High jugular bulb with a diverticulum and vestibular aqueduct dehiscence: an anatomical variant to be aware in patients with hearing loss

PURPOSE

To describe an anatomical variant that should be consider in patients with hearing loss.

METHODS

An 8-year-old girl underwent to temporal bone computed tomography for the evaluation of bilateral conductive hearing loss and further assessment of possible enlarged vestibular aqueduct or high jugular bulb on brain magnetic resonance imaging (MRI).

RESULTS

CT of temporal bone showed a cystic cavity with bony sclerotic margins extending from the right jugular foramen to the vestibular aqueduct. Bony dehiscence of the jugular foramen with the right carotid canal was also noted. On brain MRI, there was no evidence of enlargement of the endolymphatic duct and sac on T2 thin-section gradient echo sequence. Time of flight MR angiography did not show arterial flow in the cavity. Contrast enhanced MR venography confirmed the presence of a high right jugular bulb with a diverticulum extending into the vestibular aqueduct due to jugular bulb-vestibular aqueduct dehiscence.

CONCLUSION

Knowledge of high jugular bulb-vestibular aqueduct dehiscence is important in the assessment of patients with otologic symptoms such as vertigo, tinnitus and hearing loss.

Análisis filogenético del gen Spike del virus de la diarrea epidémica porcina en Colombia, 2014-2015

Se reportaron brotes de diarrea epidémica porcina en Colombia durante 2014-2015. En el presente análisis, se descargaron secuencias de nucleótidos completas del Genbank para el gen Spike de las cepas del virus de la diarrea epidémica porcina (PEDV) reportadas en Colombia. En el árbol filogenético basado en proteínas de espiga de PEDV, las cepas de Colombia se agruparon en los genotipos G2a y S-INDEL, las cepas mostraron alta homología (> 99,9%) con cepas de Estados Unidos (Colorado / 2013, OH851), como así como inserciones y deleciones en el dominio S1 del gen Spike presente tanto en cepas colombianas como en cepas de referencia. Se han identificado varias sustituciones de aminoácidos en los epítopos neutralizantes de las cepas colombianas en comparación con la cepa de referencia CV777. Estos estudios podrían ayudar a rastrear las posibles rutas de introducción del PEDV en Colombia, reconocer las relaciones filogenéticas de las cepas que circulan en el país e implementar estrategias de control y prevención.

Evaluation of the impact of pre- and post-harvest maize handling practices on mycotoxin contamination on smallholder farms in Guatemala

Mycotoxins are secondary metabolites produced by fungi including Aspergillus and Fusarium that commonly contaminate crops, such as maize, resulting in economic losses and food insecurity. Mycotoxins can contaminate crops during pre- and post-harvest stages. Consumption of mycotoxin-contaminated foods has been linked to a variety of negative health outcomes including liver cancer, stunting, and neural tube defects. In countries such as Guatemala where maize constitutes a major portion of the diet, mycotoxins can be a significant contributor to disease burden. This review describes maize pre- and post-harvest practices in Guatemala that can lead to the development of mycotoxins and subsequent exposure to humans and animals, current information gaps, and opportunities for future research. There are specific challenges to minimising fungal growth and subsequent mycotoxin production during storage of maize in Guatemala, including reducing moisture content, minimising pest damage, and controlling temperature. Research on maize-handling practices that are associated with the greatest mycotoxin exposure in Guatemala is needed to prioritise allocation of resources and reduce exposure.

Reliability and accuracy of individual Alberta Stroke Program Early CT Score regions using a medical and a smartphone reading system in a telestroke network

Introduction

The aim of this study was to assess individual regions of the Alberta Stroke Program Early CT Score in noncontrast head computed tomography interpretations using a smartphone in a telestroke network, by comparison to a medical monitor.

Methods

The review board of our institution approved this retrospective study. A factorial design with 188 patients, four radiologists and two reading systems was used. Accuracy and reliability were evaluated.

Results

Very good interobserver agreements were observed on the total Alberta Stroke Program Early CT Score for both the medical and smartphone reading systems, with intraclass correlation coefficients of 0.91 and 0.84 respectively. Interobserver agreements were moderate to very good for the medical reading system (all intraclass correlation coefficients >0.74), whereas they were fair to very good for the smartphone (intraclass correlation coefficients ranged from 0.31–0.81). All intraobserver agreements were good (intraclass correlation coefficient >0.64), except for internal capsule (0.48) and M2 (0.55) regions. The areas under the receiver-operating curve ranged from 0.69–0.89 for the medical system, while for the smartphone ranged from 0.44–0.86. No statistical differences were observed between medical and smartphone reading systems for each region (all p > 0.05).

Discussion

If radiologists are better trained in the evaluation of the lesions in the insula, the internal capsule and the M2 regions, the total and the dichotomised Alberta Stroke Program Early CT Score will be more precise. Hence, ruling out contraindications to thrombolysis administration will be improved, allowing assessment of head computed tomography in a telestroke network using a smartphone to be a common practice.

High prevalence of non-alcoholic fatty liver disease and metabolic risk factors in Guatemala: A population-based study

BACKGROUND

There are no data on the prevalence of non-alcoholic fatty liver disease (NAFLD) in general population samples in Guatemala or in other Central American countries. The prevalence and distribution of NAFLD and its associated risk factors were evaluated in a population-based sample of adults in Guatemala.

METHODS

Cross-sectional study of 411 men and women 40 years of age or older residing in urban and rural areas of Guatemala. Metabolic outcomes included obesity, central obesity, hypercholesterolemia, diabetes, and metabolic syndrome (MetS). Liver disease outcomes included elevated liver enzymes, elevated Fatty Liver Index (FLI), and elevated FIB-4 score.

RESULTS

The overall prevalence of obesity, central obesity, diabetes, and MetS were 30.9, 74.3, 21.6, and 64.2%, respectively. The fully-adjusted prevalence ratios (95% CI) for obesity, central obesity, diabetes, and MetS comparing women to men were 2.83 (1.86-4.30), 1.72 (1.46-2.02), 1.18 (1.03-1.34), and 1.87 (1.53-2.29), respectively. The overall prevalence of elevated liver enzymes (ALT or AST), elevated FLI, and elevated FIB-4 scores were 38.4, 60.1, and 4.1%, respectively. The fully-adjusted prevalence ratios (95% CI) for elevated liver enzymes (either ALT or AST) and elevated FLI score comparing women to men were 2.99 (1.84-4.86) and 1.47 (1.18-1.84), respectively.

CONCLUSIONS

The prevalence of metabolic abnormalities and liver outcomes in this general population study was very high. The prevalence of metabolic and liver abnormalities was particularly high among women, an observation that could explain the atypical 1:1 male to female ratio of liver cancer in Guatemala.

Abstract 03: Imaging characteristics of head and neck tumors according to human papillomavirus (HPV) status in Bogotá, Colombia

Background: HPV-positive head and neck tumors (HNT) correspond to a unique entity given their clinical behavior and molecular characteristics. These tumors can show distinct features on pretreatment imaging, such as well-defined borders and cystic nodal metastases; therefore, the aim of our study was to evaluate the imaging characteristics and determine if there are differences between HPV-positive and HPV-negative HNT tumors in patients studied at our institution.

Design: A retrospective pretreatment imaging review from 35 HNT cases recruited under INTERCHANGE- IARC project in Latin America between 11-2014 and 12-2016 was performed. Imaging evaluation included primary lesion and nodal metastases. Initial evaluation by radiologists was blinded for patients' histological findings and HPV status. Radiology was evaluated for: location, tumor size, tumor border morphology, contrast enhancement, nodal metastases, size of metastasis and morphology of nodal metastasis. Radiological findings were correlated with histology and p16 INK4a inmunohistochemistry using clone E6H4 (HPV surrogate marker).

Results: Pretreatment images were available for review only in 17 of 35 cases (48,5%). 10 cases had computerized tomography (CT) examination, 1 case magnetic resonance (MR) and 6 cases had 18F-FDG PET-CT. 6/17 cases (35.3%) were excluded due to no visualization of the primary tumor or due to limitation artifacts (amalgam). From the 11 cases available for review, 7 were from the oropharynx (OP), 2 from the oral cavity (OC) and 1 from the larynx (LA). All OP tumors were positive for p16 and all the rest tumors were p16 negative. Tumor size ranged from 7 to 51 mm in greatest dimension. Well-defined borders were present in 4/7 p16 positive tumors vs 2/4 p16 negative tumors. Tumor enhancement with contrast was present and able to evaluate only in 5 out of 11 tumors (3 p16 + and 2 p16 -). All the OP p16 positive tumors presented with nodal metastasis greater than 10 mm in dimension. 6/7 had nodal cystic change and these p16 positive cases were more likely to have large cystic nodal metastases with a cystic component larger than 50% of the nodal size (6/7) than p16/HPV negative tumors (1 out of 4 cases had smaller nodal metastasis with cystic component <50%).

Conclusion: Large nodal metastasis (>10 mm) with cystic component larger than 50% of the node size is an important finding seen in p16 HNT. One should consider these findings when examining neck images in patients with unknown primary in order to exclude malignancy given that usually cystic nodes could be misdiagnosed as benign. Our nondiagnostic imaging rate pretreatment was 35%; in order to improve the use of diagnostic tools we recommend the use of MR especially in patients with amalgams and/or tumor located at the oral cavity and oropharynx. Further studies are granted with a larger sample size in order to validate and confirm imaging characteristics in p16/HPV positive HNT.

Citation Format: Nicolás Useche, Oscar Torres, Maria M. Rojas, Mauricio Palau-Lázaro, Marcela Mejía-Arango, Ana Margarita Baldión, José A. Hakim, Johanna Campos, Alberto Escallon, Aylen Vanessa Ospina, Sandra Perdomo, Paula A. Rodríguez-Urrego. Imaging characteristics of head and neck tumors according to human papillomavirus (HPV) status in Bogotá, Colombia [abstract]. In: Proceedings of the AACR-AHNS Head and Neck Cancer Conference: Optimizing Survival and Quality of Life through Basic, Clinical, and Translational Research; April 23-25, 2017; San Diego, CA. Philadelphia (PA): AACR; Clin Cancer Res 2017;23(23_Suppl):Abstract nr 03.

Linking hepatitis C virus infection to pre-1994 blood transfusions in female patients

INTRODUCTION

Most blood transfusions occur in female patients. The introduction of serologic screening practices by blood banks reduced the transfusion-related rate of infection with hepatitis C virus (HCV). In Mexico patients with pre-1994 transfusion history are at high risk of being detected with HCV infection. We aimed at establishing an interrelationship between two variables: pre-1994 transfusion history and rate of infection in women treated in the Guadalajara Metropolitan Area hospitals, in Mexico.

METHODS

Analytical observational case-control study which included both non-infected women and patients diagnosed with hepatitis C virus infection, in whom the pre-1994 transfusion history was determined. The cases were 150 women with confirmed hepatitis C virus serologic diagnosis. The controls were 150 women whose hepatitis C virus-detection serologic tests had yielded negative results.

RESULTS

An odds ratio of 9.07 (95% CI: 5.37 – 15.3; p< 0.001) was found where the rate of infection for the case group was 0.72 while the control group had a ratio of 0.22; population attributable risk (PAR) was 0.64 (95% CI: 0.53 – 0.73), while etiologic fraction was 0.88 (95% CI: 0.81 – 0.93).

CONCLUSIONS

Among women, having been exposed to pre-1994 blood transfusion means a risk 9.07 times higher than not being exposed to blood transfusion in the same time frame.

Tropospheric Emissions: Monitoring of Pollution (TEMPO)

TEMPO was selected in 2012 by NASA as the first Earth Venture Instrument, for launch between 2018 and 2021. It will measure atmospheric pollution for greater North America from space using ultraviolet and visible spectroscopy. TEMPO observes from Mexico City, Cuba, and the Bahamas to the Canadian oil sands, and from the Atlantic to the Pacific, hourly and at high spatial resolution (~2.1 km N/S×4.4 km E/W at 36.5°N, 100°W). TEMPO provides a tropospheric measurement suite that includes the key elements of tropospheric air pollution chemistry, as well as contributing to carbon cycle knowledge. Measurements are made hourly from geostationary (GEO) orbit, to capture the high variability present in the diurnal cycle of emissions and chemistry that are unobservable from current low-Earth orbit (LEO) satellites that measure once per day. The small product spatial footprint resolves pollution sources at sub-urban scale. Together, this temporal and spatial resolution improves emission inventories, monitors population exposure, and enables effective emission-control strategies. TEMPO takes advantage of a commercial GEO host spacecraft to provide a modest cost mission that measures the spectra required to retrieve ozone (O3), nitrogen dioxide (NO2), sulfur dioxide (SO2), formaldehyde (H2CO), glyoxal (C2H2O2), bromine monoxide (BrO), IO (iodine monoxide),water vapor, aerosols, cloud parameters, ultraviolet radiation, and foliage properties. TEMPO thus measures the major elements, directly or by proxy, in the tropospheric O3 chemistry cycle. Multi-spectral observations provide sensitivity to O3 in the lowermost troposphere, substantially reducing uncertainty in air quality predictions. TEMPO quantifies and tracks the evolution of aerosol loading. It provides these near-real-time air quality products that will be made publicly available. TEMPO will launch at a prime time to be the North American component of the global geostationary constellation of pollution monitoring together with the European Sentinel-4 (S4) and Korean Geostationary Environment Monitoring Spectrometer (GEMS) instruments.

Estudio preliminar de la diversidad genética de perros con fenotipo Poodle en Colombia usando microsatélites

El objetivo de este estudio fue estimar la variabilidad genética de una muestra poblacional de perros con fenotipo Poodle en Bogotá - Colombia. La variabilidad genética de 81 perros con fenotipo Poodle se estudió mediante el genotipado de cinco loci de microsatélites. La heterocigosidad esperada (HE) para los loci: AHTK253, CXX279, INU030, INU055 y REN162C04 fue de 0,747, 0,788, 0,767, 0,679 y 0,751, respectivamente. La HE para el conjunto de la población fue de 0,746. La población de Poodles analizada tuvo una alta diversidad genética y se encontró que no existe una subestructuración poblacional, hecho que desvía el equilibrio HW; con lo que demuestra que la población de Poodle colombiana sea una perfecta candidata para estudios de asociación genética, y de conservación de la biodiversidad de los animales domésticos.

Influence of ethnicity on the distribution of genetic polymorphisms associated with risk of chronic liver disease in South American populations

BACKGROUND

The global burden of chronic liver disease is rising. Besides environmental, behavioral, viral and metabolic factors, genetic polymorphisms in patatin-like phospholipase-3 (PNPLA3) and vitamin D receptor (VDR) genes have been related to the development of chronic liver disease and progression towards liver cancer. Although their prevalence differs remarkably among ethnic groups, the frequency of these polymorphisms in South American populations -whose genetic background is highly admixed- has been poorly studied. Hence, the aim of this study was to characterize polymorphisms related to chronic liver disease and their association with the genetic ancestry of South American populations.

RESULTS

DNA samples from 258 healthy unrelated male volunteers were analyzed. The frequencies of G and C alleles of rs738409 polymorphism (PNPLA3 gene) were 74 % and 26 %, respectively; whereas the bAt (CCA) haplotype (VDR gene) was observed in 32.5 % of the samples. The GG genotype of PNPLA3 rs738409 and the bAt (CCA) haplotype -associated with an increased risk of chronic liver disease and progression towards liver cancer- were significantly more frequent among samples exhibiting maternal and paternal Native American haplogroups (63.7 % and 64.6 %), intermediate among admixed samples (45.1 % and 44.9 %; p = 0.03) and the lowest for Non-native American ancestry (30.1 % and 29.6 %; p = 0.001 and p = 0.0008).

CONCLUSIONS

These results suggest that individuals with Native American ancestry might have a high risk of chronic liver disorders and cancer. Furthermore, these data not only support the molecular evaluation of ancestry in multi-ethnic population studies, but also suggest that the characterization of these variants in South American populations may be useful for establishing public health policies aimed at high risk ethnic communities.

Human health implications from co-exposure to aflatoxins and fumonisins in maize-based foods in Latin America: Guatemala as a case study

Co-occurrence of fumonisin B1 (FB1) and aflatoxin B1 (AFB1) in maize has been demonstrated in many surveys. Combined-exposure to FB1 and AFB1 was of concern to the Joint FAO/WHO Expert Committee on Food Additives because of the known genotoxicity of AFB1 and the ability of FB1 to induce regenerative proliferation in target tissues. Humans living where maize is a dietary staple are at high risk for exposure to both mycotoxins. Our work has focused on Guatemala, a country in Central America where maize is consumed in large amounts every day and where intake of FB1 has been shown to be potentially quite high using biomarker-based studies. In 2012 a survey was conducted which analysed maize samples for FB1 and AFB1 from all 22 departments of Guatemala. The results show that the levels of AFB1 exposure are also potentially quite high in Guatemala, and likely throughout Central America and Mexico. The implications of co-exposure for human health are numerous, but one area of particular concern is the potential of FB1 to modulate AFB1 hepatoxicity and/or hepatocarcinogenicity. Both the mechanism of action of FB1 and its ability to promote liver carcinogenicity in rats and rainbow trout is consistent with this concern. In farm and laboratory animals FB1 inhibits ceramide synthases, key enzymes in de novo ceramide biosynthesis. The inhibition of sphingolipid signalling pathways mediating programmed cell death and activation of pathways stimulating cell proliferation in livers of individuals exposed to AFB1 could contribute to the tumorigenicity of AFB1. Studies investigating the health effects of either toxin should consider the potential for co-exposure to both toxins. Also, in countries where maize-based food are prepared by alkaline treatment of the maize kernels, the effect of traditional processing on AFB1 levels and toxicity needs to be determined, especially for maize highly contaminated with AFB1.

Adjuvants for vaccines to drugs of abuse and addiction

Immunotherapeutic vaccines to drugs of abuse, including nicotine, cocaine, heroin, oxycodone, methamphetamine, and others are being developed. The theoretical basis of such vaccines is to induce antibodies that sequester the drug in the blood in the form of antibody-bound drug that cannot cross the blood brain barrier, thereby preventing psychoactive effects. Because the drugs are haptens a successful vaccine relies on development of appropriate hapten-protein carrier conjugates. However, because induction of high and prolonged levels of antibodies is required for an effective vaccine, and because injection of T-independent haptenic drugs of abuse does not induce memory recall responses, the role of adjuvants during immunization plays a critical role. As reviewed herein, preclinical studies often use strong adjuvants such as complete and incomplete Freund's adjuvant and others that cannot be, or in the case of many newer adjuvants, have never been, employed in humans. Balanced against this, the only adjuvant that has been included in candidate vaccines in human clinical trials to nicotine and cocaine has been aluminum hydroxide gel. While aluminum salts have been widely utilized worldwide in numerous licensed vaccines, the experience with human responses to aluminum salt-adjuvanted vaccines to haptenic drugs of abuse has suggested that the immune responses are too weak to allow development of a successful vaccine. What is needed is an adjuvant or combination of adjuvants that are safe, potent, widely available, easily manufactured, and cost-effective. Based on our review of the field we recommend the following adjuvant combinations either for research or for product development for human use: aluminum salt with adsorbed monophosphoryl lipid A (MPLA); liposomes containing MPLA [L(MPLA)]; L(MPLA) adsorbed to aluminum salt; oil-in-water emulsion; or oil-in-water emulsion containing MPLA.

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

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

Fumonisin biomarkers in maize eaters and implications for human disease

Maize is the predominant food source contaminated by fumonisins and this has particular health risks for communities consuming maize as a staple diet. The main biochemical effect of fumonisins is the inhibition of ceramide biosynthesis causing an increase in sphingoid bases and sphingoid base 1-phosphates and a depletion of the complex sphingolipids, thereby disrupting lipid metabolism and sphingolipid-mediated processes and signalling systems. Attempts to use the elevation of sphinganine as a human biomarker of fumonisin exposure have to date been unsuccessful. Consequently, recent research has focussed on developing a urinary exposure biomarker based on the measurement of the nonmetabolised toxin. In animals, fumonisins are poorly absorbed in the gut and are mostly excreted unmetabolised in faeces, with only a small percentage (0.25-2.0%) in urine. This appears to also be true in humans were fumonisin B1 (FB1) is detectable in urine soon after exposure, but in very small amounts relative to total intake. However, with modern sensitive and selective analytical methods such as liquid chromatography-tandem mass spectrometry, these low levels can be readily determined. The first study to show a positive correlation between consumption of maize and urinary FB1 was conducted in a Mexican population consuming tortillas as a staple food. Further validation of this relationship was achieved in a South African subsistence farming community with a positive correlation between urinary FB1 and fumonisin exposure, as assessed by food analysis and food intake data. The most recent developments are aimed at measuring multiple mycotoxin biomarkers in urine, including FB1. Current exposure studies in Guatemala are combining the urinary biomarker with measurement of sphinganine-1-phosphate in blood spots as a measure of biochemical effect. Thus, the urinary FB1 biomarker could contribute considerably in assessing the adverse health impact of fumonisin exposure.

External financial aid to blood transfusion services in sub-Saharan Africa: a need for reflection

Jean-Pierre Allain and colleagues argue that, while unintended, the foreign aid provided for blood transfusion services in sub-Saharan Africa has resulted in serious negative outcomes, which requires reflection and rethinking.

Effects of auditory and physical enrichment on 3 measurements of fear and stress (tonic immobility duration, heterophil to lymphocyte ratio, and fluctuating asymmetry) in several breeds of layer chicks

The purpose of this study was to analyze the effect of auditory enrichment (by means of classical music) or physical enrichment (by means of hanging colored string bunches and barley grains on the floor) on tonic immobility duration, heterophil to lymphocyte ratio, and fluctuating asymmetry (FA) in chicks of several layer breeds. In experiment 1, 192 chicks from 8 Spanish breeds and 1 White Leghorn population were reared in cages with or without music auditory enrichment until 8 wk of age. The effect of music auditory enrichment was significant for heterophil to lymphocyte ratio (P < 0.05). The ratios were higher in chicks reared without music than in those reared with music, suggesting that auditory enrichment from classical music reduces stress in chicks. There were significant differences in morphological trait measurements (relative asymmetry of wing length, leg width, and combined asymmetry; P < 0.05), being greater in chicks reared without music. This result suggests that FA is a good indicator for stress level in chicks, given that it follows the same trend as that found for heterophil to lymphocyte ratio. There was a significant treatment by breed interaction (P < 0.05) for tonic immobility duration, indicating no consistent effect by auditory enrichment on tonic immobility duration across breeds. In experiment 2, 180 chicks from 3 Spanish breeds were housed in pens with or without physical enrichment (colored plastic string bunches and barley grains on the floor) until 6 wk of age. The effect of physical enrichment on tonic immobility duration, heterophil to lymphocyte ratio, and FA was not significant, indicating no effect on fear and stress in layer chicks. In conclusion, auditory enrichment by means of classical music is a reliable method for reducing stress levels in several breeds of layer chicks. However, music auditory enrichment was not effective in reducing fearfulness in any of the layer breeds. Physical enrichment by means of colored plastic string bunches and floor barley grains does not appear to be an effective method for reducing stress and fear in layer chicks.

Determinants of membrane activity from mutational analysis of the HIV fusion peptide

We have synthesized a small library of 38 variants of the 23-residue fusion peptide domain found at the N-terminus of gp41 glycoprotein of HIV. This hydrophobic, glycine-rich sequence is critical for viral infectivity and is thought to be central in the membrane fusion of viral envelope with the host membrane. There has been extensive discussion regarding the origin of fusogenicity in this viral fusion sequence. Our library of fusion peptide variants was designed to address the biophysical importance of secondary structure, peptide flexibility, glycine content, and placement. We assayed each peptide for its ability to induce lipid mixing and membrane permeablization in synthetic vesicles. We find that the viral fusion peptide may be greatly simplified while retaining fusogenic function and minimizing membrane-permeablizing function; to the best of our knowledge, this is the first attempt to optimize fusogenic function of the HIV fusion peptide through sequence variation. Our data show that many flexible, linear, minimally hydrophobic peptides may achieve the biophysical function of fusion; glycine does not appear to be essential. These findings will be useful in the design of synthetic fusogens for cellular delivery.

The low viability of human CD34+ cells under acidic conditions is improved by exposure to thrombopoietin, stem cell factor, interleukin-3, or increased cyclic adenosine monophosphate levels

BACKGROUND

Transplanted hematopoietic progenitor cells (CD34+) have shown great promise in regenerative medicine. However, the therapeutic potential of transplanted cells is limited by their poor viability. It is well known that the microenvironment in which progenitors reside substantially affects their behavior. Because extracellular acidosis is a common feature of injured tissues or the tumor microenvironment and is a critical regulator of cell survival and activation, we evaluated the impact of acidosis on CD34+ cell biology.

STUDY DESIGN AND METHODS

Apoptosis was evaluated by fluorescence microscopy and binding of annexin V, hypodiploid cells, Bcl-xL expression, active caspase-3, and mitochondrial membrane potential was determined by flow cytometry. Colony-forming units were studied by clonogenic assays, and cell cycle was evaluated by flow cytometry.

RESULTS

Exposure of CD34+ cells to low pH (7.0-6.5) caused intracellular acidification, decreased cell proliferation, and triggered apoptosis via the mitochondrial pathway. Whereas exposure to thrombopoietin (TPO), stem cell factor (SCF), interleukin (IL)-3 or increases in cyclic adenosine monophosphate (cAMP) levels prevented CD34+ cell death induced by acidic conditions, granulocyte-macrophage-colony-stimulating factor, FMS-like tyrosine kinase 3-ligand, erythropoietin, and vascular endothelial growth factor had no effect. Despite their cytoprotective effect, CD34+ cell expansion triggered by TPO, SCF, or IL-3 was significantly impaired at low pH. However, a cocktail of these three cytokines synergistically supported proliferation, cell cycle progression, and colony formation.

DISCUSSION

Our findings indicate that an acidic milieu is deleterious for CD34+ cells and that a combination of certain cytokines and cAMP donors may improve cell viability and function. These data may be useful to develop new therapeutic strategies or to optimize protocols for regenerative medicine.

Incidence of HIV type 1 infection, antiretroviral drug resistance, and molecular characterization in newly diagnosed individuals in Argentina: A Global Fund Project

An HIV incidence estimation was performed among men who have sex with men (MSM), drug users (DUs), sex workers (SWs), and pregnant women (PW) from Argentina. Volunteers older than 18 years old without a previous HIV-positive diagnosis were included. HIV-positive samples were analyzed by the Serological Testing Algorithm for Recent HIV Seroconversion (STARHS) to estimate incidence. By partial RT-PCR and sequencing of the HIV pol gene, an HIV subtype and resistance profile were determined. A total of 12,192 volunteers were recruited from October 2006 to September 2008. A higher HIV prevalence was detected among trans SWs (33.9%, 38/112), male SWs (10.8%, 12/111), and MSM 10.4% (161/1549). HIV incidence estimates by STARHS was also higher on trans SWs (11.31 per 100 person-years), male SWs (6.06 per 100 person-years), and MSM (6.36 per 100 person-years). Antiretroviral primary resistant mutations were detected in 8.4% of the study group, with a higher frequency in female DUs (33.3%). Phylogenetic analysis showed that 124 (57.9%) samples were subtype B, 84 (39.3%) intersubtype BF recombinants, 5 (2.3%) subtype C, and 1 (0.5%) subtype F in the pol region. Subtype B was most commonly found in MSM and male SWs whereas the intersubtype BF recombinant was more prevalent in female DUs, female SWs, and PW. Given the high HIV prevalence and incidence found in most of these groups, monitoring the continuing spread of the HIV epidemic is essential for determining public health priorities, assessing the impact of interventions, and estimating current and future health care needs.

Evaluation of the trypanocidal, cytotoxic and genotoxic activity of styrylquinoline analogs

Styrylquinolines isolated from Galipea longiflora have shown leishmanicidal, trypanocidal, nematocidal and antimalarial activity. Here, we propose to use analogs of these styrylquinolines to enhance the activity against Trypanosoma cruzi. Three compounds in a reduced and oxidized state were synthesized, and the activity against epimastigotes and trypomastigotes was evaluated. in addition, the cytotoxic activity and genotoxic effect were also determined. The results indicated that epimastigotes from different T. cruzi I stocks were highly sensitive to the three compounds. The PQM4 compound presented promising activity against trypomastigotes and low cytotoxic and genotoxic effects. Finally, we observed that the doublebond reduction of the lateral chain of the three carbons made on these compounds improved the activity and substantially diminished the toxicity of the compounds.

Junín virus infection of human hematopoietic progenitors impairs in vitro proplatelet formation and platelet release via a bystander effect involving type I IFN signaling

Argentine hemorrhagic fever (AHF) is an endemo-epidemic disease caused by Junín virus (JUNV), a member of the arenaviridae family. Although a recently introduced live attenuated vaccine has proven to be effective, AHF remains a potentially lethal infection. Like in other viral hemorrhagic fevers (VHF), AHF patients present with fever and hemorrhagic complications. Although the causes of the bleeding are poorly understood, impaired hemostasis, endothelial cell dysfunction and low platelet counts have been described. Thrombocytopenia is a common feature in VHF syndromes, and it is a major sign for its diagnosis. However, the underlying pathogenic mechanism has not yet been elucidated. We hypothesized that thrombocytopenia results from a viral-triggered alteration of the megakaryo/thrombopoiesis process. Therefore, we evaluated the impact of JUNV on megakaryopoiesis using an in vitro model of human CD34⁺ cells stimulated with thrombopoietin. Our results showed that CD34⁺ cells are infected with JUNV in a restricted fashion. Infection was transferrin receptor 1 (TfR1)-dependent and the surface expression of TfR1 was higher in infected cultures, suggesting a novel arenaviral dissemination strategy in hematopoietic progenitor cells. Although proliferation, survival, and commitment in JUNV-infected cultures were normal, viral infection impaired thrombopoiesis by decreasing in vitro proplatelet formation, platelet release, and P-selectin externalization via a bystander effect. The decrease in platelet release was also TfR1-dependent, mimicked by poly(I:C), and type I interferon (IFN α/β) was implicated as a key paracrine mediator. Among the relevant molecules studied, only the transcription factor NF-E2 showed a moderate decrease in expression in megakaryocytes from either infected cultures or after type I IFN treatment. Moreover, type I IFN-treated megakaryocytes presented ultrastructural abnormalities resembling the reported thrombocytopenic NF-E2^−/− mouse phenotype. Our study introduces a potential mechanism for thrombocytopenia in VHF and other diseases associated with increased bone marrow type I IFN levels.

Argentine hemorrhagic fever (AHF) is an endemo-epidemic disease caused by Junín virus (JUNV). Although a recently introduced live attenuated vaccine has proven to be effective, AHF remains a potentially lethal infection and JUNV is considered to be a potential biological weapon. Like other viral hemorrhagic fevers (VHF), AHF patients present fever with a combination of neurological and bleeding complications. Although the causes of the bleeding are poorly understood, impaired hemostasis and endothelial cell function as well as low platelet counts have been described. In this study, we have examined the impact of JUNV on an in vitro model of platelet production. We found that neither infection of hematopoietic progenitors with JUNV nor poly(I:C) (a double-stranded RNA that mimics viral infection) affected cell survival or megakaryocyte generation. However, these treatments triggered the main anti-viral cytokines produced by host type I IFN (IFN α/β), which acted in a paracrine fashion and led to abnormal platelet formation. Thus, this study identifies type I IFN as a new regulator that selectively affects the last steps of megakaryocyte lifespan, and it suggests a potential mechanism for thrombocytopenia in AHF and other diseases associated with increased bone marrow type I IFN levels.

Lack of association between macrophage migration inhibitory factor-173 gene polymorphism with disease susceptibility and cardiovascular risk in rheumatoid arthritis patients from northwestern Spain

OBJECTIVES

To assess whether the polymorphism of the macrophage migration inhibitory factor (MIF) gene at the position -173 is implicated in the disease susceptibility, risk of cardiovascular (CV) events and presence of subclinical atherosclerosis in patients with rheumatoid arthritis (RA).

PATIENTS AND METHODS

A series of 293 unselected patients fulfilling the 1987 American College of Rheumatology classification criteria for RA seen at the rheumatology outpatient clinic of Hospital Xeral-Calde, Lugo, Spain and 526 matched controls were studied for differences in the MIF-173 G/C gene biallelic polymorphism. A total of 182 consecutive patients that had been periodically followed between March 1996 and September 1996 until patient's death or January 1, 2008 were assessed for the presence of CV events. Moreover, between March and December 2007, a subgroup of unselected RA patients with no history of CV events was studied for the presence of subclinical atherosclerosis by the assessment of the endothelial function (n=107) and the carotid artery intima-media thickness (IMT) (n=91) by ultrasonography studies. Patients and controls were genotyped for the MIF-173 G/C gene polymorphism using a PCR system with pre-developed TaqMan allelic discrimination assay.

RESULTS

No significant differences in allele or genotype frequencies for the MIF-173 gene polymorphism between RA patients and controls were found. Forty-four of the 182 patients followed between 1996 and January 2008 experienced CV events. Although the frequency of MIF-173 GG homozygous was increased in those who had CV events (88.6%) compared to those who did not suffer these complication (73.2%), the difference was not statistically significant. It was also the case when we analyzed the potential influence of MIF-173 genotypes in the presence of endothelial dysfunction or increased carotid IMT of patients with RA.

CONCLUSIONS

Our results do not show that MIF-173 gene polymorphism may infer a direct risk for disease susceptibility or CV disease in patients with RA.

The interleukin 23 receptor gene does not confer risk to systemic sclerosis and is not associated with systemic sclerosis disease phenotype

Objectives:

Multiple studies indicate the role of the interleukin (IL)-17/IL-23 axis in autoimmune diseases, including systemic sclerosis (SSc). The aim of the current study was to investigate the possible implication of the IL23R gene in SSc susceptibility and/or clinical phenotype.

Methods:

An initial case–control study in 143 Dutch patients with SSc and geographically matched healthy individuals (n = 246) was carried out and followed by a replication study in a cohort of 365 Spanish patients with SSc and 515 healthy individuals. Seven single nucleotide polymorphisms (SNPs) spanning the IL23R gene were selected and genotyped using a Taqman assay.

Results:

Using a Dutch cohort of patients with SSc and controls we observed an association between two (rs11209032, rs1495965) of the seven tested SNPs and disease susceptibility (allelic p values: p = 0.02 and p = 0.01 respectively). However, a replication study in an independent Spanish cohort did not confirm these findings and reveal no association of any of the IL23R-tested SNP with disease susceptibility or clinical phenotype. Similarly, a meta-analysis considering both populations did not reveal any significant association. In addition, no association was observed between IL23R genetic variants and SSc clinical phenotypes.

Conclusions:

Our results suggest that the IL23R gene is not associated with SSc susceptibility or clinical phenotype.

Antigenic differentiation of classical swine fever vaccinal strain PAV-250 from other strains, including field strains from Mexico

Twenty-nine classical swine fever virus (CSFv) strains were grown in the PK15 or SK6 cell lines. Antigenic differentiation studies were performed using monoclonal antibodies (McAbs), produced at Lelystad (CDI-DLO), The Netherlands. The monoclonals which were classified numerically as monoclonals 2-13. Epitope map patterns that resulted from the reactivity with McAbs were found to be unrelated to the pathogenicity of the viruses studied. Antigenic determinants were recognized by McAbs 5 and 8, were not detected in some Mexican strains; however, sites for McAb 6 were absent in all strains. The PAV-250 vaccine strain was recognized by all MAbs, except by MAb 6. Furthermore, the Chinese C-S vaccine strain was found to be very similar to the GPE(-) vaccine. None of the studied Mexican vaccines or field strains was found to be similar to the PAV-250 vaccine strain.

Activation of cyclic AMP pathway prevents CD34(+) cell apoptosis

OBJECTIVE

Although cAMP is involved in a number of physiologic functions, its role in hematopoietic cell fate decision remains poorly understood. We have recently demonstrated that in CD34(+)-derived megakaryocytes, cAMP-related agents prevent apoptosis. In this study we addressed the question of whether cAMP also regulates survival of their precursors, CD34(+) cells.

METHODS

Apoptosis was evaluated by fluorescence microscopy, and detection of hypodiploid or annexin V(+) cells by flow cytometry. Mitochondrial membrane potential and bcl-xL or caspase-3 expression were assessed by flow cytometry. Colony-forming units were studied by clonogenic assays in methylcellulose.

RESULTS

We found that two different cAMP analogs such as Dibutiril-cAMP and sp-5,6-DCl-BIMPS (BIMPS) promoted survival of human umbilical cord-derived CD34(+) cells by suppressing apoptosis induced by either nitric oxide (NO) or serum deprivation. Involvement of PKA and PI3K pathway was demonstrated by the ability of their specific inhibitors Rp-cAMP and Wortmannin or LY294002 respectively to reverse the antiapoptotic effect of BIMPS. Treatment of CD34(+) cell with BIMPS not only restrained the bcl-xL downregulation but also suppressed the loss of mitochondrial membrane potential and caspase-3 activation induced by serum starvation. While thrombopoietin (TPO), granulocyte colony-stimulating factor (G-CSF) or stem cell factor (SCF) were not able to increase cAMP levels, the antiapoptotic activity exerted by these growth factors was blocked by inhibition of the adenylate cyclase and synergized by BIMPS. Cyclic AMP analogs suppressed the decreased colony formation in cells exposed to NO or serum deprivation.

CONCLUSION

Altogether, our results strongly suggest that cAMP appears to be not only a key pathway controlling CD34(+) survival, but also a mediator of the TPO-, G-CSF- and SCF-mediated cytoprotection.

Total gastrectomy with or without abdominal drains. A prospective randomized trial

The most common postoperative complications of total gastrectomy are esophagojejunal anastomotic leakage and subphrenic abscess. These complications are a cause of morbidity and mortality, relaparotomy, and longer postoperative stay. The use of abdominal drains is useful for the early diagnosis and management of anastomotic leaks. The aim of this study was to analyze our experience with total gastrectomy for gastric cancer in patients with and without abdominal drains, and to evaluate the results regarding postoperative morbidity, postoperative hospital stay, postoperative days for oral intake, relaparotomy and mortality. This prospective and randomized study examines the results in 60 consecutive patients (43 males and 17 females) with gastric cancer who underwent total gastrectomy in the Regional Clinical Hospital of Concepción, Chile, between 2000 and 2003. Patients were divided into two groups: group I (without drains) and group II (two drains). We found 31 patients in group I and 29 patients in group II. The mean length of postoperative stay was 12.9 days in group I and 18.8 days in group II (p = 0.0242, s.). Morbidity was 9.7% in group I and 37.9% in group II (p = 0.0242, s.). Re-explorations were more frequent in group II (24.1%) versus group I (9.7%) (p = 0.1239, n.s.). Postoperative days for oral intake were 9.4 in group I and 12.8 in group II (p = 0.0514, n.s.) Mortality was 0% in group I and 3.4% in group II (p = 0.4833, n.s.). In our experience, morbidity and postoperative hospital stay were statistically higher in the group of patients with abdominal drains.