Experimental diabetes in neonatal mice induces early peripheral sensorimotor neuropathy

Animal models of diabetes do not reach the severity of human diabetic neuropathy but relatively mild neurophysiological deficits and minor morphometric changes. The lack of degenerative neuropathy in diabetic rodent models seems to be a consequence of the shorter length of the axons or the shorter animal life span. Diabetes-induced demyelination needs many weeks or even months before it can be evident by morphometrical analysis. In mice myelination of the peripheral nervous system starts at the prenatal period and it is complete several days after birth. Here we induced experimental diabetes to neonatal mice and we evaluated its effect on the peripheral nerve 4 and 8 weeks after diabetes induction. Neurophysiological values showed a decline in sensory nerve conduction velocity at both time-points. Morphometrical analysis of the tibial nerve demonstrated a decrease in the number of myelinated fibers, fiber size and myelin thickness at both time-points studied. Moreover, aldose reductase and poly(ADP-ribose) polymerase activities were increased even if the amount of the enzyme was not affected. Thus, type 1 diabetes in newborn mice induces early peripheral neuropathy and may be a good model to assay pharmacological or gene therapy strategies to treat diabetic neuropathy.

Abstract P5-13-14: Breast cancer in very young patient is a more aggressive entity independent from breast cancer subtype

BACKGROUND AND OBJECTIVES: Breast cancer in very young patients (< 35 years) (BCVY) is an uncommon disease and when it occurs it usually has aggressive biological characteristics. Whether this effect is due to an overrepresentation of aggressive breast cancer subtypes in younger patients or not remains an issue of controversial. The objective of this study was to identify potential differences in the molecular and clinical features of breast carcinomas from patients < = 35 years versus a cohort of older counterparts previously matched by breast cancer subtype.

METHODS: We performed a retrospective analysis of a prospectively maintained database that included 424 patients diagnosed with an invasive breast carcinoma from 1995 to 2012 at Hospital Clinico of Valencia. We selected 89 patients separated in two groups, the study group with very young women ≤ 35 years old and with no BRCA mutation or unknown and a second group with women older than 50 years. Data related to clinical and pathological features from both groups such as tumor size, nodal status, histological grade, Ki 67 labeling oestrogen and progesterone receptor and HER2 overexpression were obtained from medical records and we used the statistic model of chi-squared to compare the two groups.

RESULTS: Of the 89 patients, 43 patients ≤ 35 year were included in the study group (median age 31.4 years, standard deviation (SD): 3.82) and 46 patients >50 years were included in the control group (median age 66.4 years, SD: 10.00). Ductal carcinoma was the most common histological subtype in both groups (88.4% of BCVY and 78.3% of the old woman). The majority of tumors were ER and PR positive in both groups, but younger women had a higher proportion of HER2 positive tumors, although the result was not significant. By subtype 57.4% of BCVY presented an immunohistochemical luminal subtype, compared to 71.7% in older patients. Triple negative and HER2 profiles were 11.6% and 34.8% in youngest versus 15.2% and 13.04% in older women respectively. No statistically significant differences were found in terms of breast cancer subtype (p = 0.279)). However, BCVY had a higher pathological grade (56% younger patients had grade IIII vs 26% in oldest, p = 0.002), higher proportion of Ki67 >30% (32.5% of youngest versus 17.4% in older women, p = 0.008), larger tumors (16.3% of BCVY had size tumor > 5 cm, versus 2.2% in controls, p<0.0001) and more frequent nodal involvement (39.5% in young women vs 28.2% in oldest, p = 0.0264).

CONCLUSIONS: Patients diagnosed with breast cancer at ≤ 35 years present more aggressive tumors compared to older patients. These data suggest that BCVY is a distinct entity, further studies to confirm these findings are needed.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P5-13-14.

Abstract P4-07-04: A distinctive miRNA profile highlights breast cancer in very young women (BCVY) as a new molecular subgroup

Background: Although less frequent (1% of all breast cancer) than in older women, breast cancer (BC) in very young women (BCVY),(≤35 years old) often exhibits larger tumor sizes, high pathological grade, high proliferation percentage, nodal involvement, and greater HER2+ percentage, usually associated with a poorer prognosis. BC and BCVY might arise as different disease entities derived from different underlying mechanisms.

MicroRNAs (miRNAs) are short RNA molecules with post-transcriptional regulatory function, usually silencing targeted mRNAs. Recently, miRNA profiling has arisen as major approaching study technique, demonstrating a widespread miRNA deregulation in various tumor types.

In this study we offer a miRNA profile of a subset of BCVY patients and evaluate whether there are any miRNA deregulated pointing out some pathway to better understand the ongoing mechanism and characterize BCVY as a new molecular entity.

Material and methods: We performed a comprehensive study of miRNA expression using miRNA Affymetrix 2.0 array. We extracted RNA from FFPE tumor tissue of both 44 BC patients ≤35years (BCVY) and 46 older than 45years in two age groups (45-65 and >65), we used normal breast tissue as control and evaluated the differences in expression of each age group. We tried to validate most interesting miRNA by qRT-PCR. We performed enrichment analysis of multiple miRNA target genes (DIANA mirpath) to search for putative pathways that could be deregulated by the miRNAs.

Results: We obtained a differential and unique miRNA expression profile of 121 miRNAs (p-value<0.05), 96 of those with FDR<0.05. After hierarchical clustering, samples were unsupervised grouped according to their age, neither by subtype nor by tumor characteristics. Of the 11 miRNA selected for validation, we were able to validate differences in the expression of 6 miRNAs: miR-1228*, miR-3196, miR-1275, miR-92b, miR-139, miR-1207, moreover, all of the miRNAs maintained the expression's trend. The validated miRNAs pointed out pathways related with cell motility and invasion (adherens junction, chondroitin sulfate biosynthesis, cell adhesion molecules) and cell proliferation (calcium signaling, wnt signaling).

Conclusion: We performed a comprehensive study of the miRNA expression on a total of 89 BC patients, detecting a differential molecular profile in BCVY patients, suggesting that there might be a different underlying mechanism and that BCVY could be identified as a different entity.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P4-07-04.

Efficacy and safety of fibrin glue and tranexamic acid to prevent postoperative blood loss in total knee arthroplasty: a randomized controlled clinical trial

BACKGROUND

Postoperative blood loss in patients after total knee arthroplasty may cause local and systemic complications and influence clinical outcome. The aim of this study was to assess whether fibrin glue or tranexamic acid reduced blood loss compared with routine hemostasis in patients undergoing total knee arthroplasty.

METHODS

A randomized, single-center, parallel, open clinical trial was performed in adult patients undergoing primary total knee arthroplasty. Patients were divided into four groups. Group 1 received fibrin glue manufactured by the Blood and Tissue Bank of Catalonia, Group 2 received Tissucol (fibrinogen and thrombin), Group 3 received intravenous tranexamic acid, and Group 4 (control) had no treatment other than routine hemostasis. The primary outcome was total blood loss collected in drains after surgery. Secondary outcomes were the calculated hidden blood loss, transfusion rate, preoperative and postoperative hemoglobin, number of blood units transfused, adverse events, and mortality.

RESULTS

One hundred and seventy-two patients were included. The mean total blood loss (and standard deviation) collected in drains was 553.9 ± 321.5 mL for Group 1, 567.8 ± 299.3 mL for Group 2, 244.1 ± 223.4 mL for Group 3, and 563.5 ± 269.7 mL for Group 4. In comparison with the control group, Group 3 had significantly lower total blood loss (p < 0.001), but it was not significantly lower in Groups 1 and 2. The overall rate of patients who had a blood transfusion was 21.1% (thirty-five of 166 patients analyzed per protocol). Two patients required transfusion in Group 3 compared with twelve patients in Group 4 (p = 0.015). No significant difference was observed between the two fibrin glue groups and the control group with regard to the need for transfusion. There was no difference between groups with regard to the percentage of adverse events.

CONCLUSIONS

Neither type of fibrin glue was more effective than routine hemostasis in reducing postoperative bleeding and transfusion requirements, and we no longer use them. However, this trial supports findings from previous studies showing that intravenous tranexamic acid can decrease postoperative blood loss.

C1q-fixing human leukocyte antigen assay in immunized renal patients: correlation between Luminex SAB-C1q and SAB-IgG

BACKGROUND

There is no consensus about the impact of thresholds of complement-fixing antibody assays. Recently, a C1q-SAB assay has been developed to identify complement-fixing HLA antibodies with high sensitivity and specificity. Our aim was to determine the correlation between IgG single antigens beads (SAB) and C1q-SAB assay results among patients on the renal waiting list.

PATIENTS AND METHODS

Serum samples from immunized renal waiting list patients as well as negative and positive controls were valided by Luminex (LMX). These sera, which were positive for 166 antibody specificities, were tested for HLA class I in parallel by LMX-IgG and LMX-C1q.

RESULTS

Comparison of antibody detection revealed no correlation based on median fluorescent intensity (MFI), levels between the IgG SAB and the C1qSAB assay (P > .05). IgG-positive sera with MFIs as low as 700 were able to fix C1q, whereas other sera with MFIs as high 14,500 did not. Furthermore, there appeared to be disparities in the profiles of class I antigens able to fix C1q-SAB. In our series, only 34% class I IgG SAB antibodies were also C1qSAB+. In several patients, we detected C1qSAB+ against IgGSAB- that was surely due to IgM antibodies. So, the C1qSAB assay detected IgM antibodies that fix complement.

CONCLUSION

These data suggested that the C1q-SAB assay could be an important method to evaluate pretransplant virtual crossmatch and to define nonpermitted specificities (C1q-fixing) in kidney transplantation.

Predictors of self-injurious behaviour exhibited by individuals with autism spectrum disorder

BACKGROUND

Presence of an autism spectrum disorder is a risk factor for development of self-injurious behaviour (SIB) exhibited by individuals with developmental disorders. The most salient SIB risk factors historically studied within developmental disorders are level of intellectual disability, communication deficits and presence of specific genetic disorders. Recent SIB research has expanded the search for risk factors to include less commonly studied variables for people with developmental disorders: negative affect, hyperactivity and impulsivity.

METHOD

A heterogeneous sample of 617 individuals with autism spectrum disorder diagnoses was derived from the National Database of Autism Research. Latent constructs were estimated from items of the community version of the Aberrant Behaviour Checklist. Structural equation modelling was used to assess whether impulsivity, hyperactivity, negative affect, severity of stereotypy, intellectual functioning or severity of autism symptoms predicted severity of SIB.

RESULTS

Impulsivity (β = 0.46), followed by intellectual functioning (β = -0.39), and stereotypy (β = 0.23) were the variables most highly predictive of increased SIB; impulsivity and stereotypy remained significant predictors of SIB after severity of autism symptoms and intelligence quotient (IQ) were controlled for.

CONCLUSIONS

High levels of impulsivity and stereotypy were significant predictors of SIB in a large and diverse sample of people with confirmed autism diagnoses. Future research is needed on the effects of reducing impulsivity and stereotypy on the outcomes of treatment, early intervention and attempts to prevent the development of SIB.

Right hemothorax: An unusual presentation of a Barrett's ulcer perforation

INTRODUCTION

Despite improvements in detection and surgical techniques perforation of the esophagus are lifethreatening. In this case report a rare presentation esophageal perforation due to Barrett's ulceration into an aortic vessel is described.

PRESENTATION OF CASE

We report a 42 year old man with known Barrett's esophagus presenting with abdominal pain. Further investigations showed an active intrathoracal hemorrhage due to esophageal perforation at exactly the same site of the known Barret's ulcer one year before. Thoracotomy with evacuation of blood was performed and an aortic branch as bleeding focus was found.

DISCUSSION

Hemothorax due to esophageal perforation of a benign Barrett's ulcer is rare. The diagnosis of aortoesophageal fistula's can be complicated and its presentation is frequently unspecific and is simply confused with other disorders. Acute thoracotomy is necessary and choice of closure depends on the cause and size of the perforation.

CONCLUSION

This case illustrates the need for maintaining a wide-ranging view of potential casus of hemothorax. The key to survival in patients with aorto-esophageal fistula is maintaining awareness of the condition to allow early diagnosis and operative management of this treatable lesion.

P2-17-07: Construction of a Predictive Model of Probability of Ovarian Function Recovery in a Series of Premenopausal Breast Cancer Patients with Chemotherapy-Induced Amenorrhea Switched to an Aromatase Inhibitor (AI) after Adjuvant Tamoxifen

Introduction: AI therapy is not recommended in breast cancer patients with conserved ovarian function as AI decreases estrogenic feedback leading to an increased of FSH and LH. In patients older than 40 and with prolonged amenorrhea, switching to an AI after tamoxifen therapy is a controversial approach but with an adequate follow-up for early detection of potential menses renewal it might be feasible. Several factors have been identified in the literature as clinical defining variables of CIA while other factors have been associated with high probability of permanent CIA. Among clinical defining variables are time from last menses date (LMD) and low estradiol (E2) levels. Risk variables for permanent CIA are chemotherapy schedule administered and advanced age. We aimed to construct a predictive model to identify high risk of renewal of menses after switching to AI in premenopausal patients with CIA lasting at least 1 year.

Methods: Based on defining and prognostic variables of CIA, a predictive model of high probability of permanent amenorrhea was constructed by assigning a score as follows:

1) Time from LMD to switching date &gt;3 years: 1 point, &lt; 3 years: 0 points

2) E2 levels &lt;20 ng/ml: 1 point, &gt;20 ng/ml or unknown: 0 points

3) Age &gt; 45 years: 1 point, &lt; or = 45: 0 points

4) Chemotherapy regimen administered: dose dense or high doses: 2 points, conventional doses regimen with anthracycline and taxanes: 1 point, conventional doses only anthracycline-based or other: 0 points. Final score obtained from 0 to 5 points was classified in two groups: Low-probability of permanent amenorrhea: score 0–2, and high probability of permanent amenorrhea: score 3–5. To validate this probability model we retrospectively analysed data from a prospective maintained database of early breast cancer patients, clinically premenopausal at diagnosis that were treated in our institution from May 2004 to December 2009. All patients had histologically confirmation of hormone-sensitive breast carcinoma at stage I-III. Therapy included in all cases adjuvant or neoadjuvant chemotherapy and adjuvant tamoxifen and all patients referred a CIA lasting at least 1 year. Since 2006, in most patients E2 levels before switching were determined.

Results: Validation of probability model was performed in our series of 102 premenopausal patients of whom 9 recovered ovarian function (prevalence ratio: 0.088).

P5-11-06: Immunohistochemistry Discordance between Primary and Recurrent Tumors in Breat Cancer. Analysis of Potential Influence of Technique Bias by Comparing Test-Results under Two Different Conditions

Introduction: Discordance in expression of estrogen (ER) or progesterone receptors (PgR) and HER2 has been previously described in several studies, having this discordance an important impact on therapeutic approach or even in survival. However it is unclear whether discordance is a reflex of a clonal differentiation to a more aggressive biological tumour or the consequence of technical biases or inter-explorer variability. We aimed to assess the role of technique biases in observed discordance between primary tumour (PT) and recurrent tumour (RT) by analyzing discordance in two different situations: routine versus optimal conditions.

Patients and methods: We conducted a retrospective study in patients (pts) diagnosed with a recurrent breast cancer in the Hospital Clinico of Valencia between January 2000 and June 2010. All patients had a previous histological diagnose of the PT and all underwent a second histological study of the RT. Discordance was assessed in terms of hormone-sensibility (HS) (any ER or PgR +) vs hormone-resistance (HR) (ER-/PgR -) and triple negativity (TN) (ER-, PgR-, HER2−) vs non-TN (any positive). Routine conditions were referred to the immunohistochemistry (IHC) assessment of the normal practice on the base of which therapeutic decisions were made. Routine conditions were performed in the Pathology Department of our institution but PT and RT were usually evaluated at different timing and ocasionally by different pathologists. In order to assess potential laboratory biases we repeated IHC analysis under optimal conditions. For these optimal conditions analyses, paired samples from both PT and RT were reassessed at the same time and tests were performed in the same way. Final determination of the results was made by two highly trained pathologists and in case of disagreement in any determination, both explorers re-assessed the sample at the same time.

We evaluated discordance between PT and RT under both conditions, and the accuracy of determinations in PT or RT between both conditions.

Results: 128 paired samples (from 64 different pts) were analysed. Median age of the series was 48.5 years (range 27–83). Recurrences were loco-regional in 14 pts (21.9%) and distant in 50 pts (78.1%). RT tissue was obtained from skin and soft-tissues in 18 pts (28.1%), lung in 11 (17.2%), bone in 10 (15.6%), lymph nodes in 10 (15.6%), pleura/peritoneum in 9 (14.1%) and liver in 6 (9.4%). Discordant cases between PT an RT in terms of HS/HR were 30.4% in routine conditions and 9.8% in optimal conditions. In terms of TN/non-TN were 14.3% in routine vs 8.2% in optimal conditions. Accuracy in results HS/HR between routine and optimal conditions was 80.7% in PT and 76.0% in RT. In results of TN/non-TN accuracy between both conditions was 94.2% in PT and 87.2% in RT.

Conclusions: Results suggest that an important rate of discordance observed in routine conditions might be strongly influenced by technique biases. However, changes observed in optimal conditions with 9.8% discordance in HS/HR and 8.2% in TN/non-TN suggest that in a small proportion of tumours, observed discordance might be explained by biological mechanisms.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P5-11-06.

Detection of infectious astroviruses in water

A method based on the infection of CaCo-2 cells and molecular hybridization with a specific cDNA probe has been developed for the detection of infectious astroviruses in environmental samples. By this procedure wild-type astroviruses have been detected in water from an area where a concurrent gastroenteritis outbreak was reported.

[Use of the recombinant baculovirus BacVP6C for the construction of an internal positive control of rotavirus C]

AIMS

Unlike group A, a few studies have interested other groups of the rotavirus, especially in Tunisia. The role of rotavirus C (RVC) infection is underestimated because of its sporadic nature. The aim of our study was to develop rapid diagnostic procedures of RVC by using an internal positive control of reverse transcription PCR (RT-PCR).

METHODS

The internal positive control (386pb) was designed from the recombinant baculovirus BacVP6C containing the full length cDNA of the Cowden strain gene 5 (1353pb). A fragment of 596pb was amplified by PCR using the BacVP6C DNA ds as template. Then, a central part of 210pb was deleted and the remaining fragment (386pb) was cloned into pGEM-3Zf(+) plasmid between SP6 and T7 RNA polymerase promoters.

RESULTS

The obtained recombinant plasmid "pIAM1" was then used for the generation of the internal positive control by in vitro transcription. The sensibility of the RT-PCR was about 3.66×10(5) molecules of RNA/μl.

CONCLUSION

The use of a shorter positive control, as compared to the wild type, allows increased specificity of the RT-PCR reaction, and could be used for efficient diagnostic and surveillance of RVC-caused diseases.

Outbreak of hepatitis A among men who have sex with men in Barcelona, Spain, September 2008-March 2009

Between 1 September 2008 and 9 March 2009, 150 cases of hepatitis A were reported in Barcelona representing a threefold increase compared with the same period in previous two years. The majority of the cases occurred in adult men, including 87 who reported having sex with men. This indicated the possibility of an outbreak ongoing in the population of men who have sex with men (MSM) and emphasised the need to target this community with more effective vaccination programmes.

Outbreak of hepatitis A among men who have sex with men in Barcelona, Spain, September 2008 – March 2009

Between 1 September 2008 and 9 March 2009, 150 cases of hepatitis A were reported in Barcelona, representing a threefold increase compared with the same period in the previous two years. The majority of the cases occurred in adult men, including 87 who reported having sex with men. This indicated the possibility of an outbreak ongoing in the population of men who have sex with men (MSM) and emphasised the need to target this community with more effective vaccination programmes.

Palladium(II) binding to N(7) of acyclovir: DNA interaction and herpes simplex virus (HSV-1) inhibitory activity

Cytotoxicity and herpes simplex virus (HSV-1) inhibitory activity of acyclovir (ACV), 9-[(2-hydroxyethoxy)methyl]guanine, and the palladium(II) coordination complex cis-[PdCl(2)(H(2)O)(N7-ACV)] x ACV x xH(2)O have been tested in African green monkey kidney (Vero line) epithelial cell cultures. The N(7) position of ACV represents the preferred binding site to afford a pseudo-chelate N7/O6 Pd(II) complex involving H-bonds with the cis H(2)O molecule. The Pd(II)-ACV complex has been structurally characterized by FTIR and (1)H NMR spectroscopy techniques, chemical composition was measured by elemental analysis, and the thermoanalytical study was performed by TG/DTA. The recognition of secondary ACV molecules by the Pd(II) derivative promotes cooperatively potent HSV-1 inhibitory activity which, in turn, strongly depends on concentration conditions. At the optimal concentration of 10 microM, this complex exhibits antiviral efficiency in vitro, approximately hundred-fold (ca. 1.87 log(10)) more effective in herpes-infected cells when compared with that of the parent ACV molecules. The molecular-level observation of noticeable modifications caused by the complex on the morphology of the plasmid pBR322 DNA was monitored by AFM, whose mutual interaction evolves to eventually afford DNA condensates upon increasing the period of incubation.

Multicentre European study of thalamic stimulation for parkinsonian tremor: a 6 year follow-up

AIM

To evaluate the results of ventral intermediate (Vim) thalamic deep brain stimulation (DBS) in patients with tremor predominant Parkinson's disease (PD) at 6 years post surgery.

METHODS

This was a prolonged follow-up study of 38 patients from eight centres who participated in a multicentre study, the 1 year results of which have been published previously. Total scores as well as scores for individual items of the motor part and the disability part of the Unified Parkinson's Disease Rating Scale were used for evaluation.

RESULTS

Tremor was still effectively controlled by DBS and appendicular rigidity and akinesia remained stable compared with baseline. Axial scores (speech, gait and postural instability), however, worsened, and in parallel the initial improvement in activities of daily living scores at the 1 year follow-up had disappeared at 6 years, despite sustained improvement of tremor. Remarkably, neither daily doses of dopaminergic medication nor fluctuations and dyskinesias had changed at 6 years compared with baseline in this particular patient group.

CONCLUSION

This study confirms that patients with tremor dominant PD who do not present with fluctuations and dyskinesias may have a relatively benign progression of the disease. Vim DBS, although having no effect on akinesia and rigidity, is a relatively lenient surgical procedure and may still have a place for long term symptomatic control of PD tremor in selected patients.

[Technical aspects of mechanical insufflator-exsufflators. Construction and function of the Emerson CoughAssist]

The electromechanical insufflator-exsufflator (Emerson CoughAssist) was developed as an aid for patients with neuromuscular disorders suffering from impaired cough. The insufflator-exsufflator simulates and supports physiological cough by supporting inspiration with positive pressure and shifting this positive pressure rapidly into a negative pressure that supports exsufflation and thus bronchial clearance. Maximum pressures are +/- 60 cm H2O, pressures between 30 and 50 cm H2O are sufficient to produce assisted cough in adults with neuromuscular disease. The pressure shift from positive to negative occurs with 0.02 sec and is regulated by a magnetic valve. An anaesthetic facemask is used as interface, alternatively, a mouthpiece can be used in combination with a nose strap. It is also possible to use the insufflator-exsufflator in patients with tracheostomy. We present in this article detailed information about the technical principles and practical use of the electromechanical insufflator-exsufflator.

Study comparing oesophageal capsule endoscopy versus EGD in the detection of varices

BACKGROUND

Endoscopic screening and surveillance of cirrhotic patients for oesophageal varices is advocated before initiation of prophylactic therapy for prevention of the first variceal haemorrhage.

AIMS

To compare the diagnostic yield of oesophageal capsule endoscopy (ECE) with Esophagogastroduodenoscopy (EGD) for detecting and grading oesophageal varices and to determine patient tolerance for each procedure.

PATIENTS

Twenty consecutive cirrhotic patients scheduled for EGD were enrolled in the study.

METHODS

Patients underwent ECE followed by EGD. Patients completed a visual analogue scale after each procedure, assessing level of anxiety, pain, overall satisfaction, and willingness to repeat each procedure.

RESULTS

On EGD, 19/20 patients had oesophageal varices. ECE detected varices in 13/19 (68% sensitivity). ECE identified nine out of ten varices rated grade II or higher on EGD. The post-study analogue scale showed a greater level of anxiety before EGD (avg. 2.75/10) versus ECE (avg. 1.5/10).

CONCLUSIONS

ECE may be used in the assessment of EV. It appears to have more discordance with EGD when evaluating smaller varices. The minimal discomfort, lack of sedation, and decreased risk make ECE a possible substitute to EGD in patients unable or unwilling to undergo EGD.

Data quality of 5 years of central norovirus outbreak reporting in the European Network for food-borne viruses

BACKGROUND

The food-borne viruses in Europe (FBVE) network database was established in 1999 to monitor trends in outbreaks of gastroenteritis due to noroviruses (NoVs), to identify major transmission routes of NoV infections within and between participating countries and to detect diffuse international food-borne outbreaks.

METHODS

We reviewed the total of 9430 NoV outbreak reports from 13 countries with date of onset between 1 January 2002 and 1 January 2007 for representativeness, completeness and timeliness against these objectives.

RESULTS

Rates of reporting ranged from a yearly average of 1.8 in 2003 to 11.6 in 2006. Completeness of reporting of an agreed minimum dataset improved over the years, both for epidemiological and virological data. For the 10 countries that provided integrated (epidemiological AND virological) reporting over the 5-year period, the completeness of the minimum dataset rose from 15% in 2003 to 48% in 2006. Two countries have not been able to combine both data types due to the structure of the national surveillance system (England and Wales and Germany). Timeliness of reporting (median days between the onset of an outbreak and the date of reporting to the FBVE database) differed greatly between countries, but gradually improved to 47 days in 2006.

CONCLUSION

The outbreaks reported to the FBVE reflect the lack of standardization of surveillance systems across Europe, making direct comparison of data between countries difficult. However, trends in reported outbreaks per country, distribution of NoV genotypes, and detection of diffuse international outbreaks were used as background data in acute questions about NoV illness and the changing genotype distribution during the 5-year period, shown to be of added value. Integrated reporting is essential for these objectives, but could be limited to sentinel countries with surveillance systems that allow this integration. For successful intervention in case of diffuse international outbreaks, completeness and timeliness of reporting would need to be improved and expanded to countries that presently do not participate.

Hepatitis A virus detection in food: current and future prospects

Hepatitis A virus (HAV) is responsible for around half of the total number of hepatitis infections diagnosed worldwide. HAV infection is mainly propagated via the faecal-oral route and as a consequence of globalisation, transnational outbreaks of foodborne infections are reported with increasing frequency. Molecular procedures are now available and should be employed for the direct surveillance of HAV in food and environmental samples.

Essential thrombocythemia in young individuals: frequency and risk factors for vascular events and evolution to myelofibrosis in 126 patients

The frequency of vascular events and evolution to myelofibrosis (MF) in young individuals with essential thrombocythemia (ET) is not well known. The incidence and predisposing factors to such complications was studied in 126 subjects diagnosed with ET at a median age of 31 years (range: 5-40). Overall survival and probability of survival free of thrombosis, bleeding and MF were analyzed by the Kaplan-Meier method and the presence of the Janus Kinase 2 (JAK2) V617F mutation correlated with the appearance of such complications. The JAK2 mutation (present in 43% of patients) was associated with higher hemoglobin (Hb) (P<0.001) and lower platelets at diagnosis. With a median follow-up of 10 years (range: 4-25), 31 thrombotic events were registered (incidence rate: 2.2 thromboses/100 patients/year). When compared with the general population, young ET patients showed a significant increase in stroke (odds ratio 50, 95% CI: 21.5-115) and venous thromboses (odds ratio 5.3, 95% CI: 3.9-10.6). Thrombosis-free survival was 84% at 10 years, with tobacco use being associated with higher risk of thrombosis. Actuarial freedom from evolution to MF was 97% at 10 years. In conclusion, young ET patients have thrombotic events, especially stroke and venous thrombosis, more frequently than generally considered, whereas they rarely transform to MF.

Coxsackie adenovirus receptor and alpha nu beta3/alpha nu beta5 integrins in adenovirus gene transfer of rat cochlea

This study was designed to determine whether Coxsackie adenovirus receptor (CAR) and alpha nu beta3/alpha nu beta5 integrin co-receptors are involved in adenovirus gene transfer in the rat cochlea. We find that CAR and integrin co-receptors are expressed in every cell subtype transduced by the adenoviral vector Ad5 DeltaE1-E3/cytomegalovirus/green fluorescent protein (GFP) on cochlear slices in vitro. The spiral ganglion neurons, which do not express CAR, were not transduced by the virus. Blocking these receptors by monoclonal antibodies decreased transgene expression, whereas disrupting tight junctions with ethylenediaminetetraacetic acid led to an increased transgene expression. However, sensory hair cells and strial cells also expressing CAR and alpha nu integrins were not transduced by the vector. GFP expression was also studied in vivo. Perilymphatic perfusion of adenovirus in vivo did not affect hearing and only cells lining the perilymphatic spaces were transduced. Endolymphatic perfusion resulted in low-frequency hearing loss and although some cells of the organ of Corti were efficiently transduced, the sensory and the strial cells were not. Transduced sensory and strial cells were occasionally observed in cochleas after single shot of adenovirus. Pretreatment with anti-CAR and anti-alpha nu antibodies decreases GFP expression in vivo, suggesting that the CAR/alpha nu integrin pathway is involved in adenovirus transduction in the cochlea.

Impact of chemotherapy dose-related factors on survival in breast cancer patients treated with adjuvant anthracycline-based chemotherapy

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Background: The relationship between chemotherapy (CT) dose intensity and patient (pt) outcome in the management of early stage breast cancer (EBC) is still controversial. Although randomised clinical trials have provided evidence that supports the delivery of full standard doses of CT on schedule, precise thresholds for CT dose-related factors and their impact on survival-related endpoints have not yet been fully defined. The objective of this project is to assess the impact of CT dose-related factors on event-free and overall survival in a large group of EBC pts treated with anthracycline-based chemotherapy. Methods: A total of 1056 EBC (stage I-II-IIIA) cases diagnosed and treated from January 1980 to December 2000 were retrospectively studied. All of them received adjuvant anthracycline non-taxanes-based CT. Consecutive charts from 793 pts that were fully completed were included in the analysis. Survival-related endpoints were analysed through Kaplan-Meier estimates, log-rank tests, and Cox proportional hazards models. Results: With a median follow-up of 10.0 years, pts exposed to either > 2 cycle-delay (delay at any cycle defined as ≥ 3 days vs. plan), or ≥ 15 day-delay across the whole CT regimen, or < 95% relative dose intensity (RDI) showed significantly worse 10-year Event-Free Survival (EFS) and Overall Survival (OS) as compared to pts with no dose delay/reduction (data shown below). Controlling for age at diagnosis, disease stage, histological grade, menopausal status and year of treatment did not modify these results. Conclusions: Based on this preliminary analysis, CT dose delays and reductions in EBC pts treated with adjuvant anthracycline-based regimens have a significantly negative impact on EFS and OS.

[Table: see text]

No significant financial relationships to disclose.

Gutless adenovirus: last-generation adenovirus for gene therapy

Last-generation adenovirus vectors, also called helper-dependent or gutless adenovirus, are very attractive for gene therapy because the associated in vivo immune response is highly reduced compared to first- and second-generation adenovirus vectors, while maintaining high transduction efficiency and tropism. Nowadays, gutless adenovirus is administered in different organs, such as the liver, muscle or the central nervous system achieving high-level and long-term transgene expression in rodents and primates. However, as devoid of all viral coding regions, gutless vectors require viral proteins supplied in trans by a helper virus. To remove contamination by a helper virus from the final preparation, different systems based on the excision of the helper-packaging signal have been generated. Among them, Cre-loxP system is mostly used, although contamination levels still are 0.1-1% too high to be used in clinical trials. Recently developed strategies to avoid/reduce helper contamination were reviewed.

Microbiological quality of reclaimed water used for golf courses' irrigation

Microbial quality of reclaimed water used for irrigation in two golf courses located in the southern Iberian Peninsula (Spain and Portugal) was evaluated. Bacterial indicators for faecal pollution (total and faecal coliforms, Escherichia coli and enterococci) were tested by membrane filtration using appropriate selective media. In addition, somatic E. coli bacteriophages, enteric viruses (entero-, hepatitis A and rota-) and Legionella pneumophila were also analysed. The results obtained showed that all wastewater treatment processes reduced adequately the number of indicator microorganisms although a significant correlation between pathogenic and indicator microorganisms tested was not found. L. pneumophila was detected by PCR but not confirmed by culture. Survival experiments of pathogenic microorganisms in aerosols and irrigated turf are conducted to determine the health hazards for the golf practice and to propose a microbial standard for wastewater used for irrigation of golf courses.

Characterization of Bordetella pertussis growing as biofilm by chemical analysis and FT-IR spectroscopy

Although Bordetella pertussis, the etiologic agent of whooping cough, adheres and grows on the ciliated epithelium of the respiratory tract, it has been extensively studied only in liquid cultures. In this work, the phenotypic expression of B. pertussis in biofilm growth is described as a first approximation of events that may occur in the colonization of the host. The biofilm developed on polypropylene beads was monitored by chemical methods and Fourier transform infrared (FT-IR) spectroscopy. Analysis of cell envelopes revealed minimal differences in outer membrane protein (OMP) pattern and no variation of lipopolysaccharide (LPS) expression in biofilm compared with planktonically grown cells. Sessile cells exhibited a 2.4- to 3.0-fold higher carbohydrate/protein ratio compared with different types of planktonic cells. A 1.8-fold increased polysaccharide content with significantly increased hydrophilic characteristics was observed. FT-IR spectra of the biofilm cells showed higher intensity in the absorption bands assigned to polysaccharides (1,200-900 cm(-1) region) and vibrational modes of carboxylate groups (1,627, 1,405, and 1,373 cm(-1)) compared with the spectra of planktonic cells. In the biofilm matrix, uronic-acid-containing polysaccharides, proteins, and LPS were detected. The production of extracellular carbohydrates during biofilm growth was not associated with changes in the specific growth rate, growth phase, or oxygen limitation. It could represent an additional virulence factor that may help B. pertussis to evade host defenses.

Human astrovirus diagnosis and typing: current and future prospects

Human astroviruses (HAstV) are important human pathogens causing gastroenteritis worldwide. The increased recognition of astroviruses as the cause of sporadic outbreaks of disease is due to the recent availability of improved diagnostic methods. During the last decade, most epidemiological surveys have chosen astrovirus-specific RT-PCR as screening methods. In addition to serotyping by molecular techniques, new typing methods are being developed that may also identify other viral properties related to virulence. The information provided by different typing assays is required for a better understanding of both the antigenic diversity and the molecular mechanisms of pathogenicity.

A new international framework for palliative care

In spite of recent advances in anti-cancer treatments, most adult cancer patients still ultimately die from their disease. There should therefore be free access to palliative care around the clock and seven days a week, for all cancer patients, as a fundamental human right. At present, the implementation of palliative care and patients' access to it are inconsistent across Europe and many other parts of the world. The World Health Organisation (WHO) made an important advance in 1986 by first defining palliative care and, then updating this definition in 2002. However, this definition could benefit from further refinement in order to reflect the increasing multi-professional specialisation in this subject, and to recognise the different models for delivering this type of care. We recommend that palliative care should be defined as follows: Palliative care is the person-centred attention to symptoms, psychological, social and existential distress in patients with limited prognosis, in order to optimise the quality of life of patients and their families or close friends. Based on this definition, we propose two further types of palliative care which reflect the reality of how palliative care is actually delivered: Basic palliative care is the standard of palliative care which should be provided by all healthcare professionals, in primary or secondary care, within their normal duties to patients with life-limiting disease. Specialised palliative care is a higher standard of palliative care provided at the expert level, by a trained multi-professional team, who must continually update their skills and knowledge, in order to manage persisting and more complex problems and to provide specialised educational and practical resources to other non-specialised members of the primary or secondary care teams. If a patient has difficult symptoms which cannot be controlled by his/her current healthcare team, he/she has a right to be referred, and the current healthcare provider has an obligation to refer, to the local palliative care team. Important priorities to ensure the standardisation of, and uniform access to, palliative care for all cancer patients include: Integration of palliative care services with the primary care and oncology teams. Establishment of a specialised palliative care service in each major cancer centre. Establishment of educational programmes covering palliative care for undergraduates, oncologists, primary care team members and specialists training in palliative care. Support for research using appropriate methodologies to underpin the scientific basis of palliative care. Establishment of quality assurance programmes. Recognition of palliative medicine as a medical specialty. Establishment of academic centres of excellence with chairs of palliative medicine and palliative care nursing. Removal of unnecessary restrictions on all drugs which are proven to be of benefit in symptom control, especially improving access to strong opioids. Improved information for patients and family carers to allow them to make choices and exercise autonomy.

A large infantile gastroenteritis outbreak in Albania caused by multiple emerging rotavirus genotypes

By the end of December 2000, the epidemiological system 'Alert' of the Public Health Institute in Tirane reported an outbreak of acute gastroenteritis. The outbreak involved children in Tirane and in the rural area. In total, 2722 children were seen in Tirane Hospital and 982 (56.4%) were treated for acute gastroenteritis. The age group with the highest morbidity was 0-5 years (89.7%), followed by the 6-9 (6.2%) and 10-15 years age groups (4.1%). The distribution of acute gastroenteritis cases, which occurred along the same water distribution system, suggests a waterborne origin. The nucleic acid amplification confirmed the co-circulation of different genotypes of rotavirus, mainly P[8]G9 and P[8]G3, responsible for the outbreak. Other enteric viruses such as astrovirus serotype 1, adenovirus and Norovirus, genogroups I and II were detected. Co-infections with different rotavirus genotypes and even with different enteric viruses were detected in several samples.

Waterborne gastroenteritis outbreak in Albania

Three different studies are reported concerning the environmental pollution caused by viruses in Albania. The first study describes an outbreak of gastroenteritis in the capital city, involving 2,722 children attending the Paediatric Unit of Tirana Hospital. The age group with the highest morbidity was 0-5 years, with 89.5%; no fatalities were recorded during the outbreak. Rotavirus was detected in 26/28 faecal samples by RT-PCR, although astrovirus, adenovirus and calicivirus were also present. The second study describes an outbreak of hepatitis A virus involving the city of Lac. Two hundred cases were recorded, with the highest incidence in the age-group 5-9 years. Phylogenetic analysis of the VP1/2A region showed the presence of a unique sequence: genotype IA. Rotavirus was identified in drinking-water samples collected during the outbreak. The third study describes the prevalence of HAV and HEV in 202 sera randomly collected from 12 different cities in Albania. HAV showed a high incidence (66.2%), whereas none was positive for HEV. The genomic analysis of the VP1/2A junction revealed the presence of only one genotype (IA) with few point mutations and just two amino acid substitutions at codons 22 and 34. Additionally, two potential antigenic variants were detected, the first at position 46 of VP3 and the second at position 23 of VP1.

Molecular epidemiology of caliciviruses causing outbreaks and sporadic cases of acute gastroenteritis in Spain

The molecular epidemiology of human caliciviruses (HuCVs) causing sporadic cases and outbreaks of acute gastroenteritis around eastern Spain (Catalonia and the Valencian Community) was studied by reverse transcription-PCR (RT-PCR) and by sequencing part of the RNA polymerase gene in open reading frame 1. HuCVs were detected in 44 of 310 stool specimens (14.19%) negative for other enteric pathogens obtained from children with acute gastroenteritis. Norwalk-like viruses (NLVs) were the most common cause of the gastroenteritis outbreaks investigated here. They were detected in 14 out of 25 (56%) outbreaks with an identified pathogen. Genotypes producing both sporadic cases and outbreaks were diverse, with a predominance of GGII strains related to genotypes Melksham and Lordsdale. Five strains clustered with a "new variant" designated GGIIb, which was detected circulating throughout quite a few European countries in the years 2000 and 2001. The emergence mechanism of these strains might be the occurrence of intertypic recombinations between different viruses. The nucleotide sequence of part of the capsid gene (ORF2) from three of these strains demonstrated their relationship with Mexico virus.

[Prospects for gene treatment in paediatric neurology]

INTRODUCTION

The current advances in the field of human genetics allow for the development of alternative therapies for the treatment of diseases affecting the central nervous system (CNS). One of the most promising new therapies is the use of therapeutic genes or gene therapy.

OBJECTIVE

To briefly review the recent advances for the treatment of diseases affecting the CNS.

DEVELOPMENT

We consider the therapeutic strategies currently in study for gene therapy of diseases with neurologic symptoms as monogenic diseases, CNS malignancies and neurodegenerative diseases. We describe the pros and cons of viral, non viral vectors and cell based therapy.

CONCLUSIONS

The current gene therapy approaches allow for specific and efficient administration of therapeutic genes to the CNS. Despite the need of optimization of the available vectors, mainly regarding to safety and efficacy, gene therapy has an important potential for the treatment of neuropediatric diseases.

Prevalence of enterovirus and hepatitis A virus in bivalve molluscs from Galicia (NW Spain): inadequacy of the EU standards of microbiological quality

A study of the presence of hepatitis A virus (HAV) and enterovirus (EV) in shellfish from the northwestern coast of Spain, one of the most important mussel producers in the world, was carried out employing dot-blot hybridization and RT-PCR techniques. In addition, bacterial contamination of the samples was evaluated by Escherichia coli (EC) counts, according to the European Union (EU) standards of shellfish microbiological quality. Shellfish samples included raft-cultured and wild mussels, as well as wild clams and cockles. Bacterial counts showed that the majority of samples (40.8%) could be classified as moderately polluted following the EU standards, and therefore should undergo depuration processes. However, differences in bacterial contamination were observed between cultured mussel and wild shellfish. Thus, percentage of clean samples (<230 EC/100 g shellfish) was clearly higher in cultured mussels (49.1%) than in wild mussels (22.8%) or clams and cockles (10.7%). HAV was detected in 27.4% and EV in 43.9% of the samples that were analyzed. Simultaneous detection of both viral types occurred in 14.1% of the samples. Statistical tests of dependence (chi-square test) showed no relationship either between viral and bacterial contamination, or between the presence of HAV and EV. Comparative analysis of hybridization and RT-PCR for viral detection yielded different results depending on the virus type that was studied, RT-PCR being effective for HAV but not for EV detection. The obtained results reinforce once again the inadequacy of bacteriological standards to assess viral contamination and suggest that although virological analysis of shellfish is possible by molecular techniques, interlaboratory standardization and validation studies are needed before the routine use in monitoring shellfish microbiological safety.

Potential role of fomites in the vehicular transmission of human astroviruses

The persistence of human astroviruses dried on representative porous (paper) and nonporous (china) surfaces was investigated. Long-term astrovirus survival on fomites was monitored by an integrated cell culture-reverse transcription-PCR procedure. Viruses were applied to inanimate surfaces in the presence and absence of fecal material, and their survival was assayed at 4 and 20 degrees C with high relative humidity. Astroviruses exhibited a notable persistence when dried on porous and nonporous materials, particularly at low temperature. Short-term survival of astroviruses on fomites was compared to that of other enteric viruses significant for health, such as rotavirus, adenovirus, poliovirus, and hepatitis A virus. Overall, astroviruses persisted better than poliovirus and adenovirus, although they exhibited a shorter survival than rotavirus and hepatitis A virus. Astroviruses show a high level of persistence at the desiccation step, which is of major significance in determining the chance of subsequent virus survival dried on fomites. Astroviruses are able to survive on inert surfaces long enough to suggest that fomites may play a relevant role in the secondary transmission of astrovirus diarrhea.