Gene expression profiles for the human pancreas and purified islets in type 1 diabetes: new findings at clinical onset and in long-standing diabetes

Type 1 diabetes (T1D) is caused by the selective destruction of the insulin-producing beta cells of the pancreas by an autoimmune response. Due to ethical and practical difficulties, the features of the destructive process are known from a small number of observations, and transcriptomic data are remarkably missing. Here we report whole genome transcript analysis validated by quantitative reverse transcription-polymerase chain reaction (qRT-PCR) and correlated with immunohistological observations for four T1D pancreases (collected 5 days, 9 months, 8 and 10 years after diagnosis) and for purified islets from two of them. Collectively, the expression profile of immune response and inflammatory genes confirmed the current views on the immunopathogenesis of diabetes and showed similarities with other autoimmune diseases; for example, an interferon signature was detected. The data also supported the concept that the autoimmune process is maintained and balanced partially by regeneration and regulatory pathway activation, e.g. non-classical class I human leucocyte antigen and leucocyte immunoglobulin-like receptor, subfamily B1 (LILRB1). Changes in gene expression in islets were confined mainly to endocrine and neural genes, some of which are T1D autoantigens. By contrast, these islets showed only a few overexpressed immune system genes, among which bioinformatic analysis pointed to chemokine (C-C motif) receptor 5 (CCR5) and chemokine (CXC motif) receptor 4) (CXCR4) chemokine pathway activation. Remarkably, the expression of genes of innate immunity, complement, chemokines, immunoglobulin and regeneration genes was maintained or even increased in the long-standing cases. Transcriptomic data favour the view that T1D is caused by a chronic inflammatory process with a strong participation of innate immunity that progresses in spite of the regulatory and regenerative mechanisms.

Prognostic factors in paranasal sinus cancer

PURPOSE

This study was designed to evaluate the influence of several different prognostic factors in determining both local recurrence rates and survival in patients treated for carcinoma of the paranasal sinuses.

MATERIALS AND METHODS

A retrospective study of patients treated between January, 1975 and December, 1991 was undertaken. Hospital charts were reviewed collecting demographic, clinical, and radiographic findings, which were correlated with treatment and subsequent follow-up.

RESULTS

Carcinoma of the paranasal sinuses was identified in 129 patients. This included 95 men and 34 women with an average of 59 years. The ethmoid sinus was primarily involved in 50 patients, the maxillary sinus and 49, the nasal sinus and 25, sphenoid sinus in three in the frontal sinus and two patients. Advanced stage (T3/T4) was diagnosed in 60% of patients at presentation. The most commonly encountered histologies were squamous-cell carcinoma and adenocarcinoma. The most accurate predictors of poor prognosis were advanced T stage and involvement of the anterior skill base. Involvement of the posterior wall of the maxillary sinus, infratemporal fossa, and erosion of the orbital wall was not associated with the worst prognosis.

CONCLUSION

In spite of advances in imaging technique and surgical therapy, the primary cause of death is inability to control local disease. Diagnosis at an earlier stage is associated with improved outcome.

Neck dissection with or without postoperative radiotherapy in supraglottic carcinomas

A retrospective review of 302 previously untreated patients with primary supraglottic carcinoma was undertaken to ascertain the efficacy of postoperative radiotherapy. The 302 patients underwent a total of 383 functional neck dissections and 45 classic radical neck dissections. Pathological examination revealed nodal involvement in 117 patients (39%). In the histologically N0 group, the incidence of contralateral neck recurrence when a unilateral neck dissection and postoperative radiotherapy were carried out was 8%, rising 21% when no postoperative radiation was given. There was no difference in the ipsilateral recurrence rate in the N0 group, radiated patients (3%) and nonradiated patients (2%). Similar figures were found in the N1 group. Bilateral functional neck dissection in histologically N0, N1, and N2 necks had similar recurrence rates with or without radiotherapy. Distant metastasis appeared in 10% of N0 patients and in 35% of N3 patients. Patients who received postoperative radiotherapy showed a significantly higher rate of distant metastasis (21%) than patients who did not (8%). The number of involved lymph nodes had no relevance both in neck recurrence and distant metastasis.

Determination of the immunization schedule for field trials with the synthetic malaria vaccine SPf 66

The synthetic malaria vaccine SPf 66 has been shown to be safe, immunogenic and effective in trials performed with controlled groups naturally and experimentally exposed to the disease. In order to continue the trials in open populations, it was necessary to standardize the vaccination characteristics. We have performed four field trials with soldier volunteers with the aim, among others, of defining the number of doses required, the intervals between applications, the protein concentration, and the adjuvant to be used. In these trials, the vaccinated individuals' immune responses were evaluated by assaying anti-SPf 66 antibody titres, in vitro growth inhibition of the P. falciparum parasite, and the vaccinees' capacity to recognize P. falciparum native proteins. From these results we conclude that the best vaccination schedule, for adults, is three doses administered subcutaneously on days 0, 30 and 180, each containing 2 mg of the synthetic polymerized petide SPf 66 adsorbed to alum hydroxide.

Coffee Silverskin Extract: Nutritional Value, Safety and Effect on Key Biological Functions

This study aimed to complete the scientific basis for the validation of a coffee silverskin extract (CSE) as a novel food ingredient according to European legislation. Nutritional value, safety, effects on biochemical biomarkers and excretion of short chain fatty acids (SCFAs) in vivo of CSE were assessed. Proteins, amino acids, fat, fatty acids, fiber, simple sugars and micronutrients were analyzed. For the first time, toxicological and physiological effects were evaluated in vivo by a repeated-dose study in healthy Wistar rats. Hormone secretion, antioxidant (enzymatic and no-enzymatic) and anti-inflammatory biomarkers, and dietary fiber fermentability of CSE (analysis of SCFAs in feces) were studied in biological samples. This unique research confirms the feasibility of CSE as a human dietary supplement with several nutrition claims: "source of proteins (16%), potassium, magnesium, calcium and vitamin C, low in fat (0.44%) and high in fiber (22%)". This is the first report demonstrating that its oral administration (1 g/kg) for 28 days is innocuous. Hormone secretion, antioxidant or anti-inflammatory biomarkers were not affected in heathy animals. Total SCFAs derived from CSE fiber fermentation were significantly higher (p < 0.05) in male treated rats compared to male control rats. All the new information pinpoints CSE as a natural, sustainable and safe food ingredient containing fermentable fiber able to produce SCFAs with beneficial effects on gut microbiota.

Distribution of genetic polymorphisms associated with hepatitis C virus (HCV) antiviral response in a multiethnic and admixed population

The prevalence of genetic polymorphisms identified as predictors of therapeutic-induced hepatitis C virus (HCV) clearance differs among ethnic groups. However, there is a paucity of information about their prevalence in South American populations, whose genetic background is highly admixed. Hence, single-nucleotide polymorphisms rs12979860, rs1127354 and rs7270101 were characterized in 1350 healthy individuals, and ethnicity was assessed in 259 randomly selected samples. The frequency of rs12979860CC, associated to HCV treatment response, and rs1127354nonCC, related to protection against hemolytic anemia, were significantly higher among individuals with maternal and paternal Non-native American haplogroups (64.5% and 24.2%), intermediate among admixed samples (44.1% and 20.4%) and the lowest for individuals with Native American ancestry (30.4% and 6.5%). This is the first systematic study focused on analyzing HCV predictors of antiviral response and ethnicity in South American populations. The characterization of these variants is critical to evaluate the risk-benefit of antiviral treatment according to the patient ancestry in admixed populations.

Antibodies to Borrelia burgdorferi in European populations

We compared the antibodies to B. burgdorferi in three different populations in order to evaluate the diagnostic reliability of Lyme borreliosis serologic analysis. The subjects included 25 patients with Lyme borreliosis (Group 1); 50 patients with diseases of unknown cause, B. burgdorferi ELISA-positive in serum and without B. burgdorferi infection (Group 2); and 1,251 individuals without Lyme borreliosis (Group 3). All samples were tested for B. burgdorferi B31 and B. afzelii antigens using ELISA. The positive results of the ELISA B. burgdorferi B31 assay were confirmed with Western blot for the same strain. In Group 3, 162 (12.9%) patients were ELISA positive for B. burgdorferi B31, while only 6 (0.6%) patients had IgG ELISA antibodies to B afzelii. Bands in WB were detected in 104 (8.4%) of the Group 3 subjects. The bands found to be most reliable for the identification of strain B. burgdorferi B31 by IgG WB were those representing the 93, 39, 34, and 23-kDa proteins. Our results show that serologic diagnosis of Lyme borreliosis is far from clearly established. To date, the only reliable criteria are clinical ones correlated with laboratory evidence.

A transcriptional signature associated with the onset of benign prostate hyperplasia in a canine model

BACKGROUND

Benign prostatic hyperplasia (BPH) represents the most frequent proliferative abnormality of the human prostate. In spite of the well-characterized architectural development of BPH, little is known about the cellular and molecular events that contribute to it.

METHODS

We have developed an animal model to evaluate the follow-up of hormone-induced BPH and the analysis of the gene expression associated with BPH. Immunohistochemistry on human patient samples validated the BPH-related molecular alterations.

RESULTS

Canine specific Affymetrix microarray analysis performed on sequential biopsies obtained from a beagle dog dynamic model characterized a number of genes altered during the onset of BPH. In addition to the genes involved in calcification, matrix remodeling, detoxification, cell movement, and mucosa protection (MGP, MMP2, TIMP2, ITIH3, GST, MT2A, SULT1A1, FKBP1B, MUC1, STRBP, TFF3), the up-regulation of TGFB3 and CLU indicated a complete adjustment of the transdifferentiation, senescence and apoptosis programs. The up-regulation of Clusterin was validated by RT-qPCR and immunohistochemistry, both in the dog dynamic model and in human samples, further confirming the suitability of the animal model for the study of the molecular alterations associated with BPH.

CONCLUSIONS

Transcriptome analysis performed on a dynamic animal model that accurately mimicked the human clinic, allowed us to characterize a gene expression pattern associated with the onset of BPH.

Polyacrylonitrile membrane interposition between a xenograft and an animal in fulminant liver failure. The concept of xenohemodiafiltration

In fulminant liver failure (FLF) there is need for support as a bridge to liver transplantation. Based on the concepts of hemofiltration and xenotransplantation, the authors present a model of liver support in FLF. The authors performed a portacaval shunt and ligature of the hepatic artery in 12 pigs. In six pigs (Group A) continuous hemofiltration through a polyacrylonitrile membrane was performed. Six isolated dog's livers were catheterized through the portal vein and perfused with autologous erythrocytes, albumin, and electrolytes in a closed circuit. With the use of the auxiliary liver, the circuit was connected to one of the lateral outlets of the hemofilter, while the other lateral outlet was connected to the portal vein through the pump. Thus, a polyacrylonitrile exchange membrane was created between the blood of the pig with FLF and the auxiliary liver's circulation. In Group B (controls), six pigs were connected directly to the auxiliary liver through a pump. In Group A, the auxiliary liver worked for 8 hr, without evidence of macroscopic or histologic damage. Lactic acid and ammonia levels improved: lactic acid, 8.2 +/- 6 mmol/L to 1.6 +/- 1 mmol/L; ammonia 487 +/- 110 micrograms/dl to 117 +/- 13 micrograms/dl, p < 0.1. The lidocaine clearing (MEGX) test results remained at functional levels (> 90 ng/ml) at the end of the perfusion. In Group B, the perfusion was discontinued at 60 +/- 15 min because of evidence of necrosis of the auxiliary liver. Lactic acid levels increased from 8.19 +/- 1.1 mmol/L to 13 +/- 4 mmol/L, ammonia levels remained high (390 +/- 15 micrograms/dl to 480 +/- 80 micrograms/dl), and the MEGX test results showed levels below functional activity by the end of the perfusion (45 +/- 30 ng/ml). The authors conclude that the concept of xenohemodiafiltration based on the interposition of a polyacrylonitrile membrane between a xenograft and an animal in FLF is adequate to support functions of detoxification and could be used in the future in the support of patient with FLF.

Efficacy of Beclomethasone Dipropionate in Lowering Fecal Calprotectin Levels in Patients with Ulcerative Colitis in Clinical Remission and at Risk of Relapse: The Becalcu Randomized, Controlled Trial

INTRODUCTION

Identifying novel treatment strategies for patients with ulcerative colitis (UC) and at risk of relapse is critical. The objective of this study was to assess the efficacy of beclomethasone dipropionate (BDP) in lowering fecal calprotectin (FC) levels in UC patients in clinical remission and at risk of relapse.

METHODS

This multicenter study comprised a double-blind, randomized, placebo-controlled phase (part I) and an open-label, non-randomized phase (part II). Eligible participants with UC in clinical remission treated with 5-aminosalicylic acid and with FC levels ≥250 μg/g were randomized to receive 5 mg/day of BDP or placebo for 4 weeks (part I). At week 5, patients with FC ≥100 μg/g were treated with 5 mg/day of BDP for 4 weeks (part II), and FC levels were tested at week 9.

RESULTS

Forty-three patients were randomized: 22 received BDP (group A) and 21 placebo (group B). At week 4, 13 patients (59.1%) in group A and 3 (17.6%) in group B had FC levels <100 μg/g (p value = 0.010). In the double-blind phase of the study, no patient relapsed in group A and 4 in group B (p value = 0.049). Both treatment groups showed a favorable safety profile, with the most common adverse events being gastrointestinal disorders.

CONCLUSION

In this multicenter, randomized clinical trial including patients with UC in clinical remission but with elevated FC, BDP was efficacious in reducing FC and well-tolerated.

Sino-nasal adenocarcinoma: epidemiological and clinico-pathological study of 34 cases

Thirty-four cases of sino-nasal adenocarcinoma treated between 1976 and 1992 are presented. The purpose of this work is the epidemiological analysis of this disease and to put forward a classification of the lesions according to their degree of differentiation, based on the histopathological examination of 29 tumors. The risk increase of having a sino-nasal neoplasia was significant in the population exposed to wood dust in their working environment--896 times greater (540 in the male population) for adenocarcinoma and 20 times greater for squamous-cell adenocarcinoma. The proposed histopathological classification divides these lesions according to their degree of differentiation. In this series 23 well-differentiated cases were found, three moderately differentiated and three colloid-type. The five-year determinate survival of this series was 30%. The tumor stage (especially intracranial involvement) was the only significant clinico-pathological parameter that impaired the survival.

Assessment of groundwater-driven dissolved nutrient inputs to coastal wetlands associated with marsh-coastal lagoons systems of the littoral of the outer Río de la Plata estuary

In coastal wetlands the hydrological dynamics and in particular the groundwater flows play a critical role in the establishment of wetlands and in the transport of salts and nutrients. The aim of the work is to analyze the role that groundwater discharge has in the dynamics of the dissolved nutrients of the wetland associated with the coastal lagoon and marshes of the Punta Rasa Natural Reserve, which is located on the coastal sector of the southern end of the Río de la Plata estuary. A monitoring network in the form of transects was generated in order to define groundwater flows and take samples of dissolved species of N and P. The presence of sandy sediments with similar granulometric profiles in all geomorphological environments determines that the underground flow occurs in a homogeneous aquifer. From the dunes and beach ridges the fresh to brackish groundwater flows with a very low hydraulic gradient towards the marsh and coastal lagoon. The contributions of N and P would derive from the degradation of the organic matter of the environment, in the case of the marsh and coastal lagoon also from the tidal flow and discharge of groundwater, and possibly from atmospheric sources in the case of N. Since in all environments oxidizing conditions dominate, nitrification is the main process which is why the most abundant species of N is the NO₃^-. Under oxidizing conditions, P has a greater affinity for the sediments in which it is mostly retained, registering it in low concentrations in water. The discharge of groundwater from the dunes and beach ridges provides dissolved nutrients to the marsh and coastal lagoon. However, the low hydraulic gradient and the dominant oxidizing conditions determine that the flow is scarce and that it only acquires relevance in the contribution of NO₃^-.

[Value of isotopic cystography in the diagnosis of vesicoureteral reflux in childhood]

We have studied 62 children with urinary infection simultaneously by means of micturitional cystoureterography (MCU) and indirect isotopic cystography. We confirm a correlation between the results of the MCU and in the indirect isotopic cystography in 86% of the ureters explored, whilst the results of the MCU and of the direct isotopic cystography coincided in 92% of the ureters explored. We discuss the advantages and drawbacks of isotopic cystography, concluding that it is a suitable method for the diagnosis and evolutive control of vesicoureteral reflux in infancy.

Findings and lessons learned from a multi-partner collaboration to increase cervical cancer prevention efforts in Bolivia

Cervical cancer is a leading cause of cancer death among women in Bolivia, where cytology based screening has not performed well due to health-systems constraints. In response, the Centers for Disease Control and Prevention and the Pan American Health Organization partnered with the Bolivian Ministry of Health and the Peruvian Cancer Institute (INEN) to build capacity in Bolivia for the use of visual inspection of the cervix with acetic acid (VIA) and cryotherapy. Four 5-day courses on basic clinical skills to perform these procedures, provide related counseling, and manage side effects and infections were conducted from September 2010 to December 2012 for 61 Bolivian nurses and physicians. Of these courses, two were conducted by Bolivian trainers that were certified through a Training-of-Trainers course taught by the INEN. Classroom didactic sessions included lectures and practice with anatomic models followed by clinical practice sessions to provide trainees with practical experience in VIA and cryotherapy. Pre- and post-training evaluations were administered to ascertain knowledge gained. Evaluation of competency was conducted during simulation exercises in the classroom and during supervised performances of procedures in clinical settings. This report summarizes findings and lessons learned that will be useful for planning the supervision and monitoring phase of this project as well as for future partnerships in the Latin American and the Caribbean region.

[The Ask-Upmark kidney: a form of reflux nephropathy]

We present six female patients aged 14 to 47, all diagnosed histopathologically as suffering from Ask-Upmark Kidney and who had clinical manifestations of severe arterial tension associated with urinary infection in four cases. Mictional Cystourethrography was carried out in all cases, and four of them displayed vesicoureteral reflux in the small kidney. Although this pathology has classically been considered a congenital malformation in the context of renal hypoplasias (segmental hypoplasia), the observation of glomerular traces with PAS staining in the renal segments regarded classically as "aglomerular" and the frequent association of this pathology with vesicoureteral reflux point significantly towards Ask-Upmark Kidney being a form of reflux nephropathy. Nephrectomy cured the arterial hypertension in half the cases, and the factors with prognostic importance in this respect are commented upon.