Longitudinal outcomes of obeticholic acid therapy in ursodiol-nonresponsive primary biliary cholangitis: Stratifying the impact of add-on fibrates in real-world practice

BACKGROUND

Suboptimal response to ursodeoxycholic acid occurs in 40% of primary biliary cholangitis (PBC) patients, affecting survival. Achieving a deep response (normalisation of alkaline phosphatase [ALP] and bilirubin ≤0.6 upper limit of normal) improves survival. Yet, the long-term effectiveness of second-line treatments remains uncertain.

AIMS

To evaluate the long-term effectiveness of obeticholic acid (OCA) ± fibrates. Focusing on biochemical response (ALP ≤1.67 times the upper limit of normal, with a decrease of at least 15% from baseline and normal bilirubin levels), normalisation of ALP, deep response and biochemical remission (deep response plus aminotransferase normalisation).

METHODS

We conducted a longitudinal, observational, multicentre study involving ursodeoxyccholic acid non-responsive PBC patients (Paris-II criteria) from Spain and Portugal who received OCA ± fibrates.

RESULTS

Of 255 patients, median follow-up was 35.1 months (IQR: 20.2-53). The biochemical response in the whole cohort was 47.2%, 61.4% and 68.6% at 12, 24 and 36 months. GLOBE-PBC and 5-year UK-PBC scores improved (p < 0.001). Triple therapy (ursodeoxycholic acid plus OCA plus fibrates) had significantly higher response rates than dual therapy (p = 0.001), including ALP normalisation, deep response and biochemical remission (p < 0.001). In multivariate analysis, triple therapy remained independently associated with biochemical response (p = 0.024), alkaline phosphatase normalisation, deep response and biochemical remission (p < 0.001). Adverse effects occurred in 41.2% of cases, leading to 18.8% discontinuing OCA. Out of 55 patients with cirrhosis, 12 developed decompensation. All with baseline portal hypertension.

CONCLUSION

Triple therapy was superior in achieving therapeutic goals in UDCA-nonresponsive PBC. Decompensation was linked to pre-existing portal hypertension.

Spatially preserved multi-region transcriptomic subtyping and biomarkers of chemoimmunotherapy outcome in extensive-stage small cell lung cancer

BACKGROUND

Transcriptomic subtyping holds promise for personalized therapy in extensive-stage small-cell lung cancer (ES-SCLC). In this study, we aimed to assess intratumoral transcriptomic subtype diversity and to identify biomarkers of long-term chemoimmunotherapy benefit in human ES-SCLC.

PATIENTS AND METHODS

We analyzed tumor samples from 58 ES-SCLC patients enrolled in two multicenter single-arm phase IIIb studies evaluating front-line chemoimmunotherapy in Spain: n=32 from the IMfirst trial, and n=26 from the CANTABRICO trial. We utilized the GeoMxTM DSP system to perform multi-region transcriptomic analysis. For subtype classification, we performed hierarchical clustering using the relative expression of ASCL1 (SCLC-A), NEUROD1 (SCLC-N), POU2F3 (SCLC-P), and YAP1 (SCLC-Y).

RESULTS

Subtype distribution was similar between both cohorts, except for SCLC-P, not identified in the CANTABRICO_DSP cohort. A total of 44% of the patients in both cohorts had tumors with multiple co-existing transcriptional subtypes. Transcriptional subtypes or subtype heterogeneity were not associated with outcomes. Most potential targets did not show subtype-specific expression. Consistently in both cohorts, tumors from patients with long-term benefit (time to progression ³12 months) contained an IFNg-dominated mRNA profile, including enhanced capacity for antigen presentation. Hypoxia and glycolytic pathways were associated with resistance to chemoimmunotherapy.

CONCLUSIONS

This work suggests that intratumoral heterogeneity, inconsistent association with outcome, and unclear subtype-specific target expression might be significant challenges for subtype-based precision oncology in SCLC. Pre-existing IFNg-driven immunity and mitochondrial metabolism seem correlates of long-term efficacy in this study, although the absence of a chemotherapy control arm precludes concluding that these are predictive features specific for immunotherapy.

Oral cortisol and dexamethasone intake: Differential physiology and transcriptional responses in the marine juvenile Sparus aurata

This study approached the long-term oral administration of cortisol (F) and dexamethasone (DEX), two synthetic glucocorticoids, compared to a control group (CT) in the juveniles of a marine teleost, the gilthead seabream (Sparus aurata). Physiologically, DEX treatment impaired growth, which appears to be linked to carbohydrate allocation in muscle and liver, hepatic triglycerides depletion, and reduced hematocrit. Hypophyseal gh mRNA expression was 2-fold higher in DEX than in CT or F groups. Similarly, hypothalamic trh and hypophyseal pomcb followed this pattern. Plasma cortisol levels were significantly lower in DEX than in CT, while F presented intermediate levels. In the posterior intestine, measured short circuit-current (Isc) was more anion absorptive in CT and F compared to the DEX group, whereas Isc remained unaffected in the anterior intestine. The derived transepithelial electric resistance (TEER) significantly differed between intestinal regions in the DEX group. These results provide new insights to understand better potential targeted biomarkers indicative of the differential glucocorticoid or mineralocorticoid-receptors activation in fish.

Role of the melanocortin system in zebrafish skin physiology

The agouti-signaling protein (ASIP) acts as both a competitive antagonist and inverse agonist of melanocortin receptors which regulate dorsal-ventral pigmentation patterns in fish. However, the potential role of ASIP in the regulation of additional physiological pathways in the skin is unknown. The skin plays a crucial role in the immune function, acting as a physical limitation against infestation and also as a chemical barrier due to its ability to synthesize and secrete mucus and many immune effector proteins. In this study, the putative role of ASIP in regulating the immune system of skin has been explored using a transgenic zebrafish model overexpressing the asip1 gene (ASIPzf). Initially, the structural changes in skin induced by asip1 overexpression were studied, revealing that the ventral skin of ASIPzf was thinner than that of wild type (WT) animals. A moderate hypertrophy of mucous cells was also found in ASIPzf. Histochemical studies showed that transgenic animals appear to compensate for the lower number of cell layers by modifying the mucus composition and increasing lectin affinity and mucin content in order to maintain or improve protection against microorganism adhesion. ASIPzf also exhibit higher protein concentration under crowding conditions suggesting an increased mucus production under stressful conditions. Exposure to bacterial lipopolysaccharide (LPS) showed that ASIPzf exhibit a faster pro-inflammatory response and increased mucin expression yet severe skin injures and a slight increase in mortality was observed. Electrophysiological measurements show that the ASIP1 genotype exhibits reduced epithelial resistance, an indicator of reduced tissue integrity and barrier function. Overall, not only are ASIP1 animals more prone to infiltration and subsequent infections due to reduced skin epithelial integrity, but also display an increased inflammatory response that can lead to increased skin sensitivity to external infections.

Estimating spatio-temporal fields through reinforcement learning

Prediction and estimation of phenomena of interest in aquatic environments are challenging since they present complex spatio-temporal dynamics. Over the past few decades, advances in machine learning and data processing contributed to ocean exploration and sampling using autonomous robots. In this work, we formulate a reinforcement learning framework to estimate spatio-temporal fields modeled by partial differential equations. The proposed framework addresses problems of the classic methods regarding the sampling process to determine the path to be used by the agent to collect samples. Simulation results demonstrate the applicability of our approach and show that the error at the end of the learning process is close to the expected error given by the fitting process due to added noise.

Efficacy of niraparib by time of surgery and postoperative residual disease status: A post hoc analysis of patients in the PRIMA/ENGOT-OV26/GOG-3012 study

OBJECTIVE

To evaluate the association between surgical timing and postoperative residual disease status on the efficacy of niraparib first-line maintenance therapy in patients with newly diagnosed advanced ovarian cancer at high risk of recurrence.

METHODS

Post hoc analysis of the phase 3 PRIMA/ENGOT-OV26/GOG-3012 (NCT02655016) study of niraparib in patients with newly diagnosed primary advanced ovarian, primary peritoneal, or fallopian tube cancer with a complete/partial response to first-line platinum-based chemotherapy. Progression-free survival (PFS) was assessed by surgical status (primary debulking surgery [PDS] vs neoadjuvant chemotherapy/interval debulking surgery [NACT/IDS]) and postoperative residual disease status (no visible residual disease [NVRD] vs visible residual disease [VRD]) in the intent-to-treat population.

RESULTS

In PRIMA (N = 733), 236 (32.2%) patients underwent PDS, and 481 (65.6%) received NACT/IDS before enrollment. Median PFS (niraparib vs placebo) and hazard ratios (95% CI) for progression were similar in PDS (13.7 vs 8.2 months; HR, 0.67 [0.47-0.96]) and NACT/IDS (14.2 vs 8.2 months; HR, 0.57 [0.44-0.73]) subgroups. In patients who received NACT/IDS and had NVRD (n = 304), the hazard ratio (95% CI) for progression was 0.65 (0.46-0.91). In patients with VRD following PDS (n = 183) or NACT/IDS (n = 149), the hazard ratios (95% CI) for progression were 0.58 (0.39-0.86) and 0.41 (0.27-0.62), respectively. PFS was not evaluable for patients with PDS and NVRD because of sample size (n = 37).

CONCLUSIONS

In this post hoc analysis, niraparib efficacy was similar across PDS and NACT/IDS subgroups. Patients who had NACT/IDS and VRD had the highest reduction in the risk of progression with niraparib maintenance.

Tissue and salinity specific Na+/Cl- cotransporter (NCC) orthologues involved in the adaptive osmoregulation of sea lamprey (Petromyzon marinus)

Two orthologues of the gene encoding the Na⁺-Cl⁻ cotransporter (NCC), termed ncca and nccb, were found in the sea lamprey genome. No gene encoding the Na⁺-K⁺-2Cl⁻ cotransporter 2 (nkcc2) was identified. In a phylogenetic comparison among other vertebrate NCC and NKCC sequences, the sea lamprey NCCs occupied basal positions within the NCC clades. In freshwater, ncca mRNA was found only in the gill and nccb only in the intestine, whereas both were found in the kidney. Intestinal nccb mRNA levels increased during late metamorphosis coincident with salinity tolerance. Acclimation to seawater increased nccb mRNA levels in the intestine and kidney. Electrophysiological analysis of intestinal tissue ex vivo showed this tissue was anion absorptive. After seawater acclimation, the proximal intestine became less anion absorptive, whereas the distal intestine remained unchanged. Luminal application of indapamide (an NCC inhibitor) resulted in 73% and 30% inhibition of short-circuit current (I_sc) in the proximal and distal intestine, respectively. Luminal application of bumetanide (an NKCC inhibitor) did not affect intestinal I_sc. Indapamide also inhibited intestinal water absorption. Our results indicate that NCCb is likely the key ion cotransport protein for ion uptake by the lamprey intestine that facilitates water absorption in seawater. As such, the preparatory increases in intestinal nccb mRNA levels during metamorphosis of sea lamprey are likely critical to development of whole animal salinity tolerance.

Ocean acidification compromises energy management in Sparus aurata (Pisces: Teleostei)

The effects of ocean acidification mediated by an increase in water pCO₂ levels on marine organisms are currently under debate. Elevated CO₂ concentrations in the seawater induce several physiological responses in teleost fish, including acid-base imbalances and osmoregulatory changes. However, the consequences of CO₂ levels enhancement on energy metabolism are mostly unknown. Here we show that 5 weeks of exposure to hypercapnia (950 and 1800 μatm CO₂) altered intermediary metabolism of gilthead seabream (Sparus aurata) compared to fish acclimated to current ocean values (440 μatm CO₂). We found that seabream compromises its physiological acid-base balance with increasing water CO₂ levels and the subsequent acidification. Intestinal regions (anterior, mid, and rectum) engaged in maintaining this balance are thus altered, as seen for Na⁺/K⁺-ATPase and the vacuolar-type H⁺-ATPase activities. Moreover, liver and muscle counteracted these effects by increasing catabolic routes e.g., glycogenolysis, glycolysis, amino acid turnover, and lipid catabolism, and plasma energy metabolites were altered. Our results demonstrate how a relatively short period of 5 weeks of water hypercapnia is likely to disrupt the acid-base balance, osmoregulatory capacity and intermediary metabolism in S. aurata. However, long-term studies are necessary to fully understand the consequences of ocean acidification on growth and other energy-demanding activities, such as reproduction.

Osmoregulatory role of the intestine in the sea lamprey (Petromyzon marinus)

Lampreys are the most basal vertebrates with an osmoregulatory strategy. Previous research has established that the salinity tolerance of sea lamprey increases dramatically during metamorphosis, but underlying changes in the gut have not been examined. In the present work, we examined changes in intestinal function during metamorphosis and seawater exposure of sea lamprey (Petromyzon marinus). Fully metamorphosed juvenile sea lamprey had 100% survival after direct exposure to 35 parts per thousand seawater (SW) and only slight elevations in plasma chloride (Cl^-) levels. Drinking rates of sea lamprey juveniles in seawater were 26-fold higher than juveniles in freshwater (FW). Na⁺-K⁺-ATPase (NKA) activity in the anterior and posterior intestine increased 12- and 3-fold, respectively, during metamorphosis, whereas esophageal NKA activity was lower than in the intestine and did not change with development. Acclimation to SW significantly enhanced NKA activity in the posterior intestine but did not significantly change NKA activity in the anterior intestine, which remained higher than that in the posterior intestine. Intestinal Cl^- and water uptake, which were observed in ex vivo preparations of anterior and posterior intestine under both symmetric and asymmetric conditions, were higher in juveniles than in larvae and were similar in magnitude of those of teleost fish. Inhibition of NKA by ouabain in ex vivo preparations inhibited intestinal water absorption by 64%. Our results indicate drinking and intestinal ion and water absorption are important to osmoregulation in SW and that preparatory increases in intestinal NKA activity are important to the development of salinity tolerance that occurs during sea lamprey metamorphosis.

Survival rates and physiological recovery responses in the lesser-spotted catshark (Scyliorhinus canicula) after bottom-trawling

In 2019, Europe will adopt a no-discards policy in fisheries. This entails the landing of captured species unless strong evidence is provided supporting their survival and recovery after fishing. Thus, research on this topic is gaining momentum. Bottom-trawling, as a non-selective fishing method, is characterized by a high proportion of discards including vulnerable key species, such as demersal sharks. Their survival may also depend on capture depth. By paralleling onboard and laboratory experiments with the small-spotted catshark, Scyliorhinus canicula, we offer a robust experimental design to assess the survival of discarded sharks. Catsharks were captured by bottom-trawling at two depths (shallow ~89 m and deep ~479 m). Blood samples were collected following trawl capture and analyzed for stress biomarkers (lactate, osmolality, phosphate, urea). During recovery in onboard tanks, behavior was video-recorded and fish were re-sampled after 24 h. A second experiment was conducted in laboratory facilities to simulate air-exposure after trawling and to analyze the physiological recovery. Our results showed that 95.7% of the animals survived 24 h after trawling. We confirmed that trawling elicited acute stress responses in catshark but that they managed to recover. This was demonstrated by lactate concentrations that were 2.6 mM upon capture, but recovered to assumed baselines after 24 h (0.2 mM). Non-invasive video monitoring revealed behavioral differences with depth, whereby those captured at 89 m depth required longer to recover than those captured at 479 m depth. Implementation of standardized survival studies by fishery managers can benefit from holistic physiological approaches, such as the one proposed here.

High rates of intestinal bicarbonate secretion in seawater tilapia (Oreochromis mossambicus)

Osmoregulation in fish is a complex process that requires the orchestrated cooperation of many tissues. In fish facing hyperosmotic environments, the intestinal absorption of some monovalent ions and the secretion of bicarbonate are key processes to favor water absorption. In the present study, we showed that bicarbonate levels in the intestinal fluid are several fold higher in seawater than in freshwater acclimated tilapia (Oreochromis mossambicus). In addition, we analyzed gene expression of the main molecular mechanisms involved in HCO₃^- movements i.e. slc26a6, slc26a3, slc4a4 and v-type H-ATPase sub C in the intestine of tilapia acclimated to both seawater and freshwater. Our results show an anterior/posterior functional regionalization of the intestine in tilapia in terms of expression patterns, which is affected by environmental salinity mostly in the anterior and mid intestine. Analysis of bicarbonate secretion using pH-Stat in tissues mounted in Ussing chambers reveals high rates of bicarbonate secretion in tilapia acclimated to seawater from anterior intestine to rectum ranging between ~900 and ~1700nmolHCO₃^-cm^-2h^-1. However, a relationship between the expression of slc26a6, slc26a3, slc4a4 and the rate of bicarbonate secretion seems to be compromised in the rectum. In this region, the low expression of the bicarbonate transporters could not explain the high bicarbonate secretion rates here described. However, we postulate that the elevated v-type H-ATPase mRNA expression in the rectum could be involved in this process.

Intestinal response to salinity challenge in the Senegalese sole (Solea senegalensis)

Fish are continuously forced to actively absorb or expel water and ions through epithelia. Most studies have focused on the gill due to its role in Na⁺ and Cl^- trafficking. However, comparatively few studies have focused on the changing function of the intestine in response to external salinity. Therefore, the present study investigated the main intestinal changes of long-term acclimation of the Senegalese sole (Solea senegalensis) to 5, 15, 38 and 55ppt. Through the measurement of short-circuit current (Isc) in Ussing chambers and biochemical approaches, we described a clear anterior/posterior functional regionalization of the intestine in response to salinity. The use of specific inhibitors in Ussing chamber experiments, revealed that the bumetanide-sensitive Na⁺/K⁺/Cl^- co-transporters are the main effectors of Cl^- uptake in both anterior intestine and rectum. Additionally, the use of the anion exchanger specific inhibitor, DIDS, showed a salinity/region dependency of anion exchanger function. Moreover, we also described ouabain-sensitive Na⁺/K⁺-ATPase (NKA) and Bafilomycin A1-sensitive H⁺-ATPase activities (HA), which displayed changes related to salinity and intestinal region. However, the most striking result of the present study is the description of an omeprazole-sensitive H⁺/K⁺-ATPase (HKA) in the rectum of Senegalese sole. Its activity was consistently measurable and increased at lower salinities, reaching rates even higher than those of the NKA. Together our results provide new insights into the changing role of the intestine in response to external salinity in teleost fish. The rectal activity of HKA offers an alternative/cooperative mechanism with the HA in the final processing of intestinal water absorption by apical titration of secreted bicarbonate.

Microcytic carcinoma of the urinary bladder: Experience over 22 years

INTRODUCTION

Microcytic carcinoma of the urinary bladder or bladder Small Cell Carcinoma (SCC) is a rare entity, characterised by an aggressive behaviour, with a poor prognosis, elevated metastatic potential, and is commonly found in older patients and in advanced disease stages. Here we present our experiences with the behaviour of the disease and the treatments applied.

MATERIAL AND METHOD

This was a retrospective study on patients diagnosed with bladder SCC in our hospital between February 1992 and February 2014. We analysed the demographic and clinical characteristics of the tumour, the applied treatments and survival. We performed a descriptive statistical analysis of the median follow-up time, Overall Survival (OS) and Cancer-Specific Survival (CSS), using the SPSS statistical package v. 15.0.

RESULTS

Over 22 years, 20 patients with an average age of 75 years were diagnosed with bladder SCC (2 female). The predominant symptom was macroscopic haematuria (75%). After the first transurethral resection (TUR) of the bladder and the histological diagnosis, 35% (7 patients) did not receive additional treatment, 15% (3 patients) were treated with chemoradiotherapy (CRT), 10% (2 patients) with TUR, 15% (3 patients) with chemotherapy (QT), 5% (1 patient) with TUR associated to CRT, 5% (1 patient) with radical surgery, 5% (1 patient) with radical surgery treatment followed by adjuvant CRT, 5% (1 patient) with palliative surgery (hypogastric arteriae ligation) followed by adjuvant QT and 5% (1 patient) with hemostatic radiotherapy (RT). With a median follow-up time of 13.8 months, the OS was 14.48 months (95% CI: 6.22 - 22.75) and the CSS 18.04 months (95% CI: 6.51-29.57). Only 10% (2 patients) survived till the end of the study.

CONCLUSION

Microcytic carcinoma of the urinary bladder is a rare and aggressive entity commonly diagnosed in males of advanced age and in advanced disease stages. It has a poor prognosis and reduced survival. Due to its aggressiveness previous to the initial diagnosis, a cystectomy is only possible in very few cases; therefore multimodal treatment is necessary. This treatment is yet to be defined.

Predictive factors of evolution of patients after pT0 radical cystectomy due to bladder cancer

OBJECTIVES

To analyze the influence of the different pre - cystectomy factors, both clinical and pathological, in the follow up of patients with no residual tumor ( pT0) in the pathological examination of the radical cystectomy specimen as predictors of tumor recurrence. Secondly we intend to compare overall survival, disease free survival and cancer-specific survival with the rest of cystectomy patients in our series.

METHODS

Between 1985 and 2010, radical cystectomy was performed in 280 patients with bladder cancer, being 41 pT0 (14.6%). We analyzed potential predictors for overall survival and disease-free survival: age, sex , number of transurethral resections of bladder tumor before cystectomy , tumor type , tumor grade, tumor stage, tumor size, number of tumors, associated Cis and previous instillations. We used univariate analysis of Cox regression. Survival analysis was performed using Kaplan - Meier curves and log-rank test.

RESULTS

Mean age was 61.7 years and 37 patients were males (90.2%). Stages before cystectomy were pT1 in eight (19.5%) , pT2 in 31 (75.6%) and Cis in two (4.9 %) with tumor grade III in 37 (90.2%). Cystectomy specimens revealed the presence of papillary transitional cell carcinoma in 38 (92.7%) cases. The median number of pre-cistectomy-TURBT was one. Eleven patients (26.8%) received intravesical instillations. Six patients (14.63 %) had tumor recurrence and 10 (24.4 %) died from causes unrelated to the disease. None of the variables analyzed was statistically significant in the univariate analysis as a predictor of tumor recurrence. With a median follow up of 70 months (3-272) disease-free survival and overall survival at five years were 85.9% and 72.8% respectively. Compared to the non pT0 cystectomies in our series, pT0 had a statistically significant difference for better recurrence-free survival (63.4 % and 36.8%, respectively in pT0 and no-pT0 patients) (p〈0,05).

CONCLUSIONS

According to the results, we have found a better outcome for pT0 patients after cystectomy compared to those with residual tumor. We have not found any pre - cystectomy predictive factor related to disease-free survival and overall survival.

Review of a series of cystectomies in women for bladder cancer:Complications and quality of life

OBJECTIVES

To analyze the complications and quality of life after cystectomies performed in women with bladder cancer at our hospital.

METHODS

Descriptive analysis of demographic data and early/late complications of cystectomies and urinary diversions performed in women at our hospital between 1990-2010. We also assessed quality of life using the Functional Assessment of Cancer Therapy-Bladder Cancer (ACT-BL) questionnaire and a comparison was drawn between groups of clinical variables.

RESULTS

Out of 265 cystectomies, 25 (10%) were performed in women. The predominant urinary diversion was ureterosigmoidostomy (60%), followed by cutaneous ureterostomy (16%), orthotopic ileal neo-bladder Studer pouch (12%), ileal conduit (10%) and permanent nephrostomy (4%). Mean age was 55.75 years. The most commonly occurring early complications were prolonged ileus (20%) and urinary fistula (20%). Late complications included hydronephrosis (32%) and pyelonephritis (32%). The results of quality of life questionnaires were very similar for the different types of urinary diversions, with a mean score of 104.5 out of 156 points.

CONCLUSIONS

Radical cystectomy is a high-risk procedure associated with many complications. In women, ureterosigmoidostomy may be a good choice for urinary diversion in selected patients, with a quality of life very similar to those with different urinary diversions.

Variations in the expression of vasotocin and isotocin receptor genes in the gilthead sea bream Sparus aurata during different osmotic challenges

The dynamic changes in mRNA expression levels for vasotocin (AVT) and isotocin (IT) receptor gene levels were assessed in a time-course response study in immature male specimens of the gilthead sea bream (Sparus aurata) submitted to hyper- (55‰ salinity) and hypo-osmotic (5‰ salinity) challenges. Two different cDNAs for the AVT receptor and one for the IT receptor (V1a2-type and V2-type AVTR, and ITR, respectively) were cloned by screening an S. aurata brain cDNA library. Genes for these receptors were expressed differentially and is nearly ubiquitously in 26 of the examined tissues. In the gills, both environmental salinity challenges up-regulated AVTR V1a2-type gene expression concomitantly with mRNA expression protein activity of Na(+), K(+)-ATPase gene expression and protein, whereas the AVTR V2-type and cystic fibrosis transmembrane conductance regulator (CFTR) mRNA levels were associated with mRNAs environmental salinity, indicating a possible connection between AVTRs and these transporters. In kidney, AVTR V1a2-type gene expression peaked rapidly and lasted only a short time (12-24h) in response to both osmotic challenges. In contrast, AVTR V2-type mRNA levels were enhanced in specimens exposed to hyperosmotic conditions, whereas they decreased under hypoosmotic environments, suggesting an antidiuretic role related to the vasoconstriction function. In the hypothalamus, only the expression of the AVTR V2-type gene was enhanced at 7 and 14 days under both experimental conditions. In the liver, both AVTRs had increased mRNA levels, with the upregulation of their AVTR V2-type gene increasing faster than the V1a2-type. The ITR gene was not sensitive to variations of external salinity in any of the analyzed tissues. Our results demonstrate the involvement of the vasotocinergic, but not the isotocinergic, pathway as well as the hypothalamic function, in the adjustments of both osmoregulatory and metabolic processes after osmotic challenges.

Systems scale assessment of the sustainability implications of emerging green initiatives

This paper demonstrates a systems framework for assessment of environmental impacts from 'green initiatives', through a case study of meso-scale, anthropogenic-biogenic interactions. The following cross-sectoral green initiatives, combining the emerging trends in the North East region of the United Kingdom, have been considered - increasing the vegetation cover; decarbonising road transport; decentralising energy production through biomass plants. Two future scenarios are assessed - Baseline_2020 (projected emissions from realisation of policy instruments); Aggressive_2020 (additional emissions from realisation of green initiatives). Resulting trends from the Aggressive_2020 scenario suggest an increase in emissions of pollutant precursors, including biogenic volatile organic compounds and nitrogen dioxide over the base case by up to 20% and 5% respectively. This has implications for enhanced daytime ozone and secondary aerosols formation by up to 15% and over 5% respectively. Associated land cover changes show marginal decrease of ambient temperature but modest reductions in ammonia and ambient particulates.

In vitro evaluation of the effect of a high plant protein diet and nucleotide supplementation on intestinal integrity in meagre (Argyrosomus regius)

In the present study, the protective effect of nucleotides over damages induced by the consumption of a diet containing a high amount of vegetable ingredients (560 g kg(-1)) in the intestinal epithelia of the meagre (Argyrosomus regius) was assessed by assays performed with an Ussing-type chamber. Two experimental feeds were prepared including or not a commercial mixture of nucleotides (1 g kg(-1)). Nucleotides significantly enhanced fish growth during the experiment. On the other hand, differences in the integrity and functionality of intestinal epithelia were evidenced by a change in the polarity of intestinal trans-epithelial potential. Samples of fish fed on the control diet showed a preferentially secretory short-circuit current, while those of fish receiving the nucleotide-supplemented diet showed a significantly lower and preferentially absorptive negative current. It is concluded that alterations of intestinal physiology juvenile meagre resulting from the intake of high amounts of plant ingredients could be minimized by nucleotide supplementation.

[Therapeutic options for renal graft tumors]

Renal graft neoplasias are a rare complication,possibly due to the immunosuppressive therapy itself and increased susceptibility to potentially oncogenic viruses. Few case series have been reported in the literature on the treatment of such tumors, so far there is no clear consensus on how to deal with them. We conducted an exhaustive review of the literature to examine the treatment performed by different authors.

Prolactin regulates luminal bicarbonate secretion in the intestine of the sea bream (Sparus aurata L.)

The pituitary hormone prolactin is a pleiotropic endocrine factor that plays a major role in the regulation of ion balance in fish, with demonstrated actions mainly in the gills and kidney. The role of prolactin in intestinal ion transport remains little studied. In marine fish, which have high drinking rates, epithelial bicarbonate secretion in the intestine produces luminal carbonate aggregates believed to play a key role in water and ion homeostasis. The present study was designed to establish the putative role of prolactin in the regulation of intestinal bicarbonate secretion in a marine fish. Basolateral addition of prolactin to the anterior intestine of sea bream mounted in Ussing chambers caused a rapid (<20 min) decrease of bicarbonate secretion measured by pH-stat. A clear inhibitory dose-response curve was obtained, with a maximal inhibition of 60-65% of basal bicarbonate secretion. The threshold concentration of prolactin for a significant effect on bicarbonate secretion was 10 ng ml(-1), which is comparable with putative plasma levels in seawater fish. The effect of prolactin on apical bicarbonate secretion was independent of the generation route for bicarbonate, as shown in a preparation devoid of basolateral HCO(3)(-)/CO(2) buffer. Specific inhibitors of JAK2 (AG-490, 50 μmol l(-1)), PI3K (LY-294002, 75 μmol l(-1)) or MEK (U-012610, 10 μmol l(-1)) caused a 50-70% reduction in the effect of prolactin on bicarbonate secretion, and demonstrated the involvement of prolactin receptors. In addition to rapid effects, prolactin has actions at the genomic level. Incubation of intestinal explants of anterior intestine of the sea bream in vitro for 3 h demonstrated a specific effect of prolactin on the expression of the Slc4a4A Na(+)-HCO(3)(-) co-transporter, but not on the Slc26a6A or Slc26a3B Cl(-)/HCO(3)(-) exchanger. We propose a new role for prolactin in the regulation of bicarbonate secretion, an essential function for ion/water homeostasis in the intestine of marine fish.

The association between neck disability and jaw disability

The association between cervical spine disorders (CSD) and temporomandibular disorders (TMD) has been extensively investigated. However, no studies investigating the relationship between the level of jaw disability and neck disability have been published. Therefore, the objective of this study was to determine whether there was a relationship between neck disability measured using the neck disability index (NDI) and jaw disability measured through the jaw function scale (JFS). A sample of 154 subjects who attended the TMD/Orofacial Pain clinic and students and staff at the University of Alberta participated in this study. All subjects were asked to complete the NDI, the JFS, the jaw disability checklist (JDC), and the level of chronic disability of TMD (chronic pain grade disability questionnaire used in the RDC/TMD). Spearman rho test was used to analyse the relationship between neck disability and jaw disability. Multiple regression analysis was used to determine the association between the level of chronic disability of TMD and neck disability. A strong relationship between neck disability and jaw disability was found (r = 0.82). A subject with a high level of TMD disability (grade IV) increased by about 19 points on the NDI when compared with a person without TMD disability. These results have implications for clinical practice. If patients with TMD have neck disability in addition to jaw disability, treatment needs to focus on both areas because the improvement of one could have an influence on the other.

Prognostic value of lymph node micrometastasis in patients with colorectal cancer in Dukes stages A and B (T1-T4, N0, M0)

BACKGROUND

30% of patients with colorectal cancer (CRC) in Dukes stages A and B (T1-T4, N0, M0) present tumor recurrence and die after 5 years follow up. This unexpectedly poor evolution might be attributable to the presence of lymph node micrometastasis undetected in routine examination with haematoxilin-eosine (H&E).

OBJECTIVE

To assess the presence of undetected micrometastasis.

PATIENTS AND METHODS

we conducted a retrospective study of the locoregional lymph nodes in 85 patients operated for CRC in Dukes stages A and B (T1-T4, N0, M0), using immunohistochemistry with anticytokeratin antibodies AE1/AE3. In this descriptive, inferential bivariant and survival study, we analyzed different risk factors, including local infiltration T1/T4, Dukes A/B, number of dissected lymph nodes, vascular invasion, micrometastasis, tumor recurrence and death in the context of the presence or absence of micrometastases.

RESULTS

Dukes stage and neoplastic angioinvasion are influential in patient prognosis; however, lymph node micrometastases were not associated with a poorer outcome of CRC.

CONCLUSIONS

Locorregional lymph node micrometastases detected with anticytokeratine antibodies AE1/AE3 in Dukes A and B CRC patients are not associated with reduced survival.

Melatonin concentrations during larval and postlarval development of gilthead sea bream Sparus auratus: more than a time-keeping molecule?

In this study, melatonin (MEL) and thyroxine (T(4)) concentrations were measured during larval and postlarval development of gilthead sea bream Sparus auratus Hormones were measured in whole bodies of larvae or the head and trunk of postlarvae after 67 days of exposure to constant light, 24L:0D, constant darkness, 0L:24D or 12L:12D and in the plasma of 6 month juveniles kept under the 12L:12D, 0L:24D and 24L:0D regimes. High MEL concentrations in larvae suggested a distinct role of MEL in early organogenesis and development of S. auratus. In larvae, the gastro-intestinal tract seemed to be an important extrapineal and extraretinal source of MEL. No endogenous rhythm of MEL synthesis was demonstrated in 67 day larvae; however, in 6 month juveniles, it was evident. At early ontogenesis of S. auratus, the role of MEL is probably related mostly to the control of development and protection against free radicals, whereas its action as a time-keeping molecule develops later. The increase in T(4) concentration during the S. auratus larva-juvenile transition, i.e. between 50 and 70 days post-hatch, which was observed concurrently with the decrease of MEL concentration, may suggest an inverse relationship between T(4) and MEL.

Use of the Plasma Spectrum RMS Signal for Arc-Welding Diagnostics

A new spectroscopic parameter is used in this paper for on-line arc-welding quality monitoring. Plasma spectroscopy applied to welding diagnostics has typically relied on the estimation of the plasma electronic temperature, as there is a known correlation between this parameter and the quality of the seams. However, the practical use of this parameter gives rise to some uncertainties that could provoke ambiguous results. For an efficient on-line welding monitoring system, it is essential to prevent the appearance of false alarms, as well as to detect all the possible defects. In this regard, we propose the use of the root mean square signal of the welding plasma spectra, as this parameter will be proven to exhibit a good correlation with the quality of the resulting seams. Results corresponding to several arc-welding field tests performed on Inconel and titanium specimens will be discussed and compared to non-destructive evaluation techniques.

Design of computerized maintenance management system for the chilean naval hospital biomedical engineering department

The purpose of this project was to design and implement a computerized maintenance management system (CMMS) to be used at the Chilean Naval Hospital Biomedical Engineering Department. It is designed to meet the specific needs of this military facility and follows the generic clinical engineering maintenance management system suggested by Association for the Advancement of Medical Instrumentation (AAMI).

Photosensitizing properties of 6-methoxy-2-naphthylacetic acid, the major metabolite of the phototoxic non-steroidal anti-inflammatory and analgesic drug nabumetone

The photobiological properties of 6-methoxy-2-naphthylacetic acid (6-MNAA) were studied using a variety of in vitro phototoxicity assays: photohemolysis, photoperoxidation of linoleic acid, photosensitized degradation of histidine and thymine and the Candida phototoxicity test. 6-MNAA was phototoxic in vitro. 6-MNAA reduced nitro blue tetrazolium (NBT) when irradiated with lambda > or = 300 nm in deoxygenated aqueous buffer solution (pH 7.4). NBT can be reduced by reaction with the excited state of 6-MNAA subject to interference with molecular oxygen. The photohemolysis rate was inhibited by the presence of 1,4-diazabicyclo[2.2.2]octane (DABCO), sodium azide (NaN3) and reduced glutathione (GSH). Photoperoxidation of linoleic acid and photosensitized degradation of histidine and thymine were significantly inhibited by sodium azide and reduced glutathione. 6-MNAA was phototoxic to C. albicans, C. lipolytica and C. tropicalis. A mechanism involving singlet oxygen, radicals, and electron transfer reactions is suggested for the observed phototoxicity.

Mycophenolate mofetil in steroid/cyclosporine-dependent/resistant nephrotic syndrome

Attempts to minimize the effects of prolonged steroid use in steroid-dependent nephrotic syndrome (SDNS) and the need to overcome steroid resistance (SRNS) justifies immunosuppressant therapy. We report our experience in a cohort of patients with SD/SRNS during the administration of mycophenolate mofetil (MMF) in a prospective protocol initiated in January 2001. Twenty-six children with idiopathic nephrotic syndrome were included (21 steroid dependent and 5 steroid resistant), whose response did not change after sequential treatment with cyclophosphamide (CPM) and cyclosporine (CsA). Histopathologic patterns were: 11 minimal change disease (MCD), 1 diffuse mesangial proliferation (DMP), 13 focal segmental glomerulosclerosis (FSGS) and membranous 1 glomerulonephritis (MGN). The median age of onset of NS was 2.8 years (range 1.2-12.5), and treatment with MMF was performed at a median age of 11.4 years (range 5-17) with an initial dose of 600 mg/m(2)/12 h, adjusted to maintain levels of mycophenolic acid (MPA) at 2.5-5 mcg/ml. The planned duration of study to assess treatment efficacy was 6 months. The mean MMF dose required was 624 (SD=136) mg/m(2)/12 h (range 415-970), which maintained mean C(0)-MPA levels of 2.9 (SD=1.17) mcg/ml (range 1.2-5.9 mcg/ml). In the five patients with SRNS, only one achieved complete remission. In the patients with SDNS, steroid sparing was achieved in 15 and 9 remained in remission on MMF monotherapy. Withdrawal of MMF resulted in immediate relapse in 47%. In our study, MMF was a useful immunosuppressant due to its fewer undesirable effects and similar efficacy to other drugs used. It appears effective for the maintenance of remission in SDNS patients, with a response similar to that of CsA.

7-day rescue therapy with ranitidine bismuth citrate after Helicobacter pylori treatment failure

BACKGROUND

Quadruple rescue therapy requires a complex scheme with four drugs.

AIM

To evaluate the efficacy of ranitidine bismuth citrate-tetracycline-metronidazole rescue regimen, and to compare two different metronidazole dose schemes.

METHODS

Prospective multicentre study including proton-pump inhibitor + clarithromycin + amoxicillin failures. Rescue regimen included two 7-day treatment: (i) ranitidine bismuth citrate (400 mg b.d.)-tetracycline (500 mg q.d.s.)-metronidazole (500 mg t.d.s.; RTM1); or (ii) the same regimen but with metronidazole 250 mg q.d.s. (RTM2). Eradication was confirmed with (13)C-urea breath test.

RESULTS

A total of 150 patients were included (58 RTM1, 92 RTM2). All patients but two (one in each group) returned after treatment. About 86% in group RTM1 and 95% in RTM2 correctly took all the medications (P = 0.076). Per-protocol eradication rates with RTM1 and RTM2 were 74 (95% CI: 60-84) and 69% (59-78). The intention-to-treat eradication rates were 64 (51-75) and 70% (59-78; P > 0.05). The type of regimen was not associated with eradication in the multivariate analysis. Adverse effects were more frequent with RTM1 (41%) than with RTM2 (30%; P > 0.05).

CONCLUSION

Seven-day triple rescue therapy with ranitidine bismuth citrate-tetracycline-metronidazole is effective for Helicobacter pylori eradication, and represents an encouraging alternative to quadruple therapy, with the advantage of simplicity. The administration of metronidazole every 6 h (together with tetracycline), and at a low dose (250 mg), achieves similar efficacy and is probably associated with a better compliance and a lower incidence of adverse effects.