Immobilized biocatalyst engineering: Biocatalytic tool to obtain attractive enzymes for industry

Biocatalysis can improve current bioprocesses by identifying or improving enzymes that withstand harsh and unnatural operating conditions. Immobilized Biocatalyst Engineering (IBE) is a novel strategy integrating protein engineering and enzyme immobilization as a single workflow. Using IBE, it is possible to obtain immobilized biocatalysts whose soluble performance would not be selected. In this work, Bacillus subtilis lipase A (BSLA) variants obtained through IBE were characterized as soluble and immobilized biocatalysts, and how the interactions with the support affect their structure and catalytic performance were analyzed using intrinsic protein fluorescence. Variant P5G3 (Asn89Asp, Gln121Arg) showed a 2.6-fold increased residual activity after incubation at 76 °C compared to immobilized wild-type (wt) BSLA. On the other hand, variant P6C2 (Val149Ile) showed 4.4 times higher activity after incubation in 75 % isopropyl alcohol (36 °C) compared to Wt_BSLA. Furthermore, we studied the advancement of the IBE platform by performing synthesis and immobilizing the BSLA variants using a cell-free protein synthesis (CFPS) approach. The observed differences in immobilization performance, high temperature, and solvent resistance between the in vivo-produced variants and Wt_BSLA were confirmed for the in vitro synthesized enzymes. These results open the door for designing strategies integrating IBE and CFPS to generate and screen improved immobilized enzymes from genetic diversity libraries. Furthermore, it was confirmed that IBE is a platform that can be used to obtain improved biocatalysts, especially those with an unremarkable performance as soluble biocatalysts, which wouldn't be selected for immobilization and further development for specific applications.

Active immunization with a structurally aggregated PD-L1 antigen breaks T and B immune tolerance in non-human primates and exhibits in vivo anti-tumoral effects in immunocompetent mouse tumor models

Despite the clinical success of the programmed death ligand 1 (PD-L1) blocking therapy in cancer treatment, only a subset of patients exhibits durable responses, therefore further exploration of other immunotherapeutic alternatives are needed. This paper reported the development of the PKPD-L1^Vac vaccine, a new protein vaccine candidate that uses aluminum phosphate as an adjuvant and as an antigen the extracellular domain of human PD-L1 fused to a 47 amino-terminal portion of the LpdA protein from N. meningitides (PKPD-L1). The PKPD-L1 antigen has different physical and biological characteristics than those found in the natural molecule and in others PD-L1 vaccine candidates. The quimeric protein has a reduced binding capacity to the PD-1 and CD80 receptors to decrease their pro-tumoral activity. Besides, the distinctive feature of the PKPD-L1 polypeptide to be structurally aggregated could be desirable for its immunogenic properties. PKPD-L1^Vac elicited anti-PD-L1-specific IgG antibodies and T lymphocyte-mediated immunity in mice and non-human primates. The vaccine administration demonstrated antitumor activity on CT-26 and B16-F10 primary tumor models in mice. Moreover, the immunization with PKPD-L1^Vac increased the tumor-infiltrating lymphocytes and decreased the proportion of CD3⁺CD8⁺PD1^+high anergic T cells in CT-26 tumor tissues, suggesting that the vaccine may remodel the tumor microenvironment. In summary, the PKPD-L1^Vac vaccine exhibits very promising preclinical results and deserves to move forward to a phase I clinical trial.

Implementation of the use of SPECT-portable for evaluation of surgical margins in breast cancer with indication of ROLL: First results

OBJECTIVES

Main objective: To compare the effectiveness for checking surgical margins between SPECT-portable and mammography of the piece (RxM).

SECONDARY OBJECTIVE

To standardize a pre-operative protocol using SPECT-portable and to evaluate the time required in the use of this technique.

MATERIAL AND METHODS

Prospective longitudinal study with 36 patients (39 lesions) diagnosed with breast cancer (CM) with criteria for SNOLL/ROLL. A pre-surgical study of the tumor lesion was performed, after the eco-guided administration of ^99mTc-nanocolloids of albumin/^99mTc-macroaggregates of albumin, in the tumor lesion. Hybrid images (optical + SPECT) and 3D navigation images with gamma probe are obtained using freehandSPECT. In the operating room, 4-5 images are obtained with freehandSPECT, (I) on skin for tumor location, (II) after exposure of surgical bed for resection guide, (III) of the surgical bed after exeresis, (IV and V) the anterior-posterior and lateral surface of the surgical specimen. The three criteria to decide to extend the margins are: (a) residual activity (cps) at the edges of the surgical bed resection; (b) visual analysis of the uptake in the specimen; (c) a minimum distance of 10 mm from the edges of the specimen to the center of greatest uptake, plus the radius of the lesion. We study the concordance of: the depth measurement between ultrasound and freehandSPECT; the surgical margins between freehandSPECT vs. mammography of the specimen (RxM), considering anatomical pathology (AP) as the gold standard technique as reference; surgical time used with freehandSPECT and RxM.

RESULTS

Intraoperative localization was performed in all cases. False negative (FN: no detection margin affected) with freehandSPECT: 9 margins; with RxM: 8. True positive (TP: detection margin affected) with freehandSPECT: 5 margins, with RxM: 6. True negative (TN: consider free margin when healthy) with freehandSPECT: 213 margins; with RxM: 196. Negative predictive value (NPV: probability of negative margin on unaffected part) with freehandSPECT: 95.9%, with RxM: 96.07%. Specificity with freehandSPECT: 96.8%, with RxM: 97%. The concordance of surgical bed margins between freehandSPECT and RxM: 94.5%. Between freehandSPECT and AP: 93.1%. Between RxM and PA: 93.5%, being all statistically significant (p-value <0.000), so we can affirm that both techniques are related or dependent on the reference technique, the PA. Degree of correlation between SPECT-portable and low PA (Kappa index: 0.34, 95% CI [0.22-0.47], and between RxM and moderate PA (Kappa index: 0.42, 95% CI [0.29-0.56], p-value <0.001. Comparison of the successes and failures of both techniques (SPECT-portable and RxM) and PA: Distribution χ2: 0.023 with degree of freedom 1, with value <0.05, so we can affirm that both techniques are similar, since there are no significant statistical differences. Median total OR time: 60.25 min (30-145). Mean freehandSPECT OR time: 5 scans = 10 min.

CONCLUSIONS

There are no statistically significant differences in the probability to rule out affective margins that require a second surgery between both techniques (SPECT-portable and RxM) so, the technique performed with SPECT-Portable is a useful and effective procedure, which requires specific training with an optimized and multidisciplinary protocol. The time spent with SPECT-portable is feasible for daily practice.

AB0415 UPADACITINIB. EFFECTIVENESS AND SAFETY IN PATIENTS WITH REFRACTORY RHEUMATOID ARTHRITIS

Background

Upadacitinib is the third janus kinase (JAKi) inhibitor approved for rheumatoid arthritis after baricitinib and tofacitinib. Upadacitinib is a selective JAK1 inhibitor, and is indicated for the treatment of moderate to severe active RA in adult patients with inadequate response or intolerance to one or more DMARDs.

Objectives

To describe the effectiveness and safety data of upadacitinib in patients with moderate-severe RA refractory to multiple synthetic and/or biologic DMARDs.

Methods

Descriptive and retrospective observational study conducted in patients who met RA classification criteria, refractory to synthetic and/or biologic DMARDs in the Rheumatology department of the Valme Hospital. Epidemiological, clinical, analytical, and safety and treatment-related variables were collected. A descriptive quantitative analysis of the data was performed.

Results

Forty five patients were included (37 women and 8 men), with a mean age of 53 years and mean time of RA evolution of 11 years. Of the patients, 44.4% had some cardiovascular risk factor. With respect to previous treatment, 100% were on DMARDsc, with a median of 2 DMARDsc per patient. Regarding biologic or targeted therapy, 77.8% had a history of biologic therapy failure with a median of 1 biologic; in addition, 8 patients had received at least 3 previous biologic drugs prior to upadacitinib. A total of 28.9% (13 patients) had previously received JAKi, discontinued due to secondary failure or from clinical trials at other centers. In terms of disease activity at the start of upadacitinib, patients had a mean of number of swollen joints (SJC) 3, number of tender joints (TJC) 4, CRP 11 mg/dl, DAS28 of 4.23 and CDAI of 21.5. When starting upadacitinib, 80% of the patients were on steroid therapy, 51% with doses > 5 mgr/day of prednisone. Combination therapy with DMARDs was maintained in 76.3% of patients (56.7% MTX, 36.7% LFN and the rest with SSZ). The results were analyzed after a median of 7 months from the start of upadacitinib: DMARDsc were discontinued in 4 patients and the steroid dose was reduced in 58.3% of the total, being discontinued in 21.2%. With respect to disease activity analyzed post-treatment in patients who maintained the drug, a mean of SJC 0, TJC 2, CRP 0.8 mg/dl, DAS28 2.7 and CDAI 12.5 were observed (Table 1). The drug was discontinued in 11 patients: 5 for adverse events (headache, hypersensitivity, gastrointestinal discomfort, instability accompanied by photopsia, lymphopenia and irritative cough) that resolved after drug discontinuation, 5 for primary failure and 1 for secondary failure. No cases of herpes, thrombosis or cardiovascular events were recorded.

Table 1.

Medians pre-treatment and post-treatment outcomes in patients who maintained upadacitinib: SJC, TJC, C-Reactive Protein (CRP) and disease activity indices DAS28 and CDAI.

Pre upadacitinibPost-treatment (medians 7 months)Statistical significanceSJC30< 0,05TJC420,03CRP110,8< 0,05DAS284,232,7< 0,05CDAI21,512,5< 0,05

Conclusion

Upadacitinib managed to control disease activity in a high percentage of our series of patients resistant to multiple synthetic and/or biologic DMARDs, making it possible to reduce or even suspend steroid treatment in a significant number of patients, so it may be an option to consider in patients with refractory RA. Longer-term studies are needed to continue evaluating the effectiveness, safety and survival of the drug in real clinical practice.

References

[1]Strand V, Schiff M, Tundia N, Friedman A, Meerwein S, Pangan A, Ganguli A, Fuldeore M, Song Y, Pope J. Effects of upadacitinib on patient-reported outcomes: results from SELECT-BEYOND, a phase 3 randomized trial in patients with rheumatoid arthritis and inadequate responses to biologic disease-modifying antirheumatic drugs. Arthritis Res Ther. 2019 Dec 2;21(1):263.

Disclosure of Interests

None declared

AB1186 ACUTE PERICARDITIS IN TIMES OF COVID

Background

The most common etiology of acute pericarditis is usually infectious, especially viral. When its cause is inflammatory (up to 7% of cases), it can be presented as an isolated process or be a clinical manifestation in the context of multiple systemic autoimmune diseases (SAD), therefore it is necessary to make a broad differential diagnosis. Nowadays, an increased incidence has been described in relation to SARS-CoV-2 infection, and especially in global vaccination against this one. This represents a clinical challenge when we have to identify the cause of this pathology with a not insignificant comorbidity.

Objectives

To describe the characteristics of a series of patients with acute pericarditis and its association with SAD.

Methods

Retrospective and descriptive observational study. Digitalised records of patients with acute pericarditis evaluated in the Rheumatology unit of a tertiary hospital in Seville during 2021 were reviewed. Demographic, epidemiological, clinical and therapeutic variables were analysed.

Results

Eight cases of acute pericarditis were detected. The average age of the patients was 51.50 ± 18.601 years. 62.5% were women. 50% had previous rheumatological pathology: two rheumatoid arthritis (RA), one systemic lupus erythematosus (SLE) and one limited systemic sclerosis (LSS); with an average disease duration of 8.63 ± 2.387 months. Of these, 3 were on treatment with steroids and DMARDs (leflunomide or hydroxychloroquine) and 1 had previously received rituximab. Pericardial effusion was moderate in 50% of cases, severe in 33.3% and mild in 16.7%. One patient had cardiac tamponade. Five patients had pleural effusion, which was moderate in 80%, and in one case associated with pneumonia. As complications, one patient developed heart failure and the patient with ESL was diagnosed with pulmonary arterial hypertension. Two patients had previous COVID19 and 7 were vaccinated against Sars-CoV2. Treatment was colchicine in 57.15% of cases, steroids in 85.7%, DMARDsc in 85.8% (3 hydroxychloroquine and 3 azathioprine) and DMARDsb in 42.9% (1 anakinra, 1 tocilizumab and 1 rituximab). Pericarditis resolved in all patients. Table 1.

Table 1.AgeSexUnderlying rheumatological diseasePrevious treatmentTreatment performedPericardial effusionEvolutionCase123MaleSeronegative oligoarthritis and vasculitisHydroxychloroquineColchicineModerateResolutionSteroidsAzathioprineAnakinraCase248WomanNoNoColchicineNoResolutionSteroidsHydroxychloroquineCase368WomanSeropositive RA and Sjögren syndromeLeflunomideSteroidsMildResolutionHydroxychloroquineLeflunomideTocilizumabRituximabCase447WomanNoNoColchicineModerateResolutionSteroidsHydroxychloroquineCase527MaleNoNoColchicineSevereResolutionSteroidsCase661WomanIcSScD-penicillamineSteroidsSevereResolutionAzathioprineCase768WomanSLESteroidsSteroidsNoResolutionAzathioprineRituximabCase871MaleANA+ polyarthritisSteroidsSteroidsNoResolutionHydroxychloroquine

Conclusion

In the previous year, an increase in consultations from other departments for acute pericarditis with suspected inflammatory origin was observed. The possibility of a correlation with COVID19 or vaccination against COVID was initially considered, but it could not be demonstrated, since vaccination was later in vaccinated patients, and in those who had been infected, the time interval until the development of pericarditis was too long for it in order to be attributed to COVID19. Finally, in 5 of the 8 patients, pericarditis was related to SAD, in particular with the rheumatic pathologies most associated with this clinical manifestation (RA and SLE). Therefore, in the middle of the COVID pandemic, in addition to considering COVID19 or its vaccine in the differential diagnosis of acute pericarditis, we must not forget to include SAD in this diagnosis.

References

[1]Bizzi E, Trotta L, Pancrazi M, Nivuori M, Giosia V, Matteucci L, Montori D, Brucato A. Autoimmune and Autoinflammatory Pericarditis: Definitions and New Treatments. Curr Cardiol Rep. 2021 Jul 28;23(9):128.

Disclosure of Interests

None declared

P–398 Decidualization inhibits the expression of CXCR3-binding chemokines by human decidual stromal cells. Role in maternal-fetal immune tolerance

Study question

We aimed to analyze the effects of decidualization on the expression of chemokines that attract abortogenic T cells by human DSCs.

Summary answer

Decidualization inhibits the expression of chemokines that attract Th1 and Tc1 cells by DSCs, thereby preventing the arrival of abortogenic T cells into the decidua.

What is known already

Decidual stromal cells (DSCs) are the most abundant cells in the human decidua, the tissue that constitutes the maternal component of the placenta. Numerous evidences confirm that DSCs play a key role in maternal-fetal immune tolerance. In normal pregnancy, DSCs undergo a process of differentiation (decidualization) under the effect of progesterone and other pregnancy hormones. Decidualized DSCs become rounded and secrete prolactin, IL–15 and other factors. In the mouse, it has been observed that during pregnancy, DSCs inhibit the expression of chemokines that attract abortogenic Th1 and Tc1 cells from blood to the decidua.

Study design, size, duration

We compared the expression of CXCR3-binding chemokines by undifferentiated and decidualized human DSCs. We also compared the capacity of these cells to attract activated Th1 and Tc1 cells in vitro. Ten DSC lines were obtained from elective vaginal terminations of first-trimester pregnancies (6–11 weeks). Donors were healthy women aged 20–30 years. Informed consent was obtained from each donor. This study was approved by the Research and Ethics Committee of the University of Granada.

Participants/materials, setting, methods

Decidual stromal cell lines were established as previously described. These lines were decidualized with progesterone and cAMP in vitro. The expression of chemokines by these cells was studied by RT-PCR. Peripheral blood lymphocytes were activated with PHA, anti-CD28 and IL–2. As a consequence of this activation, CXCR3+ Th1 and Tc1 cells were produced. We used a migration assay in Transwell chambers to study the capacity of DSCs to attract these activated T cells.

Main results and the role of chance

We observed that those chemokines that bind to CXCR3, a chemokine receptor detected in activated Th1 and Tc1 cells, were not expressed by either undifferentiated and decidualized DSCs (CXCL9) or their expression was inhibited in decidualized DSCs (CXCL10 P &lt; 0.01, CXCL11 P &lt; 0.05). We found that conditioned media of undifferentiated DSCs decreased the migration of CXCR3+ activated T cells (Th1 and Tc1 cells) (P &lt; 0.05), and this effect was even stronger with conditioned media of decidialized DSCs P &lt; 0.001). These results demonstrated that decidualization of DSCs during pregnancy inhibits the expression of chemokines that attract Th1 and Tc1 cells by DSCs, thereby preventing the arrival of abortogenic T cells into the decidua.

Limitations, reasons for caution

This is an in vitro study due to the impossibility of performing an in vivo study in humans for ethical reasons.

Wider implications of the findings: Several publications have shown that DSCs have a therapeutic effect in various Th1-associated diseases. Our results explain this effect and suggest the extension of the use of these cells in the treatment of this type of diseases.

Trial registration number

Not applicable

Surgical treatment of proximal humeral fractures with the transosseous suture fixation

BACKGROUND

The surgical treatment of displaced proximal humeral fractures is commonly affected by implant-related complications. We evaluated the functional and radiographic results of transosseous suture fixation in a series of displaced proximal humeral fractures (PHF).

METHODS

Sixty-four patients were retrospectively classified by age, sex, and the Neer fracture classification. Two-part greater tuberosity (2pGT) displaced fractures and 3-part (varus and valgus) and 4-part valgus impacted fractures were managed with fragment reduction and transosseous suture fixation. Patients with minimum follow-up of 24 months and assessed with the Constant-Murley score (CMS) were included. Radiological and medical complications, as well as reinterventions were also recorded.

RESULTS

Forty-six patients with a mean follow-up of 58 (24-132) and a mean age of 58 years old were analyzed. Patients with 2pGT (n = 10) fractures had a CMS of 76 points (59-89); patients with 3-part fractures (n = 22) had a score of 67 points (13-91); and those with 4-part fractures (n = 14) had a score of 64 (24-76) points. The overall complication rate was 6 out of 46, and 4 patients required reintervention for different reasons. Patients presenting with 3-part varus fractures had significantly lower functional outcomes scores (p = 0.007). Humeral head osteonecrosis was present in 9 patients and significantly affected the functional outcomes (p < 0.05). However, only three out of nine patients with osteonecrosis required subsequent surgery at the indicated follow-up.

CONCLUSIONS

The fracture reduction and transosseous fixation technique represents a safe technique with low complication and reintervention rates. The presence of humeral head necrosis did not lead to subsequent surgical intervention because no hardware had protruded.

LEVEL OF EVIDENCE

Level IV, retrospective study.

Tranexamic acid use in severely injured patients, is it always appropriate?

Recently, it has been suggested that tranexamic acid should be administered only in those patients with hyperfibrinolysis determined using viscoelastic assays, as severely injured patients may present with fibrinolytic shutdown. However the last European guidelines on management of major bleeding and coagulopathy following trauma endorse the use of tranexamic acid to the trauma patient who is bleeding or at risk of significant hemorrhage as soon as possible without waiting for viscoelastic results. We present a severely blunt trauma patient treated with on-scene administration of tranexamic acid that developed immediate pulmonary embolism.

Tranexamic acid use in severely injured patients, is it always appropriate?

Recently, it has been suggested that tranexamic acid should be administered only in those patients with hyperfibrinolysis determined using viscoelastic assays, as severely injured patients may present with fibrinolytic shutdown. However the last European guidelines on management of major bleeding and coagulopathy following trauma endorse the use of tranexamic acid to the trauma patient who is bleeding or at risk of significant hemorrhage as soon as possible without waiting for viscoelastic results. We present a severely blunt trauma patient treated with on-scene administration of tranexamic acid that developed immediate pulmonary embolism.

Immobilized Biocatalyst Engineering: High throughput enzyme immobilization for the integration of biocatalyst improvement strategies

The increasing use of sustainable manufacturing technologies in the industry presents a constant challenge for the development of suitable biocatalysts. Traditionally, improved biocatalysts are developed either using protein engineering (PE) or enzyme immobilization (EI). However, these approaches are usually not simultaneously applied. In this work, we designed and validated an enzyme improvement platform, Immobilized Biocatalyst Engineering (IBE), which simultaneously integrates PE and EI, with a unique combination of improvement through amino acid substitutions and attachment to a support material, allowing to select variants that would not be found through single or subsequent PE and EI improvement strategies. Our results show that there is a significant difference on the best performing variants identified through IBE, when compared to those that could be identified as soluble enzymes and then immobilized, especially when evaluating variants with low enzyme as soluble enzymes and high activity when immobilized. IBE allows evaluating thousands of variants in a short time through an integrated screening, and selection can be made with more information, resulting in the detection of highly stable and active heterogeneous biocatalysts. This novel approach can translate into a higher probability of finding suitable biocatalysts for highly demanding processes.

Tisseel® versus Hemopatch® for dural sealing in neurosurgery. A prospective study in a tertiary center

BACKGROUND

Dural repair is a potential source of complications in neurosurgery. We make a comparison in pseudomeningocele and CSF leak incidence with the sealants Tisseel® and Hemopatch®.

METHODS

We collected 147 patients from September 2017 to December 2018 in a prospective observational study. Inclusion criteria were adult patients with an intradural cranial or spinal surgery whose dura was closed with a fibrin sealant. Primary endpoints were the incidence of pseudo meningocele and CSF leak. Secondary endpoints were the surgical-site infection, epidural hematoma, and the influence of previous surgery.

RESULTS

In 65 and 82 patients Tisseel® and Hemopatch® were used as sealants respectively. The incidence of CSF leak presented a significant statistical relation with the use of Tisseel® in a univariate and multivariate analysis. Infratentorial surgery presented a higher incidence of pseudomeningocele and CSF leak, but the approach used was not a significant factor in multivariate analysis. Patients who were operated previously had a higher risk present a postoperative complication.

CONCLUSIONS

The incidence of pseudomeningocele and CSF leak was higher with Tisseel® compared with Hemopatch® with a statistic significant relation in case of CSF fistulae. The procedure done may be a confusion factor in our study. There was no report of adverse effects or a higher incidence of complications. However, it is recommended to plan randomized trials with larger samples to get stronger evidence.

Development of alginate-pectin microcapsules by the extrusion for encapsulation and controlled release of polyphenols from papaya (Carica papaya L.)

The papaya fruit (Carica papaya L.) contains a wide variety of bioactive compounds with potential applications in the food and nutraceutical industries. The entrapment and release of such bioactive compounds remain a critical step for the development of functional, stable, and cost-effective storage and delivery systems, since the interaction of polymers on capsules and the payload molecules can influence the performance of the capsule system under operational conditions. The present study describes the encapsulation of rutin and trans-ferulic acid-rich extracts from papaya exocarp in a pectin-alginate composite, evaluating the performance of gallic acid encapsulation obtained through in situ and two-step entrapment methods. The best alginate:pectin ratio for gallic acid encapsulation was 55:45 and 61:39, achieving 6.1 mg and 28.1 mg GAE/g capsules when the papaya exocarp extract was encapsulated by in situ and two-step, respectively. We also evaluated the payload release performance of the obtained capsules under in vitro conditions simulating gastrointestinal conditions. Our results indicate an increased protective effect at gastric pH and targeted release of polyphenols when in situ encapsulation is used to encapsulate the extracts. PRACTICAL APPLICATIONS: Currently, adding value to agroindustry processing waste is an important focus to achieve a more economically and environmentally sustainable food industry. The recovery of bioactive molecules such as polyphenols, for food supplements or formulation additives in the form of by-product extracts is gaining importance as novel sustainable processes in the agricultural industry. Thus, the encapsulation of such bioactive extracts for storage and consumption is an active research field, aiming to overcome the low storage stability and lability to gastric conditions, currently hindering their applications in food or pharmaceutical formulations. In this sense, capsule design and the development of efficient encapsulation methods are very important to obtain a suitable carrier and protector system for the capsulated bioactive extracts or molecules. This research aims to add value to papaya waste and potentially to other agroindustry wastes such as pectin and alginate, resulting in a polyphenol carrier with excellent encapsulation and targeted release properties under gastrointestinal conditions. In conclusion, this kind of works could allow to the application of the agroindustry byproducts to obtain high added-value products, in the form of polyphenol-loaded capsules.

Outcome and characteristics of patients in methadone maintenance program depending on whether they are or not drug consumption room users

Introduction

In January 2012, a drug consumption room (DCR) opened in an outpatient treatment center for alcoholism and drug abuse (CADA) to reach people who inject drugs (PWID) who did not seek treatment.

Objectives/aims

To evaluate the characteristics and evolution of 76 patients undergoing methadone maintenance treatment (MMT) during a year in a CADA, depending on whether they are DCR users or nonusers.

Methods

A retrospective cross-sectional observational study was conducted by reviewing data collected from patients in MMT during 2015, performing a statistical comparison between DCR users and nonusers. Outcome was evaluated through urine controls, considering a poor outcome when positive to heroin > 20%.

Results

Of the 76 patients in MMT, the average age was 40 years, 21% were women, mean dosage of methadone was 48.2 mg/day and more than a half were DCR users (52.63%). Of the 40 patients, which formed the DCR user subgroup, the average age was 36.4 years, 20% were women and mean dosage of methadone was 47 mg/day. The outcome of all the patients in PMM was successful in 48.68% of the cases, presenting differentially the nonusers a 91.67% of good response and the users only a 10%.

Conclusions

Inclusion of a drug consumption room in an outpatient treatment center for alcoholism and drug abuse, which facilitates accessibility for people who inject drugs to treatment, poses new challenges in order to improve the effectiveness of the PMM.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Deletion and Randomization of Structurally Variable Regions in B. subtilis Lipase A (BSLA) Alter Its Stability and Hydrolytic Performance Against Long Chain Fatty Acid Esters

The continuous search for novel enzyme backbones and the engineering of already well studied enzymes for biotechnological applications has become an increasing challenge, especially by the increasing potential diversity space provided by directed enzyme evolution approaches and the demands of experimental data generated by rational design of enzymes. In this work, we propose a semi-rational mutational strategy focused on introducing diversity in structurally variable regions in enzymes. The identified sequences are subjected to a progressive deletion of two amino acids and the joining residues are subjected to saturation mutagenesis using NNK degenerate codons. This strategy offers a novel library diversity approach while simultaneously decreasing enzyme size in the variable regions. In this way, we intend to identify and reduce variable regions found in enzymes, probably resulting from neutral drift evolution, and simultaneously studying the functional effect of said regions. This strategy was applied to Bacillus. subtilis lipase A (BSLA), by selecting and deleting six variable enzyme regions (named regions 1 to 6) by the deletion of two amino acids and additionally randomizing the joining amino acid residues. After screening, no active variants were found in libraries 1% and 4%, 15% active variants were found in libraries 2% and 3%, and 25% for libraries 5 and 6 (n = 3000 per library, activity detected using tributyrin agar plates). Active variants were assessed for activity in microtiter plate assay (pNP-butyrate), thermal stability, substrate preference (pNP-butyrate, -palmitate), and compared to wildtype BSLA. From these analyses, variant P5F3 (F41L-ΔW42-ΔD43-K44P), from library 3 was identified, showing increased activity towards longer chain p-nitrophenyl fatty acid esters, when compared to BSLA. This study allowed to propose the targeted region 3 (positions 40-46) as a potential modulator for substrate specificity (fatty acid chain length) in BSLA, which can be further studied to increase its substrate spectrum and selectivity. Additionally, this variant showed a decreased thermal resistance but interestingly, higher isopropanol and Triton X-100 resistance. This deletion-randomization strategy could help to expand and explore sequence diversity, even in already well studied and characterized enzyme backbones such as BSLA. In addition, this strategy can contribute to investigate and identify important non-conserved regions in classic and novel enzymes, as well as generating novel biocatalysts with increased performance in specific processes, such as enzyme immobilization.

Desequilibrio de ligamiento, estratificación y patrones de ancestría en ganado Simmental

El uso masivo de pocos toros en programas de inseminación artificial afecta la composición y la estructura genética de una población. El objetivo de este estudio fue estimar la diversidad genética, estratificación genética, patrones de ancestría y el desequilibrio de ligamiento en ganado Simmental. Una muestra de 233 animales genotipados con 30106 marcadores tipo polimorfismo de nucleótido simple (SNP) fue usada. Los patrones de subdivisión genética y ancestría fueron estimados a través de análisis de componentes principales y probabilidades de asignación a grupos genéticos. El desequilibrio de ligamiento fue estimado como el cuadrado del coeficiente de correlación entre los SNP. El análisis por componentes principales no mostró patrones de subdivisión genética dentro de la población Simmental de Colombia. Sin embargo, el análisis de ancestría identificó una subdivisión genética de de tres grupos. Un valor de 0.3 para desequilibrio de ligamiento fue encontrado a una distancia de 33 kb. Los resultados permiten evidenciar el cambio en la estructura genética de una población debido al uso e importación de material genético proveniente de poblaciones que difieren en objetivos de cría y criterios de selección.

Evaluation of Polysaccharide Typhim Vi Antibody Response as a predictor of Humoral Immunodeficiency in Haematological Malignancies

An increasing healthcare challenge in the management of haematological malignancy (HM) is secondary immunodeficiency. From January 2019, the EMA included the evaluation of specific antibody (Ab) responses to better select patients for immunoglobulin replacement therapy (IgRT). We evaluated Ab responses to pneumococcal and Salmonella typhi pure polysaccharide immunization in a cohort of 42 HM patients and 24 healthy-controls. Pre-post specific Ab concentrations were measured by ELISA at 4 weeks. Globally, significantly lower Typhim Vi (TV) seroprevalence (9%) compared to 23-valent pneumococcal polysaccharide vaccine (PPV) (76%) (p <0.001) was observed. TV non responders (88%) were higher than PPV non responders (62%) (p <0.0001) and correlated better to infectious history. By ROC analysis, pre-post 5-fold TV increase was the best cut-off to discriminate HM with recurrent infections and controls (sensitivity 91%, specificity 100%). Despite the small sample cohort, our results suggest that specific anti-S typhi Ab response is a useful complementary assay in the diagnosis and management decision of SID to HM.

Predictive capacity of prodromal symptoms in first-episode psychosis of recent onset

BACKGROUND

Both the nature and number of a wide range of prodromal symptoms have been related to the severity and type of psychopathology in the psychotic phase. However, at present there is an incomplete picture focused mainly on the positive pre-psychotic dimension.

AIM

To characterize the prodromal phase retrospectively, examining the number and nature of prodromal symptoms as well as their relationship with psychopathology at the onset of first-episode psychosis.

METHODS

Retrospective study of 79 patients experiencing a first-episode psychosis of less than 1 year from the onset of full-blown psychosis. All patients were evaluated with a comprehensive battery of instruments including socio-demographic and clinical questionnaire, IRAOS interview, PANSS, stressful life events scale (PERI) and WAIS/WISC (vocabulary subtest). Bivariate associations and multiple regression analysis were performed.

RESULTS

Regression models revealed that several prodromal dimensions of IRAOS (delusions, affect, language, behaviour and non-hallucinatory disturbances of perception) predicted the onset of psychosis, with positive (22.4% of the variance) and disorganized (25.6% of the variance) dimensions being the most widely explained.

CONCLUSION

In addition to attenuated positive symptoms, other symptoms such as affective, behavioural and language disturbances should also be considered in the definitions criteria of at-high-risk people.

Survey of Aujeszky's Disease Virus in Hunting Dogs from Spain

Direct contact with swine infected by Aujeszky's disease virus (ADV) represents a potential risk of transmission to carnivore species, in which the infection is normally fatal. We assessed exposure to ADV in hunting dogs in an area where the virus is highly endemic in wild boar populations. Two out of 466 (0.43%; 95% CI 0.00-1.02%) hunting dogs analyzed were positive by gE-bELISA, gB-bELISA and the virus neutralization test. The seroprevalence levels detected, as well as the absence of reports of clinical cases in the hunting dog groups tested, indicate limited contact of this species with ADV in the study area. Further studies are warranted to assess the pathogenicity of Aujeszky's disease virus strains infecting wild boar.

Effect of perfluorodecanoic acid on pig oocyte viability, intracellular calcium levels and gap junction intercellular communication during oocyte maturation in vitro

Perfluorodecanoic acid (PFDA) is a synthetic perfluorinated compound, which has been reported to exert adverse effects on somatic cells. However, its effects on germ cells have not been studied to date. The aim of the present study was to analyze the effects of PFDA on the viability, intracellular calcium levels and gap junction intercellular communication (GJIC) during porcine oocyte maturation in vitro. PFDA negatively impacted oocyte viability (medium lethal concentration, LC₅₀ = 7.8 μM) and maturation (medium inhibition of maturation, IM₅₀ = 3.8 μM). Oocytes exposed to 3.8 μM PFDA showed higher levels of intracellular calcium relative to control oocytes. In addition, GJIC among the cumulus cells and the oocyte was disrupted. The effects of PFDA on oocyte calcium homeostasis and intercellular communication seem to be responsible for the inhibition of oocyte maturation and oocyte death. In addition, since the deleterious effects of PFDA on oocyte viability, maturation and GJIC are significantly stronger than the previously reported effects of another widely used perfluorinated compound (Perfluorooctane sulfonate) in the same model, the use of PFDA in consumer products is questioned.

Rate and factors influencing the conversion of abstracts presented at the argentinian congress of hypertension meetings to indexed full peer-reviewed publications

INTRODUCTION

Publication rates vary significantly among different scientific meetings, with many abstracts never being published as peer-reviewed articles. This issue has never been investigated in the Hypertension field in Argentina. Our purpose was to determine the proportion of abstracts presented at the Argentinian Congress of Hypertension meetings that were published as full articles in peer-reviewed indexed journals, the time lag to publication and the factors associated with successful publication.

METHODS

we conducted a PubMed search to identify peer-reviewed publications of abstracts presented at the Argentinian Congress of Hypertension meetings between 2006 and 2015, assessing publication rate along with the time lag to publication. We also extracted information about several abstract characteristics and, for those that got published, we recorded the date of publication and journal name with its impact factor and H index. Predictors of publication were analyzed using a multivariable model.

RESULTS

a total of 619 abstracts were presented between 2006 and 2015. The rate of conversion to full-text peer-reviewed articles by June 2017 was 28.1% (95%CI 24.7-31.8%), with a median time to publication of 15.7 months (IQR 8-30.9). On multivariable analysis, the independent predictors of publication were basic science category (OR 5 [95%CI 2.3-10.8], p<0.001), oral presentation (OR 2.8 [95%CI 1.6-4.9], p<0.001) and being an award winner for the presentation (OR 3 [95%CI 1.3-6.8], p=0.01).

CONCLUSION

conversion rate to full peer-reviewed articles of abstracts presented at the Argentinian Congress of Hypertension meetings is far from ideal, with potential areas where efforts should be concentrated to improve dissemination of knowledge.

Towards the Unification of Inference Structures in Medical Diagnostic Tasks

The central purpose of artificial intelligence applied to medicine is to develop models for diagnosis and therapy planning at the knowledge level, in the Newell sense, and software environments to facilitate the reduction of these models to the symbol level. The usual methodology (KADS, CommonKADS, GAMES, HELIOS, Protégé, etc.) has been to develop libraries of generic tasks and resuable problem-solving methods with explicit ontologies. The principal problem which clinicians have with these methodological developments concerns the diversity and complexity of new terms whose meaning is not sufficiently clear, precise, unambiguous and consensual for them to be accessible in the daily clinical environment. As a contribution to the solution of this problem, we develop in this article the conjecture that one inference structure is enough to describe the set of analysis tasks associated with medical diagnoses. To this end, we first propose a modification of the systematic diagnostic inference scheme to obtain an analysis generic task and then compare it with the monitoring and the heuristic classification task inference schemes using as comparison criteria the compatibility of domain roles (data structures), the similarity in the inferences, and the commonality in the set of assumptions which underlie the functionally equivalent models. The equivalences proposed are illustrated with several examples. Note that though our ongoing work aims to simplify the methodology and to increase the precision of the terms used, the proposal presented here should be viewed more in the nature of a conjecture.

A robust protocol for directed aryl sulfotransferase evolution toward the carbohydrate building block GlcNAc

Bacterial aryl sulfotransferases (AST) utilize p-nitrophenylsulfate (pNPS) as a phenolic donor to sulfurylate typically a phenolic acceptor. Interest in aryl sulfotransferases is growing because of their broad variety of acceptors and cost-effective sulfuryl-donors. For instance, aryl sulfotransferase A (ASTA) from Desulfitobacterium hafniense was recently reported to sulfurylate d-glucose. In this study, a directed evolution protocol was developed and validated for aryl sulfotransferase B (ASTB). Thereby the well-known pNPS quantification system was advanced to operate efficiently as a continuous screening system in 96-well MTP format with a true coefficient of variation of 14.3%. A random mutagenesis library (SeSaM library) of ASTB was screened (1,760 clones) to improve sulfurylation of the carbohydrate building block N-acetylglucosamine (GlcNAc). The beneficial variant ASTB-V1 (Val579Asp) showed an up to 3.4-fold increased specific activity toward GlcNAc when compared to ASTB-WT. HPLC- and MS-analysis confirmed ASTB-V1's increased GlcNAc monosulfurylation (2.4-fold increased product formation) representing the validation of the first successful directed evolution round of an AST for a saccharide substrate.

Exposure to West Nile virus and tick-borne encephalitis virus in dogs in Spain

In the past decade, the spread of emerging zoonotic flaviviruses (genus Flavivirus, family Flaviviridae) has been reported in many regions worldwide, representing a threat to both human and animal health. A serosurvey was carried out to assess exposure and risk factors associated with antigenically related flaviviruses, particularly West Nile virus (WNV), Usutu virus (USUV) and tick-borne encephalitis virus (TBEV), in dogs in Spain. Flavivirus antibodies were detected in 39 of 815 dogs (4.8%; 95% CI: 3.3-6.3) by bELISA. Significantly higher seropositivity was observed in hunting dogs compared to pet dogs. Virus neutralization tests confirmed WNV-specific and TBEV-specific antibodies in 11 and 14 bELISA-positive dogs, respectively. This is the first serosurvey of WNV and TBEV in dogs in Spain and the first report of TBEV circulation in this country. The seropositivity obtained indicates widespread, but not homogeneous, distribution of WNV and TBEV in dogs in Spain. In 2013 and 2015, WNV-seropositive dogs were detected in those areas of Andalusia where the highest number of WNV outbreaks were reported in both horses and humans. Antibodies against TBEV have been found in dogs sampled in two different periods and regions in Spain. Serosurveillance in dogs could be a complementary way of monitoring the activity of emerging flaviviruses in Spain.

Pedigree-based estimation of covariance between dominance deviations and additive genetic effects in closed rabbit lines considering inbreeding and using a computationally simpler equivalent model

Inbreeding generates covariances between additive and dominance effects (breeding values and dominance deviations). In this work, we developed and applied models for estimation of dominance and additive genetic variances and their covariance, a model that we call "full dominance," from pedigree and phenotypic data. Estimates with this model such as presented here are very scarce both in livestock and in wild genetics. First, we estimated pedigree-based condensed probabilities of identity using recursion. Second, we developed an equivalent linear model in which variance components can be estimated using closed-form algorithms such as REML or Gibbs sampling and existing software. Third, we present a new method to refer the estimated variance components to meaningful parameters in a particular population, i.e., final partially inbred generations as opposed to outbred base populations. We applied these developments to three closed rabbit lines (A, V and H) selected for number of weaned at the Polytechnic University of Valencia. Pedigree and phenotypes are complete and span 43, 39 and 14 generations, respectively. Estimates of broad-sense heritability are 0.07, 0.07 and 0.05 at the base versus 0.07, 0.07 and 0.09 in the final generations. Narrow-sense heritability estimates are 0.06, 0.06 and 0.02 at the base versus 0.04, 0.04 and 0.01 at the final generations. There is also a reduction in the genotypic variance due to the negative additive-dominance correlation. Thus, the contribution of dominance variation is fairly large and increases with inbreeding and (over)compensates for the loss in additive variation. In addition, estimates of the additive-dominance correlation are -0.37, -0.31 and 0.00, in agreement with the few published estimates and theoretical considerations.

Role of inbreeding depression, non-inbred dominance deviations and random year-season effect in genetic trends for prolificacy in closed rabbit lines

In closed rabbit lines selected for prolificacy at the Polytechnic University of Valencia, genetic responses are predicted using BLUP. With a standard additive BLUP model and year-season (YS) effects fitted as fixed, genetic trends were overestimated compared to responses estimated using control populations obtained from frozen embryos. In these lines, there is a confounding between genetic trend, YS effects and inbreeding, and the role of dominance is uncertain. This is a common situation in data from reproductively closed selection lines. This paper fits different genetic evaluation models to data of these lines, aiming to identify the source of these biases: dominance, inbreeding depression and/or an ill-conditioned model due to the strong collinearity between YS, inbreeding and genetic trend. The study involved three maternal lines (A, V and H) and analysed two traits, total born (TB) and the number of kits at weaning (NW). Models fitting YS effect as fixed or random were implemented, in addition to additive genetic, permanent environment effects and non-inbred dominance deviations effects. When YS was fitted as a fixed effect, the genetic trends were overestimated compared to control populations, inbreeding had an apparent positive effect on litter size and the environmental trends were negative. When YS was fitted as random, the genetic trends were compatible with control populations results, inbreeding had a negative effect (lower prolificacy) and environmental trends were flat. The model fitting random YS, inbreeding and non-inbred dominance deviations yielded the following ratios of additive and dominance variances to total variance for NW: 0.06 and 0.01 for line A, 0.06 and 0.00 for line V and 0.01 and 0.08 for line H. Except for line H, dominance deviations seem to be of low relevance. When it is confounded with inbreeding as in these lines, fitting YS effect as random allows correct estimation of genetic trends.

Prevalence of diabetes mellitus and impaired glucose metabolism in the adult population of the Basque Country, Spain

AIMS

To assess the prevalence of diabetes mellitus and impaired glucose metabolism in the Basque Country and their relationship with cardiovascular risk factors.

METHODS

A population-based, cross-sectional, cluster sampling design study was carried out in an adult (≥18 years) Basque population. A total of 847 participants completed a questionnaire on personal and family medical history and lifestyle. Anthropometric variables and blood pressure were measured and biochemical analysis and an oral glucose tolerance test (75 g) were also performed.

RESULTS

The total prevalence of diabetes was 10.6% (95% CI 8.65-12.95). Among them 6.3% (95% CI 4.79-8.22) had previously been diagnosed and 4.3% (95% CI 3.04-5.92) were not aware that they had diabetes. Impaired glucose tolerance was present in 7.2% (95% CI 5.53-9.15) and impaired fasting glucose in 3.8% (95% CI 2.64-5.37) of the population. In total, 21.6% of the population had some type of glucose metabolism disturbance, with a higher rate among men (28.3 vs 16.3%; P<0.001) and with the rate increasing with age. Risk factors independently associated with the development of diabetes were: male sex [odds ratio 4.58 (95% CI 2.34-8.97)]; abdominal obesity [odds ratio 2.80 (95% CI 1.47-5.36)]; high triglyceride levels [odds ratio 2.46 (95% CI 1.26-4.81)]; hypertension [odds ratio 2.40 (95% CI 1.16-4.96)]; family history of diabetes [odds ratio 2.30 (95% CI 1.25-4.24)]; high LDL cholesterol levels [odds ratio 1.83 (95% CI 1.01-3.31)] and older age [odds ratio 1.08 (95% CI 1.05-1.10)].

CONCLUSIONS

The prevalence of diabetes in the Basque Country was lower than in Spain and was independently associated with family history of diabetes and with cardiovascular risk factors such as abdominal obesity, hypertension, high LDL cholesterol levels and high triglyceride levels, which were also observed in those with prediabetes.

Outcomes After Direct Thrombectomy or Combined Intravenous and Endovascular Treatment Are Not Different

Background and Purpose—

Whether intravenous thrombolysis adds a further benefit when given before endovascular thrombectomy (EVT) is unknown. Furthermore, intravenous thrombolysis delays time to groin puncture, mainly among drip and ship patients.

Methods—

Using region-wide registry data, we selected cases that received direct EVT or combined intravenous thrombolysis+EVT for anterior circulation strokes between January 2011 and October 2015. Treatment effect was estimated by stratification on a propensity score. The average odds ratios for the association of treatment with good outcome and death at 3 months and symptomatic bleedings at 24 hours were calculated with the Mantel–Haenszel test statistic.

Results—

We included 599 direct EVT patients and 567 patients with combined treatment. Stratification through propensity score achieved balance of baseline characteristics across treatment groups. There was no association between treatment modality and good outcome (odds ratio, 0.97; 95% confidence interval, 0.74–1.27), death (odds ratio, 1.07; 95% confidence interval, 0.74–1.54), or symptomatic bleedings (odds ratio, 0.56; 95% confidence interval, 0.25–1.27).

Conclusions—

This observational study suggests that outcomes after direct EVT or combined intravenous thrombolysis+EVT are not different. If confirmed by a randomized controlled trial, it may have a significant impact on organization of stroke systems of care.

In vitro modulation of Drimys winteri bark extract and the active compound polygodial on Salmo salar immune genes after exposure to Saprolegnia parasitica

The rapid development of the aquaculture industry has global concerns with health management and control strategies to prevent and/or treat diseases and increase sustainability standards. Saprolegniosis is a disease caused by Saprolegnia parasitica, and is characterized by promoting an immunosuppression in the host. This study evaluated in vitro the extract and one active compound (polygodial) of Drimys winteri, a Chilean medicinal tree as a potential early immunostimulatory aid in Saprolegniosis control. Atlantic salmon (Salmo salar) head kidney cells (ASK-1) were incubated with both extract and pure polygodial before exposure to S. parasitica mycelium, and the expression of the immune-related genes interleukin 1β (IL-1β), interferon α (IFNα), and major histocompatibility complex II (MHCII) was evaluated. Both evidenced immunomodulatory capacities by increasing gene expressions. This immunomodulation related to a mitigatory action counteracting the immunosuppressing effects of S. parasitica. Despite that most immune-related genes were up-regulated, the down-regulation of MHCII, characteristic of S. parasitica infection, was lessened by pre-incubation with the compounds. This study provides the first insight on the potential of D. winteri bark extract as a possible immunomodulatory and defensive strategy against this oomycete infection in fish.

Interval aerobic training combined with strength-endurance exercise improves metabolic markers beyond caloric restriction in Zucker rats

AIMS

To investigate the effects of interval aerobic training combined with strength-endurance exercise (IASE) and caloric restriction (CR) on body composition, glycaemic and lipid profile and inflammatory markers.

METHODS AND RESULTS

Thirty-two Zucker diabetic fatty rats were randomised into 4 groups (sedentary + CR; sedentary + adlibitum; IASE + CR; and IASE + adlibitum). Training groups conducted an IASE programme in the same session, 5 days/week for 2 months. Body weight, fat and muscle mass and body water were measured using a body composition analyser. Plasma total, LDL and HDL cholesterol, phospholipids, triglycerides, insulin, adiponectin, tumour necrosis factor alpha, interleukin 1 and 10 were measured. Blood fasting and postprandial glucose were assessed. Body weight was lower in the CR compared to the adlibitum groups (p < 0.001). Fat mass was lower in the CR compared to the adlibitum (p < 0.05) and in the IASE compared to the sedentary groups (p < 0.001), but IASE increased lean mass (p < 0.001). Triglycerides were lower in the CR compared to the adlibitum groups (p < 0.001) whereas total and LDL-cholesterol and fasting glucose were reduced only in the IASE groups (all, p < 0.001). Phospholipids decreased in the CR compared to the adlibitum (p < 0.05) and the IASE compared to the sedentary groups (p < 0.001). The area under the curve after oral glucose tolerance test, insulin and homoeostatic model assessment were lower in the IASE and the CR compared to the sedentary and adlibitum groups, respectively (all, p < 0.001). Adiponectin was lower in the CR groups (p < 0.001).

CONCLUSION

Overall, IASE as well as CR were both useful interventions, especially when combined. However, IASE showed greater improvements on body composition, inflammatory and glycaemic profile than CR did.

On the geometric growth in a class of homogeneous multitype Markov chain

In this paper, we investigate the geometric growth of homogeneous multitype Markov chains whose states have nonnegative integer coordinates. Such models are considered in a situation similar to the supercritical case for branching processes. Finally, our general theoretical results are applied to a class of controlled multitype branching process in which the control is random.

Stochastic Monotonicity and Continuity Properties of the Extinction Time of Bellman-Harris Branching Processes: An Application to Epidemic Modelling

The aim of this paper is to study the stochastic monotonicity and continuity properties of the extinction time of Bellman-Harris branching processes depending on their reproduction laws. Moreover, we show their applications in an epidemiological context, obtaining an optimal criterion to establish the proportion of susceptible individuals in a given population that must be vaccinated in order to eliminate an infectious disease. First the spread of infection is modelled by a Bellman-Harris branching process. Finally, we provide a simulation-based method to determine the optimal vaccination policies.

Clinical and genetic characterization of congenital hyperinsulinism in Spain

CONTEXT

Congenital hyperinsulinism (CHI) is a clinically and genetically heterogeneous disease characterized by severe hypoglycemia caused by inappropriate insulin secretion by pancreatic β-cells.

OBJECTIVE

To characterize clinically and genetically CHI patients in Spain.

DESIGN AND METHODS

We included 50 patients with CHI from Spain. Clinical information was provided by the referring clinicians. Mutational analysis was carried out for KCNJ11, ABCC8, and GCK genes. The GLUD1, HNF4A, HNF1A, UCP2, and HADH genes were sequenced depending on the clinical phenotype.

RESULTS

We identified the genetic etiology in 28 of the 50 CHI patients tested: 21 had a mutation in KATP channel genes (42%), three in GLUD1 (6%), and four in GCK (8%). Most mutations were found in ABCC8 (20/50). Half of these patients (10/20) were homozygous or compound heterozygous, with nine being unresponsive to diazoxide treatment. The other half had heterozygous mutations in ABCC8, six of them being unresponsive to diazoxide treatment and four being responsive to diazoxide treatment. We identified 22 different mutations in the KATP channel genes, of which ten were novel. Notably, patients with ABCC8 mutations were diagnosed earlier, with lower blood glucose levels and required higher doses of diazoxide than those without a genetic diagnosis.

CONCLUSIONS

Genetic analysis revealed mutations in 56% of the CHI patients. ABCC8 mutations are the most frequent cause of CHI in Spain. We found ten novel mutations in the KATP channel genes. The genetic diagnosis is more likely to be achieved in patients with onset within the first week of life and in those who fail to respond to diazoxide treatment.

Access to Endovascular Treatment in Remote Areas

Background and Purpose—

Since demonstration of the benefit of endovascular treatment (EVT) in acute ischemic stroke patients with proximal arterial occlusion, stroke care systems need to be reorganized to deliver EVT in a timely and equitable way. We analyzed differences in the access to EVT by geographical areas in Catalonia, a territory with a highly decentralized stroke model.

Methods—

We studied 965 patients treated with EVT from a prospective multicenter population-based registry of stroke patients treated with reperfusion therapies in Catalonia, Spain (SONIIA). Three different areas were defined: (A) health areas primarily covered by Comprehensive Stroke Centers, (B) areas primarily covered by local stroke centers located less than hour away from a Comprehensive Stroke Center, and (C) areas primarily covered by local stroke centers located more than hour away from a Comprehensive Stroke Center. We compared the number of EVT×100 000 inhabitants/year and time from stroke onset to groin puncture between groups.

Results—

Baseline characteristics were similar between groups. Throughout the study period, there were significant differences in the population rates of EVT across geographical areas. EVT rates by 100 000 in 2015 were 10.5 in A area, 3.7 in B, and 2.7 in C. Time from symptom onset to groin puncture was 82 minutes longer in group B (312 minutes [245–435]) and 120 minutes longer in group C (350 minutes [284–408]) compared with group A (230 minutes [160–407]; P <0.001).

Conclusions—

Accessibility to EVT from remote areas is hampered by lower rate and longer time to treatment compared with areas covered directly by Comprehensive Stroke Centers.

Case report: Hallucinations as depressive equivalents

We comment the case of a 12 years old girl who started with visual and auditive hallucinations. Hallucinations are not a common symptom between children. They may also be linked to many conditions, some of them with poor outcome as schizophrenia. Symptoms appeared in a short time, after a previous normal development. She talked about a man who followed her and that was always behind, she also had heard some insults of undeterminated voices. These symptoms were just of one-month duration and made her feel anxious and very afraid. After a normal organical study and a first proposal of medication they asked for our consultation. We found that the patient was alone at home every afternoon. Family, from other country, hadn’t any social support, and the father had had to travel away some days before the child began to suffer hallucinations. Suspecting an affective disorder as the basis of anxious symptoms, and hallucinations as a cultural presentation of them, we started with a social intervention mixed with support therapy. After some sessions the patient could talk about her loneliness and fears, disappearing the other symptoms. We will resume this case and literature about other cultural presentations that may difficult diagnosis or treatment.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

High-intensity Exercise Modifies the Effects of Stanozolol on Brain Oxidative Stress in Rats

We analyzed the effects of high-intensity exercise (HIE) and anabolic androgenic steroids (AAS) on brain redox status. 40 male Wistar rats were randomly distributed in 4 experimental groups (n=10) with or without HIE and with or without weekly Stanozolol administration. Thiobarbituric acid-reactive substances (TBARs) and protein carbonyl content (PCC) were assessed. Total superoxide dismutase (tSOD), manganese superoxide dismutase (Mn-SOD), copper/zinc superoxide dismutase (CuZn-SOD) and catalase (CAT) activities were measured. Finally, protein expression levels of glutathione peroxidase (GPx), NAD(P)H dehydrogenase, Quinone 1 (NQO1), NF-E2-Related Factor 2 (Nrf2), glial fibrillary acidic protein (GFAP), nuclear factor kappa β p65 (NF-κβ) and signal transducer and activator of transcription 3 were determined. Brain PCC concentrations were lower in the HIE groups compared to the untrained controls, whereas CAT activity was higher (both, p<0.01). Both HIE and AAS groups exhibited higher expression levels of GFAP and GPx, but lower NQO1 levels (all, p<0.05). There were increased expression levels of NF-κβ in the AAS groups (p<0.01). In addition, there was increased expression of Nrf2 in the HIE groups (p<0.001). HIE*AAS interactions were found on TBARs content and GFAP expression, with HIE downregulating and upregulating AAS-mediated increases in TBARs and GFAP, respectively (p<0.05). Overall, HIE appeared to reduce the AAS-mediated negative effect on brain redox status.