NADPH oxidase 1 mediates caerulein-induced pancreatic fibrosis in chronic pancreatitis

Inflammatory disorders of the pancreas are divided into acute (AP) and chronic (CP) forms. Both states of pancreatitis are a result of pro-inflammatory mediators, including reactive oxygen species (ROS). One of the sources of ROS is NADPH oxidase (Nox). The rodent genome encodes Nox1-4, Duox1 and Duox2. Our purpose was to assess the extent to which Nox enzymes contribute to the pathogenesis of both AP and CP using Nox-deficient mice. Using RT-PCR, Nox1 was found in both isolated mouse pancreatic acini and pancreatic stellate cells (PaSCs). Subsequently, mice with genetically deleted Nox1 were further studied and showed that the histo-morphologic characteristics of caerulein-induced CP, but not caerulein-induced AP, was ameliorated in Nox1 KO mice. We also found that the lack of Nox1 impaired caerulein-induced ROS generation in PaSCs. Using Western blotting, we found that AKT mediates the fibrotic effect of Nox1 in a mouse model of CP. We also found a decrease in phospho-ERK and p38MAPK levels in Nox1 KO mice with CP, but not with AP. Both CP-induced TGF-β up-regulation and NF-ĸB activation were impaired in pancreas from Nox1 KO mice. Western blotting indicated increases in proteins involved in fibrosis and acinar-to-ductal metaplasia in WT mice with CP. No change in those proteins were observed in Nox1 KO mice. The lack of Nox1 lowered mRNA levels of CP-induced matrix metalloproteinase MMP-9 and E-cadherin repressor Twist in PaSCs. CONCLUSION: Nox1-derived ROS in PaSCs mediate the fibrotic process of CP by activating the downstream redox-sensitive signaling pathways AKT and NF-ĸB, up-regulating MMP-9 and Twist, and producing α-smooth muscle actin and collagen I and III.

C-Reactive protein and insulin growth factor 1 serum levels during the menstrual cycle in adolescents with Type 1 diabetes

AIMS

To evaluate C-reactive protein, insulin growth factor 1 and lipid levels during the follicular and luteal phases in adolescents with Type 1 diabetes.

METHODS

Adolescents with Type 1 diabetes (N = 40) and healthy controls (C; N = 43) were studied during the follicular and luteal phases of their menstrual cycles. C-Reactive protein, insulin growth factor 1 and lipid levels were measured.

RESULTS

Adolescents with Type 1 diabetes exhibited higher C-reactive protein levels than the C group during the follicular (P < 0.0001) and luteal phases (P < 0.01). The elevation of C-reactive protein levels was more pronounced in overweight adolescents with Type 1 diabetes than in adolescents in the C group. More adolescents with Type 1 diabetes were classified as having an elevated risk of cardiovascular disease (C-reactive protein > 3 mg/l) in the luteal phase than in the follicular phase (37.5% and 17.5%, respectively); half of the overweight adolescents with Type 1 diabetes in the luteal phase reached this level. BMI was the only significant factor affecting follicular and luteal phase C-reactive protein levels in adolescents with Type 1 diabetes. Lower insulin growth factor 1 levels were observed during both phases of the menstrual cycle in adolescents with Type 1 diabetes compared with controls. An elevation in insulin growth factor 1 levels in the luteal phase relative to the follicular phase was observed in controls, but not in adolescents with Type 1 diabetes. Luteal insulin growth factor 1 and C-reactive protein exhibited an inverse correlation (r = -0.4, P = 0.01).

CONCLUSIONS

Adolescents with Type 1 diabetes have higher C-reactive protein levels and lower insulin growth factor 1 levels relative to controls, especially during the luteal phase. Type 1 diabetes diminishes the natural elevation in insulin growth factor 1 levels observed during the luteal phase in controls. Excess weight exacerbates the subclinical inflammatory state observed during both phases of the menstrual cycle in adolescents with Type 1 diabetes.

Sildenafil prevents the increase of extravascular lung water and pulmonary hypertension after meconium aspiration in newborn piglets

Meconium aspiration syndrome causes respiratory failure after birth and in vivo monitoring of pulmonary edema is difficult. The objective of the present study was to assess hemodynamic changes and edema measured by transcardiopulmonary thermodilution in low weight newborn piglets. Additionally, the effect of early administration of sildenafil (2 mg/kg vo, 30 min after meconium aspiration) on this critical parameter was determined in the meconium aspiration syndrome model. Thirty-eight mechanically ventilated anesthetized male piglets (Sus scrofa domestica) aged 12 to 72 h (1660 ± 192 g) received diluted fresh human meconium in the airway in order to evoke pulmonary hypertension (PHT). Extravascular lung water was measured in vivo with a PiCCO monitor and ex vivo by the gravimetric method, resulting in an overestimate of 3.5 ± 2.3 mL compared to the first measurement. A significant PHT of 15 Torr above basal pressure was observed, similar to that of severely affected humans, leading to an increase in ventilatory support. The vascular permeability index increased 57%, suggesting altered alveolocapillary membrane permeability. Histology revealed tissue vessel congestion and nonspecific chemical pneumonitis. A group of animals received sildenafil, which prevented the development of PHT and lung edema, as evaluated by in vivo monitoring. In summary, the transcardiopulmonary thermodilution method is a reliable tool for monitoring critical newborn changes, offering the opportunity to experimentally explore putative therapeutics in vivo. Sildenafil could be employed to prevent PHT and edema if used in the first stages of development of the disease.

Epidemiology of bacteremia and factors associated with multi-drug-resistant gram-negative bacteremia in hematopoietic stem cell transplant recipients

The incidence of Gram-negative bacteremia has increased in hematopoietic stem cell transplant (HSCT) recipients. We prospectively collected data from 13 Brazilian HSCT centers to characterize the epidemiology of bacteremia occurring early post transplant, and to identify factors associated with infection due to multi-drug-resistant (MDR) Gram-negative isolates. MDR was defined as an isolate with resistance to at least two of the following: third- or fourth-generation cephalosporins, carbapenems or piperacillin-tazobactam. Among 411 HSCT, fever occurred in 333, and 91 developed bacteremia (118 isolates): 47% owing to Gram-positive, 37% owing to Gram-negative, and 16% caused by Gram-positive and Gram-negative bacteria. Pseudomonas aeruginosa (22%), Klebsiella pneumoniae (19%) and Escherichia coli (17%) accounted for the majority of Gram-negative isolates, and 37% were MDR. These isolates were recovered from 20 patients, representing 5% of all 411 HSCT and 22% of the episodes with bacteremia. By multivariate analysis, treatment with third-generation cephalosporins (odds ratio (OR) 10.65, 95% confidence interval (CI) 3.75-30.27) and being at one of the hospitals (OR 9.47, 95% CI 2.60-34.40) were associated with infection due to MDR Gram-negative isolates. These findings may have important clinical implications in the decision of giving prophylaxis and selecting the empiric antibiotic regimen.

Converting to a Generic Formulation of Mycophenolate Mofetil in Stable Kidney Transplant Recipients: 1 Year of Drug Surveillance and Outcome

OBJECTIVE

The objective of this study was to compare the pharmacokinetic profiles of a generic formulation with the innovator mycophenolate mofetil (MMF).

METHODS AND PATIENTS

Thirteen patients with stable renal grafts received MMF posttransplantation (mean, 32 months; confidence interval 95%: 51, 9-12, 36). Graft function improved significantly (serum creatinine levels 2.72 +/- 1.75 mg/dL to 1.9 +/- 0.66 and 1.79 +/- 0.86 mg/dL at 12 and 30 months, respectively; P < .05). Three point (basal, 2, and 6 hours) profiles were performed. Five patients were switched 1:1 to a generic formulation for 60 days and repeating the pharmacokinetics were repeated. Afterwards, they returned to the innovator MMF for 45 days. Finally, all patients received generic MMF, repeating the pharmacokinetics between 15 days and 6 months later.

RESULTS

The area under the curve (AUC 0-6) of MPA was 52.68 +/- 17.5 microg/mL*hr, with 61.5% of basal determinations (Co) under 5 microg/mL (4.08 +/- 0.74). The Pearson correlation coefficient was high between both MMF formulations regarding FMPA AUC 0.768 (P < .005), Co (0.774; P < 0.05), and C6 (0.996; P < .005). GMPA AUC were similar (Pearson) 0.7 (P < .01), Co 0.99 (P < .01), and C6 0.86 (P < .01). C2 MMF levels were variable and showed poor correlation. FMPA AUC of generic and original formulations after 60 days had tight correlation. (Pearson 0.883; P < .025) and comparing 15 and 60 days postconversion with generic drug in the same patients were similar (Pearson 0.58; P < .025). Renal function at 12 months remained stable postconversion.

CONCLUSIONS

Conversion to generic MMF in stable renal transplant recipients showed good clinical results.

Plasma profiles of ivermectin in horses following oral or intramuscular administration

A study was undertaken in order to evaluate and compare ivermectin's (IVM) plasma disposition kinetic parameters after oral or intramuscular (IM) administration in horses. Ten clinically healthy adult horses, weighing 380-496 kg body weight (BW), were allocated to two experimental groups of five horses. Group I, was treated with an oral paste formulation of IVM at the manufacturer's recommended dose of 0.2 mg/kg BW. Group II, was treated IM with an injectable 1% formulation of IVM at a dose of 0.2 mg/kg BW. Blood samples were collected by jugular puncture at different times between 0.5 h and 75 days post-treatment. After plasma extraction and derivatization, samples were analysed by high-performance liquid chromatography with fluorescence detection. A computerized kinetic analysis was performed, and data were compared using the Wilcoxon signed rank test. The parent molecule was detected in plasma between 30 min and either 20 (oral) or 40 (IM) days post-treatment. Significant differences were found for the time corresponding to peak plasma concentrations (tmax) and for absorption half-life. Peak plasma concentrations (Cmax) of 51.3 +/- 16.1 ng/ml (mean +/- SD) were obtained after oral administration and of 31.4 +/- 6.0 ng/ml for the IM route. The values for area under concentration-time curve were 137.1 +/- 35.9 ng day/ml for the group treated orally, and 303.2 +/- 4.3 ng day/ml for the IM treated group. The mean plasma residence times were 4.2 +/- 0.4 and 8.9 +/- 0.7 days for oral and IM-treated groups, respectively. The results of this study show that the route of administration considerably affects the disposition of IVM. A significant difference in bioavailabilty and half-life of elimination of IVM was observed after IM administration compared with oral administration. A close relationship between pharmacokinetic profiles and the clinical efficacy of IVM was established.

Pharmacokinetics of doramectin and ivermectin after oral administration in horses

A study was undertaken in order to compare plasma disposition kinetic parameters of doramectin (DRM) and ivermectin (IVM) in horses after oral administration. Ten crossbreed adult horses, clinically healthy, weighing 380-470 kg body weight (bw) were selected for study. Faecal examinations were performed to determine faecal parasite egg counts. Horses were allocated to two groups of five animals to provide an even distribution considering the variables sex, body weight and faecal egg count. Group I, were treated with an oral paste formulation of IVM at 0.2 mg/kg b/w and Group II, were treated with an oral dose of 0.2 mg/kg bw of DRM prepared as paste from the injectable formulation for oral administration. Blood samples were collected by jugular puncture between 0 h and 75 days post-treatment. Plasma was separated and later solid phase extraction and derivatization samples were analysed by high performance liquid chromatography (HPLC); a computerised kinetic analysis was carried out. Data were compared using the Mann-Whitney U-test. The mean plasma concentrations of DRM and IVM after oral administration in horses were detected until 30 and 20 days, respectively. Both drugs showed similar patterns of absorption and no significant differences were found for peak concentration, the time to peak concentration, or for absorptive half-life. The terminal elimination half-life was significantly (P<0.05) longer in the DRM treated group than for the IVM treated group. The differences observed in the elimination half-life explain the longer mean residence time and high values of area under the concentration time curve for the group treated with DRM, which are 30% higher than those of the IVM group. Considering its pharmacokinetics, tolerance and anthelmintic efficacy, the oral administration of DRM, could be an alternative to IVM for the control of parasitic diseases of horses.

A survey of homopteran species (Auchenorrhyncha) from coffee shrubs and poró and laurel trees in shaded coffee plantations, in Turrialba, Costa Rica

A survey of homopteran species (Auchenorryncha) was conducted in coffee plantations with no shade (C), and in those with shade of either poró (Erythrina poeppigiana) (CP) or poró plus laurel (Cordia alliodora) (CPL), in Turrialba, Costa Rica. A total of 130 species in ten families were collected, dominated by Cicadellidae (82 species). Species richness was highest in the CP system (88), followed by CPL (74) and C systems (60). Five most common species for all systems were Fusigonalia lativittata, Hebralebra nicaraguensis, Neocoelidia sp., Oliarus sp. and Clastoptera sp. Diversification of the coffee agroecosystem favors some species while limiting others, and have no effect on the majority of species. Thus, only F. lativittata, Neocoelidia sp. and Scaphytopius ca. latidens were well represented in all systems, but were more abundant in coffee shrubs. Additionally, the following were the dominant species in each system: Graphocephala sp. 1 (C), F. lativittata (CP) and H. nicaraguensis (CPL). Four species abundant on laurel trees, including H. nicaraguensis, appeared almost exclusively on these tree species. Species similarity was highest on the CP and CPL systems (51% of the species in common), followed by the C and CP (39%) and the C and CPL systems (38%). These findings show that even disturbed systems can harbor many insect species, so that they deserve attention from conservation advocates and biologists.

Monitoring of HIV-1 infection prevalence and trends in the general population using pregnant women as a sentinel population: 9 years experience from the Kagera region of Tanzania

In the Kagera region of Tanzania, a population-based study was initiated in 1987 followed by the establishment of antenatal-clinic-based sentinel surveillance system in the town of Bukoba in 1990. Repeat studies in both populations in Bukoba in 1993 and 1996 made it possible to study the dynamics of HIV infection prevalence and incidence in the area. This study aims at comparing the findings from this sentinel surveillance system with those of cross-sectional studies in the general population to assess its validity in estimating HIV prevalence and their trends in the general population. A multistage cluster sampling technique was used in the population-based studies whereas the antenatal-clinic-based population was obtained by consecutively recruiting antenatal care attenders coming for the first time during a given pregnancy. Antibodies against HIV infection were tested using two independent enzyme-linked immunosorbent assay (ELISA) antibody detection tests. Unlinked anonymous testing strategy was adopted for the sentinel population. Age-adjusted prevalence among antenatal care attenders decreased from 22.4% (95% confidence interval [CI], 20.6-25.2) in 1990 to 16.1% (95% CI, 15.9-18.8) in 1993 and further to 13.7% (95% CI, 11.8-14.3) in 1996. These results closely resemble those of the general population of adult women in the clinic's catchment area (the town of Bukoba) where the age-adjusted prevalence of 29.1% (95% CI, 24.4-34.6) in 1987 showed a decrease in the studies in 1993 18.7% (95% CI, 15.1-23.0) and in 1996 14.9% (95% CI, 12.0-17.1). The study indicates that general population trend estimates can be generated using sentinel surveillance data based on pregnant women visiting an antenatal clinic for the first time during a given pregnancy. The benefits of using this group outweigh its limitations that are brought about by possible selection bias. Continued surveillance of the epidemic based on antenatal care patients as a sentinel population is therefore recommended.

Decline in the prevalence of HIV-1 infection in young women in the Kagera region of Tanzania

In northwestern Tanzania, a population-based survey of HIV-1 infection in the Kagera region in 1987 demonstrated a high prevalence (24.2%) in adults of Bukoba town, whereas it was lower (10.0%) in the surrounding rural district of Bukoba. In 1993 and 1996, population-based cross-sectional studies were carried out in urban and rural Bukoba districts, respectively, to monitor the time trend in the prevalence of HIV-1 infection in the region. In both studies, a multistage cluster sampling technique was adopted in selecting study individuals. Consenting individuals between 15 and 54 years of age were interviewed using a structured questionnaire. Following individual counseling, blood samples were drawn and tested for HIV infection using enzyme-linked immunosorbent assay (ELISA) antibody detection tests. The overall age-adjusted HIV-1 seroprevalence in urban Bukoba decreased from 24.2% (134 of 553) in 1987 to 18.3% (118 of 653) in 1993 (p = .008). The age-adjusted gender-specific prevalence declined significantly in women, from 29.1% (95 of 325) to 18.7% (74 of 395; p = .0009). Except for men > or = 35 years of age, whose prevalence appeared to have an upward trend between the two studies, all other age groups in both genders had a downward trend; this finding was most significant in women between 15 and 24 years of age (from 27.6% to 11.2%; p = .0004). For the rural population, the overall prevalence decreased from 10.0% (54 of 538) in 1987 to 6.8% (118 of 1728) in 1996 (p = .01). Except for rural women between 15 and 24 years of age whose prevalence decreased from 9.7% (12 of 124) to 3.1% (12 of 383; p = .002), other age groups in the rural populations showed no change in prevalence. Ongoing interventions in this area leading to behavioral change may have contributed to this observation. An incidence study is under way to confirm this observation and to investigate the factors that are responsible for the decline in the HIV-1 prevalence.

[Results after two years of an alcoholic rehabilitation program]

BACKGROUND

Alcoholism is a serious public health problem in Chile and the best treatment strategy for this problem is far from being clear.

AIM

To assess the long term results of an alcoholism rehabilitation program.

PATIENTS AND METHODS

One hundred eighty two alcoholics admitted for treatment of their alcoholism were followed during two years in a special clinic. The effects of length of alcoholism, withdrawal symptoms on admission and the presence of histological liver damage on long term outcome were assessed using life table analysis.

RESULTS

During the two years period, 75% of patients were lost from control and 63% relapsed in their alcoholic ingestion. None of the above mentioned parameters had an effect on relapse or loss from follow up.

CONCLUSIONS

There are high attrition and failure rates and the length of alcoholism, degree of initial withdrawal and liver damage do not influence the long term results of this program.

Characterization of cwl1+, a gene from Schizosaccharomyces pombe whose overexpression causes cell lysis

From a Schizosaccharomyces pombe genomic library we have isolated the gene cwl1+ that causes cell lysis when it is overexpressed in the absence of an osmotic stabilizer. Southern hybridization showed that cwl1+ exists as a single copy in the S. pombe genome. The cwl1+ gene nucleotide sequence revealed a putative open reading frame of 924 bp encoding a polypeptide of 308 amino acids with a calculated Mt of 27000. The cwl1+ DNA hybridizes to a major RNA transcript of 1.5 kb whose 5' end maps at a position 452 bp upstream from the predicted translation start. Comparison of the amino acid sequence with those included in the current databases, showed no significant similarity to any known sequences. Cells overexpressing the cwl1+ gene under the control of the S. pombe nmt inducible promoter displayed a reduced cell wall content, were unable to separate after division and lysed drastically in the absence of osmotic stabilizer. Disruption of the cwl1+ gene caused no noticeable phenotype.

The Schizosaccharomyces pombe cwg2+ gene codes for the beta subunit of a geranylgeranyltransferase type I required for beta-glucan synthesis

The product of the Schizosaccharomyces pombe cwg2+ gene is involved in the biosynthesis of beta-D-glucan. When grown at the non-permissive temperature, cwg2-1 mutant cells lyse in the absence of an osmotic stabilizer and display a reduced (1-3) beta-D-glucan content and (1-3) beta-D-glucan synthase activity. The cwg2+ gene was cloned by the rescue of the cwg2-1 mutant phenotype using an S. pombe genomic library and subsequently verified by integration of the appropriate insert into the S. pombe genome. Determination of the nucleotide sequence of this gene revealed a putative open reading frame of 1065 bp encoding a polypeptide of 355 amino acids with a calculated M(r) of 40,019. The cwg2+ DNA hybridizes to a main transcript, the 5' end of which maps to a position 469 bp upstream of the predicted start of translation. The sequence between the transcription and the translation start sites is unusually long and has several short open reading frames which suggest a translational control of the gene expression. Comparative analysis of the predicted amino acid sequence shows that it possesses significant similarity to three Saccharomyces cerevisiae proteins, encoded by the DPR1/RAM1, CDC43/CAL1 and ORF2/BET2 genes respectively, which are beta subunits of different prenyltransferases. When grown at 37 degrees C, cwg2-1 mutant extracts were specifically deficient in geranylgeranyltransferase type I activity, as measured in vitro. Multiple copies of the CDC43 gene can partially suppress the growth and (1-3) beta-D-glucan synthase defect of the cwg2-1 mutant at the restrictive temperature. In a similar manner, the cwg2+ gene can partially suppress the cdc43-2 growth defect. These results indicate that cwg2+ is the structural gene for the beta subunit of geranylgeranyltransferase type I in S. pombe and that this enzyme is required for (1-3) beta-D-glucan synthase activity. The functional homology of Cwg2 with Cdc43, which has been implicated in the control of cell polarity, suggests a link between two morphogenetic events such as establishment of cell polarity and cell wall biosynthesis.

[Multiple codification of the causes of death: from dying "of" to dying "from"]

Multiple-cause mortality data is examined in the Valencian Region. In addition to coding the underlying cause of death (UCD), all causes of death which appeared mentioned on death certificates (MCD) were coded according to preliminary rules established by the Mortality Statistics Office. Specific diseases were selected to explore mortality patterns. The average number of conditions coded per death certificate was 2.7. Two or more conditions on the lowest used line appeared in 33.8% of all medical certificates. Septicaemia, high blood pressure and arteriosclerosis stand out among the conditions more often coded as MCD than coded as UCD. Exploring for mortality patterns a statistical association between coronary heart disease and diabetes emerged (p less than 0.0001). Multiple-cause mortality coding allow to discriminate mortality patterns and show a new magnitude to some specific causes of death.

Long-term effects on lymphocytotoxic antibodies and immune reactivity in hemodialysis patients treated with recombinant human erythropoietin

Twenty-six hemodialysis patients were given human recombinant erythropoietin to correct anemia. Eighteen patients had previously received multiple transfusions and 18 had been transfused within the preceding six months. Ten patients had lymphocytotoxic antibodies (panel reactive antibodies, PRA), measured as percent positive reactions against a panel of lymphocytes from 22 lymphocyte donors before the start of erythropoietin treatment. There was a significant decrease in mean PRA activity from 60% to 35% (p less than 0.05) during 6-18 months of treatment. Three of 26 patients received blood transfusions after the start of erythropoietin treatment, because of intercurrent disease or blood loss. Kidney transplantation was performed in four of the PRA-positive patients and in eight of the PRA-negative patients. Nine kidney transplants are currently functioning. The three graft losses were due to rejections. The lymphocyte immune reactivity measured after stimulation in MLC (mixed lymphocyte culture) against pooled lymphocytes and after PHA (phytohemagglutinin) and Con A (Concanavalin A) stimulation, was significantly lower in the hemodialysis patients than in the healthy controls (p less than 0.05). The responses did not change after correction of anemia. The number of OKM1 (Ortho's monoclonal antibody against M1 cells [monocytes])-positive cells among peripheral blood lymphocytes were significantly higher (p less than 0.001) in uremic patients than in healthy controls. After 12-18 months of treatment with erythropoietin this difference disappeared.(ABSTRACT TRUNCATED AT 250 WORDS)

A multicenter comparison of adhesion, preference, tolerability, and safety characteristics of two transdermal nitroglycerin delivery systems: Transderm-Nitro and Deponit

One hundred forty-two patients with stable angina were enrolled in a four-week, multicenter, office-based study to compare the adhesion properties, patient preference, and tolerability of two commercially available transdermal nitroglycerin patches. Data from 139 patients were analyzed. Each patient simultaneously wore one 5-mg Transderm-Nitro (TDN) patch and one 5-mg Deponit (DPT) patch. Patients daily recorded the following information in a diary format: number of angina attacks, frequency of sublingual nitroglycerin use, patch adhesion, and problems at the adhesion site or other medical problems. At the end of the study, patients rated their patch preferences based on ease of application and removal, ease of removing backing, overall adhesion, and adhesion under specific conditions, such as showering, swimming, exercise, hot weather, high humidity, and perspiration. They also specified which patch they would choose for their next prescription. Differences in adhesion properties (P less than 0.0001) and tolerability at the site of application favored TDN over DPT. In addition, significantly more patients (P less than 0.0001) specified TDN as their next prescription choice (83% vs 11%).