Vaccination schedule for adolescents. Consensus of the AEV, CAV-AEP and SEMA

We present the consensus document on the immunization schedule for adolescents developed by 3 scientific societies: the Spanish Association of Pediatrics (AEP), through its Advisory Committee on Vaccines (CAV-AEP), the Spanish Society of Adolescent Medicine (SEMA) and the Spanish Association of Vaccinology (AEV). There are particularities in infectious disease during adolescence, such as an increased susceptibility to pertussis, poorer outcomes of chickenpox, mumps and hepatitis A, a high incidence of sexually transmitted infections or increased prevalence of meningococcal carriage. The document analyses the schedule for adolescents in the context of vaccination policy overall. It contemplates the vaccines to be included in the immunization schedule for healthy adolescents: against invasive meningococcal disease (tetravalent ACWY and B), against human papillomavirus (which should be gender-neutral), against pertussis, against influenza and against SARS-CoV-2 (in unvaccinated individuals and at-risk groups). It is worth noting that the 4CMenB vaccine appears to confer some protection against gonococcal infection, which would be a considerable added value for adolescents. The vaccination of adolescents belonging to risk groups or travelling abroad also needs to be contemplated, as is the case in any other age group. Vaccination against hepatitis A, which is included in the routine immunization schedule of Catalonia, Ceuta and Melilla from the second year of life, should also be considered a priority in adolescents traveling to endemic areas.

Hypothermic Storage of Periportal and Perivenous Rat Hepatocytes

High yields of intact parenchymal cells are produced by the two-step Digitonin-collagenase perfusion of whole liver, and it has gained wide acceptance for biochemical and cellular analyses of zonal hepatocytes. The development reached by this methodology is in contrast to the time-limited use of the isolated cells unless those other methods, such as primary cultures, are employed. An alternative option to have cells ready to be used for several days, is the cold storage in University of Wisconsin solution as a preservation solution. This procedure is easy, not too expensive, and does not require specialized equipment. We study the competence of this system to maintain liver cells: mixed or total cells and cell-enriched fractions. We affirm viability of hepatocytes during hypothermic storage (UW-96h-4°C) by Trypan Blue exclusion, the capacity to retain cytoplasmic enzymes, metabolic competence to maintain total Glutathione content, and immunocytochemistry (gene detection). After 96 h of cold storage, mixed cells and cell-enriched fractions, were submitted to normothermic incubation (120 min, 37°C) and we check Trypan Blue exclusion, cytoplasmic enzyme release, and the capacity of cell populations to synthesize urea. The results show that it is possible to use, after several days of storage, mixed liver cells and cell-enriched fractions in metabolic and gene expression studies. This procedure allows us to reduce the number of experimental animals needed, to save experimental time and costs, and to facilitate further studies in vitro about the basis and consequences of metabolic heterogeneity of the liver cell plate.

Importance of pH in Resuspension Media on Viability of Hepatocytes Preserved in University of Wisconsin Solution

The effect of different pH of resuspension media on the viability of hepatocytes preserved (for 96 h at 4°C) in University of Wisconsin solution (UW solution) was analyzed. After this cold resuspension media storage, we evaluated the rewarming step (incubation time 120 min at 37°C) using different pH levels (6.80, 7.00, 7.20, and 7.40). Cell viability assessed by trypan blue exclusion (TBE) showed a significant difference (p < 0.05) for cells incubated at pH = 7.20. For instance, TBE expressed as percent of change was 78.1 ± 1.4 compared with cells tested at other pH (pH = 6.80, TBE = 44.2 ± 9.5; pH = 7.00, TBE = 66.5 ± 1.1 and pH = 7.40, TBE = 62.0 ± 1.4). We also evaluated the capacity of these cells both to maintain potassium content (0.509 ± 0.230 μEq. K+/106 cells) and to synthesize urea (5.36 ± 1.81 μmol Urea/106 cells). These results were compared with those obtained from freshly isolated non preserved hepatocytes (0.518 ± 0.060 μEq. K+/106 cells and 5.91 ± 0.43 μmol Urea/106 cells). The results show that viability is pH dependent and suggest that when resuspension media were used, the viability of hepatocytes was improved after 96 h of cold storage.

Protective Effect of Glutathione (GSH) over Glutathione Monoethyl-Ester (GSH-E) on Cold Preservation of Isolated Rat Liver Cells

Hepatocyte suspensions provide a rapid method to determine how hypothermic storage affects liver cell metabolism and viability. We investigated whether reduced Glutathione (GSH) inclusion into a modified University of Wisconsin (UW) solution, has a protective effect over Glutathione derivatives, such as Glutathione-monoethylester (GSH-E), when suspensions of hepatocytes are cold stored for several days. Isolated rat liver cells were cold preserved 96 h in UW, UW plus 3 mM GSH and UW plus 3 mM GSHE. During the cold storage, not significant changes in cell viability were observed, but the total Glutathione content was higher in systems with extracellular GSH over those with GSH-E or without. After cold storage, the liver cells were gently resuspended in Krebs-Henseleit — 1% Albumin and used for 120 min of normothermic (37°C) incubation. We evaluate the functional response of the cells measuring the exclusion of Trypan Blue (TBE). This response was clearly different in preserved cells in presence of GSH. These results indicate a protective role of extracellular Glutathione, due to an accumulation of it, rather than the derivative, for hepatic cell during the cold storage in UW solutions. And also, it is possible to extend experiments with hepatocytes from a single cell isolation over 4 or more consecutive days

Experience with lyophilized human dura mater for urethral strictures

PURPOSE

We report our results using lyophilized human dura mater for urethral strictures.

MATERIALS AND METHODS

The results of 131 urethroplasties using lyophilized human dura mater grafts were reviewed. The etiology of the stricture was unknown in most cases and 44.3% had not been previously treated. Mean stricture length was 10 cm. A dura mater patch was used in 124 cases and tubular graft in 7.

RESULTS

Average followup was 56.6 months. The overall complication rate during the first month was 16.3%. At 6 months the graft failed in 2 cases and 25.2% had stricture recurrence. Good results were obtained in the longer term in 41.1% of cases, with a high recurrence rate and malignancy in 4 cases (3.2%) which required penectomy.

CONCLUSIONS

Despite being a biologically well tolerated material, lyophilized human dura mater is not good for urethral strictures because of the high number of relapses and possibility of malignancy.

Hypothermic storage of periportal and perivenous rat hepatocytes

High yields of intact parenchymal cells are produced by the two-step Digitonin-collagenase perfusion of whole liver, and it has gained wide acceptance for biochemical and cellular analyses of zonal hepatocytes. The development reached by this methodology is in contrast to the time-limited use of the isolated cells unless those other methods, such as primary cultures, are employed. An alternative option to have cells ready to be used for several days, is the cold storage in University of Wisconsin solution as a preservation solution. This procedure is easy, not too expensive, and does not require specialized equipment. We study the competence of this system to maintain liver cells: mixed or total cells and cell-enriched fractions. We affirm viability of hepatocytes during hypothermic storage (UW-96 h-4 degrees C) by Trypan Blue exclusion, the capacity to retain cytoplasmic enzymes, metabolic competence to maintain total Glutathione content, and immunocytochemistry (gene detection). After 96 h of cold storage, mixed cells and cell-enriched fractions, were submitted to normothermic incubation (120 min, 37 degrees C) and we check Trypan Blue exclusion, cytoplasmic enzyme release, and the capacity of cell populations to synthesize urea. The results show that it is possible to use, after several days of storage, mixed liver cells and cell-enriched fractions in metabolic and gene expression studies. This procedure allows us to reduce the number of experimental animals needed, to save experimental time and costs, and to facilitate further studies in vitro about the basis and consequences of metabolic heterogeneity of the liver cell plate.

Glutathione movements during cold preservation of rat hepatocytes

In this study we have examined the movements of glutathione (GSH) during cold preservation of rat hepatocytes in University of Wisconsin solution. During the preservation process at a low temperature (4 degrees C), with a high extracellular potassium concentration, an extracellular nondiffusible anion (lactobionate), and a Cl(-)-free medium, there is a depletion of metabolites and the development of a time-dependent injury. Also, there is a loss of GSH that is not compensated by transport or synthesis and is basically due to increased catabolic processes. This sensitizes the cells to different forms of oxidative injury, which can play a negative role during transplantation. The addition of GSH improves liver cell preservation but the mechanism is unclear. To elucidate this process we have isolated hepatocytes and preserved them under different conditions: with or without GSH: in the presence of DL-buthionine-[S,R]-sulfoximine, an inhibitor of glutathione synthetase, and acivicine to inhibit the ectoactivity of cellular gammaglutamyl transpeptidase; or by obtaining hepatocytes from rats depleted of GSH by an injection of diethyl maleate. Under all these conditions we evaluated the GSH content of the cells during cold storage. We also report the time course of accumulation of [glycine-2-3H]GSH. Our results show that during hypothermic storage in University of Wisconsin solution, hepatocytes are permeable to GSH, and the mechanism involved is a rapid nonsaturable process, with linear dependence of the extracellular GSH concentration. This finding may have valuable applications in the improvement of the delivery of compounds to cells.

[Complete urodynamic office evaluation; a method for the delivery of health care]

INTRODUCTION

The goal of the study was to evaluate the usefulness of the complete urodynamic office evaluation. This assistance modality consists on the realisation in the same moment of the clinical chart, physical examination, urodynamic study, report, therapeutic indications, program of other complementary studies, hospitalisation or discharge from the outpatient office.

PATIENTS AND METHODS

During 1 year complete urodynamic office evaluation was performed to 100 patients (87 female, 13 male) All patients were directed to our department to perform a urodynamic test, most of them due to incontinence. Different kinds of urodynamic tests were performed in 91 patients, with a medium of 2 studies per test. Abnormalities were detected in 59 cases.

RESULTS

After the complete urodynamic office evaluation, 16 patients were programmed for surgery, 26 were discharged from outpatient office, 37 were directed to follow up in the outpatient setting, 2 were hospitalised, and 19 were lost of follow up.

CONCLUSIONS

The complete urodynamic office evaluation allowed us to get the diagnostic and therapeutic approach in 98% of patients, employing a standard of 90 minutes. Twenty six percent of patients could be discharged from our center. Sixteen patients were operated on following this unique visit, that means an important reduction in the usual assistance delay.

[Lithiasis in megacalyosis]

OBJECTIVE

To review our series of lithiasis associated with megacalyosis, a rare disease entity.

METHODS/RESULTS

The clinical records of patients treated from 1976 to 1994 were reviewed. Of 39 cases of megacalyosis, 27 were associated with lithiasis and was slightly more prevalent in males (59.3%). Struvite and whewelite calculi were more prevalent and 40.7% also had urinary tract infection, E. coli, Pseudomonas and Proteus being the most frequent pathogens. ESWL with hyperhydration was the most frequently utilized treatment.

CONCLUSIONS

Megacalyosis is an embryogenic anomaly of Malpighi's pyramids that is associated with lithiasis in 69.2% of our series, frequently localized to the left side. We have found no significant difference according to sex or a hereditary component. IVP is the principal diagnostic method for megacalyosis. The frequent association of urinary tract infection should be taken into account when instituting treatment.

Importance of pH in resuspension media on viability of hepatocytes preserved in University of Wisconsin solution

The effect of different pH of resuspension media on the viability of hepatocytes preserved (for 96 h at 4 degrees C) in University of Wisconsin solution (UW solution) was analyzed. After this cold resuspension media storage, we evaluated the rewarming step (incubation time 120 min at 37 degrees C) using different pH levels (6.80, 7.00, 7.20, and 7.40). Cell viability assessed by trypan blue exclusion (TBE) showed a significant difference (p < 0.05) for cells incubated at pH = 7.20. For instance, TBE expressed as percent of change was 78.1 +/- 1.4 compared with cells tested at other pH (pH = 6.80, TBE = 44.2 +/- 9.5; pH = 7.00, TBE = 66.5 +/- 1.1 and pH = 7.40, TBE = 62.0 +/- 1.4). We also evaluated the capacity of these cells both to maintain potassium content (0.509 +/- 0.230 microEq. K+/10(6) cells) and to synthesize urea (5.36 +/- 1.81 mumol Urea/10(6) cells). These results were compared with those obtained from freshly isolated non preserved hepatocytes (0.518 +/- 0.060 microEq. K+/10(6) cells and 5.91 +/- 0.43 mumol Urea/10(6) cells). The results show that viability is pH dependent and suggest that when resuspension media were used, the viability of hepatocytes was improved after 96 h of cold storage.

Temperature-metabolism relations in the cotton-top tamarin (Saguinus oedipus) model for ulcerative colitis

Examination of temperature-metabolism relations found no significant differences between thermoregulation of temperature housed laboratory cotton-top tamarins (Saguinus oedipus) and wild tamarins in Colombia, S.A. The results indicate that tamarins do not acclimate to a temperature environment and are metabolically stressed at Ta less than 32 degrees C. This is consistent with an hypothesis of chronic metabolic stress as a factor in the etiology of cotton-top tamarin colitis, which is restricted to captive populations and not found in wild tamarins.

[Endoscopy surgery of utriculocele]

Of 12 patients with utriculocele, 6 consulted for sterility and were submitted to endoscopic surgery. Transurethral resection of the utricular capsule removed distal obstruction of the seminal duct in all cases (increased ejaculate volume), in half of the cases sperm density and motility improved, and in 1 case pregnancy was achieved with insemination of capacitated semen (ICA).

Urinary concentrating defect in glutathione-depleted rats

The effect of an acute depletion of glutathione by diethyl maleate injection on renal concentrating function was examined in rats. The parameters tested were the concentration and dilution of urine, applying conventional clearance techniques. Tissue osmolality and Na+-K+ ATPase activity were also measured. Diethyl maleate treated rats showed a diminished renal glutathione concentration and an impairment in the glomerular filtration rate and in electrolyte and water excretion. Treated rats also showed a diminished urine-to-plasma osmolality ratio as compared with controls. The studies on free water formation revealed a marked difference between groups; these data were supported with a diminished medullary Na+-K+ ATPase and a diminished corticomedullary osmolality gradient in the treated rats. The studies suggest that one area of target cells of glutathione depletion is that of the ascending limb of Henle's loop.

Renal and hepatic glutathione pool modifications in response to depletion treatments

In this study we examined the response of the renal and hepatic glutathione (GSH) pool in rats to drastic GSH depletion treatments. For this purpose, we used a protein-free diet, starvation, and the injection of varying doses of diethyl maleate as depleting agents. We analysed GSH levels in both kidney and liver tissue homogenates after rats were fed a protein-free diet for 2 or 7 days or starved for 1, 2, or 3 days, as well as after diethyl maleate administration in a single maximal dose or in varying doses. The results indicated that the liver GSH pool was always more labile than the kidney GSH pool. Moreover, kidney GSH levels were almost unchanged after 7 days on a protein-free diet or after 2 days of starvation, while liver showed significant changes in GSH levels. When we analysed the repletion rate, kidney had higher kinetic parameters (k = 0.148 h-1) than liver (0.097 h-1). We conclude that efficient mechanisms of maintaining GSH levels exist in the kidney and these may serve to avoid GSH diminution and hence preserve renal function during states of GSH depletion.