Absorption-line-locked fiber laser for gas-sensing applications

An absorption-line-locked fiber laser based on the selection and conversion of a gas absorption line into a highly stable intracavity transmission narrowband filter is demonstrated. The laser has attractive properties for gas-sensing applications due to its frequency stability and multiwavelength selection capability.

[Analysis of esophageal strictures secondary to surgical correction of esophageal atresia]

Oesophageal Stricture (ES) is one of the most frequent complications of oesophageal atresia repair surgery. The treatment consists of dilatation of the stricture. Mostly more than one procedure is necessary for its correction.

AIM

Present our experience in balloon dilatation in the treatment of ES post-correction of oesophageal atresia.

PATIENTS AND METHODS

A retrospective study of 34 children diagnosed and treated of oesophageal atresia was done. In all cases the surgical repair included a termino-terminal oesophageal anastomosis. Prevalence of ES (requiring dilatation), number of necessary dilatations, time between the correcting atresia surgery and the first dilatation, time between the first and the last dilatation and complications were analyzed. Dilatations were done under direct radioscopic control with general anesthesia using balloons of 6 to 20 mm diameter. Afterwards esophageal lumen was checked by oral endoscopy.

RESULTS

Thirty-four patients were studied (19 male, 16 female) with a medium weight of 2474 g (rango 1800 to 3300 g). Twenty-nine patients had a type III oesophageal atresia (Vogt classification) which was corrected in their first 24-48 hours of life, five patients had a type I oesophageal atresia and repair surgery was done with a medium age of five months. All patients received medical treatment for the gastroesophageal reflux and 11 patients needed a surgical antireflux surgery. Sixty-eight endoscopic procedures were done. Seventy-nine % of the children required some endoscopic dilatation (27 patients) and received an average of 2.5 dilatations (1 to 8 dilatations): 55.5% between 1 and 2 dilatations, 37% between 3 and 4, and 7.5% more than 5. The first dilatation took place in the average of 49.4 days post-correction surgery (15 days to 1 year). The medium time interval between the first dilatation and the last one was 131 days, although in more than 50% of the cases it did not reach 2 months. Only 2 oesophageal perforations were observed (2.3% of the dilatations), one of which had a favourable outcome with conservative management and the second one required surgery. All patients except for one are alive at this time and in more than 90% of the cases they have a complete and normal oral intake.

CONCLUSIONS

Es requiring dilatations after oesophageal atresia repair are a frequent problem, appearing generally in an early period. Balloon dilatation under radioscopic control is an efficient and safe procedure for its treatment. Usually more than 1 dilatation is needed being the time period between two dilatations small. We think that associated medical antirreflux treatment is necessary in all cases, but only in specific cases surgical management of the gastroesophageal reflux.

Interleukin 6 determination in the detection of microbial invasion of the amniotic cavity

A growing body of evidence suggests a role for cytokines in the mechanisms responsible for preterm parturition associated with intrauterine infection. Interleukin 6, a polyfunctional cytokine that is secreted by tissues in the feto-maternal interface in response to microbial products, has been implicated in the host response to intrauterine infection. The purpose of this study was to establish whether measurement of amniotic fluid concentrations of interleukin 6 could be of value in the diagnosis of microbial invasion of the amniotic cavity. Fluid was obtained by transabdominal amniocentesis from patients with preterm labour and intact chorioamniotic membranes and cultured for aerobic and anaerobic bacteria and mycoplasmas. Interleukin 6 concentrations were determined by an ELISA validated for human amniotic fluid. An interleukin 6 concentration above 11.2 ng/ml had a 93.7% sensitivity and a 92.3% specificity in the diagnosis of intra-amniotic infection. Moreover, patients with an amniotic fluid interleukin 6 level above 11.2 ng/ml and a negative amniotic fluid culture failed to respond to tocolysis, delivered a preterm infant and showed histological evidence of chorioamnionitis, and their neonates were at risk for congenital infections.

Calcineurin Inhibitor Reduction Based on Maintenance Immunosuppression With Mycophenolate Mofetil in Renal Transplant Patients: POP Study

Since calcineurin inhibitors (CNI) have been introduced, they have become the cornerstone of immunosuppression for renal transplant patients, but their cardiovascular and neurological toxicities, and primarily their renal toxicity, have brought about an increased effort to find combinations of immunosuppressants that are either CNI-free or that use minimum doses of these drugs. The weight of immunosuppression therefore lies with drugs that have a better toxicity profile. The POP observational transverse study including 213 renal transplant patients was designed to study CNI minimization strategies. The mean time of transplant evolution to the time of reduction was 9.9 +/- 11.8 months. The acute rejection rate to the start of reduction was 9.4%. Almost all the patients were undergoing treatment with CNI + mycophenolate mofetil (MMF) + steroids in the immediate posttransplantation period. When reduction was chosen, all patients were undergoing treatment with MMF (mean dose at the start of reduction = 1490.7 +/- 478.0 mg/d). Among the cohort, 66.7% of patients were being treated with tacrolimus (mean C0 levels 13.3 +/- 6.6 ng/mL) and 33.3% with cyclosporine (mean C0 levels 192.2 +/- 94.0 ng/mL; mean C2 levels 1097.5 +/- 457.6). The main reasons for withdrawal were nephrotoxicity (55.9% of the cases), as well as prevention of adverse effects (21.6%). The mean target CNI dose reduction was 41.4% +/- 21.45% in the tacrolimus group and 28.6 +/- 10.0% in the cyclosporine group. In conclusion, CNI toxicity, primarily renal toxicity, makes reduction of these drugs based on the use of full MMF doses an alternative to manage renal transplant patients.

Do Anti-CD25 Monoclonal Antibodies Potentiate Posttransplant Diabetes Mellitus?

Anti-CD25 monoclonal antibodies (MAbs) are directed against the IL-2 (CD-25) receptor, which is associated with the pathogenesis of diabetes mellitus (DM). Measuring CD25 on peripheral blood lymphocytes could be a new immunologic marker to identify patients with prediabetes.

OBJECTIVE

The study aimed to analyze whether administration of anti-CD25 MAbs was an independent risk factor for posttransplant diabetes mellitus (PTDM) in kidney transplant (KT) patients at 3 months after transplantation.

PATIENTS AND METHODS

Seventy-four stable, nondiabetic KT patients were included in the study. The overall sex distribution was 70% men and mean overall age, 52 +/- 10 years. Thirty-eight subjects where treated with anti-CD25 antibodies (basiliximab). The diagnosis of PTDM was made if patients required insulin or oral antidiabetic drugs and/or had glycemia >200 mg/dL at 120 minutes after an oral glucose tolerance test (75 g glucose). We determined the age, weight, body mass index, acute rejection, chronic hepatitis C virus (HCV) infection, and type of calcineurin inhibitor.

RESULTS

Thirty-four percent of patients developed PTDM. Patients treated with anti-CD25 antibodies were older (P = .022) and showed a greater incidence of PTDM (P = .041). The logistic regression analysis (dependent variable: PTDM; independent variables: age, anti-CD25, tacrolimus vs cyclosporine) showed that treatment with anti-CD25 is an independent risk factor for PTDM (P = .041; OR 3.28; CI 95% 1.04-10.31).

CONCLUSION

Patients treated with anti-CD25 MAbs showed greater incidence of PTDM.

Pars planitis in children: epidemiologic, clinical, and therapeutic characteristics

PURPOSE

To report the demographics and clinical characteristics, therapy logarithm, and prognosis of children with pars planitis.

PATIENTS AND METHODS

The medical records were reviewed of all patients diagnosed with pars planitis between June 1995 and December 2005 in the Department of Pediatric Ophthalmology at Hospital Universitario La Paz, Madrid, Spain. A retrospective, descriptive, and longitudinal study of 30 eyes in 16 children was performed.

RESULTS

Pars planitis was bilateral in 87.5% and more frequent in males (68.8%). Average age at onset was 9.2 years. The main ophthalmologic findings recorded were snowballs (96.7%) and vitritis (93.3%). Cataract formation was the most prevalent complication (36.7%). Mean initial and final best-corrected visual acuities were 0.640 and 0.840, respectively. Periocular corticosteroids were used in 33.3% of cases and cryotherapy or laser photocoagulation in 16.7%. Complications requiring surgical management occurred in 4 eyes (13.3%).

CONCLUSION

Pars planitis treated with adequate medical and surgical procedures has a good prognosis in most cases.

Use of the New Proliferation Signal Inhibitor Everolimus in Renal Transplant Patients in Spain: Preliminary Results of the EVERODATA Registry

Everolimus (Eve) has shown good efficacy and safety profiles in clinical trials in combination with low doses of cyclosporine but there is limited experience in other modes, especially with calcineurin inhibitor elimination. We developed a retrospective study to analyze its clinical use after approval in Europe in 2005. Herein we have presented the results of a series of 272 patients followed for the first 6 months after Eve introduction. In 93.8% of cases Eve was introduced after the first month posttransplantation (conversion use), and 6 months after introduction, the CNI had been eliminated in 75% of cases. The main indication for Eve introduction was the diagnosis of a malignant neoplasm (42%), whereas the combined indication of prevention and/or treatment of toxicity, especially nephrotoxicity, accounted for 46.3% of cases. Initial doses were low (1.37 mg/d), but were progressively increased up to 2 mg/d at 6 months. Renal function remained unchanged during the follow-up period, whereas proteinuria moderately increased. Only 5 cases (2%) of acute rejection episodes were observed with excellent patient and graft survivals at 6 months after conversion. Further analysis of this extensive series of patients with a longer follow-up is needed.

Atorvastatin Treatment in the Short Term: Does It Induce Renoprotection or Vasculoprotection in Renal Transplantation?

INTRODUCTION

Proteinuria and dyslipidemia are nonimmune risk factors implicated in the deterioration of kidney function and associated with an increased risk of accelerated atherogenesis. Statin therapy, used for cholesterol reduction, has shown a renoprotective effect in animal models, particularly in cases of proteinuria. This may occur through lipid-independent mechanisms, such as improved endothelial dysfunction/vascular biology, reduced inflammatory cytokine production (transforming growth factor-beta 1 [TGF-beta1]), and regulation of fibrogenic responses. We studied mechanisms of action of agents, such as statins, to change proteinuria, inflammatory parameters, and TGF-beta1 plasma levels in relation to vascular tone.

METHODS

Fifty-six kidney transplant recipients (30 men and 26 women of overall mean age 54 +/- 13 years) were treated posttransplantation with atorvastatin (10 mg/d) for 12 weeks without renin-angiotensin-system blockade drugs. Inflammatory variables, biochemical parameters, lipid profile, renal function, and TGF-beta1 levels were determined at baseline and at 3 months. Vascular stiffness was evaluated using pulse wave velocity (PWV).

RESULTS

Baseline TGF-beta1 plasma levels were higher among transplant recipients than healthy controls, namely 8.12 ng/mL (range, 5.82-13.12) to 2.55 (range, 1.78- 4.35) (P < .01). Furthermore, the levels remained higher after the treatment with atorvastatin, namely, 7.59 (range, 4.97-12.35) to 2.55 (range, 1.78-4.35) ng/mL (P < .01). Atorvastatin treatment significantly decreased total cholesterol as well as low-density lipoprotein cholesterol plasma levels, but did not modify mean blood pressure (MBP), proteinuria, creatinine clearance, or inflammatory factors. Reduction in TGF-beta1 plasma levels was statistically significant among patients with PWV >9.75 (m/s) (pathology reference value) namely, from 10.7 ng/mL (range, 7.02-13.98) to 6.7 (range, 3.96-11.94) (P = .038). Among older patients, atorvastatin significantly decrease TGF-beta1 plasma levels: from 9.5 ng/mL (range, 6.45-14.44) to 5.65 (range, 3.63-9.48; P < .05). The decreased TGF-beta1 was not related to changes in lipid profiles.

CONCLUSIONS

Atorvastatin (10 mg/d) improved the lipid profile and moreover among older patients with worse PWV (>9.75 m/s), TGF-beta1 levels were significantly reduced. Our results suggested that statins displayed potent actions distinct from their hypolipidemic effects.

[Effectiveness of high pressure balloon dilatation in the treatment of postsurgical strictures of urinary tract in children]

INTRODUCTION

Endoscopic dilatation using a high pressure balloon is a widely used technique for the treatment of strictures of the urinary tract secondary to surgery in adult patient. Several studies have evaluated its usage in the treatment of primary and secondary strictures of the urinary tract of child with a disparity of results.

GOAL

Evaluate Effectiveness and Safetiness of high pressure balloon dilatation and double "J" implantation in the treatment of postsurgical strictures of urinary tract in children.

PATIENTS AND METHODS

Retrospective study of endoscopic dilatation of secondary to surgery strictures performed in our unit during the last past 18 months. Demographical data, surgical records, symptoms, renal function, dilatation technique, postsurgery complications and ultrasonography and isotopic data (pre and post dilatation) were evaluated.

RESULTS

Six children, aged 13 months-9 years (media = 4.3 years) were treated in our unit. Four presented ureteropelvic junction obstruction (UPO) after Anderson-Hynes pyeloplasty and 2 vesico-ureteral junction stenosis (VUO) in 3 reimplants units, (one with Cohen tecnique and two with Politano tecnique). All 6 patients showed dilatation of urinary tract and isotopic diuretic renogram prior to dilatation that showed for all cases an obstructed pattern with T1/2 > 20 minutes. Two of the children presented lumbar pain and one of them had suffered an urine infection. Time interval between surgery and dilatation varied between 23 and 118 months. Surgical technique used for all cases was high pressure retrograde balloon dilatation and placement of double "J" before retrograde pielography. In all patients a double J catheter was implanted and left in place for 4 to 9 weeks. Technical inability to place the catheter after the expansion forced to the accomplishment of a percutaneus nephrostomy echo guided in one case. One of the children showed hematuria up to 7 days after dilatation procedure. Hospilatization varied between 24 hours to 10 days being (moda = 3 days). The patient that needed nephrostomy underwent ulterior sucessful dilatation 4 months after first procedure. The 2 children presenting vesico-ureteral junction stricture underwent calibration 10 and 12 months after dilatation, showing both good caliber. Diuretic renogram curve Improvement was confirmed for all patients but one of the VUO children that showed renal function deterioration after dilatation procedure. Lumbar pain disappear for both 2 children that had referred it.

CONCLUSIONS

Endoscopic dilatation of strictures of urinary tract using balloon in children that were previously sommeted to surgical interventions is technically available and shows good results in the short-medium term with low index of post procedural complications, so, it should be considered as initial treatment for these patients.

Distribution of CD14+ and CD68+ Macrophages in the Placental Bed and Basal Plate of Women With Preeclampsia and Preterm Labor

OBJECTIVE

Macrophages play a key role in implantation, placentation and parturition. Yet, whether or not the number of macrophages at the fetomaternal interface (basal plate of the placenta and placental bed) is altered in women with preeclampsia is the subject of controversy. The purpose of this study was to compare the immunoreactivity and distribution patterns of CD14 and CD68 positive macrophages in both the basal plate and placental bed from preeclamptic and non-preeclamptic pregnancies.

METHODS

A cross-sectional study was conducted. Paraffin embedded sections of placental tissues and placental bed biopsies were obtained from patients with early onset preeclampsia (n=10) and from those with preterm labor/delivery (n=10) without preeclampsia matched for gestational age. Double immunohistochemistry using antibodies to CD14 and CD68 was performed, and the density of double or single positive cells in the basal plate and placental bed was evaluated. Non-parametric statistics were used for analysis.

RESULTS

1) A unique subset of CD14-/CD68+ cells was identified. The cells in question were present at a higher level in the decidua than in the myometrial segment of the placental bed (p<0.01); 2) The density and proportion of CD14+/CD68+ cells (double positive cells) were significantly higher in the myometrial segment than in the basal plate (p=0.0003); and 3) There were no significant differences in the density and patterns of immunopositive macrophages in the basal plate, the decidua, and the myometrium between women with preeclampsia and those with preterm labor/delivery (p>0.05).

CONCLUSION

The macrophages at the fetomaternal interface can be dichotomized by CD14 and CD68 immunoreactivity. A gradient of CD14+/CD68+ macrophages was demonstrated between the superficial myometrium and the basal plate regardless of the etiology of preterm birth (preeclampsia or spontaneous preterm labor). The biological function of single positive (CD14-/CD68+) and double positive (CD14+/CD68+) macrophages at the fetomaternal interface remains to be established. The overall findings also suggest that the discrepancies in the literature are due to the varying markers used to detect macrophages and in the anatomical plane of the fetomaternal junction analyzed.

Quantitative assessment of gestational sac shape: the gestational sac shape score

OBJECTIVE

To develop a quantitative method for characterizing gestational sac shape.

METHODS

Twenty first-trimester gestational sacs in normal pregnancies were studied with three-dimensional (3D) ultrasonography. The 3D coordinates of surface-point sets were obtained for each sac using 30-, 15- and six-slice sampling. Cubic spline interpolation was used with the 15- and six-slice surface-point samples to generate coordinates for those 30-slice surface points not measured. Interpolated and measured values, the latter from the 30-slice sample, were compared and the percent error calculated. Cubic spline interpolation was used to determine the coordinates of a standard surface-point sample (3660) for each sac in each slice sample. These coordinate data were used to give each sac a standard configuration by moving its center of gravity to the origin, aligning its inertial axes along the coordinate axes and converting its volume to 1.0 mL. In this form, a volume shape descriptor could be generated for each sac that was then transformed into a vector containing only shape information. The 20 shape vectors of each slice sample were subjected to principal components analysis, and principal component scores (PCSs) calculated. The first four PCSs were used to define a gestational sac shape score (GSSS-30, GSSS-15 or GSSS-6) for each sac in a given slice sample. The characteristics of each set of GSSSs were determined and those for the GSSS-15 and GSSS-6 were compared with the GSSS-30 characteristics.

RESULTS

Cubic spline interpolations were very accurate in most cases, with means close to 0%, and approximately 95% of the errors being less than 10%. GSSS-30 accounted for 67.6% of the shape variance, had a mean of zero and an SD of 1.1, was normally distributed and was not related to menstrual age (R=-0.16, P=0.51). GSSS-15 and GSSS-6 had essentially the same characteristics. No significant differences between individual GSSS-30 values and those for GSSS-15 or GSSS-6 were found, indicating the absence of a slice sample effect.

CONCLUSION

Using sophisticated mathematical methods, the gestational sac shape, initially represented by the 3D coordinates of 3660 surface points, was converted to a single number, the GSSS. This score had the appropriate properties for quantitatively characterizing normal, first-trimester gestational sac shapes. As it can be obtained from as few as six slices, it should be useful in many clinical situations. This novel approach has the potential for providing quantitative shape information about a variety of biological shapes and how they change over time.

Surfactant protein-A mRNA expression by human fetal membranes is increased in histological chorioamnionitis but not in spontaneous labour at term

Surfactant protein-A (SP-A) is produced by the fetal lung, participates in innate immunity, and has been proposed to play a role in the initiation of parturition in mice. Amniotic fluid SP-A concentration increases as a function of gestational age, and SP-A protein has been demonstrated in human chorioamniotic membranes. This study was conducted to determine whether parturition at term, gestational age and chorioamnionitis in preterm delivery (PTD) are associated with changes in the expression of SP-A in the chorioamniotic membranes. Chorioamniotic membranes were obtained from women at term and women with PTD (n=58). SP-A mRNA and protein expression was detected in amniotic epithelial cells, chorionic trophoblasts and macrophages by in situ hybridization and immunohistochemistry. Quantitative real-time reverse transcription-PCR demonstrated predominant expression of SP-A1 mRNA, whose expression was 17.4-fold higher in patients with PTD with chorioamnionitis (n=15) than in those without (n=13) (p=0.018). While no difference was observed in SP-A1 mRNA expression in the chorioamniotic membranes of women at term not in labour (n=16) and those in labour (n=14) (p=0.87), the expression in term membranes was higher than that of membranes from women with PTD without chorioamnionitis (p=0.003). Analysis of JAR choriocarcinoma cells demonstrated SP-A1 mRNA expression that was up-regulated following lipopolysaccharide treatment. Furthermore, monocytic cell lines (THP-1 and U937) and peripheral blood monocytes (CD14+/CD115+) obtained from pregnant women also expressed SP-A1 mRNA and protein, suggesting the presence of autocrine/paracrine activation in vivo. Interestingly, a mid-trimester amniotic fluid sample obtained from a case of tracheal atresia contained SP-A (3.13 microg/ml), indicating the presence of SP-A of extrapulmonary origin. These findings suggest not only that SP-A expression is a part of the innate immune response deployed during chorioamniotic inflammation, but also that chorioamniotic membranes are a source of SP-A in the amniotic fluid with advancing gestation.

Pleural and pericardial effusion: a potential ultrasonographic marker for the prenatal differential diagnosis between congenital diaphragmatic eventration and congenital diaphragmatic hernia

OBJECTIVES

To determine whether or not the presence of pleural and/or pericardial effusion can be used prenatally as an ultrasonographic marker for the differential diagnosis between diaphragmatic eventration and diaphragmatic hernia.

METHODS

We present two case reports of non-isolated diaphragmatic eventration associated with pleural and/or pericardial effusion. Additionally, we reviewed the literature for all cases of congenital diaphragmatic hernia (CDH) and diaphragmatic eventration that met the following criteria: (1) prenatal diagnosis of a diaphragmatic defect and (2) definitive diagnosis by autopsy or surgery. The frequencies of pleural effusion, pericardial effusion and hydrops were compared between the two conditions using Fisher's exact test. A subanalysis was conducted of cases with isolated diaphragmatic defects (i.e. diaphragmatic defects not associated with hydrops and other major structural or chromosomal anomalies).

RESULTS

A higher proportion of fetuses with diaphragmatic eventration had associated pleural and pericardial effusions compared with fetuses with diaphragmatic hernia (58% (7/12) vs. 3.7% (14/382), respectively, P < 0.001). This observation remained true when only cases of diaphragmatic defects not associated with hydrops and other major structural or chromosomal anomalies were compared (29% (2/7) with eventration vs. 2.2% (4/178) with CDH, P < 0.02).

CONCLUSIONS

The presence of pleural and/or pericardial effusion in patients with diaphragmatic defects should raise the possibility of a congenital diaphragmatic eventration. This information is clinically important for management and counseling because the prognosis and treatment for CDH and congenital diaphragmatic eventration are different. Published by John Wiley & Sons, Ltd.

Assessment of functional status, symptoms and comorbidity in elderly patients with advanced non-small-cell lung cancer (NSCLC) treated with gemcitabine and vinorelbine

BACKGROUND

The incidence and prevalence of comorbid conditions in lung cancer patients increase with age. The aim of the study was to determine response and tolerability with the biweekly combination gemcitabine-vinorelbine in elderly non-small-cell lung cancer (NSCLC) patients. In order to characterise the population included in the study well and assess the results achieved properly, an evaluation of the functional status, comorbidity and survival was performed.

PATIENTS AND METHOD

Between June 2001, and December 2003, 59 untreated advanced NSCLC patients over the age of 70 years entered the study. Treatment consisted of gemcitabine 1750 mg/m(2) and vinorelbine 30 mg/m(2) on day 1 every two weeks. The response was evaluated every f ive cycles (RECIST guidelines). Comorbidity was evaluated according to the Charlson and Kaplan Feinstein scales. To measure functional status, activities of daily living (ADL) and instrumental ADL (IADL) were considered.

RESULTS

Median age was 74; ECOG performance status was >2 in 59.3%; no dependence in ADL or IADL was found in 24.8% and 42.4% of patients, respectively. A total of 381 courses were administered. Grade 3-4 neutropenia was present in 6.8% of these courses and correlated with IADL. Objective response was 22% (95% CI 12-32). Mean global survival and cause-specific survival were 29 weeks (95% CI 19.9-38.1) and 32 weeks (95% CI 23.4-40.8) respectively. Comorbidity displayed no close correlation with functional status, but comorbidity according to the Kaplan Feinstein index correlated with IADL. Performance status, ADL, IADL and weight loss were significantly related to survival in multivariate analysis.

CONCLUSIONS

This biweekly combination is feasible in elderly lung cancer patients with a high burden of comorbidity and dependence. Toxicity is acceptable, whereas response rate and survival fall in the range of active regimens. ADL and IADL indices allow the identification of elderly patients with a worse prognosis.

Obesity, adiponectin and inflammation as predictors of new-onset diabetes mellitus after kidney transplantation

The high incidence of new-onset diabetes mellitus after transplantation (NODAT) suggests the need to find new factors to explain the pathogenesis. Our objectives were (1) to confirm that low levels of pre-transplant adiponectin are an independent risk factor for the development of NODAT in a larger transplanted population; (2) to analyze whether adiponectin is a better predictor of NODAT than other inflammatory markers (C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha) and pregnancy-associated plasma protein A (PAPP-A)) and (3) to assess the relationship between obesity, inflammatory markers and NODAT. One hundred ninety-nine non-diabetic patients (128 men; age: 53 +/- 11 years; body mass index (BMI) 24.98 +/- 3.76 kg/m2) were included. Pre-transplant plasma glucose, insulin, adiponectin, CRP, TNF-alpha, IL-6 and PAPP-A were measured. Forty-five patients developed NODAT. Patients with NODAT had a greater BMI (p = 0.005). Adiponectin was lower (p < 0.001) and CRP higher (p = 0.032) in patients with NODAT. Multivariate logistic regression and Cox analysis showed that the calcineurin inhibitor used, pre-transplant BMI and adiponectin were predictors of NODAT. ROC analysis showed that an adiponectin concentration of 11.4 microg/mL had a significant negative prediction for NODAT risk (sensitivity: 81% and specificity: 70%). Of the inflammatory markers studied, adiponectin proved to be an independent predictor of NODAT.

[The microbial pattern of the catheter exit-site infection in peritoneal dialysis: A non-diphtheria Corynebacteria emergence?]

BACKGROUND

A prospective cohort study was undertaken to compare the rates of the infecting microorganisms of the peritoneal catheter exit-site in three periods of the prophylactic protocol of a peritoneal dialysis program. All patients treated for more than one month on Peritoneal Dialysis were included: Fourty-eight in Period 1 (P1), 48 in Period 2 (P2), and 54 in Period 3 (P3). Each period was of 3 years.

METHODS

Infection prophylaxis protocol: P1: hydrogen peroxide or povidone iodine and non-occlusive dressing; P2: sterile water (boiled water) instead of antiseptic agents, semi-permeable dressing for taking showers, and nasal mupirocine prophylaxis for Staphylococcus aureus carriers; P3: equal to P2, plus local application of antibiotics in equivocal exit-site for infection and argentic nitrate in granulation tissue.

MAIN OUTCOME MEASURE

The rates of catheter infection and microorganisms causing infection were analysed by means of the Poisson regression method. Chi-square and ANOVA when appropriate.

RESULTS

The proportion of catheters implanted by nephrologist or surgeon (p<0.01) and modality treatment by CAPD or CCPD (p<0.0001) were significantly different in the three periods, while the Staph. Aureus carrieres was in the limit of significance (p=0.048). Throughout the three periods, a significantly decreasing rate of total (P=0.0035) and acute infections (P<0.001), Staph. aureus (P=0.003) and peritonitis (P=0.0025) were found. The Pseudomonas aer. (P=0.006) and Gram negative Bacteria (P=0.023) decreased significantly in P2. The multiple factor analysis included eight factors: sex, age group, ESRD, DM, catheter implantation (nephrologist, surgeon), modality treatment (CAPD, CCPD), manufacturer and prophylaxis period as possible predictors of the catheter infections, the specific microorganisms and the peritonitis. That analysis revealed the prophylaxis period as the main predictive factor of the improvements found (p<0.02,- p<0.001). In contrast, the Corynebacteria spp. increased significantly (P=0.008) throughout the three periods. One half of the Corynebacteria in each period could be considered colonisers. The other half caused true infections, but not one of those episodes required catheter intervention. The non-diphtheria Corynebacteria increase was found related with the continuous cycling Peritoneal Dialysis treatment in multiple factor analysis (p=0.0023) and in the proportion analysis (P=0.039, c2).

CONCLUSION

The progressive protocol applied obtained good results, without the continued use of local antiseptics or antibiotics at the exit-site. However, the non-diphtheria Corynebacteria sp. infection increment favours the consideration of an antiseptic agent for the exit-site care.

Trophoblast?Macrophage Interactions: a Regulatory Network for the Protection of Pregnancy

PROBLEM

Macrophages are one of the first immune cells observed at the implantation site. Their presence has been explained as the result of an immune response toward paternal antigens. The mechanisms regulating monocyte migration and differentiation at the implantation site are largely unknown. In the present study, we demonstrate that trophoblast cells regulate monocyte migration and differentiation. We propose that trophoblast cells 'educate' monocytes/macrophages to create an adequate environment that promote trophoblast survival.

METHOD OF STUDY

CD14(+) monocytes were isolated from peripheral blood using magnetic beads. Co-culture experiments were conducted using a two-chamber system. Monocytes were stimulated with lipopolysaccharide (LPS) and cytokine levels were determined using multiplex cytokine detecting assay.

RESULTS

Trophoblast cells increase monocyte migration and induce a significant increase in the secretion and production of the pro-inflammatory cytokines [interleukin-6 (IL-6), IL-8, tumor necrosis factor-alpha] and chemokines (growth-related oncogen-alpha, monocyte chemoattractant protein-1, macrophage inflammatory protein-1beta, RANTES). Furthermore, the response of monocytes to LPS was different in monocytes pre-exposed to trophoblast cells.

CONCLUSION

The results of this study suggest that trophoblast cells are able to recruit and successfully educate monocytes to produce and secrete a pro-inflammatory cytokine and chemokine profile supporting its growth and survival. Furthermore we demonstrate that trophoblast cells can modulate monocytes response to bacterial stimuli.

Dermatitis as a component of the fetal inflammatory response syndrome is associated with activation of Toll-like receptors in epidermal keratinocytes

Aims

Microbial invasion of the amniotic cavity (MIAC) elicits a fetal inflammatory response such as funisitis and chorionic vasculitis. However, little is known about the changes of fetal skin during MIAC. Toll-like receptors recognize microbial products and initiate an immune response. The aims of this study were to examine histopathological features of fetal skin exposed to MIAC and to assess the changes in Toll-like receptor (TLR)-2 and TLR-4 expression.

Methods and results

Skin samples were obtained from fetal autopsies (n = 12). The cases were classified according to the presence (n = 8) or absence (n = 4) of acute chorioamnionitis and analysed by immunohistochemistry using a panel of antibodies. Leucocytic infiltrates into the superficial dermis were observed in cases with chorioamnionitis; the majority of inflammatory cells were neutrophils, lymphocytes and histiocytes. TLR-2 immunoreactivity in the skin was stronger in fetuses with chorioamnionitis than in those without this condition. However, immunoreactivity of TLR-4 in the fetal skin was constitutively expressed, regardless of the presence or absence of chorioamnionitis.

Conclusions

This study demonstrates for the first time that fetal dermatitis can be detected and is part of the fetal inflammatory response syndrome (FIRS). We propose that this ‘FIRS-associated fetal dermatitis’ is a fetal counterpart of chorioamnionitis.

The use of high-dimensional biology (genomics, transcriptomics, proteomics, and metabolomics) to understand the preterm parturition syndrome

High-dimensional biology (HDB) refers to the simultaneous study of the genetic variants (DNA variation), transcription (messenger RNA [mRNA]), peptides and proteins, and metabolites of an organ, tissue, or an organism in health and disease. The fundamental premise is that the evolutionary complexity of biological systems renders them difficult to comprehensively understand using only a reductionist approach. Such complexity can become tractable with the use of "omics" research. This term refers to the study of entities in aggregate. The current nomenclature of "omics" sciences includes genomics for DNA variants, transcriptomics for mRNA, proteomics for proteins, and metabolomics for intermediate products of metabolism. Another discipline relevant to medicine is pharmacogenomics. The two major advances that have made HDB possible are technological breakthroughs that allow simultaneous examination of thousands of genes, transcripts, and proteins, etc., with high-throughput techniques and analytical tools to extract information. What is conventionally considered hypothesis-driven research and discovery-driven research (through "omic" methodologies) are complementary and synergistic. Here we review data which have been derived from: 1) genomics to examine predisposing factors for preterm birth; 2) transcriptomics to determine changes in mRNA in reproductive tissues associated with preterm labour and preterm prelabour rupture of membranes; 3) proteomics to identify differentially expressed proteins in amniotic fluid of women with preterm labour; and 4) metabolomics to identify the metabolic footprints of women with preterm labour likely to deliver preterm and those who will deliver at term. The complementary nature of discovery science and HDB is emphasised.

The reintroduction and possible establishment of Aedes albopictus in New Mexico

We report on the collection of adults and larvae of Aedes albopictus from Carlsbad, New Mexico. In 1989, in Albuquerque, individual adults of this species were intercepted and destroyed. This recent investigation in Carlsbad disclosed the presence of adults from four sites and larvae from one site, on August 19 and on September 12, 14, and 15, 2005.

The preterm parturition syndrome

The implicit paradigm that has governed the study and clinical management of preterm labour is that term and preterm parturition are the same processes, except for the gestational age at which they occur. Indeed, both share a common pathway composed of uterine contractility, cervical dilatation and activation of the membranes/decidua. This review explores the concept that while term labour results from physiological activation of the components of the common pathway, preterm labour arises from pathological signalling and activation of one or more components of the common pathway of parturition. The term "great obstetrical syndromes" has been coined to reframe the concept of obstetrical disease. Such syndromes are characterised by: (1) multiple aetiology; (2) long preclinical stage; (3) frequent fetal involvement; (4) clinical manifestations that are often adaptive in nature; and (5) gene-environment interactions that may predispose to the syndromes. This article reviews the evidence indicating that the pathological processes implicated in the preterm parturition syndrome include: (1) intrauterine infection/inflammation; (2) uterine ischaemia; (3) uterine overdistension; (4) abnormal allograft reaction; (5) allergy; (6) cervical insufficiency; and (7) hormonal disorders (progesterone related and corticotrophin-releasing factor related). The implications of this conceptual framework for the prevention, diagnosis, and treatment of preterm labour are discussed.

Outbreak of gastroenteritis caused by the pandemic Vibrio parahaemolyticus O3 : K6 in Mexico

During 2003 and during late September of 2004, more than 1230 cases of gastroenteritis were reported in the south of Sinaloa State, north-western Mexico. All cases were attributed to the consumption of raw or undercooked shrimp collected at the Huizache-Caimanero lagunary system. Vibrio parahaemolyticus was identified by standard biochemical methods, and many strains were positive for PCR amplifications of the tlh and tdh genes and negative for the trh gene. A representative strain belonged to the O3:K6 serogroup. This is the first outbreak of gastroenteritis caused by the pandemic strains of O3:K6 V. parahaemolyticus in México.

[Treatment of two cases of diffuse retinal pigment epitheliopathy with photodynamic therapy]

CASE REPORT

We present two patients with Diffuse Retinal Pigment Epitheliopathy (DRPE) treated with verteporfin photodynamic therapy (PDT). The first patient was treated with PDT because there was foveal involvement. The second patient received PDT because he had multiple recurrences of DRPE with poor resolution following previous argon-laser photocoagulation. Resolution of the lesions occurred in both cases with improvement in visual acuity. No recurrences have been documented at eleven months of follow-up.

DISCUSSION

The outcomes in our patients were satisfactory. We consider PDT is a safe and effective option, but further randomized studies are necessary to confirm this.

[Are there some clinical factors that indicate the best moment of the surgery in the congenital diaphragmatic hernia?]

AIM

To determine if the needs of cardiopulmonary support of neonates with congenital diaphragmatic hernia (CDH) they can be indicators for the election of the most suitable moment to the surgery.

METHODS

We treated 16 consecutive neonates with congenital diaphragmatic hernia (CDH) from 2004 to 2005. Mean birth weight was 2900.63 +/- 531.51 g. Patients was divided in 2 groups. Group A: newborns without adrenaline nor noradrenaline like vasoactive drugs and conventional respiratory assistant; the surgery was performed during the first 48 hours of life. Group B: newborns with adrenaline or noradrenaline like vasoactive drugs, high-frequency oscillatory ventilation or extracorporeal membrane oxygenation; surgery was delayed (10.66 +/- 8.26 days).

RESULTS

Four neonates died during the first 24 hours of life without surgical treatment not fulfilling criteria of support ECMO. Five patients were operated during the first 48 hours, fulfilling all of them the clinical criteria of the group A. Mortality does not exist in this group. Seven patients were operated late fulfilling the criteria of the group B. They all needed VAFO. Two patients of this group needed support ECMO. The survival rate in this group was 83.3%.

DISCUSSION

In our opinion, the patients with CDH that need initially high cardiopulmonary support, VAFO and/or ECMO would be necessary a time of wait to realize the surgery. In those patients who don't need this level of treatment the delay would not justify itself in the surgical intervention.

[Recurrence of peripheral primitive neuroectodermal tumor of the orbit with systemic metastases]

CASE REPORT

A six-year-old boy presented with proptosis of the right eye. Imaging studies detected a mass in the medial wall of the right orbit. This mass was biopsied revealing a histopathologic diagnosis of primitive neuroectodermal tumor, so chemotherapy treatment was given. After seven years in remission he presented with a recurrence of the orbital tumor and was found to also have systemic metastases. Treatment with chemotherapy, radiotherapy and orbital exenteration was unsuccessful.

DISCUSSION

The orbital occurrence of these tumors is extremely rare. Differentiation from other small round cell tumors requires immunohistochemical and ultrastructural techniques.

Quantitative and morphological assessment of early gestational sacs using three-dimensional ultrasonography

OBJECTIVE

Our main objective was to determine the value of three-dimensional ultrasonography (3DUS) and Virtual Organ Computer-aided AnaLysis (VOCAL) in the evaluation of gestational sac volume and morphology during early pregnancy.

METHODS

Twenty-eight normal early pregnancies were scanned approximately every 2 weeks using transabdominal (TAS) and transvaginal (TVS) sonography. The VOCAL technique was used to create computerized surface models to classify gestational sac shapes as discoid or ellipsoid. Serial sac volume changes were analyzed using repeated measures ANOVA. Bland-Altman plots determined examiner bias and limits of agreement (LOA) for sac volume measurements. Gestational sac volumes were compared between the two-dimensional (2D) ellipsoid and VOCAL techniques. Differences between volume measurements were tested using the two-tailed paired t-test with statistical significance at the P < 0.05 level.

RESULTS

Each subject was examined at a mean +/- SD menstrual age of 7.9 +/- 0.6 weeks (Scan 1), 9.9 +/- 0.6 weeks (Scan 2), and 11.9 +/- 0.6 weeks (Scan 3). Sac volumes significantly increased over time from 22 +/- 11 mL at Scan 1, to 57 +/- 21 mL at Scan 2 and 116 +/- 35 mL at Scan 3 (P < 0.001). Predominant sac shapes were classified as ellipsoid (76.2%) or discoid (23.8%). Additional descriptors included: concave (60.7%), irregular (53.6%), or smooth (7.1%), with 19% of the overall group having more than one additional shape attribute. Clinically acceptable volume measurement bias and agreement were found for the following comparisons: (1) TAS versus TVS; (2) interobserver volume measurements; and (3) intraobserver volume measurements. The VOCAL technique yielded slightly greater sac volumes (64 +/- 45.4 mL) when compared to the 2D ellipsoid model (48.6 +/- 36.8 mL) (28.9 +/- 24.3% (95% limit of agreement range, - 18.7 to 76.5%), P < 0.001).

CONCLUSIONS

Reproducible sac volume measurements can be obtained using VOCAL with either TAS or TVS. Early gestational sacs variably appear as discoid or ellipsoid structures with a concave indentation from the placenta. Sac volumes can be underestimated if an ellipsoid shape is assumed. Morphological and quantitative analysis of the gestational sac may provide baseline parameters for studying patients at risk for early pregnancy failure.

[Surgical management of cloacal malformations]

INTRODUCTION

Cloaca is a defect in which the rectum, the vagina and the uretra are fused in a single common channel. Cloaca is the most complex anorectal malformation. The surgical management depends on the length of the common channel and the associated defects.

METHODS

Since 1993 we have treated 9 cases of cloacas. The average age at surgery was 12 months. Five patients had associated vertebral defects, six had urological defects and six had vaginal defects. All patients were approached posterior sagitally; 4 of them also required a laparotomy.

RESULTS

Five patients underwent a total urogenital mobilization. In the four patients requiring laparotomy we performed vaginal switch in 1, and vaginal replacement in 3 (2 with ileum and 1 with colon). Six patients are older than four and have fecal continence. Three of them are continent of urine, and 1 remains dry with intermittent catheterization. Two patients remain derivated (ureterostomy, vesicostomy).

CONCLUSIONS

Surgical repair should be completed early, and it should include cystoscopy, posterior sagital approach, and laparotomy depending on the complexity of the defect. Cloaca is a challenge for the surgeon because of the wide spectrum of anatomic defects and the need to apply different surgical techniques in order to achieve good functional and cosmetic results.

[Clinical management of terrorist bomb explosions]

At 07:39 on 11 March 2004 terrorist bomb explosions ocurred in 4 trains in Madrid killing 177 people instantly and 14 more later in the hospital. This report describes the organization, clinical management and patterns of injuries in casualties who were taken to our chil-patients were taken to the Gregorio Marañon hospital and 12 to the children's one. The mean age was 16 years (14-21), Two of them were critically ill and needed intensive care (ITP 5). Tympanic perforations occurred in 81% victims with moderate to severe trauma, shrapnel wounds in 36% and eye lesions in 27%. Among critically ill patients blast lung injury, cranial and abdominal trauma were the most important lesions. Training in AITP courses and hospital logistics were essential in clinical management of these casualties.

The effect of bariatric surgery on adipocytokines, renal parameters and other cardiovascular risk factors in severe and very severe obesity: 1-year follow-up

AIMS

To evaluate the effect of weight loss after bariatric surgery (BS) on peripheral adipocytokines, renal parameters and other cardiovascular risk factors (CVRFs).

METHODS

A total of 70 (41 women) extremely obese adults were prospectively studied before and 12 months after surgery.

CONTROLS

24 (15 women) normal-weight adults. Anthropometric, biochemical and renal parameters were recorded.

RESULTS

Presurgery, adiponectin (ADPN) was lower, whereas leptin, insulin resistance, C-reactive protein, creatinine clearance and albuminuria were higher in patients than controls (P<0.001). All parameters improved postsurgery. Changes in ADPN correlated negatively with leptin, insulin resistance, albumin, C-reactive protein, and creatinine clearance. Multiple regression analysis: using changes in ADPN as the dependent variable, only changes in insulin resistance (P=0.005) and albumin (P=0.019) were significant independent determinants for changes in ADPN. No statistical differences were found in relation to the degree of obesity.

CONCLUSION

Patients changed to obesity type I after surgery. This implies a substantial improvement of CVRFs including ADPN, creatinine clearance and albuminuria. Changes in plasma ADPN correlated negatively with insulin resistance and with albuminemia but not with renal parameters. The lack of differences between different degrees of obesity suggests that the relationship between weight and CVRFs no longer exists when obesity becomes very extreme.

Modification of pepsinogen I levels and their correlation with gastrointestinal injury after administration of dexibuprofen, ibuprofen or diclofenac: a randomized, open-label, controlled clinical trial

OBJECTIVE

To assess the effect of a 2-week treatment with dexibuprofen, in comparison with ibuprofen and diclofenac, on pepsinogen plasma concentrations and gastrointestinal mucosa, as well as the correlation of these changes with gastrointestinal mucosal injury.

METHODS

60 patients with rheumatologic disease in chronic therapy with NSAID, were included. After a 7-day run-in period patients were randomly assigned to receive a 14-day treatment with dexibuprofen (Group A; Day 1 - 3 = 400 mg t.i.d; Day 4 - 14 = 400 mg b.i.d.), ibuprofen (Group B; Day 1 - 3 = 800 mg t.i.d; Day 4 -14 = 800 mg b.i.d.) or diclofenac (Group C; Day 1 - 3 = 50 mg t.i.d; Day 4 - 14 = 50 mg b.i.d.). Upper gastrointestinal endoscopy (Day 15), capsule-endoscopy (Day 16, 7 patients of each group) and determination of pepsinogen plasma concentrations were performed (basal and Day 15). A semiquantitative scale was designed for the assessment of the gastrointestinal mucosa.

RESULTS

No differences in plasma pepsinogen were found between treatment groups or gastrointestinal injury grades or between basal and post-therapy determinations. Dexibuprofen showed gastroduodenal mucosal injury in fewer patients (42.1%) than was the case with ibuprofen (5%; p = 0.003) and diclofenac (30%; p = N.S.). Dexibuprofen administration was also associated with more patients having no intestinal mucosal damage (42.86% vs. 28.7% in the diclofenac group and 14.29% in the ibuprofen group; p = 0.0175). The rate of clinical adverse events was similar in Groups A, B and C (28%, 38% and 34%).

CONCLUSIONS

Dexibuprofen showed a lower rate of gastroduodenal and intestinal mucosal injury. This effect was not mediated by modifications of plasma pepsinogen levels.

Three-dimensional ultrasound in the prenatal diagnosis of cleidocranial dysplasia associated with B-cell immunodeficiency

A patient with a singleton pregnancy was referred for three-dimensional ultrasonography (3DUS) at 18 + 3 weeks for suspected hypomineralization of the skull bones and absence of the nasal bones. Three-dimensional rendered images of the fetal skull revealed widening of the coronal sutures, absence of the squamous portion of the temporal bone, and absence of the occipital bone, except for two areas of ossification. In addition, a fractured right clavicle was identified. The remainder of the fetal anatomy was normal and biometry was appropriate for gestational age. Genetic amniocentesis revealed a 46,XX fetal karyotype. Family history was positive for a 5-year-old sibling with an open anterior fontanelle. Cleidocranial dysplasia was suspected. A female neonate was delivered by elective repeat Cesarean section at 40 + 3 weeks of gestation without complications and discharged home 3 days after delivery. Prenatal diagnosis was confirmed by physical and radiological evaluation. The infant died at 8 weeks of age due to respiratory syncytial virus pneumonia secondary to B-cell deficiency. RUNX2 mutations were not detected by molecular analysis. There are three relevant aspects to this case: (1) clear visualization of the widened fontanelles and hypomineralized occipital bones was possible with the use of 3DUS; (2) a clavicular fracture was identified in utero with combined high-resolution two-dimensional and 3DUS; and (3) although absence of the nasal bones is most commonly observed in fetuses with chromosomal disorders (e.g. trisomy 21 and trisomy 18), a careful examination of the skeleton should be considered in fetuses with absent nasal bones and a normal karyotype.

Structural analysis of a set of proteins resulting from a bacterial genomics project

The targets of the Structural GenomiX (SGX) bacterial genomics project were proteins conserved in multiple prokaryotic organisms with no obvious sequence homolog in the Protein Data Bank of known structures. The outcome of this work was 80 structures, covering 60 unique sequences and 49 different genes. Experimental phase determination from proteins incorporating Se-Met was carried out for 45 structures with most of the remainder solved by molecular replacement using members of the experimentally phased set as search models. An automated tool was developed to deposit these structures in the Protein Data Bank, along with the associated X-ray diffraction data (including refined experimental phases) and experimentally confirmed sequences. BLAST comparisons of the SGX structures with structures that had appeared in the Protein Data Bank over the intervening 3.5 years since the SGX target list had been compiled identified homologs for 49 of the 60 unique sequences represented by the SGX structures. This result indicates that, for bacterial structures that are relatively easy to express, purify, and crystallize, the structural coverage of gene space is proceeding rapidly. More distant sequence-structure relationships between the SGX and PDB structures were investigated using PDB-BLAST and Combinatorial Extension (CE). Only one structure, SufD, has a truly unique topology compared to all folds in the PDB.

Detection and treatment of post kidney transplant hyperglycemia: a Spanish multicenter cross-sectional study

INTRODUCTION

The prevalence of diabetes mellitus (DM) is greater among patients with solid organ transplants than in the general population, although the factors associated with posttransplant DM (PTDM) are unknown.

OBJECTIVES

The objective of this study was to estimate the prevalence of and assess the risk factors for PTDM.

PATIENTS AND METHODS

We included outpatients with functioning isolated solid organ allografts (kidney, liver, heart, and lung). We collected demographic and posttransplant clinical data that included DM diagnostic ADA criteria, DM treatment, DM family history, presence of hepatitis C virus (HCV), immunosuppression treatment, hypertension, and dyslipidemia.

RESULTS

A total of 2178 patients included, 1410 kidney recipients, 489 liver transplants, 207 heart transplants, and 72 lung recipients. Seventeen and four-tenths percent of the patients who did not have DM prior to transplantation, developed PTDM (median time: 79 days). A greater prevalence was observed among patients with a family history, HCV, and tacrolimus treatment (with or without steroids P < .05). By logistic regression analyses, OR for these factors were 1.51, 1.65, and 1.38, respectively. Of those patients who did not suffer PTDM, 55.2% showed basal blood glucose values under 100 mg/dL; only 68% presented with a hemoglobin Alc under 6.

CONCLUSIONS

The prevalence of PTDM among kidney recipients was higher than that in the general population. DM family history, HCV positive, and tacrolimus were risk factors associated with this entity.

Effect of low doses of atorvastatin on adiponectin, glucose homeostasis, and clinical inflammatory markers in kidney transplant recipients

INTRODUCTION

Various studies describe the pleiotropic antiinflammatory and antioxidant effects of atorvastatin, in addition to its hypolipemic effects. It has been suggested that statins modify glucose homeostasis via their antiinflammatory effects. A further hypothesis suggests that the incidence of posttransplantation diabetes is lower in statin-treated patients. This study sought to ascertain whether atorvastatin modifies glucose homeostasis, adiponectin, and inflammatory markers in kidney transplant recipients.

PATIENTS AND METHODS

Sixty-eight kidney transplant recipients (41 men, 27 women; mean age, 53 +/- 12 years) with stable renal function and dyslipidemia were treated with atorvastatin (10 mg/d) for 12 weeks. Glucose, insulin, homeostasis model assessment (HOMA-IR) index, adiponectin, tumor necrosis factor (TNF)-alpha, and serum C-reactive protein (CRP) concentrations were determined at baseline and at 3 months. The lipid profile, renal function parameters (creatinine, creatinine clearance, and proteinuria), as well as GOT, GPT, and CK were determined at baseline and at 3 months.

RESULTS

Treatment with atorvastatin achieved a statistically significant decrease in lipid profile. After 3 months of treatment, 74.6% of patients had total cholesterol and 78.7% low-density lipoprotein (LDL) cholesterol concentrations within reference range (<5.2 and 3.3 mmol/L, respectively). Furthermore, 47.5% of patients attained an LDL concentration <2.59 mmol/L. A greater reduction in total cholesterol (P = .05) and LDL cholesterol (P = .04) was achieved in patients with creatinine clearance <60 mL/min. Atorvastatin did not modify glucose homeostasis parameters, adiponectin, TNF-alpha, or CRP. At baseline and after 3 months of treatment, an inverse correlation was found between adiponectin and glucose, insulin, HOMA- IR index, and creatinine clearance, and a positive correlation was found between adiponectin and high-density lipoprotein (HDL) cholesterol.

CONCLUSION

Atorvastatin at a dose of 10 mg/d in kidney transplant recipients does not modify glucose homeostasis or alter inflammatory markers, despite its hypolipemic effects. Its efficacy to reduce total cholesterol and LDL cholesterol was greater in patients with worse renal function.

[Renal transplantation in the northwest of Spain: analysis of the activity in the region of Galicia]

BACKGROUND

Spain is the world leader in organ transplant rates, and the national average is maintained in the northwestern Spanish region of Galicia. However, there is no official registry recording transplantation results in this region. In this paper we report a study of patient and graft survival and risk factors among kidney transplant patients in Galicia between January 1996 and December 2000.

METHODS

Patients receiving kidney transplants in Galicia in the above period were monitored up to the end of 2001, deaths and graft losses were recorded and analysed by actuarial and Kaplan-Meier methods, and possible risk factors for death and graft loss were evaluated using Cox's proportional hazards model.

RESULTS

In the study period, 672 kidneys were transplanted, all from deceased donors. Graft and patient survival rates were respectively 80% and 94% after 1 year, and 67% and 83%, after 5 years. Two-thirds of graft losses occurred within the first year and the most common cause was vascular thrombosis (44%). Independent risk factors for graft loss were donor asystole (relative risk [RR] = 3.41, 95% confidence interval [CI]: 1.73-6.73), donor age (RR = 1.54, CI: 1.05-2.27 for 40-60-year-olds, RR = 2.59, CI: 1.66-4.07 for over-60s, relative to under-40s), donation from outside the institution in which implant was performed (RR = 1.43, CI: 1.02-2.02), acute rejection (RR = 2.32, CI: 1.63-3.22), and retransplantation (RR = 1.56, CI: 1.03-2.37). The main causes of death were infections (38%), followed by cardiovascular pathologies (30%) and tumours (11%).

CONCLUSIONS

The kidney transplant rate varies excessively within Galicia; the global rate is 50 per million inhabitants per year. Patient survival is similar to those recorded in national registers, but graft survival is deficient, apparently due to a high incidence of vascular thrombosis.

[Secondary amyloidosis with irreversible acute renal failure caused by visceral leishmaniasis in a patient with AIDS]

We report a case of visceral leishmaniasis and acute renal failure in a white male patient, 28 years of age, infected with the human immunodeficiency virus (HIV). The clinical presentation of the patient was diarrheic syndrome of long evolution, fever, hepatosplenomegaly and pancytopenia, accompanied by nephrotic syndrome and irreversible acute renal failure. Renal biopsy showed glomerular AA amyloid deposits. This is the first case described in humans of secondary amyloidosis caused by visceral leishmaniasis.

Partial aortic obstruction improves cerebral perfusion and clinical symptoms in patients with symptomatic vasospasm

OBJECTIVE

Stroke studies in animals showed that aortic obstruction increases cerebral blood flow (CBF) and reduces infarct size. In this study we evaluate the safety and efficacy of a device providing partial and transitory aortic obstruction.

METHODS

We report the results in 24 selected patients with symptomatic vasospasm by aneurysmal subarachnoid hemorrhage treated by partial and transitory aortic obstruction with a novel device (NeuroFlo, CoAxia, MN). Aneurysms were secured by coils prior to the procedure. We studied the adverse effects related to the aorta-obstructing device, and changes in CBF and neurological outcome.

RESULTS

Mean flow velocity increased in both middle cerebral arteries over 15%, and the score in the National Institute of Health Stroke Scale decreased >or=2 point in 20 patients (83%). During the procedure, three patients developed symptoms that were controlled. At 30 days follow-up, three patients had 6 points (unrelated death), three had 3 points, six had 1 point, and 12 had 0 points, in the modified Rankin scale.

DISCUSSION

Partial aortic obstruction was safe, the cerebral blood flow increased without inducing significant hypertension and the neurological defects improved in most of the patients. Efficacy with a better level of evidence will be determined by a randomized study.

F2-Isoprostanes in Kidney Transplant Patients: Relationship With Inflammatory Markers

This prospective study evaluated the relationship between inflammation and oxidative stress in a group of dialysis patients just before and 3 months after kidney transplantation and compared the results with a control group of healthy subjects. The oxidative stress markers determined were different F2-isoprostane isomers. The inflammatory markers included C-reactive protein, interleukin-6, tumor necrosis factor-alpha, and pregnancy-associated plasma protein A. Forty-three patients were the study group and 50 healthy subjects from a hospital blood bank as controls. The results showed levels of inflammatory and oxidative stress markers to be higher in the dialysis patients than in the control group, although they improved following kidney transplantation. Finally, significant correlations were observed between F2-isoprostane isomers and inflammatory markers.

Intensity-referenced and temperature-independent curvature-sensing concept based on chirped fiber Bragg gratings

An intensity-referenced temperature-independent curvature-measurement technique that uses a smart composite that comprises two chirped fiber Bragg gratings is demonstrated. The two gratings are embedded on opposite sides of the composite laminate and act simultaneously as curvature sensors and as wavelength discriminators, enabling a temperature-independent intensity-based scheme to measure radius of curvature. Also, the system's performance is independent of arbitrary power losses that are induced in the lead fibers to the sensing head. It is demonstrated that the measurement range depends on the relative positions of the chirped fiber Bragg gratings and on their spectral bandwidths. By using two chirped fiber Bragg gratings with bandwidths W1 = 2.8 nm and W2 = 3.7 nm and with central wavelengths at lambda 01 = 1560.3 nm and lambda 02 = 1563.7 nm, we obtained a resolution of 1.6 mm/square root of Hz for the measurement of the radius of curvature (approximately R = 350 mm) over the measurement range 190 mm < R < infinity.