[Gamma-sarcoglycanopathy:two new cases in a gypsy family family in Spain]

INTRODUCTION

Included under the heading of limb girdle muscular dystrophy is a heterogeneous group of myopathies which share the same phenotype characteristics. The illness is of early onset, progressive and basically involves muscles of the shoulder and pelvic girdles. Recent identification of muscle proteins and the genes which codify them has led to new classification of these conditions according to their genetic characteristics. It is currently accepted that there are two major groups: the dominant and recessive forms. The latter includes type 2C limb girdle muscular dystrophy associated with chromosome 13, where the gene for gamma-sarcoglycan is found. This protein belongs to the glycoprotein complex associated with dystrophin. Recently a new mutation has been identified, the C283Y, exclusive to the Gypsy race, which affects this gene and therefore the alterations in gamma-sarcoglycan produced by it.

CLINICAL CASE

We describe two patients, Gypsy brothers, who complained of myopathy, which they had had for some years, compatible with this condition and in whom the C283Y mutation had recently been detected.

CONCLUSIONS

We describe another Spanish Gypsy family, all members of which have the characteristic mutation. We emphasize the importance of genetic studies in all cases of myopathy which have not been fully diagnosed.

Gonadotrophin-releasing hormone antagonists inhibit sperm binding to the human zona pellucida

Previous work from our laboratory indicated that gonadotrophin-releasing hormone (GnRH) increases human sperm-zona pellucida binding. Here we present evidence that GnRH antagonists inhibit sperm-zona pellucida binding in humans. Motile spermatozoa (10(7) cells/ml) were incubated in modified Tyrode's medium at 37 degrees C, in 5% CO(2) in air. After 4.5 h, aliquots of spermatozoa were treated with saline (control) or with different concentrations of GnRH antagonists (test). Each sperm aliquot was then tested in the hemizona binding assay. In this assay, the control aliquot was incubated with half a human zona pellucida (hemizona) and the test aliquot was incubated with the matching half. After 20 min, the hemizonae were withdrawn and the number of zona-bound spermatozoa counted using phase-contrast microscopy. In addition, the effect of GnRH antagonists upon the pattern of sperm movement, frequency of sperm-zona pellucida collisions, and percentage of living and acrosome-reacted spermatozoa was determined. The results indicated that treatment with GnRH antagonists decreased the number of zona-bound spermatozoa and did not change the pattern of sperm movement, frequency of sperm-zona collisions, and percentage of acrosome-reacted spermatozoa. We suggest that this action of GnRH antagonists may be due to an effect on zona receptors on the sperm plasma membrane.

Antimutagenic effect of fruit and vegetable ethanolic extracts against N-nitrosamines evaluated by the Ames test

The inhibitory effect of nine fruit and vegetable ethanolic extracts against the mutagenicity of N-nitrosodimethylamine (NDMA), N-nitrosopyrrolidine (NPYR), N-nitrosodibutylamine (NDBA), and N-nitrosopiperidine (NPIP) was evaluated by means of the Ames test. Licorice ethanolic extract was the only one that showed an inhibitory effect (ranging from moderate to strong) against mutagenicity of all N-nitrosamines tested. This ethanolic extract showed the greatest inhibition effect against NPIP (72%), NDMA (45%), and NPYR (39%). The greatest inhibition effect (51%) of the mutagenicity of NDBA was shown by kiwi ethanolic extract. Vegetable and fruit ethanolic extracts that exhibited an antimutagenic effect (at the range 50-2000 microg/plate), in decreasing order, against NDMA and NPYR were as follows: licorice > kiwi > carrot and licorice > broccoli > pineapple > kiwi, respectively. Decreasing orders against NDBA and NPIP were, respectively, kiwi > onion > licorice = garlic > green pepper > carrot and licorice > garlic > pineapple > carrot.

Influence of prolactin on the differentiation of mouse B-lymphoid precursors

Development and activation of immune cells are submitted to hormonal influences, as illustrated by the roles of corticosteroids in thymus, pregnancy-related estrogens in B-cell development, or prolactin (PRL) on T-cell generation and function. We have analyzed the putative role of PRL in B lymphopoiesis and differentiation. We chose as an experimental model the interleukin (IL)-3 dependent BaF-3 pro-B cell line, which was transfected with the rat long form of the PRL receptor (PRL-R) and transferred from IL-3- to PRL-enriched media. When stimulated with PRL, the PRL-R transfectants underwent some changes characteristic of B-cell differentiation: (a) IL-2R alpha chain became positively controlled by PRL; (b) antiapoptotic Bcl-2 protein was induced by PRL in a dose-dependent manner; and (c) transcription of the pre-B cell receptor encoding the lambda5 gene was strongly up-regulated. We attempted to evaluate the differentiation-promoting activity of PRL in more physiological conditions, and the presence of PRL-R in bone marrow B-cell precursors was revealed. Furthermore, PRL promoted significant expansions of defined B-lineage cell populations in short-term bone marrow cell cultures. These findings suggest that PRL, in collaboration with other cytokines and hormonal influences, modulates B-cell development.

[Chronic obstructive pulmonary disease and lung transplants: results in Spain]

OBJECTIVE

To determine the outcome of lung transplantation in patients with chronic obstructive pulmonary disease (COPD) in Spain.

METHODS

In all COPD patients transplanted at four Spanish hospitals over a period of seven years, we studied actuarial survival rates retrospectively using the Kaplan Meier test in relation to demographic characteristics, type of transplant, underlying disease, lung function evolution in terms of forced vital capacity (FVC), maximum expiratory flow in 1 second (FEV1) and gasometric evolution (PaO2 and PaCO2).

RESULTS

Seventy-four transplants were performed in COPD patients over a five-year period. Mean age was 47 +/- 7 years (26-61) and 77% of the patients were men. A diagnosis of emphysema was made in 58%, alpha-1 antitrypsin deficiency emphysema in 14% and chronic bronchitis in 28%. The likelihood of survival was 75% for the first year, 63% for two years and 41% for the third year. Lung function and blood gases improved significantly by the third month after transplantation: FVC was 1677 +/- 637 ml before transplantation and 2631 +/- 670 ml afterwards; FEV1 was 585 +/- 189 ml before transplantation and 2118 +/- 673 ml afterwards (p < 0.001). Double lung transplants achieved significantly greater improvement in function variables than did single-lung transplants (FVC 2843 +/- 681 ml and FEV1 2543 +/- 620 ml by the third month in DLT patients versus FVC 2402 +/- 587 ml and FEV1 1659 +/- 350 ml for SLT), with no significant differences in blood gases after the two types of transplant. Half the sing-lung transplant patients developed hyperinflation of the native lung and reached maximum lung function values, which tended to be lower than those for patients who did not experience this complication (FEV1 1638 +/- 349 ml versus 1930 +/- 307 ml, p = 0.051).

CONCLUSIONS

First-year mortality in patients with COPD undergoing lung transplantation in Spain is similar to that described in the International Transplant Registry. We found no differences between double- and single-lung transplant patients. Functional change is good for both types of transplantation, although this aspect of outcome is significantly better when two lungs are transplanted.

Evolution of MHC-G in primates: a different kind of molecule for each group of species

When MHC-G molecules in primates (New World and Old World monkeys, Anthropoids and humans) were compared phylogenetically, very different evolutionary patterns within each species were found; their molecules did not have a straight forward and linear development throughout the postulated evolutionary pathway of primates. The earlier New World monkeys (South America) had relatively more alleles and the polymorphism was placed in the T-cell receptor (TcR), NK receptors and antigen binding sites; MHC-G probably works as a classical class I presenting molecule in these monkeys. MHC-G intron 2 from New World monkeys does not show the typical 23 bp deletion found in all other more recent primate species. Thus, it is possible that MHC-G molecules in New World monkeys belong to a different lineage than the MHC from higher primates. Another early lineage, Eurasian Old World monkeys, shows stop codons at exon 3: MHC-G proteins lacking the alpha2 domain may functionally suffice or otherwise reading-through stop-codon translational mechanisms may exist, as shown for other genes. Orangutans show lower (but significant) polymorphism than New World monkeys at NK, TcR and antigen binding regions; gorilla and chimpanzee show very low polymorphism. Humans only show three different HLA-G proteins with changes not affecting NK, TcR or antigen binding sites. It is observed that the more exposed the mother to allogeneic fetuses (polygamy), the less polymorphic HLA-G is observed within a given species. The data are concordant with the postulated immune inhibitory function for MHC-G in Old World monkeys, anthropoids and humans both at placental and inflammatory level.

Static lung volumes: reference values from a Latin population of Spanish descent

BACKGROUND AND OBJECTIVES

The aim of this study was to develop a set of prediction equations and 90% confidence intervals for static lung volumes using the multibreath helium equilibration method from a sample of asymptomatic Caucasian subjects of Spanish descent. Moreover, these equations were compared with those of previous studies.

METHODS

Measurements of static lung volumes using techniques recommended by the American Thoracic Society and the European Community for Steel and Coal were carried out on a selected sample of 591 healthy nonsmoking volunteers (305 men and 286 women) aged 18-88 years, living in the metropolitan area of Valencia, on the east coast of Spain. Multiple regression analysis using height, age and weight as independent variables were used to provide predicted values for both sexes. These reference values were compared with other sets of prediction equations reported in the literature using an independent sample of 69 subjects (32 men and 37 women).

RESULTS

Simple linear regression equations using age, height and body weight predicted all the subdivisions of lung volumes (vital capacity, expiratory reserve volume (ERV), inspiratory capacity, functional residual capacity (FRC), residual volume (RV), total lung capacity (TLC), FRC/TLC and RV/TLC) as well as more complex equational models. The distribution of residuals fulfilled the assumptions of multiple regression analysis (independence, homoscedasticity and Gaussian distribution of residuals), except for ERV, using simple linear models. The derived equations did not differ significantly from most of the previously reported equations and were usually superior in their ability to predict the lung volumes.

CONCLUSIONS

The use of the present prediction equations is recommended in the Latin population of Spanish descent and in populations with similar Caucasian characteristics.

Sperm penetration through the human zona pellucida as a predictor of in vitro fertilization

The aim of this study was to determine the predictive value of sperm penetration into the perivitelline space of human cadaveric oocytes on in vitro fertilization outcome. Forty-two patients with tubal infertility undergoing ovarian stimulation with gonadotropin for in vitro fertilization and embryo transfer participated in the study. The number of spermatozoa bound to the human zona pellucida, the percentage of cadaveric oocytes with one or more spermatozoa in the perivitelline space, and the in vitro fertilization outcome were evaluated. Spermatozoa from 37 of 42 patients were able to penetrate the perivitelline space of cadaveric oocytes as well as to fertilize human oocytes in vitro. In three individuals, no penetration of the perivitelline space of cadaveric oocytes was observed and no in vitro fertilization was detected. Only two patients were able to fertilize the couple's oocytes without penetration of the cadaveric oocytes. Based on these results the specificity and the sensitivity of the assay to predict in vitro fertilization was 100% and 94.1%, respectively. Accordingly, these results suggest that sperm-zona penetration is a useful bioassay to predict male fertility potential in IVF outcome.

[Lung transplantation in cystic fibrosis. The results of the Clínica Puerta de Hierro (Madrid) and the Hospital La Fe (Valencia)]

Retrospective analysis of cystic fibrosis patients who underwent pulmonary transplantation at Clínica Puerta de Hierro, Madrid, and at Hospital La Fe, Valencia. Since the beginning of the programme and until March 1998, a total of 63 patients with cystic fibrosis were studied. Among transplanted patients, 18 were males and 16 females, with a mean age of 18.9 years. All patients underwent sequential bilateral pulmonary transplantation. After transplantation, the most common complication was bacterial pneumonia which affected all patients. Six patients had dehiscence or stenosis of the bronchial suture. Other specific complications of this condition by frequency were intestinal obstruction and diabetes mellitus. Six patients developed obliterans bronchiolitis and one of them underwent a repeat transplantation. Three out of the 34 patients died, and the likelihood of survival after one and three years was 94%. Respiratory function tests and PaO2 peaked at sixth post-transplantation month.

CONCLUSION

Pulmonary transplantation is a therapeutic option to be considered for the patient with cystic fibrosis and severe involvement of his/her pulmonary disease.

Antifungal prophylaxis during the early postoperative period of lung transplantation. Valencia Lung Transplant Group

INTRODUCTION

Fungal infections occur frequently in lung transplant patients, with the highest risk being in the early postoperative period (the initial hospitalization after lung transplantation). Aspergillus is responsible for more than half of all fungal infections, and Aspergillus has even been considered a contraindication for lung transplantation because of its difficult therapy and frequently fatal outcome. The aim of this article is to evaluate the success of an antifungal prophylaxis protocol to prevent fungal infection in the immediate postoperative period in lung transplant recipients.

MATERIAL AND METHODS

From March 1994 to March 1997, we performed 52 lung transplants in 31 men and 21 women who received antifungal prophylaxis with fluconazole, 400 mg/d, and aerosolized amphotericin B, 0.6 mg/kg/d, during the postoperative period.

RESULTS

The mean (+/- SD) postoperative period duration was 49 +/- 27.5 days. No fungal infections were observed during this period, and all patients provided negative cultures. We also found no toxicity related to antifungal drugs. The dose of cyclosporine was easily adjusted in every recipient according to blood levels so that effective immunosuppression was not compromised.

DISCUSSION

In our study, the removal of the lungs and antifungal prophylaxis with fluconazole and aerosolized amphotericin B prevented fungal infection in the postoperative period in all 52 lung transplant recipients.

Persistent neuronal density changes related to the establishment of a motor memory

Rats were trained in a lateralized reaching motor task during either an 'early' (22-31 days old) or a 'late' (62-71 days old) postnatal period. The 'late' group showed significant neuronal density reduction in cortical layers II-III of the contralateral motor forelimb representation. The 'early' group evidenced a similar localized contralateral effect that persisted after a subsequent period without training. Furthermore, in this group, a bilateral overall decrease in neuronal density was found throughout the motor cortex. This bilateral experience and age-dependent effect is conceivably related to a critical period of motor cortical development. The localized reduction of neuronal density strongly indicates a morphological expression of the motor engram. Our present study supports the concept that the acquisition and retention of motor learning involves the persistence of structural changes in the brain.

Suspected intestinal torsion in a blacktip reef shark (Carcharhinus melanopterus)

A blacktip reef shark (Carcharhinus melanopterus) with a history of recurrent eversion or prolapse of the valvular intestine, arrived at the Steinhart Aquarium in June 1996 and was placed in a mixed species shark display. The eversion soon reappeared, and the animal became thin and anorexic. The everted portion of the intestine was bitten by another shark and became infected. Treatment included force-feeding, manual reduction of the eversion, hydrocortisone suppositories held in place with purse-string sutures, and injections of enrofloxacin. All treatments ultimately failed, and the animal died in March 1997. Necropsy revealed that the intestine had separated into two segments at the distal portion of the pyloric stomach (duodenum); both ends were scarred and sealed off. It is suggested that a torsion (twisting along the long axis) of the intestine was responsible for the condition.

[The first simultaneous double unilateral lung transplantation in Spain: clinical course and results. Transplantation Group]

Unilateral lung transplantation of two organs allows two patients to benefit from a single donor. We report the first and only such transplants--carried out simultaneously in the same surgical unit--to be performed in Spain to date. The diagnosis was idiopathic pulmonary fibrosis in both cases and the donor came from the same hospital. No complications developed during the subsequent hospital stay. Two years later, both patients are asymptomatic and carrying out normal activities with no limitations.

Developmental hematopoiesis

Hematopoiesis is a developmental process that evolves throughout the lifespan of an individual. Most work in the field has focused on events occurring in the adult bone marrow (BM). In the embryo, blood and endothelial cell generation begins very early after gastrulation, in defined intraembryonic mesodermic sites. Recent multidisciplinary studies, taking advantage of classic embryological and gene targeting technology in various species, have provided a new image of embryofetal lymphohemopoiesis, which includes the suggestion of developmental compartmentalization or waves. The first hematopoietic stem cells (HSC) migrate further and home in an ordered sequence of supporting microenvironments depending on scarcely known molecular requirements. These early hematopoietic progenitors show important differences in their cell biology and differentiation potentialities with respect to those present in adult stages; this fact, together with specific microenvironmental influences, define a process that diverges significantly from that occurring in the BM. Here, we update the latest developments in the field, the new understanding of lymphohemopoiesis in prenatal life, and the novel questions that this emerging paradigm is producing.

Hygiene behaviour in rural Nicaragua in relation to diarrhoea

BACKGROUND

Childhood diarrhoea is a leading cause of morbidity and mortality in Nicaragua. Amongst the risk factors for its transmission are 'poor' hygiene practices. We investigated the effect of a large number of hygiene practices on diarrhoeal disease in children aged <2 years and validated the technique of direct observation of hygiene behaviour.

METHODS

A prospective follow-up study was carried out in a rural zone of Nicaragua. From the database of a previously conducted case-control study on water and sanitation 172 families were recruited, half of which had experienced a higher than expected rate of diarrhoea in their children and the other half a lower rate. Hygiene behaviour was observed over two mornings and diarrhoea incidence was recorded with a calendar, filled out by the mother, and collected every week for 5 months.

RESULTS

Of 46 'good' practices studied, 39 were associated with a lower risk of diarrhoea, five were unrelated and only for two a higher risk was observed. Washing of hands, domestic cleanliness (kitchen, living room, yard) and the use of a diaper/underclothes by the child had the strongest protective effect. Schooling (>3 years of primary school) and better economic position (possession of a radio) had a positive influence on general hygiene behaviour, education having a slightly stronger effect when a radio was present. Individual hygiene behaviour appeared to be highly variable in contrast with the consistent behaviour of the community as a whole. Feasible and appropriate indicators of hygiene behaviour were found to be domestic cleanliness and the use of a diaper or underclothes by the child.

CONCLUSION

A consistent relationship between almost all hygiene practices and diarrhoea was detected, more schooling producing better hygiene behaviour. The high variability of hygiene behaviour at the individual level requires repeated observations (at least two) before and after the hygiene education in the event one wants to measure the impact of the campaign on the individual.

Use of intrauterine contraceptive devices in nulliparous women: personal experience over a 12-year period

OBJECTIVE

To evaluate the use of intrauterine contraceptive devices (IUDs) in nulliparous women compared to their use in parous women.

METHODS

A comparative cross-sectional study was carried out to determine the reasons for removal of IUDs inserted between 1985 and 1996 in a sample of 227 nulliparous women and 2080 parous women. The statistical analysis was performed using the chi 2 test; the differences were considered to be significant when p < 0.05.

RESULTS

The reasons for removal of IUDs in the two groups were: expiry, 49.1% in the nulliparous group vs. 48.2% in the parous group; planned pregnancy, 21.7% vs. 15.4%; accidental pregnancy, 4.8% vs. 6.3%; expulsion, 1.6% vs. 5.1%; pelvic inflammatory disease, 1.6% vs. 1.1%; pain and/or bleeding, 14.5% vs. 10.2%; other, 6.4% vs. 6.3%; vasectomy or tubal sterilization, 0% vs. 7%.

CONCLUSION

Our data suggest that nulliparity is not a contraindication for the use of an IUD, and that the use of an IUD in nulliparous women is as safe and effective as in parous women.

Lack of HLA-G soluble isoforms in Graves-Basedow thyrocytes and complete cDNA sequence of the HLA-G*01012 allele

The presence of HLA-G mRNA has been studied in thyroid follicular cells from autoimmune patients with Graves' disease. Investigating the possible role of the expression of the HLA-G gene in tissue inflammation, we have found four of the six HLA-G mRNA isoforms described: G1, G2, G3 and G4, but not the soluble ones G5 and G6. Soluble G isoforms may be responsible for inducing tolerance and inflammation control and their absence in autoimmune thyroid follicular cells may induce failure of such control. In addition, the complete coding sequence of HLA-G*01012 has been obtained from thyrocytes and it shows only four synonymous changes with respect to the HLA-G*01011 allele; this further supports the existence of an evolutionary pressure for invariance on HLA-G genes.

Gonadotropin-releasing hormone increases ability of the spermatozoa to bind to the human zona pellucida

Sperm-zona pellucida binding, a crucial step in the process of fertilization, takes place in vivo in the upper portion of the fallopian tube. The presence of GnRH-like peptides in the female and the male genital tract has been described. In this work, the effect of GnRH and related peptides upon sperm-zona pellucida binding ability was studied. Sperm aliquots, capacitated for 4.5 h, were incubated for 5 min with saline (control) or 20 nM of GnRH, C-terminal (1-5) or N-terminal (5-10) fragments of GnRH, Substance P, dynorphin, bombesin, or mixed GnRH (a synthetic peptide with the same amino acids as GnRH but in different order). Sperm were also incubated with the GnRH antagonist Ac-3,4-dehydro-Pro1, -p-fluoro-<FONT SIZE=-1>D-Phe2, <FONT SIZE=-1>D-Trp3,6-LHRH, alone or before adding GnRH. The sperm were then tested using the hemizona assay. After 10 min, the number of zona-bound sperm was determined. In addition, the effect of GnRH upon the acrosome reactions, sperm movement characteristics, and sperm-zona collisions was evaluated. Sperm treated with GnRH bound in higher numbers to the zona than did control sperm (p < 0.005). The GnRH fragments, the GnRH antagonist, and related peptides did not have any effect on sperm-zona interaction; however, the GnRH antagonist totally blocked the stimulatory effect of GnRH. GnRH did not affect the percentage of acrosome-reacted sperm, pattern of sperm movement, or frequency of sperm-zona collisions. I suggest that the increased ability of the sperm to bind to the zona may be due to exposure and/or change of affinity of zona receptors on the sperm plasma membrane.

[Sudden death due to recuperated ventricular fibrillation: Brugada syndrome?]

We report a 47 years old male who was recuperated from a sudden death, and in whom the cardiological assessment showed a right bundle branch block and a fluctuating ST segment elevation V1 to V3. During the electrophysiological study, a polymorphic tachycardia and a ventricular fibrillation were induced. Procainamide administration enhanced ST segment alterations in right precordial leads, and isoproterenol normalized the EKG. All these disturbances are similar to the condition described by Brugada brothers. The patient was treated with an internal implantable defibrillator, without the use of antiarrhythmic drugs and is well after four months of follow up.