Round spermatid injection into human oocytes: a systematic review and meta-analysis / 亚洲男科学杂志(英文版)

Many azoospermic men do not possess mature spermatozoa at the time of surgical sperm extraction. This study is a systematic review and meta-analysis evaluating outcomes following round spermatid injection (ROSI), a technique which utilizes immature precursors of spermatozoa for fertilization. An electronic search was performed to identify relevant articles published through October 2018. Human cohort studies in English involving male patients who had round spermatids identified and used for fertilization with human oocytes were included. Fertilization rate, pregnancy rate, and resultant delivery rate were assessed following ROSI. Meta-analysis outcomes were analyzed using a random-effects model. Data were extracted from 22 studies involving 1099 couples and 4218 embryo transfers. The fertilization rate after ROSI was 38.7% (95% confidence interval [CI]: 31.5%-46.3%), while the pregnancy rate was 3.7% (95% CI: 3.2%-4.4%). The resultant delivery rate was low, with 4.3% of embryo transfers resulting in a delivery (95% CI: 2.3%-7.7%). The pregnancy rate per couple was 13.4% (95% CI: 6.8%-19.1%) and the resultant delivery rate per couple was 8.1% (95% CI: 6.1%-14.4%). ROSI has resulted in clinical pregnancies and live births, but success rates are considerably lower than those achieved with mature spermatozoa. While this technique may be a feasible alternative for men with azoospermia who decline other options, couples should be aware that the odds of a successful delivery are greatly diminished and the prognosis is relatively poor.

Regional cooperation and health diplomacy in Africa: from intra-colonial exchanges to multilateral health institutions / Cooperação regional e diplomacia sanitária na África: dos intercâmbios intracoloniais às instituições multilaterais de saúde

Abstract Tracing the pathways of cooperation in health in sub-Saharan Africa from hesitant exchanges to institutionalized dimensions from the 1920s to the early 1960s, this article addresses regional dynamics in health diplomacy which have so far been under-researched. The evolution thereof from early beginnings with the League of Nations Health Organization to the Commission for Technical Assistance South of the Sahara and the World Health Organization's Regional Office for Africa, shows how bilateral dimensions were superseded by WHO's multilateral model of regional cooperation in health. Alignments, divergences, and outcomes are explored with respect to the strategies and policies pursued by colonial powers and independent African states regarding inter-regional relations, and their implications for public health and epidemiological interventions.

Resumo Trilhando os caminhos da cooperação sanitária na África subsaariana, de intercâmbios incertos a dimensões institucionalizadas dos anos 1920 até início dos anos 1960, este artigo aborda a dinâmica regional na diplomacia sanitária que, até o momento, carece de pesquisas. A evolução, desde os primórdios da Organização da Saúde da Liga das Nações até a Cooperação Técnica na África Subsaariana e o Escritório Regional da África da OMS, demonstra como dimensões bilaterais foram substituídas pelo modelo multilateral da OMS de cooperação sanitária regional. São analisados alinhamentos, divergências e resultados de estratégias e políticas empregados por potências coloniais e Estados africanos independentes em relações inter-regionais, bem como suas implicações em intervenções epidemiológicas e de saúde pública.

Unicompartmental vs. segmental bicompartmental vs. total knee replacement: comparison of clinical outcomes

Purpose@#Combined medial tibiofemoral and symptomatic patellofemoral osteoarthritis is not amenable to unicompartmental knee replacement (UKR). Total knee replacement (TKR) is an invasive option in younger adults with high functional demands. The aim of this study was to compare the clinical outcome of patients who have undergone UKR, bicompartmental knee replacement (BKR) and TKR up to 2 years post-operatively. @*Materials and methods@#This prospective study comprised 133 subjects including 30 patients in the medial UKR group, 53 patients in the BKR group (combined medial UKR with patellofemoral joint replacement) and 50 patients in the TKR group. All subjects were evaluated using the Oxford Knee Score (OKS) and the Western Ontario and MacMaster Universities Osteoarthritis Index (WOMAC). Patients in each group were assessed using both scoring systems pre-operatively and 6 months, 1 year and 2 years post-operatively. @*Results@#Significant improvement of OKS was found at 6 months compared to baseline for UKR (22.7 to 38.1, p = 0.046), BKR (22.6 to 36.8, p < 0.001) and TKR (16.6 to 34.5, p< 0.001). Significant improvement was also found for the WOMAC sub-scores for all three groups during this time period. After 6 months, there was no further statistically significant improvement in either outcome score in any of the groups up to the 2-year follow-up results. There was no significant difference in either outcome score post-operatively between the three groups. @*Conclusion@#The magnitude of clinical improvement following knee replacement is greatest at 6 months; thereafter, only modest improvements continue to occur. This study also found no significant differences of outcomes at 2 years after surgery among UKR, BKR and TKR. BKR is a good alternative option for combined symptomatic medial and patellofemoral arthritis of the knee.

Unicompartmental vs. segmental bicompartmental vs. total knee replacement: comparison of clinical outcomes

Purpose@#Combined medial tibiofemoral and symptomatic patellofemoral osteoarthritis is not amenable to unicompartmental knee replacement (UKR). Total knee replacement (TKR) is an invasive option in younger adults with high functional demands. The aim of this study was to compare the clinical outcome of patients who have undergone UKR, bicompartmental knee replacement (BKR) and TKR up to 2 years post-operatively. @*Materials and methods@#This prospective study comprised 133 subjects including 30 patients in the medial UKR group, 53 patients in the BKR group (combined medial UKR with patellofemoral joint replacement) and 50 patients in the TKR group. All subjects were evaluated using the Oxford Knee Score (OKS) and the Western Ontario and MacMaster Universities Osteoarthritis Index (WOMAC). Patients in each group were assessed using both scoring systems pre-operatively and 6 months, 1 year and 2 years post-operatively. @*Results@#Significant improvement of OKS was found at 6 months compared to baseline for UKR (22.7 to 38.1, p = 0.046), BKR (22.6 to 36.8, p < 0.001) and TKR (16.6 to 34.5, p< 0.001). Significant improvement was also found for the WOMAC sub-scores for all three groups during this time period. After 6 months, there was no further statistically significant improvement in either outcome score in any of the groups up to the 2-year follow-up results. There was no significant difference in either outcome score post-operatively between the three groups. @*Conclusion@#The magnitude of clinical improvement following knee replacement is greatest at 6 months; thereafter, only modest improvements continue to occur. This study also found no significant differences of outcomes at 2 years after surgery among UKR, BKR and TKR. BKR is a good alternative option for combined symptomatic medial and patellofemoral arthritis of the knee.

Blockade of Endogenous Angiotensin-(1-7) in Hypothalamic Paraventricular Nucleus Attenuates High Salt-Induced Sympathoexcitation and Hypertension / 神经科学通报·英文版

Angiotensin (Ang)-(1-7) is an important biologically-active peptide of the renin-angiotensin system. This study was designed to determine whether inhibition of Ang-(1-7) in the hypothalamic paraventricular nucleus (PVN) attenuates sympathetic activity and elevates blood pressure by modulating pro-inflammatory cytokines (PICs) and oxidative stress in the PVN in salt-induced hypertension. Rats were fed either a high-salt (8% NaCl) or a normal salt diet (0.3% NaCl) for 10 weeks, followed by bilateral microinjections of the Ang-(1-7) antagonist A-779 or vehicle into the PVN. We found that the mean arterial pressure (MAP), renal sympathetic nerve activity (RSNA), and plasma norepinephrine (NE) were significantly increased in salt-induced hypertensive rats. The high-salt diet also resulted in higher levels of the PICs interleukin-6, interleukin-1beta, tumor necrosis factor alpha, and monocyte chemotactic protein-1, as well as higher gp91 expression and superoxide production in the PVN. Microinjection of A-779 (3 nmol/50 nL) into the bilateral PVN of hypertensive rats not only attenuated MAP, RSNA, and NE, but also decreased the PICs and oxidative stress in the PVN. These results suggest that the increased MAP and sympathetic activity in salt-induced hypertension can be suppressed by blockade of endogenous Ang-(1-7) in the PVN, through modulation of PICs and oxidative stress.

Forty hours with a traumatic carotid transection: A diagnostic caveat and review of the contemporary management of penetrating neck trauma / 中华创伤杂志(英文版)

Although penetrating neck trauma (PNT) is uncommon, it is associated with the significant morbidity and mortality. The management of PNT has changed significantly over the past 50 years. A radiological assessment now is a vital part of the management with a traditional surgical exploration. A 22 years old male was assaulted by a screwdriver and sustained multiple penetrating neck injuries. A contrast CT scan revealed a focal pseudoaneurysm in the left common carotid artery bulb. There was no active bleeding or any other vascular injuries and the patient remained haemodynamically stable. In view of these findings, he was initially managed conservatively without an open surgical exploration. However, the patient was noted to have an acute drop in his hemoglobin count overnight post injury and the catheter directed angiography showed active bleeding from the pseudoaneurysm. Surgical exploration 40 hours following the initial injury revealed a penetrating injury through both arterial walls of the left carotid bulb which was repaired with a great saphenous vein patch. A percutaneous drain was inserted in the carotid triangle and a course of intravenous antibiotics for five days was commenced. The patient recovered well with no complications and remained asymptomatic at five months followup.

International validation of the Chinese university prognostic index for staging of hepatocellular carcinoma: a joint United Kingdom and Hong Kong study / 癌症

The outcome of hepatocellular carcinoma (HCC) patients significantly differs between western and eastern population centers. Our group previously developed and validated the Chinese University Prognostic Index (CUPI) for the prognostication of HCC among the Asian HCC patient population. In the current study, we aimed to validate the CUPI using an international cohort of patients with HCC and to compare the CUPI to two widely used staging systems, the Barcelona Clinic Liver Cancer (BCLC) classification and the Cancer of the Liver Italian Program (CLIP). To accomplish this goal, two cohorts of patients were enrolled in the United Kingdom (UK; n = 567; 2006-2011) and Hong Kong (HK; n = 517; 2007-2012). The baseline clinical data were recorded. The performances of the CUPI, BCLC, and CLIP were compared in terms of a concordance index (C-index) and were evaluated in subgroups of patients according to treatment intent. The results revealed that the median follow-up durations of the UK and HK cohorts were 27.9 and 29.8 months, respectively. The median overall survival of the UK and HK cohorts were 22.9 and 8.6 months, respectively. The CUPI stratified the patients in both cohorts into three risk subgroups corresponding to distinct outcomes. The median overall survival of the CUPI low-, intermediate-, and high-risk subgroups were 3.15, 1.24, and 0.29 years, respectively, in the UK cohort and were 2.07, 0.32, and 0.10 years, respectively, in the HK cohort. For the patients who underwent curative treatment, the prognostic performance did not differ between the three staging systems, and all were suboptimal. For those who underwent palliative treatment, the CUPI displayed the highest C-index, indicating that this staging system was the most informative for both cohorts. In conclusion, the CUPI is applicable to both western and eastern HCC patient populations. The performances of the three staging systems differed according to treatment intent, and the CUPI was demonstrated to be optimal for those undergoing palliative treatment. A more precise staging system for early-stage disease patients is required.

The Relationship between Preoperative Wound Classification and Postoperative Infection: A Multi-Institutional Analysis of 15,289 Patients

BACKGROUND: Despite advances in surgical techniques, sterile protocols, and perioperative antibiotic regimens, surgical site infections (SSIs) remain a significant problem. We investigated the relationship between wound classification (i.e., clean, clean/contaminated, contaminated, dirty) and SSI rates in plastic surgery. METHODS: We performed a retrospective review of a multi-institutional, surgical outcomes database for all patients undergoing plastic surgery procedures from 2006-2010. Patient demographics, wound classification, and 30-day outcomes were recorded and analyzed by multivariate logistic regression. RESULTS: A total of 15,289 plastic surgery cases were analyzed. The overall SSI rate was 3.00%, with superficial SSIs occurring at comparable rates across wound classes. There were similar rates of deep SSIs in the clean and clean/contaminated groups (0.64%), while rates reached over 2% in contaminated and dirty cases. Organ/space SSIs occurred in less than 1% of each wound classification. Contaminated and dirty cases were at an increased risk for deep SSIs (odds ratios, 2.81 and 2.74, respectively); however, wound classification did not appear to be a significant predictor of superficial or organ/space SSIs. Clean/contaminated, contaminated, and dirty cases were at increased risk for a postoperative complication, and contaminated and dirty cases also had higher odds of reoperation and 30-day mortality. CONCLUSIONS: Analyzing a multi-center database, we found that wound classification was a significant predictor of overall complications, reoperation, and mortality, but not an adequate predictor of surgical site infections. When comparing infections for a given wound classification, plastic surgery had lower overall rates than the surgical population at large.

High Density Lipoprotein: A Therapeutic Target in Type 2 Diabetes

High density lipoproteins (HDLs) have a number of properties that have the potential to inhibit the development of atherosclerosis and thus reduce the risk of having a cardiovascular event. These protective effects of HDLs may be reduced in patients with type 2 diabetes, a condition in which the concentration of HDL cholesterol is frequently low. In addition to their potential cardioprotective properties, HDLs also increase the uptake of glucose by skeletal muscle and stimulate the synthesis and secretion of insulin from pancreatic beta cells and may thus have a beneficial effect on glycemic control. This raises the possibility that a low HDL concentration in type 2 diabetes may contribute to a worsening of diabetic control. Thus, there is a double case for targeting HDLs in patients with type 2 diabetes: to reduce cardiovascular risk and also to improve glycemic control. Approaches to raising HDL levels include lifestyle factors such as weight reduction, increased physical activity and stopping smoking. There is an ongoing search for HDL-raising drugs as agents to use in patients with type 2 diabetes in whom the HDL level remains low despite lifestyle interventions.

Prevalence of obesity, tobacco use, and alcohol consumption by socioeconomic status among six communities in Nicaragua / Prevalencia de la obesidad, el tabaquismo y el consumo de alcohol según la condición socioeconómica en seis comunidades de Nicaragua

Objective. To describe the prevalence of noncommunicable disease (NCD) risk factors(overweight/obesity, tobacco smoking, and alcohol consumption) and identify correlationsbetween these and sociodemographic characteristics in western and central Nicaragua.Methods. This was a cross-sectional study of 1 355 participants from six communitiesin Nicaragua conducted in September 2007–July 2009. Demographic and NCD risk-relatedhealth behavior information was collected from each individual, and their body mass index(BMI), blood pressure, diabetes status, and renal function were assessed. Data were analyzedusing descriptive statistics, bivariate analyses, and (non-stratified and stratified) logisticregression models.Results. Of the 1 355 study participants, 22.0% were obese and 55.1% were overweight/obese. Female sex, higher income, and increasing age were significantly associated with obesity.Among men, lifelong urban living correlated with obesity (Odds Ratio [OR] = 4.39,1.18–16.31). Of the total participants, 31.3% reported ever smoking tobacco and 47.7%reported ever drinking alcohol. Both tobacco smoking and alcohol consumption were strikinglymore common among men (OR = 13.0, 8.8–19.3 and 15.6, 10.7–22.6, respectively) andlifelong urban residents (OR = 2.42, 1.31–4.47 and 4.10, 2.33–7.21, respectively).Conclusions. There was a high prevalence of obesity/overweight across all income levels.Women were much more likely to be obese, but men had higher rates of tobacco and alcoholuse. The rising prevalence of NCD risk factors among even the poorest subjects suggests thatan epidemiologic transition in underway in western and central Nicaragua whereby NCDprevalence is shifting to all segments of society. Raising awareness that health clinics can beused for chronic conditions needs to be priority.

Objetivo. Describir la prevalencia de los factores de riesgo (sobrepeso/obesidad,tabaquismo y consumo de alcohol) de las enfermedades no transmisibles (ENT), ydeterminar las correlaciones entre estos y las características sociodemográficas en laszonas occidental y central de Nicaragua.Métodos. De septiembre del 2007 a julio del 2009, se llevó a cabo este estudio transversalen 1 355 participantes de seis comunidades de Nicaragua. Para cada persona,se recopiló información demográfica y sobre la conducta en materia de salud relacionadacon el riesgo de ENT, y se evaluaron el índice de masa corporal (IMC), la presiónarterial, la presencia o no de diabetes y la función renal. Se analizaron los datosmediante estadísticas descriptivas, análisis de dos variables, y modelos de regresiónlogística (análisis no estratificado y estratificado).Resultados. De los 1 355 participantes en el estudio, 22,0% eran obesos y 55,1%presentaban sobrepeso u obesidad. El sexo femenino, los ingresos más altos y la edadmás avanzada se asociaron significativamente con la obesidad. En los varones, laresidencia de por vida en un entorno urbano se correlacionó con la obesidad (razónde posibilidades [OR] = 4,39, 1,18–16,31). Del total de participantes, 31,3% habíanfumado tabaco y 47,7% habían consumido alcohol alguna vez. Tanto el tabaquismocomo el consumo de alcohol fueron considerablemente más frecuentes en los varones(OR = 13,0, 8,8–19,3 y 15,6, 10,7–22,6, respectivamente) y en los que residían de porvida en un entorno urbano (OR = 2,42, 1,31–4,47 y 4,10, 2,33–7,21, respectivamente).Conclusiones. Se observó una alta prevalencia de obesidad/sobrepeso en todos losniveles de ingresos. Las mujeres tenían muchas más probabilidades de ser obesas,pero los varones mostraban mayores tasas de tabaquismo y consumo del alcohol.

Intrathecal morphine in two patients undergoing deep hypothermic circulatory arrest during aortic surgery: A case report / 대한마취과학회지

We retrospectively report the first use of intrathecal morphine prior to incision in two male patients undergoing a complex aortic reconstruction, who required complete circulatory arrest under deep hypothermia for intraoperative and postoperative pain control. We administered intrathecal morphine to two male patients undergoing circulatory arrest and deep hypothermia. Patients were fully heparinized prior to cardiopulmonary bypass. Deep hypothermic circulatory arrest was performed by cooling the patients to 18degrees C. Following the surgery, the neurologic status was monitored. The management of postoperative pain is a quality standard in health care. During the first 24 hours after surgery, we observed excellent analgesia without the associated side effects, thus, reducing the time required for pain control by the nursing staff. A successful analgetic strategy not only enhances the patient satisfaction, but may improve the postoperative outcome. However, complications, such as increased risk of epidural hematoma formation, are of special concern in cardiac surgery.

Impact of Mentorship on WHO-AFRO Strengthening Laboratory Quality Improvement Process Towards Accreditation (SLIPTA)

Background: The improvment of the quality of testing services in public laboratories is a high priority in many countries. Consequently; initiatives to train laboratory staff on quality management are being implemented; for example; the World Health Organization Regional Headquarters for Africa (WHO-AFRO) Strengthening Laboratory Management Towards Accreditation (SLMTA). Mentorship may be an effective way to augment these efforts.Methods: Mentorship was implemented at four hospital laboratories in Lesotho; three districts and one central laboratory; between June 2009 and December 2010. The mentorship model that was implemented had the mentor fully embedded within the operations of each of the laboratories. It was delivered in a series of two mentoring engagements of six and four week initial and follow-up visits respectively. In total; each laboratory received 10 weeks mentorship that was separated by 6-8 weeks. Quality improvements were measured at baseline and at intervals during the mentorship using the WHO-AFRO Strengthening Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) checklist and scoring system. Results: At the beginning of the mentorship; all laboratories were at the SLIPTA zero star rating. After the initial six weeks of mentorship; two of the three district laboratories had improved from zero to one (out of five) star although the difference between their baseline (107.7) and the end of the six weeks (136.3) average scores was not statistically significant (p = 0.25). After 10 weeks of mentorship there was a significant improvement in average scores (182.3; p = 0.034) with one laboratory achieving WHO-AFRO three out of a possible five star status and the two remaining laboratories achieving a two star status. At Queen Elizabeth II (QE II) Central Laboratory; the average baseline score was 44; measured using a section-specific checklist. There was a significant improvement by five weeks (57.2; p = 0.021). Conclusion: The mentorship programme in this study resulted in significant measurable improvements towards preparation for the WHO-AFRO SLIPTA process in less than six months. We recommend that mentorship be incorporated into laboratory quality improvement and management training programmes such as SLMTA; in order to accelerate the progress of laboratories towards achieving accreditation

Prenatal alcohol exposure did not affect impulsivity in rats that performed delay or probability discounting tasks

Individuals who fall under the spectrum of the Fetal Alcohol Syndrome have a higher prevalence of several cognitive disturbances, including a greater probability of being diagnosed with attention-deficit hyperactivity disorder (ADHD). Some of these effects, such as hyperactivity and attentional impairments, are already well established in the literature. The assessment of impulsive choice, however, has received little attention in human and animal studies. In the present study, we attempted to investigate the effects of prenatal ethanol exposure on two tasks related to impulsive choice that have never been studied in this condition: delay and probability discounting. METHOD: Rats prenatally exposed to ethanol (liquid diets with 0 percent, 10 percent, or 35 percent ethanol-derived calories [EDC] or laboratory chow) were trained to respond for food in either delay (n = 21) or probability (n = 48) discounting tasks performed in computer-controlled operant conditioning chambers. RESULTS: Prenatal treatment failed to differentiate the rates at which the rats chose the larger reinforcer associated with delay - in a task in which 35 percent EDC was not tested - or risk, although the results suggest that further tests are warranted.

The Causes and Consequences of Low Levels of High Density Lipoproteins in Patients with Diabetes

Type 2 diabetes is commonly accompanied by a low level of high density lipoprotein cholesterol (HDL-C) that contributes to the increased cardiovascular risk associated with this condition. Given that HDLs have the ability to improve increase the uptake of glucose by skeletal muscle and to stimulate the secretion of insulin from pancreatic beta cells the possibility arises that a low HDL concentration in type 2 diabetes may also contribute to a worsening of diabetic control. Thus, there is a double case for raising the level of HDL-C in patients with type 2 diabetes: to reduce cardiovascular risk and to improve glycemic control. Approaches to raising HDL-C include lifestyle factors such as weight reduction, increased physical activity and stopping smoking. Of currently available drugs, the most effective is niacin. Newer formulations of niacin are reasonably well tolerated and have the ability to increase HDL-C by up to 30%. The effect of niacin on cardiovascular events in type 2 diabetes is currently being tested in a large-scale clinical outcome trial.

Small lymphocytic lymphoma in a patient with CREST syndrome

We report a case of a 61-year-old man with a history of CREST syndrome [calcinosis cutis, Raynaud phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia] who presented for evaluation of thrombocytopenia. He had evident cervical adenopathy and lymph node biopsy showed small lymphocytic lymphoma [SLL] with evident systemic adenopathy and bone marrow involvement. The patient achieved a complete remission with FCR [fludarabine/cyclophosphamide/rituximab] chemotherapy. About 30 cases of lymphomas are reported in the literature in association with systemic sclerosis. To our knowledge, there are no reports of a small lymphocytic lymphoma [SLL] in association with limited cutaneous systemic sclerosis with classic features of the CREST syndrome

Asthma cases in childhood attributed to atopy in tropical area in Brazil / Asma infantil atribuida a atopia en la zona tropical de Brasil

OBJECTIVE: This study aimed to explore the association between asthma and atopy in a cohort of children living in a large urban center in Brazil. Atopy was defined by the presence of allergen-specific IgE in serum or by a positive skin prick test. METHODS: In a sample of 1 445 Brazilian children, the association between the prevalence of asthma, skin prick test positivity, and allergen-specific IgE in serum was investigated. RESULTS: The prevalence of asthma was 22.6 percent. The presence of serum allergen-specific IgE was frequent in asthmatics and nonasthmatics, and the prevalence of asthma increased only with levels of allergen-specific IgE > 3.5 kilounits/L. The proportion of asthma attributable to atopy was estimated to be 24.5 percent when atopy was defined by the presence of allergen-specific IgE. With a given level of specific IgE, no association between skin test reactivity and asthma was observed. Skin prick tests were less sensitive than specific IgE for detection of atopy. CONCLUSIONS: Most asthma cases in an urban underprivileged setting in Brazil were not attributable to atopy. This observation has important implications for understanding the risk factors for the asthma epidemic in Latin America.

OBJETIVO: Explorar la relación entre el asma y la atopia en una cohorte de niños que viven en un gran centro urbano de Brasil. En este estudio, se considera atopia la detección de IgE sérica específica de algún alérgeno o un resultado positivo a la prueba de punción cutánea. MÉTODOS: Se estudió la relación entre la prevalencia del asma, el resultado positivo a la prueba de punción cutánea y la detección de IgE sérica específica de algún alérgeno en una muestra de 1 445 niños brasileños. RESULTADOS: El asma registró una prevalencia de 22,6 por ciento. La presencia de IgE séricas específicas de alérgenos fue frecuente tanto en los asmáticos como en los no asmáticos, y la prevalencia del asma fue mayor solo cuando el valor detectado de la IgE específica del alérgeno era > 3,5 kilounidades/litro. Se calculó que la atopia definida como la detección de IgE específicas de alérgenos es responsable de 24,5 por ciento de los casos de asma. No se observó ninguna relación entre la reactividad a la prueba de punción cutánea y el asma en función de los valores de IgE específicas. La prueba de punción cutánea es menos sensible que la detección de IgE específicas en lo que respecta al diagnóstico de atopia. CONCLUSIONES: La mayoría de los casos de asma que se registran en entornos urbanos desfavorecidos de Brasil no son atribuibles a atopia. Esta observación tiene implicaciones importantes en lo que respecta a la comprensión de los factores de riesgo que predisponen a la epidemia de asma en América Latina.

Vascular endothelial growth factor production is regulated by gene polymorphisms

Vascular endothelial growth factor [VEGF] has a key role in angiogenesis and in transplantation. The level of VEGF is related to the differences in the DNA sequence of its promoter region. In this study, the association between the combination of VEGF -1154 G and -2578 C alleles and VEGF production by LPS-stimulated PBMCs was investigated. In addition; the relationship between VEGF polymorphisms and the influence of TNF-alpha and IL-4 on VEGF production was studied. VEGF -1154 G/A and -2578 C/A were detected using ARMS-PCR. To determine the impact of combinations of these two polymorphisms on VEGF production; PBMCs were stimulated by LPS and VEGF production was measured by ELISA. The combinations of -1154 GG/-2578 CC and -1154 GG/-2578 CA were significantly associated with higher VEGF production [p<0.0001]. Production of VEGF was significantly influenced by TNF-alpha in individuals who had certain VEGF genotype combinations. Although VEGF production was dramatically suppressed by IL-4, it was not dependent on VEGF genotype. Since TNF-alpha has influence on the graft outcome, to avoid allocation of grafts from high TNF-alpha producer donors to recipients, it might be useful to predict and minimize graft rejection by having prior knowledge of TNF-alpha and also VEGF genotypes especially -1154 G/A and -2578 C/A VEGF