L-Tryptophan administered orally at night modifies the melatonin plasma levels, phagocytosis and oxidative metabolism of ringdove (Streptopelia roseogrisea) heterophils

The essential amino acid tryptophan is the precursor in the anabolic pathway of melatonin, a hormone with immunomodulatory properties. The present study shows the in vivo effect of tryptophan on the phagocytic function and oxidative metabolism of heterophils from Streptopelia roseogrisea of < 1 year of age, with a parallel evaluation of the plasma levels of melatonin. The L-tryptophan was administered orally (125 and 300 mg/kg b.w.) at 19:00, before the beginning of the period of darkness, for 7 days. At the end of the tryptophan treatment, determinations were made at 21:00 and 02:00 of the Phagocytosis Index, the Phagocytosis Percentage, the Phagocytic Efficiency and the superoxide anion levels in heterophils isolated from blood and of the plasma levels of melatonin. The results showed, for the determinations at 21:00 in the animals that had received 125 mg L-tryptophan/kg b.w., enhanced heterophil phagocytic function and raised levels of plasma melatonin, with no affect on the oxidative metabolism of the phagocytes. For the administration of the greater concentration of tryptophan (300 mg/kg b.w.), there were raised plasma melatonin levels together with increases in heterophil phagocytic capacity and phagocyte oxidative metabolism at 02:00. The results indicate that tryptophan administered orally at night to diurnal animals of less than 1 year in age affects the circulating levels of melatonin at the same time as inducing stimulation of the innate immune function.

Improved circadian sleep-wake cycle in infants fed a day/night dissociated formula milk

On the basis of the circadian nutritional variations present in breast milk, and of the implications for the sleep/wake cycle of the nutrients present in infant formula milks, we designed a formula milk nutritionally dissociated into a Day/Night composition. The goal was to improve the bottle-fed infant's sleep/wake circadian rhythm. A total of 21 infants aged 4-20 weeks with sleeping difficulties were enrolled in the three-week duration study. The sleep analysis was performed using an actimeter (Actiwatch) placed on an ankle of each infant to uninterruptedly record movements during the three weeks. The dissociated Day milk, designed to be administered from 06:00 to 18:00, contained low levels of tryptophan (1.5g/100g protein) and carbohydrates, high levels of proteins, and the nucleotides Cytidine 5 monophosphate, Guanosine 5 monophosphate and Inosine 5 monophosphate. The dissociated Night milk, designed to be administered from 18.00 to 06.00, contained high levels of tryptophan (3.4g/100g protein) and carbohydrates, low levels of protein, and the nucleotides Adenosine 5 monophosphate and Uridine 5 monophosphate. Three different milk-feeding experiments were performed in a double-blind procedure covering three weeks. In week 1 (control), the infants received both by day and by night a standard formula milk; in week 2 (inverse control), they received the dissociated milk inversely (Night/Day instead of Day/Night); and in week 3, they received the Day/Night dissociated formula concordant with the formula design. When the infants were receiving the Day/Night dissociated milk in concordance with their environment, they showed improvement in all the nocturnal sleep parameters analyzed: total hours of sleep, sleep efficiency, minutes of nocturnal immobility, nocturnal awakenings, and sleep latency. In conclusion, the use of a chronobiologically adjusted infant formula milk seems to be effective in improving the consolidation of the circadian sleep/wake cycle in bottle-fed infants.

Influence of dietary source of docosahexaenoic and arachidonic acids on their incorporation into membrane phospholipids of red blood cells in term infants

Here we studied whether the chemical structure of dietary arachidonic and docosahexaenoic acids in full-term infant diets affects their incorporation into erythrocyte membrane phospholipids. From birth to 3 months, infants were fed breast milk (n = 9) or formula milk containing arachidonic acid and docosahexaenoic acid provided by egg phospholipids (n = 10) or by low-eicosapentaenoic acid fish oil and fungal triglycerides (n = 10). We compared the fatty acid composition of erythrocyte phosphatidylethanolamine, phosphatidylcholine and sphingomyelin before and after administration of the experimental diet. At 3 months, infants on formula milk showed lower concentrations of docosahexaenoic acid (in phosphatidylcholine and in phosphatidylethanolamine) and arachidonic acid (in phosphatidylcholine) than those receiving breast milk. We conclude the incorporation of the two fatty acids into erythrocyte phospholipids depends mainly on the lipid composition of the diet received rather than the chemical form in which they are delivered.

[Renal transplantation in HIV-infected patients in Spain]

HIV infection has experienced dramatic improvement in morbidity and mortality with the highly active antiretroviral therapy (HAART). This prompted a reevaluation of organ-solid transplantation as a treatment option for HIV-infected patients. Some trials in the United States have shown that one- and 2-year graft and patient survival is comparable to HIV-negative transplant population. In Europe the experience is still scarce. The aim of this study is to analyse the outcome and the clinical characteristics of HIV-infected patients who received kidney transplantation in Spain in the HAART era. Ten patients were transplanted in our country since 2001. Only one patient was black. The main cause of end-stage renal disease reported was glomerulonephritis. Six of the recipients were coinfected by hepatitis C virus. Inclusion criteria included undetectable HIV viral load and CD4 counts greater than 200/pL. Immunosuppression consisted of steroids, tacrolimus and mycophenolate mofetil, with antibody induction in 4 cases. The median and mean follow-up was 11 and 16.3+/-15.6 (3-46) months, respectively. One recipient lost his graft because of early renal venous thrombosis. The remaining patients are functioning graft with mean serum creatinina level of 1.5 +/- 0.5 mg/dl. Biopsy-proven acute rejection was diagnosed in 4 recipients and was reversed in all cases with antirejection treatment. The plasma HIV RNA levels have remained controlled and CD4 counts have been stable in excess of 200 cell/microL. None of patients have developed AIDS complications. Recipients receiving protease inhibitor-based HAART regimens required significant dosing modification to maintain appropriate tacrolimus levels. Our results show that renal transplantation can be a safe and effective treatment in select HIV-infected patients. Like other series, the acute rejection rate was higher than in non-HIV recipients. The reasons of this rejection incidence remain unknown.

The circadian rhythm of tryptophan in breast milk affects the rhythms of 6-sulfatoxymelatonin and sleep in newborn

INTRODUCTION

The hormone melatonin regulates the sleep and this pineal hormone is synthesized in the organism from the amino acid tryptophan. It is known that breast-fed babies have better sleep patterns and a better entrained sleep/wake cycle than bottle-fed babies (adapted formula).

OBJECTIVE

To compare the circadian rhythm of 6-sulfatoxymelatonin (aMT6s)--the metabolite of melatonin excreted in the urine--in urine of bottle-fed and breast-fed children, and relate it to the circadian rhythm of tryptophan in breast milk, also evaluating the possible effects on the baby's night-time rest.

METHODS

16 infants of 12 weeks of age were studied, divided into two groups depending on their exclusively natural or artificial feeding. The circadian rhythm of 6-sulfatoxymelatonin in urine was measured for the two groups of infants and for the breast-feeding mothers. In the breast milk, the circadian rhythm of the amino acid tryptophan was measured. The rest of the infants was tested by wrist actimeters for a week and the sleep parameters of the infants were measured and evaluated.

RESULTS

The tryptophan in the breast milk presented a circadian rhythm with acrophase at around 03:00. This affected the 6-sulfatoxymelatonin circadian rhythm with acrophase at 06:00 in the breast-fed infants, and also promoted nocturnal sleep. Assumed sleep, actual sleep, and sleep efficiency were significantly increased in the breast fed infants with respect the formula fed infants.

CONCLUSION

A temporal relationship was observed between the circadian rhythm of 6-sulfatoxymelatonin of the exclusively breast-fed babies and that of tryptophan in the mother's milk. Acting this amino acid as a zeitgeber entrainment of the biological rhythms in the breast-fed infant.

Treatment with adefovir dipivoxil in a renal transplant patient with renal insufficiency and lamivudine-resistant hepatitis B infection

Lamivudine is a safe, effective treatment for hepatitis B virus (HBV) reactivation after renal transplantation. However, prolonged lamivudine therapy can produce resistance to the drug. Adefovir dipivoxil (ADV) has demonstrated efficacy in patients with lamivudine resistance, but there is limited clinical experience in patients with either renal transplants or severe renal insufficiency. A 47-year-old man with asymptomatic HBV infection underwent renal transplantation in November 1995. In September 2000 lamivudine therapy was initiated to treat HBV reactivation. The outcome was good, with negative HBV DNA levels. Two years later, significant viral replication developed again. At that time the patient already had advanced renal insufficiency due to chronic graft nephropathy. The transaminase levels were increased, and the HBV DNA reached greater than 200,000 copies/mL by polymerase chain reaction, with development of ascites and cirrhosis. The patient was started on ADV 10 mg every 72 hours (dose adjusted to renal function). There was rapid normalization of hepatic enzymes and progressive decline of the viral load. HBV DNA became negative after 6 months of ADV treatment. The renal function has since remained stable. This case suggests that ADV can be safe and effective in the treatment of renal transplant patients with lamivudine-resistant hepatitis B, even in the presence of advanced renal insufficiency.

Effect of Parathyroidectomy on Renal Graft Function

Some authors have reported acute impairment of renal transplant function after parathyroidectomy (PTx). Since 1996 PTx has been performed in 22 renal transplant recipients (follow-up, 24.2 +/- 15 months; serum creatinine concentration (SCr) pre-PTx, 1.26 +/- 0.4 mg/dL). We analyzed the serum levels of immunoreactive parathyroid hormone, calcitriol, calcium, phosphate, alkaline phosphatase, SCr, and hemoglobin, as well as proteinuria, blood pressure, and immunosuppressive treatment at several times: before PTx and at 7 days, 1 month, and then every 3 months post-PTx. After PTx we observed acute renal function deterioration until the third post-PTx month, when SCr levels returned to baseline values. We found no changes in blood pressure, although there was a trend toward a reduced dosage of antihypertensive drugs. We compared the patients who showed more significant increases (>30% from baseline) in SCr (group A, n = 7) with those who did not (group B, n = 15). Group A had higher SCr levels pre-PTx. We observed no other significant differences, either pre-PTx or post-PTx. In 2 patients in group A, SCr returned to baseline at the third month after PTx, but in the other 5 the renal function impairment persisted. Taking into account this risk and that severe hyperparathyroidism does not revert after transplantation, it would seem more appropriate in such cases to perform PTx while the patient is on the waiting list. The causes of this renal functional impairment are not clear, but the patients who showed worse deterioration also had a worse renal function pre-PTx.

[Systemic arterial hypertension in primary chronic glomerulonephritis: prevalence and its influence on the renal prognosis]

Nowadays, glomerulonephritis is one of the most common causes of End-stage Renal Disease and starting point of dialysis in Spain. Several factors may influence negatively in this prognosis; among them, we may show up the systemic arterial hypertension. Though its prevalence in the glomerulonephritis is considered higher than in other nephropathies, with variations among series, probably due to difference in ages, in geographical areas, in histological types, in time on evolution of the nephritis ... and because it is difficult to distinguish if the hypertension is a consequence of the nephritis or a consequence of the renal failure that can be present in several cases. In the same way, its negative influence in the renal prognosis may be influenced more by this renal failure, which can be its cause when it is quite severe, than by the hypertension itself. Our aims were to analyse, on the one hand the prevalence of hypertension in the 394 patients diagnosed of primary glomerulonephritis by means of a renal biopsy during two decades in the Bay of Cadiz, as well as its influence in the renal prognosis since the moment of the diagnosis, even with the absence of severe renal failure. We gathered demographic, clinical, analytical and histological data, as well as the situation of the renal function and the survival period of it at the end of each patient study. For the analysis prognosis and renal survival, Kaplan-Meier curves and the long-rank test were used. Of the 394 patients, 247 are men and 147 are women, with an average age of 36.7 +/- 17.7 years old. The global prevalence of hypertension was 39%, with a higher frequency in older patients. The gathered rate of renal survival for hypertensive patients was 54%, 28%, 20% and 4% at 5, 10, 15 and 20 years respectively; while for non-hypertensive patients, it was 83%, 75%, 66% and 62% for the same periods of time (p < 0.001). This worse tendency for hypertensive patients is observed too in each particular histological type, especially in the IgA nephropathy and membranous nephropathy. These results were the same for the patients who did not have severe renal failure in the moment of the biopsy.

CONCLUSIONS

Hypertension is a common fact in the primary glomerulonephritis, which also conditions, in an important way, the renal prognosis itself in a long term, from the moment of diagnosis and even before the existence of a significant renal failure.

[Study of the biopsied nephrotic syndrome for 20 years in the Cadiz Bay Area: histological correspondence, renal prognosis and clinical prognostic factors]

AIMS

To analyse the histological correspondence, the renal survival and the clinical prognostic factors in the nephrotic syndrome for more than 20 years in our environment as well as the influence of the nephrotic proteinuria in the renal survival in the different histological particular types of glomerulonephritis.

PATIENTS AND METHODS

Among the 542 primary and secondary glomerulonephritis diagnosed by kidney biopsy for two decades in the Cadiz Bay Area, we selected 242 patients whose clinical presentation and the biopsy indication was the nephrotic syndrome. Statistics methods: means +/- typical deviation, percentiles, percentages, Kaplan-Meier curves, long-rank test, student's t-test, chi-square analysis and Cox proportional hazards model test.

RESULTS

242 patients with nephrotic syndrome (44.66% out of the total of glomerulonephritis), average age of 39.15 +/- 18 years old. Average proteinuria 6.75 +/- 4.53 g/day.

ETIOLOGY

membranous nephropathy (33.85%), lupus nephritis (14.46%), minimal change disease (11.57%), focal segmental glomerulosclerosis (10.33%), renal amyloidosis (9.95%). 33%, 45%, 63% and 72% of the patients with nephrotic syndrome developed to the End-stage Renal Disease and starting point of dialysis in 5, 10, 15 and 20 years respectively. After the multivariate model, the age older than 60 years old, the high levels of proteinuria and the coexistence with hypertension or renal failure, in the moment of diagnosis, showed to be independents clinical prognostic factors. The nephrotic proteinuria had a negative influence in the prognosis in the different histological types, especially in the IgA nephropathy and the lupus nephritis.

CONCLUSIONS

The nephrotic syndrome is the main indication of the renal biopsy in our environment. In general, as an independent group, its development is slowly progressive to the End-stage Renal Disease, having the possibility of being also conditioned by certain clinical factors present in the moment of the biopsy. The presence of nephrotic proteinuria is also a negative factor in the progression in many of the glomerulonephritis.

[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.

The chemoattraction of lymphocytes by rheumatoid arthritis - synovial fluid is not dependent on the chemokine receptor CCR5

OBJECTIVE

The objective was to study the potential role of the chemokine receptor CCR5 in the chemoattraction of lymphocytes by rheumatoid arthritis synovial fluid (RA-SF).

METHODS

The expression of the CCR5 receptor was studied by flow cytometry. Chemotaxis of peripheral blood lymphocytes in response to RA-SF was analyzed on transmigration chambers. Chemotaxis of immortalized lymphocytes from individuals homozygous for the Delta32 deletion of the CCR5 gene (CCR5-/-) was analyzed. The effect of a neutralizing anti-CCR5 antibody on the migration of CCR5+/+ cells was also studied.

RESULTS

We confirmed an increase in the proportion of CCR5-expressing lymphocytes in RA-SF and a preferential migration of CCR5+ lymphocytes toward RA-SF in vitro. CCR5-/- lymphocytes showed decreased chemotactic responses to the chemokine MIP-1beta but not to RA-SF. The chemotactic responses of CCR5+/+ lymphocytes to RA-SF were not modified by anti-CCR5 neutralizing antibody.

CONCLUSIONS

We confirm a preferential accumulation of CCR5-expressing lymphocytes into RA-SF. However, the chemotactic responses of lymphocytes to RA-SF were not dependent on a functional CCR5 receptor, suggesting that CCR5 is a marker of a lymphocyte subset rather than a specific mediator of chemotactic responses to chemokines in RA-SF.

Involvement of the Fas system in liver allograft rejection

OBJECTIVE

Recent studies suggest that apoptosis is an important mechanism of cell death in the rejection of liver allografts and that this process is mediated via Fas. The aim of this study was to analyze the expression of the Fas system during the liver allograft rejection and its evolution after treatment.

METHODS

We evaluated 14 patients with liver allograft rejection before and after treatment. Fas immunostaining was performed by the labeled streptavidin-biotin peroxidase method using a 200-fold dilution of a monoclonal antibody. Assessment of apoptosis was determined by the terminal deoxynucleotidyltransferase-mediated deoxyuridine triphosphate nick end labeling (TUNEL) technique on deparaffined liver samples. Serum levels of soluble Fas antigen (sFas) were detected by an enzyme immunoassay procedure. Twelve liver transplant patients without allograft rejection were analyzed as a control group.

RESULTS

The number of hepatocytes expressing Fas antigen, the percentage of apoptotic hepatocytes, and the sFas levels were higher in patients with liver allograft rejection than in controls (27.9+/-23.1% vs 1.4+/-1.2%, p < 0.001; 2.2+/-0.9% vs 1.0+/-0.1%, p = 0.02; 24.2+/-39.6 vs 2.8+/-4.0 IU/ml, p = 0.03, respectively). There was a correlation between the levels of sFas, AST (r = 0.86, p < 0.001), ALT (r = 0.78, p = 0.02), and gamma-globulin levels (r = 0.86, p < 0.001). After the rejection treatment we found a significant decrease in the Fas antigen expression (18.6+/-13.3%, p < 0.05), TUNEL index (0.2+/-0.4, p < 0.05), and levels of sFas (9.9+/-30.25 IU/ml, p = 0.005).

CONCLUSIONS

1) The demonstration of hepatocytes with Fas antigen expression and the labeling of the nuclei by the TUNEL assay suggest that apoptosis mediated by the Fas system plays a role in the pathogenesis of liver allograft rejection. 2) The Fas expression and the sFas levels decreased in patients with treatment response.

Cyclooxygenase-2 inhibition lacks immunomodulatory effects on T cells

OBJECTIVE

In T cells, cyclooxygenase-1 is constitutively expressed, and cyclooxygenase-2 is induced during activation but their functions are not well known. Although exogenous prostaglandins are potent inhibitors of T cell activation, both immunoactivation and immunosuppression have been attributed to cyclooxygenases inhibitors (NSAIDs). Understanding the functions of the cyclooxygenases on T cells is relevant to the therapeutic use of NSAIDs on T cell mediated rheumatic diseases such as rheumatoid arthritis. In this study, we analyze whether cyclooxygenases play a significant role in T cell functions.

METHODS

Activation, proliferation, and Fas induced apoptosis were analyzed in T cells treated with non-selective (indomethacin) or cyclooxygenase-2 selective (dimethyl-furanone) inhibitors. Intracellular peroxidation was studied in activated T cells by dihydrorhodamine 123 fluorescence analysis of cells treated with COX-2 antisense or control oligonucleotides. COX-2 expression was analyzed by RT-PCR analysis.

RESULTS

Our data show that neither non-selective or selective cyclooxygenase-2 inhibition modify T cell activation, proliferation or apoptosis susceptibility. Furthermore, inhibition of cyclooxygenase-2 expression by antisense oligonucleotides lacks significant effects on T lymphocytes and does not modify their peroxydative capacity.

CONCLUSIONS

According to these data, cyclooxygenases do not seem to play a relevant role in T cells functions in vitro. Therefore, the use of either cyclooxygenase-2 selective or non-selective NSAIDs in patients with autoimmune inflammatory diseases is not expected to induce direct immunomodulatory effects through direct effects on T cells.

Role of intrapartum hypoxia in carnitine nutritional status during the early neonatal period

We analyze markers of carnitine insufficiency and deficiency, lysine (LYS) and methionine (MET), in 39 neonates with intrapartum hypoxia (selection criteria: umbilical artery pH <7.20, lactate >1.8 mmol/l and PaO2 <25 mm Hg), and in 35 healthy newborn infants (control group) in the early neonatal period (1-7 days of life). Free (FC), total (TC) carnitine and acylcarnitines (AC=short-chain+long-chain acylcarnitines) were measured using a radioisotopic micromethod; LYS and MET were determined by high-pressure liquid chromatography. AC and TC plasma concentrations and AC/FC ratio were higher while FC/TC ratio was lower in the hypoxic neonates than in the control group. Hypoxic newborn infants (59%) presented "carnitine deficiency" (FC/TC <0.7) and 60% of them "carnitine insufficiency" (AC/FC ratio >0.4) vs. 31% and 28%, respectively, for the neonates of the control group (p<0.05). In the healthy neonates group, MET correlated with FC/TC and the AC/FC ratio. FC, TC, AC, AC/FC and umbilical artery pH (pHua) were inversely correlated. FC/TC and MET correlated with pHua. We conclude that: (1) an important percentage of newborn infants with intrapartum hypoxia suffer carnitine deficiency and carnitine insufficiency in the early neonatal period, related to MET plasma levels; (2) the carnitine deficiency or insufficiency in the neonate is determined by the degree of intrapartum acidosis.

Dendroaspis natriuretic peptide in hepatic cirrhosis

OBJECTIVES

Dendroaspis natriuretic peptide (DNP) is a novel peptide that is structurally similar to atrial, brain, and C-type natriuretic peptides. Many natriuretic peptides are increased in hepatic cirrhosis, but the role of DNP in cirrhosis is unknown at present. The aim of the study was to investigate plasma levels of dendroaspis natriuretic-like immunoreactivity in cirrhosis.

METHODS

We measured plasma concentrations of DNP by radioimmunoassay methods in 12 cirrhotic patients without ascites and 44 cirrhotic patients with ascites, and compared these values with 20 age-matched healthy subjects. Renal function, plasma cGMP concentration, plasma renin activity, and plasma endothelin concentration were measured in each patient.

RESULTS

Patients without ascites had circulating levels of DNP similar to those of healthy subjects. By contrast, patients with ascites had increased circulating DNP levels compared to both patients without ascites and healthy subjects. In addition, circulating levels of DNP increased in relation to the severity of cirrhosis. Significant positive correlations were also found between DNP levels, endothelin concentrations, and plasma renin activity.

CONCLUSIONS

The results of this study indicate that plasma DNP is increased in cirrhotic patients with ascites.

Decreased susceptibility to Fas-induced apoptosis of systemic sclerosis dermal fibroblasts

OBJECTIVE

To determine whether dysregulated apoptosis of systemic sclerosis (SSc) fibroblasts contributes to progressive fibrosis by promoting fibroblast longevity.

METHODS

We examined the pattern of fibroblast proliferation and apoptosis in SSc skin lesions and the susceptibility of cultured SSc dermal fibroblasts to apoptosis. Skin biopsy samples from SSc patients and control subjects were used to establish fibroblast cultures and were examined histologically. In skin sections, apoptosis was examined by TUNEL, and proliferation by immunostaining for proliferating cell nuclear antigen. Susceptibility of fibroblasts to apoptosis induced in vitro by different stimuli was studied by TUNEL. Expression of Bcl-2, Bcl-x, and Bax proteins in cultured fibroblasts was studied by Western blotting.

RESULTS

Proliferation of dermal fibroblasts was not observed in normal skin but was present in skin from patients with SSc and other inflammatory skin diseases. Apoptosis of fibroblasts in SSc fibrotic skin lesions was not observed. In vitro, SSc fibroblasts were specifically resistant to apoptosis induced by Fas receptor stimulation but had normal susceptibility to apoptosis induced by nonspecific stimuli (protein kinase inhibition or serum withdrawal). Decreased susceptibility to Fas stimulation was not caused by decreased levels of surface Fas receptor. In SSc fibroblasts, quiescence induced by confluence and serum starvation was followed by an abnormal down-regulation of proapoptotic Bax protein. Up-regulation of the Bax:Bcl-2 ratio in SSc fibroblasts by Bcl-2 antisense oligonucleotides restored their susceptibility to Fas-mediated apoptosis.

CONCLUSION

Our findings suggest that abnormal apoptotic regulation in fibroblasts can contribute to the pathogenesis of progressive fibrosis in SSc. Modulation of Bcl-2-related proteins appears to be a potential target for the development of apoptosis-based antifibrotic strategies.

Chemokine expression by systemic sclerosis fibroblasts: abnormal regulation of monocyte chemoattractant protein 1 expression

OBJECTIVE

Chemokines are important mediators in the chemoattraction of leukocytes to sites of inflammation. This study investigated the potential contribution of systemic sclerosis (SSc) fibroblasts to chemokine production and its potential relevance to the pathogenesis of SSc.

METHODS

The expression of messenger RNA (mRNA) for different C-C and C-X-C chemokines by SSc and normal fibroblasts was studied by RNase protection assay. Monocyte chemoattractant protein 1 (MCP-1) protein production was analyzed by enzyme-linked immunosorbent assay. The chemotactic effect of fibroblast-derived MCP-1 on monocytic cells was analyzed in a transmigration assay. Nuclear factor kappaB (NF-kappaB) and activator protein 1 (AP-1) activation in fibroblasts was studied by electromobility shift analysis. MCP-1 expression in SSc skin sections was studied by immunohistochemistry.

RESULTS

Among all chemokine genes studied, only MCP-1 and interleukin-8 mRNA were expressed by nonstimulated normal and SSc fibroblasts. SSc fibroblasts displayed increased constitutive expression of MCP-1 mRNA and protein and showed a blunted response to oxidative stress. Increased MCP-1 production was associated with higher chemotactic activity for monocytic cells. Increased NF-kappaB or AP-1 activation was not responsible for the constitutive overexpression of MCP-1 by SSc fibroblasts. In SSc skin sections, MCP-1 expression was detected in fibroblasts, keratinocytes, and mononuclear cells, whereas it was undetectable in normal skin.

CONCLUSION

SSc fibroblasts display a specific pattern of chemokine gene expression that is characterized by constitutively increased and abnormally regulated expression of MCP-1 in vitro. MCP-1 is also expressed in lesional skin and can participate in the pathogenesis of SSc.

Magnetic resonance imaging of two normal equine brains and their associated structures

Magnetic resonance images were obtained from two isolated horses' heads. Ten mm thick, T1-weighted images were taken with a 1.5 Tesla magnet and a body coil, and compared with the corresponding frozen cross-sections of the heads, relevant structures being identified and labelled at each level. The images should provide reference material for clinical magnetic imaging studies of horses' heads.

[Use of troponin-I, CPK-MB and myoglobin in the diagnosis of myocardial infarct and processes of muscular necrosis of non-cardiac origin]

BACKGROUND

Thoracic pain is one of most frequent reasons for consultations at an Emergency Unit. Clinical description and the ECG are fundamental for its analysis, but a serious diagnostic problem arises when these do not provide typical data. Our aim is to analyse recently introduced biochemical parameters in order to test whether it is possible to discriminate between entities that are associated with myocardial necrosis and those others in which necrosis is due to striated muscle.

MATERIAL AND METHODS

We analysed troponin-I and the relation between CPK-MB and total CPK in the serum of 45 patients who attended the Emergency Services with different processes of striated muscle in whom the total CPK was elevated, and 50 patients with acute myocardial infarct. The serum was analysed through an immunotest by fluorescence with monoclonal antibodies.

RESULTS

Troponin-I proved to be above the normal value in the 50 patients with myocardial infarct an in 4 of the 45 in the muscular group. The total CPK/MB/CPK ratio was significantly higher in the infarct group than in the muscular group. In all of the patients of this latter group the relation was less than 5%.

CONCLUSIONS

Troponin-I rises above the normal value and is very sensitive in a myocardial infarct. The total CPK/MB/CPK relation discriminates between processes of muscular necrosis (value <5%) and processes with myocardial infarct (that are generally associated with value >5%). The increase of troponin-I supports the diagnosis of myocardial lesion when the pain suggests a coronary origin but the ratio does not reach 5%.

Hypoxia induces expression of the chemokines monocyte chemoattractant protein-1 (MCP-1) and IL-8 in human dermal fibroblasts

Hypoxia is an important factor in the pathophysiology of vascular and inflammatory diseases. Leucocyte infiltration, as a consequence of adhesion molecule up-regulation and chemokine release, is a prominent feature of these diseases. The objective of our study was to investigate the potential role of resident fibroblasts in hypoxia-induced chemotactic responses. We show that MCP-1 and IL-8 mRNA are specifically induced by hypoxia in dermal fibroblasts. This response is paralleled by increased NF-kappaB p65/p50 binding activity, and it is inhibited by pretreatment with N-acetyl-L-cysteine. MCP-1 secreted by fibroblasts is chemotactic for monocytic cells and this activity is significantly increased by hypoxia. Chemotactic index correlates with MCP-1 protein levels and is significantly decreased by neutralizing anti-MCP-1 MoAb. These findings demonstrate the ability of resident fibroblasts to mediate chemotaxis of leucocytes through the release of chemokines in response to hypoxia. Our data point to MCP-1 as an important component in this response, and therefore it may be a potential target in inflammatory responses associated with hypoxia.

Use and misuse of antimicrobial agents in a general hospital in the AIDS era

A prevalence study was carried out to ascertain the pattern of antimicrobial use, costs and relevance in a general hospital during the AIDS era. All patients receiving antimicrobials were studied. Antimicrobials were divided into antibacterial drugs and others and the costs evaluated in US dollars. Of 1526 patients surveyed, 455 (29.8%) were receiving 664 courses of antimicrobials: 109 (7.2%) as prophylaxis and 346 (22.6%) as treatment. Fifteen percent of courses involved non-antibacterial drugs. In 188 patients (40.9% of those treated) treatment was inadequate, usually because of incorrect drug choice. Daily cost of antimicrobials was $14953. AIDS accounted for 3% of all patients, 9% of those receiving antimicrobials, 19.7% of antimicrobial usage and 9.6% of the antimicrobial expenditure. Misuse occurred in 43% of non-HIV patients and 17% of those with HIV. Thus, despite a disproportionate contribution of patients with AIDS, adequacy of use of antimicrobials was better in this population.

Computed tomography of normal cranioencephalic structures in two horses

The purpose of this investigation was to define the anatomy of the cranioencephalic structures in horses using computed tomography (CT). Transverse images of two isolated equine cadaver heads were obtained using a Toshiba 600 HQ (third-generation equipment TCT). CT images were compared to corresponding frozen cross-sections of the cadaver head. Relevant anatomical structures were identified and labelled at each level. The resulting images provided excellent anatomic detail of the structures of the central nervous system and associated formations. Annotated CT images from this study are intended as a reference for clinical CT imaging studies of the equine head.

Involvement of the fas system in hepatitis C virus recurrence after liver transplantation

To date, there have been no reports of the involvement of the Fas system in recurrent hepatitis C virus (HCV) infection after orthotopic liver transplantation (OLT). In 25 patients who underwent OLT for HCV-related liver cirrhosis, we evaluated the expression of the Fas antigen (FasAg) on hepatocytes, apoptic hepatocytes, and serum levels of soluble Fas (sFas). The level of HCV viremia and HCV genotype were determined by polymerase chain reaction. Serum sFas levels were determined by an enzyme immunoassay procedure. DNA fragmentation was determined by the terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end-labeling (TUNEL) technique on deparaffinized liver samples. FasAg expression was evaluated by an immunoperoxidase method. Sixteen patients had evidence of recurrent HCV disease. The number of hepatocytes expressing FasAg and the percentage of apoptotic hepatocytes was greater among patients who developed recurrent hepatitis than among those who did not (P <.01 and P <.0001, respectively). There was a correlation between hepatic expression of FasAg, intensity of lobular inflammation (P =.007), and TUNEL index (P <.001). The levels of sFas were greater among the patients with recurrent HCV hepatitis than those without recurrent hepatitis (P <.04). We conclude that (1) Fas expression is up-regulated in recurrent HCV after OLT and is related to the grading of liver disease; likewise, levels of sFas were greater in the patients with recurrent HCV hepatitis; and (2) the demonstration of hepatocytes with FasAg expression and the labeling of the nuclei by TUNEL assay suggest that hepatic apoptosis mediated by the Fas system may have a role in the pathogenesis of recurrent HCV hepatitis after OLT.

[1,3-Bis(diphenylphosphino)propane]trichlorooxorhenium(V)

Trichlorooxo[1,3-propanediylbis(diphenylphosphine)-P,P ']rhenium(V), [ReCl(3)O(C(27)H(26)P(2))], crystallizes with four formula units per unit cell. The crystal structure consists of neutral complexes of [ReOCl(3)(dppp)] [dppp is 1,3-bis(diphenylphosphino)propane] packed by H.pi-ring interactions. The Re atom is octahedrally coordinated to the oxo anion, three Cl atoms and two P atoms from the dppp ligand. The six-membered ring formed by the bidentate dppp ligand and the rhenium metal centre is in a chair conformation. The title compound is an intermediate in the synthesis of bis(dppp) complexes of rhenium.

Magnetic resonance imaging and cross sectional anatomy of the normal equine sinuses and nasal passages

The purpose of this investigation was to define the magnetic resonance imaging anatomy of the rostral part of the equine head. 10 mm-thick, T1-weighted images of two isolated equine cadaver heads were obtained using a 1.5 Tesla magnet and a body coil. MR images were compared to corresponding frozen cross-sections of the cadaver head. Relevant anatomic structures were identified and labeled at each level. The resulting images provided excellent anatomic detail of the oral and nasal cavities, paranasal sinuses and associated structures. Annotated MR images from this study are intended as a reference for clinical MR imaging studies of the equine head.

[Soluble Fas in acute rejection in patients with liver transplantation. Response to treatment]

It has been suggested that in the cellular rejection of hepatic graft, the lesion provoked by cytotoxic T-lymphocytes might be mediated by the Fas antigen/Fas ligand system, producing cell death by apoptosis.

AIM

To determine whether soluble Fas (sFas) is increased during treatment and to evaluate response to treatment.

MATERIAL AND METHODS

Fourteen patients with orthotopic liver transplantation who presented an episode of acute cellular rejection were studied. Serum levels of sFas were detected by enzyme-immunoanalysis at diagnosis and again 5 days after treatment was completed. As control groups, sFas was analyzed in 12 patients with liver transplantation without rejection and in 10 healthy subjects.

RESULTS

sFas levels were found to be significantly higher in patients with rejection than in those without rejection and in healthy subjects (24.2 +/- 39.1 vs. 2.8 +/- 4.0 vs. 0.6 +/- 1.5 UI/ml; p = 0.03). In patients with acute cellular rejection, immunosuppressive treatment significantly decreased sFas levels compared with basal values (24.2 +/- 39.1 vs. 9.9 +/- 30.2 UI/ml; p = 0.005). A clear correlation between the serum levels of sFas, glutamate oxaloacetate transaminase (GOT), glutamate-pyruvate transaminase/glutamic-pyruvic transaminase (GPT) and gamma-glutamyl transferase (GGT).

CONCLUSIONS

a) The increase of sFas during rejection and the decrease in patients with a good evolution suggests that the Fas system may play an important role in the hepatocyte lesion produced by an apoptosis mechanism in these patients. b) Monitoring sFas could be useful in diagnosing rejection and in evaluating response to treatment.

Anatomical evaluation of the caprine mammary gland by computed tomography, radiology and histology

An anatomical study of the mammary gland by computed tomography, X-rays and histology was carried out. Three canarian breed goats were used. Identification of the udder structures by different methods represented the basis of this study. Using these techniques the internal and external organization of the caprine mammary gland was studied.

Granulocyte elastase in cirrhotic patients with spontaneous bacterial peritonitis

Granulocyte elastase (GE) is a powerful proteolytic enzyme that is released by PMNs when degranulated in infectious processes. The aim of this study was to measure GE in ascites and plasma of cirrhotic patients with spontaneous bacterial peritonitis (SBP). We studied 29 cirrhotic patients, 17 of them having SBP (group A). Twelve patients with noninfected ascites formed the control group (group B). At the time of diagnosis of SBP, GE levels in ascites (183.17 +/- 86.11 microg/liter) and plasma (114.6 +/- 35.99 microg/liter) were higher in group A than in group B (27.41 +/- 11.54 microg/liter, P < 0.00001 and 82.54 +/- 20.52 microg/liter, P = 0.01, respectively). Levels of GE in ascites had a high value for discriminating between patients with and without SBP. In the patients who responded to the initial antibiotic treatment, these values significantly decreased in ascites (67.69 +/- 54.22 microg/liter, P = 0.003) and plasma (67 +/- 22.39 microg/liter, P = 0.01) 48 hr after therapy was started, in parallel with the decrease of PMN in ascites. In patients who did not respond, the production of GE remained elevated. Patients who developed renal insufficiency following SBP had more marked elevation of GE in plasma (144.8 +/- 33.43 microg/liter) than those with normal renal function (99.5 +/- 27.53 microg/liter, P = 0.02). These results suggest that the measurement of GE may be helpful for the diagnosis of SBP in patients with cirrhosis and for assessing the efficacy of therapy. In addition, the release of GE into plasma may contribute to the impairment of renal function that follows SBP in some patients.

[Antimicrobial drug use in the department of internal medicine of a general hospital: prevalence study]

OBJECTIVE

To ascertain the general pattern of hospital antimicrobial use, costs, and adequacy of treatment in the department of internal medicine of a general hospital.

MATERIAL AND METHODS

A prevalence study was carried out and all department beds were visited. Every patient who was being treated with antimicrobials during or 24 hours prior to the visit was selected for the study. Treatment was considered adequate when indication, selected drug, dosage, and treatment duration were all adequate. When considering costs, only the price of the antimicrobials was evaluated.

RESULTS

We identify 173 hospitalized patients, 79 (45.6%) of them were treated with 96 antimicrobial agents. The prevalence of community-acquired and hospital-acquired infections was 39.3% and 8.1%, respectively. Empirical use amounted to 77%. Overall, b-lactams antibiotics were the most frequently used (63.5%). In 22 (27.8%) patients treatment was judged inadequate, the most frequent error being an excessive duration (17.8%). The daily spending on antimicrobials was 187,750 ptas., representing 1,085 ptas. per hospitalized patient and day.

CONCLUSIONS

A high percentage of hospitalized patients receive treatment with antimicrobial drugs. Because of the low rate of antimicrobials with a specific indication, the long antibiotic course duration, the incorrect drug choice, and even more the antimicrobial prescription in non-infected patients, strategies to improve the quality of antimicrobial use are clearly required

Cleaning and disinfection of gastrointestinal endoscopes. Comparative analysis of two disinfectants

Gastrointestinal endoscopy can lead to infectious complications, and endoscopes must be disinfected to prevent them.

AIM

to evaluate three methods of disinfection: 1) usual cleaning technique and immersion in glutaraldehyde phenolate (GP); 2) meticulous cleaning and immersion in GP, and 3) meticulous cleaning and immersion in hydrogen peroxide.

METHOD

thirty endoscopes (15 gastroscopes and 15 colonoscopes) were disinfected with each method. Samples were taken following endoscopic exploration, after cleaning and after disinfection, and were cultured. The number of positive culture (cfu/ml > 1) was counted.

RESULTS

the rate of contamination of endoscopes did not decrease significantly after cleaning with method 1 (66 vs 60%), but did decrease with method 2 (38 vs 16%) and method 3 (53 vs 17%). The contamination rate after cleaning was significantly lower with methods 2 and 3 (p < 0.005). This rate was also lower after disinfection (p < 0.025). Method 3 achieved 0% contamination following disinfection.

CONCLUSIONS

the greatest decrease in contamination rate was achieved with conscientious cleaning followed by disinfection. Both disinfectants yielded similar results, although hydrogen peroxide produced a higher level of disinfection.

Severe clinical course of de novo hepatitis B infection after liver transplantation

The aim of this study is to determine the origin, clinical outcome, allograft histological characteristics, and virological outcome of de novo hepatitis B virus (HBV) infection after orthotopic liver transplantation (OLT). We studied 136 hepatitis B surface antigen (HBsAg)-negative liver transplant recipients. HBV DNA was detected by dot-blot hybridization and polymerase chain reaction (PCR). The S gene was sequenced. Hepatitis C virus (HCV) RNA was assessed by PCR. The long-term clinical and histological outcome was determined. Six of 136 HBsAg-negative patients (4.4%) became HBsAg positive after transplantation. The source of HBV infection was reactivation of latent HBV infection in 2 patients and was not identified in 4 patients. Two donors had isolated core antibody. Two of these 6 patients developed acute liver failure related to hepatitis B. The 4 other patients had severe chronic hepatitis related to hepatitis B. All patients had high-level HBV replication. No significant mutations in the S gene were found. These data suggest that de novo hepatitis B infection is not a mild disease and might represent a significant cause of graft dysfunction. This is the first report of fulminant hepatitis caused by de novo hepatitis B infection after OLT.

Variceal ligation compared with endoscopic sclerotherapy for variceal hemorrhage: prospective randomized trial

BACKGROUND

To evaluate the safety and efficiency of variceal ligation compared with endoscopic sclerotherapy, 88 patients with cirrhosis with recent variceal bleeding were randomized to undergo either treatment.

METHODS

Sclerotherapy was performed using ethanolamine and polidocanol injection at 1, 2, and 3 weeks and every 3 weeks thereafter. The Stiegmann-Goff device was used for variceal ligation at the same intervals.

RESULTS

The rate of variceal eradication was the same for both groups, but eradication was accomplished sooner in patients undergoing variceal ligation (5.3+/-1.6 vs. 6.6+/-2.4 endoscopic sessions, p < 0.05) and with fewer complications (19 vs. 6, p < 0.005). The rate of recurrent bleeding was lower in patients treated by ligation (31% vs. 50%, p < 0.05). After eradication, variceal recurrence was more frequent in patients treated by variceal ligation at 1 and 3 years (47% and 92% vs. 23% and 55%, p < 0.01). Portal hypertensive gastropathy was significantly worse in the patients who had variceal ligation (17 patients vs. 6, p < 0.01). Survival and treatment failure were similar in both groups.

CONCLUSIONS

Variceal ligation was superior to sclerotherapy in terms of the rate of recurrent bleeding and the occurrence of complications but worse with respect to recurrence of varices and the evolution of portal hypertensive gastropathy. Long-term follow-up studies are required to find out whether there are deleterious effects of variceal ligation.

Hepatitis G virus infection as a possible causative agent of community-acquired hepatitis and associated aplastic anaemia

Aplastic anaemia complicating hepatitis is a rare but well-documented phenomenon; however in many patients the cause remains unknown. We present a 24-year-old man with a well-defined community-acquired hepatitis, probably due to hepatitis G virus (HGV), who developed severe aplastic anaemia. In this case, the absence of other agents likely to cause the clinical manifestations, and the detection of HGV RNA at the time of illness, clearly point to this agent as being responsible for both the hepatitis and the aplastic anaemia. Further studies in serial serum samples and meticulous evaluation of the disorders associated with the infection will be needed to prove or dispute a causal association of HGV and aplastic anaemia.

Ability of a cocoa product to correct chronic Mg deficiency in rats

Epidemiological studies have reported that Western diets are often deficient in Mg. We investigated the ability of a cocoa-derived product, used in some European countries as a dietary complement added to milk, to aid recovery from chronic Mg deficiency in rats. The animals were divided into three groups, each of which received a different amount of dietary Mg. Rats in the Mg-deficient (D) group received an Mg-deficient diet (0.225 g Mg/kg food) during 8 weeks. In the cocoa-supplement group (D + CC), the rats consumed the Mg-deficient diet for 5 weeks, and were then switched for 3 further weeks to the same diet supplemented with 3% (wt/wt) cocoa product, so that the Mg content of the diet was 0.27 g/kg food. Rats in the control group (C) were given the same diet as in group D, except that the amount of Mg was 0.56 g Mg/kg food. We measured the concentration of Mg, Ca and P from ten rats in plasma, whole blood, skeletal muscle, heart, kidney and femur in rats that were fed the diets for 35, 42, 49 or 56 days. In animal fed the cocoa-supplemented diet (D + CC) significant improvements were found between days 35 and 56 in the alterations in Mg, Ca and P caused by Mg deficiency in all tissues studied. On day 56, kidney and bone concentrations of Mg and Ca had returned to normal. Our findings show that the habitual use of the cocoa product as a dietary supplement favors correction of the negative effects of long-term feeding with a diet moderately deficient in Mg.

Evaluation of carnitine nutritional status in full-term newborn infants

Carnitine supplements may be advisable not only in premature but also in artificially-fed full-term babies. The acyl-carnitine/free carnitine (AC/FC) and FC/total carnitine (FC/TC) ratios have been considered markers of "carnitine insufficiency" and "carnitine deficiency", respectively. Values of AC/FC>0.40 are considered abnormal and mean that FC has a low bioavailability to the cells and so reflects a "carnitine insufficiency". Values of FC/TC<0.7 indicate "carnitine deficiency". We analyze the validity of such ratios and the limits for them in three groups of full-term neonates (n=66): 22 breast-fed (BF), 22 with formula (F); and 22 fed with carnitine-supplemented formula. Several studies have shown the need to give supplements of carnitine to the neonate because of its "essentiality", but no one has demonstrated the adequate dosages. We therefore propose to establish new limit levels for these ratios to control carnitine nutritional status in neonates, based on the control of percentile ranges for normal BF infants (in this study: 97th percentile of AC/FC>0.83; 3rd percentile of FC/TC<0.54) and on evaluating the needs of neonates and dosages required to supplement F. The supplement of 2.2 mg of L-carnitine/100 ml in the cow's milk formula used in the present study produces a similar biochemical pattern of plasma carnitine and ACs to that observed in BF infants, together with a lower risk of developing "carnitine deficiency" or "carnitine insufficiency" than those babies fed with nonenriched F. Considering that human milk is the best source of nutrition for full-term infants, the limit established for AC/FC and FC/TC ratios at other ages of life seems to be "inadequate" for neonates.

Malt lymphoma as first clinical presentation of a celiac disease

We report a case of a 35 year-old-woman who suffered from abdominal pain and weight loss. Asymptomatic celiac disease was discovered and complicated with a MALT Lymphoma in the jejunum. This is an uncommon combination because lymphoma that arises in the presence of enteropathy is commonly from T lymphocytes. Also because it normally appears in patients with long standing celiac disease who report a recrudescence of the abdominal symptoms.