Spanish cohort of VEXAS syndrome: clinical manifestations, outcome of treatments and novel evidences about UBA1 mosaicism.

BACKGROUND: The vacuoles, E1-enzyme, X linked, autoinflammatory and somatic (VEXAS) syndrome is an adult-onset autoinflammatory disease (AID) due to postzygotic UBA1 variants. OBJECTIVES: To investigate the presence of VEXAS syndrome among patients with adult-onset undiagnosed AID. Additional studies evaluated the mosaicism distribution and the circulating cytokines. METHODS: Gene analyses were performed by both Sanger and amplicon-based deep sequencing. Patients' data were collected from their medical charts. Cytokines were quantified by Luminex. RESULTS: Genetic analyses of enrolled patients (n=42) identified 30 patients carrying UBA1 pathogenic variants, with frequencies compatible for postzygotic variants. All patients were male individuals who presented with a late-onset disease (mean 67.5 years; median 67.0 years) characterised by cutaneous lesions (90%), fever (66.7%), pulmonary manifestations (66.7%) and arthritis (53.3%). Macrocytic anaemia and increased erythrocyte sedimentation rate and ferritin were the most relevant analytical abnormalities. Glucocorticoids ameliorated the inflammatory manifestations, but most patients became glucocorticoid-dependent. Positive responses were obtained when targeting the haematopoietic component of the disease with either decitabine or allogeneic haematopoietic stem cell transplantation. Additional analyses detected the UBA1 variants in both haematopoietic and non-haematopoietic tissues. Finally, analysis of circulating cytokines did not identify inflammatory mediators of the disease. CONCLUSION: Thirty patients with adult-onset AID were definitively diagnosed with VEXAS syndrome through genetic analyses. Despite minor interindividual differences, their main characteristics were in concordance with previous reports. We detected for the first time the UBA1 mosaicism in non-haematopoietic tissue, which questions the previous concept of myeloid-restricted mosaicism and may have conceptual consequences for the disease mechanisms.

Propranolol degradation through processes based on the generation of hydroxyl free radical.

Pharmaceutical substances such as propranolol (PRO) are an emerging class of aquatic contaminants that have increasingly been detected in ground and surface water. For this reason, the aim of this study was to evaluate the efficiency of advanced oxidation systems for the PRO degradation. The tests started with anodic oxidation (AO), using 0.01, 0.05, and 0.1 M Na2SO4 as the supporting electrolyte and 16, 32, 48, and 64 mA cm-2 as current density. Under the best conditions obtained in AO, the electro-Fenton (EF) process was reviewed, where the effect of Fe2+ was analyzed with 5, 10, 15, and 20 mg Fe2+ L-1. The Fenton reaction (FR) was studied using the Fe2+ concentration that promoted the highest percentage of PRO removal and initial concentration of 16 mg L-1 of H2O2, in addition to these conditions, in the photo-Fenton (PF) system, the effect of UV light with wavelengths 254 and 365 nm were evaluated. The results obtained showed that the degradation efficiency of the EF > AO > PF > FR system along with a percent removal of 94.52, 90.4, 25.97, and 4.4%, respectively. The results showed that PRO can be removed through the studied systems, with the EF system being the most efficient.

Alcohol Enhances Responses to High Frequency Stimulation in Hippocampus from Transgenic Mice with Increased Astrocyte Expression of IL-6.

Recent studies show that alcohol exposure can induce glial production of neuroimmune factors in the CNS. Of these, IL-6 has gained attention because it is involved in a number of important physiological and pathophysiological processes that could be affected by alcohol-induced CNS production of IL-6, particularly under conditions of excessive alcohol use. For example, IL-6 has been shown to play a role in hippocampal behaviors and synaptic plasticity (long-term potentiation; LTP) associated with memory and learning. Surprisingly, in our in vitro studies of LTP at the Schaffer collateral to CA1 pyramidal neuron synapse in hippocampus from transgenic mice that express elevated levels of astrocyte produced IL-6 (TG), LTP was not altered by the increased levels of IL-6. However, exposure to acute alcohol revealed neuroadaptive changes that served to protect LTP against the alcohol-induced reduction of LTP observed in hippocampus from non-transgenic control mice (WT). Here we examined the induction phase of LTP to assess if presynaptic neuroadaptive changes occurred in the hippocampus of TG mice that contributed to the resistance of LTP to alcohol. Results are consistent with a role for IL-6-induced neuroadaptive effects on presynaptic mechanisms involved in transmitter release in the resistance of LTP to alcohol in hippocampus from the TG mice. These actions are important with respect to a role for IL-6 in physiological and pathophysiological processes in the CNS and in CNS actions of alcohol, especially when excessive alcohol used is comorbid with conditions associated with elevated levels of IL-6 in the CNS.

Class I defensins (BraDef) from broccoli (Brassica oleracea var. italica) seeds and their antimicrobial activity.

The objective of this study was to determine whether seeds of Brassica oleracea var. italica (i.e. broccoli, an edible plant) produce defensins that inhibit phytopathogenic fungi and pathogenic bacteria of clinical significance. Crude extracts obtained from broccoli seeds were fractioned by molecular exclusion techniques and analyzed by liquid chromatography-high-resolution mass spectrometry. Two peptides were identified, BraDef1 (10.68 kDa) and BraDef2 (9.9 kDa), which were categorized as Class I defensins based on (a) their primary structure, (b) the presence of four putative cysteine disulfide bridges, and (c) molecular modeling predictions. BraDef1 and BraDef2 show identities of, respectively, 98 and 71%, and 67 and 85%, with defensins from Brassica napus and Arabidopsis thaliana. BraDef (BraDef1 + BraDef2) disrupted membranes of Colletotrichum gloeosporioides and Alternaria alternata and also reduced hyphal growth of C. gloeosporioides by ~ 56% after 120 h of incubation. Pathogenic bacteria (Bacillus cereus 183, Listeria monocytogenes, Salmonella typhimurium, Pseudomonas aeruginosa, and Vibrio parahaemolitycus) were susceptible to BraDef, but probiotic bacteria such as Bifidobacterium animalis, Lactobacillus acidophilus, and Lactobacillus casei were not inhibited. To our knowledge, this is the first report of defensins present in seeds of B. oleracea var. italica (i.e. edible broccoli). Our findings suggest an applied value for BraDef1/BraDef2 in controlling phytopathogenic fungi and pathogenic bacteria of clinical significance.

Catatonia in patients with anti-NMDA receptor encephalitis.

AIM: There is a lack of studies related to the frequency, phenomenology, and associated features of catatonic syndrome in patients with anti-NMDA receptor encephalitis (ANMDARE). This study aimed to measure the frequency of catatonia in this condition and to delineate its particular symptoms. METHODS: A prospective study was done with all inpatients who fulfilled the criteria of definite ANMDARE admitted to the National Institute of Neurology and Neurosurgery of Mexico from January 2014 to September 2018. The Bush-Francis Catatonia Rating Scale and Braünig Catatonia Rating Scale were administered at admission. RESULTS: Fifty-eight patients were included and catatonia was diagnosed in 41 of these patients (70.6%). Immobility, staring, mutism, and posturing were the most frequent catatonic signs. Catatonia was associated with delirium, hallucinations, psychomotor agitation, generalized electroencephalography dysfunction, and previous use of antipsychotics. Mortality was present in 10% of the total sample; it was associated with status epilepticus, and was less frequent in the catatonia group. After immunotherapy, all cases showed a complete recovery from catatonic signs. CONCLUSION: This systematic assessment of catatonic syndrome shows that it is a frequent feature in patients with ANMDARE as part of a clinical pattern that includes delirium, psychomotor agitation, and hallucinations. The lack of recognition of this pattern may be a source of diagnostic and therapeutic errors, as most physicians associate catatonia with schizophrenia and affective disorders.

Experience with the HeartMate II Left Ventricular Assist Device in Patients Older than 60 Years.

BACKGROUND: Advanced age is a relative contraindication for heart transplantation, but no age cutoff has been defined for patients receiving mechanical circulatory support. METHODS: Between November 1, 2003 and November 1, 2012, we implanted the HeartMate II (HMII) left ventricular assist device (LVAD) in 319 patients. One hundred seven patients (89 men, 18 women) were over 60 years old (mean, 66 ± 4 years, range, 61-78 years) and received the HMII as a bridge to transplantation (n = 45) or as destination therapy (n = 62). We evaluated their experience by performing a retrospective analysis. RESULTS: Seventy-two patients had ischemic cardiomyopathy, and 34 had idiopathic cardiomyopathy. Three patients (2.8%) already had a HeartMate XVE LVAD, 54 (50.5%) were receiving intra-aortic balloon pump support, 52 (48.6%) had undergone a previous cardiac procedure, and 9 (8.4%) had received renal replacement therapy (RRT) (continuous venovenous hemofiltration, hemodialysis, or both) before HMII implantation. The median duration of HMII support was 313 days (range, 1-3339 days). After device implantation, 36 patients (33.6%) had gastrointestinal bleeding, 24 (23%) required RRT, 18 (17.5%) had ventricular arrhythmias, and 24 (22.4%) had LVAD-related infections, and 9 (8.4%) had right ventricular failure requiring mechanical support, and 28 (26.2%) had neurologic complications. The actual survival rate was 69% at 6 months, 63% at 1 year, and 54% at 2 years. Eighty-one patients died, 9 are still receiving HMII support, and 17 are alive after heart transplantation. CONCLUSIONS: Older patients can benefit from LVAD therapy, and advanced age should not preclude LVAD implantation.

Co-synthesis of kenyacin 404 and heterologous thurincin H enhances the antibacterial activity of Bacillus thuringiensis.

OBJECTIVES: To develop a recombinant strain of Bacillus thuringiensis that synthesizes two bacteriocins that enhance the antibacterial potency of the strain and that could have applied clinical and industrial value. RESULTS: We cloned the thurincin H cluster into the pHT3101 vector by assembling two genetic cassettes harboring genes for the synthesis, modification, immunity and transport of thurincin H. This construct was used to transform a thurincin H-sensitive strain of B. thuringiensis that synthesizes the kenyacin 404 to generate the recombinant Btk 404/pThurH which was immune to thurincin H and produces bacteriocins of approximately 3 kDa. A significant increase in the inhibitory activity, respectively, ~ 40 and 300%, was observed when compared with parental Btm 269 and Btk 404. Btk 404/pThurH showed increased activity against ten Gram-positive bacteria, including B. cereus, Listeria monocytogenes and B. pseudomycoides, and the Gram-negative bacterium, Sphingobacterium cabi. However, an antagonistic effect against Vibrio parahaemolyticus, relative to native strains, was observed. CONCLUSIONS: We have generated a recombinant strain of B. thuringiensis that co-synthesizes two bacteriocins (kenyacin 404, thurincin H) with improved inhibitory activity, when compared with parental strains. To our knowledge, this is the first study that shows that B. thuringiensis could be manipulated to produce two bacteriocins, one being of heterologous origin, that enhance the antibacterial activity of the recombinant strain.

Neuronal medium that supports basic synaptic functions and activity of human neurons in vitro.

Human cell reprogramming technologies offer access to live human neurons from patients and provide a new alternative for modeling neurological disorders in vitro. Neural electrical activity is the essence of nervous system function in vivo. Therefore, we examined neuronal activity in media widely used to culture neurons. We found that classic basal media, as well as serum, impair action potential generation and synaptic communication. To overcome this problem, we designed a new neuronal medium (BrainPhys basal + serum-free supplements) in which we adjusted the concentrations of inorganic salts, neuroactive amino acids, and energetic substrates. We then tested that this medium adequately supports neuronal activity and survival of human neurons in culture. Long-term exposure to this physiological medium also improved the proportion of neurons that were synaptically active. The medium was designed to culture human neurons but also proved adequate for rodent neurons. The improvement in BrainPhys basal medium to support neurophysiological activity is an important step toward reducing the gap between brain physiological conditions in vivo and neuronal models in vitro.

Study of polymorphisms in the TP53 and RB1 genes in children with retinoblastoma in northern Mexico.

PURPOSE: To determine the frequency and association of polymorphisms in the TP53 and RB1 genes with clinical characteristics in a group of children with retinoblastoma (RB) in northern Mexico. METHODS: A prospective, longitudinal, and analytical study of 11 patients diagnosed with RB was conducted. Endpoint PCR and high-resolution real-time PCR were performed. Chi-square and Student t tests were used to evaluate associations between variables. Allelic frequencies, as well as genotypic and Hardy-Weinberg equilibriums, were evaluated using Guo and Thompson's method. RESULTS: We found a statistically significant difference between the polymorphism RB1-GG/rs9568036 and tumor chemoresistance (p<0.05). The allelic variants RB1-AA and AG/rs9568036 were determined to be associated with tumor chemosensitivity (p<0.05). A statistically significant relation between the polymorphism RB1-GG/rs9568036 and males (p = 0.0386), rate ratio (RR) = 2.0 (95% confidence interval [CI] = 0.76-5.32), as well as between the allelic variants RB1-AA and AG/rs9568036 and females (p = 0.0027), RR = 8.0 (95% CI = 1.28-50.04), was observed. We also observed a statistically significant association between the rs1042522 polymorphism in the TP53 gene and unilateral presentation of the disease. CONCLUSIONS: The rs9568036 polymorphism in the RB1 gene and the allelic variants can be associated with type of response to medical therapy and associated with male sex, while the allelic variant rs1042522 polymorphism in the TP53 gene is associated with the unilateral presentation of the disease in a group of Mexican children with RB.

Recombinant Bacillus thuringiensis subsp. kurstaki HD73 strain that synthesizes Cry1Ac and chimeric ChiA74∆sp chitinase inclusions.

In this study, the endochitinase chiA74 gene lacking its secretion signal peptide sequence (chiA74∆sp) was fused in frame with the sequence coding for the C-terminal crystallization domain and transcription terminator of cry1Ac. The chimeric gene was expressed under the strong pcytA-p/STAB-SD promoter system in an acrystalliferous Cry-B strain of Bacillus thuringiensis and B. thuringiensis subsp. kurstaki HD73. We showed that the chimeric ChiA74∆sp produced amorphous inclusions in both Cry-B and HD73. In addition to the amorphous inclusions putatively composed of the chimera, bipyramidal Cry1Ac crystals, smaller than the wild-type crystal, were observed in recombinant HD73, and chitinase activity was remarkably higher (75-fold) in this strain when compared with parental HD73. Moreover, we observed that lyophilized samples of a mixture containing Cry1Ac, amorphous inclusions, and spores maintained chitinase activity. Amorphous inclusions could not be separated from Cry1Ac crystals by sucrose gradient centrifugation. Interestingly, the chitinase activity of purified Cry1Ac/amorphous inclusions was 51-fold higher compared to purified Cry1Ac inclusions of parental HD73, indicating that the increased enzymatic activity was due primarily to the presence of the atypical amorphous component. The possibility that the chimera is occluded with the Cry1Ac crystal, thereby contributing to the increased endochitinolytic activity, cannot be excluded. Finally, bioassays against larvae of Spodoptera frugiperda with spore/crystals of HD73 or spore-crystal ChiA74∆sp chimeric inclusions of recombinant HD73 strain showed LC50s of 396.86 and 290.25 ng/cm2, respectively. Our study suggests a possible practical application of the chimera in formulations of B. thuringiensis-based lepidopteran larvicides.

Effect of removable functional appliances on mandibular length in patients with class II with retrognathism: systematic review and meta-analysis.

BACKGROUND: Orthopedic functional devices, are used to improve mandibular length in skeletal class II patients. However, the orthopedic functional device with the best effect to increasing the mandibular length, has not been identified before. Thus, the aim of the present investigation was to evaluate Randomized Controlled Trials (RCT), to determine the best functional appliance improving mandibular length in subjects with retrognathism. METHODS: A systematic review and meta-analysis was performed, including studies published and indexed in databases between 1966 and 2016. RCTs evaluating functional appliances' effects on mandibular length (Condilion-Gnation (Co-Gn) and Condilion-Pogonion (Co-Po)), were included. Reports' structure was evaluated according to 2010 CONSORT guide. The outcome measure was distance between Co-Gn and/or Co-Po after treatment. Data were analyzed with Cochran Q Test and random effects model. RESULTS: Five studies were included in the meta-analysis. The overall difference in mandibular length was 1.53 mm (Confidence Interval (CI) 95% 1.15-1.92) in comparison to non-treated group. The Sander Bite Jumping reported the greatest increase in mandibular length (3.40 mm; CI 95% 1.69-5.11), followed by Twin Block, Bionator, Harvold Activator and Frankel devices. CONCLUSIONS: All removable functional appliances, aiming to increase mandibular length, are useful. Sander Bite Jumping was observed to be the most effective device to improve the mandibular length.

Degradation of gestodene (GES)-17α-ethinylestradiol (EE2) mixture by electrochemical oxidation.

Evidence of the negative effects of several pharmaceutical molecules, such as hormones and steroids, on the environment can be observed throughout the world. This paper presents the results of the anodic oxidation of the mixture of gestodene steroid hormones and 17 α-ethinylestradiol present in aqueous medium. The tests were conducted in an undivided cell containing a working volume of 50 mL, using a Na2SO4 solution as support electrolyte and boron-doped diamond electrodes. The experiments were adjusted to the structure of a 33 factorial design. The evaluated factors were: support electrolyte concentration (0.02, 0.05, and 0.10 M), pH of the reaction media (2, 3, and 4), and current density (16, 32, and 48 mA cm-2). Under the optimum conditions (0.02 M Na2SO4, pH 4, and current density of 32 mA cm-2), the degradation of at least 93% of the initial concentration of gestodene and 17α-ethinylestradiol was reached in a reaction time of 5 and 10 min, respectively. The complete degradation of both molecules required 15 min of reaction. Under these conditions, the degradation profile of the pharmaceutical mixture as each one of the active ingredients, followed a pseudo-first order kinetic behavior (kmix = 0.0321, kGES = 0.4206, and kEE2 = 0.3209 min-1).

Variability in prevalence of Cymatocarpus solearis (Trematoda, Brachycoeliidae) in Caribbean spiny lobsters Panulirus argus (Decapoda: Palinuridae) from Bahía de la Ascensión (Mexico).

Cymatocarpus solearis, a brachycoeliid trematode that parasitizes sea turtles, uses spiny lobsters Panulirus argus as second intermediate hosts. We examined variability in infection by C. solearis in Bahía de la Ascensión, Mexico, a tropical bay with a highly productive fishery for P. argus that is based on the extensive use of casitas (large artificial shelters), which can harbor multiple juveniles and adults of this gregarious lobster species. We sampled 3956 lobsters from 466 casitas distributed over three bay zones within two closed seasons and one fishing season. In these lobsters (9.5-115.2mm carapace length, CL), the average infection prevalence was 11.7% but the probability of infection increased significantly with size. Prevalence varied with season but was consistently higher in one zone than in the other two zones. Infection with C. solearis was negatively related with clinical infection with Panulirus argus Virus 1 (PaV1). We also sampled 405 lobsters from the commercial catch obtained throughout the bay at the onset of the fishing season. In these relatively larger lobsters (70.3-168.0mm CL), average prevalence of C. solearis was higher (23.5%) but was not affected by lobster size or sex. Encysted metacercariae occurred in both abdominal and cephalothoracic muscles. The effects of C. solearis on phenotypic traits of P. argus that may potentially impact the host population dynamics and fisheries remain to be investigated.

[Preclinical horizon of depression in adults]. / Horizonte preclínico de la depresión en adultos.

OBJECTIVE: Identify factors related to preclinical depression in healthy adults, their risk factors and concordance with family doctor diagnostic. MATERIALS AND METHODS: Case-control study in adult from family medicine consulting room. Beck inventory for depression was applied. The correlation between depression and the diagnosis by the family physician was evaluated. Odds ratio (OR) was determined. RESULTS: Involved 138 patients randomly from four family medicine units (FMU) in the Northern Region of Quintana Roo, Mexico. The mean age 34.9 ± 11.4 years, 55.8% women, prevalence for depression was 26.1%. Being male OR: 3.76; 95% CI: 1.69-8.36, under 30 years OR: 2.76; 95% CI: 1.27-5.99, low socioeconomic status (SES) OR: 2.11; 95% CI: 0.97-4.59 and be married OR: 3.22; 95% CI: 1.41.-7.36 had depression risk. Diagnosis by the family physician and inventory Beck. Kappa Index 0.2, 95% CI: -0057-0176; p = 0.05. CONCLUSIONS: Almost a third of young adults have some depression degree in family medicine consulting room, it is necessary a depression screening for male patients, low SES, married, and under 30 years old, attending medical consultation familiar, for a early diagnosis and improve prognosis.

Application of the Fenton process in the elimination of helminth eggs.

This study relates to a method for evaluating the degradation efficiency of Ascaris lumbricoides eggs through a Fenton reaction, using hydrogen peroxide (H2O2) at 100, 250, and 500 mg/L, ferrous sulfate (FeSO4) at 458 mg/L Fe(2+) and pH values of 3, 4.5, and 6. The experiments were conducted according to a 3(2) experimental design, with 1:1, 3:1, and 5:1 (H2O2/Fe(2+)) molar ratios. The oxidation and flocculation stages were performed at 130 rpm during 2 hours and at 25-30 rpm during 20 min, respectively. As a result of the Fenton reaction, an average of 91.2% Ascaris lumbricoides egg degradation was achieved at pH 6 using a 500 mg/L dose of H2O2 and a 3:1 (H2O2/Fe(2+)) molar ratio. Thus, this process is an alternative for eliminating parasites that are resistant to conventional disinfection processes and significantly reduces the human health hazard they represent.

HeartMate II left ventricular assist device implantation in patients with advanced hepatic dysfunction.

BACKGROUND: We sought to determine the outcomes for patients with advanced hepatic dysfunction undergoing HeartMate II left ventricular assist device (LVAD) implantation. METHODS: Between November 1, 2003 and December 1, 2012, we implanted the HeartMate II continuous-flow LVAD in 338 patients, either for bridging to heart transplantation or for destination therapy. Twenty-three of these patients (19 men and 4 women; mean age, 47 ± 16 years) had advanced hepatic dysfunction, as characterized by alanine aminotransferase (ALT) or aspartate transaminase (AST) levels five times normal; serum total bilirubin levels three times normal; and/or necessity for a liver biopsy before or during device implantation. Of this group, 17 patients received the LVAD as a bridge to transplantation, and six patients received it for destination therapy. RESULTS: Nine of the 23 patients required either a transjugular or a core liver biopsy during LVAD implantation. Three patients died within the first postoperative month; the 20 surviving patients had significant improvements in their hepatic parameters. The ALT decreased from 238 ± 296 to 27 ± 13 U/L (p = 0.022), AST decreased from 209 ± 199 to 29 ± 8 U/L (p = 0.009), and total bilirubin level decreased from 6.9 ± 6.0 to 0.6 ± 0.1 mg/dL (p = 0.044). The serum albumin level increased from 3.2 ± 0.6 to 4.3 ± 0.3 g/dL (p = 0.003), and creatinine clearance increased from 77.6 ± 35.2 to 110.2 ± 35.7 mL/min/1.73 m2 (p = 0.101). CONCLUSION: Continuous-flow LVAD support may significantly improve hepatic function, allowing patients with poor preimplant liver function to become better candidates for heart transplantation.