[Local public health networks. Apropos of an experience]

Public health action on a territory is complex and requires the involvement of multiple actors, who do not always act coordinately. Networks of organizations structures including the whole of the local actors facilitate the generation of synergies and enable greater effectiveness and efficiency of the joint action from the different actors on a same landscape. We present 3 years experience of four Public Health Committees in a region of Catalonia (Spain), composed by the main actors in public health planning. Each of the committees is organized on a plenary and working groups on issues arising from the regional health diagnosis, and coincident with the Health Plan of the Region. Coordination in no case implies the loss or dilution of the firm of the actor generator of intervention initiative in public health, but their empowerment and collaboration by the other actors. In conclusion welcomes the creation of a culture of collaboration and synergies between the different organizations concerned. Lack of specificity is observed in establishing operational objectives, and the need for greater coordination and involvement of the components of the various working groups.

Regulation of the tumor suppressor PTEN by SUMO

The crucial function of the PTEN tumor suppressor in multiple cellular processes suggests that its activity must be tightly controlled. Both, membrane association and a variety of post-translational modifications, such as acetylation, phosphorylation, and mono- and polyubiquitination, have been reported to regulate PTEN activity. Here, we demonstrated that PTEN is also post-translationally modified by the small ubiquitin-like proteins, small ubiquitin-related modifier 1 (SUMO1) and SUMO2. We identified lysine residue 266 and the major monoubiquitination site 289, both located within the C2 domain required for PTEN membrane association, as SUMO acceptors in PTEN. We demonstrated the existence of a crosstalk between PTEN SUMOylation and ubiquitination, with PTEN-SUMO1 showing a reduced capacity to form covalent interactions with monoubiquitin and accumulation of PTEN-SUMO2 conjugates after inhibition of the proteasome. Moreover, we found that virus infection induces PTEN SUMOylation and favors PTEN localization at the cell membrane. Finally, we demonstrated that SUMOylation contributes to the control of virus infection by PTEN.

[Amino acids in cerebrospinal fluid and plasma: its usefulness in the study of neuropaediatric diseases]

INTRODUCTION

Studying the amino acids in cerebrospinal fluid (CSF) is essential in the diagnosis of some neurological diseases and is an important aid in the diagnosis of others. No research has been published in the literature to prove the physiological relationship between the values of amino acids in CSF and plasma in the paediatric population.

AIM

To define a set of ratios for amino acids in plasma and CSF in the paediatric population that can be used in daily clinical practice.

PATIENTS AND METHODS

The aminograms in plasma and CSF of 105 patients with ages between 0 and 12 months were collected and analysed retrospectively. Aminograms with amino acid values that are considered to be normal according to the reference values of our laboratory were included in the sample. The quantitative analysis of amino acids was performed using high-resolution liquid chromatography and statistical analysis with the software application SPSS 19.0.

RESULTS

The mean values, range and standard deviation of the amino acid concentrations in plasma and CSF, together with the CSF/plasma ratios, are reported. Significant correlations were found from 0.6 onwards between different neutral amino acids, above all in those with smaller molecular weights (Thr, Ser, Gly and Ala).

CONCLUSIONS

The existence of significant correlations between the different neutral amino acids supports the idea that they share the same transporters in the blood-brain barrier. Standardising the amino acid ratios will make it possible to increase sensitivity in the detection of pathological values in plasma and CSF, to further knowledge of the pathophysiology of neurological diseases and perhaps to describe new aminoacidopathies.

Obtaining and storage of ready-to-use segments from traditional orange obtained by enzymatic peeling

The aim of this study was to optimize all parameters implied in the process of obtaining orange segments as minimally processed product by enzymatic peeling, from the method of segment obtaining to the storage conditions, and also to evaluate two films with different permeability. Enzymatic peeling was carried out by fruit infusion under vacuum conditions in a commercial preparation of pectinases and cellulases (Peelzym II). The best condition to obtain Cadenera segments by enzymatic peeling was 1 mL/L of Peelzym II applied at 53 kPa with three vacuum pulses of 2 min and a subsequent period of 30 min in the enzymatic solution at atmospheric pressure. The segments were packaged in two films with different permeability and they were stored for 10 days at 4 °C. Samplings were carried out after 4, 7 and 10 days of storage. The results showed that the concentration of CO2 in the less permeable film (PA 120) ranged between 0.7 and 1.2 mL/100 mL, while in the most permeable one (PA 240) was around 0.2 mL/100 mL. Under these conditions, the weight loss was kept at low levels until day 7 of storage, showing a significant increase after 10 days. Colour (a/b) increased with the peeling process and it remained without significant changes during the whole storage period for both films. The antioxidant capacity slightly decreased after 10 days of storage. The microbial flora was reduced after the enzymatic peeling. Both the sensory and the microbiological quality were kept in adequate levels for consumption during 7 days. From this moment, they lost sweetness and aroma and the microbial development increased. Thus, the use of the most permeable film and a maximum storage time of 7 days are recommended to maintain the most quality of the segments.

A negative feedback loop that limits the ectopic activation of a cell type-specific sporulation sigma factor of Bacillus subtilis

Two highly similar RNA polymerase sigma subunits, σ^F and σ^G, govern the early and late phases of forespore-specific gene expression during spore differentiation in Bacillus subtilis. σ^F drives synthesis of σ^G but the latter only becomes active once engulfment of the forespore by the mother cell is completed, its levels rising quickly due to a positive feedback loop. The mechanisms that prevent premature or ectopic activation of σ^G while discriminating between σ^F and σ^G in the forespore are not fully comprehended. Here, we report that the substitution of an asparagine by a glutamic acid at position 45 of σ^G (N45E) strongly reduced binding by a previously characterized anti-sigma factor, CsfB (also known as Gin), in vitro, and increased the activity of σ^G in vivo. The N45E mutation caused the appearance of a sub-population of pre-divisional cells with strong activity of σ^G. CsfB is normally produced in the forespore, under σ^F control, but sigGN45E mutant cells also expressed csfB and did so in a σ^G-dependent manner, autonomously from σ^F. Thus, a negative feedback loop involving CsfB counteracts the positive feedback loop resulting from ectopic σ^G activity. N45 is invariant in the homologous position of σ^G orthologues, whereas its functional equivalent in σ^F proteins, E39, is highly conserved. While CsfB does not bind to wild-type σ^F, a E39N substitution in σ^F resulted in efficient binding of CsfB to σ^F. Moreover, under certain conditions, the E39N alteration strongly restrains the activity of σ^F in vivo, in a csfB-dependent manner, and the efficiency of sporulation. Therefore, a single amino residue, N45/E39, is sufficient for the ability of CsfB to discriminate between the two forespore-specific sigma factors in B. subtilis.

Positive auto-regulation of a transcriptional activator during cell differentiation or development often allows the rapid and robust deployment of cell- and stage-specific genes and the routing of the differentiating cell down a specific path. Positive auto-regulation however, raises the potential for inappropriate activity of the transcription factor. Here we unravel the role of a previously characterized anti-sigma factor, CsfB, in a negative feedback loop that prevents ectopic expression of the sporulation-specific sigma factor σ^G of Bacillus subtilis. σ^G is activated in the forespore, one of the two chambers of the developing cell, at an intermediate stage in spore development. Once active, a positive feedback loop allows the rapid accumulation of σ^G. Synthesis of both σ^G and CsfB is under the control of the early forespore regulator σ^F, and CsfB may help prevent the premature activity of σ^G in the forespore. However, CsfB is also produced under σ^G control in non-sporulating cells, setting a negative feedback loop that we show limits its ectopic activation. We further show that an asparagine residue conserved among σ^G orthologues is critical for binding and inhibition by CsfB, whereas the exclusion of asparagine from the homologous position in σ^F confers immunity to CsfB.

Hypokinetic-rigid syndrome in children and inborn errors of metabolism

Hypokinetic-rigid syndrome (HRS) or "parkinsonism" is rare in children. From a clinical point of view it is characterised by a group of signs in which hypokinesia (decreased number of movements), bradykinesia (slowness of movements), rigidity and rest tremor are the fundamental traits. Nervous system infections, immunomediated encephalitis, hypoxia and some drugs have been described as acquired or secondary causes of HRS in the paediatric age. Inborn errors of metabolism (IEM) comprise and important group regarding genetic causes. Main diseases causing HRS in children are neurotransmitter (biogenic amines) defects, metal storage diseases, energy metabolism disorders and lysosomal diseases. In general, in IEM, the HRS is associated to other neurological signs such as dykinesias, pyramidal signs, and psychomotor delay, is very rare in the neonatal period, tends to be more frequent in advanced stages of progressive diseases, and may respond to specific therapies. In particular, l-dopa + carbidopa can be a very effective treatment in neurotransmitter defects, whereas other disorders such as Wilson disease and some particular lysosomal disorders have different therapeutic possibilities. Furthermore, other genetic conditions in dopa-responsive and non-responsive HRS should be also considered, especially in juvenile parkinsonism. Through this review, a practical orientation for paediatric neurologists concerning clinical clues, diagnostic procedure and treatment of metabolic HRS will be provided.

Economic impact of an electronic alert system to prevent venous thromboembolism in hospitalised patients

OBJECTIVES

The prevention of venous thromboembolism (VTE) is a priority for improved safety in hospitalised patients. Worldwide, there is growing concern over the undersuse of appropriate thromboprophylaxis. Computerised decision support improves the implementation of thromboprophylaxis and reduces inpatient VTE. However, an economic assessment of this approach has not yet been performed.

OBJECTIVES

To evaluate the economic impact of an electronic alert (e-alert) system to prevent VTE in hospitalised patients over a 4year period.

PATIENTS/METHODS

 All hospitalised patients at a single institution during the first semesters of 2005-2009 (n=32280) were included. All cases of VTE developed during hospitalisation were followed and direct costs of diagnosis and management collected.

RESULTS

 E-alerts achieved a sustained reduction of the incidence of in-hospital VTE, OR 0.50 (95% CI, 0.29-0.84), the impact being especially significant in medical patients, OR 0.44 (95% CI, 0.22-0.86). No increase in prophylaxis-related bleeding was observed. In our setting, the mean direct cost (during hospitalisation and after discharge) of an in-hospital VTE episode is €7058. Direct costs per single hospitalised patient were reduced after e-alerts from €21.6 to €11.8, while the increased use of thromboprophylaxis and the development of e-alerts meant €3 and €0.35 per patient, respectively. Thus, the implementation of e-alerts led to a net cost saving of €6.5 per hospitalised patient. Should all hospitalised patients in Spain be considered, total yearly savings would approach €30million.

CONCLUSIONS

 E-alerts are useful and cost-effective tools for thromboprophylaxis strategy in hospitalised patients. Fewer thromboembolic complications and lower costs are achieved by its implementation.

The effect of feeding system in the expression of genes related with fat metabolism in semitendinous muscle in sheep

The effect of feeding system on the expression of LPL, ACACA, FASN, FABP4, DGAT1, SCD, CPT1B, PRKAA2, LEP, SREBP1, PPARG, PPARA and CEBPB genes in semitendinous muscle was studied. Forty-four single born male lambs of the Rasa Aragonesa breed, allocated to four different dietary treatments, were used: grazing alfalfa, grazing alfalfa with supplement for lambs, indoor lambs with grazing ewes and drylot. Significant differences were found in the expression of genes LPL, ACACA, FASN, FABP4, CPT1B and SCD. Genes related to adipogenesis (LPL, ACACA, FASN, FABP4, and SCD) are up-regulated in the intensive groups. In grazing groups CPT1B gene expression, related to β-oxidation process, is up-regulated. The relative expression of CPT1B was 1.54 fold higher in ALF+S, and 0.43 and 0.37 fold lower in IND- GRE and IND, respectively. The results support the hypothesis that changes in fatty acid profile due to feeding system implicate changes in the mRNA expression level of genes related with fat metabolism. Feeding strategy is an important tool to manipulate intramuscular fatty acid profile in meat through altering gene expression of enzymes related with fat metabolism.

Methodological limitations in research on late psychoses

Introduction

Late psychoses are a heterogeneous group of disorders whose nosology has been controversial throughout history. The concept of dementia praecox introduced by Kraepelin, and based on the progressive deterioration and early onset, has been so dominant in the last decades that few issues have created as much controversy as that schizophrenia can begin in late age. Our purpose is to identify the different obstacles in the research in late psychoses to be able to overcome these limitations and improve the study in this area.

Methods

A literature review was achieved using the National Library of Medicine and PubMed search system.

Results

We found historical limitations, because over the last century, different schools of psychiatry have used different nomenclatures and age limits to define late-onset psychotic disorders. Prevailing beliefs in the low frequency of these diseases or in the association of the onset of psychotic symptoms in the elderly with cognitive impairment have interfered with epidemiological research in this area. Moreover, older psychotic patients are often excluded from epidemiological and pharmacological research. Lack of insight and social isolation determine sampling bias and reliability problems.

Conclusions

Seemengly strong knowledge on late-onset schizophrenia is based, in fact, in samples from patients with late paraphrenia or mixed samples. It becomes mandatory to define concepts and establish diagnostic criteria, and to conduct multicenter studies to increase the size of our samples.

SIRT1 stabilizes PML promoting its sumoylation

SIRT1, the closest mammalian homolog of yeast Sir2, is an NAD(+)-dependent deacetylase with relevant functions in cancer, aging, and metabolism among other processes. SIRT1 has a diffuse nuclear localization but is recruited to the PML nuclear bodies (PML-NBs) after PML upregulation. However, the functions of SIRT1 in the PML-NBs are unknown. In this study we show that primary mouse embryo fibroblasts lacking SIRT1 contain reduced PML protein levels that are increased after reintroduction of SIRT1. In addition, overexpression of SIRT1 in HEK-293 cells increases the amount of PML protein whereas knockdown of SIRT1 reduces the size and number of PML-NBs and the levels of PML protein in HeLa cells. SIRT1 stimulates PML sumoylation in vitro and in vivo in a deacetylase-independent manner. Importantly, the absence of SIRT1 reduces the apoptotic response of vesicular stomatitis virus-infected cells and favors the extent of this PML-sensitive virus replication. These results show a novel function of SIRT1 in the control of PML and PML-NBs.