Human immunology studies using organ donors: Impact of clinical variations on immune parameters in tissues and circulation.

Organ donors are sources of physiologically healthy organs and tissues for life-saving transplantation, and have been recently used for human immunology studies which are typically confined to the sampling of peripheral blood. Donors comprise a diverse population with different causes of death and clinical outcomes during hospitalization, and the effects of such variations on immune parameters in blood and tissues are not known. We present here a coordinate analysis of innate and adaptive immune components in blood, lymphoid (bone marrow, spleen, lymph nodes), and mucosal (lungs, intestines) sites from a population of brain-dead organ donors (2 months-93 years; n = 291) across eight clinical parameters. Overall, the blood of donors exhibited similar monocyte and lymphocyte content and low serum levels of pro-inflammatory cytokines as healthy controls; however, donor blood had increased neutrophils and serum levels of IL-8, IL-6, and MCP-1 which varied with cause of death. In tissues, the frequency and composition of monocytes, neutrophils, B lymphocytes and T cell subsets in lymphoid or mucosal sites did not vary with clinical state, and was similar in donors independent of the extent of clinical complications. Our results reveal that organ donors maintain tissue homeostasis, and are a valuable resource for fundamental studies in human immunology.

Inflammation markers and their trajectories after deep vein thrombosis in relation to risk of post-thrombotic syndrome.

BACKGROUND: Post-thrombotic syndrome (PTS) is a frequent chronic complication of deep vein thrombosis (DVT). OBJECTIVE: In the BioSOX study, we investigated whether inflammation markers predict the risk of PTS after DVT. METHODS: We measured C-reactive protein (CRP), ICAM-1, interleukin (IL)-6, and IL-10, at baseline, and 1 month and 6 months after a first proximal DVT, among 803 participants in the SOX trial. Participants were prospectively followed for 24 months for development of PTS. RESULTS: Median CRP levels at 1 month, ICAM-1 levels at baseline, 1 month and 6 months, IL-6 levels at 1 month and 6 months and IL-10 levels at 6 months were higher in patients who developed PTS than in those who did not. Multivariable regression with the median as a cutoff showed risk ratios (RRs) for PTS of 1.23 (95% confidence interval [CI] 1.05-1.45) and 1.25 (95% CI 1.05-1.48) for ICAM-1 at 1 month and 6 months, respectively, and 1.27 (95% CI 1.07-1.51) for IL-10 at 6 months. Quartile-based analysis demonstrated a dose-response association between ICAM-1 and PTS. ICAM-1 and IL-10 were also associated with PTS severity. Analysis of biomarker trajectories after DVT demonstrated an association between the highest-trajectory group of ICAM-1 and PTS. CONCLUSIONS: In this prospective study, ICAM-1 over time was most consistently associated with the risk of PTS. Further study is required to confirm these findings and assess their potential clinical relevance.

Graduated compression stockings to treat acute leg pain associated with proximal DVT. A randomised controlled trial.

Acute deep venous thrombosis (DVT) causes leg pain. Elastic compression stockings (ECS) have potential to relieve DVT-related leg pain by diminishing the diameter of distended veins and increasing venous blood flow. It was our objective to determine whether ECS reduce leg pain in patients with acute DVT. We performed a secondary analysis of the SOX Trial, a multicentre randomised placebo controlled trial of active ECS versus placebo ECS to prevent the post-thrombotic syndrome.The study was performed in 24 hospital centres in Canada and the U.S. and included 803 patients with a first episode of acute proximal DVT. Patients were randomised to receive active ECS (knee length, 30-40 mm Hg graduated pressure) or placebo ECS (manufactured to look identical to active ECS, but lacking therapeutic compression). Study outcome was leg pain severity assessed on an 11-point numerical pain rating scale (0, no pain; 10, worst possible pain) at baseline, 14, 30 and 60 days after randomisation. Mean age was 55 years and 60% were male. In active ECS patients (n=409), mean (SD) pain severity at baseline and at 60 days were 5.18 (3.29) and 1.39 (2.19), respectively, and in placebo ECS patients (n=394) were 5.38 (3.29) and 1.13 (1.86), respectively. There were no significant differences in pain scores between groups at any assessment point, and no evidence for subgroup interaction by age, sex or anatomical extent of DVT. Results were similar in an analysis restricted to patients who reported wearing stockings every day. In conclusion, ECS do not reduce leg pain in patients with acute proximal DVT.

Electrochemiluminescent disposable cholesterol biosensor based on avidin-biotin assembling with the electroformed luminescent conducting polymer poly(luminol-biotinylated pyrrole).

An electrochemiluminescent cholesterol disposable biosensor has been prepared by the formation of assembled layers on gold screen-printed cells. The detection layer is based on the electro-formation of new luminol copolymers with different synthesized biotinylated pyrroles prepared by click-chemistry, offering a new transduction layer with new electroluminescent properties on biosensors. The electrochemiluminescence (ECL) luminol copolymers are electroformed by cyclic voltammetry (five cycles) at pH 7.0 uses a10(-3)M biotinylated pyrrole-luminol ratio of 1:10 in PBS buffer. With respect to the recognition layer, cholesterol oxidase was biotinylated by incubation with biotin vinyl sulfone, and immobilized on the copolymer by avidin-biotin interaction. The analytical signal of the biosensor is the ECL enzymatic initial rate working in chronoamperometric mode at 0.5V excitation potential with 10s between pulses at pH 9.5. The disposable device offers a cholesterol linear range from 1.5×10(-5)M to 8.0×10(-4)M with a limit of detection of 1.47×10(-5)M and accuracy of 7.9% for 9.0×10(-5)M and 14.1% for 2.0×10(-4)M, (n=5). Satisfactory results were obtained for cholesterol determination in serum samples compared to a reference procedure.

SPE biosensor for cholesterol in serum samples based on electrochemiluminescent luminol copolymer.

A poly(luminol-3,3',5,5'-tetramethylbenzidine) copolymer manufactured by electropolymerization on screen-printed gold electrodes greatly improves the electrochemiluminescence of hydrogen peroxide. Cholesterol oxidase was immobilized on the surface of a poly(luminol-3,3',5,5'-tetramethylbenzidine) screen-printed cell modified with chitosan to prepare an ECL biosensor for cholesterol. Working under the optimized conditions, the linear dynamic range of cholesterol was 2.4 × 10(-5)-1.0 × 10(-3)M with a limit of detection of 7.3 × 10(-6)M and a precision of 10.3% (5.0 × 10(-4)M, n=5) expressed as relative standard deviation. This biosensor was applied to the determination of total cholesterol in serum samples obtaining satisfactory results with respect to the reference procedure. This cholesterol biosensor offers an alternative analytical method with low cost and high speed.

Economic burden and cost determinants of deep vein thrombosis during 2 years following diagnosis: a prospective evaluation.

BACKGROUND: Few studies have evaluated the long-term economic consequences of deep vein thrombosis (DVT). None of them have incorporated prospectively collected clinical data to ensure accurate identification of incident cases of DVT and DVT-related health outcomes of interest, such as post-thrombotic syndrome (PTS). OBJECTIVES: To prospectively quantify medical and non-medical resource use and costs related to DVT during 2 years following diagnosis, and to identify clinical determinants of costs. METHODS: Three hundred and fifty-five consecutive patients with acute DVT were recruited at seven Canadian hospital centers. Resource use and cost information were retrieved from three sources: weekly patient-completed cost diaries, nurse-completed case report forms, and the Quebec provincial administrative healthcare database (RAMQ). RESULTS: The rate of DVT-related hospitalization was 3.5 per 100 patient-years (95% confidence interval [CI] 2.2-4.9). Patients reported a mean (standard deviation) of 15.0 (14.5) physician visits and 0.7 (1.2) other healthcare professional visits. The average cost of DVT was $5180 (95% CI $4344-6017) in Canadian dollars, with 51.6% of costs being attributable to non-medical resource use. Multivariate analysis identified four independent predictors of costs: concomitant pulmonary embolism (relative increase in cost [RIC] 3.16; 95% CI 2.18-4.58), unprovoked DVT (RIC 1.65; 95% CI 1.28-2.13), development of PTS during follow-up (RIC 1.35; 95% CI 1.05-1.74), and management of DVT in the inpatient setting (RIC 1.79; 95% CI 1.33-2.40). CONCLUSIONS: The economic burden of DVT is substantial. The use of measures to prevent the occurrence of PTS and favoring outpatient care of DVT has the potential to diminish costs.

Disposable luminol copolymer-based biosensor for uric acid in urine.

A new electrochemiluminescent (ECL) disposable biosensor for uric acid was manufactured by immobilization in a double-layer design of luminol as a copolymer with 3,3',5,5'-tetramethylbenzidine (TMB) and the enzyme uricase in chitosan on gold screen-printed cells. The good mechanical and improved electroluminescent characteristics of the new copolymer poly(luminol-TMB) make it possible to determine uric acid by measuring the growing ECL emission with the analyte concentration. The combination of enzymatic selectivity with ECL sensitivity results in a disposable analytical device with a linear range for uric acid from 1.5×10(-6) to 1.0×10(-4) M, a limit of detection of 4.4×10(-7) M and a precision of 13.1% (1.0×10(-5) M, n=10) as relative standard deviation. Satisfactory results were obtained for uric acid determination in 24h-urine samples compared to a reference procedure. This uric acid biosensor can be used as a low-cost alternative to conventional methods.

Copolymerization of luminol on screen-printed cells for single-use electrochemiluminescent sensors.

An efficient electrochemiluminescent (ECL) single-use sensor for H(2)O(2) is presented based on an electropolymerized film prepared on screen-printed gold electrode (gold SPE). A study of the copolymerization of luminol in the presence of different monomers was carried out. The polymeric films were grown potentiodynamically with a potential interval between -0.2 and 1.0 V in 0.2 M H(2)SO(4) and were characterized by their electrochemical, electrochemiluminescent, and superficial features. The polymer with the most efficient growth and ECL emission was poly(luminol-3,3',5,5'-tetramethylbenzidine) at 1:5 ratio. These prepared SPE cells present good mechanical and photoemissive properties. A semi-logarithmic linearization shows a noticeable four decade-width concentration range with a limit of detection (LOD) of 2.6 × 10(-9) M and a precision of 10.2% (n = 5; as relative standard deviation, RSD) in the medium range level. The described SPE ECL sensors will be useful for the determination of oxidase substrates in ECL single-use biosensors.

Relation between D-dimer level, venous valvular reflux and the development of post-thrombotic syndrome after deep vein thrombosis.

BACKGROUND: The pathophysiology of post-thrombotic syndrome (PTS) is postulated to involve persistent venous obstruction and venous valvular reflux. OBJECTIVE: To study the association between D-dimer level, valvular reflux and the PTS in a well-defined cohort of deep vein thrombosis (DVT) patients. METHODS: Consecutive patients with acute symptomatic DVT were recruited at eight centers and were followed for 24months. D-dimer was measured at 4months. A standardized ultrasound assessment for popliteal valvular reflux was performed at 12months. Using the Villalta scale, patients were assessed for PTS during follow-up by evaluators who were unaware of D-dimer or reflux results. RESULTS: Three hundred and eighty-seven patients were recruited; of these, 305 provided blood samples for D-dimer and 233 had a 12-month reflux assessment. PTS developed in 45.1% of subjects. Mean D-dimer was significantly higher in patients with vs. without PTS (712.0 vs. 444.0µgL(-1) ; P=0.02). In logistic regression analyses adjusted for warfarin use at the time of D-dimer determination and risk factors for PTS, D-dimer level significantly predicted PTS (P=0.03); when stratifying for warfarin use at the time of blood draw, adjusted odds ratio (OR) for developing PTS per unit difference in log D-dimer was 2.33 (95% CI 0.89, 6.10) in those not on warfarin vs. 1.25 (95% CI 0.87, 1.79) in those on warfarin. Ipsilateral reflux was more frequent in patients with moderate-to-severe PTS than in patients with mild PTS (65% vs. 40%, respectively; P=0.01) and was independently associated with moderate-to-severe PTS in logistic regression analyses (P=0.01). CONCLUSION: D-dimer levels, measured 4months after DVT in patients not on warfarin, are associated with subsequent development of PTS. Venous valvular reflux is associated with moderate-to-severe PTS.

Disposable electrochemiluminescent biosensor for lactate determination in saliva.

An electrochemiluminescence-based disposable biosensor for lactate is characterized. The lactate recognition system is based on lactate oxidase (LOx) and the transduction system consists of luminol. All the needed reagents, luminol, LOx, BSA, electrolyte and buffer have been immobilized by a Methocel membrane placed on the working electrode of the screen-printed electrochemical cell. The measurement of the electrochemiluminescence (ECL) is made possible via a photocounting head when 50 microl of sample is placed into the screen-printed cell with a circular container containing the disposable sensing membrane. The compositions of the membrane and reaction conditions have been optimized to obtain adequate sensitivity. The disposable biosensor responds to lactate after 20 s when two 1 s pulses at 0.5 V are applied to obtain the analytical parameter, the ECL initial rate. The linearized double logarithmic dependence for lactate shows a dynamic range from 10(-5) to 5 x 10(-4) M with a detection limit of 5 x 10(-6) M and a sensor-to-sensor repeatability, as relative standard deviation, RSD, of 3.30% at the medium level of the range. The ECL disposable biosensor was applied to the analysis of lactate in human saliva as an alternative procedure for obtaining the lactate level in a non-invasive way. Interferences coming from components of saliva were studied and eliminated in a simple way that was easy to handle. The procedure was validated for use in human saliva, comparing the results against an enzymatic reference procedure. The proposed method is quick, inexpensive, selective and sensitive and uses conventional ECL instrumentation.

The adenovirus E4orf4 protein induces growth arrest and mitotic catastrophe in H1299 human lung carcinoma cells.

The human adenovirus E4orf4 protein, when expressed alone, induces p53-independent death in a wide range of cancer cells. Earlier studies by our groups suggested that although in some cases cell death can be associated with some hallmarks of apoptosis, it is not always affected by caspase inhibitors. Thus it is unlikely that E4orf4-induced cell death occurs uniquely through apoptosis. In the present studies using H1299 human lung carcinoma cells as a model system we found that death is induced in the absence of activation of any of the caspases tested, accumulation of reactive oxygen species, or release of cytochrome c from mitochondria. E4orf4 caused a substantial change in cell morphology, including vigorous membrane blebbing, multiple nuclei in many cells and increased cell volume. Most of these characteristics are not typical of apoptosis, but they are of necrosis. FACS analysis and western blotting for cell cycle markers showed that E4orf4-expressing cells became arrested in G(2)/M and also accumulated high levels of cyclin E. The presence of significant numbers of tetraploid and polyploid cells and some cells with micronuclei suggested that E4orf4 appears to induce death in these cells through a process resulting from mitotic catastrophe.

One-shot lactate chemiluminescent biosensor.

A new chemiluminescence-based one-shot biosensor for lactate is described. The lactate recognition system is based on lactate oxidase (LOx) and the transduction system consists of luminol, peroxidase from Arthromyces ramosus (ARP) and metallic aluminum, all immobilized in a polyion complex membrane. The measurement of the chemiluminescence in a luminometer when 1 mL of sample is injected into a conventional cell containing the disposable sensing membrane makes it possible to determine lactate. The compositions of the membrane and reaction conditions have been optimized to obtain adequate sensitivity. The one-shot biosensor responds to lactate rapidly, with the typical CL acquisition time being 2 min, with a linearized logarithmic dependence whose dynamic range was from 5 x 10(-5) to 4 x 10(-3) with a detection limit of 9.2 x 10(-6)M and a sensor-to-sensor reproducibility (relative standard deviation, R.S.D.) of 5.5% at the medium level of the range. The performance of the chemiluminescent one-shot biosensor was tested for the analysis of lactate in yoghurt, validating the results against an enzymatic reference procedure. The proposed method is quick, inexpensive and sensitive and uses conventional CL instrumentation.

Determinants of health-related quality of life during the 2 years following deep vein thrombosis.

BACKGROUND/OBJECTIVES: We prospectively measured change in quality of life (QOL) during the 2 years after a diagnosis of deep vein thrombosis (DVT) and evaluated determinants of QOL, including development of the post-thrombotic syndrome (PTS). PATIENTS/METHODS: Consecutive patients with acute DVT were recruited from 2001 to 2004 at eight hospitals in Canada. At study visits at baseline, and 1, 4, 8, 12 and 24 months, clinical data were collected, standardized PTS assessments were performed, and QOL questionnaires were self-completed. Generic QOL was measured using the Short-Form Health Survey-36 (SF-36) questionnaire. Venous disease-specific QOL was measured using the Venous Insufficiency Epidemiological and Economic Study (VEINES)-QOL/Sym questionnaire. The change in QOL scores over a 2-year follow-up was assessed. The influence of PTS and other characteristics on QOL at 2 years was evaluated using multivariable regression analyses. RESULTS: Among the 387 patients recruited, the average age was 56 years, two-thirds were outpatients, and 60% had proximal DVT. The cumulative incidence of PTS was 47%. On average, QOL scores improved during follow-up. However, patients who developed PTS had lower scores at all visits and significantly less improvement in QOL over time (P-values for PTS*time interaction were 0.001, 0.012, 0.014 and 0.006 for PCS, MCS, VEINES-QOL and VEINES-Sym). Multivariable regression analyses showed that PTS (P < 0.0001), age (P = 0.0009), proximal DVT (P = 0.01) and inpatient status (P = 0.04) independently predicted 2-year SF-36 PCS scores. PTS alone independently predicted 2-year VEINES-QOL (P < 0.0001) and VEINES-Sym (P < 0.0001) scores. CONCLUSIONS: Development of PTS is the principal determinant of health-related QOL 2 years after DVT. Our study provides prognostic information on patient-reported outcomes after DVT and emphasizes the need for effective prevention and treatment of the PTS.

Ammonia excretion increased and urea excretion decreased in urine of a new world nectarivorous bat with decreased nitrogen intake.

We determined the effect of water and nitrogen intake on nitrogenous waste composition in the nectarivorous Pallas's long-tongued bat Glossophaga soricina (Phyllostomidae) to test the hypothesis that bats reduce excretion of urea nitrogen and increase the excretion of ammonia nitrogen as nitrogen intake decreases and water intake decreases. Because changes in urine nitrogen composition are expected only in animals whose natural diets are low in nitrogen and high in water content, we also measured maintenance nitrogen requirements (MNR). We hypothesized that, similar to other plant-eating vertebrates, nectarivorous bats have low MNR. Our nitrogen excretion hypothesis was partly proved correct. There was an increase in the proportion of N excreted as ammonia and a decrease in the proportion excreted as urea in low-nitrogen diets. The proportion of N excreted as ammonia and urea was independent of water intake. Most individuals were ureotelic (n = 28), and only a few were ureo-ammonotelic (n = 3) or ammonotelic (n = 2). According to our nitrogen requirement hypothesis, apparent MNR (60 mg kg(-0.75) d(-1)) and truly digestible MNR (54 mg N kg(-0.75) d(-1)) were low. A decrease in urea excretion in low-nitrogen diets may result from urea recycling from liver to the gut functioning as a nitrogen salvage system in nectarivorous bats. This mechanism probably contributes to the low MNR found in Pallas's long-tongued bats.

Effect of diet quality on carbon and nitrogen turnover and isotopic discrimination in blood of a New World nectarivorous bat.

Diet composition of carbon and nitrogen (C:N) could affect diet-tissue isotopic discrimination and elemental turnover rate in consumers but studies that test the nature of these changes are scarce. We compared carbon and nitrogen isotopic discrimination and turnover rates in individuals of Pallas' long-tongued bats Glossophaga soricina fed diets with protein soya isolate or amaranth grains as their main source of protein. Diets were of similar protein biological value but the soya diet had higher nitrogen content (2.2%N) and lower C:N ratio (39.6) than the amaranth diet (1.3%N, C:N=40.5). Most bats on the soya diet gained body mass whereas most bats on the amaranth diet lost body mass. Half-lives of carbon (24.3+/-3.8 days) and nitrogen (25.6+/-4.4 days) in bats switched to the soya diet were very similar. In contrast, in the bats switched to the amaranth diet, carbon half-life (39.7+/-3.4 days) was longer than that of nitrogen (25.0+/-6.0 days). The enrichment in 15N between diet and blood was higher when bats were fed the amaranth diet (4.4+/-0.2 per thousand) than when they were fed the soya diet (3.3+/-0.2 per thousand). Similarly, bats on the amaranth diet had higher 13C enrichment (2.0+/-0.2 per thousand) than bats on the soya diet (0.1+/-0.1 per thousand). Our results support recent hypotheses of the effect of nutrition on diet-tissue isotopic discrimination and turnover rate, and further shows that blood stable isotope analysis is an adequate approach to track seasonal dietary shifts in wild bats.

Influencia del empleo de opioides epidurales durante el parto / Impact of the use of epidural opiates during labour

Objetivos: Analizar la relación entre el empleo de opioides en la analgesia epidural obstétrica y su posible repercusión sobre la evolución y finalización del parto, así como sobre diversas variables obstétrico-fetales. Material y métodos: Estudio retrospectivo y observacional que incluyó a todas las mujeres que dieron a luz en el Complejo Hospitalario de Segovia durante un periodo de 8 meses. La analgesia epidural obstétrica, cuando se administró, consistió en una perfusión de bupivacaína al 0,125% más fentanilo a 2 µg.mL-1 (grupo F), o en una perfusión de bupivacaína al 0,125% (grupo B). Se recogieron los siguientes parámetros: edad, nuliparidad, administración de analgesia epidural (sí/no), tipo de parto, duración de la dilatación, duración del expulsivo, causa de la cesárea, peso fetal, test de Apgar y pH arterial umbilical fetal. Resultados: Se recogieron datos de 576 mujeres. Se administró analgesia epidural en el 47,7% de las parturientas, de las cuales 29,4% recibieron fentanilo en la perfusión continua. La duración de los periodos de dilatación y expulsivo fue más larga en las mujeres con analgesia epidural (p = 0,01 y p = 0,03, respectivamente), con independencia de que recibieran o no opioides epidurales. La analgesia epidural con y sin opioides también se asoció a un mayor riesgo de parto instrumental (28%; p = 0,006), pero no a un incremento de la tasa de cesáreas. Las pacientes que recibieron opioides epidurales presentaron fiebre intraparto en el 12,8% de los casos, frente al 7,1% de las que sólo recibieron bupivacaína en la perfusión. Estas diferencias no se mostraron estadísticamente significativas. Conclusiones: La analgesia epidural durante el parto no modificó el bienestar fetal ni la tasa de partos mediante cesárea, pero sí alteró la dinámica del parto, provocando una prolongación de las fases del mismo, mayor número de partos instrumentados y una alteración en la regulación de la temperatura materna. La adición de fentanilo epidural no modificó en absoluto la asociación existente entre la analgesia epidural y dichas variables (AU)

Objectives: To analyze the relationship between the use of opiates for obstetric epidural analgesia and its potential impact on the evolution and termination of labour, as well as on other obstetric-fetal variables. Material and methods: Retrospective and observational study that included all women that gave birth at the Hospital Center of Segovia over a 8-month period. Obstetric epidural analgesia, when administered, was provided by infusion of bupivacaine 0.125% plus fentanyl 2 µg.mL-1 (Group F), or by infusion of bupivacaine 0.125% (Group B). The following parameters were determined: age, nulliparity, epidural analgesia (yes/no), type of labour, length of dilatation, length of expulsion, cause of Cesarean, fetal weight, Apgar test and fetal umbilical arterial pH. Results: Data were collected from 576 women. Epidural analgesia was administered to 47.7% of women giving birth, 29.4% of which received fentanyl by continuous perfusion. Dilatation and expulsion periods were longer among women with epidural analgesia (p = 0.01 and p = 0.03, respectively), regardless whether they received or not epidural opiates. Epidural analgesia with or without opiates was also associated to a greater risk of instrumental labour (28%; p = 0.006), but it was not associated to an increased Cesarean rate. Patients that received epidural opiates had intralabour fever in 12.8% of the cases, compared with 7.1% of the women that did not received bupivacaine infusion. These differences were not statistically significant. Conclusions: Epidural analgesia during labour did not modified fetal well-being nor Cesarean labour rate, but it did change labour dynamics, with longer periods, greater number of instrumented labours and altered regulation of maternal temperature. The addition of epidural fentanyl did not change the association between epidural analgesia and such variables (AU)

[Tuberculous chylothorax: case report and review of the literature]. / Quilotórax tuberculoso: caso clínico y revisión de la literatura.

Chylothorax is an unusual manifestation of tuberculous disease. Anecdotal cases of chylothorax due to Mycobacterium tuberculosis have been reported in the literature. We describe a case of tuberculous chylothorax and review the previously published cases. None of these cases was diagnosed by the application of polymerase chain reaction in pleural effusion. This test applied to different specimens has shown high specificity and sensitivity; for this reason, the routine use of this test, on pleural effusion, could be very useful, quick, and few aggressive in the diagnosis of tuberculous chylothorax, especially when chest X-ray is normal.

Quilotórax tuberculoso: caso clínico y revisión de la literatura / Tuberculous chylothorax: case report and review of the literature

El quilotórax es una manifestación infrecuente de la enfermadad tuberculosa. En la literatura se han descrito casos anecdóticos de quilotórax producido por Mycobacterium tuberculosis. Describimos un caso clínico de quilotórax de etiología tuberculosa y revisamos los casos publicados en la literatura médica. En ningún caso el diagnóstico etiológico se realizó mediante la aplicación de la reacción en cadena de polimerasa (PCR) en el líquido de quilotórax. Esta técnica ha demostrado una alta sensibilidad y especificidad cuando se aplica a distintos especímenes; por este motivo, el uso sistemático de esta técnica poco agresiva podría ser de gran utilidad para establecer el diagnóstico precoz del quilotórax tuberculoso especialmente en aquellos casos sin evidencia radiológica de afectación pulmonar

Chylothorax is an inusual manifestation of tuberculous disease. Anecdotal cases of chylothorax due to Mycobacterium Tuberculosis have been reported in the literature. We describe a case of tuberculous chylothorax and review the previously published cases. None of these cases was diagnosed by the aplication of polymerase chain reaction in pleural effusion. This test applaied to different specimenes has shown a high especificity and sensitivity; for this reason, the routin use of this test, on pleural effusion, could be very useful, quick, and few agressive in the diagnosis of tuberculous chylothorax, especially when chest X-ray is normal

Regulation of translation via TOR signaling: insights from Drosophila melanogaster.

The target of rapamycin (TOR) proteins are large protein kinases evolutionarily conserved from yeast to human. A large body of evidence demonstrates that TOR proteins function in a nutrient-sensing checkpoint whose role is to restrict growth under conditions of low nutrient availability. Under such conditions, TOR blocks the transmission of growth-promoting signals from extracellular stimuli. Recent data obtained by genetic studies in the fruit fly Drosophila melanogaster demonstrate the importance of both insulin-like signaling and TOR signaling in promoting growth. Importantly, these studies identified a major downstream target of TOR and insulin-like signaling as the translational machinery.