Heterogeneity of sensitization profiles and clinical phenotypes among patients with seasonal allergic rhinitis in Southern European countries-The @IT.2020 multicenter study

BACKGROUND

Pollen allergy poses a significant health and economic burden in Europe. Disease patterns are relatively homogeneous within Central and Northern European countries. However, no study broadly assessed the features of seasonal allergic rhinitis (SAR) across different Southern European countries with a standardized approach.

OBJECTIVE

To describe sensitization profiles and clinical phenotypes of pollen allergic patients in nine Southern European cities with a uniform methodological approach.

METHODS

Within the @IT.2020 multicenter observational study, pediatric and adult patients suffering from SAR were recruited in nine urban study centers located in seven countries. Clinical questionnaires, skin prick tests (SPT) and specific IgE (sIgE) tests with a customized multiplex assay (Euroimmun Labordiagnostika, Lübeck, Germany) were performed.

RESULTS

Three hundred forty-eight children (mean age 13.1 years, SD: 2.4 years) and 467 adults (mean age 35.7 years SD: 10.0 years) with a predominantly moderate to severe, persistent phenotype of SAR were recruited. Grass pollen major allergenic molecules (Phl p 1 and/or Phl p 5) ranged among the top three sensitizers in all study centers. Sensitization profiles were very heterogeneous, considering that patients in Rome were highly poly-sensitized (sIgE to 3.8 major allergenic molecules per patient), while mono-sensitization was prominent and heterogeneous in other cities, such as Marseille (sIgE to Cup a 1: n = 55/80, 68.8%) and Messina (sIgE to Par j 2: n = 47/82, 57.3%). Co-sensitization to perennial allergens, as well as allergic comorbidities also broadly varied between study centers.

CONCLUSIONS

In Southern European countries, pollen allergy is heterogeneous in terms of sensitization profiles and clinical manifestations. Despite the complexity, a unique molecular, multiplex, and customized in-vitro IgE test detected relevant sensitization in all study centers. Nevertheless, this geographical diversity in pollen allergic patients imposes localized clinical guidelines and study protocols for clinical trials of SAR in this climatically complex region.

Cytokine profiles in cord blood in relation to prenatal traffic-related air pollution: The NELA cohort

BACKGROUND

Outdoor air pollution may disturb immune system development. We investigated whether gestational exposure to traffic-related air pollutants (TRAP) is associated with unstimulated cytokine profiles in newborns.

METHODS

Data come from 235 newborns of the NELA cohort. Innate response-related cytokines (IL-6, IFN-α, IL1-β, and TNF-α), Th1-related (IFN-γ and IL-2), Th2-related (IL-4, IL-5, and IL-13), Th17-related (IL-17 and IL-23), and immunomodulatory cytokine IL-10 were quantified in the supernatant of unstimulated whole umbilical cord blood cells after 7 days of culture using the Luminex technology. Dispersion/chemical transport modeling was used to estimate long-term (whole pregnancy and trimesters) and short-term (15 days before delivery) residential exposures to traffic-related nitrogen dioxide (NO₂ ), particulate matter (PM_2.5 and PM₁₀ ), and ozone (O₃ ). We fitted multivariable logistic regression, Bayesian kernel machine regression (BKMR), and weighted quantile sum (WQS) regression models.

RESULTS

NO₂ during the whole pregnancy increased the odds of detection of IL-1β (OR per 10 µg/m³ increase = 1.37; 95% CI, 1.02, 1.85) and IL-6 (OR per 10 µg/m³ increase = 1.32; 95% CI 1.00, 1.75). Increased odds of detected concentrations of IL-10 was found in newborns exposed during whole pregnancy to higher levels of NO₂ (OR per 10 µg/m³ increase = 1.30; 95% CI 0.99, 1.69), PM₁₀ (OR per 10 µg/m³ increase = 1.49; 95% CI 0.95, 2.33), and PM_2.5 (OR per 5 µg/m³ increase = 1.56; 95% CI 0.97, 2.51). Exposure to O₃ during the whole pregnancy increased the odds of detected IL-13 (OR per 10 µg/m³ increase = 1.22; 95% CI 1.01, 1.49). WQS model revealed first and third trimesters of gestation as windows of higher susceptibility.

CONCLUSIONS

Gestational exposure to TRAP may increase detection of pro-inflammatory, Th2-related, and T regulatory cytokines in newborns. These changes might influence immune system responses later in life.

Transition of adolescents with severe asthma from pediatric to adult care in Spain: the STAR consensus

OBJECTIVE

To assess the consensus level among a multidisciplinary expert panel on the transition of adolescents with severe asthma from pediatric to adult care.

METHODS

A 61-item survey was developed based on guidelines for other chronic pathologies, covering transition planning, preparation, effective transfer, and follow-up. A two-round Delphi process assessed the consensus level among 98 experts (49 pediatricians, 24 allergists and 25 pulmonologists). Consensus was established with ≥70% agreement.

RESULTS

Forty-two items (70%) reached consensus. No age range to initiate the transition was agreed upon by the panelists. The main goal to achieve during the transition identified by the experts is that adolescents gain autonomy to manage their severe asthma and prescribed treatments. The panelists agreed on the importance of developing an individualized plan, promoting patient's autonomy, and identifying home environment factors. They agreed that the adult healthcare team should have expertise in severe asthma, biologics and management of adolescent patients. Pediatric and adult healthcare teams should share clinical information, agree on the criteria to maintain the biological therapy, and have an on-site joint visit with the patient before the effective transfer. Adult healthcare professionals should closely follow the patient after the effective transfer to ensure correct inhaler technique, treatment adherence and attendance to healthcare appointments.

CONCLUSION

This consensus document provides the first roadmap for Spanish pediatric and adult teams to ensure that key aspects of the transition process in severe asthma are covered. The implementation of these recommendations will improve the quality of care offered to the patient.

Human influenza A virus causes myocardial and cardiac-specific conduction system infections associated with early inflammation and premature death

AIMS

Human influenza A virus (hIAV) infection is associated with important cardiovascular complications, although cardiac infection pathophysiology is poorly understood. We aimed to study the ability of hIAV of different pathogenicity to infect the mouse heart, and establish the relationship between the infective capacity and the associated in vivo, cellular and molecular alterations.

METHODS AND RESULTS

We evaluated lung and heart viral titres in mice infected with either one of several hIAV strains inoculated intranasally. 3D reconstructions of infected cardiac tissue were used to identify viral proteins inside mouse cardiomyocytes, Purkinje cells, and cardiac vessels. Viral replication was measured in mouse cultured cardiomyocytes. Human-induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) were used to confirm infection and study underlying molecular alterations associated with the in vivo electrophysiological phenotype. Pathogenic and attenuated hIAV strains infected and replicated in cardiomyocytes, Purkinje cells, and hiPSC-CMs. The infection was also present in cardiac endothelial cells. Remarkably, lung viral titres did not statistically correlate with viral titres in the mouse heart. The highly pathogenic human recombinant virus PAmut showed faster replication, higher level of inflammatory cytokines in cardiac tissue and higher viral titres in cardiac HL-1 mouse cells and hiPSC-CMs compared with PB2mut-attenuated virus. Correspondingly, cardiac conduction alterations were especially pronounced in PAmut-infected mice, associated with high mortality rates, compared with PB2mut-infected animals. Consistently, connexin43 and NaV1.5 expression decreased acutely in hiPSC-CMs infected with PAmut virus. YEM1L protease also decreased more rapidly and to lower levels in PAmut-infected hiPSC-CMs compared with PB2mut-infected cells, consistent with mitochondrial dysfunction. Human IAV infection did not increase myocardial fibrosis at 4-day post-infection, although PAmut-infected mice showed an early increase in mRNAs expression of lysyl oxidase.

CONCLUSION

Human IAV can infect the heart and cardiac-specific conduction system, which may contribute to cardiac complications and premature death.

Patient characteristics, clinical course and factors associated to ICU mortality in critically ill patients infected with SARS-CoV-2 in Spain: A prospective, cohort, multicentre study

Background

The clinical course of COVID-19 critically ill patients, during their admission in the intensive care unit (UCI), including medical and infectious complications and support therapies, as well as their association with in-ICU mortality has not been fully reported.

Objective

This study aimed to describe clinical characteristics and clinical course of ICU COVID-19 patients, and to determine risk factors for ICU mortality of COVID-19 patients.

Methods

Prospective, multicentre, cohort study that enrolled critically ill COVID-19 patients admitted into 30 ICUs from Spain and Andorra. Consecutive patients from March 12th to May 26th, 2020 were enrolled if they had died or were discharged from ICU during the study period. Demographics, symptoms, vital signs, laboratory markers, supportive therapies, pharmacological treatments, medical and infectious complications were reported and compared between deceased and discharged patients.

Results

A total of 663 patients were included. Overall ICU mortality was 31% (203 patients). At ICU admission non-survivors were more hypoxemic [SpO₂ with non-rebreather mask, 90 (IQR 83–93) vs 91 (IQR 87–94); p < 0.001] and with higher sequential organ failure assessment score [SOFA, 7 (IQR 5–9) vs 4 (IQR 3–7); p < 0.001]. Complications were more frequent in non-survivors: acute respiratory distress syndrome (ARDS) (95% vs 89%; p = 0.009), acute kidney injury (AKI) (58% vs 24%; p < 10⁻¹⁶), shock (42% vs 14%; p < 10⁻¹³), and arrhythmias (24% vs 11%; p < 10⁻⁴). Respiratory super-infection, bloodstream infection and septic shock were higher in non-survivors (33% vs 25%; p = 0.03, 33% vs 23%; p = 0.01 and 15% vs 3%, p = 10⁻⁷), respectively. The multivariable regression model showed that age was associated with mortality, with every year increasing risk-of-death by 1% (95%CI: 1–10, p = 0.014). Each 5-point increase in APACHE II independently predicted mortality [OR: 1.508 (1.081, 2.104), p = 0.015]. Patients with AKI [OR: 2.468 (1.628, 3.741), p < 10⁻⁴)], cardiac arrest [OR: 11.099 (3.389, 36.353), p = 0.0001], and septic shock [OR: 3.224 (1.486, 6.994), p = 0.002] had an increased risk-of-death.

Conclusions

Older COVID-19 patients with higher APACHE II scores on admission, those who developed AKI grades II or III and/or septic shock during ICU stay had an increased risk-of-death. ICU mortality was 31%.

Patient characteristics, clinical course and factors associated to ICU mortality in critically ill patients infected with SARS-CoV-2 in Spain: A prospective, cohort, multicentre study

Antecedentes

No se ha reportado plenamente la evolución clínica de los pacientes críticos de COVID-19 durante su ingreso en la unidad de cuidados intensivos (UCI), incluyendo las complicaciones médicas e infecciosas y terapias de soporte, así como su asociación con la mortalidad en UCI.

Objetivo

El objetivo de este estudio es describir las características clínicas y la evolución de los pacientes ingresados en UCI por COVID-19 y determinar los factores de riesgo de la mortalidad en UCI de dichos pacientes.

Métodos

Estudio prospectivo, multicéntrico y de cohorte, que incluyó a los pacientes críticos de COVID-19 ingresados en 30 UCI de España y Andorra. Se incluyó a los pacientes consecutivos del 12 de marzo al 26 de mayo del 2020 si habían fallecido o habían recibido el alta de la UCI durante el periodo de estudio. Se reportaron los datos demográficos, los síntomas, los signos vitales, los marcadores de laboratorio, las terapias de soporte, terapias farmacológicas y las complicaciones médicas e infecciosas, realizándose una comparación entre los pacientes fallecidos y los pacientes dados de alta.

Resultados

Se incluyó a un total de 663 pacientes. La mortalidad general en UCI fue del 31% (203 pacientes). Al ingreso en UCI los no supervivientes eran más hipoxémicos (SpO₂ con mascarilla de no reinhalación, de 90 [RIC 83-93] vs. 91 [RIC 87-94]; p < 0,001] y con mayor puntuación en la escala SOFA-Evaluación de daño orgánico secuencial (SOFA, 7 [RIC 5-9] vs. 4 [RIC 3-7]; p <0,001]). Las complicaciones fueron más frecuentes en los no supervivientes: síndrome de distrés respiratorio agudo (SDRA) (95% vs. 89%; p = 0,009), insuficiencia renal aguda (IRA) (58% vs. 24%; p < 10^–6), shock (42% vs. 14%; p < 10^–13) y arritmias (24% vs. 11%; p < 10^–4). Las superinfecciones respiratorias, infecciones del torrente sanguíneo y los shock sépticos fueron más frecuentes en los no supervivientes (33% vs. 25%; p = 0,03, 33% vs. 23%; p = 0,01 y 15% vs. 3%, p = 10^–7, respectivamente). El modelo de regresión multivariable reflejó que la edad estaba asociada a la mortalidad y que cada año incrementaba el riesgo de muerte en un 1% (IC del 95%: 1-10, p = 0,014). Cada incremento de 5 puntos en la escala APACHE II predijo de manera independiente la mortalidad (odds ratio [OR]: 1,508 [1,081, 2,104], p = 0,015). Los pacientes con IRA (OR: 2,468 [1,628, 3,741], p < 10^–4)], paro cardiaco (OR: 11,099 [3,389, 36,353], p = 0,0001] y shock séptico [OR: 3,224 [1,486, 6,994], p= 0,002) tuvieron un riesgo de muerte incrementado.

Conclusiones

Los pacientes mayores de COVID-19 con puntuaciones APACHE II más altas al ingreso, que desarrollaron IRA en grados ii o iii o shock séptico durante la estancia en UCI tuvieron un riesgo de muerte incrementado. La mortalidad en UCI fue del 31%.

Correlation between work impairment, scores of rhinitis severity and asthma using the MASK-air® App

BACKGROUND

In allergic rhinitis, a relevant outcome providing information on the effectiveness of interventions is needed. In MASK-air (Mobile Airways Sentinel Network), a visual analogue scale (VAS) for work is used as a relevant outcome. This study aimed to assess the performance of the work VAS work by comparing VAS work with other VAS measurements and symptom-medication scores obtained concurrently.

METHODS

All consecutive MASK-air users in 23 countries from 1 June 2016 to 31 October 2018 were included (14 189 users; 205 904 days). Geolocalized users self-assessed daily symptom control using the touchscreen functionality on their smart phone to click on VAS scores (ranging from 0 to 100) for overall symptoms (global), nose, eyes, asthma and work. Two symptom-medication scores were used: the modified EAACI CSMS score and the MASK control score for rhinitis. To assess data quality, the intra-individual response variability (IRV) index was calculated.

RESULTS

A strong correlation was observed between VAS work and other VAS. The highest levels for correlation with VAS work and variance explained in VAS work were found with VAS global, followed by VAS nose, eye and asthma. In comparison with VAS global, the mCSMS and MASK control score showed a lower correlation with VAS work. Results are unlikely to be explained by a low quality of data arising from repeated VAS measures.

CONCLUSIONS

VAS work correlates with other outcomes (VAS global, nose, eye and asthma) but less well with a symptom-medication score. VAS work should be considered as a potentially useful AR outcome in intervention studies.

The DOT1L inhibitor Pinometostat decreases the host-response against infections: Considerations about its use in human therapy

Patients with acute myeloid leukemia frequently present translocations of MLL gene. Rearrangements of MLL protein (MLL-r) in complexes that contain the histone methyltransferase DOT1L are common, which elicit abnormal methylation of lysine 79 of histone H3 at MLL target genes. Phase 1 clinical studies with pinometostat (EPZ-5676), an inhibitor of DOT1L activity, demonstrated the therapeutic potential for targeting DOT1L in MLL-r leukemia patients. We previously reported that down-regulation of DOT1L increases influenza and vesicular stomatitis virus replication and decreases the antiviral response. Here we show that DOT1L inhibition also reduces Sendai virus-induced innate response and its overexpression decreases influenza virus multiplication, reinforcing the notion of DOT1L controlling viral replication. Accordingly, genes involved in the host innate response against pathogens (RUBICON, TRIM25, BCL3) are deregulated in human lung epithelial cells treated with pinometostat. Concomitantly, deregulation of some of these genes together with that of the MicroRNA let-7B, may account for the beneficial effects of pinometostat treatment in patients with MLL-r involving DOT1L. These results support a possible increased vulnerability to infection in MLL-r leukemia patients undergoing pinometostat treatment. Close follow up of infection should be considered in pinometostat therapy to reduce some severe side effects during the treatment.

Mutations of the segment-specific nucleotides at the 3' end of influenza virus NS segment control viral replication

The vRNAs of influenza A viruses contain 12 and 13 nucleotide-long sequences at their 3' and 5' termini respectively that are highly conserved and constitute the vRNA promoter. These sequences and the next three segment-specific nucleotides show inverted partial complementarity and are followed by several unpaired nucleotides of poorly characterized function at the 3' end. We have performed systematic point-mutations at the segment-specific nucleotides 15-18 of the 3'-end of a NS-like vRNA segment. All NS-like vRNAs containing mutations at position 15, and some at positions 16-18 showed reduced transcription/replication efficiency in a transfection/infection system. In addition, the replication of recombinant viruses containing mutations at position 15 was impaired both in single and multi-cycle experiments. This reduction was the consequence of a decreased expression of the NS segment. The data indicate that NS1 plays a role in the transcription/replication of its own segment, which elicits a global defect on virus replication.

Altered materno-fetal transfer of 13C-polyunsaturated fatty acids in obese pregnant women

BACKGROUND & AIMS

Maternal obesity at conception is considered a major predictor of offspring obesity. This could by driven at least in part by an altered placental fat transfer. However, the pathophysiological mechanisms involved are not fully understood. We investigated the in vivo materno-fetal transfer of fatty acids (FAs) in obese pregnant women using stable isotopes.

METHODS

Ten obese and ten normo-weight pregnant women (control) received orally a bolus of ¹³C-labeled FAs 12 h before elective caesarean section: oleic acid (¹³C-OA), linoleic acid (¹³C-LA) and docosahexaenoic acid (¹³C-DHA). Maternal blood samples were collected at -12 (basal), -8, -4, -2, 0 h relative to the time of cesarean section. At the time of birth, arterial and venous cord bloods as well as placental tissue were collected. FAs composition was determined by gas-liquid chromatography and isotopic enrichment by gas chromatography-combustion-isotope ratio mass spectrometry.

RESULTS

Maternal plasma insulin and placental weight tended to higher values in obese pregnant women although they did not present serum hyperlipidemia. Higher concentrations of ¹³C-LA and ¹³C-DHA were found in non-esterified FAs fraction in maternal plasma of obese mothers. The ratio of placental uptake for ¹³C-LA and ¹³C-DHA was lower in obese women compared to normal weight pointing toward a limited capacity of FA placental transfer, especially of essential FAs. Maternal insulin was associated to this lower placenta/maternal plasma ratio for both ¹³C-LA (R = -0.563, P = 0.012) and ¹³C-DHA (R = -0.478, P = 0.033). In addition, the ratio cord/maternal plasma of ¹³C-LA was significantly lower in obese women compared to controls.

CONCLUSIONS

In conclusion, obese mothers without hyperlipidemia showed a reduced materno-fetal transfer of polyunsaturated FAs which could affect fetal development. This affect dietary recommendation for obese pregnant women.

TRIAL REGISTRY NUMBER

ISRCTN69794527.

hCLE/RTRAF-HSPC117-DDX1-FAM98B: A New Cap-Binding Complex That Activates mRNA Translation

hCLE/C14orf166/RTRAF, DDX1, and HSPC117 are components of cytoplasmic mRNA-transporting granules kinesin-associated in dendrites. They have also been found in cytoplasmic ribosome-containing RNA granules that transport specific mRNAs halted for translation until specific neuronal signals renders them accessible to the translation machinery. hCLE associates to DDX1, HSPC117, and FAM98B in HEK293T cells and all four proteins bind to cap analog-containing resins. Competition and elution experiments indicate that binding of hCLE complex to cap resins is independent of eIF4E; the cap-binding factor needed for translation. Purified hCLE free of its associated proteins binds cap with low affinity suggesting that its interacting proteins modulate its cap association. hCLE silencing reduces hCLE accumulation and that of its interacting proteins and decreases mRNA translation. hCLE-associated RNAs have been isolated and sequenced; RNAs involved in mRNA translation are specifically associated. The data suggest that RNA granules may co-transport RNAs encoding proteins involved in specific functions together with RNAs that encode proteins needed for the translation of these specific RNAs and indicate an important role for hCLE modulating mRNA translation.

Mutation S110L of H1N1 Influenza Virus Hemagglutinin: A Potent Determinant of Attenuation in the Mouse Model

Characterization of a pandemic 2009 H1N1 influenza virus isolated from a fatal case patient (F-IAV), showed the presence of three different mutations; potential determinants of its high pathogenicity that were located in the polymerase subunits (PB2 A221T and PA D529N) and the hemagglutinin (HA S110L). Recombinant viruses containing individually or in combination the polymerase mutations in the backbone of A/California/04/09 (CAL) showed that PA D529N was clearly involved in the increased pathogenicity of the F-IAV virus. Here, we have evaluated the contribution of HA S110L to F-IAV pathogenicity, through introduction of this point mutation in CAL recombinant virus (HA mut). The HA S110L protein has similar pH stability, comparable mobility, and entry properties both in human and mouse cultured cells that wild type HA. The change HA S110L leads to a non-significant trend to reduce the replication capacity of influenza virus in tissue culture, and HA mut is better neutralized than CAL virus by monoclonal and polyclonal antibodies against HA from CAL strain. In addition, recombinant viruses containing HA S110L alone or in combination with polymerase mutations considerably increased the LD50 in infected mice. Characterization of the lungs of HA mut infected animals showed reduced lung damage and inflammation compared with CAL infected mice. Accordingly, lower virus replication, decreased presence in bronchioli and parenchyma and lower leukocytes and epithelial infected cells were found in the lungs of HA mut-infected animals. Our results indicate that, mutation HA S110L constitutes a determinant of attenuation and suggest that its interaction with components of the respiratory tract mucus and lectins, that play an important role on influenza virus outcome, may constitute a physical barrier impeding the infection of the target cells, thus compromising the infection outcome.

Do the Conventional Clinicopathologic Parameters Predict for Response and Survival in Head and Neck Cancer Patients Undergoing Neoadjuvant Chemotherapy?

Aims and Background

Neoadjuvant chemotherapy for head and neck carcinoma is still an important treatment modality. The prognostic value of patient and tumor parameters has been extensively evaluated in several trials, yielding mixed results. We report the prognostic factors emerging from a group of patients undergoing neoadjuvant chemotherapy.

Patients and methods

From April 1986 to June 1992, 149 consecutive patients received cisplatin-5-fluorouracil-based neoadjuvant chemotherapy. After four courses of chemotherapy, patients underwent local-regional treatment with surgery, radiation or both. A variety of patient and tumor characteristics were evaluated as predictors for response to chemotherapy and survival.

Results

The complete response, partial response and no response rates to NAC were 52%, 33% and 15%, respectively. No parameters predicted response to chemotherapy. At a maximum follow-up of 87 months, overall survival was 39% and disease-free survival was 49%. Variables shown to be predictors of survival in univariate analyses were age, performance status, histology, site, T, N, stage, and response to chemotherapy. Using the Cox regression analysis, only complete response to induction chemotherapy ( P = 0.0006), performance status ( P = 0.03), stage ( P = 0.01), age ( P = 0.03) and primary tumor site ( P = 0.04) emerged as independent prognostic factors for survival.

Conclusions

Complete response to chemotherapy was confirmed as the strongest prognostic factor influencing survival. However, conventional clinicopathologic factors did not predict response, hence, potential prognostic biologic and molecular factors for response must be sought. At present, much effort must be made for the improvement of the complete response rate, which seems to be a requisite to prolong survival.

Meal composition influences postprandial sensations independently of valence and gustation

BACKGROUND

Palatability of meals with identical composition has been shown to influence postprandial sensations. Our aim was to determine to what extent meal composition influences postprandial sensations independently of palatability.

METHODS

Randomized, crossover, double-blind trial comparing the postprandial responses to a low-fat vs a high-fat test meal, with the same physical and organoleptic characteristics (taste, smell, texture, color, and temperature). The test meal consisted in 150 g hummus containing either 17.7 g fat (low-fat) or 22.3 g fat (high-fat), 19.8 g toasts, 120 mL water and 50 g apple puree. In 12 non-obese healthy men, palatability, homeostatic sensations (hunger/satiety, fullness) and hedonic sensations (digestive well-being, mood) were measured on 10 cm scales before and during the 60-min postprandial period. Comparisons between meals were performed with a two-way repeated measures ANCOVA with premeal data as co-variate.

KEY RESULTS

Both test meals were rated equally palatable (palatability scores 3.8 ± 0.3 low-fat, 3.3 ± 0.2 high-fat; P = .156). As compared to the high-fat meal, the low-fat meal induced more satisfaction (meal effect on well-being F(1,21) = 4.92; P = .038) and tended to improve mood (meal effect F(1,21) = 3.02; P = .064), and this was associated with a non-significant decrease in satiety (meal effect F(1,21) = 2.29; P = .145) and fullness (meal effect F(1,21) = 1.57; P = .224).

CONCLUSIONS AND INFERENCES

The composition of meals with equal palatability influences postprandial satisfaction, even without significant impact on homeostatic sensations, although an effect on homeostatic sensations has not been excluded. These conditioning factors may have clinical implications in patients with impaired meal tolerance or meal-related symptoms.

[Identification of gaps in the clinical patient care of asthma in Spain. Results of the OPTIMA-GEMA survey]

BACKGROUND

Based on the GEMA 2009 guidelines (Spanish Asthma Management Guidelines), this project identified and assessed the main deficiencies in the implementation of the guidelines and proposed initiatives for improvement.

METHODS

The study gathered and evaluated the opinions of a multidisciplinary group of asthma experts (allergists, pulmonologists, pediatricians, and primary care physicians). The first step identified health care aspects of GEMA 2009 that could be improved (Phase I). Subsequently, the issues were prioritized, using a 9-point Likert scale (Phase II).

RESULTS

In Phase I, 134 physicians participated, and 107 of them took part in Phase II. High priority was assigned to 81% and 49.2% of the limitations identified in health care for adults and children respectively. The most important deficiency in adult care was improving treatment for pregnant women; in pediatric care, it was the use of high doses of beta-2 adrenergic antagonists in asthma deterioration. Other relevant needs were the limited use of spirometry, symptom questionnaires, and written action plans for the patients, as well as the lack of involvement of nursing staff in asthma care and the need to adjust treatment according to levels of control in follow-ups.

CONCLUSIONS

The priority areas for improvement were those related to asthma treatment. Future programs for implementation of asthma guidelines should prioritize the use of symptom questionnaires, nursing staff involvement, and attention to pregnant women with asthma.

Effects of meal palatability on postprandial sensations

BACKGROUND

Food palatability has been shown to influence satiation and meal consumption; our aim was to determine its effects on postprandial satisfaction, ie digestive well-being (primary outcome), and homeostatic sensations (satiety, fullness).

METHODS

Randomized, cross-over trial comparing the postprandial responses to conventional (potato-cheese cream followed by vanilla cream) vs unconventional test meals (mixture of both creams) with identical composition and physical characteristics (color, texture, consistency, temperature) but distinctively different palatability. In 22 non-obese healthy men sensations were measured on 10 cm scales before and during the 60-min postprandial period (-5 to +5 score scales for palatability, satiety, well-being, and mood, and 0-10 score scales for fullness and discomfort). Comparisons between meals were performed with a 2-way repeated measures ANCOVA with premeal data as co-variate.

KEY RESULTS

As compared to the palatable conventional meal, the unconventional meal was rated unpalatable (-1.8 ± 0.4 score vs 2.8 ± 0.1 score potato cream and 2.9 ± 0.2 vanilla cream; P < .001 for both), induced significantly more fullness sensation [meal effect F (1, 19) = 7.389; P = .014] but had less effect on digestive well-being [meal effect F (1, 19) = 47.016; P < .001] and mood [meal-effect F (1, 19) = 6.609; P = .019]. The difference in satiety was not significantly different.

CONCLUSION & INFERENCES

Meal palatability influences the postprandial experience: it bears a direct relation to the hedonic response (well-being/mood) but an inverse relation to homeostatic sensations (fullness). These relations could be applicable to influence eating behavior, because at equal conditions, more palatable meals induce less fullness but more satisfaction, and vice-versa.

Education of the postprandial experience by a sensory-cognitive intervention

BACKGROUND

Ingestion of a meal induces homeostasis-related sensations (satiety/fullness) that have a hedonic dimension (satisfaction/mood). We have previously shown that a previous physiological intervention, a meal preload, influences the responses to a subsequent meal, specifically: it increases satiety/fullness and decreases satisfaction. We now wished to determine the differential effects of education on the homeostatic and hedonic postprandial experience.

METHODS

Randomized, parallel study comparing the effect of real vs sham education on the responses to a probe meal. In two groups of healthy subjects (n = 14 each), homeostatic (satiety, fullness) and hedonic sensations (digestive well-being, mood) in response to a probe meal (250 mL soup, 25 g bread) were measured on 2 separate days before and after a single sensory-cognitive educational intervention (taste recognition test of supra- and sub-threshold tastands for real and sham education, respectively).

KEY RESULTS

Before education, in both groups the probe meal induced homeostatic sensations (satiety, fullness) with a positive hedonic dimension (increased digestive well-being and mood). In contrast to sham education, real education enhanced both homeostatic and hedonic responses to the probe meal (P < .05 vs sham education for all).

CONCLUSIONS AND INFERENCES

Education modifies the subjects' receptiveness and influences the responses to a meal, not only the hedonic postprandial experience, but also homeostatic sensations. Since homeostatic and hedonic responses are dissociable, education might be tailored to target different conditions.

Validation of a Spanish version of the EuroPrevall Food Allergy Quality of Life Questionnaire-Parental Form

BACKGROUND

Food allergy can have a major impact on quality of life of children and their parents. Questionnaires have been developed to measure the impact of this disorder. We aimed to validate the EuroPrevall questionnaire on Food Allergy-Quality of Life Questionnaire, Parent Form (FAQLQ-PF) and the Food Allergy Independent Measure (FAIM), translated into Spanish.

METHODS

The internal consistency of the FAQLQ-PF and the FAIM, translated into Spanish (Spain) and completed by the parents of 74 children with IgE-mediated food allergy, were evaluated with Cronbach's alpha. To test construct validity of the FAQLQ-PF, its correlation with the FAIM was also calculated. To assess their discriminant validity, we compared the values of both depending on the number of offending foods and for children with and without anaphylaxis.

RESULTS

The values of Cronbach's alpha for the three domains in the FAQLQ-PF were over 0.9. The value of alpha for FAIM questions was below 0.6, which was attributed to the wording of one question. When this question was removed, alpha increased to over 0.70. There was a significant correlation between the FAQLQ-PF score and the FAIM. There were significantly poorer FAQLQ-PF scores in children with more food allergies and worse FAIM in those who had had anaphylaxis.

CONCLUSIONS

The Spanish version of the FAQLQ-PF had a good internal consistency, good construct validity and validity to discriminate patients with more food allergies and anaphylaxis. It can be used as a tool to evaluate and monitor the quality of life in families with food allergic children.

Appetite influences the responses to meal ingestion

BACKGROUND

We have previously shown that the postprandial experience includes cognitive sensations, such as satiety and fullness, with a hedonic dimension involving digestive well-being and mood. Preload conditioning has been shown to modulate appetite and food consumption under certain conditions, but its effects on the responses to meal ingestion are not clear. We hypothesized that appetite modulation by preload conditioning has differential effects on the cognitive and the emotive responses to meal ingestion.

METHODS

The effects of preload conditioning (ingestion of a low- vs a high-calorie breakfast) on appetite and on the cognitive and emotive responses to a comfort probe meal ingested 2 hours later (ham and cheese sandwich with orange juice; 300 mL, 425 Kcal) was tested in healthy subjects (n=12) in a cross-over design. Sensations were measured at regular intervals 15 minutes before and 60 minutes after the probe meal.

KEY RESULTS

As compared to the low-calorie breakfast, the high-calorie breakfast reduced basal hunger sensation and influenced the responses to the subsequent probe meal: it increased satiety (4.3±0.2 score vs 2.7±0.2 score; P<.001) and fullness (5.4±0.5 score vs 3.1±0.5; P<.001), but reduced the expected postprandial experience of digestive well-being after a palatable meal (1.3±0.7 score vs 3.0±0.3; P=.045).

CONCLUSION AND INFERENCES

Appetite modulation by preload conditioning has differential effects on the cognitive and emotive responses to a meal. Preload conditioning of the postprandial experience may be applicable to dietary planning and prevention of postprandial symptoms.

Identification of Rare PB2-D701N Mutation from a Patient with Severe Influenza: Contribution of the PB2-D701N Mutation to the Pathogenicity of Human Influenza

Several amino acid changes have been previously implicated in adaptation of avian influenza viruses to human hosts, among them the D701N change in the PB2 polymerase subunit that also is the main determinant of avian virus pathogenesis in animal models. However, previous studies using recombinant viruses did not provide conclusive information of the contribution of this PB2 residue to pathogenicity in human influenza virus strains. We identified this mutation in an A(H1N1)pdm09-like human influenza virus isolated from an infected patient with pneumonia and acute respiratory failure, admitted to the intensive care unit. An exhaustive search has revealed PB2-D701 as a highly conserved position in all available H1N1 human virus sequences in NCBI database, showing a very low prevalence of PB2-D701N change. Presence of PB2-701N amino acid correlates with severe or fatal outcome in those scarce cases with known disease outcome of the infection. In these patients, the residue PB2-701N may contribute to pathogenicity as it was previously reported in humans infected with avian viruses. This study helps to clarify a debate that has arisen regarding the role of PB2-D701N in human influenza virus pathogenicity.

Apoptosis, Toll-like, RIG-I-like and NOD-like Receptors Are Pathways Jointly Induced by Diverse Respiratory Bacterial and Viral Pathogens

Lower respiratory tract infections are among the top five leading causes of human death. Fighting these infections is therefore a world health priority. Searching for induced alterations in host gene expression shared by several relevant respiratory pathogens represents an alternative to identify new targets for wide-range host-oriented therapeutics. With this aim, alveolar macrophages were independently infected with three unrelated bacterial (Streptococcus pneumoniae, Klebsiella pneumoniae, and Staphylococcus aureus) and two dissimilar viral (respiratory syncytial virus and influenza A virus) respiratory pathogens, all of them highly relevant for human health. Cells were also activated with bacterial lipopolysaccharide (LPS) as a prototypical pathogen-associated molecular pattern. Patterns of differentially expressed cellular genes shared by the indicated pathogens were searched by microarray analysis. Most of the commonly up-regulated host genes were related to the innate immune response and/or apoptosis, with Toll-like, RIG-I-like and NOD-like receptors among the top 10 signaling pathways with over-expressed genes. These results identify new potential broad-spectrum targets to fight the important human infections caused by the bacteria and viruses studied here.

ARIA 2016: Care pathways implementing emerging technologies for predictive medicine in rhinitis and asthma across the life cycle

The Allergic Rhinitis and its Impact on Asthma (ARIA) initiative commenced during a World Health Organization workshop in 1999. The initial goals were (1) to propose a new allergic rhinitis classification, (2) to promote the concept of multi-morbidity in asthma and rhinitis and (3) to develop guidelines with all stakeholders that could be used globally for all countries and populations. ARIA—disseminated and implemented in over 70 countries globally—is now focusing on the implementation of emerging technologies for individualized and predictive medicine. MASK [MACVIA (Contre les Maladies Chroniques pour un Vieillissement Actif)-ARIA Sentinel NetworK] uses mobile technology to develop care pathways for the management of rhinitis and asthma by a multi-disciplinary group and by patients themselves. An app (Android and iOS) is available in 20 countries and 15 languages. It uses a visual analogue scale to assess symptom control and work productivity as well as a clinical decision support system. It is associated with an inter-operable tablet for physicians and other health care professionals. The scaling up strategy uses the recommendations of the European Innovation Partnership on Active and Healthy Ageing. The aim of the novel ARIA approach is to provide an active and healthy life to rhinitis sufferers, whatever their age, sex or socio-economic status, in order to reduce health and social inequalities incurred by the disease.

Correction: ISG15 Regulates Peritoneal Macrophages Functionality against Viral Infection

[This corrects the article DOI: 10.1371/journal.ppat.1003632.].

MP-AzeFlu is more effective than fluticasone propionate for the treatment of allergic rhinitis in children

The objective was to evaluate the efficacy of MP-AzeFlu (Dymista(®) ) vs fluticasone propionate (FP), (both 1 spray/nostril bid), in children with allergic rhinitis (AR). MP-AzeFlu combines azelastine hydrochloride, FP and a novel formulation in a single spray. Children were randomized in a 3 : 1 ratio to MP-AzeFlu or FP in this open-label, 3-month study. Efficacy was assessed in children aged ≥ 6 to <12 years (MP-AzeFlu: n = 264; FP: n = 89), using a 4-point symptom severity rating scale from 0 to 3 (0 = no symptoms; 3 = severe symptoms). Over the 3-month period, MP-AzeFlu-treated children experienced significantly greater symptom relief than FP-treated children (Diff: -0.14; 95% CI: -0.28, -0.01; P = 0.04), noted from the first day (particularly the first 7 days) and sustained for 90 days. More MP-AzeFlu children achieved symptom-free or mild symptom severity status, and did so up to 16 days faster than FP. MP-AzeFlu provides significantly greater, more rapid and clinically relevant symptom relief than FP in children with AR.

Analysis of Pregnancy-Induced Anti-HLA Antibodies Using Luminex Platform

BACKGROUND

The impact of pregnancy on the incidence of HLA sensitization is poorly explored, and most of the data were obtained by use of a complement-dependent cytotoxicity (CDC) assay with an incidence of 18% to 30%. In many cases, antibodies cannot be detected by CDC as their level fades in time. However, this state of "latent" sensitization can still have a significant clinical impact in a subsequent transplantation setting.

METHODS

Pregnancy-induced HLA sensitization was analyzed in 69 mothers without a history of transfusions or transplants. The mothers and their offspring were typed for HLA-A, HLA-B, and HLA-DR. Sera from the mothers were studied using the Luminex screening test to detect anti-HLA class I and class II antibodies. Positive and borderline sera were further analyzed using single antigen kits.

RESULTS

Thirty-four sera (49.3%) were positive in the screening test (52.9% for class I and 61.7% for class II antibodies). All of them tested positive for paternal alloantigens by single antigen. Positive paternal alloantigens were also detected in 52.9% of class I and 36.3% of class II sera with borderline screening. Interestingly, in a further analysis, the mean of the MFIs of paternal alloantigens that resulted negative was calculated and compared with that of neutral alloantigens and that of maternal self-antigens; in both cases, differences were highly significant (288 vs 153, P < .0001; 288 vs 102, P < .0001; respectively).

CONCLUSIONS

This study shows a high incidence of pregnancy-induced HLA sensitization and suggests that HLA typing of partners of women who have been pregnant may contribute to a better risk assessment in the transplantation setting.

Pattern of neuropsychological impairment in the early phase of relapsing-remitting multiple sclerosis

To investigate the neuropsychological profile in the first few years post-onset of relapsing-remitting multiple sclerosis (MS) we carried out a comprehensive neuropsychological evaluation of 33 patients characterized by very short evolution of this disease, minimal levels of neurological disability and preserved general cognition. Thirty-three individually pair-matched controls were also evaluated. Patients performed as well as controls on many of the cognitive exploration measures. Nevertheless, the group of patients evinced a general slowness that affected motor execution and cognitive processing. Memory functions were characterized by preservation of working memory, retrieval or storage of information and a deficit at the acquisition phase in (verbal and visual) supraspan tasks. In addition, significant correlations were observed between some measures of information processing speed and memory. These results highlight the importance of studying cognitive deficits not only in the different subtypes of MS but also in different phases of the disease.

Prevalence of endometriosis in women with systemic lupus erythematosus and Sjögren's syndrome

Endometriosis is associated with a number of immunologic alterations. It has been suggested that autoimmune disorders could be more frequent in patients with endometriosis. The aim of this study is to ascertain whether the prevalence of two well-known autoimmune diseases [systemic lupus erythematosus (SLE) and Sjögren's syndrome (SS)] is increased in women with endometriosis. The clinical charts of four different populations assisted at the same hospital were manually revised: (i) SLE population ( n = 120), (ii) SS ( n = 22), (iii) endometriosis ( n = 342) and (iv) control population ( n = 501 consecutive unselected asymptomatic women). Among SLE women, the prevalence of endometriosis was 1.67% (2/120), similar to the 4.39% prevalence of the control group (22/501), the OR being 0.37 [95%CI 0.09—1.59]. Among SS women, the prevalence of endometriosis was 9.09 (2/22), also similar to the control group OR 2.17 [95%CI 0.48—9.90]. In the same way, when comparing endometriosis cases with asymptomatic women, similar frequencies of SLE (0.58% and 0.2%) and SS were found (0% and 0%). Women with endometriosis do not have an increased prevalence of SLE or SS. Lupus (2007) 16, 736—740.

Immunohistochemical Expression of p53, Fibroblast Growth Factor-b, and Transforming Growth Factor-α in Feline Vaccine-associated Sarcomas

Fifty feline sarcomas associated with vaccine-site injection were evaluated to determine the immunohistochemical expression of p53 protein, basic fibroblast growth factor (FGF-b), and transforming growth factor-α (TGF-α). Forty-one tumors (82%) were fibrosarcomas (FS), eight (16%) were malignant fibrous histiocytomas (MFH), and one (2%) was a chondrosarcoma (CS). Overexpression of p53 protein was observed in the nuclei of tumor cells in 28 (56%) sarcomas; FGF-b expression was found in the cytoplasm of tumor cells in 40 (80%) feline sarcomas, but the staining was more intense in the spindle-shaped cells of FS than in polygonal or round cells of MFH. The single CS faintly expressed FGF-b. The majority of feline vaccine-associated sarcomas (43 of 50, 86%) expressed moderate or intense staining for TGF-α in the cytoplasm of tumor cells. Heterogeneous immunolabeling for p53, FGF-b, and TGF-α was present in neoplastic, multinucleated giant cells. Intense expression of FGF-b was statistically associated with younger cats ( P < 0.01) and with tumors with nodular growth patterns ( P = 0.02). In addition, sarcomas negative for p53 protein expressed FGF-b more frequently than did p53-positive tumors ( P = 0.04). The frequency of FGF-b immunostaining was significantly higher in sarcomas with intense expression of TGF-α ( P = 0.05). Immunohistochemical detection of p53 protein, FGF-b, and TGF-α suggests that these growth-regulating proteins may play different roles in the development of sarcomas associated with vaccine sites.

Hyperthermic intraperitoneal chemotherapy with paclitaxel or cisplatin in patients with stage III-C/IV ovarian cancer. Is there any difference?

OBJETIVE

To compare the results of the administration of HIPEC with Paclitaxel or Cisplatin after cytoreduction in patients with stage IIIC-IV ovarian cancer, especially focused on disease-free survival.

PATIENTS

We retrospectively analyzed a consecutive series of patients operated after being diagnosed with stage III-C/IV serous epithelial ovarian carcinoma. Patients included in the study were treated between January 2008 and March 2015. After cytoreduction, Paclitaxel (doses of 60 mg/m(2)O or Cisplatin (doses of 75 mg/m(2)) were used.

RESULTS

A total of 111 patients were included. Median age was 61 years. In 60 of them (54%) Paclitaxel was used during HIPEC treatment and 51 patients (46%) were treated with Cisplatin. PCI was similar between groups (PCI = 11 in both cases). Median follow up was 34 months (12-96 months). The median disease free survival in Paclitaxel Group was 27 months and 33 months in Cisplatin Group (p = 0.551). In patients treated with Paclitaxel disease free survival rates at 1, 2, and 3 years were 79%, 60% and 46%. In patients treated with Cisplatin disease free survival at 1, 2, and 3 years were 64%, 50% and 40% respectively. After a multivariate analysis, incomplete cytoreduction (HR: 6.54, 95% CI 2.98-10.17, p < 0.01) and PCI >11 (HR: 2.15, 95% CI 1.42-6.68, p < 0.05) were identified as independent factors associated with a reduced disease-free survival. Cystotatic used was not relevant regarding disease free survival analysis.

CONCLUSION

HIPEC with paclitaxel or cisplatin after cytoreduction in patients with ovarian cancer IIIC-IV has not shown different results in disease-free survival outcomes.

Inhibition of Influenza Virus Replication by DNA Aptamers Targeting a Cellular Component of Translation Initiation

The genetic diversity of the influenza virus hinders the use of broad spectrum antiviral drugs and favors the appearance of resistant strains. Single-stranded DNA aptamers represent an innovative approach with potential application as antiviral compounds. The mRNAs of influenza virus possess a 5'cap structure and a 3'poly(A) tail that makes them structurally indistinguishable from cellular mRNAs. However, selective translation of viral mRNAs occurs in infected cells through a discriminatory mechanism, whereby viral polymerase and NS1 interact with components of the translation initiation complex, such as the eIF4GI and PABP1 proteins. We have studied the potential of two specific aptamers that recognize PABP1 (ApPABP7 and ApPABP11) to act as anti-influenza drugs. Both aptamers reduce viral genome expression and the production of infective influenza virus particles. The interaction of viral polymerase with the eIF4GI translation initiation factor is hindered by transfection of infected cells with both PABP1 aptamers, and ApPABP11 also inhibits the association of NS1 with PABP1 and eIF4GI. These results indicate that aptamers targeting the host factors that interact with viral proteins may potentially have a broad therapeutic spectrum, reducing the appearance of escape mutants and resistant subtypes.

[Consensus-based approach for severe paediatric asthma in routine clinical practice]

INTRODUCTION

Accurate identification of paediatric patients with severe asthma is essential for an adequate management of the disease. However, criteria for defining severe asthma and recommendations for control vary among different guidelines.

MATERIAL AND METHODS

An online survey was conducted to explore expert opinions about the definition and management of severe paediatric asthma. To reach a consensus agreement, a modified Delphi technique was used, and practice guidelines were prepared after the analysis of the results.

RESULTS

Eleven paediatric chest disease physicians and allergy specialists with wide expertise in severe asthma responded to the survey. Consensus was reached in 50 out of 65 questions (76.92%). It was considered that a patient has severe asthma if during the previous year they have required 2 or more cycles of oral steroids, required daily treatment with medium doses of inhaled corticosteroids (with other controller medication) or high doses (with or without other controller medication), did not respond to optimised conventional treatment, or if the disease threatened the life of the patient or seriously impairs their quality of life. The definition of severe asthma may also include patients who justifiably use health resources on a regular basis, or have psychosocial or environmental factors impeding control. For monitoring, the use of questionnaires designed specifically for paediatric population, such as CAN or ACT, is recommended. As regards treatment, the use of omalizumab should be considered prior to the use of oral corticosteroids.

CONCLUSIONS

This paper provides consensus recommendations that may be useful in the management of severe paediatric asthma.

CCR5 deficiency predisposes to fatal outcome in influenza virus infection

Influenza epidemics affect all age groups, although children, the elderly and those with underlying medical conditions are the most severely affected. Whereas co-morbidities are present in 50% of fatal cases, 25-50% of deaths are in apparently healthy individuals. This suggests underlying genetic determinants that govern infection severity. Although some viral factors that contribute to influenza disease are known, the role of host genetic factors remains undetermined. Data for small cohorts of influenza-infected patients are contradictory regarding the potential role of chemokine receptor 5 deficiency (CCR5-Δ32 mutation, a 32 bp deletion in the CCR5 gene) in the outcome of influenza virus infection. We tested 171 respiratory samples from influenza patients (2009 pandemic) for CCR5-Δ32 and evaluated its correlation with patient mortality. CCR5-Δ32 patients (17.4%) showed a higher mortality rate than WT individuals (4.7%; P = 0.021), which indicates that CCR5-Δ32 patients are at higher risk than the normal population of a fatal outcome in influenza infection.

Clinical response to pandemic H1N1 influenza virus from a fatal and mild case in ferrets

Background

The majority of pandemic 2009 H1N1 (A(H1N1)pdm09) influenza virus (IV) caused mild symptoms in most infected patients, however, a greater rate of severe disease was observed in healthy young adults and children without co-morbid conditions. The purpose of this work was to study in ferrets the dynamics of infection of two contemporary strains of human A(H1N1)pdm09 IV, one isolated from a patient showing mild disease and the other one from a fatal case.

Methods

Viral strains isolated from a patient showing mild disease-M (A/CastillaLaMancha/RR5661/2009) or from a fatal case-F (A/CastillaLaMancha/RR5911/2009), both without known comorbid conditions, were inoculated in two groups of ferrets and clinical and pathological conditions were analysed.

Results

Mild to severe clinical symptoms were observed in animals from both groups. A clinical score distribution was applied in which ferrets with mild clinical signs were distributed on a non-severe group (NS) and ferrets with severe clinical signs on a severe group (S), regardless of the virus used in the infection. Animals on S showed a significant decrease in body weight compared to animals on NS at 4 to 7 days post-infection (dpi). Clinical progress correlated with histopathological findings. Concentrations of haptoglobin (Hp) and serum amyloid A (SAA) increased on both groups after 2 dpi. Clinically severe infected ferrets showed a stronger antibody response and higher viral titres after infection (p = 0.001).

Conclusions

The severity in the progress of infection was independent from the virus used for infection suggesting that the host immune response was determinant in the outcome of the infection. The diversity observed in ferrets mimicked the variability found in the human population.

Factors related to the development of CMV-specific CD8+ T cell response in CMV-seropositive solid organ transplant candidates

This cross-sectional study analyzes factors associated with the development of CMV-specific CD8+ response, measured by IFNg production after cytomegalovirus (CMV) peptide stimulation, in CMV-seropositive solid organ transplantation candidates. A total of 114 candidates were enrolled, of whom 22.8% (26/114) were nonreactive (IFNγ < 0.2 IU/mL). Multivariate logistic regression analysis showed that age, HLA alleles and organ to be transplanted were associated with developing CMV-specific CD8+ immunity (reactive; IFNγ ≥ 0.2 IU/mL). The probability of being reactive was higher in candidates over 50 than in those under 50 (OR 6.33, 95%CI 1.93-20.74). Candidates with HLA-A1 and/or HLA-A2 alleles had a higher probability of being reactive than those with non-HLA-A1/non-HLA-A2 alleles (OR 10.97, 95%CI 3.36-35.83). Renal candidates had a higher probability of being reactive than lung (adjusted OR 8.85, 95%CI 2.24-34.92) and liver candidates (OR 4.87, 95%CI 1.12-21.19). The AUC of this model was 0.84 (p < 0.001). Positive and negative predictive values were 84.8% and 76.9%, respectively. In renal candidates longer dialysis was associated with an increased frequency of reactive individuals (p = 0.040). Therefore, although the assessment of CMV-specific CD8+ response is recommended in all R+ candidates, it is essential in those with a lower probability of being reactive, such as non-renal candidates, candidates under 50 or those with non-HLA-A1/non-HLA-A2 alleles.

Presence of radionuclides in sludge from conventional drinking water treatment plants. A review

The analysis of sludge samples generated during water treatment processes show that different radioisotopes of uranium, thorium and radium, among others can accumulate in that kind of samples, even the good removal rates obtained in the aqueous phase (by comparison of influent and effluent water concentrations). Inconsequence, drinking water treatment plants are included in the group of Naturally Occurring Radioactive Material (NORM) industries. The accumulation of radionuclides can be a serious problem especially when this sludge is going to be reused, so more exhaustive information is required to prevent the possible radiological impact of these samples in the environment and also on the people. The main aim of this review is to outline the current situation regarding the different studies reported in the literature up to date focused on the analysis of the radiological content of these sludge samples from drinking water treatment plants. In this sense, special attention is given to the recent approaches for their determination. Another important aim is to discuss about the final disposal of these samples and in this regard, sludge reuse (including for example direct agricultural application or also as building materials) are together with landfilling the main reported strategies.

Prevalence of endometriosis in epithelial ovarian cancer. Analysis of the associated clinical features and study on molecular mechanisms involved in the possible causality

PURPOSE OF INVESTIGATION

To determine the prevalence of endometriosis in patients with epithelial ovarian cancer and explore the differences between women with endometrioid and clear-cell histologic subtypes with and without associated endometriosis.

MATERIALS AND METHODS

The medical charts of 496 patients with epithelial ovarian cancer at the Hospital Virgin de la Arrixaca (Murcia, Spain) between 1971 and 2010 were reviewed.

RESULTS

Endometriosis was present in 27 (5.4%) of the 496 cases (p < 0001), and was associated with the endometrioid histotype in 13/45 cases (29%) and with the clear cell histotype in 7/22 (32%). The prevalence of an association with endometriosis according to histologic type was 28.8% (13/45) for endometrioid carcinoma and 31.8% (7/22) for clear-cell carcinoma.

CONCLUSION

Both endometrioid and clear-cell ovarians tumours are associated with pelvic endometriosis. Patients with endometiosis associated ovarian cancer differ from non-endometiosis associated ovarian cancer in their clinical characteristics.