Genome-wide association study and functional analyses for clinical and subclinical ketosis in Holstein cattle

Ketosis is one of the most frequent metabolic diseases in high-yielding dairy cows and is characterized by high concentrations of ketone bodies in blood, urine, and milk, causing high economic losses. The search for polymorphic genes, whose alleles have different effects on resistance to developing the disease, is of extreme importance to help select less susceptible animals. The aims of this study were to identify genomic regions associated with clinical and subclinical ketosis (β-hydroxybutyrate concentration) in North American Holstein dairy cattle and to investigate these regions to identify candidate genes and metabolic pathways associated with these traits. To achieve this, a GWAS was performed for 4 traits: clinical ketosis lactation 1, clinical ketosis lactation 2 to 5, subclinical ketosis lactation 1, and subclinical ketosis lactation 2 to 5. The estimated breeding values from 77,277 cows and 7,704 bulls were deregressed and used as pseudophenotypes in the GWAS. The top-20 genomic regions explaining the largest proportion of the genetic variance were investigated for putative genes associated with the traits through functional analyses. Regions of interest were identified on chromosomes 2, 5, and 6 for clinical ketosis lactation 1; 3, 6, and 7 for clinical ketosis lactation 2 to 5; 1, 2, and 12 for subclinical ketosis lactation 1; and 20, 11, and 25 for subclinical ketosis lactation 2 to 5. The highlighted genes potentially related to clinical and subclinical ketosis included ACAT2 and IGF1. Enrichment analysis of the list of candidate genes for clinical and subclinical ketosis showed molecular functions and biological processes involved in fatty acid metabolism, lipid metabolism, and inflammatory response in dairy cattle. Several genomic regions and SNPs related to susceptibility to ketosis in dairy cattle that were previously described in other studies were confirmed. The novel genomic regions identified in this study aid to characterize the most important genes and pathways that explain the susceptibility to clinical and subclinical ketosis in dairy cattle.

Molecular alterations in non-functioning pituitary adenomas

BACKGROUND

Clinically non-functioning Pituitary Adenomas (NFPA) are among the most common neoplasms of the sellar region. They usually present with compressive symptoms such as headache and visual field defects and not infrequently, are found incidentally. NFPA are classified as gonadotropinomas, null cell adenomas, according to their immunohistochemical phenotype. The molecular alterations responsible for the development of these lesions are incompletely understood, and there is scarce information regarding the molecular alterations and markers.

OBJECTIVE

We carried out an in-silico analysis aimed at identifying the molecular alterations in NFPA and to discover new molecular markers.

METHODS

Twenty-three microarray libraries were analyzed. Fourteen correspond to NFPA and 9 to control tissue gland. They were analyzed using Partek Genomic Suite to identify differentially expressed genes and WebGestalt and Metascape to understand the meaning behind the gene lists.

RESULTS

Pituitary adenomas showed a markedly different transcriptome compared to the non-tumoral gland, regardless of their putative immunophenotype. Genes related to calcium metabolism such as CACNA2D4, immune-related CXCR4, and stem cell-related KLF8 and PITX2 were altered.

CONCLUSIONS

Differentially expressed calcium metabolism and immune-related genes in NFPA represent attractive molecular markers and potential therapeutic targets.

Pituitary apoplexy in nonfunctioning pituitary macroadenomas: a case-control study

OBJECTIVE

Pituitary apoplexy (PA) is an endocrinologic emergency characterized by headache, visual abnormalities, and hemodynamic instability in the context of hemorragic infarction of a pituitary adenoma. Our goal was to estimate the incidence, precipitating factors, clinical characteristics, and outcome of PA in a cohort of patients with nonfunctioning pituitary macroadenomas (NFPMAs).

METHODS

A retrospective, case-control study of 46 patients with PA and 47 controls matched for age, gender, and tumor invasiveness. Clinical, hormonal, and tumoral charactersitics, as well as the presence of potential precipitating factors and long-term outcome were evaluated using both bivariate and multivariate analysis.

RESULTS

The prevalence of PA was 8%. Cases and controls were similar in regards to the prevalence of diabetes, hypertension, use of antiplatelet agents, and the presence of headaches and visual field defects. Oculomotor paralysis was present in 18% of cases and in none of the controls (P = .001). Prior use of dopamine agonists was significantly more frequent among cases than in controls on both bivariate and multivariate analysis. Pituitary hormone deficiencies were more common among cases than in controls on bivariate but not on multivariate analysis. Early and late surgical treatment was carried out in 11 and 25 patients, respectively; 11 patients were managed conservatively. Visual and endocrine outcomes were similar among the 3 groups.

CONCLUSION

PA represents a life-threatening medical emergency. Prior use of dopamine agonists and the presence of oculomotor abnormalities clearly distinguished patients with NFPMA who developed PA from those who did not.

ERRα promotes breast cancer cell dissemination to bone by increasing RANK expression in primary breast tumors

Bone is the most common metastatic site for breast cancer. Estrogen-related-receptor alpha (ERRα) has been implicated in cancer cell invasiveness. Here, we established that ERRα promotes spontaneous metastatic dissemination of breast cancer cells from primary mammary tumors to the skeleton. We carried out cohort studies, pharmacological inhibition, gain-of-function analyses in vivo and cellular and molecular studies in vitro to identify new biomarkers in breast cancer metastases. Meta-analysis of human primary breast tumors revealed that high ERRα expression levels were associated with bone but not lung metastases. ERRα expression was also detected in circulating tumor cells from metastatic breast cancer patients. ERRα overexpression in murine 4T1 breast cancer cells promoted spontaneous bone micro-metastases formation when tumor cells were inoculated orthotopically, whereas lung metastases occurred irrespective of ERRα expression level. In vivo, Rank was identified as a target for ERRα. That was confirmed in vitro in Rankl stimulated tumor cell invasion, in mTOR/pS6K phosphorylation, by transactivation assay, ChIP and bioinformatics analyses. Moreover, pharmacological inhibition of ERRα reduced primary tumor growth, bone micro-metastases formation and Rank expression in vitro and in vivo. Transcriptomic studies and meta-analysis confirmed a positive association between metastases and ERRα/RANK in breast cancer patients and also revealed a positive correlation between ERRα and BRCA1mut carriers. Taken together, our results reveal a novel ERRα/RANK axis by which ERRα in primary breast cancer promotes early dissemination of cancer cells to bone. These findings suggest that ERRα may be a useful therapeutic target to prevent bone metastases.

Persistence of Diabetes and Hypertension After Multimodal Treatment of Acromegaly

CONTEXT

Diabetes and hypertension are frequent comorbidities of acromegaly.

OBJECTIVE

To analyze the course of diabetes and hypertension at diagnosis and after multimodal therapy in a large cohort of patients with acromegaly.

DESIGN AND SETTING

Retrospective study at a tertiary care center.

PATIENTS AND METHODS

A total of 522 patients with acromegaly treated according to a preestablished protocol.

MAIN OUTCOME MEASURES

Prevalence of diabetes and hypertension and its relationship with biochemical indices of acromegalic control.

RESULTS

The cohort was stratified according to disease activity upon last visit to clinic: (1) surgical remission (n = 122), (2) pharmacologically controlled (n = 92), (3) active disease (n = 148), (4) insulinlike growth factor (IGF)-1 discordance (n = 64), and (5) growth hormone (GH) discordance (n = 96). The prevalence of diabetes and hypertension at diagnosis was 30% and 37%, respectively, and did not change upon the last visit (30.6% and 38%). Both comorbidities were more prevalent at diagnosis and on the last visit than in the general population. Diabetes was less prevalent on the last visit in patients who achieved surgical remission than in those who persisted with active disease (25% vs 40%, P = 0.01). Upon multivariate analysis, diabetes was associated with an IGF-1 at diagnosis >2× upper limit of normal, with the persistence of active acromegaly, the presence of hypertension upon the last visit, with the presence of a macroadenoma, and with female sex.

CONCLUSION

Our findings underscore the importance of an integral approach when managing these patients, focusing not only on the control of GH and IGF-1 levels but also on the timely diagnosis and the specific treatment of each comorbidity.

The Diatraea Complex (Lepidoptera: Crambidae) in Colombia's Cauca River Valley: Making a Case for the Geographically Localized Approach

The sugarcane stem borers Diatraea saccharalis (Fabricius) and D. indigenella Dyar & Heinrich are common pests of sugarcane crops in Colombia's Cauca river valley (CRV). In 2012, however, D. tabernella Dyar was recorded for the first time in northern CRV and just 1 year later, D. busckella Dyar & Heinrich was detected, also for the first time, in central CRV. The Diatraea outbreak in the CRV was studied, its distribution and population in the region was analyzed, and levels of larval parasitism were observed. During the study of the outbreak, Diatraea species in the CRV were characterized based on the morphology of larval, pupal, and adult stages. Keys to the identification of Diatraea in the CRV based on male genitalia and pupa are provided. Pupal cephalic horns and lateral lobes were discovered as new, reliable characteristics to separate the species at the pupal stage. We suggest biological control program modifications to decrease economic impact and studies at geographically localized levels to better understand the dynamics between the pest species and their parasitoids.

Genetic analysis of feet and leg conformation traits in Nelore cattle

Feet and leg conformation scores are important traits in beef cattle because they encompass a wide range of locomotion disorders that can lead to productive and reproductive losses. Thus, the study of feet and legs in beef cattle is essential for evaluating possible responses to selection focusing on minimizing economic losses caused by the occurrence of feet and leg problems. The aim of this study was to estimate variance components for feet and leg conformation traits in Nelore cattle. The data set contained records of approximately 300,000 animals that were born between 2000 and 2013. These animals belonged to the commercial beef cattle breeding program of the CRV Lagoa (). Feet and legs were evaluated by assigning visual scores at 2 different time points: feet and leg evaluated as a binary trait (FL1), measured at yearling (about 550 d of age) to identify whether (or not) an animal has feet and leg defects, and feet and leg score (FL2), ranging from 1 (less desirable) to 5 (more desirable) was assigned to the top 20% of animals according to the selection index adopted by the beef cattle breeding program, which was measured 2 to 5 mo after the yearling evaluation. The FL1 and FL2 traits were analyzed together with yearling weight (YW). The (co)variance components and breeding values were estimated by Bayesian inference using 2-trait animal models. The posterior means (standard errors) of the heritabilities for FL1, FL2, and YW were 0.18 (0.04), 0.39 (0.07), and 0.47 (0.01), respectively. The results indicate that the incidence of feet and leg problems in this population might be reduced by selection. The genetic correlation between FL1 and FL2 (-0.47) was moderate and negative as expected because the classification score that holds up each trait has opposite numerical values. The genetic trends estimated for FL1 and FL2 (-0.042 and 0.021 genetic standard deviations per year, respectively) were favorable and they indicate that the independent culling strategy for feet and leg problems promotes favorable changes and contributes to the genetic progress of these traits in the population under study.

An FSH and TSH pituitary adenoma, presenting with precocious puberty and central hyperthyroidism

A 19-year-old woman with a history of isosexual precocious puberty and bilateral oophorectomy at age 10 years because of giant ovarian cysts, presents with headaches and mild symptoms and signs of hyperthyroidism. Hormonal evaluation revealed elevated FSH and LH levels in the postmenopausal range and free hyperthyroxinemia with an inappropriately normal TSH. Pituitary MRI showed a 2-cm macroadenoma with suprasellar extension. She underwent successful surgical resection of the pituitary tumor, which proved to be composed of two distinct populations of cells, each of them strongly immunoreactive for FSH and TSH, respectively. This mixed adenoma resulted in two different hormonal hypersecretion syndromes: the first one during childhood and consisting of central precocious puberty and ovarian hyperstimulation due to the excessive secretion of biologically active FSH and which was not investigated in detail and 10 years later, central hyperthyroidism due to inappropriate secretion of biologically active TSH. Although infrequent, two cases of isosexual central precocious puberty in girls due to biologically active FSH secreted by a pituitary adenoma have been previously reported in the literature. However, this is the first reported case of a mixed adenoma capable of secreting both, biologically active FSH and TSH.

THE PREVALENCE OF COLONIC POLYPS IN PATIENTS WITH ACROMEGALY: A CASE-CONTROL, NESTED IN A COHORT COLONOSCOPIC STUDY

OBJECTIVE

Acromegaly is associated with an increased risk of colonic polyps. The magnitude of such risk is controversial, and the characteristics that distinguish patients who develop polyps from those who do not are not well established. This study was performed to determine the prevalence of colonic polyps upon the diagnosis of acromegaly and to compare the clinical and biochemical features of patients with and without polyps.

METHODS

Out of 165 patients who underwent a full colonoscopy upon diagnosis of acromegaly, 53 were found to harbor colonic lesions (cases), whereas the remaining 112 were used as controls. Demographic, clinical, and biochemical characteristics were compared between the 2 groups.

RESULTS

The prevalence of colonic polyps was 32%, with an estimated relative risk of 6.21 (95% confidence interval [CI] 4.08-9.48). Adenomatous and nonadenomatous polyps were found in 22 and 31 patients, respectively. The most common location was the descending colon. Compared to patients without polyps, subjects with polyps were somewhat older and had significantly higher insulin-like growth factor-1 (IGF-1) levels and a higher prevalence of diabetes. Upon multivariate analysis, only IGF-1 level at diagnosis remained significantly associated with colonic polyps in general and with hyperplastic polyps in particular.

CONCLUSION

Acromegaly is associated with an elevated risk of developing colonic polyps, particularly, distally located hyperplastic lesions. Except for a higher IGF-1 level at diagnosis, no distinctive clinical or biochemical features can be found among those who develop polyps compared to those who do not.

ABBREVIATIONS

CI = confidence interval GH = growth hormone IGF-1 = insulin-like growth factor 1 IQR = inter-quartile range RR = relative risk ULN = upper limit of normal.

AIP mutations in young patients with acromegaly and the Tampico Giant: the Mexican experience

Although aryl hydrocarbon receptor-interacting protein (AIP) mutations are rare in sporadic acromegaly, their prevalence among young patients is nonnegligible. The objectives of this study were to evaluate the frequency of AIP mutations in a cohort of Mexican patients with acromegaly with disease onset before the age of 30 and to search for molecular abnormalities in the AIP gene in teeth obtained from the "Tampico Giant". Peripheral blood DNA from 71 patients with acromegaly (51 females) with disease onset <30 years was analysed (median age of disease onset of 23 years) and correlated with clinical, biochemical and imaging characteristics. Sequencing was also carried out in DNA extracted from teeth of the Tampico Giant. Five patients (7 %) harboured heterozygous, germline mutations of the AIP gene. In two of them (a 9-year-old girl with gigantism and a young man with symptoms of GH excess since age 14) the c.910C>T (p.Arg304Ter), well-known truncating mutation was identified; in one of these two cases and her identical twin sister, the mutation proved to be a de novo event, since neither of their parents were found to be carriers. In the remaining three patients, new mutations were identified: a frameshift mutation (c.976_977insC, p.Gly326AfsTer), an in-frame deletion (c.872_877del, p.Val291_Leu292del) and a nonsense mutation (c.868A > T, p.Lys290Ter), which are predicted to be pathogenic based on in silico analysis. Patients with AIP mutations tended to have an earlier onset of acromegaly and harboured larger and more invasive tumours. A previously described genetic variant of unknown significance (c.869C > T, p.Ala299Val) was identified in DNA from the Tampico Giant. The prevalence of AIP mutations in young Mexican patients with acromegaly is similar to that of European cohorts. Our results support the need for genetic evaluation of patients with early onset acromegaly.

Orange Peel Oxidative Gasification on Ni Catalysts Promoted with CaO, CeO2 or K2O

Orange peel can be considered as an attractive raw material to be gasified for hydrogen or syngas production. In this work, the catalytic evaluation of several silica-supported nickel catalysts in the oxidative degradation of waste orange peel is reported. It was found that the catalytic gasification with the K2O-Ni/silica catalyst produces more hydrogen than the non-catalytic route at 600 degrees C. Surprisingly, a significant amount of ethene was obtained with the CeO2-Ni/silica catalyst, which was explained in terms of an oxidative dehydrogenation reaction of ethane formed during biomass or tar decomposition.

La relación de <i>Helicobacter pylori</i> con la displasia y el cáncer gástrico en Costa Rica

Se comparó la incidencia de labaéteria Hdicobacter pylori en un lugar pe baja incidencia de cáncer gástrico, Poás ( 15. 13%) y otro de incidencia muy alta, Puriscal (83. 53%) Se eligió a 185 adultos de cada cantón, similares en edad y sexo y se practicó un estudio serológico para buscar anticuerpos IgG para H. pylori, y una gastroscopía para tomar dos biopsias por caso. Los resultados no apoyan la existencia de una fuerte relación entre H. pylori y cáncer gástrico

Octreotide LAR treatment of acromegaly in "real life": long-term outcome at a tertiary care center

OBJECTIVE

To report our day-to day experience with the long-term use of octreotide LAR in the treatment of acromegaly.

PATIENTS AND METHODS

Patients with acromegaly managed between 2003 and 2012 with octreotide LAR for a median of 27 months (interquartile ranges 12-60) and who had not received radiation therapy or concomitant treatment with cabergoline were retrospectively evaluated. Both primarily treated patients (n = 33) and patients who received octreotide after failed pituitary surgery (adjunctive treatment, n = 124) were included. Full biochemical response was defined as the achievement of a GH <2.5 ng/mL and an IGF-1 <1.2 times the upper limit of normal (× ULN); we also evaluated efficacy using a GH cut off of <1 ng/mL.

RESULTS

Over 60% of the patients achieved a GH of <2.5 ng/mL. The combined GH (<2.5 ng/mL) and IGF-1 (<1.2 × ULN) target was achieved by 35.5 and 33.6% of the patients treated primarily and adjunctively, respectively; these figures dropped to 22.6 and 23% when using a GH target of <1 ng/mL. All patients reported a significant improvement in acromegalic symptoms. Lower pretreatment GH and IGF-1 levels were both associated with a higher probability of achieving the composite biochemical target.

CONCLUSION

Currently recommended GH and IGF-1 targets are reached by <36% of patients treated with octreotide LAR in a day-to day practice context. Nevertheless, in most instances a clinical benefit and an improvement in biochemical markers can be clearly documented.

Clinical characteristics and treatment outcome of 485 patients with nonfunctioning pituitary macroadenomas

Background. Nonfunctioning pituitary adenomas (NFPAs) are the most common benign lesions of the pituitary gland. Objective. To describe our experience with the management of NFPA. Study Design and Methods. Retrospective evaluation of NFPA patients managed between 2008 and 2013. We analyzed data regarding clinical presentation, imaging diagnosis, hormonal status, surgical, radiotherapeutic, and pharmacological treatment, and outcome. Results. 485 patients (54% men, mean age 53 ± 14 years) were followed for a median of 6.5 years. Visual field abnormalities and headaches were the presenting complaints in 87% and 66%, respectively. The diagnosis of NFPA was made incidentally in 6.2%, and 8% presented with clinical evidence of apoplexy. All patients harbored macroadenomas, with a median volume of 10306 mm(3); 57.9% had supra- or parasellar invasion and 19.6% had tumors larger than 4 cm. Central hypothyroidism, hypogonadism, and hypocortisolism were present in 47.2%, 35.9%, and 27.4%, respectively. Surgical resection was performed at least once in 85.7%. Tumor persistence was documented in 27% and was related to the size and invasiveness of the lesion. In selected cases, radiotherapy proved to be effective in controlling or preventing tumor growth. Conclusions. The diagnosis and treatment of NFPA are complex and require a multidisciplinary approach.

Inflammatory Cytokine Profile Associated with Metabolic Syndrome in Adult Patients with Type 1 Diabetes

OBJECTIVE

To compare the serum concentration of IL-6, IL-10, TNF, IL-8, resistin, and adiponectin in type 1 diabetic patients with and without metabolic syndrome and to determine the cut-off point of the estimated glucose disposal rate that accurately differentiated these groups.

DESIGN

We conducted a cross-sectional evaluation of all patients in our type 1 diabetes clinic from January 2012 to January 2013. Patients were considered to have metabolic syndrome when they fulfilled the joint statement criteria and were evaluated for clinical, biochemical, and immunological features.

METHODS

We determined serum IL-6, IL-8, IL-10, and TNF with flow cytometry and adiponectin and resistin concentrations with enzyme linked immunosorbent assay in patients with and without metabolic syndrome. We also compared estimated glucose disposal rate between groups.

RESULTS

We tested 140 patients. Forty-four percent fulfilled the metabolic syndrome criteria (n = 61), 54% had central obesity, 30% had hypertriglyceridemia, 29% had hypoalphalipoproteinemia, and 19% had hypertension. We observed that resistin concentrations were higher in patients with MS.

CONCLUSION

. We found a high prevalence of MS in Mexican patients with T1D. The increased level of resistin may be related to the increased fat mass and could be involved in the development of insulin resistance.

Successful mortality reduction and control of comorbidities in patients with acromegaly followed at a highly specialized multidisciplinary clinic

CONTEXT

Acromegaly is usually due to the excessive secretion of GH by a pituitary adenoma. It is frequently accompanied by comorbidities that compromise quality of life and results in elevated mortality rates.

OBJECTIVE

To evaluate mortality and morbidity in patients with acromegaly receiving multimodal care.

SETTING

Tertiary care center.

DESIGN, PATIENTS, AND METHODS

Retrospective evaluation of 442 patients (65.4% women; mean age, 43.5 ± 13.1 y) followed for a median of 6 years (interquartile range [IQR], 3-10).

RESULTS

Twenty-two patients died during the study period (4.9%), representing a total standardized mortality ratio (SMR) of 0.72 (95% confidence interval [CI], 0.41-1.03). Standardized mortality ratios were 1.5 and 0.44 for patients whose last GH was above and below 2.5 ng/mL, respectively; 1.17 and 0.16 for those whose last GH was above and below 1 ng/mL, respectively; and 0.94 and 0.46 for those whose last IGF-1 was above and below 1.2 times the upper limit of normal (ULN), respectively. The prevalence of diabetes mellitus, hypertension, heart disease, and cancer was 30%, 35%, 8%, and 4.7%, respectively. The most common cause of death was cancer. On multivariate analysis, diabetes, heart disease, and cancer were related to a baseline GH > 10 ng/mL; the presence of cancer and the last IGF-1 were significant predictors of mortality. Survival decreased as the latest GH levels increased from < 1 ng/mL to > 5 ng/mL and as IGF-1 increased from < 1.2 to > 2 times the ULN.

CONCLUSIONS

Mortality in acromegaly can be successfully reduced, provided patients are treated using a multimodal approach with careful management of comorbidities.

Vitamin D deficiency among medical residents and its relationship with metabolic indices

OBJECTIVE

To evaluate different elements of the calciotropic system in a group of house staff physicians, comparing them with age, gender, and body mass index (BMI) matched controls.

METHODS

We measured vitamin D, calcium, phosphorus, parathyroid hormone (PTH), glucose, insulin (estimating the insulin resistance index by the homeostatic model [HOMA]), and lipid levels in 20 medical residents and 20 age-, gender-, and BMI-matched controls. We looked for correlations between elements of the calciotropic system and metabolic indices.

RESULTS

Medical residents and controls were similar in regard to gender distribution, weight, height, BMI, abdominal circumference, as well as systolic and diastolic blood pressure. No differences were found between the two groups in regard to low-density lipoprotein (LDL)-cholesterol, high-density lipoprotein (HDL)-cholesterol, plasma insulin levels, and HOMA-IR. Vitamin D and calcium levels were significantly lower among the medical residents (P = .001 and P = .003, respectively), whereas PTH concentrations tended to be higher. We found an inverse correlation between triglyceride concentrations and vitamin D (r = -0.31, P = .04).

CONCLUSION

Vitamin D deficiency among resident physicians is frequent and could have metabolic effects. Our findings highlight the consequences of the lack of sun exposure due to occupational reasons. We recommend a higher intake of vitamin D during this period.

Maternal effects shape dynamic trajectories of reproductive allocation in the ladybird Coleomegilla maculata

We followed lifetime trajectories of reproductive allocation in Coleomegilla maculata females of three different size classes produced by rearing beetles on three different daily larval feeding regimes (30 min, 6 h or ad libitum access to eggs of Ephestia kuehniella). We hypothesized that small females would produce fewer and smaller eggs than larger females and that reproductive effort would decline with female age. Females were mated with a male from the same treatment and then isolated with ad libitum food for their entire adult lives. Egg size increased over time in all treatments; small females started off laying the smallest eggs, but increased egg size more rapidly than larger females, until all treatments converged on a similar egg size around the 20th day of oviposition. Large females realized a larger proportion of their fecundity early in life, but smaller females increased daily fecundity over time. Reproductive effort (egg mass/body mass) did not decline over 30 oviposition days; it remained constant in large females, but increased among small and medium females, suggesting gradual compensation for larval food deprivation. An increase in egg size with maternal age may be an adaptive strategy to maximize fitness on ephemeral patches of aphid prey, assuming females reproduce in a single aphid outbreak and that offspring produced later in the aphid cycle experience greater competition and risk of mortality compared to those produced earlier. We demonstrate for the first time in Coleoptera that dynamic changes in both egg size and number occur as a function of female age and illustrate that such changes are constrained by larval feeding histories via their effects on maternal body size.

C6 knock-out mice are protected from thrombophilia mediated by antiphospholipid antibodies

BACKGROUND

Complement activation plays a role in pathogenesis of the antiphospholipid syndrome (APS), but the involvement of the C5b-9 membrane attack complex (MAC) is unknown. Here we studied the effects of human polyclonal antiphospholipid (aPL) antibodies on thrombosis and tissue factor (TF) up-regulation in C6 deficient (C6(-/-)) mice.

METHODS

C6(-/-) mice or the wild-type C3H/HeJ (C6(+/+)) mice were injected twice with IgG-APS (n = 2) or IgM-APS (n = 1) isolated from APS patients or with the corresponding control immunoglobulins (Igs) of normal human serum, (NHS) (IgG-NHS or IgM-NHS). Then, the sizes of induced thrombi in the femoral vein were determined 72 hours after the first injection. Tissue factor was determined in homogenates of carotid arteries and in peritoneal macrophages.

RESULTS

Thrombus sizes were significantly larger in C6(+/+) treated with IgG-APS1 or with IgG-APS2 or with IgM-APS when compared with C6(+/+) mice treated with IgG-NHS or with IgM-NHS, respectively. The sizes of thrombi were significantly smaller in the C6(-/-) mice injected with IgG-APS1, IgG-APS2 or IgM-APS (p < 0.001), compared to their C6(+/+) counterparts showing an important abrogation of thrombus formation in mice lacking C6. The TF expression and activity in the C6(-/-) mice treated with IgG-APS or IgM-APS were diminished when compared to C3H/HeJ (C6(+/+)) mice treated with the same Igs. All mice injected with IgG-APS and IgM-APS had medium-high titers of anticardiolipin (aCL) and anti-β(2)glycoprotein I (aβ(2)GPI) antibodies.

CONCLUSIONS

These data indicate that the C6 component of the complement system mediates aPL-thrombogenic effects, underscoring an important pathogenic mechanism and indicating the possibility of inhibiting complement to ameliorate APS-related manifestations.

Expression of Ki-67, PTTG1, FGFR4, and SSTR 2, 3, and 5 in nonfunctioning pituitary adenomas: a high throughput TMA, immunohistochemical study

CONTEXT

Nonfunctioning pituitary adenomas (NFPA) are the most common pituitary neoplasms. There is no clinical, biochemical, or histopathological marker that would accurately predict recurrence of NFPA.

OBJECTIVE

The aim of this study was to evaluate a large group of NFPA for the presence of potential markers of biological behavior.

DESIGN AND SETTING

A cross-sectional study using a high throughput tissue microarray technology was conducted at tertiary care centers.

MATERIALS AND METHODS

Seventy-four gonadotroph and null cell adenomas were included in the tissue microarray. Using highly specific antibodies and appropriate controls, we determined the expression of Ki-67, pituitary tumor transforming gene 1, the N-terminally truncated pituitary tumor-derived fibroblast growth factor receptor-4 (FGFR4), as well as somatostatin receptor subtypes 2, 3, and 5 (SSTR2, -3, and -5), in an attempt to establish correlations and/or associations with clinical characteristics of the patients.

RESULTS

Median Ki-67 index was 1.49 (interquartile range, 0.62-2.49). Pituitary tumor transforming gene 1 nuclear immunoreactivity was found in all but one tumor (median percentage of positive nuclei, 11.44); immunopositivity for FGFR4 was found in the majority of the tumors, with variable levels of expression. The immunostaining score for SSTR2 was significantly higher than that for SSTR3 or SSTR5. FGFR4 expression correlated positively with SSTR2 and SSTR5 immunostaining scores (r = 0.59; P < 0.001; and r = 0.46; P < 0.001, respectively). Multivariate analysis revealed that the Ki-67 index was significantly associated with a tumor size greater than 3 cm (odds ratio, 2.32; 95% confidence interval, 1.17-4.58) as well as with tumor recurrence (odds ratio, 1.4; 95% confidence interval, 1.03-1.89).

CONCLUSIONS

Ki-67 is the most consistent marker of biological behavior in NFPA. The finding of significant amounts of SSTR2 and SSTR5 may have therapeutic implications regarding the use of somatostatin analogs in preventing tumor recurrence.

Discontinuation of octreotide LAR after long term, successful treatment of patients with acromegaly: is it worth trying?

BACKGROUND

Somatostatin analogs (SA) have been used for over 25 years in the treatment of acromegaly. A major disadvantage is the need to continue therapy indefinitely.

OBJECTIVE

To evaluate the feasibility of discontinuing therapy in well-controlled patients with acromegaly treated chronically with SA.

DESIGN AND METHODS

Of the 205 subjects on octreotide LAR, we selected those who met the following criteria: two or more years of treatment, a stable dose and injection interval of 20  mg every 8 weeks or longer for the previous year, no history of radiation, no cabergoline for the previous 6 months, a GH <1.5  ng/ml, and an IGF1 <1.2×upper limit of normal (ULN). Octreotide LAR was stopped and both GH and IGF1 were measured monthly for 4 months; a glucose-suppressed GH value and magnetic resonance imaging were obtained at the 4th month, thereafter, basal GH and IGF1 were measured q. 3 months, for 12-18 months. Patients were removed from the study if GH or IGF1 rose to 1.5  ng/ml or 1.2×ULN respectively.

RESULTS

Twelve patients (ten women, mean age 48±13 years) were studied. Seven patients (58.3%) relapsed biochemically within 1 year of having stopped the SA; two patients relapsed by GH and IGF1 criteria, the remaining five patients kept GH levels within target. Five patients (41.7%) remain in remission after 12 months of follow-up. Non-recurring patients were on longer injection intervals but no other characteristic was associated with a successful withdrawal.

CONCLUSION

Withdrawal of SA is possible in a small but distinct subset of patients, particularly in those who are very well controlled on relatively low doses administered at long intervals.

Clinical and biochemical characteristics of acromegalic patients with different abnormalities in glucose metabolism

To determine the prevalence of diabetes, glucose intolerance and impaired fasting glucose in Mexican patients with acromegaly and establish associations with clinical, anthropometric and biochemical variables. 257 patients with acromegaly were evaluated by a 75 g-oral glucose tolerance test with measurements of both GH and glucose (0, 30, 60, 90 120 min) as well as baseline IGF-1. Normal glucose tolerance (NGT), impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and diabetes (DM) were defined based on the 2003 ADA criteria. NGT, IFG, IGT and DM were found in 27.6, 8.9, 31.6 and 31.9% of the subjects, respectively; 42 of the DM patients were unaware of the diagnosis. Patients with diabetes were older than subjects in the other 3 categories (P = 0.001), and the proportion of women was significantly higher in the DM (74%) and IGT (68%) groups than in the NGT group (52%) (P = 0.004). Odds ratio for the development of DM was 3.29 (95% CI 3.28-3.3). GH and IGF-1 levels were comparable among the different groups. In a multivariable analysis DM was significantly associated with age, presence of a macroadenoma, disease duration and a basal GH > 30 μg/dl. DM and probably IGT are more prevalent in acromegaly than in the general Mexican population. DM was more frequent in females of all ages, in subjects with severely elevated GH concentrations, in patients with macroadenomas, and long-standing disease duration. The odds ratio for DM in our subjects with acromegaly is more than 3 times higher than in the general population.

[Elevated stimulated thyroglobulin levels in the identification of persistent papillary thyroid carcinoma]

BACKGROUND

Persistence of papillary thyroid carcinoma is usually associated with elevated stimulated thyroglobulin levels.

AIM OF THE STUDY

To evaluate the association between moderately elevated stimulated thyroglobulin levels and the persistence of papillary thyroid carcinoma one year after thyroidectomy and radioiodine ablation.

METHODS

Out of a cohort of 97 patients with papillary thyroid carcinoma, we selected those with available stimulated thyroglobulin level measurements (in the absence of thyroglobulin antibodies) after one year of initial treatment with surgery and radioiodine. The subjects were stratified according to whether the stimulated thyroglobulin level was between 1-10 ng/ml or above 10 ng/ml.

RESULTS

Twenty-seven patients were included in the study, 11 with a stimulated thyroglobulin level between 1-10 ng/ml, and 16 with values greater than 10 ng/ml. Median age and gender proportion was similar between both groups. As expected, median stimulated thyroglobulin levels were significantly greater in the second group (5.1 vs. 42 ng/ml; p < 0.001). A stratified analysis aiming at associating stimulated thyroglobulin levels with disease persistence yielded an overall risk of 0.58 (95% CI: 0.1-3.09; p = 0.52) for those subjects with levels between 1-10 ng/ml, while for those with levels > 10 ng/ml the overall risk was 1.71 (95% CI: 0.32-9.1; p = 0.52). The positive predictive value for a stimulated thyroglobulin level between 1-10 ng/ml was 64%.

CONCLUSION

A moderately elevated stimulated thyroglobulin level is an uncertain predictor of papillary thyroid carcinoma persistence.

In vivo inhibition of antiphospholipid antibody-induced pathogenicity utilizing the antigenic target peptide domain I of beta2-glycoprotein I: proof of concept

SUMMARY OBJECTIVES

In the antiphospholipid syndrome (APS), the immunodominant epitope for the majority of circulating pathogenic antiphospholipid antibodies (aPLs) is the N-terminal domain I (DI) of beta(2)-glycoprotein I. We have previously shown that recombinant DI inhibits the binding of aPLs in fluid phase to immobilized native antigen, and that this inhibition is greater with the DI(D8S/D9G) mutant and absent with the DI(R39S) mutant. Hence, we hypothesized that DI and DI(D8S/D9G) would inhibit aPL-induced pathogenicity in vivo.

METHODS

C57BL/6 mice (n = 5, each group) were injected with purified IgG derived from APS patients (IgG-APS, 500 microg) or IgG from normal healthy serum (IgG-NHS) and either recombinant DI, DI(R39S), DI(D8S/D9G), or an irrelevant control peptide (at 10-40 microg). Outcome variables measured were femoral vein thrombus dynamics in treated and control groups following standardized vessel injury, expression of vascular cell adhesion molecule-1 (VCAM-1) on the aortic endothelial surface, and tissue factor (TF) activity in murine macrophages.

RESULTS

IgG-APS significantly increased thrombus size as compared with IgG-NHS. The IgG-APS thrombus enhancement effect was abolished in mice pretreated with recombinant DI (P

CONCLUSION

Our findings in this proof-of-concept study support the development of recombinant DI or the novel variant DI(D8S/D9G) as a potential future therapeutic agent for APS.

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MESH Headings

• Animals
• Antibodies, Antiphospholipid/immunology
• Antibodies, Antiphospholipid/physiology
• Enzyme-Linked Immunosorbent Assay
• Macrophages, Peritoneal/metabolism
• Mice
• Mice, Inbred C57BL
• Thromboplastin/metabolism
• beta 2-Glycoprotein I/chemistry
• beta 2-Glycoprotein I/metabolism

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Grants

• R01 AR056745 NIAMS NIH HHS
• Arthritis Research UK

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[Treatment of acromegaly with octreotide LAR]

BACKGROUND

Treatment of acromegaly with somastostatin analogues, albeit highly effective, is not curative and its elevated cost represents a major disadvantage. Hereby we describe our Center's experience using a fixed, 20 mg q.4 weeks- dose of octreotide LAR.

METHODS

97 patients, 69 females, 71 with macroadenomas, treated with 20-mg im injections of octreotide LAR every 4 weeks, in 23 as primary therapy. No dose escalation was allowed. Patients were evaluated with GH and IGF-1 levels at 4 weeks after the third injection; thereafter, assessments occurred at 3 to 6 months intervals. In 27 unselected patients, evaluations were also performed 6 weeks after the SA injection.

RESULTS

A GH concentration < 2.5 ng/mL was reached by 71%, 75% and 83% of patients at the 3rd , 6th and 12th months of follow up respectively, whereas over 30% achieved an IGF-1 index < or = 1.0 at each of these time points, and both biochemical goals were achieved by 30%, 33% and 32% of patients at the same time points. Biochemical success was the same for those patients treated primarily and those treated secondarily and prior radiation made no difference. A baseline GH level > 10 ng/mL was associated with a poor response.

CONCLUSIONS

A biochemical control rate comparable with other published series it is feasible to reach with the treatment with a fixed dose of 20 mg.

Clinical and biochemical impact of the d3 growth hormone receptor genotype in acromegaly

CONTEXT

Lack of exon 3 of the GH receptor (d3-GHR) has been associated with increased responsiveness to GH therapy. By analogy, we hypothesized that patients with acromegaly bearing the d3-GHR genotype may have a more morbid clinical and biochemical picture.

OBJECTIVE

Our objective was to determine whether the GHR genotype, by modifying tissue sensitivity to GH, influences the clinical/biochemical expression of acromegaly and its outcome after treatment.

SETTING

The study was conducted at a specialized clinic at a tertiary care hospital.

DESIGN, PATIENTS, AND METHODS

We conducted a prospective genotype investigation and retrospective analysis and correlation with clinical, biochemical, and outcome data from a group of 148 patients. Samples from 175 healthy blood donors were used as controls. GHR genotyping was performed by real-time PCR.

MAIN OUTCOME MEASURES

We assessed prevalence of the three GHR genotypes (fl/fl, d3/d3, and d3/fl), associations between the genotypes, and baseline as well as post-therapeutic characteristics.

RESULTS

Prevalence of the fl/fl, d3/d3, and d3/fl genotypes was 45, 22, and 32%, respectively, similar to what was found in the controls. Baseline characteristics were similar in carriers of the three genotypes. A positive correlation between IGF-I and log GH concentrations was significant only in homo- or heterozygous d3 carriers. Among d3-GHR carriers, diabetes, but no other comorbidities, was more prevalent (odds ratio = 2.02; 95% confidence interval = 0.96-4.2). d3-GHR carriers had significantly higher IGF-I concentrations after treatment. Multiple regression analysis revealed that the homo- or heterozygous lack of exon 3 was the strongest predictor of persistent biochemical activity (odds ratio = 1.29; 95% confidence interval = 0.65-2.58).

CONCLUSIONS

The absence of exon 3 of the GHR may be associated with a more morbid acromegalic clinical and biochemical picture and a lower chance of achieving IGF-I normalization after therapy.

Simple approach to prenatal diagnosis of transposition of the great arteries

OBJECTIVE

To analyze the most relevant anomalies, seen in a sequential segmental transverse views approach to imaging the fetal heart, that provide clues to the diagnosis of complete transposition of the great arteries (TGA).

METHODS

We reviewed retrospectively all the cases of isolated TGA diagnosed in our center or submitted for a second opinion through the spatio-temporal image correlation (STIC) telemedicine (TELE-STIC) program. Only transverse cardiac sweeps were obtained. Digital video clips and STIC volumes were reviewed. The abnormal features on four-chamber, five-chamber, three-vessel (3V) and three vessels and trachea (3VT) views were analyzed.

RESULTS

The study population consisted of eight fetuses with TGA with normal extracardiac anatomy. The gestational age ranged from 13 to 32 (mean, 23) weeks. The maternal age ranged from 25 to 42 (mean, 32) years. A normal four-chamber view was seen in seven cases. Only one case demonstrated a significant ventricular septal defect. At the level of the five-chamber view a straight course arterial vessel arose from the left ventricle with lateral branches in all fetuses. In the 3V view, the ascending aorta was seen reaching more anteriorly than was the pulmonary artery in six cases. At the level of the 3VT view, two vessels (transverse aortic arch and superior vena cava) rather than three were seen in all cases.

CONCLUSION

Our proposed sequential segmental approach to imaging the fetal heart apparently allows, in five-chamber and 3VT views, clear and confident signs to be detected that aid diagnosis of TGA.

Distribution and enrichment evaluation of heavy metals in Mejillones Bay (23 degrees S), Northern Chile: geochemical and statistical approach

A suite of 36 surface sediment samples, taken between 10 and 100 m water depth in Mejillones Bay (Northern Chile), were analyzed for mineralogy, grain size, total organic carbon, Al, and heavy metal content (Cd, Zn, Ni, Mn, V, Mo). Quartz and feldspars were the main lithogenic minerals and carbonate the predominant biogenic mineral. Sediments were fine sands in the shallow zone and organic silt in the deeper zone. Enrichment Factor and Factor Analysis approach showed that the presence of Mn in the marine sediment of Mejillones is due to a partial influence of continental input, while all other metals are not supported by lithogenic debris. Although all metals showed high concentrations in the marine sediment of Mejillones Bay, comparison between metal concentration in surface sediments and preindustrial levels in this bay, show that present values agree with natural levels.

Prenatal diagnosis of congenital heart disease using four-dimensional spatio-temporal image correlation (STIC) telemedicine via an Internet link: a pilot study

OBJECTIVE

To assess whether the spatio-temporal image correlation (STIC) acquisition technique can be taught to a general obstetrician by e-mail; whether STIC volume datasets can be transmitted over the Internet; and whether STIC volume datasets analyzed offline at a remote setting can be used to confirm or exclude major cardiac defects (TELE-STIC).

METHODS

This was a prospective study involving 50 pregnant women with gestational ages ranging between 20 and 36 weeks. These patients were selected by two general obstetricians (operators) working in geographically remote areas of Chile. Although both obstetricians were users of equipment capable of four-dimensional (4D) ultrasound with STIC, they lacked skill in the performance of fetal cardiac examination. A dedicated web disk was created to upload the acquired volume datasets using an Internet broadband connection. Offline analysis was performed by a single investigator experienced in fetal echocardiography (the administrator).

RESULTS

A telemedicine link via the Internet was possible in all cases. Seventy-seven volume datasets were sent to the web server. A complete cardiac examination according to set criteria was achieved by the administrator in 86% of the cases scanned by one operator and 95% of the cases scanned by the other operator. Three patients had cardiac defects confirmed postnatally, two fetuses had extracardiac anomalies and one fetus had a suspected cardiac defect unconfirmed by second-opinion TELE-STIC. There were two isolated major congenital heart defects. Both patients were given advice by e-mail and teleconference using a web camera about the likely outcome and benefits of scheduling in utero transport to a tertiary care center.

CONCLUSIONS

STIC volumes can be obtained by operators inexperienced in fetal echocardiography, transmitted via the Internet, and their analysis enables recognition of most of the structures and views necessary to assess fetal cardiac anatomy. The preliminary use of TELE-STIC allowed us to demonstrate that some intracardiac anomalies can be ruled out and others confirmed, allowing perinatal management to be tailored accordingly.

Modulation by PKA of the hyperpolarization-activated current (Ih) in cultured rat olfactory receptor neurons

The hyperpolarization-activated Ih channel is modulated by neurotransmitters acting through the cAMP messenger system. In rat olfactory receptor neurons (ORNs), dopamine, by inhibition of adenylyl cyclase, shifts the voltage of half-maximal activation (V1/2) of Ih to more negative potentials and decreases Ih maximal relative conductance. Whether these effects result from a phosphorylation-dependent mechanism is unclear. Therefore, we used whole-cell patch-clamp recording techniques to study cAMP-dependent phosphorylation via PKA on Ih in rat ORNs. General protein kinase inhibition (50 nM K252a) produced a hyperpolarizing shift in Ih V1/2 and decreased Ih maximal conductance. Specific inhibition of PKA with H-89 (500 nM) also shifted the V1/2 of Ih to more negative potentials, and, in some cells, decreased Ih maximal conductance. PKA-mediated phosphorylation (cBIMPS, 50 mM) shifted Ih V1/2 more positive, modulated the kinetics of Ih channel activation and increased Ih peak current amplitude. Internal perfusion of the catalytic subunit of PKA (84 nM) also shifted Ih V1/2 positive and this shift was blocked by co-perfusion with PKI (50 nM). These results show that in rat ORNs, the voltage dependence of Ih activation can be modulated by PKA-dependent phosphorylation. We also show that PKA and other protein kinases may be involved in the regulation of Ih maximal conductance. Our findings suggest that changes in the phosphorylation state of ORNs may affect resting properties as well as modulate odor sensitivity.

An alternative to sutures

Cyanoacrylate tissue adhesives are used in numerous settings to close wounds without the use of sutures. The product and its use for closing chest tube wounds is discussed.

Use of osmotically active agents to alter optical properties of tissue: effects on the detected fluorescence signal measured through skin

BACKGROUND AND OBJECTIVE

Hyper-osmotic chemical agents were used to study the effects of transient tissue scattering on the remitted fluorescence emission intensity from a target placed under a tissue sample.

STUDY DESIGN/MATERIALS AND METHODS

A fluorescent film was placed underneath in vitro and in vivo samples of hamster skin, and the remitted fluorescent signal traveling to the tissue surface was monitored over time as the tissue was treated with an osmotically active agent.

RESULTS

The detected fluorescent signal increased as the scattering in tissue samples was substantially reduced. The increase was greater for dimethyl sulfoxide than glucose or glycerol. It was not statistically different between in vivo skin and in vitro skin.

CONCLUSION

The study shows how chemical agents can be used to improve the detected signal for a specific optical application. It could be useful in a number of optical therapeutic and diagnostic applications that can benefit from an increase in the penetration depth of light.

Renal proximal tubular cell growth and differentiation are differentially modulated by renotropic growth factors and tyrosine kinase inhibitors

BACKGROUND

The renotropic growth factors (GFs), hepatocyte GF (HGF), epidermal GF (EGF), and insulin-like GF-I (IGF-I) accelerate renal regeneration in animal models after toxic or ischemic injury. These GFs initiate their biological effects on renal tubular cells by interaction with specific transmembrane receptor tyrosine kinases.

MATERIALS AND METHODS

In the proximal tubular cell line PT-1, the biological effects of HGF, EGF, and IGF-I and the growth-inhibitory effects of different tyrosine kinase inhibitors (TKIs) were investigated. Receptor binding and tyrosine kinase phosphorylation were determined by ligand binding studies and Western blot analysis.

RESULTS

HGF, EGF, and IGF-I bound with nanomolar affinity to their specific cell membrane receptor tyrosine kinases. In contrast to EGF or IGF-I, HGF induced a variety of cell morphological changes, including cell scattering, formation of tubular structures, and expression of long microvilli on the apical cell membrane. HGF was a 10-fold more potent and more effective growth promoter than EGF or IGF-I. Among the TKIs tested, the mitogenic effect of HGF could be more specifically inhibited by emodin and tyrphostin, that of EGF by methyl-2,5-dihydroxycinnamate, lavendustin A, and genistein, and that of IGF-I by geldanamycin.

CONCLUSIONS

In contrast to EGF and IGF-I, HGF stimulated both growth and differentiation of renal proximal tubular cells, demonstrating the amazing biological potency of this renotropic growth factor. Selective TKIs may be a promising approach to modulate diseases with abnormalities in protein kinase signalling pathways such as renal cell carcinoma.

The effect of repeated controlled ovarian stimulation in donors

BACKGROUND

The effect of repeated controlled ovarian stimulation in young, healthy women who consented to donate their oocytes was assessed through a retrospective study.

METHODS AND RESULTS

Between March 1994 and February 2000, 284 donors consented to at least two controlled ovarian stimulation cycles, with four donors undergoing up to nine cycles. Through an intra-group analysis we studied the oocyte retrieval rate, controlled by the duration and doses of stimulation, as well as the interval between cycles, finding that the number of retrieved oocytes was maintained during repeated controlled ovarian stimulation cycles. The oocyte quality, assessed as fertilization, implantation and pregnancy rates, was similar through five repeated controlled ovarian stimulation cycles. The same result was obtained when the interval in days was analysed as a continuous variable or categorized in <90 and > or =90 days.

CONCLUSIONS

The analysis of the data suggests that successive stimulation cycles do not impair ovarian response in terms of quantity and quality of the oocytes obtained in this group of women. Furthermore, the interval between cycles does not influence the result of the stimulations.