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Rivera Nales CJ, Triplett NS, Woodard GS, Meza R, Valdivieso A, Goel V, Dorsey S, Berliner L, Martin P. CBT+ Training Initiative in Washington State Community Mental Health: An Evaluation of Child Clinical Outcomes. Community Ment Health J 2024; 60:649-661. [PMID: 37880492 DOI: 10.1007/s10597-023-01194-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 09/23/2023] [Indexed: 10/27/2023]
Abstract
The Washington State CBT+ Initiative offers a flexible training and consultation approach for community mental health providers in evidence-based practices for four child mental health targets: cognitive behavioral therapy for depression, anxiety, trauma, and behavioral difficulties. As part of consultation, clinicians used an online system to track delivery of treatment components and clinical outcomes using standardized symptom measures. The current study used these clinician-input data to examine symptom change for children using paired sample t-tests. Additionally, we explored if time elapsed or number of sessions between measurements related to symptom change using simple linear regression. Children had significant symptom reduction across all four targets. For most measures, children did not show greater improvements with increased length of time or increased number of sessions between assessment measures. Findings suggest that children treated by a CBT+ trained clinician may demonstrate symptom reduction for their primary clinical problem. Findings add to support for flexible training approaches for community mental health clinicians.
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Affiliation(s)
- Cristian J Rivera Nales
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.
| | - Noah S Triplett
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Grace S Woodard
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Rosemary Meza
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Alejandro Valdivieso
- Department of Clinical and Counseling Psychology, Columbia University, New York, NY, USA
| | - Vanshika Goel
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Shannon Dorsey
- Department of Psychology, University of Washington, Seattle, WA, USA
| | | | - Prerna Martin
- Department of Psychiatry, University of California Los Angeles, Los Angeles, CA, USA
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Valdivieso A, Caballero-Huertas M, Moraleda-Prados J, Piferrer F, Ribas L. Exploring the Effects of Rearing Densities on Epigenetic Modifications in the Zebrafish Gonads. Int J Mol Sci 2023; 24:16002. [PMID: 37958987 PMCID: PMC10647740 DOI: 10.3390/ijms242116002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/25/2023] [Accepted: 10/27/2023] [Indexed: 11/15/2023] Open
Abstract
Rearing density directly impacts fish welfare, which, in turn, affects productivity in aquaculture. Previous studies have indicated that high-density rearing during sexual development in fish can induce stress, resulting in a tendency towards male-biased sex ratios in the populations. In recent years, research has defined the relevance of the interactions between the environment and epigenetics playing a key role in the final phenotype. However, the underlying epigenetic mechanisms of individuals exposed to confinement remain elucidated. By using zebrafish (Danio rerio), the DNA methylation promotor region and the gene expression patterns of six genes, namely dnmt1, cyp19a1a, dmrt1, cyp11c1, hsd17b1, and hsd11b2, involved in the DNA maintenance methylation, reproduction, and stress were assessed. Zebrafish larvae were subjected to two high-density conditions (9 and 66 fish/L) during two periods of overlapping sex differentiation of this species (7 to 18 and 18 to 45 days post-fertilization, dpf). Results showed a significant masculinization in the populations of fish subjected to high densities from 18 to 45 dpf. In adulthood, the dnmt1 gene was differentially hypomethylated in ovaries and its expression was significantly downregulated in the testes of fish exposed to high-density. Further, the cyp19a1a gene showed downregulation of gene expression in the ovaries of fish subjected to elevated density, as previously observed in other studies. We proposed dnmt1 as a potential testicular epimarker and the expression of ovarian cyp19a1a as a potential biomarker for predicting stress originated from high densities during the early stages of development. These findings highlight the importance of rearing densities by long-lasting effects in adulthood conveying cautions for stocking protocols in fish hatcheries.
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Affiliation(s)
- Alejandro Valdivieso
- IHPE, Université de Montpellier, CNRS, IFREMER, Université de Perpignan Via Domitia, 34090 Montpellier, France
| | - Marta Caballero-Huertas
- CIRAD, UMR ISEM, 34398 Montpellier, France;
- ISEM, Université de Montpellier, CIRAD, CNRS, IRD, EPHE, 34090 Montpellier, France
| | - Javier Moraleda-Prados
- Institut de Ciències del Mar, Consejo Superior de Investigaciones Científicas (ICM-CSIC), 08003 Barcelona, Spain; (J.M.-P.); (F.P.)
| | - Francesc Piferrer
- Institut de Ciències del Mar, Consejo Superior de Investigaciones Científicas (ICM-CSIC), 08003 Barcelona, Spain; (J.M.-P.); (F.P.)
| | - Laia Ribas
- Institut de Ciències del Mar, Consejo Superior de Investigaciones Científicas (ICM-CSIC), 08003 Barcelona, Spain; (J.M.-P.); (F.P.)
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3
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Gawra J, Valdivieso A, Roux F, Laporte M, de Lorgeril J, Gueguen Y, Saccas M, Escoubas JM, Montagnani C, Destoumieux-Garzόn D, Lagarde F, Leroy MA, Haffner P, Petton B, Cosseau C, Morga B, Dégremont L, Mitta G, Grunau C, Vidal-Dupiol J. Epigenetic variations are more substantial than genetic variations in rapid adaptation of oyster to Pacific oyster mortality syndrome. Sci Adv 2023; 9:eadh8990. [PMID: 37683000 PMCID: PMC10491289 DOI: 10.1126/sciadv.adh8990] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 08/09/2023] [Indexed: 09/10/2023]
Abstract
Disease emergence is accelerating with global changes. Understanding by which mechanisms host populations can rapidly adapt will be crucial for management practices. Pacific oyster mortality syndrome (POMS) imposes a substantial and recurrent selective pressure on oyster populations, and rapid adaptation may arise through genetics and epigenetics. In this study, we used (epi)genome-wide association mapping to show that oysters differentially exposed to POMS displayed genetic and epigenetic signatures of selection. Consistent with higher resistance to POMS, the genes targeted included many genes in several pathways related to immunity. By combining correlation, DNA methylation quantitative trait loci, and variance partitioning, we revealed that a third of phenotypic variation was explained by interactions between the genetic and epigenetic information, ~14% by the genome, and up to 25% by the epigenome alone. Similar to genetically based adaptation, epigenetic mechanisms notably governing immune responses can contribute substantially to the rapid adaptation of hosts to emerging infectious diseases.
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Affiliation(s)
- Janan Gawra
- IHPE, Université de Perpignan Via Domitia, CNRS, Ifremer, Université de Montpellier, Perpignan, France
| | - Alejandro Valdivieso
- IHPE, Université de Montpellier, CNRS, Ifremer, Université de Perpignan Via Domitia, Montpellier, France
| | - Fabrice Roux
- LIPME, INRAE, CNRS, Université de Toulouse, Castanet-Tolosan, France
| | - Martin Laporte
- Division de l'expertise sur la faune Aquatique, Ministère des Forêts, de la Faune et des Parcs (MFFP), 880 chemin Sainte-Foy, G1S 4X4 Québec, Québec, Canada
| | - Julien de Lorgeril
- IHPE, Université de Montpellier, CNRS, Ifremer, Université de Perpignan Via Domitia, Montpellier, France
- Ifremer, IRD, Université de la Nouvelle-Calédonie, Université de La Réunion, ENTROPIE, Nouméa, Nouvelle-Calédonie, France
| | - Yannick Gueguen
- IHPE, Université de Montpellier, CNRS, Ifremer, Université de Perpignan Via Domitia, Montpellier, France
- MARBEC, Université de Montpellier, CNRS, Ifremer, IRD, Sète, France
| | - Mathilde Saccas
- IHPE, Université de Montpellier, CNRS, Ifremer, Université de Perpignan Via Domitia, Montpellier, France
| | - Jean-Michel Escoubas
- IHPE, Université de Montpellier, CNRS, Ifremer, Université de Perpignan Via Domitia, Montpellier, France
| | - Caroline Montagnani
- IHPE, Université de Montpellier, CNRS, Ifremer, Université de Perpignan Via Domitia, Montpellier, France
| | | | - Franck Lagarde
- MARBEC, Université de Montpellier, CNRS, Ifremer, IRD, Sète, France
| | - Marc A. Leroy
- IHPE, Université de Montpellier, CNRS, Ifremer, Université de Perpignan Via Domitia, Montpellier, France
| | - Philippe Haffner
- IHPE, Université de Montpellier, CNRS, Ifremer, Université de Perpignan Via Domitia, Montpellier, France
| | - Bruno Petton
- Université de Brest, Ifremer, CNRS, IRD, LEMAR, F-29280 Plouzané, France
| | - Céline Cosseau
- IHPE, Université de Perpignan Via Domitia, CNRS, Ifremer, Université de Montpellier, Perpignan, France
| | - Benjamin Morga
- Ifremer, ASIM, Adaptation Santé des Invertébrés Marins, La Tremblade, France
| | - Lionel Dégremont
- Ifremer, ASIM, Adaptation Santé des Invertébrés Marins, La Tremblade, France
| | - Guillaume Mitta
- IHPE, Université de Perpignan Via Domitia, CNRS, Ifremer, Université de Montpellier, Perpignan, France
- Université de la Polynésie Française, ILM, IRD, Ifremer, F-98719 Tahiti, French Polynesia, France
| | - Christoph Grunau
- IHPE, Université de Perpignan Via Domitia, CNRS, Ifremer, Université de Montpellier, Perpignan, France
| | - Jeremie Vidal-Dupiol
- IHPE, Université de Montpellier, CNRS, Ifremer, Université de Perpignan Via Domitia, Montpellier, France
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Valdivieso A, Anastasiadi D, Ribas L, Piferrer F. Development of epigenetic biomarkers for the identification of sex and thermal stress in fish using DNA methylation analysis and machine learning procedures. Mol Ecol Resour 2023; 23:453-470. [PMID: 36305237 PMCID: PMC10098837 DOI: 10.1111/1755-0998.13725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/28/2022] [Accepted: 10/14/2022] [Indexed: 01/04/2023]
Abstract
The sex ratio is a key ecological demographic parameter crucial for population viability. However, the epigenetic mechanisms operating during gonadal development regulating gene expression and the sex ratio remain poorly understood. Moreover, there is interest in the development of epigenetic markers associated with a particular phenotype or as sentinels of environmental effects. Here, we profiled DNA methylation and gene expression of 10 key genes related to sex development and stress, including steroidogenic enzymes, and growth and transcription factors. We provide novel information on the sex-related differences and on the influence of elevated temperature on these genes in zebrafish, a species with mixed genetic and environmental influences on sex ratios. We identified both positive (e.g., amh, cyp11c and hsd11b2) and negative (e.g., cyp11a1 and dmrt1) correlations in unexposed males, and negative correlation (amh) in exposed females between DNA methylation and gene expression levels. Further, we combined DNA methylation analysis with machine learning procedures and found a series of informative CpGs capable not only of correctly identifying sex (based on cyp19a1a DNA methylation levels) but also of identifying whether males and females had been exposed to abnormally elevated temperature when young (based on amh and foxl2a DNA methylation levels, respectively). This was achieved in the absence of conspicuous morphological alterations of the gonads. These DNA methylation-based epigenetic biomarkers represent molecular resources that can correctly recapitulate past thermal history and pave the way for similar findings in other species to assess potential ecological effects of environmental disturbances in the context of climate change.
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Affiliation(s)
- Alejandro Valdivieso
- Institut de Ciències del Mar, Consejo Superior de Investigaciones Científicas (CSIC), Barcelona, Spain.,IHPE, Univ Montpellier, CNRS, IFREMER, Univ Perpignan Via Domitia, Montpellier, France
| | - Dafni Anastasiadi
- Institut de Ciències del Mar, Consejo Superior de Investigaciones Científicas (CSIC), Barcelona, Spain.,The New Zealand Institute for Plant and Food Research Limited, Nelson, New Zealand
| | - Laia Ribas
- Institut de Ciències del Mar, Consejo Superior de Investigaciones Científicas (CSIC), Barcelona, Spain
| | - Francesc Piferrer
- Institut de Ciències del Mar, Consejo Superior de Investigaciones Científicas (CSIC), Barcelona, Spain
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5
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Pina AA, Stoll RD, Holly LE, Wynne H, Chiapa A, Parker J, Caterino L, Tracy SJ, Gonzales NA, Valdivieso A. Streamlined pediatric anxiety program for school mental health services. J Anxiety Disord 2023; 93:102655. [PMID: 36517320 PMCID: PMC9844125 DOI: 10.1016/j.janxdis.2022.102655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 11/08/2022] [Accepted: 11/22/2022] [Indexed: 12/10/2022]
Abstract
There needs to be serious transformation of evidence-based interventions (EBIs) into real-world solutions; otherwise, EBIs will never achieve the intended public health impact. In a randomized trial, we reported effects of a redesigned anxiety program. Herein, we described the redesign process that led to the program. Survey data revealed provider preferences for school mental health anxiety services. Focus groups and prototype feedback sessions revealed service barriers to uptake, implementation, and sustainability along with corresponding enabling strategies. Prototype feedback sessions also focused on refinement and fine-tuning of the redesign. In the end, traditional EBI strategies were transformed and packaged into six lessons, lasting 20-30 minutes each, and amenable to delivery in small-group format. The redesign achieved the intended purpose of retaining elements from cognitive and behavior therapy and social skills training for the target population of the intervention (e.g., 3rd to 5th graders with heterogeneous anxiety problems - identified and referred). The streamlined EBI is accessible from PBS LearningMedia™ - a service that hosts public, research-based, and school-ready materials.
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Affiliation(s)
- Armando A Pina
- Department of Psychology, Arizona State University, Tempe, AZ, USA.
| | - Ryan D Stoll
- Department of Psychology, Arizona State University, Tempe, AZ, USA
| | - Lindsay E Holly
- Department of Psychology, Marquette University, Milwaukee, WI, USA
| | - Henry Wynne
- Department of Psychology, Arizona State University, Tempe, AZ, USA
| | - Amanda Chiapa
- Department of Psychology, Arizona State University, Tempe, AZ, USA
| | - Julia Parker
- Department of Psychology, Arizona State University, Tempe, AZ, USA
| | - Linda Caterino
- Department of Psychology, Arizona State University, Tempe, AZ, USA
| | - Sarah J Tracy
- Department of Psychology, Arizona State University, Tempe, AZ, USA
| | - Nancy A Gonzales
- Department of Psychology, Arizona State University, Tempe, AZ, USA
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Valdivieso A, Wilson CA, Amores A, da Silva Rodrigues M, Nóbrega RH, Ribas L, Postlethwait JH, Piferrer F. Environmentally-induced sex reversal in fish with chromosomal vs. polygenic sex determination. Environ Res 2022; 213:113549. [PMID: 35618011 PMCID: PMC9620983 DOI: 10.1016/j.envres.2022.113549] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/18/2022] [Accepted: 05/19/2022] [Indexed: 06/15/2023]
Abstract
Sex ratio depends on sex determination mechanisms and is a key demographic parameter determining population viability and resilience to natural and anthropogenic stressors. There is increasing evidence that the environment can alter sex ratio even in genetically sex-determined species (GSD), as elevated temperature can cause female-to-male sex reversal (neomales). Alarmingly, neomales are being discovered in natural populations of several fish, amphibian and reptile species worldwide. Understanding the basis of neomale development is important for conservation biology. Among GSD species, it is unknown whether those with chromosomal sex determination (CSD), the most common system, will better resist the influence of high temperature than those with polygenic sex determination (PSD). Here, we compared the effects of elevated temperature in two wild zebrafish strains, Nadia (NA) and Ekkwill (EKW), which have CSD with a ZZ/ZW system, against the AB laboratory strain, which has PSD. First, we uncovered novel sex genotypes and the results showed that, at control temperature, the masculinization rate roughly doubled with the addition of each Z chromosome, while some ZW and WW fish of the wild strains became neomales. Surprisingly, we found that at elevated temperatures WW fish were just as likely as ZW fish to become neomales and that all strains were equally susceptible to masculinization. These results demonstrate that the Z chromosome is not essential for male development and that the dose of W buffers masculinization at the control temperature but not at elevated temperature. Furthermore, at the elevated temperature the testes of neomales, but not of normal males, contained more spermatozoa than at the control temperature. Our results show in an unprecedented way that, in a global warming scenario, CSD species may not necessarily be better protected against the masculinizing effect of elevated temperature than PSD species, and reveal genotype-by-temperature interactions in male sex determination and spermatogenesis.
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Affiliation(s)
- Alejandro Valdivieso
- Institut de Ciències del Mar, Consejo Superior de Investigaciones Científicas, Barcelona, Spain
| | | | - Angel Amores
- Institute of Neuroscience, University of Oregon, Eugene, OR, USA
| | - Maira da Silva Rodrigues
- Reproductive and Molecular Biology Group, Department of Structural and Functional Biology, Institute of Biosciences, São Paulo State University, São Paulo, Brazil
| | - Rafael Henrique Nóbrega
- Reproductive and Molecular Biology Group, Department of Structural and Functional Biology, Institute of Biosciences, São Paulo State University, São Paulo, Brazil
| | - Laia Ribas
- Institut de Ciències del Mar, Consejo Superior de Investigaciones Científicas, Barcelona, Spain
| | | | - Francesc Piferrer
- Institut de Ciències del Mar, Consejo Superior de Investigaciones Científicas, Barcelona, Spain.
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Desvignes T, Lauridsen H, Valdivieso A, Fontenele RS, Kraberger S, Murray KN, Le François NR, Detrich HW, Kent ML, Varsani A, Postlethwait JH. A parasite outbreak in notothenioid fish in an Antarctic fjord. iScience 2022; 25:104588. [PMID: 35800770 PMCID: PMC9253362 DOI: 10.1016/j.isci.2022.104588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 05/25/2022] [Accepted: 06/07/2022] [Indexed: 11/18/2022] Open
Abstract
Climate changes can promote disease outbreaks, but their nature and potential impacts in remote areas have received little attention. In a hot spot of biodiversity on the West Antarctic Peninsula, which faces among the fastest changing climates on Earth, we captured specimens of two notothenioid fish species affected by large skin tumors at an incidence never before observed in the Southern Ocean. Molecular and histopathological analyses revealed that X-cell parasitic alveolates, members of a genus we call Notoxcellia, are the etiological agent of these tumors. Parasite-specific molecular probes showed that xenomas remained within the skin but largely outgrew host cells in the dermis. We further observed that tumors induced neovascularization in underlying tissue and detrimentally affected host growth and condition. Although many knowledge gaps persist about X-cell disease, including its mode of transmission and life cycle, these findings reveal potentially active biotic threats to vulnerable Antarctic ecosystems.
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Affiliation(s)
- Thomas Desvignes
- Institute of Neuroscience, University of Oregon, Eugene, OR 97403, USA
| | - Henrik Lauridsen
- Department of Clinical Medicine, Aarhus University; Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Alejandro Valdivieso
- Institut de Ciències del Mar, Consejo Superior de Investigaciones Científicas (CSIC), Barcelona Spain
| | - Rafaela S Fontenele
- The Biodesign Center for Fundamental and Applied Microbiomics, Center for Evolution and Medicine and School of Life Sciences, Arizona State University, Tempe, AZ 85287, USA
| | - Simona Kraberger
- The Biodesign Center for Fundamental and Applied Microbiomics, Center for Evolution and Medicine and School of Life Sciences, Arizona State University, Tempe, AZ 85287, USA
| | - Katrina N Murray
- Institute of Neuroscience, University of Oregon, Eugene, OR 97403, USA
| | - Nathalie R Le François
- Laboratoire Physiologie, Aquaculture et Conservation, Biodôme de Montréal/Espace pour la vie, 4777 Avenue Pierre-De Coubertin, Montreal, QC H1V 1B3, Canada
| | - H William Detrich
- Department of Marine and Environmental Sciences, Northeastern University Marine Science Center, 430 Nahant Rd, Nahant, MA 01908, USA
| | - Michael L Kent
- Department of Microbiology, Oregon State University, Corvallis, OR 97331, USA
| | - Arvind Varsani
- The Biodesign Center for Fundamental and Applied Microbiomics, Center for Evolution and Medicine and School of Life Sciences, Arizona State University, Tempe, AZ 85287, USA
- Structural Biology Research Unit, Department of Integrative Biomedical Sciences, University of Cape Town, 7925 Cape Town, South Africa
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Moraleda-Prados J, Caballero-Huertas M, Valdivieso A, Joly S, Ji J, Roher N, Ribas L. Epigenetic differences in the innate response after immune stimulation during zebrafish sex differentiation. Dev Comp Immunol 2021; 114:103848. [PMID: 32888969 DOI: 10.1016/j.dci.2020.103848] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 08/27/2020] [Accepted: 08/27/2020] [Indexed: 06/11/2023]
Abstract
Infections are able to trigger epigenetic modifications; however, epigenetic-mediating infections in the immune system in fish is currently unavailable. Within this purpose, zebrafish were immune-stimulated with three lipopolysaccharides (LPS) during sex differentiation. Methylation patterns of three immune genes were studied by a candidate gene approach together with gene expression analysis, and in adulthood, sex ratios were determined. It was shown that the entrance of LPS was through the gills and accumulated in the pronephros. Significant hypomethylation levels of CASP9 and a significant CpG site for IL1β after Pseudomonas aeruginosa LPS exposure were found. No methylation difference was observed for TNFα. Gene expression and correlation data differed among studied genes. Sex ratios showed a feminization in dose and LPS strain-dependent manner. Here, it is provided epigenetic regulatory mechanisms derived by innate response and the first evidence of possible epigenetic interactions between the immune and reproductive systems.
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Affiliation(s)
- J Moraleda-Prados
- Institut de Ciències del Mar, Spanish National Research Council (CSIC), Passeig Marítim de la Barceloneta, 37-49, 08003, Barcelona, Spain
| | - M Caballero-Huertas
- Institut de Ciències del Mar, Spanish National Research Council (CSIC), Passeig Marítim de la Barceloneta, 37-49, 08003, Barcelona, Spain; Institute of Aquatic Ecology (IEA), Department of Environmental Sciences. Faculty of Sciences, University of Girona (UdG), Campus Montilivi, 17003 Girona, Spain
| | - A Valdivieso
- Institut de Ciències del Mar, Spanish National Research Council (CSIC), Passeig Marítim de la Barceloneta, 37-49, 08003, Barcelona, Spain
| | - S Joly
- Institut de Ciències del Mar, Spanish National Research Council (CSIC), Passeig Marítim de la Barceloneta, 37-49, 08003, Barcelona, Spain
| | - J Ji
- Institut de Biotecnologia i Biomedicina (IBB) and Dep. de Biologia Cel·lular, Fisiologia Animal i Immunologia, Universitat Autònoma de Barcelona, 08193, Barcelona, Spain; Department of Marine Science and Engineering, Nanjing Normal University, Nanjing, China
| | - N Roher
- Institut de Biotecnologia i Biomedicina (IBB) and Dep. de Biologia Cel·lular, Fisiologia Animal i Immunologia, Universitat Autònoma de Barcelona, 08193, Barcelona, Spain
| | - L Ribas
- Institut de Ciències del Mar, Spanish National Research Council (CSIC), Passeig Marítim de la Barceloneta, 37-49, 08003, Barcelona, Spain.
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9
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Valdivieso A, Ribas L, Monleón-Getino A, Orbán L, Piferrer F. Exposure of zebrafish to elevated temperature induces sex ratio shifts and alterations in the testicular epigenome of unexposed offspring. Environ Res 2020; 186:109601. [PMID: 32371278 DOI: 10.1016/j.envres.2020.109601] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 06/11/2023]
Abstract
Accumulating evidence shows that environmental changes can affect population sex ratios through epigenetic regulation of gene expression in species where sex depends on both genetic and environmental cues. Sometimes, altered sex ratios persist in the next generation even when the environmental cue is no longer present (a multigenerational effect). However, evidence of transgenerational effects (i.e., beyond the first non-exposed generation), which tend to be paternally transmitted, is scarce and a matter of debate. Here, we used the AB strain of zebrafish, where sex depends on both genetic and environmental influences, to study possible multi- (to the F1) and transgenerational (to the F2) effects of elevated temperature during the critical period of sex differentiation. From eight initial different families, five were selected in order to capture sufficient variation between the sex ratio of the control group (28 °C) and the group exposed to elevated (35 °C) temperature only at the parental (P) generation. Results showed a consistent increase in the proportion of males in the P generation in all five families as a result of heat treatment. Sex ratios were then determined in the F1 and F2 offspring derived from both above groups, which were all raised at 28 °C. A persisting male-skewed sex ratio in the 35°C-derived, unexposed offspring of the F1 generation was observed in three families, denoting family-dependent multigenerational effects. However, no transgenerational effects were observed in the F2 generation of any family. DNA methylation was also assessed in the testis of P, F1 and F2 males derived from exposed and non-exposed fathers and grandfathers. DNA methylation was significantly decreased only in the testis of the 35°C-derived males in the F1 generation but not of the F2 generation and, surprisingly, neither in the 35°C-exposed males of the P generation. Taken together, our results show great interfamily variation, not only in sex ratio response to elevated temperature, but also on its multigenerational effects, denoting a strong influence of genetics. Alterations in the testicular epigenome in F1 males calls for attention to possible, previously unnoticed, effects of temperature in the unexposed offspring of heat-exposed parents in a global warming scenario.
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Affiliation(s)
- Alejandro Valdivieso
- Institut de Ciències del Mar, Consejo Superior de Investigaciones Científicas (CSIC), Barcelona, Spain
| | - Laia Ribas
- Institut de Ciències del Mar, Consejo Superior de Investigaciones Científicas (CSIC), Barcelona, Spain
| | - Antonio Monleón-Getino
- Group of Research in Biostatistics and Bioinformatics (GRBIO), BIOST(3), Department of Genetics, Microbiology and Statistics: Section of Statistics. University of Barcelona (UB), Barcelona, Spain
| | - László Orbán
- Frontline Fish Genomics Research Group, Department of Animal Sciences, Georgikon Faculty, University of Pannonia, Keszthely, Hungary
| | - Francesc Piferrer
- Institut de Ciències del Mar, Consejo Superior de Investigaciones Científicas (CSIC), Barcelona, Spain.
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Piferrer F, Anastasiadi D, Valdivieso A, Sánchez-Baizán N, Moraleda-Prados J, Ribas L. The Model of the Conserved Epigenetic Regulation of Sex. Front Genet 2019; 10:857. [PMID: 31616469 PMCID: PMC6775248 DOI: 10.3389/fgene.2019.00857] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 08/16/2019] [Indexed: 12/18/2022] Open
Abstract
Epigenetics integrates genomic and environmental information to produce a given phenotype. Here, the model of Conserved Epigenetic Regulation of Sex (CERS) is discussed. This model is based on our knowledge on genes involved in sexual development and on epigenetic regulation of gene expression activation and silencing. This model was recently postulated to be applied to the sexual development of fish, and it states that epigenetic and gene expression patterns are more associated with the development of a particular gonadal phenotype, e.g., testis differentiation, rather than with the intrinsic or extrinsic causes that lead to the development of this phenotype. This requires the existence of genes with different epigenetic modifications, for example, changes in DNA methylation levels associated with the development of a particular sex. Focusing on DNA methylation, the identification of CpGs, the methylation of which is linked to sex, constitutes the basis for the identification of Essential Epigenetic Marks (EEM). EEMs are defined as the number and identity of informative epigenetic marks that are strictly necessary, albeit perhaps not sufficient, to bring about a specific, measurable, phenotype of interest. Here, we provide a summary of the genes where DNA methylation has been investigated so far, focusing on fish. We found that cyp19a1a and dmrt1, two key genes for ovary and testis development, respectively, consistently show an inverse relationship between their DNA methylation and expression levels, thus following CERS predictions. However, in foxl2a, a pro-female gene, and amh, a pro-male gene, such relationship is not clear. The available data of other genes related to sexual development such as sox9, gsdf, and amhr2 are also discussed. Next, we discuss the use of CERS to make testable predictions of how sex is epigenetically regulated and to better understand sexual development, as well as the use of EEMs as tools for the diagnosis and prognosis of sex. We argue that CERS can aid in focusing research on the epigenetic regulation of sexual development not only in fish but also in vertebrates in general, particularly in reptiles with temperature sex-determination, and can be the basis for possible practical applications including sex control in aquaculture and also in conservation biology.
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Affiliation(s)
- Francesc Piferrer
- Institut de Ciències del Mar (ICM), Spanish National Research Council (CSIC), Barcelona, Spain
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Valdivieso A, Ribas L, Piferrer F. Ovarian transcriptomic signatures of zebrafish females resistant to different environmental perturbations. J Exp Zool (Mol Dev Evol) 2019; 332:55-68. [DOI: 10.1002/jez.b.22848] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 03/06/2019] [Indexed: 11/10/2022]
Affiliation(s)
- Alejandro Valdivieso
- Institut de Ciències del Mar (ICM)Consejo Superior de Investigaciones Científicas (CSIC)Barcelona Spain
| | - Laia Ribas
- Institut de Ciències del Mar (ICM)Consejo Superior de Investigaciones Científicas (CSIC)Barcelona Spain
| | - Francesc Piferrer
- Institut de Ciències del Mar (ICM)Consejo Superior de Investigaciones Científicas (CSIC)Barcelona Spain
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Garcia-Tejedor A, Guma A, Soler T, Valdivieso A, Petit A, Contreras N, Chappuis CG, Falo C, Pernas S, Anselem A, Fernandez-Montoli E, Pla MJ, Burdio F, Ponce J. Abstract P3-13-07: Is radiofrequency ablation better than lumpectomy for margin status in breast cancer? Results of a randomized clinical trial. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p3-13-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
PURPOSE: To study the safety and efficacy of ultrasound-guided percutaneous radiofrequency ablation (RFA) as local treatment for breast cancer and to intraoperatively evaluate the margin status after RFA in comparison with lumpectomy.
MATERIAL and METHODS: Preliminary in vitro RF ablation experimentation with two mastectomy specimens was performed to test the electrode, practice the ultrasound technique and evaluate the macroscopic and microscopic effects of RF. Then, aprospective, randomized open-label phase II clinical trial (NCT02281812) was conducted in a single institution from 2013-2017. Forty subjects, mean age 64 (range 46-86), with ductal infiltrating carcinoma of the breast ≤2 cm were randomly assigned to RFA plus lumpectomy or lumpectomy alone. Margin status, tumor cell viability (TCV) after RFA (by nicotinamide adenine dinucleotide (NADH) and Cytokeratin 18 (CK18) staining), adverse events and local recurrences were evaluated by univariable and multivariable analyses (SPSS statistical software).
RESULTS: In the experimental design with mastectomies, the only procedural complication was a skin burn at the entrance site of the electrodes. We learned that the tip of the electrodes should cut cross the tumor by at least 10mm.
The clinical trial includes two groups: study group (n=20) and control group (n=20). NADH and CK18 staining demonstrated absence of TCV after RFA with at least one of the two techniques. The percentage of intraoperatively affected surgical margins was higher in the control group although local adverse effects after surgery was higher in the RFA treatment arm. Three study subjects presented local infection (two had partial irradiation of the breast) and none in the control group. Median follow up was 25 months (range 1–83). No recurrence or second surgery was required during the study period.
Outcomes RFA group (n = 20)Control group (n=20)p valueSpecimen weight (median, gr)42 (24-80)27 (11-60)0.004Specimen volume (median, ml)369 (259-847)201 (100-602)0.004Positive margin (intraoperative)4/20 (20%)11/20 (55%)0.022Pathological size (median, mm)11.5 (5-20)10.5 (6-16)0.07Local Adverse effect8/20 (40%)1/20 (5%)0.01Breast Inflammation5/20 (25%)1/20 (5%)0.182Breast Infection3/20 (15%)0/20 (0%)0.23RFA: radiofrequency ablation. n=number of subjects
CONCLUSION: RFA seems effective in the cases considered and could be more accurate than lumpectomy in terms of obtaining more free margins. Surgical excision associated with RFA leads to a higher amount of local adverse effects, especially if combined with partial irradiation of the breast. RFA could be considered as a less invasive treatment in tumors smaller than 20 mm; however, this warrants further investigation.
Citation Format: Garcia-Tejedor A, Guma A, Soler T, Valdivieso A, Petit A, Contreras N, Chappuis CG, Falo C, Pernas S, Anselem A, Fernandez-Montoli E, Pla MJ, Burdio F, Ponce J. Is radiofrequency ablation better than lumpectomy for margin status in breast cancer? Results of a randomized clinical trial [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-13-07.
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Affiliation(s)
- A Garcia-Tejedor
- Hospital Universitari Bellvitge, Idibell, Hospitalet de Llobregat, Barcelona, Spain; Institut Català d'Oncología, Hospitalet de Llobregat, Barcelona, Spain; Parc de Salut-Hospital del Mar, Barcelona, Spain
| | - A Guma
- Hospital Universitari Bellvitge, Idibell, Hospitalet de Llobregat, Barcelona, Spain; Institut Català d'Oncología, Hospitalet de Llobregat, Barcelona, Spain; Parc de Salut-Hospital del Mar, Barcelona, Spain
| | - T Soler
- Hospital Universitari Bellvitge, Idibell, Hospitalet de Llobregat, Barcelona, Spain; Institut Català d'Oncología, Hospitalet de Llobregat, Barcelona, Spain; Parc de Salut-Hospital del Mar, Barcelona, Spain
| | - A Valdivieso
- Hospital Universitari Bellvitge, Idibell, Hospitalet de Llobregat, Barcelona, Spain; Institut Català d'Oncología, Hospitalet de Llobregat, Barcelona, Spain; Parc de Salut-Hospital del Mar, Barcelona, Spain
| | - A Petit
- Hospital Universitari Bellvitge, Idibell, Hospitalet de Llobregat, Barcelona, Spain; Institut Català d'Oncología, Hospitalet de Llobregat, Barcelona, Spain; Parc de Salut-Hospital del Mar, Barcelona, Spain
| | - N Contreras
- Hospital Universitari Bellvitge, Idibell, Hospitalet de Llobregat, Barcelona, Spain; Institut Català d'Oncología, Hospitalet de Llobregat, Barcelona, Spain; Parc de Salut-Hospital del Mar, Barcelona, Spain
| | - CG Chappuis
- Hospital Universitari Bellvitge, Idibell, Hospitalet de Llobregat, Barcelona, Spain; Institut Català d'Oncología, Hospitalet de Llobregat, Barcelona, Spain; Parc de Salut-Hospital del Mar, Barcelona, Spain
| | - C Falo
- Hospital Universitari Bellvitge, Idibell, Hospitalet de Llobregat, Barcelona, Spain; Institut Català d'Oncología, Hospitalet de Llobregat, Barcelona, Spain; Parc de Salut-Hospital del Mar, Barcelona, Spain
| | - S Pernas
- Hospital Universitari Bellvitge, Idibell, Hospitalet de Llobregat, Barcelona, Spain; Institut Català d'Oncología, Hospitalet de Llobregat, Barcelona, Spain; Parc de Salut-Hospital del Mar, Barcelona, Spain
| | - A Anselem
- Hospital Universitari Bellvitge, Idibell, Hospitalet de Llobregat, Barcelona, Spain; Institut Català d'Oncología, Hospitalet de Llobregat, Barcelona, Spain; Parc de Salut-Hospital del Mar, Barcelona, Spain
| | - E Fernandez-Montoli
- Hospital Universitari Bellvitge, Idibell, Hospitalet de Llobregat, Barcelona, Spain; Institut Català d'Oncología, Hospitalet de Llobregat, Barcelona, Spain; Parc de Salut-Hospital del Mar, Barcelona, Spain
| | - MJ Pla
- Hospital Universitari Bellvitge, Idibell, Hospitalet de Llobregat, Barcelona, Spain; Institut Català d'Oncología, Hospitalet de Llobregat, Barcelona, Spain; Parc de Salut-Hospital del Mar, Barcelona, Spain
| | - F Burdio
- Hospital Universitari Bellvitge, Idibell, Hospitalet de Llobregat, Barcelona, Spain; Institut Català d'Oncología, Hospitalet de Llobregat, Barcelona, Spain; Parc de Salut-Hospital del Mar, Barcelona, Spain
| | - J Ponce
- Hospital Universitari Bellvitge, Idibell, Hospitalet de Llobregat, Barcelona, Spain; Institut Català d'Oncología, Hospitalet de Llobregat, Barcelona, Spain; Parc de Salut-Hospital del Mar, Barcelona, Spain
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Ribas L, Valdivieso A, Díaz N, Piferrer F. Response to "The importance of controlling genetic variation - remarks on 'Appropriate rearing density in domesticated zebrafish to avoid masculinization: links with the stress response'". ACTA ACUST UNITED AC 2018; 220:4079-4080. [PMID: 29093193 DOI: 10.1242/jeb.167437] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 09/20/2017] [Indexed: 02/04/2023]
Affiliation(s)
- Laia Ribas
- Institut de Ciències del Mar, Consejo Superior de Investigaciones Científicas (CSIC), Passeig Marítim, 37-49, Barcelona 08003, Spain
| | - Alejandro Valdivieso
- Institut de Ciències del Mar, Consejo Superior de Investigaciones Científicas (CSIC), Passeig Marítim, 37-49, Barcelona 08003, Spain
| | - Noelia Díaz
- Institut de Ciències del Mar, Consejo Superior de Investigaciones Científicas (CSIC), Passeig Marítim, 37-49, Barcelona 08003, Spain
| | - Francesc Piferrer
- Institut de Ciències del Mar, Consejo Superior de Investigaciones Científicas (CSIC), Passeig Marítim, 37-49, Barcelona 08003, Spain.
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Loinaz C, Ochando F, Vicente E, Serrablo A, López Cillero P, Gomez M, Fabregat J, Varo E, Miyar de León A, Fondevila C, Valdivieso A, Blanco G, Sanchez B, López Andújar R, Fundora Y, Cugat E, Diez Valladares L, Herrera J, García Gil A, Morales R, Pardo F, Sabater L, Lopez Baena J, Muñoz Bellvis L, Martin Perez E, Perez Saborido B, Suarez M, Meneu J, Albiol M, Sanjuanbenito A, Ramia J, Pereira F, Paseiro G, Palomo J, León M. Results of a survey on peri-operative nutritional support in pancreatic and biliary surgery in Spain. Clin Nutr 2018. [DOI: 10.1016/j.clnu.2018.06.1577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Gastaca M, Prieto M, Valdivieso A, Ruiz P, Ventoso A, Palomares I, Matarranz A, Martinez-Indart L, Ortiz de Urbina J. Intraoperative Portal Flow of Less Than 1 Liter per Minute After Orthotopic Liver Transplantation Is Not Associated Per Se With an Increased Rate of Early Graft Dysfunction. Transplant Proc 2017; 48:2495-2498. [PMID: 27742333 DOI: 10.1016/j.transproceed.2016.08.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The aim of this study was to determine whether a portal flow of <1,000 mL/min in orthotopic liver transplantation (OLT) is associated with a higher incidence of early graft dysfunction (EGD) and graft loss. METHODS A retrospective study was performed of 540 OLTs carried out consecutively from December 2004 to December 2013. Patients were divided into 2 groups: group A, portal flow <1,000 mL/min; and group B, portal flow >1,000 mL/min. We studied the incidence of EGD and graft survival. A subanalysis was performed to define the minimum acceptable portal flow/100 g of liver weight to reduce the development EGD and graft loss. RESULTS Group A included 29 patients and group B, 511 patients. Group A had significantly lower-weight donors and recipients, female recipients with cholestatic disease, lower MELD scores, and lower hepatic artery flow. EGD occurred in 7 patients in group A (24.1%) versus 101 patients in group B (19.8%; P = .43). No significant differences were found in 1- and 5-year graft survival. A portal flow of <80 mL/min/100 g of liver weight was related to a significantly higher risk of developing EGD (odds ratio, 4.35; 95% confidence interval [CI], 1.46-12.91; P = .008) and graft loss (hazard ratio, 4.05; 95% CI, 1.32-12.42; P = .014). CONCLUSIONS Intraoperative portal flow of <1,000 mL/min in OLT was not related per se with a higher incidence of EGD or graft loss. Significantly higher risk of developing EGD and graft loss was associated with a portal flow of <80 mL/min/100 g of liver weight.
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Affiliation(s)
- M Gastaca
- Hepatobiliary Surgery and Liver Transplantation Unit, Cruces University Hospital, University of the Basque Country, Bilbao, Spain.
| | - M Prieto
- Hepatobiliary Surgery and Liver Transplantation Unit, Cruces University Hospital, University of the Basque Country, Bilbao, Spain
| | - A Valdivieso
- Hepatobiliary Surgery and Liver Transplantation Unit, Cruces University Hospital, University of the Basque Country, Bilbao, Spain
| | - P Ruiz
- Hepatobiliary Surgery and Liver Transplantation Unit, Cruces University Hospital, University of the Basque Country, Bilbao, Spain
| | - A Ventoso
- Hepatobiliary Surgery and Liver Transplantation Unit, Cruces University Hospital, University of the Basque Country, Bilbao, Spain
| | - I Palomares
- Hepatobiliary Surgery and Liver Transplantation Unit, Cruces University Hospital, University of the Basque Country, Bilbao, Spain
| | - A Matarranz
- Hepatobiliary Surgery and Liver Transplantation Unit, Cruces University Hospital, University of the Basque Country, Bilbao, Spain
| | - L Martinez-Indart
- Clinical Epidemiology Unit, Cruces University Hospital, Biocruces Health Research Institute, Bilbao, Spain
| | - J Ortiz de Urbina
- Hepatobiliary Surgery and Liver Transplantation Unit, Cruces University Hospital, University of the Basque Country, Bilbao, Spain
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Ribas L, Valdivieso A, Díaz N, Piferrer F. Appropriate rearing density in domesticated zebrafish to avoid masculinization: links with the stress response. ACTA ACUST UNITED AC 2017; 220:1056-1064. [PMID: 28082617 DOI: 10.1242/jeb.144980] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 12/29/2016] [Indexed: 02/02/2023]
Abstract
The zebrafish (Danio rerio) has become a well-established experimental model in many research fields but the loss of the primary sex-determining region during the process of domestication renders laboratory strains of zebrafish susceptible to the effects of environmental factors on sex ratios. Further, an essential husbandry aspect - the optimal rearing density to avoid stress-induced masculinization - is not known. We carried out two experiments: the first focusing on the effects of density on survival, growth and sex ratio by rearing zebrafish at different initial densities (9, 19, 37 and 74 fish per litre) for 3 months (6-90 days post-fertilization, dpf), and the second focusing on the effects of cortisol during the sex differentiation period (15-45 dpf) for zebrafish reared at low density. The results showed an increase in the number of males in groups subjected to the two highest initial rearing densities; we also observed a reduction of survival and growth in a density-dependent manner. Furthermore, zebrafish treated with cortisol during the sex differentiation period showed a complete masculinization of the population; treatment with the cortisol synthesis inhibitor metyrapone negated the effects of exogenous cortisol. Our results indicate that the process of sex differentiation in domesticated zebrafish can be perturbed by elevated stocking density and that this effect is likely to be mediated by an increase in cortisol through the stress response. However, the underlying mechanism needs further study.
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Affiliation(s)
- Laia Ribas
- Institut de Ciències del Mar, Consejo Superior de Investigaciones Científicas (CSIC), Passeig Marítim, 37-49, Barcelona 08003, Spain
| | - Alejandro Valdivieso
- Institut de Ciències del Mar, Consejo Superior de Investigaciones Científicas (CSIC), Passeig Marítim, 37-49, Barcelona 08003, Spain
| | - Noelia Díaz
- Institut de Ciències del Mar, Consejo Superior de Investigaciones Científicas (CSIC), Passeig Marítim, 37-49, Barcelona 08003, Spain
| | - Francesc Piferrer
- Institut de Ciències del Mar, Consejo Superior de Investigaciones Científicas (CSIC), Passeig Marítim, 37-49, Barcelona 08003, Spain
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Gastaca M, Matarranz A, Martinez L, Valdivieso A, Ruiz P, Ventoso A, Fernandez JR, Palomares I, Prieto M, Suarez MJ, Ortiz de Urbina J. Risk factors for biliary complications after orthotopic liver transplantation with T-tube: a single-center cohort of 743 transplants. Transplant Proc 2015; 46:3097-9. [PMID: 25420833 DOI: 10.1016/j.transproceed.2014.09.173] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Despite recent advances in organ preservation, surgical procedures, and immunosuppression, biliary reconstruction after orthotopic liver transplantation (OLT) remains as a major source of morbidity. The purpose of this study was to identify risk factors for the development of biliary complications (BCs) after end-to-end choledochocholedochostomy (EE-CC) with a T-tube as the standard technique for biliary reconstruction after OLT. METHODS A total of 833 consecutive liver transplantations that took place from February 1996 to April 2010 were retrospectively reviewed. Patients with concomitant hepatic artery complications were excluded, as were those who underwent urgent retransplantation or died within 1 week after transplantation. Finally, the study group comprised 743 patients. RESULTS The overall BC rate was 9.8% (73 patients), including stricture in 19 patients (2.6%) and bile leakage in 39 patients (5.2%). After univariate analysis, significant risk factors for BCs were surgery time >5 hours, arterial ischemia time >30 minutes, use of a classic transplant technique, transfusion of red blood cells ≥5 units, anti-cytomegalovirus treatment, and period of transplantation between 1996 and 2002. Stepwise logistic regression study was performed, including those variables with a value of P <.200. Multivariate analysis showed that pretransplant serum creatinine (odds ratio = 1.27; 95% confidence interval [CI], 1.03-1.57; P = .025) and arterial ischemia time >30 minutes (odds ratio = 2.44; 95% CI, 1.45-4.12; P = .001) were the only independent risk factors related to the development of BCs after biliary reconstruction with the T-tube. CONCLUSIONS The performance of different variables in predicting occurrence of BCs was assessed with the use of receiver operating characteristic analysis. The area under the receiver operating characteristic curve of our model was 0.637 (95% CI, 0.564-0.710), and therefore we must conclude that other variables not included in our model may have influence in the development of BCs after OLT with an EE-CC with a T-tube as the procedure for biliary reconstruction.
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Affiliation(s)
- M Gastaca
- Hepatobiliary Surgery and Liver Transplantation Unit, Cruces University Hospital, University of the Basque Country, Bilbao, Spain.
| | - A Matarranz
- Hepatobiliary Surgery and Liver Transplantation Unit, Cruces University Hospital, Bilbao, Spain
| | - L Martinez
- Hepatology Unit, Cruces University Hospital, Bilbao, Spain
| | - A Valdivieso
- Hepatobiliary Surgery and Liver Transplantation Unit, Cruces University Hospital, University of the Basque Country, Bilbao, Spain
| | - P Ruiz
- Hepatobiliary Surgery and Liver Transplantation Unit, Cruces University Hospital, Bilbao, Spain
| | - A Ventoso
- Hepatobiliary Surgery and Liver Transplantation Unit, Cruces University Hospital, University of the Basque Country, Bilbao, Spain
| | - J R Fernandez
- Hepatology Unit, Cruces University Hospital, Bilbao, Spain
| | - I Palomares
- Hepatobiliary Surgery and Liver Transplantation Unit, Cruces University Hospital, University of the Basque Country, Bilbao, Spain
| | - M Prieto
- Hepatobiliary Surgery and Liver Transplantation Unit, Cruces University Hospital, University of the Basque Country, Bilbao, Spain
| | - M J Suarez
- Hepatology Unit, Cruces University Hospital, Bilbao, Spain
| | - J Ortiz de Urbina
- Hepatobiliary Surgery and Liver Transplantation Unit, Cruces University Hospital, University of the Basque Country, Bilbao, Spain
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Gastaca M, Prieto P, Valdivieso A, Ortiz de Urbina J. Liver transplantation with aged donors in patients with hepatitis C virus. Am J Transplant 2015; 15:572. [PMID: 25556951 DOI: 10.1111/ajt.13068] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- M Gastaca
- Hepatobiliary Surgery and Liver Transplantation Unit, Cruces University Hospital, University of the Basque Country, Plaza de Cruces s/n. 48903, Baracaldo, Vizcaya, Spain
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Gastaca M, Matarranz A, Muñoz F, Valdivieso A, Aguinaga A, Testillano M, Bustamante J, Terreros I, Suarez MJ, Montejo M, Ortiz de Urbina J. Biliary complications in orthotopic liver transplantation using choledochocholedochostomy with a T-tube. Transplant Proc 2013; 44:1554-6. [PMID: 22841211 DOI: 10.1016/j.transproceed.2012.05.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Despite significant advances in orthotopic liver transplantation (OLT), biliary tract reconstruction is still a major source of complications. Choledochocholedochostomy with a T-tube used to be the standard procedure for biliary reconstruction after OLT. However, many centers currently avoid use of the T-tube because of the high incidence of complications. Our aim was to study the biliary complications occurring at our center when end-to-end choledochocholedochostomy (EE-CC) over a T-tube was used as the standard procedure for biliary reconstruction. A retrospective review was conducted of all patients who underwent liver transplantation from February 1, 1996, to April 30, 2010. Only patients requiring any therapy to treat biliary complications were considered, whereas those with concomitant hepatic artery complications were excluded. The study cohort consisted of 743 patients who had EE-CC with a T-tube. Of these, 73 patients (9.8%) experienced any biliary complication. Anastomotic strictures occurred in 17 patients (2.3%), and non-anastomotic strictures in 2 (0.3%). Fifteen patients with anastomotic strictures were successfully treated by dilatation and stenting. Bile leakage was diagnosed in 39 patients (5.2%). Leakage occurred at the anastomosis in 15 patients (2%), and at the exit site of the T-tube in 24 patients (3.2%). Tube opening was the only treatment used in 30 patients with bile leakage (76.9%). Seven patients experienced leaks after elective T-tube removal (1%). Overall, repeat surgery to manage biliary complications was needed in 9 patients (1.2%). The mortality rate from biliary complications was 0.13%. In conclusion, EE-CC with a T-tube was followed by a low incidence of biliary complications. The complication rate after elective T-tube removal and the repeat surgery rate were extremely low. These results might challenge the current trend to avoid T-tube stenting in OLT.
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Affiliation(s)
- M Gastaca
- Hepato-biliary Surgery and Liver Transplantation Unit, Hospital Universitario de Cruces, Bilbao, Spain.
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Gastaca M, Valdivieso A, Montejo M, Bustamante J, de Urbina JO. Is antithrombotic prophylaxis required after liver transplantation in HIV-infected recipients? Am J Transplant 2012; 12:2258. [PMID: 22682230 DOI: 10.1111/j.1600-6143.2012.04132.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Ortiz de Urbina J, Valdivieso A, Matarranz A, Gastaca M, Fernandez J, Bustamante J, Gonzalez J, Ventoso A, Testillano M, Ruiz P, Suarez M. Advagraf De Novo in Liver Transplantation: A Single-Center Experience. Transplant Proc 2011; 43:724-5. [DOI: 10.1016/j.transproceed.2011.01.089] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Charco R, Caralt M, Lladó L, Valdivieso A, Fabregat J, Matarranz A, Gonzalez-Pinto I, Pardo F, Fábrega E, Bilbao I. A Prospective, Multicenter Study of Once-Daily Extended-Release Tacrolimus in De Novo Liver Transplant Recipients. Transplant Proc 2011; 43:718-23. [DOI: 10.1016/j.transproceed.2011.01.093] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ruiz P, Gastaca M, Gonzalez J, Hernandez MJ, Ventoso A, Valdivieso A, Montejo M, Ortiz de Urbina J. Incidence and clinical relevance of bacterial contamination in preservation solution for liver transplantation. Transplant Proc 2010; 41:2169-71. [PMID: 19715863 DOI: 10.1016/j.transproceed.2009.06.036] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Postoperative infection is considered one of the most important causes of morbidity and mortality after liver transplantation. We prospectively studied the incidence and significance of infections in preservation solutions for liver transplantation. MATERIALS AND METHODS From March 2007 to March 2008, we cultured the University of Wisconsin preservation solution for 60 consecutive liver transplantations. Fluid samples were obtained at the beginning and at the end of the back table procedure. Our posttransplant infection prophylactic protocol consisted of ampicillin and cefotaxime for 48 hours. RESULTS Cultures were positive in 59 patients (98.4%). Seventy-five percent of the isolates were superficial saprophytic flora (SSF; Staphylococcus coagulase negative, Streptococcus viridans, and Corynebacterium), nevertheless in 15 cases (25.1%) we isolated high virulence pathogens (Staphylococcus aureus, Klebsiella, Escherichia coli, Enterobacter, and Pseudomonas aeruginosa). There were neither anaerobic nor fungal isolates. Sixteen patients (36%) from the group with SSF developed postoperative fever, including 12 with negative posttransplant cultures, while 4 patients showed positive cultures for various microorganisms distinct from those isolated from the preservation solution. Five patients (30%) with high virulence pathogens in the preservation solution developed posttransplant fever, although no pathogen was isolated. CONCLUSIONS Positive cultures of preservation fluids were observed in 98% of patients, although most of them (75%) were SSF. Microorganisms isolated from posttransplant cultures did not match the ones obtained from the preservation solution. Our results did not support routine culturing of the preservation solution provided that one administrator an adequate posttransplant antibiotic prophylactic regimen.
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Affiliation(s)
- P Ruiz
- Transplantation and Liver Surgery Unit, Hospital de Cruces, Barakaldo, Vizcaya, Spain.
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Montejo M, Montejo E, Gastaca M, Valdivieso A, Fernandez JR, Testillano M, Gonzalez J, Bustamante J, Ruiz P, Suarez MJ, Ventoso A, Rubio MC, de Urbina JO. Prophylactic therapy with valgancyclovir in high-risk (cytomegalovirus D+/R-) liver transplant recipients: a single-center experience. Transplant Proc 2010; 41:2189-91. [PMID: 19715869 DOI: 10.1016/j.transproceed.2009.06.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A retrospective study was performed in liver transplant patients with high risk to develop cytomegalovirus infection (CMV D+/R-) who were treated with valgancyclovir for 3 months as prophylactic therapy. The aim of this study was to determine the safety and efficacy of prophylactic therapy with valgancyclovir. Weekly CMV antigenemia was routinely assessed during the first 3 months posttransplantation, twice a month to month 6, and monthly until the end of the first year, as well as when clinically indicated. The follow-up period was 1 year. From January 2003 to February 2007, 199 liver transplantations were performed at our institution, including 23 (11%) high-risk patients for CMV infection. Median age was 47 +/- 11.6 years. Nineteen patients (70.4%) were men. Five subjects (21.7%) developed CMV infections. Three patients with positive CMV antigenemia at 3, 4, or 6 months posttransplantation were asymptomatic, while 2 (8.7%) showed gastrointestinal CMV disease at 2 months posttransplantation or CMV hepatitis at 1 month after the end of the prophylactic therapy. Treatment with intravenous gancyclovir followed by oral valgancyclovir was successful in both patients. No opportunistic infections were observed and only 1 patient developed leukopenia as an adverse event related to valgancyclovir.
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Affiliation(s)
- M Montejo
- Unidad de Enfermedades Infecciosas y Servicios de Cirugía Hepáto-biliar y Trasplante Hepático, Digestivo y Microbiología, Hospital Universitario de Cruces, Bilbao, Spain.
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de Diego C, Vila-Córcoles Á, Ochoa-Gondar O, Valdivieso A, Arija V, Rodríguez-Blanco T. Vacunación antigripal y mortalidad invernal en pacientes diabéticos mayores de 65 años. Semergen 2010. [DOI: 10.1016/j.semerg.2009.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Basaldua F, Lopategi A, Arteta B, Valdivieso A, de Urbina JO, Vidal-Vanaclocha F. 172 POSTER Tumor-induced liver nerve growth factor (NGF): a new target for stromal cell inhibition during metastatic colorectal carcinoma growth. EJC Suppl 2008. [DOI: 10.1016/s1359-6349(08)72104-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Vila-Córcoles A, Ochoa O, de Diego C, Valdivieso A, Herreros I, Bobé F, Alvarez M, Juárez M, Guinea I, Ansa X, Saún N. Effects of annual influenza vaccination on winter mortality in elderly people with chronic pulmonary disease. Int J Clin Pract 2008; 62:10-7. [PMID: 17573840 DOI: 10.1111/j.1742-1241.2007.01414.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Although there is a general agreement for the recommendation of the influenza vaccine to persons with chronic obstructive pulmonary disease (COPD), the magnitude of clinical effectiveness and benefit from the annual vaccination is controversial. We assessed the effects of annual influenza vaccination on winter mortality in older adults with COPD. METHODS This prospective cohort study included 1298 Spanish community-dwelling individuals aged 65 years or older with a diagnosis of COPD followed from 1 January 2002 to 30 April 2005. The primary outcome was all-cause death during influenza periods (January-April). Multivariable Cox proportional hazard models adjusted by age, sex and comorbidity were used to evaluate vaccine effectiveness. RESULTS Influenza vaccination was associated with a non-statistically significant 16% reduction in winter mortality among vaccinated COPD patients [unadjusted hazard ratio (HR): 0.84; 95% confidence interval (CI): 0.60-1.17]. Multivariable analysis showed that there was an insignificant trend towards a reduced mortality in the vaccinated group considering overall influenza periods 2002-2005 (adjusted HR: 0.76; 95% CI: 0.52-1.06; p=0.098). We estimated that, in the total COPD population, one death was prevented for every 187 annual vaccinations (95% CI: 62 to infinity). CONCLUSIONS Our data suggest benefit from the influenza vaccination and support an annual vaccination strategy for elderly COPD patients.
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Affiliation(s)
- A Vila-Córcoles
- Primary Care Service of Tarragona-Valls, Institut Català de la Salut, Tarragona, Spain.
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Estraviz B, Quintana JM, Valdivieso A, Bilbao A, Ortiz de Urbina J, Sarabia S. Propiedades psicométricas de un cuestionario específico de calidad de vida en trasplante hepático. Rev esp enferm dig 2007; 99:13-8. [PMID: 17295593 DOI: 10.4321/s1130-01082007000100004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To translate and evaluate the psychometric properties of a quality of life questionnaire specific to liver transplant patients. MATERIAL AND METHODS The questionnaire was administered to 60 patients on the waiting list for liver transplant in the Cruces Hospital Transplant Unit, and again at 6 months after the transplant. The reliability, validity, sensitivity to change, and minimum detectable change (MDC) were studied. Two questionnaires, the SF-36 (Health Survey Short Form 36) and HADS (Hospital Anxiety and Depression Scale), were used to evaluate the convergent validity. RESULTS The specific questionnaire presented a Cronbach s alpha coefficient of over 0.7. The factor analysis demonstrates a single dimension. Correlations with the areas of SF-36 varied between -0.34 and -0.71 in the preoperative phase, and between -0.21 and -0.67 at 6 months. With respect to the HAD-anxiety scale, the coefficients were 0.44 in the preoperative phase and 0.51 at 6 months, and for the HAD-depression scale these were 0.64 and 0.39, respectively. Discriminant validation studies confirm that the questionnaire shows differences between patients with cirrhosis of various etiologies and severities. In the study of sensitivity to change, values were obtained for the SES (standardised effect size) and SRM (standardised response mean) indices of 0.92 and 0.99, respectively. Furthermore, 58.33% of patients had scores higher than MDC. CONCLUSIONS The specific questionnaire has adequate psychometric properties. Its use in these patients may therefore be recommended as another scale for evaluating the results of this intervention.
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Affiliation(s)
- B Estraviz
- Servicio de Cirugía General y Aparato Digestivo, Hospital de Galdakao, Vizcaya, Spain.
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Gastaca M, Valdivieso A, Pijoan J, Errazti G, Hernandez M, Gonzalez J, Fernandez J, Matarranz A, Montejo M, Ventoso A, Martinez G, Fernandez M, de Urbina JO. Donors older than 70 years in liver transplantation. Transplant Proc 2006; 37:3851-4. [PMID: 16386560 DOI: 10.1016/j.transproceed.2005.10.040] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Expansion of donor criteria has become necessary with the increasing number of liver transplantation candidates, as aged donors who have been considered to yield marginal organs. METHODS Our database of 477 liver transplants (OLT) included 55 cases performed from donors at least 70 years old vs 422 with younger donors. We analyzed pretransplantation donor and recipient characteristics as well as evolution of the recipients. RESULTS The old donor group showed significantly lower ALT (23 +/- 17 vs 48.9 +/- 67; P = .0001) and LDH (444 +/- 285 vs 570 +/- 329; P = .01). There was a trend toward fewer hypotensive events in the aged donor group (27.2% vs 40.5%; P = .07). No steatosis (>10%) was accepted in the old donor group. Cold ischemia time was statistically shorter for the aged donors (297 +/- 90 minutes vs 346 +/- 139 minutes; P = .03). With these selected donors, the results were not different for primary nonfunction, arterial and biliary complications, hospitalization, acute reoperation or acute retransplantation, and hospital mortality when donors > or =70 years old were compared to younger donors. Functional cholestasis, neither related to rejection nor to biliary complications, was seen more frequently in old donor recipients (40% vs 22%; P = .03). No differences in 1, and 3 year survivals were observed between recipients of donors over 70 years old and these of younger organs: 93.8% and 90.6% vs 90.7% and 82.8%, respectively. CONCLUSION When using selected donors > or =70 years old the outcomes were comparable to those obtained with younger donors. Strict selection is necessary to achieve good long-term survival.
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Affiliation(s)
- M Gastaca
- Liver Transplantation Unit, Hospital de Cruces, Bilbao, Spain.
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Abstract
OBJECTIVE The main objective is to evaluate the complications and problems encountered in a population with inner ear congenital malformation undergoing cochlear implantation. MATERIALS AND METHODS The present study includes 33 patients with congenital inner ear malformation, from a total population of 346 cochlear implant patients, implanted from February 1993 to March 2004. Radiological evaluation and neurological exams were performed to all these patients in order to evaluate all the preoperative conditions. RESULTS The most common cochlear anomalies we found were: cochlear hypoplasia, Incomplete partition and Common cavity (n=15). In 4 cases an enlarge aqueduct was also associated to the cochlear anomaly. We also found 6 cases with labyrinthine anomalies. The surgical procedure was performed in 23 cases, and in 18 of them we obtained an electrical stimulation of the neural elements. CONCLUSIONS There are no differences between patients with Incomplete Partition of the cochlea and mild Cochlea hypoplasia, if compared with those with normal cochlea. Severe malformations as Common Cavity or severe hypoplasia may have a higher rate of surgical complications and the outcome cannot be predicted.
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Affiliation(s)
- A Ramos
- Servicio de Otorrinolaringología y Patología Cervico Facial, Hospital Universitario Insular de Gran Canaria.
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González-Uriarte J, Valdivieso A, Gastaca M, Errasti G, Campo M, Hernandez MJ, Montejo M, Bustamante J, Suarez MJ, Testillano M, Fernandez JR, Ortiz de Urbina J. Liver transplantation for hepatocellular carcinoma in cirrhotic patients. Transplant Proc 2003; 35:1827-9. [PMID: 12962811 DOI: 10.1016/s0041-1345(03)00582-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
A consecutive series of 88 patients underwent transplantation for hepatocellular carcinoma with cirrhosis over a 7-year period. Liver transplantation was indicated because of the tumor in 75 cases (85.2%); tumor was an incidental finding in 13 cases (14.8%). One patient was retransplanted due to primary nonfunction. The perioperative mortality was 4.5%. Tumor recurrence was observed in seven patients (7.95%) with incidental tumor recurrence in one case. As in patients with known primary liver tumors pretransplant, a thorough follow-up is advisable to establish an early diagnosis of recurrence. The actuarial survival for nonincidental hepatocellular carcinoma at 1, 3, and 5 year was 92%, 77%, and 75%, respectively. The differences in actuarial survival between hepatitis C negative and positive hepatocellular carcinoma were not significant (log-rank test P=.27), though there was a clear improvement in results (94%, 85%, and 78% vs 90%, 71%, and 71%), at 1, 3, and 5 years meaning that HCV infection is an important prognostic factor. Although transplantation for HCC has the advantages of removing the tumor and the cirrhotic liver, it remains a controversial topic. In our experience patients showing lesions less than 5 cm or three or fewer lesions experience an equivalent survival to transplanted patients who do not have cancer.
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Affiliation(s)
- J González-Uriarte
- Liver Transplantation Unit, Hospital de Cruces, Baracaldo, Vizcaya, Spain
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Robles R, Figueras J, Turrión VS, Margarit C, Moya A, Varo E, Calleja J, Valdivieso A, Garcia-Valdelcasas JC, López P, Gómez M, de Vicente E, Loinaz C, Santoyo J, Fleiras M, Bernardos A, Marín C, Fernández JA, Jaurrieta E, Parrilla P. Liver transplantation for peripheral cholangiocarcinoma: Spanish experience. Transplant Proc 2003; 35:1823-4. [PMID: 12962809 DOI: 10.1016/s0041-1345(03)00725-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Palliative treatment for nondisseminated unresectable peripheral cholangiocarcinoma (PCC) carries a 0% 5-year survival rate. The role of orthotopic liver transplantation (OLT) in these patients is controversial because the survival rate is lower than with other indications for transplantation and the lack of available donor organs. The aim of this paper was to review the Spanish experience in OLT for PCC to identify prognostic factors for survival. METHODS We retrospectively reviewed 23 patients undergoing OLT in Spain for PCC over a period of 13 years. RESULTS The actuarial survival rates were 77%, 65%, and 42% at 1, 3, and 5 years, respectively. The main cause of death was tumor recurrence (35%). Prognotic factors for an adverse outcome were pTNM classification (P<.05) in the univariate analysis and perineural invasion (P<.05) and stages III or IVA (P<.05) in the multivariate analysis. CONCLUSIONS OLT for nondisseminated irresectable PCC displays higher survival rates at 3 and 5 years than palliative treatments, especially for tumors in the initial stages, which means that more information is needed to help better select PCC patients for transplantation.
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Affiliation(s)
- R Robles
- Virgen de la Arrixaca University Hospital, Murcia, Spain.
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Robles R, Figueras J, Turrión VS, Margarit C, Moya A, Varo E, Calleja J, Valdivieso A, Garcia-Valdelcasas JC, López P, Gómez M, de Vicente E, Loinaz C, Santoyo J, Casanova D, Bernardos A, Fernández JA, Marín C, Ramírez P, Bueno FS, Jaurrieta E, Parrilla P. Liver transplantation for hilar cholangiocarcinoma: Spanish experience. Transplant Proc 2003; 35:1821-2. [PMID: 12962808 DOI: 10.1016/s0041-1345(03)00724-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Palliative treatment for nondisseminated irresectable hilar cholangiocarcinoma (HCC) carries a 0% 5-year survival rate. The role of orthotopic liver transplantation (OLT) in these patients is controversial because the survival rate is lower than that for other indications for transplantation and the lack of available donor organs. The aim of this paper was to review the Spanish experience in OLT for HCC and identify prognostic factors for survival. METHODS We retrospectively reviewed 36 patients undergoing OLT for HCC over 13 years. RESULTS The actuarial survival rate at 1, 3, and 5 years was 82%, 53%, and 30%, respectively. The main cause of death was tumor recurrence (53%). In the univariate analysis, the factors for a poor prognosis were vascular invasion (P<.001) namely 0% survival at 3 years when present versus 63% and 35% at 3 and 5 years, respectively, when it was not; and stages III to IVA (P<.05), namely 15% survival at 5 years versus 47% for stages I to II. Lymph node and perineural invasion also reduce survival. In the multivariate analysis, the factors for poor prognosis included vascular invasion (P<.01) and stages III to IVA (P<.01). CONCLUSION OLT for nondisseminated irresectable HCC has higher survival rates at 3 and 5 years than palliative treatments, especially with initial stage tumors, which means that more information is needed to better select cholangiocarcinoma patients for transplantation.
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Affiliation(s)
- R Robles
- Virgen de la Arrixaca University Hospital, Murcia, Spain.
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Jara A, Chacón C, Valdivieso A, Ibaceta M. [Effect of PTH, phosphate, and metabolic acidosis on the progression of renal insufficiency in the azotemic rat]. Nefrologia 2003; 23 Suppl 2:37-42. [PMID: 12778852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
In a previous study we have observed that NH4Cl-induced metabolic acidosis halted the progression of renal disease in azotemic rats with a high phosphate diet. We hypothesized that NH4Cl-induced metabolic acidosis may exert its protective effect by decreasing renal calcium content independent of serum levels of PTH and phosphate loading. To test this hypothesis we studied azotemic rats with very low phosphate diet or parathyroidectomy. Rats with low phosphate diet and parathyroidectomized rats developed renal failure after 5/6 nephrectomy, and in both groups the acid loading significantly decreased the progression of renal disease. Calcium renal content increased in both groups, even in rats with low phosphate diet, and this effect was also significantly decreased after an acid loading. Rats with acid loading developed greater hypertrophy of renal tissue than rats without acid loading. We conclude that NH4Cl-induced metabolic acidosis halted the progression of renal disease by decreasing calcium precipitation on renal tissue. Parathyroidectomy did not prevent progression of renal disease nor calcium precipitation, and a low phosphate diet in azotemic rats did not prevent increased calcium content on remnant renal tissue.
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Affiliation(s)
- A Jara
- Departamento de Nefrología, Facultad de Medicina, Pontificia Universidad Católica de Chile.
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Gainza FJ, Valdivieso A, Quintanilla N, Errazti G, Gastaca M, Campo M, Lampreabe I, Ortiz-de-Urbina J. Evaluation of acute renal failure in the liver transplantation perioperative period: incidence and impact. Transplant Proc 2002; 34:250-1. [PMID: 11959269 DOI: 10.1016/s0041-1345(01)02747-6] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- F J Gainza
- Nephrology Department, Hospital de Cruces, Barakaldo, Bizkaia, Spain
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Jara A, Chacón C, Valdivieso A, Aris L, Jalil R, Felsenfeld AJ. Effect of calcitriol treatment and withdrawal on hyperparathyroidism in haemodialysis patients with hypocalcaemia. Nephrol Dial Transplant 2001; 16:1009-16. [PMID: 11328908 DOI: 10.1093/ndt/16.5.1009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Calcitriol is used to treat secondary hyperparathyroidism in dialysis patients. For similarly elevated parathyroid hormone (PTH) levels, the PTH response to calcitriol treatment is believed to be better in hypocalcaemic dialysis patients than in dialysis patients with higher serum calcium values. Furthermore, few studies have evaluated the rapidity of the rebound in serum PTH values after prolonged treatment with calcitriol. Our goal was to evaluate (i) the PTH response to calcitriol treatment in hypocalcaemic haemodialysis patients, (ii) the rapidity of rebound in PTH after calcitriol treatment was stopped, and (iii) whether the effect of calcitriol treatment on PTH levels could be separated from those produced by changes in serum calcium and phosphate values. METHODS Eight haemodialysis patients (29+/-3 years) with hypocalcaemia and hyperparathyroidism were treated thrice weekly with 2 microg of intravenous calcitriol and were dialysed with a 3.5 mEq/l calcium dialysate. Parathyroid function (PTH-calcium curve) was determined before and after 30 weeks of calcitriol treatment and 15 weeks after calcitriol treatment was stopped. RESULTS Pretreatment PTH and ionized calcium values were 907+/-127 pg/ml and 3.89+/-0.12 mg/dl (normal, 4.52+/-0.07 mg/dl). During calcitriol treatment, one patient did not respond, but basal (predialysis) PTH values in the other seven patients decreased from 846+/-129 to 72+/-12 pg/ml, P<0.001 and in all seven patients, the decrease exceeded 85%. During the 15 weeks after calcitriol treatment was stopped, a slow rebound in basal PTH values in the seven patients was observed, 72+/-12 to 375+/-44 pg/ml. Covariance analysis was used to evaluate the three tests of parathyroid function (0, 30, and 45 weeks), and showed that calcitriol treatment was associated with reductions in maximal PTH values while reductions in basal PTH were affected by ionized calcium and serum phosphate. The basal/maximal PTH ratio and the set point of calcium were associated with changes in ionized calcium. CONCLUSIONS In haemodialysis patients with hypocalcaemia, (i) moderate to severe hyperparathyroidism responded well to treatment with calcitriol, (ii) reductions in maximal PTH were calcitriol dependent while reductions in basal PTH were affected by the ionized calcium and serum phosphate concentrations, (iii) changes in the basal/maximal PTH ratio and the set point of calcium were calcium dependent, and (iv) the delayed rebound in basal PTH levels after withdrawal of calcitriol treatment may have been due to the long duration of treatment and the marked PTH suppression during treatment.
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Affiliation(s)
- A Jara
- Department of Nephrology, Hospital Clinico, Pontificia Universidad Catolica de Chile, Marcoleta 345, Santiago, Chile
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Jara A, González S, Felsenfeld AJ, Chacón C, Valdivieso A, Jalil R, Chuaqui B. Failure of high doses of calcitriol and hypercalcaemia to induce apoptosis in hyperplastic parathyroid glands of azotaemic rats. Nephrol Dial Transplant 2001; 16:506-12. [PMID: 11239023 DOI: 10.1093/ndt/16.3.506] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Whether calcitriol administration, which is used to treat secondary hyperparathyroidism in dialysis patients, induces regression of parathyroid-gland hyperplasia remains a subject of interest and debate. If regression of the parathyroid gland were to occur, the presumed mechanism would be apoptosis. However, information on whether high doses of calcitriol can induce apoptosis of parathyroid cells in hyperplastic parathyroid glands is lacking. Consequently, high doses of calcitriol were given to azotaemic rats and the parathyroid glands were evaluated for apoptosis. METHODS Rats were either sham-operated (two groups) or underwent a two-stage 5/6 nephrectomy (three groups). For the first 4 weeks, all rats were given a high (1.2%) phosphorus (P) diet to stimulate parathyroid gland growth and then were changed to a normal (0.6%) P diet for 2 weeks. At week 7, three of the five groups were given high doses of calcitriol (500 pmol/100 g body weight) intraperitoneally every 24 h during 72 h before sacrifice. The five groups during week 7 were: (i) normal renal function (NRF)+0.6% P diet; (ii) NRF+0.6% P+calcitriol; (iii) renal failure (RF)+0.6% P; (iv) RF+1.2% P+calcitriol; and (v) RF+0.6% P+calcitriol. Parathyroid glands were removed at sacrifice and the TUNEL stain was performed to detect apoptosis. RESULTS At sacrifice, the respective serum calcium values in calcitriol-treated groups (groups 2, 4, and 5) were 15.52+/-0.26, 13.41+/-0.39 and 15.12+/-0.32 mg/dl. In group 3, PTH was 178+/-42 pg/ml, but in calcitriol-treated groups, PTH values were suppressed, 8+/-1 (group 2), 12+/-2 (group 4), and 7+/-1 pg/ml (group 5). Despite, the severe hypercalcaemia and marked PTH suppression in calcitriol-treated groups, the percentage of apoptotic cells in the parathyroid glands was very low (range 0.08+/-0.04 to 0.25+/-0.20%) and not different among the five groups. CONCLUSIONS We found no evidence in hyperplastic parathyroid glands that apoptosis could be induced in azotaemic rats by the combination of high doses of calcitriol and severe hypercalcaemia despite the marked reduction in PTH levels that was observed.
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Affiliation(s)
- A Jara
- Department of Nephrology, Pontificia Universidad Católica de Chile, Santiago, Chile
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Casar JC, Valdivieso A, Bravo JA, Chacón C, Boric MP. Reduced natriuresis after oral sodium load in cholestatic rats: role of compartment volumes and ANP. Proc Soc Exp Biol Med 2000; 225:23-31. [PMID: 10998195 DOI: 10.1046/j.1525-1373.2000.22503.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The purpose of this study was to assess the participation of the atrial natriuretic peptide (ANP)-cGMP system in electrolyte and volume handling of cholestatic rats submitted to an acute oral sodium load. Cholestasis was induced by ligation and section of the common bile duct (n = 51). Control rats were sham operated (n = 56). Three weeks after surgery, 24-hr urinary volume, sodium, potassium, cGMP and creatinine excretion were measured. Three days later, animals received 10 mmol/kg NaCl (1 M) by gavage, and urinary excretion was measured for 6 hr. In parallel groups of rats, plasma volume, electrolytes and ANP concentration, extracellular fluid volume (ECFV), and renal medullary ANP-induced cGMP production were determined in basal conditions or 1 hr after oral sodium overload. As compared with controls, cholestatic rats had a larger ECFV and higher plasma ANP (67.2 +/- 5.2 vs 39.7 +/- 3.5 pg/ml), but lower hematocrit and blood volume, and were hyponatremic. Cholestatic rats showed higher basal excretion of sodium, potassium, and volume than controls, but equal urinary cGMP. After the NaCl overload, cholestatic rats showed a reduced sodium excretion but equal urinary cGMP. One hr after sodium overload, both groups showed hypernatremia, but whereas in control rats ECFV and ANP increased (50.7 +/- 4.1 pg/ml), in cholestatic rats ECFV was unchanged, and plasma volume and ANP were reduced (37.5 +/- 5.8 pg/ml). ANP-induced cGMP production in renal medulla was similar in cholestatic and control nonloaded rats (14.2 +/- 5.2 vs 13.4 +/- 2.6 fmol/min/mg). One hr after the load, medullary cGMP production rose significantly in both groups, without difference between them (20.6 +/- 3.1 vs 22.7 +/- 1. 7 fmol/min/mg). We conclude that the blunted excretion of an acute oral sodium load in cholestatic rats is associated with lower plasma ANP due to differences in body fluid distribution and cannot be explained by renal refractoriness to ANP.
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Affiliation(s)
- J C Casar
- Departamento de Ciencias Fisiológicas, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
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Montejo M, Grande C, Valdivieso A, Testillano M, Minguillan J, Aguirrebengoa K, Ortiz de Urbina J. Abdominal abscess due to leuconostoc species in a liver transplant recipient. J Infect 2000; 41:197-8. [PMID: 11023775 DOI: 10.1053/jinf.2000.0705] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Riquelme A, Méndez F, Ortiz AM, Müller H, Campos C, Rocha V, Valdivieso A. [Severe and recent hyponatremia and hypokalemia associated to the use of hydrochlorothiazide, enalapril and citalopram. Clinical case]. Rev Med Chil 1999; 127:1223-8. [PMID: 10835739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
We report a 72 years old hypertensive female, treated with enalapril 10 mg/day and hydrochlorothiazide 25 mg/day during three years. She presented a depressive disorder and cytalopram was prescribed in a dose of 10 mg/day. Two weeks before admission, a serum electrolyte analysis disclosed normal results and the cytalopram dose was increased to 20 mg/day. The patient was admitted with a hyponatremic encephalopathy with a plasma sodium of 100 mEq/L and a plasma potassium of 2.0 mEq/L. Cytalopram, enalapril and hydrochlorothiazide were discontinued, hypertonic NaCl and KCl were administered. The patient had a favorable evolution with a remarkable improvement of her symptoms.
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Affiliation(s)
- A Riquelme
- Departamento de Nefrología, Facultad de Medicina, Pontificia Universidad Católica de Chile
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Valdivieso A. The kidney in chronic liver disease: circulatory abnormalities, renal sodium handling and role of natriuretic peptides. Biol Res 1998; 31:291-304. [PMID: 9830517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
Patients with chronic liver disease (Läennec's cirrhosis) present sodium chloride retention, leading to fluid accumulation within the extracellular space (edema) and specially in the abdomen (ascites). This article reviews the pathogenesis of the hemodynamic abnormalities observed in these patients, particularly the hypothesis of "primary arterial vasodilation", with an increased nitric oxide production by endothelial cells playing a major role in the pathogenesis of vasodilation. Since excessive renal sodium reabsorption precedes ascites formation, two hypotheses are analyzed with respect to the handling of renal sodium in chronic liver disease: the underfilling and overflow theories. Furthermore, the role of natriuretic peptides is reviewed, the increment in atrial natriuretic peptide observed in well compensated cirrhotic patients being considered as a compensatory response to volume expansion, although with renal resistance to this peptide in early stages of the disease. This review ends with an integrated explanation of the circulatory disturbances, renal sodium retention and renal resistance to atrial natriuretic peptide resulting in the sodium and water abnormalities observed in chronic liver disease.
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Affiliation(s)
- A Valdivieso
- Department of Nephrology, Catholic University of Chile, Santiago, Chile
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Aguilera S, López R, Valdivieso A. [Distal renal tubular acidosis and nephrolithiasis in 3 cases of primary Sjögren syndrome]. Rev Med Chil 1996; 124:1467-75. [PMID: 9334481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Tubulo interstitial nephritis, the main manifestation of renal involvement in Sjögren syndrome, may lead to a tubular dysfunction that is usually subclinical. We report three women, aged 32, 35 and 35 years old, with a primary Sjögren syndrome and symptomatic type I or distal tubular acidosis. Two patients had nephrolithiasis and one a nephrocalcinosis. Two had a basal hyperchloremic metabolic acidosis. The ammonium chloride acidification test was abnormal in all, demonstrating a distal tubular defect. None had proximal tubular dysfunction. All had an urinary pH over 6.5 and hypocitraturia and none had hypercalciuria. Renal calculi were composed of calcium oxalate and calcium phosphate in two patients and calcium phosphate and ammonium phosphate in the other. All women had positive antinuclear antibodies with mottled pattern, two had anti Ro antibodies and positive rheumatoid factor and one had hypergammaglobulinemia. None had anti La antibodies, crioglobulinemia or monoclonal proteins.
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Affiliation(s)
- S Aguilera
- Clínica Indisa, Escuela de Medicina, Universidad de Chile
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Aguirre C, Trocóniz IF, Valdivieso A, Jiménez RM, González JP, Calvo R, Rodríguez-Sasiaín JM. Pharmacokinetics and pharmacodynamics of penbutolol in healthy and cancer subjects: role of altered protein binding. Res Commun Mol Pathol Pharmacol 1996; 92:53-72. [PMID: 8733828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The pharmacokinetic and pharmacodynamic profiles of penbutolol were examined in healthy volunteers and in cancer patients using a pharmacokinetic/pharmacodynamic (pk/pd) model. After receiving a 40 mg single oral dose of penbutolol, the absorption rate constant, apparent volume of distribution and serum clearance of penbutolol were found to be reduced in the cancer group. Changes in the disposition of the conjugate metabolite were also observed in the cancer patients. Penbutolol unbound fraction in serum was statistically decreased (p < 0.005) in the cancer group, according to the increase in the serum levels of alpha 1-acid glycoprotein seen in that group (p < 0.05). The pharmacodynamic effect of penbutolol was measured as the reduction in heart rate (HR); in healthy volunteers, a linear relationship (p < 0.01) between effect and penbutolol serum concentrations (total or unbound) was found. In contrast, in cancer patients, values of HR did not vary statistically in respect to baseline values. These results show that in cancer patients, a change in the pharmacokinetics of penbutolol occurs (associated with changes in drug protein binding), together with an alteration in the pharmacodynamics.
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Affiliation(s)
- C Aguirre
- Department of Pharmacology, School of Medicine, University of Basque Country, Leioa, Vizcaya, Spain
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Andresen M, Letelier LM, Dougnac A, Espejo J, Valdivieso A. Hemodynamics effects of methylene blue (MB) in patients with liver disease (LD). Intensive Care Med 1996. [DOI: 10.1007/bf01921198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Gonzalez JP, Valdivieso A, Calvo R, Rodríguez-Sasiaín JM, Jimenez R, Aguirre C, du Souich P. Influence of vitamin C on the absorption and first pass metabolism of propranolol. Eur J Clin Pharmacol 1995; 48:295-7. [PMID: 7589058 DOI: 10.1007/bf00198315] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The effect of ascorbic acid on the availability of propranolol has been examined. After oral administration of propranolol 80 mg with or without ascorbic acid pretreatment (2 g), the plasma concentrations and urinary excretion of propranolol and its metabolites, 4-hydroxy-propranolol and propranolol-conjugated, were determined by HPLC. Compared to controls, vitamin C decreased the maximum concentration of propranolol from 463 to 334 nmol.l-1, and the area under the propranolol concentration-time curve (from 0 to 24 hours) from 3.13 to 1.96 mumol.l-1.h. The time to reach maximum propranolol concentration was increased from 1.9 to 2.7. The total amount of drug recovered in urine has also significantly diminished (from 12.6 to 4.29 mg). No change in elimination rate was observed, indicating that ascorbic acid had affected both the absorption process and the first pass metabolism. The heart-rate decreased less when propranolol was administered with ascorbic acid in comparison to control subjects, although this interaction has little biological importance.
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Affiliation(s)
- J P Gonzalez
- Department of Pharmacology, Faculty of Medicine, University of the Basque Country, Vizcaya, Spain
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Affiliation(s)
- A Valdivieso
- Department of Surgery, Galdakao Hospital, University of the Basque Country, Galdakao-Vizcaya, Spain
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Valdivieso A, Calvo R, Suarez E, Gonzalez JP. Propranolol absorption in peptic ulcer disease. Scand J Gastroenterol 1993; 28:643-6. [PMID: 8362221 DOI: 10.3109/00365529309096104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This study was designed to determine whether gastroduodenal ulcer influences propranolol absorption. Eleven patients with peptic ulcer disease and eight healthy subjects received 80 mg of propranolol orally. Serum propranolol levels were measured with high-performance liquid chromatography. Ulcer patients showed a significant decrease in mean peak concentration of propranolol (90 +/- 12 ng/ml versus 151 +/- 23 ng/ml) (p < 0.025), in the absorption constant (1.43 +/- 0.21 h-1 versus 0.96 +/- 0.12 h-1) (p < 0.05), and in the area under concentration-time curve (802 +/- 129 ng/ml.h versus 492 +/- 73 ng/ml.h) (p < 0.05). No significant difference was seen in drug effect on the heart at 90 min. We conclude that propranolol is absorbed more slowly in ulcer patients than in healthy subjects, but this delay has no clinical effect after a single dose.
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Affiliation(s)
- A Valdivieso
- Dept. of Surgery, Galdakano Hospital, Vizcaya, Spain
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Valdivieso A, Calvo R, Gonzalez JP, Mugica JA, Suarez E. Influence of several surgical techniques in peptic ulcer disease on the oral kinetic of a basic drug. Acta Chir Belg 1993; 93:88-91. [PMID: 8372590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The effect of gastric surgery on the absorption of a basic drug propranolol was studied in 11 patients. 80 mg of propranolol were administered orally before and after surgery. Irrespective of the surgical technique, there was only a significant decrease in the absorption constant Ka (1.10 +/- 0.14 vs 0.72 +/- 0.09) (p < 0.05), indicating a delay in the gastrointestinal absorption, which agreed with the delay in the urine excretion in the first six hours after surgery (6.8 +/- 0.8 vs 1.7 +/- 0.4) (p < 0.001). Patients with vagotomy but without gastric resection showed a significant increase in the time of attainment of peak concentration tmax (2.4 +/- 0.2 vs 3.2 +/- 0.3), and decrease in Ka (1.5 +/- 0.12 vs 0.73 +/- 0.17) (p < 0.05), indicating also a delay in the gastrointestinal absorption, that is not seen in patients with partial gastric resection. We conclude that vagotomy with gastric resection does not modify the absorption of propranolol, and vagotomy without resection delays its absorption but does not decrease it.
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Valdivieso A, Mardones JM, Loyola MS, Cubillos AM. [Hypomagnesemia associated with hypokalemia, hyponatremia and metabolic alkalosis. Possible complication of gentamycin therapy]. Rev Med Chil 1992; 120:914-9. [PMID: 1340968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Hypomagnesemia is a serious abnormality with different causes and usually associated to other disorders of electrolyte metabolism. We report a female patient developing hypomagnesemia after administration of gentamycin. This was associated to severe hypokalemia, hyponatremia and metabolic alkalosis. Possible pathogenetic mechanisms and therapeutic measures are discussed.
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Affiliation(s)
- A Valdivieso
- Departamento de Nefrourología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago
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