The R30Q DLG5 variant is not associated with celiac disease or inflammatory bowel disease in the Spanish population

Alterations in intestinal epithelial permeability could underlie inflammatory bowel disease (IBD) and celiac disease (CeD) etiology, as supported by previous association studies. One related gene, DLG5 [discs, large homologue 5 (Drosophila)], has been associated with IBD in several populations and with CeD in the Dutch population. We tried to confirm the involvement of DLG5 in CeD performing a case-control study (725 CeD patients and 803 controls) by analysing the R30Q variant (rs1248696). Genetic frequencies did not significantly differ between groups (P > 0.80) and the meta-analysis with the Dutch data did not show any association. Additionally, we evaluated the effect of R30Q in IBD risk (858 patients), as discordant results were previously obtained. No association was detected. Our study does not support the effect of the R30Q DLG5 variant in CeD or IBD predisposition in the Spanish population.

Effect of BSN-MST1 locus on inflammatory bowel disease and multiple sclerosis susceptibility

Genome-wide studies highlighted the effect in Crohn's disease (CD) and ulcerative colitis (UC) susceptibility of single nucleotide polymorphisms (SNPs) in 3p21, where BSN (bassoon), MST1 (macrophage stimulating-1) and MST1R (MST1 Receptor) genes map. MST1R expression was significantly downregulated in multiple sclerosis (MS) compared with control brains, resembling findings in the MS mouse model. We pursued to replicate the effect of this locus on inflammatory bowel diseases and to evaluate its contribution to MS risk. Polymorphisms rs9858542, rs2131109 and rs1128535 were analysed by TaqMan assays in Spanish patients (370 CD, 405 UC and 415 MS) and 800 ethnically matched controls. Allele frequencies of these SNPs were significantly different in CD patients compared with controls [rs9858542: P=0.001, Odds ratio (OR)=1.35; rs2131109: P=0.0005, OR=1.37; rs1128535: P=0.007, OR=0.78] and, specifically, in the ileal phenotype [rs9858542: P=0.0004, OR=1.47; rs2131109: P=0.00009, OR=1.52; rs1128535: P=0.02, OR=0.69]. No differences were detected between UC or MS patients and control individuals. The effect of this locus on CD predisposition was replicated, but no influence on UC or MS predisposition could be detected. This susceptibility locus seems to affect mainly to the ileal CD subphenotype, although this point awaits further corroboration in independent cohorts.

Lack of replication of celiac disease risk variants reported in a Spanish population using an independent Spanish sample

Celiac disease (CD) is an inflammatory condition affecting small bowel and triggered by gluten (or related proteins) ingestion in genetic susceptible individuals. Polymorphisms in three genes, SERPINE2, PPP6C and PBX3, have recently been associated with CD in the Spanish population. However, this association could not be replicated in the UK population using imputed data. As this second study analyzed a different population, we aimed at reevaluating the role of those polymorphisms using an independent Spanish sample. We genotyped three single nucleotide polymorphisms: rs6747096 in SERPINE2, rs458046 in PPP6C and rs7040561 in PBX3, in 417 CD patients, 527 ethnically matched healthy controls and parents of 304 CD patients. A case-control study using the chi(2)-test and a familial study using the transmission disequilibrium test were performed. No association was detected in those analyses. Therefore, our results seem to discard the role of the previously described polymorphisms in SERPINE2, PPP6C and PBX3 in CD susceptibility.

Association of IL18RAP and CCR3 with coeliac disease in the Spanish population

BACKGROUND AND AIMS

Genome-wide association studies in coeliac disease (CD) have resulted in the finding of eight new genetic regions associated with disease susceptibility. However, a replication study performed in the Italian population could not confirm two of those new regions: 2q12 (IL18RAP) and 3p21 (CCR3). The aim of this study was to investigate the role of those regions in CD risk in a different Mediterranean population, the Spanish population.

METHODS

A case-control study with 722 patients with CD and 794 ethnically matched healthy controls was performed. Two single-nucleotide polymorphisms, rs917997 (2q12) and rs6441961 (3p21), were genotyped and their genetic frequencies were compared between both groups using the chi(2) test.

RESULTS

An association was found with rs6441961 (p = 0.0004, OR = 1.32, 95% CI 1.13 to 1.54). A non-significant result (but concordant with the initial study) was obtained for rs917997.

CONCLUSION

The association of the 3p21 genetic region with CD susceptibility in the Spanish population was confirmed. In 2q12, the initially described OR is most probably overestimated and therefore the real situation may be the existence of a genuine but weak risk factor, which generates statistical power limitations.

Autoimmune disease association signals in CIITA and KIAA0350 are not involved in celiac disease susceptibility

Celiac disease (CD) is a multifactorial disease characterized by intestinal inflammation after gluten exposure in genetically susceptible individuals. A strong influence of certain human leukocyte antigen (HLA) alleles (those coding the HLA-DQ2 and DQ8 heterodimers) is well established, but they cannot explain the overall genetic risk. CIITA could be a good candidate gene for CD because it is mainly transcriptionally regulated, and it encodes the master regulator of major histocompatibilty complex class II gene transcription. CIITA is located in 16p13, a region also containing KIAA0350 (CLEC16A), associated with two autoimmune diseases in genome-wide association studies. We aimed at studying the involvement of polymorphisms in CIITA and KIAA0350 in CD susceptibility, with special attention to evaluate the possible presence of more than one risk factor in the region. We performed a case-control study with 607 CD patients and up to 794 healthy controls, all Spaniards. All samples were genotyped for five single nucleotide polymorphisms: rs3087456 (-168A/G) and rs4774 in CIITA and rs7203459, rs6498169 and rs2903692 in KIAA0350. No significant results were obtained when comparing genotypic, allelic or haplotypic frequencies between patients and controls. Our results seem to discard the influence in CD susceptibility of CIITA and KIAA0350 markers previously associated with other autoimmune diseases.

Role of polymorphisms in the TNFRSF13B (TACI) gene in Spanish patients with immunoglobulin A deficiency

Mutations in the TNFRSF13B (TACI) gene have been associated with common variable immunodeficiency, and a role in immunoglobulin A deficiency (IgAD) has also been suggested. We aimed at studying the role of several polymorphisms along this gene in IgAD susceptibility. Three TNFRSF13B mutations (C104R, A181E and R202H) and eight additional single nucleotide polymorphisms in the gene were genotyped in 338 Spanish IgAD patients and 553 ethnically matched healthy controls and tested for association. Data from parents of 114 IgAD patients were also collected and used for additional analysis. No statistically significant differences were observed after comparing patients and controls for any single nucleotide polymorphism analysed. Therefore, our work seems to discard a role of TNFRSF13B mutations in IgAD, concordantly with the most recent published studies.

A preliminary study on the incidence of heteroplasmy in mitochondrial DNA from vitreous humour

Vitreous humour is routinely sampled in Forensic Medicine as several post-mortem analyses can be performed. However, it is not used for DNA analyses probably due to its scarce cellularity. In these samples, in which the study of nuclear DNA is difficult, the analysis of mtDNA is an alternative approach. The aim of this study was to investigate the utility of vitreous humour for forensic identification purposes. Samples were collected during vitrectomy from retinopathy patients, in collection bags with saline solution. Blood samples were also obtained in order to contrast results. Before DNA organic extraction, several centrifugation steps were needed to concentrate the vitreous humour samples. Unlike blood, direct amplification of 400-bp fragments of the hipervariable regions I and II (HVI and HVII) was not successful, possibly due to damage to the DNA strand caused by the surgery conditions (UV radiation, oxidative stress). Therefore, amplification of two overlapping fragments for each control region was performed in vitreous humour. In order to eliminate undesired products, all samples were purified by an enzymatic method. Thereafter, mtDNA fragments were sequenced using dye terminators in a MegaBACE 500 capillary sequencer. Sequences of HVI and HVII of approximately 400 bp were obtained from all samples. The sequences obtained from each patient matched almost perfectly those from blood. In summary, herein we describe for the first time a methodology suitable for the mtDNA analysis of vitreous humour samples.

IL23R: a susceptibility locus for celiac disease and multiple sclerosis?

Recent studies have shown association of the IL23R gene with inflammatory bowel disease, psoriasis and ankylosing spondylitis. We aimed at studying the involvement of IL23R in celiac disease (CD) and multiple sclerosis (MS). We performed a case-control study including 598 patients with CD, 414 with MS and 546 healthy controls, all of them white Spaniards. All samples were genotyped for two single nucleotide polymorphisms: rs7517847 and rs11209026 (Arg381Gln). Statistical analyses were performed using chi(2-)tests or the Fisher's exact test. The minor allele (Gln) of the coding variant Arg381Gln was significantly increased in CD and MS patients when compared to controls (8% in CD vs 6% in controls, P=0.02; 9% in MS, P=0.006). In MS, a stronger effect was observed in patients showing primary-progressive disease (16%, P=0.004). Moreover, heterozygotes for rs7517847 were significantly increased in this group of MS patients (81% in MS vs 48% in controls, P=0.0002). In conclusion, contrary to what has been described previously, the less frequent allele of the functional polymorphism Arg381Gln (rs11209026) seems to be increasing susceptibility to CD and MS, although in this last group of patients a stronger effect is observed in patients affected of a primary-progressive form.

[Changes in vascular access in a dialysis unit in recent years: planning problems, change in preferences, or demographic change?]

BACKGROUND

Evidence on the reasons for the general and discouraging overutilization of catheters in DOPPS countries is lacking.

METHODS

We analysed the changes in distribution of the different types of vascular access in all 398 patients ongoing hemodialysis at our unit, from January 2000 until December 2005, as well as patients' characteristics. Secondly, risk factors associated with the use of permanent catheters were evaluated in all 95 patients who used that kind of vascular access from January 1997 until April 2006.

RESULTS

The percentage of fistulas in prevalent patients diminished from year 2000 until year 2005 (from 95% to 77.9%); concurrently there was an increase in the use of permanent catheters (from 4.2% to 21.5%). The percentage of incident patients having a usable fistula or graft at the beginning of hemodialysis diminished progressively (83.4% in 2000; 69.3% in 2005), and there was a significant increase in the percentage of incident patients using a permanent catheter (from 0 to 23%). Coincidentally, there was a change in patients characteristics: increasing age (71.3 vs. 60.5 years); greater diabetes percentage (7.1% vs. 18.5%) and less time on dialysis (93.2 vs 37 months; p < 0.03). Causes of permanent catheter insertion varied, exhaustion of all other arteriovenous options being the most frequent in the first period of the study and the presence of an unsuitable vascular anatomy in the second.

CONCLUSIONS

Despite our policy favoring arteriovenous angioaccess, our results with regards to vascular access worsened in both prevalent and incident patients, coinciding with a change in patients' characteristics. We believe that reversing this trend may become more complicated as the population on dialysis grows older and becomes more prone to diabetes.

[Can we improve our results in hemodialysis? Setting quality objectives, feedback, and benchmarking]

To diminish inter centres variability in applied medical treatments, as well as in the results obtained with them, is one of the main challenges that Nephrology faces now a days. The systematic and planned use of Clinical Performance Measures (CPMs), Feedback and Benchmarking are tools that can help clinicians to reach such an objective. In this study we evaluate the consequences of applying those techniques in the results obtained in three haemodialysis units.

METHODS

we analyzed the results obtained in 311 patients dialyzed in the three units during the period 2006-2007. Established and evaluated objectives were as follows: 1.- To increase the percentage of patients with a serum calcium below 9,5 mg/dl over 70%; 2.- To increase the percentage of patients with a serum phosphorus under 5,5 mg/dl over 80%; 3.- To increase the percentage of patients with a serum PTH in between 150-300 pg/ml over 40%; 4.- To diminish the percentage of patients with a serum ferritine below 100 ng/ml under 10%, in one of the units that at the beginning of the study was not accomplishing that objective. Every three months each unit received their own results as well as the results of the two other units.

RESULTS

the percentage of patients with serum calcium below 9,5 mg/dl increased significantly in the three units (54,6%, 56,1% and 55,6% at the beginning; 87,7%, 82.9% and 75,1% at the end of the study, respectively; p<0,001). The same was observed for the percentage of patients with a serum phosphorus below 5,5 mg/dl (77,9%, 73,6% and 66,0% at the beginning; 81,7%, 78,0% and 85.9% at the end, respectively; p: not significant), and for the percentage of patients with PTH between 150-300 pg/ml (32,9%, 43,1% and 26,4% versus 47,5%, 41,4% and 39.5%, respectively; p: not significant). The percentage of patients with a serum ferritin below 100 ng/ml in unit B diminished from 30% to 5,3% (p<0,001), reaching results similar the the two other units. Mean erythropoietin (EPO) consumption during the year 2005 was 145,5+/-13,2 U/kg/week in unit A; 226,2+/-39,8 U/kg/week in unit B, and 175,5+/-13,9 U/kg/week in unit C. At the end of year 2007, mean EPO consumption was significantly lower in unit B (144,2+/-15 U/kg/week), and similar to the other two units (140+/-14,2 in unit A and 135,1+/-13,8 in unit C).

CONCLUSION

The results of this study permit to conclude that the use of QPM's and quality targets, combined with feedback and benchmarking, allows for the improvement of clinical results. Each centre should establish their own objectives, independently of the defined quality standards, so as to reach such standards or even to improve them. In this study, the three units showed a general improvement in their results, tending towards similar outcomes for the same clinical processes.

[Use of the aluminum phosphate-binders in hemodialysis in the ultrapure water era]

INTRODUCTION

Aluminium binder has been ill-advised, but his use remain applicable in the clinique practice in very seleccionated and particular patients. The repercussion of prolonged treatment with low doses of aluminium phosphate-binders in haemodialysis was studied. The haemodialysis unit had a double osmosis inverse and the aluminium levels in haemodialysis liquid was less than 2 micrograms/liter.

METHODS

41 patients of the 295 on haemodialysis received aluminium phosphate-binders since the 2005 January to the 2007 November. The mean time of treatment was 17.8 months, and the doses was 3.9 tablets day (mean of 463 grams in the studied period). The association of low doses of aluminium phosphate-binders permitted a better control of phosphorus (6.8 to 4.8 mg/dl; p<0.0001), with a reduction of the others phosphate-binders: sevelamer (10.4 a 8 tablets/day; p<0.0001) and calcium phosphate-binders (4.6 to 3.1 tablets/day; p<0.0001). The serum aluminium increased after the aluminium treatment (6.8 to 13.8 mcg/l; p<0.0001), and no toxicity indirect signs were observed on CMV, haemoglobin, none PTH. Five patients (12.1%) reached aluminium serum levels higher 20 mcg/l, and none reached the 40 mcg/l.

CONCLUSIONS

The aluminium phosphate-binders were effective, economical and, now, with an apparent better security profile than in a previous time, but it is very important to be careful with this use and to follow a vigilance strict on patients and haemodialysis liquid.

[Is Cinacalcet a cost-effective treatment in severe secondary hyperparathyroidism in patients on hemodialysis?]

BACKGROUND

A previous study using cinacalcet, as compared to vitamin D alone, showed a better reduction response of PTH levels and a significant diminution of secondary effects. The objective of present study was to evaluate the additional cost of adding cinacalcet to the standard treatment of patients with severe secondary hyperparathyroidism (SHPT) taking into account the treatment goals achieved.

METHODS

12 month prospective study of 23 patients with severe SHPT. Two treatment regimens were considered: standard treatment (m 0) and standard treatment plus cinacalcet (m 12). Four consequences of inadequate control of SHPT were registered: parathiroid hormone (PTH), Calcium (Ca), Phosphorus (P) and the Ca x P product serum levels. Treatment effectiveness was measured as percentage of patients who achieved treatment goal according to each indicator: PTH < 800 pg/mL, PTH between 150 and 300 pg/mL, Calcium < 9.5 mg/dL, Phosphorus < 5.5 mg/dL, and Ca x P product < 55. Annual and monthly costs were calculated for both treatment regimens using Spanish 2007 tariffs, and taking into account the dose reduction in some other treatments. Results are presented as incremental costs and cost per patient who achieved treatment goal.

RESULTS

At 12 month it was observed a higher percentage of patients who achieved simultaneously the 4 therapeutic goals with respect to basal moment, from 0% to 52.1%. Cinacalcet allowed to save costs in concomitant drugs, achieving a total saving of 149 euros per patient and month. At 12 month, Cinacalcet achieved a reduction of percentage of patients with PTH > 800 pgr/mL with half of costs than standard treatment (651.35 euros vs 1363.68 euros). It was not possible to calculate the cost for PTH indicator since at the study onset, there was no patient who achieved a level between 150 and 300 pg/mL. Cinacalcet allowed reaching treatment goals in Calcium, Phosphorus and Ca x P product in a more cost-effective way (2164.2 euros vs 2684.8 euros).

CONCLUSIONS

Although Cinacalcet is expensive,p atients treated with Cinacalcet showed a minor cost per patient who achieved treatment goal than patients without Cinacalcet. The ability of cinacalcet to reduce PTH secretion, along with the reductions in the serum Ca, P, and Ca x P product, provides an alternative to the traditional treatment paradigm, and should be a welcomed addition in the management of SHPT.

Epistatic interaction between FCRL3 and MHC in Spanish patients with IBD

Inflammatory bowel disease (IBD), which comprises ulcerative colitis (UC) and Crohn's disease (CD), shows a multifactorial origin, with genetic and environmental factors involved. Although the genetic influence is clear for both diseases, the genetics involved is complex and epistatic interactions with other genes probably exist. The Fc receptor-like 3 gene (FCRL3) maps to the human chromosome 1q21-22 and certain single nucleotide polymorphisms (SNPs) in its promoter have been associated with some autoimmune diseases. Our aim was to study the role of two promoter SNPs of the FCRL3 gene (-169A>G, rs7528684 and -110C>T, rs11264799) in patients with IBD and their interaction with HLA-DRB1 and CARD15 in patients with UC and CD, respectively. A case-control study with 311 patients with CD, 324 patients with UC and 497 healthy controls was performed. All the individuals were White Spaniards. No significant associations were found between any FCRL3 SNP and CD or UC, but the stratification in patients with UC by human leukocyte antigen (HLA) showed a significant increase in heterozygosity at the FCRL3 locus, especially -169 AG (AG vs AA+GG, P= 0.0027, odds ratio = 3.6, 95% confidence interval 1.4-2.9), when HLA-DRB1*0103 carrier patients were compared with HLA-DRB1*0103 noncarriers. Our data suggest an epistatic interaction between genes in chromosomes 6p21 and 1q21-22, marked, respectively, by HLA-DRB1*0103 and FCRL3-169 AG.

Involvement of macrophage migration inhibitory factor gene in celiac disease susceptibility

The MIF gene has been associated with several diseases with inflammatory and autoimmune background, such as ulcerative colitis, rheumatoid arthritis and systemic lupus erythematosus. We aimed at testing the influence of two functional MIF promoter variants in celiac disease (CD) susceptibility. A (CAAT)(5-8) tetranucleotide repeat at position -794 and a single-nucleotide polymorphism at -173G/C were analyzed in the Spanish population (531 patients and 887 healthy controls). chi(2) statistics or Fisher exact test were used for comparisons. The -173C allele significantly increased risk ((CC+GC) vs GG: odds ratio (OR) (95% confidence interval (CI))=1.41 (1.10-1.81); P=0.005), as did carriage of the (CAAT)(7) allele (OR (95% CI)=1.36 (1.02-1.82); P=0.03) and of the haplotype (CAAT)(7)//-173C (OR (95% CI)=1.33 (1.00-1.76); P=0.04). Our data evidence for first time the role of the MIF gene increasing predisposition to CD. A common effect of MIF variants seems to underlie the etiology of these complex conditions.

Surgical treatment of distal renal artery expansive pseudoaneurysm after blunt trauma

Renal artery pseudoaneurysms are rare after blunt abdominal trauma. Pseudoaneurysms are caused by decelerating injuries of the renal artery after major falls or car accidents. Patients may be asymptomatic for months or years, and the pseudoaneurysm may expand and rupture before diagnosis or treatment. We report a case of distal renal artery pseudoaneurysm in a 51-year-old male patient, who had had a previous trauma while playing tennis 16 months ago. It was diagnosed by consecutive computed tomography-scans demonstrating a thrombosed pseudoaneurysm of the distal right renal artery, with progressive enlargement and involving persistent pain. Angiography showed right lower polar artery aneurysm and a small renal infarction due to a distal branch thrombosis. Open surgery was performed revealing a hole in a segmentary artery ostium, that was sutured with single stitches. The patient was discharged a few days late with normal renal function. Despite the development of endovascular techniques, sometimes surgical treatment is the only therapeutic alternative.

No evidence of association of the MYO9B polymorphisms with celiac disease in the Spanish population

Inconsistent results concerning the association of polymorphisms in the MYO9B gene with celiac disease (CD) have been recently published. This gene encodes a myosin with a guanosine-triphosphatase (GTPase)-activating protein domain for the Rho-family of small G proteins, which are involved in cytoskeleton remodeling and therefore potentially involved in intestinal permeability. Functional and positional reasons led us to investigate the role of MYO9B polymorphisms in the Spanish CD population. A case-control study, including 415 CD patients and 433 ethnically matched healthy controls, and a familial study, including parents of 145 of those CD patients, was performed. Six MYO9B variants previously associated with CD were analyzed: rs2305767, rs2279003, rs962917, rs1457092, rs2305765 and rs2305764. No MYO9B variants or MYO9B haplotypes were found associated with CD, either before or after stratification of the patients for the human leucocyte antigen (HLA)-DQ2-positive risk factor. The family study revealed no distorted transmission of the aforementioned MYO9B polymorphisms or haplotypes. Our results support a negligible influence of this gene on CD predisposition.

A functional variant in the CD209 promoter is associated with DQ2-negative celiac disease in the Spanish population

AIM: To address the role of CD209 in celiac disease (CD) patients. Non-human leukocyte antigen (HLA) genetic factors in CD predisposition are poorly understood, and environmental factors like infectious pathogens may play a role. CD209 is a dendritic and macrophage surface molecule involved in pathogen recognition and immune activation. Recently, a functional variant in the promoter of the CD209 gene (-336A/G) has been shown to affect the transcriptional CD209 activity in vitro and it has been associated with a higher susceptibility to/or severity of infection.

METHODS: The study population was composed of two case-control cohorts of 103 and 386 CD patients and 312 y 419 healthy controls as well as a panel of 257 celiac families. Genotyping for the -336A/G CD209 promoter polymorphism was performed using a TaqMan 5´ allelic discrimination assay. HLA-DQ was determined by hybridization with allele specific probes.

RESULTS: Initially, the case-control and familial studies did not find any association of the -336 A/G CD209 genetic variant with CD susceptibility. However, the stratification by HLA-DQ2 did reveal a significant association of CD209 promoter polymorphism in the HLA-DQ2 (-) group (carrier A vs GG in DQ2 (-) vs DQ2 (+) patients (P = 0.026, OR = 3.71).

CONCLUSION: The -336G CD209 allele seems to be involved in CD susceptibility in HLA-DQ2 (-) patients. Our results might suggest a possible role of pathogens in the onset of a minor group of CD patients.

Association of NOD2/CARD15 mutations with previous surgical procedures in Crohn's disease

OBJECTIVE

The aim of this study is to assess the importance of NOD2/CARD15 gene mutations as prognostic factors for surgical indications in Crohn's disease. PATIENTS AND EXPERIMENTAL DESIGN: A total of 165 Crohn s disease patients were studied, considering previous surgery related to Crohn's disease. We analyzed for previous surgery in global procedures as well as separately for the two main surgical indications: ileal resection and fistula treatment. The need for appendectomy was also studied. All patients were genotyped for the three CARD15 mutations, and association studies were developed using Chi-square statistics and Fisher's exact test whenever appropriate.

RESULTS

Carriers of the G908R or 1007fs mutation needed surgery more frequently, both for ileal resection and fistula repair. In contrast, appendectomy was not associated with CARD15 mutations.

CONCLUSIONS

As previously reported in this population, the R702W mutation does influence parameters of disease or need of surgery. The need for Crohn's disease-related surgery is higher in carriers of the G908R or 1007fs CARD15 mutation in the Galician population. Nevertheless, the frequency of these mutations does not allow their use to predict the course of disease.

Trypanosoma vivax: A novel method for purification from experimentally infected sheep blood

Trypanosoma vivax is the principal etiological agent of bovine trypanosomosis, a widely disseminated disease in tropical and subtropical regions. Here, we present a simple and reproducible method for the purification of T. vivax from experimentally infected and immunosuppressed sheep, using an isopycnic Percoll gradient, followed by DEAE-cellulose chromatography, with an estimated yield of 11-15%. This method could be used for the purification of T. vivax geographical isolates from various locations and from different natural hosts.

Molecular epidemiology of rabies in northern Colombia 1994-2003. Evidence for human and fox rabies associated with dogs

During the period 2000-2003, wild grey foxes (Urocyon cinereoargenteus) in northern Colombia became infected with rabies. In order to derive phylogenetic relationships between rabies viruses isolated in foxes, dogs and humans in this region, 902 nt cDNA fragments containing the G-L intergenic region and encoding the cytoplasmic domain of protein G and a fragment of protein L were obtained by RT-PCR, sequenced and compared. Phylogenetic analysis showed that rabies viruses isolated in foxes, dogs and humans belonged to a single genetic variant. Speculative analysis together with epidemiological data indicated that rabies in foxes may have been due to contact with rabid dogs. Rabies transmission between dogs, wild foxes and humans may happen in natural conditions in northern Colombia. This finding is the first to suggest dog-to-fox rabies transmission in South America, and provides another example of dog rabies variants being able to successfully colonize wildlife hosts.

Probability of prostate cancer as a function of the percentage of free prostate-specific antigen in patients with a non-suspicious rectal examination and total prostate-specific antigen of 4–10 ng/ml

Our aim was to assess the usefulness of measuring the percentage of free prostate specific antigen (PSA) in serum in relation to reducing the number of prostate biopsies in men with benign prostate examinations and serum PSA levels between 4 and 10 ng/ml. The percentage of free PSA (Immulite) in serum was analyzed prospectively in 500 men, all of whom underwent ultrasound-guided sextant prostate biopsies. Cancer was detected in 21.4% (107/500) of the patients. Using a free PSA cutoff of < or = 23% as a criterion for performing prostate biopsy would have detected 94.4% of cancers, avoided 18.8% of benign biopsies and yielded a positive predictive value of 25.3%. The percentage of free PSA increased with prostate volume. Mean total PSA and mean free percent PSA values increased as patient age increased, influencing the calculation of cutoff values, sensitivity and specificity. PSA density had a sensitivity and specificity not significantly different than the percentage of free PSA. Measurement of the percentage of free serum PSA improves the specificity of prostate cancer detection in patients with elevated total serum PSA levels and benign prostate examinations.

[Nutrition and dietary recommendations for the elderly "Public Health" Working Group of the Spanish Nutrition Society]

With the increase of life expectancy, the desire to maintain good health, functionality and maximum quality of life at advanced ages, for which nutrition plays a critical role, is a priority for the elderly. Though genetic factors are a determinant of life expectancy, there are several extrinsic factors which have a great influence on the quality of life of the elderly. Diet and nutritional status have a great influence, especially in the prevention and treatment of several diseases, which affect this heterogeneous and vulnerable age group. The nutritional status and needs of elderly people are associated with age-related biological, psychological and often socio-economic changes. All of these changes can increase the risk of developing a number of age-related diseases. In developed countries the elderly are the most affected by malnutrition, either because of a deficiency (energy and several nutrients) or an excess, leading to obesity and related diseases. This review highlights the most important factors affecting nutritional status in elderly people and focus on the need to maintain adequate physical activity level and an optimal physic, psychic and social functional capacity. It discusses dietary reference intakes and guidelines to improve and/or maintain adequate nutritional status in older people in order to reduce susceptibility to some illness and disease.