Interleukin 12 (IL12B), interleukin 12 receptor (IL12RB1) and interleukin 23 (IL23A) gene polymorphism in systemic lupus erythematosus

OBJECTIVE

The aim of this study was to assess the possible association between the interleukin-12B (IL12B) and interleukin-12 receptor beta 1 (IL12RB1) gene polymorphisms with systemic lupus erythematosus (SLE). In addition, we have undertaken a systematic search for genetic variants of interleukin 23 (IL23A).

METHODS

The study was conducted on 559 SLE patients and 603 ethnically matched healthy controls. Genotyping of the IL12B [IL12Bpro and IL12B 3' untranslated region (UTR)] and IL12RB1 (641A-->G, 1094T-->C and 1132G-->C) polymorphisms was performed with polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and PCR-fluorescent methods, whereas IL23A genetic variants were realized with direct sequencing.

RESULTS

No statistically significant differences in the distribution of the IL12B and the IL12RB1 genotypes and alleles were observed when comparing SLE patients and control subjects. Additionally, no differences in the genotype and allele distribution were found when SLE patients were stratified according to the presence or absence of lupus nephritis. Despite an extensive analysis in 30 individuals, variations located in the exons and in the 5' and 3' UTR regions of IL23A gene were not found in any case.

CONCLUSIONS

These results suggest that polymorphisms located in IL12B, IL12RB1 and IL23A genes may not play a relevant role in the susceptibility or severity of SLE in the Spanish population.

Effect of organic loading rate on the stability, operational parameters and performance of a secondary upflow anaerobic sludge bed reactor treating piggery waste

A study of anaerobic digestion of piggery wastewater was carried out in a laboratory-scale sludge bed reactor as a secondary treatment. The effect of organic volumetric loading rates (BV) in the range of 1.0-8.1 g TCOD/ld on the process performance was evaluated. The best results were obtained at BV equal to or lower than 4 g TCOD/ld. At higher BV values, the removal efficiency of the process decreased suddenly. A linear relationship was found between the effluent SCOD and the TVFA/alkalinity ratio (P). A relationship was found among the different operational variables (BV , removal efficiency, effluent soluble COD, soluble COD removal rate (R), retention factor (phi), specific microbial growth rate (mu), methane production rate per volume of reactor and per volume of waste treated--QM and qM, respectively) and the corresponding regression equations were obtained. An increase of BV determined a decrease of removal efficiency, phi and qM and an increase of effluent soluble COD, mu, R and QM. The value of the maximum specific microbial growth rate (muM) determined through the equation that correlated BV and mu was found to be 0.19 d(-1). This value was of the same magnitude as those reported in other works of anaerobic digestion of piggery waste.

Analysis of the functional NFKB1 promoter polymorphism in rheumatoid arthritis and systemic lupus erythematosus

Nuclear factor (NF)-kappaB plays an important role in inflammatory diseases such as rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). A functional insertion/deletion polymorphism (-94ins/delATTG) has been identified in the promoter of the NFKB1 gene. In addition, a polymorphic dinucleotide repeat (CA) has been identified in proximity to the coding region of the human NFKB1 gene. The aim of the present study was to investigate the influence of both the -94ins/delATTG and the (CA) microsatellite NFKB1 polymorphisms in the susceptibility/severity of RA and SLE. We analyzed the distribution of -94ins/delATTG and the multiallelic (CA)(n) repeat in 272 RA patients, 181 SLE patients, and 264 healthy controls from Southern Spain, in both cases using a polymerase chain reaction-fluorescent method. No statistically significant difference in the distribution of the -94delATTG NFKB1 genotypes and alleles between RA patients, SLE patients, and control subjects was observed. Similarly, we found no statistically significant differences in the (CA)(n) microsatellite allele frequency between controls and RA patients or SLE patients. In addition, no association was found between the above mentioned NFKB1 polymorphisms with any of the demographic and clinical parameters tested either in RA or in SLE patients. From these results, it seems that the -94ins/delATTG and the (CA)(n) repeat of NFKB1 gene may not play a relevant role in RA and/or SLE in our population.

Polymorphisms of toll-like receptor 2 and 4 genes in rheumatoid arthritis and systemic lupus erythematosus

Human toll-like receptors (TLRs) participate in the innate response and signal the activation of adaptive immunity. Therefore, these TLRs may be important in autoimmune diseases such as rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). We investigated, by using a polymerase chain reaction restriction-fragment length polymorphism method, the possible association between the polymorphisms of TLR2 (Arg677Trp and Arg753Gln) and TLR4 (Asp299Gly and Thr399Ile) genes with the susceptibility or severity of RA and SLE. Our study population consisted of 122 patients with SLE, 224 patients with RA, and a control group of 199 healthy individuals. The TLR2 polymorphisms were very rare in our population; no individual carrying the TLR2-Arg677Trp polymorphism was observed, whereas the TLR2-Arg753Gln polymorphism was present in only 1% of the total population. We found no statistically significant differences in the TLR4-Asp299Gly and the TLR4-Thr399Ile genotype or allele distribution between SLE patients, RA patients, and control individuals. Similarly, no association was found with any of the demographic and clinical parameters tested either in RA or in SLE patients. In conclusion, a case-control study was used to analyze, for the first time, the influence of TLR2 and TLR4 gene polymorphism on the predisposition and clinical characteristics of SLE and RA but provided no evidence for association of TLR2 or TLR4 gene polymorphism with either disease in the population under study.

Ciprofloxacin implants for bone infection. In vitro-in vivo characterization

To elucidate the antibiotic release mechanism from implants composed of calcium phosphates (hydroxyapatite [HAP] and tricalcium phosphate [TCP]), 30 kDa poly(DL-lactide) (PLA-30) and ciprofloxacin (CFX), nine formulations were prepared. In vitro results show that the release rate decreased as compression load and PLA/phosphates ratio increased. In contrast, a slower percent release rate was observed with higher drug loading. Swelling-erosion-disintegration of the implants was observed during the release assays, due to CFX swelling. Two CFX implant formulations were selected for implantation in the femur of rabbits, according to in vitro results. The implant drug loads tested were 10% and 40% of CFX. The in vivo results showed that the antibiotic concentrations achieved throughout the femur were higher for 4 weeks than the minimum inhibitory concentrations (MIC) against the most common of the pathogens that cause osteomyelitis. The CFX-10% implant was considered the best formulation as CFX was totally released within 6 weeks, and therapeutic bone levels were achieved, and the histological and radiographic analyses showed the osteoconductive properties of the materials. All these results showed that CFX release is limited by its solubility, and the erosion-disintegration and bone ingrowth into the implants enhanced the antibiotic release.

High lipoprotein (a), diabetes, and the extent of symptomatic intracranial atherosclerosis

BACKGROUND

Lipoprotein (a) (Lp[a]) has important atherothrombogenic properties, but its role in intracranial atherosclerosis remains unclear.

OBJECTIVE

To investigate the relationship between Lp(a) level and the extent of intracranial large-artery occlusive disease.

METHODS

Between June 2001 and August 2003, 166 consecutive first-ever TIA or stroke patients had intracranial stenoses on transcranial Doppler, of which 100 fulfilled all inclusion criteria. The extent of intracranial large-artery occlusive disease was assessed by the number of angiographically confirmed intracranial stenoses. Serum Lp(a) was determined a minimum of 3 months after stroke onset.

RESULTS

Two hundred eighty-one intracranial stenoses were documented. Fifty-one (51%) patients had three or more stenoses (greater-extent group). Patients in the highest Lp(a) quartile had a higher adjusted odds ratio (OR) for a greater extent than those in the lowest quartile (OR 3.43, 95% CI 1.04 to 11.33, p = 0.04). A positive correlation was found between Lp(a) concentration and the number of stenoses (r = 0.310, p = 0.002). Moreover, Lp(a) level increased gradually with the number of stenoses (p = 0.02). A multiple logistic regression model identified diabetes (OR 2.4, 95% CI 1.04 to 5.57, p = 0.04) and high Lp(a) (OR 2.52, 95% CI 1.03 to 6.18, p = 0.043) as independent markers of a greater extent of intracranial large-artery occlusive disease.

CONCLUSIONS

High Lp(a) level and diabetes mellitus are independent markers of a greater extent of intracranial large-artery occlusive disease. These findings support a role for Lp(a) in intracranial stenotic atherogenesis and might be useful for the selection of high-risk patients.

Newly developed blockers of the M-current do not reduce spike frequency adaptation in cultured mouse sympathetic neurons

The M-current (I(K(M))) is believed to modulate neuronal excitability by producing spike frequency adaptation (SFA). Inhibitors of M-channels, such as linopirdine and 10,10-bis(4-pyridinylmethyl)-9(10H)-anthracenone (XE991), enhance depolarization-induced transmitter release and improve learning performance in animal models. As such, they are currently being tested for their therapeutic potential for treating Alzheimer's disease. The activity of these blockers has been associated with the reduction of SFA and the depolarization of the membrane observed when I(K(M)) is inhibited. To test whether this is the case, the perforated patch technique was used to investigate the capacity of I(K(M)) inhibitors to alter the resting membrane potential and to reduce SFA in mouse superior cervical ganglion neurons in culture. Linopirdine and XE991 both proved to be potent blockers of I(K(M)) when the membrane potential was held at -30 mV (IC(50) 2.56 and 0.26 microM, respectively). However, their potency gradually declined upon membrane hyperpolarization and was almost null when the membrane potential was kept at -70 mV, indicating that their blocking activity was voltage dependent. Nevertheless, I(K(M)) could be inhibited at these hyperpolarized voltages by other inhibitors such as oxotremorine-methiodide and barium. Under current-clamp conditions, neither linopirdine (10 microM) nor XE991 (3 microM) was effective in reducing the SFA and both provoked only a small slowly developed depolarization of the membrane (2.27 and 3.0 mV, respectively). In contrast, both barium (1 mM) and oxotremorine-methiodide (10 microM) depolarized mouse superior cervical ganglion neurons by about 10 mV and reduced the SFA. In contrast to classical I(K(M)) inhibitors, the activity of linopirdine and XE991 on the I(K(M)) is voltage dependent and, thus, these newly developed I(K(M)) blockers do not reduce the SFA. These results may shed light on the mode of action of these putative cognition enhancers in vivo.

Evaluation of a laboratory and full-scale microalgae pond for tertiary treatment of piggery wastes

Piggery wastes tertiary treatment in laboratory and full-scale microalgal ponds was evaluated. COD, BOD, inorganic nitrogen and orthophosphate removals of up to 57%, 69%, 79% and 74%, respectively, were obtained. The effect of the hydraulic retention time (HRT) on removal efficiencies followed an exponential relationship. COD, BOD and orthophosphate removal rate decreased with increased effluent concentration while the inorganic nitrogen removal rate increased with an increasing effluent substrate concentration at inorganic nitrogen concentration values lower than 0.07 g l(-1). Values of maximum substrate removal rate, half rate constant, cell yield coefficient, endogenous constant and maximum specific growth rate were 7.1 +/- 0.5 d(-1), 0.21 +/- 0.02 g l(-1), 0.26 +/- 0.01 g VSS g(-1) COD, 0.012 +/- 0.001 d(-1)and 1.9 +/- 0.9 d(-1), respectively. At full-scale, effluent COD, BOD, MPN, inorganic nitrogen and orthophosphate decreased while pH and Chlorophyll a increased with the operation time. It was found that the use of the final effluent as drinking water did not affect pigs growth.

Performance and kinetic evaluation of the anaerobic digestion of two-phase olive mill effluents in reactors with suspended and immobilized biomass

A lab-scale study was conducted on the mesophilic anaerobic digestion of two-phase olive mill effluents constituted by the mixture of the wash waters derived from the initial cleansing of the olives and those obtained in the washing and purification of virgin olive oil. The digestion was conducted in two continuously stirred tank reactors, one with biomass immobilized on Bentonite (reactor B) and other with suspended biomass used as control (reactor C). The reactors B and C operated satisfactorily between hydraulic retention times of 25.0 and 4.0 days and 25.0 and 5.0 days, respectively. Total chemical oxygen demand (TCOD) efficiencies in the ranges of 88.8-72.1% and 87.9-71.2% were achieved in the reactors with immobilized and suspended biomass, respectively, at organic loading rates of between 0.86 and 5.38 g TCOD/ld and 0.86-4.30 g TCOD/ld, respectively. On comparing both reactors for the same OLRs applied, it was observed that the reactor with support was always more efficient and stable showing higher TCOD, SCOD removal efficiencies and lower VFA/alkalinity ratio values than those found in the control reactor. A mass (TCOD) balance around the reactors allowed the methane yield coefficient, Y(G/S), to be obtained, which gave values of 0.31 and 0.30l CH(4)/g TCOD(removed) for reactors B and C, respectively. The cell maintenance coefficients,k(m), obtained by means of this balance were found to be 0.0024 and 0.0036 g TCOD(removed)/g VSSd, respectively. The volumetric methane production rates correlated with the biodegradable TCOD concentration through an equation of the Michaelis-Menten type for the two reactors studied. This proposed model predicted the behavior of the reactors very accurately showing deviations lower than 10% between the experimental and theoretical values of methane production rates.

[Use of teleradiology in the evaluation and management of head-injured patients. Results of a pilot study of a link between a district general hospital and a neurosurgical referral center]

Because of the centralization of neurosurgical services, many head-injured patients who are initially evaluated in district general hospitals need to be transferred to a high technology centre for neurosurgical assessment. However, after assessment, many of these patients are sent back to the original hospital. Establishing a teleradiological system between the two hospitals would eliminate these unnecessary transfers.

OBJECTIVES

1) to describe our initial experience and the results of a pilot study of the teleradiological link between a district general hospital and a tertiary hospital for neurosurgical assessment of head-injured patients, 2) to describe the infrastructure and the technological support required for this project, 3) to analyse the effects of the teleradiological link in both centers (referring and receiving), 4) to evaluate the effectiveness of the system in avoiding unnecessary transfers, and 5) to assess its effectiveness in improving the speed and the quality of transfers in head-injured patients.

MATERIAL AND METHODS

In January 1998, the Neurotraumatology Unit of Vall d'Hebron University Hospital established a teleradiological link with the General Hospital of Vic for the neurosurgical evaluation of headinjured patients. The General Hospital of Vic sent the patients' clinical information by fax. CT scan images were digitalized, compressed and prepared for transmission with the StatView program, and were then transmitted by modem to the receiving center. The duty neurosurgeon viewed the images on a PC screen using MutiView software. After evaluating this clinical and radiological information the neurosurgeon sent a report back to the referring center recommending transfer or management (admission, observation, etc.).

RESULTS

We analyse the results of our experience 5 years after the implantation of the teleradiological link.

CONCLUSIONS

The use of teleradiology in the daily management of head-injured patients provides clear benefits and leads to a more rational use of resources, thus significantly reduces costs. The effectiveness of the system in reducing the interval between the injury and treatment in severe cases depends more on the infrastructure of the health system in each geographical area than on sophisticated telemedicine systems. These methods should be accompanied by other measures designed to hasten the transfer of selected patients.

Cutaneous reactions to pine processionary caterpillar (Thaumetopoea pityocampa) in pediatric population

Cutaneous lesions caused by pine processionary caterpillar (Thaumetopoea pityocampa, TP) are frequent in pinewood areas. However, no epidemiological studies have been performed so far in the pediatric population. In this study, we evaluated the relevance of reactions to pine processionary caterpillar in the pediatric population of our environment and determined the possible role of an IgE-mediated mechanism. A questionnaire was developed and given to 1,101 children and adolescents ranging from 3 to 17 years of age from rural areas with large pine forests. A total of 653 questionnaires were answered by the children or their parents. The search for immunoglobulin E (IgE)-mediated cases was based on the presence of a suspected reaction to caterpillar and confirmed by in vivo (skin prick) and in vitro (immunoblotting) tests. Sixty of the 653 people interviewed (9.18%) identified a cutaneous reaction from exposure to the processionary caterpillar. Within this group only four cases (6.7%) were because of an IgE-mediated mechanism. The predominant clinical feature of these patients with allergy to caterpillar was contact urticaria. We present the first study of cutaneous reactions to pine processionary caterpillar in a large pediatric population. This is a frequent pathology in pinery zones and only in a minority of the cases are because of an IgE-mediated allergic mechanism. This fact contrasts with studies in adults, where this percentage is much greater.

A reduction in dietary saturated fat decreases body fat content in overweight, hypercholesterolemic males

BACKGROUND AND AIM

The effect of the quality of dietary fat on body composition is unknown. Our objective was to determine whether body composition is modified by the isocaloric substitution of a diet rich in saturated fat by a diet high in monounsaturated fat (Mediterranean diet) or a carbohydrate-rich diet in overweight subjects with hypercholesterolemia.

METHODS AND RESULTS

The study involved 34 hypercholesterolemic males aged 18-63 years with a body mass index (BMI) of 28.2 (2.6), all of whom consumed a diet rich in saturated fat (SAT) for 28 days. They were then randomly divided into two groups of 17 subjects and underwent two dietary periods of 28 days each in a crossover design: a Mediterranean diet high in monounsaturated fat (MONO) and a carbohydrate-rich diet (CHO). The order of the diets was different for the two group. The CHO diet contained 57% CHO and 28% total fat (< 10% saturated fat, 12% monounsaturated fat and 6% polyunsaturated fat); the Mediterranean diet contained 47% CHO and 38% fat (< 10% saturated fat, 22% monounsaturated fat--75% of which was provided by olive oil- and 6% polyunsaturated fat). The variables measured at the end of each dietary intervention period were: 1) body composition by means of bioelectrical impedance; 2) plasma lipoproteins using enzymatic techniques; and 3) fatty acids in cholesterol esters by means of gas chromatography. BMI and the waist/hip ratio remained the same during the three dietary periods. A decrease in fat was observed when changing from a saturated fat diet (23.3 (6.3) kg) to a Mediterranean diet (20.8 (7.2) kg) (p < 0.05), or a carbohydrate-rich diet (20.6 (6.7) kg) (p < 0.05). Lean mass increased when changing from a SAT diet (58.4 (7.0) kg) to a CHO diet (60.2 (7.0) kg) (p < 0.05).

CONCLUSION

The isocaloric substitution of a saturated fat-rich diet by a Mediterranean or carbohydrate-rich diet decreases total body fat in hypercholesterolemic males.

Acetaldehyde metabolism by liver mitochondrial ALDH from UChA and UChB rats: effect of inhibitors

We have observed that blood acetaldehyde (AcH) levels after an ethanol dose were significantly higher in disulfiram-pre-treated UChA (low ethanol consumer) than in UChB (high ethanol consumer) rats. In order to explore these results further, we studied the effect of disulfiram (300 mg/kg i.p.) and chlorpropamide (80) mg/kg i.p.) pre-treatment on blood AcH levels after oral ethanol (60 mmol/kg) and on AcH metabolism by liver mitochondrial aldehyde(s) dehydrogenase(s) from UChA and UChB rats. AcH metabolism by liver mitochondrial aldehyde dehydrogenase (ALDH) was studied by following AcH disappearance rate and the formation of NADH at 340 nm in the incubation medium. The results showed that chlorpropamide, like disulfiram, produced a higher blood AcH level consistent with a greater inhibition of the low-Km mitochondrial ALDH in the UChA rats than in the UChB rats. These drugs did not inhibit the high Km mitochondrial ALDH. Kinetic studies of mitochondrial ALDH show that low-Km mitochondrial ALDH from UChB rats exhibits a higher affinity for NAD than UChA rats. This observation could explain the different inhibition of ALDH by both drugs, assuming that the inhibitors reduce NAD availability, the rate limiting step in the mitochondrial ALDH oxidation.

Peripheral neuropathy associated with treatment for multidrug-resistant tuberculosis

OBJECTIVE

To review the incidence and management of peripheral neuropathy in patients receiving therapy for MDR-TB.

METHODS

A case series with retrospective chart review of 75 patients who initiated individualized therapy for multidrug-resistant tuberculosis (MDR-TB) in Lima, Peru, between 1 August 1996 and 31 January 1999.

RESULTS

All patients had confirmed MDR-TB and were receiving individualized therapy, comprised of an average of six drugs. Ten (13%) of these patients presented with symptoms of peripheral neuropathy, confirmed by electromyography. All symptoms were reported in the lower extremities, and all were sensory in nature. Median time to presentation from initiation of MDR-TB therapy was 9.1 months. No significant risk factors associated with development of peripheral neuropathy were identified. Management strategies depended on the severity of symptoms and included the treatment of contributing co-morbidities, medications for neuropathic pain, and adjustment of doses of possible offending agents. All patients responded to management; three patients were left with mild residual symptoms. Patients whose neuropathy resolved had symptoms for a median of 7 months.

CONCLUSIONS

Peripheral neuropathy was encountered in 13% of our cohort of MDR-TB patients. The diagnosis of peripheral neuropathy can be based on clinical presentation alone, and effective management of this side-effect is possible without sacrificing MDR-TB treatment efficacy.

Endoscopic follow-up of patients after curative surgery for colorectal cancer: results of a medical assistance protocol

AIMS

To evaluate the results of an endoscopic follow-up assistance protocol for colorectal cancer (CRC) after curative surgery.

PATIENTS AND METHODS

Between 1994 and 1996, 205 patients with CRC were submitted to curative surgery in our hospital. An endoscopic follow-up was proposed to the patients based on an endoscopy six months following surgery, in the case they did not have a complete endoscopy prior to surgery, or one year after surgery if they did, another one two years later, and a third endoscopy between the third and fifth year. We retrospectively analyzed the follow-up outcome and endoscopic findings.

RESULTS

155 patients were submitted to follow-up, of which 74,2% completed the protocol. 3 synchronous tumours, 4 anastomosis relapses and 2 metachronous tumours were detected. Curative surgery was performed on 100% of the synchronous tumours, 50% of the relapses and 50% of the metachronous tumours. 48.3% and 20.6% of the patients had synchronous and metachronous polyps, respectively. 14.7% of the polyps were larger than 1 cm, 21.7% and 4.8% were tubulovillous and villous, respectively, and 3.7% had severe dysplasia. Finally, patients with synchronous polyps had higher risk of developing metachronous polyps (RR 7.1, CI 95% 2.3; 22.2, p<0.0001).

CONCLUSIONS

The rate of adenomatous polyps with high risk of malignant degeneration, metachronous tumours or relapses detected by colonoscopy is low in our series. On the other hand, the detection of polyps during follow-up was related to the presence of synchronous polyps.