[Epidemiology of pressure ulcers: interpreting data epidemiological as an indicator of quality]

INTRODUCTION

The incidence of pressure ulcers (PU) is still a current problem in our society and a constant challenge for all professionals and health institutions. Health professionals worry increasingly about the safety of their patients in the hospital environment. However, pressure ulcers continue to be one of the most common types of injuries acquired during hospitalization.

OBJECTIVE

The objective of this study is to compare the incidence and prevalence of pressure ulcers in community settings and care differentiated and interpret these values as indicators of quality of care.

METHODS

A review of literture reporting incidence and prevalence of pressure ulcer as an outcome measure and is relation with quality indicators. Electronic databases (CINAHL, MEDLINE and EBSCO) were searched from 1 January 1999 to 31 Dezembro 2012 in the English, Spanish and Portuguese language. The MESH descriptors data were Pressure ulcer, epidemiology, Quality indicator, incidence and prevalence.

RESULTS

The 17 papers reported studiest conducted in nine countries. Diderent measurement instruments were utilised to measure theincidence and prevalence of pressure ulcers. Four themes emerged from the thematic analysis, the importance of prevention and treatment, diferential diagnosis and summary minimum data set for epidemiological studies. Prevalence varies in Europe between 3 and 28%, and the locations with the highest incidences services and intensive care medicine.

CONCLUSION

A system of classification of pressure ulcers in their different categories and the differential diagnosis with injuries humidity reduces the misclassification of UP. Different instruments of data collection does not allow us to compare results between different countries but identifies different contexts.

Transcriptional analysis of differentially expressed genes in response to stem inclination in young seedlings of pine

The gravitropic response in trees is a widely studied phenomenon, however understanding of the molecular mechanism involved remains unclear. The purpose of this work was to identify differentially expressed genes in response to inclination using a comparative approach for two conifer species. Young seedlings were subjected to inclination and samples were collected at four different times points. First, suppression subtractive hybridisation (SSH) was used to identify differentially regulated genes in radiata pine (Pinus radiata D. Don). cDNA libraries were constructed from the upper and lower part of inclined stems in a time course experiment, ranging from 2.5 h to 1 month. From a total of 3092 sequences obtained, 2203 elements were assembled, displaying homology to a public database. A total of 942 unigene elements were identified using bioinformatic tools after redundancy analysis. Of these, 614 corresponded to known function genes and 328 to unknown function genes, including hypothetical proteins. Comparative analysis between radiata pine and maritime pine (Pinus pinaster Ait.) was performed to validate the differential expression of relevant candidate genes using qPCR. Selected genes were involved in several functional categories: hormone regulation, phenylpropanoid pathway and signal transduction. This comparative approach for the two conifer species helped determine the molecular gene pattern generated by inclination, providing a set of Pinus gene signatures that may be involved in the gravitropic stress response. These genes may also represent relevant candidate genes involved in the gravitropic response and potentially in wood formation.

Abstract P4-06-16: TWEAK/Fn14 Signaling Axis as a Driver of Breast Cancer Cell Invasion and Metastasis

The molecular events associated with the multi-step process of cell invasion and metastasis are poorly understood. Tumor necrosis factor receptor family member fibroblast growth factor-inducible 14 (Fn14) and its ligand TWEAK (tumor necrosis factor-like weak inducer of apoptosis) have recently emerged as a pro-invasive signaling mechanism and indicator of poor prognosis in breast cancer. Our laboratory has recently reported enhanced Fn14 expression in a significant proportion of breast tumor samples, but not in normal breast epithelium. Analysis of publicly available breast cancer data indicates that high Fn14 expression positively correlates with HER2/neu positivity, estrogen receptor negativity, high tumor grade, positive lymph nodes, and metastasis. Modulation of Fn14 expression in breast cancer cell lines either by exogenous overexpression or siRNA-mediated blockade is sufficient to regulate breast cancer cell invasive behavior in vitro. However, the mechanisms leading to Fn14 overexpression, and how activation of the TWEAK/Fn14 signaling axis contributes to breast tumor malignant progression remain unclear. We hypothesized that genomic alterations and inappropriate autocrine or paracrine growth factor signaling may play a role in aberrant Fn14 regulation. Using array genomic hybridization and fluorescence in situ hybridization, we found increased Fn14 gene copy number relative to centromere 16 in two out of four Fn14-expressing, invasive breast cancer cell lines and in 28% of primary breast tumors. We also investigated the role of exogenous growth factors known to play important roles in the breast tumor microenvironment in stimulating Fn14 expression in vitro. TWEAK, EGF, IGF1, HRG and HGF/SF were sufficient to stimulate Fn14 expression de novo in a variety of biologic contexts. Many of these growth factors converge on the MAPK signaling axis. We have confirmed a functional role for the MAPK pathway in facilitating Fn14-mediated invasion. Consistent with this observation, Fn14 expression in primary breast tumors is high in the context of K-RAS mutation. We are currently evaluating the presence of important key regulatory regions within the Fn14 promoter that may be contributing Fn14 over expression in breast cancer cells. To define mechanisms by which Fn14 contributes to a malignant cell phenotype we have identified an Fn14-specific invasion signature using gene expression microarray profiling. Analysis of this data points to key malignant mechanisms likely to be impacted by Fn14 activation within different biologic contexts that warrants further investigation.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P4-06-16.

Abstract P2-09-23: Investigating VAV3 Expression as a Novel Biomarker and Indicator of Chemosensitivity in Basal-Like Breast Cancer

Background: Basal-like breast (BLB) cancer accounts for ∼15% of all breast cancers diagnosed. Patients with BLB cancer are typically younger, present with higher tumor grade and despite recent advances in therapy, still have a poor outcome. BLB cancers are the most proliferative breast tumor sub-type, are commonly triple-negative (ER-, PgR-, HER2/neu-), and often harbor mutations in TP53 and BRCA1. The biological drivers of disease progression in this tumor subtype remains poorly understood. Recently, VAV3, a guanine nucleotide exchange factor and a member of the of the Rho/Rac/Cdc42 GTPase superfamily, has been reported as overexpressed and oncogenic in ER+ breast cancer cells. Our preliminary studies using publicly available microarray data indicates a consistent lack of VAV3 in BLB cancer, particularly those patients with shorter survival time following chemotherapy. We therefore hypothesize that VAV3 is a novel biomarker of BLB cancer and potential predictor of chemosensitivity in this subtype.

Materials and Methods: Gene expression microarray technology, qRTPCR and western blotting was used to investigate relative expression of VAV3 in a panel of breast cancer cell lines and tumors. Array Comparative Genomic Hybridization and Fluorescence in Situ Hybridization were used to evaluate VAV3 gene copy number. BLB cancer cell lines stably overexpressing VAV3 were developed to evaluate the role of VAV3 in sensitivity to chemotherapy.

Results: Unsupervised hierarchical clustering revealed low VAV3 expression in BLB tumors compared to all other intrinsic subtypes. Consistently lower VAV3 mRNA and protein expression were observed in BLB cancer cell lines compared to luminal epithelial cell lines, consistent with our in silico observations. We confirmed that low VAV3 expression in the BLB cancer cell lines is not due to gene copy number loss. Ectopic expression of VAV3 in MDA-MB-231 BLB cancer cells significantly enhanced their sensitivity to cisplatin.

Discussion: A consistent lack of VAV3 gene expression is evident in BLB tumors, however the mechanism underlying this loss is yet to be elucidated. Our findings support a hypothesis that low VAV3 expression is a potential diagnostic biomarker of BLB cancer, and that VAV3 expression may be a predictor of response to chemotherapy.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P2-09-23.

Abstract P4-02-12: Genomic Evolution of Endocrine-Resistant Breast Cancer Cell Lines Reveals Molecular Aberrations Consistent with Biological Phenotype

Suppression of estrogen synthesis using aromatase inhibitors (AIs) is highly effective in the treatment of postmenopausal women with estrogen receptor alpha-positive (ER+) breast cancer. Third generation AIs are superior to adjuvant tamoxifen resulting in improved disease-free survival and a lower incidence of side effects. Unfortunately, one of the consequences of long-term estrogen deprivation or exhaustive endocrine therapy is the development of drug resistance. We and others have shown that acquisition of resistance to long term estrogen deprivation or to selective estrogen receptor modulators (SERMs) in breast cancer cells is accompanied by an increase in malignant cell behavior. The Jordan Laboratory has developed in vitro and in vivo models of endocrine-resistant breast cancer that mimic pathobiology observed in anti-hormone refractory breast tumors. MCF-7:5C and MCF-7:2A are two ER+ human breast cancer cell lines derived from long term estrogen deprivation of hormone-dependent MCF-7 cells. MCF-7:TAM2 and MCF-7:RAL2 are also ER+ derivatives of MCF-7 that are resistant to tamoxifen and raloxifene, respectively. These models of resistance share several phenotypic and molecular characteristics, which differ dramatically from the isogenic parental line. Differences include robust growth in estrogen-deprived medium, mesenchymal morphology, and increased invasiveness and motility in vitro. They also exhibit elevated AKT activity, loss of E-cadherin, and additional molecular markers consistent with malignant progression. We have conducted an array-based genomic study to elucidate molecular mechanisms associated with development of endocrine resistance in each model. We observed a high degree of genomic evolution in all endocrine-resistant models. Several regions of common genomic aberration were observed in the MCF-7:5C and MCF-7:2A cells that indicate significant deregulation of glycolysis and glucose metabolism, a metabolic process known to be driven by activated AKT. Gene ontology analysis of genes differentially expressed by both MCF-7:5C and MCF-7:2A also highlighted deregulated AKT signaling and cell cycle control in these cells. Interestingly, amplification of the estrogen receptor 1 (ESR1) gene, which encodes estrogen receptor alpha, was observed in MCF-7:5C and MCF-7:2A models but not in the SERM-resistant models supporting diversity underlying mechanisms of endocrine resistance depending on therapies used. This study indicates that biological drivers of endocrine resistance can be identified using integrated genomic and bioinformatic approaches. We are currently prioritizing the likely molecular drivers of endocrine-resistant disease using high throughput RNAi technology.

Grant support: Department of Defense Breast Program under award number BC050277 Center of Excellence (V.C. Jordan). Views and opinions of and endorsements by the author(s) do not reflect those of the U.S. Army or the Department of Defense.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P4-02-12.

Analysis of the presence of improper materials in the composting process performed in ten MBT plants

Composting of the organic fraction of municipal solid waste (OFMSW) reduces the amount of biodegradable waste landfilled. However, the final product or compost used as organic soil amendment shows a large presence of improper materials and alarming concentrations of heavy metals. In this work, 30 samples of OFMSW before and after composting have been characterized to determine qualitatively and quantitatively this contamination and its origin. In addition, technical features of the equipment installed in 10 waste treatment plants have been assessed because of their influence on the streams involved in the composting process. Results show 78.2% of the samples stabilized by composting to be organic matter and the rest corresponds to improper materials, mainly paper, plastic and glass. Origin is due to the composting feedstocks, the OFMSW obtained by size separation in trommels which, due to non-source separation and poor selectivity, contains one third of impurities. In seven of the 30 samples household batteries were found.

Sub-critical water hydrolysis of hog hair for amino acid production

A recycling method using sub-critical water hydrolysis to convert hog hair from slaughterhouses into amino acids was developed. The influence of the reaction parameters such as temperature, time of reaction and initial substrate concentration were investigated in a batch reactor. The quality and quantity of amino acids in hydrolysates were determined and 17 kinds of amino acids were obtained. Under the tested conditions, the highest amino acid yield (325 mg/g protein) was reached at an initial substrate concentration of 10 g/l, a temperature of 250 degrees C and a reaction time of 60 min. A large amount of low-molecular weight amino acids, such alanine and glycine, was observed at these operating conditions. Sub-critical water hydrolysis was confirmed as an effective and practical process to recover amino acids from hog hair waste.

Substance use among road traffic casualties admitted to emergency departments

OBJECTIVE

To describe the prevalence of recent psychoactive substance use and associated factors among road traffic casualties admitted to emergency departments.

METHODS

A cross-sectional study was carried out, including adults injured in road traffic crashes admitted to the emergency department (ED) of eight hospitals in Catalonia (Spain), during three cross-sections, each of 4 days duration (2005-2006). Information sources were an interview, an oral fluid specimen and the patient's clinical record. Dependent variables were presence of alcohol, cannabis, cocaine, ecstasy, opiates or benzodiazepines. Independent variables were socioeconomic characteristics and circumstances of the injuries and admission. Prevalence and exact 95% confidence intervals were estimated for men and women. Bivariate analyses and multivariate binomial regression modelling were carried out to study factors associated with substance use in male drivers and pedestrians.

RESULTS

The prevalence of substance use was higher in men (n = 226) than in women (n = 161) for any substance (34.4% and 16.2%), any illegal substance (19.3% and 7.6%), alcohol (18.5% and 9.2%) and cannabis (17.0% and 3.8%), respectively. In male drivers and pedestrians, alcohol use was associated with being in the 25-30-year age group, being injured at night and the weekend, and arriving at the ED by ambulance; cannabis use was only associated with being in the 18-30-year age group.

CONCLUSIONS

A high prevalence of recent psychoactive substance use, especially alcohol, cannabis and cocaine, was observed in all age groups. The results indicate the need to screen for substance use and to give simple advice to casualties at EDs.

Differential Gene Expression Profiles in Breast Cancer Tumors from Young and Post-Menopausal Patients

Breast cancer in young patients (<35 yrs) has been hypothesized to be more histologically aggressive than those occurring in older cohorts, based mainly in their histopahtological features and worse prognosis. Our current knowledge of the genes involved in such differences is limited. To obtain insight into the molecular processes underlying tumorigenesis in young women we have used 44K cDNA microarrays (Agilent) to compare the gene expression profiles of 30 samples obtained from patients younger than 35 years (median 32,5, range 25-35) and 19 post-menopausal patients (median 66, range 55-88 ), all of them with ductal invasive carcinoma. Both age groups showed similar incidence of ER and PR-positive cases (70 and 60%, respectively). We considered as differentially expressed genes those presenting a p value below 0.01(t test) and fold variation of+/- 2.5.Gene ontology was performed using the GOTree machine tool (GOTM). By such criteria, 121 genes (86% down-regulated) were identified between the two groups here analyzed. In tumors arising in younger women we found an overrepresentation of genes involved with G-protein receptor signaling,cytoskeleton and muscle development, including ankyrin 3,filamin B, gfsarcoglycan and small proline- rich protein, one of the cornified-envelope structural precursor protein. In addition, solely in the younger women set we compared the gene profiles between women with (n =19) or without (n = 10) familial history of breast carcinoma. Using the same criteria, 59 transcripts distinguished the two subsets: GO categories over represented in tumors from patients with familial history included cell-cell adhesion, cytoskeleton organization,cell motility and protein binding related genes. These results indicate that breast cancer tumors arising in young women, besides their uniqueness regarding tumorigenesis, also differ among familial and non-familial cases as revealed by gene expression profiles.Support: FAPESP 04/14029-1

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 6138.

Outcome after steroid withdrawal in heart transplantation

BACKGROUND

There is a lack of consensus and insufficient data to assess the impact of late steroid withdrawal after heart transplantation (HTx). The aim of the study was to investigate the security and feasibility of corticosteroid withdrawal at 1 year after transplantation.

METHODS AND RESULTS

Steroid withdrawal was attempted after at least 12 months of treatment in 86 HTx patients who fulfilled the criteria. At 1 and 3 months after drug discontinuation, patients underwent 2 endomyocardial biopsies (EMB). After a mean follow-up of 25 +/- 13 months, 63% of the patients remained steroid free. In 30 patients (35%) corticosteroids were reinitiated, in 15 cases because of acute rejection (7%), 5 (6%) because of worsening renal function, 5 (6%) because of malignancy, 3 (4%) because of adverse effects of immunosuppressive drugs, and 2 because of severe allograft coronary artery disease. Four patients (5%) died after drug discontinuation. There was a significant decrease in total cholesterol (198 +/- 35 to 181 +/- 38 mg/dL; P < .001) and low-density lipoprotain (LDL) cholesterol levels (113 +/- 30 to 105 +/- 30 mg/dL; P < .001). There were no differences in mortality between patients with and without corticosteroids.

CONCLUSION

Steroid withdrawal is feasible and safe in HTx patients. In our study, it was successfully maintained in 63% of the patients. EMB is helpful to identify patients with acute rejection at 1 and 3 months after withdrawal. Short- to mid-term metabolic benefits are significant reductions in serum total and LDL cholesterol.

[Insufficiency of psychopathological identification in a case on non-processual schizophrenia]

A case of non-processual and primarily non-productive schizophrenia is presented. However, its evolutive development and clinical manifestations of <<self>> experiences alterations are prototypic of the picture they represent. Nevertheless, this case was not diagnosed during more than one decade of observation. The presentation of this patient's case history shows how clinical praxis dissociates the theory of schizophrenia from the patient's experience. The discussion elaborated from the conceptual history and the self in schizophrenia suggests that the subjective phenomena manifested in these patients cannot be approached by the present applicable operatives criteria in psychiatry nor from a unifying criterion based on an exclusive nuclear approach that aims to explain the final cause. All of this refers to the insufficiency of psychopathology as mere semiology and raises the need for a psychopathological praxis that can implement the results of the theory.

Endometrioid adenocarcinoma of the ovary and endometriosis

OBJECTIVE

We present a retrospective analysis of 22 cases of endometrioid ovarian carcinoma, reviewed to identify endometriosis and its malignant transformation.

STUDY DESIGN

Twenty-two patients with endometrioid ovarian cancer were included in the review. Their clinical and histological data were retrospectively reviewed. The origin of the tumours was considered endometriosis-related when the presence of malignant changes in endometriosis glands leading to endometrioid carcinoma were found.

RESULTS

Endometriosis was detected in three cases (3/22=14%). One of them presented a clearly benign to malignant transformation area. In another patient, the transition zone was abrupt and present in both ovaries. In the third, a pre-menopausal woman, ovarian endometriosis with only focal endometrioid carcinoma was observed. The three of them had a clear-cell carcinoma component. The presence of a clear-cell component was significantly greater in patients with endometriosis than in patients without endometriosis Each patient had a different clinical presentation: increase in abdominal perimeter, post-menopausal vaginal haemorrhage and hypermenorrhea. Preoperative CA 125 levels were avalaible in 15 of the patients (15/22=68%). Endometriosis was found in two of these 15 patients, both with the highest CA 125 measured levels, exceeding 1700 U/ml. In the remaining of the patients, CA 125 value did not exceed 35 U/ml.

CONCLUSION

Although this association is not very frequent, patients with ovarian endometriosis and a high CA 125 serum level should be managed with special care, regardless of their pre-menopausal or post-menopausal status.

Evaluation of fruit-vegetable and fish wastes as alternative feedstuffs in pig diets

Fruit-vegetable and fish wastes were evaluated as potential feedstuffs for growing-finishing pigs. Wastes were collected from shops in the city of Salamanca (Spain) and their nutritional composition, mineral content and digestibility were determined. The dry matter of the wastes under study was relatively low (12% for fruit-vegetable waste and 26% for fish waste), but they presented all of the nutrient requirements for swine diets. The fish waste contained 58% crude protein, 22% ash, 19% ether extract and 1% crude fibre, whereas the fruit-vegetable waste contained 65% nitrogen free extract, 13% crude fibre, 12% crude protein, 8% ash and 2% ether extract. Waste digestibility decreased with temperature, and hence temperatures over 65 degrees C for fruit-vegetable waste and 105 degrees C for fish waste should not be used in the treatment to reduce the moisture and to ensure the microbiology quality. Therefore, two diets were formulated using linear programming. The analysed waste was included in approximately 20% of one of the diets, while another diet was formulated without any type of waste. These data showed that this part of biodegradable municipal waste could be managed as alternative feedstuffs in swine diets, reducing the amount of biodegradable municipal waste going to landfills.

Nosocomial outbreak of Pseudomonas aeruginosa infections related to a flexible bronchoscope

An outbreak of Pseudomonas aeruginosa infections affecting 17 patients was detected in the 27-bed intensive care unit (ICU) of a community hospital from 1 July to 30 September 2003. An ambidirectional cohort study was conducted to identify the risk factors for infection. Nosocomial infections were defined using the criteria of the Centers for Disease Control and Prevention. Random arbitrary polymorphic DNA-polymerase chain reaction was used for genotypic characterization. Logistic regression analyses demonstrated that case patients were more likely than non-cases to have had a longer stay in the ICU, and to have undergone mechanical ventilation and antimicrobial treatment. The multi-variate analysis identified recent bronchoscopy [risk ratio (RR) 3.8, 95% confidence interval (CI) 2.5-3.9] and exposure to an infected patient (RR 2.9, 95% CI 1.1-3.7) as independent risk factors. Molecular analysis showed that of the nine isolates available, four patients had a similar strain. The factor with the strongest influence on the risk of death was infection with P. aeruginosa (RR 2.1, 95% CI 1.0-2.4, P=0.04). A combined infection control strategy was implemented, including strict compliance with isolation precautions and recommendations for cleaning and disinfecting bronchoscopes, and a sharp reduction in the incidence of P. aeruginosa infection followed. It is thought that this outbreak was caused by patient-to-patient transmission and infection from a common source, i.e. the flexible bronchoscope.

Study of drying systems for the utilization of biodegradable municipal solid wastes as animal feed

The effectiveness of different drying systems used for the dehydration of certain fractions of biodegradable municipal solid wastes with a high moisture content (fruit and vegetable remains) was analyzed. Some tests using small amounts of the material were carried out in natural and forced convection ovens. For larger quantities of wastes, a discontinuous cabinet dryer and a continuous rotary dryer were used. With these dryers, the moisture content was reduced from 800 to 100 g kg(-1). It was verified that the continuous rotary dryer was the most efficient type of equipment studied, since it allowed a dried waste to be obtained with better nutritional and microbiological qualities and in accordance to the specifications of the products for animal feeding.

Vitreous humour as a complementary sample to blood for the detection/confirmation of diazepam: ante-mortem and post-mortem studies in an animal model

The quantification of medical or toxic substances in vitreous humour (VH) could be very useful in forensic toxicology when blood sample determinations are impossible due to absence or deterioration. However, few studies have been made in this area and even fewer have tried to find a relationship between drug levels in both samples. To determine a correlation ratio between blood and VH diazepam (DZ) levels, we performed an experimental study using rabbits administered with a sub-toxic dose of DZ under known and controlled conditions. Blood and VH samples were collected 0.5, 1, 2, 3 and 6 hours after the drug administration in order to determine DZ and its main active metabolite, desmethyldiazepam (DMD). In addition, we have studied an animal group sacrificed 2 hours after intramuscular (i.m.) drug administration with blood and VH collection 24 hours later, to evaluate the existence of possible post-mortem changes. After DZ administration, a fast absorption phase was observed with a plasma Cmax value 1 hour after, followed by a rapid concentration decrease, with a half-life of 1 hour, indicating that, besides elimination, a fast distribution to other organs and tissues and/or hepatic metabolism occurred. Diazepam Cmax value in VH was achieved between 1 and 2 hours, when plasma concentrations had already decreased to half the value. The plasma/VH DZ ratio calculated at this time was 10. In the post-mortem study, while plasma DZ concentration at 24 hours was smaller, DMD levels were higher than those at the time of death. In the VH, both DZ and DMD concentrations at 24 hours were higher than those obtained at the time of death. That is, in both fluids DZ and DMD concentrations were different from those at the time of death and post-mortem distribution and redistribution phenomena occurred. The combination of ante-mortem and post-mortem studies has allowed the determination of a correlation ratio for DZ in the rabbit of 6 x, comparing the concentrations in VH collected 24 hours after death with the concentrations detected in plasma at the time of death. This study opens new perspectives for the use of VH as a complementary sample to blood for DZ detection and confirmation. The putative relevance of the correlation ratio obtained, for forensic toxicology practice with medical substances, namely benzodiazepines, recommends further studies in humans.

Biodegradable municipal solid waste: characterization and potential use as animal feedstuffs

Five different fractions of the biodegradable municipal solid waste (BMSW) were evaluated as potential animal feedstuffs. For each source of waste (meat waste (MW), fish waste (FW), fruit and vegetables waste (FVW), restaurant waste (RW), household waste (HW)), samples were obtained from small shops (butchers, fishmongers, fruit and vegetable shops), restaurants and a MSW treatment plant (household waste). The chemical composition, microbiological characterization, dioxins, furans, PCB's and mineral content were determined for every type of waste fraction. The analysed biodegradable waste presented high moisture content (from 60% to 90%). Some fractions were dense in one nutrient: meat waste in ether extract, fish waste in crude protein, fruit and vegetable waste in nitrogen free extract. The other studied fractions (restaurant fraction and household fraction) presented a more balanced composition, but the presence of toxic concentrations of contaminants such as metals was higher than European legislation permitted values in animal feeding. From a microbiological standpoint, a heat treatment at 65 degrees C for 20 min was sufficient to ensure microbiological quality of the samples. This treatment was also advisable to reduce the moisture content: a lower moisture content facilitates the waste handling and processing and, therefore, the inclusion of these waste fractions in commercial animal diets. This paper presents a potential alternative for the recovery of organic matter content in municipal solid waste. The results obtained in this research and the feedstuffs legislation in force related to animal feed, indicated that some of the studied biodegradable waste fractions (meat waste, fruit and vegetable waste and fish waste) could be considered as alternatives to typical raw materials used in animal feeds.

Sewage outfall plume dispersion observations with an autonomous underwater vehicle

This work represents one of the first successful applications of Autonomous Underwater Vehicles (AUVs) for interdisciplinary coastal research. A monitoring mission to study the shape and estimate the initial dilution of the S. Jacinto sewage outfall plume using an AUV was performed on July 2002. An efficient sampling strategy enabling greater improvements in spatial and temporal range of detection demonstrated that the sewage effluent plume can be clearly traced using naturally occurring tracers in the wastewater. The outfall plume was found at the surface highly influenced by the weak stratification and low currents. Dilution varying with distance downstream was estimated from the plume rise over the outfall diffuser until a nearly constant value of 130:1, 60 m from the diffuser, indicating the near field end. Our results demonstrate that AUVs can provide high-quality measurements of physical properties of effluent plumes in a very effective manner and valuable considerations about the initial mixing processes under real oceanic conditions can be further investigated.

[Coverage of the 23-valent pneumococcal vaccine in those older than 64 years of age in the region of Castellon and Valencia, Spain]

The different serotypes of Streptococcus pneumoniae isolated from adults aged over 64 years in the Valencia and Castellon health region of Spain from June 1999 to December 2003 were analyzed. A total of 163 strains were evaluated; 58.3% were invasive, 47.24% were from respiratory source, and 4.9% were from exudates. The greatest percentage of samples was obtained from the group of patients aged 65 to 75 years (60.7%), while the lowest percentage was obtained from the group of patients aged over 85 years (10.4%). In the latter group, 53% of the strains were invasive and 29.4% were isolated from sputum. A total of 21 serotypes were identified, with the most common (> 3%) being: serotype 3 (22.1%); serotype 19 (12.9%); serotype 6 (12.3%); serotype 9 (8.6%); serotype 14 (10.4%); serotype 23 (8%); serotype 29 (3.7%); and serotype 18 (3.1%). Serotype 3 was the most common serotype found in all samples, with the exception of exudate, while serotype 23 was not isolated in blood. In this population group, the coverage of the 23-valent vaccine was 88.4%. Serotypes not included in this vaccine but isolated from invasive samples were serotypes 16, 24, 29 and 35. No changes were observed in serotype distribution over the 4-year period of the study. However, it is necessary to continue epidemiological monitoring to determine whether serotype substitution occurs.

Preoperatively irradiated rectal carcinoma: analysis of the histopathologic response and predictive value of proliferating cell nuclear antigen immunostaining

OBJECTIVES

To investigate the relationship between the histopathologic effects of preoperative chemoradiotherapy in rectal cancer and the proteins, proliferating cell nuclear antigen (PCNA) and p53.

METHODS

Samples from 73 tumors were examined. The histopathologic effects observed in the resected specimens induced by preoperative chemoradiotherapy were correlated with the inmunohistochemical expression of PCNA and p53 in biopsies obtained by rectoscopy before chemoradiotherapy.

RESULTS

Thirty-five tumors showed a high PCNA index (48%). Nuclear accumulation of p53 protein was detected in 53 tumors (72%). Specimens were assigned one of four grades based on the amount of residual viable tumor. Three neoplasms (4%) showed complete regression; 8 other carcinomas (11%) showed only small numbers of tumor cells scattered within the field of stromal reaction. In these cases, it was considered that the tumor had responded significantly to radiotherapy. Tumors with a high PCNA index responded to chemoradiotherapy more frequently (8/35; 72%) than tumors with a low index (3/38; 43%) (p = 0.07). p53-negative tumors responded more frequently (4/20; 20%) than positive tumors (7/53; 13.2%) (p = 0.50). When pathologic and immunohistochemical characteristics of the tumors were included in a logistic regression model, only high PCNA index (odds ratio 5.35, 95% confidence interval 1.07-26.7) (p = 0.04) was significantly associated with the histologic response to preoperative chemoradiotherapy.

CONCLUSION

High proliferative activity of rectal cancer, as determined by PCNA immunostaining, is predictive of the response to preoperative chemoradiotherapy.

Müllerian adenosarcoma of the cervix with heterologous elements: report of a case and review of the literature

BACKGROUND

Müllerian adenosarcoma (MA) is a rare neoplasm composed of benign epithelial and malignant stromal components. Its location in the cervix and the presence of heterologous elements are extremely infrequent (to our knowledge, only 14 more cases have been reported in the English literature). We describe another case of MA of the uterine cervix with heterologous elements and review the clinical and pathological features of these tumors.

CASE REPORT

A nulliparous 25-year-old woman was admitted to the hospital because of metrorrhagia and recurrent masses, dependent on the cervix, initially considered endocervical polyps. Microscopically, the last curettage performed revealed a tumor composed of two elements, epithelial and mesenchymal. The epithelial elements were benign endocervical type glands, and the mesenchymal were sarcomatous, containing minor foci of cartilage. A diagnosis of endocervical heterologous adenosarcoma was reached, and a total hysterectomy and bilateral salpingo-oophorectomy were performed. The patient is alive 2 years after the surgical procedure. Neither chemotherapy nor other adjuvant therapies have been administered, and she is clinically free of disease at the moment.

CONCLUSION

Because MA with heterologous elements seems to appear at the earliest stages of the reproductive lifespan in women, commonly with a history of recurrent polyps, and because its malignant potential is uncertain, gynecologists and pathologists should be aware and think about the possibility of this tumor. Long-term follow-up is essential and so is the accumulation of individual cases to provide further experience with these unusual neoplasms.

Cutaneous infection with Mycobacterium fortuitum after localized microinjections (mesotherapy) treated successfully with a triple drug regimen

Mesotherapy is a treatment method devised for controlling pain syndromes or diseases by subcutaneous microinjections given at or around the involved areas at short intervals of time. Different adverse effects have been described due to this modality of treatment. This report describes 3 patients with cutaneous infection caused by Mycobacterium fortuitum after mesotherapy. Three women, aged 24, 27 and 44 years, presented with similar clinical features, consisting of painful nodules located at the points where mesotherapy had been applied. A smear from a skin biopsy revealed the presence of acid-fast bacilli in all 3 cases. The specimen was cultured and eventually identified as M. fortuitum. A multidrug long-term regimen (combinations of 3 drugs from the following: ciprofloxacin, cotrimoxazole, clarithromycin and amoxicillin-clavulanic acid) was needed to achieve resolution of the lesions. After 15, 25 and 26 months of follow-up, no patient relapsed. Mycobacterium fortuitum is a rapidly growing mycobacterium that can lead to cutaneous infection after minor surgical procedures when aseptic measures are not adequate. Multiple drugs for several months are usually needed to treat this disease successfully.

Detection of Leishmania infantum by PCR, serology and cellular immune response in a cohort study of Brazilian dogs

The sensitivity and specificity of PCR, serology (ELISA) and lymphoproliferative response to Leishmania antigen for the detection of Leishmania infantum infection were evaluated in a cohort of 126 dogs exposed to natural infection in Brazil. For PCR, Leishmania DNA from bone-marrow was amplified with both minicircle and ribosomal primers. The infection status and time of infection of each dog were estimated from longitudinal data. The sensitivity of PCR in parasite-positive samples was 98%. However, the overall sensitivity of PCR in post-infection samples, from dogs with confirmed infection, was only 68%. The sensitivity of PCR varied during the course of infection, being highest (78-88%) 0-135 days post-infection and declining to around 50% after 300 days. The sensitivity of PCR also varied between dogs, and was highest in sick dogs. The sensitivity of serology was similar in parasite-positive (84%), PCR-positive (86%) and post-infection (88%) samples. The sensitivity of serology varied during the course of infection, being lowest at the time of infection and high (93-100%) thereafter. Problems in determining the specificity of serology are discussed. The sensitivity and specificity of cellular responsiveness were low. These data suggest that PCR is most useful in detecting active or symptomatic infection, and that serology can be a more sensitive technique for the detection of all infected dogs.

Nitric oxide inhibits isoproterenol-stimulated adipocyte lipolysis through oxidative inactivation of the beta-agonist

Nitric oxide has been implicated in the inhibition of catecholamine-stimulated lipolysis in adipose tissue by as yet unknown mechanisms. In the present study, it is shown that the nitric oxide donor, 2,2-diethyl-1-nitroso-oxyhydrazine, antagonized isoproterenol (isoprenaline)-induced lipolysis in rat adipocytes, freshly isolated from white adipose tissue, by decreasing the potency of the beta-agonist without affecting its efficacy. These data suggest that nitric oxide did not act downstream of the beta-adrenoceptor but reduced the effective concentration of isoproterenol. In support of the latter hypothesis, we found that pre-treatment of isoproterenol with nitric oxide abolished the lipolytic activity of the catecholamine. Spectroscopic data and HPLC analysis confirmed that the nitric oxide-mediated inactivation of isoproterenol was in fact because of the modification of the catecholamine through a sequence of oxidation reactions, which apparently involved the generation of an aminochrome. Similarly, aminochrome was found to be the primary product of isoproterenol oxidation by 3-morpholinosydnonimine and peroxynitrite. Finally, it was shown that nitric oxide released from cytokine-stimulated adipocytes attenuated the lipolytic effect of isoproterenol by inactivating the catecholamine. In contrast with very recent findings, which suggest that nitric oxide impairs the beta-adrenergic action of isoproterenol through intracellular mechanisms and not through a chemical reaction between NO and the catecholamine, we showed that nitric oxide was able to attenuate the pharmacological activity of isoproterenol in vitro as well as in a nitric oxide-generating cellular system through oxidation of the beta-agonist. These findings should be taken into account in both the design and interpretation of studies used to investigate the role of nitric oxide as a modulator of isoproterenol-stimulated signal transduction pathways.

Influence of tumor localization on the prognostic value of P53 protein in colorectal adenocarcinomas

BACKGROUND

The prevalence of genetic alterations is different in primary carcinomas from the proximal colon when compared with carcinomas from the distal colorectum. The objective of this work was to explore the existence of possible differences in the informative weight of the risk of tumor recurrence provided by p53 immunostaining depending on the localization of the neoplasm.

PATIENTS AND METHODS

Nuclear immunohistochemical expression of p53 protein was determined in formalin-fixed paraffin-embedded archival tumor tissue samples from 190 primary colorectal adenocarcinomas. The relative prognostic importance on the risk of recurrence of each variable was assessed in a Cox's proportional hazard regression analysis. Multiplicative interaction terms between p53 and tumor site were included in the multivariate models in order to test their joint effect on survival.

RESULTS

One hundred and one patients (53.1%) manifested nuclear accumulation of the protein. P53 overexpression was more frequent in distal than in proximal tumors (58.5% ve s 41.7%) (p = 0.03). Disease-free survival was lower in p53-positive cases (75% versus 38%) (p = 0.006), but significance of the association varied according to the localization of the tumor (p = 0.004 in proximal carcinomas and p = 0.049 in distal carcinomas). Multivariate analysis identified p53 positivity and distal tumor localization as the factors significantly associated with a high risk of recurrence Interaction between p53 expression and localization was present. P53 exhibited different prognostic value in distal and proximal colon. While adjusted hazard ratio for positive p53 was 1.99 in distal cancers, it was 8.04 for proximal tumors.

CONCLUSION

The prognostic with value of tumor recurrence associated overexpression of p53 protein is influenced by the location of the tumor. The negative predictive weight is significantly higher in proximal than in distal cancers.

[Efficacy of the impulse magnetic field therapy in patients after the outer drainage of abdominal cysts diagnosed with the use of isotopic and ultrasound techniques]

154 patients with pancreatic, renal or hepatic cysts have been treated with the outer drainage under USG monitoring. Because of cysts' contact with tracts penetrating to an organ or its lack, the patients have been divided into two groups. Directly after the puncture all the patients have undergone the high frequency impulse magnetic field therapy. A distinct, positive treatment effect has been found in patients who have gone through not only drainage, but also magnetic field.

Fibrinogen in systemic lupus erythematosus: more than an acute phase reactant?

OBJECTIVE

To investigate whether plasma fibrinogen (FNG) measured longitudinally in a cohort of patients with systemic lupus erythematosus (SLE) increased over observational time faster than in a control group, and whether its increase might depend upon age, disease duration, disease activity, and medications.

METHODS

Hospital based retrospective study with repeated measurements of plasma FNG and C-reactive protein (CRP) for patients and controls and erythrocyte sedimentation rate (ESR) and lupus activity index (LAI) for patients only. Study groups included patients with SLE: n = 96 (95% female), and healthy controls: n = 39 (95% female). Of the patients, 42% had SLE only, 23% had SLE with antiphospholipid antibodies (aPL), and 34% had SLE with aPL related thrombosis.

RESULTS

Median baseline FNG was higher in patients (357 mg/dl; 95% CI 339-375) than in controls (271 mg/dl; 95% CI 251-291) by 86 mg/dl (95% CI 56-115, p < 0.001); in older subjects than younger (in patients and in controls); in patients with thrombosis than in other patient groups (by an average of 35 mg/dl; 95% CI 9-61 mg/dl): and in patients with longer disease duration (p = 0.05). Mean FNG increased faster in patients (19 mg/dl/year; 95% CI 12-26 mg/dl) than in controls (2.6 mg/dl/year; 95% CI 2.0-3.2 mg/dl). The increase was faster than the age effect and independent of patient group and disease activity.

CONCLUSION

Plasma FNG in patients with SLE increases throughout followup regardless of disease activity, mimicking the age related increment observed in population based studies. The rapidity of the increment may reflect the prematurity of vascular disease typical of SLE.

Autologous peripheral blood progenitor cell transplantation with <2 x 10(6) CD34(+)/kg: an analysis of variables concerning mobilisation and engraftment

INTRODUCTION

This study analyses the factors affecting mobilisation and engraftment in autologous peripheral blood progenitor cell transplantation according to the number of CD34(+) re-infused.

MATERIALS AND METHODS

A total of 190 patients underwent mobilisation with G-CSF alone (n=113) or in combination with chemotherapy (n=77). A total of 116 patients (61%) were autografted with <2 x 10(6) CD34(+) cells/kg and 74 patients were transplanted with >2 x 10(6) CD34(+) cells/kg. Rates of granulocyte and platelet recovery were estimated using the product-limit method of Kaplan-Meier and compared using a log-rank test. The Cox regression model was used for the multivariate analysis of factors influencing engraftment. Differences between cohorts were evaluated by one-way ANOVA or Mann-Whitney tests, and multivariate analysis was performed using a stepwise lineal regression.

RESULTS

Neutrophil and platelet engraftment was significantly longer with <2 x 10(6)/CD34(+)/kg (12 vs 10 days, P=0.014 and 16 vs 13 days, P=0.0001 respectively). Platelet recovery was affected by exposure to alkylating agents (P=0.04), refractory disease (P=0.02) and AML (P=0.0001), but only the last two variables remained significant in Cox regression (P<0.01). Granulocyte engraftment was longer in CML (univariate, P=0.04) and in refractory disease (multivariate, P=0.02). In patients re-infused with >2 x 10(6)/CD34(+)/kg, the Cox model did not identify prognostic factors for haematopoietic recovery.

CONCLUSION

Although mobilisation schedules and disease status influenced not only the yield of progenitor cells, but also the engraftment kinetics, the number of CD34(+) re-infused was the main predictor of haematopoietic recovery. While engraftment succeeded in most of the cases, the re-infusion of >2 x 10(6)/CD34(+)/kg resulted in significantly shorter recovery times.

[Experience of a renal function test unit]

The activity developed during one year in a Renal Function Tests Unit was studied prospectively. Six hundred pharmacological tests (50 tests per month) were done to 453 patients, children and adults. Abnormal tests results were found in 38.4% of the patients. 49.7% of the tests were performed in patients affected with nephrolithiasis or carriers of metabolic anomalies predisposing to renal stones, mainly idiopathic hypercalciuria. The tests were also frequently done to other group of patients affected with urinary tract infection, mitochondrial disease, vesicoureteral reflux, osteoporosis and primary Sjögren's syndrome. The urinary concentrating capacity after desmopressin (37.2%) was the most frequent performed isolated test, although the group of tests to study the renal acidification capacity (58.5%) were the most frequent requested ones.

[Pneumonia due to varicella zoster virus in adults: a review of 13 cases]

Pneumonia due to varicella-zoster virus is a complication of chickenpox that appears almost solely in adults. The clinical picture ranges from varieties with few symptoms to those with severe respiratory insufficiency. This retrospective study of adult varicella pneumonia cases treated at our hospital over a seven-year period enrolled 13 patients (9 men and 4 women) whose diagnosis of varicella pneumonia was based on clinical and radiologic criteria during the course of disease. Three patients were immunodepressed (two with HIV infection and one with systemic lupus) and one patient was in her third month of pregnancy. Seventy-seven percent of the patients were active smokers. The most common symptoms apart from skin rash and fever were coughing and dyspnea. All had extensive bilateral nodular patterns visible on the chest film, with no pleural involvement or mediastinal adenopathy. All received intravenous acyclovir and outcome was good in all but one HIV-infected patient, who died. The pregnant patient required intensive care.

Insulin-induced up-regulation of lipoprotein lipase messenger ribonucleic acid and activity in mammary gland

The effects of insulin on lipoprotein lipase (LPL) messenger RNA (mRNA) were studied in mammary glands from virgin and late-pregnant rats. Virgin and pregnant rats (at 17 days of gestation) were subjected to a continuous infusion (35 ml/day) with 50% glucose for 72 h to produce a prolonged hyperinsulinemic-euglycemic condition. Gestation causes a 4-fold increase in LPL mRNA accompanied by a 3- to 4-fold increase in total LPL activity. Experimental hyperinsulinemia, generated by the 50% glucose infusion, had a similar effect in both pregnant and virgin rats, by enhancing (2- to 3-fold) both their LPL activity and LPL mRNA. Thus, total LPL activity and LPL mRNA significantly correlated with plasma insulin (r = 0.789, P < 0.001; and r = 0.772, P < 0.001, respectively). Furthermore, total LPL activity was correlated with LPL mRNA (r = 0.765, P = 0.001). In conclusion, the present study shows that insulin participates in the control of LPL expression in mammary glands, revealing its role as a modulator of the enzyme at a mRNA level.

The cardiac acetylcholine-activated, inwardly rectifying K+-channel subunit GIRK1 gives rise to an inward current induced by free oxygen radicals

Reactive oxygen species (ROS) play a crucial role in pathophysiology of the cardiovascular system. The present study was designed to analyze the redox sensitivity of G-protein-activated inward rectifier K+ (GIRK) channels, which control cardiac contractility and excitability. GIRK1 subunits were heterologously expressed in Xenopus laevis oocytes and the resulting K+ currents were measured with the two-electrode voltage clamp technique. Oxygen free radicals generated by the hypoxanthine/xanthine oxidase system led to a marked increase in the current through GIRK channels, termed superoxide-induced current (I(SO)). Furthermore, I(SO) did not depend on G-protein-dependent activation of GIRK currents by coexpressed muscarinic m2-receptors, but could also be observed when no agonist was present in the bathing solution. Niflumic acid at a concentration of 0.5 mmol/l did not abolish I(SO), whereas 100 micromol/l Ba2+ attenuated I(SO) completely. Catalase (10(6) i.u./l) failed to suppress I(SO), whereas H2O2 concentration was kept close to zero, as measured by chemiluminescence. Hence, we conclude that O2*- or a closely related species is responsible for I(SO) induction. Our results demonstrate a significant redox sensitivity of GIRK1 channels and suggest redox-activation of G-protein-activated inward rectifier K+ channels as a key mechanism in oxidative stress-associated cardiac dysfunction.

Controlled-rate versus uncontrolled-rate cryopreservation of peripheral blood progenitor cells: a prospective multicenter study. Group for Cryobiology and Biology of Bone Marrow Transplantation (CBTMO), Spain

BACKGROUND AND OBJECTIVE

Cryopreservation of hemopoietic progenitors for transplantation has been traditionally performed by the use of a controlled-rate freezer. Several groups have reported successful cryopreservation of progenitor cells at -80 degrees C without a controlled-rate freezer. In an attempt to elucidate whether both methods are equally efficient, we compared controlled-rate versus uncontrolled cryopreservation of peripheral blood progenitor cells (PBPC) in a prospective, multicenter study.

DESIGN AND METHODS

Apheresis products from patients undergoing PBPC mobilization were split into two aliquots, and cryopreserved simultaneously by both methods, in autologous plasma plus 10% dimethylsulfoxide. Controlled-rate samples were placed into a programmable freezer with a cooling rate of 1-2 degrees C/min. Uncontrolled-rate samples were directly introduced into a -80 degrees C mechanical freezer. After thawing, cell counts, assays for viability, clonogenic cultures and CD34+ cell enumeration were performed.

RESULTS

A total of 105 cases were included. No significant differences were found in viability (mean 88.8 +/- 13% in the controlled-rate group vs. 89.7 +/- 12% in the uncontrolled-rate group), nucleated cell loss (23.5 +/- 23% vs. 23 +/- 22%), mononuclear cell loss (19 +/- 23% vs. 19.1 +/- 22%), and loss of CD34+ cells (34.3 +/- 33% vs. 28.6 +/- 34%). On the other hand, recovery of granulomonocytic colony-forming units (CFU-GM), was significantly better with the controlled-rate technique, than with the non-controlled-rate method (104.3 +/- 95 vs. 86.5 +/- 80, respectively; p = 0.048).

INTERPRETATION AND CONCLUSIONS

Our results indicate that both techniques are suitable for cryopreservation of PBPC, although a better recovery of committed progenitors is achieved by the controlled-rate method. Therefore, the use of controlled-rate freezer should probably be recommended.

Breakdown of the inner and outer blood retinal barrier in streptozotocin-induced diabetes

Using vitreous fluorophotometry and quantitative fluorescence microscopy the authors studied the permeability of the blood-retinal barrier (BRB) to fluorescein in control and in 8 days streptozotocin-induced diabetic rats. Vitreous fluorophotometry showed that fluorescein permeates BRB in control and in diabetic rats. However, in diabetic rats the permeability to fluorescein was significantly increased as compared to control rats. The vitreous penetration ratio (VPR) values for total and free fluorescein at 60 min, were higher for diabetic rats (231.2+/-12.9 min-1 for total fluorescein and 1299.24+/-58.0 min-1 for free fluorescein) than for control rats (95.5+/-3.5 min-1 for total fluorescein and 646.6+/-55. 0 min-1 for free fluorescein) (P<0.05). Quantitative confocal fluorescence microscopy confirmed these findings and identified the site of leakage across the BRB by comparing the relative importance of the fluorescein leakage across the outer and inner BRB. In control rats the fluorescence levels remained relatively low in the photoreceptor layer, next to the outer BRB but in the inner nuclear layer, next to the inner BRB reached values that were almost ten times higher. These results suggest that in retinas of control rats fluorescein penetrates predominantly through the inner BRB. In diabetic rats the fluorescence levels in the photoreceptor and in the inner nuclear layer were significantly increased as compared to the fluorescence levels in controls rats. Nevertheless, in the inner nuclear layer the fluorescence levels were also generally higher than the fluorescence levels at the photoreceptor layer. The rates of fluorescence levels between the inner nuclear layer and the photoreceptor layer were apparently 3:1, 60 min after the single intravenous injection of fluorescein. Also, the fluorescein penetration in the inner nuclear layer of the diabetic rats is higher than that observed in the inner nuclear layer of the control rats (P<0.001). These findings suggest that the permeability to fluorescein of both components of the BRB is increased 8 days after the induction of diabetes by streptozotocin and that the permeability of the retinal vasculature is preferentially affected.