Improved prediction of electrical storm in patients with prior myocardial infarction and implantable cardioverter defibrillator

AIMS

To evaluate predictors of electrical storm (ES), including chronic total occlusion in an infarct-related coronary artery (infarct-related artery CTO, IRACTO), in a cohort of patients with prior myocardial infarction (MI) and implantable cardioverter-defibrillators (ICD).

METHODS

Multicenter observational cohort study including 643 consecutive patients with prior MI and a first ICD implanted between 2005 and 2018 at three tertiary hospitals. All the patients included in the study had undergone a diagnostic coronary angiography before ICD implantation. The variable prior ventricular arrhythmias (VA+) was positive in patients with secondary prevention ICDs and in those with at least one appropriate ICD therapy after primary prevention implantation.

RESULTS

During a median follow-up of 42 months 59 patients (9%) suffered ES. The presence of at least one IRACTO not revascularized (IRACTO-NR) was associated with a significantly higher cumulative incidence of ES (14.5% vs 4.8%, p < 0.001). IRACTO-NR maintained a significant association with ES after adjustment for potential confounders (HR 2.3, p = 0.005) and was an independent predictor of ES together with VA+ and LVEF. The best cut-off of LVEF to predict ES was ≤38%. A risk-prediction model based on IRACTO-NR, VA+ and LVEF≤38% identified three categories of ES risk (low, intermediate and high), with progressively increasing cumulative incidence of ES (2.2%, 9% and 20%).

CONCLUSION

In a cohort of patients with prior MI and ICD, IRACTO-NR is an independent predictor of ES. A new risk-prediction model allowed the identification of three categories of risk, with potentially important clinical implications.

Value of 18F-Choline PET/MRI hybrid technique on the therapeutic approach for patients with prostate cancer treated with prostatectomy and rising prostate specific antigen levels below 1 ng/ml

OBJECTIVE

To assess the detection rate of ¹⁸F-Choline PET/MRI and subsequent changes in therapy approach for patients with prostate cancer treated by prostatectomy and with rising levels of PSA <1 ng/ml.

METHODS

Prospective study with our first 36 patients with prostatectomy for prostate cancer and rising levels of PSA, who were referred for an ¹⁸F-Choline PET/MRI study. A dual-phase study was acquired after intravenous administration of 185±10% MBq of ¹⁸F-Choline: 1) early imaging (immediately after tracer administration) of prostate area (emission PET/Multiparametric MRI). 2) whole-body imaging 1 h after tracer injection (emission PET/MRI: T1, T2, STIR, diffusion). The therapy approach for patients was decided upon the Oncology Committee consensus based on ¹⁸F-Choline PET/MRI findings.

RESULTS

Twenty out of 36 patients (55.6%) were positive for the ¹⁸F-Choline PET/MRI study: 8 (22.2%) within the prostatectomy bed, 7 (19.4%) with infradiaphragmatic lymph nodes, 4 (11.1%) with local recurrence and infradiaphragmatic lymph nodes, and 1 (2.8%) with bone metastasis. Sixteen out of the 36 patients (44.4%) were negative for the ¹⁸F-Choline PET/MRI study. ¹⁸F-Choline PET/MRI findings had an impact on the therapy approach to follow: 15 patients (41.6%) showed oligometastatic disease which was treated by imaging-guided radiotherapy, 5 (13.9%) with multiple metastatic disease were treated by androgen deprivation therapy, 16 (44.4%) negative were under active surveillance.

CONCLUSION

Hybrid ¹⁸F-Choline PET/MRI procedure showed a high detection rate for recurrence in prostate cancer patients treated with prostatectomy and rising PSA levels <1 ng/ml, and ¹⁸F-Choline PET/MRI findings resulted in a better tailored therapy approach delivered to our patients.

Salvage radiotherapy in prostate cancer patients. Planning, treatment response and prognosis using (11)C-choline PET/CT

OBJECTIVE

To assess the prognostic value of the therapeutic response by (11)C-choline PET/CT in prostate cancer patients with biochemical recurrence in which (11)C-choline PET/CT indicated radio-guided radiotherapy.

METHODS

The study included 37 patients initially treated with prostatectomy, who were treated due to biochemical recurrence. (11)C-choline PE/CT detected infra-diaphragmatic lymph-node involvement. All were selected for intensity modulated radiation therapy, escalating the dose according to the PET findings. One year after treatment patients underwent PSA and (11)C-choline PET/CT categorizing response (complete/partial/progression). Clinical/biochemical/image monitoring was performed until appearance of second relapse or 36 months in disease-free patients.

RESULTS

(11)C-choline PET/CT could detect lymph nodes in all 37 patients. They were 18 (48.6%) of more than a centimetre in size and 19 (51.3%) with no pathological CT morphology: 9 (24.3%) with positive lymph nodes of around one centimetre and 10 (27.0%) only less than a centimetre in size. The response by (11)C-choline PET/CT was categorised one year after radiotherapy: 16 patients (43.2%) complete response; 15 (40.5%) partial response, and 6 (16.2%) progression. The response was concordant between the PSA result and (11)C-choline PET/CT in 32 patients (86.5%), and discordant in five (13.5%). New recurrence was detected in 12 patients (80%) with partial response, and 5 (31.2%) with complete response. The mean time to recurrence was 9 months after partial response, and 18 months after complete response (significant difference, p<.0001).

CONCLUSION

(11)C-choline PET/CT allows the selection of patients with recurrent prostate cancer candidates for radiotherapy and to plan the technique. The evaluation of therapeutic response by (11)C-choline PET/CT has prognostic significance.

Diagnosis by (18)F-FDG PET/CT of infective endocarditis, staging and monitoring of antibiotic treatment after transposition of surgically corrected great arteries

Infective endocarditis is one of the leading causes of fever of unknown origin in those patients with intravascular catheters, prosthetic valves or cardiovascular implantable electronic devices. The diagnosis of infective endocarditis is made according to modified Duke criteria, which are based on blood culture and echocardiographic findings. Demonstration of vegetation with the transoesophageal echocardiography may be difficult in these cases with previous anatomical changes, especially in early phases. Positron emission tomography with (18)F-fluorodeoxyglucose ((18)F-FDG PET/CT) is well known to show an increased glucidic metabolism in malignant, inflammatory, and infectious processes. Thus, it provides useful functional imaging that enables the disease causing the fever of unknown origin to be detected well before structural changes are evident. Moreover, (18)F-FDG PET/CT helps to detect infectious extra-cardiac involvement, since the whole body is imaged with this technique. (18)F-FDG PET/CT may have an additional promising role for the monitoring of response to antimicrobial therapy in patients with established infective endocarditis, thus evaluating standard treatment outcome, as well as evaluating the need for alternative/intensified treatment options.

[Extension study and evaluation of the therapeutic response in a patient with metastatic lung adenocarcinoma using sequential study with ¹⁸F-FDG PET-CT and ¹⁸F-fluoride PET-CT]

We report a case of a patient with lung adenocarcinoma and bone and extraosseus metastases studied with (18)F-FDG PET-CT, (99m)Tc-HMDP and (18)F-fluoride PET-CT. It assesses the usefulness of (18)F-FDG PET-CT for initial staging of the disease and monitoring response to therapy. For the study of the sclerotic bone metastases it shows the superiority of 99mTc-HMDP bone scintigraphy and (18)F-fluoride PET-CT over (18)F-FDG PET-CT, and (18)F-fluoride PET-CT over bone scintigraphy. It also shows the usefulness of (18)F-fluoride PET-CT for monitoring the bone metastases.

[Detection of second tumors in 11C-choline PET/CT studies performed due to biochemical recurrence of prostate cancer]

Early localization of biochemical recurrence in patients after radical treatment of prostate cancer is a widely accepted clinical indication of (11)C-choline PET/CT. Its widespread clinical use has prompted the depiction of incidentalomas, unusual sites of metastatic lesions, as well as false positive and negative cases. Over the last 6 years, a total of 454 (11)C-choline PET/CT studies have been performed in our institution to locate biochemical recurrence of patients with prostate cancer. With these studies, a second neoplasm has been found in 7 patients (1.54%): 3 lung, 2 colorectal, 1 esophagus and 1 esophageal junction, respectively. Although the clinical usefulness of this technique for detecting cancer lesions other than prostate origin is known for those patients who undergo this technique in the accepted indication, the diagnosis of a second tumor has a significant impact on their therapeutic management.

[Metabolic and osteogenic pattern of prostate cancer bone metastases]

The current protocols include the bone scintigraphy and choline PET/CT to localize recurrence in patients having elevated serum PSA after treatment for prostate cancer. Both methods show good agreement in the diagnosis of bone metastases, however conflicting results can be found. We present three cases in which a PET/CT was performed with (18)F-Fluoride due to disagreement between the bone scintigraphy and (11)C-Choline PET/CT. The (18)F-Fluoride PET/CT was capable of confirming the existence of bone metastasis in all of them, so it may be an alternative to the MRI as a tracer of second bone imaging modality, although its use is limited by cost and availability.

[PET/CT-guided salvage surgery protocol. Results with ROLL Technique and PET probe]

OBJECTIVE

To assess the value of intraoperatory radioguided probe detection to guide surgical resection of malignant lesions previously detected by (18)F-FDG PET-CT.

MATERIAL

Twelve consecutive patients with suspected tumor recurrence detected by (18)F-FDG PET-CT considered resectable were enrolled in the study. Ultrasound guided fine needle aspiration (FNA) before surgery was performed in 6 patients and CT guided biopsy was performed in 1 patient. In 5 patients with accessible lesions, a radioguided occult lesion localization (ROLL) technique was performed after injection of (99m)Tc-colloid (1.7-2.4 mCi) inside the lesion under ultrasound or CT guidance, pre-operatively. Radioguided surgical detection was then carried out 19-24 hours afterwards using the gamma probe. In 7 patients with non-accessible needle lesions or multiple lesions, 9.5-10.5 mCi of (18)F-FDG were injected 3-5 hours before radioguided surgery using a PET-dedicated probe (Gamma locator DXI-GF&E).

RESULTS

ROLL technique: All lesions injected with nanocolloid were resected (6 lesions in 5 patients, 1 patient with 2 lesions), and recurrence was histologically confirmed. PET probe: Fourteen out of 16 hypermetabolic lesions detected on the PET-CT were resected. One cervical and one mediastinal lymph node in different patients could not be excised. Histological recurrence was confirmed in 12 out of 14 lesions. In one patient, the 2 lymph nodes excised were inflammatory.

CONCLUSIONS

(18)F-FDG PET-CT can be key in deciding surgical approach and appropriate radioguided protocol. When lesions are solitary and easily accessible, ROLL technique seems the method of choice. PET probe is more adequate for less accessible lesions.

[Impact of an additional inspiration CT scan on the conventional protocol of the ¹⁸F-FDG PET-CT in the detection of small pulmonary nodes]

AIM

To determine the impact of an additional inspiration CT scan on the conventional ¹⁸F-FDG PET-CT protocol in the detection of small pulmonary nodules.

METHOD

One hundred consecutive patients who presented with one or various nodules were studied. Whole-body PET-CT was performed using Gemini (Philips). CT acquisition parameters were 120 kV/25 mAs, the same as those for the transmission/fusion CT (mild expiration) and inspiratory CT.

RESULTS

A total of 188 nodules were detected in the inspiratory CT with sizes between 0.3-3 cm. Non-inspiratory CT did not show 20/188 nodules (10.6%) with sizes between 0.3-1cm, this corresponding to 17 patients. The most frequent localization of non-detectable nodules in non-inspiratory CT was the lower lobes. ¹⁸F-FDG uptake was detected by the PET in 83.9% and 72% of nodules with > 1 cm and between 0.7 and 1cm, respectively. However, only 10.5% of nodules <0.7 cm showed increased metabolic activity.

CONCLUSION

In selected patients, inspiratory CT added to conventional PET-CT significantly improves the detection of small nodules (10.6%), especially in those lesions located in the lower lobes, due to respiratory movements, and may have an impact on patient management.

[PET/CT with (11)C-choline and (18)F-FDG in patients with elevated PSA after radical treatment of a prostate cancer]

OBJECTIVE

To compare the diagnostic accuracy of PET/CT with (18)F-FDG and (11)C-choline for early detection and localization of recurrent prostate cancer.

MATERIAL AND METHODS

Thirty-eight patients with increased PSA levels (0.8-9.5 ng/ml) after radical treatment for prostate cancer (surgery n = 20/radiation therapy n = 18) were included. Ten patients were on hormone therapy. All patients underwent a PET/CT with (11)C-choline and (18)F-FDG, respectively, on the same day. The PET imaging findings were compared with histopathology (n = 10); PSA monitoring (n = 21) and/ or other methods (n = 7).

RESULTS

Focal uptake of (11)C-choline was detected in 26 patients (68%), and focal uptake of (18)F-FDG was detected in 13 patients (34%). The (11)C-choline uptake in 14 patients was suggested local recurrence, whereas this was true in only 4 patients (48%) with (18)F-FDG. Pelvic lymph nodes were detected with (11)C-choline PET/CT in 8 patients and only in 4 patients (50%) with (18)F-FDG. Mediastinal involvement was detected in 5 patients with (11)C-choline and 3 patients (60%) with (18)F-FDG. Focal bone involvement was detected in 3 patients with (11)C-choline and (18)F-FDG. (11)C-choline was able to detect 40% of recurrences in patients with PSA < 1 ng/ml, 50% of recurrences in patients with PSA 1-4 ng/ml and 87% of recurrences with PSA > 4 ng/ml. Sensitivity of (11)C-choline was higher for surgically treated patients, with no significant differences found between patients with and without hormone therapy.

CONCLUSIONS

(11)C-choline PET/CT was useful for the detection of biochemical recurrence of prostate cancer, with higher yielding as compared to (18)F-FDG. (11)C-choline sensitivity was clearly related to PSA levels, was higher in patients with surgery and did not seem to be modified by hormonal therapy. Disease staging with (11)C-choline showed direct impact for the selection of the most appropriate therapeutic approach.

[Diagnosis and assessment of therapeutic response of bone metastases by bone scintigraphy and PET study]

Nuclear medicine plays an important role in staging and evaluation of the initial extension and response to treatment of bone metastases. In order to accurately read Bone Scintigraphy (BS) and Positron Emission Tomography scan (PET) procedures, it is essential to understand the different behavior of these studies. We present a case report of a woman treated for breast cancer, with suspicion of recurrent disease due to increase of tumor markers. Initial BS showed non-conclusive findings, whereas PET study was consistent with a spread of bone metastases. The patient underwent both procedures again after a course of chemotherapy. Post-treatment BS showed progression of bone lesions, while PET showed good therapeutic response. The PET demonstrates lesions earlier and more effectively than the bone scintigraphy in the evaluation of the therapeutic response of bone metastases.

[Tuberculosis: pathogenesis and clinical manifestations]

In this revision we present the general aspects of tuberculosis in relationship with its pathogenesis and clinical manifestations.

Identification of a novel, multifunctional beta-defensin (human beta-defensin 3) with specific antimicrobial activity. Its interaction with plasma membranes of Xenopus oocytes and the induction of macrophage chemoattraction

Previous studies have shown the implication of beta-defensins in host defense of the human body. The human beta-defensins 1 and 2 (hBD-1, hBD-2) have been isolated by biochemical methods. Here we report the identification of a third human beta-defensin, called human beta-defensin 3 (hBD-3; cDNA sequence, Genbank accession no. AF295370), based on bioinformatics and functional genomic analysis. Expression of hBD-3 is detected throughout epithelia of many organs and in non-epithelial tissues. In contrast to hBD-2, which is upregulated by microorganisms or tumor necrosis factor-alpha (TNF-alpha), hBD-3 expression is increased particularly after stimulation by interferon-gamma. Synthetic hBD-3 exhibits a strong antimicrobial activity against gram-negative and gram-positive bacteria and fungi, including Burkholderia cepacia. In addition, hBD-3 activates monocytes and elicits ion channel activity in biomembranes, specifically in oocytes of Xenopus laevis. This paper also shows that screening of genomic sequences is a valuable tool with which to identify novel regulatory peptides. Human beta-defensins represent a family of antimicrobial peptides differentially expressed in most tissues, regulated by specific mechanisms, and exerting physiological functions not only related to direct host defense.

Novel silicate anion: Si(8)O(22)(12-). Hydrothermal synthesis and X-ray powder structure of three new niobium silicates

A sodium niobium(V) tetrasilicate, Na(2)H(NbO)Si(4)O(11).1.25H(2)O (1), was synthesized hydrothermally at 190 degrees C from a mixture of silicic acid, NaOH, NbCl(5), and H(2)O(2) and added hydrochloric acid. The successive treatment of 1 with nitric acid yielded HNb(H(2)O)Si(4)O(11).H(2)O (2). Contact of 2 with cesium hydroxide solutions converted it to the partially exchanged Cs(+) phase Cs(0.66)H(0.33)Nb(H(2)O)Si(4)O(11) (3). The three structures were solved from X-ray powder diffraction data. All compounds crystallize in the monoclinic space group P2(1)/m with Z = 2, containing the Si(8)O(22)(12-) anion. This new silicate anion type is related to the Si(4)O(11)(6-) unit, which is present in the amphibole series. The difference between both anion types lies in the chain periodicity: two for amphiboles or four for the new niobium silicates. These niobium silicates have framework structures enclosing tunnels in which the alkali cations reside.

Effect of a diagnostic dose of 185 MBq 131I on postsurgical thyroid remnants

Stunning of thyroid remnants after diagnostic scanning with 131I may limit 131I therapy. The follow-up scans and serum thyroglobulin levels of such patients have been studied.

METHODS

Three-hundred seventy-eight patients who underwent thyroidectomy for differentiated thyroid carcinoma were studied. Diagnostic scans were obtained with 185 MBq 131I; 7.2 wk afterward, the patients received 489 ablative treatments with 4 GBq 131I. A total of 1575 scans were obtained (pre- and posttreatment scans and 615 follow-up scans). The evolution of serum thyroglobulin levels was determined.

RESULTS

In all patients, the thyroid-stimulating hormone level was more than 30 microIU/mL. Posttherapy scans showed less uptake than did diagnostic scans or even showed negative findings in 99 patients (21%). In these patients, the mean time between diagnostic scanning and therapy was 7.9 wk. In 61 of these 99 patients (61.6%), follow-up scans have shown negative findings, serum thyroglobulin was less than 3 ng/mL, and antithyroglobulin antibodies were not present. Twenty-three patients (23.2%) have not undergone follow-up scanning yet. In 8 patients (8.1%), follow-up scans showed negative findings but serum thyroglobulin was more than 3 ng/mL. In 7 patients (7.1%), follow-up scans showed less uptake than posttherapy scans, but the findings were not yet negative and thyroglobulin was less than 3 ng/mL.

CONCLUSION

Our data suggest that a stunning effect does not exist for doses of 185 MBq 131I for diagnostic scans. However, a therapeutic effect may exist.

Comparing the biological and psychosocial risks of pregnancy between groups of adolescents and adults

Pregnancy in adolescence constitutes the main public health problem for this age group, in some countries. The health problems derived from adolescent pregnancy, birth and neonatal attention depend more on factors of social and environmental risk than on physiological and biological risk factors in adolescence. A descriptive study has been conducted of adolescent and adult mothers in Cádiz, Spain, who attended Family Planning Clinic during 1994. By means of multistage, stratified random sampling, 590 women were selected: 305 adolescent mothers between 15 and 19 years of age, and 285 adult mothers of 20 years and over. Various questionnaires were applied to the women, covering: sociodemographic characteristics; pregnancy and birth; family and social support (Duke-Inc and Apgar family); evolution of the health of the baby; and maternal knowledge of child care. Sociodemographically, significant differences (p > 0.01) were obtained in: marital status (more unmarried among adolescents); living in parents' home; fewer working; abandonment of education. No differences were observed in respect of the number of check-ups received during pregnancy. Adult mothers consumed significantly more toxic substances (tobacco, alcohol and drugs) during pregnancy. No differences were appreciated in respect of the birth, or health of the neonate. In adolescents, there was significantly more breastfeeding (p > 0.01) compared with adult mothers, 61.6% (56-67%) and 34% (28.5-34.5%), respectively. Pregnancy in adolescence appears to constitute a psychosocial problem rather than a biological risk.

Prevalence of osteomyelitis in non-healing diabetic foot ulcers: usefulness of radiologic and scintigraphic findings

The study was conducted in order to assess the prevalence of osteomyelitis and the predictive value of radiographic (xR) and combined Tc 99-bone and leukocyte scanning (CS) findings in diabetic foot ulcers that met criteria for hospital admission (FUH). Out of 150 episodes of ulceration managed in an outpatient basis, 33 (in 28 NIDDM patients) requiring admission were evaluated. In all cases plain xR and CS were carried out. Seventeen episodes (51.5%) had a good outcome (healed or improving, at the time of the last follow up). Osteomyelitis was found in 21 episodes and 14 (66.6%) of them required an amputation. In 13 cases where xR showed characteristic radiologic changes of osteomyelitis (11 of them had a positive CS) 11 (84.6%) underwent an amputation. However, when osteomyelitis was diagnosed only by a positive CS, only 3/8 (37.5%) required a toe amputation. Severe peripheral vasculopathy was present in 44% of cases who required amputation and only in 17.6% of those who did not. We conclude that in FU underlying osteomyelitis is frequent and associated to a higher amputation rate than when no bone infection is identified (66.6 vs 17%), even when corrected for vascular status (OR 11, CI 95% 1.65-74.2), with a worse outcome when xR changes are already present.

[Use of the Internet in otorhinolaryngology]

The Internet is considered by some as one of the most important advances of the late 20th century. The Internet is the functional linking of personal computers via telephone lines to a worldwide network of millions of other computers, which enables them to exchange information freely. Although the Internet crops up in daily conversation, many persons are not aware of its usefulness and relevance for ear, nose and throat specialists. The Internet is accessed by special software that maximizes the potential of this vast computer network. The most important tools are e-mail and the World Wide Web. These tools make it possible to consult multimedia medical publications, access Medline, and carry out information searches, etc. The Internet and its most important uses in otolaryngology are summarized and a list of useful addresses is given. Although its advantages still are not widely appreciated, widespread Internet use is imminent and we think that it is a useful technology to know and use. Moreover, access is becoming easier and cheaper.

[Cerebral SPECT with thallium-201 in the differential diagnosis of focal cerebral lesions in patients with AIDS]

BACKGROUND

The aim of this study was to analyze the usefulness of cerebral SPECT with thallium-201 in patients with the acquired human immunodeficiency syndrome (AIDS) and focal cerebral lesions.

METHODS

Six patients with AIDS and focal cerebral lesions in whom a cerebral SPECT was performed with thallium-201 are described. Treatment was initiated with antiToxoplasma drugs in all patients. The clinical response, serology for positive toxoplasma and radiologic improvement were criteria for the diagnosis of encephalitis by Toxoplasma. In the remaining cases, cerebral biopsy and/or necropsy study were carried out.

RESULTS

In the 2 patients in whom cerebral SPECT demonstrated enhancement of the lesion, the pathologic diagnosis was cerebral lymphoma. Of the 4 remaining cases in whom no enhancement was observed, three corresponded to cerebral toxoplasmosis and one to progressive multifocal leucoencephalopathy.

CONCLUSIONS

Cerebral SPECT with thallium-201 is a simple, specific and useful technique for the differentiation of primary cerebral lymphoma from the remaining inflammatory cerebral lesions which may be present in AIDS patients.

Functional and phenotypic analysis of T-lymphocytes in laryngeal carcinoma

We studied the functional response and phenotypic characterization of peripheral blood T cells and their correlation with the clinical stage of disease in 29 males with previously untreated carcinoma of the larynx and 24 healthy male controls. Peripheral blood T cells, phenotypically CD2+ CD3+, were significantly decreased in the patients relative to the controls. Patients with advanced locoregional extension (T4 and N1, 2, 3) also showed a diminution of the CD4+ subpopulation of T cells. DNA synthesis by purified T cells showed similar blastogenic responses in patients and controls; the interleukin-2 production of phytohemagglutinin stimulated lymphocytes was also normal. We conclude that in patients with laryngeal carcinoma there is a phenotypic alteration of the T cells that is variable according to tumor stage, without functional alterations in blastogenic capacity or IL-2 production.

[The protocol of endoscopic sinus surgery: preliminary analysis of 100 cases]

Since 1989 we have been using on a regular basis in our department endoscopic technics applied to fosas and paranasal sinuses. A methodological study of the first 100 cases of this type of surgery is presented. The indications, results, and complications of the surgical technique are analyzed. The cases included: sinusitis, nasosinusal polyposis, endoscopy of malignant tumors, epistaxis, various inflammatory processes, and plastic endonasal reparations. It is concluded that nasosinusal endoscopic surgery is an advantageous technique in the treatment of general nasosinusal conditions.

Isolation and partial characterization of nigrin b, a non-toxic novel type 2 ribosome-inactivating protein from the bark of Sambucus nigra L

The bark of Sambucus nigra L. contains a non-toxic novel type 2 ribosome-inactivating protein that we named nigrin b. In vitro, nigrin b strongly inhibited mammalian protein synthesis but did not affect plant nor bacterial protein synthesis. The protein (M(r) 58,000) contains two subunits, A (M(r) 26,000) and B (M(r) 32,000); linked by disulphide bridge(s). Nigrin b was found to be an rRNA N-glycosidase of the rRNA of intact mammalian ribosomes and shares a very good N-terminal amino-acid sequence homology with the anti-HIV-1 proteins TAP 29 and trichosanthin.

Ebulin 1, a nontoxic novel type 2 ribosome-inactivating protein from Sambucus ebulus L. leaves

A novel type 2 ribosome-inactivating protein (RIP) that we named ebulin 1 has been isolated from leaves of Sambucus ebulus L. (Caprifoliaceae). In vitro ebulin 1 strongly inhibited protein synthesis by rabbit reticulocyte lysates, rat brain, and rat liver cell-free systems but did not affect in vitro plant nor bacterial protein synthesis. Ebulin 1 is composed of two subunits, a catalytic A subunit (M(r) 26,000) and a D-galactose-binding lectin B subunit (M(r) 30,000). Amino-terminal amino acid sequence homology revealed the novelty that the ebulin 1 A-chain shares a high degree of homology not with the A-chain of other type 2 RIPs but rather with the Cucurbitaceae type 1 RIP briodin S and the anti-human immunodeficiency virus type I proteins trichosanthin and TAP 29. Upon treatment with acid aniline the rRNA from ebulin 1-treated rabbit reticulocyte ribosomes released the RNA fragment which is diagnostic of RIP catalytic action. Ebulin 1 was nontoxic to mice up to 2 mg/kg of body weight and did not inhibit protein synthesis in cultured NHC human epithelial cells which are highly sensitive to ricin.

[The use of the potential years of life between the ages of 1 and 64 as an indicator of premature mortality in Aragón during 1987]

BACKGROUND

Years of potential life lost (YPLL) are a health indicator which allows to discriminate the main causes of premature mortality weighting up the deaths according to the age of dead person.

METHODS

Premature mortality in Aragón during 1987 is analysed by means of the indicator YPLL between the ages 1 and 64 years. The information given by this indicator along with that supplied by the mortality rates is used to obtain a more complete information of the role and relative importance of each one of the main groups of diseases of the International Classification of Diseases (ICD-9th revision) within the mortality in Aragón during that whole year.

RESULTS

The biggest rates of YPLL by one thousand population were due to tumours (9.87), traumatisms and poisonings (8.84), vascular diseases (5.65) and digestive diseases (1.96). Mortality and YPLL rates were higher for males than for females and statistically significant differences were also observed when comparing the provinces of Zaragoza and Huesca with the province of Teruel (higher rates in the first ones) and when comparing rural with urban areas (higher rates in the second case).

CONCLUSIONS

According to this indicator the preventive programs in Aragón should lead to the prevention of tumors, traumatisms, vascular diseases and digestive diseases, without forgetting that these illnesses have a bigger effect on male population and on urban areas.

Five-year survival for end-stage renal disease patients in the United States, Europe, and Japan, 1982 to 1987

We compared the 5-year survival for new end-stage renal disease (ESRD) patients accepted for renal replacement therapy (RRT) between 1982 and 1987 in the United States (n = 150,862), Europe (European Dialysis and Transplant Association [EDTA]) (n = 124,796), and Japan (n = 66,244). Given these large samples that approach a census in each of the three regions, all results are statistically significant. Our analysis showed that the US patients were older and more likely to be diabetic than the patients in either EDTA or Japan. After correction for patient differences in age composition and the percent diabetic, Japan had the highest survival, followed by EDTA, and then the US. Overall, the US 5-year survival was 40%. When comparison is done by age, only the youngest patients in the US (less than 15 years) have longer survival than their counterparts in Europe and Japan. For ages greater than 14 years, the survival differences between the US and EDTA and between the US and Japan grow larger with higher patient age. The comparisons of mortality by diagnosis showed that the differences between the US and EDTA and between the US and Japan were least for diabetes. For non-diabetic patients, the age adjusted relative risk (RR) of mortality for the US compared with EDTA was 1.22, ie, 22% higher in the US; for the US compared with Japan, the RR was 1.40. In contrast, the RR for diabetic patients in the US compared with EDTA was 1.07, and 1.23 for the US compared with Japan.(ABSTRACT TRUNCATED AT 250 WORDS)

Price of dialysis, unit staffing, and length of dialysis treatments

We analyzed the impact of the Medicare price for outpatient maintenance dialysis on the level and composition of staffing of dialysis units, and on the length (duration) of the average hemodialysis treatment for the period 1982 to 1987. With higher prices, dialysis units employ more total staff hours per patient per week (P less than 0.01) and use a higher proportion of registered nurses (RN) compared with other staff such as technicians and licensed practical nurses (LPN). Higher Medicare prices are also associated with longer average hemodialysis treatment duration for freestanding units (P less than 0.02), but there was no statistically significant association for hospital units. The impact of the Medicare price on both staffing and average treatment duration takes into account the calendar time trend, ie, 1987 versus 1982, which has a separate impact from the price effect. For example, to avoid the complication of technology changes over calendar time, we considered the impact of the price change at one point in time. Freestanding units that had a price cut of more than +15 in 1983, reported twice the reduction in the average dialysis treatment duration (-0.38 hours) compared with -0.20 hours (P = 0.01) for units that had a cut of less than +15. An analysis of the impact of average treatment duration on patient mortality provided some evidence that shorter treatment duration in freestanding units is associated with higher mortality. This result needs further analysis. There was no statistically significant relationship between the level of staffing in the dialysis unit or the percent of staff who were RNs and 3-year patient survival. The analysis in this report was based on 1,213 and 1,058 data forms filed with Medicare by freestanding and hospital units, respectively, for 1982 and 1987. In addition, we used a Cox proportional hazards model (multivariate) for the analysis of the 3-year patient survival for 14,807 new hemodialysis patients who started dialysis in 1984.

[Interhemispherical study of the activities of aminopeptidases, lactate dehydrogenase and glutamate-oxaloacetate transaminase in the rat brain]

Aminopeptidase activity has been assayed from both soluble and membrane bound fractions in eleven regions of the left and right hemispheres of the rat brain, using L-leucine-2-naphthylamide as substrate. Two other metabolic enzymes, lactate dehydrogenase and glutamate-oxalacetate aminotransferase activities were simultaneously determined in the same areas. When individual zones of the left hemisphere were compared with its corresponding right zones, soluble aminopeptidase activities were significantly higher in left frontal cortex and left hypothalamus than in right frontal cortex and right hypothalamus, respectively. No other significant differences were found neither in the remaining areas nor for the other enzymatic activities between both brain hemispheres.

[Brucellosis at a tertiary hospital. Retrospective epidemiologic study of 166 cases]

The epidemiologic polls concerning 166 cases of brucellosis are retrospectively analyzed; the cases are registered by the Preventive Medicine Service of Miguel Servet Hospital for five years (1980-1985). Most of our cases are of recent evolution, although 55% began to give symptoms more of 2 weeks ago and 30% more of 1 month ago. A clear annual increase of the number of cases, fundamentally of the male sex and patients coming from the rural areas, is observed. The percentage of cases in men (73.5%) is almost three times as those in women (26.5%), and the most numerous groups are the 20-29 interval age group and olders above 60. There is a small percentage of people with a professional risk factor (30.1%), which rise, slightly, for the ones who told of contact with cattle (39.2%) and rose up to 53.6% for the ones who consumed non controlled dairy products. However, in 23% of men and 40.9% of women the existence of some risk factors was unknown.

[Radioimmunoassay of plasma ferritin of Gallus domesticus L]

A new experimental procedure for chicken plasma ferritin based on the method of Luxton et al. has been carried out. All biologic reagents used were obtained in our laboratory: Ferritin from chicken liver, antiferritin antiserum from rabbits and anti-rabbit IgG from goat. Chloramine T procedure was applied to label ferritin with 125I. The iodinated protein was removed from free iodide by use of three chromatographic columns of Sephadex G-25, Sephadex G-200 and Sepharose 6B. Separation of the first antigen-antibody complex was carried out by the double antibody method. The assay working range covers from 21.8 up to 175 ng/ml. As ferritin concentration is higher in chicken plasma than in human, various plasma dilutions ranging from 1/16 to 1/64 were used.