Effect of n-3 fatty acid supplementation on urinary risk factors for calcium oxalate stone formation.

PURPOSE: Findings are inconsistent in a few studies of the effect of n-3 fatty acid supplementation on urinary calcium and oxalate excretion in stone formers. We evaluated the physiological effects of supplementation with eicosapentaenoic acid and docosahexaenoic acid on urinary risk factors for calcium oxalate stone formation under standardized conditions. MATERIALS AND METHODS: We studied 15 healthy subjects initially while consuming a standardized diet for 5 days (control phase). During consecutive intervention phases 1-5-day standardized diet, 2-20-day free diet and 3-5-day standardized diet participants received 900 mg eicosapentaenoic acid and 600 mg docosahexaenoic acid daily. While ingesting the standardized diets, daily 24-hour urine samples were collected. RESULTS: After short-term supplementation with eicosapentaenoic acid and docosahexaenoic acid in phase 1 we noted no changes in urinary parameters compared to the control phase. After 30-day supplementation with eicosapentaenoic acid and docosahexaenoic acid in phase 3 relative supersaturation with calcium oxalate decreased significantly by 23% from a mean ± SD of 2.01 ± 1.26 to 1.55 ± 0.84 due to significantly decreased urinary oxalate excretion (p = 0.023). Other urinary variables were not affected by supplementation. CONCLUSIONS: Results show that 30-day n-3 fatty acid supplementation effectively decreases urinary oxalate excretion and the risk of calcium oxalate crystallization. The mechanism of the physiological effect may be decreased cellular oxalic acid exchange attributable to an altered fatty acid pattern of membrane phospholipids with concomitant changes in oxalate transporter activity. Calcium oxalate stone formers may benefit from long-term n-3 fatty acid supplementation.

Bio-banking and genetic testing: a comparison between European countries and India.

In the last decade, the participation of patients and populations in large collections of human biological samples and genetic data ("bio-banks") played a more and more important role. The results of researches have led to a lot of new scientific findings: Regarding the high degree of ethnic diversity between and within European countries themselves and also in the Indian Union in this context, the arising question is how the consequences of this diversity are recognised and have been taken into account to provide better healthcare services. There is also a social, cultural and religous sensitivity which need to be considered in the planning and delivery of these services. At the same time, it is also necessary to recognise the danger of making a priori assumptions based on the cultural traditions of the respective researchers. In this context, the last few years also the possible benefit of pharmacogenetis has been discussed within the scientific community, though less in public. It seems questionable in which way public awareness, education and understanding of genetics and genetics related concepts and technologies were increasing and have been taken into account. Open communication and debate about real and perceived benefits as well as risks, paired with evidence of appropriate handling of data and samples, will be essential to establish a reasonable level of trust within the communities. This will be the basis which allows the scientific and medical community to conduct reasearch, and it is also capable of improving health care issues. The following presentation will discuss the ethic and legal framework in Europe and India and do a comparison in light of the questions raised above.

An empirical survey on biobanking of human genetic material and data in six EU countries.

Biobanks correspond to different situations: research and technological development, medical diagnosis or therapeutic activities. Their status is not clearly defined. We aimed to investigate human biobanking in Europe, particularly in relation to organisational, economic and ethical issues in various national contexts. Data from a survey in six EU countries (France, Germany, the Netherlands, Portugal, Spain and the UK) were collected as part of a European Research Project examining human and non-human biobanking (EUROGENBANK, coordinated by Professor JC Galloux). A total of 147 institutions concerned with biobanking of human samples and data were investigated by questionnaires and interviews. Most institutions surveyed belong to the public or private non-profit-making sectors, which have a key role in biobanking. This activity is increasing in all countries because few samples are discarded and genetic research is proliferating. Collections vary in size, many being small and only a few very large. Their purpose is often research, or research and healthcare, mostly in the context of disease studies. A specific budget is very rarely allocated to biobanking and costs are not often evaluated. Samples are usually provided free of charge and gifts and exchanges are the common rule. Good practice guidelines are generally followed and quality controls are performed but quality procedures are not always clearly explained. Associated data are usually computerised (identified or identifiable samples). Biobankers generally favour centralisation of data rather than of samples. Legal and ethical harmonisation within Europe is considered likely to facilitate international collaboration. We propose a series of recommendations and suggestions arising from the EUROGENBANK project.

The Standardized Assessment of Personality-Abbreviated Scale as a screening instrument for personality disorders in substance-dependent criminal offenders.

Personality disorders (PDs) are considered to be potential predictors of treatment outcome in substance-dependent patients and potential treatment matching variables. There is a need for a brief and simple screening instrument for PDs that can be used in routine psychological assessment, especially in a treatment setting for previously substance-dependent criminal offenders, where a high prevalence of PDs is expected. This study investigated the psychometric properties of the Standardized Assessment of Personality-Abbreviated Scale (SAPAS), a commonly used screening interview for PDs, in a population of inpatient criminal offenders with a history of substance dependence. Various statistical procedures were used to establish reliability and validity measures, such as Kuder-Richardson 20, confirmative factor analysis, receiver operating characteristic analysis and multitrait multimethod matrix. The SAPAS was administered to 101 inpatient criminal offenders with a history of substance dependence at baseline. Within three weeks, participants were administered the Structured Interview for DSM-IV Personality in order to assess the presence of PDs. Results show limited evidence to make firm conclusions on the psychometric qualities of the SAPAS as a screening instrument for comorbid PDs in a substance dependence treatment setting for criminal offenders. Suggestions for improvement concerning the psychometric qualities of the SAPAS as a screening instrument for this population are noted.

Some ethical and legal issues in Germany involving informed consent and patenting.

This paper elaborates on discussions in Germany regarding some of the ethical and legal issues in the area of the use and patenting of inventions involving human tissue. The issues discussed pertain to the benefits and problems regarding informed consent and the issue of property rights as they relate to the donation of cells and tissue.

Modern medicine and biotechnology: an ethical conflict of interest?

When confronting the issues related to developments in modern medicine and biotechnology, we must repeatedly ask ourselves anew what can and cannot be justified in an ethical sense. For radically new ethical questions seem to arise through innovative techniques such as stem cell research or preimplantation diagnosis--and with them new areas of conflicting interests. If one scrutinizes the previous positions related to this subject, it becomes conspicuous that a multitude of questions has quickly piled up--however, (as in the case of Germany) comprehensive and differentiated views have mostly been lacking.

Citric acid or citrates in urine: which should we focus on in the prevention of calcium oxalate crystals and stones?

In order to distinguish between normocitraturia and hypocitraturia, the 24 h urine excretion value of citric acid is evaluated in relation to the established limit value of 2.5 mmol/day. We propose changing this widely-used excretion value to a "minimum contribution" of citric acid to the total urine's ionic strength, since the inhibitory effect of citric acid on crystallization depends on citrate anions being available to complex calcium ions or to associate with the crystal surface. A total of 71424 h-urine samples, taken from 74 healthy persons and 58 calcium stone formers, were investigated for pH, citric acid concentration ([CA]), and related relative calcium oxalate supersaturation (RS). Based on the Henderson-Hasselbalch-equation, the individual concentrations of the differently charged citrate anion species in each of the urines were calculated from the urinary pH and [CA]. From the anion concentrations determined, the contribution of the urine's citric acid to the total urine's ionic strength, ISCA, was calculated. Referring to the limit value of 2.5 mmol/day and assuming an average urine volume of 1.5 l/day, a hypothetical concentration limit of 1.67 mmol/l can be obtained. Grouping the samples into "stone-formers" and "non-stone-formers" as well as into three different ranges of RS revealed: (1). that the groups' median [CA]-values were below 1.67 mmol/l, and (2). that [CA] was not inversely associated with the risk of stone formation. Within the pH-range of 5 and 7, the ISCA-values which are related to, for example, [CA]=1.67 mmol/l, vary considerably by a factor of nearly three between 2.48 mmol/l and 6.64 mmol/l. The use of a fixed citric acid excretion level for the distinction of normocitraturia from hypocitraturia does not take into account the different citrate species which actually modify the urine's crystallization behaviour. The proposed ISCA approach takes this fact into consideration. From this parameter, a desirable "minimum impact of citric acid" can be derived. In a first approach, a potential ISCA-limit value, which currently distinguishes between urines indicated by a "normo-protective" impact and those indicated by a "hypo-protective" impact with respect to calcium oxalate precipitation, may be set at 2.48 mmol/l.

¿Necesitan la nueva biotecnología y la medicina un nuevo empuje bioético o se trata de un conflicto de intereses? / Does new biotechnology and medicine need another type of bioethical input or is it an ethical conflict of interest?

A la hora analizar los temas relacionados con los avances en la Medicina moderna y la Biotecnologia surgen cuestiones sobre lo que puede ser o no éticamente justificable. De este modo surgen nuevas cuestiones éticas acerca de las nuevas técnicas como la investigación con células madre o el diagnóstico preimplantatorio, y junto a ello nuevas áreas de conflicto. Además la cuestión se intensifica ya que vivimos en un mundo con grandes avances que afectan al ser humano. Con las nuevas tecnologías, aparecen nuevas opciones (AU)

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Social risks and social perception of animal cloning

La percepción social de la ciencia ha experimentado un notable cambio en los últimos 20 años. De existir una mera sensibilidad sobre los riesgos de la biotecnología, se ha pasado a una total desconfianza en la misma. Esto se ve claramente en temas como la ingeniería genética. Pero existen miedos que van más allá de la propia ética, como el hecho de que todos los experimentos realizados sobre animales se lleven al campo de los humanos. Esto nos lleva a buscar desde una perspectiva sociológica razones para apoyar O combatir estas nuevas tecnologías (AU)

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