Genetic testing for primary aldosteronism in SPAIN: Results from the SPAIN-ALDO Registry and review of the literature.

PURPOSE: To determine the rate of genetic testing for familial hyperaldosteronism (FH) in the SPAIN-ALDO Registry and to describe the clinical characteristics of patients with FH. In addition, a literature review of reports of FH cases was performed. METHODS: A retrospective multicenter study of primary aldosteronism (PA) in patients followed in 35 Spanish tertiary hospitals (SPAIN-ALDO Registry). RESULTS: Twenty-five of the 855 patients (3%) with PA included in the registry underwent genetic testing for FH, with complete results available in only 24 patients. However, we found that there were 57 patients who met the criteria for performing a genetic study of PA. Only 8 out of these 57 patients were genetically tested (14.0%), while the reasons to perform a genetic study in the remaining 9 genetically studied cases were quite heterogeneous. A positive result for FH was found only in one case for FH type III (KCNJ5 pathogenic variant). A systematic review of the literature was performed and identified a total of 25 articles reporting 246 patients with FH type I; 12 articles reporting 72 patients with FH type II; 14 articles reporting 29 cases of FH type III and 3 articles reporting 12 patients with FH type IV. CONCLUSION: The genetic study of familial hyperaldosteronism is often scarce in real-world clinical practice, as 86% of patients with criteria to undergo genetic study were not evaluated in our cohort. Nevertheless, FH is an uncommon cause of PA, representing only 0.2% of cases in the SPAIN-ALDO Registry, although its prevalence may be as high as 4% among suspected cases might be studied.

Glucose metabolism outcomes after pituitary surgery in patients with acromegaly.

AIM: To investigate the impact of pituitary surgery on glucose metabolism and to identify predictors of remission of diabetes after pituitary surgery in patients with acromegaly. METHODS: A national multicenter retrospective study of patients with acromegaly undergoing transsphenoidal surgery for the first time at 33 tertiary Spanish hospitals (ACRO-SPAIN study) was performed. Surgical remission of acromegaly was evaluated according to the 2000 and 2010 criteria. RESULTS: A total of 604 acromegaly patients were included in the study with a total median follow up of 91 months (interquartile range [IQR] 45-163). At the acromegaly diagnosis, 23.8% of the patients had diabetes mellitus (DM) with a median glycated hemoglobin (HbA1c) of 6.9% (IQR 6.4-7.9) [51.9 mmol/mol (IQR 46.4-62.8)]. In the multivariate analysis, older age (odds ratio [OR] 1.02, 95% CI 1.00-1.05), dyslipidemia (OR 5.25, 95% CI 2.81 to 9.79), arthropathy (OR 1.39, 95% CI 2.82 to 9.79), and higher IGF-I levels (OR 1.30, 95% CI 1.05 to 1.60) were associated with a greater prevalence of DM. At the last follow-up visit after surgery, 21.1% of the DM patients (56.7% of them with surgical remission of acromegaly) experienced diabetes remission. The cure rate of DM was more common in older patients (hazard ratio [HR] 1.77, 95% CI 1.31 to 2.43), when surgical cure was achieved (HR 2.10, 95% CI 1.01 to 4.37) and when anterior pituitary function was not affected after surgery (HR 3.38, 95% CI 1.17 to 9.75). CONCLUSION: Glucose metabolism improved in patients with acromegaly after surgery and 21% of the diabetic patients experienced diabetes remission; being more frequent in patients of older age, and those who experienced surgical cure and those with preserved anterior pituitary function after surgery.

Pegvisomant and pasireotide in PRL and GH co-secreting vs GH-secreting Pit-NETs.

The objective of the study was to evaluate the efficacy of second-line therapies in patients with acromegaly caused by a growth hormone (GH) and prolactin (PRL) co-secreting pituitary neuroendocrine tumor (GH&PRL-Pit-NET) compared to their efficacy in patients with acromegaly caused by a GH-secreting pituitary neuroendocrine tumor (GH-Pit-NET). This is a multicenter retrospective study of patients with acromegaly on treatment with pasireotide and/or pegvisomant. Patients were classified in two groups: GH&PRL-Pit-NETs when evidence of hyperprolactinemia and immunohistochemistry (IHC) for GH and PRL was positive or if PRL were >200 ng/dL regardless of the PRL-IHC and GH-Pit-NETs when the previously mentioned criteria were not met. A total of 28 cases with GH&PRL-Pit-NETs and 122 with GH-Pit-NETs met the inclusion criteria. GH&PRL-Pit-NETs presented at a younger age, caused hypopituitarism, and were invasive more frequently than GH-Pit-NETs. There were 124 patients treated with pegvisomant and 49 with pasireotide at any time. The efficacy of pegvisomant for IGF-1 normalization was of 81.5% and of pasireotide of 71.4%. No differences in IGF-1 control with pasireotide and with pegvisomant were observed between GH&PRL-Pit-NETs and GH-Pit-NETs. All GH&PRL-Pit-NET cases treated with pasireotide (n = 6) and 82.6% (n = 19/23) of the cases treated with pegvisomant normalized PRL levels. No differences in the rate of IGF-1 control between pegvisomant and pasireotide were detected in patients with GH&PRL-Pit-NETs (84.9% vs 66.7%, P = 0.178). We conclude that despite the more aggressive behavior of GH&PRL-Pit-NETs than GH-Pit-NETs, no differences in the rate of IGF-1 control with pegvisomant and pasireotide were observed between both groups, and both drugs have shown to be effective treatments to control IGF-1 and PRL hypersecretion in these tumors.

Effectiveness of combined first-line medical treatment in acromegaly with prolactin cosecretion.

OBJECTIVE: The aim of this study is to compare the response to first-line medical treatment in treatment-naive acromegaly patients with pure growth hormone (GH)-secreting pituitary adenoma (GH-PA) and those with GH and prolactin cosecreting PA (GH&PRL-PA). DESIGN: This is a retrospective multicentric study of acromegaly patients followed from 2003 to 2023 in 33 tertiary Spanish hospitals with at least 6 months of first-line medical treatment. METHODS: Baseline characteristics, first-line medical treatment strategies, and outcomes were analyzed. We employed a multiple logistic regression full model to estimate the impact of some baseline characteristics on disease control after each treatment modality. RESULTS: Of the 144 patients included, 72.9% had a GH-PA, and 27.1% had a GH&PRL-PA. Patients with GH&PRL-PA were younger (43.9 ± 15.0 vs 51.9 ± 12.7 years, P < .01) and harboring more frequently macroadenomas (89.7% vs 72.1%, P = .03). First-generation somatostatin receptor ligand (fgSRL) as monotherapy was given to 106 (73.6%) and a combination treatment with fgSRL and cabergoline in the remaining 38 (26.4%). Patients with GH&PRL-PA received more frequently a combination therapy (56.4% vs 15.2%, P < .01). After 6 months of treatment, in the group of patients under fgSRL as monotherapy, those patients with GH&PRL-PA had worse control compared to GH-PAs (29.4% vs 55.1%, P = .04). However, these differences in the rate of disease control between both groups disappeared when both received combination treatment with fgSRL and cabergoline. CONCLUSION: In GH&PRL-PA, the biochemical control achieved with fgSRL as monotherapy is substantially worse than in patients harboring GH-PA, supporting the inclusion of cabergoline as first-line medical treatment in combination with fgSRLs in these subgroups of patients.

Climate change impacts on rainfall intensity-duration-frequency curves in local scale catchments.

The increasing intensity and frequency of rainfall events, a critical aspect of climate change, pose significant challenges in the construction of intensity-duration-frequency (IDF) curves for climate projection. These curves are crucial for infrastructure development, but the non-stationarity of extreme rainfall raises concerns about their adequacy under future climate conditions. This research addresses these challenges by investigating the reasons behind the IPCC climate report's evidence about the validity that rainfall follows the Clausius-Clapeyron (CC) relationship, which suggests a 7% increase in precipitation per 1 °C increase in temperature. Our study provides guidelines for adjusting IDF curves in the future, considering both current and future climates. We calculate extreme precipitation changes and scaling factors for small urban catchments in Barranquilla, Colombia, a tropical region, using the bootstrapping method. This reveals the occurrence of a sub-CC relationship, suggesting that the generalized 7% figure may not be universally applicable. In contrast, our comparative analysis with Illinois, USA, an inland city in the north temperate zone, shows adherence to the CC relationship. This emphasizes the need for local parameter calculations rather than relying solely on the generalized 7% figure.

Differences between GH and PRL co-secreting and GH-secreting pituitary adenomas. A series of 604 cases.

PURPOSE: To evaluate differences in clinical presentation and in surgical outcomes between growth hormone-secreting pituitary adenomas (GH-PAs) and GH and prolactin co-secreting pituitary adenomas (GH&PRL-PAs). METHODS: Multicenter retrospective study of 604 patients with acromegaly submitted to pituitary surgery. Patients were classified into two groups according to serum PRL levels at diagnosis and immunohistochemistry (IHC) for PRL: a) GH&PRL-PAs when PRL levels were above the upper limit of normal and IHC for GH and PRL was positive or PRL levels were >100ng/and PRL IHC was not available (n=130) and b) GH-PAs who did not meet the previously mentioned criteria (n=474). RESULTS: GH&PRL-PAs represented 21.5% (n=130) of patients with acromegaly. The mean age at diagnosis was lower in GH&PRL-PAs than in GH-PAs (P<0.001). GH&PRL-PAs were more frequently macroadenomas (90.6% vs. 77.4%, P=0.001) and tended to be more invasive (33.6% vs. 24.7%, P=0.057) than GH-PAs. Furthermore, they had presurgical hypopituitarism more frequently (OR 2.8, 95% CI 1.83-4.38). IGF-1 upper limit of normality (ULN) levels at diagnosis were lower in patients with GH&PRL-PAs (median 2.4 [IQR 1.73-3.29] vs. 2.7 [IQR 1.91-3.67], P=0.023). There were no differences in the immediate (41.1% vs 43.3%, P=0.659) or long-term post-surgical acromegaly biochemical cure rate (53.5% vs. 53.1%, P=0.936) between groups. However, there was a higher incidence of permanent arginine-vasopressin deficiency (AVP-D) (7.3% vs. 2.4%, P=0.011) in GH&PRL-PAs patients. CONCLUSIONS: GH&PRL-PAs are responsible for 20% of acromegaly cases. These tumors are more invasive, larger and cause hypopituitarism more frequently than GH-PAs and are diagnosed at an earlier age. The biochemical cure rate is similar between both groups, but patients with GH&PRL-PAs tend to develop permanent postsurgical AVP-D more frequently.

Role of Photo-Biomodulation Therapy in Facial Rejuvenation and Facial Plastic Surgery.

Photo-biomodulation (PBM) also known as low-level laser therapy is a rising technology with multiple potential uses in medicine and recently in the cosmetic field for the treatment of skin conditions and skin rejuvenation. Due to its wound healing and anti-inflammatory properties, there is an increase in popularity in its use as adjunctive treatment before and after surgical procedures in the face and neck.

Caso Clínico: Paciente VIH positivo con Coroideoretinits por Citomegalovirus / Case Report: Cytomegalovirus Choroideoretinitis in an hiV positive patient

INTRODUCCIÓN: La retinitis causada por citomegalovirus (CMV) es una infección ocular viral oportunista, que afecta con mayor frecuencia a personas con Virus de Inmunodeficiencia Humana ­ Síndrome de inmunodeficiencia Adquirida (VIH-SIDA). El VIH infecta a las células que expresan CD4* como: linfocitos T, monocitos, macrófagos, células dendríticas; como consecuencia se inicia una inmunosupresión que incrementa la susceptibilidad del huésped a infecciones oportunistas. La retinitis por CMV permanece como la causa más frecuente de infección oportunista en pacientes con SIDA; pero solamente el 8 % de los pacientes con SIDA tiende a presentar retinitis por CMV como manifestación inicial. CASO CLÍNICO: Paciente masculino de 26 años, en estudio por fiebre de origen desconocido, fue diagnosticado de infección por VIH. Se realizaron exámenes de extensión y se detectó PCR positivo para CMV. En examen oftalmológico se evidenció en ojo derecho un pequeño exudado perimacular en arcada vascular superior, al momento del hallazgo paciente no presentaba ninguna sintomatología. EVOLUCIÓN: Tras diagnóstico de VIH y retinitis por CMV, se inició tratamiento con TARGA y Valganciclovir. Paciente presentó evolución satisfactoria evidenciándose desaparición del exudado perimacular en controles oftalmológicos periódicos. CONCLUSION: La Retinitis por CMV es frecuente en pacientes con VIH/SIDA. Muchas veces el paciente es asintomático, o no se le ha realizado el diagnóstico oportuno de infección por VIH, por lo que es importante implementar y protocolizar medidas para detección y tratamiento oportuno de este tipo de patologías asociadas, con el fin de la mejorar la calidad de vida de los pacientes.(au)

BACKGROUND: CMV retinitis is a viral opportunistic ocular infection that affects more frequently HIV positive- AIDS patients. HIV virus infects cells that express CD4, like: lymphocytes, monocytes, macrophages, dendritic cells; as a consequence the patient gets immunosuppressed, increasing its susceptibility to opportunist infections. CMV retinitis is the most frequent cause of opportunist infections in AIDS patients; but only 8% of the patients present with CMV retinitis a an initial sign. CASE REPORT: 26 year old male patient, being evaluated for fever of unknown origin, was diagnosed of HIV infection. Complementary tests showed CMV positive PCR test. At the ophthalmological examination a perimacular exudate was evident on the right eye, the patient was asymptomatic at the moment of the diagnosis. EVOLUTION: After being diagnosed of HIV infection and CMV retinitis, patient started taking HAART and Valganciclovir. The ourtcome was good, perimacular exudate disappeared in posterior follow up. CONCLUSIONS: CMV retinitis is frequent in HIV-AIDS patients. Sometimes the patients are asymptomatic, or missing diagnosis of HIV, therefore it is important to standarize early detection and treatment measures, to improve life quality for this patients.(au)

Menopausal women have hypofibrinolysis even in subclinical stage of atherosclerosis.

BACKGROUND: PAI-1 is the main inhibitor of fibrinolysis. Increase in PAI-1 levels has been associated with the risk of coronary disease; however, there are few studies on the relationship between subclinical atherosclerosis and PAI-1 levels. OBJECTIVE: The aim of this study was to analyze the relationship between PAI-1 level and carotid intima-media thickness in premenopausal and postmenopausal women without apparent cardiovascular disease. MATERIAL AND METHODS: A cross-sectional study was conducted in 142 women aged 45 to 60 years with no history of cardiovascular disease. Anthropometric and laboratory measurements were performed, including PAI-1 levels. All participants underwent a B-Mode ultrasound to measure intima-media thickness. Subclinical atherosclerosis was considered when intima-media thickness was ≥ 0.7 mm and/or an atheromatous plaque was observed. RESULTS: Postmenopausal women had greater intima-media thickness than premenopausal women (0.688 ± 0.129 vs. 0.621 ± 0.113 mm; p < 0.05). Compared to women with normal intima-media thickness, women with subclinical atherosclerosis had higher PAI-1 levels (23.2 ± 13.7 vs. 30.4 ± 20.7 ng/ml; p < 0.05). In all participants, intima-media thickness correlated with PAI-1 (r = 0.302; p = 0.01) and with age (r = 0.358; p = 0001). CONCLUSIONS: An increase in intima-media thickness was observed in postmenopausal women compared with premenopausal women. Asymptomatic women with increased intima-media thickness had higher PAI-1 levels. These findings suggest that fibrinolytic activity is low in the subclinical stage of atherosclerosis.

Epicardial adipose tissue is associated with visceral fat, metabolic syndrome, and insulin resistance in menopausal women.

INTRODUCTION AND OBJECTIVES: Epicardial adipose tissue has been associated with several obesity-related parameters and with insulin resistance. Echocardiographic assessment of this tissue is an easy and reliable marker of cardiometabolic risk. However, there are insufficient studies on the relationship between epicardial fat and insulin resistance during the postmenopausal period, when cardiovascular risk increases in women. The objective of this study was to examine the association between epicardial adipose tissue and visceral adipose tissue, waist circumference, body mass index, and insulin resistance in postmenopausal women. METHODS: A cross sectional study was conducted in 34 postmenopausal women with and without metabolic syndrome. All participants underwent a transthoracic echocardiogram and body composition analysis. RESULTS: A positive correlation was observed between epicardial fat and visceral adipose tissue, body mass index, and waist circumference. The values of these correlations of epicardial fat thickness overlying the aorta-right ventricle were r = 0.505 (P < .003), r = 0.545 (P < .001), and r = 0.515 (P < .003), respectively. Epicardial adipose tissue was higher in postmenopausal women with metabolic syndrome than in those without this syndrome (mean [standard deviation], 544.2 [122.9] vs 363.6 [162.3] mm(2); P = .03). CONCLUSIONS: Epicardial fat thickness measured by echocardiography was associated with visceral adipose tissue and other obesity parameters. Epicardial adipose tissue was higher in postmenopausal women with metabolic syndrome. Therefore, echocardiographic assessment of epicardial fat may be a simple and reliable marker of cardiovascular risk in postmenopausal women.

An observational 7-year study of continuous subcutaneous insulin infusion for the treatment of type 1 diabetes mellitus.

UNLABELLED: This work reports the experience with use of continuous subcutaneous insulin infusion (CSII) in 112 type 1 diabetic patients followed up for 7 years and previously treated with multiple daily insulin injections (MDII). MATERIAL AND METHODS: A retrospective, observational study in 112 patients with diabetes mellitus treated with CSII from 2005 to 2012, previously treated with MDII and receiving individualized diabetic education with a specific protocol. Variables analyzed included: prevalence of the different indications of pump treatment; mean annual HbA1c and fructosamine values before and after CSII treatment; and hypoglycemia frequency and symptoms. RESULTS: The most common reason for pump treatment was brittle diabetes (74.1%), followed by frequent or severe hypoglycemia or hypoglycemia unawareness (44.6%). Other indications were irregular food intake times for professional reasons (20.2%), dawn phenomenon (15.7%), pregnancy (12.3%), requirement of very low insulin doses (8.9%), and gestational diabetes (0.9%). HbA1c decreased by between 0.6% and 0.9%, and fructosamine by between 5.1% and 12.26%. Nine percent of patients experienced hypoglycemia weekly, 24% every two weeks, and 48% monthly. No hypoglycemia occurred in 19% of patients. Only 10% had neuroglycopenic symptoms. Hypoglycemia unawareness was found in 21%. Hypoglycemia was more common at treatment start, and its frequency rapidly decreased thereafter. CONCLUSION: CSII therapy provides a better glycemic control than MDII treatment. Specific patient training and fine adjustment of insulin infusion doses are required to prevent hypoglycemic episodes, which are the most common complications, mainly at the start of treatment.

Consensus document of the Neuroendocrinology area of the Spanish Society of Endocrinology and Nutrition on management of hypopituitarism during transition.

The transition period from child to adult represents a crucial phase in the growth process where multiple physical and psychosocial changes occur. It has been arbitrarily defined as the period extending from late puberty to full adult maturity (i.e., from mid to late teenage years until 6-7 years after achievement of final height). The aim of this guideline is to emphasize the importance of adequate hormone replacement during this period and to review reassessment of pituitary function. In patients with GH deficiency diagnosed in childhood, an attempt is made to answer when to retest GH secretion, when to treat and how they should be monitored. Thyroxine, glucocorticoid, and sex steroid replacement are also reviewed.

CD 133+ and CXCR4+ colon cancer cells as a marker for lymph node metastasis.

INTRODUCTION: Colorectal cancer (CRC) stem cells or tumor-initiating cells (Co-TIC) are implicated in both cancer recurrence and extranodal metastasis. CD133 and CXCR4 are specific cell surface markers that are indicators of Co-TIC. The presence of lymph node (LN) metastases is one of the strongest negative prognostic factors for CRC patients. We examined the relationship between the Co-TIC markers CD133 and CXCR4 and LN involvement in CRC. METHODS: CRC cells were isolated via enzymatic digestion. CD133(+), CXCR4(+), and double-positive CRC cells were detected by fluorescence-activated cell sorting analysis. The percentages of CD133(+), CXCR4(+), and double-positive cells were identified and correlated to the number and percentage of positive LN on staging. RESULTS: Twenty-seven samples underwent fluorescence-activated cell sorting analysis. The mean percentage of CD133(+) cells was 3.94% (range 0.15%-19.06%). The mean percentage of CXCR4(+) cells was 6.15% (range 0%-27.11%). The mean percentage of CD133(+)CXCR4(+) cells was 0.45% (range 0%-2.08%). Thirteen patients had LN metastasis: 8 N1 disease and 5 N2 disease. The correlation coefficients between the percentage of Co-TIC marker-positive cells and percentage of positive LN were r = 0.58 (P = 0.0016) for CD133(+) cells, r = 0.36 (P = 0.5868) for CXCR4(+) cells, and r = 0.56 (P = 0.0022) for double-positive cells. DISCUSSION: Our results show CD133(+) and CD133(+)CXCR4(+) cancer cells correlate with the presence of LN metastasis in CRC. Further studies will examine whether these markers can give consistent prognostic information and may help to develop novel diagnostic and therapeutic options.

Rural income and forest reliance in highland Guatemala.

This paper estimates rural household-level forest reliance in the western highlands of Guatemala using quantitative methods. Data were generated by the way of an in-depth household income survey, repeated quarterly between November 2005 and November 2006, in 11 villages (n = 149 randomly selected households). The main sources of income proved to be small-scale agriculture (53 % of total household income), wages (19 %) and environmental resources (14 %). The latter came primarily from forests (11 % on average). In the poorest quintile the forest income share was as high as 28 %. All households harvest and consume environmental products. In absolute terms, environmental income in the top quintile was 24 times higher than in the lowest. Timber and poles, seeds, firewood and leaf litter were the most important forest products. Households can be described as 'regular subsistence users': the share of subsistence income is high, with correspondingly weak integration into regional markets. Agricultural systems furthermore use important inputs from surrounding forests, although forests and agricultural uses compete in household specialization strategies. We find the main household determinants of forest income to be household size, education and asset values, as well as closeness to markets and agricultural productivity. Understanding these common but spatially differentiated patterns of environmental reliance may inform policies aimed at improving livelihoods and conserving forests.

Frecuencia del ACV en el hemisferio dominante en pacientes hospitalizados en el Servicio de Neurología del H.N.D.M. el año 2012 / Frequency of stroke in the dominant hemisphere in patients hospitalized in the Neurology Service at the H.N.D.M. year 2012

Se sabe que el hemisferio dominante es el izquierdo en aproximadamente el 92 por ciento de las personas diestras y en más del 60 por ciento de las personas zurdas, pero no se sabe cuál hemisferio es el más afectado por los ACV siendo esto importante para el pronóstico del paciente. OBJETIVO GENERAL: DETERMINAR LA FRECUENCIA DEL ACV EN EL HEMISFERIO DOMINANTE EN PACIENTES HOSPITALIZADOS EN EL SERVICIO DE NEUROLOGIA DEL H.N.D.M - 2012. MATERIALES Y METODOS: El estudio duro todo el año 2012 es de tipo descriptivo prospectivo transversal se dio en los pacientes hospitalizados en el servicio de neurología del H.N.D.M. (Hospital Nacional Dos de Mayo) que hayan sufrido un ACV ya sea hemorrágico o isquémico durante ese año. La población fue en promedio de 40 pacientes entre varones y mujeres, siendo este el promedio de los pacientes atendidos con diagnóstico de ACV en el servicio de neurología del HNDM el 2010, 2011. La recolección de datos fue del paciente, sus familiares y las historias clínicas; esto se realizó en dos momentos una vez hospitalizado el paciente: 1.-Para determinar la dominancia hemisférica donde se usó el Inventario o protocolo de Edimburgo. 2.-El segundo momento fue para determinar el lado afectado por el ACV donde se usó una ficha de recolección de datos y una TAC cerebral. RESULTADOS: De los 40 pacientes el 57.5 por ciento (23 pacientes) fueron varones y 42.5 por ciento (17 pacientes) mujeres; de estos 12 pacientes tuvieron un ACV hemorrágico y 28 presentaron un ACV isquémico dentro de los cuales uno evoluciono a ACV isquémico hemorrágico; además de los 40 pacientes 24 correspondieron al hemisferio derecho (60 por ciento) y 16 al hemisferio izquierdo (40 por ciento). De los 24 pacientes afectados en el hemisferio derecho el 62.5 por ciento (15 pacientes) son del sexo masculino y 37.5 por ciento (9 pacientes) son del sexo femenino; y los pacientes afectados en el hemisferio izquierdo el 50 por ciento son varones y 50 por ciento mujeres. De todos...

Anaerobic power and muscle strength in human immunodeficiency virus-positive preadolescents.

OBJECTIVE: To determine the anaerobic power and muscle strength of preadolescents with human immunodeficiency virus (HIV). DESIGN: Cross-sectional design. SETTING: Human performance laboratory at the University District Hospital at the Puerto Rico Medical Center. PARTICIPANTS: Fifteen preadolescents (8 girls and 7 boys) with a classification of HIV A and B attending an investigational treatment program at the University Pediatric Hospital. Fifteen seronegative control subjects matched by age and gender also were included. MAIN OUTCOME MEASURES: The power of the lower extremities was measured with use of the Wingate Anaerobic Power Test on a MONARK cycle ergometer (mean power in watts). Local muscle strength of the dominant knee extensors (peak torque/body weight × 100) was tested with an isokinetic dynamometer set at 60 deg/s. Statistical analysis was performed with the Wilcoxon signed-rank test, and statistical significance was accepted at an α level of <.05. RESULTS: No significant differences between the control group and study group were detected on muscle strength testing. The study group presented a lower anaerobic power (mean power) compared with control subjects (P = .04). CONCLUSIONS: This exploratory study suggests that HIV-infected preadolescents present lower anaerobic power compared with uninfected control subjects. Our findings of impaired anaerobic capacity can have clinical implications in this population because most of the activities of daily living, such as play, leisure, and sport activities, are short term and high intensity (anaerobic) in nature.

Lymph node stromal cells enhance drug-resistant colon cancer cell tumor formation through SDF-1α/CXCR4 paracrine signaling.

Colorectal cancer (CRC) is the third most common malignancy and the second leading cause of cancer-related deaths in America. Nearly two thirds of newly diagnosed CRC cases include lymph node (LN) involvement, and LN metastasis is one of the strongest negative prognostic factors for CRC. It is thought that CRC tumors contain a small population of drug-resistant CRC tumor-initiating cells (Co-TICs) that may be responsible for cancer recurrence. To evaluate the effects of the LN stromal cells on Co-TICs, we established a unique xenoplant model using CRC cells isolated by enzymatic digestion from consented patient specimens, HT-29 cells, HCA-7 cells, and LN stromal cell line HK cells. We found that HK cells and HK cell-conditioned media enhanced CRC tumor formation and tumor angiogenesis. Cells expressing CD133(+) and the stromal cell-derived factor 1α (SDF-1α) receptor CXCR4 were enriched in chemotherapeutic-resistant CRC cells. CD133(+)CXCR4(+) Co-TICs isolated from patient specimens are more tumorigenic than unsorted tumor cells. Furthermore, the inhibitors specific to HK cell-derived SDF-1α reduced tumor formation and tumor angiogenesis. Our results have demonstrated a role for Co-TICs in tumor growth and defined the influence of LN stromal cells on Co-TICs. We have identified a major Co-TIC/LN microenvironment-specific mechanism for CRC resistance to chemotherapeutic agents and established experimental platforms for both in vitro and in vivo testing, indicating that SDF-1α and its receptor, CXCR4, may be targets for clinical therapy.

Association between asthma and dental caries in the primary dentition of Mexican children.

BACKGROUND: Asthma has been associated with a great number of negative health outcomes. This study was undertaken to detect the association between asthma and dental caries in the primary dentition. METHODS: Data were obtained from a cohort of 1160 Mexican children aged 4-5 years. We used the questionnaire of the International Study of Asthma and Allergies Diseases in Childhood. Asthma was classified according to parents' reports. Caries indexes were measured as the number of decayed (d), missing (m), and filled (f), teeth (t) (dmft) or surfaces (dmfs). Decayed teeth included initial caries in this study. Adjusted odds ratios (adjusted ORs) were determined for asthma using logistic regression model. Gender, sugary products consumption, and oral hygiene habits were utilized as covariates. RESULTS: The prevalence of dental caries was 17.9% in the 1160 children. Approximately 226 (19.5%) children were identified with asthma. Among them, 166 (73.5%) presented with symptoms during the day and 60 (26.5%) during the day and night. The prevalence of caries in children with asthma was 19.9%; it was higher in children with nocturnal asthma symptoms than in those with asthma symptoms only during the day. Logistic regression model showed that asthma (adjusted OR=1.24; 95% confidence interval [95% CI]=0.84-1.81) was not associated with caries. A significant association was found between nocturnal asthma symptoms (adjusted OR=1.85; 95% CI=1.00-3.44) and dental caries. CONCLUSIONS: Asthma is not associated with dental caries. Nocturnal asthma symptoms appear to be associated with dental caries in the primary dentition.