumex, Urticaceae, Cheno-Amaranthaceae, and Artemisia spp. have very low concentrations (< or = 2% yearly total pollens). The most significant allergenic pollen is that of grasses, with a prevalence of positive prick test results of 94%, followed by Olea europaea (61%), Plantago lagopus (53%), Platanus hybrida (52%), and Cupressus arizonica (20%).

CONCLUSION

The population of Madrid is exposed to high concentrations of allergenic pollen from February to July, although the most intense period is from May to June. Grass pollens are the most important cause of pollinosis in this area.

Changes in protein kinase C activity, subcellular distribution and protein phosphorylation during the lactogenic cycle in the rat mammary tissue

Direct and indirect evidence emphasizes the participation of classical protein kinase C (cPKC) in the development and function of the mammary gland. This work shows that there are changes not only in total cPKC activity during the lactogenic cycle, but also in the relative amounts of the soluble and particulate cPKC activities and that the time-course of these two events are not the same. The time-course of translocation from the cytoplasm to the plasma membrane suggests that the soluble and particulate forms of the enzyme may be associated with growth and differentiation of the tissue, respectively. Phosphorylation patterns also show characteristic and significant differences throughout the development of the gland. These results suggest that both total mammary cPKC activity and its subcellular forms change in accordance with the proliferative and differentiative stages of the mammary gland, and that the enzyme translocation occurs during the transition from pregnancy to lactation.

[Hydrops fetalis caused by congenital leukemia]

A term female infant of hydropic aspect was born from an A II Rh positive mother who had not submitted herself to prenatal medical controls. From delivery the newborn showed evidence of hydrops, tendency to bleed from needle puncture sites and poor respiratory effort, there fore it was necessary to support her with mechanical ventilation, but she died three hours after birth. Autopsy findings included proliferation of immature white blood cells of myeloid type with reduction of red blood cell precursors and megakaryocytes at the bone marrow. The same immature cell forms also infiltrated liver, spleen, lungs and adrenal glands. Leukemia is seldom seen in the neonatal period an it has been described in only rare occasions associated to non-immunological fetal hydrops.

[Implantation of mitral valve prosthesis with continuos suture]

The results obtained in 20 patients with the use of continue suture technic for prosthetic implantation of the mitral valve were compared to those observed in other 20 patients in which the prothesis were implanted with isolated suture technic. With the first one the aortic clamp time was reduced in average about 50 minutes; the extracorporeal circulation time also diminished in the same proportion. One patient died in each group, meaning a 5% of hospital mortality. The going after time in the first group was 2.5 years and in none was found prosthetic dysfunction or perivalvular lickage. We conclude that prosthetic implantation technic for mitral valve with continue suture, offers the following advantages: a) Important reduction of the transoperative myocardial ischemia. b) Reduction also, of the hole estracorporeal circulation time. c) Minor possibilities of periprosthetic lickage. d) Minor risk of valvular thrombosis in the suture line.

[Mycotic aneurysm of the ascending thoracic aorta. Clinico-pathological report of a case]

The case of a six year old girl with a congenital aortic stenosis is presented. A few months before being admitted to the Instituto Nacional de Cardiologia; her clinical manifestations suggested a bacterial endocarditis. The existance of an aneurismatic area in the ascending aorta and the later development of a crisis of angor pectoris, suggested a mycotic aneurism of the ascending aorta as a possible diagnosis; and the dissection or migration of septic material to the aneurism was found, it has a sacular form of 3.5 by 3.8 cm in the ascending aorta. There was also dissection into the left coronary artery at the ostium level. Microscopic study showed areas of recent myocardial necrosis on the free wall of the left ventricle and in the lower part of the interventricular septum. The etiopathogeny, clinical manifesations, radiology, evolution and treatment of mycotic aneurism were considered. The need of an early clinical diagnosis and early medical and surgical treatment is emphasized.

[Myocardial infarct following left ventriculography. Report of 2 cases and review of the literature]

Two cases, a sixteen-month-old girl and a 13 year-old bol, were presented who developed myocardial infarction as a consequence of angiocardiographic study. The boy (case 1) showed electrocardiographic signs of lower necrosis with elevation of the TGO and DHL and having a satisfactory clinic evolution. The girl (case 2), in the electrocardiogram, showed an inactivatable zone on the lateral wall and signs suggesting anteroseptal subendocardic necrosis, and enzymatic elevation. She died the fourth day following the hemodynamic study. The literature regarding this complication and the possible triggering causes are reviewed.