Identification of a founder EPCAM deletion in Spanish Lynch syndrome families.

Germline deletions at the 3'-end of EPCAM have been involved in the etiology of Lynch syndrome (LS). The aim of this study was to characterize at the molecular level Spanish families harboring EPCAM deletions. Non-commercial multiplex ligation-dependent probe amplification (MLPA) probes and long-range polymerase chain reaction (PCR) amplification were used to characterize each deletion. Haplotyping was performed by analyzing eight microsatellite markers and five MSH2single nucleotide polymorphisms (SNPs). Methylation of MSH2 was analyzed by methylation specific-MLPA. Tumors diagnosed in seven Spanish families harboring EPCAM deletions were almost exclusively colorectal. Mosaicism in MSH2 methylation was observed in EPCAM deletion carrier samples, being average methylation levels higher in normal colon and colorectal tumors (27.6% and 31.1%), than in lymphocytes and oral mucosa (1.1% and 0.7%). Three families shared the deletion c.858 + 2568_*4596del, with a common haplotype comprising 9.9 Mb. In two families the novel EPCAM deletion c.858 + 2488_*7469del was identified. This study provides knowledge on the clinical and molecular characteristics of mosaic MSH2 epimutations. The identification of an EPCAM founder mutation has useful implications for the molecular diagnosis of LS in Spain.

SEOM clinical guideline on hereditary colorectal cancer (2019).

In the last 2 decades, clinical genetics on hereditary colorectal syndromes has shifted from just a molecular characterization of the different syndromes to the estimation of the individual risk of cancer and appropriate risk reduction strategies. In the last years, new specific therapies for some subgroups of patients have emerged as very effective alternatives. At the same time, germline multigene panel testing by next-generation sequencing (NGS) technology has become the new gold standard for molecular genetics.

Molecular biology of exocrine pancreatic cancer.

Exocrine pancreatic cancer is one of the neoplasias with a worse prognosis, with conventional treatments having little impact on disease outcome. Research and genomic high-throughput technology is continuously expanding our knowledge of pancreas cancer biology. Characterization of genetic and epigenetic alterations in pancreatic tumors has allowed a better understanding of the progression model of the disease at the molecular level. The development of new therapeutic approaches with target- oriented agents is been tested in the preclinical and clinical settings. This review updates the current available data on pancreatic cancer molecular biology.

The value of cough peak flow measurements in the assessment of extubation or decannulation readiness.

Insufficient cough strength has a major role in extubation and decannulation outcomes. Cough capacity can be easily evaluated by measuring flows during coughing. Values vary depending on whether cough flows are measured through the mouth or through a tracheostomy or endotracheal tube. It is important to standardize these measurements and start using them routinely in the extubation and decannulation processes. Values of cough peak flow >160 L/min measured at the mouth or a value of cough PEF >60 L/min measured at the endotracheal tube suggest successful decannulation or extubation.

Endocarditis bacteriana a propósito de un caso / Bacterial endocarditis case report

OBJETIVO: informar acerca de un caso de endocarditis bacteriana. Paciente varón de 34 años de edad, con único antecedente de rinitis alérgica con tratamiento irregular. Él es procedente de Valparaiso Chile, se encuentra en sus vacaciones en la ciudad de La Paz, acude al servicio de medicina interna ­ emergencias, con clínica compatible con edema agudo de pulmón de la altura y edema cerebral de la altura, asociado a sepsis de foco pulmonar, que progresa a choque séptico, durante su internación intercurre con alzas térmicas continuas, asociado a hallazgo ecocardiográfico de vegetación en ventrículo derecho con hemocultivo positivo, por lo que se llega al diagnóstico de endocarditis bacteriana, se realizó el tratamiento correspondiente, y resolución del cuadro.

OBJECTIVE: to report a case of bacterial endocarditis A 34-year-old male patient with a unique history of allergic rhinitis with irregular treatment. He comes from Valparaiso Chile, is on vacation in the city of La Paz, goes to the service of internal medicine - emergencies with compatible clinical with acute pulmonary edema of height and cerebral edema of height, associated with sepsis of focus pulmonary disease, which progresses to septic shock, during internment with continuous hyperthermia, associated vegetation in right ventricle for echocardiography, also positive blood culture, so that a diagnosis of bacterial endocarditis is reached, Corresponding treatment was carried out, and resolution of pathology..

Regulation of the pituitary-specific transcription factor GHF-1/Pit-1 messenger ribonucleic acid levels by growth hormone-secretagogues in rat anterior pituitary cells in monolayer culture.

Pituitary-specific expression of the GH gene is dependent on a pituitary-specific transcription factor GH factor-1 (GHF-1), a homeodomain protein also known as pituitary-specific transcription factor-1 (Pit-1). The aim of this study was to investigate the regulation of GHF-1 messenger RNA (mRNA) levels in primary monolayer cultures of rat anterior pituitary cells. Specifically, in addition to direct activators of second messenger signaling systems, we studied the effects of different hormones, all of which are known to be involved in the regulation of somatotroph cell function. We found that GH-releasing hormone (GHRH) increased GHF-1 mRNA levels in a time- and dose-dependent fashion. GHF-1 mRNA levels were increased 2.5-fold (P < 0.01) after incubation for 2 h with 10(-8) M GHRH. Longer incubations (6, 12, or 24 h) with GHRH failed to show a similar stimulatory effect. A significant increase in GHF-1 mRNA concentration (1.7-fold, P < 0.01) was observed after a 2-h treatment with physiological concentrations (10(-11) M) of GHRH. The action of GHRH seems to occur at the transcriptional level without the need of protein synthesis. Thus, treatment of cells with actinomycin D (5 micrograms/ml) completely abolished GHRH-induced increase in GHF-1 mRNA levels. Cycloheximide (23 micrograms/ml) alone increased GHF-1 mRNA levels (6-fold increase after treatment for 12 h, P < 0.01), as well as potentiating GHRH-induced increase in GHF-1 mRNA concentration (9-fold increase after treatment with GHRH plus cycloheximide for 12 h, P < 0.01). The effect of GHRH on GHF-1 mRNA levels could be mimicked by direct activators of second messenger signaling systems such as forskolin (10(-5) M) or the phorbol ester tumor promoter tetradecanoyl phorbol acetate (TPA) (10(-6) M). Other peptides such as pituitary adenylate cyclase activating polypeptide-38 (10(-7) M) but not GHRP-6 (10(-10) to 10(-5) M), were also able to increase GHF-1 mRNA levels. Treatment of the cells with somatostatin (10(-6) M) for either 2 or 48 h failed to modify basal or GHRH-induced GHF-1 mRNA levels. In contrast, pretreatment of the cells with insulin-like growth factor-1 (5 nM) inhibited basal GHF-1 mRNA concentration as well as completely blunting the subsequent response to cells exposed to GHRH for 2 h. These data demonstrate that GHRH, acting at the transcriptional level and through a mechanism not dependent on protein synthesis, plays a stimulatory role on GHF-1 mRNA levels.(ABSTRACT TRUNCATED AT 400 WORDS)

Comparative genomic hybridization and amplotyping by arbitrarily primed PCR in stage A B-CLL.

Cytogenetic analysis is useful in the diagnosis and to assess prognosis of B-cell chronic lymphocytic leukemia (B-CLL). However, successful cytogenetics by standard techniques has been hindered by the low in vitro mitotic activity of the malignant B-cell population. Fluorescence in situ hybridization (FISH) has become a useful tool, but it does not provide an overall view of the aberrations. To overcome this hurdle, two DNA-based techniques have been tested in the present study: comparative genomic hybridization (CGH) and amplotyping by arbitrarily primed PCR (AP-PCR). Comparative genomic hybridization resolution depends upon the 400-bands of the human standard karyotype. AP-PCR allows detection of allelic losses and gains in tumor cells by PCR fingerprinting, thus its resolution is at the molecular level. Both techniques were performed in 23 patients with stage A B-CLL at diagnosis. The results were compared with FISH. The sensitivity of AP-PCR was greater than CGH (62% vs. 43%). The use of CGH combined with AP-PCR allowed to detect genetic abnormalities in 79% (15/19) of patients in whom G-banding was not informative, providing a global view of the aberrations in a sole experiment. This study shows that combining these two methods with FISH, makes possible a more precise genetic characterization of patients with B-CLL.

Application of the deford and hume method modified for quasi-reversible and irreversible processes to the chelates of Bi(III) with azomethine derivatives of 2-benzoylpyridine.

The polarographic behaviour of the bismuth complexes of the oxime, hydrazone and thiosemicarbazone of 2-benzoylpyridine has been studied by differential pulse polarography. The DeFord and Hume method, modified for use with quasi-reversible and irreversible processes, has been applied for the calculation of the formation constants of these chelates, which exhibit different degrees of reversibility in their electroreduction.

[Detubularized ureterosigmoidostomy (Mainz pouch II). Review and contribution of our results]. / Ureterosigmoidostomía destubulizada (bolsa de Mainz II). Revisión y aportación de nuestros resultados.

We have revised the urinary diversions made through the Mainz Pouch II technique in those patients who needed a radical cystectomy because of a neoplastic disease. We will point out the pre and post operatory manometric studies realised in all of them as well as the different complications which were found. In our opinion, the pressure advantages that such technique is supposed to prove have not succeeded in our studies, that is the reason why we believe that a future research is needed to endorse such operatory modification.

Neuropsychological symptoms in a cross-sectional sample of abstinent alcoholics.

This study examined the neuropsychological symptom reports of a cross-sectional sample of 205 abstinent alcoholics. Analysis indicated that early-abstinent alcoholics reported mild cognitive distress with a gradual course of observed recovery which eventually reached the normal range. The recovery process was essentially the same for both men and women. A nonsignificant increase in symptom reporting was found for subjects who were beyond the acute stage of detoxification, which is thought to reflect improved awareness of neuropsychological functioning. Symptoms of frustration were rated highest by alcoholics at all stages of abstinence.

[Syndrome of amenorrhea and galactorrhea. Clinical considerations]. / Sindrome de amenorréa y galactorréa. Consideraciones clínicas.

PIP: Of 180 cases of secondary amenorrhea and 20 of primary amenorrhea, 46 patients suffered from the syndrome of amenorrhea and galactorrhea. This showed that this problem is more frequent than the literature indicates. Of the 46 cases, 13% had a pituitary tumor. Such a high percentage was found with several authors so the possibility of a tumor should always be considered. Another 24% of the cases were postpartum and 52.1% were idiopathic. The latter, suffering from primary or secondary sterility were treated with different ovulation induction medication and in 37.2% pregnancy resulted. In general, the treatment of amenorrhea and galactorrhea tries to restore normal ovulation and the menstrual cycle. Possible useful medications are clomiphene, citrate, pergonal, and levo-dopa. Also, recent studies indicate that some alkaloid derivitives of ergot are effective in treating the syndrome. It is important to realize that the syndrome may have physiopathogenic implications that substantiate careful ovulation induction medication.^ieng

Clinically important molecular features of Peruvian colorectal tumours: high prevalence of DNA mismatch repair deficiency and low incidence of KRAS mutations.

BACKGROUND: The incidence of colorectal cancer (CRC) in Peru has been increasing, and no data have been published on the molecular features. We explored the most relevant genetic events involved in colorectal carcinogenesis, with clinical implications. METHODS: Using immunohistochemistry for mismatch-repair (MMR) proteins (MLH1, MSH2, MSH6, and PMS2) and microsatellite instability analysis, we evaluated the status of 90 non-selected CRC Peruvian patients followed in a nationwide reference hospital for cancer (INEN, Lima). Tumours with loss of hMLH1 were evaluated further for hMLH1 promoter hypermethylation and all cases were evaluated for the presence of KRAS and BRAF-V600E mutations. RESULTS: MMR deficiency was found in 35 (38.8%) patients. We identified an unexpected association between MMR deficiency and older age. Among the 14 cases with loss of MLH1, 10 samples exhibited hypermethylation. Of the 90 cases evaluated, 15 (16.7%) carried KRAS mutations; we found one previously unreported mutation (G13R). CONCLUSIONS: Peruvian CRC tumours exhibited the highest prevalence of MMR deficiency reported to date. The expected hereditary component was also high. The age of onset of these MMR deficient tumours was greater than that observed for non-MMR deficient cases, suggesting the ineffectiveness of the Bethesda criteria for Lynch syndrome screening in Peru. Prospective studies are warranted to define the molecular characteristics of CRC in this population.

Biallelic MYH germline mutations as cause of Muir-Torre syndrome.

Muir-Torre syndrome is a rare, inherited disease predisposing of gastrointestinal and cutaneous tumours, such as keratoacanthomas and sebaceous gland adenomas. Muir-Torre syndrome is usually inherited in an autosomal dominant fashion and associated with mutations in the mismatch repair genes, predominantly in MLH1 and MSH2 genes. This report describes a man who has multiple adenomatous colon polyps, a gastric cancer, multiple colorectal cancers and sebaceous adenomas caused by biallelic MYH germline mutations. This finding demonstrates that MYH gene analysis should be considered in Muir-Torre families where no mismatch repair gene mutations have been found. Furthermore, this report contributes to characterize the clinical phenotype caused by biallelic mutations in MYH gene, which may share with other hereditary colon cancer syndromes.

Real-time PCR with internal amplification control for detecting tuberculosis: method design and validation.

Real-time PCR has been a major development in the diagnosis of tuberculosis. However, most tests do not include an internal amplification control (IAC), which therefore limits it clinical application. In this study a new, easy to perform real-time PCR test with IAC was designed and validated in clinical samples. The primers amplified a 163-bp fragment of IS6110 of Mycobacterium tuberculosis and the IAC was designed with a fragment of a different microorganism (Chlamydia trachomatis). The interassay and intraassay variation of this test were very low (0.45-1.65% and 0.18-1.80%, respectively). The detection accuracy was validated in 50 samples (25 urine, 25 sputum) with different concentrations of M. tuberculosis, 18 clinical isolates of non-tuberculous mycobacteria and 148 samples with clinical suspicion of pulmonary tuberculosis. The specificity was 100%. The detection limit of this PCR test without IAC was approximately 15 bacteria and with IAC approximately 32 bacteria. This real-time PCR with IAC assay can improve the detection of M. tuberculosis and contribute to standardization of this diagnostic technique.