Donor age and degree of HLA matching have a major impact on the outcome of unrelated donor haematopoietic cell transplantation for chronic myeloid leukaemia.

We analysed the outcome of 92 consecutive unrelated donor haematopoietic cell transplantations (UD-HCTs) performed in Spain to treat adult patients with CML in the first chronic phase (1CP). Patients' and donors' median age was 32 (15-49) and 36 (22-56) years, respectively. In all, 73 pairs (79%) matched for A, B+/-C and DRB1+/-DQB1 loci and 19 had > or =1 mismatch. Their probability of survival and disease-free survival at 4 years were 50 and 46%, respectively. Pretransplant factors associated with a better survival were patient age <25 years (P=0.035), donor age < or =36 years (P=0.012), use of cyclosporine since day -7 (P=0.001), and matching 8/8, 9/10 or 10/10 loci at allele level (P=0.003). In multivariate analysis only donor age (P=0.003; RR=3.1 (95% CI: 1.3-7.1)) and degree of HLA-matching (P=0.009; RR: 7.7 (95% CI: 1.8-33)) maintained their significance. The addition of these two variables to the EBMT prognostic score allowed an adequate risk assessment for patients receiving a UD-HCT during 1CP. Our analysis shows that in patients with a young and fully allele-matched donor, UD-HCT should be considered in the initial therapeutic algorithm due to its excellent outcome (92% survival at 2 years).

Polyunsaturated fatty acids and parasitism: effect of a diet supplemented with fish oil on the course of rat trichinellosis.

Dietary fish oil has a beneficial effect on heart and some bacterial diseases and apart from other effects, some studies have revealed their ability to modulate the course of inflammatory and autoimmune diseases. The study here reported was designed to evaluate the possible influence of a fish oil supplement on the course of a Trichinella infection. Nutritional, parasitological and immunological parameters were analyzed. Two groups of 20 Wistar rats, one fed a standard diet and the other one a standard diet supplemented with fish oil, were infected with 1000 L1 larvae. Other two uninfected groups served as control. Results were as follows: fish oil diet intake and infection have, respectively, a positive and a negative effect on growth and food utilization. The negative effect is detected later in animals fed the fish oil diet. A reduction of 30.9 and 36.6% in the number of adult worms and L1 larvae, respectively, was observed in the fish oil group as compared to the standard diet group. Production of IFNgamma (Th1 response) and IL4 (Th2) response was measured in stimulated splenic cells. The fish oil diet increased both IFNgamma and IL4 levels. At 6 days after infection both IFNgamma and IL4 responses were detected, but at 36 days after infection only IL4 was detected in the standard group. The level of somatic and cuticular antibodies was not affected by the diet.

[Improvement of the imaging quality by a non-uniform attenuation correction system in cardiac SPECT]. / Mejora de la calidad de imagen mediante un sistema de corrección de atenuación no uniforme en SPECT cardíaco.

A non-uniform attenuation correction system has been purchased recently by the Department of Nuclear Medicine of the University Hospital in Salamanca to be used in a dual-detector Picker Axis gammacamera. This system is based on the generation of an attenuation map from each patient using a transmission scan with and without the patient using two Ba-133 sources. At present, this system is only available for a 102 configuration between the detectors so its use is restricted to cardiac single photon emission computed tomography (SPECT). The aim of this work has been to evaluate improvement of the image quality of this attenuation correction system by doing three different tests (evaluation of the recovery coefficient, activity concentration ratio and attenuation residual error). After analyzing all the tests, the results for the non-uniform attenuation correction system have been favorable compared to the conventional correction method employed in the clinical practice.

Mejora de la calidad de imagen mediante un sistema de correcciónde atenuación no uniforme en SPECT cardíaco / Improvement of the imaging quality by a non-uniform attenuation correction system in cardiac spect

En el Servicio de Medicina Nuclear del Hospital Universitario de Salamanca recientemente se ha adquirido un sistema de corrección de atenuación no uniforme para una gammacámara modelo Picker Axis de doble cabezal el cual se basa en la generación de un mapa de atenuación de cada paciente a través de un scan de transmisión con y sin paciente con dos fuentes de Ba-133. Este sistema sólo está disponible, en la actualidad, para la disposición de los cabezales de la gammacámara en 102° con lo cual su uso está restringido a los estudios de tomografía computerizada de emisión de fotón único (SPECT) cardiaco. El objetivo de este trabajo ha sido el de comprobar la mejora en la calidad de imagen de este sistema de corrección de atenuación a través de tres pruebas distintas (evaluación del coeficiente de recuperación, relación de concentraciones de actividad y error residual de actividad). El resultado ha sido favorable para el sistema de corrección de atenuación no uniforme para esas tres pruebas frente al método convencional de corrección de atenuación utilizado en la práctica clínica (AU)

Trichinella britovi human infection in Spain: antibody response to surface, excretory/secretory and somatic antigens.

A third outbreak of Trichinella britovi with 140 people involved, occurred in Granada Spain (December 1998). The source of infection was sausage made from uninspected wild boar meat. Fifty-two patients agreed to participated in this study. An elevated eosinophil level (> 5%) was detected in 59.6% of patients, and persisted in most of these cases for two months. A moderate IgG response was observed. At the onset of symptoms, Western blot (WB) test detected more positive cases than Enzyme linked immunosorbent assay (ELISA) and indirect immunofluorescence (IIF). Six months from infection, ELISA revealed fewer positive cases than the other two tests. It would appear that the response to somatic antigens starts earlier than those to cuticular and excretory/secretory (ES) antigens and that the response to ES antigens is the first to decrease.

Short report: Human infection with Trichinella britovi in Granada, Spain.

An outbreak of trichinellosis caused by ingestion of pork infected with Trichinella britovi occurred in the province of Granada in southern Spain in April-May 2000. Thirty-eight people were affected and 15 of them were hospitalized at the University Hospital of San Cecilio (Granada). The probable source of infection was sausage made from uninspected wild boar meat and inspected pork. Ninety-two percent of the patients had myalgias, 47.6% had diarrhea and/or vomited, 78.6% had periorbital edema, and 76.0% had fever. Twenty-two patients (15 hospitalized and 7 nonhospitalized) were serologically studied. Eosinophil levels were less than 5% of the total leukocyte count in 86.7% of the patients. Levels of creatinine phosphokinase (range = 200-2,213 U/L) and lactate dehydrogenase (range = 560-7,558 U/L) were elevated in 85.7% and 78.6% of the patients, respectively. Sixteen (72.7%) and 20 (90.9%) patients were positive for T. britovi by indirect immunofluorescence and Western blot, respectively.

Human trichinellosis in Sourthern Spain: serologic and epidemiologic study.

An outbreak of trichinellosis caused by wild boar meat occurred in the Iruela (Jaen) in southern Spain in February 1996. Thirty-five people were diagnosed on the basis of epidemiologic data, but only 24 patients agreed to participate in this study. Twenty-three (96%) had symptoms suggestive of trichinellosis. Immunofluorescent and Western blot test results for trichinellosis were positive in 18 persons, and 15 had circulating Trichinella spiralis antigens. These findings suggest that results of tests for circulating antigens in conjunction with clinical presentation are useful for the diagnosis of trichinellosis.

Humoral immune response and antigenemia in sheep experimentally infected with Schistosoma bovis. Cross-reactivity with Fasciola hepatica antigens.

Circulating antigen level, IgG antibody response to worm antigens and to excretory/secretory products (ES), and specificity to Fasciola hepatica antigens were determined in 6 Schistosoma bovis-infected sheep at weekly intervals for 15 wk. A noninfected control group was included. An enzyme-linked immunosorbent assay (ELISA) sandwich and a double-antibody ELISA test was used for antibody and antigen detection, respectively. The infection induced an early and relatively low IgG response to adult worm extract. This response was significantly elevated by 3 wk postinfection (PI), reached its maximum level at 9 wk PI, and was followed by a subsequent decrease. The response to ES antigens was slightly higher than that to adult worms, although the response started later, at 8 wk PI, and remained at its maximum level until 15 wk. A remarkable level of cross-reactivity was observed when adult F. hepatica extract was used. However, a low degree of cross-reactivity was found with ES antigen. The ELISA for circulating antigens was performed at weekly intervals for 8 wk. Antigens were detected as early as the first week of infection, although differences were statistically significant from week 5 onward. The highest values were observed at 7 week PI.

Fasciola hepatica: partial characterization of circulating antigens.

Antigens present in sera from Fasciola hepatica-infected goats were partially characterized by means of polyacrylamide gel electrophoresis of immunoprecipitates obtained by counterimmunoelectrophoresis. Agar containing the 2 immunoprecipitin lines, agar containing no precipitin lines, a crude extract of F. hepatica, and normal rabbit IgG were assayed. The electrophoretic pattern of 1 precipitin line showed, apart from the light and heavy chains of IgG and other faint bands, 2 prominent polypeptides of about 70 and 85 kDa. The other precipitin line showed a similar pattern, but with the 70-kDa band absent.

Immunological characteristics and localization of the Trichinella spiralis glutathione S-transferase.

Trichinella spiralis glutathione S-transferase (TsGST) was isolated from crude extracts of L1 larvae by glutathione-affinity chromatography. Two closely migrating polypeptides with molecular masses of 28.5 and 28 kDa were identified by electrophoresis. Three isoforms of pI 5.6, 5.8, and 6.0 were detected by isoelectric focusing. Purified TsGST showed a low transferase activity as measured with 1-chloro-2,4-dinitrobenzene; glutathione peroxidase activity was also demonstrated using cumene hydroperoxide. A rabbit antiserum against TsGST reacted by western blot with crude extracts of Trichinella britovi and Trichinella nativa but not with extracts of Trichinella pseudospiralis, Fasciola hepatica, Schistosoma bovis, Schistosoma mansoni, Dirofilaria immitis, Toxocara canis, or Anisakis sp. TsGST was detected by western blot in extracts of T. spiralis adults, but not in newborn larvae or L1 excretory-secretory products; yet, an antiserum against T. spiralis excretory-secretory products reacted with TsGST. By immunoelectron microscopy, TsGST was found in the granules of the alpha- and beta-stichocytes of L1 larvae, as well as in some granules of the stichocytes of 72-hr adults. Rabbits experimentally infected with T. spiralis developed substantial levels of anti-TsGST antibodies. Moreover, circulating TsGST was detected in serum by a sandwich-enzyme-linked immunosorbent assay, isolated from serum by glutathione-affinity chromatography, and characterized as TsGST by western blot.

Clinical results of a stringent policy on prophylactic platelet transfusion: non-randomized comparative analysis in 190 bone marrow transplant patients from a single institution.

The threshold for prophylactic platelet transfusion remains controversial. Usually the decision is based on arbitrary numerical criteria. The classical 20 x 10(9)/l trigger could be safely reduced with considerable benefits. Few studies have evaluated the clinical impact of stringent policies. We have performed a retrospective analysis comparing major haemorrhages during hospitalization in 190 patients undergoing BMT in two different periods. In 87 patients transplanted from 1990 to 1991, the 20 x 10(9)/l trigger was used for prophylactic platelet transfusion. In 103 other patients transplanted from 1993 to 1994, we adopted a stringent prophylactic policy: < 10 x 10(9)/l for stable patients and < 20 x 10(9)/l when higher platelet consumption factors were present. In the stringent group, 12 patients presented 13 major haemorrhages and four died from haemorrhage. In the classical group 12 patients presented 14 major haemorrhages and three died from haemorrhage. Platelet consumption factors were present in 12 of 13 haemorrhages in the stringent group and in 12 of 14 in the classical group. By contrast, stable patients presented less haemorrhages (2/14 and 1/13, respectively). A statistically significant reduction in the use of platelet units was observed when comparing both groups: the median of platelet units administered in the first 100 days of transplant was 73 (3-943) and 54 (0-647) in the classical and in the stringent group, respectively (P < 0.01); and the median of platelet units received per day was 0.8 (0.03-30) and 0.5 (0-6.94) (P < 0.01). Our results emphasize the safety of a stringent prophylactic platelet transfusion policy after BMT, reducing the overall use of platelet transfusions. Further studies are necessary to confirm these results and to define optimal transfusion strategies.

Serum levels of 25-hydroxyvitamin D in a year of residence on the Antarctic continent.

OBJECTIVE: Since exposure to sunlight is the main source of vitamin D in human beings and skin photosynthesis decreases markedly as the latitude increases, we studied the changes in serum 25-hydroxyvitamin D (25(OH)D) levels in young healthy men who lived in the Antarctic Continent during 1 year. DESIGN: Blood was drawn in the fasting state every 2 months from March 1990 to January 1991 to determine the serum levels of calcium, alkaline phosphatase and 25(OH)D. SUBJECTS: 19 healthy volunteers, who left Buenos Aires (34 degrees S) during the 1990 summer, arriving at the Antarctic bases at the end of January (Belgrano) and in mid-March (San Martín) and stayed there up to summer 1991. RESULTS: Serum calcium did not change significantly throughout the year. Serum alkaline phosphatase levels were not different comparing the beginning to the end of the year, but autumn and winter levels were lower (P < 0.05). At Belgrano Base the serum 25(OH)D levels (ng/ml) decreased from (mean +/- SD) 18.7 +/- 7.4 (March) to 10.0 +/- 4.3 (July) (P < 0.005) and did not recover for the rest of the year. At San Martín Base the serum 25(OH)D levels descended from 22.0 +/- 5.4 in March to 12.2 +/- 3.7 in August (P < 0.02) and did not increase even at the beginning of summer (January) except in two men with frequent outdoor activities. CONCLUSIONS: The levels of 25(OH)D of healthy men living in the Antarctic continent decreased to approximately 46% of the initial values and did not increase even at the onset of summer. Further studies should determine the effect of these changes upon calcium-regulating hormones and bone metabolism.

Resistance to Schistosoma bovis in sheep induced by an experimental Fasciola hepatica infection.

Sheep infected with Fasciola hepatica for 10 wk acquired a substantial level of resistance to challenge with Schistosoma bovis. The worm burden was reduced by 87.2% (P < 0.01) compared with that of a control group. But when sheep primarily were infected with S. bovis and 6 wk later with F. hepatica, no significant reduction in the S. bovis burden was observed.

Seroepidemiological studies on five outbreaks of trichinellosis in southern Spain.

Five outbreaks of trichinellosis, involving 86 people, took place in Andalucía (Southern Spain) between 1984 and 1987. Four of them were caused by eating infected pork and one by eating wild boar meat. The human sera were analysed by the immunofluorescence assay test, which showed circulating anti-Trichinella antibody titres of up to 1:10240. A micro-ELISA test, carried out with sera from two of the outbreaks, revealed the presence of circulating antigens 68 and 78 days after infection. Finally, 11 of 17 samples of products prepared with pork and wild boar meat showed Trichinella larvae after acid-pepsin digestion. The close geographical localization of three of the outbreaks suggests that the southwestern corner of Spain is an endemic focus of trichinellosis.

Differentiation between Trichinella spiralis and T. pseudospiralis infective larvae by a monoclonal antibody.

Crude saline extracts of Trichinella spiralis and T. pseudospiralis infective larvae were studied by Western blot analysis using a monoclonal antibody, named ES/TA2 and produced against T. spiralis larvae. This monoclonal antibody recognized seven major antigenic components in T. spiralis larvae with apparent Mr: 45, 48, 50, 68, 70, 92 and 105 kDa and five in T. pseudospiralis larvae: 38, 50, 70, 72 and 92 kDa. SDS-PAGE of both extracts did not reveal appreciable differences in the range of molecular weights recognized by ES/TA2. These facts show the existence of immunological differences among proteins with apparently identical molecular weights.

Human Gongylonema infection in Spain.

A case of gongylonemiasis in a 31-year-old woman of Granada, Spain, is reported. The worm, clearly belonging to Gongylonema genus, could not be identified definitively as Gongylonema pulchrum, the species usually described in humans.