[Glycine: a cell-protecting anti-oxidant nutrient]

For many researchers it is still difficult to accept that beneficial effects can be obtained in several disease states with the simplest amino acid, glycine. However, evidence is mounting in favour of this idea. It is now clear that dietary glycine protects against shock caused either by blood loss or endotoxin, reduces alcohol levels in the stomach and improves recovery from alcoholic hepatitis, diminishes liver injury caused by hepatotoxic drugs and blocks programmed cell death and reduces the nephrotoxicity caused by the drug cyclosporin A in the kidney, preventing hypoxia and free radical formation. It could be also useful in other inflammatory diseases since it diminishes cytokines production. We review some of the beneficial effects of glycine and their responsible mechanism, which could led to advice its use in the therapy of different diseases.

On the correct measurement of relative heavy charged particles to gamma thermoluminescent efficiencies

In order to better understand the most important experimental aspects for performing correct measurements of relative thermoluminescent (TL) efficiencies, an investigation has been carried out to quantify the effect of using different experimental procedures in the evaluation of 3 MeV proton-to-gamma relative efficiency (etap,gamma) of LiF:Mg,Ti. Variations in batch, presentation, annealing and reader have been studied. When the same protocol is used to measure proton and gamma TL response, efficiency values obtained range from 0.36 to 0.59 for peak 5 and from 0.44 to 0.79 for the total signal. The use of different annealings and different batches leads to 20% and 10% differences in etap,gamma respectively. Large differences (40%) are found between efficiency values measured with TLD-100 chips and those obtained using TLD-100 microcubes. When 'mixed' procedures are used to measure the proton and the gamma response, differences in etap,gamma may increase even more. The main conclusion of this work is to stress the importance of measuring an entire series of experiments in the same laboratory with a carefully defined protocol and using dosemeters from the same batch to obtain heavy charged particle TL response and gamma TL response with identical annealing and readout procedures.

Variation at the Angiotensin-converting enzyme and endothelial nitric oxide synthase genes is associated with the risk of esophageal varices among patients with alcoholic cirrhosis

Esophageal varices are a frequent complication among patients with liver cirrhosis. Nitric oxide and other vasoactive molecules regulate the vascular tone in both the liver microcirculation and the systemic and splanchnic circulation. Several genes that encode proteins involved in the maintenance of vascular tone, such as the endothelial-constitutive nitric oxide synthase (ecNOS), the angiotensinogen (AGT), the angiotensin-converting enzyme (ACE), and the angiotensin II receptor type 1 (AT1R) are polymorphic, and these polymorphisms have been associated with several cardiovascular diseases. Our aim was to define a possible role for DNA polymorphisms at these genes in the risk of developing esophageal varices among patients with alcoholic cirrhosis. We analyzed 145 male patients with liver cirrhosis. Patients and 200 healthy controls were genotyped by polymerase chain reaction for the ACE-I/D, the AGT-M235T, the AT1R-A1166C, and the ecNOS-4/5 (intron 4) polymorphisms. Ninety-five patients had varices and 50 did not show this complication. Carriers of the ACE-I allele (ID + II genotypes) were at a significantly higher frequency among patients with varices (p = 0.013). Patients without varices had a higher frequency of the ecNOS-4 allele compared with patients with varices (p = 0.026). ACE-I carriers + ecNOS-55 were at a significantly higher frequency (p = 0.0012; odds ratio = 3.19; 95% CI = 1.55-6.55) among patients with varices (51 of 95, 54%) compared with patients without (18 of 50, 36%). Allele and genotype frequencies for the AGT and AT1R polymorphisms did not differ between the two groups. The genotypes associated with an increased risk for varices have been linked to higher plasma levels of nitric oxide and reduced levels of ACE. These genotypes could have a vasodilatory effect in the systemic and splanchnic circulation, thus favoring the development of portocollaterals.

Dietary glycine inhibits activation of nuclear factor kappa B and prevents liver injury in hemorrhagic shock in the rat

We investigated the effects of a glycine-containing diet (5%) on liver injury caused by hemorrhagic shock and resuscitation in rats. Anesthetized rats were bled to a mean arterial blood pressure of 35-40 mm Hg for 1 h and then resuscitated with 60% of shed blood and lactated Ringer's solution. Feeding the rats glycine significantly reduced mortality, the elevation of plasma transaminase levels and hepatic necrosis. The increase in plasma TNFalpha and nitric oxide (NO) was also blunted by glycine feeding. Hemorrhagic shock resulted in oxidative stress (significant elevations in TBARS and in the oxidized/reduced glutathione ratio) and was accompanied by a reduced activity of the antioxidant enzymes Mn- and Cu,Zn-superoxide dismutase, glutathione peroxidase and catalase, overexpression of inducible NO synthase (iNOS), and activation of nuclear factor kappa B (NF-kappaB). Glycine ameliorated oxidative stress and the impairment in antioxidant enzyme activities, inhibited NF-kappaB activation, and prevented expression of iNOS. Dietary glycine blocks activation of different mediators involved in the pathophysiology of liver injury after shock.

Thr40 and Met122 are new partial loss-of-function natural mutations of the human melanocortin 1 receptor

Activation by melanocortins of the melanocortin 1 receptor (MC1R), expressed in epidermal melanocytes, stimulates melanogenesis. Human MC1R gene loss-of-function mutations are associated with fair skin, poor tanning and increased skin cancer risk. We identified two natural alleles: Ile40Thr, probably associated with skin types I-II, and Val122Met. Val122Met bound [(125)I][Nle(4), D-Phe(7)]-alpha-melanocyte stimulating hormone with lower affinity than the wild-type. Dose-response curves of cAMP accumulation were right-shifted for both forms. The Val122Met form failed to achieve maximal cAMP responses comparable to the wild-type or Ile40Thr receptors. Thus, the Ile40Thr and Val122Met variants are partial loss-of-function natural mutations of MC1R.

A simplified method to quantitate atherosclerosis in the rabbit aorta

A simple method to quantitatively evaluate atherosclerosis in the rabbit aorta by measuring macroscopic lesion areas (%) was attempted in the present study. Ten female New Zealand white rabbits were fed on a cholesterol-rich diet (5/1000 g of food) during 4 months. Five of them were oophorectomized at the beginning and all were sacrificed at the end. Total levels of cholesterol increased from 50.7+/-14.7 mg/dl to 782.8+/-296.0. No significant differences were observed between oophorectomized and intact rabbits. At 4 months, the cholesterol-rich diet caused in both, intact and oophorectomized rabbits, atherosclerotic lesions affecting 17 and 46% of the aortic surface, respectively. This method may be more practical, easy and useful for quantitative evaluation of aortic atherosclerosis in a large number of rabbits, than histological observations of serial sections of rabbit's aortas.

[Polyradiculopathy caused by cytomegalovirus in AIDS patients: successful treatment with highly active antiretroviral therapy (HAART)]

We report two male patients with AIDS, aged 23 and 30 years old respectively. One was admitted due to a progressive weakness of the left leg and urinary and fecal incontinence. The other was admitted due to a progressive paraparesia without incontinence, but with a severe lumbar pain. In both patients polymerase chain reactions for cytomegalovirus in cerebrospinal fluid were positive. Treatment with ganciclovir, for 21 and 14 days respectively and highly active antiretroviral therapy was started. Both patients experienced recovery of their neurological deficits after 98 and 88 days of therapy, respectively.

Lack of association between polymorphisms of the coagulation factor VII and myocardial infarction in middle-aged Spanish men

In order to determine the role of two polymorphisms in the factor VII gene (R353Q and intron 7 hypervariable region) in the susceptibility to develop early myocardial infarction, a total of 175 patients with acute myocardial infarction aged 50 years or less (mean age 41+/-7 years) and 200 controls (average age 42+/-6) without cardiovascular disease were genotyped for these polymorphisms. Gene and genotype frequencies did not differ between patients and controls. Although the 353-QQ genotype was at a higher frequency among controls (4%) compared to patients (1%), the difference did not reach statistical significance. Carriers of the H7-allele (intron 7 polymorphism) were at a slightly higher frequency among patients (51 vs. 43%; P=0.19; OR=1.36; 95% CI=1.09-1.70). Our data suggest a lack of association between both polymorphisms in the factor VII gene and early myocardial infarction in our population.

Association between the NOS3 (-786 T/C) and the ACE (I/D) DNA genotypes and early coronary artery disease

DNA polymorphisms at the endothelium constitutive nitric oxide synthase gene (NOS3) have been linked to the risk of developing coronary artery disease (CAD). In vitro, a polymorphism in the 5' region of the NOS3 gene (-786 T/C) influences promoter activity. This polymorphism has been associated with coronary spasms among Japanese. The genetic variation at the angiotensin-converting enzyme (ACE) is associated with plasma ACE activities and has also been linked with susceptibility to cardiovascular disease. Our objective was to determine if DNA polymorphisms in the NOS3 and ACE genes were associated with early CAD. We analyzed the -786 T/C polymorphism in the 5' flanking region and the 27-bp repeat polymorphism in NOS3 intron 4, as well as the ACE-I/D polymorphism. A total of 170 male smokers (CAD patients) younger than 50 years and 300 male smokers (healthy controls) were genotyped. Frequencies were compared by the chi(2) test, and odds ratios (ORs) and their 95% confidence intervals (CI) were also calculated. Only the -786 T/C polymorphism in the 5' flanking region of the NOS3 gene was significantly associated with early CAD in our population. The frequency of the CC genotype was significantly increased (P = 0.039) in patients compared to controls (OR = 1.67; 95% CI = 1.01, 2.72). We found a synergistic effect between the NOS3-CC and the ACE-DD genotypes in the risk of developing early CAD. The frequency of CC + DD was significantly increased among patients (P = 0.002). Thus, those with a NOS3-CC and an ACE-DD genotype would have a significantly increased risk of suffering an early episode of coronary artery disease (OR = 2.82; 95% CI = 1.40, 5.70). Although based on a limited number of patients, our work suggests that individuals who are NOS3-CC + ACE-DD are at a higher risk for early CAD, probably as a consequence of increased endothelial dysfunction.

Adjuvant radiochemotherapy in the treatment of completely resected, locally advanced gastric cancer

PURPOSE

To analyze the efficacy and toxicity of adjuvant whole abdomen irradiation (WAI) and concomitant chemotherapy in the treatment of completely resected, high-risk gastric cancer.

METHODS AND MATERIALS

Between October 1990 and September 1997, 52 patients with completely resected gastric cancer, with lymph node and/or serosal involvement, were treated. Ages were 16-78 (median, 53.5) years. Treatment was either total- or sub-total gastrectomy, followed by WAI, 2100 cGy/21 fractions plus a 2400 cGy/16 fractions boost to the tumor bed. Chemotherapy consisted of either 5-fluorouracil (5-FU) 450-500 mg/m(2) i.v. for 5 days first and 5th week or 200-300 mg/m(2) continuous infusion during irradiation. No further chemotherapy was given.

RESULTS

With a minimum follow-up of 30 months and a median follow-up of 43.5 months, 25 of the 52 patients have died. Overall 5-year survival rate is 54%. Three patients sustained Grade 3-5 complications. Two patients with Grade 5 complications (malabsorption syndrome) died 31 and 56 months after the beginning of the treatment, respectively, with no evidence of recurrent tumor. For patients with involvement of the lymph nodes alone (n = 19) the 5-year survival was 69%, which was significantly better than the 36% 5-year survival observed for those patients with both serosal and lymph node involvement (n = 26, p = 0.004).

CONCLUSION

Adjuvant radiochemotherapy, WAI, and concomitant 5-FU, is a feasible and a fairly well-tolerated treatment for patients with locally advanced (involvement of the lymph nodes or serosa) gastric carcinoma who undergo complete resection. The 54% overall 5-year survival compares favorably with the survival reported after surgery alone for those patients.

Genetic variation at the chemokine receptors CCR5/CCR2 in myocardial infarction

Our objective was to examine the association between myocardial infarction (MI) and two DNA-polymorphisms at the proinflammatory chemokine receptors CCR2 (I64V) and CCR5 (32 bp deletion, (Delta)ccr5), defining if these polymorphisms influence the age for the onset of MI. A total of 214 patients with an age at the first MI episode <55 years, 96 patients that suffered the first MI episode when older than 60 years, and 360 population controls were polymerase chain reaction genotyped for the CCR2-V64I and CCR5-Delta32/wt polymorphisms. Patients and controls were male from the same Caucasian population (Asturias, northern Spain). The frequency of the Deltaccr5 allele was significantly higher in controls compared to patients <55 years (P = 0.004), or in patients >60 years compared to patients <55 years (P = 0.002). Taking the patients >60 years as the reference group, non-carriers of the (Delta)ccr5-allele would have a three-fold higher risk of suffering an episode of MI at <55 years of age (OR = 3.06; 95% CI = 1.46-6.42). Gene and genotype frequencies for the CCR2 polymorphism did not differ between patients <55 years and controls or patients >60 years. Our data suggest that the variation at the CCR5 gene could modulate the age at the onset of MI. Patients carrying the (Delta)ccr5-allele would be protected against an early episode of MI. CCR5 and the CCR5-ligands are expressed by cells in the arteriosclerotic plaque. Thus, the protective role of (Delta)ccr5 could be a consequence of an attenuated inflammatory response, that would determine a slower progression of the arteriosclerotic lesion among (Delta)ccr5-carriers. Our work suggests that the pharmacological blockade of CCR5 could be a valuable therapy in the treatment of MI.

Longitudinal study of the stability of expressed emotion in families of schizophrenic patients: a 9-month follow-up

The goal of this paper is to study attitude stability in schizophrenics' relatives, as reflected in the expressed emotion (EE) construct. For this purpose, the EE of 32 families of schizophrenic patients was assessed by means of the Camberwell Family Interview (CFI, Brown, Birley, & Wing, 1972; Vaughn & Leff, 1976b), both initially and at a 9-month follow-up. The results obtained indicate that EE is stable in fathers, whereas in mothers, high EE seems to be influenced by stressful situations, because, when assessed in crisis, EE was not stable, but in-between crises, it was. These results are discussed, as well as their relevance in family interventions aimed at reducing EE, where clinicians should take into account that mothers' EE may drop because of its instability, and not because of the intervention. On the other hand, clinicians should focus especially on fathers, because their high EE is constant, which is stressful to the patient during the follow-up.

Bacterial and viral etiology of acute otitis media in Chilean children

BACKGROUND

Acute otitis media (AOM) is a main cause for antimicrobial prescription in Latin America. Pathogen diversity in different geographic regions underscores the need for updated knowledge on AOM microbiology.

AIM

To prospectively determine the role of bacteria and viruses in Chilean children with AOM.

METHODS

Between July, 1998, and June, 1999, children >3 months with a presumptive diagnosis of AOM were referred to the study ear, nose and throat physician. Middle ear fluid and nasopharyngeal aspirates were obtained from children with confirmed AOM and processed for common bacteria, Mycoplasma pneumoniae, Chlamydia pneumoniae and viruses. Antimicrobial susceptibility patterns and serotypes of Streptococcus pneumoniae strains were determined.

RESULTS

An ear, nose and throat physician confirmed diagnoses for 222 (42%) of 529 children referred with diagnosis of AOM, and 170 children met eligibility criteria for the study. One or more pathogens were detected in 140 of 170 (82%) children. Predominant bacteria were S. pneumoniae (37%), Haemophilus influenzae (24%) and Streptococcus pyogenes (13%). M. catarrhalis was detected in 2 children, C. pneumoniae was found in 1 and M. pneumoniae was not detected. Viruses were detected in 22 children (13%) from nasopharyngeal aspirates, and in 6 of them the same virus was detected in middle ear fluid. Penicillin-resistant (intermediate and high) S. pneumoniae represented 40% of isolates and 10% of H. influenzae were beta-lactamase producers. All 10 penicillin-resistant S. pneumoniae strains were resistant to cefuroxime. Eighteen S. pneumoniae serotypes were detected and 19F was associated with high level penicillin resistance.

CONCLUSION

This study can impact local management of AOM, and it should encourage continuous surveillance of AOM microbiology in Chile and other developing countries.

[Time trends in ovarian cancer incidence in Navarra (1973-1995): effect of age, birth cohort and period of diagnosis]

BACKGROUND

Ovarian cancer is the sixth most common malignancy and the first killer among gynaecologic cancers in women of the European Union. Five years after diagnosis relative survival rates were less than 35%. The aims of the present study are to describe the time trends in ovarian cancer incidence in Navarra over the period 1973-1995, and to identify the age, period-of-diagnosis and birth-cohort components underlying the trend's evolution.

METHODS

Standard summary indexes of incidence were calculated. Log-linear Poisson models to quantify risks of ovarian cancer and the relative annual trend were used. Age-period-cohort models were adjusted in order to ascertain the effects on time trend exerted by the respective age, period-of-diagnosis and birth-cohort components.

RESULTS

Ovarian cancer incidence has showed annual rises of 2.1% over the period 1973-1995, with stabilisation over the period 1988-1995. A 54% increase in the risk of ovarian cancer was shown for the period 1993-1995 vs.1973-1977. The more recent generations of women born in Navarra do not show significant changes in the risk of ovarian cancer.

CONCLUSIONS

A considerable rise in ovarian cancer incidence in Navarra over the period 1973-1995 was found, less pronounced in the last decade. The risk of ovarian cancer shown in the more recent generations of women born in Navarra is stable.

[Peripheral neuropathy associated with intestinal inflammatory disease]

The association of outlying peripheral neuropathy and inflammatory bowel disease is a rare fact leaving aside factors like the deficit of intestinal absorption of vitamins or the neurotoxicity of drugs employed for the treatment of the inflammatory bowel disease. We presented a series of four patients with this association, to whom a retrospective study was carried out. In all cases polineuropathy followed a course parallel to the inflammatory bowel disease, being acute and reversible in two cases. The polyneuropathy could be attributed to a deficit of vitamin B12 in one case and to metronidazole neurotoxicity in the other; in the remaining two cases the polineuropathy was chronic and no etiological factor could be found except for the own activity of the inflammatory bowel disease. We think that the neuropathy can represent a rare extraintestinal manifestation of the illness with a common autoimmune pathogenic mechanism. In one of our cases, the nerve biopsy demonstrated an axonal neuropathy with an alteration of the epineural vessels which showed a healed aspect.

Variation in the LRP-associated protein gene (LRPAP1) is associated with late-onset Alzheimer disease

The LRP-associated protein is involved in the amount of mature LRP expressed on liver and brain. LRP is the main ApoE receptor and also binds alpha2-macroglobulin (alpha2M), a protein that associates with the beta-amyloid protein (betaA). By binding to alpha2M, LRP is responsible for the clearance of secreted betaA, thus preventing fibril formation. Genetic variation at the APOE, A2M, and LRP genes has been associated with the risk of developing late-onset Alzheimer disease (LOAD). We genotyped 373 patients, 300 controls, and 100 healthy elderly controls for a common DNA-polymorphism at the LRPAP1 gene (Insertion/Deletion, intron 5). Homozygotes for the rare Insertion (I) allele were at a significantly lower frequency in patients compared with controls (P = 0.002; OR = 0.29; 95% CI = 0.13, 0.68), and in patients compared with healthy elderly controls (P = 0.0002; OR = 0.18; 95% CI = 0.07, 0.46). No patient with an age at the onset below 75 years was II (0 of 214) compared with 8 in the group above 75 years (8 of 159) (P = 0.0044), suggesting that this genotype delays the onset of the disease. According to our data, the variation at the LRPAP1 gene is associated with the risk of developing LOAD. This is in agreement with the role of the LRPAP1 protein in the amyloidogenic pathway.

[Instrument for the functional evaluation of disability rehabilitation. Study on the reliability and clinical experience with the use of functional independence measure]

BACKGROUND

The Functional Independence Measure (FIM) is an instrument widely used to assess the results and progress of a medical rehabilitation program.

AIM

To assess the inter rater agreement in the application of FIM and show the clinical experience with its use in disabled patients enrolled in a rehabilitation program.

PATIENTS AND METHODS

FIM was applied in 40 patients and the inter rater agreement was assessed, comparing raters with and without training in its use. Agreement was evaluated using Kappa test. Afterwards, the FIM was used to assess changes in 100 patients hospitalized and being rehabilitated at the Rehabilitation ward of a general hospital.

RESULTS

Inter rater agreement is high in physical areas of the FIM and low in cognitive areas. Training significantly improves agreement in communication and cognitive areas. During a mean period of hospitalization of 38 days, FIM score changed from a mean of 47.2 to 92 points, with an improvement of 1.18 points per hospitalization day. The higher improvement was achieved in the physical area of the instrument.

CONCLUSIONS

Training is required for a proper application of FIM. When used adequately, this instrument allows an assessment of the degree of disability and the changes obtained with rehabilitation programs.

Synergistic effect between apolipoprotein E and angiotensinogen gene polymorphisms in the risk for early myocardial infarction

BACKGROUND

Several studies based on different populations worldwide have described an association between cardiovascular diseases and genetic variations in the apolipoprotein E (A:POE), angiotensinogen (A:GT), angiotensin receptor type 1 (A:T1R), and angiotensin-converting enzyme (A:CE) genes. In addition, there is growing evidence of an interaction between hypercholesterolemia and the renin-angiotensin system in the risk for hypertension and atherosclerosis.

METHODS

To determine whether the DNA polymorphisms in A:POE (epsilon2, epsilon3, and epsilon4 alleles), A:GT (M235T), A:T1R (1166 A:/C:), and ACE (I:/D:) are associated with early onset of myocardial infarction (MI), we genotyped 220 patients and 200 controls <55 years of age. Patients and controls were males from the same homogeneous Caucasian population. Data concerning hypertension, diabetes, and tobacco consumption were recorded. The lipid profiles of patients and controls were also determined.

RESULTS

APOE, ACE, AGT, and AT1R allele and genotype frequencies did not differ between patients and controls. None of these polymorphisms was related to the biochemical values in patients or controls. The frequency of individuals who were both APOE epsilon4 allele carriers and AGT-TT homozygotes was significantly higher in patients than in controls (11% vs 3.5%; P: = 0.0037). In patients, the frequency of epsilon4 carriers was significantly higher (P: <0.00001) in those who were AGT-TT (46%) than those who were AGT-MT/MM (14%). Mean cholesterol was significantly higher in AGT-TT + APOE epsilon34/44 patients than in the TM/MM + epsilon34/44 or TT + epsilon23/33 genotypes (P: = 0. 029).

CONCLUSIONS

Our data suggest a synergistic effect between the APOE and AGT polymorphisms and early MI. The increased risk could be mediated in part through higher cholesterol concentrations among individuals who are AGT-TT + APOE epsilon4 allele carriers.

Determination of hydrocarbon types in petroleum and coal-derived products by thin-layer chromatography/densitometry

Different methodologies based on thin-layer chromatography (TLC)/densitometry were used to separate and quantitate hydrocarbon types in middle distillates (gas oil), heavy distillates (lubricant) from petroleum, and coal-derived products. Thus, petroleum products were separated into saturates and aromatics by development, using n-hexane (9 min) followed by dichloromethane (4.5 min), of silica gel plates impregnated with berberine sulfate. Detection of saturates and aromatics was performed by fluorescence scanning using 365 nm as the excitation wavelength. Alternative detection of aromatics can be performed on either silica gel or berberine-impregnated plates by using ultraviolet (UV) densitometry at 250 nm. On the other hand, polar coal-derived products were separated into aromatics, polar compounds, and uneluted components by using silica gel plates and development with toluene (12 min), followed by dichloromethane-methanol (95 + 5, v/v), with detection by UV densitometry at 250 nm. In all cases, external standard calibration was used for quantitation. Results were validated by using standard methods or well-established techniques of the petrochemical industry. The potential usefulness of TLC/densitometry is discussed.