R-mandelonitrile-lyase, homolog to Pru d 10, is a major peach allergen in peach allergic Spanish population.

BACKGROUND AND OBJECTIVE: Peach allergy is a prevalent cause of food allergy. Despite the repertoire of allergens available for molecular diagnosis, there are still patients with undetectable IgE levels to peach allergens but presenting symptoms after its ingestion. The objective of this study was to investigate the allergenic profile in a patient population with symptoms produced by peach. METHODS: An exploratory retrospective study was performed with patients presenting symptoms after the ingestion of peach. Forty-two patients were included in the study. The allergenic profile of individual patients was investigated by immunoblot. A serum pool was prepared with the sera that recognized a 70 kDa band. This pool was used to detect this protein in peach peel and pulp and to identify the 70 kDa protein in 2D immunoblot. Spots recognized in the 2D immunoblot were sequenced by LC-MS/MS. Inhibition studies were performed between peach peel and almond. RESULTS: Twenty-two patients (52.4%) recognized the 70 kDa protein in immunoblot. This protein was recognized in peel and pulp. Two different spots were observed in 2D-PAGE, both were identified as (R)-mandelonitrile lyases (RML) with high amino acid similarity with Pru du 10. Peach RML were partially inhibited with an almond extract. No association was found between any reported symptom and sensitization to RML. RML-sensitized patients were older and reported pollen associated respiratory symptoms more frequently than negative patients. CONCLUSION: A new peach allergen, a RML, homologous of Pru du 10, recognized by 52% of the population has been identified.

Sensitization to Vitis vinifera Pollen in a Wine Production Area: Identification of the Allergens Involved.

BACKGROUND: Vine cultivation is widely distributed in La Rioja, Spain (37% of all crops) and is associated with exposure of the general population to vine pollen. The aims of this study were to investigate the prevalence of sensitization to Vitis vinifera pollen in persons with respiratory allergy in the general population and to identify the allergens involved. MATERIALS AND METHODS: The study population comprised patients who came to the hospital between September 2019 and January 2020 with suspected respiratory allergy. All patients underwent skin prick testing with a panel of standardized aeroallergens, profilin, lipid transfer protein (LTP), and V vinifera pollen extract and prick-prick testing with fresh grapes. The in vitro study included specific IgE by ImmunoCap and ELISA, allergenic profile by immunoblot with individual sera from patients positive to V vinifera pollen extract, and 2D immunoblot with a pool of sera. The spots recognized by IgE were identified using mass spectrometry. RESULTS: A total of 151 patients were included. Of these, 124 were positive to some of the allergens tested. Thirty-four (27.4%) were positive to vine pollen in the skin prick tests. The serology study revealed positive results in 20 patients. Five vine pollen allergens were identified, and profilin was the most prevalent (30%). The other 4 allergens could be considered specific to this pollen. CONCLUSIONS: Sensitization to vine pollen was frequent in the general population in a vine growing area. The clinical relevance of this finding is unknown owing to sensitization to other pollens in the vine pollen-positive patients. Five new vine pollen allergens were identified.

Sensitization to Vitis vinifera Pollen in a Wine Production Area: Identification of the Allergens Involved

Background: Vine cultivation is widely distributed in La Rioja, Spain (37% of all crops) and is associated with exposure of the general population to vine pollen. The aims of this study were to investigate the prevalence of sensitization to Vitis vinifera pollen in persons with respiratory allergy in the general population and to identify the allergens involved. Materials and Methods: The study population comprised patients who came to the hospital between September 2019 and January 2020 with suspected respiratory allergy. All patients underwent skin prick testing with a panel of standardized aeroallergens, profilin, lipid transfer protein (LTP), and V vinifera pollen extract and prick-prick testing with fresh grapes. The in vitro study included specific IgE by ImmunoCap and ELISA, allergenic profile by immunoblot with individual sera from patients positive to V vinifera pollen extract, and 2D immunoblot with a pool of sera. The spots recognized by IgE were identified using mass spectrometry. Results: A total of 151 patients were included. Of these, 124 were positive to some of the allergens tested. Thirty-four (27.4%) were positive to vine pollen in the skin prick tests. The serology study revealed positive results in 20 patients. Five vine pollen allergens were identified, and profilin was the most prevalent (30%). The other 4 allergens could be considered specific to this pollen. Conclusions: Sensitization to vine pollen was frequent in the general population in a vine growing area. The clinical relevance of this finding is unknown owing to sensitization to other pollens in the vine pollen–positive patients. Five new vine pollen allergens were identified (AU)

Antecedentes: El cultivo de la vid está ampliamente distribuido en La Rioja (37% de los cultivos), lo que supone una exposición de la población general al polen de esta planta. El objetivo de este estudio fue investigar la prevalencia de sensibilización al polen de Vitis vinifera en la población general con alergia respiratoria e identificar los alérgenos implicados. Materiales y métodos: Se incluyeron en el estudio pacientes que acudieron al hospital entre septiembre de 2019 y enero de 2020 con sospecha de alergia respiratoria. A todos ellos se les realizó una prueba cutánea con el panel de aeroalérgenos estandarizados, profilina, LTP, extracto de polen de V. vinifera y Prick prick con uva. El estudio in vitro incluyó IgE específica mediante ImmunoCap y ELISA, perfil alergénico por inmunoblot con sueros individuales de pacientes positivos al extracto de polen de V. vinifera e inmunoblot 2D con un pool de sueros. Las proteínas reconocidas por la IgE fueron identificadas por espectrometría de masas. Resultados: Se incluyeron un total de 151 pacientes. De ellos, 124 fueron positivos a algunos de los alérgenos analizados. 34 (27,4%) fueron positivos a polen de vid por prueba cutánea. 20 fueron positivos tras el estudio serológico. Se identificaron 5 alérgenos del polen de la vid, siendo la profilina el más prevalente (30%). Los otros 4 alérgenos podrían considerarse específicos de este polen. Conclusión: Se detectó una alta sensibilización al polen de vid en la población general en una zona de viñedos. Se desconoce la relevancia clínica debido a la sensibilización a otros pólenes en los pacientes positivos a polen de vid. Se identificaron 5 nuevos alérgenos del polen de la vid (AU)

The Connection Between Stress and Immune Status in Pigs: A First Salivary Analytical Panel for Disease Differentiation.

This paper analyzes the association between stress and immune response activations in different diseases, based on the salivary analytics. Moreover, a first attempt to discriminate between diseases was performed by principal component analysis. The salivary analytics consisted of the measurement of psychosocial stress (cortisol and salivary alpha-amylase) indicators, innate (acute phase proteins: C-reactive protein and haptoglobin), and adaptive immune (adenosine deaminase, Cu and Zn) markers and oxidative stress parameters (antioxidant capacity and oxidative status). A total of 107 commercial growing pigs in the field were divided into six groups according to the signs of disease after proper veterinary clinical examination, especially, healthy pigs, pigs with rectal prolapse, tail-biting lesions, diarrhea, lameness, or dyspnea. Associations between stress and immune markers were observed with different intensities. High associations (r = 0.61) were observed between oxidative stress markers and adaptive immune markers. On the other hand, moderate associations (r = 0.31-0.48) between psychosocial stress markers with both innate and adaptive immune markers were observed. All pathological conditions showed statistically significant differences in at least 4 out of the 11 salivary markers studied, with no individual marker dysregulated in all the diseases. Moreover, each disease condition showed differences in the degree of activation of the analyzed systems which could be used to create different salivary profiles. A total of two dimensions were selected through the principal component analysis to explain the 48.3% of the variance of our data. Lameness and rectal prolapse were the two pathological conditions most distant from the healthy condition followed by dyspnea. Tail-biting lesions and diarrhea were also far from the other diseases but near to healthy animals. There is still room for improvements, but these preliminary results displayed a great potential for disease detection and characterization using salivary biomarkers profiling in the near future.

Esterilidad de origen uterino. Revisión narrativa de la bibliografía / Sterility of uterine origin. Narrative review of the literature

El útero es un órgano fundamental para la concepción y el desarrollo de un embarazo a término. En el estudio de la paciente con problemas reproductivos siempre debemos realizar una correcta valoración del factor uterino y tenerlo presente, ya que las anomalías de este órgano pueden estar implicadas hasta en la mitad de los casos de esterilidad. En este trabajo se realiza una revisión bibliográfica en la base de datos Medline, seleccionando los artículos con mayor evidencia científica sobre las principales anomalías uterinas que pueden causar problemas reproductivos y obstétricos: congénitas (como malformaciones müllerianas) o adquiridas. Se expone la presentación clínica, repercusiones reproductivas y obstétricas (esterilidad, abortos de repetición, complicaciones obstétricas como parto prematuro), métodos diagnósticos y principales opciones terapéuticas de cada entidad.(AU)

The uterus is a fundamental organ for the conception and development of a full-term pregnancy. In the study of the patient with reproductive problems, we should always make a correct assessment of the uterine factor and keep it in mind since uterine abnormalities may be involved in up to half of the cases of sterility. In this work, we carried out a literature review in the Medline database selecting the articles with a higher level of evidence on the main uterine anomalies that can cause reproductive and obstetric problems: congenital (such as Müllerian malformations) or acquired. The clinical presentation, reproductive and obstetric repercussions (sterility, repeated miscarriage, obstetric complications such as premature birth), diagnostic methods and main therapeutic options of each entity are exposed.(AU)

Biopsia selectiva de ganglio centinela en pacientes con cáncer de endometrio. Inicio de la técnica en el Hospital Universitario Virgen Macarena / Sentinel lymph node biopsy in patients with endometrial cancer. Beginning of using the technique in the Virgen Macarena University Hospital

Antecedentes: La biopsia selectiva de ganglio centinela (BSGC) en el cáncer de endometrio se encuentra aún en periodo de estudio para validar su implantación protocolizada y evitar así la linfadenectomía pélvica y aortocava. Objetivo: Mostrar nuestros resultados durante el proceso de validación de la técnica y así colaborar para su implantación en otros centros. Método: Estudio observacional descriptivo prospectivo de pacientes intervenidas de cáncer endometrial en las que se realizó BSGC vía laparoscópica desde julio de 2016 a diciembre de 2019. Resultados: Los ganglios centinela (GC) en todas las pacientes fueron negativos para metástasis. Hubo una concordancia del 100% entre los resultados anatomopatológicos de los GC y de las posteriores linfadenectomías de validación. En ningún caso se objetivaron complicaciones operatorias durante la realización de la BSGC. Conclusión: La BSGC en pacientes en estadios iniciales de carcinoma endometrial es una técnica en fase de validación pero cuyos resultados son prometedores, pudiéndose llevar a cabo una cirugía menos invasiva de forma segura, evitando la comorbilidad asociada a la linfadenectomía.(AU)

Background: Sentinel lymph node biopsy (SLNB) in endometrial cancer is still being assessed in order to validate its standardised protocol to avoid pelvic and aortocaval lymphadenectomy. Objective: To present the results of the technique during the validation process, and work towards its implementation in other centres. Method: A prospective descriptive observational study of endometrial cancer patients who underwent laparoscopic SLNB from July 2016 to December 2019. Results: Sentinel lymph nodes (SLN) in all patients were negative for metastasis. There was a 100% agreement between the histopathology results of the SLN and the subsequent validation of lymphadenectomies. No surgical complications were observed in any of the cases during the performing of the SLNB. Conclusion: SLNB in patients in early stages of endometrial carcinoma is a technique in the validation phase, but the results of which are promising. This means that less invasive surgery can be carried out safely, avoiding comorbidity associated with lymphadenectomy.(AU)

Lesiones de Lisfranc: repercusión clínico-funcional / Lisfranc lesions: clinical-functional repercussion

Resumen: Objetivo: Valoración clínica-funcional de pacientes con lesión de Lisfranc sin causa laboral ni deportiva tratados en nuestro centro. Material y métodos: Se analizaron 13 pacientes con lesión de Lisfranc sin causa laboral ni deportiva, divididos en dos grupos, lesiones de alta energía y de baja energía. Valoración del retorno a la actividad laboral y deportiva previa a la lesión y el uso de calzado y plantillas posteriormente. Se recogen las puntuaciones del test AOFAS y EVA postoperatorio así como la aparición de complicaciones posteriores a la recuperación de la lesión. Resultados: El grupo de alta energía lo formaron siete pacientes que fueron intervenidos en una media de 7.3 días; cuatro presentaron secuelas postquirúrgicas. De estos pacientes, un paciente no pudo reincorporarse a su actividad laboral previa y dos pacientes no pudieron realizar el deporte que practicaban previamente a la lesión. El AOFAS fue de 79.4 y el EVA de 2.8. En el grupo de baja energía encontramos seis pacientes intervenidos en 5.6 días de media. Todos ellos pudieron reincorporarse a su actividad laboral y deportiva previa. El AOFAs fue de 84.8 y el EVA de 1.6. En ninguna de las variables estudiadas se observaron diferencias estadísticamente significativas. Conclusión: Los pacientes con lesión de Lisfranc fuera del ámbito laboral y deportivo presentan buenos resultados clínicos y funcionales.

Abstract: Objective: Clinical and functional evaluation of patients with Lisfranc lesion without work or sport cause and treated in our center. Material and methods: Thirteen patients with Lisfranc lesion without occupational or sports causes were divided into two groups, high-energy and low-energy injuries. Were analyzed the return to work and sports activity prior to the injury and the use of footwear and insoles after the injury. Also were assessed AOFAS and EVA postoperative score and posterior complications after lesion recovery. Results: High-energy group included 7 patients who underwent surgery on an average of 7.3 days. Of the total of patients, 4 presented post-surgical sequelae. Of these patients, one patient was unable to return to their previous work activity and two patients were unable to practice the usual sports activity. The AOFAS was 79.4 and EVA 2.8. In the low energy group, we found six patients operated on 5.6 days on average. All of them were able to return to their previous work and sports activity. The AOFAS were 84.8 and the EVA 1.6. Statistically significant differences were not observed in any of the variables studied. Conclusion: Patients with Lisfranc injury out of laboral or sports background present good clinical and functional results.

Immunoinformatic epitope prediction to select monoclonal antibodies for Phl p 1 quantification.

BACKGROUND: Allergen quantification has become a relevant parameter for allergen extract characterization and to guarantee the consistency of the manufacturing process at allergen immunotherapy. The aim of this study was to develop and validate a method to quantify the major allergen Phl p 1 based on a prediction of the antigenic regions by immunoinformatic strategies. METHODS: Phl p 1 was purified from a Phleum pratense native extract by chromatographic methods. Immunoinformatic tools were used to predict B-cell epitopes. In silico predictions were verified by mapping linear epitopes with a peptide library and used to select the appropriate regions for producing the mAbs to develop an ELISA method, which was validated. Phl p 1 was quantified in 24 batches of P. pratense extracts. RESULTS: Phl p 1 was purified with 95 % purity and completely functional. Eight B-cell epitopes in each of the two Phl p 1 isoforms were predicted. Two of the predicted B-cell epitopes overlapped with the experimentally determined peptides recognized by two mAbs selected for development of the kit. The quantification method demonstrated to be specific to Phl p 1, linear, accurate and precise in the range from 7.7 to 123.3 µg/mg. Mean Phl p 1 content was 28.95 µg of allergen/mg of lyophilized native extract and 44.23 µg of allergen/mg of lyophilized depigmented extract. CONCLUSIONS: An ELISA method for measuring Phl p 1 in P. pratense extracts was developed and validated by producing the appropriate mAbs against epitopes selected by immunoinformatic tools.

[Lisfranc lesions: clinical-functional repercussion]. / Lesiones de Lisfranc: repercusión clínico-funcional.

OBJECTIVE: Clinical and functional evaluation of patients with Lisfranc lesion without work or sport cause and treated in our center. MATERIAL AND METHODS: Thirteen patients with Lisfranc lesion without occupational or sports causes were divided into two groups, high-energy and low-energy injuries. Were analyzed the return to work and sports activity prior to the injury and the use of footwear and insoles after the injury. Also were assessed AOFAS and EVA postoperative score and posterior complications after lesion recovery. RESULTS: High-energy group included 7 patients who underwent surgery on an average of 7.3 days. Of the total of patients, 4 presented post-surgical sequelae. Of these patients, one patient was unable to return to their previous work activity and two patients were unable to practice the usual sports activity. The AOFAS was 79.4 and EVA 2.8. In the low energy group, we found six patients operated on 5.6 days on average. All of them were able to return to their previous work and sports activity. The AOFAS were 84.8 and the EVA 1.6. Statistically significant differences were not observed in any of the variables studied. CONCLUSION: Patients with Lisfranc injury out of laboral or sports background present good clinical and functional results.

OBJETIVO: Valoración clínica-funcional de pacientes con lesión de Lisfranc sin causa laboral ni deportiva tratados en nuestro centro. MATERIAL Y MÉTODOS: Se analizaron 13 pacientes con lesión de Lisfranc sin causa laboral ni deportiva, divididos en dos grupos, lesiones de alta energía y de baja energía. Valoración del retorno a la actividad laboral y deportiva previa a la lesión y el uso de calzado y plantillas posteriormente. Se recogen las puntuaciones del test AOFAS y EVA postoperatorio así como la aparición de complicaciones posteriores a la recuperación de la lesión. RESULTADOS: El grupo de alta energía lo formaron siete pacientes que fueron intervenidos en una media de 7.3 días; cuatro presentaron secuelas postquirúrgicas. De estos pacientes, un paciente no pudo reincorporarse a su actividad laboral previa y dos pacientes no pudieron realizar el deporte que practicaban previamente a la lesión. El AOFAS fue de 79.4 y el EVA de 2.8. En el grupo de baja energía encontramos seis pacientes intervenidos en 5.6 días de media. Todos ellos pudieron reincorporarse a su actividad laboral y deportiva previa. El AOFAs fue de 84.8 y el EVA de 1.6. En ninguna de las variables estudiadas se observaron diferencias estadísticamente significativas. CONCLUSIÓN: Los pacientes con lesión de Lisfranc fuera del ámbito laboral y deportivo presentan buenos resultados clínicos y funcionales.

Profilin is a marker of severity in allergic respiratory diseases.

BACKGROUND: The capacity of profilin to induce allergic symptoms in patients with respiratory allergy has been questioned. In this sense, the aim of this study was to investigate the correlation between profilin exposure and induction of symptoms in a prospective case-control study. METHODS: The concentration of profilin as well as pollen levels in the air was measured. A diary score of symptoms was collected from allergic patients. Seventy-nine individuals were included in the study; fifty cases and 28 controls were positive or negative to profilin, respectively. Conjunctival and bronchial provocation tests were performed with purified profilin (Pho d 2) in a subgroup of cases and controls. RESULTS: Profilin was detected in the environment on 133 days (maximum peak of 0.56 ng/m3 ). A positive correlation between profilin and pollen count of Olea and Poaceae was observed (ρ = 0.24; P < .001). Intensity of total, nasal and ocular symptoms was statistically higher in cases than in controls (P < .001). The risk of suffering symptoms, measured by the percentage of patients who presented any of the symptoms each day, was also higher in cases than in controls. The provocation test was positive in 95% of bronchial and 90% of conjunctival challenges in cases, and negative in all controls. CONCLUSIONS: Profilin was detected in the environment and had the ability to induce a specific allergen response. Patients sensitized to this panallergen showed more symptoms and were more likely to have symptoms. Therefore, sensitization to profilin seems to be a marker of severity in patients with rhinoconjunctivitis and asthma mediated by pollen.

Opinión de médicos urgenciólogos sobre la práctica de ecografías por médicos no radiólogos / Opinion of emergency phisicians on the utilization of ultrasound by non-radiologist physicians

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How to interpret elevated plasmatic level of high-sensitive troponin T in newborns and infants?

Research and clinical implications on novel cardiac biomarkers has intensified significantly in the past few years. The high-sensitive troponin T (hscTnT) assay plays a dominant role in diagnostic algorithm regarding myocardial injury in adults. Despite generally accepted use of hscTnT there are no data about physiological concentrations and cut-off limits in neonates and infants to date. The aim of this study is to assess hscTnT levels in healthy newborns and infants. Consecutively 454 healthy full termed newborns and 40 healthy infants were enrolled in the study. Samples of cord or venous blood were drawn and tested for hscTnT concentrations with high-sensitive TnT assay (Roche Cobas e602 immunochemical analyzer). The 97.5 percentile of hscTnT concentration was assessed and correlation analysis was performed in neonates. Two hundred and thirteen samples (47 %) were excluded due to blood hemolysis of various degrees in neonates. Finally, the group of 241 healthy newborns was statistically analyzed. The median concentration of hscTnT was 38.2 ng/ml, 97.5 percentile reached 83.0 ng/l (confidential interval 74.1 to 106.9 ng/l). HscTnT concentrations were statistically decreased in hemolytic samples when compared to non-hemolytic samples (34.3 ng/l [26.7 to 42.0 ng/l] and 37.1 ng/l [30.5 to 47.9 ng/l], respectively, p=0.003). Elevated plasma concentrations of hscTnT decreased to adult level within six months. This study has confirmed the higher reference levels of hscTnT in neonates and young infants when compared with adult population. Many extracardiac factors as hemolysis and age may affect the hscTnT level. Based on presented results, a careful clinical interpretation of hscTnT is recommended.

Pre-operative haemoglobin levels and iron status in a large multicentre cohort of patients undergoing major elective surgery.

Pre-operative anaemia in patients undergoing major surgical procedures has been linked to poor outcomes. Therefore, early detection and treatment of pre-operative anaemia is recommended. However, to effectively implement a pre-operative anaemia management protocol, an estimation of its prevalence and main causes is needed. We analysed data from 3342 patients (44.5% female) scheduled for either: elective orthopaedic surgery (n = 1286); cardiac surgery (n = 691); colorectal cancer resection (n = 735); radical prostatectomy (n = 362); gynaecological surgery (n = 203) or resection of liver metastases (n = 122). For both sexes, anaemia was defined by a haemoglobin level < 130 g.l-1 ; absolute iron deficiency by ferritin < 30 ng.ml-1 (< 100 ng.ml-1 , if transferrin saturation < 20% or C-reactive protein > 5 mg.l-1 ); iron sequestration by transferrin saturation < 20% and ferritin > 100 ng.ml-1 ; and low iron stores by transferrin saturation > 20% and ferritin 30-100 ng.ml-1 . The overall prevalence of anaemia was 36%, with differences according to the type of surgery. Laboratory parameters allowing classification of iron status were available for 2884 patients. Among those with anaemia (n = 986), 677 (69%) were women, 608 (62%) presented with absolute iron deficiency, 101 (10%) with iron sequestration; and 150 (5%) with low iron stores. Iron status alterations were similar in women with haemoglobin < 130 g.l-1 or < 120 g.l-1 . For those who were not anaemic (n = 1898), corresponding figures were 656 (35%), 621 (33%), 165 (9%) and 518 (27%), respectively. Anaemia was present in one-third of patients undergoing major elective procedures. Over two-thirds of anaemic patients presented with absolute iron deficiency or iron sequestration. Over half of non-anaemic patients presented with absolute iron deficiency or low iron stores. We consider these data useful for planning pre-operative management of patients scheduled for major elective surgery.

Purification and immunochemical characterization of Pla l 2, the profilin from Plantago lanceolata.

Profilins are small actin-binding proteins found in eukaryotes and involved in cell development, cytokinesis, membrane trafficking, and cell motility. From an allergenic point of view, profilins are panallergens usually involved in allergic polysensitization, although they are generally recognized as minor allergens. The objectives of this study were to identify and characterize the profilin from Plantago lanceolata pollen and to investigate the cross-reactivity between profilins from different pollen allergenic sources. Profilins from P. lancelolata (Pla l 2) and palm tree pollen (Pho d 2) were purified by affinity chromatography, deeply characterized and identified by mass spectrometry. Pla l 2 allergenicity was confirmed by immunoblot with serum samples from a patient population sensitized to profilin. Immunoblot inhibition was performed to study IgG reactivity between different pollen profilins. IgE cross-reactivity was demonstrated by ImmunoCAP inhibition. Pla l 2 is the second P. lanceolata allergen included in the IUIS Allergen Nomenclature database. Four peptides from purified Pla l 2 were identified with percentages of homology with other pollen profilins between 73 and 86%. Eighty-six percent (21/24) of the patient population recognized Pla l 2. The allergenic relatedness between Pla l 2, Pho d 2 and six pollen profilins was confirmed, and IgE cross-reactivity of Pla l 2 with rBet v 2 and rPhl p 12 was demonstrated. Pla l 2 is the profilin from P. lanceolata. The demonstrated allergenicity of this protein and its cross-reactivity with other pollen profilins support its use in profilin diagnostic assays.