Utilidad de una unidad de diagnóstico rápido durante la pandemia por SARS-CoV-2 para el diagnóstico de cáncer / Utility of a quick diagnostic unit during the SARS-CoV-2 pandemic for the diagnosis of cancer

Objetivos Analizar el impacto en la actividad asistencial, tiempo de los intervalos de derivación y diagnósticos y la incidencia de cáncer durante los 2primeros años de pandemia por SARS-CoV-2 en una Unidad de Diagnóstico Rápido. Material y métodos Estudio retrospectivo observacional realizado durante el año prepandémico (1 marzo del 2019-29 febrero del 2020) y los 2primeros años de pandemia (1 marzo del 2020-28 febrero del 2022). Se evaluaron y compararon variables demográficas, clínicas, el intervalo de la primera visita, el intervalo diagnóstico y el intervalo primera visita-diagnóstico. Resultados Durante la primera ola pandémica hubo una reducción de derivaciones (–32,6%), registrándose desde la segunda ola hasta el final del primer año y segundo año de pandemia un incremento del 8,1 y el 17,7%, respectivamente. Se identificó un incremento de derivaciones de Atención Primaria y disminución de urgencias. El aumento de diagnósticos de cáncer del 2,7 y el 15,7% en los 2años de pandemia fue proporcional al incremento de derivaciones. No se observaron cambios en procesos benignos ni en las localizaciones y estadificaciones del cáncer. El intervalo de la primera vista fue superior en enfermedades benignas (p<0,0001). Se objetivó una prolongación del intervalo diagnóstico en pacientes con cáncer, aunque durante los 3años del estudio la mediana fue <15 días. Conclusiones El impacto de la pandemia incidió en el tiempo de los intervalos y en las procedencias de las derivaciones. La unidad de diagnóstico rápido constituye una ruta diagnóstica de cáncer complementaria de carácter urgente con un alto rendimiento diagnóstico (AU)

Objectives To analyse changes in health care activity, time of referral and diagnosis intervals and the incidence of cancer during the first 2years of the SARS-CoV-2 pandemic in a quick diagnosis unit. Materials and methods A retrospective observational study was carried out during the prepandemic year (March 1, 2019 to February 29, 2020) and the first 2years of the pandemic (March 1, 2020 to February 28, 2022). Demographic and clinical variables, the first visit interval, the diagnosis interval and the first visit-diagnosis interval were evaluated and compared. Results During the first pandemic wave, there was a reduction in referrals (−32.6%), which then increased 8.1% and 17.7% from the second wave until the end of the first pandemic year and the second pandemic year, respectively. An increase in referrals to primary care and a decrease in emergencies were identified. The increase in cancer diagnoses of 2.7% and 15.7% in the 2years of the pandemic was proportional to the increase in referrals. No changes were observed in benign processes or in cancer locations and stages. The first visit interval was higher for benign diseases (p < 0.0001). A prolongation of the diagnosis interval was observed in cancer patients, although during the 3years of the study the median was <15 days. Conclusions The impact of the pandemic affected the length of intervals and the origins of referrals. The quick diagnosis units constitute and urgent complementary cancer diagnostic route with a high diagnosis yield (AU)

Utility of a quick diagnostic unit during the SARS-CoV-2 pandemic for the diagnosis of cancer.

OBJECTIVES: To analyse changes in health care activity, time of referral and diagnosis intervals and the incidence of cancer during the first two years of the SARS-CoV-2 pandemic in a quick diagnosis unit. MATERIALS AND METHODS: A retrospective observational study was carried out during the prepandemic year (March 1, 2019, to February 29, 2020) and the first two years of the pandemic (March 1, 2020, to February 28, 2022). Demographic and clinical variables, the first visit interval, the diagnosis interval and the first visit-diagnosis interval were evaluated and compared. RESULTS: During the first pandemic wave, there was a reduction in referrals (-32.6%), which then increased 8.1% and 17.7% from the second wave until the end of the first pandemic year and the second pandemic year, respectively. An increase in referrals to primary care and a decrease in emergencies were identified. The increase in cancer diagnoses of 2.7% and 15.7% in the two years of the pandemic was proportional to the increase in referrals. No changes were observed in benign processes or in cancer locations and stages. The first visit interval was higher for benign diseases (p<0.0001). A prolongation of the diagnosis interval was observed in cancer patients, although during the three years of the study the median was <15 days. CONCLUSIONS: The impact of the pandemic affected the length of intervals and the origins of referrals. The quick diagnosis units constitutes and urgent complementary cancer diagnostic route with a high diagnosis yield.

Effects of metals and persistent organic pollutants on the fitness and health of juveniles of the endangered european sturgeon Acipenser sturio Exposed to W1ater and sediments of the garonne and dordogne rivers.

The last remaining population of European sturgeon (Acipenser sturio) lives in the Gironde-Garonne-Dordogne (France) catchment (GGD). Captive young individuals are released into the GGD hydrosystem each year, as part of a restocking programme. This study aims to assess the health status of juveniles A. sturio to current conditions in the GGD hydrosystem, to evaluate their capacity to survive and grow in a moderately anthropized ecosystems. 3-month-old farmed sturgeons were exposed for one month in experimental conditions that mimic the environmental conditions in the Garonne and Dordogne rivers, followed by five months of depuration. After one month of exposure, fish exposed to Dordogne and Garonne waters bioaccumulated higher levels of metals and persistent organic pollutants, displayed a reduced hepato-somatic index, and had depleted levels of lipids and glycogen content in their liver, when compared with the Reference group. However, metabolic and swimming performance, as well as the costs of swimming were not impaired. After the 5 months depuration, a significant decrease of K was observed for all exposure conditions. HSI also decreased with time. The overall health status and adaptive capacity of juvenile A. sturio appeared to be maintained over the experimental 6 months' period. Juveniles of A. sturio seem to have the adaptive capacity to survive and grow in the GGD hydrosystem, after being released as part of a restocking programme.

Ingestion and contact with polyethylene microplastics does not cause acute toxicity on marine zooplankton.

Toxicity of polyethylene microplastics (PE-MP) of size ranges similar to their natural food to zooplanktonic organisms representative of the main taxa present in marine plankton, including rotifers, copepods, bivalves, echinoderms and fish, was evaluated. Early life stages (ELS) were prioritized as testing models in order to maximize sensitivity. Treatments included particles spiked with benzophenone-3 (BP-3), a hydrophobic organic chemical used in cosmetics with direct input in coastal areas. Despite documented ingestion of both virgin and BP-3 spiked microplastics no acute toxicity was found at loads orders of magnitude above environmentally relevant concentrations on any of the invertebrate models. In fish tests some effects, including premature or reduced hatching, were observed after 12 d exposure at 10 mg L-1 of BP-3 spiked PE-MP. The results obtained do not support environmentally relevant risk of microplastics on marine zooplankton. Similar approaches testing more hydrophobic chemicals with higher acute toxicity are needed before these conclusions could be extended to other organic pollutants common in marine ecosystems. Therefore, the replacement of these polymers in consumer products must be carefully considered.

Chronic dietary exposure of zebrafish to PAH mixtures results in carcinogenic but not genotoxic effects.

Polycyclic aromatic hydrocarbons (PAHs) are ubiquitous contaminants that can be present at high levels as mixtures in polluted aquatic environments. Many PAHs are potent mutagens and several are well-known carcinogens. Despite numerous studies on individual compounds, little is known about the toxicity of PAHs mixtures that are encountered in environmental situations. In the present work, zebrafish were continuously fed from 5 days post-fertilisation to 14 months post-fertilisation (mpf) with a diet spiked with fractions of either pyrolytic (PY), petrogenic light oil (LO), or petrogenic heavy oil (HO) origin at three concentrations. A decrease in survival was identified after 3 mpf in fish fed with the highest concentration of HO or LO, but not for PY. All PAH fractions caused preneoplastic and neoplastic disorders in long-term-exposed animals. Target tissues were almost exclusively of epithelial origin, with the bile duct epithelium being the most susceptible to chronic exposure to all PAH fractions, and with germ cells being the second most responsive cells. Significantly higher incidences of neoplasms were observed with increasing PAH concentration and exposure duration. The most severe carcinogenic effects were induced by dietary exposure to HO compared to exposure to LO or PY (45, 30 and 7 %, respectively, after 9 to 10 months of exposure to an intermediate concentration of PAHs). In contrast, earliest carcinogenic effects were detected as soon as 3 mpf after exposure to LO, including the lowest concentration, or to PY. PAH bioactivation and genotoxicity in blood was assessed by ethoxyresorufin-O-deethylase activity quantification and comet and micronuclei assays, respectively, but none of these were positive. Chronic dietary exposure of zebrafish to PAH mixtures results in carcinogenotoxic events that impair survival and physiology of exposed fish.

Genetic polymorphism and its potential relation to environmental stress in five populations of the European flounder Platichthys flesus, along the French Atlantic coast.

In this study, new DNA markers were explored for the flounder Platichthys flesus. cDNA and genomic sequences of the genes encoding the glyceraldehyde-3-phosphate-deshydrogenase (GAPDH), the cytosolic creatine kinase (CK), the prostaglandin D synthase (PGDS) and the betaine homocysteine methyltransferase (BHMT) were characterized. The tumour suppressor p53 gene structure was already described. A PCR-SSCP (Single Strand Conformation Polymorphism) analysis was finally conducted to study the genetic polymorphism of different populations of flounders collected along the French Atlantic coast. Four highly contaminated French estuaries (Seine, Vilaine, Loire and Gironde) were sampled and compared to a reference estuary (Ster) to explore possible selective effect of the environment on specific allelic frequencies. Our results showed that two loci p53 and PGDS, could be potential markers of chemical stress: p53A allele frequency increased in contaminated systems compared to the reference system. In the Vilaine estuary, PGDS polymorphism could be related to pesticide stress.

Detection of environmental mutagens using the FACIM assay.

A genetically engineered diploid yeast strain named yJC2, was specifically developed for environmental mutagen detection and characterization of induced mutations. This strain contains one copy of the human TP53 tumour suppressor gene coding sequence which is used as a molecular target for mutagens and two copies of the ADE2 reporter gene allowing accurate measurement of the TP53 transcriptional activity. The strain sensitivity to mutagens was evaluated by exposing cells to UVC, 4-nitroquinoline (NQO) or to an organic extract of sediment from the Seine estuary. For all studied mutagens, a significant and dose-dependent increase of mutant frequency was observed. The present assay named FACIM II (Functional Analysis of Chemical-Induced TP53 Mutations) is more convenient than the FACIM I and more inducible than the SOS Chromotest to detect direct-acting mutagens in the environment.

Evidence of genotoxicity related to high PAH content of sediments in the upper part of the Seine estuary (Normandy, France).

In order to characterize the genotoxicity in the Seine estuary and Seine bay, chemical and toxicological analyses were performed on 17 sediments collected in June 2001 and June 2003. Many potent mutagenic and/or carcinogenic compounds - including polycyclic aromatic hydrocarbons (PAH), polychlorinated biphenyls (PCB) and metals - were detected. Those compounds were found to be at relatively high concentrations in the upper part of the Seine estuary but were barely detectable at sites outside the plume from the Seine. The levels of pollution did not vary significantly between the two sampling periods, except that PAH concentrations in sediments collected at Oissel and Le Havre showed a marked increase in June 2003. The toxicity of organic extracts from sediments was evaluated by both embryotoxicity and in vitro genotoxicity (SOS Chromotest) assays. Organic extracts from sediments taken from the Seine estuary appeared significantly more embryotoxic than those from the Seine bay. In addition, the sediment extracts from the upper part of the Seine estuary exhibited higher genotoxicity than those from the lower part, and no genotoxicity was reported for sediments from the Seine bay. The genotoxic activity was detected only after adding an S9 microsomal fraction, suggesting the preponderant involvement of pro-genotoxic organic compounds. In addition, SOS Chromotest responses obtained with purified organic fractions revealed that PAH and, to a lesser extent, unknown polar organic compounds were probably responsible for this genotoxicity. Altogether, these results suggest that sediments from the upper Seine estuary are genotoxic and embryotoxic, and therefore, could be potentially hazardous for species living or feeding in the area.

Genotoxicant accumulation and cellular defence activation in bivalves chronically exposed to waterborne contaminants from the Seine River.

The aim of the present work was to investigate genotoxicant accumulation and biological responses of zebra mussels and blue mussels collected along a pollution gradient in the Seine estuary and in the Seine Bay. The sampling area included three contaminated and one reference sites for each species. The study focused on polyaromatic hydrocarbons (PAH), lindane, polychlorobiphenyls (PCB) and metals known to be potential genotoxicants and/or reactive oxygen species (ROS) inducers. Enzymatic activities related to cellular defence systems including the phase II enzyme glutathione S-transferase (GST) and three antioxidant enzymes superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GPx) were measured in gills. DNA adducts and DNA strand breaks (Comet assay) were measured in digestive gland and hemocytes, respectively. Species differences were observed in metal accumulation (As and Pb), GPx activity and DNA adduct formation. A marked upstream-downstream gradient was reported for PAH body burden and to a lesser extent for PCB and metals with the highest values measured just downstream the industrialized area of Rouen. GST and SOD activities in gills of bivalves were positively related to PAH and metals body burden, respectively. Activation of those cellular defences may prevent accumulation of electrophilic metabolites and free radicals and thus may protect DNA and others macromolecules against oxidation and adduction. Although DNA strand breaks and bulky adducts were detected in both species, levels were relatively low and no significant site differences were observed in June 2003. Our results indicate a clear relationship between genotoxicant accumulation and positive activation of detoxification and antioxidant systems but poor consequences in term of DNA damage for wild population of mussels inhabiting the Seine estuary.

DNA adduct measurements in zebra mussels, Dreissena polymorpha, Pallas. Potential use for genotoxicant biomonitoring of fresh water ecosystems.

The purpose of this study was to examine PAH accumulation and bulky DNA adduct formation in the digestive gland of zebra mussels exposed in their habitat or in controlled laboratory conditions to complex mixture of PAH. DNA adducts were measured using a 32P-postlabelling protocol with nuclease P1 enrichment adapted from Reddy and Randerath [Reddy, M.V., Randerath, K., 1986. Nuclease P1-mediated enhancement of sensitivity of 32P-postlabelling test for structurally diverse DNA adducts. Carcinogenesis 7, 1543-1551]. Specimens collected in the upper part of the Seine estuary were shown to accumulate higher levels of PAH (up to 1.6 microg g(-1) dry weight) in comparison to individuals from the reference site (0.053 microg g(-1) dry weight). The former exhibited elevated levels of DNA adducts (up to 4.0/10(8) nucleotides) and higher diversity of individual adducts with five distinct spots being specifically detected in individuals originating from the Seine estuary. Zebra mussels exposed for 5 days to 0.01% (v/v) of organic extract of sediment from the Seine estuary were shown to accumulate high amounts of PAH (up to 138 microg g(-1) dry weight) but exhibited relatively low levels of DNA adducts. Exposure to benzo[a]pyrene led to a dose-dependent accumulation of B[a]P (up to 7063 microg g(-1) dry weight) and a clear induction of DNA adduct formation in the digestive gland of mussels (up to 1.13/10(8) nucleotides). Comparisons with other bivalves exposed to the same model PAH, revealed similar levels of adducts and comparable adduct profiles with a main adduct spot and a second faint one. This study clearly demonstrated that zebra mussels are able to biotransform B[a]P and probably other PAH into reactive metabolites with DNA-binding activity. This work also demonstrated the applicability of the nuclease P1 enhanced 32P-postlabelling method for bulky adduct detection in the digestive gland of zebra mussels. DNA adduct measurement in zebra mussels could be a suitable biomarker to monitor PAH-exposure and evaluate genotoxicity in fresh water ecosystems.

Functional analysis of chemically-induced mutations at the flounder TP53 locus, the FACIM assay.

A functional assay was developed in yeast to identify mutations induced by DNA-damaging agents at the flounder TP53 locus. This assay named FACIM for functional analysis of chemically-induced p53 mutations, is based on the assumption that most genotoxin-induced mutations inactivate transcriptional activity of the TP53 protein. The functional status of the protein expressed in yeast was measured using a p53-responsive reporter gene. The FACIM assay was used to evaluate the mutagenesis of the flounder TP53 exposed in vitro to benzo[a]pyrene diol epoxide (BPDE). A dose-dependent increase of p53 mutation rate was observed with increasing concentrations of BPDE and extension of exposure time. Flounder TP53 gene appeared highly sensitive to point mutations since most of those identified targeted different nucleotides. Mutated base-pairs corresponded predominantly to guanines located on the non-transcribed strand of the DNA. The general distribution of mutations along the flounder TP53 protein was different from that identified in the human homologue suggesting species-differences in mutagenesis of the TP53 gene. Most of flounder TP53 mutants were defective for transactivation and cell growth regulation but some maintained a partial wild-type phenotype. This functional assay in yeast could be used for both evaluation of the genotoxic potency of chemicals or environmental samples and screening of p53 mutations in fish tumours.

The European flounder (Platichthys flesus) TP53 functions as a temperature-sensitive transcription factor which inhibits cell growth in yeast.

Numerous studies focus on biological roles of the TP53 tumor suppressor gene in mammals but little is known about the actual function of TP53 in lower vertebrates. In this study, we used an in vivo functional assay in yeast to address the transactivation capacity of the flounder TP53 protein. We showed that the flounder TP53 acts as a sequence-specific transcription factor which is able to transactivate various human promoters containing a p53-responsive element (RE). This transcriptional activity was completely abrogated in the Val147Glu TP53 mutant previously identified in two flounder hepatic hyperplasia. In addition, we showed that the wild-type (wt) flounder TP53 but not the Val147Glu mutant inhibits cell growth when expressed in yeast. We finally reported that transcription regulation and growth inhibition by the wild-type flounder TP53 is temperature-dependent. The flounder TP53 optimal temperature appeared lower than those reported for the Xenopus and human homologues.

Genetic and immunological characterisation of a multixenobiotic resistance system in the turbot (Scophthalmus maximus).

Pleiotropic resistance driven by transport proteins constitutes a very ubiquitous protection mechanism against natural or synthetic toxic compounds. The multidrug (MDR) or multixenobiotic (MXR) system has been identified in many different species, and may be used as a biomarker for pollution assessment. Here we report the existence of a gene encoding a MXR-related protein in a benthic fish species, the turbot Scophthalmus maximus, and its constitutive expression in several tissues. A 433bp cDNA fragment has been cloned by RT-PCR. The deduced amino-acid sequence shares close to 80% homology with class I or class II mammalian MDR proteins. This cDNA corresponds to a major mRNA of 5.6 kb and encodes a protein having an apparent molecular weight of 83 kDa. Constitutive expression levels assessed by semi-quantitative RT-PCR and Western blot, revealed that the kidney and the brain, and to a lesser extent, the heart, gills and intestine, are the organs which contain the highest amount of both MXR mRNAs or proteins. This tissue specific expression suggests a role for the identified mechanism in protection against endogenous or exogenous toxic compounds.

Edema agudo de pulmón no cardiogénico y leucopenia recurrente por hidroclorotiazida

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Taponamiento pericárdico como primera manifestación de la enfermedad de Hashimoto / Pericardial tamponade as the first manifestation of Hashimoto disease

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Servicio de Medicina Interna y Unidad de Cuidados Paliativos / Department of Internal Medicine and Unit Palliative Care

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