[Infective endocarditis in the elderly]

BACKGROUND

The influence of age on the clinical presentation and on the prognosis of infective endocarditis (IE) is unclear. Our aim was to analyse the epidemiologic, clinical and bacteriological characteristics of IE in the elderly compared with younger adult patients. PATIENTS AND METHODS A retrospective study of all patients with IE non intravenous drug users diagnosed in our hospital during the period from 1990 to 2000. We used the Duke criteria to compare the characteristics of 46 episodes of definitive IE in elderly patients (>65 years old ) and of 46 episodes in younger adult patients (20-64 years of age ).

RESULTS

No significant differences were observed among the two groups with respect to the delay in diagnosed, possible source of infection, the frequency of positive blood cultures and the type of infective organism, clinical presentation and evolution of the IE. Elderly patients more often had risk factors predisposing (degenerative valvular disease, prosthetic valve and pacemaker ), which decreased the sensitivity of transthoracic echocardiography to 46.5% compared with 64.4% in the younger patients. Transesophageal echocardiography improved the diagnostic of IE in the 37.2% in elderly patients. The patients in the both groups underwent surgical therapy with similar frequency (36.9% in the elderly and the 39.1% in the younger adult patient ) and the mortality rate not was significantly higher in the elderly (19.5%) than in the younger adult patients (10.8%).

CONCLUSIONS

The age itself is not a poor prognostic, and should not be used prejudicially in denying a early and aggressive treatment of the patients with IE.

Role of Müller glia in neuroprotection and regeneration in the retina

Glial cells are thought to protect neurons from various neurological insults. When there is injury to retina, Müller cells, which are the predominant glial element in the retina, undergo significant morphological, cellular and molecular changes. Some of these changes reflect Müller cell involvement in protecting the retina from further damage. Müller cells express growth factors, neurotransmitter transporters and antioxidant agents that could have an important role in preventing excitotoxic damage to retinal neurons. Moreover, Müller cells contact to endothelial cells to facilitate the neovascularization process during hypoxic conditions. Finally, recent studies have pointed to a role of Müller cells in retina regeneration after damage, dedifferentiating to progenitor cells and then giving rise to different neuronal cell types. In this article we will review the role of Müller glia in neuroprotection and regeneration after damage in the retina.

[Prognostic significance and clinic utility of serum and immunohistochemical cathepsin B levels in colorectal cancer]

BACKGROUND

Aproximately one third of node-negative colorectal cancer recur suggesting the presence of micrometastasis not detected by conventional histopathologic methods. We think that the role of enzymes like Cathepsin B play in the process of invasion and metastasis in colorectal cancer might identify at earlier stages patients with high risk of shorter survival and who need more aggressive treatment. Our porpuse is to evaluate the prognostic significance of preoperative serum and inmunohistochemical levels of cathepsin B to identify colorectal carcinomas with worse prognostic.

METHODS

Fifty five patients undergoing surgical treatment for colorectal cancer from 1998 to 2000. As a control group sera from 23 patients with acute appendicitis. Serum levels of cathepsin B were obtained preoperatively (KRKA, Novo Slovenia;ng/ml); cathepsin B inmunoreactivity was determinated after surgical treatment, (C-19, Santa Cruz Biotechnology). Serum levels of CEA (Inmulit 2000 CEA), and CA 19,9 (Inmulite Gi-Ma, Diagnostic Products Corporation, Los Angeles, CA), and p53 expression (Dako) were determinated in patients with colorectal cancer. Survival analysis was realized using Cox and Kaplan-Meier methods (SPSS 10.0 for Windows).

RESULTS

The mean age of patients with colorectal cancer was 68 years (range 39-87 years). 29 males and 26 females. Tumor size was 4.6 cms., range 1-12. Rectal localization, 32.2%. Moderately differentiated, 49.1%. The median serum and inmunohistochemical levels of cathepsin B were 5.74 ng/ml and 29.56% in patients with acute appendicitis respectively. Preoperative serum levels in patients with colorectal cancer were: CEA, 46.04 ng/ml (range 0.21-7.32 ); CA 19,9, 110.52 UI/ml, (range 2.5-1920); and Cathepsin B, 6.94 ng/ml, range 3.57-11.6). Inmunohistochemical results were: p53, 44.36%, (range 0-95); Cathepsin B, 66.9% (range 10-90). Serum and inmunhistochemical values were significantly increased in patients with colorectal cancer when compared with control group, p=0,011 and p=0,000. High serum levels of cathepsib B were significantly associated wiyh shorter survival of patients with colorectal cancer in univariate and multivariate methods, p=0.041;HR 1.281 95%CI (1.043-1.716) and p= 0.022; HR 1.338.955 CI (1.043-1.716).

CONCLUSIONS

Cathepsin B can be used like an independent prognostic tumoral marker in colorectal cancer. Preoperative serum levels over 6.94 ng/ml, are associated with worse prognostic and shorter survival.

Sex and age diagnosis by ischium morphometric analysis

The growth of four variables of the ischium was analysed by polynomial regression in order to evaluate its significance and its capacity for age and sex determination during and after growth. The material used was 327 specimens ranging from birth to 97 years of age from four documented west European collections. The growth curves were calculated for ischium length and three new variables of the acetabular surface (horizontal diameter of ischium acetabular surface, vertical diameter of ischium acetabular surface and ischium acetabular index). All curves, except those of the female series of vertical diameter of ischium acetabular surface and its index, showed a lineal growth corresponding to vertical variables. All variables studied, except the ischium acetabular index, can be used variables for adult sexual discrimination. Furthermore, ischium length and the horizontal and vertical diameters of the acetabular surface can be useful for sub-adult age determination in archaeological samples, as well as in forensic samples. However, the ischium length is the best variable, as it can be applied to all the growth ages.

Heat processing of barley and enzyme supplementation of diets for broilers

The influence of heat processing (HP) of barley and enzyme supplementation (ES) of the diet on digestive and performance traits of broilers to 21 d was studied. There were four treatments arranged factorially with two barley-processing treatments (raw or heated), two levels of ES (0 or 500 ppm), and five replicates per treatment. Chicks fed HP barley grew faster than broilers fed raw barley until 8 d of age, but the effect disappeared thereafter. In general, ES improved broiler performance at all ages. Intestinal viscosity was increased by HP of barley (P < or = 0.05) and reduced by ES (P < or = 0.001), and the decrease in viscosity caused by ES was greater for HP than for raw barley diets (HP x ES; P < or = 0.05). Heat processing of barley and ES of the diet improved apparent retention of nutrients (P < or = 0.001). Age affected apparent retention of nutrients differently. For starch and neutral detergent fiber, retention increased linearly with age (P < or = 0.01), but for the remaining nutrients the retention decreased from d 4 to 8 and then increased until d 21 (P < or = 0.001). Also, the beneficial effects of HP on retention of nutrients were more pronounced at younger ages (HP x age; P < or = 0.05). Both HP (P < or = 0.001) and ES (P < or = 0.01) increased liver weight, and enzymes reduced the weights of pancreas (P < or = 0.05) and small intestine (P < or = 0.001). Villus height was improved by HP (P < or = 0.001) and ES (P < or = 0.01), but villus surface area was only improved by enzymes (P < or = 0.01). It was concluded that broiler performance is improved by HP of barley at early ages and by ES of the diet throughout the trial. Also, HP and ES increased apparent retention of nutrients, AMEn of the diet, and villus height.

[Intracellular pathways leading to apoptosis of retinal cells]

Some ocular diseases, such as retinitis pigmentosa, age-related macular degeneration, glaucoma, retinal detachment, diabetic retinopathy or pathological myopia result in apoptotic death of retinal cells. Caspases are proteases that take part in the intracellular signaling pathways that cause apoptosis in different cell types. By using different experimental models, an increase in caspase activity in retinal cells after damage has been shown. However, some studies have shown that other molecules apart from caspases are activated during apoptosis in the retina. Moreover, the type of caspase that is activated seems to be different depending on the type of retinal cell and the pathology analysed. Inhibition of the processes that result in retinal cell apoptosis could decrease the number of dead cells and prevent the irreversible loss of visual function associated with some pathologies such as glaucoma. In this study we aim to review the basic research studies published in the last years in order to know the molecules and pathways involved in the processes which cause apoptosis of the different types of retinal cells.

Effect of enzyme addition to wheat-, barley- and rye-based diets on nutrient digestibility and performance of laying hens

1. Laying hen performance, egg quality, intestinal viscosity and nutrient apparent digestibility were evaluated with respect to the main cereal used in the diet and dosage rate of a fungal beta-glucanase/xylanase enzyme complex. 2. Twelve diets were arranged factorially, with three soluble fibre cereals (SFC); 500 g/kg of wheat or barley or 350 g/kg of rye, and 4 enzyme concentrations (0, 250, 1250 and 2500 mg/kg). An additional control diet based on maize was also included. 3. The use of SFC in the diet instead of maize did not affect egg production or food efficiency, but hens fed on SFC diets exhibited a higher incidence of dirty eggs than hens fed on the maize diet (8-6 vs 4.6%; P<0.01). 4. Laying hens fed on enzyme-supplemented diets produced more eggs (2.1%; P<0.05) and had better food efficiency per dozen eggs (2.5%; P<005) than hens fed on non-supplemented diets. An excess of enzymes in the diet (10 times the recommended dose) did not produce any deleterious effect on laying hen productivity. 5. Enzyme supplementation (ES) reduced intestinal viscosity (P<0.001) and the incidence of dirty eggs (P<0.01). The reduction in viscosity was more pronounced in barley than in wheat or rye diets (P<0.05). 6. Apparent nutrient digestibility in SFC diets was higher with ES, including dry matter (3.1%; P=0.08), fat (4.4%; P<0.001), non-starch polysaccharides (83.3%; P<0.01) and AMEn (2.5%, P<0.01). 7. It is concluded that substitution of maize by SFC is facilitated by ES, especially with respect to egg production, food conversion efficiency and egg shell cleanliness. An excess of enzymes did not produce any deleterious effect on nutrient digestibility or performance of laying hens.

Interocular effect of intravitreal injection of 6-hydroxydopamine and dopamine on spinule formation in teleost retina

Terminal dendrites of cone horizontal cells (HCs) in teleost retinas show numerous spine-like protrusions named spinules, which are invaginated into the cone pedicles during light-adaptation, but retracted during dark-adaptation. Somata of HC show nematosomes whose size decreases as the number of spinules increases. Mechanisms regulating these changes in nematosomes and spinules are only partially understood, being an area of controversy in retinal cell biology. It has been suggested that efferent fibres from the brain to the retina might be involved in the control of spinule formation. Moreover, we have reported that actin depolymerization has an interocular effect on spinule formation, which could be mediated by these fibres. In the present report, we show an interocular effect on spinule dynamics: the monocular intravitreal injection of dopamine (DA) and 6-hydroxydopamine (6-OHDA), two drugs that affect the spinule formation, produces the same effects in the contralateral, untreated eye as in the injected eye. Our results reinforce the idea of an interocular central control of this phenomenon of synaptic plasticity. Dopamine-dependent events in the retina appear to be necessary to forge the afferent signals eliciting this interocular effect.

Social integration of juvenile amputees: comparison with a general population

The objective was to assess the social integration of juvenile amputees according to marital status, schooling and occupation, and to compare it with the population of Asturias, Spain. A retrospective study was carried out of the juvenile amputees registered from 1976 to 1999 at the Prosthetics Unit of the Asturias Central Hospital (n=281 amputees). The proportion of single women amongst the amputees was greater than in the population of Asturias (p<0.05). Amongst the male amputees, relative to the general population, there was a larger proportion of the group with primary studies (p<0.001) and a smaller proportion with secondary studies (p<0.001). At the higher level (university) there were no differences, either in men or in women. As regards occupation, amongst the amputees a larger number was found who were retired or unemployed (p<0.05 and p<0.001). In conclusion, juvenile amputees do not show differences compared to the general population with regard to their attendance at a higher or university level of education. However, if their social integration is considered through occupation, male amputees show a greater proportion of unemployment, which is a clear reflection of their handicap.

Isolation and characterization of a 6/85-like Mycoplasma gallisepticum from commercial laying hens

Eighty-three-week-old table egg layers with swollen sinuses were presented with a history of increased mortality. Serology revealed positive titers to Mycoplasma gallisepticum (MG). The birds were part of a flock in which some birds had been vaccinated with 6/85 live MG vaccine at 18 wk of age. Tracheal cultures were obtained from both vaccinated and unvaccinated birds within the flock. The cultures were indistinguishable from 6/85 vaccine by both random amplified polymorphic DNA analysis and DNA sequence analysis. Challenge studies were performed to compare the field isolates with 6/85 vaccine and the R strain of MG. The field isolates produced a greater antibody response by serum plate agglutination than did the 6/85 vaccine. The isolates effectively colonized the trachea without increasing the tracheal mucosal thickness; however, they did not extensively colonize the air sacs or cause airsacculitis in the experimental birds.

[Retinal ganglion cell neuroprotection in culture]

PURPOSE

To study the pig retinal ganglion cell (RGC) survival in culture, analysing the possible neuroprotective effect of retinal Müller glia (RMG) and brain-derived neurotrophic factor (BDNF).

METHODS

Adult pig retina were dissociated and cultured under different conditions: 1) on laminin/poly-D-lysine-coated coverslips in chemically defined medium (CDM); 2) on laminin/poly-D-lysine-coated coverslips in CMD supplemented with BDNF; 3) on confluent monolayer cultures of RMG in CDM; 4) on laminin/poly-D-lysine substrate in conditioned medium obtained from RMG. RGCs were identified by immunocytochemistry using antibody against 68 kDa neurofilament and observed under an fluorescent microscope. RGCs were classified on the basis of the size, number and length of neurites, and their survival was assayed for each treatment.

RESULTS

Confluent RMG substrates and RMG conditioned medium significantly increased the survival of cultured pig RGC. Moreover these two conditions increased the mean area of RGCs and enhanced neurite growth and elongation. Addition of BDNF to culture medium did not modify survival but increased RGC size, neurite number and neurite length.

CONCLUSIONS

These findings demonstrate that factor(s) secreted by RMG exert beneficial effects on adult RGC survival and neurite regeneration in vitro, and might constitute important agent(s) for RGC neuroprotection. BDNF also increases the mean area of RGCs and enhances neurite growth but it does not increase the survival of RGCs.

[Job satisfaction and burnout in general practitioners]

OBJECTIVE

To describe job satisfaction in general practitioners (GP) in the province of Barcelona, and to analyse its relationship with their job burnout, and social and professional characteristics.

DESIGN

Transversal observational study.Setting. Province of Barcelona, Spain.

PARTICIPANTS

603 General Practitioners had participated in ninety three primary care centers.

MEASUREMENT

Through a direct interview (individual or in group) a validated questionnaire was administered in three parts: general data (social, demographic and professional), job satisfaction (Font Roja-9 dimensions) and job burnout (Maslach Burnout Inventory-3 scales).

RESULTS

The job satisfaction questionnaire (score ranging from 1-5) showed a global satisfaction level of 3.02 (95%CI, 2.98%-3.05%) and we obtained a 18% non response rate. There was a positive association between overall satisfaction and the following variables: less years working in primary health, working in centres providing instruction, and willingness to receive information from the survey. Low levels of satisfaction were associated to high scores in emotional exhaustion and depersonalisation scales, and low scores in personal accomplishment scale.

CONCLUSIONS

Overall satisfaction has a medium score in the Font-Roja questionnaire. Age seems to lead to a significant tendency to decrease satisfaction as practitioners grow older. Job satisfaction and job burnout present a closely linked behaviour, inversely, as satisfaction increases when job burnout presents low scores.

Influence of enzymes on performance and digestive parameters of broilers fed rye-based diets

An experiment was conducted to study the influence of enzyme supplementation (ES) to rye-based diets on rate of food passage through the digestive tract, viscosity of jejunum content, volatile fatty acid concentration in ceca, and performance of broilers. There were seven treatments; six diets arranged factorially with three varieties of rye (Petkus, Prima, and Saratov V) and two levels of ES (0 or 500 ppm of an enzyme complex containing 858 IU of beta-glucanase and 864 IU of xylanase/g) and an additional control diet based on corn. Each treatment was replicated seven times (12 chicks caged together), and the trial lasted 25 d. Rye feeding increased intestinal viscosity and impaired bird performance at 25 d (P < 0.001). Among rye diets the greatest feed intake and weight gain were obtained with Petkus variety, which also produced the lowest intestinal viscosity. Enzyme addition reduced the time needed to recover 1% (0.78 vs. 0.98 h; P < 0.05) and 50% (4.2 vs. 6.5 h; P < 0.01) of the marker in feces and reduced the mean retention time of marker in the gastrointestinal tract (17.1 vs. 18.8 h; P < 0.05). Also, ES reduced intestinal viscosity (P < 0.001) and improved feed intake, daily gain, and feed conversion of birds from 4 to 25 d (P < 0.01) but did not modify volatile fatty acid concentration in ceca. We concluded that ES added to rye diets decreased intestinal viscosity and accelerated digestive transit, improving productive performance of broilers.

Test de olfato de connecticut (cccrc): valores en voluntarios sanos

OBJECTIVE

To know the values of the olfactory test (CCCRC) performed in healthy people. To analyse how the age and sex affect the test.

MATERIAL AND METHODS

Descriptive study in 100 volunteers with no olfactory disorders. We used CCCRC olfactory test, which it has an odor threshold component, an odor identification component and a composite score. We analysed how age and sex variables affect olfactory test data, listing a t-Student test. The size sample is calculated to 0.05 alfa error.

RESULTS

Threshold test data mean was 5.8. Identification test data mean was 7.5. Composite score mean was 6.7.

CONCLUSION

Age is a significant factor in our study but not sex. Sample size is sufficient to analyze normal values. Our results are similar to other authors.

Myeloablation enhances engraftment of transduced murine hematopoietic cells, but does not influence long-term expression of the transgene

To investigate to what extent myeloablation, graft size, and ex vivo manipulation influence the engraftment and long-term survival of transduced murine hematopoietic cells, groups of C57BL/6J (CD45.2) mice receiving total body irradiation (TBI) (1-9 Gy) or no irradiation were transplanted with either transduced bone marrow (BM) cells, at two cell doses, or with fresh BM cells from B6/SJL (CD45.1) congenic mice. Short (40 days) and long-term (5 months) engraftment and transgene expression were measured by FACS analysis. No donor cells were detected in the hematopoietic tissues of non-myeloablated mice, whereas in the irradiated animals, levels of engraftment correlated well with the dose of TBI administered. Similar percentages of transgene-expressing cells were found in the grafted hematopoietic cells of all groups of mice, regardless of the dose of TBI administered or the level of engraftment achieved. This suggests that the engrafted animals could become tolerant to the transgene product (enhanced green fluorescent protein, EGFP). Our results indicate that TBI facilitates the engraftment of manipulated hematopoietic cells in a dose-dependent manner, that mice engrafted with EGFP(+) hematopoietic cells probably acquire tolerance to EGFP, and that increasing the graft size and reducing the ex vivo manipulation required for retroviral gene transfer of hematopoietic cells also enhances their engrafting potential.

Behaviour of pesticides in a water/sediment system under laboratory and field conditions

Experiments were conducted in order to evaluate the behaviour of some pesticides commonly used in rice production. At a laboratory scale, but exposed to the environmental conditions, a known concentration of pesticides in water flowed through a cement channel over a sediment layer, at a constant flow rate. The collected water was homogenised and analysed by gas chromatography/HPLC to assess the concentration of each pesticide. Under these conditions, the reduction of each pestcide concentration in water depends on the nature of it and on the water flow rate. The lower the flow rate, the grater the reduction in the concentration of pesticides in the water that ran over the sediment layer. Experiments were also carried out under field conditions, using a 1200 m length, 2 m width and 0.3 m depth rice field channel. A pesticide mixture of known concentration was poured on the flowing water and mixed thoroughly. After the arrival of this contaminated water at preestablished sampling points down the stream, the concentration of each pesticide in water was determined. The longer the distance of the sampling points downstream from the starting point, the lower the pesticide concentration found. Only a few pesticides were detected at the 1200 m sampling point, but at very low concentration. The others were not detected. It was pointed out that the channel length was the most important factor in the reduction of the pesticide concentration in the flowing water. The influence of the flow rate on this reduction could not be clearly related as in the laboratory experiments.

Veratridine, but not elevated K+, inhibits excitatory amino acid transporter activity in rat hippocampal slices

PURPOSE

Excitatory amino acid transporter (EAAT) activity prevents Glu from reaching toxic levels, but their contribution to epileptogenesis remains controversial. We examined how the convulsant veratridine causes inhibition of EAAT activity and how it differs from the effects of another convulsant, high (50 mM) K+, that also increases Na+ conductance.

METHODS

Transverse rat hippocampal slices were incubated for 1 h with 100 microM veratridine in oxygenated artificial cerebrospinal fluid (aCSF) with or without extracellular Ca2+. The medium was replaced by 50 microM[(3)H]glutamate in aCSF, and the slices incubated for 10 min at 37 degrees C. The slices were washed 3 times with cold aCSF after removal of the extracellular medium, and the radioactivity was quantified after solubilization of the slices.

RESULTS

Veratridine caused a time- and dose-dependent decrease, whereas high K+ had no effect on EAAT activity. The effects of veratridine on EAAT activity were not prevented by tetrodotoxin (TTX; 10 microM). Coincubation of ouabain with veratridine resulted in further decreases of EAAT activity. Removal of extracellular Ca2+ potentiated the inhibitory effects of veratridine (and other convulsants) on EAAT activity. Chelation of intracellular Ca2+ with BAPTA also increased the inhibitory effects of veratridine on EAAT activity.

CONCLUSIONS

Veratridine caused changes Ca2+ dynamics that led to inhibition of EAAT activity. Such changes in EAAT activity can contribute to the sustained epileptiform activity caused by veratridine.

IGF1 gene transfer into skeletal muscle using recombinant adeno-associated virus in a rat model of liver cirrhosis

Systemic administration of recombinant IGF1 at low levels has been shown to improve hepatic function, nutritional status and testicular atrophy in rats with CCl4-induced cirrhosis. We have developed a recombinant adeno-associated (rAAV) viral vector containing the cDNA for rat IGF1 and confirmed the expression of IGF1 after intramuscular injection of this vector in a rat model of liver cirrhosis. Although weight of injected muscles was significantly increased in rats with mild cirrhosis, this was not the case in rats with advanced, de-compensated cirrhosis. Furthermore, we found no significant amelioration of liver damage in treated rats at any stage of liver cirrhosis. Our results suggest that IGF1 gene transfer into muscle results in a local effect, at least at the vector dose employed here.

Fragile sites in human and Macaca fascicularis chromosomes are breakpoints in chromosome evolution

We have analysed the expression of aphidicolin-induced common fragile sites at two different aphidicolin concentrations (0.1 micromol/L and 0.2 micromol/L) in three female and one male crab-eating macaques (Macaca fascicularis, Cercopithecidae, Catarrhini). A total of 3948 metaphases were analysed: 1754 in cultures exposed to 0.1 micromol/L aphidicolin, 1261 in cultures exposed to 0.2 micromol/L aphidicolin and 933 in controls. The number of breaks and gaps detected ranged from 439 in cultures exposed to 0.1 micromol/L aphidicolin to 2061 in cultures exposed to 0.2 micromol/L aphidicolin. The use of a multinomial FSM statistical model allowed us to identify 95 fragile sites in the chromosomes of M. fascicularis, of which only 16 are expressed in all four specimens. A comparative study between the chromosomes of M. fascicularis and man has demonstrated that 38 human common fragile sites (50%) are found in the equivalent location in M. fascicularis. The analysis of the rearrangements that have taken place during chromosome evolution has revealed that the breakpoints involved in these rearrangements correspond significantly (p < 0.025) to the location of M. fascicularis fragile sites.

[The effects of implementing a smoking cessation intervention in Spain on morbidity, mortality and health care costs]

OBJECTIVE

We estimated the effect that a smoking cessation intervention in the Spanish population of smokers would have on smoking-related morbidity, mortality and health care costs.

METHODS

We adopted the model Health and Economic Consequences of Smoking sponsored by the WHO Health Organization and developed by the The Lewin Group. The smoking cessation intervention proposed includes pharmacological treatment to 35% of smokers who are trying to quit smoking and obtains a quit rate of 7.2%. The diseases studied are: lung cancer, heart disease, stroke, chronic obstructive pulmonary disease, asthma exacerbation, and low birth weight. The smoking-related cases of disease and of averted death and the reduction in health care expenditure due to the intervention were estimated.

RESULTS

Without intervention, at year 1 of the model, 2,136,094 smokers would be affected by some smoking-related disease; health care expenditure would be 4,286 million e and deaths attributable to smoking would total 26,537. The proposed intervention would prevent 2,613, 9,192, 17,415 and 23,837 cases of smoking-related disease at years 2, 5, 10 and 20 of the model, respectively. The saving in accumulated health care costs would amount to 3.5 million e at year 2 and 386 million e over 20 years. The accumulated prevented deaths are 284 at year 2 and 9,205 over 20 years. The intervention would save a total of 78,173 life-years by the end of the period considered.

CONCLUSIONS

The availability of new effective smoking cessation interventions and the increase in accessibility to such interventions may contribute significantly to reducing morbidity, mortality and health care costs associated with smoking in Spain.

Identification of two subgroups of mantle cell leukemia with distinct clinical and biological features

INTRODUCTION

Mantle cell leukemia (MCLeu) has been considered as a leukemic form of mantle cell lymphoma (MCL). However, the presence of certain features rarely observed in MCL, such as transformation to prolymphocytic leukemia (PLL) or indolent clinical course, suggests that MCLeu may represent a distinct disorder.

METHODS

Seven cases of MCLeu with t(11;14)(q13;q32) and BCL1-IGH gene rearrangement were ascertained among 140 newly diagnosed chronic B-cell lymphoproliferative disorders with leukemic expression. Comparative genomic hybridization, FISH for specific gene loci, and immunological studies were preformed in them.

RESULTS

In comparison with CLL, MCLeu cases had low immunological scores < or =2 with respect to B-CLL (P<0.0001). Expression of CD38 was absent in 43% of MCLeu and in 44% of B-CLL. Comparative genomic hybridization analysis identified genomic imbalances in 86% of MCLeu with a similar pattern than in MCL: gains of 3q, 8q involving MYC gene and 15q, and losses of 6q, 9p, 13q and 17p affecting P53 gene. Differently from MCL and CLL, genomic loss of 8p was frequently detected in MCLeu (83%). Although clinical presentation of MCLeu was indistinguishable from CLL, all patients but one had disease progression within three years. According to the immunologic and genomic profiles, two distinct subgroups of MCLeu were defined: one related to PLL, showing CD38-, deletion of P53, and MYC amplification and another which corresponds to a leukemic form of classical MCL, presenting with CD38+ and normal P53 and MYC status.

CONCLUSION

MCLeu and MCL are closely related disorders, as they show similar genomic and molecular patterns. However, the deletion of the short arm of chromosome 8 may represent a specific marker for MCLeu. Two distinct subgroups of MCLeu may also be distinguished according to the immunologic and genomic cell profiles.