A microRNA-mediated regulatory loop modulates NOTCH and MYC oncogenic signals in B- and T-cell malignancies

Growing evidence suggests that microRNAs facilitate the cross-talk between transcriptional modules and signal transduction pathways. MYC and NOTCH1 contribute to the pathogenesis of lymphoid malignancies. NOTCH induces MYC, connecting two signaling programs that enhance oncogenicity. Here we show that this relationship is bidirectional and that MYC, via a microRNA intermediary, modulates NOTCH. MicroRNA-30a, a member of family of microRNAs that are transcriptionally suppressed by MYC, directly binds to and inhibits NOTCH1 and NOTCH2 expression. Using a murine model and genetically modified human cell lines, we confirmed that microRNA-30a influences NOTCH expression in a MYC-dependent fashion. In turn, through genetic modulation, we demonstrated that intracellular NOTCH1 and NOTCH2, by inducing MYC, suppressed microRNA-30a. Conversely, pharmacological inhibition of NOTCH decreased MYC expression, and ultimately de-repressedmicroRNA-30a. Examination of genetic models of gain and loss of microRNA-30a in diffuse large B-cell lymphoma (DLBCL) and T-acute lymphoblastic leukemia (T-ALL) cells suggested a tumor suppressive role for this microRNA. Finally, the activity of the microRNA-30a-NOTCH-MYC loop was validated in primary DLBCL and T-ALL samples. These data define the presence of a microRNA-mediated regulatory circuitry that may modulate the oncogenic signals originating from NOTCH and MYC.

[Endoscopic incision of intravesical ureteroceles in patients with duplex system]

PURPOSE

To evaluate the clinical status and renal function of pa- tients with duplex system and intravesical ureterocele after drainage by cystoscopy.

MATERIAL AND METHODS

In 9 patients with duplex system and intravesical ureterocele drainage was performed to present recurrent urinary tract infections (7 children with episodes of pyelonephritis and sepsis) or obstruction of the urinary drainage. The mean age was 33 months (range 8-108 months). The thecnique was done under general anesthesia in the operating room and puncture of the ureterocele was performed using cystourethroscopy with loop electrode. The minimum follow-up was 12 months (range 12-48 months) and includes renal ultrasound, renal isotopic study (Mag3 with furosemide) and-echocystography study in patients with preoperative vesicoureteral reflux or postoperative urinary tract infection.

RESULTS

The average operative time was 60 minutes. Mean hospital stay was 48 hours. There were no complications during the procedure. In five patients urinary infection episodes disappeared. Ultrasound demonstrated decreased hydronephrosis and megaureter. In two patients the differential renal function following the technique improved. One patient with preoperative split renal function of 14% required nephrectomy. One patient had postoperative vesicoureteral reflux.

CONCLUSIONS

The drainage of intravesical ureterocele in patients with duplex system reduces episodes of urinary tract infection and urinary tract dilation.

Ultrasound-guided platelet-rich plasma injections for the treatment of common peroneal nerve palsy associated with multiple ligament injuries of the knee

PURPOSE

Peroneal nerve palsy in traumatic knee dislocations associated with multiple ligament injuries is common. Several surgical approaches are described for this lesion with less-than-optimal outcomes. The present case represents the application of plasma rich in growth factors (PRGF) technology for the treatment of peroneal nerve palsy with drop foot. This technology has already been proven its therapeutic potential for various musculoskeletal disorders. Based on these results, we hypothesized that PRGF could stimulate the healing process of traumatic peroneal nerve palsy with drop foot.

METHODS

The patient was a healthy 28-year-old man. He suffered peroneal nerve palsy with drop foot after multiple ligament injuries of the knee. PRGF was prepared according to the manufactured instruction. Eleven months after the trauma with severe axonotmesis, serial intraneural infiltrations of PRGF were started using ultrasound guidance. The therapeutic effect was assessed by electromyography (EMG), echogenicity of the peroneal nerve under ultrasound (US) and manual muscle testing.

RESULTS

Twenty-one months after the first injection, not complete but partial useful recovery is obtained. He is satisfied with walking and running without orthosis. Sensitivity demonstrates almost full recovery in the peroneal nerve distribution area. EMG controls show complete reinnervation for the peroneus longus and a better reinnervation for the tibialis anterior muscle, compared with previous examinations.

CONCLUSION

Plasma rich in growth factors (PRGF) infiltrations could enhance healing process of peroneal nerve palsy with drop foot. This case report demonstrates the therapeutic potential of this technology for traumatic peripheral nerve palsy and the usefulness of US-guided PRGF.

LEVEL OF EVIDENCE

V.

Evaluation of quality of life in dogs with idiopathic epilepsy

Background

The impact of epilepsy and its treatment on the quality of life (QoL) is considered an important part of treatment supervision in human epilepsy.

Objectives

To develop a list of key questions evaluating QoL in dogs with idiopathic epilepsy (IE) and their carers.

Animals

One hundred fifty‐nine dogs with IE.

Methods

Cross‐sectional study. An online project questionnaire was developed containing 90 QoL‐associated questions that were initially allocated to 14 themes representing specific areas associated with the treatment and care of an epileptic dog. Principal component analysis was applied with the aim of refining the questionnaire to the least number of questions representing useful themes without loss of descriptive value. Carers were recruited by paper mail, primary practices, and canine epilepsy websites. Data were acquired from January to November 2011.

Results

Principal component analysis removed 54 questions, leaving 7 themes with 36 questions with a minimum Cronbach's alpha value of 0.7 indicating a good internal consistency: “Seizure severity and frequency”, “Adverse effects of antiepileptic drug (AED)”, “Restrictions on the carer's life”, “Frustrations over caring for a dog with IE”, “Carer distaste of AED adverse effects”, “Carer anxiety around the seizure event”, “Perceptions on rectal diazepam use”.

Conclusions and Clinical Importance

Principal component analysis successfully reduced the number of questions without loss in descriptive value. The remaining questions correlate well with each other in capturing valuable details about aspects of QoL and represent valuable key questions (EpiQoL) in the assessment of QoL for the carers of dogs with IE.

DNA paternity tests in Spain without the mother's consent: the legal responsibility of the laboratories

It is technically feasible to perform paternity diagnosis testing solely involving an alleged father and his descendent. However, there are serious legal and ethical problems for forensic genetics laboratories when it comes to paternity testing cases for investigating the alleged father-child relationship if the biological mother has not given consent to access her genetic information. Based on the Spanish Constitution, the new Code of Ethics of the Spanish Medical Association includes several articles on studies about genetic information and their acceptance by all the individuals involved. This problem is greater when the child is a minor, mentally incapacitated or psychologically incapable, because current Spanish law requires informed consent from legal representatives, but the law does not typify what happens when one parent gives consent (the putative father) and the other parent (the mother) does not agree. The aim of this study is to put forward legal solutions to avoid potential legal problems.

Epidemiology and prognostic determinants of bacteraemic catheter-acquired urinary tract infection in a single institution from 1991 to 2010

OBJECTIVES

To determine the epidemiology of bacteraemic Catheter-Acquired Urinary Tract Infection (CA-UTI) and to identify independent predictors of mortality.

METHODS

This study was part of a bloodstream infection surveillance study that prospectively collected data on consecutive patients with bacteraemia in our institution from 1991 to 2010. Factors associated with 30-day mortality were determined.

RESULTS

CA-UTI was the confirmed source of 1007 bacteraemias. The most common microorganisms isolated were Escherichiacoli (42%), Klebsiella spp (15%), Enterococcus faecalis (12%) and Pseudomonas aeruginosa (12%). Along the 2006-2010 periods, antibiotic-resistant E. coli and Klebsiella spp isolates accounted for 49% of the bacteraemia due to CA-UTI. Shock and mortality accounted for 125 and 92 cases, respectively (12% and 9%). Factors associated with mortality were: inappropriate empirical treatment (OR: 1.86, 95% CI: 1.48-2.44), ultimately or rapidly fatal prognosis of underlying disease (OR: 2.56, 95% CI: 1.48-4.44) and shock on presentation (OR: 12.62, 95% CI: 7.61-20.95). Inappropriate empirical treatment was most frequent in cases of bacteraemia produced by antibiotic-resistant E. coli or Klebsiella spp, Enterococcus spp. and P. aeruginosa. Factors associated with the isolation of a microorganism of this type were previous antibiotic therapy and healthcare-associated bacteraemia (OR: 1.50, 95% CI: 1.16-2.14 and OR: 3.03, 95% CI: 2.22-4.01, respectively).

CONCLUSIONS

In cases of previous antibiotic therapy or healthcare-associated bacteraemic CA-UTI may indicate the need to initiate empirical therapy activity against antibiotic-resistant Enterobacteriaceae, E. faecalis and P. aeruginosa.

Synthesis and characterization of PbSe nanoparticles obtained by a colloidal route using Extran as a surfactant at low temperature

Lead selenide nanoparticles (PbSe NPs) have been obtained through an easy and low cost route using colloidal synthesis in aqueous solution. The synthesis was carried out at room temperature using Extran (Na₅P₃O₁₀, NaOH and H₂O) as surfactant. Hydrochloric acid (HCl) was used to eliminate the generated by-products. The size of PbSe NPs was varied by changing the Pb:Se molar concentration. The PbSe NPs were characterized by powder x-ray diffraction (XRD), scanning electron microscopy (SEM), energy dispersive x-ray analysis (EDAX), high-resolution transmission electron microscopy (HRTEM) and Raman spectroscopy. The XRD measurements showed that the PbSe NPs have the face-centered cubic phase structure. The crystal size was found to be between 14 and 20 nm as calculated from the XRD patterns and these values were corroborated with SEM and TEM. Additionally, HRTEM micrographs showed crystalline planes at (200), (220) and (111) of the PbSe NPs, in agreement with the XRD results.

Epidemiology and prognostic determinants of bacteraemic biliary tract infection

OBJECTIVES

To determine the epidemiology of bacteraemia due to biliary tract infection (BTI) and to identify independent predictors of mortality.

METHODS

This study was part of a bloodstream infection surveillance study that prospectively collected data on consecutive patients with bacteraemia in our institution from 1991 to 2010. BTI was the confirmed source of 1373 patients with bacteraemia, and the independent prognostic factors of 30 day mortality were determined.

RESULTS

The mean age of patients with biliary sepsis was 71 years (± 14 years). The most frequent comorbidities were biliary lithiasis and solid-organ cancer [484 cases (35%) and 362 cases (26%), respectively]. The BTI was healthcare-associated in 33% of patients. Shock and mortality accounted for 209 and 126 cases, respectively (15% and 9%). The most frequent microorganisms isolated were Escherichia coli (749, 55%), Klebsiella spp. (240, 17%), Enterococcus spp. (171, 12%), Pseudomonas aeruginosa (86, 6%) and Enterobacter spp. (63, 5%). There were 47 (3%) cefotaxime-resistant (CTX-R) E. coli or Klebsiella spp. Inappropriate empirical antibiotic treatment was an independent factor associated with mortality (OR 1.4, 95% CI 1.1-1.7). Inappropriate empirical treatment was more frequent in P. aeruginosa and CTX-R Enterobacteriaceae bacteraemia. These microorganisms were significantly more common in patients with previous antibiotic therapy, solid-organ cancer or transplantation and in healthcare-associated bacteraemia.

CONCLUSIONS

In patients with bacteraemic BTI, inappropriate empirical therapy was more frequent in P. aeruginosa and CTX-R Enterobacteriaceae infection and was associated with a higher mortality rate. In patients with bacteraemia due to BTI and solid-organ cancer or transplantation, healthcare-associated infection or previous antibiotic treatment, initial therapy with piperacillin/tazobactam or a carbapenem would be advisable.

Algorithm for registration of full Scanning Laser Ophthalmoscope video sequences

Fluorescein angiography is an established technique for examining the functional integrity of the retinal microcirculation for early detection of changes due to retinopathy. This paper describes a new method for the registration of large Scanning Laser Ophthalmoscope sequences (SLO), where the patient has been injected with a fluorescent dye. This allows the measurement of parameters such as the arteriovenous passage time. Due to the long time needed to acquire these sequences, there will inevitably be eye movement, which must be corrected prior to the application of quantitative analysis. The algorithm described here combines mutual information-based registration and landmark-based registration. The former will allow the alignment of the darkest frames of the sequence, where the dye has not still arrived to the retina, because of its ability to work with images without a preprocessing or segmentation, while the latter uses relevant features (the vessels) extracted by means of a robust creaseness operator, to get a very fast and accurate registration. The algorithm only detects rigid transformations but proves to be robust against the slight alterations derived from the eye location perspective during acquisition. Results were validated by expert clinicians.

[Epidemiology and clinical presentation of Panton-Valentin leukocidin positive methicillin-resistant Staphylococcus aureus]

INTRODUCTION

the aim of our study was to review the epidemiology and clinical manifestations of infections due to Panton-Valentine leukocidin-positive methicillin-resistant Staphylococcus aureus (PVL-MRSA).

MATERIAL AND METHODS

Medical history of patients infected by MRSA-PVL admitted to our hospital from January 2007 to July 2009 was reviewed. PVL and the type of cromosomic cassette were determined in all strains by PCR.

RESULTS

A total of 37 cases were included. Seventy percent were males and the median age was 39 years. Sixtytwo percent were Spanish, 14 (37.8%) were HIV-positive and 11 (29.7%) were homosexual. The source of the infection was the skin and soft tissue in 36 cases and pneumonia in 1. Sixteen patients were hospitalized, 5 had bacteremia and 5 developed septic metastasis. The relapse rate was 24% (9 cases). The prevalence during the study period was 11.2% of all MRSA isolated (37 out of 329). All the strains had a cromosomic cassette type IV and were susceptible to cotrimoxazole, rifampin, vancomyin, daptomycin and linezolid. The MIC of vancomycin, measured by E-test, was ≥ 1.5 mg/L in 28 out of 34 cases (82.3%).

CONCLUSIONS

Eleven percent of the MRSA strains isolated in our hospital are PVL positive. In general, skin and soft tissue infections are the most common and bacteremia or septic metastasis are frequent. In contrast to previous Spanish studies, more cases are observed in patients born in Spain and the infections are more severe.

Regional pattern of white matter microstructural changes in normal aging, MCI, and AD

OBJECTIVE

To cross-sectionally compare the regional white matter fractional anisotropy (FA) of cognitively normal (CN) older individuals and patients with mild cognitive impairment (MCI) and Alzheimer disease (AD), separately focusing on the normal-appearing white matter (NAWM) and white matter hyperintensities (WMH), and to test the independent effects of presumed degenerative and vascular process on FA differences.

METHODS

Forty-seven patients with AD, 73 patients with MCI, and 95 CN subjects received diffusion tensor imaging and vascular risk evaluation. To properly control normal regional variability of FA, we divided cerebral white matter into 4 strata as measured from a series of young healthy individuals (H1 = highest; H2 = intermediate high; H3 = intermediate low; H4 = lowest anisotropy stratum).

RESULTS

For overall cerebral white matter, patients with AD had significantly lower FA than CN individuals or patients with MCI in the regions with higher baseline anisotropy (H1, H2, and H3), corresponding to long corticocortical association fibers, but not in H4, which mostly includes heterogeneously oriented fibers. Vascular risk showed significant independent effects on FA in all strata except H1, which corresponds to the genu and splenium of the corpus callosum. Similar results were found within NAWM. FA in WMH was significantly lower than NAWM across all strata but was not associated with diagnosis or vascular risk.

CONCLUSIONS

Both vascular and Alzheimer disease degenerative process contribute to microstructural injury of cerebral white matter across the spectrum of cognitive ability and have different region-specific injury patterns.

[Methicillin-resistant Staphylococcus aureus bacteremia. Predictor factors for an isolate with a vancomycin minimal inhibitory concentration > or =2 mg/l]

A greater rate of treatment failures with vancomycin in methicillin-resistant Staphylococcus aureus (MRSA) bacteremia has been reported recently when the minimum inhibitory concentration (MIC) is > or =2 mg/l. This study has aimed to evaluate if there are clinical and/or epidemiological factors that predict isolation of a MRSA strain with MIC of vancomycin of > or =2 mg/L in the bacteremia episodes collected during a 15 year period (January 1991 to December 2005) in a tertiary urban hospital. During the study period, a total of 478 episodes of MRSA bacteremia were studied prospectively. The following clinical variables were recorded for each one: age, gender, comorbidity, previous administration of vancomycin or another antibiotic, prognosis of baseline diseases, bacteremia focus, shock, empiric antibiotic received and mortality. The MIC of vancomycin of 419 strains (88%) was determined with the E-test. In 216 (52%) of the isolations the MIC of vancomycin was 1.50 mg/L, in 110 (26%) of the cases it was < or =1 mg/l and in 93 (22%) 2 mg/l. Uni-and multivariate analyses were made, comparing the clinical variables of the patients infected by strains with MIC of vancomycin > or =2 mg/l regarding the MIC strains < or =1 mg/l. In the last 3 years of the study (2003-2005) the proportion of the strains with MIC of vancomycin > or =2 mg/l was significantly greater than those isolated with MIC < or = 1 mg/L (44 % vs 3 %; p<0.001). In the multivariate analysis, the only clinical characteristic associated independently to the isolation of a strain with MIC > or =2 mg/l was the nosocomial-acquired infection OR (95 % CI): 1.94 (1.04-3.63); p=0.04. Although the isolation of a MRSA strain with MIC of vancomycin > or =2 mg/l is more frequent in the nosocomial-acquired bacteremia episodes, in the clinical practice, it is not a useful predictive parameter because the frequency of isolation of these strains in the community is also high.

[Localization of sentinel node in squamous cell carcinoma of the penis. Initial experience]

OBJECTIVE

To assess the validity of radioguided sentinel node biopsy in squamous cell penile carcinoma.

MATERIAL AND METHODS

Fifteen patients were studied. The first 5 patients were included in a group for validation of the technique, in which a standard inguinal lymphadenectomy was performed after the procedures described below. The remaining 10 patients were included in the technique application group. The day before surgery, lymphoscintigraphy was performed on all patients. During the operation, radioguided biopsy to locate the sentinel node was done. Methylene blue dye was injected shortly before surgery in 10 patients. All patients were followed for an average of 32 months.

RESULTS

In the validation group, lymphoscintigraphy revealed inguinal drainage in 5/5 patients. Unilateral metastases were detected in 3/5 patients. No metastatic nodes were detected among the nodes removed during inguinal lymphadenectomy. In the application group, lymphoscintigraphy showed inguinal drainage in 9/10 patients. Nineteen nodes were removed, none of which showed tumour involvement. During the follow-up period, no disease progression or recurrence were observed in either patient group.

CONCLUSIONS

Radioguided localization and biopsy of the sentinel nodes can avoid unnecessary lymphadenectomies in patients with squamous cell penile carcinoma and high or intermediate risk of lymph node involvement. This technique shows high reliability and negative predictive value in penile carcinoma.

Decreasing gradient of antibiotic concentration in the lumen of catheters locked with vancomycin

The purpose of this study was to investigate if vancomycin concentration is maintained along the lumen of dialysis catheters after 48 h of lock therapy. Each lumen of nine catheters (three subclavian and six femoral) was locked with 2,500 mg/l of vancomycin for 48 h. After that period, the content of the lumen was aspirated with three different syringes of 0.4 ml each to measure the proximal, medial and distal vancomycin concentration. Vancomycin concentration was measured using a homogeneous particle-enhanced turbidimetric inhibition immunoassay. A non-parametric ANOVA, by means of a rank transformation on the antibiotic concentration, was used to assess the influence of the catheter segment (proximal, medial and distal) and the catheter type (femoral or subclavian). A significant decrease in vancomycin concentration from proximal to distal segments was observed (p < 0.001). In addition, the vancomycin concentration in subclavian catheters was significantly higher than in femoral catheters (p < 0.001). In our study there was a decreasing gradient in vancomycin concentration from proximal to distal segments of the catheter. This may explain the failure of antibiotic lock-therapy.

Haplotype frequencies of 16 Y-chromosome STR loci in the Barcelona metropolitan area population using Y-Filer™ kit

Haplotype frequencies for 16 Y-chromosomal short tandem repeat (STR) loci, included in the Y-Filer kit, were determined in 247 unrelated healthy individuals from the Barcelona metropolitan area (Catalonia, NE Spain). After PCR amplification and denaturing PAGE electrophoresis, DYS456, DYS389I, DYS390, DYS389II, DYS458, DYS19, DYS385a/b, DYS393, DYS391, DYS439, DYS635, DYS392, Y GATA H4.1, DYS437, DYS438 and DYS448 loci were typed. The aim of this study is to evaluate the performance in our population of the 16 loci of the Y-chromosome present in the new Y-Filer commercial identification kit, and acquire haplotype frequencies for mathematic processing of the forensic diagnosis in our geographical working area. In this sample, all haplotypes were unique. From the forensic point of view, the combined polymorphisms of the Y-Filer kit provide a high diagnostic efficiency.

[Severe sepsis and septic shock]

Sepsis and consequent multiorgan dysfunction syndrome are responsible for over 60% of deaths in patients receiving critical care in spite of improvements in patient management. We describe the pathophysiology, epidemiology, clinical picture, and biochemical markers that contribute to the diagnosis and assessment of infection severity and progression of infection to sepsis and from severe sepsis to septic shock. Our focus is on the guidelines of the Surviving Sepsis Campaign, complemented with additional information published since those guidelines appeared. The Ovid MEDLINE database was used for a search from 1997 through 2006.

Epidemiology and outcome of primary community-acquired bacteremia in adult patients

We conducted this study to determine the associated factors and outcomes of community-acquired primary bacteremia (PB), to describe the most frequently isolated microorganisms, the antibiotic resistance pattern, and to guide the most appropriate antibiotic treatment. A total of 1,640 community-acquired bacteremia cases in nonneutropenic adults were consecutively enrolled from January 2003 to May 2006 and prospectively followed up. Nonconditional logistic regression methods were used with PB and death as dependent variables. Secondary bacteremia (SB) was present in 1,440 patients, and 200 (12%) cases were PB. The independent factors associated with PB were male sex (OR 1.69, 95%CI 1.27-2.25, P = 0.001) and an ultimately or rapidly fatal prognosis for an underlying disease (OR 2.48, 95%CI 1.84-3.34, P = 0.001). The most frequently isolated microorganisms in PB were E. coli and other enterobacteria (26 and 22%, respectively) and S. aureus (15%). There were 28 and 37% ciprofloxacin-resistant E. coli strains in SB and PB, respectively (P = 0.2). Mortality was significantly higher in PB cases (13 vs 8%, P = 0.04). The independent factors associated with mortality in PB were ultimately or rapidly fatal prognosis of underlying disease (OR 2.1, 95%CI 1.41-3.13, P = 0.001), lack of fever at the moment of bacteremia (OR 2.38, 95%CI 1.18-4.76, P = 0.02) and incorrect empirical antibiotic therapy (OR 2.01, 95%CI 1.22-3.33, P = 0.006). The initial empiric antibiotic treatment was more frequently incorrect in PB than in SB, and this was a predictive factor for mortality in PB. The resistance pattern of E. coli, other enterobacteria and S. aureus in every setting should guide the most appropriate empirical treatment for PB.

Data for Y-chromosome haplotypes in Fang and Bubi populations from Bioko (Equatorial Guinea)

Haplotype frequencies for 16 Y-chromosomal short tandem repeat (DYS456, DYS389I, DYS390, DYS389II, DYS458, DYS19, DYS385a/b, DYS393, DYS391, DYS439, DYS635, DYS392, Y GATA H4, DYS437, DYS438 and DYS448) loci, included in the AmpFLSTR Yfiler PCR Amplification Kit, were analysed in 110 Fang and 133 Bubi individuals from Bioko Island, Equatorial Guinea. The diversity was higher in Fang population, probably since they were originally from the mainland, with which they maintain tribal village and family links, and to which they travel frequently. Comparisons were made with previously published haplotype data on European and African populations, and significant differences were found between them.