[Statement of the Spanish Interdisciplinary Vascular Prevention Committee on the updated European Guidelines on Cardiovascular Disease Prevention]

Statement of the Spanish Interdisciplinary Vascular Prevention Committee on the updated European Guidelines on Cardiovascular Disease Prevention. We present the Spanish adaptation of the 2021 European Guidelines on Cardiovascular Disease (CVD) prevention in clinical practice. The current guidelines besides the individual approach greatly emphasize on the importance of population level approaches to the prevention of cardiovascular diseases. Systematic global CVD risk assessment is recommended in individuals with any major vascular risk factor. Regarding LDL-Cholesterol, blood pressure, and glycemic control in patients with diabetes mellitus, goals and targets remain as recommended in previous guidelines. However, it is proposed a new, stepwise approach (Step 1 and 2) to treatment intensification as a tool to help physicians and patients pursue these targets in a way that fits patient profile. After Step 1, considering proceeding to the intensified goals of Step 2 is mandatory, and this intensification will be based on 10-year CVD risk, lifetime CVD risk and treatment benefit, comorbidities and patient preferences. The updated SCORE algorithm-SCORE2, SCORE-OP- is recommended in these guidelines, which estimates an individual's 10-year risk of fatal and non-fatal CVD events (myocardial infarction, stroke) in healthy men and women aged 40-89 years. Another new and important recommendation is the use of different categories of risk according different age groups (< 50, 50-69 ≥ 70 years). Different flow charts of CVD risk and risk factor treatment in apparently healthy persons, in patients with established atherosclerotic CVD, and in diabetic patients are recommended. Patients with chronic kidney disease are considered high risk or very high-risk patients according to the levels of glomerular filtration rate and albumin-to-creatinine ratio. New lifestyle recommendations adapted to the ones published by the Spanish Ministry of Health as well as recommendations focused on the management of lipids, blood pressure, diabetes and chronic renal failure are included.

Germline pathogenic variants among Mexican patients with adenocarcinoma of the pancreas

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Background: The reported frequency of germline pathogenic variants (PVs) in patients with pancreatic cancer is 8-10%. Depending on the setting, pancreatic cancer-associated germline PVs in the BRCA and CDKN2A genes are the most commonly detected. The mismatch repair genes (MMR; Lynch syndrome) , TP53, STK11, ATM and PALB2 are also associated with an increased risk of pancreatic cancer . The identification of PVs in patients with pancreatic cancer is important as there may be a benefit of targeted therapies, such as PARP inhibitors for cases with defective double strand break repair or response to immunotherapy with defective MMR and high tumor mutational burden. Additionally, identification of predisposing PVs can enable screening and prevention for other family members through cascade testing. According to international guidelines, all patients diagnosed with exocrine pancreatic cancer are candidates for genetic testing. However, there is an underrepresentation of ethnic/ racial minorities, including Hispanic patients, in genetic studies. Methods: Between April 2017 and May 2020, patients with diagnosis of pancreatic adenocarcinoma who were treated at the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán and enrolled in the international Clinical Cancer Genomics Community Research Network registry were included in this analysis. Genetic testing was performed by full sequencing of the following genes: BRCA1, BRCA2, TP53, NF1, ATM, CHEK2, PALB2, CDKN2A, BRIP1, RAD50, RAD51C, RAD51D, MLH1, MSH2, MSH6, PMS2 and EPCAM, as well as multiplex ligation-dependent probe amplification for selected genes and BRCA1 ex9-12del (Mexican founder mutation) screening with a three-primer polymerase chain reaction. Pedigrees, clinical and demographic data were obtained from the clinical records. Results: Forty-two patients with a diagnosis of pancreatic adenocarcinoma were included, with a median age at diagnosis of 57 years (range, 43-79), and 23/42 (55%) were women. The proportion of cases with operable, unresectable and metastatic disease at diagnosis was similar (33.3% for each group). The frequency of PVs was 11.9% ( ATM n =2, TP53 n =1, PALB2 n =1 and CHEK2 n =1). With a median follow-up 20 months 29/42 patients had died at the time of analysis (69%), the median overall survival was 16 months (range 3-84 months). No PVs were detected in the 4/42 patients who met the definition of familial pancreatic cancer (9.5%). Conclusions: Our results confirm the presence of PVs in cancer susceptibility genes in Mexican patients with pancreatic cancer, which is similar to that reported in other populations. However, it is notable that no BRCA PVs were identified in this small sample, as they are the most common PV found in other populations. Given to the heterogeneity of the PVs identified, our study supports the use of multi- gene panel testing in Hispanic patients with pancreatic cancer.

Panorama of the Intracellular Molecular Concert Orchestrated by Actinoporins, Pore-Forming Toxins from Sea Anemones

Actinoporins (APs) are soluble pore-forming proteins secreted by sea anemones that experience conformational changes originating in pores in the membranes that can lead to cell death. The processes involved in the binding and pore-formation of members of this protein family have been deeply examined in recent years; however, the intracellular responses to APs are only beginning to be understood. Unlike pore formers of bacterial origin, whose intracellular impact has been studied in more detail, currently, we only have knowledge of a few poorly integrated elements of the APs’ intracellular action. In this review, we present and discuss an updated landscape of the studies aimed at understanding the intracellular pathways triggered in response to APs attack with particular reference to sticholysin II, the most active isoform produced by the Caribbean Sea anemone Stichodactyla helianthus. To achieve this, we first describe the major alterations these cytolysins elicit on simpler cells, such as non-nucleated mammalian erythrocytes, and then onto more complex eukaryotic cells, including tumor cells. This understanding has provided the basis for the development of novel applications of sticholysins such as the construction of immunotoxins directed against undesirable cells, such as tumor cells, and the design of a cancer vaccine platform. These are among the most interesting potential uses for the members of this toxin family that have been carried out in our laboratory.

Uncommon tumors in multiple endocrine neoplasia (MEN) type 1: Do they have a relationship with the prognosis of these patients?

INTRODUCTION

The prognosis of MEN 1 patients is not only determined by pancreatic disease; it is also related to other uncommon tumors. The objective of this study is to analyze the tumors associated with MEN 1 outside the classic triad and to investigate their relationship with mortality.

MATERIALS AND METHODS

One hundred and five MEN 1 patients were studied in a tertiary referral hospital (1980-2019).

RESULTS

With a follow-up of 11 ± 4 years, seven patients died (8%), four as a consequence MEN syndrome. Thirty-three percent had adrenal gland tumors. One patient died of adrenal cancer. Eight percent presented with a neuroendocrine thoracic neoplasm, and one patient died. Another patient died due to cutaneous T-cell lymphoma. A further patient died because of a gastrinoma with liver metastasis.

CONCLUSIONS

To conclude, 75% of MEN-related deaths were the result of an uncommon pathology, and we, therefore, recommend that these tumors should be taken into account in the screening and follow-up of these patients.

Assessment of artifacts reduction and denoising techniques in Electrocardiographic signals using Ensemble Average-based method

BACKGROUND AND OBJECTIVE

Outpatient vital signs monitoring has a key role in medical diagnosis and treatment. However, ambulatory vital signs monitoring has great challenges to overcome, being the most important, the reduction of noise and Motion Artifacts, which hide essential information, particularly in Electrocardiographic signals. Despite efforts being made to reduce these artifacts, a comparative performance assessment of proposed techniques does not exist to the best of our knowledge and there are no enhancement level measurements obtained by the signals in the artifacts reduction. This article presents a new method based on Ensemble Average for the performance comparison of reported techniques for the processing and reduction of noise and artifacts in Electrocardiographic signals.

METHODS

The comparison was done using a dataset composed by six synthetic noised Electrocardiographic signals and six real one acquired from healthy volunteers that intentionally introduced Motion Artifacts. Several techniques that have reported positive results in the enhancement of Electrocardiographic signals were applied to this dataset to compare their performance in the reduction of Motion Artifacts. The Signal-to-Noise Ratio and the Ensemble Average as a distortion measurement were used to compare the performance of algorithms to produce an enhanced signal.

RESULTS

In agreement to previous reports, all studied methods show a significant improvement of the Signal-to-Noise Ratio. Concerning the distortion of the waveform, although all methods caused high distortion on the enhanced signal waveform, the Wavelet-ICA method showed the best performance. The percentage of signal distortion introduced by denoising techniques was evaluated through the proposed Ensemble Average Electrocardiographic method.

CONCLUSIONS

It was found that the proposed method based on Ensemble Average offers a complementary way to measure the performance of denoising techniques when considering the introduced distortion in the waveform segments once the artifact reduction process was applied and not only the change in the Signal-to-Noise Ratio.

Limited sampling strategy to predict the area under the curve of tacrolimus in Mexican renal transplant pediatric patients receiving Prograf® or non-innovator formulations

TDM of tacrolimus is usually performed with trough levels (C_0h ). However, in pediatric patients, C_0h may not be an adequate marker. The AUC is considered a more suitable indicator of drug exposure. As several blood samples are needed for the estimation of AUC, and LSS for predicting tacrolimus AUC and optimizing the dose adjustment have been proposed. Moreover, in emerging countries such as Mexico, non-innovator formulations, which bioequivalence has not been demonstrated, are frequently used. Hence, the aim of this study was to develop and validate a LSS to predict the tacrolimus AUC_0-12h in Mexican pediatric kidney transplant recipients who received either Prograf^® or non-innovator tacrolimus formulations. A total of 56 pharmacokinetic profiles were randomized into two groups: model development (n = 28) and model validation (n = 28). The limited sampling equations were obtained after a stepwise multiple regression using AUC as the dependent variable and tacrolimus blood concentrations, quantified by CMIA, at different time points as the independent variables. The final equation included observed concentrations at 1 hour (C_1h ) and 4 hours (C_4h ) after dose administration. The predictive performance of the model was adequate in terms of both, bias and precision. Results strongly suggest that the clinical use of this LSS could provide an ethical, cost-, and time-effective method in the TDM of tacrolimus in pediatric patients with kidney transplant. The model proved to be adequate with either Prograf^® or non-innovator tacrolimus formulations of dubious bioequivalence.

A Multicentre and stratified study of the attitude of medical students towards organ donation in Spain

INTRODUCTION

Medical students represent a new generation of medical thought, and if they have a favourable attitude towards organ donation this will greatly encourage its promotion.

OBJECTIVE

To analyse the attitude of medical students in Spanish universities towards the donation of their own organs and to determine the factors affecting this attitude.

MATERIAL AND METHODS

Type of study: A sociological, interdisciplinary, multicentre, and observational study in Spain.

STUDY POPULATION

Students studying a degree in medicine enrolled in Spain (n = 34,000).

SAMPLE SIZE

A sample of 9598 students (confidence of 99% and precision of ±1%), stratified by geographical area and academic year. Instrument of measurement: A validated questionnaire of attitude towards organ donation and transplantation (PCID-DTO RIOS) was self-administered and completed anonymously.

RESULTS

The questionnaire completion rate was 95.7% (n = 9.275). 80% were in favour of donation, 2% against and 18% were undecided. The following main variables were related to a favourable attitude: being of the female sex (Odds Ratio = 1.739); being in the sixth year of the degree (OR = 2.506); knowing a donor (OR = 1.346); having spoken about the subject with one's family (OR = 2.132) and friends (OR = 1.333); having a family circle that is in favour, more specifically, having a father (OR = 1.841), mother (OR = 2.538) or partner in favour (OR = 2.192); being a blood donor (OR = 2.824); acceptance of the mutilation of the body if it were necessary (OR = 2.958); and being an atheist or an agnostic (OR = 1.766).

CONCLUSIONS

Spanish medical students generally have a favourable attitude towards organ donation, although 20% are not in favour.

Sensitization Toward Organ Donation Among Medical Students in Spanish Regions With More Than 50 Donors Per Million Population

The awareness of organ donation among health professionals is important at the time of transplant promotion. In this sense, the training and awareness of the professionals in training is fundamental.

OBJECTIVE

To analyze the differences in the attitude toward organ donation and the factors that condition it among medical students of regions with donation rates >50 donors per million population (pmp) with respect to those with rates <40 donor pmp.

METHOD

Population under study: medical students in Spanish universities. Database of the Collaborative International Donor Project, stratified by geographic area and academic course. The completion was anonymous and self-administered. Groups under study: Group 1 (n = 1136): students in universities of regions with >50 donors pmp. Group 2 (n = 2018): university students in regions with <40 donors pmp. Assessment instrument: attitude questionnaire for organ donation for transplant PCID-DTO-Ríos.

RESULTS

The attitude toward organ donation for transplantation is similar among students from the autonomous communities with >50 donors pmp and with <40 donors pmp. In group 1, 79% (n = 897) of students are in favor compared with 81% (n = 1625) of group 2 (P=.29). The psychosocial profile toward donation is similar in both groups relating to the following variables (P < .05): sex, having discussed transplantation with family and as a couple, considering the possibility of needing a transplant, involvement in prosocial activities, attitude toward the manipulation of corpses, knowledge of the brain death concept, and religion.

CONCLUSIONS

The awareness of organ donation in Spanish medical students is quite homogeneous and is not related to the local donation rates of each region.

There Is Great Ignorance About the Brain Death Concept Among the Population in Santiago de Cuba (Cuba)

INTRODUCTION

The knowledge of the brain death (BD) concept is important when determining the attitude toward organ donation.

OBJECTIVE

To analyze the level of knowledge of the BD concept among the population in Santiago de Cuba and determine the factors that condition it.

METHODS

From the Collaborative International Donor Project, we obtained a sample of Cubans living in the area of Santiago de Cuba (n = 455). The attitude was assessed using a validated questionnaire (PCID-DTO-RIOS). The survey was self-administered and completed anonymously. Student t test, χ², Fisher, and logistic regression analysis were used.

RESULTS

Forty percent (n = 180) of the respondents know the BD concept and consider it as the death of an individual. Of the rest, 43% (n = 199) do not know about it, and the remaining 17% (n = 76) consider that it does not mean the death of a patient. The variables significantly related to the correct knowledge of BD in the multivariate analysis and considered as independent are: level of studies; the opinion of the couple toward organ donation; the religion of the respondent; having offspring; and a favorable attitude toward organ donation.

CONCLUSION

There is ignorance about the brain death concept among the population of Santiago de Cuba. This lack of knowledge has a direct relationship with various psychosocial factors.

Attitude Toward Organ Donation in the Population of Cienfuegos, Cuba

INTRODUCTION

The sensitization of the population toward organ donation is fundamental; for that reason, it is important to determine the factors that condition the opinion toward donation on the population scope in order to carry out cost-effective campaigns.

OBJECTIVE

To analyze the attitude toward the donation of the proper organs for transplantation among the population residing in Cienfuegos, Cuba.

METHOD

Population under study: Population who reside in Cienfuegos, Cuba.

INCLUSION CRITERIA

Population over 15 years old as stratified by age and sex. Assessment instrument: The attitude questionnaire for organ donation for transplant-PCID-DTO Ríos. Fieldwork: A random selection based on stratification. The available data from the census were used. The completion was anonymous and self-administered. Verbal consent was requested to collaborate in the study.

STATISTICS

Student t test, χ², Fisher, and a logistic regression analysis.

RESULTS

A sample of 636 respondents was included in the study, of which 71% (n = 453) are in favor of donating their organs after death, 16% (n = 103) are against, and 13% (n = 80) are undecided. This attitude is associated with different psychosocial variables (P < .001): age, marital status, having offspring, level of studies, carrying out prosocial activities, discussing with the family the subject of donation and transplantation, knowledge of the concept of brain death, the attitude toward the manipulation of the corpse, the religion of the respondent, and the attitude of the couple toward organ transplantation. The main independent factors obtained in the multivariate analysis (odds ratio >2.5): knowledge of the brain death concept, attitude toward the manipulation of the corpse, religion, and attitude of the couple toward transplantation.

CONCLUSIONS

The attitude toward organ donation among the population of Cienfuegos, Cuba, is favorable and is conditioned by several psychosocial factors.

Gypsy Population Presents a Favorable Attitude Toward Related Living Donation

INTRODUCTION

Negative organ donation rates among the Gypsies is much higher than that of any other social group in Spain. However, living donation rates have not been raised much in this social group, despite the existence of several Gypsy patients on the waiting list for transplantation.

OBJECTIVE

To analyze the attitude toward related living donation among the Gypsy population who reside in Spain.

METHODS

This type of study is an observational sociological study. The study consisted of the adult Gypsy population residing in Spain, and a random sampling of 230 adult gypsies was conducted. Attitude questionnaires for live donation, both hepatic PCID-DVH-Ríos and renal PCID-DVR-Ríos, were used, and random selection was based on stratification. Questionnaires were self-administered and completed anonymously. Student t test, χ2, Fisher, and a logistic regression analysis were used.

RESULTS

A sample of 206 Gypsies (52% women) with a mean age of 34 years is obtained. Seventy-two percent (n = 150) would donate an organ to a relative in life, 8% (n = 16) would not donate it, and 20% (n = 41) have doubts. Respondents with a favorable attitude toward living donation presented a more favorable attitude toward cadaveric organ donation (55% vs 0%, P < .001). The attitude toward living kidney donation was more favorable (81% in favor) than toward living liver donation (P < .001).

CONCLUSIONS

The Gypsy ethnic group is sensitized to live donor transplantation. The family and cultural roots of Gypsy people could condition this favorable attitude, a fact to be taken into account to sensitize this social group and promote donation campaigns with the aim of increasing donation rates.

What Is the Attitude Toward Cadaveric Organ Donation of the Ghanian Residents in Spain?

INTRODUCTION

The Ghanaian population is migrating toward the European economic community, especially toward the southern countries.

OBJECTIVE

To analyze the attitude toward organ donation among the population born in Ghana but currently residing in Spain.

METHOD

The study included the population born in Ghana who are ≥ 15 years of age and residents of Spain, stratified by age and sex. The assessment instrument used is the donation and transplant attitude questionnaire of Proyecto Colaborativo Internacional Donante (PCID-DTO Ríos), which was self-administered and anonymously completed with verbal consent. The statistics used were descriptive, χ², Student t test, and a logistic regression analysis.

RESULTS

The questionnaire was completed by 237 Ghanaians. Forty-three percent (n = 102) are in favor of cadaveric organ donation, 35% (n = 83) are against donating their own organs, and 20% (n = 48) are undecided. In the multivariate analysis, the association was maintained at the level of the primary studies (P < .001, OR = 25), not being afraid of possible mutilation after donating (P < .001, OR = 76.923), religion (P < .001; OR = 27.777), performing prosocial activities (P = .016, OR = 12.048), and having previously commented on the issue of organ donation and transplantation in the family setting (P = .012, OR = 4.878).

CONCLUSIONS

The Ghanaian immigrant population in Spain has an unfavorable attitude toward the donation of their own organs at death, which is conditioned by multiple psychosocial factors.

Validation of the Attitude Toward Living Liver Donation Questionnaire (PCID-DVH-Ríos) in Spanish-Speaking Populations: Characteristics and Psychometric Properties

INTRODUCTION

Given the lack of a sufficient number of livers available for transplantation, living liver donation (LLD) is being developed in the Spanish-speaking world. Knowing the population's attitude toward this donation will help in designing more effective campaigns to increase the number of such donations. However, there are few validated questionnaires.

OBJECTIVE

To analyze the psychometric characteristics of questionnaire PCID-DVH-Ríos [questionnaire of the International Collaborative Donor Project about Living Liver Donation ("Proyecto Colaborativo Internacional Donante sobre Donación de Vivo Hepático" in Spanish) developed by Dr. Ríos, in order to validate the questionnaire for the Spanish-speaking population.

METHODS

The study population comprised native Spanish citizens. A sample of the population was obtained randomly and stratified by age and sex (N = 600) according to the following: 1. being older than 18 years; 2. being Spanish; and 3. living in Spain. Attitude was assessed using a validated questionnaire of attitude toward liver donation (PCID-DVH-Ríos). This questionnaire included items distributed into subscales or factors, an initial description of the data, an exploratory factor analysis, and an internal consistency analysis.

RESULTS

The questionnaire consists of a total of 11 items, distributed into 3 subscales: 1. factor 1 (6 items); 2. factor 2 (3 items); and 3. factor 3 (2 items), presenting a total explained variance of 63.995%. The factors have an explained variance of F1: 38.461%; F2: 14.228%; and F3: 11.306%, respectively. The analysis of items and internal consistency supported the 3 factors' composition. The internal consistency of each factor is as follows: α1 = 0.80; α2 = 0.70; and α3 = 0.55, respectively.

CONCLUSIONS

The dimensions analyzed in the PCID-DVH-Ríos questionnaire on attitudes toward living liver donation show a good fit in relation to their factorial validity and internal consistency values.

Are Senegalese Immigrants Residing in Spain in Favor of Organ Donation?

The Senegalese population is an emerging group in Europe. The number of foreign residents in Spain, France, and Italy has increased significantly. However, there are no studies that analyze their awareness of organ donation and transplantation.

OBJECTIVE

To analyze the attitude toward organ donation among the population born in Senegal residing in Spain.

METHODS

The study population was born in Senegal and resides in Spain. A sample of the population older than 15 years was obtained randomly and stratified by age and sex according to census data and immigrant support associations. Attitude was assessed using a validated questionnaire on psychosocial aspects toward organ donation (PCID-DTO Rios). A random selection of people to be surveyed was carried out. Assistance from African immigration support associations in Spain was needed to advise on the location of potential respondents. The survey was self-administered and completed anonymously.

RESULTS

A sample of 295 respondents was included in the study. Attitude toward deceased donation was favorable in 37% (n = 109) of respondents; 35% (n = 104) were against and 28% (n = 82) were undecided. Several variables were associated with having a more favorable attitude (P < .05): sex, having discussed donation with the family, not being concerned about the possible mutilation of the body after donation, the respondent's religion, and knowledge of one's partner's attitude in favor of organ donation.

CONCLUSIONS

The attitude toward organ donation among the population born in Senegal and residing in Spain is unfavorable, and it is associated with psychosocial factors.

Multivariate Analysis of the Factors Affecting Attitude Toward Organ Donation Among the Ecuadorian Population Residing in Spain

INTRODUCTION

Immigrants from Ecuador represent the largest group of Latin Americans in Spain and are, therefore, a subgroup of interest to understand their attitudes and influences in respect to organ donation and transplantation.

OBJECTIVE

To analyze the attitude of nationals of Ecuador residing in Spain regarding deceased organ donation.

METHODS

The study population included the Ecuadorian population residing in Spain. A sample of population older than 15 years was obtained randomly and stratified by age and sex (n=461). Attitude was assessed using a validated questionnaire on psychosocial aspects toward organ donation (PCID-DTO-Ríos). Assistance from immigration support associations in Spain was needed to advice on the location of potential respondents.

RESULTS

Attitude toward cadaveric donation was favorable in 59% (n=271) of respondents, 12% (n=57) were against cadaveric donation, and 29% (n=133) were undecided. Several variables were associated with having a more favorable attitude. In the multivariate analysis, the following variables were independently associated with a more positive attitude toward organ donation: 1. level of formal education (odds ratio [OR]=6.849 [25.641-1.818]; P = .004); 2. being in favor of donating a family member's organs (OR=8.849 [20.833-3.717]; P < .001); 3. having commented at a family level about transplant (OR=3.717 [6.578-2.109]; P < .001); 4. not being concerned about the possible mutilation of the body after donation (OR=4.608 [8.547-2.487]; P < .001) and 5. knowing the attitude of one's religion toward donation (OR=7.462 [34.482-1.623]; P = .010).

CONCLUSIONS

The attitude toward cadaveric organ donation among the Ecuadorian population residing in Spain is less favorable than that of the Spanish population and is determined by many different psychosocial variables.

Attitude Toward Organ Donation and Transplantation in Veterinary Students: A Multicenter and Stratified Study in Spain

BACKGROUND

Veterinarians often hold decision-making positions in the public health care system and can therefore influence public opinion about organ donation and transplantation (ODT). The aim of this work was to analyze the attitude of Spanish veterinary students toward ODT, because they may influence public opinion in the future, and to determine the factors that condition it.

METHODS

This was a sociologic, interdisciplinary, multicenter, observational study in Spain. The study population was students studying for a veterinary degree in Spain (n = 9000), and a sample of 2815 students (confidence of 99% and precision of ±1%) was stratified by geographic area and academic year. A validated questionnaire of attitude toward ODT (PCID-DTO-Ríos) was self-administered and anonymous.

RESULTS

Of the 2815 selected students (2790 plus the 0.9% per type of sample), 2650 completed the questionnaire (response rate, 94.14%): 83% (n = 2207) of the respondents were in favor of donation and 17% against. The following main variables were related to a favorable attitude: being female (odds ratio [OR], 0.752; P = .034); knowing a donor (OR, 1.834; P = .003); having discussed the matter with one's family (OR, 1.587; P = .002); having spoken about the subject in social circles with friends (OR, 1.633; P < .001), and being in favor of donating a deceased family member's organs (OR, 2.403; P < .001).

CONCLUSIONS

Seventeen percent of Spanish veterinary students were not in favor of ODT. It is important to know the factors that determine their attitude, because this will make it possible to optimize the resources invested in campaigns to promote ODT and to take more specific action.

Attitude Toward Organ Donation Related to Personal Preferences for the Final Disposition of the Dead Body in Nursing Students in Southeast Spain

INTRODUCTION

In organ donation and transplantation (ODT) and in nursing students, it is important to know the preferences about the final destination of the body once deceased. Whether these future professionals are afraid of this issue could influence their attitude toward ODT and future donation rates.

OBJECTIVE

To analyze the attitude of nursing students toward cremation, burial, and autopsy and to determine the factors affecting this attitude.

METHODS

A sociologic, interdisciplinary, multicenter, and observational study included nursing diploma students (n = 750) from 2010 to 2011 at 3 universities in the southeast of Spain. A validated questionnaire (PCID-DTO RIOS) was self-administered and completed anonymously.

RESULTS

Questionnaire completion rate was 92% (n = 687), with 71% (n = 486) of students accepting cremation as a body treatment after death. Those who were not worried about the possible mutilation of the body after donation (P < .05) and those who were in favor of deceased donation (P < .001) had a greater degree of acceptance. Of the students, 43% (n = 278) would accept burial of their body, which was related with being in the second year (P < .05) of study. Finally, 86% (n = 586) of students would accept an autopsy being carried out, if necessary, and this was related with the attitude toward ODT (P = .004).

CONCLUSIONS

A high percentage of nursing students would accept an autopsy being carried out. This degree of acceptance was related with a favorable attitude toward organ donation. The appropriate training of future nurses in ODT process will optimize their promotion.

Guinean Population Emigrant to Spain Has Very Little Awareness of the Donation and Transplantation of Organs

INTRODUCTION

The Guinean population is an emerging group in Europe, but the group's awareness of organ donation and transplantation has not been studied.

OBJECTIVE

To analyze the attitude toward organ donation among the population born in Guinea living in Spain.

METHODS

The population older than 15 years, born in Guinea, and resident in Spain was studied, stratified by age and sex, according to census data and immigrant assistance associations. The valuation tool used was the attitude questionnaire toward organ donation PCID-DTO RIOS (questionnaire on "Donor International Collaborative Project" on organ donation and transplantation developed by Dr Ríos). A random selection of people to survey was based on stratification. Support from African immigration support associations was needed to advise on the location of potential respondents. The completion was anonymous and self-administered. A descriptive statistic was performed, and Student t, χ², and Fisher tests and a logistic regression analysis were applied.

RESULTS

In all, 181 Guineans were surveyed, of whom 32% (n = 58) were in favor of the donation of their own organs after death, 32% (n = 57) were against, and 36% (n = 66) were undecided. The variables that are associated with attitude toward donation are separated mainly into 4 large groups (P < .001): (1) knowledge about the process of donation and organ transplantation; (2) attitude toward the manipulation of the body; (3) religious variables; and (4) sociofamily variables, especially in relation to the couple.

CONCLUSIONS

The Guinean population emigrant to Spain has an unfriendly attitude toward organ donation.

Emigration From Puerto Rico to Florida: Multivariate Analysis of Factors That Condition Attitudes of the Puerto Rican Population Toward Organ Donation for Transplant

BACKGROUND

The Puerto Rican population represents one of the largest immigration groups in Florida, and this has an impact on the organ transplant donation process. Our aim was to analyze attitudes toward organ donation among Puerto Ricans who currently reside in the state of Florida (USA).

METHODS

The population screened consisted of individuals >15 years old, who were born in Puerto Rico, living in Florida, and awaiting organs for transplant. All participants completed the "PCID-DTO Rios" questionnaire. Random selection was done according to stratification. Support from immigration associations in Spain was needed for advice on the locations of potential respondents. Study participation was anonymized and self-administered.

RESULTS

There were 259 respondents, 37% (n = 95) were in favor of donation, 36% (n = 93) were against donation, and 27% (n = 71) were undecided. The variables associated with these attitudes were: age (P = .017); civil status (P = .021); level of education (P < .001); previous experience with donation and transplant (P < .001); attitude toward organ donation of a relative (P < .001); carrying out pro-social activities (P < .001); discussing the issue of transplant with the family (P < .001) or couple (P < .001); attitude toward incineration (P < .001), burial (P < .001), and autopsy (P < .001); fear of mutilation after donation (P < .001); and religious beliefs (P < .001). In the multivariate study, it remained an independent variable to have discussed the issue at the family level (odds ratio = 11.627; P = .009).

CONCLUSION

The Puerto Rican study population residing in Florida has an unfavorable attitude toward organ donation.

Psychosocial Factors Affecting Attitude Toward Organ Donation in Santiago, Cuba

INTRODUCTION

Awareness about organ donation among the general population is fundamental to organ donation programs. It is important to determine the factors that influence attitudes toward organ donation within the general population in order to carry out cost-effective campaigns.

OBJECTIVE

To analyze the attitude toward organ donation among Santiago, Cuba, citizens.

METHODS

The study population encompassed residents in Santiago, Cuba. A sample population of residents older than 15 years was obtained randomly and stratified by age and sex. Attitude was assessed using a validated questionnaire on psychosocial aspects toward organ donation and transplant (PCID-DTO Ríos). Available census data were used. The survey was self-administered and completed anonymously.

RESULTS

Of the 455 respondents, 70% of respondents are in favour of cadaveric donation, 16% are against, and 14% were undecided. Several variables were associated with having a more favorable attitude. And in the multivariate analysis, the following variables continue to feature as independent variables: 1. knowledge of the concept of brain death [OR = 2.386 (4.761-1.194); P = .014]; 2. being in favor of donating a family member's organs [OR = 3.067 (5.952-1.584); P = .001]; 3. a partner's favorable attitude [OR = 5.795 (1.477-22.731); P = .012]; 4. being an atheist/agnostic as the religious beliefs [OR = 1.845 (3.289-1.038); P = .037]; 5. not being concerned about the possible mutilation of the body after donation [OR = 7.437 (2.918-18.955); P < .001]; 6. not accepting other treatment options after death, such as inhumation [OR = 3.048 (5.714-1.626); P = .001].

CONCLUSIONS

The attitude toward cadaveric organ donation among the Santiago, Cuba population is favorable and it is associated with several psychosocial factors.

Factors That Affect the Attitudes of the Bolivian Population in Spain With Regard to Organ Donation for Transplant

BACKGROUND

The Bolivian population is an emerging Latin American immigrant group in Spain, several of whom have been transplanted or are awaiting transplant. We aimed to assess attitudes toward organ donation among Bolivians currently residing in Spain.

METHOD

The population screened was born in Bolivia but living in Spain, stratified by gender and age. The appraisal tool used was a questionnaire that assesses attitudes toward organ donation for transplant ("PCID-DTO Ríos"). Support from immigration associations in Spain was needed for advice on locations of potential respondents. Survey participation was anonymized and the questionnaire was self-administered. Verbal consent was obtained before participation.

RESULTS

There were 206 respondents: 49% (n = 101) in favor of donating their organs after death; 21% (n = 44) against donation; and 30% (n = 61) undecided. Their attitudes were found to be associated with level of education (P = .008), previous experience with donation and transplant (P = .011), concern regarding mutilation after donation (P = .002), knowing the attitude of their religion toward transplant (P = .001), the opinion of their partner (P < .001), and the possibility of needing a future transplant (P = .050). In the multivariate study, the main factor was having a partner in favor of organ donation (odds ratio = 16.129; P = .003).

CONCLUSION

Attitudes toward organ donation among Bolivians residing in Spain are far more negative compared with rest of the Spanish population, due to various factors.

Multivariate Analysis of Factors That Influence the Attitude of the Ecuadorian Population Resident in Spain Toward Living-Related Kidney Donation

BACKGROUND

The Ecuadorian population is the largest Latin-American immigrant group in Spain. Currently, several Ecuadorians have received transplants or are awaiting transplants in Spain. The aim of this work was to analyze the attitude toward living kidney donation among the Ecuadorian population residing in Spain.

METHODS

The population screened were born in Ecuador, residing in Spain, and >15 years old, stratified by gender and age, and appraised with the use of the questionnaire on attitude toward organ donation for transplantation "PCID-DVR-Ríos." Support from immigration associations in Spain was used to advise on the location of potential respondents. The completion was anonymous and self-administered. Verbal consent was obtained. Statistics included Student t test, χ², Fisher exact test, and logistic regression analysis.

RESULTS

A total of 461 respondents were included: 80% (n = 367) were in favor of living-related kidney donation (for a relative or close friend). This attitude was associated with psychosocial variables that persisted in the multivariate study: 1) female gender (odds ratio [OR], 3.086; P = .001); 2) considering oneself a potential kidney receptor in the future (OR, 16.949; P = .002); 3) economic incentive in the donation (OR, 100; P = .004); and 4) knowing the attitude of their religion toward transplantation (OR, 32.258; P < .001).

CONCLUSIONS

Living-related donation is accepted among the Ecuadorian population residing in Spain and is associated with sociopersonal and religious factors.

Veterinary Students' Attitude Toward Living Kidney Donation: A Multicenter Stratified Study From Spain

Living kidney related donations (LKRD) should be promoted because of the current deficit of organs for transplantation. The objective of the study was to analyze the attitude of Spanish veterinary students toward LKRD, because they may influence public opinion in the future, and to determine the factors that condition it.

METHODS

A sociological, interdisciplinary, multicenter, and observational study was carried out in the veterinary students enrolled in Spain (n = 9000) in the university academic year 2010-2011. A sample of 2815 students was stratified by geographical area and academic year. The students' attitude toward LKRD was assessed using a psychosocial validated questionnaire (PCID-DVR Rios), was self-administered, and was completed anonymously. Veterinary schools were randomly selected. The questionnaire was applied to each academic year at compulsory sessions. Statistical analysis was preformed using t test, χ² test, and logistic regression analysis.

RESULTS

The completion rate was 95% (n = 2683); 93% (n = 2504) were in favor of LKRD and 36% (n = 945) supported unrelated living kidney donation. The following variables were associated with having a more favorable attitude: (1) sex (P < .001), (2) being a student of southern universities (P = .03), (3) attitude toward deceased donation (P < .001), (4) having a father (P < .001) or a mother (P < .001) in favor of organ donation, and (5) having discussed the subject with friends (P = .03) or family (P = .02). However, only 60% would accept a kidney from a relative.

CONCLUSION

Spanish veterinary students have a favorable attitude toward LKRD. However, only 60% would accept a kidney from a relative.

Multicenter Stratified Study From Spain About Acceptance of Living Liver Donation Among Veterinarian Students

Veterinarians often hold decision-making positions in the public health care system, and therefore can influence public opinion about organ donation. The objective is to analyze the attitude of Spanish veterinarian students toward living liver donation (LLD) and to establish which factors have an influence on this attitude.

METHODS

A sociological, interdisciplinary, multicenter, and observational study was carried out in the veterinarian students enrolled in Spain (n = 9000) (university academic year 2010-2011). A sample of 2854 students was stratified by geographic area and academic year. A validated questionnaire (PCID-DVH RIOS) was self-administered and completed anonymously. The questionnaire was applied to each academic year at compulsory sessions at randomly selected veterinary schools. Statistical analysis included t test, χ² test, and logistic regression analysis.

RESULTS

Completion rate was 94% (n = 2683); 89% (n = 2345) were in favor of related LLD, and 40% (n = 1053) supported unrelated LLD. The following variables were associated with a more favorable attitude: (1) age (P < .001), (2) sex (P < .001), (3) academic year (P < .001), (4) believing in the possibility of needing a transplant oneself in the future (P < .001), (5) attitude toward deceased donation (P < .001), (6) attitude toward living kidney donation (P < .001), (7) acceptance of a donated liver segment from a family member if one were needed (P < .001), (8) having discussed the subject with one's family (P = .009) and friends (P < .001), (9) a partner's opinion about the subject (P = .002), and (10) fear of the possible mutilation of the body after donation (P < .001).

CONCLUSION

Spanish veterinary students have a favorable attitude toward LLD.

Attitude Toward Organ and Tissue Xenotransplantation Questionnaire (PCID-XENOTx-Ríos): Characteristics and Psychometric Properties of the Validation in Spanish-Speaking Populations

INTRODUCTION

Making xenotransplantation socially acceptable is the first step in working toward the promotion of this potential therapy option for providing transplant organs. However, most of the questionnaires used for this task are not validated.

OBJECTIVE

To analyze the psychometric characteristics of the questionnaire of attitud toward xenotransplantation PCID-XENOTx-Ríos (Questionnaire of Proyecto Colaborativo Internacional Donante about Xenotransplantation developed by Dr. Ríos) to validate the questionnaire in the Spanish speaking population.

METHODS

The study population was the native Spanish population living in southeast Spain. A sample of the population was obtained randomly and stratified by age and sex (N = 600), using the following inclusion criteria: 1. being older than 18 years; 2. being Spanish; and 3. living in Spain. Instrument valuation. Attitude was assessed using the validated PCID-XENOTx-Ríos questionnaire to gauge attitudes toward organ and tissue xenotransplantation. The statistical analysis included an initial description of the data, an exploratory factor analysis, an items analysis, and an internal consistency analysis.

RESULTS

The questionnaire consists of a total of 30 items, distributed in 4 subscales: 1. Factor 1: consequences (11 items); 2. Factor 2: associated risks (7 items); 3. Factor 3: transmission of infections (6 items); and 4. Factor 4: origins of transplantation (6 items). This structure presents a total explained variance of 61.18%. The internal consistency of each factor was as follows: α1 = 0.91; α2 = 0.92; α3 = 0.89; and α4 = 0.72. The analysis of items and internal consistency supported the 4 factors' composition.

CONCLUSIONS

Dimensions analyzed in the PCID-XENOTx-Ríos questionnaire of attitudes toward organ and tissue xenotransplantation show a good fit in relation to their factorial validity and internal consistency values.

Attitude of the Citizens of Havana, Cuba, Toward Organ Donation: A Multivariate Analysis of the Psychosocial Factors Affecting Attitude

INTRODUCTION

Because personal decisions affect the availability of organs for transplants, awareness about organ donations among the general population is fundamental.

OBJECTIVE

To analyze attitudes toward organ donation among the citizens of Havana, Cuba.

METHODS

The sample population was the residents of the city of Havana, Cuba. The inclusion criterion was being older than 15 years; the sample was obtained randomly and stratified by age and sex. Attitude was assessed using a validated questionnaire on psychosocial aspects of organ donation and transplant (PCID-DTO-Ríos). A random selection of people to be surveyed was carried out.

RESULTS

A sample of 920 respondents was included in the study. Attitude toward cadaveric donation was favorable in 68% of respondents, while 14% were against and 18% were undecided. Several variables were associated with having a more favorable attitude. In the multivariate analysis, the following variables continue to feature as independent variables (P <  .05): 1. level of studies; 2. knowledge of the concept of brain death; 3. attitude toward organ donation of a relative; 4. having discussed the issue of organ donation and transplantation with one's family; 5. the attitude of the couple toward organ donation and transplantation; 6. the religion of the respondent; 7. knowing the opinion of one's religion toward organ transplantation; 8. fear of manipulation of the body after death; and 9. acceptance of burial as a treatment of the body after the death.

CONCLUSIONS

The attitude toward cadaveric organ donation among the residents of Havana is favorable and similar to that of the citizens of Spain. Improving the organ procurement system will increase donation rates given the population's awareness of the issue.

Defining Natural Antibodies

The traditional definition of natural antibodies (NAbs) states that these antibodies are present prior to the body encountering cognate antigen, providing a first line of defense against infection thereby, allowing time for a specific antibody response to be mounted. The literature has a seemingly common definition of NAbs; however, as our knowledge of antibodies and B cells is refined, re-evaluation of the common definition of Nabs may be required. Defining Nabs becomes important as the function of NAb production is used to define B cell subsets (1) and as these important molecules are shown to play numerous roles in the immune system (Figure 1). Herein, we aim to briefly summarize our current knowledge of NAbs in the context of initiating a discussion within the field of how such an important and multifaceted group of molecules should be defined.

B-CD8+ T Cell Interactions in the Anti-Idiotypic Response against a Self-Antibody

P3 is a murine, germline, IgM mAb that recognizes N-glycolylated gangliosides and other self-antigens. This antibody is able to induce an anti-idiotypic IgG response and B-T idiotypic cascade, even in the absence of any adjuvant or carrier protein. P3 mAb immunization induces the expression of activation markers in a significant percentage of B-1a cells in vivo. Interestingly, transfer of both B-1a and B-2 to BALB/Xid mice was required to recover anti-P3 IgG response in this model. In fact, P3 mAb activated B-2 cells, in vitro, inducing secretion of IFN-γ and IL-4, although this activation was not detected ex vivo. Interestingly, naïve CD8+ T cells increased the expression of activation markers and IFN-γ secretion in the presence of B-1a cells isolated from P3 mAb-immunized mice, even without in vitro restimulation. In contrast, B-2 cells were able to stimulate CD8+ T cells only if P3 was added in vitro. Using bioinformatics, a MHC class I-binding peptide from P3 VH region was identified. P3 mAb was able to induce a specific CTL response in vivo against cells presenting this peptide. Both humoral and CTL anti-idiotypic responses could be mechanisms to protect against the self-reactive antibody, contributing to keeping the tolerance to self-antigens.

The Psychopathology of Delusion of Control According to Subjective Experience

BACKGROUND

Delusion of control, including thought insertion, occurs in 20% of patients with schizophrenia. However little is known of its psychopathology, and studies involving patients are scarce.

AIMS

To explore the subjective experience of patients with delusion of control and to propose a psychopathological explanation based on empirical evidence.

METHODS

Qualitative exploratory study of 7 patients (6 with schizophrenia and 1 with schizophreniform disorder). A phenomenologically-oriented semi-structured interview was used.

RESULTS

Delusion of control is not an isolated and pure symptom; it is always immersed in the context of a persecutory delusion and other psychiatric symptoms. The patient experiences partial control, i.e. the control is never complete. In all cases, it is possible to trace the history of the narrative formation of delusion of control from its origins in persecutory delusions and other concomitant symptoms.

CONCLUSIONS

The delusion of control is a narrative resulting from the joint presence of a persecutory delusion and other psychiatric symptoms. For the patient, the delusion of control is the narrative of the elaborate expression of the meaning of the anomalous experience. Delusion of control is a narrative variety of persecutory delusion.

Detection of Naturally Occurring Human Antibodies Against Gangliosides by ELISA

Gangliosides are sialic acid-containing glycolipids that have been considered attractive targets for cancer immunotherapy, based on the qualitative and quantitative changes they suffer during malignant transformation and due to their importance for tumor biology. Natural antibodies against gangliosides have been detected not only in cancer patients but also in healthy donors. The presence of these antibodies can be used as diagnostic or prognostic factor. However, these responses are difficult to detect because anti-ganglioside antibodies are usually of IgM isotype and low affinity. Enzyme Linked Immunosorbent Assay (ELISA) is an immunoassay based on the specific binding of antibodies to antigens bound to a solid phase. These antigens can be glycolipids like gangliosides. An enzyme linked to the last reactant allows the detection of specific binding through the development of color after the addition of a suitable substrate. ELISA combines the specificity of antibodies with the sensitivity of enzyme reactions. The ELISA method described herein can be used to detect antibody responses against gangliosides not only related to cancer but also to autoimmune diseases and infections, both in healthy donors, and patients, untreated or receiving specific immunotherapy.

Distinctions among Circulating Antibody-Secreting Cell Populations, Including B-1 Cells, in Human Adult Peripheral Blood

Human Ab-secreting cell (ASC) populations in circulation are not well studied. In addition to B-1 (CD20(+)CD27(+)CD38(lo/int)CD43(+)) cell and conventional plasmablast (PB) (CD20-CD27(hi)CD38(hi)) cell populations, in this study, we identified a novel B cell population termed 20(+)38(hi) B cells (CD20(+)CD27(hi)CD38(hi)) that spontaneously secretes Ab. At steady-state, 20(+)38(hi) B cells are distinct from PBs on the basis of CD20 expression, amount of Ab production, frequency of mutation, and diversity of BCR repertoire. However, cytokine treatment of 20(+)38(hi) B cells induces loss of CD20 and acquisition of CD138, suggesting that 20(+)38(hi) B cells are precursors to PBs or pre-PBs. We then evaluated similarities and differences among CD20(+)CD27(+)CD38(lo/int)CD43(+) B-1 cells, CD20(+)CD27(hi)CD38(hi) 20(+)38(hi) B cells, CD20(-)CD27(hi)CD38(hi) PBs, and CD20(+)CD27(+)CD38(lo/int)CD43(-) memory B cells. We found that B-1 cells differ from 20(+)38(hi) B cells and PBs in a number of ways, including Ag expression, morphological appearance, transcriptional profiling, Ab skewing, Ab repertoire, and secretory response to stimulation. In terms of gene expression, B-1 cells align more closely with memory B cells than with 20(+)38(hi) B cells or PBs, but differ in that memory B cells do not express Ab secretion-related genes. We found that B-1 cell Abs use Vh4-34, which is often associated with autoreactivity, 3- to 6-fold more often than other B cell populations. Along with selective production of IgM anti-phosphoryl choline, these data suggest that human B-1 cells might be preferentially selected for autoreactivity/natural specificity. In summary, our results indicate that human healthy adult peripheral blood at steady-state consists of three distinct ASC populations.

A randomized, multicenter, placebo-controlled clinical trial of racotumomab-alum vaccine as switch maintenance therapy in advanced non-small cell lung cancer patients

PURPOSE

Racotumomab-alum is an anti-idiotype vaccine targeting the NeuGcGM3 tumor-associated ganglioside. This clinical trial was conducted to provide a preliminary estimate of efficacy and safety of racotumomab as switch maintenance for patients with advanced non-small cell lung cancer (NSCLC).

EXPERIMENTAL DESIGN

Patients with stage IIIb/IV NSCLC who have at least stable disease after first-line chemotherapy were randomized 1:1 to racotumomab-alum (5 immunizations every 2 weeks and re-immunizations every 4 weeks) or placebo. Treatment was administered beyond progressive disease, until severe performance status worsening or toxicity. At progression, only five patients per group received further anticancer therapy. The primary endpoint was overall survival (OS).

RESULTS

One-hundred and seventy-six patients were randomized to racotumomab-alum (n = 87) and placebo (n = 89). Median OS was 8.23 and 6.80 months, respectively [HR, 0.63; 95% confidence interval (CI), 0.46-0.87; P = 0.004]. Median progression-free survival (PFS) in vaccinated patients was 5.33 versus 3.90 months for placebo (HR, 0.73; 95% CI 0.53-0.99; P = 0.039). The most common adverse events in the racotumomab-alum arm were burning and pain at the injection site, bone pain, and asthenia. A high antibody response of IgM and IgG isotype against the NeuGcGM3 ganglioside was obtained. Hyperimmune sera were able to specifically recognize and kill the NeuGcGM3-expressing L1210 cell line. Patients who developed anti-NeuGcGM3 antibodies capable to bind and kill ≥30% L1210 cells showed longer median survival times.

CONCLUSIONS

Switch maintenance with racotumomab-alum is an effective and a well-tolerated treatment option for patients with advanced NSCLC.

Human antibodies reactive to NeuGcGM3 ganglioside have cytotoxic antitumor properties

N-glycolylated gangliosides are not naturally expressed in healthy human tissues but are overexpressed in several tumors. We demonstrate the existence of antibodies that bind (N-glycolylneuraminyl)-lactosylceramide (NeuGcGM3) and are detectable in the sera of 65 from the 100 donors (65%) tested by ELISA. From those 65 NeuGcGM3 antibody-positive donors, 35 had antibodies that were able to recognize and kill NeuGcGM3-expressing tumor cells by a complement-mediated mechanism. After complement inactivation, 11 of the 35 positive sera showed a direct cytotoxic effect on the tumor cells. This complement-independent cytotoxicity was dependent on the presence of antigen on the membrane and resembles an oncotic necrosis cell death. Both the levels of anti-NeuGcGM3 antibodies in the sera as well as the percentage of healthy donors with this immunity decreased with the age of the donor. In contrast to age and gender-matched healthy donors, we could only detect low reactivity against NeuGcGM3 in the sera of six out of 53 non-small cell lung cancer patients. These results suggest the existence of antibodies against NeuGcGM3 with antitumor immune surveillance functions, reinforcing the importance of N-glycolylated gangliosides as antitumor targets.

Serum soluble interleukin 2 receptor (sIL-2R) as a marker of acute rejection in renal transplant children

The aim of the study was to evaluate whether or not serum levels of soluble interleukin 2 receptor (sIL-2R) predict acute rejection in pediatric recipients. We studied 51 pediatric renal transplant recipients divided into three groups: Group 1) Biopsy-proven cellular acute rejection (n = 19), Group 2) Graft dysfunction with histological diagnosis other than acute rejection (n = 8) and Group 3) Patients with stable graft function, no biopsy (n = 24). Serum samples for sIL-2R measurement by sandwich ELISA were obtained at the time of renal transplant and at the time of renal biopsy due to graft dysfunction (Groups 1 and 2) or at six months post-transplant in the case of Group 3. The mean ± s.e. serum values of sIL-2R were higher in patients during acute rejection (6539 ± 1802 pg/mL) compared to patients with other causes of graft dysfunction (2217 ± 256 pg/mL) or stable graft function at six months (2183 ± 283 pg/mL) (Kruskal-Wallis p = 0.004). When the sIL2-R levels at the time of transplant were compared to those at the time of biopsy (Groups 1 and 2) or at six months post-transplant in Group 3, there was no significant difference between baseline and biopsy in the acute rejection group (paired t-test = 0.07), whereas there was a significant reduction in Groups 2 and 3.

P3 mAb: An Immunogenic Anti-NeuGcGM3 Antibody with Unusual Immunoregulatory Properties

P3 is a murine IgM mAb that recognize N-glycosylated gangliosides, sulfatides, and antigens expressed in melanoma, breast, and lung human tumors. This antibody has the ability to trigger an IgG antibody response in the syngeneic BALB/c model, even when it is administered in the absence of adjuvant or carrier protein. The mechanism by which the P3 mAb, a self-immunoglobulin, induce this immune response in the absence of co-stimulatory or classical danger signals is still unknown. In the present paper we show that the high immunogenicity of P3 mAb depends not only on CD4 but also on CD8⁺ T cells, since the depletion of CD8⁺ or CD4⁺ T cells led to the loss of P3 mAb immunogenicity in the syngeneic model. Furthermore, the immunization with P3 mAb enhanced the recovery of the CD8⁺ T cell population in mice treated with an anti-CD8a antibody. Additionally, the immunization with P3 mAb restored the capacity of immunosuppressed mice to reject allogeneic tumors, a mechanism mediated by the action of CD8⁺ T cells. Finally, in mice with cyclophosphamide induced lymphopenia, the administration of P3 mAb accelerated the recovery of both CD4⁺ and CD8⁺ T cells. These results show new possibilities for B and CD8⁺ T cells interactions during the immune response elicited by a self-protein. Furthermore they point to P3 mAb as a potential interesting candidate for the treatment of immunosuppressed patients.

Immunopharmacology 2011: an updated report of clinical achievements and perspectives

On 26-30 June 2011 the Cuban Society of Pharmacology organized the Second International Congress on Immunopharmacology (Immunopharmacology 2011), held at the beautiful Convention Centre 'Plaza América' and the Meliá Varadero Hotel, in Varadero beach, Cuba. The main topics of the congress were immunopharmacology (including inflammation, cancer immunotherapy and immunomodulation), neuroimmunology, and the pharmacology of cytochrome P450 and transporters, among other relevant and updated related topics. Immunopharmacology 2011 offered an outstanding scientific program with the active contribution of 90 speakers from 23 foreign countries, as well as more than 170 Cuban researchers from the most important local institutions devoted to the development of immunology and pharmacology sciences.

Anti-NeuGcGM3 antibodies, actively elicited by idiotypic vaccination in nonsmall cell lung cancer patients, induce tumor cell death by an oncosis-like mechanism

1E10 is a murine anti-idiotypic mAb specific for an idiotypic mAb that reacts with NeuGc-containing gangliosides, sulfatides, and Ags expressed in some human tumors. In melanoma, breast, and lung cancer patients, this anti-idiotypic Ab was able to induce a specific Ab response against N-glycosylated gangliosides, attractive targets for cancer immunotherapy as these glycolipids are not naturally expressed in humans. A clinical study with nonsmall cell lung cancer patients showed encouraging clinical benefits. Immunological studies performed in 20 of these patients suggested a correlation between the induction of Abs against NeuGcGM3 and longer survival times. The induced anti-NeuGcGM3 Abs recognized and directly killed tumor cells expressing the Ag, by a mechanism independent of complement activation. In the present work, we show that this cytotoxicity differs from apoptosis because it is temperature independent, no chromatin condensation or caspase 3 induction are detected, and the DNA fragmentation induced has a different pattern than the one characteristic for apoptosis. It is a very quick process and involves cytosqeleton reorganization. The Abs induce cellular swelling and the formation of big membrane lesions that allow the leakage of cytoplasm and the loss of the cell membrane integrity. All of these characteristics resemble a process of oncotic necrosis. To our knowledge, this is the first report of the active induction in cancer patients of NeuGcGM3-specific Abs able to induce complement independent oncotic necrosis to tumor cells. These results contribute to reinforcing the therapeutic potential of anti-idiotypic vaccines and the importance of NeuGcGM3 ganglioside as antitumor target.

Pre-transplant mycophenolate mofetil pharmacokinetics in Mexican children

Mycophenolate mofetil is an immunosuppressive pro-drug frequently used to prevent renal graft rejection. It is hydrolyzed by esterases to obtain the active drug mycophenolic acid (MPA). There is high inter-patient variation in mycophenolic acid pharmacokinetics. Area under the concentration versus time curve (AUC) is used for therapeutic drug monitoring and recommended levels are 30-60 microg x hr/L. The aim of this study was to determine mycophenolic acid pharmacokinetics in children awaiting renal allograft in order to predict mycophenolate mofetil dose requirements. Children with end-stage renal disease on the waiting list for renal allograft transplantation were invited to participate in the study. A nine-point pharmacokinetic profile was performed. All patients received a single dose (600 mg/m2, subcutaneously) of mycophenolate mofetil at time zero. Mycophenolic acid was measured by HPLC. The AUC0-12h was estimated by the trapezoidal rule. Ten children were included in the study. Mean age was 13.5 +/- 3.5 years. The median AUC0-12h was 20.3 microg x hr/L, median Cmax = 0.7 microg/mL. Two children (20%) had no detectable levels of mycophenolic acid after a single mycophenolate mofetil dose, other two patients had AUC > 60 microg x hr/L. One patient had abdominal pain 1 hr after the mycophenolate mofetil dose. Twenty percent of our patients had AUC0-12h higher than the recommended value after a single mycophenolate mofetil dose, those patients should receive lower mycophenolate mofetil dose since the beginning of the transplant to avoid adverse events, and another 20% of patients had no detectable mycophenolic acid levels after a single mycophenolate mofetil dose. UGT1A9 gene polymorphisms remain to be studied in our patients, since they could explain the differences in bioavailability.

Efficacy and safety of conversion of mycophenolate mofetil to enteric-coated mycophenolate sodium in Mexican renal transplant children

The aim of the study was to evaluate the efficacy and safety of the conversion of MMF to EC-MPS in pediatric renal transplant recipients. We included 12 patients with stable graft function who were receiving MMF treatment. In the first visit, a complete medical examination was performed, which included a GSRS, a nine-point pharmacokinetic profile, samples for renal, liver and hematological tests and evaluation of IMPDH2 gene expression. The patients were transferred to an equimolar dose of EC-MPS. Two wk later, a clinical evaluation and blood collection, as in the first visit were performed. There was no change in serum creatinine, leukocyte count, serum albumin, or transaminase levels, but we found a statistically significant reduction of hemoglobin after conversion (13.2 +/- 1.6 g/dL with MMF vs. 12.5 +/- 1.3 g/dL when receiving EC-MPS). The GSRS total mean score was 16 +/- 12 with MMF vs. 8 +/- 5 with EC-MPA (p < 0.05). There was no statistically significant difference between formulations in the gene expression of IMPDH 2, in the AUC(0-12h) or in C(max). However, peak concentration occurred later with EC-MPS.

Anti-tumor necrosis factor α F(ab')2 antibody fragments protect in murine polymicrobial sepsis: Concentration and early intervention are fundamental to the outcome

BACKGROUND

Negative results are frequent using anti-TNFalpha antibodies in sepsis models and clinical trials.

METHODS AND RESULTS

Different prophylactic doses of anti-TNFalpha F(ab')2 antibody fragments were compared for the prevention of death by sepsis induced by cecal ligation and puncture (CLP) in mice. High (10 mg/kg) and very low (0.01 and 0.1 mg/kg) concentrations of anti-TNFalpha antibody fragments were not the most adequate for treating polymicrobial sepsis, since they did not significantly improve survival. To the contrary, intermediate doses (1 mg/kg) significantly protected the challenged animals. Protective activity was also observed when administration of the antibody fragments was initiated early (up to 30 min) after CLP.

CONCLUSIONS

These results suggest that in processes where excessive production of cytokines is involved, the aim should be to return them to their physiologically acting range but not to inhibit their production. The timing of initiating therapy should also be considered in order to maximize the possible benefits.

Generation of anti-Neu-glycolyl-ganglioside antibodies by immunization with an anti-idiotype monoclonal antibody: A self versus non-self-matter

We have previously generated a murine anti-idiotype (Ab2) monoclonal antibody (mAb) to a murine Ab1 mAb, named P3, which selectively binds Neu-glycolyl (NeuGc)-sialic acid on several monosialo- and disialogangliosides, and also reacts with sulfatides and antigens expressed in human melanoma and breast tumors. This Ab2 mAb, designated as 1E10, induced anti-anti-idiotype antibodies (Ab3) in mice and cancer patients. These Ab3 generated by 1E10 mAb were characterized by bearing P3 mAb idiotopes (Ab3, Id +). But when the specificity of these Ab3 antibodies was tested, no specific humoral response against NeuGc-containing gangliosides was detected in sera from immunized mice. However, hyperimmune sera from melanoma and breast cancer patients vaccinated with this Ab2 mAb were able to react specifically with these gangliosides. The different expression of NeuGc-containing gangliosides in the normal tissues of mice and humans could explain these results. In order to demonstrate these findings in other animal species with a different NeuGc-sialic acid expression, we performed similar studies in monkeys and chickens. In monkeys, as in most mammals, NeuGc-containing gangliosides are self-antigens. In contrast, chickens, like humans, lack the expression of these antigens in normal tissues. Here we report that the antibody response against NeuGc-containing gangliosides induced by immunization with 1E10 mAb was completely different in both species. No specific antibody response against these gangliosides was detected in hyperimmune monkey sera. In contrast, a strong and specific Ab3 response against GM3(NeuGc) and GM2(NeuGc) gangliosides (Ab3, Ag+) was generated in chickens due to the administration of 1E10 mAb.

Effects of isolated obesity on systolic and diastolic left ventricular function

BACKGROUND

Obesity is associated with increased cardiovascular morbidity and mortality. A direct effect of isolated obesity on cardiac function is not well established.

OBJECTIVE

To determine the direct effect of different grades of isolated obesity on echocardiographic indices of systolic and diastolic left ventricular function.

METHODS

48 obese and 25 normal weight women were studied. They had no other pathological conditions. Obesity was classed as slight (n = 17; body mass index (BMI) 25-29.9 kg/m2), moderate (n = 20; BMI 30-34.9 kg/m2), or severe (n = 11; BMI > or = 35 kg/m2). Echocardiographic indices of systolic and diastolic function were obtained, and dysfunction was assumed when at least two values differed by > or = 2 SD from the normal weight group.

RESULTS

Ejection fraction (p < 0.05), fractional shortening (p < 0.05), and mean velocity of circumferential shortening (p < 0.05) were increased in slight and moderate obesity. Left ventricular dimensions were increased (p < 0.001) but relative wall thickness was unchanged. No obese patients met criteria for systolic dysfunction. In obese subjects, the mitral valve pressure half time (p < 0.01) and the left atrial diameter (p < 0.001) were increased and the deceleration slope was decreased (p < 0.01); all other diastolic variables were unchanged. No differences were found between obesity subgroups. Subclinical diastolic dysfunction was more prevalent among obese subjects (p = 0.002), being present in two with slight obesity (12%), seven with moderate obesity (35%), and five with severe obesity (45%). BMI correlated significantly with indices of left ventricular function.

CONCLUSIONS

Subclinical left ventricular diastolic dysfunction is present in all grades of isolated obesity, correlates with BMI, and is associated with increased systolic function in the early stages of obesity.

An anti-idiotype vaccine elicits a specific response to N-glycolyl sialic acid residues of glycoconjugates in melanoma patients

We generated the 1E10 gamma-type anti-idiotype mAb (Ab2) specific to an Ab1 mAb able to react specifically with N-glycolyl-containing gangliosides and with Ags expressed on human melanoma and breast carcinoma cells. This Ab2 mAb induced an Ab response in animal models sharing immunochemically defined idiotopes with the Ab1. The treatment of tumor-bearing mice with 1E10 mAb induced a strong antitumor activity. A clinical trial was conducted in 20 patients with advanced malignant melanoma. Patients were treated with six intradermal injections of aluminum hydroxide-precipitated 1E10 anti-Id mAb given at 2-wk intervals. Sixteen of the 17 patients who received at least four doses of the anti-Id vaccine develop Ab3 Abs capable of inhibiting Ab2 binding to Ab1 (Ab3Id+). In contrast to the incapacity of 1E10 mAb to generate Ab3 Abs with the same antigenic specificity as the Ab1 mAb in mice, a very specific and strong Ab3 response against N-glycolyl-containing gangliosides was induced in 16 patients (Ab3Ag+). No evidence of serious or unexpected adverse effects has been observed in this clinical trial. 1E10 anti-Id vaccine was safe, well tolerated, and immunologically effective, with most patients being able to generate a specific immune response against 1E10 and Neu-glycolyl-GM(3) ganglioside.

Influence of human wet cerumen on the growth of common and pathogenic bacteria of the ear

The available data on the effect of human wet cerumen on bacterial growth are not conclusive. Nevertheless it is widely accepted that cerumen has a bactericidal effect. In this study the activity of human wet cerumen on bacterial growth was assessed by applying cerumen suspensions to bacterial cultures. Bacterial counts were performed before and after application of cerumen suspensions. A total of 383 assays was carried out with 73 pools of cerumen that were tested against cultures of Staphylococcus aureus, Staphylococcus epidermidis, Corynebacterium spp., Escherichia coli, Proteus mirabilis, Pseudomonas aeruginosa and Serratia marcescens. An increase in growth occurred much more frequently than a decrease in growth in almost every microrganism tested, with the mean increase percentage being much higher than the mean decrease percentage, except in the case of S. aureus. The largest average growth increase was obtained with E. coli. The largest average decrease in bacterial growth was recorded with S. marcescens. Our study does not support the conception of a decrease in bacterial growth produced by humen wet cerumen. In vitro, the most observable effect was in fact an increase in microbial growth.

Antitumor properties of an anti-idiotypic monoclonal antibody in relation to N-glycolyl-containing gangliosides

We examined the antitumor effects of 1E10 monoclonal antibody, an anti-idiotypic IgG to an IgM monoclonal antibody, named P3, that reacts specifically with N-glycolyl-containing gangliosides and also recognizes antigens in human breast and melanoma tumors. Two murine tumor cell lines positive for the P3 antibody, F3II mammary carcinoma (BALB/c) and B16 melanoma (C57BL/6), were employed. In BALB/c mice, vaccination with several i.p. doses at 14-day intervals of 50 microgram of 1E10 coupled to keyhole limpet hemocyanin in Freund's adjuvant, significantly reduced s.c. tumor growth of F3II carcinoma cells and the number of spontaneous lung metastases. Also, the effect of 1E10 as a biological response modifier on tumor lung colonization was evaluated in C57BL/6 mice injected i.v. with B16 melanoma cells. Interestingly, i.v. administration of 10 microgram of uncoupled 1E10 antibody, 10-14 days after inoculation of B16 cells, dramatically reduced the number of experimental metastases in comparison with lungs from mice treated with an irrelevant IgG. The present data suggest that this 'non-internal image' anti-idiotypic monoclonal antibody may activate more than one mechanism of antitumor response against melanoma and mammary tumor cells.