[An abscessed granulomatous prostatitis]. / Une prostatite granulomateuse abcédée.

INTRODUCTION: Prostatic abscesses are usually diagnosed in the setting of bacterial prostatitis. Rarely, they reveal or complicate granulomatous prostatitis. CASE REPORT: A 55-year-old man was admitted for acute urinary retention. Urine culture was sterile, with leukocyturia > 106/ml. After failure of antibiotic therapy with cefotaxime, CT scan revealed a necrotic prostatic collection and a nodular non-necrotic tissular lesion in the left upper lung lobe. Trans-rectal drainage of the prostatic lesion and lung biopsies revealed granuloma with multinucleated giant cells (without mycobacteria). The diagnosis of granulomatosis with polyangiitis was confirmed by high level of anti-proteinase 3 antibodies. Treatment with steroids and rituximab resulted in apyrexia, regression of the inflammatory syndrome and clinical manifestations. CONCLUSION: The diagnosis of granulomatosis with polyangiitis should be considered in the presence of a non-infectious granulomatous prostatitis with systemic involvement.

[A tularemia mimicking lymphoma]. / Une tularémie mimant un lymphome.

INTRODUCTION: Adenopathies are a frequent cause of recourse in internal medicine. When histological analysis reveals the presence of granuloma, multiple infectious or non-infectious etiologies are considered. If diagnoses of lymphoma, sarcoidosis or tuberculosis are easily mentioned, tularemia should also be considered in the differential diagnosis. OBSERVATION: A 54-year-old patient had a fever at the evening with night sweats and a cough resistant to two lines of antibiotics. A thoraco-abdomino-pelvic CT scan revealed hilar and mediastinal adenopathies that appeared hypermetabolic with PET-TDM, as well as pulmonary nodules. A PCR performed on lymph node biopsy and serology allowed the diagnosis of tularemia. The evolution was favourable after antibiotic treatment. CONCLUSION: The association of fever, night sweats, altered general state and mediastinal adenopathies should be considered as a diagnosis of tularemia. Ganglionic biopsy, combined with molecular biology techniques and serology, can confirm the diagnosis.

African-Caribbean Cancer Consortium Scientific and Training Conference 2017.

The sixth International African-Caribbean Cancer Consortium (AC3) Conference was held 6-9 October 2017 in Miami, Florida, U.S.A. The conference was open to all researchers, trainees, clinical and public health professionals, and community members, and served as an international hub for the United States, the Caribbean, and Africa. Sessions included AC3 collaboration meetings, cancer surveillance and research skills training workshops, and a community cancer prevention conference.

Implications of the clone by harvest interaction in the selection of sugarcane genotypes in a regionalized program.

The recommendation of sugarcane clones depends on several factors, as the response or performance of the clones over different cuts or harvests. The clone by harvest interaction might be difficult to identify superior clones in the final stages of the sugarcane breeding program. Thus, the objective of this study was to investigate and describe the implications of the genotype by harvest interaction in the adaptability and stability of genotypes and delineation of mega-environments from a set of multi-environment trials. Fifteen clones and four checks were evaluated in eight environments. The trait TPH (tons of pol per hectare) was evaluated in two harvests (plant cane and ratoon cane) in 2010 and 2011. The joint analysis showed significance for harvest (H), environment (E), and genotype (G) effects. The interactions GxE, ExH, GxH, and ExGxH were also significant. The last three-way interaction indicated the differential response of the genotypes over environments, and that it depends on the harvests. The overall mean of the trials was 12.77 TPH. The coefficient of variation was 8.70% and the selective accuracy was 98.63%, indicating high experimental precision. The genotypes G4, G14, and G16 were statistically superior to the check varieties used; however, these genotypes did not show high stability as described by the additive main effects and multiplicative interaction method. There was a specific adaptation between the E7 and E5 environments and the G4 and G5 genotypes, respectively. In general, the grouping of the environments was inconsistent throughout the harvests, except for the E1 and E4 environments, which exhibited similarities for the different genotypes.

Eosinophilic ascites secondary to toxocariasis.

Eosinophilic ascites is a very rare disorder. It can be a manifestation of the eosinophilic gastroenteritis in its serosal form or it can be secondary to infections, malignancies, vasculitis or hypereosinophilic syndrome. Among all infections, the ones produced by invasive helminth parasites should be initially suspected and ruled out. We report the case of a patient with eosinophilic ascites associated with diarrhea, abdominal pain and eosinophilia in peripheral blood. Eosinophilic colitis was also demonstrated in a colonic biopsy and empirical steroid treatment was started for suspected eosinophilic gastroenteritis. Later on, the patient improved; the ascites disappeared and the eosinophil blood count returned to normal. Subsequently, serologic testing for toxocariasis was received positive and therefore, the diagnosis of eosinophilic gastroenteritis was discarded; albendazole was also added to treatment. The patient remained asymptomatic on follow-up. We emphasize the need to rule out parasitic infections in all patients with gastrointestinal symptoms, eosinophilia and eosinophilic infiltration of gastrointestinal tissues.

Prospective evaluation of glutamine and phospholipids levels in first degree relatives of patients with Type 1 Diabetes from a multiethnic population.

BACKGROUND: A dysregulation in the metabolism of lipids may be an early marker of autoimmunity in Type 1 Diabetes (T1D). It would be of general importance to identify metabolic patterns that would predict the risk for T1D later in life. The aim of this study was to perform a prospective evaluation of glutamine and phospholipids levels in Brazilian first degree relatives (FDR) of patients with T1D in a mean interval of 5 years. FINDINGS: Brazilian FDR (n = 30) of patients with T1D were evaluated and blood was sampled to measure the levels of glutamine and phospholipids in the fasting serum by quantitative colorimetric method. The tests were repeated after a mean interval of 5 years and compared to a control group (n = 20). The FDR presented lower levels of phospholipids than controls (p = 0.028), but not of glutamine (p = 0.075). Phospholipids levels decreased over time (p = 0.028) in FDR and were associated with Glutamic acid decarboxylase autoantibody (GADA) titers (p = 0.045), autoantibody positivity (p = 0.008) and PTPN22 polymorphisms (p = 0.014). CONCLUSIONS: In this Brazilian multiethnic population, there was a significant decrease in phospholipids levels in FDR in patients with T1D during a 5-year prospective follow-up, as well as a significant association between these metabolite, GADA and PTPN22 polymorphisms. For Glutamine no difference was found. These findings suggest that a dysregulation in the metabolism of lipids may precede the onset of the autoimmunity in T1D.

Tratamiento de la acalasia en el hospital nacional de itaugua / Treatment of achalasia in the hospital nacional de itaugua

Antecedentes: La acalasia es el desorden motor primario del esófago, en el cual hay una relajación ineficiente del esfínter esofágico inferior con pérdida progresiva de la perístasis esofágica, como consecuencia de ambos mecanismos se produce dilatación gradual del esófago. La acalasia puede ser primaria (idiopática) y secundaria. La causa más común de acalasia secundaria es la enfermedad de Chagas. OBJETIVO: Analizar nuestra experiencia con los datos de pacientes diagnosticados y tratados de acalasia en el Servicio de Cirugía General del Hospital Nacional de Itaugua. Diseño: Observacional. MATERIAL Y MÉTODO: Pacientes diagnosticados de Acalasia en el Servicio de Cirugía General del Hospital Nacional de Itaugua entre enero de 2008 y diciembre de 2013. Todos los casos de acalasia diagnosticados de forma consecutiva en el período e institución antes señalados que pudieron ser intervenidos quirurgicamente. Se excluyeron los casos sin intervención quirurgica. Se consideró la edad, género; también nos interesó la presentación de los pacientes con anemia y el motivo de consulta con el cual se presentaron. CONCLUSIONES: La miotomía asociada a una funduplicatura parcial por laparoscopía, es una técnica segura y efectiva para el alivio de la disfagia en los pacientes con acalasia. En los dolicomegaesofagos de no existir contraindicación la esofagectomía debe ser evaluada.

BACKGROUND: Achalasia is a primary Motor disorder of the esophagus in which there is an inefficient lower esophageal sphincter relaxation with progressive loss of esophageal peristalsis, as a result of two mechanisms gradual dilation of the esophagus occurs. Achalasia can be primary (idiopathic) and secondary. The most common cause of secondary achalasia is Chagas disease. To analyze our experience with data from patients diagnosed and treated for achalasia in the Department of Surgery of the National Hospital of Itaugua. DESIGN: Observational. MATERIAL AND METHODS: Patients diagnosed with achalasia in General Surgery Itaugua National Hospital between January 2008 and December 2013 All cases of achalasia diagnosed consecutively in the mentioned period and institution that could be surgically operated. Cases without surgical intervention were excluded. Age, gender was considered; also interested us Patients presenting with anemia and the reason for consultation which were presented. CONCLUSIONS: myotomy associated with a partial laparoscopic fundoplication is safe and effective for the relief of dysphagia in patients with achalasia art. In the absence of contraindications dolicomegaesofagos esophagectomy should be evaluated.

[Vitamin B12 deficiency due to nitrous oxide use: unrecognized cause of combined spinal cord degeneration]. / Carence en vitamine B12 par toxicité du protoxyde d'azote : une cause méconnue de sclérose combinée de la moelle.

INTRODUCTION: Nitrous oxide is widely used in anesthesia. It is usually safe but may be associated with severe side effects when it is used repeatedly or on a prolonged time. Here, we report a case of drug-induced subacute combined spinal cord degeneration related to cobalamin deficiency. CASE REPORT: A 20-year-old man with sickle-cell disease (SS) who was followed for severe recurrent vaso-occlusive crisis with repeated hospital admissions presented with ascending motor and sensitive neurological deficits that were later associated with bladder dysfunction. He was first considered to develop Guillain-Barre syndrome. However, persisting neurological signs despite adequate treatment lately led to diagnose subacute combined medullar degeneration due to abnormal cobalamin (vitamin B12) metabolism induced by repeated use of nitrous oxide during painful episodes of sickle-cell disease. CONCLUSION: Inhaled nitric oxide is widely used in the treatment of vaso-occlusive crisis. Clinicians should be aware of possible severe neurologic side effects.

Validação de metodologia analítica para determinação de taninos pelo método de difusão radial / Validation of the analytical methodology for the determination of tannins by radial diffusion method

A metodologia para doseamento de taninos através de difusão radial desenvolvido por Hagerman (1987) vem sendo utilizada em laboratórios de fitoterápicos devido, principalmente, à sua simplicidade de execução, rapidez e baixo custo; contudo, não há relato na literatura sobre a submissão desta metodologia a um estudo de validação. Baseando-se neste fato, o presente estudo visou validar a metodologia de Difusão Radial para o doseamento de taninos. Todos os parâmetros obrigatórios exigidos pela ANVISA foram avaliados. O método foi considerado linear e com alta sensibilidade de quantificação (27,72 µg/poço). Mostrou-se também robusto e com recuperação aceitável (85,96%). Os resultados obtidos para repetibilidade (intra-corrida) e precisão intermediária (inter-corridas), certificaram a precisão do método, obtendo-se valores entre 1,89 e 7,03%. Para a exatidão, valores entre 100,47 e 105,26% foram obtidos, os quais se encontram dentro dos limites preconizados pela ANVISA. O método foi considerado preciso, exato e reprodutível, além de ser de fácil execução e de baixo custo.

The method to determine tannins by radial diffusion developed by Hagerman (1987) has been explicitly used in herbal laboratories mainly because of its simplicity to implement, speed and low cost; yet, there are no reports in the literature on the submission of this method to a validation study. Based on this fact, this study sought to validate the method of Radial Diffusion in the tannin determination. All mandatory parameters required by ANVISA were evaluated. The method was considered linear and with high sensitivity quantitation (27.72 µg / well). It also showed robust and acceptable recovery (85.96%). The results obtained for repeatability (within-run) and intermediate precision (inter-run) certified the accuracy of the method, obtaining values between 1.89 and 7.03%. For accuracy, values between 100.47 and 105.26% were obtained, which is within the limits recommended by ANVISA. Thus, the method was considered as precise, accurate and reproducible, and is easy to perform and inexpensive.

Doramectin reduces sexual behavior and penile erection in male rats.

Doramectin (DOR) is an antiparasitic drug that is widely used in domestic animals. In mammals, DOR acts as a γ-aminobutyric acid receptor agonist. This neurotransmitter plays an important role in the regulation of sexual behavior. The present study investigated the effects of two medically relevant doses of DOR on sexual behavior in male rats. We also examined whether previous sexual experience modulates responses to DOR. General activity was first observed in an open field 24, 48, and 72 h after administration of 0.1 and 0.3 mg/kg DOR to determine the dose and time effects of the drug. Apomorphine-induced penile erection and sexual behavior in inexperienced male rats were then analyzed. The effects of previous sexual experience on subsequent sexual behavior in DOR-treated rats (0.3 mg/kg, 24 h prior to the test) were also assessed. The standard therapeutic dose (0.2 mg/kg) did not modify general activity or penile erection. A slightly concentrated dose of 0.3 mg/kg, which is still within the therapeutic range, decreased apomorphine-induced penile erection, whereas 0.2 mg/kg did not modify this behavior. Compared with controls, sexual behavior in inexperienced male rats was impaired after 0.3 mg/kg DOR. Previous sexual experience had little impact on the effects of 0.3 mg/kg DOR. In conclusion, the 0.2 mg/kg dose of DOR did not affect motor behavior or apomorphine-induced penile erection. At a more slightly higher dose level, the appetitive and consummatory phases of sexual behavior in inexperienced male rats were impaired. Previous sexual experience was unable to reverse this sexual impairment, suggesting that previous sexual experience does not exert a positive effect in attenuating sexual impairment produced by DOR treatment.

Neospora caninum: infection induces high lysosomal activity.

Neospora caninum is a protozoan that causes abortion in cattle and neuromuscular lesions in dogs, making it an important target of veterinary medicine. Lysosomes are cellular organelles responsible for important biological functions as cellular defense mechanisms. The aim of this work was to evaluate the lysosomal stability of rat gliocytes infected in vitro with N. caninum. Rat glial cultures were infected at a ratio of 1:1 (cell/parasite). The enzymatic activity of acid phosphatase (orthophosphoric-monoester phosphohydrolase, EC 3.1.3.2) was assayed in the medium of control and infected cell cultures. The activity observed at 24h of incubation was 0.4±0.08mU/mg/min for control cells and 1.3±0.5mU/mg/min for infected cells. After 72h, control and infected cells exhibited activities of 1.3±0.5 and 4.1±0.9mU/mg/min, respectively. These results suggested that lysosomal compartment plays an important role in the mechanisms of cellular infection by N. caninum.

Experimental evaluation of birds as disseminators of the cosmopolitan tick Rhipicephalus sanguineus (Acari: Ixodidae).

Rhipicephalus sanguineus is believed to be the most widespread tick species of the world and its dissemination seems to rely on the diffusion of its main host, the dog. Empirical observations indicate that several bird species in urban areas regularly steal dog food. Such circumstances create a chance for R. sanguineus ticks to climb on birds and carry ticks to another site. In this work we evaluated experimentally the likelihood of birds (chicks) to either feed and/or carry R. sanguineus ticks from an infested site to another and to infest a host (rabbit) in the new location. Chicks were not suitable hosts for R. sanguineus ticks. Not a single adult tick engorged on chicks, yield as well as weight of engorged larvae and nymphs were very low and feeding period of these ticks was very long. However, a few larvae and, chiefly, nymphs were delivered to a new location either mechanically or after attachment and engorging total or partially on chicks. A few of these ticks fed successfully on rabbits. Further evidence on the capacity of birds to introduce R. sanguineus into non-infested dog settings should be provided by systematic examination of birds from urban areas, close to tick infested households.

Evaluation of Toxoplasma gondii and Neospora caninum infections in sheep from Uberlândia, Minas Gerais State, Brazil, by different serological methods.

Toxoplasmosis and neosporosis have been recognized as economically important diseases with considerable impact on the livestock industry. Considering the scarce information on the occurrence of Toxoplasma gondii and Neospora caninum infections in sheep from Uberlândia, Minas Gerais State, Brazil, this study aimed to investigate the frequency of antibodies against these parasites in sheep sera from this region by using different serological methods. A total of 155 sheep serum samples were analyzed by the indirect fluorescence antibody test (IFAT) and enzyme-linked immunosorbent assay (ELISA) for the detection of IgG against T. gondii and N. caninum. Seroreactivity by IFAT showed 80% of samples with titers between 512 and 2048 for T. gondii (cutoff ≥ 64) and 78% presenting titers between 50 and 200 for N. caninum (cutoff ≥ 50). Seroreactivity by ELISA showed 75% of samples with ELISA index (EI) between 2.0 and 3.0 for T. gondii (cutoff ≥ 1.3) and 54% presenting EI between 1.3 and 2.0 for N. caninum (cut off ≥ 1.3). Discordant results by both tests were analyzed by immunoblot, resulting in a total seropositivity of 61% for T. gondii and 23% for N. caninum, with 41% to T. gondii only, 3% to N. caninum only, and 20% to both parasites. There was a significant positive association between seropositivity to T. gondii and age over one year (P<0.001), but such association was not found for N. caninum infection. In conclusion, as T. gondii and N. caninum infections are simultaneously present in sheep flocks of this region, it should be emphasized the importance to carry out a regular monitoring of Toxoplasma infection due to its high prevalence, its zoonotic potential and induction of reproductive disorders leading to economic losses. For neosporosis, sheep farmers should be instructed about the presence of the parasite in the flock, its risk factors and potential abortifacient role in sheep. Differential flock management could be valuable tool to establish the association of serological positivity and reproductive disease induced by N. caninum in sheep.

Prevalent vertebral fractures among children initiating glucocorticoid therapy for the treatment of rheumatic disorders.

OBJECTIVE: Vertebral fractures are an under-recognized problem in children with inflammatory disorders. We studied spine health among 134 children (87 girls) with rheumatic conditions (median age 10 years) within 30 days of initiating glucocorticoid therapy. METHODS: Children were categorized as follows: juvenile dermatomyositis (n = 30), juvenile idiopathic arthritis (n = 28), systemic lupus erythematosus and related conditions (n = 26), systemic arthritis (n = 22), systemic vasculitis (n = 16), and other conditions (n = 12). Thoracolumbar spine radiograph and dual x-ray absorptiometry for lumbar spine (L-spine) areal bone mineral density (BMD) were performed within 30 days of glucocorticoid initiation. Genant semiquantitative grading was used for vertebral morphometry. Second metacarpal morphometry was carried out on a hand radiograph. Clinical factors including disease and physical activity, calcium and vitamin D intake, cumulative glucocorticoid dose, underlying diagnosis, L-spine BMD Z score, and back pain were analyzed for association with vertebral fracture. RESULTS: Thirteen vertebral fractures were noted in 9 children (7%). Of these, 6 patients had a single vertebral fracture and 3 had 2-3 fractures. Fractures were clustered in the mid-thoracic region (69%). Three vertebral fractures (23%) were moderate (grade 2); the others were mild (grade 1). For the entire cohort, mean +/- SD L-spine BMD Z score was significantly different from zero (-0.55 +/- 1.2, P < 0.001) despite a mean height Z score that was similar to the healthy average (0.02 +/- 1.0, P = 0.825). Back pain was highly associated with increased odds for fracture (odds ratio 10.6 [95% confidence interval 2.1-53.8], P = 0.004). CONCLUSION: In pediatric rheumatic conditions, vertebral fractures can be present prior to prolonged glucocorticoid exposure.

Heavy metals in water, sediment and tissues of Liza saliens from Esmoriz-Paramos lagoon, Portugal.

Esmoriz-Paramos lagoon is an ecosystem of great ecological importance that is located on the northwest coast of Portugal and has been degraded as a result of industrial and anthropogenic activities. Concentrations of heavy metals (Cr, Cu, Pb and Zn) were measured in water, sediment and in tissues (liver and muscle) of Liza saliens, which is the dominant fish from the lagoon. Comparisons between metal concentrations in water and sediments were made with those in tissues of fish caught at the lagoon. Metals in water were quantified predominantly bound to particulate and equalled or exceeded the limit of chronic reference values. Metal concentrations in sediments varied among sampled sites. The relative order of concentrations was "Zn > Cu approximately Pb > Cr" the same pattern observed for metals in water. Metals in fish tissues showed higher concentrations in liver (262 mg CuxKg(-1) and 89 mg ZnxKg(-1)) than in muscle (<3 mg CuxKg(-1) and 26 mg ZnxKg(-1)), while Pb and Cr were not detected. These results suggest that Cu and Zn are the metals of major concern in the lagoon. Mullet detritivorous feeding habits, bioaccumulation pattern and the high sediment metals concentrations relative to the water suggest that sediments can be the most important source of contamination in this ecosystem. The positive relationship found between Cu in liver and fish length demonstrates that time of exposure is a crucial factor in bioaccumulation. Condition indices (K and HSI) in mullets from the lagoon were higher compared to mullets from sea, suggesting abnormal condition in the lagoon population. We conclude that metals chronic exposure in the lagoon can impose considerable fish stress. The results also show that the lagoon is an area of environmental concern.

Rose Dieback Caused by Trichothecium roseum in Argentina.

Rose (Rosa sp.) is one of the most important ornamentals in Argentina. Since 2002, a severe disease has been observed on crops cultivated for cut flowers and garden plants in Escobar, San Pedro, Río Negro, and the surrounding area of Buenos Aires and La Plata. Symptoms consisted of a stem dieback progressing to plant death. In some cases, stem cankers were observed on the dieback limits. Mean incidence of stem dieback was 8% regardless of location. The disease was associated with pruning or harvest wounds. The objective of this study was to identify the causal agent of the described symptoms. Small pieces of diseased tissues from cvs. Rafaela, Merlise, Confeti, Mini rosal, Exótica, Macarena, and Peckowo were surfaced sterilized with a 2-min immersion in 0.2% NaOCl, washed with sterile distilled water, the tissue blotted dry, placed on 2% potato dextrose agar (PDA), and incubated at 22°C. Pure salmon-colored fungal colonies developed within 72 h. Hyaline, two-celled (the upper cell slightly larger), ovoid to ellipsoid conidia formed in chains at the apex of simple, long, slender, septate conidiophores. These characteristics are consistent with the description of Trichothecium roseum (Pers.) Link ex Gray (1) The pathogenicity tests were carried out on 10 plants of cv. Rafaela and 10 plants of cv. Mini Rosal using a conidial suspension (2.4 × 105 spores/ml). All plants were pruned just before inoculation. Another 10 pruned plants (five from each cultivar) were sprayed with sterile water and served as controls. Inoculated and noninoculated plants were placed in a climatic chamber at 20°C and covered with polyethylene bags for 3 days to achieve a humid environment. Stem dieback was evident 7 days after inoculation on both cultivars and cankers appeared in 14 days. A dense, white mold that turned salmon-pink covered all the stems within 25 days. Inoculated plants died after 40 days. Symptoms did not develop on the control plants. The pathogen was recovered from inoculated stems, thus fulfilling Koch's postulates. To our knowledge, this is the first report of T. roseum causing a disease on rose in Argentina. Reference: (1) K. H. Domsch et al. Compendium of Soil Fungi. Academic Press. London, 1980.

A randomized controlled trial of mailed osteoporosis education to older adults.

INTRODUCTION: Osteoporosis represents a growing public health concern; however, current rates of management are sub-optimal. The aim of our study was to assess, in a randomized controlled trial, the effect of a mailed educational intervention on older adults' knowledge, attitudes, and preventive behaviors regarding osteoporosis. The setting was a large publicly funded state pharmacy benefits program. The patients were 31,715 Medicare beneficiaries from Pennsylvania who participated in a drug benefits program for low-to-moderate income elderly people. METHODS: All women aged over 65 years, and all men and women with a history of fracture or long-term oral use of glucocorticoid, were included. Approximately half of the participants (intervention group) were randomly selected to receive three mailings aimed at improving knowledge of osteoporosis and enhancing preventive activities, such as using calcium and vitamin D, reducing fall risks in the home, obtaining a bone mineral density (BMD) test, and taking medications when necessary. The other participants did not receive the intervention mailings and served as controls. We surveyed a sample of intervention and control subjects to determine the effects of the intervention on knowledge, attitudes, self-efficacy (confidence in one's ability to perform specific activities), and behavior regarding osteoporosis prevention and treatment. Six hundred randomly selected participants in the intervention group and an equal number in the control group were invited to participate. RESULTS: Twenty-six had died and 636 of the remaining 1,185 (54%) completed the survey. Respondents and non-respondents did not differ significantly with respect to measured sociodemographic factors. All scales had good reliability (all Cronbach's alphas>0.65). Knowledge of osteoporosis was generally very good and did not differ between intervention (mean=65% correct responses) and control subjects (mean=67% correct; P=0.4). Perceived susceptibility to osteoporosis was relatively high and similar across groups (P=0.4). Self-efficacy for participating in osteoporosis prevention and treatment was very strong in both the intervention (mean=4.3 on a 0-5 scale) and control (mean=4.2, P=0.03) groups . On average, subjects in the intervention group reported participating in 3.5 of 6 preventive osteoporosis activities compared with 3.4 in the control group (P=0.5). CONCLUSIONS: Compared with the controls, a mailed educational intervention for osteoporosis was not associated with better knowledge, higher perceived susceptibility, or performance of preventive measures among the at-risk older adults that we studied. The intervention group demonstrated a small increase in self-efficacy. More intensive patient interventions or intervention aimed at other aspects of the care process may be required to bring about changes that lead to a reduction in fractures.

Cytokine genotypes correlate with pain and radiologically defined joint damage in patients with juvenile rheumatoid arthritis.

OBJECTIVES: Single nucleotide polymorphisms (SNPs) in cytokine genes have been associated with risk of a number of autoimmune diseases. Moreover, some SNPs are associated with variations in rates of in vitro gene expression, and it is therefore possible that these functional polymorphisms may differentially affect inflammatory processes and disease outcome. This project's objective was to determine whether cytokine genotypes correlate with disease outcomes in patients with juvenile rheumatoid arthritis (JRA). METHODS: Genotypes of SNPs of pro-inflammatory cytokines, tumour necrosis factor-alpha -308G -->A, interleukin-6 (IL-6) -174G -->C and interferon-gamma +874G -->A, and anti-inflammatory, immunosuppressive cytokines, interleukin-10 -1082G -->A, -819C -->T and -592A -->C and transforming growth factor-beta1 (TGF-beta1) codon 10T -->C and codon 25G -->C, were determined for patients with JRA who previously participated in a long-term outcome study. Cytokine genotypes and clinical variables showing significant correlations with clinical outcomes at the alpha = 0.100 level in univariate analyses were entered in multivariate tests. RESULTS: In multivariate tests, the IL-6 genotype -174G/G was positively correlated with pain [regression coefficient B = 0.899, 95% confidence intervals (CI) 0.185, 1.612, P = 0.014]. The homozygous TGF-beta1 codon 25G/G genotype showed a protective effect against joint space narrowing on radiographs taken within 2 yr of disease onset, but confidence intervals were wide [odds ratio (OR) 0.176, 95% CI 0.037, 0.837 P = 0.029]. CONCLUSIONS: The correlation of IL-6 genotype with pain and the possible association of the TGF-beta1 codon 25 genotype with short-term radiographic damage (G/C with greater risk and G/G with decreased risk) suggests that both these polymorphisms may be useful early prognostic indicators. Further studies of the relation between cytokine genotypes and outcomes in patients with all forms of juvenile idiopathic arthritis (JIA) are warranted.

Rarity of DNA sequence alterations in the promoter region of the human androgen receptor gene

The human androgen receptor (AR) gene promoter lies in a GC-rich region containing two principal sites of transcription initiation and a putative Sp1 protein-binding site, without typical "TATA" and "CAAT" boxes. It has been suggested that mutations within the 5'untranslated region (5'UTR) may contribute to the development of prostate cancer by changing the rates of gene transcription and/or translation. In order to investigate this question, the aim of the present study was to search for the presence of mutations or polymorphisms at the AR-5'UTR in 92 prostate cancer patients, where histological diagnosis of adenocarcinoma was established in specimens obtained from transurethral resection or after prostatectomy. The AR-5'UTR was amplified by PCR from genomic DNA samples of the patients and of 100 healthy male blood donors, included as controls. Conformation-sensitive gel electrophoresis was used for DNA sequence alteration screening. Only one band shift was detected in one individual from the blood donor group. Sequencing revealed a new single nucleotide deletion (T) in the most conserved portion of the promoter region at position +36 downstream from the transcription initiation site I. Although the effect of this specific mutation remains unknown, its rarity reveals the high degree of sequence conservation of the human androgen promoter region. Moreover, the absence of detectable variation within the critical 5'UTR in prostate cancer patients indicates a low probability of its involvement in prostate cancer etiology.