Fat Oxidation during Exercise in People with Spinal Cord Injury, and Protocols Used: A Systematic Review

BACKGROUND

The aim of this study was to summarize evidence on energy metabolism through peak fat oxidation (PFO) and maximum fat oxidation (Fat_max), as well as to analyze the protocols used in people with spinal cord injury (SCI) and to examine the main factors related to fat oxidation ability (i.e., age, sex, level of physical activity, and level and degree of injury).

METHODS

Studies to determine PFO and Fat_max using indirect calorimetry with an arm exercise protocol for SCI patients were included after a systematic search. Other endpoints included study design, sample size, control group, demographic data, level of injury, physical condition, protocol, outcomes measured, and statistical findings.

RESULTS

Eight studies (n = 560) were included. The mean value of VO_2peak was 1.86 L∙min^-1 (range 0.75-2.60 L∙min^-1) (lowest value in the tetraplegic subjects). The PFO ranged between 0.06 and 0.30 g∙min^-1 (lowest rates: the non-trained subjects with cervical SCI; highest: the tetraplegic subjects). Two types of exercise protocol were found: arm cycle ergometer, and wheelchair propulsion with a computerized ergometer. Five studies used an incremental protocol (2-3 min/stage, different load increments); the rest performed tests of 20 min/stage at three intensities.

CONCLUSION

There are few existing studies measuring fat oxidation in SCI, many of which used small and heterogeneous samples. PFO was lower in SCI subjects when compared with non-injured people performing lower-limb exercise; however, comparing upper-limb exercise, people with SCI showed higher values.

Biomedical image classification made easier thanks to transfer and semi-supervised learning

BACKGROUND AND OBJECTIVES

Deep learning techniques are the state-of-the-art approach to solve image classification problems in biomedicine; however, they require the acquisition and annotation of a considerable volume of images. In addition, using deep learning libraries and tuning the hyperparameters of the networks trained with them might be challenging for several users. These drawbacks prevent the adoption of these techniques outside the machine-learning community. In this work, we present an Automated Machine Learning (AutoML) method to deal with these problems.

METHODS

Our AutoML method combines transfer learning with a new semi-supervised learning procedure to train models when few annotated images are available. In order to facilitate the dissemination of our method, we have implemented it as an open-source tool called ATLASS. Finally, we have evaluated our method with two benchmarks of biomedical image classification datasets.

RESULTS

Our method has been thoroughly tested both with small datasets and partially annotated biomedical datasets; and, it outperforms, both in terms of speed and accuracy, the existing AutoML tools when working with small datasets; and, might improve the accuracy of models up to a 10% when working with partially annotated datasets.

CONCLUSIONS

The work presented in this paper allows the use of deep learning techniques to solve an image classification problem with few resources. Namely, it is possible to train deep models with small, and partially annotated datasets of images. In addition, we have proven that our AutoML method outperforms other AutoML tools both in terms of accuracy and speed when working with small datasets.

Low-Grade Inflammation Is Not Present in Former Obese Males but Adipose Tissue Macrophage Infiltration Persists

Macrophage infiltration in two subcutaneous adipose tissue depots and systemic low-grade inflammation were studied in post-obese (PO), obese (O), and control (C) subjects. Young males were recruited into PO: (n = 10, weight-loss avg. 26%, BMI: 26.6 ± 0.7, mean ±SEM kg/m²), O: (n = 10, BMI: 33.8 ± 1.0kg/m²) and C: (n = 10, BMI: 26.6 ± 0.6 kg/m²). PO and C were matched by BMI. Blood and abdominal and gluteal subcutaneous adipose tissue were obtained in the overnight fasted state. Plasma concentrations of IL-6 and CRP were higher (p < 0.05) in O than in PO and C, TNF-α was higher (p < 0.05) only in O compared to PO and IL-18 was similar between groups. The number of CD68⁺ macrophages was higher (p < 0.05) in the gluteal than the abdominal depot, and higher (p < 0.05) in O and PO compared to C in both depots. The content of CD163⁺ macrophages was similar between depots but was higher (p < 0.05) in PO compared to C and O in the gluteal depot. In post obese men with a long-term sustained weight loss, systemic low-grade inflammation was similar to non-obese controls despite a higher subcutaneous adipose tissue CD68⁺ macrophage content. Interestingly, the anti-inflammatory CD163⁺ macrophage adipose tissue content was consistently higher in post obese than obese and controls.

DeepClas4Bio: Connecting bioimaging tools with deep learning frameworks for image classification

BACKGROUND AND OBJECTIVE

Deep learning techniques have been successfully applied to tackle several image classification problems in bioimaging. However, the models created from deep learning frameworks cannot be easily accessed from bioimaging tools such as ImageJ or Icy; this means that life scientists are not able to take advantage of the results obtained with those models from their usual tools. In this paper, we aim to facilitate the interoperability of bioimaging tools with deep learning frameworks.

METHODS

In this project, called DeepClas4Bio, we have developed an extensible API that provides a common access point for classification models of several deep learning frameworks. In addition, this API might be employed to compare deep learning models, and to extend the functionality of bioimaging programs by creating plugins.

RESULTS

Using the DeepClas4Bio API, we have developed a metagenerator to easily create ImageJ plugins. In addition, we have implemented a Java application that allows users to compare several deep learning models in a simple way using the DeepClas4Bio API. Moreover, we present three examples where we show how to work with different models and frameworks included in the DeepClas4Bio API using several bioimaging tools - namely, ImageJ, Icy and ImagePy.

CONCLUSIONS

This project brings to the table benefits from several perspectives. Developers of deep learning models can disseminate those models using well-known tools widely employed by life-scientists. Developers of bioimaging programs can easily create plugins that use models from deep learning frameworks. Finally, users of bioimaging tools have access to powerful tools in a known environment for them.

SEOM clinical practice guideline: management and prevention of febrile neutropenia in adults with solid tumors (2018)

Febrile neutropenia (FN) is a common dose-limiting toxicity of chemotherapy, with a profound impact on the evolution of patients with cancer, due to the potential development of serious complications, mortality, delays, and decrease in treatment intensity. This article seeks to present an updated clinical guideline, with recommendations regarding the diagnosis, prevention, and treatment of febrile neutropenia in adults with solid tumors. The aspects covered include how to properly approach the risk of microbial resistances, epidemiological aspects, considerations about the initial empirical approach adapted to the risk, special situations, and prevention of complications. A decision-making algorithm is included for use in the emergency department based on a new, validated tool, the Clinical Index of Stable Febrile Neutropenia, which can be used in patients with solid tumors who appear stable in the initial phase of neutropenic infections, and can help detect those at high risk for complications in whom early discharge must be avoided.

Effect of aspirin in vascular surgery in patients from a randomized clinical trial (POISE-2)

BACKGROUND

In the POISE-2 (PeriOperative ISchemic Evaluation 2) trial, perioperative aspirin did not reduce cardiovascular events, but increased major bleeding. There remains uncertainty regarding the effect of perioperative aspirin in patients undergoing vascular surgery. The aim of this substudy was to determine whether there is a subgroup effect of initiating or continuing aspirin in patients undergoing vascular surgery.

METHODS

POISE-2 was a blinded, randomized trial of patients having non-cardiac surgery. Patients were assigned to perioperative aspirin or placebo. The primary outcome was a composite of death or myocardial infarction at 30 days. Secondary outcomes included: vascular occlusive complications (a composite of amputation and peripheral arterial thrombosis) and major or life-threatening bleeding.

RESULTS

Of 10 010 patients in POISE-2, 603 underwent vascular surgery, 319 in the continuation and 284 in the initiation stratum. Some 272 patients had vascular surgery for occlusive disease and 265 had aneurysm surgery. The primary outcome occurred in 13·7 per cent of patients having aneurysm repair allocated to aspirin and 9·0 per cent who had placebo (hazard ratio (HR) 1·48, 95 per cent c.i. 0·71 to 3·09). Among patients who had surgery for occlusive vascular disease, 15·8 per cent allocated to aspirin and 13·6 per cent on placebo had the primary outcome (HR 1·16, 0·62 to 2·17). There was no interaction with the primary outcome for type of surgery (P = 0·294) or aspirin stratum (P = 0·623). There was no interaction for vascular occlusive complications (P = 0·413) or bleeding (P = 0·900) for vascular compared with non-vascular surgery.

CONCLUSION

This study suggests that the overall POISE-2 results apply to vascular surgery. Perioperative withdrawal of chronic aspirin therapy did not increase cardiovascular or vascular occlusive complications. Registration number: NCT01082874 ( http://www.clinicaltrials.gov).

Influence of different sports on fat mass and lean mass in growing girls

PURPOSE

The aim of this study was to analyze and compare the effects of different sports (swimming, football, basketball, and handball) on fat mass and lean mass in prepubertal and pubertal girls.

METHODS

Two hundred girls (10.6 ± 1.5 years old, Tanner stages I-III) participated in the study and were divided into 5 groups: 40 swimmers, 40 football players, 40 basketball players, 40 handball players, and 40 controls. Fat and lean masses at whole body, arms, trunk, and legs were measured using dual-energy X-ray absorptiometry (DXA). Pubertal status was determined using Tanner test. Effects of different sports on fat and lean masses were assessed through analysis of covariance with height as covariates. Analyses were performed separately in 2 groups depending on the Tanner stage (prepubertal and pubertal).

RESULTS

The girls of the control group had less lean mass and more fat mass compared to the girls who play sports (p < 0.05). There were differences in body fat between sports. The swimmers and football players had less body fat (p < 0.05). On the other hand, handball players showed the highest values in lean mass (p < 0.05).

CONCLUSION

Impact sports (football, basketball, and handball) and low-impact sports (swimming) provide an appropriate development of lean mass in growing girls. We can conclude that people practicing sports at early ages ensure a lower fat mass and higher lean mass compared to those who do not practice. These results may be useful as a preventive method of adult obesity.

Antibiogramj: A tool for analysing images from disk diffusion tests

BACKGROUND AND OBJECTIVES

Disk diffusion testing, known as antibiogram, is widely applied in microbiology to determine the antimicrobial susceptibility of microorganisms. The measurement of the diameter of the zone of growth inhibition of microorganisms around the antimicrobial disks in the antibiogram is frequently performed manually by specialists using a ruler. This is a time-consuming and error-prone task that might be simplified using automated or semi-automated inhibition zone readers. However, most readers are usually expensive instruments with embedded software that require significant changes in laboratory design and workflow.

METHODS

Based on the workflow employed by specialists to determine the antimicrobial susceptibility of microorganisms, we have designed a software tool that, from images of disk diffusion tests, semi-automatises the process. Standard computer vision techniques are employed to achieve such an automatisation.

RESULTS

We present AntibiogramJ, a user-friendly and open-source software tool to semi-automatically determine, measure and categorise inhibition zones of images from disk diffusion tests. AntibiogramJ is implemented in Java and deals with images captured with any device that incorporates a camera, including digital cameras and mobile phones. The fully automatic procedure of AntibiogramJ for measuring inhibition zones achieves an overall agreement of 87% with an expert microbiologist; moreover, AntibiogramJ includes features to easily detect when the automatic reading is not correct and fix it manually to obtain the correct result.

CONCLUSIONS

AntibiogramJ is a user-friendly, platform-independent, open-source, and free tool that, up to the best of our knowledge, is the most complete software tool for antibiogram analysis without requiring any investment in new equipment or changes in the laboratory.

Physical activity assessment in the general population; validated self-report methods

Self-reported questionnaires have been commonly used to assess physical activity levels in large cohort studies. As a result, strong and convincing evidences that physical activity can protect health are widely recognized. However, validation studies using objective measures of physical activity or energy expenditure (double labelled water, accelerometers, pedometers, etc.) indicate that the accuracy and precision of survey techniques are limited. Physical activity questionnaires could fail in estimating particularly non-vigorous physical activity. They have a disproportionate focus on volitional type exercise (i.e. biking, jogging, and walking), while not capturing the activities of daily living and low to moderate intensity movements. Energy expenditure estimates from these data are not recommended. On the other hand, despite objective tools should be the measurement of choice to assess PA level, self-reported questionnaires remain valid, and have many advantages. i.e. low costs. These kind of recalls are designed and validated for different age groups and provide value and important information, mainly about physical activity pattern. Future studies will require more precision and accuracy in physical activity measurement than those provided by traditional survey methods. We can conclude that probably a mixed approach that combines both the objective and subjective techniques involving novel devices and electronic capture of physical activity questionnaires will be more effective.

[Conjunctival squamous cell carcinoma: paradoxical response to interferon eyedrops]

CASE REPORT

A 67 year-old male seen for a longstanding corneal-conjunctival tumor.

TREATMENT

topical interferon α2b (IFN-α2b) 10 U/ml. A significant increase in lesion size was observed after 8 weeks. A surgical excision with cryotherapy was then performed. Pathological examination confirmed the diagnosis of squamous cell carcinoma. At this time the patient was found to have a positive HIV serology.

DISCUSSION

Conjunctival intraepithelial neoplasia (CIN) is a pre-cancerous lesion of the ocular surface. Medical treatment of CIN is essentially with IFN-α2b due to its antiviral/antitumor properties. In patients with HIV, treatment response could be paradoxical. We recommend serology for HIV before treatment with topical IFN-α2b.

[Sarcopenic obesity and physical fitness in octogenarians: the multi-center EXERNET Project]

OBJECTIVE

The aim of this study was to analyze the usefulness of different fitness test to detect the risk of sarcopenic obesity (SO) in octogenarian people.

METHODS

306 subjects (76 men, 230 women) with a mean age of 82.5 ± 2.3 years from the Multi-center EXERNET Project sample fulfilled the inclusion criteria. Body composition was assessed in all subjects by bioelectrical impedance. Four groups were created based on the percentage of fat mass and muscle mass: 1) normal, 2) high fat mass, 3) low muscle mass and 4) SO. Physical fitness was assessed using 8 different tests modified from the batteries “Senior Fitness Test” and Eurofit (EXERNET battery). The risk of suffering SO depending on the fitness level was studied by logistic regression.

RESULTS

Among the studied physical fitness tests, those that better predicted the risk of SO were leg strength, arm strength, agility, walking speed and balance in men; 95% CI [(0.606-0.957) (0.496-0.882), (0.020-2.014), (0.17-1.39), (0.913-1.002), all p < 0.05, except balance test (p = 0.07)] and balance test and agility in women; (95% CI [(0.928-1.002) (0.983-1.408), (both p = 0.07)].

CONCLUSION

Adequate levels of physical fitness are associated with a lower risk of SO. Some easy fitness tests seem to be useful for the detection of SO in those cases where the body-composition required methods for diagnosis are not available.

Influence of hard vs. soft ground surfaces on bone accretion in prepubertal footballers

Information regarding osteogenic effects of physical activity performed on different playing surfaces is scarce. A total of 42 children (9.2±0.2 years, Tanner stages I-II) participated in this study. 14 were playing on artificial turf soft ground (SG), 14 on a natural non-grass hard ground (HG) and 14 were assigned to the sedentary control group (C). Whole body and hip scans (dual energy X-ray absorptiometry), anthropometric variables (weight and height) and physical fitness (VO2max) were determined in all participants. Bone mineral content (BMC) values were higher in the SG group compared to the C group at the legs (209.75±5.11 g vs. 187.42±5.14 g, respectively), pelvis (122.72±4.27 g vs. 98.58±4.29 g respectively) and whole-body level (1 126.1±22.81 g vs. 1 035.34±22.92 g, respectively). The hard ground (HG) group also showed higher values in the majority of BMC variables compared to the C group. Additionally, bone mineral density (BMD) was significantly higher at all sites of the hip in both active groups compared to control (P<0.05). No differences between HG and SG were found. In summary, similar bone mass accretion is obtained by prepubescent footballers independently of the surface on which they practice football.

Sitting time increases the overweight and obesity risk independently of walking time in elderly people from Spain

INTRODUCTION

Obesity, defined as an excess of total body fat, is a matter of concern all over the world, and its prevalence is still increasing among elderly people.

OBJECTIVES

To examine whether sedentary behaviour (hours sitting per day) is associated with higher risk of central obesity, overweight-obesity and overfat in a representative sample of non-institutionalized Spanish elderly population and if so, whether hours walking per day modified this association.

STUDY DESIGN

A cross-sectional study in a sample of 3136 people ≥65 years of age.

MAIN OUTCOMES MEASURES

Anthropometric measurements were obtained using standardized techniques and equipment. Active and sedentary behaviours were recorded by questionnaire.

RESULTS

For both men and women, the higher prevalence of overweight-obesity, central obesity and overfat was found in those who spent sitting more than 4h per day and walk less than 1h, compared with those who spent sitting less than 4h per day and walk more than 1h (all p<0.001, except for central obesity in women). In men, more than 4h sitting per day was associated with 1.7-fold higher odds of having central obesity compared with those sitting less than 4h per day (p<0.01). In women, this sedentary behaviour increased the risk of overweight-obesity and overfat by 1.5 and 1.4, respectively (p<0.01). Age or time spent walking did not significantly change these results.

CONCLUSION

Sitting time increases the risk of overweight-obesity and overfat in women and the risk of central obesity in men, independently of walking time.

Prevalence of overweight and obesity in non-institutionalized people aged 65 or over from Spain: the elderly EXERNET multi-centre study

Coupled with the growth of the older population, an increase in the prevalence of overweight and obesity in this age group has occurred in the last decades. The main aims of the present study were (i) to provide an updated prevalence of overweight and obesity in a representative sample of the Spanish elderly population; (ii) to calculate the prevalence of sarcopenic obesity (SO) and (iii) to analyse the relationships between adiposity measurements and lifestyle. A cross-sectional study was carried out in a sample of 3136 persons representative of the non-institutionalized population ≥65 years of age. Anthropometric measurements were obtained using standardized techniques and equipment. Overall, 84% of the population can be categorized as overweight and/or obese. The present study indicates that 67% of the Spanish elderly population has an increased percentage of fat mass and more than 56% suffer from central obesity. Moreover, SO is present in 15% of the Spanish elderly population. Finally, a strong relationship between both physically active and sedentary lifestyles and the level of adiposity was found. Prevalence of overweight and obesity among elderly people in Spain is very high and is still increasing. Lifestyle seems to be a determinant factor in the development of obesity among elderly people.

Adjuvant activity of polymer microparticles and Montanide ISA 720 on immune responses to Plasmodium falciparum MSP2 long synthetic peptides in mice

The purpose of this work was to test the immunogenicity in C57BL mice of two synthetic peptides derived from the constant region of 3D7 and FC27 Plasmodium falciparum MSP2 dimorphic proteins, either microencapsulated into poly-lactide-co-glycolide acid microparticles (PLGA MP) or delivered with the human compatible adjuvant Montanide ISA 720 for comparison. Potent and prolonged antibody responses were obtained for both peptides by using PLGA MP formulations after subcutaneous or intradermal injections. As compared to the subcutaneous route of immunization, the intradermal route induced greater immune responses. Montanide adjuvant was effective in eliciting antibodies against the 3D7 peptide but not against the FC27 peptide. Peptide-specific cytophilic antibodies (IgG2a) were detected after boosting with homologous peptide for all vaccine formulations. MP formulations elicited a lower IgE secretion as compared to that observed for both Montanide formulated vaccines. Our results demonstrate the ability of the polymer microparticles to overcome the lack of immunogenicity of FC27 MSP2 peptide in C57BL mice and their potential to induce desirable immune responses against malaria.

Criteria of evaluation and of interpretation of Sepharose drug IgE-RIA to anaesthetic drugs

The detection of antidrug specific IgE in serum is usually performed by a sandwich-type immunoassay in which the serum IgE is first adsorbed to a reactive phase and subsequently quantified via the binding of an anti-IgE tracer. The preparation of a new drug-reactive phase requires one to establish carefully different steps of validation: 1) criteria of positivity of control sera 2) competitive inhibition assays with the soluble drug, which should include the determination of the inhibition constant rather than estimation of a single inhibition percentage, especially when the assay is performed for the identification of determinants 3) estimation of nonspecific binding of IgE to the solid phase, including hydrophobic binding. The competitive inhibition depends on the concentration of the competitor and of IgE in the test-tube and the concentration of reactive drug bound to the solid phase. We have improved the inhibition assay by performing the Dixon test for calculating the inhibition constant (Ki) of the competitor. The Ki of six different muscle relaxants was determined in 12 patients who experienced an anaphylactic reaction to muscle relaxants. The values ranged between 1.5 nM and 2.5 microM. This confirmed the great heterogeneity of drug IgE cross-reactivity among patients. The Ki value of the incriminated drug was the lowest (affinity, the highest) in eight of the 12 patients. It was better correlated to clinical data than the classical inhibition assay. A hydrophobic environment seemed to be necessary, close to the quaternary ion, to allow IgE binding to the muscle relaxant. By contrast, in tiemonium, a hydroxyl group present at a distance of about 3 A from the quaternary ion may explain why this molecule had a high Ki (microM). In conclusion, it should be recommended, in molecular-recognition studies, that the inhibition constant of the soluble drug and of the related compounds be determined to complement the experiments based only on hapten inhibition assays.

[Public health structures in Spain: a changing panorama]

In the last years the health care system in Spain has undergone very important transformations. However, the public health services have not followed a comparable process. Until 1979 public health structures were based in central services and their provincial units, on one side, and in the resources of local governments on the other. From then on began the process of transferring responsibilities and resources to the regional governments of Autonomous Communities (AC), which today manage most public health services, while the central government keeps as its responsibility the development of basic norms, the administration of public health services at borders and customs, and the general health coordination. The situation in 1995 resembles that of a Federal Country, although the Kingdom of Spain is not formally defined as such. The role of central government services is visibly reoriented towards coordination and the building of consensual and shared structures for health information, for need evaluation, and for policy formulation and evaluation. Although the General Health Law of 1986 considered public health as a main axis for all health agencies, its actual development has been more patchy. Several AC with an Autonomous Health Service have kept public health services separated from it. Besides, many public health functions and activities are developed today from other structures. The processes of change reveal two contradictory aspects. On one side, structures have been upgraded after decentralization, and teams reinforced, with trained and full-time staff. However, there is some dilution of public health responsibility in the periphery, and a lower visibility of the health authority.

Association between giardiasis and allergy

BACKGROUND

Previous studies have indicated that there may be an association between infection by the intestinal protozoan Giardia lamblia and the expression of allergic disease.

OBJECT

We evaluated a group of children who attended the Outpatient Clinic of the Children's Hospital in Caracas, Venezuela, a group in which both allergic disease and giardiasis were common.

METHODS

We performed feces examination and measured total and specific serum IgE (immunoglobulin E) in these children.

RESULTS

We found that 70% of the children infected with G. lamblia presented symptoms of allergy, in contrast to 43% of the non-Giardia parasitized group (P <.05). In addition, the G. lamblia parasitized children showed significantly higher levels of total serum IgE (1194 IU/mL) than the non-Giardia group (822 IU/mL) (P <.005). Children infected with G. lamblia showed higher levels of specific serum IgE antibody against food allergens compared both with the non-parasitized group (P <.0001) and children infected with parasites other than Giardia (P <.05). In contrast, IgE responses against the house dust mite Dermatophagoides pteronyssinus were similar in all the groups studied.

CONCLUSIONS

These results reveal a clear relationship between giardiasis and allergy, possibly because infection by this protozoon enhances sensitization towards food antigens, due to increased antigen penetration through damaged intestinal mucosa.

Non-specific cross-reactivity of hydrophobic serum IgE to hydrophobic drugs

The purpose of this work was to study the involvement of serum hydrophobic IgE in non-specific cross-reactions with hydrophobic drugs such as cyclohexenyl derivatives. Hydrophobic IgE were detected by radioimmunoassay. The results were expressed as the percentage of labelled anti-IgE which were adsorbed to the drug solid phase via IgE of the patient serum. Phenyl-Sepharose IgE-RIA was at 4.6 +/- 0.7%, 125 +/- 6.5% and 17.8 +/- 8.9% in control subjects (n = 24), in atopic patients with positive Phadiatop (n = 30) and in patients with drug allergy (n = 23), respectively. We selected five patients who were allergic to either penicillin, propofol, glafenin or paracetamol and who had a Phenyl-Sepharose IgE-RIA greater than 20%. In these five cases, IgE-RIA were positive (percentage at least twice more than that obtained with control sera) with all the solid phases prepared with hydrophobic drugs such as penicillin, propofol, glafenin, paracetamol and mexiletine. Inhibition of IgE binding by monoethylene-glycol showed that the cross-reactivity was due to hydrophobic binding of IgE to the drug. Three of the five patients were allergic to penicillin and underwent on adverse reaction against another cyclohexenyl derivative, namely propofol and glafenin. In conclusion, we have observed the presence of 'hydrophobic IgE (with positive Phenyl-Sepharose RIA)' in 64% of patients allergic to a hydrophobic drug.

Epidemiologic study of an outbreak of clenbuterol poisoning in Catalonia, Spain

In an investigation of 113 cases of clenbuterol poisoning in Catalonia, Spain, in 1992, more than 50 percent of those affected were found to have had symptoms of nervousness, tachycardia, muscle tremors, myalgia, and headache. There was no significant difference in the distribution of symptoms according to sex (P = 0.97). The period of incubation varied between 15 minutes and 6 hours and the duration of symptoms between 90 minutes and 6 days. Clenbuterol was detected in 47 urine samples in amounts ranging from 11 to 486 parts per billion. No traces of clenbuterol were found in serum samples. Intoxication occurred in association with the ingestion of veal liver, irrespective of the way in which the liver had been cooked. The association between consuming liver and falling ill was statistically significant (P < 0.0001). In one family, the suspected source of intoxication was meat (veal tongue) and in another canneloni. None of the patients died as a result of the intoxication. The findings reinforce the need to uphold the prohibition of the use of clenbuterol in cattle farming in those countries and communities where it already exists and to contemplate a stricter regulation of its therapeutic use.

Surimi and native codfish contain a common allergen identified as a 63-kDa protein

We have compared the allergenicity of codfish and surimi (prepared from codfish) by skin testing, specific IgE-RIA, and leukocyte histamine release (LHR) in six fish-allergic patients. Prick tests were positive for codfish and, to a lesser extent, surimi. The percentages of labeled anti-IgE bound to surimi-Sepharose were 1.55 +/- 0.19% and 3-6% with control and patient sera, respectively. Inhibition of the surimi protein-Sepharose IgE-RIA was greatest (80%) at protein concentrations of 13.4 and 408.5 micrograms/ml for codfish and surimi extract, respectively. The allergenic protein was isolated by gel filtration and subjected to SDS-PAGE. The eluate from codfish contained several proteins ranging from 13 to 63 kDa, while the eluate from surimi contained a single 63-kDa protein. It was concluded that surimi contained a single allergenic protein.

Platelet serotonin is a mediator potentially involved in anaphylactic reaction to neuromuscular blocking drugs

A platelet serotonin release test was performed on blood from 10 patients who had suffered from an IgE-dependent allergic reaction to a neuromuscular blocking drug. The results were compared with those of a leukocyte histamine release test. The upper limit of serotonin release induced by neuromuscular blockers was estimated to be 2.3% in non-allergic patients. The test was positive in six patients and was consistent with histamine release in five. Serotonin release induced by neuromuscular blockers comprised 2.9-25% of total platelet serotonin content. We conclude that serotonin is one of the mediators associated with histamine release during anaphylaxis to neuromuscular blockers. Platelet serotonin release tests may be useful for the investigation of anaphylactic responses to neuromuscular blocking drugs.

Non specific interactions in anti-agent IgE-RIA to anesthetic agents

The sensitivity of usual IgE-RIA for detecting seric anti-neuromuscular blocking drug (NMBD) IgE antibodies is low. Our group and other authors have proposed quaternary ammonium compounds other than NMBD for the preparation of sepharose solid drug phase. These compounds cannot be cyclohexenyl derivatives in order to prevent hydrophobic interactions with seric hydrophobic IgE. Allergic reactions against cyclohexenyl derivatives such as propofol could be linked to a non-specific hydrophobic binding of the drug to hydrophobic seric IgE. Such hydrophobic IgE are seen in 30% of atopic subjects, in 41% of patients with drug allergy and in 100% of those allergic to propofol. The latter had also anti-quaternary ammonium IgE in 5 out of the 8 cases studied. These NMBD antibodies could bind to the quaternary-ammonium ion of the lecithins from Diprivan micelles.

Clinical evaluation of in vitro leukocyte histamine release in allergy to muscle relaxant drugs

We have evaluated the in vitro leukocyte histamine release tests for the diagnosis of allergy to muscle relaxant drugs in 40 patients (Group A) and a control group of 44 subjects with negative leukocyte histamine release (Group B). Non-IgE dependent histamine release, expressed as a percentage of the total blood histamine, was 3.94% +/- 0.49 in Group B. The upper limit of positivity was estimated to be 5% (mean + 2 SD). Leukocyte histamine release tests were positive in 65% of the patients from Group A. The concordance between LHR and QAS-RIA was 64%. The maximal histamine release was observed at dilutions of 10(-2)-10(-4) in 20 of the 26 positive cases. The maximal histamine release was 43.8% +/- 23.3. The spontaneous histamine release was as low as 1.7% +/- 1.1. Cross-reactivity among the 5 different muscle relaxant drugs has been investigated and compared by intradermal testing. The muscle relaxant drugs which gave the lower skin reaction (M2) and the drug responsible for shock (M1) were selected for the study of in vitro leukocyte histamine release. Of 20 M2. All of the 10 cases had negative ID tests with M2. Three of these patients subsequently underwent general anesthesia with the muscle relaxant chosen as harmless (M2) without any clinical reaction.

Basophil histamine release in atopic patients after in vitro provocation with thiopental, Diprivan and chlormethiazole

The degree of histamine release induced by three different anesthetic drugs was studied in vitro using basophil leukocytes from atopic patients (n = 11) and controls (n = 14). In all, eight dilutions (1/2 to 10(-5)) of Diprivan and its solvent Intralipid, thiopental and chlormethiazole in aqueous solution, were used. Histamine was released in four controls with weak dilutions (1/2 to 10(-5)) of Diprivan (n = 2) and thiopental (n = 2). The reaction with thiopental was greater than that with Diprivan. Five of the atopic subjects released histamine with one or more drug: thiopental and Diprivan four times each, Intralipid twice, and chlormethiazole once. Histamine release was greater in these patients than in controls, and occurred with dilutions ranging from 1/2 to 10(-2), except for one case. It is concluded that atopic patients release histamine with hypnotic anesthetic drugs more easily than normal subjects. In the clinical setting, where blood concentration of the drugs studied is equivalent to a dilution of less than 10(-3), they do not release much histamine. They may be used in atopic patients if the drugs are injected slowly.

Evaluation of a new reactive solid phase for radioimmunoassay of serum specific IgE against muscle relaxant drugs

Until now, immunoassays for detection of anti-muscle relaxant IgE in serum have been performed with the drug coupled to epoxy-activated Sepharose or to RAST papers dics. In the present work we have used a quaternary ammonium-Sepharose in which the quaternary ammonium reactive group (choline chloride) was directly coupled to Sepharose via an ether linkage. 50 microliters of the quaternary ammonium solid phase (QAS) was incubated with 50 microliters of serum for 3 h, washed, incubated 18 h with 125I-anti-IgE and washed again. The results were expressed as the percentage of 125I-anti-IgE absorbed onto the solid phase. The results were at 1.3 +/- 0.5% for 20 control sera, with an upper normal limit estimated to 2.3%. The within-run reproducibility ranged from 3.2% to 10.0%. The results were significantly correlated with those obtained with either alcuronium-epoxy-Sepharose, choline-epoxy-Sepharose, the RAST-alcuronium or with the RAST-succinyl choline (respectively, r = 0.66, r = 0.80, r = 0.81, r = 0.40 and r = 0.85). The values obtained with the sera of 83 patients ranged from 0.3 to 38.5%. The sensitivity was estimated at 87.9%, 66.7% and 40.7% with the QAS-RIA, the RAST-succinyl choline and the RAST-alcuronium, respectively. The inhibition of adsorption of specific IgE onto the gel ranged from 13.0 to 90.6% in presence of 130 nmol of soluble muscle relaxants. In 83.3% of 30 cases, the highest inhibition was obtained with the muscle relaxant which was clinically incriminated.(ABSTRACT TRUNCATED AT 250 WORDS)

[Probable allergy to polyvidon, responsible for a reaction to iodinated contrast medium: a case of asthma after hysterosalpingography]

A case of asthma induced by a iodinated medium (ICM) is reported. The ordinary ICM for urography were well tolerated. The suspected drug included polyvidon (PVP). Skin test, human basophil degranulation tests and leukocyte histamine release are negative for meglumine ioxitalamate, and positive for PVP. PVP is a macromolecule, used in different drugs, and as a clarifying agent of alcohols. An IgE-dependent allergy to PVP is postulated.

Skeletal muscle regeneration after myonecrosis induced by Bothrops asper (terciopelo) venom

In order to assess the extent of regeneration, creatine kinase content of injected gastrocnemius muscle were determined at four time intervals after inoculation. Simultaneously, the diameters of regenerating fibers were measured, the wet weight of the gastrocnemius was recorded and electrophoretic patterns of muscle proteins and histology of the tissue were analyzed. Injection of crude B. asper venom caused myonecrosis and hemorrhage; in these cases regeneration was very poor, as there was only a small increase in creatine kinase content by four weeks. Histologically, large areas of fibrosis were observed, intermixed with small areas of regenerating muscle. Furthermore, the diameter of regenerating muscle cells was abnormally small, even four weeks after envenomation. In order to test the role of hemorrhage in impairment of regeneration, we also studied the effects of B. asper venom that had been incubated with a volume of antivenom that completely neutralized hemorrhagic activity, but not myotoxic activity. At 24 hr mice showed a generalized picture of myonecrosis, without hemorrhage. Afterwards, regeneration proceeded and significant increases in creatine kinase content were demonstrated at 1, 2 and 4 weeks. Also, histological observations showed the presence of many areas of regenerating muscle, intermixed with small areas of fibrosis and adipose tissue. The diameter of regenerating cells increased with time, reaching values of 25.8 microns by four weeks. Electrophoretic analyses of muscle proteins showed that muscle injected with partially neutralized venom underwent a more complete regeneration than muscle injected with crude venom.(ABSTRACT TRUNCATED AT 250 WORDS)

Prophylactic use of penicillin V in teeth with necrotic pulps and asymptomatic periapical radiolucencies

As a result of (1) clinical experience with flare-ups occurring in teeth with necrotic pulps and asymptomatic periapical radiolucencies and (2) on apparent reduction to the incidence of such flare-ups by the administration of penicillin V at the first sign of swelling, this study on the prophylactic administration of penicillin V in similar cases was undertaken. The subjects were 100 consecutive clinic patients whose teeth had necrotic pulps and asymptomatic periapical radiolucencies. At the initial visit, all teeth were instrumented completely to the radiographic apex, with 0.5% to 2.54% sodium hypochlorite as the irrigant. Sterile, dry cotton pellets and ZOE restorations were used. Alternate patients were given 250 mg of penicillin V and an identical-appearing placebo with instructions to take two tablets every 6 hours for the first 24 hours, followed by one tablet every 6 hours until all tablets were taken. Pain and swelling were graded by the patients on five-point scales, and flare-ups were scored when either pain and/or swelling necessitated an unscheduled emergency visit. Fifteen patients developed flare-ups, with significantly more flare-ups in the placebo group (p less than 0.05). The findings indicate that, in selected cases, prophylactic penicillin can be used to prevent flare-ups.

Isolation from a polyvalent antivenom of antibodies to a myotoxin in Bothrops asper snake venom

Antibodies against Bothrops asper myotoxin were purified from a polyvalent antivenom by affinity chromatography. These antibodies neutralized most of the myotoxic activity of crude B. asper venom, as judged by histologic evaluation of skeletal muscle and determination of plasma creatine kinase levels in mice. When tested by immunoelectrophoresis, purified antibodies formed two superimposed bands of precipitation against an homogeneous (by SDS-PAGE analysis) preparation of B. asper myotoxin, as well as against crude B. asper venom. Ouchterlony immunodiffusion analysis of purified antibodies showed two precipitation bands with a pattern of complete immunologic identity between samples of crude B. asper venoms from specimens collected in the Atlantic and Pacific regions of Costa Rica. In addition, these antibodies precipitated when reacted against venom of newborn B. asper specimens from the Pacific region, but not against venom of newborn specimens from the Atlantic region. Purified antibodies were tested by immunodiffusion against eleven different snake venoms from Costa Rica. Only the venom of B. schlegelii cross-reacted, indicating the presence in this venom of components immunologically related to B. asper myotoxin. Analysis of purified antibodies to B. asper myotoxin by agarose electrophoresis and by SDS-PAGE suggests the presence of both IgG and IgM on the basis of electrophoretic position and molecular weight of the bands. Results obtained in neutralization experiments suggest that this myotoxin is a major factor in the development of local myonecrosis induced by crude B. asper venom.