Lepeophtheirus salmonis secretory/excretory products and their effects on Atlantic salmon immune gene regulation

We have previously shown that Lepeophtheirus salmonis produces trypsin and prostaglandin E(2) (PGE(2)) that are most likely responsible for the limited inflammatory response of Atlantic salmon to infection. After removal of the dopamine and PGE(2), the immunomodulatory activity of unfractionated and pools of the fractionated secretions was determined by examining the effects of the secretions on Atlantic salmon immune gene expression. Incubation of macrophage-enriched isolates of Atlantic salmon head kidney cells with the unfractionated secretion + PGE(2) revealed a significant inhibition of interleukin-1beta (IL-1beta) and major histocompatibility class I gene expression. Inhibition of lipopolysaccharide-induced IL-1beta expression in the Atlantic salmon head kidney cell line (SHK-1) was observed when three pools of the secretory/excretory products were tested. Further purification of products within these pools revealed that fraction 1-2 could account fully for the inhibition of IL-1beta expression in SHK-1 cells observed in pooled fraction 1. This study demonstrates that there are other immunomodulatory compounds produced by L. salmonis, in addition to PGE(2) and trypsin, that can inhibit the expression of Atlantic salmon immune-related genes in vitro.

Cultural Dissimilarities in General Practice: Development and Validation of a Patient’s Cultural Background Scale

Due to increased migration physicians encounter more communication difficulties due to poor language proficiency and different culturally defined views about illness. This study aimed to develop and validate a 'patient's cultural background scale' in order to classify patients based on culturally conditioned norms instead of on ethnicity. A total of 986 patients from 38 multi-ethnic general practices were included. From a list of 36 questions, non-contributing and non-consistent questions were deleted and from the remaining questions the scale was constructed by principal component analysis. Comparing the scale with two other methods of construction assessed internal validity. Comparing the found dimensions with known dimensions from literature assessed the construct validity. Criterion validity was determined by comparing the patient's score with criteria assumed or known to have relationship with cultural background. Criterion validity was reasonably good but poor for income. A valid patient's cultural background scale was developed, for use in large-scale quantitative studies.

Assessment of mutual understanding of physician patient encounters: development and validation of a Mutual Understanding Scale (MUS) in a multicultural general practice setting

Mutual understanding between physician and patient is essential for good quality of care; however, both parties have different views on health complaints and treatment. This study aimed to develop and validate a measure of mutual understanding (MU) in a multicultural setting. The study included 986 patients from 38 general practices. GPs completed a questionnaire and patients were interviewed after the consultation. To assess mutual understanding the answers from GP and patient to questions about different consultation aspects were compared. An expert panel, using nominal group technique, developed criteria for mutual understanding on consultation aspects and secondly, established a ranking to combine all aspects into an overall consultation judgement. Regarding construct validity, patients' ethnicity, age and language proficiency were the most important predictors for MU. Regarding criterion validity, all GP-related criteria (the GPs perception of his ability to explain to the patient, the patient's ability to explain to the GP, and the patient's understanding of consultation aspects), were well-related to MU. The same can be said of patient's consultation satisfaction and feeling that the GP was considerate. We conclude that the Mutual Understanding Scale is regarded a reliable and valid measure to be used in large-scale quantitative studies.

Characterization of HPV genotype profile in squamous cervical lesions in Portugal, a southern European population at high risk of cervical cancer

A different prevalence of human papillomavirus (HPV) types has been reported in distinct populations. Although Portugal has a relatively high incidence of cervical cancer within the European Union, no studies have been reported in the Portuguese population. Recently, a clinical trial using a vaccine targeted against HPV-16 demonstrated a high efficacy in preventing HPV-16 cervical lesions. The aim of the present study was the characterization of HPV genotype profile in squamous intraepithelial lesions (SIL) and invasive cervical cancer (ICC) from 608 patients using polymerase chain reaction (PCR) methodology. We frequently detected HPV-6/11 and HPV-16 in low-grade SIL (HPV-6/11, 18.9%; HPV-16, 44.2%). In high-grade SIL, HPV-16 was demonstrated in 74.2% of those lesions and in 80.0% of the cases with ICC. HPV-18 was found in 3.1%, 0.8% and in 15.0% of low, high SIL and ICC, respectively. The overall prevalence of multiple infections with high-risk HPV was 7.2%. Other types of HPV were detected in 7.0% of all cases. Our results demonstrate a high prevalence of HPV-16 in SIL and ICC in Portuguese women. Therefore, a prophylactic HPV-16/18 vaccine may be effective in the prevention of cervical cancer in a significant number of women from this southern European population.

The influence of smoking and other cofactors on the time to onset to cervical cancer in a southern European population

Cervical cancer is a complex and multifactorial disease. Although there are substantial data supporting the causative role of persistent human papillomavirus (HPV) infection in the development of cervical cancer, the complete course of the disease has never been completely understood. Several risk cofactors have been suggested with controversial results. Portugal has the highest incidence of squamous cell carcinoma (SCC) within western Europe and there are no known studies regarding the role of cofactors in SCC. The aim of our study was to evaluate the role of smoking, sexual behaviour, reproductive and contraceptive history, in the time-to-onset (TTO) of severe cervical lesions (HGSIL/SCC) in the Portuguese population. We verified that age of first sexual intercourse under 18 years (odds ratio (OR) 2.8), pregnancy (OR 2.9), first pregnancy under 21 years (2.6), number of pregnancies (OR 2.3-5.4) and parity (OR 1.9-5.7) are risk factors in the development of cervical neoplasia. Smoke exposure index (SEI) was significantly different (P=0.002) between cases and controls. Our results regarding time-to-onset demonstrate that smoking (P<0.001, log rank test), number of sexual partners (P<0.001, log rank test) and use of oral contraceptives (P<0.001, log rank test) are important determinants in the earlier onset of severe cervical lesions. Using this approach, our findings may help to clarify the role of smoking and other cofactors in the persistence and progression of cervical lesions.

HER2 polymorphism and breast cancer risk in Portugal

Breast cancer is a major public health problem around the world, and its carcinogenesis is not yet well understood. The human epidermal growth factor Receptor 2 (HER2) seems to play an important role in the development of this neoplasia, and genetic alterations in this gene, such as point mutations and polymorphisms have been detected in breast cancer patients. We analysed the frequency of a single nucleotide polymorphism in the HER2 gene in blood samples from 152 breast cancer patients and 146 healthy controls using the polymerase chain reaction methodology, followed by restriction fragment length polymorphism (PCR-RFLP). We found a twofold increase in risk of breast cancer in women who are carriers of a Val allele genotype-Ile/Val and Val/Val genotypes [odds ratio (OR)=2.00; 95% confidence interval (CI) 1.23-3.25; P=0.005]. Our results indicate an association between the presence of the Val allele in the HER2 polymorphism and the risk of breast cancer. Further studies are needed to evaluate the role of this polymorphism in the behaviour of breast cancer.

Association between CYP2E1 polymorphisms and susceptibility to prostate cancer

Several genetic alterations have been associated with sporadic prostate cancer (PCa). In this study, the association between RsaI and DraI polymorphisms of CYP2E1 and PCa risk was analysed in a case-control study of 227 individuals using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Regarding DraI polymorphisms, the DD genotype is over-represented in PCa cases when compared with the control group (odds ratio (OR) 2.12; 95% confidence interval (CI) 1.11-4.05; P=0.022). Regarding the RsaI polymorphism, no significant differences were found. The results of this study indicate that DraI polymorphisms of the CYP2E1 gene may be associated with a twofold increased risk for the development of PCa.

Clinical impact of MR cholangiopancreatography in patients with biliary disease

PURPOSE

To evaluate the role of MR Cholangiopan-creatography (MRCP) as a first imaging modality in patients with suspected biliary tree pathology and indications to endoscopic retrograde cholangiopancreatography (ERCP).

MATERIAL AND METHODS

Eighty-eight patients, with clinical signs of biliary tree pathology underwent MRCP, performed with a 1.5 T unit and a phased-array coil. Surgery, intraoperative cholangiography, percutaneous transhepatic cholangiography (PTC) or ERCP were regarded as the gold standard in patients with obstruction; the remaining patients underwent follow-up MRCP examinations at 6-9 months. The MR examination was performed with baseline T1w 2D FLASH and T2w TSE sequences, followed by the MRCP study (single-slab breath-hold RARE and multislice breath-hold HASTE sequences). The MR images were independently evaluated by two radiologists.

RESULTS

MRCP showed normal findings in 20 patients; 68 patients had biliary duct dilatation. In 11 out of 68 patients MRCP did not identify any obstruction (9/11 were true negative cases). A diagnosis of benign obstruction was expressed in 36/59 patients (4 chronic pancreatitis, 29 choledocolithiasis, 4 inflammatory obstruction, 2 primary sclerosing cholangitis), with 1 false positive and 5 false negatives (sensitivity, specificity and diagnostic accuracy of 86%, 95% and 90%, respectively). MRCP identified 23 neoplastic stenoses (20/23 were true positives): the sensitivity, specificity and diagnostic accuracy values were 100%, 87% and 95%, respectively. MRCP correctly identified the level of obstruction in 100% of cases.

CONCLUSIONS

MRCP may be considered as a first-step imaging method in patients with clinical signs of biliary disease. The workload of ERCP in the diagnostic stage could therefore be reduced and its use be reserved for therapeutic indications.

Endothelial nitric oxide synthase gene polymorphisms and genetic susceptibility to prostate cancer

The endothelial cell-specific form of nitric oxide synthases (ecNOS) is localized at 7q35-q36 and is involved in vascular development and tumour growth in human prostate cancer. We have conducted a case-control study to investigate the prevalence of two polymorphisms at intron 4 (ecNOS4a/b) and exon 7 (Glu-Asp298) of ecNOS gene in 125 prostate cancer (PCa) patients and in 153 controls. We observed that the a-allele (aa or ab genotypes from ecNOS4a/b) was over-presented in the group of PCa with Gleason histological grade >or=7 (P=0.041). With regard to the Glu-Asp298 polymorphism, patients with the T-allele were younger than patients with no T-allele (P=0.037), and a statistically significant difference was noted in the Glu-Asp298 genotype distribution between cases with advanced disease and cases with localized disease (P=0.0013). When comparing cases and controls with logistic regression analysis we observed that the presence of the a-allele is associated with prostate cancer risk (odds ratio (OR) 1.83; 95% confidence interval (CI) 1.06-3.17; P=0.029), to high histological grade (Gleason >or=7) of PCa (OR 2.18; 95% CI 0.95-4.98; P=0.062) and with the risk of progression of the cancer disease (OR 2.85; 95% CI 1.19-6.82; P=0.018). Furthermore, we found that carriers with the combination of the a-allele (aa and ab ecNOS4a/b genotypes) and T-allele (GT and TT from Glu-Asp298) have a threefold increase in prostate cancer risk (OR 3.13; 95% CI 1.41-6.91, P=0.004). In summary, we have identified an NO-related genetic risk factor for prostate cancer that may help in understanding the molecular mechanism involved in the individual susceptibility to prostate cancer.

Contrast-enhanced magnetic resonance angiography MoBI-trak in the study of peripheral vascular disease

PURPOSE

To evaluate the diagnostic accuracy of contrast-enhanced magnetic resonance angiography (CE-MRA) MoBI-trak of peripheral vessels in patients with peripheral vascular disease who were candidates for digital subtraction angiography (DSA).

METHODS

Eleven patients underwent CE-MRA with automated table movement (MoBI-trak) using a 1.5 T superconducting magnet (Philips Gyroscan ACS NT) equipped with a Power Trak 6000 gradient. Contrast medium (Gd-DTPA) was administered in two sequential boluses-20 cm(3) at 0.6 cm(3)/sec (starting phase) and 20 cm(3) at 0.3 cm(3)/sec (maintenance phase)-using a MedRad Spectris automatic injector. DSA was the gold standard and was performed using a Philips Integris 3000, with a brilliance intensifier of 38 seconds. DSA and MRA were evaluated on printed films.

RESULTS

DSA provided 213 diagnostic assessments: 144 negative, 30 stenosis <50%, 5 stenoses in the 51-70% range, 12 stenoses in the 71-99% range and 22 occlusions. CE-MRA MoBI-trak sensitivity, specificity, positive and negative predictive value and diagnostic accuracy were 94.1%, 99.2%, 98.4%, 80.0% and 97.5%, respectively.

CONCLUSIONS

Our work is in accordance with the literature. Using this technique MoBI-trak has been shown to be a reliable technique for the detection of peripheral vascular disease up to the trifurcation, although it underlines the necessity for more diagnostic investigation and improvements in the technique.

Inpatient or outpatient initiation of antiarrhythmic medications: why the controversy?

The decision of whether to initiate antiarrhythmic medications in or out of the hospital for patients with atrial fibrillation remains an issue of significant controversy. The current review analyzes the available data pertaining to the safety of antiarrhythmic agent initiation in patients with atrial fibrillation and provides a practice guideline.

Nanoflow gradient generator coupled with mu-LC-ESI-MS/MS for protein identification

The large-scale identification of proteins from proteomes of complex organisms, and the availability of various types of protein and DNA databases, increasingly require the additional information provided by tandem mass spectrometry. HPLC and microLC coupled to ESI-MS/MS presently dominate the field of protein identification by tandem mass spectrometry and database searching. The analysis of protein digests is typically performed using HPLC or LC columns with 50-100-microm diameters, requiring the delivery of solvent gradients at low to mid nanoliter per minute flow rates. This has been typically achieved using expensive generic HPLC pumping systems for the delivery of microliter per minute gradients that were either flow-split or sampled. Here we present an alternative system for the delivery of nanoliter per minute gradients. The inexpensive nanoflow gradient generator (etagrad) described here can be modulated to reproducibly deliver selected gradients. The performance of the etagrad on-line with a microLC-ESI-MS/MS system has been demonstrated for the identification of standard protein digests. Moreover, the performance of the etagrad-microLC-ESI-MS/MS system, with protein prefractionation by IPG isoelectric focusing, was also evaluated for rapid study of yeast and human proteomes.

Proteomics on a chip: promising developments

The field of proteomics is expanding rapidly due to the completion of the human genome and the realization that genomic information is often insufficient to comprehend cellular mechanisms. This considerable expansion of proteomics towards high-throughput platforms is stressing its current technical capabilities. In recent years, technologies in microfluidic and array technologies have appeared for proteomics. These novel approaches might help solve current technical challenges in proteomics. This review presents a general survey of the recent development in microfluidic and array technologies from a proteomics perspective.

[Magnetic resonance angiography of the peripheral vessels with automatic moving bed infusion tracking]

PURPOSE

To investigate the actual diagnostic reliability of the Mobitrack technique with a slow intravenous infusion of paramagnetic contrast agent (CA) in MR Angiography of the peripheral arterial district.

MATERIAL AND METHODS

Twelve healthy volunteers (mean age: 34) with no personal or family history of peripheral arterial pathologic conditions, underwent MR Angiography of the peripheral vascular district. A 1.5 T superconductive magnet equipped with automatic table feed was used. In the preliminary phase, the circulation time at the abdominal aorta was optimized and customized for each patient. This was done by performing a pre-targeting Fast Field Echo 2D (FFE 2D) sequence with intravenous administration of 1-2 mL CA by an injector, to evaluate the delay time. A 2D Time of Flight (2D TOF) sequence was then performed for topographic purposes. The partially overlapping volumes were acquired using Fast T1-weighted sequences, intravenous CA administration and an automatic table feed of 10 mm/s. A Fast Field Echo 3D (FFE 3D) T1-weighted sequence with TR/TE/FA: of 6.3/1.6/40 degrees and a slice thickness of 1.5 mm were also performed. Thirty to forty mL CA were slowly administered intravenously at a rate of 0.3-0.6 mL/s. Two blinded readers independently evaluated the images giving one of three diagnostic judgements: 1) arteries were well visualized, 2) heterogeneous arteries with(out) the presence of veins, and 3) arteries seen poorly or not at all. The first two judgements were considered diagnostic. The readers considered 19 different anatomical districts for each patient, giving a total of 190 evaluations.

RESULTS

A blinded evaluation of the readers judgements did not indicate a statistically significant difference (agreement: 100%). Overall, 82% of the images were rated as 1, 8.5% as 2 and 8.4% as 3.

DISCUSSION

In 174/190 judgements the vessels were rated as 1 or 2, that is of diagnostic value. Judgement 3 was always due to the inability to visualize the medial and/or distal third of the arterial circulation of the leg.

CONCLUSIONS

The results of this technique optimization study confirm the overall validity of the Mobitrack technique. However they also indicate that further technical advances are required to ensure maximum diagnostic accuracy in this vascular district.

Increased cytogenetic damage in outdoor painters

Painters are exposed to an extensive variety of hazardous substances such as organic solvents, lead-containing pigments and residual plastic monomers. In this particular case, workers used commercially available exterior paints and occasionally gasoline or thinner as solvents. The application or removal of paints was performed without protection (masks or gloves). To determine occupational exposure risk, a monitoring study was designed. Group selection was made after a questionnaire administration, which included questions about lifestyle and medical history to exclude exposure to other potential sources of genotoxics. Smoking and drinking habits were also considered. Blood and buccal cell samples were obtained from 25 public building male painters and from a similar number of age- and gender-matched controls. Lead levels were measured in paint samples and in individuals' blood. Organic solvents and/or its metabolites were also determined in blood. Chromosomal aberrations (CA) and sister chromatid exchanges (SCE) were determined in peripheral blood lymphocyte cultures. Also, the frequency of micronuclei (MN) in buccal cells was investigated. Painters had higher lead levels in blood (p<0.05); CA and SCE in lymphocytes and MN in epithelial cells were also elevated (p<0.05). Cytogenetic damage was significantly associated with occupational exposure time but not with the levels of lead found in blood.