A β-mercaptoethanol-modified enzyme-linked immunosorbent assay for diagnosis of canine visceral leishmaniasis

Two immunoglobulin G enzyme-linked immunosorbent assay (ELISA) versions using whole promastigotes of Leishmania infantum (syn. Leishmania chagasi) treated either with β-mercaptoethanol (β-ME-ELISA) or trypsin (TRYP-ELISA) as antigens were developed for the diagnosis of canine visceral leishmaniasis (CVL). By comparison with the direct agglutination test (DAT; 100%, 31/31; 95% confidence interval [CI]: 86.3-100%), slightly lower sensitivity was demonstrated for the newly developed β-ME-ELISA (93.5%, 29/31; 95% CI: 77.2-98.9%). Sensitivity was higher for β-ME-ELISA compared with TRYP-ELISA (87.1%, 27/31; 95% CI: 69.2-95.8%) in serum samples from dogs with CVL. When tested with sera from 37 healthy dogs and from 45 dogs with clinical conditions other than CVL, a specificity of 97.6% (80/82; 95% CI: 90.1-99.6%) was estimated for β-ME-ELISA as compared to 100% (82/82; 95% CI: 94.4-100%) and 95.1% (78/82; 95% CI: 87.3-98.4%) for DAT and TRYP-ELISA, respectively. Observed agreement was 94.0% (95% CI: 88.7-97.1%) between DAT and β-ME-ELISA (κ = 0.879; 95% CI: 0.803-0.956) and 87.4% (95% CI: 80.8-92.1%) between DAT and TRYP-ELISA (κ = 0.743; 95% CI: 0.636-0.851). Current results advocate application of the new β-ME-ELISA for diagnosis of CVL at the laboratory level and confirmation of results obtained with the DAT in field studies.

Periodontitis and atherosclerosis: an observational study

BACKGROUND

Poor oral health has been related with cardiovascular diseases. Specifically, periodontitis has been implicated in the pathogenesis of atherosclerosis. Our aim was to evaluate the relationship between the degree of carotid atherosclerosis and severity of periodontitis in a patient cohort.

METHODS

Fifty adult patients receiving carotid duplex scans in a cerebral hemodynamics lab were included in the study. Ultrasound protocol included measurement of carotid intima-media thickness (IMT), which is a marker of atherosclerosis, and characterization of any atherosclerotic plaques in the cervical common and internal carotid arteries. Patients were divided into two main groups: the test group had IMT ≥ 1 mm or the presence of any carotid atherosclerotic plaque, and the control group had IMT < 1 mm and absence of atherosclerotic plaques. Periodontal evaluation was performed in all the teeth and characterized according to the clinical attachment level, which between 1 mm and 2 mm was classified as slight, 3 mm and 4 mm as moderate and ≥5 mm as severe.

RESULTS

The control group included 15 (30%), while the test group included 35 (70%) subjects. The most common diagnosis was severe periodontitis (40%); moderate and slight periodontitis were also frequent occurrences (32% and 28%, respectively). In the control group, 53.3% had slight, 33.3% had moderate and 13.3% had severe periodontitis. In the test group, those percentages were respectively 22.2%, 44.4% and 33.3%. Patients with atheroma plaque had the highest percentage of severe periodontitis (70.6%). More severe periodontitis was related to atherosclerosis (P = 0.007).

CONCLUSION

This study showed an association between periodontitis severity and carotid atherosclerosis, suggesting that periodontal disease might be a risk indicator for atherosclerotic disease.

BMP8B increases brown adipose tissue thermogenesis through both central and peripheral actions

Thermogenesis in brown adipose tissue (BAT) is fundamental to energy balance and is also relevant for humans. Bone morphogenetic proteins (BMPs) regulate adipogenesis, and, here, we describe a role for BMP8B in the direct regulation of thermogenesis. BMP8B is induced by nutritional and thermogenic factors in mature BAT, increasing the response to noradrenaline through enhanced p38MAPK/CREB signaling and increased lipase activity. Bmp8b(-/-) mice exhibit impaired thermogenesis and reduced metabolic rate, causing weight gain despite hypophagia. BMP8B is also expressed in the hypothalamus, and Bmp8b(-/-) mice display altered neuropeptide levels and reduced phosphorylation of AMP-activated protein kinase (AMPK), indicating an anorexigenic state. Central BMP8B treatment increased sympathetic activation of BAT, dependent on the status of AMPK in key hypothalamic nuclei. Our results indicate that BMP8B is a thermogenic protein that regulates energy balance in partnership with hypothalamic AMPK. BMP8B may offer a mechanism to specifically increase energy dissipation by BAT.

Hypothalamic AMP-activated protein kinase as a mediator of whole body energy balance

The AMP-activated protein kinase (AMPK) is the downstream constituent of a kinase cascade that acts as a sensor of cellular energy levels. Current data unequivocally indicate that hypothalamic AMPK plays a key role in the control of the whole body energy balance, by integrating peripheral signals, such as hormones and metabolites, with central signals, such as neuropeptides, and eliciting allostatic changes in energy homeostasis. Although the molecular details of these interactions are not fully understood, recent evidence has suggested that the interaction between AMPK with hypothalamic lipid metabolism and other metabolic sensors, such as the uncoupling protein 2 (UCP-2), the mammalian target of rapamycin (mTOR) and the deacetylase sirtuin 1 (SIRT1), may play a main role in the hypothalamic control of feeding and energy expenditure. Here, we summarize the role of hypothalamic AMPK as whole body energy gauge. Understanding this key molecule and especially its functions at central level may provide new therapeutic targets for the treatment of metabolic alterations and obesity.

Assessing peristomal skin changes in ostomy patients: validation of the Ostomy Skin Tool

BACKGROUND

Peristomal skin problems are common and are treated by a variety of health professionals. Clear and consistent communication among these professionals is therefore particularly important. The Ostomy Skin Tool (OST) is a new assessment instrument for the extent and severity of peristomal skin conditions. Formal tests of reliability and validity are necessary for its use in clinical practice, research, and education.

OBJECTIVES

To estimate inter- and intra nurse assessment variability of the OST and validity by comparison to a 'gold standard' (GS) defined by an expert panel.

METHODS

Thirty photographs of peristomal skin were presented twice to 20 ostomy care nurses--10 from Denmark (DK) and 10 from Spain (ES)--to determine intra- and inter nurse assessment variability. The same photographs were presented to an international group of experts (dermatologist and ostomy care nurses), to establish a GS for comparison and validation of the results.

RESULTS

A high intra-nurse assessment agreement, κ=0·84, was found with no differences in the intra-nurse assessments from the two groups of nurses (DK and ES). The inter-nurse assessment agreement was 'moderate to good', κ=0·54, with the agreement between the experts higher, κ=0·70. A high correlation between the scores from the nurses and the GS were seen in the lower part of the two scales [Discoloration, Erosion, Tissue overgrowth (DET) score<7)].

CONCLUSION

The study supported the validity of the OST. It is suggested that a categorical scale can be used to illustrate the severity of the DET scores.

Global cardiovascular risk stratification of hypertensive patients followed in Portugal in primary care or in hospital care according to the 2007 ESH/ESC guidelines

INTRODUCTION

Hypertension is one of the major risk factors for cardiovascular (CV) disease. Our aim was to assess and stratify the CV risk of two cohorts of hypertensive patients in Portugal attended in primary care (PC) or in outpatient hospital care (HC) using the global CV risk stratification model of the 2007 ESH/ESC guidelines.

METHODS

We retrospectively analyzed the clinical data of hypertensive patients (aged 18-75 years) enrolled in other population studies and attended in PC (n = 2299, 66 +/- 11 years, 64% women) or in HC (n = 2028, 51 +/- 14 years, 54.7% women). Global risk stratification was performed according to the 2007 ESH/ESC guidelines.

RESULTS

In patients attended in PC (67% treated with antihypertensive drugs, 31% with BP < 140/90 mmHg, 22% with dyslipidemia and 16% with diabetes), added global CV risk was average or low in 26%, moderate in 31%, high in 27% and very high in 16%; in patients attended in HC (77% treated with antihypertensive drugs, 16% with BP <140/90 mmHg, 47% with dyslipidemia and 26% with diabetes), added global CV risk was average or low in 16%, moderate in 30%, high in 28% and very high in 26%.

CONCLUSIONS

The majority of hypertensiv patients attended in PC or HC have a high or very high global CV risk according to the 2007 ESH/ECS guidelines. Thus, global CV risk stratification should be undertaken in all hypertensive patients, as well as the implementation and reinforcement of strategies aimed at adequate control of hypertension and of all other modifiable CV risk factors.

Injectable gellan gum hydrogels with autologous cells for the treatment of rabbit articular cartilage defects

In this work, the ability of gellan gum hydrogels coupled with autologous cells to regenerate rabbit full-thickness articular cartilage defects was tested. Five study groups were defined: (a) gellan gum with encapsulated chondrogenic predifferentiated rabbit adipose stem cells (ASC + GF); (b) gellan gum with encapsulated nonchondrogenic predifferentiated rabbit adipose stem cells (ASC); (c) gellan gum with encapsulated rabbit articular chondrocytes (AC) (standard control); (d) gellan gum alone (control); (e) empty defect (control). Full-thickness articular cartilage defects were created and the gellan gum constructs were injected and left for 8 weeks. The macroscopic aspect of the explants showed a progressive increase of similarity with the lateral native cartilage, stable integration at the defect site, more pronouncedly in the cell-loaded constructs. Tissue scoring showed that ASC + GF exhibited the best results regarding tissue quality progression. Alcian blue retrieved similar results with a better outcome for the cell-loaded constructs. Regarding real-time PCR analyses, ASC + GF had the best progression with an upregulation of collagen type II and aggrecan, and a downregulation of collagen type I. Gellan gum hydrogels combined with autologous cells constitute a promising approach for the treatment of articular cartilage defects, and adipose derived cells may constitute a valid alternative to currently used articular chondrocytes.

Monoamine deficits in the brain of methyl-CpG binding protein 2 null mice suggest the involvement of the cerebral cortex in early stages of Rett syndrome

Rett syndrome is a neurodevelopmental disorder caused by mutations in the methyl-CpG binding protein 2 gene (MECP2). Several neural systems are affected in Rett, resulting in an autonomic dysfunction, a movement disorder with characteristic loss of locomotor abilities and profound cognitive impairments. A deregulation of monoamines has been detected in the brain and cerebrospinal fluid of both Rett patients and a Rett syndrome murine model, the Mecp2 knock-out mouse. Our goal was to characterize the onset and progression of motor dysfunction in Mecp2(tm1.1Bird) knock-out mice and the possible neurochemical alterations in different brain regions potentially playing a role in Rett-like pathophysiology, at two different time-points, at weaning (3 weeks old) and in young adults when overt symptoms are observed (8 weeks old). Our results revealed significant age- and region-dependent impairments in these modulatory neurotransmitter systems that correspond well with the motor phenotype observed in these mice. At 3 weeks of age, male Mecp2 knock-out mice exhibited ataxia and delayed motor initiation. At this stage, noradrenergic and serotonergic transmission was mainly altered in the prefrontal and motor cortices, whereas during disease progression the neurochemical changes were also observed in hippocampus and cerebellum. Our data suggest that the deregulation of norepinephrine and serotonin systems in brain regions that participate in motor control are involved in the pathophysiology of Rett syndrome motor phenotypes. Moreover, we highlight the contribution of cortical regions along with the brainstem to be in the origin of the pathology and the role of hippocampus and cerebellum in the progression of the disease rather than in its establishment.

Acute coronary syndrome in young adults

INTRODUCTION

The aim of this study was to assess the features of acute coronary syndrome (ACS) in patients younger than 46 years of age.

METHODS

This was a retrospective study of clinical features, complications and diagnostic and therapeutic strategies of patients hospitalized between 1999 and 2007 with a diagnosis of ACS in a non-tertiary hospital. Data were collected from clinical records.

RESULTS

The study population included 128 patients. The male/female ratio was 94%/6% and mean age was 40 +/- 3.9 years. The distribution of ACS was as follows: ST-elevation acute myocardial infarction (AMI) 69%, non-ST elevation AMI 20%, unstable angina 9%, AMI with undetermined ECG 1%, and Prinzmetal angina 1%. The prevalence of cardiovascular risk factors was as follows: smoking 82.8%, dyslipidemia 42.2%, hypertension 28.9%, and diabetes 4.7%. Thrombolysis was the main myocardial reperfusion therapy, used in 76.1%. Echocardiography during hospitalization revealed normal left ventricular (LV) function in 66.1%, mild LV dysfunction in 14.5%, moderate LV dysfunction in 10.5% and severe LV dysfunction in 8.9%. Predischarge exercise testing was performed in 64.1% of patients and was normal in 85.4%, abnormal in 13.4% and inconclusive in 1.2%. Only 3.9% underwent single photon emission computed tomography (SPECT) myocardial perfusion imaging, which was positive for ischemia in 60% and negative in 40%. Elective catheterization was performed in 22.7% of patients; 44.9% underwent percutaneous coronary intervention and 6.9% were referred for cardiac surgery. Medication prescribed at discharge was as follows: aspirin 97.7%, beta-blockers 90.6%, statins 84.4%, angiotensin-converting enzyme inhibitors 50% and clopidogrel 25%. Arrhythmias were the main complication of ACS and no deaths occurred during hospitalization.

CONCLUSIONS

As expected, ACS in young adults had a higher incidence in males. ST-elevation AMI was the main type. Most patients were smokers. Thrombolysis was the main myocardial reperfusion therapy. Echocardiography and predischarge exercise testing were the main complementary diagnostic tests for risk stratification. Prescription rates of drugs that improve prognosis were high.