Polymorphism Trp64Arg of beta 3 adrenoreceptor gene: allelic frequencies and influence on insulin resistance in a multicenter study of Castilla-León

BACKGROUND AND OBJECTIVE

The genetic variant (Trp64Arg) is a missense mutation located within the beta3 adrenoreceptor (Beta3AR). The aim of our study was to investigate the influence of Trp64Arg polymorphism in the Beta3AR gene on insulin resistance in obese patients and the allelic distribution of this polymorphismin a geographic area of Spain.

DESIGN

A population of 264 obese patients was analyzed. A bioimpedance, blood pressure, an assessment of nutritional intake, and biochemical parameters were measured. The beta 3 adrenoreceptor gene polymorphism(Trp64Arg) was genotyped.

RESULTS

Two hundred and twenty six patients (77 males/149 females) (85.6%) had the genotype Trp64/Trp64 (wild type group) with and average age of 41.12 +/- 13.1 years and 38 patients (16 males/22 females) Trp64/Arg64 (14.4%) (mutant type group) with an average age of 40.5 +/- 12.7 years. High frequencies of Arg64 allele were observed in Salamanca and Valladolid. In the mutant type group, HOMA (3.75 +/- 2.77 vs 5.27 +/- 5.4; p < 0.05) was higher than wild type group.

CONCLUSION

The finding of this study is the association of the Trp64/Arg64 Beta3AR with higher levels of HOMA. Frequencies of this polymorphism are different among geographic areas.

[Anesthesia for cesarean section in a patient with recessive dystrophic epidermolysis bullosa]

Recessive dystrophic epidermolysis bullosa is inherited as a rare autosomal disorder which causes blisters to form in the skin. We describe the treatment of a 39-year-old parturient with this condition. She was scheduled for elective cesarean section at 37 weeks' gestation. The patient had widespread skin lesions, had lost fingers, and had esophageal stenosis. The cesarean was performed under spinal anesthesia without complications. Recessive dystrophic epidermolysis bullosa requires adaptation of anesthetic technique that includes control over posture and careful handling of the skin. Material for attaching monitoring devices and inserting venous lines must be adapted to the particular deformities and skin lesions present.

Effects of plane of nutrition of ewes in early and mid-pregnancy on performance of the offspring: female reproduction and male carcass characteristics

This study investigated the effects of different planes of nutrition in early pregnancy (EP) and mid-pregnancy (MP) of crossbred ewes on carcass characteristics of male offspring and reproductive performance of female offspring. During EP (d 1 to 39 after synchronized mating) ewes were allocated 60% (low, L-EP), 100% (medium, M-EP), or 200% (high, H-EP) of their energy requirements for maintenance. Between d 40 and 90 (MP), ewes were then allocated 80% (M-MP) or 140% (H-MP) of their maintenance energy requirement. After d 90, all ewes were fed to fully meet energy requirements for late pregnancy. Male offspring (n = 83) were reared on a grass-based system and slaughtered at 42, 46, or 50 kg of BW. Female offspring (n = 60) were reared on a grass-based system, mated at 8 mo, and performance recorded until weaning of their first lamb crop. Concentrations of leptin, an adiposity indicator, in female offspring varied with the plane of maternal nutrition in early pregnancy. The L-EP offspring had greater leptin concentrations than H-EP offspring (P = 0.04), with M-EP offspring showing intermediate concentrations. Reproductive performance of female offspring was not affected by maternal plane of nutrition (P > or = 0.16). Female H-EP offspring gave birth to heavier lambs (generation 2 offspring) than M-EP (P = 0.006) with L-EP offspring intermediate. Male offspring of L-EP dams showed a trend toward poorer carcass conformation (P = 0.06) and increased fat classification (P = 0.07), consistent with increased fat depths over the loin (P = 0.02). There was a significant interaction between plane of nutrition in early pregnancy and mid-pregnancy for female offspring BW at 2 mo postmating and 16 wk postlambing (P < or = 0.04), and for male offspring perinephric and retroperitoneal fat and tissue depth (P < or = 0.02). For dams offered diet L-EP during early pregnancy, diet H-MP gave heavier offspring with more perinephric and retroperitoneal fat. In contrast, for dams offered diet H-EP during EP, diet M-MP gave offspring that were heavier or fatter or both. Maintenance level of nutrition in EP followed by M-MP or H-MP treatments resulted in offspring intermediate in fatness and BW. The data indicate that adaptations in EP and MP to compensate for nutritional deprivation or nutritional excess can alter the BW, adiposity, conformation, and leptin concentrations of offspring. Such changes have potential to alter health and lifetime productive performance.

Identification and characterization of novel uroporphyrinogen decarboxylase gene mutations in a large series of porphyria cutanea tarda patients and relatives

Porphyria cutanea tarda (PCT) arises from decreased hepatic activity of uroporphyrinogen decarboxylase (UROD). Both genetic and environmental factors interplay in the precipitation of clinically overt PCT, but these factors may vary between different geographic areas. Decreased activity of UROD in erythrocytes was used to identify patients with UROD mutations among a group of 130 Spanish PCT patients. Nineteen patients (14.6%) were found to harbor a mutation in the UROD gene. Eight mutations were novel: M1I, 5del10, A22V, D79N, F84I, Q116X, T141I and Y182C. Five others were previously described: F46L, V134Q, R142Q, P150L and E218G. The new missense mutations and P150L were expressed in Escherichia coli. D79N and P150L resulted in proteins that were localized to inclusion bodies. The other mutations produced recombinant proteins that were purified and showed reduced activity (range: 2.3-73.2% of wild type). These single amino acid changes were predicted to produce complex structural alterations and/or reduced stability of the enzyme. Screening of relatives of the probands showed that 37.5% of mutation carriers demonstrated increased urinary porphyrins. This study emphasizes the role of UROD mutations as a strong risk factor for PCT even in areas where environmental factors (hepatitis C virus) have been shown to be highly associated with the disease.

Effect of supplementation with barium selenate on the fertility, prolificacy and lambing performance of hill sheep

Six weeks before mating, the ewes on six hill farms were randomly assigned to receive either a subcutaneous injection of a long-acting supplement containing 50 mg/ml selenium as barium selenate, or no injected selenium. Before the treatment, the mean activity of glutathione peroxidase (GSHPx) in the ewes on the six farms ranged from 166 to 592 U/g haemoglobin (Hb) and their plasma selenium concentrations ranged from 0.60 to 1.61 micromol/l. Treated ewes had higher plasma selenium concentrations and higher GSHPx activities than control ewes during the study. Conception rates were higher in the treated ewes than in the control ewes. At six weeks, the lambs born to the treated ewes had higher plasma selenium and GSHPx levels than the controls. The treated ewes reared 9 per cent more lambs than the control ewes. The treated ewes had lower abortion rates, and higher liveweights and body condition scores than the controls. There were weak but positive associations between the plasma selenium and GSHPx levels of the ewes and their reproductive performance.

Effects of the AMPA receptor modulator S 18986 on measures of cognition and oxidative stress in aged rats

RATIONALE

Development of cognitive-enhancing drugs that delay or halt mild cognitive impairment progression to Alzheimer's disease would be of great benefit.

OBJECTIVES

The aim of this study was to examine the ability of (S)-2,3-dihydro-[3,4]-cyclopentano-1,2,4-benzothiadiazine-1,1-dioxide (S 18986), a positive allosteric modulator of alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptors, to improve behavioral performance and alleviate age-related deficits in oxidative stress status in the prelimbic cortex and hippocampus.

MATERIALS AND METHODS

Daily administration of S 18986 (0.1, 0.3, and 1.0 mg/kg) or vehicle was given to separate groups of male rats starting at 12 months of age. Additionally, daily vehicle administration was given to a group of rats starting at 3 months of age. Four months after initiation of drug administration, rats were trained and tested in an operant-delayed alternation task and a reinforcer devaluation task. Upon completion of testing, oxidative stress status was assessed in the prelimbic cortex and hippocampus.

RESULTS

S 18986 dose-dependently altered responses in the reinforcer devaluation task such that aged rats came to resemble young rats. There were no age or drug effects in the operant-delayed alternation task. Levels of the lipid peroxidation product 4-hydroxy-nonenal (HNE) were increased, and Cu/Zn-superoxide dismutase (SOD) levels were decreased in prelimbic cortex in aged rats, changes that were reversed by S 18986. Similarly, age-related increases in hippocampal HNE levels were prevented by S 18986.

CONCLUSIONS

Positive modulation of AMPA receptor activity may be a therapeutic approach to halt or slow progression of mild cognitive impairment via improvement in oxidative stress status in the hippocampus and prelimbic cortex.

Sliding mode control of dissolved oxygen in an integrated nitrogen removal process in a sequencing batch reactor (SBR)

This paper presents a sliding mode controller (SMC) for dissolved oxygen (DO) in an integrated nitrogen removal process carried out in a suspended biomass sequencing batch reactor (SBR). The SMC performance was compared against an auto-tuning PI controller with parameters adjusted at the beginning of the batch cycle. A method for cancelling the slow DO sensor dynamics was implemented by using a first order model of the sensor. Tests in a lab-scale reactor showed that the SMC offers a better disturbance rejection capability than the auto-tuning PI controller, furthermore providing reasonable performance in a wide range of operation. Thus, SMC becomes an effective robust nonlinear tool to the DO control in this process, being also simple from a computational point of view, allowing its implementation in devices such as industrial programmable logic controllers (PLCs).

Mercury biomethylation assessment in the estuary of Bilbao (North of Spain)

The relationship between the microbial methylation of mercury and the microbial activities in sediments and water collected from the estuary of Bilbao (North of Spain) was studied in three different sampling points and in two different seasons. Three different cultures were prepared with a sediment slurry to distinguish between biotic and abiotic methylation pathways and the variations of the methylmercury concentration and the variations of the population of total number of bacteria (TDC), anaerobic heterotrophic bacteria (AHB), sulphate-reducing bacteria (SRB) and Desulfovibrio were measured. From this work, it can be concluded that the variation of MeHg concentrations is a result of the methylation/demethylation processes in the sediments, and that the abiotic processes have a negligible contribution to those processes. According to the statistical analysis of the results (partial least squares analysis) a significant statistical correlation was established between methylmercury and the SRB counts.

Deregulated expression of miR-106a predicts survival in human colon cancer patients

MicroRNAs (miRNAs) are noncoding RNAs that regulate expression of target mRNAs and are controlled by tumor suppressors and oncogenes. Altered expression of specific miRNAs in several tumor types and its association with poor prognosis parameters have been reported. Fewer data are available on its impact on patients' survival. We studied the impact of the expression of miR-17-5p, miR-106a, and miR-126 on survival and its correlation with the levels of their target mRNAs and host gene and TP53 alterations. We assessed in 110 colon cancer patients the levels of miR-17-5p, miR-106a, miR-126, E2F1, and EGFL7 by quantitative real-time RT-PCR and loss of heterozygosity (LOH) in the TP53 region. Tumor characteristics, disease-free survival (DFS), and overall survival (OS) were examined in each patient. Altered expression of miR-17-5p, miR-106a, and EGFL7 was associated with pathological tumor features of poor prognosis. Downregulation of miR-106a predicted shortened DFS (P = 0.03) and OS (P = 0.04). miR-17-5p correlated with DFS only at early stages (P = 0.07). Inverse correlations were found between miR-17-5p and miR-106a levels and their target expression, E2F1 (P = 0.04 and P = 0.03, respectively). No correlation was found between miR-126 expression and its host gene levels, EGFL7. miR-106a deregulation was revealed as a marker of DFS and OS independent of tumor stage. The lack of association between expression of miR-126 and its host gene EGFL7 suggests their regulation by independent stimuli. Inverse correlation between miR-17-5p and miR-106a and E2F1 levels supports E2F1 as a target mRNA for the two miRNAs.

[Prevalence of mild cognitive impairment, amnestic-type, in a Colombian population]

INTRODUCTION

Mild cognitive impairment (MCI) is a clinical syndrome that presents with memory disorders, normal general cognition, and no compromise of activities of daily living or dementia. Its diagnosis has important clinical implications, since it behaves as a possible predictor of cognitive disorders that would suggest the onset of dementia. Amnestic-type MCI is considered to be a stage prior to Alzheimer-type dementia. The prevalence of MCI varies from 1-29% and the existence of this diagnosis implies a risk of presenting dementia at 12% per year.

AIM

To establish the prevalence of amnestic-type MCI in a group of persons over the age of 50 years from the Valle de Aburra.

PATIENTS AND METHODS

The sample was made up of 848 participants of both genders, over 50 years old, who lived in the metropolitan area of Medellin and had different socioeconomic and educational levels. Amnestic MCI was diagnosed according to the criteria proposed by the American Academy of Neurology.

RESULTS

Prevalence of amnestic MCI was 9.7%, and was more predominant in males (p = 0.01) than in females. The prevalence was significantly lower in the group with more than 12 years of schooling (p < 0.05), and no significant differences in the prevalence were found in relation to age or economic status.

CONCLUSION

The prevalence of amnestic MCI, 9.7%, found in our study is within the range reported by other researchers.

[Validity and reliability of the CERAD-Col neuropsychological battery]

INTRODUCTION

Alzheimer's disease (AD) is an important public health problem due to its disabling character and high individual, familial and social costs. The CERAD neuropsychological battery has been widely used for evaluation and diagnosis of the cognitive deficit associated with AD. This instrument has been adapted to the Colombian culture (CERAD-Col) for the Neurosciences Group.

SUBJECTS AND METHODS

A study was carried out to establish the validity and reliability of the CERAD-Col in Colombian, Spanish-speaking individuals aged 50 years or more. It included 151 controls and 151 AD patients. Controls were selected from a convenience sample of 848 adults aged 50 years or more. The construct validity was determined in three ways: 1) factorial analysis; 2) correlation with the functional scales FAST and GDS (convergent-type validity) and, 3) comparison between the two groups. Internal consistency was determined by means of Cronbach's alpha coefficient.

RESULTS

Three factors -memory, language and praxis- explained 88% of the total variance. Moderate but statistically significant correlations were found between neuropsychological tests and functional scales. Internal consistency and test-retest reproducibility were high. The AD group exhibited significantly lower scores (p < 0.05) than the control one.

CONCLUSION

CERAD-Col is valid and reliable for the diagnosis of AD in Colombian Spanish-speaking population aged 50 years or more.

[Analysis of surgical treatment for nonmelanoma skin cancer performed by dermatologists in a public hospital: clinical-pathological correlation, use of hospital resources, and waiting list time from diagnosis]

BACKGROUND

Nonmelanoma skin cancer is the most common form of cancer in humans. It can be treated by a variety of specialists and using different techniques, surgical excision being the procedure associated with the lowest rates of recurrence. No studies have been published addressing differences in the management of surgical treatment for nonmelanoma skin cancer according to the specialties involved.

OBJECTIVES

To assess the preoperative diagnostic accuracy and the use of health care resources when surgical treatment of nonmelanoma skin cancer is done by dermatologists belonging to the Spanish national health service.

METHODS

A prospective observational study was carried out over a period of 36 months using data corresponding to all patients diagnosed with nonmelanoma skin cancer and treated surgically in the Dermatology Department of Complejo Hospitalario de Burgos, Spain. Data were analyzed for clinical-pathological correlation, complexity of the intervention, use of health care resources, and time elapsed between clinical diagnosis and surgery.

RESULTS

The study included 448 patients and 521 skin lesions suspected to be nonmelanoma skin cancer (basal cell carcinoma or squamous cell carcinoma). Diagnosis was exclusively clinical in 487 tumors and a clinical-pathological correlation of 84.39% was observed. Surgery was performed with local anesthesia in 96.42% of patients, although 111 (21.29%) required complex surgical repair. In 349 patients (77.90%) the procedure was performed on an outpatient basis, 73 (16.29%) required a short stay in the surgical day care unit, and 26 (5.80%) required hospital admission. The mean (SD) delay from clinical diagnosis to surgery was 68.44 (42.22) days, with a median delay of 60 days.

CONCLUSIONS

Dermatology specialists are highly qualified to diagnose malignant skin tumors and accurately identify those patients requiring surgery. Dermatological surgeons use minimal health care resources, shorten the overall length of the process, and help to control overall health care costs for cancer.

Comparison of single vs. multiple administrations of the AMPA receptors modulator S 18986 in the object recognition task in rats

The present study aimed at defining the best scheme of administration of the alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptor-positive modulator (S)-2,3-dihydro-[3,4]-cyclopentano-1,2,4-benzothiadiazine-1,1-dioxide (S 18986) [once daily (o.d.) administration of 1 mg/kg for 3 days vs. three times daily (t.i.d.) administration of 0.3 mg/kg for 3 days] to get an optimal procognitive activity in the object recognition task in rats. Memory performance [Recognition Index (RI)] of rats was significantly improved 1 h (RI = 41%, P < 0.01) and 3 h (RI = 46%, P < 0.001) following oral administration of S 18986 (1 mg/kg, o.d.) when compared with animals receiving the vehicle (RI = 6%). When the interval between administration and testing was increased to 6 h and 9 h, no statistically significant improvement in memory performance was observed (RI = 42% for 6 h and RI = 18% for 9 h vs. 20% for the vehicle group). When S 18986 was administered at 0.3 mg/kg t.i.d., no statistically significant improvement in memory performance was observed (RI = 36%). These findings show a long-lasting efficacy of the AMPA receptor allosteric modulator in the object recognition task despite a short half-life in plasma and in brain (approximately 1 h). Accordingly, multiple administrations of S 18986 are not required to obtain a maximal efficacy in this paradigm, because a o.d. schedule of administration leads to a powerful procognitive activity.

A Case of Hyper-reactive Malarial Splenomegaly. The Role of Rapid Antigen-detecting and PCR-based Tests

Hyper-reactive malarial splenomegaly (HMS) - originally referred to as tropical splenomegaly syndrome - is characterized by a massive splenomegaly, high titres of anti-malarial antibodies and polyclonal IgM hypergammaglobulinemia. It is believed to be a consequence of an aberrant immunological response to prolonged exposure to malarial parasites. Although it is a frequent disease in the tropics, it is infrequent in western countries and is only seen in long-term residents from endemic areas. We describe the case of a 67-year-old Spanish man, a missionary in Cameroon for 30 years, who presented with a clinical history that fulfilled the diagnosis of HMS. We discuss the role and importance of PCR-based techniques in demonstrating lowgrade malarial parasitemia and the usefulness of new rapid antigen-detecting dipstick tests.

Translocation of bacterial DNA from Gram-positive microorganisms is associated with a species-specific inflammatory response in serum and ascitic fluid of patients with cirrhosis

Translocation of bacterial-DNA in patients with cirrhosis and ascites triggers an innate immune response. Identification of characteristics to which this response is sensitive is relevant from a clinical standpoint. The aim of this study has been to determine if the proinflammatory immune response established in vivo in cirrhotic patients with ascites as a consequence of bacterial-DNA translocation is related to the identified bacterial species and their frequency of cytosine-guanosine content in serum and ascitic fluid. Patients with advanced cirrhosis and ascites were included in the study and distributed into groups I and II according to the absence or presence of bacterial-DNA translocation, respectively. Serum and ascitic fluid levels of proinflammatory cytokines after normalization of bacterial-DNA concentration and the activated form of nuclear factor-kappa B in ascitic fluid pellets were measured by enzyme-linked immunosorbent assay techniques. Translocation of bacterial-DNA with higher cytosine-guanosine content induced the highest cytokine response, which was higher than that in patients without bacterial-DNA translocation. The activated form of nuclear factor-kappa B in ascitic fluid pellets of patients with bacterial-DNA translocation was greater in patients with higher bacterial-DNA cytosine-guanosine content, whereas the amount of total nuclear factor-kappa B remained unaltered. Bacterial-DNA translocation induces a marked immune reaction in vivo in patients with advanced cirrhosis and ascites which is related, among other factors, to the bacterial-DNA cytosine-guanosine content. Therefore, the host's immune response to bacterial-DNA translocation constitutes a species-specific phenomenon.

Multiple furunculoid myiasis on the scalp of a child

Cutaneous myiasis is easy to diagnose and treat if clinicians are aware of the condition. Because of widespread travel, physicians may encounter this infestation in patients living in geographical regions where the condition is rare. A child is presented with cutaneous myiasis that presented as furuncle-like nodules on the scalp. The larvae were identified as a stage of the bluebottle-like fly, Dermatobia hominis.

Genetic studies in variegate porphyria in Spain. Identification of gene mutations and family study for carrier detection

BACKGROUND

First, to establish the mutations of the protoporphyrinogen-oxidase (PPOX) gene in four Spanish patients with variegate porphyria (VP). Second, study of carrier status detection in the families, including a four-generation Balearic family. Third, evaluation of the results of carrier detection screening methods.

DESIGN

Blood samples of four patients and of 139 members belonging to four families, including four generations of a Balearic family were processed for mutation analysis of the 13 exons of PPOX gene. Biochemical studies were performed together (blood and faecal porphyrin analysis) and plasma fluorescence scanning for 626 nm peak emission detection. A questionnaire regarding clinical manifestations was submitted to all family members studied.

RESULTS

Single strand conformational analysis (SSCP) of DNA allowed the detection of the following mutations: W224R, 746delT: exon 7, 1077-1082insC: exon 10, and IVS6+2T-->A. Mutation was present in 19 of the 139 members of the families studied. Clinical manifestations or biochemical alterations were checked in the carriers detected and found as not relevant or not present. Only 11 members of the 19 mutation-bearing individuals showed plasma fluorescence PV peak positivity.

CONCLUSION

Demonstration of gene mutation is the most reliable means of detecting carriers in studies of variegate porphyria families. DNA analysis is the most sensitive carrier detection method and also allows transmission behaviour of the genetic defect to be established in successive generations of the affected families.

Genetic and biochemical characterization of 16 acute intermittent porphyria cases with a high prevalence of the R173W mutation

Acute intermittent porphyria (AIP) is a metabolic disease with a variable prevalence among different countries. In some areas of southern Europe it remains to be fully evaluated. We undertook a genetic and biochemical study of 16 unrelated Spanish AIP patients and relatives. The genetic analyses showed they harboured the following mutations in the porphobilinogen deaminase gene: R173W, G111R, L278P, L238P, R116W, R26C, 340insT, 730delCT, 691del30bp, and IVS14+1g>a. The mutation R173W was found in 6 patients (37.5%), including the only patients of our series with >3 recurrent porphyria attacks. While in clinical remission, all AIP patients exhibited sustained increased excretion of porphyrins and precursors. PBG excretion showed a high between-subject variation and was not related to erythrocyte PBG deaminase activity. The study of family members allowed the identification of 22 asymptomatic AIP carriers. These included 8 persons harbouring the R173W mutation belonging to four different families. Six of these latent AIP subjects showed increased PBG elimination, and in two the urinary levels were >10-fold the normal limit. These results reinforce the hypothesis that the R173W mutation may have a high biochemical and clinical penetrance among AIP patients.

Proposal for a supersymmetric standard model

The fact that neutrinos are massive suggests that the minimal supersymmetric standard model (MSSM) might be extended in order to include three gauge-singlet neutrino superfields with Yukawa couplings of the type H2Lnuc. We propose to use these superfields to solve the mu problem of the MSSM without having to introduce an extra singlet superfield as in the case of the next-to-MSSM (NMSSM). In particular, terms of the type nuc H1H2 in the superpotential may carry out this task spontaneously through neutrino vacuum expectation values. In addition, terms of the type (nuc)3 avoid the presence of axions and generate effective Majorana masses for neutrinos at the electroweak scale. On the other hand, these terms break lepton number and R parity explicitly. For Dirac masses of the neutrinos of order 10(-4) GeV, eigenvalues reproducing the correct scale of neutrino masses are obtained.

Sustained virological response to peginterferon plus ribavirin in chronic hepatitis C genotype 1 patients is associated with a persistent Th1 immune response

BACKGROUND

An impairment of cellular immune response may contribute to the persistency of hepatitis C virus infection.

AIM

To analyse the Th1/Th2 cytokine profile in peripheral blood CD4(+) and CD8(+) T cells from patients with chronic hepatitis C (CHC) during treatment with pegylated interferon-alpha2a plus ribavirin and to correlate the Th1/Th2 balance with virological response (SVR).

METHODS

Prospective longitudinal study: 44 naïve genotype 1 CHC patients received PEG-IFNalpha2a plus ribavirin for 48 weeks: 26 (59.1%) achieved a SVR, 13 relapsed (29.5%) and 5 (11.4%) were non-responders. Sixteen healthy controls were analysed. The production of IL-4, IFNgamma and TNFalpha by CD4(+) and CD8(+) T cells was measured using flow cytometry, both in resting and phorbol-ester-stimulated cells.

RESULTS

First three months of treatment: the synthesis of TNFalpha by phorbol-ester-stimulated-CD4(+) T cells was higher in patients with SVR (P < 0.01). At the end of treatment, SVR was associated with higher intracellular expression of IFNgamma by stimulated-CD4(+) and CD8(+) T cells (P < 0.05). At the end of follow-up, a higher intracellular expression of IFNgamma by CD4(+) T cells was associated with a SVR.

CONCLUSIONS

A Th1-type immune response was associated with achievement of a SVR, as indicated by the persistent elevation of intracellular IFNgamma and TNFalpha.

Dihydropyrimidine dehydrogenases (DPYD), and cytidine-deaminase (CDA) gene polymorphisms as genomic predictors of clinical outcome in resected gastric cancer patients (GCP) treated with fluoropyrimidine-based adjuvant chemotherapy

4052

Background: Single nucleotide polymorphisms (SNPs) of DPYD gene induces DPD deficiency resulting in decreased activity of 5-fluorouracil derivatives in treatment of colorectal cancer patients (pts). In GCP has not been previously analysed. Methods: We analysed paraffin-embedded biopsies from 50 consecutive resected GCP who received adjuvant chemotherapy with four cycles of Mitomycin C (MMC), 20 mg/m2 iv day 1 plus oral Tegafur (TG), 500 mg/m2 day 1 to day 45 every six weeks, for SNPs of genes DPYD1 (A/G; Ile/Val), DPYD2 (C/T; Arg/Cys) and CDA (A/C; Lys/Gin). The status of alleles (wild type or at least 1 polymorphism) was correlated with outcome, overall survival (OS) and toxicity. Results: The status of SNPs frequencies according to the classification between wild type/non-wild type, were 36/14 in DPYD1; 26/24 in DPYD2; and 17/23 in CDA or between homozygous/heterozygous were 39/11 in DPYD1; 33/17 in DPYD2 and 26/24 in CDA respectively. After 77 months of median follow-up, 18 pts died of tumor relapse, (7 in peritoneum and 11 in distant organs). Difference in survival was observed in DPYD1 pts only, for non wild-type over wild-type (p = 0.0283) and in any of the 3 genes tested heterozygous over homozygous pts (p = 0.0463). In 10 pts (20%) total dose was reduced by toxicity (5 diarrhea, 2 neutropenia, 2 hepatotoxicity, 1 vomiting), only 3 of them were homozygous. Conclusions: SNPs of DPYD1, DPYD2 and CDA predict outcome, survival and toxicity of GCP treated with 5-FU-based adjuvant chemotherapy.

No significant financial relationships to disclose.

The value of colonoscopy to assess rectal bleeding in patients referred from Primary Care Units

OBJECTIVES

Rectal bleeding is very common in the general population. It is produced mainly because of benign disease originating in the anus and the rectum. Our aim was to evaluate the need for colonoscopy in patients presenting with rectal bleeding.

PATIENTS AND METHODS

Patients referred from Primary Care Units and complaining of rectal bleeding were included prospectively in a three-month study. All patients underwent a careful medical history along with physical examination, laboratory tests, and colonoscopy.

RESULTS

126 patients with a mean age of 49.2 years (range: 19-80) were studied. Rectal digital examination was abnormal in 75 cases (59.5%). Severe disease was encountered in 22 patients (neoplasm, angiodysplasia, and inflammatory bowel disease); 10 patients had polyps, 6 had colorectal cancer, and 6 had inflammatory bowel disease. Out of 63 patients younger than 50 years, 5 had severe disease, all of them in the form of inflammatory bowel disease.

CONCLUSIONS

A neoplasm of the rectum and colon in patients younger than 50 years is a rare event. A colonoscopy must be performed in this group of patients to rule out inflammatory bowel disease.

Prevalence and characteristics of smoking in primary healthcare workers in Iquique, Chile

OBJECTIVE

To determine the prevalence and characteristics of the smoking habits of primary healthcare workers in Iquique, Chile.

STUDY DESIGN

Cross-sectional study through a survey of all personnel working in primary health care in Iquique, Chile.

METHODS

The following variables were investigated: biodemographical characteristics and aspects of smoking, knowledge of the adverse effects of smoking, and some lifestyle factors.

RESULTS

Among the study population, a high prevalence of smokers was found (37%) and a further 26% were ex-smokers. The smokers were predominantly practical nurses, female, aged 25-45 years and married. The only significant relationship was between age and smoking habit (P=0.02), with smoking prevalence among younger groups being very high (56%). There was a high level of awareness about the adverse effects of smoking and its addictiveness (99 and 93%, respectively). Forty-three percent of participants had been smoking for more than 15 years, and the main reasons for smoking were 'social consumption' and 'stress' (36 and 29%, respectively). Thirty-two percent of the ex-smokers ceased smoking for discomfort or health reasons. There were no differences between smokers and ex-smokers with respect to participation in sports or working shifts. Fifty-two percent of those surveyed reported they they were annoyed when others smoked near them.

CONCLUSION

This study revealed a high prevalence of smoking, particularly among practical nurses. Regarding attitudes to health, a dichotomy between knowledge and behaviour was found in this group. In pursuing the commitment to smoking cessation in healthcare personnel, a deeper review of cultural issues and motivation should be considered.

[Current status of clinical nutrition at the network of public hospitals from Castilla y León]

INTRODUCTION

Clinical nutrition is an activity realized in most of Health Centres of France, Canada, Great Britain and USA. The aim of our work was to determine activity and resources of Nutrition Units of Hospitals in the Community of Castilla y León.

MATERIAL AND METHODS

A questionnaire was send to all Hospitals of Castilla y León (SACYL); Hospital Universitario Rio Hortega, Hospital Clinico Universitario, Hospital Comarcal de Medina del Campo, Hospital General Yagüe-Divino Vallés (Burgos), Complejo Hospitalario de Le6n, Hospital General de Segovia, Hospital Virgen de Sonsoles de Avila, Hospital Virgen de la Concha de Zamora, Hospital Comarcal de Aranda de Duero, Hospital Comarcal de Miranda, Hospital General de Soria, Hospital Clinico Universitario de Salamanca.

RESULTS

Nine Centres responded questionnaire (75%). A total of 5 Hospitals had a Unit of Nutrition (55.6%). The results showed an average of 0.37 +/- 0.55 specialists for each 400 beds, 0.87 +/- 0.63 nurses for each 400 beds and 1.91 +/- 2.3 auxiliaries for each 400 beds, with an average of 0.21 +/- 0.41 specialists for each 100,000 habitants, 0.49 +/- 0.36 nurses for each 100,000 habitants and 1.09 +/- 1.2 auxiliaries for each 100,000 habitants. The activity of these Units is demanded by other Units, with an average of 3.2 +/- 3.4 consultations per day. The main diseases of this activity were 33.3% tumoral pathology, 55.6% surgery and 11.1% neurological pathology. Oral supplements were the first intervention tool. Only 3 Centres had a home artificial nutrition consultation. The main diseases of this activity were post surgical patients (33,3%), tumoral pathology (33,3%), neurological pathology (22%) and inflammatory bowel disease (11%).

CONCLUSION

Resources in Units of Nutrition of Castilla y Leon were limited. However, activity in Hospital an in home is equal than other areas. New actions of Local Administration are necessaries to follow recommendations of Council of Europe.

Molecular mapping of genes for resistance to the bean pod weevil (Apion godmani Wagner) in common bean

The bean pod weevil (Apion godmani Wagner) is a serious insect pest of common beans (Phaseolus vulgaris L.) grown in Mexico and Central America that is best controlled by host-plant resistance available in Durango or Jalisco genotypes such as J-117. Given unreliable infestation by the insect, the use of marker-assisted selection is desirable. In the present study, we developed a set of nine molecular markers for Apion resistance and mapped them to loci on chromosomes 2, 3, 4 and 6 (linkage groups b01, b08, b07 and b11, respectively) based on genetic analysis of an F (5:10) susceptible x resistant recombinant inbred line population (Jamapa x J-117) and two reference mapping populations (DOR364 x G19833 and BAT93 x JaloEEP558) for which chromosome and linkage group designations are known. All the markers were derived from randomly amplified polymorphic DNA (RAPD) bands that were identified through bulked segregant analysis and cloned for conversion to sequence tagged site (STS) markers. One of the markers was dominant while four detected polymorphism upon digestion with restriction enzymes. The other markers were mapped as RAPD fragments. Phenotypic data for the population was based on the evaluation of percentage seed damage in replicated trials conducted over four seasons in Mexico. In single point regression analysis, individual markers explained from 3.5 to 22.5% of the variance for the resistance trait with the most significant markers overall being F10-500S, U1-1400R, R20-1200S, W9-1300S and Z4-800S, all markers that mapped to chromosome 2 (b01). Two additional significant markers, B1-1400R and W6-800R, were mapped to chromosome 6 (b11) and explained from 4.3 to 10.2% of variance depending on the season. The latter of these markers was a dominant STS marker that may find immediate utility in marker-assisted selection. The association of these two loci with the Agr and Agm genes is discussed as well as the possibility of additional resistance genes on chromosome 4 (b07) and chromosome 3 (b08). These are among the first specific markers developed for tagging insect resistance in common bean and are expected to be useful for evaluating the mechanism of resistance to A. godmani.

Maintenance of T1 response as induced during PEG-IFNalpha plus ribavirin therapy controls viral replication in genotype-1 patients with chronic hepatitis C

OBJECTIVES

To analyze the T1/T2 cytokine profile in CD8 T cells from peripheral blood mononuclear cells from patients with genotype-1 CHC during treatment with pegylated interferon (Peg-IFN) alpha2a plus ribavirin (RBV). To correlate Th1/Th2 balance with virological response.

PATIENTS AND METHODS

In this prospective longitudinal study, a total of 28 naïve genotype-1 CHC patients received Peg-IFNalpha2a (180 microg/week) plus RBV (1-1.2 g/day) for 48 weeks. All patients (mean age 45 +/- 8 years) completed treatment and follow-up: 12 (43%) achieved a sustained virological response (SVR), 13 relapsed after end of treatment (47%), and only 3 (10%) were non-responders. Sixteen healthy controls were also analyzed (mean age 39 +/- 17 years). The production of IL-4, IFNgamma, and TNFalpha by CD8 T cells was measured by intracytoplasmic detection using flow cytometry in both resting and stimulated cells with a phorbol ester.

STATISTICS

Student's t test for independent values, chi2 test, and ANOVA test were used; relapsers and non-responders were joined to achieve a higher statistical power.

RESULTS

At third month during treatment, phorbol ester-stimulated-IL-4 levels tend to be lower in patients who presented with SVR versus those who did not (0.97 vs 2.58; p = 0.1). No statistically significant differences were found in IFNgamma and TNFalpha levels at month 3. At EOT, the stimulated-IFNgamma production was significantly higher in patients with SVR (20 vs. 8; p < 0.05). Conversely, IL-4 production was higher in NR patients although these data did not reach statistical significance (p < 0.1). No significant differences were found in TNFalpha (14 vs. 7; p < 0.2).

CONCLUSIONS

Cytokine T1 induced-response maintenance during combination treatment, measured as IFNgamma production by CD8+ T lymphocytes, is associated with SVR and suggests the replication control and later clearance of patients infected by genotype-1 HCV.

[Performance of carriers and non-carriers of the E280A mutation for familial Alzheimer's disease in a naming test]

INTRODUCTION

Early preclinical diagnosis is the greatest challenge faced by researchers into dementia. Cognitive, neuroanatomical, neurophysiological and genetic markers have been reported. One of the preclinical cognitive markers is anomia and it is often assessed using visual naming tests.

AIMS

The aim of this study was to analyse the type of mistakes made in a visual naming test in a group of carriers and non-carriers of the E280A PS1 mutation.

PATIENTS AND METHODS

The sample was made up of 91 participants who were genotyped for the E280A PS1 mutation and divided into three groups: non-carriers (n = 30), asymptomatic carriers (n = 39) and sick carriers (n = 22). Selection was performed using the Minimental and the Fast and EDG scales and mistakes in the CERAD naming test were classified. The types of mistakes taken into account were: no answer, visual, semantic, phonological, the whole for the part, and not related.

RESULTS

There is a significant difference in the number of semantic errors between non-carriers and asymptomatic carriers; on comparing the three groups, no statistically significant differences were found in visual mistakes.

CONCLUSIONS

Visual mistakes are a general characteristic, even in healthy subjects and, therefore, these errors did not provide any information that could be used to classify patients with or without dementia. Semantic mistakes can be considered as being a preclinical sign in familial Alzheimer's disease (FAD). Both visual and auditory naming tests must be applied when evaluating patients with FAD.

Relevance of the pH probe in sleep study analysis in infants

BACKGROUND

To establish the relationship between sleep apnoea and gastro-oesophageal reflux in infants and describe the clinical, demographic and pHmetric profile and the characteristic of the sleep polysomnography with a pH probe.

METHODS

A total of 102 consecutive patients were evaluated. Parents were requested to fill out a questionnaire about symptoms and previous therapy. Gastro-oesophageal reflux was considered abnormal when the percentage of time with pH less than 4 was higher than 4% of total sleep time.

RESULTS

A total of 102 infants were enrolled, 53% males. Seventy-four per cent of the infants were full-term babies. At the moment of the polysomnography, the mean age of the sample was 2.6 months. Suspicion of apnoea was the most common clinical diagnosis prior to the study. Only two infants have abnormal electroencephalogram. Mild gastro-oesophageal reflux was seen in 37 (36%) infants, while 22 (21.5%) did not have any reflux episode, and the remaining 43 (42%) infants had reflux index in the pathologic range. Only one patient had an unequivocal temporal relationship between acid oesophageal reflux and respiratory pause with oxygen desaturation.

DISCUSSION

Infants with history of apnoea or acute life threatening event frequently had gastro-oesophageal reflux episodes which did not correlated with respiratory events, suggesting that gastro-oesophageal reflux and apnoea often occur in the same infant as two separate events.

Bacterial DNA activates cell mediated immune response and nitric oxide overproduction in peritoneal macrophages from patients with cirrhosis and ascites

BACKGROUND AND AIMS

Translocation of intestinal bacteria to ascitic fluid is probably the first step in the development of episodes of spontaneous bacterial peritonitis in patients with cirrhosis. We have recently reported the detection of bacterial DNA in blood and ascitic fluid from patients with advanced cirrhosis, what we consider as molecular evidence of bacterial translocation. Several studies have shown the immunogenic role of bacterial DNA in vitro, and we hypothesised that the presence of bacterial DNA could activate the type I immune response in peritoneal macrophages from these patients, leading to greater cytokine synthesis (interleukin (IL)-2 and IL-12, tumour necrosis factor alpha, and interferon gamma) and effector molecules such as nitric oxide.

METHODS

Peritoneal macrophages obtained from patients with cirrhosis and culture negative non-neutrocytic ascitic fluid were collected and characterised by flow cytometry. Inducible nitric oxide synthase, nitric oxide levels, and cytokine production were measured by immunoenzymometric assays in basal and harvested conditions according to the presence/absence of bacterial DNA.

RESULTS

The ability of peritoneal macrophages to synthesise nitric oxide and levels of all cytokines were significantly increased in patients with bacterial DNA. There was a positive correlation between inducible nitric oxide synthase and nitric oxide levels.

CONCLUSIONS

The presence of bacterial DNA in patients with decompensated cirrhosis is associated with marked activation of peritoneal macrophages, as evidenced by nitric oxide synthesising ability, together with enhanced cytokine production.

[Recurrent ischemic strokes secondary to acquired hypercoagulability in a patient with prostatic adenocarcinoma]

Hypercoagulable states are frequently associated to malignancies. We report the case of a 67 year-old patient with prostatic cancer (T3NxM1) and deep venous thrombosis, whose initial coagulation studies were normal. He was treated with acenocumarol and hormonal blockade with flutamide and leuprolerin acetate. Six months later he developed recurrent brain ischemic strokes in the territories of both median cerebral arteries, that did not respond to anticoagulant treatment. Coagulation studies, showed a procoagulant activity with a probable paraneoplastic origin. We conclude that prostatic adenocarcinoma treated with hormonal blockage may promote a complex procoagulant state leading to recurrent occlusive arterial disease, refractory to anticoagulation.

Prognostic significance of the allelic loss of the BRCA1 gene in colorectal cancer

BACKGROUND

Survival at the intermediate stage of colorectal cancer (CRC) is less predictable than in the early and advanced stages. Several genetic markers possibly involved in growth and progression of CRC can be used for prognosis.

AIMS

This study investigated the proportion of allelic loss (loss of heterozygosity (LOH)) at the BRCA1 locus in sporadic CRC and its value in patient prognosis.

PATIENTS AND METHODS

A total of 314 patients were investigated for LOH at the BRCA1 locus using polymerase chain reaction by means of three intragenic polymorphic microsatellite markers. Allelic losses were compared with clinicopathological characteristics of patients, recurrence rate, disease free survival (DFS), and overall survival.

RESULTS

Twenty six patients were excluded because of microsatellite instability. Of the remaining 288 cases, 244 (84.7%) were informative, with 97 (39.8%) patients bearing BRCA1 LOH. Recurrence rate was higher in patients with LOH (p=0.0003), and DFS was 73.3% (SEM 5.7) at five years in patients without LOH, and 49.2% (7.1) in cases with positive allelic loss (p=0.0004). Retention of alleles at the BRCA1 locus was associated with a favourable DFS in stages I and II (p<0.05). The presence of LOH was also significantly associated with short overall survival (p=0.02). Multivariate analysis in the complete series showed that stage (p=0.006) and lymph node metastases (> or =4 nodes, p=0.0001; 1-3 nodes, p=0.038) were independent prognostic factors. However, multivariate study by stages revealed that BRCA1 LOH was an independent prognostic factor in stages I and II (p=0.001).

CONCLUSIONS

BRCA1 LOH is a molecular alteration present in CRC, with unfavourable repercussions for overall survival, that could be considered as an outstanding independent prognostic factor in stages I and II.

Prevalence of aberrant methylation of p14ARF over p16INK4a in some human primary tumors

The INK4a/ARF locus encodes two unrelated tumor suppressor proteins, p16INK4a and p14ARF, which participate in the two main cell-cycle control pathways, p16-Rb and p14-p53. Methylation of CpG promoter islands has been described as a mechanism of gene silencing. Exon 1 of the p16INK4a gene and the p14ARF promoter gene reside within CpG islands. Therefore, both can become methylated de novo and silenced. It has recently been proposed that the methylation changes in certain genes could be used as molecular markers for the detection of almost all forms of human cancer. Here, we analyzed concomitantly in each tumor sample and normal tissue the methylation status of p16INK4a and p14ARF by methylation-specific PCR (MSP) in 100 breast, 95 colon and 27 bladder carcinomas. A series of clinicopathological parameter were obtained from the medical records of the patients, p14ARF showed a higher rate of hypermethylation than p16INK4a in all three tumor types. p16INK4a and p14ARF aberrant methylation was significantly correlated with poor prognosis clinicopathological parameters of the three tumor types. We conclude that both p16INKa and p14ARF hypermethylation may be involved in breast, colon and bladder carcinogenesis, with special emphasis on the role of the lesser studied p14ARF gene, and that tumors with aberrant methylation in the two genes were associated with worse prognosis.

Intratumoral Heterogeneity in Microsatellite Alterations in BRCA1 and PTEN Regions in Sporadic Colorectal Cancer

BACKGROUND

Chromosome regions 17q21 (BRCA1) and 10q23 (PTEN) have been found deleted in colorectal cancer.

METHODS

We studied the frequency of loss of heterozygosity (LOH) in these 2 regions in 214 patients with only 1 sample per tumor and in 100 patients with several samples per tumor. Three microsatellite markers of each region were used for the LOH test. The polymerase chain reaction product was electrophoresed in 8% polyacrylamide gels, and band intensity was shown by silver staining.

RESULTS

The proportions of LOH in the two regions were 38.4% for 17q21 and 30.8% for 10q23 in the group of 214 and were 47.7% for 17q21 and 34.7% for 10q23 in the group of 100. We found a high correlation between the LOH in both regions (P <.001), where 81% of LOH in 10q23 region was matched by concomitant LOH in 17q21. In the group of tumors with several samples (group of 100), 39% and 68% did not present LOH in the 17q21 and 10q23 regions, respectively, in all of their tumor samples. However, in the 20 patients with LOH in both regions in the group of 100 (several samples per tumor), all samples with LOH in 10q23 also had LOH in 17q21, whereas not all samples with LOH in 17q21 had LOH in 10q23.

CONCLUSIONS

These results show that colorectal cancer is highly heterogeneous, at least for these tumors markers, and suggest a sequential acquisition pattern of these anomalies during tumor growth, in which changes in 17q21 could occur before those in 10q23.

Study of the correlation between two methods used to monitor thymoglobulin therapy in renal transplantation

The aim of this study is to evaluate the correlation between the 2 methods used to monitor thymoglobulin therapy: the total lymphocyte count and the number of T cells. We have performed daily collections of peripherical blood samples from 24 renal grafts, recipients who were receiving thymoglobulin, including 14 cases for induction and 10 for acute rejection. Absolute lymphocyte and T-cell counts were measured in the 298 samples after administration of a dose of 1.25 mg/kg/d. The dose was omitted if the T-cell count had decreased to <10 cells/microL. The theoretical total lymphocyte count considered to omit dose was <100 cells/microL. A total of 137 doses were given according to T-cell count. We performed the comparison in 3 steps. First, we correlated values in the daily samples; second, we examined samples as a whole and third, assessed the percentage of discrepancy between the omission of the daily dose according to each method. There was a poor correlation between the methods according to sets of daily samples or the sets as a whole. The rate of discrepancy was 66%, including 121 of 216 decisions (P<.001). In conclusion, the results of the 2 methods of monitoring thymoglobulin therapy are different, and the total administered dose depends on the method used.

[Presence of hepatitis C virus in renal tissue in membranoproliferative glomerulonephritis and cryoglobulinemia]

Although hepatitis C virus infection has been documented in several extrahepatic diseases, the deposition of HCV RNA in glomerular structures has proved to be difficult to demonstrate. We report a patient with membranoproliferative glomerulonephritis, type III circulating cryoglobulins and hepatitis C virus infection with detection of HCV RNA in serum, cryoprecipitate and renal tissue using specific RT-PCR technique. These data confirm that HCV could have a direct role in renal damage.