Health-Related Quality of Life in Mexican Children and Adolescents with Non-Syndromic Craniosynostosis.

OBJECTIVE: Assess the Health-Related Quality of Life in children and adolescents with non-syndromic craniosynostosis and compare it with participants without craniosynostosis. DESIGN: Non-experimental, cross-sectional design. SETTING: The assessment was done remotely and the instrument was sent via chat or email. PATIENTS/PARTICIPANTS: Participants (ages 8-17) with non-syndromic craniosynostosis (n = 27) and without craniosynostosis (n = 26). MAIN OUTCOME MEASURE(S): We used an adapted version for the Mexican population of the Health-Related Quality of Life Questionnaire for Children and Adolescents -KIDSCREEN-52. RESULTS: All scores were in the average clinical range and both groups scored similarly in all domains except those with craniosynostosis were significantly lower in the Social Support and Peers domain (rpb = 0.48). CONCLUSIONS: Children and adolescents with non-syndromic craniosynostosis reported similar Health-Related Quality of Life as the control group, except for the Social Support domain, which should be investigated in future studies.

The Transcriptomic Landscape of Pediatric Astrocytoma.

Central nervous system tumors are the most common solid neoplasia during childhood and represent one of the leading causes of cancer-related mortality. Tumors arising from astrocytic cells (astrocytomas) are the most frequently diagnosed, and according to their histological and pathological characteristics, they are classified into four categories. However, an additional layer of molecular classification considering the DNA sequence of the tumorigenesis-associated genes IDH1/2 and H3F3A has recently been incorporated into the classification guidelines. Although mutations in H3F3A are found exclusively in a subtype of grade IV pediatric astrocytoma, mutations in IDH1/2 genes are very rare in children under 14 years of age. The transcriptomic profiles of astrocytoma in adults and children have been extensively studied. However, there is scarce information on these profiles in pediatric populations considering the status of tumorigenesis-associated genes. Therefore, here we report the transcriptomic landscape of the four grades of pediatric astrocytoma by RNA sequencing. We found several well-documented biological functions associated with the misregulated genes in the four grades of astrocytoma, as well as additional biological pathways. Among the four grades of astrocytoma, we found shared misregulated genes that could have implications in tumorigenesis. Finally, we identified a transcriptional signature for almost all grades of astrocytoma that could be used as a transcription-based identification method.

Pediatric ependymoma: GNAO1, ASAH1, IMMT and IPO7 protein expression and 5-year prognosis correlation.

OBJECTIVE: The aim of this work was to evaluate a pediatric ependymoma protein expression that may be useful as a molecular biomarker candidate for prognosis, correlated with clinical features such as age, gender, histopathological grade, ependymal tumor recurrence and patient survival. PATIENTS AND METHODS: Immunohistochemistry assays were performed for GNAO1, ASAH1, IMMT, IPO7, Cyclin D1, P53 and Ki-67 proteins. Kaplan-Meier and Cox analysis were performed for age, gender, histopathological grade, relapse and survival correlation. RESULTS: We found that three proteins correlate with histopathological grade and relapse; two proteins correlate with survival; one protein does not correlate with any clinical feature. CONCLUSION: Our results suggest that, out of the proteins analyzed, five may be considered suitable prognostic biomarkers and one may be considered a predictive biomarker for response to treatment of pediatric ependymoma.

Pediatric pineal germinomas: Epigenetic and genomic approach.

OBJECTIVE: We identify and correlate chromosomal alterations, methylation patterns and gene expression in pediatric pineal germinomas. METHODS: CGH microarray, methylation and gene expression were performed through the Agilent platform. The results were analyzed with MatLab software, MapViewer, DAVID, GeneCards and Hippie. RESULTS: Amplifications were found in 1q24.2, 1q31.3, 2p11.2, 3p22.2, 7p13, 7p15.2, 8p22, 12p13.2, 14q24.3 y 22q12; and deletions were found in 1q21.2, 9p24.1, 10q11.22, 11q11, 15q11.2 and 17q21.31. In the methylation analysis, we observed 10,428 CpG Islands with a modified methylation status that may affect 11,726 genes. We identified 1260 overexpressed genes and 470 underexpressed genes. The genes RUNDC3A, CDC247, CDCA7L, ASAH1, TRA2A, LPL and NPC2 were altered among the three levels. CONCLUSIONS: We identified the 1q24.2 and 1q31.3 amplified regions and the 1q21.3 and 11q11 deleted regions as the most important aims. The genes NPC2 and ASAH1 may play an important role in the development, progression and tumor maintenance. The ASAH1 gene is an ideal candidate to identify drug responses. These genomic and epigenetic studies may help to characterize the formation of pineal germ cell tumors to determine prognostic markers and also to identify shared characteristics in gonadal and extragonadal tumors.

Genomics and epigenetics: A study of ependymomas in pediatric patients.

OBJECTIVE: We identify chromosomal alterations, the methylation pattern and gene expression changes in pediatric ependymomas. METHODS: CGH microarray, methylation and gene expression were performed through the Agilent platform. The results were analyzed with the software MatLab, MapViewer, DAVID, GeneCards and Hippie. RESULTS: Amplification was found in 14q32.33, 2p22.3 and 8p22, and deletion was found in 8p11.23-p11.22 and 1q21.3. We observed 42.387 CpG islands with changes in their methylation pattern, in which we found 272 genes involved in signaling pathways related to carcinogenesis. We found 481 genes with altered expression. The genes IMMT, JHDMD1D, ASAH1, ZWINT, IPO7, GNAO1 and CISD3 were found to be altered among the three levels. CONCLUSION: The 2p22.3, 8p11.23-p11.22 and 14q32.33 regions were identified as the most important; the changes in the methylation pattern related to cell cycle and cancer genes occurred in MIB2, FGF18 and ITIH5. The IPO7, GNAO1 and ASAH1 genes may play a major role in ependymoma development.

[Ventriculo subgaleal shunt in hydrocephalus secondary to intraventricular hemorrhage in prematures]. / Derivación ventrículo-subgaleal en hidrocefalia secundaria a hemorragia intraventricular (HIV) en el prematuro.

BACKGROUND: Intraventricular hemorrhage (IVH) is one of the most serious complications in premature lightweight. While in the decade of 1970-1980 the incidence was 40-50%, now it is at least 20%. But it presents a challenge because of the multiple existing therapies and the results in terms of neurological sequelae. MATERIAL AND METHODS: We performed a retrospective review of 48 patients managed with ventriculo subgaleal shunt and a therapeutic decision based on gestational age, weight, and grade of intraventricular hemorrhage. RESULTS: Of the patients, 29 (60%) of the cases were female and 19 (40%) were male. The average gestation age for placing the subgaleal system was 30 months, with an average weight of 1,511 g, and with an infection rate of 4%. In 44 cases peritoneal system was placed (92%) because four died (8%). No mortality was observed at surgery. CONCLUSIONS: Mortality in the past appeared in 75% of patients, with the realization that derivation of subgaleal irrigation reduces infections besides allowing proper control of hydrocephalus and thus decreases the long-term neurological sequelae.

Tratamiento endovascular de las fístulas arteriovenosas piales no galénicas / No disponible

Introducción y objetivos Las fístulas arteriovenosas piales son malformaciones vasculares infrecuentes. Generalmente son congénitas y su historia natural es ominosa. El objetivo es describir nuestra experiencia en su manejo endovascular y analizar la literatura. Pacientes y métodos Es un estudio retrospectivo descriptivo de pacientes tratados por vía endovascular durante 3 años en 3 instituciones latinoamericanas. Resultados Fueron 6 pacientes con edad media de 22 años. Un caso fue resultado de un traumatismo. El 50% presentó hemorragia intracraneal, el 66% desarrollaron clínica secundaria a efecto de masa y al flujo retrógrado. En los estudios de imagen se observaron varices intracraneales en el 83% de los casos. La angiografía cerebral mostró arterias fistulosas provenientes de la circulación anterior en el (..) (AU)

[Endovascular treatment of non-galenic pial arteriovenous fistulas]. / Tratamiento endovascular de las fístulas arteriovenosas piales no galénicas.

INTRODUCTION AND OBJECTIVES: Pial arteriovenous fistulas are infrequent vascular malformations. They are generally congenital and their natural history is ominous. The objective of this work is to describe our experience in their endovascular management and to review the existing literature. PATIENTS AND METHODS: This is a retrospective and descriptive study of patients treated by endovascular approach during 3 years at 3 Latin-American hospitals. RESULTS: The study included 6 patients with a mean age of 22 years. One case was caused by cranial trauma. In total, 50% suffered intracranial haemorrhage and 66% developed symptoms attributable to volume effect or retrograde blood flow. Intracranial varices were identified by CT and MRI scans in 83% of cases. Digital subtraction angiography showed arteriovenous fistulas from anterior circulation in 67% of cases and deep venous drainage in 50%. One endovascular procedure was performed in 5 cases (83%), while 2 procedures were required in one case. A single embolic agent was used to occlude fistulas in 67% of cases; whilst 33% required a combination. Coils were used in 4 cases (67%) and onyx was injected in another 4 (67%). One case required stent and balloon deployment. The fistulas were uneventfully occluded in all cases. The follow-up period was one year in 5 cases and 6 months in one case. All patients remained symptom-free. CONCLUSIONS: Endovascular management can be considered as the treatment of choice. It consists in the embolisation of arterial pedicles with one or more embolic agents and should be performed as close as possible to the drainage vein, avoiding migration of the embolic agent towards the venous side.

Proteomic approach to identify changes in protein expression modified by 17beta-oestradiol in bovine vascular smooth muscle cells.

The aim of the present study was to use proteomics to analyse modifications in the level of expression of different proteins in BVSMCs (bovine vascular smooth muscle cells) incubated in the absence and presence of 17beta-oestradiol. By using two-dimensional electrophoresis with a pH range of 4-7, we identified several areas on the gels in which the level of expression of proteins were different between control BVSMCs and cells incubated for 24 h with 17beta-oestradiol. Changes in several isoforms of alpha-enolase, HSP60 (heat-shock protein 60), vimentin and PDI (protein disulphide-isomerase) were observed in BVSMCs. The expression of alpha-enolase isoform 1 was enhanced after 17beta-oestradiol treatment. The expression of HSP60 isoform 3, vimentin isoforms 2 and 3 and caldesmon was reduced by 17beta-oestradiol. Finally, the expression of PDI isoforms was reduced by 17beta-oestradiol. In summary, 17beta-oestradiol modified the expression of isoforms of proteins associated with smooth muscle cell proliferation (alpha-enolase, vimentin and HSP-60), cell contraction (vimentin and caldesmon) and cell redox modulation (PDI). These findings confirm that 17beta-oestradiol may modulate a wide range of signalling pathways in vascular smooth muscle cells.

Endothelial hypoxic preconditioning in rat hypoxic isolated aortic segments.

Our aim was to analyse endothelial hypoxic preconditioning after hypoxia-reperfusion (HR). Endothelial functionality was analysed through the vasorelaxation responses to acetylcholine (Ach) and the level of serine1177 phosphorylated endothelial nitric oxide synthase (eNOS) (ser1177-eNOS) measured by Western blot in in vitro hypoxic preconditioned (P + HR) isolated rat aortic segments. Relaxation in response to Ach was reduced in phenylephrine-precontracted aortic segments after HR (control: IC50, 5 +/- 2.5 x 10(-8) mol l(-1); HR: IC50, 3 +/- 1.2 x 10(-7) mol l(-1); P < 0.05). Ach-dependent vasodilatation was improved by P + HR. The content of ser1177-eNOS in the HR segments was 1.5-fold lower than in P + HR. Confocal microscopy showed an increased content of both superoxide anion and peroxynitrite in the vascular wall of HR aortic segments, which it was reduced by P + HR. Geldanamycin (10 microg ml(-1)), an agent known to inhibit heat shock protein 90 (hsp90), reduced the level of ser1177-eNOS in P + HR aortic segments. However in the presence of geldanamycin, endothelial hypoxic preconditioning persisted. We conclude that short periods of hypoxia induced endothelial hypoxic preconditioning that was accompanied by enhanced levels of ser1177-eNOS in the vascular wall. The fact that endothelial hypoxic preconditioning persisted in the presence of geldanamycin suggests that other molecular mechanisms are involved in the endothelial adaptation to HR injury.

Inflamación y disfunción del endotelio / Inflammation and endothelial dysfunction

La disfunción endotelial es una patología que antecede a las patologías de origen vascular. La disfunción endotelial se ha definido como una reducción en la respuesta vasodilatadora dependiente del endotelio y del sistema del oxido nítrico (NO). Los mecanismos causantes de la disfunción endotelial no están totalmente definidos y en este artículo se hace una revisión de las más estudiadas. En este sentido, es conocido que cuando existe disfunción endotelial se favorece la activación de las plaquetas facilitándose la formación de trombos. Pero también las plaquetas podrían participar directamente en la génesis y progresión de la disfunción endotelial

Endothelial dysfunction is a pathology that appears early before any morphological vascular alteration could be detected. Endothelial dysfunction has been defined as a reduction in the endothelium and nitric oxide (NO)- dependente vasorelaxation response. The mechanisms involved in the genesis and development of endothelial dysfunction have not defined at all. In the present work, we have reviewer same of the main studied mechanisms associated with endothelial dysfunction. In this regard, it is well known that the existence of endothelial dysfunction provoked the activation of platelets although less is known if platelets by themselves could be also involved in the genesis and progression of endothelial dysfunction

Effect of C-reactive protein on Fcgamma receptor II in cultured bovine endothelial cells.

The major CRP (C-reactive protein) receptor on leucocytes has been identified as the low-affinity IgG receptor Fcgamma receptor II (CD32). Our aim was to assess whether inflammation may modify the presence of the CD32 receptor in BAEC (bovine aortic endothelial cells). Confocal microscopy experiments showed a weak expression of the CD32 receptor in control BAEC that was slightly increased by 10 microg/ml CRP. Incubation of BAEC with TNF-alpha (tumour necrosis factor-alpha) did not modify the fluorescence signal of CD32. Addition of CRP to TNF-alpha-incubated BAEC enhanced the fluorescence signal of the CD32 receptors. The CD32 receptors showed a perinuclear cytoplasmic localization in BAEC. An alteration of the NO (nitric oxide)-dependent vasorelaxation has been defined as endothelial dysfunction. Endothelial dysfunction has been associated with the presence of superoxide anion and with a reduction in the expression of the eNOS (endothelial NO synthase). A concentration of CRP similar to that detected in patients with cardiovascular risk (10 microg/ml) failed to modify the generation of superoxide anion stimulated by TNF-alpha. Western blot experiments showed that TNF-alpha decreased the expression of the eNOS protein, which was partially protected by treatment with 10 microg/ml CRP. The protective effect of 10 microg/ml CRP on eNOS expression in TNF-alpha-incubated BAEC was prevented by an antibody against CD32 receptors. In conclusion, the present results suggest that, although CRP has been associated with inflammation, CRP may protect the expression of eNOS protein against pro-inflammatory mediators such as TNF-alpha.

Proteomic analysis of plasma from patients during an acute coronary syndrome.

OBJECTIVES: The aim of this study was to analyze modifications in the plasma protein map during an acute coronary syndrome (ACS) using proteomics. BACKGROUND: Proteomics is a new technology that allows the detection and identification of several proteins at a given time in a sample. METHODS: Plasma from 19 patients, 11 with acute myocardial infarction (AMI) and 8 with unstable angina (UA), was investigated. The control group included nine age-matched volunteers. RESULTS: In two-dimensional electrophoresis using a pH range of 4 to 7, constant differences were found in at least four different areas within the plasma protein map. In area 1, we identified the presence of seven alpha(1)-antitrypsin (AAT) isoforms in plasma from control subjects. alpha(1)-antitrypsin isoform 1 was undetectable in plasma from UA and AMI patients. The AAT isoforms 5, 6, and 7 were reduced in plasma from AMI patients when compared with UA patients. Three fibrinogen gamma chain isoforms were identified in area 2. Fibrinogen gamma chain isoforms 1 and 2 were increased in AMI patients with respect to UA patients. Five apolipoprotein A-I isoforms were identified in area 3. All of them were reduced in plasma from AMI patients with respect to UA patients. In area 4, the gamma-immunoglobulin heavy chains were detected and were found increased in plasma from ACS patients. CONCLUSIONS: Plasma proteomic analysis makes it possible to develop a map of the protein isoforms that are expressed in plasma during an ACS.

Aspirin inhibits endothelial nitric oxide synthase (eNOS) and Flk-1 (vascular endothelial growth factor receptor-2) prior to rat colon tumour development.

Formation of blood vessels is a fundamental element in the control of tumour growth in which vascular endothelial growth factor (VEGF) and nitric oxide (NO) have been demonstrated to be involved. Our aim was to analyse whether changes in the expression of endothelial NO synthase (eNOS) and VEGF in colonic tissue could be detected early and even before the identification of colon tumour-associated morphological modifications in azoxymethane-treated rats. We studied further whether aspirin treatment changed these parameters. An increased expression of both eNOS and VEGF in colonic tissue from azoxymethane-treated rats compared with that from control rats was found. Aspirin treatment (10 mg/kg of body weight per day) reduced eNOS expression, but failed to modify the expression of VEGF in the colonic tissue of azoxymethane-treated rats. No evidence of aberrant crypt formation or changes in the number of blood vessels were observed in the colon of any of the animals studied. Expression of the VEGF receptor Flk-1, but not Flt-1, was increased in colonic tissue of azoxymethane-treated rats compared with control rats. The expression of Flk-1 was mainly localized in the epithelial cells, particularly in the lower part of the crypt. Aspirin treatment reduced Flk-1 expression in both control and azoxymethane-treated rats. Caspase-3 activity, which has been considered as an apoptotic index, was almost undetectable in azoxymethane-treated rats. Aspirin treatment stimulated caspase-3 activity. Overexpression of eNOS, VEGF and its receptor Flk-1 occurred early after azoxymethane administration in rat colonic tissue, even before morphological changes associated with tumour generation were observed, and aspirin prevented the overexpression of both eNOS and VEGF receptor Flk-1.

Endothelin-1 induced proinflammatory markers in the myocardium and leukocytes of guinea-pigs: role of glycoprotein IIB/IIIA receptors.

AIM: To assess whether endothelin-1 (ET-1) induces the in vivo expression of inflammatory-related proteins, namely cyclooxygenase-2 (COX-2) and tissue factor, in the myocardium and circulating leukocytes of guinea-pigs. The involvement of platelets was also analyzed. METHODS: ET-1 (0.013 microg/min) was infused to male guinea-pigs for 45 min in the presence and absence of tirofiban, a nonpeptidic blocker of the glycoprotein IIb/IIIa receptor (GPIIb/IIIa). Tissue factor and COX-2 expression were determined by Western blot. RESULTS: No changes in mean arterial pressure and heart rate were detected. ET-1-infused guinea-pigs showed a marked increase in the number of platelets expressing activated GPIIb/IIIa receptors (0.8+/-0.03% vs. 6.5+/-0.2%; P<0.05). Tirofiban (10 microg/Kg bw/min) blunted ex vivo platelet aggregation in response to ADP, although only partially reduced COX-2 and tissue factor expression in both the myocardium and leukocytes of ET-1-infused guinea-pigs. The myocardium of platelet-depleted guinea-pigs also showed a reduced COX-2 expression after ET-1 infusion (57+/-3% reduction; P<0.05). In vitro studies demonstrated that platelets (10(7) and 10(9) platelets/well) enhanced ET-1 (10(-7) mol/l)-induced COX-2 expression in heart slices. CONCLUSION: ET-1 stimulated in vivo the expression of the pro-inflammatory proteins COX-2 and tissue factor in the myocardium and in leukocytes by a mechanism GPIIb/IIIa platelet receptors.

[Effect of HMG-CoA reductase inhibition on endothelial dysfunction-inducing protein in hypercholesterolemic rabbits]. / Efecto de la inhibición de la HMG-CoA reductasa sobre la proteína inductora de disfuncion endotelial en conejos hipercolesterolémicos.

INTRODUCTION AND OBJECTIVES: In our laboratory, we recently obtained evidence that cultured bovine endothelial cells contain cytosolic proteins that form complexes with the 3'-unstranslated region of endothelial nitric oxide synthase (eNOS) mRNA and are associated with its destabilization. The aim of this study was to determine the presence of such proteins and the level of eNOS expression in hypercholesterolemic rabbits as an in vivo model of endothelial dysfunction. METHODS AND RESULTS: Endothelium-dependent relaxation in response to acetylcholine was reduced in aortic segments from hypercholesterolemic rabbits compared with controls. Treatment of hypercholesterolemic rabbits with simvastatin (25 mg/kg body weight/day) restored endothelium-dependent relaxation. Aortic eNOS expression was reduced in hypercholesterolemic rabbits and was accompanied by enhanced binding activity of a 60-KDa cytosolic protein and reduced stability of eNOS mRNA. Simvastatin treatment upregulated eNOS expression and reduced the interaction of cytosolic protein with the 3'-untranslated region of eNOS mRNA. CONCLUSIONS: These results demonstrate the presence of a 60-KDa protein that binds to eNOS mRNA and reduces eNOS expression in the vascular wall.

Efecto de la inhibición de la HMG-CoA reductasa sobre la proteína inductora de disfunción endotelial en conejos hipercolesterolémicos / Effect of HMG-CoA reductase inhibition on endothelial dysfunction-inducing protein in hypercholesterolemic rRabbits

Introducción y objetivos. Recientemente se ha demostrado en nuestro laboratorio que las células endoteliales en cultivo expresan proteínas citosólicas que forman complejos con el ARNm de la óxido nítrico sintasa endotelial (NOSe) en la región 3' que no codifica para proteína (3'-UTR). Esta unión fue asociada con la desestabilización del ARNm de dicha enzima. El objetivo de este estudio fue determinar la presencia de estas proteínas citosólicas y el nivel de expresión de la proteína NOSe en la pared vascular de conejos hipercolesterolémicos como un modelo in vivo de disfunción endotelial. Métodos y resultados. La relajación dependiente del endotelio a acetilcolina estuvo reducida en segmentos aórticos de conejos hipercolesterolémicos comparados con los conejos control. El tratamiento de los conejos hipercolesterolémicos con simvastatina (25 mg/kg peso/día) restauró la relajación dependiente del endotelio.La expresión de NOSe se encontró reducida en la pared vascular de los conejos hipercolesterolémicos, lo cual se acompañó de un aumento en la capacidad de unión de la proteína citosólica de 60 kDa y de una reducción en la estabilidad del ARNm de la NOSe. El tratamiento con simvastatina aumentó la expresión de NOSe y redujo la interacción de la proteína citosólica a la región 3'-UTR del ARNm de la NOSe. Conclusiones. Estos resultados demuestran una relación entre la presencia de la proteína de 60 kDa y la abundancia de NOSe en la pared vascular y la funcionalidad endotelial (AU)

Nitric oxide production by neutrophils obtained from patients during acute coronary syndromes: expression of the nitric oxide synthase isoforms.

OBJECTIVES: To analyze the differences in the nitric oxide (NO) forming system between neutrophils obtained from patients during unstable angina (UA) and during acute myocardial infarction (AMI). BACKGROUND: Neutrophils are involved in the regulation of thrombus formation through the release of active substances such as NO. Acute myocardial infarction is the result of an occlusive thrombus; unstable angina is attributed to intermittent thrombus formation. METHODS: We studied 49 patients admitted to hospital within 24 h after the onset of chest pain: 31 experienced AMI and 18 experienced UA. Acute myocardial infarction was defined as CK greater than two-fold the upper limit of normal value of biochemical laboratory, with CK-MB >10% total CK. Unstable angina was defined as transient ST segment changes without significant increases in CK and CK-MB. RESULTS: The amount of NO generated by neutrophils from AMI patients was significantly higher than that generated by neutrophils from UA patients. Neutrophils from UA and AMI patients showed low levels of endothelial-like NO synthase protein expression and a marked expression of the inducible NO synthase (iNOS) isoform. Although neutrophils from patients during acute coronary syndromes generated high amounts of NO, they did not demonstrate an increased ability to stimulate cyclic guanosine monophosphate (cGMP) synthesis in platelets. This lack of activity to release NO by neutrophils from patients during AMI was unrelated to a defect in the platelet cGMP-forming system; sodium nitroprusside, an exogenous NO donor, similarly increased cGMP levels in platelets from AMI patients and healthy donors. CONCLUSIONS: Neutrophils from patients during AMI and UA showed an increased production of NO and a marked expression of the iNOS isoform. However, NO released from these neutrophils showed a deficient functionality. These findings could have clinical implications because they show differences in thrombus growth in patients with UA versus patients with AMI.