Synthesis and Testing of Analogs of the Tuberculosis Drug Candidate SQ109 against Bacteria and Protozoa: Identification of Lead Compounds against Mycobacterium abscessus and Malaria Parasites

SQ109 is a tuberculosis drug candidate that has high potency against Mycobacterium tuberculosis and is thought to function at least in part by blocking cell wall biosynthesis by inhibiting the MmpL3 transporter. It also has activity against bacteria and protozoan parasites that lack MmpL3, where it can act as an uncoupler, targeting lipid membranes and Ca2+ homeostasis. Here, we synthesized 18 analogs of SQ109 and tested them against M. smegmatis, M. tuberculosis, M. abscessus, Bacillus subtilis, and Escherichia coli, as well as against the protozoan parasites Trypanosoma brucei, T. cruzi, Leishmania donovani, L. mexicana, and Plasmodium falciparum. Activity against the mycobacteria was generally less than with SQ109 and was reduced by increasing the size of the alkyl adduct, but two analogs were ∼4-8-fold more active than SQ109 against M. abscessus, including a highly drug-resistant strain harboring an A309P mutation in MmpL3. There was also better activity than found with SQ109 with other bacteria and protozoa. Of particular interest, we found that the adamantyl C-2 ethyl, butyl, phenyl, and benzyl analogs had 4-10× increased activity against P. falciparum asexual blood stages, together with low toxicity to a human HepG2 cell line, making them of interest as new antimalarial drug leads. We also used surface plasmon resonance to investigate the binding of inhibitors to MmpL3 and differential scanning calorimetry to investigate binding to lipid membranes. There was no correlation between MmpL3 binding and M. tuberculosis or M. smegmatis cell activity, suggesting that MmpL3 is not a major target in mycobacteria. However, some of the more active species decreased lipid phase transition temperatures, indicating increased accumulation in membranes, which is expected to lead to enhanced uncoupler activity.

Inequalities in the participation and outcomes of breast cancer screening programs in Valencia, Spain

Background

Breast cancer remains the most frequent tumour and first cancer related cause of death in the Valencian Community. Despite most of the population being aware of the existence of breast cancer screening programs (BCSP), there are great differences in uptake that are likely attributed to social determinants. The objective of this study, alligning with SDGs 3 and 10, is to assess inequalities in breast cancer screening uptake, diagnosis and treatment delay in the city of Valencia.

Methods

The population of study included 128 123 women invited to participate in the BCSP in the city of Valencia between 2014 and 2016. Uptake, diagnosis and treatment delay were assessed as outcomes. Covariates included country of origin, education level, size of family unit, risk of vulnerability, age, presence of disability, assigned health department and a social deprivation index. Bivariate analysis and logistic regression models were performed for each independent variable.

Results

BCSP uptake was of 63,8% with a diagnostic rate of 5,36‰. 76,7% of patients were below the 75th percentile of delay between diagnosis and treatment (52 days). Statistically significant relationships were found between uptake of BCSP and all studied covariates both in the bivariate analysis and regression model. Presence of disability, family unit size, age and health department had a statistically significant relationship with diagnosis in the bivariate analysis, of which only one health department and the social deprivation index’s second quintile remained significant in the regression model. No significant relations were found between treatment delay and any of the covariates.

Conclusions

Strong inequalities in the BCSP have been identified. Influencing factors must be targeted so as to ensure an egalitarian access to BCSP. Given its multifactorial nature, simple analyses must be avoided in the study of inequalities in breast cancer diagnosis. Data on lifestyle may contribute to future models.

Key messages

Social determinants continue to have an impact in the uptake of breast cancer screening programs in the city of Valencia. The assessment of inequalities in breast cancer diagnosis cannot be approached uniquely through the analysis of social determinants and may Benefit from the inclusion of data on lifestyle choices.

DOSE REFERENCE LEVELS IN SPANISH INTRAORAL DENTAL RADIOLOGY: STABILISATION OF THE INCORPORATION OF DIGITAL SYSTEMS IN DENTAL CLINICAL PRACTICES

A total of 34 044 official quality assurance reports in dental radiodiagnostic surgery from 16 regions of Spain, compiled from 2002 to 2014, were studied in order to determine the progress of diagnostic reference levels (DRLs) for obtaining diagnostic images under normal conditions for clinical practice in Spanish dental clinics. A DRL of 2.8 mGy was set in 2014, which represents a 41.7 % decrease compared with that of 2002 (4.8 mGy). Over the same time period, the mean dose fell by 55.2 %. However, over the last 3 y, the stabilisation of the mean dose administered to patients has been observed with only a 6.7 % reduction in DRLs, which corresponds to the stabilisation of dental radiodiagnostic surgery on replacing the use of radiographic film with digital imaging systems.

Single fraction volumetric modulated arc radiosurgery of brain metastases

PURPOSE

To show the clinical results of the treatment of brain metastases via radiosurgery using Volumetric Modulated Arc Therapy (VMAT).

MATERIALS AND METHODS

52 patients having lung (62 %), breast (17 %), colorectal (8 %) and other cancers (13 %) with one to three brain metastases were treated with 5 non-coplanar VMAT arcs. The treatment dose varied from 12 to 20 Gy, administered in one single session. The volume of metastases ranged from 0.04 to 24.92 cc. Radiosurgery alone was used for 54 % of cases, while 19 % received whole brain radiotherapy due to relapse. Patients were classified according to the Disease-specific graded prognostic assessment (DS-GPA) index and survival was assessed via the Kaplan-Meier model.

RESULTS

The median survival time was 7.2 months from the date of radiosurgery. The Karnofsky and DS-GPA indices were the most significant with regard to survival. Patients with a Karnofsky performance status (KPS) over 70 had a longer survival time of 9.2 months, as opposed to those with a KPS below 70 of 3.5 months. No significant differences were found with regard to the type of cancer or the number of lesions. Local tumour control was achieved for 42 metastases (82 %), of which a complete response was achieved for 7 lesions, a partial response for 21; 15 lesions were stabilized. Local progression was observed in 8 lesions (15 %). The median treatment time per patient was 29 min.

CONCLUSIONS

The VMAT technique proves to be safe and effective for treating brain metastases via radiosurgery.

Transcutaneous oxygen tension measurements following peripheral transluminal angioplasty procedure has more specificity and sensitivity than ankle brachial index

OBJECTIVE

To evaluate the superiority of transcutaneous oxygen pressure (TcPO2) before, during and after peripheral transluminal angioplasty (PTA) in comparison with ankle brachial index (ABI) in patients with diabetes.

METHODS

40 consecutive patients with diabetes treated by PTA where included. This study shows results before, during and after PTA and their progression for 8 weeks.

RESULTS

The TcPO2 increased from 28.11 ± 8.1 to 48.03 ± 8.4 mmHg, 8 weeks after PTA (p < 0.001). The ABI increased from 0.48 ± 0.38 to 0.77 ± 0.39 after PTA (p < 0.001). After PTA, the stenosis of the vessel decreased from 58.33 ± 20.07% to 21.87 ± 13.57% (p < 0.001). TcPO2 was determined in all the patients, but ABI could not be determined in all patients. Furthermore, we determined patients with "false negatives" with an improvement in ABI and "false positives" in 12.5% of patients. Additionally, in this study, we monitored TcPO2 while performing PTA, revealing variations in each phase of the radiological procedure.

CONCLUSION

The increase in TcPO2 measurements following PTA procedure has more specificity and sensitivity than does ABI. The use of TcPO2 may represent a more accurate alternative than traditional methods (ABI) used in assessing PTA results. The TcPO2 also allows the radiologist to assess changes in tissue oxygenation during PTA, allowing changes to the procedure and subsequent treatment.

ADVANCES IN KNOWLEDGE

This is the first time that a graph is shown with TcPO2 results during PTA performance in many patients.

Evolution of diagnostic reference levels in Spanish intraoral radiology

A total of 16 175 official reports of quality assurance on dental radiodiagnostic surgeries from 16 Spanish autonomous regions compiled during 2002-09 were studied to determine the evolution of diagnostic reference levels (DRLs) for obtaining a diagnostic image in the normal conditions of clinical practice in Spanish dental clinics. A DRL of 3.1 mGy was set in 2009, which represents a 35.4 % decrease compared with the dose determined in 2002 (4.8 mGy). During the same period, the mean dose fell by only 17.2 %. The DRL recommended by the European Union in 2004 for intraoral radiology is 4 mGy, and this study shows that 83.4 % of the installations used a dose below this. Of the installations using indirect or direct digital systems 1.1 and 1.2 %, respectively, used doses higher than those recommended, while 14.2 % of those using radiographic film exceeded this limit.

Zoledronic acid and radiation: toxicity, synergy or radiosensitization?

INTRODUCTION

Zoledronic acid (Z) is a bisphosphonate used in hypercalcaemia-related cancer, in complications for bone metastasis and in postmenopausal osteoporosis and it has been related to osteoradionecrosis, especially when associated with radiation to the head and neck structures.

OBJECTIVES

To determine the radiosensitization capacity of zoledronic acid in the combined treatment with ionizing radiation (IR) by evaluating its genotoxic and cytotoxic capacities in non-tumoral cells.

MATERIALS AND METHODS

The genotoxic effect of Z was studied by means of the micronucleus test in cytokinesis-blocked cells of human lymphocytes irradiated before and after a 2 Gy irradiation, while the cytotoxic effect was studied by a cell viability test in the PNT2 cell line before and after exposure to different X-ray doses (0-20 Gy) in four groups (Z alone, radiation alone, Z + IR and IR + Z).

RESULTS

A dose-dependent and time-dependent cytotoxic effect of Z and IR on PNT2 cells in vitro (p > 0.001) was demonstrated. With the concentrations recommended for humans, the combined treatment had a more pronounced effect than individual treatments (p < 0.001). The effect was synergic (CI < 1), increasing the Z enhancement ratio (2.6) and sensitization factor (56 %); the effect of Z was always greater after IR exposure. In the genotoxic effect, only the administration of Z after irradiation (IR + Z) increased chromosome damage (p < 0.001) and the sensibilization factor (35.7 %).

CONCLUSION

High concentrations of Z are toxic, but the concentrations recommended for clinical practice in humans give it the characteristics of a radiosensitization agent, whose effect is even greater when administered after IR.

Chemical genoprotection: reducing biological damage to as low as reasonably achievable levels

OBJECTIVES

The aim of this study was to evaluate the antioxidant substances present in the human diet with an antimutagenic protective capacity against genotoxic damage induced by exposure to X-rays in an attempt to reduce biological damage to as low a level as reasonably possible.

METHODS

Ten compounds were assessed using the lymphocyte cytokinesis-block micronucleus (MN) cytome test. The compounds studied were added to human blood at 25 μM 5 min before exposure to irradiation by 2 Gy of X-rays.

RESULTS

The protective capacity of the antioxidant substances assessed was from highest to lowest according to the frequency of the MN generated by X-ray exposure: rosmarinic acid = carnosic acid = δ-tocopherol = l-acid ascorbic = apigenin = amifostine (P < 0.001) > green tea extract = diosmine = rutin = dimetylsulfoxide (P < 0.05) > irradiated control. The reduction in genotoxic damage with the radiation doses administered reached 58%, which represents a significant reduction in X-ray-induced chromosomal damage (P < 0.001). This degree of protection is greater than that obtained with amifostine, a radioprotective compound used in radiotherapy and which is characterised by its high toxicity.

CONCLUSION

Several antioxidant substances, common components of the human diet and lacking toxicity, offer protection from the biological harm induced by ionizing radiation. Administering these protective substances to patients before radiological exploration should be considered, even in the case of small radiation doses and regardless of the biological damage expected.

The status of Spain's dental practice following the European Union directive concerning radiological installations: 11 years on (1996-2007)

OBJECTIVES

The aim of this study was to assess the influence of European Union legislation on dental radiology practice in Spain and the reduction in doses administered in dental radiological installations 11 years after its introduction.

METHODS

A total of 19 079 official reports on dental surgeries from 16 Spanish autonomous regions published between 1996 and 2007 were studied. We analysed the physical characteristics of the X-ray units, anomalies, film processing, exposure times and mean radiation doses administered in clinical situations.

RESULTS

The dose applied to obtain a radiograph of an upper second molar had decreased by 37% up until 2007, the mean dose being 2.7 mGy, with 81.1% of installations using a dose of less than 4 mGy, with a reference dose for the 3(rd) quartile of 3.6 mGy. Of note was the incorporation of digital systems (50.1%), which are gradually replacing manual processing systems (45.3%). There were significant differences between the systems: direct digital radiology < indirect digital radiology = Insight = Ektaspeed = Ultraspeed (P < 0.001). In installations with digital systems, 6.3% used more than 4 mGy (20.5% with direct radiology and 3.2% with indirect radiology) and 7.4% a dose of less than 0.5 mGy, with a mean dose of 1.8 mGy and a reference dose for the 3(rd) quartile of 2.3 mGy.

CONCLUSION

There has been a gradual improvement in dental radiology practices; however, the incorporation of digital systems has not resulted in all the benefits hoped for, and mistakes are frequent. Besides the physical parameters that have been established, anatomical and clinical image quality criteria should be established to convince dentists of the real benefits of incorporating quality guarantee procedures in their practices.

Diagnostic reference levels in intraoral radiology: from the laboratory to clinical practice

To determine the diagnostic reference levels (DRLs) for obtaining a diagnostic image in the normal conditions of clinical practice and to explain the differences between the levels found and the DRLs obtained in other experimental conditions, suggesting that there has been a reduction in the European Union (EU) recommended levels. A total of 2296 official reports on dental surgeries from 16 Spanish autonomous regions compiled during 2008 were studied. A mean DRL of 3.3 mGy was determined: 2.6 mGy for installations using direct digital systems, 3.4 mGy for those using indirect systems, 4.4 mGy for those using Ultra-speed film and 3.7 mGy for those using Insight. The DRLs found in this survey are below the EU recommended values but far above previously described values, possibly because all the different systems were considered and because values refer to those of the normal work conditions of clinical practice.

Collimator with filtration compensator: clinical adaptation to meet European Union recommendation 4F on radiological protection for dental radiography

OBJECTIVE

Our aim was to develop a compensated filtration collimator for use in paediatric patients undergoing cephalometric radiography that reduces the radiation dose administered and fulfils recommendation 4F of the European guidelines on radiation protection in dental radiology.

METHODS

An easy to use filtration-compensated collimator was constructed of plastic, lead and aluminium and used randomly with a group of 32 children (mean age 11 years) undergoing cephalometric radiography before receiving orthodontic treatment. The radiation doses administered to patients (eye lens and thyroid, submandibular and parotid glands) and to the chassis of the radiographic equipment were determined.

RESULTS

The filtration-compensated collimator is easily fixed to the external surface of the radiographic equipment and results in (a) as collimator, a reduction of 40% in the surface irradiated in the children and of 61.4% in the dose administered to the thyroid glands (P<0.001); (b) as filtration compensator, a reduction of 32.8% administered to the eye lens (P<0.001), 31.45% to the submaxillary gland (P<0.01) and 11.4% to the parotid gland (P<0.05); there was no difference in the dose determined on the radiographic film.

CONCLUSIONS

A radiographic examination can be carried out with children using only a third of the dose normally used with no increase in the time or cost involved.

Liposoluble antioxidants provide an effective radioprotective barrier

Ionising radiation causes the massive generation of reactive oxygen species and induces cellular DNA damage. The antioxidant, protective effects of several compounds against gamma-ray-induced chromosomal damage were determined by the micronucleus test, evaluating the reduction in the frequency of micronuclei in cytokinesis-blocked human lymphocytes. The compounds studied were added to human blood at 25 microM, 5 min before or after irradiation with 2 Gy of caesium-137. The results suggest that different protective mechanisms are operating in each case. When the phenolic compounds are added before gamma-irradiation, their protective antimutagenic activity is based on their scavenging capacity against superoxide anion (O(2)(.-)) and, especially, hydroxyl radical ((.)OH), regardless of whether they are oil- or water-soluble compounds. When the phenolic compounds are added after gamma-irradiation treatment, the protective effect relies on activity against reactive oxygen species present in cells, i.e. lipoperoxy radicals (R(-)OO(.)), which are mainly responsible for continuous chromosomal oxidative damage. In addition, ionising radiation enhances lysosomal enzyme secretion and arachidonate release from membranes through lipo-oxygenase, cyclo-oxygenase and phospholipase activities, thus increasing the inflammatory cell response. Only oil-soluble compounds, such as carnosic acid, carnosol and delta-tocopherol, provide a significant protective antimutagenic activity. The most powerful water-soluble antioxidants lack the capacity to protect against gamma-ray-induced damage. The difference between anti-radical and anti-lipoperoxidant activities could explain the different behaviour of the compounds tested in terms of protecting against the lipid peroxidative processes. This anti-lipoperoxidant activity depends on several factors, but it is clear that only the lipo-antioxidants are effective in protecting human cells against oxidative damage, even when administered after exposure to ionising radiation.

Rosmarinic acid, a photo-protective agent against UV and other ionizing radiations

Solar UV and other ionizing radiations cause a generation of reactive oxygen species, induce cellular DNA damage and alter skin homeostasis. The use of exogenous antioxidants is increasingly frequents, we attempt to demonstrate that a rosmarinic acid extract acts as photo-protector; both free radical scavenger as an inducer of the body's own endogenous defence mechanisms by regulating tyrosinase activity and stimulating melanin production. Malonyldialdehyde formation (TBARS) was delayed when RA was used. The protection factor was 3.24 times vs AA. TEAC value for RA was 1.6 times vs AA. The radioprotective-antimutagenic effects of RA were measure using the micronucleus test. The level of micronucleous for treatments before irradiation was: RA [14] Collapse

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MESH Headings

• Animals
• Antioxidants/chemistry
• Antioxidants/pharmacology
• Cinnamates/chemistry
• Cinnamates/pharmacology
• DNA Damage/drug effects
• Depsides/chemistry
• Depsides/pharmacology
• Female
• Humans
• In Vitro Techniques
• Linoleic Acid/chemistry
• Lymphocytes/drug effects
• Lymphocytes/radiation effects
• Malondialdehyde/metabolism
• Mice
• Micronuclei, Chromosome-Defective/drug effects
• Micronuclei, Chromosome-Defective/radiation effects
• Micronucleus Tests
• Neoplasms, Radiation-Induced/prevention & control
• Oxidation-Reduction
• Plant Extracts/chemistry
• Plant Extracts/pharmacology
• Radiodermatitis/etiology
• Radiodermatitis/pathology
• Radiodermatitis/prevention & control
• Skin/drug effects
• Skin/pathology
• Skin/radiation effects
• Skin Neoplasms/etiology
• Skin Neoplasms/prevention & control
• Sunscreening Agents/chemistry
• Sunscreening Agents/pharmacology
• Ultraviolet Rays/adverse effects
• Rosmarinic Acid

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Beneficial action of Citrus flavonoids on multiple cancer-related biological pathways

Attempts to control cancer involve a variety of means, including the use of suppressing, blocking and transforming agents. Suppressing agents prevent the formation of new cancers from pro-carcinogens, blocking agents prevent carcinogenic compounds from reaching critical initiation sites, while transformation agents act to facilitate the metabolism of carcinogenic components into less toxic materials or to prevent their biological actions. Flavonoids can act as all three types of agent. Epidemiological and animal studies suggest that flavonoids have a protective effect against cardiovascular diseases and some types of cancer. Although flavonoids have been studied for about 50 years, the cellular mechanisms involved in their biological action are still not completely understood. In recent years, experimental studies have provided growing evidence supporting the beneficial action of flavonoids on multiple cancer-related biological pathways (carcinogen bio-activation, cell-signaling, cell cycle regulation, angiogenesis and inflammation). Within the last decade, reports on flavonoid activity have largely associated with enzyme inhibition and anti-proliferative activity. Many of these studies have pointed to a structural-functional relationship, in that the antioxidant, enzyme-inhibition or antiproliferative activities of flavonoids are dependent on particular structural motifs. Our own studies have shown that structural factors would explain the antioxidant, antiproliferative and antimetastatic properties of some citrus flavonoids. In this paper we discuss the relation between each structural factor and the anticancer activity of Citrus flavonoids.

Osteochondroma of the phalanx: a late Roman case

Accounting for 20-50% of all benign forms, solitary osteochondromae are the most common kind of bone tumour. The long bones of the lower extremity are the most frequently affected; the small bones of the hands and feet, the pelvis, the scapula, and the spine are less usual locations. This paper describes an osteochondroma in a proximal phalanx of the hand of a female aged between 17 and 25 years buried in a Late Roman necropolis from SE Spain. The bone displayed a solitary osteochondroma, which was confirmed by macroscopic and radiographic examination. This is the first palaeopathological example of a solitary sessile osteochondroma of the hand.

Dynamics of the parasite Marteilia refringens (Paramyxea) in Mytilus galloprovincialis and zooplankton populations in Alfacs Bay (Catalonia, Spain)

Since the first description of Marteilia refringens (Paramyxea) in flat oysters Ostrea edulis in 1968 in the Aber Wrach, Brittany (France), the life-cycle of this parasite has remained unknown. However, recent studies, conducted in the ‘claire’ system, have proposed the planktonic copepod Acartia grani as a potential intermediate host for the parasite. Nevertheless, experimental transmission of the parasite through the copepod has failed. Recent studies in this field have reported the presence of the parasite in zooplankton from the bays of the Delta de l'Ebre, a more complex and natural estuarine environment than that of the claire. As a result, 2 new Marteilia host species were proposed: the copepods Oithona sp. (Cyclopoida) and an indeterminate Harpaticoida. Consequently, the objective of the present work was to study the dynamics of Marteilia in the zooplankton community from one of the bays, Alfacs Bay, as well as the dynamics of the parasite in cultivated mussels during 1 complete year. Six different zooplankton taxa appeared to be parasitized by M. refringens, including copepods (3 Calanoida, Acartia discaudata, A. clausi and A. italica; 1 Cyclopoida, Oithona sp.; and 1 Harpacticoida, Euterpina acutifrons), and larval stages of decapod crustaceans (zoea larvae of Brachyura, probably Portumnus sp.). These taxa are thus proposed as new subjects for study, since they could be intermediate hosts in the infection process of mussels by Marteilia.

Dose reduction of intraoral dental radiography in Spain

OBJECTIVES

To assess the influence of new European Union (EU) legislation on radiation doses in intraoral dental radiography in Spain.

METHODS

A total of 10 109 official reports from Spanish dental offices covering the period 1996-2003 were analysed.

RESULTS

The results point to a dose reduction of 19% in 7 years, with a mean dose of 3.11 mGy being administered in 2003. The third quartile value in 2002 was 4.8 mGy. Taking the EU recommended dose of 4 mGy as standard, 73.3% (2002) and 77.3% (2003) of installations are in compliance with the EU recommendations in Spain. However, there has been no further reduction in the last 3 years. The results showed that Ultraspeed dental X-ray film was used by 77.6% of the dentists in 1996-1997 and 82.3 in 2003. There was infrequent use of E-speed films (0.6%) and F-speed films (9.6%) in 2003. Statistical analysis pointed to significant differences between the doses administered and the type of processing used, the lowest exposures being measured in digital systems, which used significantly lower doses than both manual and automatic development, and when conventional radiographic films were used.

CONCLUSION

The introduction of new legislation has resulted in a gradual reduction in the dose administered in intraoral dental radiology in Spain.

Radioprotective-antimutagenic effects of rosemary phenolics against chromosomal damage induced in human lymphocytes by gamma-rays

The radioprotective effects of carnosic acid (CA), carnosol (COL), and rosmarinic acid (RO) against chromosomal damage induced by gamma-rays, compared with those of L-ascorbic acid (AA) and the S-containing compound dimethyl sulfoxide (DMSO), were determined by use of the micronucleus test for antimutagenic activity, evaluating the reduction in the frequency of micronuclei (MN) in cytokinesis-blocked cells of human lymphocytes before and after gamma-ray irradiation. With treatment before gamma-irradiation, the most effective compounds were, in order, CA > RO > or = COL > AA > DMSO. The radioprotective effects (antimutagenic) with treatment after gamma-irradiation were lower, and the most effective compounds were CA and COL. RO and AA presented small radioprotective activity, and the sulfur-containing compound DMSO lacked gamma-ray radioprotection capacity. Therefore, CA and COL are the only compounds that showed a significant antimutagenic activity both before and after gamma-irradiation treatments. These results are closely related to those reported by other authors on the antioxidant activity of the same compounds, and the degree of effectiveness depends on their structure. Furthermore, the results for treatments before and after gamma-ray irradiation suggest the existence of different radioprotective mechanisms in each case.

The effect of the flavonoid diosmin, grape seed extract and red wine on the pulmonary metastatic B16F10 melanoma

OBJECTIVE

To study the effect of different phenolic compounds and red wine on pulmonary metastatic melanoma.

METHODS

Swiss mice were inoculated with 500000 melanocytes B16F10 and given oral doses of diosmin, grape seed extract (GSE) and red wine. A macroscopic count was made of the metastatic nodules on the lung surface and a microscopic study by image analysis of five sections, calculating the implantation percentage and tumoral growth and invasion indices.

RESULTS

Macroscopically, the group treated with diosmin showed the greatest reduction (52%) in the number of metastatic nodules compared with the control group, which was treated with ethanol, while GSE and red wine caused decreases of 26.07 and 28.81%, respectively. Microscopically, there was a decrease in the implantation percentage after the administration of diosmin (79.4%) and red wine (20.19%), and an increase of 2.12% after the administration of GSE, all relative to the ethanol-treated control. As regards the growth index, diosmin produced a reduction of 67.44% and red wine a reduction of 20.62%, while GSE again produced an increase (25.33%). The reductions in the invasion index were 45.23, 31.65 and 17.57% with diosmin, GSE and red wine, respectively.

CONCLUSIONS

Diosmin originated the greatest reduction in pulmonary metastases, both at the macroscopic and microscopic levels.

The status of Spain's dental practices following the European Union directive concerning radiological installations

OBJECTIVES

To assess the influence of new European Union (EU) legislation on dental radiology practices and the reduction in patient radiation exposure.

STUDY DESIGN

A total of 7176 official reports from Spanish dental offices or clinics covering the period 1996 to 2001 were analyzed.

RESULTS

Of the dental radiological installations inspected in 2001, 72.79% used the kilovoltage recommended by the EU (70 kVp) and 98.85% used at least 1.5 mm Al filtration. At least 90.11% of the installations had a focal film distance of 20 cm although there were no cases with a rectangular collimator as adapted to the size of film. Thirty percent of the installations showed a mechanical fault every year. In 17.62% of cases the radiological film was stored in the exposure room. Few clinics (10.24%) used high-speed films and only 11.95% of clinics employed digital systems. The mean dose received by patients fell during the 5 years studied by 18.75%. Radiological equipment fulfilling the EU specifications emitted significantly lower doses than other nonapproved equipment.

CONCLUSIONS

The introduction of legislation has resulted in a gradual improvement in dental radiology practices.

Effects of small-scale turbulence on bacteria: a matter of size

We examined the influence of small-scale turbulence and its associated shear on bacterioplankton abundance and cell size. We incubated natural microbial assemblages and bacteria-only fractions and subjected them to treatments with turbulence and additions of mineral nutrients and/or organic carbon. Bacterial abundance was not affected directly by turbulence in bacteria-only incubations. In natural microbial assemblage incubations, bacterial concentrations were higher under turbulence than in still-water controls when nutrients were added. In general, in the turbulence treatments bacteria increased significantly in size, mainly due to elongation of cells. The addition of inorganic nutrients had a negative effect on bacterial size, but a significantly positive effect on abundance independently of other factors such as turbulence and the presence of predators. Flagellate grazing did not trigger an increase in bacterial size as a grazing resistance response in unmixed containers. With the addition of organic carbon, bacteria elongated and partly settled to the bottom of the containers, in both the turbulent and still treatment, but bacterial abundance did not further increase. Furthermore, bacteria aggregated in the turbulence treatments after the second day of incubation even in the absence of other components of the microbial community. We found that turbulence and the associated shear increase bacterial size and change bacterial morphology, at least under certain nutrient conditions. This might be due to a physiological response (enhanced growth rate and/or unbalanced growth) or due to the selection of opportunistic strains when organic carbon is in excess compared to mineral nutrients. We suggest that shear associated with turbulent flow enhances the DOM flux to bacteria directly as well as indirectly through enhanced grazing activity and photosynthetic release. The formation of bacterial aggregates and filaments under turbulence might give selective advantage to bacteria in terms of nutrient uptake and grazing resistance.

Radioprotective Effects Against Chromosomal Damage Induced in Human Lymphocytes by gamma-Rays as a Function of Polymerization Grade of Grape Seed Extracts

The quantitative distribution of flavan-3-ols was determined using high-performance liquid chromatography in several grape seed extracts (GSEs). In all GSEs, polymers of four or more carbon units were the group of procyanidins present in the highest concentration, the real quantity ranging between 60% and 99.5%. In a previous paper we established a relation between antioxidant and anticlastogenic activity of GSEs. A higher grade of polymerization in GSEs allows the existence of a higher number of conjugated structures and higher antioxidant activity. The radioprotective effects of GSEs with various grades of polymerization were determined by use of the micronucleus test for anticlastogenic activity, evaluating the reduction in the frequency of micronuclei in cytokinesis-blocked cells of human lymphocytes exposed to gamma-rays. The radioprotective efficiency of GSEs was according to their grade of polymerization: GSE3 > GSE2 > GSE1 > dimethylsulfoxide. The higher antioxidant capacity and anticlastogenic activity of GSEs can be explained, structurally, by the high number of conjugated structures between the catechol groups in the B-rings and the 3-OH free groups of the polymeric polyphenolic skeleton and, in addition, by the stability of the aroxyl flavonoid radical generated in the processes.

Radioprotective effects in vivo of phenolics extracted from Olea europaea L. leaves against X-ray-induced chromosomal damage: comparative study versus several flavonoids and sulfur-containing compounds

The radioprotective effects of a polyphenolic extract of Olea europaea L. leaves (OL); the flavonoids diosmin and rutin, which are widely used as pharmaceuticals; and the sulfur-containing compounds dimethylsulfoxide (DMSO) and 6-n-propyl-2-thiouracil (PTU) were determined by using the micronucleus test for anticlastogenic activity, evaluating the reduction of the frequency of micronucleated polychromatic erythrocytes (MnPCEs) in bone marrow of mouse before and after X-ray irradiation. With treatment before X-irradiation, the most effective compounds were, in order, rutin > DMSO > OL > PTU > diosmin. These results showed, for the polyphenols studied, a linear correlation (r(2) = 0.965) between anticlastogenic activity and antioxidant capacity. The magnitude of protection with treatment after X-irradiation were lower, and the most effective compounds were, in order, OL > diosmin > rutin; DMSO and PTU lacked radioprotective activity. Therefore, OL is the only substance that showed a significant anticlastogenic activity both before and after X-ray irradiation treatments. Structurally, the free oxygen radicals and lipoperoxyradicals scavenging capacity and, consequently, the anticlastogenic activity of these polyphenolic compounds are based principally on the presence of specific functional groups, mainly catechol groups (rutin, oleuropein, hydroxytyrosol, verbascoside, luteolin), that also increase the stability of the aroxyl-polyphenol radical generated in the above processes.

Effects of several polyhydroxylated flavonoids on the growth of B16F10 melanoma and Melan-a melanocyte cell lines: influence of the sequential oxidation state of the flavonoid skeleton

The response of B16F10 melanoma and Melan-a melanocyte cell lines to treatment with five polyhydroxylated flavonoids and gallic acid, after 24 and 72 h of exposure, was determined, and the relationship between any antiproliferative effects observed and the chemical structure is discussed. After 24 h, none of the studied compounds showed significant cytotoxic activity in the B16F10 cell line, whereas compounds with an adjacent trihydroxylated substitution pattern did affect the viability of the Melan-a cell line. After 72 h of exposure, myricetin, baicalein and gallic acid significantly inhibited both B16F10 and Melan-a cell cultures, whereas luteolin and quercetin had only a moderate effect. Eriodictyol only had an effect on Melan-a cell viability, which was reduced slightly. These results suggest that the presence of a C2-C3 double bond and three adjacent hydroxyl groups in the flavonoid A- or B-rings confers greater antiproliferative activity to the flavonoid.

[Study of non-participation in the breast cancer screening program in the city of Valencia (Spain)]

AIM

To determine the reasons for non-participation of women in a breast cancer screening program.

METHODS

We performed an observational, cross-sectional study in women who were invited to participate in the breast cancer screening program in the city of Valencia and who failed to attend. The women were interviewed in their homes through a questionnaire consisting of 25 questions grouped as follows: knowledge of the program, reasons for nonparticipation, attitudes or beliefs and characteristics of the interviewees (socioeconomic and educational variables and age). A descriptive analysis was performed. Differences in the characteristics of women were evaluated through bivariate analysis. Multivariate analysis was performed through logistic regression.

RESULTS

A total of 783 addresses were used, 411 questionnaires were completed and 361 were analyzed. The 50 questionnaires used in the pilot study were excluded because, as a consequence of this study, the questionnaire had been modified. Most of the women (93.4%) (CI: 90.3-95.7) remembered having an appointment. The main reason for not attending was being screened in another health service in 48.8% (CI: 43.6-53.9), followed by various personal reasons in 16.1% (CI: 12.3-19.9) and inability to keep the appointment at the specified time in 15.5% (CI: 11.8-19.2). Comparison of women in the middle and upper social classes with those in the lower classes revealed important differences. Middle and upper class women had a higher probability of knowing about the program and of being on hormone replacement therapy (HRT) and the most frequent reason for non-attendance was attendance at another program run by another health service. In lower class women the reasons for non-attendance were fear, not believing the program to be important to health and inability to keep the appointment at the specified time. In the multivariate analysis, the variables that entered the model were HRT, social class and education. Thus, middle or upper class women undergoing HRT and with secondary or higher education had a higher probability of being screened.

CONCLUSIONS

The profile of non-participating women belongs on the one hand to those in the middle or upper social classes, undergoing HRT and being screened by other health services and, on the other, to a group of women of low social class, whose reason for non-participation is fear and timetable difficulties.

Effects of several flavonoids on the growth of B16F10 and SK-MEL-1 melanoma cell lines: relationship between structure and activity

Although flavonoids seem to be capable of acting at all stages of the carcinogenic process, little information is available on their action in melanoma cell lines. The aim of this study was to assess the response of B16F10 and SK-MEL-1 melanoma cell lines to treatment with six different flavonoids after 24 and 72 h of exposure and to relate the response to their structure. We then compared the findings with those for melphalan treatment. When cultures were treated for 24 h, only slight inhibition at the highest concentrations (25 and 50 microM) of tangeretin and luteolin were observed, whereas melphalan caused a dose-related inhibition of growth at all concentrations. Quercetin, hesperetin, 7,3'-dimethylhesperetin and eriodictyol did not produce any effect at 24 h on B16F10 or SK-MEL-1 cells, results which point to the low toxicity of flavonoids. After 72 h of exposure culture growth was inhibited by 7,3'-dimethylhesperetin at 50 microM, but lower concentrations had no effect. Tangeretin was the most effective of the flavonoids in inhibiting B16F10 and SK-MEL-1 cell growth, showing a clear dose-response curve after 72 h. These results suggest that the absence of the C2-C3 double bond on hydroxylated flavonoids results in a loss of effect on both the cell lines, while the higher activity of tangeretin compared with 7,3'-dimethylhesperetin suggests that the presence of at least three adjacent methoxyl groups confers a more potent antiproliferative effect.

Oral Cerebrolysin enhances brain alpha activity and improves cognitive performance in elderly control subjects

Cerebrolysin is a porcine brain derived peptide preparation with potential neurotrophic activity. The effects of a single oral dose of the Cerebrolysin solution (30 ml) on brain bioelectrical activity and on cognitive performance were investigated in healthy elderly people. A single oral dose of Cerebrolysin induced a progressive increase in relative alpha activity power from 1 to 6 hours after treatment in almost all the brain electrodes in elderly control subjects. As compared with baseline alpha power (45.8+/-9.5%), the increase in relative alpha activity in the left occipital electrode (O1) reached significant values at 1 hour (57.2+/-8.5%; p < 0.05), 3 hours (59.4+/-7.6%; p < 0.05) and 6 hours (63.4+/-9.8%; p < 0.05) after Cerebrolysin administration. Enhancement in relative alpha power was accompanied by a generalized decrease in slow delta activity that was maximum at 6 hours after Cerebrolysin intake. A significant improvement in memory performance, evaluated with items of the ADAS cog, was also found in elderly people taken a single dose of oral Cerebrolysin (6.9+/-1.0 errors at baseline versus 4.9+/-1.0 errors after treatment; p < 0.01). This memory improvement was more evident in recognition (2.8+/-0.6 errors vs. 1.5+/-0.7 errors; p < 0.05) than in recall tasks (4.1+/-0.5 errors versus 3.4+/-0.5 errors; ns). These data indicate that Cerebrolysin potentiates brain alpha activity, reduces slow EEG delta frequencies and improves memory performance in healthy elderly humans, suggesting that this compound activates cerebral mechanisms related to attention and memory processes. According to the present results, it seems that oral Cerebrolysin might be useful for the treatment of memory impairment and brain damage in eldely subjects with or without neurodegenerative disorders.

Seawater-atmosphere O(2) exchange rates in open-top laboratory microcosms: application for continuous estimates of planktonic primary production and respiration

Seawater-atmosphere O(2) exchange rates were experimentally measured in open-top laboratory microcosms. The objective was to establish the relationships between turbulence and oxygen transfer velocity, and thus correct continuously measured day-night changes in dissolved oxygen as estimates of planktonic primary production and respiration. After saturating 15-l sterile seawater microcosms with an oxygen-poor gas mix (4.9% O(2), 95.1% N(2)), the microcosms were left to equilibrate with the atmosphere under different turbulence conditions. The rate of increase in dissolved O(2) was measured at 15-min intervals with polarographic-pulsed electrodes and the corresponding values of the oxygen transfer velocity (the K(O(2)) constant for the different turbulence conditions) were determined. After pooling these and literature data obtained in similar experimental conditions, the relation between epsilon (turbulent kinetic energy dissipation rates) and K(O(2)) was determined. Theoretical K(O(2)) values were also calculated using semi-empirical models in which oxygen transfer velocity (K(O(2))) is related to wind velocity. Theoretical, wind related K(O(2)) values were significantly higher than the experimental ones, and as a consequence overestimate primary production and underestimate respiration rates, even resulting in nocturnal O(2) increase. The magnitude of the differences between experimentally derived and theoretically calculated oxygen transfer velocity, precludes the use of wind-derived equations to calculate K(O(2)) in meso- and microcosms experiments not affected by wind, while the equation obtained relating experimental epsilon and K(O(2)) provides statistically reliable estimations of primary production and respiration.

Antioxidant activity and radioprotective effects against chromosomal damage induced in vivo by X-rays of flavan-3-ols (Procyanidins) from grape seeds (Vitis vinifera): comparative study versus other phenolic and organic compounds

The quantitative distribution of several flavan-3-ols was determined using HPLC in a grape (Vitis vinifera) seed extract (GSE) of four cultivars grown in the region of Murcia. Polymer >/= C(4) units made up the largest group of procyanidins in the GSE (90.92%, expressed as HPLC % area). The antioxidant activity of GSE and other reference compounds was investigated by measuring their ability to scavenge the ABTS(*)(+) radical cation (TEAC). The most effective compounds were, in order: GSE > rutin > (+)-catechin > diosmin >/= ascorbic acid. The radioprotective effects of GSE and other reference compounds were determined by using the micronucleus test for anticlastogenic activity, any reduction of the frequency of micronucleated polychromatic erythrocytes (MnPCEs) being evaluated in the bone marrow of mouse exposed to X-rays. The most effective compounds were, in order: GSE > rutin > dimethyl sulfoxide (DMSO) > ascorbic acid > 6-n-propyl-2-thiouracil-6c (PTU) > diosmin. The higher ABTS(*)(+) scavenging capacity and anticlastogenic activity of GSE can be explained, structurally, by the high number of conjugated structures between the catechol groups in the B-rings and the 3-OH free groups of the polymeric polyphenolic skeleton and, in addition, by the stability of the aroxyl flavonoid radical generated in the above processes.

Double-blind placebo-controlled study with citicoline in APOE genotyped Alzheimer's disease patients. Effects on cognitive performance, brain bioelectrical activity and cerebral perfusion

Cytidine 5'-diphosphocholine (citicoline) is a an endogenous intermediate in the biosynthesis of structural membrane phospholipids and brain acetylcholine. Citicoline has been extensively used for the treatment of neurodegenerative disorders associated with head trauma, stroke, brain aging, cerebrovascular pathology and Alzheimer's disease. In this study we have investigated the efficacy and safety of the treatment with citicoline versus placebo in patients with Alzheimer disease. Thirty patients (age = 73.0 +/- 8.5 years; range = 57-87 years) with mild to moderate senile dementia (GDS: stages 3-6) of the Alzheimer type were included in a double-blind, randomized and placebo-controlled clinical trial. After a 2-week period of drug washout, patients were treated with i) placebo (n = 17; age = 73 +/- 5 years) or ii) 1,000 mg/day of citicoline (n = 13; age = 76 +/- 9 years) for 12 weeks (84 days). Examinations were done at baseline (T0) and after the 12 weeks of treatment (T12). As compared to placebo, citicoline improved cognitive performance in Alzheimer's disease patients with APOE E4 (ADAS: difference between groups = -3.2 +/- 1.8 scores, p < 0.05; ADAS-cog: difference between groups = -2.3 +/- 1.5, ns); and this improvement on cognition was more pronounced (ADAS, p < 0.01; ADAS-cog: difference between groups = -2.8 +/- 1.3, p < 0.06) in patients with mild dementia (GDS < 5). Citicoline also increased cerebral blood flow velocities in comparison with placebo (p < 0.05) when transcranial Doppler recordings from both hemispheres were considered together, as well as diastolic velocity in the left middle cerebral artery (p < 0.05). Patients treated with citicoline showed an increase in the percentage of brain bioelectrical activity of alpha (occipital electrodes) and theta type (left side electrodes), accompanied by a decrease in relative delta activity particularly marked in the left temporal lobe. Significant differences with respect to placebo (p < 0.05) were observed for theta activity in several fronto-parieto-temporal electrodes of the left hemisphere. Treatment with citicoline tended to reduce serum IL-1 beta levels, mainly after 4 weeks of administration, with no modified blood histamine content. In addition, neither adverse side effects nor alterations in biological and hematological parameters were induced by citicoline. The present data indicate that citicoline (1,000 mg/day) is well tolerated and improves cognitive performance, cerebral blood perfusion and the brain bioelectrical activity pattern in AD patients. According to our results, it seems that citicoline might be a useful treatment in Alzheimer's disease, and that the efficacy of this compound is greater in patients with mild mental deterioration and/or bearing the epsilon 4 allele of the APOE.

[The evaluation of women's health promotion services: the internal client, the external client]

OBJECTIVES

To find the opinion of internal and external customers of the Women's Health Promotion Services; to obtain information about the perceptions and suggestions of both midwives and users of the service.

DESIGN

An observational study of the qualitative evaluation of a service provided in Primary Health Care, through an open questionnaire to midwives and focus groups with users.

SETTING

Health Area 4 in the Community of Valencia.

PARTICIPANTS

15 midwives from Health Area 4, 3 groups of women using the Pregnancy Follow-up Programme and 3 groups from the Programme of Integrated Care for climacteric women, coming from two Health Districts, one urban and one rural.

MAIN RESULTS

For midwives, coordination with general practitioners was better in the urban setting, and with Family Planning Centres in the rural one. Absence of team work with gynaecologists, and gynaecologists' failure to value midwives' work, were identified as problems.

CONCLUSIONS

Different patterns for the organisation and use of women's health promotion services were identified between the urban and rural setting. The problems of coordination identified by the midwives are not perceived as such by the service's users, who evaluated as satisfactory the Primary Care services received.

[Evolution of the practice of sperm cryopreservation and fate of the preserved specimens : retrospective study of testicular cancer]

Testis cancer, chemotherapy and radiation can induce temporary or permanent infertility in men. Cryopreservation of spermatozoa seems an absolute prerequisite in such situation for male patients who are old enough to procreate. We propose a national retrospective study carried out in 17 CECOS. This survey demonstrates a regular increase for semen preservation in testis cancer and analyses the modalities of gametes preservation and their possible use. In view of this activity, we propose a discussion of the attitude of the various CECOS and of particular cases involving ethical issues.

Ultrastructural study of the osteointegration of bioceramics (whitlockite and composite beta-TCP + collagen) in rabbit bone

Study examines the osteointegration of two porous ceramic implants, beta-tricalcium phosphate (beta-TCP) and a composite (beta-TCP-collagen), in femur and tibias of 20 New Zealand white rabbits, which were sacrificed 1 week and 1, 4, and 12 months postimplant so that radiological, optical microscopic, and ultrastructural studies could be carried out. The results show a progressive degradation and resorption of both implant materials by means of a macrophagic reaction, which is at its most intense 1 month postimplant. The materials are substituted by newly formed bone tissue starting at the host bone-implant interface, the substitution being almost total by the end of the study, although less completely and earlier than in the case of the composite. Both materials can be considered as potential substitutes for bone tissue since they are biocompatible, bioreabsorbable, and osteogenic.

Laurin-Sandrow syndrome (mirror hands and feet and nasal defects): description of a new case

A child with complete syndactyly of cup shaped hands and mirror polysyndactyly of the feet, together with a nasal defect, was identified out of a total of 1,031,439 livebirths. She had a pattern of multiple congenital anomalies which was similar to that first described by Laurin et al in 1964 and by Sandrow et al in 1970. Two more cases with a similar pattern of congenital anomalies have recently been published so this is the fifth reported case with this constellation.

Effects of radiation on rabbit thyroid gland ultrastructure

The ultrastructure of irradiated rabbit thyroid gland (0 Gy, as control, 4 Gy, 8 Gy, 12 Gy, 16 Gy and 20 Gy X-ray) is studied. The thyroid gland of the control group shows ultrastructural features similar to those described in other mammals. Modifications in follicular ultrastructure and interfollicular connective tissue ultrastructure as well as the presence of small thyroid follicles, probably neoformed, are found to be dose-dependent. Follicular epithelium varies from simple cuboidal to simple squamous, the latter being characteristic of the highest X-ray dose. Follicular cells show numerous cytoplasmic light vesicles and a very extensive rough endoplasmic reticulum consisting of vacuolated cisternae. Sloughed cells are present at 8 Gy. A well-developed interstitial glandular tissue consisting of extensive extracellular matrix, abundant collagen fibres and dilated, irregularly outlined capillaries are also present.

Study of postmortem blood circulation

The objective of this work was to study the postmortem redistribution of blood volumes and its influence of the distribution of substances of different molecular weight (194.2 and 150,000 Da). Lipiodol Ultrafluide, Omnitrast, or a radioisotopic mixture of aminohippuric acid and human IgG were injected into the left ventricle of a total of 20 rabbits divided into three groups. Our results demonstrate the importance of related factors, including left ventricular postmortem contraction, the arterial vascular bed, diffusion processes connected to the physicochemical characteristics of the substances, and the anatomical distribution of the vessels. Postmortem diffusion of aminohippuric acid to the urine was observed.