A panel of biomarkers including caspase-3 and D-dimer may differentiate acute stroke from stroke-mimicking conditions in the emergency department

BACKGROUND AND AIMS

At present, a rapid and widely available diagnostic test for stroke remains elusive. The aim of this study was to examine the predictive value of a panel of blood-borne biochemical markers for stroke diagnosis.

DESIGN

Consecutive patients with strokes or stroke-mimicking conditions (mimics) were evaluated within 24 h from symptom onset (915 strokes and 90 mimics). Blood samples were analysed by enzyme-linked immunosorbent assay for C-reactive protein, d-dimer, soluble receptor for advanced glycation end products (sRAGE), metalloproteinase 9 (MMP-9), S100B, brain natriuretic peptide, caspase-3, neurotrophin-3, chimerin and secretagogin.

RESULTS

The main independent predictors of stroke versus mimics were caspase-3 >1.96 ng mL(-1) [odds ratio (OR) = 3.32; 95% confidence interval (CI) 1.88-5.88, P < 0.0001], d-dimer >0.27 μg mL(-1) (OR = 2.97; 95% CI 1.72-5.16, P = 0.0001), sRAGE >0.91 ng mL(-1) (OR = 2.19; 95% CI 1.26-3.83, P = 0.006), chimerin <1.11 ng mL(-1) (OR = 0.4; 95% CI 0.19-0.81, P = 0.011), secretagogin <0.24 ng mL(-1) (OR = 0.51; 95% CI 0.27-0.97, P = 0.041) and MMP-9 > 199 ng mL(-1) (OR = 1.66; 95% CI 1.01-2.73, P = 0.046). The model's predictive probability of stroke when the six biomarkers are above/below these cut-off levels was 99.01%. The best combination of biomarkers in the model was caspase-3 and d-dimer. Moreover, a model developed for samples obtained within the first 3 h showed high sensitivity (Se) and specificity (Sp) (threshold at 25th percentile: Se 0.87, Sp 0.55; threshold at 75th percentile: Se 0.28, Sp 0.99).

CONCLUSIONS

A combination of biomarkers including caspase-3 and d-dimer appears to be the most promising to achieve a rapid biochemical diagnosis of stroke. If replicated, this approach could be used as a tool for urgent referral of stroke patients to hospitals in which acute treatments are available.

Adherence to the Mediterranean diet and risk of metabolic syndrome and its components

BACKGROUND AND AIMS

The role of diet in the aetiology of metabolic syndrome (MetS) is not well understood. The aim of the present study was to evaluate the relationship between adherence to the Mediterranean diet (MedDiet) and MetS.

METHODS AND RESULTS

A cross-sectional study was conducted with 808 high cardiovascular risk participants of the Reus PREDIMED Centre. MetS was defined by the updated National Cholesterol and Education Program Adult Treatment Panel III criteria. An inverse association between quartiles of adherence to the MedDiet (14-point score) and the prevalence of MetS (P for trend<0.001) was observed. After adjusting for age, sex, total energy intake, smoking status and physical activity, participants with the highest score of adherence to the MedDiet (>/=9 points) had the lowest odds ratio of having MetS (OR [95% CI] of 0.44 [0.27-0.70]) compared to those in the lowest quartile. Participants with the highest MedDiet adherence had 47 and 54% lower odds of having low HDL-c and hypertriglyceridemia MetS criteria, respectively, than those in the lowest quartile. Some components of the MedDiet, such as olive oil, legumes and red wine were associated with lower prevalence of MetS.

CONCLUSION

Higher adherence to a Mediterranean diet is associated with a significantly lower odds ratio of having MetS in a population with a high risk of cardiovascular disease.

Influence of the Purification of Sodium Dodecyl Sulfate on the Physical Properties of Solutions and O/W Emulsions

The effect of the purification of sodium dodecyl sulfate (SDS) has been studied in aqueous solutions and in o/w emulsions. The physical properties (surface tension, conductivity, light dispersion, viscosity, and granulometry) depend on the degree of purity of surfactant. This effect is less important within the emulsion technology when thickener or cosurfactant agents are added to the emulsion.

Dental casting alloys behaviour during power toothbrushing with toothpastes with various abrasivities. Part I: wear behavior

The purpose of this study was to evaluate the long term effect of abrasivity of toothpastes normally used over the surface and mechanical properties of dental casting alloys. Three dental casting alloys (Ni-Cr, Co-Cr, c.p. Ti) and one ceramic were chosen. Four specimens of each material were immersed in artificial saliva, brushed without or with one of four toothpastes of different Relative Dentine Abrasivity (RDA 50, 52, 80, and 114). An electric toothbrush with a load of 250 g was used for 420 min. Mass loss was determined by difference in weight, microhardness and surface roughness were also measured. Two-way ANOVA and non-parametric tests were used to detect significant differences. Titanium specimens (478 microg/cm(2)) exhibited the most mass loss, whereas ceramic (282 microg/cm(2)) and Co-Cr (262 microg/cm(2)) exhibited the least. However, ceramic demonstrated the most volume loss (0.239 mm(3)). The abrasivity effect of the toothpaste correlated with the RDA values. Slight variations in microhardness were observed after toothbrushing and depended on the material but not on the toothpaste used. Material surfaces were slightly smoothed by toothbrushing but no significant differences were detected. Dental casting alloys and ceramic are susceptible to abrasion by brushing with an electric toothbrush depending on the RDA value of the toothpaste. Variations in microhardness and surface roughness were not clinically relevant.

Dental casting alloys behaviour during power toothbrushing with toothpastes of various abrasivities. Part II: corrosion and ion release

The purpose of this study was to evaluate the long term effect of abrasivity of toothpastes normally used over the corrosion behavior and ion release of the different dental casting alloys. Three dental casting alloys (Ni-Cr, Co-Cr and commercially pure Ti) were studied. Four specimens of each material were immersed, brushed without paste or brushed with one of four toothpastes of different Relative Dentine Abrasivity (RDA 50, 52, 80, and 114). An electric toothbrush with a load of 250 g was used for 420 min. Corrosion behavior was determined by means a potenciostat with high sensitivity and the ion release determined by Inductively Coupled Plasma-Mass Spectrometry. Two-way ANOVA and non-parametric tests were used to detect significant differences. Titanium specimens exhibited the best corrosion behavior after and before the toothbrushed, being the worst of the three alloys the Cr-Ni. Titanium oxide produced spontaneously on the Ti surface is the main cause of the high corrosion resistance of the material. However, the eutectoid of the CrNi with chemical composition between different phases produces pitting on the phases boundaries with an important decrease of the corrosion resistance. Besides, the CrNi produces high values of the Ni and Cr release. Slight increment in roughness were observed after toothbrushing and depended on the material but not on the toothpaste used. The increase of the microhardness (residual stresses) provokes a decrease of the corrosion resistance and an increase of the ion release.

Severe alterations in expression and localisation of {alpha}6{beta}4 integrin in salivary gland acini from patients with Sjogren syndrome

OBJECTIVES

In salivary glands from patients with Sjögren syndrome, overexpression of laminins 1 and 5 and disorganisation of the acinar basal lamina have been reported. Laminin 5 mediates association of the basal lamina with epithelial cells by forming adhesion complexes upon interaction with alpha6beta4 integrin. In the present work, mRNA and protein levels of alpha6beta4 integrin were determined and its localisation in salivary glands evaluated in patients with Sjögren syndrome.

METHODS

Salivary glands of 12 patients with Sjögren syndrome and 8 controls were studied. The mRNA and protein levels of alpha6beta4 were determined by semiquantitative reverse transcriptase (RT)-PCR and western blot analysis, respectively. The subcellular localisation of alpha6beta4 and laminin were evaluated by confocal microscopy.

RESULTS

In patients, no significant differences in alpha6 and beta4 mRNA levels were detected. However, beta4 integrin protein levels were significantly lower, whereas, changes in alpha6, were highly variable. In controls, alpha6beta4 was detected in the basolateral and basal surface of serous and mucous acini, respectively. In patients, alterations in alpha6beta4 distribution were particularly dramatic for acini with strong basal lamina disorganisation. alpha6beta4 was also detected in the cytoplasm and lateral plasma membrane in serous and mucous acini.

CONCLUSION

Mild alterations in the basal lamina correlated with lateral redistribution of alpha6beta4 integrin and the formation of new cell-cell adhesions that help maintain acinar organisation and promote cell survival. Conversely, in cases with severe basal lamina alterations, lateral alpha6beta4 redistribution was no longer sufficient to maintain acinar cell survival. Thus, maintenance of equilibrium between cell-cell and cell-basal lamina attachment is required to sustain gland cell survival.

Vitamin A active metabolite, all-trans retinoic acid, induces spinal cord sensitization. I. Effects after oral administration

BACKGROUND AND PURPOSE

Retinoic acid is an active metabolite of vitamin A involved in the modulation of the inflammatory and nociceptive responses. The aim of the present study was to analyze the properties of spinal cord neuronal responses of male Wistar rats treated with all-trans retinoic acid (ATRA) p.o. in the normal situation and under carrageenan-induced inflammation. We also studied the expression and distribution of cyclooxygenases (COX) in the spinal cord.

EXPERIMENTAL APPROACH

Properties of spinal cord neurons were studied by means of the single motor unit technique. The expression of COX enzymes in the spinal cord was assessed by Western blot analysis and immunohistochemistry.

KEY RESULTS

Intensity thresholds for mechanical and electrical stimulation (C-fibers) were significantly lower in animals treated with ATRA than vehicle, either in normal rats or in rats with inflammation. The size of cutaneous receptive fields was also larger in animals treated with ATRA in the normal and inflammatory conditions. The expression of COX-2 enzyme, but not COX-1, was significantly higher in animals treated with ATRA. COX-2 labeling was observed in dorsal horn cells and in ventral horn motoneurons.

CONCLUSIONS AND IMPLICATIONS

In conclusion, the oral treatment with ATRA in rats induces a sensitization-like effect on spinal cord neuronal responses similar to that observed in animals with inflammation and might explain the enhancement of allodynia and hyperalgesia observed in previously published behavioral experiments. The mechanism of action involves an over-expression of COX-2, but not COX-1, in dorsal and ventral horn areas of the lumbar spinal cord.

Basal lamina disorganisation of the acini and ducts of labial salivary glands from patients with Sjogren's syndrome: association with mononuclear cell infiltration

OBJECTIVE

To study the expression of laminin and type IV collagen as biomarkers of the organisation of the basal lamina of acini and ducts in labial salivary glands from patients with Sjögren's syndrome, and to relate this organisation to inflammatory cell invasion of acini and ducts.

METHODS

Immunohistochemistry for laminin and type IV collagen was undertaken on sections of labial salivary glands from 30 patients with Sjögren's syndrome, 10 control subjects, and 24 controls with chronic sialoadenitis. Immunohistochemistry reaction, alterations to cell morphology, and the presence of inflammatory cells in acini and ducts were evaluated and scored using a semiquantitative method.

RESULTS

Changes in the expression of laminin and type IV collagen in the basal lamina of acini and ducts of labial salivary glands from patients with Sjögren's syndrome were more pronounced than in labial salivary glands from control groups. A remarkable characteristic was the disorganisation of the basal lamina in the labial salivary glands in Sjögren's syndrome. The pattern of immunoreactivity of the basal lamina of other structures (for example, blood vessels) did not change. In Sjögren's syndrome, invasion of cytotoxic T lymphocytes was only observed in acini and ducts which had a disorganised basal lamina.

CONCLUSIONS

The high state of disorganisation of the basal lamina of acini and ducts could allow invasion of cytotoxic T lymphocytes in Sjögren's syndrome, contributing to cell death and ductal hyperplasia.

Quantitative trait loci governing carotenoid concentration and weight in seeds of chickpea (Cicer arietinum L.)

Chickpea is a staple protein source in many Asian and Middle Eastern countries. The seeds contain carotenoids such as beta-carotene, cryptoxanthin, lutein and zeaxanthin in amounts above the engineered beta-carotene-containing "golden rice" level. Thus, breeding for high carotenoid concentration in seeds is of nutritional, socio-economic, and economic importance. To study the genetics governing seed carotenoids in chickpea, we studied the relationship between seed weight and concentrations of beta-carotene and lutein by means of high-performance liquid chromatography in segregating progeny from a cross between an Israeli cultivar and wild Cicer reticulatum Ladiz. Seeds of the cross progeny varied with respect to their carotenoid concentration (heritability estimates ranged from 0.5 to 0.9), and a negative genetic correlation was found between mean seed weight and carotenoid concentration in the F(3). To determine the loci responsible for the genetic variation observed, the population was genotyped using 91 sequence tagged microsatellite site markers and two CytP450 markers to generate a genetic map consisting of nine linkage groups and a total length of 344.6 cM. Using quantitative data collected for beta-carotene and lutein concentration and seed weight of the seeds of the F(2) population, we were able to identify quantitative trait loci (QTLs) by interval mapping. At a LOD score of 2, four QTLs for beta-carotene concentration, a single QTL for lutein concentration and three QTLs for seed weight were detected. The results of this investigation may assist in improving the nutritional quality of chickpea.

The oral administration of retinoic acid enhances nociceptive withdrawal reflexes in rats with soft-tissue inflammation

OBJECTIVE AND DESIGN

To study the involvement of all-trans retinoic acid (ATRA) in the development and maintenance of inflammatory pain.

SUBJECTS

Adult male Wistar rats and murine neuro2a and human SH-SY5Y neuroblastoma cells.

TREATMENT

Soft-tissue inflammation was induced by the intraplantar administration of 100 microl of carrageenan lambda. The oral treatment with either ATRA or vehicle lasted for seven days and consisted in a dose of 15 mg/kg the first two days and a dose of 10 mg/kg the following five days. Neuroblastoma cells were incubated for 16 h with ATRA.

METHODS

Rats were tested twice daily for intensity and evolution of withdrawal reflexes evoked by mechanical and thermal stimulation. The expression of COX enzymes was studied in spinal cords and neuroblastoma cells by western blot.

RESULTS

The animals treated with ATRA showed a significantly more intense development of mechanical allodynia (p < 0.01), mechanical hyperalgesia (p < 0.01), thermal hyperalgesia (p < 0.001) and reduction of threshold for mechanical (29 +/- 4 vs. 60 +/- 6 mN, p < 0.001) and thermal stimulation (12 +/- 0.3 vs. 8.4 +/- 0.3 s, p < 0.001) than control animals. Recovery to mechanical baseline data was slower in animals treated with ATRA, the main difference was observed in the test carried out on day 2, p.m. In neuroblastoma cells incubated with ATRA, a concentration-dependent increase in the expression of COX-2 protein was observed. Changes in the expression of COX-1 enzyme were not clear. An increase in COX-2 expression in the lumbar spinal cord was also observed in animals treated with ATRA.

CONCLUSIONS

A clear relationship between the oral administration of ATRA and an enhancement of the nociceptive withdrawal reflexes was observed in rats. This relationship was associated with an increment of the expression of the COX-2 enzyme.

[Role of homocysteine in the acute phase of stroke]

INTRODUCTION

Hyperhomocysteinemia is a well known vascular risk factor. However its action mechanism and its role in the acute phase of stroke have not been determined.

OBJECTIVES

To study plasmatic homocysteine levels in the acute stroke of different etiologies and evaluate its role as a prognostic factor.

METHODS

We determined plasmatic homocysteine in 136 consecutive patients with stroke. Mean time from symptoms onset was 4.6 hours.

RESULTS

Higher than normal homocysteine levels were found in ischemic stroke (n= 119 13.1 micromol/l; 43 % of patients > normality rank) and intracranial hemorrhage (n= 17 micromol/l; 24 % of patients > normality rank). The etiological distribution of ischemic stroke was the following: 42 cardioembolic (29.4%; median Hcy: 13.1 micromol/l), 20 atherothrombotic (14 %; Hcy: 12.7 micromol/l), 33 lacunar (23.1 %; Hcy: 11.8 micromol/l) and 24 undetermined (16.8%; Hcy:15.2 micromol/l). No significant differences were found between these groups (p=0.19). Those patients who presented early neurological deterioration presented higher homocysteine levels than those who remained stable or improved (median 13.3 n=16 v 11.3 n=113; p=0.061).

CONCLUSIONS

High homocysteine levels are associated to all etiologic stroke subtypes and intracranial hemorrhage. Patients who experienced early neurological worsening tend to have higher homocysteine levels.

Expression of inducible cAMP early repressor is coupled to the cAMP-protein kinase A signaling pathway in osteoblasts

We previously showed that parathyroid hormone (PTH) induces inducible cAMP early repressor (ICER) in osteoblastic cells and mouse calvariae. PTH signaling in osteoblastic cells is transduced by PTH receptor 1, which is coupled to cAMP-protein kinase A (PKA), protein kinase C (PKC), and calcium signaling pathways. In the present study, we examined the role of these pathways in mediating PTH-induced ICER mRNA and protein expression in osteoblastic MC3T3-E1 cells. Using RT-PCR, we found that PTH(1-34), forskolin (FSK), and 8-bromo-cAMP (8Br-cAMP) induced ICER expression, while phorbol myristate acetate (PMA), ionomycin, and PTH(3-34) did not. Similar results were found for the induction of ICER protein. PKA inhibition by H89 markedly reduced PTH- and FSK-induced ICER expression, while PKC depletion by PMA had little effect. We also tested ICER induction by other osteotropic signaling agonists. Other cAMP-PKA pathway activators, such as PTH-related protein (PTHrP), induced ICER expression, while agents that signal through other pathways did not. PTHrP maximally induced ICER mRNA at 2-4 h, which then returned to baseline by 10 h. Finally, PTH, FSK, and PTHrP induced ICER in cultured mouse calvariae and osteoblastic ROS 17/2.8, UMR-106, and Pyla cells. We conclude that ICER expression in osteoblasts requires activation of the cAMP-PKA signaling pathway.

[Migraine and MIDAS (MIDASELA) in Colombian hospital workers]

AIMS

The aim of this study was to determine the prevalence of migraine and its implications in the occupational and outside employment/daily activities of the workers at a regional hospital in the Cundiboyacense Plateau in Colombia.

PATIENTS AND METHODS

The available members of the house staff at this institution were interviewed by applying the neuroepidemiological protocol drawn up by the World Health Organization (WHO); general doctors performed the initial screening and the determination of neurological disease was carried out by a clinical neurologist, both in patients who were positive and negative for neurological disease. Quality of life was evaluated by means of the MIDAS (Migraine Disability Assessment) survey, MIDASELA (in Spanish for Latin America); the analysis was performed using the EPI 6.04 software application.

RESULTS

A total of 238 people were studied: 188 females and 50 males; the prevalence of migraine was 22.5% (15.5% by the WHO protocol and 7% false negatives), with predominance in females (OR: 5.49; p< 0.005). In the MIDASELA questionnaire, 47.2% of the patients had a 50% alteration in their productivity, with regard to their occupational and outside employment/daily activities. A minimum number of patients (3.8%) were unable to work because of migraine, as compared to the figures for outside employment/daily activities (29.7%) or those involving leisure/family (66.4%). The average work, outside employment/daily and family time lost per patient because of migraine was 0.3, 2 and 5.2 days, respectively.

CONCLUSION

A sub register in the prevalence of migraine could be reported in places where the WHO protocol is used. This pathology will have to be taken well into account in Colombian hospital workers due to its individual, occupational, family, social and economic impact. It is necessary to introduce health policies and programmes aimed at evaluating, controlling and treating this type of pathology in an appropriate manner, in order to improve the quality of life of those whose job it is to look after and improve that of the other Colombians.

Metabolism of a novel nucleoside analogue, OGT 719, in the isolated perfused rat liver model, in rats, in tumour models and in patients

1. The metabolic pathway(s) of OGT 719, a novel nucleoside analogue in which galactose is covalently attached to the N1 of 5-fluorouracil (FU), have been investigated with (19)F-NMR spectroscopy in (1) the isolated perfused rat liver (IPRL) model, (2) normal rats, (3) rats bearing the HSN LV10 sarcoma, (4) nude mice xenografted with the human hepatoma HepG2 and (5) urine from patients. 2. The administration of OGT 719 results in the formation of small amounts of FU. IPRL experiments with OGT 719 in combination with asialofetuin, a natural asialoglycoprotein receptor (ASGP-r), suggest competitive binding of OGT 719 to the ASGP-r. 3. The data obtained in non-tumour rats also demonstrated an extremely low metabolization of OGT 719 into FU and alpha-fluoro-beta-alanine, the well-known major metabolite of FU. 4. A comparison of tumour extracts from rats bearing the HSN LV10 sarcoma treated with FU or OGT 719 showed the incorporation of FU into RNA in rats treated with FU but not in rats treated with OGT 719; nevertheless, the incorporation of FU into RNA was observed in the liver from rats treated with OGT 719. 5. In a human hepatoma xenografted to nude mice, both the OGT 719 and FU contents of the tumour were markedly higher than in the corresponding liver, suggesting a tumour-specific trapping of OGT 719 in hepatoma. 6. The metabolism of OGT 719 was also extremely low in patients. 7. In conclusion, the present study shows the value of (19)F-NMR for demonstrating for the first time that OGT 719 is a prodrug of FU although very poorly metabolized.

[Chronic subdural hematoma simulating a TIA. Implications for the management transient neurological deficit]

Chronic subdural hematoma that generally happens after cranial trauma doesn't have clinical manifestations until days or weeks after the traumatism. Due to the lesions nature, symptoms are almost always progressive and presentation as transient ischemic attacks (TIA) is very uncommon. We describe 2 cases of chronic subdural hematoma that started simulating TIA and we discuss its implications in the management of those patients who had presented transient neurological deficit.

Selecting the target and the message for a stroke public education campaign: a local survey conducted by neurologists

In order to determine the baseline knowledge of stroke among population (terminology, signs and symptoms, risk factors (RF) and attitude) to select the best target and message, prior to educational campaigns, a structured interview using close-ended questions was conducted by neurologists among 1000 users of several Primary Health Centers around our Hospital, randomly sampled. In our population 10.1% totally ignores the disease; of the remainder, 50% has a good knowledge of signs and symptoms and 37% of RF. To be a woman, (OR: 1.7; 95% CI: 1.2-2.5), the university education (OR: 6.6; 95% CI: 3.0-14.7), the age between 45 and 65 years (OR: 2.5; 95% CI: 1.3-5.0) and to have an afflicted relative (OR: 1.4; 95% CI: 1.001-2.0) are associated with a better stroke knowledge. If symptoms are transient, there is a trend to contact primary physicians (43.5%). Less than a quarter of our population have a good knowledge of the disease. Stroke is considered an emergency unlike TIA. The benefits of public education and the best message for each target population are discussed.