Impact of pretransplant CMV-specific T-cell immune response in the control of CMV infection after solid organ transplantation: a prospective cohort study.

INTRODUCTION: Although solid organ transplant (SOT) recipients with pretransplant serology for cytomegalovirus (CMV-R+) are considered at intermediate risk for CMV infection post transplantation, CMV infection remains a major cause of morbidity in this population. We prospectively characterized whether having pretransplant CMV-specific cellular immunity is independently associated with controlling infection after transplantation in R + SOT recipients. METHODS: A prospective cohort of consecutive R + SOT recipients that received pre-emptive treatment for CMV infection was monitored after transplantation and variables were recorded during the follow-up. The cytomegalovirus-specific T-cell immune response was characterized by intracellular cytokine staining and viral loads determined using real-time PCR. RESULTS: One hundred and thirty-five R + SOT recipients were included (67 kidney, 64 liver, four liver-kidney). Only one-third of the patients (42; 31.85%) had CMV-specific T-cell immunity (CD8+CD69+INF-γ+ T cells >0.25%) before transplantation. Patients with negative pretransplant immunity had more CMV infection (49, 52.7% vs. 15, 35.7%; p 0.07) and received more antiviral therapy than those with immunity (32, 34.4% vs. 6, 14.3%, p 0.016). Having CMV specific immunity was an independent factor for protection from developing viraemia ≥2000 IU/mL (OR 0.276, 95% CI 0.105-0.725, p < 0.01) and lower administration of treatment (OR 0.398, 95% CI 0.175-0.905, p 0.028). Only patients with no pretransplant CMV-specific T-cell response were diagnosed with CMV-disease (8, 8.6% vs. 0, 0%, p 0.05). DISCUSSION: Our results show that having a pretransplant CMV specific T-cell response may be associated with a lower rate of CMV viraemia and less antiviral treatment after transplantation; however, more prospective studies are needed to confirm these findings.

Certificación en calidad, conforme a la Norma ISO 9001: 2008, de un programa interdisciplinar de tratamiento del dolor / ISO 9001:2008 Quality Certification of a multidisciplinary pain program

Introducción y objetivos: el tratamiento del dolor constituye un desafío de gestión en todo tipo de establecimientos clínicos. Las Normas ISO 9001 pueden ser un método eficaz para integrar los diferentes componentes de un programa multidisciplinar integral. Los citados estándares internacionales aseguran que los productos y servicios son seguros, fiables y de buena calidad. Se muestra la experiencia de aplicar las Normas ISO 9001 para la gestión eficaz del dolor en un hospital universitario de gran tamaño. Métodos: se constituyó una comisión multidisciplinar de lucha contra el dolor (Comisión “Hospital sin Dolor”) en un hospital universitario de 1.400 camas en Madrid. Diecinueve médicos de 17 especialidades, 3 enfermeras, un farmacéutico y un miembro de la dirección del centro se integraron en seis grupos de trabajo con el objetivo de implementar los pasos necesarios para la certificación en calidad de la organización conforme a la Norma ISO 9001. Se diseñó un mapa de procesos, se identificaron los procedimientos operativos y se eligieron indicadores de calidad representativos de la actividad desarrollada. Se elaboraron un manual de calidad y un manual de bienvenida para los profesionales, se desarrollaron las políticas de gestión de riesgos y de protección de datos, y se creó un registro de incidentes críticos. La planificación y el desarrollo de las diferentes fases del proyecto requirieron aproximadamente un año y medio de trabajo. Resultados: tras la implementación de las recomendaciones de la Norma ISO, la gestión por procesos se adoptó como la metodología de trabajo habitual en las diferentes áreas integradas en el programa institucional de lucha contra el dolor. Un comité de calidad monitorizó tanto el cumplimiento de las normas como los datos derivados del sistema de gestión de la calidad. Una vez el comité constató la adecuación del sistema, una agencia externa acreditada (Bureau Veritas) fue la encargada de realizar la auditoría externa. El Certificado de Calidad fue otorgado en marzo de 2013. Conclusiones: los estándares internacionales de calidad de la Norma ISO 9001 pueden ser utilizados eficazmente en un programa multidisciplinar de lucha contra el dolor en un hospital de tercer nivel. La gestión por procesos constituye una metodología de trabajo adecuada para asegurar la eficiencia, la seguridad y la calidad (AU)

Background and aims: Pain management constitutes an organisational challenge in all types of clinical establishments. The ISO 9001 Norms can be an effective way of integrating the different components of a comprehensive multidisciplinary programme. ISO 9001 International Standards ensure that products and services are safe, reliable and of good quality. The experience of applying the ISO 9001 norms for the effective management of pain in a large university hospital is shown here. Methods: A Multidisciplinary Pain Committee was created in a 1,400-bed university hospital in Madrid (Spain). Nineteen doctors from 17 specialties, 3 nurses, one pharmacist and one of the hospital directors were integrated in six working groups with the objective of implementing the necessary steps leading to the ISO 9001 Quality Certification of the organisation. A process map was designed, operating procedures were developed and quality indicators were chosen. A quality manual and a welcome manual were written, policies for risk management and data protection were outlined, and a critical incidents registry was created. Setting up the process and completing the tasks took around one and a half years. Results: After the effective implementation of all of the ISO 9001 recommendations, process management became the regular methodology for work in the different areas integrated in the institutional pain programme. A quality committee monitored both the compliance with the norms and the data derived from the quality indicators. Once the committee was satisfied with the results, an accredited agency (Bureau Veritas Certification) for the external audit was chosen. The ISO 9001 Quality Certificate was awarded in March 2013. Conclusions: ISO 9001 international standards can be effectively applied to a multidisciplinary pain programme in a tertiary care hospital. Process management can be a useful methodology for work leading to efficiency, safety and quality (AU)

Eculizumab treatment of acute antibody-mediated rejection in renal transplantation: case reports.

The occurrence of acute antibody-mediated rejection (AMR), especially in more severe cases, continues to be associated with a poor prognosis for implant survival. Here, we have reported the results of treatment of two patients who developed AMR associated with thrombotic microangiopathy immediately after transplantation. We used a single dose of eculizumab at an early stage jointly with conventional modalities of steroid boluses, plasmapheresis, intravenous immunoglobulin, and rituximab. In both cases, the clinical course was favorable. Eculizumab, a monoclonal antibody with a high affinity for complement protein C5, prevents generation of the final membrane attack complex, blocking this cascade. To date, there are a few reports of the usefulness of eculizumab in AMR. Eculizumab can help to stop endothelial damage, especially in severe cases that show a risk of progression to cortical necrosis, by providing a therapeutic window until the other modalities begin to control the immune response. In our experience, the use of eculizumab can be beneficial in the treatment of AMR.

Treatment of anemia in renal transplantation: impact of a stricter application of hemoglobin targets.

OBJECTIVE: The CREATE and CHOIR studies showed a higher risk for cardiovascular events associated with hemoglobin (Hb) values >13 g/dL in patients with stage 3-4 chronic kidney disease. In 2007, a stricter policy on the use of erythropoietin (EPO) was adopted at our center, with an Hb target of 11 to 12 g/dL and withdrawal or reduction of EPO when Hb was >12.5 to 13 g/dL. This study was designed to evaluate this new approach. MATERIALS AND METHODS: The study included patients under follow-up at the transplant outpatient clinic on December 31, 2006 (n = 725), and December 31, 2007 (n = 768). Data were compared between the study populations concerning renal function, Hb, use of EPO, and associated costs. RESULTS: No significant differences in creatinine or Hb values were observed between the 2 groups (1.47 +/- 0.6 vs 1.42 +/- 0.9 mg/dL and 13.7 +/- 1.5 vs 13.7 +/- 1.6 g/dL, respectively). After implementation of the new protocol, the frequency of severe anemia (Hb <11 g/dL) increased (2% vs 4%; P = .10), the use of EPO decreased (22.1% vs 17.2%; P = .017), and the mean Hb of EPO-treated patients decreased (12.5 +/- 1.4 vs 11.9 +/- 1.0; P < .001). The Hb target (11-12 g/dL) was met in fewer than one third of patients, with no significant differences between the 2 study times. CONCLUSIONS: A strict policy on EPO application reduces its use and the rate of patients with "excessive" Hb values (which are associated with increased cardiovascular risks), with an acceptable slight increase in severe anemia cases.

Leiomiomatosis múltiple y gestación. Cesárea e histerectomía programadas / Multiple leiomyomatosis and pregnancy. Planned cesarean hysterectomy

La concurrencia de miomas uterinos en la gestación es del 0,3-2,6%, aun menor en el caso de la leiomiomatosis múltiple, e implica complicaciones obstétricas y sistémicas en la gestante. La cesárea más histerectomía programada es un procedimiento que no aumenta la morbimortalidad materna y disminuye las posibles complicaciones puerperales. Exponemos los casos de 2 pacientes, con gestaciones a término y con indicación obstétrica de cesárea e indicación ginecológica de histerectomía. En ambas se practicaron las 2 intervenciones en un mismo acto quirúrgico. Las pacientes no presentaron ningún tipo de complicación postoperatoria y el tiempo de estancia hospitalaria total se vio reducido al 50%

The prevalence of leiomyomas in pregnant women ranges from 0.3 to 2.6% while that of multiple uterine leiomyomatosis is even lower. These myomas provoke obstetric and systemic complications in pregnant women. Planned cesarean hysterectomy does not increase maternal morbidity and mortality rates and reduces puerperal complications. We present two cases of pregnant women at term with an obstetric indication for cesarean section and a gynecological indication for hysterectomy. Both procedures were performed in the same intervention. There were no postoperative complications and hospital stay was reduced by 50% (AU)

Prevalence and management of potential candidates for simultaneous pancreas-kidney transplantation in a provincial setting.

INTRODUCTION: Simultaneous pancreas-kidney (SPK) transplantation is the best therapeutic option for correctly selected diabetic patients with advanced chronic kidney disease (CKD). OBJECTIVES: The objectives of this study were to quantify in a Spanish province the prevalence and incidence of type 1 and 2 diabetics with stage IV-V CKD who are potential candidates for SPK, and to analyze the selection for SPK in clinical practice. MATERIALS AND METHODS: All patients with diabetic neuropathy (DN) in predialysis, hemodialysis, or peritoneal dialysis (PD) in our transplantation referral area (population, 1.8 million; data collection ended December 7, 2005) were examined for basic SPK criteria (NTO 2005 Consensus). A new assessment was performed 9 months later, including new possible recipients, and patients were classified as: follows in study, excluded after study, added to SPK waiting list, or SPK-transplanted. RESULTS: In 2005, there were 1371 patients in dialysis or predialysis, including 179 (13%) with DN (41 type 1 and 138 type 2 DM); only 16 of these patients (8.9% of DN patients), 8.9 per million population (PMP), met the basic criteria for SPK transplantation. There were 68 with DN in predialysis, including 8 (11.7%) possible SPK candidates; 7 with DN in PD, no candidates for SPK; and 104 patients with DN in hemodialysis, including 8 (7.2%) SPK candidates. After 9 months, 7 new potential candidates were identified (incidence of 5.1 PMP/y). Of 23 possible candidates, 3 refused SPK, 7 awaited completion of study, 8 were excluded after study, 1 was on the SPK waiting list, and 7 underwent SPK transplantation. CONCLUSIONS: In our setting, approximately 9% of DN patients with stage IV-V CKD were potential SPK candidates in 2005 and 2006. After completion of studies, less than half were eventually included on the waiting list, generating an effective demand for SPK of 2-4 new patients PMP/y.

Organoarsenical species contents in cooked seafood.

The organoarsenical species arsenobetaine (AB), arsenocholine (AC), tetramethylarsonium ion (TMA+), dimethylarsinic acid (DMA), and monomethylarsonic acid (MMA) were determined in 64 cooked seafood products (fish, bivalves, squid, crustaceans) included in a Total Diet Study carried out in the Basque Country (Spain). For cooking, various treatments were employed (grilling, roasting, baking, stewing, boiling, steaming, microwaving). The results obtained show that in cooked seafood AB is the major species, followed by DMA and TMA+. AC and MMA are minor species. The results in cooked seafood were compared with the arsenic species contents obtained for the same product raw. After cooking there was an increase in DMA for sardines and bivalves and an increase or appearance of TMA+ for meagrim, anchovy, Atlantic horse mackerel, and sardine. The data provided add to the very scant information available about organoarsenical species contents in cooked seafood.

[Octreotide in the treatment of angiodysplasia in patients with advanced chronic renal failure]. / Tratamiento con octreotide en pacientes con angiodisplasia e insuficiencia renal crónica avanzada.

Angiodysplasia is an important cause of gastrointestinal bleeding in patients with chronic renal failure. Octreotide, a long-acting synthetic somatostatin analogue that reduces splachnic blood flow have been used to treat esophageal varicose hemorrhage, but its efficacy for bleeding vascular ecstasies is awaiting support. We present three patients with chronic renal failure (two with diabetic nephropaty and the third with mesangiocapilar glomerulonephritis and hepatic cirrosis), seric creatinine 3-4,5 mg/dl, and recurrent gastrointestinal bleeding due to diffuse angiodysplasia and vascular ecstasies, diagnosed by oral endoscopy, colonoscopy and video capsule. They all were treated with octreotide, administered subcutanesly 0.1 mg twice a day for six months, with significantly decreased blood requirements in all of them, as well as the occurrence of bleeding episodes. It was well tolerated and none side-effects occurred in any subject. In our experience, octreotide is an effective and safe drug in bleeding angiodysplasia and ecstasies vascular of the gastrointestinal tract in patients with chronic renal failure, and it may be a good option especially in patients who are not candidates for surgery or endoscopic treatment due to inaccessible sites, spread of the lesion, old age and/or concomitant disorders.

Plasmapheresis for the prophylaxis and treatment of recurrent focal segmental glomerulosclerosis following renal transplant.

We evaluated 10 patients with primary focal segmental glomerulosclerosis (FSGS) treated with plasmapheresis (PS) following renal transplantation. Three patients lost their first graft due to FSGS recurrence. In seven patients, PS was indicated as treatment for probable recurrence defined as the onset of proteinuria above 1 g/24 hours. In the remaining three patients, treatment was started in the first week posttransplant as prophylaxis against recurrence. The PS protocol was 17 sessions with the exchange of 2.5 L of plasma for 5% albumin over 10 to 12 weeks. Losartan (25 to 100 mg/d) was given to most patients at the end of PS treatment. The mean follow-up time after PS was 10 months. All patients currently have a functioning graft. A full response to treatment, defined as persistently reduced proteinuria to less than 500 mg/24 hours or the lack of recurrence in prophylactic treatment, was achieved in six patients. Three patients showed a partial decrease in proteinuria (to less than 1 g/24 hours). One patient failed to respond and still has nephrotic range proteinuria. No adverse effects of PS were recorded. A prompt start of PS combined with the use of losartan yields good results in the prophylaxis and treatment of recurrent FSGS following renal transplant in terms of quickly reduced proteinuria. Given the natural course of FSGS, a longer follow-up is needed to estimate the impact of PS on graft survival.

Tratamiento con octreotide en pacientes con angiodisplasia e insuficiencia renal crónica avanzada / Octreotide in the treatment of angiodysplasia in patients with chronic renal failure

La angiodisplasia es una causa frecuente de sangrado digestivo en los pacientes con insuficiencia renal crónica. El octreotide, un análogo sintético de la somatostatina que produce una disminución del flujo esplácnico, utilizado por vía subcutánea y en uso prolongado, se ha propuesto para el tratamiento de las hemorragias digestivas asociadas a angiodisplasia y otras lesiones vasculares en casos seleccionados. Presentamos la historia clínica de tres pacientes con insuficiencia renal crónica avanzada (Cr 3-4,5 mg/dl inicialmente), todos revisados en la consulta de prediálisis y con hemorragias digestivas asociadas a lesiones de angiodisplasia y en un caso ectasias vasculares asociadas a cirrosis hepática, diagnosticadas por endoscopia oral, colonoscopia, y videocápsula en un caso. Todos recibieron octreotide por vía subcutánea a dosis de 0,1 mg/12 h, por un periodo inicial de 6 meses, con disminución llamativa de las necesidades transfusionales en dos casos y desaparición de las mismas en uno. La medicación fue bien tolerada, no refiriendo ningún efecto secundario. En nuestra experiencia, el octreotide ha resultado eficaz para disminuir las necesidades transfusionales en pacientes con insuficiencia renal crónica y hemorragias por lesiones vasculares (angiodisplasia y ectasia vascular asociada a cirrosis hepática), y puede ser un complemento o una alternativa al tratamiento quirúrgico y/o endoscópico en los casos recidivantes, en los en los que las lesiones no están accesibles o en los que la comorbilidad del paciente lo hace poco aconsejable

Angiodysplasia is an important cause of gastrointestinal bleeding in patients with chronic renal failure. Octreotide, a long-acting synthetic somatostatin analogue that asoreduces splachnic blood flow have been used to treat esophageal varicose hemorrhage, but its efficacy for bleeding vascular ecstasies is awaiting support. We present three patients with chronic renal failure (two with diabetic nephropaty and the third with mesangiocapilar glomerulonephritis and hepatic cirrosis), seric creatinine 3-4,5 mg/dl, and recurrent gastrointestinal bleeding due to diffuse angiodysplasia and vascular ecstasies, diagnosed by oral endoscopy, colonoscopy and video capsule. They all were treated with octreotide, administered subcutanesly 0.1 mg twice a day for six months, with significantly decreased blood requirements in all of them, as well as the occurrence of bleeding episodes. It was well tolerated and none side-effects occurred in any subject. In our experience, octreotide is an effective and safe drug in bleeding angiodysplasia and ecstasies vascular of the gastrointestinal tract in patients with chronic renal failure, and it may be a good option especially in patients who are not candidates for surgery or endoscopic treatment due to inaccessible sites, spread of the lesion, old age and/or concomitant disorders

[Ahmed drainage device implant. Our experience between 1995 and 2003]. / Implante de válvula de Ahmed. Nuestra experiencia 1995-2003.

PURPOSE: To evaluate the indications, results and complications of the Ahmed drainage device implanted between January 1995 and December 2003. MATERIALS AND METHODS: A retrospective study of 70 eyes in 65 patients. We analysed: the indications for surgery; the preoperative intraocular pressure (IOP), the postoperative IOP at 1 and 3 months, 1, 2 and 3 years after surgery; and the short and long term postoperative complications. We defined an absolute success as an IOP between 5 and 21 mmHg without glaucoma medications, relative success the same IOP levels whilst taking glaucoma medications and failure as an IOP of less than 5 and more than 22 mmHg. RESULTS: The most frequent indications for use of the drainage device were: neovascular glaucoma (45.7%), no response to other glaucoma surgery (20%), aphakic glaucoma (10%) and traumatic glaucoma (8.5%). Mean preoperative IOP was 39 mmHg. Mean postoperative IOP was: 19.7 mmHg (1 month), 21.6 mmHg (3 months), 19.6 mmHg (1 year), 18 mmHg (2 years) and 18.6 mmHg (3 years). The most frequent early complications were athalamia and hiphema. The most frequent late complications were tube or body valve extrusion and fibrotic reaction around the valve. CONCLUSIONS: Both the indications and success rates are similar to those previously reported. Visual acuity assessment is not of value in this group of patients because of their multiple associated ophthalmic pathologies.

Implante de válvula de Ahmed. Nuestra experiencia 1995-2003 / Ahmed drainage device implant. Our experience between 1995 and 2003

Objetivo: Evaluar las indicaciones y resultados de la cirugía de válvula de Ahmed de un plato, modelo S2, durante el período de enero de 1995 a diciembre de 2003. El período de seguimiento medio fue de 42 meses (rango 6 a 96).Material y métodos: Estudio retrospectivo de 70 ojos de 65 pacientes. Los datos recogidos fueron: indicaciones para el tratamiento quirúrgico, PIO preoperatoria, a 1 y 3 meses; 1, 2 y 3 años tras la cirugía; y complicaciones precoces y tardías del implante valvular.Se habla de éxito absoluto (PIO entre 5 y 21 mmHg sin tratamiento médico antiglaucomatoso), éxito relativo (PIO entre 5 y 21 mmHg con uno o más colirios antiglaucomatosos) y fracaso (PIO menor de 5 y mayor de 22 mmHg).Resultados: Las indicaciones más frecuentes fueron glaucoma neovascular (45,7%), glaucoma crónico simple refractario a otros tratamientos quirúrgicos (20%), glaucoma del afáquico (10%) y glaucoma traumático (8,5%).La PIO preoperatorio media fue de 39 mmHg y las PIO medias postoperatorias: a 1 mes 19,7 mmHg; a 3 meses 21,6 mmHg; a 1 año 19,6 mmHg; a 2 años 18 y a 3 años 18,6 mmHg.Las complicaciones precoces más frecuentes fueron atalamia e hipema. Las tardías: extrusión del tubo o cuerpo valvular y fibrosis perivalvular.Conclusiones: Tanto las indicaciones como los porcentajes de éxitos absoluto y relativos son equiparables a los publicados en la literatura.No es útil manejar la agudeza visual como parámetro de éxito o fracaso debido a la múltiple patología asociada, en la mayoría de los casos

Purpose: To evaluate the indications, results and complications of the Ahmed drainage device implanted between January 1995 and December 2003.Materials and methods: A retrospective study of 70 eyes in 65 patients. We analysed: the indications for surgery; the preoperative intraocular pressure (IOP), the postoperative IOP at 1 and 3 months, 1, 2 and 3 years after surgery; and the short and long term postoperative complications.We defined an absolute success as an IOP between 5 and 21 mmHg without glaucoma medications, relative success the same IOP levels whilst taking glaucoma medications and failure as an IOP of less than 5 and more than 22 mmHg.Results: The most frequent indications for use of the drainage device were: neovascular glaucoma (45.7%), no response to other glaucoma surgery (20%), aphakic glaucoma (10%) and traumatic glaucoma (8.5%).Mean preoperative IOP was 39 mmHg. Mean postoperative IOP was: 19.7 mmHg (1 month), 21.6 mmHg (3 months), 19.6 mmHg (1 year), 18 mmHg (2 years) and 18.6 mmHg (3 years).The most frequent early complications were athalamia and hiphema. The most frequent late complications were tube or body valve extrusion and fibrotic reaction around the valve.Conclusions: Both the indications and success rates are similar to those previously reported. Visual acuity assessment is not of value in this group of patients because of their multiple associated ophthalmic pathologies

[Treatment of hyperphosphatemia with sevelamer in patients with chronic renal failure]. / Tratamiento de la hiperfosfatemia con sevelamer en pacientes con insuficiencia renal crónica avanzada.

UNLABELLED: Sevelamer is a recent phosphate binder that is mineral-free, and represents a great advance in the treatment of hyperphosphatemia in patients with hypercalcemia and/or gastric intolerance to calcium-based phosphate binders. The communications about the experience with the use of sevelamer in patients non-yet in dialysis is scanty. The aim of our study is to investigate retrospectively the gastrointestinal tolerance of sevelamer, their efficacy as phosphate binder and other parameters in a group of 89 patients with chronic renal failure in predialysis. We have analysed the effects of sevelamer at baseline and after 1, 3 and 6 months on the following data and parameters: calcium, phosphate, intact PTH, venous bicarbonate, urea, creatinine, creatinine clearance, side-effects, number of patients that were discontinued, and co-treatment during the study period with phosphate-based binders, calcitriol, lipid-lowering drugs and sodium bicarbonate. RESULTS: 19 patients (21.3%) refused to continue with sevelamer at the first month (16 patients had digestive intolerance and 3 several symptoms). Serum phosphate fell at 3 months (5 +/- 0.8 mg/dl basal vs 4.8 +/- 0.7 mg/dl, p = 0.02) and 6 months (5 +/- 0.8 mg/dl basal vs 4.7 +/- 0.9 mg/dl, p = 0.07). Serum calcium fell at 6 months (9.8 +/- 0.7 mg/dl basal vs 9.4 +/- 0.6 mg/dl, p = 0.03). Venous bicarbonate and iPTH were unchanged, but the quantity of sodium bicarbonate administered increased significantly. Blood cholesterol fell at 1 months (193 +/- 49 mg/dl basal vs 173 +/- 52 mg/dl, p = 0.001) and 3 months (205 +/- 49 mg/dl basal vs 170 +/- 49 mg/dl, p = 0.004), in spite of a significant reduction of the dose of statins. CONCLUSIONS: Sevelamer is an effective phosphate binder in predialysis patients and also reduces significantly the serum cholesterol, improving the blood lipid profile. The levels of venous bicarbonate remained unchanged, at expenses of an increment in the dose of sodium bicarbonate supplementation.

Glucocorticoid-inducible gene expression vectors for use in Drosophila melanogaster Schneider 2 cells.

Inducible, vector-based, expression systems that allow fine control of transgene expression are gaining more and more use in fundamental research as well as in therapeutic applications. In an effort to develop a tightly regulated heterologous expression system for Drosophila Schneider 2 cells, three different inducible reporter constructs were compared. These comprised six copies of the glucocorticoid response element fused to one of three distinct types of Drosophila gene promoters: (1) a TATA-box containing, (2) a TATA-less and (3) a bidirectional core sequence. These were fused to a luciferase reporter gene. The promoter constructs displayed different basal as well as agonist-induced activities. The implications of the observations made are discussed in the context of promoter properties and of induction of genes that may be studied in Drosophila.

Heavy metal, total arsenic, and inorganic arsenic contents of algae food products.

The total arsenic, inorganic arsenic, lead, cadmium, and mercury contents of 18 algae food products currently on sale in Spain were determined. The suitability of the analytical methodologies for this type of matrix was confirmed by evaluating their analytical characteristics. The concentration ranges found for each contaminant, expressed in milligrams per kilogram of dry weight, were as follows: total arsenic, 2.3-141; inorganic arsenic, 0.15-88; lead, < 0.05-1.33; cadmium, 0.03-1.9; and mercury, 0.004-0.04. There is currently no legislation in Spain regarding contaminants in algae food products, but some of the samples analyzed revealed Cd and inorganic As levels higher than those permitted by legislation in other countries. Given the high concentrations of inorganic As found in Hizikia fusiforme, a daily consumption of 1.7 g of the product would reach the Provisional Tolerable Weekly Intake recommended by the WHO for an average body weight of 68 kg. A more comprehensive study of the contents and toxicological implications of the inorganic As present in the algae food products currently sold in Spain may be necessary, which might then be the basis for the introduction of specific sales restrictions.

Organoarsenical species contents in fresh and processed seafood products.

A study was carried out to determine organic species of arsenic in the main varieties of seafood consumed in the Basque country (Spain). The concentrations of arsenobetaine (AB), dimethylarsinic acid (DMA), monomethylarsonic acid (MMA), arsenocholine (AC), and tetramethylarsonium ion (TMA(+)) in 64 samples corresponding to different food items are presented. The study provides information about a possible distribution pattern of organoarsenical species in seafood products. AB was detected in all of the samples [0.3-104.1 microg g(-1) dry weight (dw)]. DMA was detected in all of the samples except squid and salted cod (0.027-1.757 microg g(-1) dw). MMA was detected only in certain fatty fish (0.004-0.028 microg g(-1) dw) and bivalves (0.031-0.047 microg g(-1) dw). AC was only present in some samples of lean fish (0.014-0.089 microg g(-1) dw), and TMA(+) was detected only in anchovy (0.039-0.169 microg g(-1) dw) and crustaceans (0.044-0.966 microg g(-1) dw).

Arsenic in cooked seafood products: study on the effect of cooking on total and inorganic arsenic contents.

Total and inorganic arsenic contents were analyzed in cooked seafood products consumed in Spain during the period July 1997-June 1998: hake, meagrim, small hake, anchovy, Atlantic horse mackerel, sardine, bivalves, crustaceans, squid, and salted cod. Various cooking treatments were used (grilling, roasting, baking, stewing, boiling, steaming, and microwaving). The results obtained were compared statistically with those found previously in the same products raw, and they showed that after cooking there was a significant increase in the concentration of total arsenic for salted cod and bivalves, and in the concentration of inorganic arsenic for bivalves and squid. The mean content of inorganic arsenic was significantly higher in bivalves than in any other type of seafood. For the Spanish population, the mean intake of total arsenic estimated on the basis of the results obtained in this study is 245 microg/day. The intake of inorganic arsenic (2.3 microg/day) represents 1.7% of the World Health Organization provisional tolerable weekly intake (PTWI), leaving an ample safety margin for this population, which has a very high consumption of seafood.

Kinetic study of transformations of arsenic species during heat treatment.

The combination of temperatures and pH levels applied in domestic or industrial cooking and in the sterilization of seafood might cause the transformation of certain species of arsenic into other more toxic species, which could pose a risk to the consumer. To clarify the effect of the temperatures traditionally used in cooking or sterilization on the stability of the various species of arsenic, a kinetic study was carried out, using standards of arsenobetaine (AB), dimethylarsinic acid (DMA), monomethylarsonic acid (MMA), trimethylarsine oxide (TMAO), tetramethylarsonium ion (TMA(+)), and arsenocholine (AC) heated at different temperatures (85--190 degrees C) and for different treatment times. Various pH levels (4.5, 5.5, 6.5, and 8.0) were applied during the heating process. The results obtained indicated that there were no transformations of arsenic species after temperature treatments up to 120 degrees C. However, when temperatures between 150 and 190 degrees C were used, a partial decomposition of AB was achieved, producing TMAO at 150 degrees C and TMAO and TMA(+) at temperatures of 160 degrees C or above, in proportions that varied according to the temperature and duration of the heat treatment.

Effect of cooking temperatures on chemical changes in species of organic arsenic in seafood.

The concentrations of arsenobetaine (AB), tetramethylarsonium ion (TMA(+)), and trimethylarsine oxide (TMAO) were determined in samples of sole, dory, hake, and sardine, raw and after being subjected to cooking processes--baking, frying, and grilling--at various temperatures. In all cases, the temperature attained inside the product during the cooking process was measured. The arsenic species extracted from the samples with methanol/water were separated by means of a column switching technique between a PRP-X100 column and a PRP-X200 column. AB was detected by hydride generation atomic absorption spectrometry, whereas TMA(+) and TMAO were detected by hydride generation atomic fluorescence spectrometry. The results obtained showed that, in all of the types of seafood studied, TMA(+) appeared after cooking, possibly because heating facilitates decarboxylation of AB to TMA(+).