High fat diet induces adhesion of platelets to endothelium in two models of dyslipidemia

Cardiovascular diseases (CVD) represent about 30% of all global deaths. It is currently accepted that, in the atherogenic process, platelets play an important role, contributing to endothelial activation and modulation of the inflammatory phenomenon, promoting the beginning and formation of lesions and their subsequent thrombotic complications. The objective of the present work was to study using immunohistochemistry, the presence of platelets, monocytes/macrophages, and cell adhesion molecules (CD61, CD163, and CD54), in two stages of the atheromatous process. CF-1 mice fed a fat diet were used to obtain early stages of atheromatous process, denominated early stage of atherosclerosis, and ApoE(-/-) mice fed a fat diet were used to observe advanced stages of atherosclerosis. The CF-1 mice model presented immunostaining on endothelial surface for all three markers studied; the advanced atherosclerosis model in ApoE(-/-) mice also presented granular immunostaining on lesion thickness, for the same markers. These results suggest that platelets participate in atheromatous process from early stages to advance d stages. High fat diet induces adhesion of platelets to endothelial cells in vivo. These findings support studying the participation of platelets in the formation of atheromatous plate.

Removal of emerging contaminants in sewage water subjected to advanced oxidation with ozone

Advanced oxidation processes (AOP) based on ozone treatments, assisted by ultrasounds, have been investigated at a pilot-plant scale in order to evaluate the removal of emerging contaminants in sewage water. Around 60 emerging contaminants, mainly pharmaceuticals from different therapeutically classes and drugs of abuse, have been determined in urban wastewater samples (treated and untreated) by LC-MS/MS. In a first step, the removal efficiency of these contaminants in conventional sewage water treatment plants was evaluated. Our results indicate that most of the compounds were totally or partially removed during the treatment process of influent wastewater. Up to 30 contaminants were quantified in the influent and effluent samples analysed, being antibiotics, anti-inflammatories, cholesterol lowering statin drugs and angiotensin II receptor antagonists the most frequently detected. Regarding drugs of abuse, cocaine and its metabolite benzoylecgonine were the most frequent. In a second step, the effectiveness of AOP in the removal of emerging contaminants remaining in the effluent was evaluated. Ozone treatments have been proven to be highly efficient in the removal, notably decreasing the concentrations for most of the emerging contaminants present in the water samples. The use of ultrasounds, alone or assisting ozone treatments, has been shown less effective, being practically unnecessary.

Influence of histological degree of seminiferous tubular degeneration and stage of seminiferous cycle on the proliferation of spermatogonia in aged Syrian hamster (Mesocricetus auratus)

The ageing testis is associated with germ loss in the seminiferous epithelium and a decrease in spermatogonia proliferation. In this work, we study whether the stages of the seminiferous epithelium cycle and/or the degree of histological tubular degeneration resulting from ageing is related with this decrease in spermatogonia proliferation. Eleven hamsters were used, five aged 6 months and six aged 24 months. In both groups, the proliferative activity was studied by BrdU immunostaining. The number of BrdU-positive and BrdU-negative cells was measured, providing the overall proliferation index in adult and aged testes. The mean number of BrdU-positive cells was also determined for each degree of histological degeneration of seminiferous epithelium, and a spermatogonia proliferation index was obtained for each stage of the seminiferous cycle. Ageing caused an overall decrease in the BrdU-positive cell percentage and a decrease in the number of BrdU-positive cells in the tubular sections with hypospermatogenesis, the sloughing of germ cells and maturation arrest, these changes being similar in both young and old animals. The spermatogonia proliferation index was only seen to be significantly lower in ageing hamster in stages VII-VIII of the seminiferous epithelium cycle. In conclusion, the overall decrease in proliferation observed in aged seminiferous epithelium is correlated with an increase in the number of degenerated sections of the seminiferous tubules, and this decrease is a phenomenon which occurs in specific stages of the seminiferous cycle.

Fatty-acid composition of maternal and umbilical cord plasma and early childhood atopic eczema in a Spanish cohort

BACKGROUND/OBJECTIVES

Fatty-acid status during in-utero development might influence the risk of atopic diseases in early childhood. The aim of this work was to identify the relationship between maternal plasma and cord blood fatty acid (FA) composition and the risk of atopic eczema in the offspring at 14 months of age.

SUBJECTS/METHODS

Two hundred and eleven non-atopic mothers and their children were studied. Mothers were recruited in their first trimester of gestation and children were monitored until 14 months of age. Samples of maternal plasma and cord blood plasma were analyzed to determine the FA profile of total lipids. Presence of atopic eczema in the infants was documented through questionnaires at 6 and 14 months of age.

RESULTS

Higher concentrations of total long-chain polyunsaturated FA (LC-PUFA) were found in maternal plasma of non-atopic children in relation to atopic group. Moreover, this maternal plasma LC-PUFA content was negatively correlated with the atopic eczema (odds ratios (OR)=0.83, P=0.04) in infants. Regarding cord blood samples, docosahexaenoic acid (DHA C22:6n3) and the sum of total n-3 and of LC-PUFA n-3 showed a negative correlation with the prevalence of the disease (OR=0.50, 0.49 and 0.49, respectively).

CONCLUSIONS

Our results show that the fatty-acid status of the fetus during pregnancy has an important role in the development of atopic eczema in early childhood. The prevalence of this atopic disorder is related to lower cord blood plasma levels of FA belonging to n-3 series, especially DHA.

Validation of a questionnaire on emotional eating for use in cases of obesity: the Emotional Eater Questionnaire (EEQ)

INTRODUCTION

Emotions have a powerful effect on our choice of food and eating habits. It has been found that in some people there is relationship between eating, emotions and the increased energy intake. This relationship should be measurable to better understand how food is used to deal with certain mood states and how these emotions affect the effectiveness of weight loss programs.

OBJECTIVE

To develop and analyze the psychometric characteristics of a questionnaire on emotional eating for obesity easy to apply in clinical practice.

SUBJECTS AND METHODS

A ten-item questionnaire called Emotional-Eater-Questionnaire (EEQ) was developed and administered to a total of 354 subjects (body mass index, 31 ± 5), aged 39 ± 12, who were subjected to a weight-reduction program. The questionnaire was specifically designed for obesity. Analysis of the internal structure, internal consistency, test-retest reliability and convergent validity with Mindful-Eater-Questionnaire (MEQ) were conducted.

RESULTS

After principal components analysis, the questionnaire was classified in three different dimensions that explained 60% of the total variance: Disinhibition, Type-of-food and Guilt. Internal consistency showed that Cronbach's alpha was 0.773 for the "Dishinibition" subscale, 0.656 for the "Type of food" subscale and 0.612 for the "Guilt" subscale. The test-retest stability was r = 0.70. The data showed that the percentage of agreement between the EEQ and the MEQ was around 70% with a Kappa index of 0.40; P < 0.0001.

CONCLUSION

We have presented a new questionnaire, which classifies individuals as a function of the relation between food intake and emotions. Such information will permit personalized treatments to be designed by drawing up early strategies from the very beginning of treatment programmes.

A high fat diet in CF-1 mice: An experimental model for metabolic syndrome

Cardiovascular diseases account for the majority of deaths worldwide. Many of their risk factors have been identified but, for their continued study, research centering on new murine models is of interest. In this study, a high fat diet (HFD) and a normal diet (ND) (25 and 4.4% fat, respectively) were tested over a 40-day period to induce the same metabolic alterations in CF-1 mice in two separate experiments. The parameters measured for these effects corresponded to the weight of ingested food and water, to the weight of the mice and their selected organs (adipose tissue, gastrocnemius, liver and heart), to their biochemical profile (glycemia, blood uric nitrogen, uric acid, triglycerides, cholesterol, proteins and albumin) and to the percentage of fat in their livers. The biochemical profile of the CF-1 mice fed a diet high in fat but balanced in proteins (16.9%) showed statistically significant increases in glycemia, cholesterol and triglyceride levels. A statistically significant increase in the weight of adipose tissue was also observed. No statistically significant differences were observed in the muscular mass of either of the groups of mice, but a high percentage of fat was found in the liver. The results lead to the conclusion that CF-1 mice fed a HFD develop metabolic alterations that correspond to an equivalent metabolic syndrome. This is important in the evaluation of the effects of various interventions, such as food, exercise and molecules, on metabolic alterations in mice induced by the intake of a HFD.

Characterization of the inflammatory response in the uteri of cows infected naturally by Neospora caninum

Bovine neosporosis manifests during gestation, when the fetus may be vulnerable to pathogens. Experimental studies of Neospora caninum-infected cattle have been performed, but little is known about the in-utero inflammatory response. The aim of this study was to characterize the inflammatory response in the uteri of pregnant and non-pregnant cows infected naturally with N. caninum. Four groups of seven animals were studied. Two groups consisted of N. caninum-seropositive pregnant and non-pregnant cows and the other two groups contained N. caninum-seronegative pregnant and non-pregnant cows. Uterine and placental samples were subjected to immunohistochemistry using antibodies specific for N. caninum, CD4, CD8, CD14 and CD21. The non-pregnant seropositive and seronegative groups did not show a difference (P >0.05) in the types of cells present. There were more lymphocytes in the uteri of the seropositive pregnant animals (P <0.05) than in the seronegative pregnant animals, but this was not considered to be consistent with an inflammatory process. N. caninum cysts were detected in eight seropositive cows; five were non-pregnant and three were pregnant. CD4(+) T cells were distributed in the endometrium and myometrium of the non-pregnant cows and were sparse in the placentomes of pregnant cows. CD8(+) T cells were distributed in a similar manner, but were present in smaller number. There were no cells expressing CD14 or CD21. The results of the study suggest that there is no consistent uterine inflammatory response against N. caninum in naturally infected animals.

Effect of PLGA hydrophilia on the drug release and the hypoglucemic activity of different insulin-loaded PLGA microspheres

The effects of viscosity and hydrophilic characteristics of different PLGA polymers on the microencapsulation of insulin have been studied in vitro and in vivo after subcutaneous administration to hyperglycemic rats. Hydrophilic PLGA polymers produced a higher burst effect than the hydrophobic ones. Moreover, an incomplete insulin release was observed with the hydrophilic PLGA polymers in comparison with the hydrophobic ones. An explanation for that incomplete release can be the development of polymer-insulin interactions associated to the polymer hydrophilic/hydrophobic character, as detected by DSC analysis. Differences in the release rate of microsphere formulations lead to differences in the hypoglycemic action and the weight of animals. Hydrophobic PLGA was able to prolong the hypoglycemic action up to 4 weeks which is at least double than that obtained with hydrophilic PLGA of a similar viscosity. Comparing insulin microspheres with an immediate release formulation, microspheres can increase insulin relative bioavailability up to four times.

Evidence of involvement of the receptor for advanced glycation end-products (RAGE) in the adhesion of Helicobacter pylori to gastric epithelial cells

The adherence of Helicobacter pylori to gastric epithelial cells is required for prolonged persistence in the stomach and for induction of injury. Here, we first reported a new role of the receptor for advanced glycation end-products (RAGE) on the adherence of H. pylori to gastric epithelial cells, assessed by different methods and binding to immobilized RAGE. RAGE-targeted knock-down in MKN74 cell line markedly reduced not only the adhesion of H. pylori, but also the levels of IL-8 transcripts and protein released in response to infection. These data suggest that RAGE may represent a new factor on the pathogenesis of H. pylori infection.

High prevalence of virulence-associated genotypes in Helicobacter pylori clinical isolates in the Region del Maule, Chile

The prevalence of Helicobacter pylori infection and the gastric cancer mortality rate in Chile are remarkably high. This study identified some virulence-associated genes in 78 H. pylori clinical isolates from dyspeptic patients from the Region del Maule, which is the region with the higher gastric cancer mortality rate in the country. The cagA, vacA and babA2 genes were detected in 94.9%, 100% and 97.4%, respectively. Two or more EPIYA C motifs were presented in 48.6% of cagA-positive strains, and this was associated with more severe histopathological findings in the gastric mucosa.

Diabetes and cancer: Looking at the multiligand/RAGE axis

The association between diabetes and hyperglycemia and the associated increased risk of several solid and hematologic malignancies has been the subject of investigation for many years. Although the association is not fully understood, current knowledge clearly indicates that diabetes may influence malignant cell transformation by several mechanisms, including hyperinsulinemia, hyperglycemia and chronic inflammation. In this context, the receptor for advanced glycation end-products (RAGE) has emerged as a focal point in its contribution to malignant transformation and tumor growth. We highlight how RAGE, once activated, as it manifests itself in conditions such as diabetes or hyperglycemia, is able to continuously bring about an inflammatory milieu, thus supporting the contribution of chronic inflammation to the development of malignancies.

Proliferation and apoptosis in aged and photoregressed mammalian seminiferous epithelium, with particular attention to rodents and humans

Imbalances in the proliferation and apoptosis processes are involved in numerous epithelial alterations. In the seminiferous epithelium, normal spermatogenesis is regulated by spermatogonia proliferation and germ cell apoptosis, and both processes are involved in diverse pathological alterations of the seminiferous epithelium. Other physiological phenomena including aging and short photoperiod, in which apoptosis and proliferation seem to play important roles, cause testicular changes. Aging is accompanied by diminished proliferation and increased apoptosis, the latter occurring in specific states of the seminiferous cycle and considered the cause of epithelium involution. However, there is no clear evidence concerning whether proliferation decreases in the spermatogonia themselves or is due to an alteration in the cell microenvironment that surrounds them. As regards the factors that regulate the process, the data are scant, but it is considered that the diminution of c-kit expression in the spermatagonia, together with the diminution in antiapoptotic factors (Bcl-x(L))) of the intrinsic molecular pathway of apoptosis play a part in epithelial regression. A short photoperiod, especially in rodents, produces a gradual involution of the seminiferous epithelium, which is related with increased apoptosis during the regression phase and a diminution of apoptosis during recrudescence. Proliferative activity varies, especially during the total regression phase, when it usually increases in the undifferentiated spermatogonia. In other species showing seasonal reproduction, however, decreased proliferation is considered the main factor in the regression of the seminiferous epithelium. Little is known about how both phenomena are regulated, although data in rodents suggest that both the intrinsic and extrinsic pathways of apoptosis contribute to the increase in this process. In conclusion, regression of the seminiferous epithelium in physiological situations, as in many pathological situations, is a result of alterations in equilibrium between the proliferation and apoptosis of germinal cell types. However, both physiological phenomena showed important differences as regard proliferation/apoptosis and their regulation pathways, probably as a result of their irreversible or reversible character.

Extended-release tacrolimus therapy in de novo kidney transplant recipients: single-center experience

BACKGROUND

Available data for extended-release tacrolimus (Tac) except in clinical trials are limited.

OBJECTIVE

To describe our initial experience with once-daily Tac in combination with corticosteroids and mycophenolate mofetil therapy in patients undergoing de novo renal transplantation.

PATIENTS AND METHODS

In this retrospective, observational, single-center study, data were obtained for 49 adult recipients treated with extended-release Tac and 30 patients treated with standard-release Tac (control group). Mean (SD) follow-up in the 2 groups was 3.5 (2.5) months and 4.0 (2.6) months, respectively. The primary characteristics were comparable between the groups.

RESULTS

The acute rejection rate in the extended-release group was 10%, and 13% in the standard-release group. Patient and graft survival rates were 98% and 96% vs 100% and 90%, respectively. Renal function in the 2 groups was comparable: serum creatinine concentration 1.3 (0.2) mg/dL vs 1.45 (0.4) mg/dL. At day 14 posttransplantation, Tac doses were 0.17 mg/kg/d vs 0.14 mg/kg/d, and blood concentrations were 9.0 ng/mL vs 14.0 ng/mL. In recipients older than 60 years, lower dosages of Tac resulted in blood concentrations similar to those in younger patients, with less variation in dosage.

CONCLUSIONS

Short-term experience with extended-release Tac therapy in de novo renal recipients confirms its efficacy and safety. Adjusting blood concentrations in the immediate posttransplantation period is less difficult with extended-release Tac compared with the twice-daily formulation.

Fueling inflammation at tumor microenvironment: the role of multiligand/RAGE axis

The receptor for advanced glycation end products (RAGE), firstly described in 1992, is a single-transmembrane and multiligand member of the immunoglobulin protein family. RAGE engagement produces activation of multiple intracellular signaling mechanisms involved in several inflammation-associated clinical entities, such as diabetes, cancer, renal and heart failures, as well as neurodegenerative diseases. Although RAGE expression has been extensively reported in many cancer types, it is now emerging as a relevant element that can continuously fuel an inflammatory milieu at the tumor microenvironment, thus changing our perception of its contribution to cancer biology. In this review, we will discuss the role of multiligand/RAGE axis, particularly at the multicellular cross talk established in the inflammatory tumor microenvironment. A better understanding of its contribution may provide new targets for tumor management and risk assessment.

Compative study of bladder versus enteric drainage in pancreas transplantation

INTRODUCTION

There is some controversy concerning the choice of best technique for drainage of exocrine secretions in pancreas transplantation. We compared patients with bladder drainage (BD) versus those with enteric drainage (ED).

PATIENTS AND METHODS

From March 1995 to September 2008, 118 patients (68 men and 50 women) of overall mean age of 37.8 +/- 7.8 years underwent pancreas transplantation. There were 109 simultaneous pancreas-kidney, and 9 pancreas after kidney procedures. Recipients were divided in a BD (n = 66 patients) and an ED group (n = 52).

RESULTS

Donor characteristics were similar in both groups. Thirty-two patients (48.5%) of the BD group versus none in the ED group experienced urinary tract infections (UTI; P < .001), and 16 patients (24.2%) BD versus 15 (29.4%) ED developed intraabdominal infections (P = NS). The overall rate of relaparotomies was 33.9% (n = 40): 34.8% (n = 23) in the BD versus 32.7% (n = 17) in the ED group (P = NS). Thirty patients (25.4%) lost their pancreas grafts: 21 (31.8%) in the BD group versus 9 (17.3%) in the ED group (P = .055). The acute rejection rates were 12.7%; namely, 15.2% in the BD versus 9.8% in the ED (P = NS). Three-year patient and graft survivals were equivalent in both groups: 96.1% and 65.3% in the BD versus 89.0% and 74.0% in the ED group, respectively (P = NS).

CONCLUSIONS

ED is a good alternative to BD for drainage of pancreatic graft exocrine secretions because both techniques have the same patient and graft survival, but BD is associated with a significantly higher rate of UTI and urologic complications.

188 DETECTION BY POLYMERASE CHAIN REACTION OF NEOSPORA CANINUM FROM OVUM PICKUP AND UTERINE FLUSHING FLUIDS FROM DAIRY CATTLE IN MEXICO

Neospora caninum, an intracellular protozoon, causes encephalomyelitis in dogs (Bjerkas I et al. 1984 Zentralblat fur Parasitenkunde 70, 271-274). For the past decade, neosporosis has been a main cause of abortion in dairy cattle worldwide (Anderson M et al. 2000 Anim. Reprod. Sci. 60-61, 417-431; Dubey JP 2003 Korean J. Parasitology 41, 1-16). Vertical transmission has been indicated as an important way of spreading neosporosis (Hall CA et al. 2005 Vet. Parasitology 31, 231-41); thus, we investigated whether the protozoon could be transferred by embryo production techniques. Blood samples were collected from 92 dairy cows with history of reproductive failure and abortion within the previous 90 days at 7 dairy farms in Tizayuca, Mexico. For serology evaluation, a commercial indirect ELISA kit (Civtest Bovis Neospora, Laboratories Hipra S.A, Girona, Spain), yielded 46.74% (43/92) positive results, 46.74% (43/92) negative results, and 6.52% (6/92) suspicious to N. caninum infection. Thirteen positive cows were chosen for uterine flush (UF), ovum pickup (OPU), and a blood sample collection. Lymphocytes from blood and cells within the UF and OPU collection fluids were collected after centrifugation and DNA was extracted. All samples were tested for the presence of N. caninum by PCR, using primers and protocols that amplified a 275-bp fragment of the genomic region (5-GGGTGAACCGAGGGAGTTG-3 and 5-CCTCCCAATGCGAACGAAA-3). The N. caninum vaccine (Bovilis® NeoGuard, Intervet, Santiago Tianguistenco, Mexico) was used as a positive control and water as a negative control. Uterine flush could not be obtained from 1 cow. From 13 cows seropositive to N. caninum, only 38% were positive to PCR from blood lymphocytes. In contrast, PCR amplification was obtained from OPU cell sediment in 92.31% (12/13) and in 33.33% (4/12) of UF. Of these 12 OPU- and 4 UF-positive samples, only 5 and 3 of their corresponding blood lymphocytes were positive. Our results using uterine and follicular fluid were contradictory to those published by Moskwa et al. (2008 Vet. Parasitology 158, 370-375) where oocytes and embryos were evaluated. These results indicate that N. caninum is present in the ovary and uterine lumen of the cows, suggesting a possible risk of neospora transmission during oocyte and embryo collection and transfer techniques. UNAM and UPF.

Prediction of survival by immunohistochemical stains (IHC) in stage D2 prostate cancer patients (pts): The importance of pTEN overexpression

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Background: Several signal transduction pathways,important for apoptosis and angiogenesis were idendified and their expression and correlation with survival was studied by IHC in archival prostate cancer biopsies. All pts has androgen deprivation for stage D2 disease and were followed at 3 month intervals. Methods: In an IRB approved study,42 pts had adequate tissue preserved between 1992 and 2006 and their charts were reviewed retrospectively.IHC stains to detect tumor expression of S6(ribosomal),p70s6,pTEN,AKT-1,BCL-1(Cyclin D1),VEGF,c-KIT,PDGFR-alpha and PDGFR-beta were performed by US Labs(Irvine,CA).All results were independently evaluated by two pathologists.Immunoreactivity was scored using a semiquantitative system combining intensity of staining(0–3+) and percentage of cells staining positive(0–3+).The total score was obtained by adding the scores for indensity and the percentage of positive cells,then averaging the resuts obtained by each reader.For the purpose of this study, stain intensity of 0–1+ was considered negative and the intensity of 2–3+ was considered positive.A Cox regression survival model for each stain was developed with variables known to predict survival :Gleason score,Hemoglobin(Hgb),Alkaline Phosphatase(Alk Phos),Prostate Specific Antigen(PSA),Lactate Dehydrogenase(LDH) levels. Results: The median values were: age 70yrs(56–92),Gleason score 8(6–10), LDH 171 IU/L(97–350),Hgb 12.9gm/dl (6.8–16.3), PSA 188ng/ml(2–5677),Alk Phos 139U/L(60–1756),survival 851 days(163- 6102).In univariate analysis,VEGF staining was predictive of survival (p<0.037) but not in multivariate analysis.The pTEN staining correlated with survival (p<0.0367) and a hazard ratio of 0.040 in multivariate analysis. Conclusions: In this small sample of pts, overexpression of S6,p70s6,AKT-1,BCL-1,VEGF,c-KIT,PDGFR-alpha and PDGFR-beta by IHC staining did not predict survival independently.The pTEN staining,however was strong predictor of survival in the multivariate analysis.

No significant financial relationships to disclose.

Comorbidity and survival of hepatocellular carcinoma patients at a VA medical canter

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Background: To determine whether comorbidity indices predict survival in hepatocellular carcinoma (HCC) pts. Methods: In an IRB approved protocol, we reviewed the records of pts with tissue diagnosis of HCC seen at a VA Medical Center between 1/1/1999 to 12/31/2008. Comorbidity was assessed with four comorbidity indices, the Charlson Comorbidity Index (CMI), the Kaplan- Feinstein Index (KFI), the Cumulative Illness Rating Scale (CIRS), and VA Comorbidity Scale (VACS). Demographics, ECOG PS, stage, alpha-fetoprotein (AFP) at diagnosis, hepatitis B (HBV) and C (HCV) status, alcohol use, and iron overload were also reviewed. Cox survival regression analysis was performed. Results: There were 44 pts. All pts were men. The median (M) age at diagnosis was 60.5 years (range 35–86). The overall M survival was 230 days (4–2784). There were Stage I 12 (27%) pts, Stage II 7 (16%) pts, Stage III 14 (32%) pts, and Stage IV 11 (25%) pts. The M ECOG PS was 1.0 (0–4), stage 3 (1–4), CMI 5.75 (1–16), CIRS15 3.0 (1–5), CIRS16 6.0 (1–14), CIRS17 2.0 (0.83–5.0), CIRS18 0 (0–2), CIRS19 0 (0–1), KFI 3.0 (1–3), VACS 6.0 (2–9), and AFP 56.35 (1.1–379567). HBV was positive in 10 pts (23%), HCV 26 (59%) pts, alcohol use 37 (84%) pts, and iron overload 11 (25%) pts. In univariate survival analysis, stage (p<.038), ECOG PS (p<.001), AFP (p<.009), presence of iron overload (p<.006), and CMI (p<.019) were significant in predicting survival. However, age, HBV, HCV, alcohol use, CIRS15, CIRS16, CIRS17, CIRS18, KFI, and VACS were not significant for survival. In multivariate survival analyses that included stage and a comorbidity index, the CMI approaches significance (p<.077). Conclusions: In this sample, the CMI was a predictor for survival in pts with HCC. Further analysis in a larger sample is needed to provide a more definitive conclusion. This was supported by the New Jersey Commission for Cancer Research 09–1133-CCR-EO.

No significant financial relationships to disclose.

[The antiproteinuric effect of the blockage of the renin-angiotensin-aldosterone system (RAAS) in obese patients. Which treatment option is the most effective? ]

BACKGROUND

Obesity increases the risk of proteinuria and chronic renal insufficiency and hastens the progression of renal diseases. Increased activity of renin-angiotensin-aldosterone system and elevated levels of aldosterone are common in obese patients. No studies have compared the efficacy of the currently available antiproteinuric strategies (ACE inhibitors -ACEI-, angiotensin receptor blockers -ARB-, aldosterone antagonists) in obese patients with proteinuric renal diseases.

METHODS

Single centre, prospective, randomized study. Twelve obese patients (body mass index > 30 Kg/m2) with proteinuria > 0.5 g/24 h were selected from our outpatient renal clinic. Patients were consecutively treated during 6 weeks with an ACEI (lisinopril 20 mg/day), combined therapy ACEI+ARB (lisinopril 10 mg/day + candesartan 16 mg/day) and eplerenone (25 mg/day) in random order. A drug washout period of 6 weeks was established between the different treatment periods. The primary outcome point was the change in 24-h proteinuria at the end of each treatment period and the number of patients showing a proteinuria reduction greater than 25% of baseline.

RESULTS

The reduction in proteinuria induced by lisinopril (11.3+/-34.8%) was not statistically significant with respect to baseline, whereas that of lisinopril plus candesartan (26.9+/-30.6%) and eplerenone (28.4+/-31.6%) showed a statistically significant difference both with respect to baseline values and to lisinopril group. The number of patients who showed a greater than 25% proteinuria reduction was significantly higher with eplerenone (67%) and lisinopril+candesartan (67%) than with lisinopril (25%).

CONCLUSIONS

Monotherapy with an aldosterone antagonist and combination therapy with ACEI+ARB were more effective than ACEI monotherapy to reduce proteinuria in obese patients with proteinuric renal diseases.

Adult celiac disease with severe or partial villous atrophy: a comparative study

BACKGROUND AND AIMS

While severe villous atrophy (SVA) is the most typical histological feature in adult celiac disease (ACD), partial villous atrophy (PVA) is now also frequently found. So far, the impact of the severity of villous atrophy on the clinical presentation of ACD has been scarcely investigated. We aimed to compare the clinical, biological and immune features and outcomes in ACD patients presenting with PVA at diagnosis versus patients with SVA.

PATIENTS AND METHODS

Medical files of 48 patients with ACD diagnosed between 1992 and 2003 were retrospectively studied. The diagnosis was based on the presence of intestinal villous atrophy, with increases in intraepithelial lymphocytes and circulating celiac specific antibodies. Villous atrophy was classified as severe (subtotal and total) or partial. Symptoms, biological signs of malabsorption, immune markers, bone mineral density at diagnosis and response to gluten-free diet were recorded.

RESULTS

At diagnosis, ten patients (four M/six F) had PVA and 38 patients (five M/33 F) had SVA, with a median age of 54 and 33 years, respectively (p<0.05). Positivity for specific antibodies, HLA typing and frequency of autoimmune disease at diagnosis were similar in both PVA and SVA patients, as was their response to gluten-free diet. Diarrhea, malabsorption syndrome and osteopenia were independent of the degree of villous atrophy.

CONCLUSION

PVA was observed in 21% of patients with ACD. Except for their older age at diagnosis, patients with PVA presented with similar clinical, biological and immune characteristics and outcomes as did patients with SVA.

Rapid and deep control of inflammation in rheumatoid arthritis with infliximab and its correlation with acute-phase reactants

Rheumatoid arthritis (RA) is a chronic inflammatory disease with predominant joint involvement and possible systemic compromise, which leads to a handicapped status and poor quality of life. An optimal approach to treat RA requires early and intensive intervention with close monitoring of treatment response. Tumor necrosis factor (TNF) blockers are recommended in cases of active RA after the unsuccessful use of effective disease-modifying antirheumatic drugs (DMARDs); even adding them to treatment or replacing these drugs. Anti-TNF therapies have been demonstrated to reduce significant joint damage and to relieve symptoms during a prolonged time (see Scott and Kingsley, 2006). The efficacy of infliximab in an open-label trial is summarized with respect to speed of onset of action, durability of response, and its correlation between clinical and laboratory parameters. Safety for long-term treatment is also summarized. We studied 105 RA patients with more than 3 years' history of disease during 24 months on i.v. infliximab (75 completed study). We evaluated ACR responses at base line, and at 1, 6, 12, 16, 52, 77, and 104 weeks. Morning stiffness, swollen and tender joints, HAQ, SF-36% (PCS/MCS), polymerase chain reaction (PCR), erythrosedimentation rate (ESR), transaminases, rheumatoid factor (RF) levels, hemogram, and adverse events profile were all assessed. The treatment offered rapid and sustained clinical improvements as revealed by ACR responses and marked changes in the parameters previously described. Important changes were made in functional status and acute-phase reactants. Finally, infliximab was considered well tolerated and did not affect the safety profile of this trial.