Diversity of Phytophthora capsici in Northwest Spain: Analysis of Virulence, Metalaxyl Response, and Molecular Characterization

Phytophthora crown rot, caused by Phytophthora capsici, is potentially the most destructive disease of pepper in Spain. Phenotypic and genetic diversity of 16 P. capsici isolates collected from 11 farms in northwest Spain was characterized based on virulence, mating type, sensitivity to metalaxyl, and genetic analysis using random amplified polymorphic DNA (RAPD) methods. Low variability was observed among the isolates in their metalaxyl response, with 87.5% being highly sensitive. No isolates of the A2 mating type were detected. More variability was found in the virulence assay, and isolates were classified into two groups according to their pathogenicity on a set of four pepper cultivar differentials. Genetic variation examined with eight RAPD primers generated 92 polymorphic bands and revealed the existence of different patterns among isolates. Cluster analysis using the unweighted pair-group method with arithmetic averages (UPGMA) separated the Spanish isolates into three RAPD groups and established a relationship between the Spanish population and a representative worldwide group of isolates. No correlation was found between groups obtained by RAPD analysis and groups defined by virulence or metalaxyl response.

Usefulness of acr Expression for Monitoring Latent Mycobacterium tuberculosis Bacilli in 'In Vitro' and 'In Vivo' Experimental Models

Real-time RT-PCR was used to quantify the expression of genes possibly involved in Mycobacterium tuberculosis latency in in vitro and murine models. Exponential and stationary phase (EP and SP) bacilli were exposed to decreasing pH levels (from 6.5 to 4.5) in an unstirred culture, and mRNA levels for 16S rRNA, sigma factors sigA,B,E,F,G,H and M, Rv0834c, icl, nirA, narG, fpbB, acr, rpoA, recA and cysH were quantified. The expression of acr was the one that best correlated with the CFU decrease observed in SP bacilli. In the murine model, the expressions of icl, acr and sigF tended to decrease when bacillary counts increased and vice versa. Values from immunodepressed mice (e.g. alpha/beta T cells, TNF, IFN-gamma and iNOs knock out strains), with accelerated bacillary growth rate, confirmed this fact. Finally, the expression of acr was maintained in mice following long-term treatment with antibiotics. The quantification of acr expression could be useful for monitoring the presence of latent bacilli in some murine models of tuberculosis.

The impact of the summer 2003 heat wave in Iberia: how should we measure it?

We present a new approach to improve the reliability of quantifying the impact of a heat wave on mortality rates. We show, for the recent European summer 2003 heat wave, that the use of absolute maximum temperature values, or number of days above a given threshold, can be misleading. Here, we have assessed the impact of the heat wave on Iberian mortality by applying a four step procedure: (1) calculating, for each observatory, the local maximum temperature (T (max)) distributions, (2) calculating the corresponding 95th percentile values (T (threshold)), (3) locally defining extremely hot days (EHD) as those days on which the local threshold of the 95th percentile of the series is exceeded, and (4) calculating the total degrees-days (DD) of exceedance, by calculating the difference T (max)-T (threshold) and summing these values for all days above T (threshold). We show that the relationship between summer mortality rates and the DD index is non-linear and can be described by a logarithmic function, with a correlation coefficient of 0.78, which explains 60.6% of the mortality variance (F value of 24.64, significant at P<0.0001). Using maximum temperatures, no significant relationship is found with mortality, whereas the EHD frequency shows a significant association with mortality, albeit weaker than that obtained with DD.

Real-Time Polymerase Chain Reaction Quantification of Phytophthora capsici in Different Pepper Genotypes

ABSTRACT Reliable and sensitive quantification of Phytophthora capsici in pepper plants is of crucial importance in managing the multiple syndromes caused by this pathogen. A real-time polymerase chain reaction (PCR) assay was developed for the determination of P. capsici in pepper tissues. DNA levels of a highly virulent and a less virulent isolate were measured in different pepper genotypes with varying degrees of resistance. Using SYBR Green and specific primers for P. capsici, the minimal amount of pathogen DNA quantified was 10 pg. Pathogen DNA was recorded as early as 8 h postinoculation. Thereafter, the increase was rapid in susceptible cultivars and slower in resistant ones. The amount of pathogen DNA quantified in each pepper genotype correlated with susceptibility to Phytophthora root rot. Likewise, there was a relationship between the virulence of the pathogen and the degree of colonization. Differences also were found in oomycete amount among pepper tissues, with maximal pathogen biomass occurring in stems. The real-time PCR technique developed in this study was sensitive and robust enough to assess both pathogen development and resistance to Phytophthora root rot in different pepper genotypes.

Impact of urban air pollutants and noise levels over daily hospital admissions in children in Madrid: a time series analysis

OBJECTIVE

The aim of this paper was to analyse the effects of the urban air pollutants and noise levels on daily emergency hospital admissions of children less than 10 years of age in Madrid.

MATERIAL AND METHODS

Poisson Regression Models were used to quantify the associations. Meteorological variables, influenza epidemics, pollen concentrations and trends and periodicities were used as controlling variables.

RESULTS

The main results obtained were the detected relationship (p<0.05) between emergency hospital admissions due to organic diseases and noise levels (AR=2.4%) and for PM(10) concentrations (AR=2.1%). For respiratory diseases statistically significant associations were detected for noise levels (AR=4.7%) and cold temperatures (AR=3.8%). The main association detected for causes of admissions due to bronchitis was for O(3) (AR=36.8%) and for pneumonia was for noise levels (AR=7.7%).

CONCLUSION

The results obtained suggest that noise level particularly is a risk factor for daily emergency hospital admissions for organic and respiratory diseases in children less than 10 years old in Madrid.

Liver Transplantation at the Cuban Center for Medical and Surgical Research

From July 4, 1999, when a liver transplantation program was started in Cuba, to October 2003, 66 procedures had been performed in 60 patients. The most frequent reason was cirrhosis caused by hepatitis C virus (29%), and alcoholic cirrhosis (22%). Two patients received simultaneous liver-kidney transplants. Half of the patients were men. Patient ages ranged from 12 to 62 years; the average surgical time was 6 hours; and cold ischemia time was 4 to 14 hours. The average blood consumption was 2033 mL; 2900 mL of plasma and 8 units of platelets were used in 7 cases. Immunosuppression was mainly cyclosporine (Neoral), mycophenolate mofetil or azathioprine, and prednisone. Acute cellular rejections were treated in almost all cases with 3 doses of methylprednisolone. The most frequent complications were biliary (24%), hepatic arterial thrombosis (12%), post-surgical bleeding (10%), acute cellular rejection (24%), and ductopenic rejection (2%). The overall 1-year survival rate was 73.7%.

[Prevention of cardiovascular diseases by an antihypertensive program in the elderly, a cohort study]

INTRODUCTION

We started on year 2000 a Complex Intervention Program addressed at hypertension control among our patients.

AIM

To compare the risk of cardiovascular events and of dying in hypertensive patients under Program care.

METHOD

We started follow-up of a cohort of 1922 patients over 65 years in August 2000. Hipertension diagnosis was ascertained if patient reported to be hypertensive, or was under anti hypertensive treatment or if he/she had two blood pressure measurements = 140/90 mm Hg. Cardiovascular events were considered to be admissions due to coronary disease, cardiac insufficiency or stroke. Incidence is reported by 100 person years follow-up. Relative risks between hypertensive and normotensive patients were calculated and Cox regresión was used to adjust for potential confounders. We compared time to first cardiovascular event and to death with Log Rank Test.

RESULTS

Fourty eight point three percent of patients were hypertensive and differed from normotensive patients as to age (79 (5) years vs. 77 (5) p < 0.001), proportion of diabetic patients (16.1% vs. 7.6% p < 0.001). Mean follow-up time was 28 months. Mortality RR was 1.04 (95% CI 0.69-1.58). As to incidence of cardiovascular events it was 1.86 in normotensive vs. 3.02 (RR 1.62 95% CI 1.09-2.42). When adjusted by age, sex, smoking, dislipemia and diabetes, OR was 1.3 (95% CI 0.86-1.98).

CONCLUSIONS

Hypertension did not increase the risk in cardiovascular events among our hypertensive patients at 2.3 years follow-up.

Selective memory impairment on an adapted Mini-Mental State Examination increases risk of future dementia

OBJECTIVE

To determine whether selective memory impairment (SMI) on an adapted Mini-Mental State Examination (aMMSE) test increases risk of future dementia in a population-based survey of central Spain.

BACKGROUND

SMI is a strong predictor of dementia in the elderly. However, most approaches have used extensive memory batteries, which are not always suitable for screening purposes.

METHODS

The basal cohort consisted of 2982 poorly educated individuals aged 65 or over. Dementia, stroke and parkinsonism cases were previously excluded. At entry, participants received a structured interview including an aMMSE. Two groups were created according to basal cognitive performance, namely: (1) aMMSE > 23 and no word remembered on the aMMSE delayed-recall task (SMI group); and (2) aMMSE > 23 and at least one word remembered on the delayed-recall task (control group). In a three-year follow-up wave, conversion rate to dementia was calculated and logistic regression was performed.

RESULTS

Of a total of 2507 subjects who completed the two evaluations, 280 qualified for SMI at entry. In the SMI group, 25 subjects (8.9%) developed dementia vs 26 subjects (1.2%) in the control group. Taking the two groups together, and once demographic and medical variables had been controlled, a low delayed-recall score increased dementia conversion rate (OR 0.47, 95% CI 0.34-0.64). Alzheimer's disease was the main cause of dementia (79.8%).

CONCLUSIONS

Memory impairment is a risk factor for future dementia in the neurologically-healthy elderly. This can be observed in a subgroup of subjects with SMI defined on the aMMSE delayed-recall subscore. Some other measurements should be added to the SMI construct to improve its predictive validity.

[Hepatic abscess demonstrated by 67Ga-citrate scintigraphy within a diagnosis of fever of unknown origin]

We report a case of a 63 year old man who was seen in the hospital because of fever having a possible infectious or oncological origin. A 67Ga scintigraphy was performed and showed high pathological accumulation in the hepatic dome. The patient was re-evaluated and studied with other diagnostic tests including a CT scan, coinciding with the findings in the 67Ga-citrate scintigraphy. A correct final diagnosis of liver abscess was made.

[Hepatotoxicity and pancreatitis associated with gold salts: case report]

The case of a patient, 37 years old, born and resident of Lima, suffering rheumatoid arthritis who underwent treatment with prednisone, methotrexate, and chloroquine is reported. This therapy was substituted for gold salts one month before her admission. After the third dose she presented symptoms of abdominal pain and diarrhea, itching, and jaundice, associated with asthenia and a feverish sensation. Liver biochemistry demonstrated elevated transaminase, bilirubin, alkaline phosphatase, eosinophilia, inversion of the rate albumin/globulin, higher titer of immunoglobulin G, as well as an elevation of amylase and lipase. The anatomopathological study showed cholestasis, hepatocyte ballooning, spotty necrosis, predominantly in zone 3 of the acinus. These findings where found consistent with a toxic reaction.

Impact of Temperature and Air Pollution on the Mortality of Children in Madrid

This work analyzes the impact of temperature and air pollution on infant mortality in Madrid. Daily values of mortality of children younger than 10 years, maximum and minimum temperatures, and air pollutants were considered for an 11-year period. In winter, mortality was mostly associated with very low temperatures and high total suspended particles (TSP) concentrations, whereas summer mortality depended crucially on the occurrence of high TSP and nitrogen oxides concentrations. In winter, the temperature effect increases dramatically for daily maximum temperature values lower than 6degreesC. This pattern is rather different from the one obtained for older age groups in the same location, which show the well-known V relationship between temperature and mortality. The association with TSP shows 2 linear branches without threshold and a strong increase in mortality for concentrations more than 100 microg/m3.

Effect of a low-dose oral contraceptive containing 20 μg ethinylestradiol and 150 μg desogestrel on dysmenorrhea

This observational study evaluated the effect of a low-dose oral contraceptive (OC), containing 20 mug ethinylestradiol and 150 mug desogestrel (20EE/150DSG) on dysmenorrhea. Of the 346 women enrolled, 301 (87%) completed the three-cycle study. All participants (mean age: 22.6 years) wished to use oral contraception and had dysmenorrhea for at least 3 months. Dysmenorrhea was assessed using both the adapted verbal multidimensional scoring system (VMSS-A) and a visual analogue scale (VAS) to rate pain intensity. General dysmenorrhea symptoms and the use of analgesics were also assessed. The mean total combined scores on the VMSS-A scale decreased from 5.4 to 1.4 (p < 0.001), during the three cycles of OC use. The mean VAS pain-intensity score decreased from 6.8 to 1.8 (p < 0.001). During treatment there were substantial improvements in most individual parameters of dysmenorrhea. The percentage of women with dysmenorrhea lasting > or =2 days decreased from 81% at baseline to 14% at cycle 3. The percentage of women reporting generalized dysmenorrhea symptoms (e.g., lumbago, asthenia) decreased from 79% to 21% and the percentage needing analgesics dropped from 100% to 41%. The percentage of women for whom dysmenorrhea interfered with daily activities decreased from 73% to 10%. The results indicate that 20EE/150DSG can statistically and clinically significantly reduce the incidence and severity of dysmenorrhea, and its impact on daily activities.

Use of recombinant human erythropoietin in kidney transplant patients with stable graft function

The purpose of this work was to determine the necessity for rhuEPO for 50 kidney transplant patients with stable graft function. We analyzed the red cell series, blood pressure, renal function, anthropometric data of the donor and recipient, proteinuria, and relationship with other factors, including immunosuppressants, angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARB). The patients were divided into three groups depending on renal function: group A (with plasma creatinine <150 micromol/L), group B (151-250 micromol/L), and group C (>250 micromol/L). All patients were studied for 1 year. Erythropoietin use did not affect renal function, proteinuria or number of antihypertensive drugs group. The degree of renal dysfunction determined the time necessary to reach an adequate hemoglobin level (>12 g/L) and and the mean dose of weekly rhuEPO needed. The use of ACE inhibitors or ARBs increased the rhuEPO requirements in each group.

A simple noninvasive pressure-time index at the mouth to measure respiratory load during acute exacerbation of COPD A comparison with normal volunteers

We assessed the validity of the pressure-time index (PTI) measured at the mouth as a noninvasive and simplified alternative to conventional tension-time index for assessing respiratory load and inspiratory muscle force reserve. PTI was measured within 48 h of hospital admission and at 24 h before discharge in 37 consecutive patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) using the equation PTI = (P(awo)/MIP)(T(I)/T(T)) 100, where P(awo) is the mean airway pressure measured at the mouth, MIP the maximal inspiratory pressure, and T(I)/T(T) the inspiratory time (T(I)) to total cycle length (T(T)) ratio. Controls were 30 normal volunteers with similar anthropometric features. Mean (+/- SD) PTI values were significantly higher in COPD patients (0.29 +/- 0.10) than in controls (0.11 +/- 0.04) (P < 0.001) primarily because MIP and T(I)/T(T) were significantly lower and P(awo) was higher in the COPD population than in controls. As a result of improvement of the respiratory condition, PTI values were significantly lower at discharge (0.20 +/- 0.10 vs. 0.29 +/- 0.10, P < 0.001) due to a drop in P(awo) and an increase in MIP. The accuracy of different PTI cutpoints was assessed by comparison of the receiver operating characteristics curves. Best cutpoint values for differentiating COPD patients on admission and at hospital discharge from controls were 0.13 (positive predictive value 76%) and 0.17 (positive predictive value 92%) respectively. Noninvasive PTI measured at the mouth provides a valid and easy method for assessing respiratory muscle load and reserve. Changes in PTI values reflect functional improvement following treatment of acute exacerbation of COPD.

Relationship between gonadotrophin secretion, inhibin B and spermatogenesis in oligozoospermic men treated with highly purified urinary follicle-stimulating hormone (uFSH-HP): a preliminary report

PURPOSE

To study the potential relationship between circulating follicle-stimulating hormone (FSH) gonadotrophin, inhibin B, spermatogenesis and the benefit of highly purified urinary FSH (uFSH-HP) treatment in men with oligozoospermia.

METHODS

Twenty-nine normogonadotropic, normogonadal men with oligozoospermia were evaluated. Serum hormonal concentration and spermiogram were analyzed before and after 3-month treatment with uFSH-HP.

RESULTS

Our results support the hypothesis that inhibin B is involved in the physiological regulation of FSH secretion and reflects the FSH-stimulated Sertoli cell function. After treating with uFSH-HP for 3 months a significant increase in all semen parameters was observed in most of the patients.

CONCLUSIONS

Although the benefit of inhibin B as a prognosis factor in oligozoospermic patients treated with FSH is not defined, it can be considered as an important serum marker in reproductive and testicular functions. Treatment of oligozoospermic patients with uFSH-HP has shown to be an effective and safe therapy.

Use of poisson regression and box-jenkins models to evaluate the short-term effects of environmental noise levels on daily emergency admissions in Madrid, Spain

The relationship between environmental factors and hospital admissions has usually been analysed without taking into account the influence of a factor closely related to traffic in big cities, that is, environmental noise levels. We analysed the relationship between environmental noise and emergency admissions, for all causes and specific causes in Madrid (Spain), for the study period 1995-1997, using two statistical methods for the analysis of epidemiological time series data: Poisson autoregressive models and Box Jenkins (ARIMA) methodology. Both methods produce a clear association between emergency admissions for all and specific causes and environmental noise levels. We found very similar results from both methods for all and circulatory causes, but slightly different for respiratory causes. Around 5% of all emergency admissions can be attributed to high noise levels, with a lower figure for specific causes. Current levels of environmental noise have a considerable epidemiological impact on emergency admissions in Madrid. A reduction of environmental noise levels could be accompanied by a possible reduction in the number of emergency admissions.

[Anterior sacral meningocele with Currarino's syndrome: report of two cases]

The anterior sacral meningocele is the congenital hernia of the thecal sac into the pelvis through a bone defect of the anterior wall of the sacrum. The association of anorectal anomaly, anterior sacral defect and presacral mass, known as Currarino's triad, can be diagnosed during the first decade of life in the eighty per cent of the cases However, in the incomplete syndrome, the symptoms appear in adults. In order to avoid late complications and due to the clear genetic origin of this uncommon pathology, the investigation of the family is of paramount importance for the early diagnosis and treatment. We review the literature and add two cases of anterior sacral meningocele with rectal fistula and incomplete Currarino's syndrome. In one of the cases the pathology is also present in another member of the same family and is complicated with meningitis. The importance of early diagnosis and treatment of these malformations and the need for fammily genetic investigation are discussed.

Effects of extremely hot days on people older than 65 years in Seville (Spain) from 1986 to 1997

The effects of heat waves on the population have been described by different authors and a consistent relationship between mortality and temperature has been found, especially in elderly subjects. The present paper studies this effect in Seville, a city in the south of Spain, known for its climate of mild winters and hot summers, when the temperature frequently exceeds 40 degrees C. This study focuses on the summer months (June to September) for the years from 1986 to 1997. The relationships between total daily mortality and different specific causes for persons older than 65 and 75 years, of each gender, were analysed. Maximum daily temperature and relative humidity at 7.00 a.m. were introduced as environmental variables. The possible confounding effect of different atmospheric pollutants, particularly ozone, were considered. The methodology employed was time series analysis using Box-Jenkins models with exogenous variables. On the basis of dispersion diagrams, we defined extremely hot days as those when the maximum daily temperature surpassed 41 degrees C. The ARIMA model clearly shows the relationship between temperature and mortality. Mortality for all causes increased up to 51% above the average in the group over 75 years for each degree Celsius beyond 41 degrees C. The effect is more noticeable for cardiovascular than for respiratory diseases, and more in women than in men. Among the atmospheric pollutants, a relation was found between mortality and concentrations of ozone, especially for men older than 75.

Prevalence of erectile dysfunction in Colombia, Ecuador, and Venezuela: a population-based study (DENSA)

The purpose of this study was to estimate the prevalence of erectile dysfunction (ED) in Colombia, Ecuador, and Venezuela. A 49-item questionnaire was completed by 1946 men aged 40 years and older. The age-adjusted combined prevalence of minimal, moderate, and complete ED for all three countries was 53.4%, with 19.8% of all men reporting moderate to complete ED. Age was the variable most strongly linked to ED; the prevalence of complete ED increased markedly in men older than 79 y of age (31.9%) and 70-79 y (17.2%) compared with men aged 40-49 y (<3%). Several medical conditions, such as hypertension, benign prostatic hyperplasia, and diabetes, and the use of medications to treat these conditions were correlated with the prevalence of ED. This study corroborates earlier studies demonstrating that ED is very common, increases dramatically with age, and has multiple correlates, including some that are also risk factors for cardiovascular disease.

Suppression of soft nuclear bremsstrahlung in proton-nucleus collisions

Photon energy spectra up to the kinematic limit have been measured in 190 MeV proton reactions with light and heavy nuclei to investigate the influence of the multiple-scattering process on the photon production. Relative to the predictions of models based on a quasifree production mechanism, a strong suppression of bremsstrahlung is observed in the low-energy region of the photon spectrum. We attribute this effect to the interference of photon amplitudes due to multiple scattering of nucleons in the nuclear medium.

Heat waves in Madrid 1986-1997: effects on the health of the elderly

OBJECTIVE

The objective of this paper is to analyse and quantify the effects exerted on summer mortality by extremes of heat, particularly among persons aged 65-74 and 75 years and over, groups in which mortality is higher.

METHODS

The study included the period from 1 January 1986 to 31 December 1997, for all people aged over 65 years resident in Madrid, based on mortality due to all causes except accidents (ICD-9 codes 1-799), and circulatory (390-459) and respiratory (460-487) causes. Meteorological variables analysed were: daily maximum temperature, daily minimum temperature and relative humidity. To control the effect of air pollution on mortality we considered the daily mean values of sulphur dioxide (SO2), total suspended particulate (TSP), nitric oxides (NOx), nitrogen dioxide (NO2) and tropospheric ozone (O3). Univariate and multivariate ARIMA models were used. Box-Jenkins pre-whitening was performed.

RESULTS

The results yielded by this study indicate a mortality increase up to 28.4% for every degree the temperature rises above 36.5 degrees C, with particular effect in women over the age of 75 years and circulatory-cause mortality. The first heat wave that leads to the greatest effects on mortality, due to the higher number of susceptible people and the duration of the heat wave, show an exponential growth in mortality. Furthermore, low relative humidity enhances the effects of high temperature, linking dryness to air pollutants, ozone in particular.

CONCLUSIONS

Since a warmer climate is predicted in the future, the incidence of heat wave should increase, and more comprehensive measures, both medical and social, should be adopted to prevent the effects of extreme heat on the population, particularly the elderly.

Copper metabolism and biliary secretion in patients receiving orthotopic liver transplantation

BACKGROUND

The quantitative aspects of biliary copper excretion in health and disease have not been fully defined yet. The aim of the study was to evaluate copper metabolism and biliary excretion of patients who have received an orthotopic liver transplant (OLT) during the immediate postoperative period.

METHODS

We have studied retrospectively 16 patients undergoing primary OLT and eight undergoing cholecystectomy, and measured serum concentration of copper and its secretion in bile and urine by flame atomic absorption spectrometry (FAAS).

RESULTS

We found a progressive increase of biliary copper secretion rates and a corresponding lowering of urinary copper during the postoperative period. Thus, in OLT patients, the mean of biliary copper secretion on day 1 is 0.7+/-0.2 micromol/day compared with 2.3+/-1.1 micromol/day on day 7 (p<0.01) and 6.1+/-2.5 micromol/day on day 15 (p<0.0001). The rate of copper output on day 5 after surgery is about one sixth of the value reported for patients who had undergone cholecystectomy. In patients suffering an acute rejection episode, there was an abrupt fall in bile flow (<15 ml/day) and excretion of biliary copper (<1 micromol/day), accompanied by an increase of urine copper excretion (>3 micromol/day), and both were recovered when the rejection episode was solved. We found an inverse relationship between the serum bilirubin (Bt), alkaline phosphatase (ALP) and the biliary copper excretion (p<0.01), and a direct relationship with urinary copper excretion (p<0.01).

CONCLUSIONS

The copper measurements in urine and bile are non-invasive techniques, of low cost, rapid and easy to accomplish, and available in hospitals accredited for hepatic transplantation. These characteristics make these methods helpful in the monitoring of patients submitted to OLT for assessment of graft quality and subsequent outcome.

Organizing a public-sector vasectomy program in Brazil

Although models of high-quality family planning services for men exist in Latin America, few if any have been organized within the complex and resource-constrained national public health systems. This study provides evidence from the Santa Barbara project in southern Brazil showing how vasectomy was introduced into the municipal health system. It demonstrates that once the necessary operational and quality-of-care improvements were in place, and sufficient political and technical support existed to proceed, it was possible to establish low-cost, well-used, and sustainable vasectomy services free of charge. The findings show that careful attention to the development of strong technical competence and an informed choice process resulted in high user satisfaction. Focus-group discussions with men who underwent vasectomy indicate that they had no objection to being served in the context of a women's health center and that they act as opinion leaders who draw an increasing clientele to the service.

[Prevalence of sleep apnea-hypopnea syndrome among long-haul professional drivers]

Sleep apnea-hypopnea syndrome (SAHS) has been associated with traffic accidents. The aim of this study was to estimate the prevalence of SAHS and analyze risk factors. We studied 163 professional drivers (86.7%) of the 188 employed by 25 participating companies. The subjects completed a questionnaire on SAHS symptoms and risk factors and underwent physical examination and conventional nighttime polysomnographic testing.

RESULTS

The prevalence of an apnea-hypopnea index (AHI) ( 5 was 25.2% (95% CI 18.7-32.5) among the drivers. The prevalence of SAHS was 8.6% (95% CI 3.4-12.1). The prevalence increased with age (p = 0.012). Sleepiness while driving or habitual snoring had a sensitivity of 67.5%, specificity of 62.6% and a positive predictive value of 38.6% for detecting SAHS. Logistic regression modelling showed that the risk factors were a body mass index over 29 kg/m2 (OR: 3.56, 95% CI 1.53-8.4) and sleepiness while driving (OR: 3.7, 95% CI: 1.303-10.3).

CONCLUSION

These results suggest that detecting SAHS among drivers may be useful for preventing traffic accidents; a questionnaire on SAHS symptoms and objective measures such as polysomnography allow cases to be detected and treated.

A model for forecasting emergency hospital admissions: effect of environmental variables

This study modeled patterns and trends in emergency hospital admissions at a hospital in Madrid, Spain. The purpose was to quantify qualitative associations that have been detected between such admissions and a number of environmental variables. The following data were used: unscheduled daily emergency hospital admissions, Madrid air pollution data, and meteorological data. Time-series analysis was performed, with Box-Jenkins modeling. A multivariate model was constructed, incorporating the different causes of admissions and the respective environmental variables. Statistically significant associations were found between hospital admissions and other variables, indicating relationships with temperature, relative humidity, and mean daily tropospheric ozone concentrations. Whereas the effect of heat on admissions was short term, that of cold was in evidence from the second week. The association with ozone showed a seven-day lag and basically manifested itself as an influence on admissions for circulatory disease.

Hydroxyapatite particles are capable of inducing osteoclast formation

Hydroxyapatite (HA) coatings have been used to improve implant fixation by promoting bone formation around the prosthesis. A macrophage response to HA particulates has been noted around loosened HA-coated prostheses. As biomaterial wear particle-associated macrophages are known to be capable of differentiating into osteoclasts that are capable of bone resorption, we examined whether particulate HA could similarly induce macrophage-osteoclast differentiation. HA-associated macrophages were isolated from granulomas, formed by subcutaneous implantation of HA, and co-cultured with UMR 106 osteoblast-like cells in the presence of 1,25-dihydroxyvitamin D(3) for up to 14 days on glass coverslips and bone slices. HA-associated macrophage-osteoclast differentiation was evidenced by the formation of numerous multinucleated tartrate resistant acid phosphatase (TRAP)-positive cells which formed lacunar resorption pits on bone slices. Polymethylmethacrylate (PMMA) particle-associated macrophages, isolated from subcutaneous PMMA-containing granulomas, caused significantly more osteoclast formation and bone resorption than HA-associated macrophages. These results indicate that macrophages responding to HA particles are capable of osteoclast differentiation. They also suggest that particles derived from uncemented (HA-coated) implants are likely to induce less osteoclast formation and osteolysis than cemented implants.

Radiative proton capture on (6)He

Radiative capture of protons is investigated as a probe of clustering in nuclei far from stability. The first such measurement on a halo nucleus is reported here for the reaction 6He(p,gamma) at 40 MeV. Capture into 7Li is observed as the strongest channel. In addition, events have been recorded that may be described by quasifree capture on a halo neutron, the alpha core, and 5He. The possibility of describing such events by capture into the continuum of 7Li is also discussed.

[Antioxidative state and lipid peroxidation in erectile dysfunction: preliminary study]

OBJECTIVE

The aims of this study were to analyze the cavernosal tissue metabolic status of patients with vascular and psychogenic impotence and attempt to establish metabolic differences between these types of erectile dysfunction.

METHODS

103 patients were classified according to the type of erectile dysfunction into group A (vascular) and group B (psychogenic). Diagnosis was based on clinical history, physical examination, intracavernosal injection test, penile echo-doppler assessment, cavernosography-cavernosometry and nocturnal penile test. Cavernosal and peripheral venous blood samples were obtained from each patient and the lipoperoxide (LPO) levels and total antioxidant status (TAS) were determined. SPSS V9.0 was used for the statistical analysis.

RESULTS

The mean age was 62 years (range 32-73). Cavernosal blood lipoperoxide levels were statistically higher (p < 0.05) in patients with vascular impotence (2.45 mumol/L) than in those with psychogenic impotence (1.47 mumol/L). Cavernosal blood total antioxidant status was statistically higher (p < 0.05) in patients with psychogenic (1.40 mmol/L) than those with vascular impotence (1.10 mmol/L). The lipoperoxide levels and total antioxidant status for peripheral blood were 1.68 mumol/L vs 1.60 mumol/L and 1.29 mmol/L vs 1.35 mmol/L, respectively, with no statistically significant differences between both groups.

CONCLUSIONS

Cavernosal blood lipoperoxide levels and total antioxidant status can be an indicator of cavernosal tissue metabolic status and function.

Comparison of the performances of TCu380A and TCu380S IUDs up to five years

A modification of the TCu380A IUD to create the model TCu380S was introduced many years ago. The TCu380S utilizes copper sleeves that are flush in the plastic and are set at both ends of the horizontal arm. The objective of this study is to compare the clinical performance of the TCu380A and the TCu380S IUDs, especially regarding contraceptive performance and expulsion, in a cohort of women who had one of these two devices inserted at random. This paper presents the results up to 5 years of use. A total of 1568 women were enrolled: 806 women received a TCu380A and 762 women received a TCu380S IUD. The performance was evaluated by life-table analysis and significance between rates was tested by the method of log-rank. The cumulative pregnancy rate was low in users of both models of IUD but lower in users of the TCu380S model through the 5 years of use, without statistical significance. Expulsion was significantly higher in users of the TCu380S model during the five years of use. The other reasons for discontinuation were similar for both devices and did not show statistical significance. The continuation rate was significantly lower in users of the TCu380S model in the first and second years of use. Both devices presented a very low pregnancy rate and TCu380S presented a lower pregnancy rate than the TCu380A, although without statistical significance.

Relationship between atmospheric pressure and mortality in the Madrid Autonomous Region: a time-series study

This study set out to determine the possible influence of variations in atmospheric pressure on mortality in the Madrid Autonomous Region (MAR), taking into account the possible confounding effect of other atmospheric variables. The study was based on daily mortality data from the MAR Revenue and Excise Authority, meteorological data from Getafe Observatory and air pollution data from the Madrid Municipal Automatic Air Pollution Monitoring Grid. A time-series analysis was performed, using Box-Jenkins modelling and controlling for the respective confounding variables. Furthermore, the different variables studied (pressure, temperature, pollutants, etc.) were used to produce a multivariate model of the different causes of mortality. A significant association was found between anticyclonic trend and mortality with circulatory causes in the medium-long term and anticyclonic trend and mortality with respiratory causes in the long term.

Towards a 'human-like' model of tuberculosis: intranasal inoculation of LPS induces intragranulomatous lung necrosis in mice infected aerogenically with Mycobacterium tuberculosis

It is well known that one of the differences between murine and human tuberculosis is the lack of intragranulomatous necrosis in the former. The aim of this study was to create a feasible and reproducible model of an experimental model of murine tuberculosis in which this necrosis should be present. Considering the Shwartzman reaction as a possible explanation for intragranulomatous necrosis in human tuberculosis, C57Bl/6 mice, infected aerogenically with a virulent strain of Mycobacterium tuberculosis, were intranasally inoculated with lipopolysaccharide (LPS) on day 19 postinfection (p.i.). Twenty-four hours later, neutrophils infiltrated the lung parenchyma in a significant level, and 10 days after necrosis could be detected in the centres of primary granulomas, that showed scanty macrophages and large amounts of collagen on an eosinophilic background. On the other hand, a significant decrease in the concentration of colony forming units (CFU) could be appreciated 24 h after the LPS inoculation. Afterwards, nonbronchogenic spreading of granulomas increased and higher levels of interferon (IFN)-gamma mRNA were detected. These results lend support to the Shwartzman reaction as the origin of the intragranulomatous necrosis in the M. tuberculosis infection, and provides a useful tool to improve experimental murine models in tuberculosis.

Fruit development in Capsicum annuum: changes in capsaicin, lignin, free phenolics, and peroxidase patterns

Pepper fruits, of Capsicum annuum cv. Padron, undergo changes in content of capsaicinoids, lignin, and free phenolics during the maturation process. Although capsaicinoids increase with development, the maximal levels of free phenolics and lignin are observed during the early stages of development. A decrease of peroxidase activity was observed during maturation, and this was related with a decrease in other physiological parameters studied, namely chlorophylls and pH. Subcellular fractionation studies reveal that most peroxidase activity is localized in the soluble fraction throughout development. The changes in the peroxidase activity were accompanied by changes in the different isoenzymes. Acidic isoenzymes increased whereas the basic isoenzymes decreased over the same period, and the changes in these isoenzymes were related with capsaicin metabolism.

17beta-estradiol prevents oxidative stress and decreases blood pressure in ovariectomized rats

In this study, we tested whether estrogen deficiency is associated with oxidative stress and decreased nitric oxide (NO) production, which could be responsible for an increased blood pressure in ovariectomized rats. Hemodynamic studies were performed on conscious, chronically instrumented rats. Chronic estrogen replacement on ovariectomized rats lowered blood pressure approximately 13 mmHg, from 119 +/- 3 mmHg in ovariectomized rats to 106 +/- 3 mmHg in ovariectomized-treated rats; it was also accompanied by an increase in cardiac index and vascular conductance, achieving hemodynamic values similar to those shown by sham-operated rats. N(G)-nitro-L-arginine methyl ester administration lowered significantly less the vascular conductance (0.14 +/- 0.01 vs. 0.22 +/- 0.03 and 0.26 +/- 0.01 ml. min(-1). mmHg(-1)/100 g; P < 0.05) in ovariectomized rats than in the sham-operated and estrogen-treated ovariectomized rats, respectively. Estrogen replacement prevented the lower plasma levels of nitrites/nitrates observed in ovariectomized rats. The lower plasma total antioxidant status and reduced thiol groups and the increase in plasma lipoperoxides presented in ovariectomized animals were reestablished with the estrogen treatment. These results show that estrogen administration decreases blood pressure and increases vascular conductance in ovariectomized rats. This effect may be related to an increase in NO synthesis and/or preventing oxidative stress, then improving endothelial function.

A five-year report on experience in the detection of pheochromocytoma

OBJECTIVE

The purpose of the study is to identify biochemical tests that are good predictors for the diagnosis of pheochromocytoma in patients at hypertension.

SETTING

Review of data from of 3826 patients studied over a 5-year period, between 1994 and 1998, at the University Hospital Virgen de la Arrixaca, Murcia, Spain.

DESIGN AND METHODS

A retrospective study for the diagnosis of pheochromocytoma of 24-h urinary free catecholamines (norepinephrine, epinephrine, and dopamine) measured by high-performance liquid chromatography (HPLC)-electrochemical detector (ECD), total metanephrines (MNt), and vanillylmandelic acid measured by spectrophotometric methods.

RESULTS

During this period, 57 patients were found to have pheochromocytoma, being 47 sporadic, 9 with multiple endocrine neoplasia type 2A, and 1 with neurofibromatosis. In all patients multiple endocrine neoplasia type 2A the tumor were bilateral but only in four of the sporadic tumor group (p < 0.0001, Fisher's exact test). MNt was determined to be the best discriminator of hypertension and pheochromocytoma. It scored a sensitivity of 94.7% (95% confidence interval, 88.3-99.9%), a specificity of 95.3% (89.5-99.9%), and thus had the best negative predictive value of 99.9% (99.8-99.9%), and this biochemical test also had the best positive predictive value of 23.3% (10.8-59.9%). When combining both MNt and norephinephrine, the positive predictive value to increases to 85.6% (65.3-95.6%).

CONCLUSION

Urinary 24-h MNt excretion level is the best single biochemical test for screening and, in combination with norephinephrine, is diagnostic of the presence of pheochromocytoma.

Double-blind, randomized, placebo-controlled pilot study with anapsos in senile dementia: effects on cognition, brain bioelectrical activity and cerebral hemodynamics

The aim of this study was to evaluate the effects of two doses of anapsos in comparison with placebo on cognitive performance, brain bioelectrical activity pattern and cerebral hemodynamic parameters in patients with mild to moderate senile dementia of vascular type and Alzheimer type. Forty-five patients (age 73.8 +/- 7.6 years; range 56-89 years) with mild to moderate senile dementia (Global Deterioration Scale: stages 3-5) of the vascular (VD; n = 22) or the Alzheimer type (AD; n = 23) were included in a double-blind randomized placebo-controlled clinical trial. After a 2-week period of drug washout, patients were treated with placebo (n = 15; age 72.7 +/- 7.5 years), 360 mg/day of anapsos (n = 15; age 75.5 +/- 7.2 years), or 720 mg/day of anapsos (n = 15; age 73 +/- 7.7 years) for 4 weeks (28 days). At baseline and after the 4-week period of double-blind treatment, cognitive performance, brain bioelectrical activity power and blood flow hemodynamics in the middle cerebral arteries were evaluated with ADAScog, brain mapping and transcranial Doppler ultrasonography, respectively. Patients receiving 360 mg/day of anapsos showed a significant improvement in cognitive performance after treatment (ADAScog scores: p < 0.05) that was not observed in patients treated with placebo or 720 mg/day of anapsos. As compared to placebo, anapsos (360 mg/day) induced a significant improvement in ADAScog scores in mild senile dementia patients (p < 0.01) and in the subset of patients with AD (p < 0.05). Anapsos (360 mg/day) also increased cerebral blood flow velocities in left and right middle cerebral arteries in the subgroup of AD patients, whereas with the dose of 720 mg/kg this increase was only observed in the left side. Patients treated with anapsos (360 mg/day) showed a decrease in relative delta power and an increase in relative theta and alpha brain bioelectrical activity frequencies, indicating an acceleration of the EEG pattern. The present results show that anapsos (360 mg/day) improves cognitive performance, cerebral blood perfusion and brain bioelectrical activity in patients with senile dementia. These effects of anapsos were more marked in demented patients with mild mental deterioration and/or with dementia of the Alzheimer type.

Evolution of granulomas in lungs of mice infected aerogenically with Mycobacterium tuberculosis

Aerogenous infection of C57Bl/6 mice with a virulent strain of Mycobacterium tuberculosis (CL 511) leads to the formation of primary granulomas in the lung where neutrophils, macrophages and subsequently, lymphocytes accumulate progressively around an initial cluster of infected macrophages. The spread of infection through the lung parenchyma gives rise to secondary granulomas featuring numerous lymphocytes that surround a small number of infected macrophages. Afterwards, foamy macrophages add an outer layer to the granulomas, which characteristically respect the pulmonary interstitium and remain confined within the alveolar spaces. This feature, in conjunction with the constant presence of M. tuberculosis in the products of broncho-alveolar lavage, suggests that the upward bronchial migration of infected macrophages may contribute significantly to pulmonary dissemination of mycobacterial infection. The latter would be in agreement with the persistence of chronic pulmonary infection in spite of a concomitant strong T helper 1 cell response.

The effect upon the human vaginal histology of the long-term use of the injectable contraceptive Depo-Provera

The objective of the study was to evaluate the effect of long-term use of the injectable contraceptive depot medroxyprogesterone acetate (DMPA) on human vaginal histology. Twenty premenopausal women currently using DMPA as a contraceptive method for two and three years were compared with 20 regularly menstruating women, who never used Depo-Provera and/or other kind of hormonal contraceptive in the last 6 months prior to the study. Subjects and controls were matched by age (+/-1 year), body mass index (kg/m2) (+/-1.0), number of pregnancies (+/-1), age at first intercourse (+/-1 year), years of sexual activity (+/-1 year), and number of partners during their life (+/-1). Vaginal biopsies were performed in users at 90+/-7 days after the last injection and in nonusers at day 20-25 of the menstrual cycle. In addition, at the day of the biopsy a blood sample was collected to measure estradiol (in all women) and DMPA in users. The level of serum estradiol was significant lower in Depo-Provera users than in controls (p < 0.001). The thickness of the vaginal epithelium was not smaller among DMPA users than among controls, the mean count of Langerhans cells per mm of epithelium were almost identical in both groups, and no significant differences were found on the vaginal maturation indices. In conclusion, the use of Depo-Provera between two and three years did not affect vaginal thinning of the epithelium, Langerhans cell count or maturation index.

Vaccination against Taenia solium cysticercosis in underfed rustic pigs of México: roles of age, genetic background and antibody response

Vaccination of pigs of mixed genetic make-up, raised as rustically as done in rural Mexico, resulted in effective protection to experimental challenge against Taenia solium cysticercosis. Maximum protection was achieved if pigs were immunized at 70 days of age. There was large variation of viable parasite load within vaccinated pigs and controls, which is suggestive of significant genetic factors influencing susceptibility, besides immunization. Our results strengthen the advisability of pig vaccination for control of T. solium cysticercosis, since it lowers the number of viable cysticerci capable of transforming into tapeworms.

Hormone replacement therapy for oxidative stress in postmenopausal women with hot flushes

OBJECTIVE

To assess the association of hot flushes during postmenopause with oxidative stress and to determine whether hormone replacement therapy (HRT) affects the plasma redox status of postmenopausal women.

METHODS

We conducted a prospective clinical study of 49 postmenopausal women who have (n = 29) or do not have (n = 20) hot flushes. Twelve of the postmenopausal women with hot flushes and six without were treated with HRT (estradiol patches and medroxyprogesterone acetate) for 4 months. Plasma level of estradiol, total antioxidant status, reduced sulfhydryl groups, lipoperoxides, total cholesterol, and triglycerides were measured at 4-month intervals in both groups, before and after treatment.

RESULTS

Postmenopausal women who have hot flushes, had lower total basal antioxidant status in plasma (.9 +/-.01 compared with 1.14 +/-.01 mmol/L), lower concentration of reduced sulfhydryl groups (145 +/- 4 compared with 200 +/- 3 micromol/L), and higher concentration of lipoperoxides (2.88 +/-.04 compared with 2.61 +/-.04 micromol/L) than women without hot flushes. After HRT, total antioxidant status and reduced sulfhydryl groups increased, and lipoperoxides decreased similarly in both groups. Hormone replacement therapy decreased the frequency of hot flushes per day from 11.2 +/- 0.8 to 1.4 +/- 0.3.

CONCLUSION

Hot flushes in postmenopausal women were associated with the oxidative process. Hormone replacement therapy decreases oxidative stress and the number of episodes of hot flushes. Because oxidative stress is associated with a high risk for cardiovascular diseases, HRT might protect women with hot flushes.

Depletion of liver glutathione potentiates the oxidative stress and decreases nitric oxide synthesis in a rat endotoxin shock model

OBJECTIVE

To verify the effects of liver glutathione depletion on redox status and nitric oxide system in a rat endotoxic shock model.

DESIGN

Prospective, randomized, controlled study on rats.

SETTING

A cardiocirculatory research laboratory.

SUBJECTS

A total of 28 Sprague-Dawley male rats (200-250 g body weight) were divided into four experimental groups.

INTERVENTIONS

Arterial blood, liver, and lung samples were taken from each animal under sodium pentobarbital (40 mg/kg i.p.) anesthesia 4 hrs after lipopolysaccharide (LPS group: 5 mg/kg i.p.; n = 7) or vehicle (control group: isotonic NaCl sterile solution i.p.; n = 7) treatments. Phorone (250 mg/kg i.p.) was injected to deplete glutathione in another two experimental groups of rats 30 mins before LPS (phorone+LPS group; n = 7) or vehicle (phorone group; n = 7) treatments, and 4 hrs later the same samples as in LPS and control groups were taken under anesthesia.

MEASUREMENTS AND MAIN RESULTS

Compared with the control group, the LPS group presented higher plasma concentration of end products of nitric oxide metabolism nitrites/nitrates, higher lung activity of inducible nitric oxide synthase, and oxidative stress defined by increased plasma concentration of the lipid peroxides malonaldehyde and 4-hydroxynonenal, and decreased plasma total antioxidant capacity. Treatment with phorone depleted liver glutathione (80% to 90%). In the liver glutathione-depleted animals, the oxidative stress induced by LPS was potentiated and blunted the increases in inducible nitric oxide synthase and plasma nitrites/nitrates.

CONCLUSION

These results show that depletion of the liver glutathione increases the oxidative stress and decreases nitric oxide synthesis of LPS-induced shock in rats.

Plasma redox status relates to severity in critically ill patients

OBJECTIVE

To determine the relation between plasma redox status and severity of illness for patients admitted to an intensive care unit (ICU).

DESIGN

A prospective cohort study.

SETTING

A mixed medical and surgical adult ICU with 12 beds.

PATIENTS

A total of 73 consecutive patients admitted to the ICU.

INTERVENTIONS

Venous blood samples were routinely obtained within 24 hrs of admission.

MEASUREMENTS AND MAIN RESULTS

Plasma total antioxidant capacity and lipoperoxides were measured by spectrophotometric technique at admission to the ICU. The plasma ratio total antioxidant capacity (mM)/lipoperoxides (microM) was used as an index of plasma redox status. Plasma concentration of the markers of leukocyte activation myeloperoxidase (enzyme-linked immunosorbent assay) and polymorphonuclear-elastase (immunoactivation assay) were also measured at admission to the ICU. Analysis of correlation between plasma ratio total antioxidant capacity/lipoperoxides and APACHE III score showed a negative association (p < .001, Spearman correlation test). Myeloperoxidase and polymorphonuclear-elastase correlated positively with Acute Physiology and Chronic Health Evaluation III scores (r2 = 0.58; p < .001; and r2 = 0.05; p = .035; respectively).

CONCLUSIONS

Plasma redox status relates to severity in critically ill patients. We propose that it would be reasonable to provide antioxidant therapy as part of routine management of patients admitted to a mixed ICU, regardless of the specific reason for ICU admission. Plasma redox status might become useful to evaluate the risk in critically ill patients.

[Relationship between leptin and insulin blood levels in obese and lean Chilean women]

BACKGROUND

Leptin, a product of ob gene and insulin blood levels, are proportional to the amount of adipose tissue. Insulin could have an independent regulatory effect on leptin secretion.

AIM

To assess the relationship between serum leptin and plasma insulin levels in obese and lean Chilean women.

MATERIAL AND METHODS

One hundred forty five women, aged 20 to 60 years old, were studied. Weight, height, waist and hip circumference, fasting blood glucose, insulin and leptin levels were measured. Insulin resistance was assessed using the homeostasis model assessment. The relationship between different variables was determined using multiple linear regression, variance analysis and non parametric correlation.

RESULTS

Leptin serum concentrations were positively correlated with body mass index, insulin plasma levels and degree of insulin resistance. The association of leptin with insulin was independent of body mass index and persisted after adjustments by body fat distribution and age.

CONCLUSIONS

Insulin and insulin resistance are associated to high blood leptin levels and this association is independent of the degree of adiposity and body fat distribution.

Modeling of air pollution and its relationship with mortality and morbidity in Madrid, Spain

OBJECTIVE

Evaluation of the association between air pollution and mortality and morbidity is becoming ever more complex owing to changes in inner-city air pollution, marked by decreasing values for all main pollutants save those associated with traffic. This has led to the need for the study of new epidemiological scenarios in which most pollutants are below guideline values. Nonetheless, the health effects are significant.

METHODS

This report presents the results of a statistically based model for real-time forecasting of mortality and morbidity in Madrid, with meteorological and pollution series serving as inputs.

RESULTS AND CONCLUSIONS

Not only did the models perform well with correlation coefficients between predicted and observed values (r = 0.683 for mortality, r = 0.681 for morbidity), but they enabled quantification of the impact of air pollution on mortality and morbidity (with increases ranging from 1. 8% to 12% for mortality and from 2.3% to 18% for morbidity for a 25-microg/m(3) increase in pollutants). Moreover, attention should be drawn to the observation that the model proved to be easy to implement and operate on a routine basis.

Implication of soluble and membrane HLA class I and serum IL-10 in liver graft acceptance

Membrane HLA class-I expression (mHLA-I), soluble HLA class-I antigens (sHLA-I) and interleukin (IL)-10 are different factors implicated in the special acceptance of liver allograft. In this study, pre- and post-operative levels of mHLA-I in peripheral blood lymphocytes (PBL) and serum sHLA-I were analyzed in 86 liver transplants, immunosuppressed with Cyclosporine-A, methylprednisolone and azathioprine, and classified into acute-rejection (AR, n = 28) and non-acute-rejection (NAR, n = 58) groups. Serum IL-10 was studied in 47 recipients (AR-group, n = 16 and NAR-group, n = 31). Pre-transplant values of mHLA-I and sHLA-I showed a bimodal distribution (high/low) in NAR-recipients, but in AR-patients were mainly included in the low expression/secretion zone (mHLA-I, p < 0.02 and sHLA-I, p < 0.05). Consequently, average pre-transplant mHLA-I (868 +/- 109 versus 998 +/- 123, p < 0.05) and sHLA-I (1.3 +/- 0.4 versus 2.02 +/- 0.7 microg/ml, p < 0.01) was lower in the AR- than in the NAR-group. After transplant both parameters decreased in the NAR-group, but increased in AR-recipients previous to and on rejection diagnosis day. Additionally, serum IL-10 levels were significantly higher (p < 0.01) in the NAR than in the AR-group during the first 24 h post-transplant. In conclusion, low pre-transplant mHLA-I and sHLA-I levels pre-dispose liver recipients to acute rejection, whereas early post-transplant increases of serum IL-10 appear to be related to a good liver allograft acceptance.