[Analysis of clinical safety in the units of Allergy of the Valencian Community]. / Análisis de la seguridad clínica en las unidades de Alergología de la Comunidad Valenciana.

The introduction of new diagnostic and therapeutic procedures involving allergen exposure may increase the risk of allergic reactions. We designed and distributed an anonymous questionnaire among the allergy units of the Valencian Community in order to collect information on measures to ensure clinical safety. Twelve hospital outpatient clinics and 8 ambulatory care centres reported similar patterns of activities, including the use of critical care units, emergency rooms or day hospitals for higher risk techniques. The provision of security-related instruments is broader in hospital outpatient clinics and included: oxygen (91.7%), pulse oximeter (75.0%) or vital signs monitor (8.3%), resuscitation material (91.7%) and defibrillator (83.3%). The response time for emergencies is set in 50% of clinics. The resuscitation material is systematically reviewed and informed consent signed. Security is more limited in ambulatory care centres. It is necessary to set down the conditions for clinical safety in allergology. Key words. Allergy. Ambulatory care. Clinical safety. Health services. Hospital outpatient clinic.

Microbial Community Dynamics and Response to Plant Growth-Promoting Microorganisms in the Rhizosphere of Four Common Food Crops Cultivated in Hydroponics.

Plant growth promoting microorganisms (PGPMs) of the plant root zone microbiome have received limited attention in hydroponic cultivation systems. In the framework of a project aimed at the development of a biological life support system for manned missions in space, we investigated the effects of PGPMs on four common food crops (durum and bread wheat, potato and soybean) cultivated in recirculating hydroponic systems for a whole life cycle. Each crop was inoculated with a commercial PGPM mixture and the composition of the microbial communities associated with their root rhizosphere, rhizoplane/endosphere and with the recirculating nutrient solution was characterised through 16S- and ITS-targeted Illumina MiSeq sequencing. PGPM addition was shown to induce changes in the composition of these communities, though these changes varied both between crops and over time. Microbial communities of PGPM-treated plants were shown to be more stable over time. Though additional development is required, this study highlights the potential benefits that PGPMs may confer to plants grown in hydroponic systems, particularly when cultivated in extreme environments such as space.

Association between arachidonate 5-lipoxygenase-activating protein (ALOX5AP) and lung function in a Korean population.

Arachidonate 5-lipoxygenase-activating protein (ALOX5AP) plays a role in the 5-lipoxygenase (LO) pathway, which includes the LTC(4), LTD(4), LTE(4) and LTB(4). These leukotrienes are known causative factors of asthma, allergy, atopy and cardiovascular diseases. ALOX5AP lacks enzyme activity and acts by helping 5-LO function. In this study, healthy and general subjects who live in rural and urban areas of Korea were tested for the association of ALOX5AP polymorphisms with lung function. Lung function was also estimated by calculating the predicted values for forced expiratory volume in one second (FEV(1) _%PRED) and the proportion of the forced vital capacity exhaled in the first second (FEV(1) /FVC_PRED). The linear regression was adjusted for residence area, gender, age, height and smoking status. The analysis revealed associations between FEV(1) and the single-nucleotide polymorphism (SNP) rs9506352 and the haplotype TCAC (permuted P-value < 0.05). The linkage disequilibrium block that included the significant SNPs overlapped with SNPs that were revealed previously to associate with myocardial infarction and asthma and to affect lung function. This study is the first to demonstrate the association between lung function and ALOX5AP polymorphisms in a healthy and general population.

A unilateral sympathetic blockade does not affect stress-related pain and muscle activity in patients with chronic musculoskeletal pain.

OBJECTIVE: Chronic musculoskeletal pain is often exacerbated by mental and social stress. The association between stress and musculoskeletal pain is potentially mediated by peripheral sympathetic nerves, either directly or indirectly through muscle activity. In the present study we wanted to determine whether sympathetic blockade could affect either the pain or the muscular activity experienced during mental stress in patients with chronic musculoskeletal pain. METHODS: We performed a unilateral anaesthetic blockade of the lower cervical sympathetic ganglion (ganglion stellatum) in 18 patients with chronic musculoskeletal pain (10 with fibromyalgia and eight with chronic shoulder/neck pain). After the blockade the patients performed a 60-minute stressful task with low-grade mental stress that has induced pain and muscle activity in earlier experiments. Surface electromyography (SEMG) of the forehead, temples, neck, and shoulders, and heart rate and blood pressure were recorded together with ratings of pain. RESULTS: We did not find any side or sidextime effect for pain or muscular activity in any of the four muscle groups (p>0.12). CONCLUSION: We investigated the potential involvement of peripheral sympathetic nerves in stress-related musculoskeletal pain. A peripheral sympathetic block did not affect pain and muscle responses to a stressful task. Other explanatory models should be implemented and tested experimentally to further investigate the clinical impression that mental stress exacerbates pain in patients with chronic musculoskeletal pain.

Pain induced by low-grade stress in patients with fibromyalgia and chronic shoulder/neck pain, relation to surface electromyography.

The mechanisms of pain causation in fibromyalgia (FMS) and chronic shoulder/neck pain (SNP) are still debated. We wanted to compare muscle activity and pain development during and after low-grade mental stress in FMS and SNP patients. Twenty-three women with FMS, 29 women with chronic SNP and 35 healthy women performed a stressful task lasting 60 min followed by a 30 min recovery period. We recorded surface electromyography over the trapezius, neck, temporalis and frontalis muscles. Subjects reported their pain at the corresponding locations together with the development of fatigue and perceived tension. Significant differences between FMS and SNP groups were not observed either for muscular or subjective responses. SNP patients and controls responded with more pain in the trapezius and neck regions than in the forehead, in contrast to FMS patients who had a more generalized pain response. Development of pain, tension and fatigue was not related to muscle activity for any group. We conclude that FMS and SNP patients have similar pain and electromyographic responses. The results suggest that similar pathophysiological mechanisms are involved although the responses are more generalised in FMS than in SNP patients. Muscular activity did not explain the pain which developed during the stressful task for either group. Pain lasted longer during recovery in both FMS and SNP patients compared to healthy controls, possibly a result of disease-related sensitisation in pain pathways.

Comparison of two physical exercise programs for the early intervention of pain in the neck, shoulders and lower back in female hospital staff.

The aim of the present study was to compare the effect of increased aerobic capacity versus muscle strength rehabilitation of female hospital staff with long-lasting musculoskeletal back pain. Seventy-nine women agreed to participate in the intervention study. After a medical examination, 65 individuals were assigned to one of three balanced groups: Endurance training (aerobic capacity promoting training: ET: n = 22), strength promotion exercise (SP: n = 24) or a control group (CON: n = 19). The active groups met twice a week for 60 minutes of exercise over 15 weeks. Aerobic capacity (VO2max) and musculoskeletal pain were measured immediately before (T1) and after the intervention period (T2). Aerobic capacity significantly increased in the ET group, whereas no change was observed in the SP group, and a significant reduction was found in the CON group from T1 to T2. Musculoskeletal pain was significantly reduced in both intervention groups, whereas minor changes were observed in the control group. Results from a 7-month follow-up (T3) survey confirmed the beneficial effects of interventions on musculoskeletal pain. In conclusion, improved aerobic capacity appeared not to be a necessary mechanism in musculoskeletal back pain reduction.

[Fall from high altitude]. / Fall fra stor høyde.

BACKGROUND: It is controversial in which way the human body can tolerate mechanical stress and later develop sequelae after deceleration trauma. MATERIAL AND METHODS: A report on a 26-year-old male who survived a free fall of 28 metres from a building. RESULTS: It is accounted for an achieved velocity of 81 kph and accumulated energy of 21,000 Joule. The incident lead to multiple complicated fractures, nerve injuries and an acute head injury. The patient's cognitive function was restored after a few months, and he is satisfied with the outcome.

Neuroacanthocytosis--the variability of presenting symptoms in two siblings.

Neuroacanthocytosis is a progressive multisystem disease with a wide range of symptoms. The involuntary movements mainly include chorea and orofaciolingual dyskinesias. The descriptive name of the disease refers to the presence of abnormal erythrocytes in peripheral blood. Two siblings are presented. One young female had dystonia, self-mutilating behaviour, lip biting and eating difficulties. Her brother had repeated generalized epileptic seizures several years before developing choreatic movements and neuropsychiatric symptoms. Both had clinical signs of sensorimotor axonal polyneuropathy. Fresh blood smears in each patient contained between 15 and 20% acanthocytes compared to less than 2% in normal controls. Neuroacanthocytosis must be kept in mind in young adult patients without heredity for Huntington's disease and the diagnosis is easily confirmed when making a fresh blood smear.

The association of educational achievement and school dropout with risk of alcoholism: a twenty-five-year prospective study of inner-city children.

OBJECTIVE: This prospective study is focused on the characteristics leading to alcohol use disorders in early adulthood among a cohort of black children. The principal aim of this work is to examine the impact of educational attainment, school dropout and early school adaptation on the development of alcohol abuse and dependence in adulthood. METHOD: From a population that consisted of 1,242 first graders in 1966-67, a total of 953 were interviewed at age 32-33 about their current alcohol and drug use, educational attainment, employment and family situation. RESULTS: Diagnoses of alcohol abuse and dependence were defined according to DSM-III-R criteria resulting in identification of 13.5% as having a lifetime alcohol use disorder. Early predictions of an alcohol use disorder in adulthood included early reports of underachievement in first grade by the child's teacher, dropping out of high school, whether the family set definite rules about school during adolescence, and how often the adolescent worked on homework with his/her family. CONCLUSIONS: The results suggest that educational achievement and some early adaptive behaviors in school are associated with risk for alcohol use disorders. The public health importance of the findings are discussed.

Cell surface polysaccharide and protein antigens of an encapsulated Porphyromonas gingivalis 16-1 strain.

We have extracted the cell surface polysaccharide antigen (PS) and protein antigen from an encapsulated and virulent strain of Porphyromonas gingivalis 16-1. The PS was separated from lipopolysaccharide (LPS) by Sephacryl S-300 gel chromatography. It was distinguished from LPS by immunodiffusion with homologous rabbit antiserum. The PS reacted specifically with serogroup b antiserum against P. gingivalis 16-1 and Su63 strains, but not with antisera against serogroup a (ATCC 33277) or serogroup c (W83). The outer membrane protein was extracted with the Zwittergent 3-16 and sarcosyl detergents in a Tris-EDTA buffer. SDS-Page analysis revealed that the extracted protein antigen of P. gingivalis 16-1 contained 2 immunodominant proteins with molecular weights of 41 KDa and 27 KDa.

Mapping and mutagenesis of the amino-terminal transcriptional repression domain of the Drosophila Krüppel protein.

We previously demonstrated that the Drosophila Krüppel protein is a transcriptional repressor with separable DNA-binding and transcriptional repression activities. In this study, the minimal amino (N)-terminal repression region of the Krüppel protein was defined by transferring regions of the Krüppel protein to a heterologous DNA-binding protein, the lacI protein. Fusion of a predicted alpha-helical region from amino acids 62 to 92 in the N terminus of the Krüppel protein was sufficient to transfer repression activity. This putative alpha-helix has several hydrophobic surfaces, as well as a glutamine-rich surface. Mutants containing multiple amino acid substitutions of the glutamine residues demonstrated that this putative alpha-helical region is essential for repression activity of a Krüppel protein containing the entire N-terminal and DNA-binding regions. Furthermore, one point mutant with only a single glutamine on this surface altered to lysine abolished the ability of the Krüppel protein to repress, indicating the importance of the amino acid at residue 86 for repression. The N terminus also contained an adjacent activation region localized between amino acids 86 and 117. Finally, in accordance with predictions from primary amino acid sequence similarity, a repression region from the Drosophila even-skipped protein, which was six times more potent than that of the Krüppel protein in the mammalian cells, was characterized. This segment included a hydrophobic stretch of 11 consecutive alanine residues and a proline-rich region.

Helicobacter pylori infection and chronic active gastritis.

Helicobacter pylori (H. pylori) is an S-Shaped, gram-negative bacillus that recently has been implicated in the pathogenesis of chronic active gastritis and other peptic ulcer disease. These findings have encouraged gastroenterologists to provide a new rationale for patient management, with hope of providing more successful treatment of peptic ulcer disease, particularly gastritis. Therefore, a cooperative diagnostic effort was made at the pathology laboratory of St Francis Medical Center to adopt a simple and reliable method for the identification of H. pylori in tissue sections of endoscopic biopsies of stomach and duodenum. We attempted to estimate the prevalence of H. pylori infection in patients biopsied for upper Gl disorders who were refractory to medication. A prevalence of H. pylori infection among different ethnic groups also was studied.

Selective repression of transcriptional activators at a distance by the Drosophila Krüppel protein.

The Krüppel (Kr) protein, bound at kilobase distances from the start site of transcription, represses transcription by RNA polymerase II in mammalian cells. Repression is monotonically dependent on the dose of Kr protein and the presence of Kr binding site(s) on the DNA. These data suggest an inhibitory protein-protein interaction between the Kr protein and proximal transcription factors. Repression by Kr depends on the specific activator protein driving transcription. In particular, Kr protein selectively represses transcription mediated by the Sp1 glutamine-rich activation domain, tethered to the promoter by a GAL4 DNA-binding domain, but does not repress transcription stimulated by the acidic GAL4 activator. We believe this represents repression by a quenching interaction between DNA-bound Kr protein and the activation region of Sp1, rather than competition between Sp1 and Kr for a limiting transcriptional component. Selective, context-related repression affords an added layer of combinatorial control of gene expression by sequence-specific transcription factors.

NGFIA (EGR1) contains transcription activating domains in both the amino terminal and carboxyl terminal regions of the protein.

We constructed and tested a number of lac repressor fusion proteins containing various portions of the zinc-finger containing protein NGFIA for their ability to stimulate transcription of a reporter gene containing lac operators. NGFIA contains two transcription activation regions, found in two distinct regions of the protein. The carboxyl (C) terminal portion of the molecule contains a weak activation domain, including five tandem copies of an eight amino acid repeat (T/S,T/S,F/Y,P,S,P,X,X). These five tandem copies of the repeated sequence activated reporter gene transcription 4-7 fold. Amino acids 1 through 293 in the amino (N) terminus of NGFIA function as a strong transcription activation domain stimulating transcription up to 80-fold. Fusions including amino acids 1-393 failed to activate transcription, indicating the presence of a domain capable of suppressing the N-terminal transcriptional activation function.

Development of a hybrid bioartificial liver.

OBJECTIVE: The authors developed an extracorporeal liver support system and tested its efficacy in experimental animals with liver failure. The first clinical use of this system to treat a patient with liver failure is reported. SUMMARY BACKGROUND DATA: Multiple attempts have been made, ranging from plasma exchange to use of charcoal columns, to develop liver support systems for treating patients with acute severe liver failure. None of these systems has achieved wide clinical use. There is a need for providing liver support as a "bridge" to transplantation and for treating patients with potentially reversible liver dysfunction. METHODS: A hybrid liver support system has been developed consisting of plasma perfusion through a charcoal column and a porous hollow fiber module inoculated with 5 x 10(9) matrix-attached hepatocytes. The system was tested in dogs with ischemic liver failure (n = 7) who underwent plasmapheresis; a control group (n = 6) underwent charcoal perfusion alone. A patient with liver failure was treated with this hybrid system. RESULTS: After 6 hours of hybrid liver support treatment, animals had significantly decreased serum ammonia and lactate levels, increased glucose level, normal prothrombin time, and increased systolic blood pressure compared with controls treated with charcoal perfusion alone. Use of the system to treat a patient was well tolerated with evidence of clinical improvement. CONCLUSIONS: Plasma perfusion through a system consisting of a charcoal column and matrix-attached porcine hepatocytes had significant beneficial effects in animals with liver failure and was well tolerated by a patient with liver failure.

Use of a novel bioartificial liver in a patient with acute liver insufficiency.

We have developed a bioartificial liver support system (BAL) using porcine hepatocytes attached to microcarriers and placed on the outer surface of hollow fibers. The BAL system was attached to a plasmapheresis device that was then used to treat the plasma of a patient with acute liver failure. Our aim was to test the efficacy and safety of this system after a single short treatment period. A patient with alcohol-induced, severe, acute liver failure manifested by coagulopathy, rising plasma ammonia level, and deteriorating mental status was studied. The procedure was well tolerated by the patient, who remained hemodynamically stable throughout the treatment period. A marked increase in coagulation factor V, VII, VIII, and IX activities, a decrease in serum ammonia level (120 to 32 mumol/L), a twofold increase in all serum amino acids except for aminobutyric acid, and an improvement in mental status were noted after a 6-hour treatment period. This preliminary report of the first use of this novel BAL system in conjunction with plasmapheresis appears promising. A clinical study is now in progress to prove its efficacy.

Development of a bioartificial liver: properties and function of a hollow-fiber module inoculated with liver cells.

We have developed a bioartificial liver support system utilizing hollow-fiber bioreactor, plasmapheresis and microcarrier cell culture technologies. Liver cells were obtained through portal vein perfusion with ethylenediaminetetraacetate or ethylenediaminetetraacetate/collagenase. A mathematical model of mass transport in a hollow-fiber module, at various plasma flow velocities and system configurations, was developed. The bioartificial liver's ability to carry out specific differentiated metabolic liver functions was tested in vitro and in vivo. A reproducible large-animal model of acute ischemic liver failure was developed. Most major first-generation cyclosporine and 19-norterstosterone metabolites were isolated after substrate addition to the bioartificial liver in vitro. After bioartificial liver treatment for 6 hr (with dog or pig liver cells), dogs with acute liver failure had significantly lower serum ammonia and lactate levels and significantly higher serum glucose levels than did control animals treated with a bioartificial liver system inoculated with microcarriers alone. In addition, bioartificial liver-treated animals had significantly higher mean systolic blood pressures than did controls. Liver cell viability at the end of the 6-hr in vivo experiment was greater than 90%.

CT of extraforaminal disc herniation with associated vacuum phenomenon.

Lumbo-sacral extraforaminal disc herniation with spinal nerve compression is a well recognized entity. The diagnosis is difficult, however, and the true incidence therefore unknown. We report a case where CT was diagnostic.