Transcriptome profiling of type VI secretion system core gene tssM mutant of Xanthomonas perforans highlights regulators controlling diverse functions ranging from virulence to metabolism

IMPORTANCE

T6SS has received attention due to its significance in mediating interorganismal competition through contact-dependent release of effector molecules into prokaryotic and eukaryotic cells. Reverse-genetic studies have indicated the role of T6SS in virulence in a variety of plant pathogenic bacteria, including the one studied here, Xanthomonas. However, it is not clear whether such effect on virulence is merely due to a shift in the microbiome-mediated protection or if T6SS is involved in a complex virulence regulatory network. In this study, we conducted in vitro transcriptome profiling in minimal medium to decipher the signaling pathways regulated by tssM-i3* in X. perforans AL65. We show that TssM-i3* regulates the expression of a suite of genes associated with virulence and metabolism either directly or indirectly by altering the transcription of several regulators. These findings further expand our knowledge on the intricate molecular circuits regulated by T6SS in phytopathogenic bacteria.

Estimated Glomerular Filtration Rate, Albuminuria, and Adverse Outcomes: An Individual-Participant Data Meta-Analysis

Importance

Chronic kidney disease (low estimated glomerular filtration rate [eGFR] or albuminuria) affects approximately 14% of adults in the US.

Objective

To evaluate associations of lower eGFR based on creatinine alone, lower eGFR based on creatinine combined with cystatin C, and more severe albuminuria with adverse kidney outcomes, cardiovascular outcomes, and other health outcomes.

Design, Setting, and Participants

Individual-participant data meta-analysis of 27 503 140 individuals from 114 global cohorts (eGFR based on creatinine alone) and 720 736 individuals from 20 cohorts (eGFR based on creatinine and cystatin C) and 9 067 753 individuals from 114 cohorts (albuminuria) from 1980 to 2021.

Exposures

The Chronic Kidney Disease Epidemiology Collaboration 2021 equations for eGFR based on creatinine alone and eGFR based on creatinine and cystatin C; and albuminuria estimated as urine albumin to creatinine ratio (UACR).

Main Outcomes and Measures

The risk of kidney failure requiring replacement therapy, all-cause mortality, cardiovascular mortality, acute kidney injury, any hospitalization, coronary heart disease, stroke, heart failure, atrial fibrillation, and peripheral artery disease. The analyses were performed within each cohort and summarized with random-effects meta-analyses.

Results

Within the population using eGFR based on creatinine alone (mean age, 54 years [SD, 17 years]; 51% were women; mean follow-up time, 4.8 years [SD, 3.3 years]), the mean eGFR was 90 mL/min/1.73 m2 (SD, 22 mL/min/1.73 m2) and the median UACR was 11 mg/g (IQR, 8-16 mg/g). Within the population using eGFR based on creatinine and cystatin C (mean age, 59 years [SD, 12 years]; 53% were women; mean follow-up time, 10.8 years [SD, 4.1 years]), the mean eGFR was 88 mL/min/1.73 m2 (SD, 22 mL/min/1.73 m2) and the median UACR was 9 mg/g (IQR, 6-18 mg/g). Lower eGFR (whether based on creatinine alone or based on creatinine and cystatin C) and higher UACR were each significantly associated with higher risk for each of the 10 adverse outcomes, including those in the mildest categories of chronic kidney disease. For example, among people with a UACR less than 10 mg/g, an eGFR of 45 to 59 mL/min/1.73 m2 based on creatinine alone was associated with significantly higher hospitalization rates compared with an eGFR of 90 to 104 mL/min/1.73 m2 (adjusted hazard ratio, 1.3 [95% CI, 1.2-1.3]; 161 vs 79 events per 1000 person-years; excess absolute risk, 22 events per 1000 person-years [95% CI, 19-25 events per 1000 person-years]).

Conclusions and Relevance

In this retrospective analysis of 114 cohorts, lower eGFR based on creatinine alone, lower eGFR based on creatinine and cystatin C, and more severe UACR were each associated with increased rates of 10 adverse outcomes, including adverse kidney outcomes, cardiovascular diseases, and hospitalizations.

Diastolic stress echocardiography in patients with normal resting diastolic function: prognostic utility in presence and absence of myocardial ischemia

Background

Abnormal diastolic response to exercise is reportedly associated with worse cardiovascular events. However, this has not been well studied in patients with normal diastolic function at rest.

Purpose

We sought to study diastolic response to exercise in patients referred for exercise stress echocardiography (ExE) and to explore its association with adverse outcomes in the presence and absence of exercise-induced myocardial ischemia.

Methods

In a retrospective study, patients referred for ExE to assess myocardial ischemia between April 2017 and December 2018 were enrolled. Patients were included if they had guideline-defined normal diastolic function at rest and availability of a full set of post exercise diastolic variables (post exercise tissue Doppler derived septal mitral annular early diastolic velocity (e'), ratio of pulsed Doppler derived mitral forward flow early diastolic velocity (E) over e' (E/e') and continuous wave Doppler derived maximum tricuspid regurgitation velocity (TRV)). The patients were followed for a median of 3.4 years for the occurrence of composite death, acute coronary syndrome, cardiac hospitalization, and need of follow-up ischemia testing. Abnormal exercise diastolic variables were defined as e' <7 cm/s, E/e' >15, and TRV >2.8 m/s.

Results

We studied 492 patients [age: 55.7±12.9 year, 268 (54%) women, EF: 61±5.8%]. Mean achieved metabolic equivalents of tasks (METs) was 9.7±3.1, and a total of 49 (10%) patients had evidence of exercise-induced ischemia. At rest, mean left atrial volume index was 25.4±12 ml, e' was 8±2 cm/s, E/e' was 9.5±2.4, and TRV was 2.1±0.44 m/s. Post exercise e' was 10±3 cm/s [<7cm/s in 63 (13%)], E/e' was 11.1±3.9 [>15 in 95 (19%)], and TRV was 2.37±0.68 m/s [>2.8 m/s in 152 (31%)]. Ischemic ExE was found to be strongly associated with the outcome (HR: 4.46, 95% CI: 2.8 to 7.1, p<0.001). In addition, all diastolic variables predicted the outcome in isolation if they were abnormal (e': 2.28, 95% CI: 1.4 to 3.7, p=0.001, E/e': 1.81; 95% CI: 1.15 to 2.84, p=0.01; TRV: 1.58, 95% CI: 1.17 to 2.13, p=0.003). When combined, however, association with the outcome was seen only when 2 or 3 of these variables were abnormal simultaneously (Figure 1A). When patients were stratified by ischemia and abnormal diastolic variables (figure 1B), patients with 2 or 3 abnormal variables were more likely to experience the outcome compared to patients with 0 or 1 abnormal variables in both absence of ischemia (p<0.001) and presence of ischemia (p=0.016). The stratified groups were different in their clinical and exercise profiles, with worse profiles in patients with both ischemia and 2 or 3 abnormal variables, and best profiles in patients with no ischemia and 0 or 1 abnormal variables.

Conclusions

In patients referred for ExE to assess ischemia with normal baseline diastolic function, exercise can unmask abnormal diastolic properties and stratify patients' risk regardless of the overt myocardial ischemia.

Funding Acknowledgement

Type of funding sources: None.

Urinary liver-type fatty acid-binding protein is independently associated with graft failure in outpatient kidney transplant recipients

Urinary liver-type fatty acid-binding protein (uL-FABP) is a biomarker of kidney hypoxia and ischemia, and thus offers a novel approach to identify early kidney insults associated with increased risk of graft failure in outpatient kidney transplant recipients (KTR). We investigated whether uL-FABP is associated with graft failure and whether it improves risk prediction. We studied a cohort of 638 outpatient KTR with a functional graft ≥1-year. During a median follow-up of 5.3 years, 80 KTR developed graft failure. uL-FABP (median 2.11, interquartile range 0.93-7.37 µg/24"/>h) was prospectively associated with the risk of graft failure (hazard ratio 1.75; 95% confidence interval 1.27-2.41 per 1-SD increment; P = .001), independent of potential confounders including estimated glomerular filtration rate and proteinuria. uL-FABP showed excellent discrimination ability for graft failure (c-statistic of 0.83) and its addition to a prediction model composed by established clinical predictors of graft failure significantly improved the c-statistic to 0.89 (P for F-test <.001). These results were robust to several sensitivity analyses. Further validation studies are warranted to evaluate the potential use of a risk-prediction model including uL-FABP to improve identification of outpatient KTR at high risk of graft failure in clinical care.

Quality of Laypersons' Assessment of Forensically Relevant Stimuli

The current study examined the potential for cognitive bias in lay examiners' comparisons of footwear impressions within the technical review process while addressing limitations of previous research. Prior research has found inconsistent results regarding the extent to which cognitive bias may influence forensic comparisons, often asking non-experts to review forensic stimuli above their competency level. Furthermore, past research has largely ignored the potential for cognitive bias during the technical review process. In collaboration with the Miami-Dade Police Department's Forensic Services Bureau, we examined the effects of previous examiners' level of experience and prior knowledge of the previous examiner's decision on the technical review stage of footwear impression stimuli. Before lay examiners were presented with pairs of known match and nonmatch footwear impressions, they were either told that an expert or a novice had previously examined them and determined them to be either a match, nonmatch, or inconclusive (plus a no-information condition). Participants then evaluated each pair of footwear impressions to make their own determinations of match, nonmatch, or inconclusive. Results support the technical review process for all decision types, as known nonmatch stimuli were generally more difficult for lay examiners to assess than known match stimuli. Knowledge of a prior examiner's decision and status was observed only when the prior decision was inconclusive, suggesting the need for inclusion of inconclusive decisions in future research examining cognitive bias in forensic examination.

Multimarker Panels in Diabetic Kidney Disease: The Way to Improved Clinical Trial Design and Clinical Practice?

Diabetic kidney disease (DKD) is a complex and multifactorial disorder associated with deregulations in a large number of different biological pathways on the molecular level. Using the 2 established biomarkers, estimated glomerular filtration rate (eGFR) and albuminuria will not allow allocating patients to tailored therapy. Molecular multimarker panels as sensors for the deregulation of the various disease mechanisms combined with a better understanding of how investigational as well as approved drugs interfere with these disease processes forms the basis for platform trials in DKD. In these platform trials, patients with DKD are assigned to the most suitable treatment arm based on their molecular marker profile. Close monitoring of biomarkers after treatment initiation together with assessment of renal function and "off-target" effects will allow identification of therapy responders, with nonresponders shifted to the next-best treatment arm based on their molecular profile. In this viewpoint article, we summarize evidence on the variation of DKD disease progression as well as the response to therapy and outline procedures to model disease pathophysiology supporting biomarker panel construction. Finally, the use of biomarkers in clinical trial setup is discussed.

Systems Biology-Derived Biomarkers to Predict Progression of Renal Function Decline in Type 2 Diabetes

OBJECTIVE

Chronic kidney disease (CKD) in diabetes has a complex molecular and likely multifaceted pathophysiology. We aimed to validate a panel of biomarkers identified using a systems biology approach to predict the individual decline of estimated glomerular filtration rate (eGFR) in a large group of patients with type 2 diabetes and CKD at various stages.

RESEARCH DESIGN AND METHODS

We used publicly available "omics" data to develop a molecular process model of CKD in diabetes and identified a representative parsimonious set of nine molecular biomarkers: chitinase 3-like protein 1, growth hormone 1, hepatocyte growth factor, matrix metalloproteinase (MMP) 2, MMP7, MMP8, MMP13, tyrosine kinase, and tumor necrosis factor receptor-1. These biomarkers were measured in baseline serum samples from 1,765 patients recruited into two large clinical trials. eGFR decline was predicted based on molecular markers, clinical risk factors (including baseline eGFR and albuminuria), and both combined, and these predictions were evaluated using mixed linear regression models for longitudinal data.

RESULTS

The variability of annual eGFR loss explained by the biomarkers, indicated by the adjusted R² value, was 15% and 34% for patients with eGFR ≥60 and <60 mL/min/1.73 m², respectively; variability explained by clinical predictors was 20% and 31%, respectively. A combination of molecular and clinical predictors increased the adjusted R² to 35% and 64%, respectively. Calibration analysis of marker models showed significant (all P < 0.0001) but largely irrelevant deviations from optimal calibration (calibration-in-the-large: -1.125 and 0.95; calibration slopes: 1.07 and 1.13 in the two groups, respectively).

CONCLUSIONS

A small set of serum protein biomarkers identified using a systems biology approach, combined with clinical variables, enhances the prediction of renal function loss over a wide range of baseline eGFR values in patients with type 2 diabetes and CKD.

Electrophysiological evidence of statistical learning of long-distance dependencies in 8-month-old preterm and full-term infants

Using electroencephalography, we examined 8-month-old infants' ability to discover a systematic dependency between the first and third syllables of successive words, concatenated into a monotonous speech stream, and to subsequently generalize this regularity to new items presented in isolation. Full-term and preterm infants, while exposed to the stream, displayed a significant entrainment (phase-locking) to the syllabic and word frequencies, demonstrating that they were sensitive to the word unit. The acquisition of the systematic dependency defining words was confirmed by the significantly different neural responses to rule-words and part-words subsequently presented during the test phase. Finally, we observed a correlation between syllabic entrainment during learning and the difference in phase coherence between the test conditions (rule-words vs part-words) suggesting that temporal processing of the syllable unit might be crucial in linguistic learning. No group difference was observed suggesting that non-adjacent statistical computations are already robust at 8 months, even in preterm infants, and thus develop during the first year of life, earlier than expected from behavioral studies.

Expression of Nek1 during kidney development and cyst formation in multiple nephron segments in the Nek1-deficient kat2J mouse model of polycystic kidney disease

BACKGROUND

Neks, mammalian orthologs of the fungal protein kinase never-in-mitosis A, have been implicated in the pathogenesis of polycystic kidney disease. Among them, Nek1 is the primary protein inactivated in kat2J mouse models of PKD.

RESULT

We report the expression pattern of Nek1 and characterize the renal cysts that develop in kat2J mice. Nek1 is detectable in all murine tissues but its expression in wild type and kat2J heterozygous kidneys decrease as the kidneys mature, especially in tubular epithelial cells. In the embryonic kidney, Nek1 expression is most prominent in cells that will become podocytes and proximal tubules. Kidney development in kat2J homozygous mice is aberrant early, before the appearance of gross cysts: developing cortical zones are thin, populated by immature glomeruli, and characterized by excessive apoptosis of several cell types. Cysts in kat2J homozygous mice form postnatally in Bowman's space as well as different tubular subtypes. Late in life, kat2J heterozygous mice form renal cysts and the cells lining these cysts lack staining for Nek1. The primary cilia of cells lining cysts in kat2J homozygous mice are morphologically diverse: in some cells they are unusually long and in others there are multiple cilia of varying lengths.

CONCLUSION

Our studies indicate that Nek1 deficiency leads to disordered kidney maturation, and cysts throughout the nephron.

Considerations regarding major bleeding after cardiac transplantation

Postoperative bleeding is one of the most frequent complications after cardiac surgery, leading to longer stays in the intensive care unit (ICU) and the hospital as well as increased morbidity and mortality. We designed an observational prospective study to evaluate early complications after cardiac transplantation, focusing on major bleeding and transfusion requirements. We also evaluated whether massive transfusion was related to increased morbidity and mortality. In patients who received ≥6 blood units, we observed significant differences regarding the need for continuous renal replacement techniques (50% vs 12.5%; P=.01) and ICU mortality (33.3% vs 4%; P=.01). This difference in mortality was also observed when comparing plasma transfusion requirements (35.3% vs 9.4%; P=.04). The overall mortality rate was 24.50%, showing significant differences in patients with massive transfusion (83.3% vs 37.8%; P=.008). In conclusion, perioperative bleeding and massive transfusion were associated with increased morbidity and mortality in this group of patients, which may prompt a review of surgical procedures and the introduction of new techniques, such as thromboelastography.

Mutation of NIMA-related kinase 1 (NEK1) leads to chromosome instability

BACKGROUND

NEK1, the first mammalian ortholog of the fungal protein kinase never-in-mitosis A (NIMA), is involved early in the DNA damage sensing/repair pathway. A defect in DNA repair in NEK1-deficient cells is suggested by persistence of DNA double strand breaks after low dose ionizing radiation (IR). NEK1-deficient cells also fail to activate the checkpoint kinases CHK1 and CHK2, and fail to arrest properly at G1/S or G2/M-phase checkpoints after DNA damage.

RESULTS

We show here that NEK1-deficient cells suffer major errors in mitotic chromosome segregation and cytokinesis, and become aneuploid. These NEK1-deficient cells transform, acquire the ability to grow in anchorage-independent conditions, and form tumors when injected into syngeneic mice. Genomic instability is also manifest in NEK1 +/- mice, which late in life develop lymphomas with a much higher incidence than wild type littermates.

CONCLUSION

NEK1 is required for the maintenance of genome stability by acting at multiple junctures, including control of chromosome stability.

Management of child optic pathway gliomas: new therapeutical option

OBJECTIVE

To present our experience in the treatment of child optic pathway gliomas in the last 25 years.

MATERIAL AND METHODS

Seventeen children under 10 years of age have been analyzed and assessed from clinic, ophthalmologic, endocrinologic, neurological, neuropathologic, and imaginologic points of view.

RESULTS

Predominance of female patients, 10 girls and 7 boys between 6 and 122 months old; mean age was 3 years and 8 months. The most frequent symptoms have been ophthalmologic and visual alterations in all 17 patients, endocrine alterations in 10, and neurological signs in 6. One of the patients presented neurofibromatosis type 1 (NF1), another patient had Down syndrome. Diagnosed using computed tomography or/and magnetic resonance imaging, histological studies showed pilocytic astrocytomas in 13 cases and a fibrillary astrocytoma grade II in 1 case. There were three patients without histological diagnosis; one of them had NF1. The treatment consisted of surgery, external beam radiotherapy, chemotherapy, and brachytherapy with iodine 125, separately or combined. Five patients died; the causes were secondary tumors in two children, tumor recurrence in one, sepsis secondary to respiratory and urinary tract infections in the child with Down syndrome, and finally, hydrocephaly due to hyperproteinorachia of tumor origin in one. Average survival was 89 months.

CONCLUSION

Chemotherapy and brachytherapy are therapeutic methods to be considered, especially in children under 5. Marsupialization of the residual cyst into the ventricular system postradio or oncolytic treatment through endoscopic or stereotactic techniques is useful in the treatment of endocranial hypertension and/or hypothalamic compression in these patients.

Phoneme perception in a neonate with a left sylvian infarct

We report the case of a neonate tested three weeks after a neonatal left sylvian infarct. We studied her perception of speech and non-speech stimuli with high-density event-related potentials. The results show that she was able to discriminate not only a change of timbre in tones but also a vowel change, and even a place of articulation contrast in stop consonants. Moreover, a discrimination response to stop consonants was observed even when syllables were produced by different speakers. Her intact right hemisphere was thus able to extract relevant phonetic information in spite of irrelevant acoustic variation. These results suggest that both hemispheres contribute to phoneme perception during the first months of life and confirm our previous findings concerning bilateral responses in normal infants.

Report of Sugarcane yellow leaf virus in Ecuador, Guatemala, and Nicaragua

In 1998, sugarcane plants with symptoms similar to yellow leaf syndrome were observed in Ecuador, Guatemala, and Nicaragua. These plants showed yellowing of the central portion of the third to sixth leaves on the abaxial surface from the youngest expanding spindle leaf. Intense yellowing and necrosis of the leaf tip and the central portion of the leaf blade near the midrib occurred in severe cases. A tissue blot immunoassay was used to detect Sugarcane yellow leaf virus (SCYLV) in the midrib of the top visible dewlap leaf (2) using an antiserum specific to a Florida isolate of SCYLV (1). Since the virus can be detected in asymptomatic plants, leaf samples were collected from both symptomatic and asymptomatic plants. Symptom expression was most intense in plants at maturity that were under stress. Cut ends of leaf samples were imprinted on nitrocellulose membranes in the country of origin, and control samples of healthy and SCYLV-infected leaves were imprinted in Florida on each membrane prior to serological processing. The results from the following locations and cultivars, and the ratio of SCYLV-positive samples over the total samples is indicated: Milagro, Ecuador, PR 70-2085 (11/24) and PR 76-3385 (48/63) in 1999; Escuintla, Guatemala, CP 57-603 (1/10), CP 73-1547 (0/10), CP 72-2086 (120/308), PR 75-2002 (8/11), PR 78-294 (10/10), and PR 87-2080 (13/13) in both 2000 and 2001; Tipitapa, Nicaragua, L 68-40 (21/70) in 1998; and Chinandega, Nicaragua, CP 72-2086 (30/30) and CP 74-2005 (13/45) in 2000. CP 72-2086 is a major commercial cultivar in Central American countries and was infected in both Guatemala and Nicaragua. SCYLV was detected in 9 of 10 cultivars sampled. An exception was noticed in CP 73-1547 in Guatemala where none of the 10 plants tested were infected; however this cultivar has a high incidence of SCYLV in Florida. Only 1 of 10 samples of CP 57-603 was SCYLV positive in Guatemala; however, this cultivar has a low incidence of infection in Florida and is considered more resistant than the other CP cultivars sampled. To our knowledge, this is the first report SCYLV in Ecuador, Guatemala, and Nicaragua. References: (1) S. M. Scagliusi and B. E. L. Lockhart. Phytopathology 90:120, 2000. (2) S. Schenck et al. Sugar Cane 4:5, 1997.

Electrophysiological evidence for automatic phonetic processing in neonates

At least two fundamental properties should be present in a network computing a phonetic representation: categorical perception and normalization across different utterances. Normalization processes were studied at birth by recording high density evoked potentials to strings of syllables in sleeping neonates. We compared the response to a change of phoneme when irrelevant speaker variation was present or absent. A mismatch response was recorded at the same latency in both cases, suggesting that relevant phonetic information was extracted from the irrelevant variation. Combined with our previous work showing that the mismatch response is sensitive to categorical perception in infants, this result suggests that a phonetic network like that of adults, is already present in the infant brain. Furthermore, efficient phonetic processing does not require attention.

The effect of intranasal fentanyl on the emergence characteristics after sevoflurane anesthesia in children undergoing surgery for bilateral myringotomy tube placement

Children undergoing placement of bilateral myringotomy tubes (BMT) often exhibit pain-related behavior (agitation) in the postanesthesia care unit. We compared the emergence and recovery profiles of pediatric patients who received sevoflurane with or without supplementary intranasal fentanyl for BMT surgery. By using a prospective, double-blinded design, 150 children 6 mo to 5 yr of age, scheduled for routine BMT surgery, were anesthetized with sevoflurane (2%-3%) in a 60% N(2)O/O(2) gas mixture. Patients were randomized to receive equal volumes of intranasal saline (Control), 1 microg/kg fentanyl or 2 microg/kg fentanyl. A blinded observer evaluated each patient using a previously described 4-point agitation scale and the Steward recovery scale. Response to parental presence was observed after a score of six (full recovery) was achieved on the Steward recovery scale. There were no significant differences among the three groups regarding age, weight, surgeon, duration of anesthesia, or ear condition. Recovery times and emergence characteristic scores were not statistically different. Agitation scores were significantly reduced in the 2-microg/kg Fentanyl group as compared with the Control group (P = 0.012). Fentanyl 2 microg/kg is recommended to reduce the incidence of agitation seen in these patients.

IMPLICATIONS

We examined the use of nasally administered fentanyl for the relief of agitation or discomfort after placement of bilateral myringotomy tubes in 150 children ages 6 mo to 5 yr using a prospective, double-blinded design. Fentanyl 2 microg/kg was found to reduce the incidence of agitation in these patients.

Five novel RPGR mutations in families with X-linked retinitis pigmentosa

X-linked forms of retinitis pigmentosa (XLRP) are among the most severe because of their early onset, often leading to significant visual impairment before the fourth decade. RP3, genetically localized at Xp21.1, accounts for 70% of XLRP in different populations. The RPGR (Retinitis Pigmentosa GTPase Regulator) gene that was isolated from the RP3 region is mutated in 20% of North American families with XLRP. From mutation analysis of 27 independent XLRP families, we have identified five novel RPGR mutations in 5 of the families (160delA, 789 A>T, IVS8+1 G>C, 1147insT and 1366 G>A). One of these mutations was detected in a family from Chile. Hum Mutat 17:151, 2001.

Mode of physical activity and self-efficacy in older adults: a latent growth curve analysis

A randomized controlled trial examined the effect of two physical activity modes on changes in self-efficacy over the course of a 12-month period in older, formerly sedentary adults (N = 174, M age = 65.5 years). Participants were randomized into either an aerobic activity group or a stretching and toning group. Structural equation modeling was employed to conduct multiple sample latent growth curve analyses of individual growth in exercise and physical self-efficacy over time. Results revealed a curvilinear growth pattern for both types of efficacy with increases occurring over the first 6 months followed by declines at the 6-month follow-up. There was a significant treatment by mean level growth interaction for exercise efficacy with both groups increasing over time, but the aerobic group evidenced a twofold increase in growth over the stretching group. Structural analyses indicated that frequency of exercise participation was a significant predictor of overall growth in efficacy, and improvements in fitness were only related to exercise efficacy growth in the stretching group. Findings are discussed in terms of social cognitive theory and further application of latent growth curve modeling to studies of physical activity effects in older adults.

Prevalence of allergy to latex in the pediatric population

Latex is a substance that is extracted from the plant Hevea Brasiliensis, and world production is 6 million metric tons per year. After gathering it undergoes a series of processes in which ammonia, vulcanization-accelerating additives or anti-oxidants are added. All of this may constitute the antigenic load that latex contains. It is used in medicine for gloves, drainage tubes, dental implants and a growing number of products from condoms to sport products or automobile components. Over fifteen different allergenic bands have been described, with molecular weights of between 2 and 100 kDa. In a joint study, USA-Finland identified three antigenic bands that predominate according to the population type studied (2). In children with spina bifida, congenital urogenital abnormalities or those submitted to multiple surgical interventions, the band of 27 kDa is predominant. This antigen has not been detected in adult serum, which suggests that contact with the antigen is through the mucous membranes and the sensitization is triggered from here. The incidence of allergy to latex in the general population is not known, but it seems to be lower than 1%. Turjanmaa (1) establishes a frequency of 0.125% (1/800) in patients submitted to general surgery. The incidence of sensitization to latex varies according to the population studied. Among the population considered to be at risk are the workers of the health environment, where the incidence is between 2.6 and 16.9%, whereas in the general population the percentage is around 1%. Sensitivity to latex is of great importance in patients suffering from spina bifida, in whom an incidence of between 28 and 67% has been found. We present our experience in a group of children attending our service for the first time for diverse reasons of supposed allergic etiology. The objective is to determine the incidence of sensitization to latex according to the diagnostic methodology [cutaneous test or by determination of specific IgE (CAP)]; according to the type of patient (atopic or non-atopic), the direct relationship with latex material and the role that can be played by a history of surgical intervention. In our experience with 282 children studied in our pediatric allergology service using diverse methods, the incidence of allergy to latex is 3.19%. Nevertheless, if we analyze this percentage we observe that if the diagnosis is based exclusively on cutaneous tests, it is only 1.08%; if to establish a diagnosis we used exclusively the determination of specific IgE (CAP) we would label 7. 2% of our children as allergic. Atopy is a factor that facilitates sensitization. In our sample, the incidence among the atopic population is 4.4%, though this percentage may vary between 1.69% and 9.5% depending on the methodology used. There are several hypotheses for explaining these discrepancies in the diagnostic tests. Although there do not seem to be differences regarding the ammonia content of the different lots, it seems that the differential factor could lie in the type of extract and in whether it is commercial or a natural latex extract. It could be a consequence of the existence of a prophyllin, so it has not been ruled out that a part of the IgE is an antiprophyllin. The presence of different epitopes would mean that each of them has the ability to produce its own specific IgE, though the RAST/CAP was not able to differentiate them and identified them as whole. The rate of allergy to latex in a group of children suffering from myelomeningocele is 80%. At a paediatric level, sensitization to latex is influenced by the means of contact, the duration of the exposure to the antigen and the fact that the exposure occurs early, which in the case of children with myelomeningocele is associated with the immaturity of the defence mechanism of the mucous membranes.

[Anorexia nervosa in a patient with type-1 diabetes mellitus]

Female patient, 21 years of age, with diabetes mellitus type I, admitted due to progressive weight loss, with a recent history of impaired glycemic control, ketosis and amenorrhea for 12 months. Studies were conducted in order to exclude an endocrine or malignant disorder. After nutritional, endocrine and psychiatric evaluation, the diagnosis of anorexia nervosa, was made. Therapeutic results and clinical course after the first year are shown. The case raises important problems, especially within diabetic population, puzzling the clues for diagnosis and therapy.

Blood sample processing effect on eosinophil cationic protein concentration

BACKGROUND

Asthma is considered to be an inflammatory disease. The most important cell involved in the inflammation is the eosinophil. These cells and their mediators, such as eosinophil cationic protein (ECP), are potential markers of the inflammation's severity. Eosinophil cationic protein may be used for monitoring antiasthma treatment. It is well known that sample processing conditions can affect the ECP blood levels.

OBJECTIVE

The aim of this work is to study the effect of temperature, time, and anticoagulants on ECP levels.

METHODS

We studied five asthmatic patients and five healthy controls. We obtained three different blood samples from each subject, one with heparin, one with EDTA, and one without anticoagulant. To evaluate the effect of temperature, serum samples were clotted for an hour, one at 0 degree C, one at room temperature, and the other at 37 degrees C. Plasma (heparin and EDTA) samples were treated as follows: one was immediately centrifuged, and two were stored for an hour, one at 0 degree C, and the other at room temperature. Eosinophil cationic protein levels were measured by fluoroimmunoassay (CAP-System ECP FEIA Pharmacia).

RESULTS

A higher temperature during blood clotting resulted in a higher ECP concentration. There were no differences between ECP determination in serum samples and plasma samples with heparin, under the same conditions of time and temperature; so clotting may not be necessary for ECP release in vitro. Eosinophil cationic protein was not released in plasma samples with EDTA, neither at 0 degree C nor room temperature.

CONCLUSIONS

More studies must be done to clarify the mechanism of the ECP release in vitro.

The prick test and specific IgE (RAST and MAST-CLA) compared with the oral challenge test with milk, eggs and nuts

In spite of the development of numerous in vivo and in vitro diagnostic techniques for food allergy, the oral challenge test (OCT) is still the "gold standard". Consequently, we have compared it with some of the more recent techniques. We studied 36 patients with a medical history compatible with food allergy (to milk, eggs or nuts) and 11 patients without food allergy (6 nonatopic and 5 with acarid allergy). A prick test, specific IgE (RAST and MAST-CLA) and an OCT with the suspected food were performed in all patients. The following parameters were calculated for all patients overall and for each of the three allergic groups separately: sensitivity, specificity and match with the OCT. We also studied the RAST-MAST-CLA correlation and the variability of the MAST-CLA. The prick test was the most sensitive (95%) and the MAST-CLA (13% divergence in two measurements) the most specific (92%). The RAST and the MAST-CLA (68% match) gave similar results, with an acceptable match (75% and 77%, respectively) with the OCT. The medical history could only suggest the diagnosis (39% false-positives). After comparing the results with those in the literature, it is suggested that greater attention should be paid to the limitations of these techniques compared with the OCT.

The value of specific IgG4 determination in childhood allergy to egg in relation to specific IgE and the provocation test

The value of IgG4 determination in food allergy shows conflicting results in the medical literature. Our pediatric study was carried out in two phases. The first compared the percentage of detection and agreement of specific IgE (RAST) and IgG4 (FAST) for egg white and egg yolk in 104 patients with possible hypersensitivity to egg and positive skin tests. The second, in 22 new patients, compared IgG4 determination with the oral provocation test (OPT; the diagnostic "gold standard"). In the first phase, the percentage of positive cases for both antibodies was almost identical, but little agreement was observed between them. In the second phase, the sensitivity, specificity and agreement with the OPT were higher for IgE than for IgG4. Thus, we conclude that IgG4 levels may be high in food allergy, but their detection seems to have little diagnostic value in allergy to egg proteins in children.

Study of the sensitization to storage mites in a pediatric population in Barcelona

We performed the following study in order to determine the prevalence and characteristics of sensitization to storage mites in children mostly from the city of Barcelona. All children over 3 years of age attending our unit for the first time due to respiratory problems were given cutaneous tests using the prick test for the house dust mites Dermatophagoides pteronyssinus and D. farinae, and the storage mites Acarus siro, Lepidoglyphus destructor and Tyrophagus putrescentiae. We carried out a RAST and conjunctival test when it was considered appropriate. Of a total of 356 children studied, 39 showed cutaneous sensitization to storage mites, which represented 11% of the population studied, and 20% of the total sensitized to mites. However, only 3 of these children were only sensitized to storage mites, the remaining 36 (92%) also showing sensitization to house dust mites. Of the storage mites studied, L. destructor was the most significant. A history of immunotherapy to mites was associated with a greater percentage of positive cutaneous tests to storage mites, although this was not the case with the RAST test.

Mustard allergy. Two anaphylactic reactions to ingestion of mustard sauce

Two cases of anaphylactic reactions set off by the ingestion of a small amount of mustard sauce are described. Mediation by specific IgE to mustard was determined by skin prick tests and radioimmunoassay, which suggested a type I hypersensitivity mechanism. Despite the antigenic potency of mustard, a spice that is consumed frequently, very few cases of hypersensitivity from ingestion have been described.

Allergy to pomegranate (Punica granatum)

We present the case of a 7-year-old IgE-dependent asthmatic child who, moments after ingesting several pomegranate seeds, showed a clinical condition of bronchospasm which responded to treatment with inhaled salbutamol. Cutaneous tests using the prick-by-prick techniques with extract of the fresh fruit were positive and the RAST for pomegranate was 0.8 PRU/ml. In the literature studied, we have found few specific references to allergy to pomegranate.

Amino acid alterations and encephalopathy in the sepsis syndrome

OBJECTIVE

To evaluate the role of amino acid profiles in septic encephalopathy.

DESIGN

Retrospective analysis.

SETTING

Medical wards and medical ICU of a university hospital.

PATIENTS

Patients with infections and normal mental status were compared with patients with septic shock and altered sensorium.

INTERVENTIONS

Plasma amino acid levels and Acute Physiology and Chronic Health Evaluation (APACHE II) scores were determined.

MEASUREMENTS AND MAIN RESULTS

Patients with septic shock and altered sensorium had higher circulating concentrations of ammonia (425 +/- 55 vs. 127 +/- 7 mmol/L) and the aromatic amino acids phenylalanine (122 +/- 19 vs. 74 +/- 3 mmol/L) and tryptophan (97 +/- 7 vs. 32 +/- 13 mmol/L), and lower levels of the branch-chain amino acid isoleucine (48 +/- 7 vs. 68 +/- 5 mmol/L) than patients with infections and normal sensorium (p less than .05). Aromatic amino acid levels correlated with APACHE II scores (R2 = .4, p less than .001) and mortality. APACHE II scores were higher in the septic shock patients (30 +/- 2 vs. 8 +/- 1, p less than .001), and these patients had a higher mortality rate (71% vs. 12%, p less than .01). Patients with septic shock who died had higher levels of ammonia (524 +/- 58 vs. 227 +/- 40 mmol/L, p less than .05) and sulfur-containing amino acids (172 +/- 31 vs. 61 +/- 7 mmol/L, p less than .05) than patients who survived.

CONCLUSIONS

Plasma amino acid profiles appear to be important in septic encephalopathy and the severity of septic disease.

Cancellation in elective orthopaedic surgery

The management of operating theatre time is a crucial element in the size of surgical waiting lists, and this paper reports a survey of causes of the cancellation of operations for orthopaedic surgery. The results show that, although the majority of cancellations were due to medical causes, others were the result of extended theatre schedules. These findings suggest that closer co-operation between surgical staff, general practitioners and theatre staff could help to reduce this problem.

Clinical antecedents to in-hospital cardiopulmonary arrest

While the outcome of in-hospital cardiopulmonary arrest has been studied extensively, the clinical antecedents of arrest are less well defined. We studied a group of consecutive general hospital ward patients developing cardiopulmonary arrest. Prospectively determined definitions of underlying pathophysiology, severity of underlying disease, patient complaints, and clinical observations were used to determine common clinical features. Sixty-four patients arrested 161 +/- 26 hours following hospital admission. Pathophysiologic alterations preceding arrest were classified as respiratory in 24 patients (38 percent), metabolic in 7 (11 percent), cardiac in 6 (9 percent), neurologic in 4 (6 percent), multiple in 17 (27 percent), and unclassified in 6 (9 percent). Patients with multiple disturbances had mainly respiratory (39 percent) and metabolic (44 percent) disorders. Fifty-four patients (84 percent) had documented observations of clinical deterioration or new complaints within eight hours of arrest. Seventy percent of all patients had either deterioration of respiratory or mental function observed during this time. Routine laboratory tests obtained before arrest showed no consistent abnormalities, but vital signs showed a mean respiratory rate of 29 +/- 1 breaths per minute. The prognoses of patients' underlying diseases were classified as ultimately fatal in 26 (41 percent), nonfatal in 23 (36 percent), and rapidly fatal in 15 (23 percent). Five patients (8 percent) survived to hospital discharge. Patients developing arrest on the general hospital ward services have predominantly respiratory and metabolic derangements immediately preceding their arrests. Their underlying diseases are generally not rapidly fatal. Arrest is frequently preceded by a clinical deterioration involving either respiratory or mental function. These features and the high mortality associated with arrest suggest that efforts to predict and prevent arrest might prove beneficial.

Effects of progesterone on postovariectomy bone loss in aged rats

The effects of progesterone on oophorectomy-induced bone loss in aged rats were evaluated. Female rats aged 12 months were divided into three groups: (1) sham-operated controls (SHAM); (2) oophorectomized (OVX); (3) OVX rats treated with progesterone (OVX + PROG). After 20 weeks the dry weight, bone ash, and calcium content of femur, tibia, and fourth lumbar vertebra were significantly lower in OVX than in sham rats. These reductions did not occur in OVX rats treated with PROG. There was no difference in the bone composition between the control and progesterone-treated rats. Vertebral bone histomorphometry showed increased bone resorption as well as increased bone formation parameters in OVX rats. Progesterone treatment inhibited the increased resorption indices, but the bone formation remained elevated. The results indicate that progesterone therapy prevents the postovariectomy bone loss in aged rats. The protective effect of progesterone is mediated by inhibition of bone resorption while maintaining the increased bone formation. These findings suggest that progesterone alone may be a valuable agent for management of postmenopausal osteoporosis.

Etodolac: analgesic effects in musculoskeletal and postoperative pain

Numerous clinical trials have shown etodolac to be an effective analgesic. The purpose of the present report is to review results of 14 studies that demonstrate the effectiveness of etodolac in a variety of painful conditions. Presented are the results of four postsurgical pain studies, one study of acute gouty arthritis and nine studies of acute musculoskeletal disorders: acute low back pain, acute painful shoulder, tendinitis and bursitis, and acute sports injuries. A single oral dose of etodolac (25, 50, 100, 200, or 400 mg) was compared with aspirin (650 mg) or a combination of acetaminophen (600 mg) plus codeine (60 mg) for the relief of pain up to 12 h following oral, urogenital or orthopedic surgery. In multiple dose studies of acute gouty arthritis and musculoskeletal conditions, etodolac 200 or 300 mg twice a day (b.i.d.) or 200 mg three times a day (t.i.d.) was compared with naproxen 500 mg b.i.d. or t.i.d., diclofenac 50 mg b.i.d. or t.i.d., and piroxicam 20 or 40 mg once a day (o.d.) administered over 5 to 14 days. The efficacy of etodolac was at least equal and in some ways superior to aspirin and acetaminophen plus codeine in the relief of postsurgical pain. In studies of acute gouty arthritis, significant improvement from baseline were seen for all efficacy parameters evaluated for both the etodolac- and naproxen-treated patients. All the present studies of musculoskeletal conditions have shown etodolac to be effective and comparable in analgesic efficacy to naproxen, diclofenac or piroxicam. In summary, etodolac therapy for pain following surgery, in acute gouty arthritis and in acute musculoskeletal conditions resulted in analgesia comparable to that provided by several well-established analgesic or anti-inflammatory agents.

Failure of lactose and glucose to influence in vivo intestinal calcium transport in normal rats

The influence of luminal lactose and glucose on intestinal calcium transport was examined in vivo in normal post-weaned young rats. In situ segments of duodenum, midgut and ileum were perfused through the lumen for 1 h with an isotonic solution of 3.4 mM calcium containing radioactive isotopic 45Ca as tracer and additionally either 10 mM lactose or 10 mM glucose, or, for the control group, no saccharide. Net absorption was measured by disappearance of luminal calcium; lumen-to-plasma flux was determined from the disappearance of tracer 45Ca. This concentration of luminal lactose or glucose had no direct effect on calcium transport under these steady state conditions.

Calcium-binding activity of rat intestinal mucosa after massive small bowel resection

Male Sprague-Dawley rats underwent resection of 50 cm of either proximal or distal small intestine or sham-operation. 6-7 weeks after operation mucosal calcium-binding activity was measured in segments of duodenum ileum and remaining 'midgut'. Similar measurements were obtained from weight and age-matched unoperated rats. There was no difference in calcium-binding activity between unoperated and sham-operated animals. After proximal resection the binding activity increased significantly in duodenum and midgut but did not change in ileum. After distal resection the binding activity decreased in duodenum but was unchanged in midgut and ileum. These studies show that mucosal calcium-binding activity undergoes changes but alteration of the binding activity in remaining gut varies with the location of the small bowel resection.