Improvement of quality of life in allergic rhinoconjunctivitis patients using nasal filters, a preliminary study

BACKGROUND

Allergic rhinoconjunctivitis is a clinical condition that impairs quality of life. The use of traditional drugs in many cases is not enough to improve quality of life in these patients.

METHODS

In this pilot study we used the Sanispira Nasal filters in 15 patients (mean age 34,7 years) affected by allergic rhinoconjunctivitis for 18 days. At each follow-up visit, patients were assessed with a specific quality of life questionnaire, a symptoms form and a drugs form that evaluates the use of antiallergic drugs in the last week. Patients sensitive to environmental allergens wore Sanispira nasal filters during the day, while patients sensitive to domestic allergens wore the device during the night.

RESULTS

Thirteen patients completed the study. We found an improvement significative (p=0,0241) of the total score of RQLQ of 23,10 points between baseline and 18 days ( total score at baseline prior to nasal filter insertion= 60,60, at 1 week = 42, 28, at 18 days= 34, 10). A significative improvement in the nasal symptoms domain between baseline and 18 days (in particular stuffy nose p=0,047; runny nose p=0,012; sneezing p=0,0021; ) and one item of practical problems domain, the need to repeatedly blow the nose(p=0,082). The total score of symptoms evaluated with the symptoms form improved significantly from baseline to 18 days. Total symptoms score at baseline was 9,7; at 1 week it was 8,1 and at 18 days it was 4,7. The improvement was statistically significant (p=0,0092). Three of the thirteen patients that completed the study eliminated completely the use of drugs during of the study.

CONCLUSIONS

The use of SANISPIRA ®, has shown encouraging results, with an improvement in the quality of life in Rhinoconjunctivitis patients specially an improvement in nasal and ocular symptoms.

Human hepatocyte transplantation in patients with hepatic failure awaiting a graft

BACKGROUND

Hepatocyte transplantation (HT) has the potential to become a promising treatment to temporarily support liver function in patients with liver failure.

METHODS

Two patients, who had already received a liver transplant (LT) in the past, with an end-stage liver disease due to recurrent hepatitis C virus cirrhosis, suffering acute-on-chronic liver failure while on the waiting list for an LT, received HT as a bridge to whole-organ retransplantation. After HT and during intensive care unit admission, blood tests and ammonia levels were determined every 12 and 24 h, respectively, before and after each hepatocyte infusion.

RESULTS

The present study describes monitoring of analytical and clinical parameters and improvement of liver function following HT. In both patients, we managed to lower the blood ammonia levels and clinically improve the degree of hepatic encephalopathy, thus serving as a bridge to liver retransplantation in 1 patient.

CONCLUSIONS

We believe that this therapy may be an alternative treatment in patients with chronic liver disease who suffer episodes of acute decompensation as a bridge to conventional LT.

Mortality on the waiting list for liver transplantation: management and prioritization criteria

The excellent outcomes of liver transplantation (OLT) have increased its demand and the size of the waiting list, resulting in a substantial mortality rate before OLT, which is a treatment failure owing to disease development. We have reviewed the medical literature on this theme, focusing on prioritization methods.

New alternatives to the treatment of acute liver failure

INTRODUCTION

Acute-on-chronic liver failure (ACLF) is defined as an acute deterioration of a chronic liver disease. The most effective treatment in these patients is orthotopic liver transplantation (OLT), which is highly limited by the donor shortage. The aim of this study was to increase the usefulness of hepatocyte transplantation (HT) as a bridge or alternative to OLT.

METHODS

During the last 2 years, we have performed HT in 3 patients with ACLF. The diagnosis was graft cirrhosis due to hepatitis C virus in 2 of them, who were already included on waiting lists for retransplantation, and the third, unknown alcoholic cirrhosis.

RESULTS

After the first HT infusion, we observed an improvement in the clinical condition in all patients, hyperammonemia, and a partial correction of the degree of encephalopathy; 1 patient was retransplanted 6 days after the first HT.

DISCUSSION

The main indications for HT are inborn errors of metabolism in children. Other indications especially in adults, are acute liver failure, ACLF in patients with end-stage-liver disease who are a waiting OLT, and acute liver failure after an hepatectomy. HT may be a new treatment to improve the clinical condition in patients awaiting OLT.

Systematic review and meta-analysis of randomised clinical trials on topical treatments for vernal keratoconjunctivitis

AIMS

The aim of this study was to assess the efficacy of currently available topical drugs for vernal keratoconjunctivitis (VKC) through a meta-analysis of randomised clinical trials (RCTs).

METHODS

Twenty-seven RCTs (n = 2184 eyes) that had evaluated the efficacy of topical drugs for the treatment of VKC were selected according to the set criteria; 10 of these trials were suitable for statistical analysis and were enrolled in the meta-analysis. Articles published up to December 2005 were identified from the following

DATA SOURCES

Medline, Embase, Lilacs, the Cochrane Controlled Trials Register, and references from relevant articles. Articles in any language published with an English abstract, were screened, and those selected for inclusion were written in English, French, German, Italian, Portuguese or Spanish. The quality of the trials was assessed by the Delphi list. Statistical analysis was performed using STATA software.

RESULTS

A significant improvement in all signs and symptoms, except photophobia, was observed after topical treatment for active VKC, independent of the type of treatment. Comparison of the efficacy of different drugs was not possible due to a lack of standardised criteria among studies.

CONCLUSION

The currently available topical drugs are effective in treating acute phases of VKC. However, there is a lack of evidence to support the recommendation of one specific type of medication for treating this disorder. There is a need for standard criteria to assess diagnosis and therapy based on severity. There is also a need for RCTs assessing long-term effects of single drugs to control the disease and to prevent complications.

LMO4 can interact with Smad proteins and modulate transforming growth factor-beta signaling in epithelial cells

LIM-only protein 4 (LMO4) plays critical roles in mammalian development, and has been proposed to play roles in epithelial oncogenesis, including breast cancer. As LMO4 is highly expressed in the epithelial compartments at locations of active mesenchymal-epithelial interactions, we reasoned that LMO4 might act by modulating signaling pathways involved in mesenchymal-epithelial signaling. One such candidate signal is the transforming growth factor-beta (TGFbeta) cytokine pathway, which plays important roles both in development and cancer. We show here that the transcriptional response to TGFbeta in epithelial cells is sensitive to LMO4 levels; both up- and downregulation of LMO4 can enhance TGFbeta signaling as assessed by a TGFbeta-responsive reporter gene. Furthermore, LMO4 can interact with the MH1 and linker domains of receptor-mediated Smad proteins, and associate with the endogenous TGFbeta-responsive Plasminogen Activator Inhibitor-1 gene promoter in a TGFbeta-dependent manner, suggesting that such interactions may mediate the effects of LMO4 on TGFbeta signaling. When introduced into mammary epithelial cells, LMO4 potentiated the growth-inhibitory effects of TGFbeta in those cells. These results define a new function for LMO4 as a coactivator in TGFbeta signaling, and provide a potential novel mechanism for LMO4-mediated regulation in development and oncogenesis.

Upregulation of ICAM-1 expression in the conjunctiva of patients with chronic graft-versus-host disease

PURPOSE

To correlate conjunctival intercellular adhesion molecule 1 (ICAM-1) expression with cytologic and clinical findings of chronic graft-versus-host disease (GVHD).

METHODS

Seven patients with chronic GVHD-related keratoconjunctivitis and five age-matched normal controls were recruited for the study. Clinical examination included medical history, visual acuity, evaluation of ocular signs and symptoms (scored from 0 to 3), corneal fluorescein staining (scored from 0 to 5 on the basis of the number of corneal sectors involved), Schirmer test type I, and break-up time (BUT). Impression cytology samples were collected from the nasal and inferior bulbar conjunctiva of patients and controls. Goblet cells were counted in three randomly selected fields and averaged. Immunofluorescent staining for ICAM-1 was carried out and the percentage of cells expressing the marker was evaluated.

RESULTS

All patients showed signs and symptoms of keratoconjunctivitis sicca. Schirmer test type I and BUT were reduced (4.8+/-6.7 mm/5 min and 3.9+/-2.7 seconds, respectively). Goblet cells were significantly reduced in GVHD eyes with respect to normal eyes (65+/-30.5 and 192+/-16.9 cells/field respectively; p<0.001). Goblet cell number was directly related to Schirmer test values (p<0.01, rho=0.817) and inversely related to total sign score (p<0.01, rho=-0.939). ICAM-1 expression was increased in GVHD eyes with respect to normal controls, in which no staining was observed. ICAM-1 expression showed an inverse relation to goblet cell number (p<0.01, rho=-0.852) and Schirmer test values (p<0.01, rho=-0.926), and was directly correlated to total sign score (p<0.01, rho=0.982).

CONCLUSIONS

Conjunctival ICAM-1 expression is increased in GVHD patients. The severity of the disease is associated with tear parameters, goblet cell decrease, and inflammatory markers, such as ICAM-1.

Antileishmanial activity of polycyclic derivatives

33 polycyclic derivatives have been studied and tested on Leishmania donovani and L. major promastigotes. Their antileishmanial activity was assessed in vitro and an assay of their cytotoxicity was realized on human myelomonocytic cell line. The reference molecules used in the assays were amphotericin B and pentamidine. Among the compounds tested, 29 possess an antileishmanial activity; 25 of those were more active against L. donovani than amphotericin B, and nine were as effective as amphotericin B against L. major. Many synthesized derivatives were more active against L. donovani than against L. major. The cytotoxicity studies have shown that among the thirty-three derivatives tested, 12 molecules have an IC50 towards THP-1 cells about equal than that reference drugs, the 21 other derivatives are much less toxic. A 3D QSAR study was undertaken and has permitted to predict activity against L. donovani and L. major and to highlight critical area to optimize activity against the two species.

Genetic variation in the vulnerable and endemic Monkey Puzzle tree, detected using RAPDs

Araucaria araucana (Monkey Puzzle), a southern South American tree species of exceptional cultural and economic importance, is of conservation concern owing to extensive historical clearance and current human pressures. Random amplified polymorphic DNA (RAPD) markers were used to characterise genetic heterogeneity within and among 13 populations of this species from throughout its natural range. Extensive genetic variability was detected and partitioned by analysis of molecular variance, with the majority of variation existing within populations (87.2%), but significant differentiation was recorded among populations (12.8%). Estimates of Shannon's genetic diversity and percent polymorphism were relatively high for all populations and provide no evidence for a major reduction in genetic diversity from historical events, such as glaciation. All pairwise genetic distance values derived from analysis of molecular variance (Phi(ST)) were significant when individual pairs of populations were compared. Although populations are geographically divided into Chilean Coastal, Chilean Andes and Argentinean regions, this grouping explained only 1.77% of the total variation. Within Andean groups there was evidence of a trend of genetic distance with increasing latitude, and clustering of populations across the Andes, suggesting postglacial migration routes from multiple refugia. Implications of these results for the conservation and use of the genetic resource of this species are discussed.

The validity of self-reported seatbelt use: Hispanic and non-Hispanic drivers in El Paso

The validity of self-reported seatbelt use among low belt use populations has not been evaluated directly, despite the importance of such data for estimating the effectiveness of community-wide interventions and compliance with state laws. To address this gap in knowledge 612 drivers were recruited from convenience stores located in 12 randomly generated zip code areas located in El Paso, TX. Self-reported seatbelt use was compared with observed seatbelt use in a single sample of participants. Both data sets were collected almost contemporaneously and no participant was aware of having their seatbelt use observed. Hispanic (n = 388) and white/non-Hispanic (n = 126) drivers over reported seatbelt use by 27 and 21%, respectively. These findings suggest that response bias within low belt use populations may be greater than suggested by state and national data.

Control of lymphocyte development by the Ikaros gene family

Lymphoid cell differentiation relies on precisely orchestrated gene activation and repression events. Gene targeting studies have demonstrated crucial roles for the transcription factors Ikaros and Aiolos in regulating multiple stages of B and T cell development. Recent experiments suggest that Ikaros and Aiolos set B cell antigen-receptor (BCR)- and TCR-mediated signaling thresholds and that the molecules exist within T cells in nuclear complexes that contain nucleosome remodeling and histone deacetylase activities.

Seatbelt use and belief in destiny among Hispanic and non-Hispanic drivers

In order to determine if fatalism is associated with seatbelt use, 312 drivers were recruited from convenience stores located within 12 randomly generated zip-code areas along the Texas-Mexico border. The seatbelt use of drivers was recorded unobtrusively; self-reported seatbelt use and belief in destiny (fatalism) were subsequently obtained by interview. The majority of respondents rejected a fatalistic orientation, although Hispanic drivers were significantly less likely to do so. Fatalism was not associated with observed seatbelt use. Our results suggest that ethnic differences in seatbelt use are not due to ethnic differences in fatalism. These findings have implications for developing health interventions in Hispanic and non-Hispanic communities.

ETS-core binding factor: a common composite motif in antigen receptor gene enhancers

A tripartite domain of the murine immunoglobulin mu heavy-chain enhancer contains the muA and muB elements that bind ETS proteins and the muE3 element that binds leucine zipper-containing basic helix-loop-helix (bHLH-zip) factors. Analysis of the corresponding region of the human mu enhancer revealed high conservation of the muA and muB motifs but a striking absence of the muE3 element. Instead of bHLH-zip proteins, we found that the human enhancer bound core binding factor (CBF) between the muA and mu elements; CBF binding was shown to be a common feature of both murine and human enhancers. Furthermore, mutant enhancers that bound prototypic bHLH-zip proteins but not CBF did not activate transcription in B cells, and conversely, CBF transactivated the murine enhancer in nonlymphoid cells. Taking these data together with the earlier analysis of T-cell-specific enhancers, we propose that ETS-CBF is a common composite element in the regulation of antigen receptor genes. In addition, these studies identify the first B-cell target of CBF, a protein that has been implicated in the development of childhood pre-B-cell leukemias.