Anti-endotoxin antibodies consumption in cardiovascular collapse: Pathophysiological concerns / Consumo de anticuerpos antiendotoxina en el shock: relación etiológica

Objective Abnormal endotoxin activity in critically ill patients has been described in the absence of Gram-negative bacterial (GNB) infection. As disease severity seems to be crucial in the detection of this phenomenon, we decided to assess and compare endotoxin exposure in those patients representing the critical situation: septic shock and cardiogenic shock. Design Prospective, observational non intervention study. Setting Critical Care Department of a University tertiary hospital. Patients Cardiogenic shock (CS) and septic shock (SS) patients. Interventions None. Measurements and main results Follow-up was performed for the first three days. Inflammatory biomarkers (C-reactive protein, procalcitonin and interleuquin-6) and IgM antiendotoxin-core antibodies titter (IgM EndoCAb) were daily analyzed. Sixty-two patients were included; twenty-five patients with SS and thirty-seven with CS. Microbial etiology was established in 23 SS patients (92%) and GNB were present in 13 cases (52%). Although infection was suspected and even treated in 30 CS patients (81%), any episode could be finally confirmed. EndoCAb consumption was more intense in SS patients, although twenty-two CS patients (59.5%) had IgM anti-endotoxin value below 10th percentile range for healthy people. No statistically significant difference in endotoxin exposure was detected between Gram-positive and Gram-negative infections in the SS group. Endotoxin exposure ability to distinguish between SS and CS was moderate (AUC 0.7892, 95% IC: 0.6564–0.9218).Conclusions In the severely ill patient some mechanisms take place allowing endotoxin incursion and therefore blurring the limits of diseases pathophysiology. Our work representatively shows how exposure to endotoxin was not fully capable of distinguishing between CS and SS. (AU)

Objetivo En el paciente crítico se ha descrito una actividad incrementada de la endotoxina no asociada a infección por bacterias gramnegativas (BGN). La gravedad de la enfermedad influye en este fenómeno, por ello realizamos este estudio en el paciente crítico por antonomasia: shock séptico y cardiogénico. Diseño Estudio prospectivo, observacional, sin intervención.Lugar de estudioUnidad de Cuidados Intensivos. Pacientes Pacientes en shock cardiogénico (SC) o séptico (SS).Intervención Ninguna. Determinaciones y principales resultados Seguimiento durante los 3 primeros días. Proteína C reactiva, procalcitonina e interleucina-6, y el título de anticuerpos IgM anti-edotoxina (IgM EndoCAb) se analizaron diariamente. Se incluyó a 62 pacientes; 25 con SS y 37 con SC. La etiología fue identificada en 23 pacientes con SS (92%), los BGN estuvieron presentes en 13 casos (52%). Se sospechó e incluso trató la infección en 30 pacientes con SC, pero en ningún caso se pudo confirmar. El consumo de EndoCAb fue más intenso en los pacientes con SS, pero 22 pacientes con SC (59,5%) tuvieron unos valores por debajo del percentil 10. Los niveles de EndoCAb no fueron significativamente diferentes entre las infecciones por BGN y cocos grampositivos. La capacidad de EndoCab para diferenciar entre SC y SS resultó ser moderada (AUC 0,7892; IC del 95%, 0,6564-0,9218).Conclusiones En el paciente crítico es frecuente que la endotoxina provoque una respuesta inflamatoria y la sumación de distintos mecanismos fisiopatológicos. En este sentido, nuestro trabajo pone de manifiesto que la determinación de exposición a endotoxina no es totalmente capaz de distinguir entre los pacientes con SC y SS. (AU)

Anti-endotoxin antibodies consumption in cardiovascular collapse: Pathophysiological concerns.

OBJECTIVE: Abnormal endotoxin activity in critically ill patients has been described in the absence of Gram-negative bacterial (GNB) infection. As disease severity seems to be crucial in the detection of this phenomenon, we decided to assess and compare endotoxin exposure in those patients representing the critical situation: septic shock and cardiogenic shock. DESIGN: Prospective, observational non intervention study. SETTING: Critical Care Department of a University tertiary hospital. PATIENTS: Cardiogenic shock (CS) and septic shock (SS) patients. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Follow-up was performed for the first three days. Inflammatory biomarkers (C-reactive protein, procalcitonin and interleuquin-6) and IgM antiendotoxin-core antibodies titter (IgM EndoCAb) were daily analyzed. Sixty-two patients were included; twenty-five patients with SS and thirty-seven with CS. Microbial etiology was established in 23 SS patients (92%) and GNB were present in 13 cases (52%). Although infection was suspected and even treated in 30 CS patients (81%), any episode could be finally confirmed. EndoCAb consumption was more intense in SS patients, although twenty-two CS patients (59.5%) had IgM anti-endotoxin value below 10th percentile range for healthy people. No statistically significant difference in endotoxin exposure was detected between Gram-positive and Gram-negative infections in the SS group. Endotoxin exposure ability to distinguish between SS and CS was moderate (AUC 0.7892, 95% IC: 0.6564-0.9218). CONCLUSIONS: In the severely ill patient some mechanisms take place allowing endotoxin incursion and therefore blurring the limits of diseases pathophysiology. Our work representatively shows how exposure to endotoxin was not fully capable of distinguishing between CS and SS.

Phenotypic and genetic analysis of reproductive traits in horse populations with different breeding purposes.

Reproductive traits have a major influence on the economic effectiveness of horse breeding. However, there is little information available. We evaluated the use of reproductive traits as selection criteria in official breeding programs to increase the reproductive efficiency of breeding studs, analysing 696 690 records from the pedigree data of eight Spanish horse populations, with different breeding purposes. The reproductive parameters studied in both sexes were age at first foaling (AFF), age at last foaling, average reproductive life and generational interval. In the females, the average interval between foaling (AIF) and interval between first and second foaling were also studied. There were clear differences between sexes and breeds, which may be due to management practices, breeding purposes and the status of the populations, rather than to differences in actual physiological conditions. Riding mares were the most precocious (AFF, 1937.64 to 2255.69 days) and had a more intensive reproductive use (AIF, 625.83 to 760.07 days), whereas sires used for meat production were the most precocious males (AFF, 1789.93 to 1999.75 days), although they had a shorter reproductive life (1564.34 to 1797.32 days). Heritabilities (0.02 to 0.42 in females and 0.04 to 0.28 in males) evidenced the genetic component of the reproductive traits, with Sport Horses having the higher average values. These results support the selection by AFF to improve reproductive aspects because of its medium-high heritability and its positive correlations with other important reproductive traits. The inclusion of the AIF is also recommended in sport populations, because this determines the length of the breaks between foaling and conditions the reproductive performance of the dams, as well as their selective intensity, genetic gain and genetic improvement. It is therefore an important economic parameter in breeding studs.

Heritability and factors associated with number of harness race starts in the Spanish Trotter horse population.

BACKGROUND: Longevity/durability is a relevant trait in racehorses. Genetic analysis and knowledge of factors that influence number of harness race starts would be advantageous for both horse welfare and the equine industry. OBJECTIVES: To perform a genetic analysis on harness racing using number of races as a measure of longevity/durability and to identify factors associated with career length in Spanish Trotter Horses (STH). STUDY DESIGN: Longitudinal study. METHODS: Performance data (n = 331,970) on the STH population for harness racing at national level between 1990 and 2014 were used. A grouped data model was fitted to assess factors influencing the risk of ending harness racing career and to estimate the heritability and breeding values for total number of harness races starts as an indicator of horses' longevity and durability. The model included sex, age at first race and first start earnings as time-independent effects, and the calendar year, driver, trainer, racetrack category and season of competition as time-dependent effects. RESULTS: Across the whole dataset, the average number of harness races horses achieved in Spain was 54.7 races, and this was associated with the horses' sex, age at first race and first start earnings, calendar year, driver, racetrack category, and season. The heritability estimated (0.17 ± 0.01) for number of harness race starts indicates that a beneficial response to direct genetic selection can be expected. MAIN LIMITATIONS: Data on horses' health status were not available. CONCLUSIONS: Horses' total number of harness race starts is a promising tool for genetic analysis and the evaluation of racing longevity and durability. The estimated heritability provides evidence to support the application of genetic selection of total career number of races to improve longevity/durability of STH.

Quantitative analysis of short- and long-distance racing performance in young and adult horses and association analysis with functional candidate genes in Spanish Trotter horses.

The association of five candidate genes with sporting performance in young and adult Spanish Trotter horses (STHs) was performed according to a previous selection based on quantitative analysis of the trait time per kilometre (TPK). A total of 334 516 records of TPK from 5958 STHs were used to estimate the estimated breeding values (EBVs) at different age groups (young and adults horses) throughout the range of distances (1600-2700 m) using a bicharacter random regression model. The heritability estimated by distance ranged from 0.16 to 0.40, with a different range for the two age groups. Considering the animals with the best and the worst deregressed EBV, 321 STHs were selected for SNP genotyping in MSTN, COX4I2, PDK4, DMRT3 and CKM genes. An association analysis based on ridge and logistic regression revealed that the young trotters with genotype GG in PDK4 (p < 0.05) and AA of DMRT3 (p < 0.001) SNPs show the best potential in short-distance races, while those carrying the genotype AA in DMRT3 (p < 0.001) and CC in CKM (p < 0.05) genes seem to be the best in long-distance races. Adult trotters with genotype AA in DMRT3 also display greater speed (p < 0.05) and endurance (p < 0.001).

Evaluation of conformation against traits associated with dressage ability in unridden Iberian horses at the trot.

The work describes and compares the conformation traits and gait characteristics in the main native Iberian dressage Purebreds (Lusitano, Spanish and Menorca horses). In total, 4 strides belonging to each of 66 males (4-14 years old) were recorded at handled trot, using a 3D semi-automatic movement analysis system. Principal component analysis (PCA) and intraclass Correlations (iC) were computed. The Menorca Purebred showed proportionally higher limbs (23.8 and 15.1cm for the forelimb cannon and pastern lengths), the Lusitano Purebred had larger inclinations (66.1°, 37.7° and 47.9° for the scapula and pastern angles), and the Spanish Purebred presented a longer scapula (41.5 cm) and a larger hip angle (132.1°), apparently showing a better conformation for dressage gaits. However, the three breeds presented undesirable tarsus joint conformation (<155.5°) for dressage performance. In general, all of them showed good features in the kinematics of the forelimbs. Nevertheless, the functional capacity of their hindlimbs and linear parameters probably need to be improved for their competitiveness.

Implementation of Optimum Contributions selection in endangered local breeds: the case of the Menorca Horse population.

Limiting the inbreeding rate (∆F) while maximizing genetic gain for any trait of economic interest is especially important in small populations of local breeds, like the Menorca Horse. In this breed, dressage performance is important for the profitability of the breed and should be accounted in the selection criterion. The aim of this study was to assess if a breeding programme aiming at improved dressage performance is feasible in such a small breed. To perform the analysis, animals that were currently available for breeding (between 3 and 20 years) were used. Selection was based on the estimated breeding values for dressage obtained by BLUP. The pedigree and molecular coancestry between potential breeding horses was used (separately or in combination) to account for the restriction on ∆F. Results show that it is possible to avoid large increases in inbreeding while obtaining acceptable levels of genetic gain (i.e. a ∆F of 1% would imply a maximum loss in genetic gain of 2%). Thus, the Menorca Horse population is suitable for a management procedure which jointly optimizes the response to selection and the levels of variability and inbreeding (Optimal Contribution selection). Regarding the source of information used to calculate the relationships, molecular information would provide a greater range of solutions to increase genetic gain than using pedigree coancestry (gain was 1-4% higher for the same levels of restriction on the increase in inbreeding).

Prevalence of Trypanosoma cruzi infection in pregnant Latin American women and congenital transmission rate in a non-endemic area: the experience of the Valencian Health Programme (Spain).

This study describes the results of the health programme implemented in the Valencian Community (Spain) to achieve an early diagnosis of Chagas disease in pregnant Latin American women and their newborns. During 2009 and 2010, 1975 women living in the health districts of three university hospitals were enrolled via midwives or at the time of delivery. Diagnosis of disease was performed using two serological tests with different antigens. Congenital infection was diagnosed by parasitological, molecular or serological methods from blood samples obtained at birth or in subsequent controls. The overall seroprevalence of Chagas infection in pregnant women from 16 different endemic countries was 11·4%. Infection was higher in those from countries in the Gran Chaco Region (Bolivia, 34·1%; Paraguay, 7·4%; Argentina, 5·3%). Eight newborn infants from Bolivian mothers had congenital Chagas which represents a vertical transmission rate of 3·7%. In conclusion, this work supports the benefits of offering an early diagnosis to pregnant women and newborns during routine prenatal healthcare.

Estimation of genetic parameters for racing speed at different distances in young and adult Spanish Trotter horses using the random regression model.

A total of 71 522 records (from 3154 horses) with the times per kilometre (TPK), recorded in Spanish Trotter horses (individual races) from racing performances held from 1991 to 2007, were available for this study. The TPK values for the different age groups (young and adult horses) and different distances (1600-2700 m) were considered as different traits, and a bi character random regression model (RRM) was applied to estimate the (co)variance components throughout the trajectory of age groups and distances. The following effects were considered as fixed: the combination of hippodrome-date of race (404 levels); sex of the animals (3 levels); type of start (2 levels) and a fixed regression of Legendre polynomials (order 2). Those considered as random effects were the random regression Legendre polynomial (order 1) for animals (9201 animals in the pedigree); the individual environment permanent (3154 animals with data) and the driver (n = 957 levels). The residual variance was considered as heterogeneous with two classes (ages). The heritability estimated by distance ranged from 0.12 to 0.34, with a different trajectory for the two age groups. Within each age group, the genetic correlations between adjacent distances were high (>0.90), but decreased when the differences between them were over 400 metres for both age groups. The genetic correlations for the same distance across the age groups ranged from 0.47 to 0.78. Accordingly, the analysed trait (TPK) can be considered as positive genetic correlated but as different traits along the trajectory of distance and age. Therefore, some re-ranking should be expected in the breeding value of the horses at different characteristics of the racing. The use of RRM is recommended because it allows us to estimate the breeding value along the whole trajectory of race competition.

[Impact of a short stay unit in a tertiary hospital]. / Impacto de una unidad de corta estancia en un hospital de tercer nivel.

OBJECTIVE: To analyze the health care activity indicators of a short-stay unit (SSU) and compare them with those of other services in a Conventional Hospital. MATERIAL AND METHODS: A descriptive, retrospective study was conducted of the patients admitted to SSU during 2003-2007. Number of admissions, mean stay (MS), mortality and destination were analyzed. Mean stay and number of admissions of the main diagnosis-related groups (DRGs) in the SSU were compared with other services of conventional hospitalization. RESULTS: A total of 15.3% of the patients who came to the Emergency Service were admitted to the SSU. Mean stay was significantly lower in the SSU than in the rest of the hospital (year 2003, SSU 3.2 days, rest of the hospital 10.2 days; year 2007, SSU 3.3 days, rest of the hospital 8.6 days). The 4 most common DRGs (71.3% of all those admitted to the SSU) were COPD, respiratory infection/bronchitis, simple pneumonia/pleuritis and heart failure/shock. Mean stay for the 4 DRGs in the SSU was significantly lower (p<0.01) than in Internal Medicine, Pneumology and Cardiology (heart failure/shock). CONCLUSIONS: The SSU handles its most prevalent diseases with greater agility compared to other conventional hospitalization services.

[Final size attained in type 1 diabetes children]. / Talla final en diabéticos tipo 1 diagnosticados en la edad pediátrica.

OBJECTIVE: To describe the final height and height-gain in relation to target height, in children with type 1 diabetes mellitus, and analyse their relationship to different variables. PATIENTS AND METHODS: Retrospective analysis of the growth data of 52 children (27 girls) diagnosed with type 1 diabetes mellitus before 14 years old, and followed up until their final height was attained. MAIN VARIABLES: final height, target height, illness duration, glycated haemoglobin (HbA1c), insulin dose, BMI, and other autoimmune diseases. RESULTS: The height SDS (standard deviation scale) at diagnosis was slightly higher (0.734 in boys and 0.563 in girls). During the development of the disease, a growth reduction was seen, which was significantly higher in boys of prepubertal age (p = 0.016). The mean final height attained was 173.14 +/- 5.28 cm in boys and 161.9 +/- 6.97 cm in girls. Height gain was 1.56 +/- 3.66 in boys (SDS = -0.034) and 2.26 +/- 6.13 in girls (SDS = 0.385). The only variable significantly related to height gain was mean glycated-haemoglobin (growth reduction of 2 cm for every increment of 1% in mean glycated-haemoglobin). CONCLUSIONS: At onset, diabetic children were slightly taller than the general population. A growth reduction was shown as the disease developed, significantly higher in boys of prepubertal age. The final height in boys was slightly lower than the mean, but in girls was similar to the general population. Both sexes attained their target height, although the height gain was less in boys. Poorer metabolic control was associated with reduced height gain.

Clinical significance of the detection of Candida albicans germ tube-specific antibodies in critically ill patients.

The present study, comprising a prospective multicentre study including 53 non-neutropenic patients from intensive care units (ICU) in six Spanish tertiary-care hospitals, was carried out to determine the clinical significance and influence on mortality of Candida albicans germ tube-specific antibodies (CAGTA). There were 22 patients (41.5%) for whom the CAGTA results were positive, although none of had a blood culture positive for Candida. The intra-ICU mortality rate was significantly lower (p = 0.004) in CAGTA-positive patients (61.2% vs. 22.7%). Multivariate analysis confirmed that a positive CAGTA result was the only protective factor to be independently associated with ICU mortality (beta coefficient = -0.3856; 95% confidence interval = -0.648 to -0.123).

Sire x stud interaction for body measurement traits in Spanish Purebred horses.

The mating policy for Spanish Purebred horses encourages the same or closely related stallions to be used for reproduction across studs differing in environments. Stallions may perform differently across studs, and if so, adjustment for the sire x stud (ss) interaction is recommended. However, there are no studies available that analyzed the influence of ss interaction on estimation of genetic parameters in horses. This research is aimed at assessing the implications of including ss interaction in models fitted for the estimation of genetic parameters for traits under selection using 8 body measurements in Spanish Purebred (Andalusian) horses: height at withers, height at chest, leg length, body length, width of chest, heart girth circumference, knee perimeter, and cannon bone circumference. Body measurements were available for 11,894 horses. Genetic parameters and EBV were estimated using animal models by REML. The inclusion of the ss interaction gives reduced estimates of heritability. Generally, the genetic correlations estimated using the models including the ss interaction were greater than those obtained using the simpler model. Estimates for the ss variance as a proportion of the total phenotypic variance ranged from 0.02 (height at withers) to 0.11 (width of chest). Estimates between the ss interaction correlations associated with each body measurement were positive, significant, and from moderate to low. The range of EBV estimated using the model including the ss interaction decreased with respect to those estimated using the simpler model, and the EBV ranking order was affected. The models including ss interaction fitted significantly better. Therefore, the genetic parameters estimated using the ss interaction may be more realistic, and the obtained (co)variances may be assumed to be closer to the true population parameters. This interaction may result from selective decisions or preferential management practices causing greater similarity between the progeny of a sire in the same stud. It is therefore advisable to include it in genetic models used in horse breeding schemes.

Talla final en diabéticos tipo 1 diagnosticados en la edad pediátrica / Final size attained in type 1 diabetes children

Objetivo: describir la talla final y la ganancia sobre la talla diana, en un grupo de niños diabéticos tipo 1 y analizar su relación con distintas variables. Pacientes y métodos: estudio retrospectivo de 52 pacientes (27 mujeres) diagnosticados de diabetes tipo 1 antes de los 14 años y seguidos hasta la talla final. Variables principales: talla final, talla diana, tiempo de evolución de la diabetes, glucohemoglobina (HbA1c) media, requerimiento insulínico, índice de masa corporal, enfermedades autoinmunes asociadas. Resultados: al inicio de la diabetes la escala de desviación estándar (EDE) de talla se encontraba ligeramente por encima de la media (0,734 en varones y 0,563 en mujeres). A lo largo de la evolución se produce un pérdida de talla generalizada, más acusada en varones en etapa prepuberal (p=0,016). La talla final alcanzada fue 173,14±5,28cm en varones (EDE=−0,034) y 161,9±6,97cm en mujeres (EDE=0,385). La ganancia de talla fue 1,56±3,66cm en varones y 2,26±6,13cm en mujeres. La única variable relevante relacionada significativamente con la ganancia de talla fue la HbA1c media (pérdida de 2cm por cada aumento del 1% de HbA1c media a igualdad del resto de las variables). Conclusiones: nuestros resultados indican que, aunque al inicio de la diabetes los niños tienen una talla algo mayor que la de la población de referencia, se produce una pérdida de talla durante la evolución de la enfermedad, más acusada en varones en periodo prepuberal. Ello produce que la talla final de los varones se encuentre ligeramente por debajo de la media, mientras que las mujeres alcanzan una talla final similar a la de la población de referencia. Ambos sexos alcanzaron su talla diana, pero en varones la ganancia sobre ésta fue escasa. El mal control metabólico se relacionó con la menor ganancia de talla en niños diabéticos (AU)

Objective: To describe the final height and height-gain in relation to target height, in children with type 1 diabetes mellitus, and analyse their relationship to different variables. Patients and methods: Retrospective analysis of the growth data of 52 children (27 girls) diagnosed with type 1 diabetes mellitus before 14 years old, and followed up until their final height was attained. Main variables: final height, target height, illness duration, glycated haemoglobin (HbA1c), insulin dose, BMI, and other autoimmune diseases. Results: The height SDS (standard deviation scale) at diagnosis was slightly higher (0.734 in boys and 0.563 in girls). During the development of the disease, a growth reduction was seen, which was significantly higher in boys of prepubertal age (p=0.016). The mean final height attained was 173.14±5.28cm in boys and 161.9±6.97cm in girls. Height gain was 1.56±3.66 in boys (SDS=−0.034) and 2.26±6.13 in girls (SDS=0.385). The only variable significantly related to height gain was mean glycated-haemoglobin (growth reduction of 2cm for every increment of 1% in mean glycated-haemoglobin). Conclusions: At onset, diabetic children were slightly taller than the general population. A growth reduction was shown as the disease developed, significantly higher in boys of prepubertal age. The final height in boys was slightly lower than the mean, but in girls was similar to the general population. Both sexes attained their target height, although the height gain was less in boys. Poorer metabolic control was associated with reduced height gain (AU)

Breed effect on carcass and meat quality of foals slaughtered at 24months of age.

In some areas, horsemeat may be considered as an alternative to beef. And recent studies have shown that it may be positive from a nutritional point of view. However, little research has been done on the effects that influence horse carcass traits and meat quality. Breed effect has been studied by comparing two Spanish local breeds (Burguete and Hispano-Bretón) reared following the same traditional production system (24months old). Some differences between breeds were observed for carcass quality measurements and colour parameters. Proximate composition was generally not affected by breed. Burguete foals had lower SFA and MUFA and higher PUFA than Hispano-Bretón ones. PUFA/SFA ratio from both breeds was higher than 0.4 and CLA levels were similar to those found in ruminants.

Genetic parameters of biokinematic variables of the trot in Spanish Purebred horses under experimental treadmill conditions.

The purpose of this study was to estimate the genetic parameters of biokinematic variables in Spanish Purebred (SPB) horses in order to select those of sufficient interest to be measured in the pre-selection of the animals for possible inclusion in the breeding programme. Kinematic analysis of 130 SPB horses 4.6+/-1.5 years old were recorded at the trot (4m/s) on a treadmill. Genetic parameters were estimated using VCE software and a bivariate mixed animal model including age and stud as fixed effects and animal additive genetic effect and residual error as random effects. In general, heritabilities were high (0.33-0.88). The angular variables presented the lowest heritabilities, whereas the maximum height of the fore-hoof and the duration of swing phase in the hindlimb gave the highest scores. Genetic correlations were also very high, so it was possible to reduce the number of breeding programme characteristics to stride duration, hindlimb swing phase duration, range of stifle and elbow angles, minimal angle of carpus, and minimal retraction-protraction angle of the hindlimb.

Rotura uterina asociada a desprendimiento prematuro de placenta normalmente inserta en gestante de 25 semanas / Uterine rupture associated with premature separation of a normally inserted placenta at 25 weeks’ gestation

Se presenta un caso de rotura uterina en paciente secundípara de 25 semanas que ingresó en nuestro centro por rotura prematura de membranas. Se practicó una cesárea de urgencia ante la sospecha de desprendimiento prematuro de placenta normalmente inserta y se objetivó rotura de la cicatriz de la cesárea anterior (AU)

We report a case of uterine rupture in a secundipara at 25 weeks’ gestation who was admitted to our center for premature rupture of membranes. Emergency cesarean section was performed due to suspicion of premature separation of a normally inserted placenta. Rupture of a previous cesarean section scar was observed (AU)

Genetic similarity of hepatitis C virus and fibrosis progression in chronic and recurrent infection after liver transplantation.

The effect of hepatitis C virus (HCV) genetic heterogeneity on clinical features of post-transplantation hepatitis C is controversial. Different regions of the HCV genome have been associated with apoptosis, fibrosis, and other pathways leading to liver damage in chronic HCV infection. Besides, differences in immunodominant regions, such as NS3, may influence HCV-specific immune responses and disease outcome. In the liver transplant setting, a recent study has reported a positive association between HCV-1b Core region genetic relatedness 5-year post-transplantation and histological severity of recurrent hepatitis C. We have compared nucleotide sequences of HCV Core, NS3 and NS5b regions in HCV-1b-infected patients 3 years post-transplantation (n = 22). A cohort of nontransplanted patients (n = 22) was used as control of natural chronic HCV-1b infection. Histological evaluation was used to define the rate of fibrosis progression. Molecular variance analysis did not show significant differences in HCV sequences between transplanted and nontransplanted patients, or between those with fast or slow fibrosis progression. The same results were obtained when analysing phylogenetic trees for Core, NS3 and NS5b regions. A more appropriate clustering method (using minimum spanning networks) revealed a significant positive relationship between HCV genetic similarity in Core (r = 0.550, P < 0.01) and NS5b regions (r = 0.847, P < 0.01) and the yearly rate of fibrosis progression in nontransplanted patients which, in contrast, was not observed in transplanted patients. Our results indicate that some strains of HCV-1b might be more pathogenic in the natural course of chronic infection by this virus subtype. In the liver transplant setting, when the immune response is severely compromised, other mechanisms are probably more important in determining hepatitis C progression.

Réplica a “disminución de las necesidades de sangre alogénica en cirugía protésica de rodilla mediante la reinfusión de sangre recuperada y procesada” / Author's reply to "Reduced allogenic transfusion requirements through reinfusion of processed shed blood"

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