Influence of the Current Management of Renal Transplant Recipients on the Prevalence of Anemia and Related Costs

The use of mycophenolate mofetil (MMF) and renin-angiotensin system blockers (RAB) to prevent and treat chronic graft nephropathy may affect the incidence of anemia in renal transplant recipients. We compared 2 sets of cadaver-donor recipients, namely those followed at the end of 1995 (group 1; n = 252) versus 2003 (group 2; n = 530) in terms of general characteristics, incidence of anemia (hemoglobin [Hb] < or =13 g/L males, 12 g/L females) or severe anemia (Hb < or =11 g/L males, 10 g/L females) and use cost of treatment with erythropoietin (EPO). Group 2 was significantly older, heavier and longer since grafting. Fifty-seven percent received MMF, 21% received azathioprine, and 5% received rapamycin. In group 1, 83% were given azathioprine. RAB were administered to 35.1% in group 2 versus 14.7% in group 1 (P < .001). Mean blood pressure was identical in the 2 groups, but graft function was worse in group 2 (Cockroft, 62 vs 74 mL/min; P < .001). Mean Hb levels (13.66 + - 3.1 vs 13.82 + - 1.7 g/L) and prevalence of anemia (36.9% vs 34.5%) for groups 1 and 2, respectively, were similar. The rate of severe anemia, however, was lower in group 2 (2.3% vs 8.7%; P < .001). The use of EPO increased from 2.8% (group 1) to 8.7% (group 2; P < .01). In 2003, the cost of EPO was calculated at 1982 Euros/patient-year and 91,150 Euros per year for the whole patient group. Despite accumulation of predisposing factors, the control of anemia in our patients has improved due to the expanded use of EPO. Along with its high cost, EPO therapy has potential positive repercussions on the quality of life and patient prognosis. Therefore, we need to precisely define the optimal use of EPO in renal transplant recipients.

Clinical efficacy of anti-pneumococcal vaccination in patients with COPD

BACKGROUND

A study was undertaken to evaluate the clinical efficacy of the 23-valent pneumococcal polysaccharide vaccine (PPV) in immunocompetent patients with chronic obstructive pulmonary disease (COPD).

METHODS

A randomised controlled trial was carried out in 596 patients with COPD of mean (SD) age 65.8 (9.7) years, 298 of whom received PPV. The main outcome was radiographically proven community acquired pneumonia (CAP) of pneumococcal or unknown aetiology after a mean period of 979 days (range 20-1454).

RESULTS

There were 58 first episodes of CAP caused by pneumococcus or of unknown aetiology, 25 in the intervention group and 33 in the non-intervention group. Kaplan-Meier survival curves for CAP did not show significant differences between the intervention and non-intervention arms (log rank test = 1.15, p = 0.28) in the whole group of patients. The efficacy of PPV in all patients was 24% (95% CI -24 to 54; p = 0.333). In the subgroup aged <65 years the efficacy of PPV was 76% (95% CI 20 to 93; p = 0.013), while in those with severe functional obstruction (forced expiratory volume in 1 second <40%) it was 48% (95% CI -7 to 80; p = 0.076). In younger patients with severe airflow obstruction the efficacy was 91% (95% CI 35 to 99; p = 0.002). There were only five cases of non-bacteraemic pneumococcal CAP, all in the non-intervention group (log rank test = 5.03; p = 0.025). Multivariate analysis gave a hazard ratio for unknown and pneumococcal CAP in the vaccinated group, adjusted for age, of 0.20 (95% CI 0.06 to 0.68; p = 0.01).

CONCLUSIONS

PPV is effective in preventing CAP in patients with COPD aged less than 65 years and in those with severe airflow obstruction. No differences were found among the other groups of patients with COPD.

Hepatosplenic large cell immunoblastic lymphoma in a bottlenose dolphin (Tursiops truncatus) with high levels of polychlorinated biphenyl congeners

This report describes a large cell immunoblastic lymphoma in a bottlenose dolphin found stranded alive in Gran Canaria, Spain. Diffuse infiltration of round neoplastic cells was observed in the splenic cords and sinuses and in hepatic sinusoids, resulting in moderate organ enlargement. The tumour cells (immunophenotype IgG+ and CD3-) showed scant, lightly eosinophilic or basophilic cytoplasm, distinct cell boundaries and hyperchromatic nuclei, each with one or more nucleoli. Mitoses were common. On the basis of histopathological, immunohistochemical and ultrastructural features, the tumour was classified as an immunoblastic lymphoma. Eleven polychlorinated biphenyl (PCB) congeners, 23 organochlorine pesticides and 16 polycyclic aromatic hydrocarbons (PAHs) were detected in the blubber and liver. High concentrations of PCBs 153, 180, 138 and 187 found in the liver may have been associated with the hepatosplenic lymphoma.

Pancreas Islet Transplantation in Patients With Type 1 Diabetes Mellitus After Kidney Transplantation

Diabetic patients with end-stage renal disease have a high mortality rate. A combined kidney-pancreas transplant is associated with greater life expectancy. Pancreas islet transplantation is an alternative involving a lower degree of morbidity. We present two patients, of 41 and 37 years of age, with a long history of diabetes mellitus (C-peptide negative), both with a previous kidney transplant, who had been treated with 22 and 28 U of insulin/d, respectively. Both patients had frequent episodes of unawareness hypoglycemia. Pancreatic islets were infused to a total of 7809 and 19,180 IE/kg, respectively. Basal posttransplant C peptide levels were 2.9 and 1.3 ng/mL. After the implant, one patient required occasional doses of insulin, and the other patient more than 50% reduced dose. After the first implant neither patient had any episodes of unawareness hypoglycemia. HbA1c at 4 months were 6.2% and 6.9%. There were no transplant-related complications.

Cellular localization and changes in expression of prolactin receptor isoforms in sheep ovary throughout the estrous cycle

The actions of prolactin (PRL) on target cells depend on the type of prolactin receptor (PRLr) predominantly expressed, particularly whether the long PRLr isoform is expressed. The aims of this study were to determine the cellular localization and the changes in expression of long and short PRLr isoforms in sheep ovary throughout the estrous cycle. Long and short PRLrs were localized mostly in the same ovarian cells. Maximum signal intensity, particularly for long PRLrs, was found in stromal cells surrounding primordial and primary follicles, and, for both PRLrs, in granulosa cells of preantral follicles and in luteal cells. Moderate signal intensity for PRLrs was found in theca cells of preantral to ovulatory follicles, and in granulosa cells of antral follicles up to the gonadotropin-dependent stage. Decreasing immunoreactivity to PRLrs was found in granulosa cells of gonadotropin-dependent to ovulatory follicles. For long PRLrs in particular, no signal was found in mural granulosa cells of gonadotropin-dependent follicles; for both isoforms, no signal was found in most granulosa cells of ovulatory follicles. In primordial to gonadotropin-dependent follicles, cellular localization of PRLr was similar on days 0, 10 and 15 of the cycle. Oocytes consistently showed positive immunostaining for PRLrs. Comparative RT-PCR analysis of long and short PRLr expression showed that the short isoform is evenly expressed throughout the estrous cycle, whereas the expression of the long form increases at the time of estrus and decreases at mid-luteal phase and at the onset of the follicular phase. Expression of long PRLrs was greater than that of short PRLrs on day 0 of cycle; expression of both isoforms was similar on day 10 and on day 15, long PRLrs expression was lower than that of short PRLrs. Our results indicate that in sheep ovary, the maximum responsiveness to PRL might occur during the preovulatory phase of the estrous cycle.

Solid-phase extraction–gas chromatography–mass spectrometry using a fullerene sorbent for the determination of inorganic mercury(II), methylmercury(I) and ethylmercury(I) in surface waters at sub-ng/ml levels

A novel, straightforward solid-phase extraction system for the determination of inorganic mercury and organomercury compounds in water is proposed. The analytes, in a buffer medium at pH 4.5, are sorbed as diethyldithiocarbamate complexes on a C60 fullerene column an subsequently eluted and derivatized with sodium tetra-n-propylborate in ethyl acetate. Following elution, 1 microl of extract is injected into a gas chromatograph-mass spectrometer system. The proposed gas chromatography-mass spectrometry speciation method exhibits a linear range of 4-1 ng/ml, and a detection limit of 1.5 ng/l (sample volume, 50 ml). Its repeatibility, as relative standard deviation (RSD) (from 11 standards containing 50 ng/l for each analyte), is ca. 7%. No interferences from metals ions, such as Zn2+, Fe3+, Sb3+, As3+, Pb2+, Ni2+, Cu2+, Sn2+, Co2+, Mn2+ and Cd2+ were encountered at concentrations 1000 times higher than those of the mercury compounds. The method was used for the speciation of inorganic mercury, methylmercury and ethylmercury in various types of water including sea and waste water.

Mitochondrial phylogeography of the long-eared bats (Plecotus) in the Mediterranean Palaearctic and Atlantic Islands

Long-eared bats of the genus Plecotus are widespread and common over most of the western Palaearctic. Based on recent molecular evidence, they proved to represent a complex of several cryptic species, with three new species being described from Europe in 2002. Evolutionary relationships among the different lineages are still fragmentary because of the limited geographic coverage of previous studies. Here we analyze Plecotus mitochondrial DNA sequences from the entire Mediterranean region and Atlantic Islands. Phylogenetic reconstructions group these western Palaearctic Plecotus into two major clades which split at least 5 Myr ago and that are each subdivided into further subgroups. An 'auritus group' includes the traditional P. auritus species and its sister taxon P. macrobullaris (=P. alpinus) plus related specimens from the Middle East. P. auritus and P. macrobullaris have broadly overlapping distributions in Europe, although the latter is apparently more restricted to mountain ranges. The other major clade, the 'austriacus group,' includes the European species P. austriacus and at least two other related taxa from North Africa (including P. teneriffae from the Canary Islands), the Balkans and Anatolia (P. kolombatovici). The sister species of this 'austriacus group' is P. balensis, an Ethiopian endemic. Phylogenetic reconstructions further suggest that P. austriacus reached Madeira during its relatively recent westward expansion through Europe, while the Canary Islands were colonized by a North African ancestor. Although colonization of the two groups of Atlantic Islands by Plecotus bats followed very distinct routes, neither involved lineages from the 'auritus group.' Furthermore, the Strait of Gibraltar perfectly segregates the distinct lineages, which confirms its key role as a geographic barrier. This study also stresses the biogeographical importance of the Mediterranean region, and particularly of North Africa, in understanding the evolution of the western Palaearctic biotas.

Effects of ionic strength on the production of short chain volatile hydrocarbons by Dunaliella salina (Teodoresco)

The effect of ionic strength on the production of short chain volatile hydrocarbons was studied in cultures of Dunaliella salina. Axenic cultures of D. salina were grown at three different ionic strengths 0.5, 2 and 3 M of NaCl in Johnson (J/1) culture medium [Journal of Bacteriology 95 (1968) 1461] under the following laboratory growth conditions: a 12:12 h photoperiod, 300 micromolm(-2)s(-1) of photosynthetic active radiation (PAR) provided by a fluorescent lamp of 40 W combined with a 100 W incandescent lamp at 20 +/- 1 degrees C at pH 7.5. C1 to C5 hydrocarbons were detected using a head space technique and GC-FID. Cell numbers and growth rate was greatest at 2 M NaCl 4.3 x 10(6) cellml(-1) after a 15 days period of culture. Maximum hydrocarbon production was measured in the concentration of 0.5 NaCl with lower production rates in the more concentrated solutions. The principal hydrocarbon was pentane at 0.5 M but was ethane in 2 and 3 M solutions. Production rates for individual compounds ranged between 0.13 and 22 x 10(-15) microgCcell(-1)h(-1). It is suggested that the ability to produce and release volatile organic compounds of D. salina is related to osmotic conditions established by the ionic strength of growth solution.

Speciation of butyltin compounds in marine sediments by preconcentration on C60 and gas chromatography–mass spectrometry

A new method for the speciation of butyltin compounds by solid phase extraction and direct injection using gas chromatography-mass spectrometry (GC/MS) is described. The compounds were complexed with sodium diethyldithiocarbamate and retained on a C60 sorbent column. The neutral chelates of butyltin compounds were eluted with ethyl acetate containing NaBPr4 as derivatising reagent. The main analytical figures of merit of the proposed method for 10 ml of sample are: linear range 0.2-35 ng/g expressed as Sn; limits of detection, 0.07, 0.09 and 0.10 ng/g as Sn for monobutyltin, dibutyltin and tributyltin, respectively. No interferences from metal ions such as Zn2+, Fe3+, Sb3t, Pb2+, Ni2+ and Mn2+ were observed in the determination of organotin compounds. The validation of method was performed out by the analysis of a standard reference sediment (CRM 462). The method was also applied to the determination of butyltin compounds in marine sediment samples.

Prognostic value of Pulsatility Index in acute intracerebral hemorrhage

OBJECTIVE

To investigate whether data obtained by transcranial Doppler (TCD) have prognostic value in patients with intracerebral hemorrhage (ICH).

METHODS

A prospective study of patients with an acute (<12 hours from onset of symptoms) spontaneous supratentorial ICH was conducted. Mortality was assessed at 30-day follow-up. TCD parameters were obtained from both middle cerebral arteries: systolic, diastolic, and mean velocities and Pulsatility Index (PI) from the affected and unaffected hemispheres. The following variables were included in a univariate analysis: age, sex, hematoma volume, hypodense volume around the hematoma, total volume, midline shift, ventricular size, Glasgow Coma Scale score, intraventricular hemorrhage, body temperature, white cell count, blood glucose, mean blood pressure, and TCD data. A multivariate analysis was performed with variables that showed significance in the univariate analysis. Receiver-operator characteristic (ROC) curves were obtained.

RESULTS

Forty-eight patients (age 66.5 +/- 12.5 years; 28 men) were studied. Mortality at 30 days was 31%. The only predictor of mortality was the Glasgow Coma Scale score (odds ratio [OR] 0.67, CI 0.53 to 0.84, p = 0.001), whereas the PI from the unaffected hemisphere was correlated with mortality (OR 2.3, CI 0.92 to 5.72, p = 0.07). The area under the ROC curve was 0.92. A cutoff for PI from the unaffected hemisphere of 1.75 showed a specificity of 94% and a sensitivity of 80% as a predictor of death at 30 days.

CONCLUSIONS

The PI of the unaffected hemisphere may be a predictor of death in acute ICH. These findings suggest that intracranial hypertension is the most likely cause of death in most patients with ICH.

Spinal cord compression due to tumoral idiopatic calcinosis

STUDY DESIGN

A case of thoracic spinal cord compression due to tumoral calcinosis (TC) is reported.

SETTING

Galiza, Spain.

CASE REPORT

A 59-year-old man was admitted to our hospital with a 2-month history of gradual leg weakness and sensory deficit. The neurological examination revealed paraparesis with T12 sensory level. Magnetic resonance imaging (MRI) showed an extradural right posterolateral mass at T11-T12 level, resulting in a marked spinal cord compression. He underwent T11-T12 laminectomy and mass excision. Histological examination finally led to the diagnosis of TC.

CONCLUSION

TC is an uncommon cause of mass lesions of the spine. Since there is no typical spine TC MRI appearance, the final diagnosis is done by histological studies. TC should be considered in differential diagnosis of spinal cord compression and constitutes a treatable cause of paraparesis.

Acoustic and perceptual indicators of normal and pathological voice

The aim of this study was to obtain acoustic correlates to vocal quality of a group of men and women with and without voice disorders, based on evaluations of a group of judges experienced in the field of vocal rehabilitation. In male subjects, perceptual evaluation of normal, hoarse and rough voice qualities was related to the following acoustic features: frequency perturbation measures (JITA, RAP, and SPPQ), amplitude perturbation (SAPQ and VAM), soft phonation index (SPI) and fundamental frequency tremor intensity (FTRI). While these measures presented normal values for normal voice, hoarseness showed some deviations in perturbation frequency variables and very high SPI values, while rough voice showed deviations in all the measures. Qualities of female voices were perceived as normal, breathy and hoarse, but the acoustic correlates of these qualities were less conclusive.

Dietary influence of kefir on microbial activities in the mouse bowel

AIMS

In this work the microflora present in kefir, a fermented milk product, was studied together with the effect of kefir administration on different groups of indigenous bacteria of mouse bowel.

METHODS AND RESULTS

Kefir microflora was composed of lactic acid bacteria, acetic acid bacteria and yeasts. Yeast population was composed of Saccharomyces cerevisiae, S. unisporus, Candida kefir, Kluyveromyces marxianus and K. lactis. The streptococci levels in kefir treated mice increased by 10-fold and the levels of sulfite-reducing clostridia decreased by 100-fold. The number of lactic acid bacteria increased significantly.

CONCLUSIONS

The administration of kefir significantly increased the lactic acid bacteria counts in the mucosa of the bowel. Ingestion of kefir specifically lowered microbial populations of Enterobacteriaceae and clostridia.

SIGNIFICANCE AND IMPACT OF THE STUDY

This is the first long-term study about the effects of the kefir administration on the intestinal microflora of mice.

Electrochemical platinum coatings for improving performance of implantable microelectrode arrays

The formation and properties of electrochemical platinum films grown on platinum contacts contained in implantable flexible microelectrodes were investigated. The resulting platinum deposits were obtained by applying cyclic voltammetry to baths containing concentrations around 70 mM of chloroplatinic acid. A pre-activation step was necessary before the platinum-electroplating step in order to achieve good adhesive properties. The benefits of this process were ascribed to higher corrosion resistance, lower impedance and improved adhesion to the sputtered platinum. These improvements can make the application of this electrochemical technique highly useful for increasing the lifetime of implantable microelectrode arrays, such as cuff structures (IEEE Trans. Biomed. Eng. 40 (1993) 640). These medical devices, obtained by semiconductor technology could be used for selective stimulation of nerve fascicles, although, poor long-term performance has been achieved with them. The dissolution rate for platinum thin-film microelectrodes under fixed corrosion test conditions was 38.8 ng/C. Lower rates were observed for electroplated microelectrodes, obtaining a dissolution rate of 7.8 ng/C under analogous experimental ageing conditions. The corrosion behaviour of the electroplated platinum during stimulation experimental conditions was estimated by electrochemical impedance spectroscopy.

[Results of C1-C2 transarticular screw fixation in a series of 20 patients]

OBJECTIVE

C1-C2 transarticular fixation is an increasingly used surgical method of treating atlantoaxial instability. When properly performed, it can safely provide fusion rates near 100%, but techniques of fixation in this region allow only a small margin of error. We here report the results of C1-C2 transarticular fixation in a series of 20 patients in which different procedures were selected according to the presenting disorder in each case.

METHODS

The study group included 9 men and 11 women with a mean age of 48 years (range 17 to 68 years). The causes of instabilities were rheumatoid arthritis in nine patients, type II and III Hangman's fracture of traumatic origin in nine (in association with other lesions in three cases), pseudoarthrosis after type II odontoid fracture in one, and type III complex C1 fracture in a patient with ankylosing spondylitis. Preoperative assessment included flexion and extension plain radiographs and computed tomography (CT) and magnetic resonance imaging (MRI) scans. Operations included transarticular screw fixation in all cases; in patients with rheumatoid arthritis it was associated with sublaminar fixation and bone grafting following Sonntag's technique in all but two cases. Postoperative results were evaluated in relation to the biomechanical stability and fusion was studied by flexion and extension radiographs and CT scans. Pain relief in patients with rheumatoid arthritis patients was assessed using a 0-10 visual analogic scale (V.A.S.).

RESULTS

In the traumatic group, a consolidation of the fracture and radiologic stability was achieved in all cases. In patients with rheumatoid arthritis, pain improved in all but not the neurological deficit, and in all cases a C1-C2 biomechanical stability was reached despite interlaminar graft resorption in two (25%) cases. With respect to complications, a lesion of the vertebral artery occurred in one case, deviation of the screw in two cases, and breakage of the screw without clinical repercussion in two other cases.

CONCLUSION

C1-C2 transarticular screw fixation was a useful technique to achieve satisfacory biomechanical stability in patients with atlatoaxial instability of both inflammatory and traumatic origin with a low rate of complications.

Perceptual analysis in different voice samples: agreement and reliability

The objective of this study was to estimate the agreement and reliability of voice evaluation by a group of expert listeners using the central portion of a sustained vowel and a fragment of connected speech as voice samples. Ratings were made using Wilson's Buffalo III Voice Screening Profile. Analysis showed that intraindividual listeners' agreement presented variability in the evaluation of both voice samples. In the evaluation of the central portion of the sustained vowel, interindividual listener agreement was moderate for breathiness, hyponasal resonance, and overall voice rating; in connected speech, agreement was moderate for most voice qualities (breathy, rough, high/low pitch, and hyponasal resonance). Finally, Wilson's Buffalo III Voice Screening Profile presented good reliability values for both voice samples, with overall voice rating achieving higher values (.90) than any other voice-quality variable.

Hydrophobic similarity between molecules: a MST-based hydrophobic similarity index

A similarity index based on the hydrophilic/hydrophobic properties of molecules is presented. Such an index is defined based on the fractional partition of the free energy of solvation developed within the framework of the self-consistent reaction field MST model, which divides the free energy of solvation or the free energy of transfer into contributions assigned to the surface elements defining the solute/solvent interface. These surface contributions can be integrated to derive atomic or group contributions. The suitability of the index to compute the molecular similarity based on hydrophobic/hydrophilic properties is examined by considering their application in a variety of test systems, including structure-activity relationships, absorption properties, and molecular recognition. The similarity index is expected to be a very powerful tool in molecular similarity studies for compounds of chemical, biochemical, and pharmaceutical interest.

[Short term synaptic plasticity]

INTRODUCTION

At many chemical synapses, the amount of transmitter released by each action potential can increase or decrease markedly after the onset of specific temporal patterns of activity.

OBJECTIVES

This review focuses on mechanisms and functions of short term presynaptic plasticity that last from milliseconds to minutes. The short term enhancement of neurotransmitter release is due to three calcium dependent presynaptic processes differing in their durations: about one second or less (facilitation), about 30 seconds (augmentation) and several minutes (post tetanic potentiation). These forms of short term potentiation are usually attributed to a transient elevation in presynaptic calcium ions (Ca2+) concentration following the arrival of the action potential. Otherwise, presynaptic depression processes, as well as the facilitation ones, depend on neurotransmitter release probability. Thus, synapses with high release probability show few facilitation and are easily depressed because of their ability to deplete faster all synaptic vesicles of the ready releasable pool.

CONCLUSIONS

Short term synaptic plasticity appears to serve as a flexible mechanism for temporal information processing in higher cortical integration.

[Clinical and epidemiological characteristics of persons newly diagnosed of HIV infection]

BACKGROUND

We describe the characteristics of people with a recent diagnosis of HIV infection.

PATIENTS AND METHOD

Series of 126 new cases of HIV infection diagnosed in an infectious diseases Service.

RESULTS

Sexual transmission was the commonest form of infection (74%). Fifteen percent of individuals were aged over 50 years and 16% were immigrants. A late diagnosis (stage C) accounted for 36% of cases and it was associated with being more than 50 years old (OR: 5.1; 95% CI: 1.6-16.8).

CONCLUSIONS

It is necessary to implement HIV infection surveillance systems and to improve preventive services.

A fish cell surface receptor defined by a mAb mediates leukocyte aggregation and deactivation

Cell adhesion molecules play a key role in the inflammatory response. Selectins, integrins and immunoglobulin gene superfamily adhesion receptors mediate the different steps of leukocyte migration from the blood-stream towards inflammatory foci. In addition to their adhesive function, these receptors modulate major cellular processes such as cell activation, growth, differentiation and death. To characterise the fish molecules involved in cell adhesion, a panel of mAbs was raised by immunising mice with macrophages from the marine fish gilthead seabream (Sparus aurata L.). One of these mAbs, which we named anti-Aggregatin, was found to induce a rapid heterotypic aggregation of seabream leukocytes. Anti-Aggregatin defined a 140-kDa cell surface receptor which was highly expressed by macrophages and was up-regulated after co-stimulation with LPS and MAF. Functionally, the cell adhesion which occurred upon exposure to anti-Aggregatin required Ca(2+), an intact cytoskeleton and an active cell metabolism. More importantly, Aggregatin engagement resulted in strong inhibition of the phagocyte respiratory burst, although the cells showed neither loss of viability nor DNA fragmentation. The results are discussed in relation to the potential role of cell adhesion molecules in fish immune responses.

Molecular pathology of endometrial hyperplasia and carcinoma

Four different genetic abnormalities may occur in endometrioid adenocarcinomas of the endometrium (mircosatellite instability and mutations in the PTEN, k-RAS and beta-catenin genes), whereas nonendometrioid carcinomas of the endometrium often have p53 mutations and loss of heterozygosity on several chromosomes. Occasionally, a nonendometrioid carcinoma may develop as a result of dedifferentiation of a preexisting endometrioid carcinoma; in such a case, the tumor exhibits overlapping clinical, morphologic, immunohistochemical, and molecular features of the 2 types. The insaturation of microsatellite instability in endometrial carcinogenesis seems to occur late in the transition from complex hyperplasia to carcinoma, and it is preceded by progressive inactivation of MLH-1 by promoter hypermethylation. Moreover, the endometrioid adenocarcinomas that exhibit microsatellite instability show a stepwise progressive accumulation of secondary mutations in oncogenes and tumor suppressor genes that contain short-tandem repeats in their coding sequences. Mutations in the PTEN and k-RAS genes are also frequent in endometrioid adenocarcinomas of the endometrium, particularly in the tumors that exhibit microsatellite instability, whereas beta-catenin mutations do not seem to be associated with such a phenomenon.

Radicular involvement and medullary invasion from a malignant mesothelioma

We present the case of a 57-year-old patient who had worked at a fiber-cement factory for 28 years. The patient developed an epithelioid-type pleural mesothelioma 5 years after retiring, after he was diagnosed with asbestosis. Only 5 months after the diagnosis of mesothelioma, a medullar section appeared to be totally invaded by a tumor in the medullar canal, thus causing paraplegia and affecting the bladder and anal sphincters. The patient underwent radiotherapy and chemotherapy, and achieved partial recovery, but died 9 months after the diagnosis.

Usefulness of route of transmission, absolute CD8+ T-cell counts, and levels of serum tumor necrosis factor alpha as predictors of survival of HIV-1-infected patients with very low CD4 + T-cell counts

Potential cofactors of survival in HIV-1-infected patients with CD4+ T-cell counts of < or = 100 cells/microl were investigated. All 132 patients with CD4+ T-cell counts of < or = 100 cells/microl were selected from 416 patients included in an antiretroviral therapy cohort (1989-1999). Fifty of 54 deaths were due to AIDS. There were significant associations (P<0.05) between survival and CD8+ T-cell counts, clinical AIDS stage, risk group, and antiretroviral drug regimen after baseline, but only the use of protease inhibitors had an independent effect on survival (hazard ratio [HR], 0.096; 95% confidence interval [95%CI], 0.094-0.097). A substudy restricted to the cohort of 108 patients never exposed to PIs detected independent associations between survival and CD8+ T-cell counts (P=0.0016), experience with antiretroviral therapy before baseline (HR, 2.52; 95%CI, 1.31-4.82), sexual risk group for HIV infection (HR, 3.7; 95%CI, 1.92-7.12), and levels of serum tumor necrosis factor alpha (P=0.02). This study confirms that the use of PI-containing antiretroviral regimens strongly predicts survival of HIV-1-infected patients with very low CD4+ T-cell counts. When the study was restricted to patients never exposed to PIs, the parenteral route of disease transmission, high absolute CD8 + T-cell counts, and low serum levels of tumor necrosis factor alpha were independent predictors of survival in extremely advanced HIV-1 disease.

Critical factors in chitin production by fermentation of shrimp biowaste

Factors affecting Lactobacillus fermentation of shrimp waste for chitin and protein liquor production were determined. The objective of the fermentation is medium conditioning by Lactobacillus through production of proteases and lowering of the pH. The efficiency was tested by conducting fermentation of biowaste in 1-1 beakers with or without pH adjustment using different acids. Addition of 5% glucose to the biowaste supported the growth of lactic acid bacteria and led to better fermentation. Among four acids tested to control pH at the start and during fermentation, acetic acid and citric acid proved to be the most effective. In biowaste fermented with 6.7% L. plantarum inoculum, 5% glucose, and pH 6.0 adjusted with acetic acid, 75% deproteination and 86% demineralization was achieved. Replacement of acetic acid by citric acid gave 88% deproteination and 90% demineralization. The fermentation carried out in the presence of acetic acid resulted in a protein fraction that smelled good and a clean chitin fraction.

Mitoxantrone, etoposide, carboplatinum and ara-C combination therapy (MECA) in refractory and relapsed acute leukemia

The present study was undertaken to assess the feasibility, toxicity and antileukemic activity of sequential chemotherapy including mitoxantrone, etoposide, carboplatin and intermediate-dose cytarabine in adult patients with refractory and relapsed acute myelogenous (AML) or lymphoid (ALL) leukemia. Fifty-one patients with poor-risk AML and ALL received 64 courses of MECA therapy. The overall response in the entire group was 51% (43% complete remission). The stage of the disease (relapsed or primarily refractory) and the age of the patients did not strongly affect the response rate. MECA therapy was more effective in ALL than in AML, and in those patients who presented at salvage treatment with a bone marrow infiltration lower than 25% blasts. Hematological and extra-hematological toxicities were tolerable and there were 6 deaths related to the treatment (11%). The incidence of documented infectious episodes was 71%. MECA therapy is a safe treatment and has a high antileukemic activity in relapsed and primarily refractory AML or ALL.

[Molecular genetics of astrocytomas]

Astrocytomas are the most frequent group of intracranial tumors. Among them, glioblastoma is the most aggressive one. In this review we will describe the most common genetic abnormalities found out in astrocytomas. We will refer to the epidermal growth factor receptor (EGFR), p53, p16, PTEN and DMBT1 genes. We will also present certain genetic aspects that influence the progression to glioblastoma.

Aged mice exhibit greater mortality concomitant to increased brain and plasma TNF-alpha levels following intracerebroventricular injection of lipopolysaccharide

BACKGROUND

Age-related defects in the development of peripheral inflammatory responses have been observed in rodents and humans.

OBJECTIVE

We examined the effects of age on a centrally injected endotoxin-induced cytokine production and cellular activation in mice.

METHODS

Male C57BL/6J (B6) mice, C3H/HeN mice, and C3H/HeJ mice received an intracerebroventricular injection of lipopolysaccharide (LPS) and were sacrificed at various times (2, 4, 8 h) thereafter. ELISA for IL-1beta, IL-6, IL-12, and TNF-alpha were conducted on forebrain tissue homogenates as well as plasma samples, and lectin staining to detect activated microglia was prepared for selected brain slices.

RESULTS

Intracerebroventricular injection of LPS in B6 mice produced an age-associated increase in mortality which was paralleled with a significant increase in brain and plasma levels of TNF-alpha. AntiTNF-alpha- and IL-6-immunoreactive cells possessed macrophagelike morphologies and were observed along the LPS injection tract and scattered throughout the hilus of the dorsal hippocampus and cerebral cortices. This LPS-mediated response was found to be specific in that the LPS-hyporesponsive mouse strain (C3H/HeJ) failed to demonstrate significant brain or plasma levels of TNF-alpha after LPS administration compared to C3H/HeN mice.

CONCLUSION

These results suggest that the age-related increases in TNF-alpha production and mortality following the intracerebroventricular administration of LPS may be due to an increased endotoxin hypersensitivity of brain microglia/macrophages within aged animals.

Prolactin (PRL)-PRL receptor system increases cell proliferation involving JNK (c-Jun amino terminal kinase) and AP-1 activation: inhibition by glucocorticoids

PRL receptor (PRLR) signal transduction supports PRL-induced growth/differentiation processes. While PRL is known to activate Jak2-Stat5 (signal transducer and activator of transcription 5) signaling pathway, the mechanism by which cell proliferation is stimulated is less known. We show that PRL induces proliferation of bovine mammary gland epithelial cells and AP-1 site activation. Using PRLR mutants and the PRLR short form, we have found that both homodimerization of PRLR wild type and the integrity of box-1 and C-distal tyrosine of PRLR intracellular domain are needed in PRL-induced proliferation and AP-1 activation. The effect of PRL has been assayed in the presence of dexamethasone (Dex), insulin, and alone. We found that Dex negatively regulates PRL-induced proliferation and AP-1 site activation. We demonstrate that PRL exerts activation of AP-1 transcriptional complex, and the mechanism by which this activation is produced is also studied. We show that PRL induces an increase in the c-Jun content of AP-1 transcriptional complexes. The PRL-induced c-Jun of AP-1 transcriptional complex diminishes in the presence of Dex in a dose-dependent manner. Dex inhibition was reversed by the higher concentration of PRL added to cells. Despite the fact that the regulation of the AP-1 site is complex, we found that PRL activates the c-Jun amino terminal kinase (JNK), while glucocorticoid prevents this JNK activation. These data support a regulation of cellular growth by PRL-PRLR system by increasing AP-1 transcriptional complex activity via JNK activation. JNK activation can be repressed by glucocorticoid in a DNA-binding-independent manner.

[Control of inhaled triggering factors decreases prolonged drug therapy requirements in patients with asthma]

The past decade of research has led to a greater understanding of the pathogenesis of asthma and, in particular, the pivotal role of the underlying inflammatory process. Along with inheritance in atopic patients, the presence of inhaled triggering allergens are considered the predominant predisposing factors in the development of the disease. We have conducted a longitudinal clinical therapeutic study, which included 45 pediatrics patients with asthma, in order to evaluate whether the removal of any potential inhaled triggering factor, could decrease the requirement of drug based anti-inflammatory therapy. Patients admitted in this study presented at least, two monthly asthma attacks during the last four months. A single treatment with theophylline (group A), beclomethasone (group B) or salbutamol (group C), was prescribed during the first 2 weeks, along with specific instructions to avoid inhaled allergens. Regardless of the drug used, patients showed impressive and prolonged clinical improvement during 6 months, reduction of total IgE serum levels in the three groups (p < 0.02; 0.005 and 0.02 respectively) and favorable modification of force expiratory volume at the first second, forced vital capacity and flow expiratory peak. During the observation period a constant monitoring of mites allergens concentrations was performed, showing a decrease of these antigens, associated with clinical improvement, and only in those patients who remained symptomatic (group A 31%, group B 29% and group C 9%), failures performing the measures designed to reduce their exposure to environmental allergens, was demonstrated. These results suggest that reduction of inhaled triggering factors may decrease the requirement of anti-inflammatory drug therapy to control the symptoms in patients with asthma.

Chemical and rheological properties of an extracellular polysaccharide produced by the cyanobacterium Anabaena sp. ATCC 33047

The cyanobacterium (blue-green alga) Anabaena sp. ATCC 33047 produces an exopolysaccharide (EPS) during the stationary growth phase in batch culture. Chemical analysis of EPS revealed a heteropolysaccharidic nature, with xylose, glucose, galactose, and mannose the main neutral sugars found. The infrared (IR) spectrum of EPS showed absorption bands of carboxylate groups. The average molecular mass of the polymer was 1.35 MDa. Aqueous dispersions at EPS concentrations ranging from 0.2% to 0.6% (w/w) showed marked shear-thinning properties (power-law behavior). Linear dynamic viscoelastic properties showed that the elastic component was always higher than the viscous component. Viscous and viscoelastic properties demonstrated the absence of conformational changes within the concentration range studied. Stress-growth experiments revealed that 0.4% and 0.6% (w/w) EPS dispersions showed thixotropic properties. A detailed comparison of the linear dynamic viscoelasticity, transient flow, and decreasing shear rate flow curve properties was made for 0.4% (w/w) dispersions of xanthan gum (XG), Alkemir 110 (AG), and EPS. Viscoelastic spectra demonstrated that the EPS dispersion turned out to be more "fluidlike" than the AG and XG dispersions. The flow indexes indicated that the EPS dispersion was less shear-sensitive than that of XG, showing essentially the same viscosity, that is, >50 s(-1). The fact that viscosities of EPS and AG dispersions were not substantially different within the shear-rate range covered must be emphasized, in relation to EPS potential applications. The rheological behavior of EPS dispersions indicates the formation of an intermediate structure between a random-coil polysaccharide and a weak gel.