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Ma de la Encina Arias,Isabel Cantarino,Paloma de la Quintana,Ma Antonia Estrada,Fernández Adelina,F J Martínez,Ma Carmen Martínez,Dolores Martínez,Lourdes Mateos,Teresa Poca,Dolores Ruiz,Fuensanta Salvador,Ma Isabel Sánchez,Esperanza VillalbaThe authors publish the first precise, specific, valid questionnaire in Spanish which measures the quality of life related to health for patients who have undergone an intestinal or urological ostomy; furthermore, this questionnaire has been validated in a sample of Spanish population. The OPM Divi... ( view more )sion of B. Braun Medical was the sponsor of the study which led to the creation of this QUALYPOLL questionnaire. Statistical validation of the data complied was performed by Health Outcomes Research Europe which carried out a multi-centric national study to evaluate the measuring properties of the aforementioned QUALYPOLL questionnaire on patients who have undergone an intestinal or urological ostomy. ( view less ) Eva Esteban Cardeñosa,Pascual Bolufer Gilabert,Sarai Palanca Suela,Eva Barragán González,Silvestre Oltra Soler,Isabel Chirivella González,Angel Segura Huerta,Carmen Guillén Ponce,Eduardo Martínez de Dueñas,Dolores Cuevas Cuerda,Dolores Salas Trejo,Grupo de Asesoramiento en Cáncer Hereditario de la Comunidad Valenciana  BACKGROUND AND OBJECTIVE: The objective of the present study was to investigate the mutational spectrum of BRCA1 and BRCA2 in the Valencian Community, comparing this spectrum with that reported in Spain. We also analyze the association of the mutations with the family history of the selected famili... ( view more )es. PATIENTS AND METHOD: We analyzed the mutations in the BRCA1 and BRCA2 in 147 families with history of breast and/or ovarian cancer. The detection was based on the amplification of in frame and flanking regions of BRCA1 and BRCA2 genes by polymerase chain reaction, detection of the heteroduplex formed by conformation-sensitive gel electrophoresis and their characterization by sequencing. RESULTS: We identified 24 different pathogenic mutations in 50 out of the 147 families (34.0%; 23 in BRCA1 and 27 in BRCA2). The higher incidence of pathogenic mutations was observed in families with breast and ovarian cancer or with more than 3 cases of breast cancer. The most frequent mutations in BRCA1 were the c.187_188delAG, c.2080delA and the c.3889_3890delAG, whereas for BRCA2 the mutations with higher prevalence was observed for c.9254_9258delATCAT and the c.9204delCATCAGATTTATAT. We detected 5 pathogenic mutations (p.Y1429X in BRCA1 and c.1835insT, c.5025delT, c.6722delT and p.Q3156X in BRCA2) not reported in the Breast Cancer Information Core Database. Among them, the BRCA2 mutations c.1835insT and c.5025delT were recurrent and seemed to be characteristic of the population the Valencian Community. CONCLUSIONS: We detected pathogenic mutations in BRCA1 and BRCA2 genes in 34.0% of the families studied. The mutations c.1835insT and c.5025delT were 2 new recurrent pathogenic mutations in BRCA2 that seemed to be characteristic of the population of the Valencian Community. The study reports 5 new pathogenic mutations to the world spectrum of BRCA1 and BRCA2 mutations and other 5 mutations to the Spanish spectrum. ( view less ) Antonia Moral,María Dolores Sicilia,Soledad Rubio,Dolores Pérez-Bendito In this work multifunctional sorbents, based on surfactant-coated mineral oxides, are assessed for the simultaneous extraction/preconcentration of pesticide multiresidues from aqueous environmental samples. Seventeen pesticides, representative of all the common groups (triazines, phenylureas, carba... ( view more )mates, azols, anilides, chloroacetanilides, organophosphorous, phenoxyacids, aryloxy acids and phenols), are selected for this study. The sorbents assessed are pure sodium dodecyl sulphate (SDS) and mixed tetrabutylammonium (TBA)-SDS hemimicelles and/or admicelles adsorbed onto alumina. Because of their multifunctional character, these sorbents provide different retention mechanisms (i.e. hydrophobic, ionic and/or pi-cation interactions), which highly contribute to the efficient retention of pesticides with different polarities and acidities (bases, neutrals and acids). In addition, the low volume of eluent required for complete elution of analytes (typically 1-2mL) avoided the need of using time-consuming and tedious evaporation steps that generally are needed when cross-linked polymeric resins or carbon materials are used as sorbents. The performance of two sorbents, i.e. SDS and TBA-SDS mixed hemimicelles/admicelles, for the admicellar solid-phase extraction (ASPE) of pesticide multiresidue was comparatively investigated. The latter was selected on the basis of the higher breakthrough volumes permitted, the lower volume of eluent required and the higher sample and eluent flow rates allowed. The proposed ASPE/LC/UV approach provided detection limits lower than 100 ngL(-1) for the determination of the 17 pesticides tested. Recoveries from spiked (at the ngL(-1) level) river and underground water samples was quantitative for most of the pesticides tested. ( view less ) David Valcárcel,Rodrigo Martino,Dolores Caballero,Jesus Martin,Christelle Ferra,Jose B Nieto,Antonia Sampol,M Teresa Bernal,Jose L Piñana,Lourdes Vazquez,Jose M Ribera,Joan Besalduch,Jose M Moraleda,Dolores Carrera,M Salut Brunet,Jose A Perez-Simón,Jorge Sierra PURPOSE: Reduced-intensity conditioning (RIC) for allogeneic stem-cell transplantation (allo-SCT) reduces nonrelapse mortality (NRM). This reduction makes it possible for patients who are ineligible for high-dose myeloablative conditioning allo-SCT to benefit from graft-versus-leukemia reaction. In... ( view more ) this multicenter, prospective study of patients with acute myeloid leukemia (AML) and high-risk myelodysplastic syndrome (MDS), we investigated the efficacy of RIC allo-SCT from a human leukocyte antigen-identical sibling by using a regimen that uses fludarabine and busulfan. PATIENTS AND METHODS: Ninety-three patients with AML (n = 59) and MDS (n = 34) were included, and the median age was of 53 years. Follow-up for survivors was 43 months (range, 3 to 89 months). The conditioning regimen consisted of fludarabine (150 mg/m(2)) and oral busulfan (8 to 10 mg/kg). All except one patient received mobilized peripheral blood stem cells. Graft-versus-host disease (GVHD) prophylaxis consisted of cyslosporine and methotrexate or mycophenolate mofetil. RESULTS: The 100-day, 1-year, and 4-year incidences of NRM were 8, 16%, and 21%, respectively. The 1- and 4-year relapse cumulative incidences were 23% and 37%, respectively, and leukemia recurrence was the main cause of death. The 4-year disease-free survival (DFS) and overall survival (OS) rates were 43% and 45%, respectively. The 4-year cumulative incidence of chronic GVHD was 53% (45% extensive), and its development was the major factor associated with lower relapse incidence and improved DFS and OS. CONCLUSION: Our results confirm the capacity of this RIC regimen to obtain long-term remissions in patients ineligible for a conventional allo-SCT. The results suggest an important role of the development of chronic GVHD in reducing relapse and improving DFS and OS. ( view less ) Francisco M Kovacs,Joan Bagó,Ana Royuela,Jesús Seco,Sergio Giménez,Alfonso Muriel,Víctor Abraira,José Luis Martín,José Luis Peña,Mario Gestoso,Nicole Mufraggi,Montserrat Núñez,Josep Corcoll,Ignacio Gómez-Ochoa,Ma José Ramírez,Eva Calvo,Ma Dolores Castillo,David Martí,Salvador Fuster,Carmen Fernández,Nuria Gimeno,Alejandro Carballo,Alvaro Milán,Dolores Vázquez,Montserrat Cañellas,Ricardo Blanco,Pilar Brieva,Ma Trinidad Rueda,Luis Alvarez,María Teresa Gil Del Real,Joaquín Ayerbe,Luis González,Leovigildo Ginel,Mariano Ortega,Miryam Bernal,Gonzalo Bolado,Anna Vidal,Ana Ausín,Domingo Ramón,María Antonia Mir,Miquel Tomás,Javier Zamora,Alejandra Cano BACKGROUND: The NDI, COM and NPQ are evaluation instruments for disability due to NP. There was no Spanish version of NDI or COM for which psychometric characteristics were known. The objectives of this study were to translate and culturally adapt the Spanish version of the Neck Disability Index Qu... ( view more )estionnaire (NDI), and the Core Outcome Measure (COM), to validate its use in Spanish speaking patients with non-specific neck pain (NP), and to compare their psychometric characteristics with those of the Spanish version of the Northwick Pain Questionnaire (NPQ). METHODS: Translation/re-translation of the English versions of the NDI and the COM was done blindly and independently by a multidisciplinary team. The study was done in 9 primary care Centers and 12 specialty services from 9 regions in Spain, with 221 acute, subacute and chronic patients who visited their physician for NP: 54 in the pilot phase and 167 in the validation phase. Neck pain (VAS), referred pain (VAS), disability (NDI, COM and NPQ), catastrophizing (CSQ) and quality of life (SF-12) were measured on their first visit and 14 days later. Patients' self-assessment was used as the external criterion for pain and disability. In the pilot phase, patients' understanding of each item in the NDI and COM was assessed, and on day 1 test-retest reliability was estimated by giving a second NDI and COM in which the name of the questionnaires and the order of the items had been changed. RESULTS: Comprehensibility of NDI and COM were good. Minutes needed to fill out the questionnaires [median, (P25, P75)]: NDI. 4 (2.2, 10.0), COM: 2.1 (1.0, 4.9). Reliability: [ICC, (95%CI)]: NDI: 0.88 (0.80, 0.93). COM: 0.85 (0.75,0.91). Sensitivity to change: Effect size for patients having worsened, not changed and improved between days 1 and 15, according to the external criterion for disability: NDI: -0.24, 0.15, 0.66; NPQ: -0.14, 0.06, 0.67; COM: 0.05, 0.19, 0.92. Validity: Results of NDI, NPQ and COM were consistent with the external criterion for disability, whereas only those from NDI were consistent with the one for pain. Correlations with VAS, CSQ and SF-12 were similar for NDI and NPQ (absolute values between 0.36 and 0.50 on day 1, between 0.38 and 0.70 on day 15), and slightly lower for COM (between 0.36 and 0.48 on day 1, and between 0.33 and 0.61 on day 15). Correlation between NDI and NPQ: r = 0.84 on day 1, r = 0.91 on day 15. Correlation between COM and NPQ: r = 0.63 on day 1, r = 0.71 on day 15. CONCLUSION: Although most psychometric characteristics of NDI, NPQ and COM are similar, those from the latter one are worse and its use may lead to patients' evolution seeming more positive than it actually is. NDI seems to be the best instrument for measuring NP-related disability, since its results are the most consistent with patient's assessment of their own clinical status and evolution. It takes two more minutes to answer the NDI than to answer the COM, but it can be reliably filled out by the patient without assistance. TRIAL REGISTRATION: Clinical Trials Register NCT00349544. ( view less ) Héctor Guadalajara,Carolina Domínguez-Berzosa,Mariano García-Arranz,María Dolores Herreros,Isabel Pascual,Raquel Sanz-Baro,Dolores C García-Olmo,Damián García-Olmo BACKGROUND: Detection of cell-free plasma DNA has considerable potential as a tool for the diagnosis and assessment of the prognosis of many types of cancer. The aim of the present study was to quantify, by spectrophotometry, the cell-free DNA in plasma samples from patients with colorectal cancer ... ( view more )at different stages of the disease and to attempt to correlate the resultant values with the clinical picture. METHODS: We reviewed the medical reports of 73 patients, who had undergone resection of primary colorectal cancer. Samples of blood had been taken from each patient immediately prior to surgery. DNA was extracted from samples of plasma and quantified, by spectrophotometry, after a storage period of no longer than 2 years in 89% of the cases examined. RESULTS: The mean(+/-S.D.) concentration of DNA in plasma samples was 108+/-156 ng/microl. We found a statistically significant correlation between the concentration of DNA and the presence of metastases (mainly liver metastases). CONCLUSION: The detection and quantitation of cell-free DNA in plasma, using this simple technique, might be of clinical value for the surveillance of colon cancer patients and the detection of metastases. ( view less ) Ana Pedraza,María Dolores Sicilia,Soledad Rubio,Dolores Pérez-Bendito A selective method for the determination of L-glutamate in foodstuffs has been developed. It was based on the competition established between the analyte and the dye Coomassie brilliant blue G (CBBG) to interact with the surfactant didodecyldimethylammonium bromide (DDABr). The measurement paramete... ( view more )r was the amount of DDABr required to reach a given dye-to-surfactant binding degree. It was obtained by photometric titration on the basis of the changes observed in the spectral characteristics of the dye when CBBG-DDABr aggregates were formed. The calibration graph obtained was linear in the L-glutamate concentration interval 0.2-5 mM (detection limit 0.05 mM). The high selectivity of the proposed method (other amino acids and food additives did not interfere at the concentrations present in foodstuffs) permitted the direct analysis of food samples after dissolution of the analyte in hot water. The accuracy of the surfactant to the dye binding degree method was demonstrated by determining L-glutamate in different kinds of foodstuffs (liquid and dried soups, seasonings, pasta sauces and dried mushroom creams) and comparing the results obtained with those provided by the commercial Boehringer Mannheim essay. ( view less ) Eduardo López-Viñas,Assia Bentebibel,Chandrashekaran Gurunathan,Montserrat Morillas,Dolores de Arriaga,Dolors Serra,Guillermina Asins,Fausto G Hegardt,Paulino Gómez-Puertas Carnitine palmitoyltransferase 1 (CPT1) catalyzes the conversion of palmitoyl-CoA to palmitoylcarnitine in the presence of l-carnitine, thus facilitating the entry of fatty acids to mitochondria, in a process that is physiologically inhibited by malonyl-CoA. To examine the mechanism of CPT1 liver i... ( view more )soform (CPT1A) inhibition by malonyl-CoA, we constructed an in silico model of both its NH2- and COOH-terminal domains. Two malonyl-CoA binding sites were found. One of these, the "CoA site" or "A site," is involved in the interactions between NH2- and COOH-terminal domains and shares the acyl-CoA hemitunnel. The other, the "opposite-to-CoA site" or "O site," is on the opposite side of the enzyme, in the catalytic channel. The two sites share the carnitine-binding locus. To prevent the interaction between NH2- and COOH-terminal regions, we produced CPT1A E26K and K561E mutants. A double mutant E26K/K561E (swap), which was expected to conserve the interaction, was also produced. Inhibition assays showed a 12-fold decrease in the sensitivity (IC50) toward malonyl-CoA for CPT1A E26K and K561E single mutants, whereas swap mutant reverts to wild-type IC50 value. We conclude that structural interaction between both domains is critical for enzyme sensitivity to malonyl-CoA inhibition at the "A site." The location of the "O site" for malonyl-CoA binding was supported by inhibition assays of expressed R243T mutant. The model is also sustained by kinetic experiments that indicated linear mixed type malonyl-CoA inhibition for carnitine. Malonyl-CoA alters the affinity of carnitine, and there appears to be an exponential inverse relation between carnitine Km and malonyl-CoA IC50. ( view less ) Eva P Cuevas,Oscar Escribano,Antonio Chiloeches,Sara Ramirez Rubio,Irene Dolores Román,María Dolores Fernández-Moreno,Luis G Guijarro BACKGROUNDS/AIMS: Insulin receptor substrate-4 (IRS-4) is a scaffold protein that mediates the actions of insulin-like growth factor-I (IGF-I). Its expression increases dramatically after partial hepatectomy (a liver regeneration model). Herein, we report IRS-4 expression in a human hepatoblastoma ... ( view more )cell line (HepG2) and IGF-I-dependent IRS-4 tyrosine phosphorylation. METHODS: The role of IRS-4 in HepG2 proliferation was established by RNA interference (siRNA). After 72h of transfection with IRS-4 siRNA, we observed a specific reduction in IRS-4 expression. RESULTS: Depletion of IRS-4 levels decreased ERK phosphorylation, p70S6K phosphorylation and IGF-I-stimulated cell proliferation. Changes in ERK phosphorylation in IRS-4-depleted cells were independent of ras/raf/MEK1/2- and PI3K/Akt-cascades. IRS-4 down-regulation abolished IGF-I-, TPA- and IGF-I plus TPA-stimulated ERK and p70S6K activities. Our results suggest that PKC-epsilon mediates the effect of IRS-4 on ERK activity. Moreover, decreased IRS-4 levels diminished FBS- and IGF-I-stimulated HepG2 growth and cause stress fiber disruption in HepG2 cell line. CONCLUSIONS: Collectively, our data suggest that IRS-4 plays an important role in HepG2 proliferation/differentiation and exerts its actions through ERK and p70S6K activation in a ras/raf/MEK1/2- and PI3Kinase/Akt-independent manner and in a PKC-dependent way. ( view less ) Natalia Nieto,María Dolores Mesa,José María López-Pedrosa,M Isabel Torres,Antonio Ríos,María Dolores Suárez,Angel Gil The aim of this study was to assess the effect of polyunsaturated fatty acids supplied in the diet on intestinal mucosa repair in a rat model of protein-energy malnutrition. Rats were fed either a standard semipurified diet or the same diet containing lactose as the only source of carbohydrate to c... ( view more )ause protein-energy malnutrition. Diarrhea was induced within 24 h and was maintained for 2 weeks, after which both groups of rats were fed for 1 week either the standard diet or the standard diet supplemented with different sources of fatty acids, such as olive oil (OO), fish oil (FO), and purified phospholipids from pig brain (BPL). The lactose-enriched diet caused loss of enterocyte microvilli, lymphocyte infiltration, supranuclear cytoplasmic vesiculation, decreased number of goblet cells, low-density enlarged mitochondria, and less cristae. The FO diet improved the pathology score according to the histological and ultrastructural analysis, with an increased number of goblet cells, ratio of microvilli length to crypt depth, and percentage of intraepithelial lymphocytes compared to those found in rats with protein-energy malnutrition. We previously reported that chronic diarrhea depletes the antioxidant defense in rat intestine; we now show that both, the FO and the BPL diets, increase GSH levels in colon and that some antioxidant enzyme activities vary according to the source of fatty acids, with higher catalase and superoxide dismutase by the FO diet in jejunum, increased catalase by the BPL diet in jejunum, and elevated glutathione peroxidase by the OO diet in colon. The fatty acid profile of intestinal mucosa reflects the source of fat in the diet, with the lowest ratio of n-6/n-3 for rats fed the FO diet. These results suggest that dietary polyunsaturated fatty acids, particularly those in the n-3 series, may play an important role in intestinal repair in chronic diarrhea due to protein-energy malnutrition. ( view less ) Ana Pedraza,María Dolores Sicilia,Soledad Rubio,Dolores Pérez-Bendito The surfactant to dye binding degree (SDBD) method is proposed for the routine monitoring of anionic surfactants in aqueous environmental samples and their analytical features compared with those provided by the standard methylene blue (MB) method. This new analytical approach is based on the effec... ( view more )t that anionic surfactants exert on the binding degree of the cationic surfactant didodecyldimethylammonium bromide (DDABr) to the anionic dye Coomassie Brilliant Blue G (CBBG). The formation of DDABr-CBBG aggregates is monitored photometrically. The analytical applicability of the proposed method was demonstrated by determining anionic surfactants in tap, river and swamp water, and raw and treated sewage. The mean recoveries obtained ranged between 99 and 101%. The SDBD method offers important advantages over the classical MB method: it is more sensitive, selective, precise, simple and rapid; the analytical response is independent of the molecular structure of the anionic surfactants, and the volume of sample required for analysis and the consumption of organic solvents are significantly reduced. ( view less ) José Rodríguez,Eulogio Conde,Antonio Gutiérrez,Reyes Arranz,Marcos Gandarillas,Angel Leon,Jesus Ojanguren,Anna Sureda,Dolores Carrera,Mauricio Bendandi,Jose Moraleda,Jose Maria Ribera,Carmen Albo,Alfonso Morales,Juan Carlos García,Pascual Fernández,Guillermo Cañigral,Juan Bergua,María Dolores Caballero,Grupo Español de Linfomas/Trasplante Autólogo de Médula Osea  OBJECTIVES: Angioimmunoblastic T-cell lymphoma (AIL) is a rare lymphoma with a poor prognosis and no standard treatment. Here, we report our experiences with 19 patients treated with high-dose chemotherapy and autologous stem cell transplantation (HDC/ASCT) within the GELTAMO co-operative group bet... ( view more )ween 1992 and 2004. METHODS: The median age at transplantation was 46 yr. Fifteen patients underwent the procedure as front-line therapy and four patients as salvage therapy. Most patients received peripheral stem cells (90%) coupled with BEAM or BEAC as conditioning regimen (79%). RESULTS: A 79% of patients achieved complete response, 5% partial response and 16% failed the procedure. After a median follow-up of 25 months, eight patients died (seven of progressive disease and secondary neoplasia), while actuarial overall survival and progression-free survival at 3 yr was 60% and 55%. Prognostic factors associated with a poor outcome included bone marrow involvement, transplantation in refractory disease state, attributing more than one factor of the age-adjusted-International Prognostic Index, Pretransplant peripheral T-cell lymphoma (PTCL) Score or Prognostic Index for PTCL. CONCLUSIONS: More than half of the patients with AIL that display unfavourable prognostic factors at diagnosis or relapse would be expected to be alive and disease-free after 3 yr when treated with HDC/ASCT. Patients who are transplanted in a refractory disease state do not benefit from this procedure. ( view less ) Maria Dolores Frutos,Maria Dolores Morales,Juan Luján,Quiteria Hernández,Graciela Valero,Pascual Parrilla BACKGROUND: Surgery in patients with super-obesity (BMI > or = 50) involves technical difficulties that are related, among other factors, to increased liver volume. Although the intragastric balloon is not a definitive alternative to surgery, it has been used in these patients as a primary therapeu... ( view more )tic means of reducing excess weight and the risks of subsequent surgery. It has also been reported to considerably diminish liver volume to facilitate technical aspects of the operation. We evaluated preoperative weight loss in patients with super-obesity after placement of an intragastric balloon and its effect on liver volume measured by computed axial tomography (CT) prior to laparoscopic Roux-en-Y gastric bypass (LRYGBP). METHODS: The balloon was implanted preoperatively under endoscopic guidance and sedation in 31 patients with super-obesity, to reduce weight prior to LRYGBP. Two patients were excluded from the study for intolerance and the balloon was removed 2 weeks after placement. Measurement of liver volume was done with axial images obtained by spiral CT with a section thickness of 10 mm, reconstitution index 10 mm, pitch 1.5 and acquisition delay 60 seconds. Volumes were calculated using the sum of areas technique. Measurement of volume was done in these 29 patients prior to balloon placement and the week before surgery. RESULTS: After placement of the balloon, 27 patients (93%) had nausea and 25 patients (86%) had vomiting, which abated 1 week after placement. Mean liver volume prior to balloon placement was 2938.53 +/- 853.1 cm3, which at 6 weeks dropped to values of 1918.2 +/- 499.8 cm3, revealing a considerable reduction in liver volume [31.8% +/- 18.16% (range 3.1%-58.5%)]. Percent of excess weight loss was 22.14% +/- 7.39. LRYGBP was performed at 6 months. CONCLUSIONS: In patients with super-obesity, preoperative treatment with intragastric balloon considerably reduces liver volume to facilitate LRYGBP. ( view less ) Llorenç Caballería,Ma Antonia Auladell,Pere Torán,Dolores Miranda,Jesús Aznar,Guillem Pera,Dolors Gil,Laura Muñoz,Jaume Planas,Santiago Canut,Jesús Bernad,Josep Aubà,Gregorio Pizarro,Miren Maite Aizpurua,Anna Altaba,Albert Tibau BACKGROUND: Fatty liver disease is characterized by the accumulation of fat vacuoles inside of the hepatocytes. Non alcoholic fatty liver is associated with obesity, type 2 diabetes, dyslipemia, the intake of certain drugs and with the so-called metabolic syndrome. However, there is little informat... ( view more )ion on the clinical relevance of this disorder as a healthcare problem in the general population, since the studies published generally include a limited number of patients and the diagnosis is established on the basis of clear biochemical alterations and liver biopsy. METHODS/DESIGN: The aim of the study is the prevalence of non-alcoholic fatty liver disease in a general adult population by hepatic ultrasonography.A population-based, descriptive, transversal, multicentre study. Eighteen primary care centres of the north of Barcelona and the Maresme Areas of Healthcare Management attending an urban and semi-urban population of 360.000 inhabitants.A randomized sample of 786 subjects of 15 years or older were selected from the population and assigned to the participating centres according to the Primary Care Information System (SIAP): This population is practically the same as the general population of the area.The following determinations will be carried out in all the participants: hepatic ultrasonography to detect fatty liver, a questionnaire concerning liver diseases, alcohol intake, smoking and drug use, physical examination including abdominal perimeter and body mass index and biochemical analysis including liver function tests and parameters related to the metabolic syndrome and the HAIR score.Ultrasonographic diagnosis of fatty liver will be made according to established criteria (American Gastroenterology Association) and diagnosis of metabolic syndrome according to the criteria of the European Group for the Study of Insulin Resistance. DISCUSSION: This study will attempt to determine the prevalence of non alcoholic fatty liver disease, as well as, the factors most frequently associated with the presence of this disease to thereby achieve the most appropriate treatment and avoid the evolution of the disease. ( view less ) Esther María Costi,María Dolores Sicilia,Soledad Rubio,Dolores Pérez-Bendito The surfactant to dye binding degree (SDBD) method was extended for the first time to the determination of cationic amphiphiles. For this purpose, Cresyl Violet (CV) and sodium dodecylsulphate (SDS) were selected as dye and reactant surfactant, respectively. This chemical system was used for the de... ( view more )termination of cationic surfactants in pharmaceuticals. The approach was based on the competition established between the dye and cationic analytes to form mixed aggregates with the anionic surfactant (SDS-CV and SDS-analyte), which resulted in an increase of the amount of SDS required to reach a given SDS-CV binding degree. The feasibility of the proposed method to determine quaternary ammonium surfactants belonging to different structural groups (alkyldimethylbenzylammonium chlorides, alkyltrimethylammonium bromides and alkylpyridinium chlorides) in a wide variety of pharmaceutical formulations (solutions, creams and powders) was proved. The analytical features of the SDBD method (versatility, high precision and selectivity, ruggedness, rapidity, simplicity and low cost) made it an advantageous alternative to the conventional methods used in cationic surfactant quality control. ( view less ) Pedro Navarrete-Navarro,Ricardo Rivera-Fernández,Ma Dolores Rincón-Ferrari,Manuel García-Delgado,Angeles Muñoz,Jose Manuel Jiménez,F J Fernández Ortega,Dolores Ma Mayor García,GITAN multicenter project  PURPOSE: The aim of the study was to identify early risk factors for development of acute respiratory distress syndrome (ARDS) in severe trauma patients. MATERIALS AND METHODS: This was a prospective observational study of 693 severe trauma patients (Injury Severity Score >or=16 and/or Revised Trau... ( view more )ma Score or=2) of long bone fractures, and with chest injuries (rib/sternal fracture [ICD-9 code 807] and hemo/pneumothorax [ICD-9 code 860/861]). Patients with ARDS required more colloids (P = .005) and red blood cell units (P = .02) than patients without ARDS during the first 24 hours. Multivariate analysis showed that ARDS was related to chest trauma diagnosis (ICD-9 code 807) (odds ratio [OR], 3.85), femoral fracture (OR, 3.16), APACHE II score (OR, 1.05), and blood transfusion during resuscitation (OR, 1.32). CONCLUSIONS: Risk of ARDS development is related to the first 24-hour admission variables, including severe physiologic derangements and specific ICD-9-classified injuries. Blood transfusion may play an independent role. ( view less ) Mireia Camós,Jordi Esteve,Pedro Jares,Dolors Colomer,María Rozman,Neus Villamor,Dolors Costa,Ana Carrió,Josep Nomdedéu,Emili Montserrat,Elías Campo Acute myeloid leukemia (AML) with translocation t(8;16)(p11;p13) is an infrequent leukemia subtype with characteristic clinicobiological features. This translocation leads to fusion of MYST3 (MOZ) and CREBBP (CBP) genes, probably resulting in a disturbed transcriptional program of a myelomonocytic ... ( view more )precursor. Nonetheless, its gene expression profile is unknown. We have analyzed the gene expression profile of 23 AML patients, including three with molecularly confirmed MYST3-CREBBP fusion gene, using oligonucleotide U133A arrays (Affymetrix). MYST3-CREBBP cases clustered together and clearly differentiated from samples with PML-RARalpha, RUNX1-RUNX1T1, and CBFbeta-MYH11 rearrangements. The relative expression of 46 genes, selected according to their differential expression in the high-density array study, was analyzed by low-density arrays in an additional series of 40 patients, which included 7 MYST3-CREBBP AML cases. Thus, genes such as prolactin (PRL) and proto-oncogene RET were confirmed to be specifically overexpressed in MYST3-CREBBP samples whereas genes such as CCND2, STAT5A, and STAT5B were differentially underexpressed in this AML category. Interestingly, MYST3-CREBBP AML exhibited a characteristic pattern of HOX expression, with up-regulation of HOXA9, HOXA10, and cofactor MEIS1 and marked down-regulation of other homeobox genes. This profile, with overexpression of FLT3, HOXA9, MEIS1, AKR7A2, CHD3, and APBA2, partially resembles that of AML with MLL rearrangement. In summary, this study shows the distinctive gene expression profile of MYST3-CREBBP AML, with overexpression of RET and PRL and a specific pattern of HOX gene expression. ( view less ) Francisco Javier Peñalver,Victor Jiménez-Yuste,Manuel Almagro,Alberto Alvarez-Larrán,Lluis Rodríguez,Marisol Casado,Laura Gallur,Pilar Giraldo,Roberto Hernández,Dolores Menor,Maria José Rodríguez,Dolores Caballero,Raúl González,José Mayans,Isabel Millán,José Rafael Cabrera,Multi-institutional Retrospective Spanish Study Group on the Use of Rituximab in Refractory ITP  Rituximab induces B-cell depletion; therefore, it has been used in the treatment of immune thrombocytopenic purpura (ITP). The aim of this retrospective study was to evaluate the effectiveness of rituximab in the treatment of 89 patients with chronic ITP refractory to several treatments. All the pa... ( view more )tients had platelet counts <30 x 10(9)/l. They had received a median of five (2-13) previous treatments, and 47 had undergone splenectomy. Rituximab was administered i.v. at 375 mg/m(2) in four weekly doses in 77 patients, and 12 patients received 1-6 doses. Forty-nine patients (55.1%) reached platelet counts >50 x 10(9)/l; 41 (46%) achieved a complete response (CR; platelets >100 x 10(9)/l), and eight (9%) obtained a partial response (platelets 50-100 x 10(9)/l). Overall, 31 patients (35%) maintained response, including 15 patients in whom splenectomy failed, with a median follow-up of 9 months (2-42), 12 for more than 1 year. The unique predictor of a maintained response was to reach a CR. Heavily treated patients (more than three different previous treatments, including any corticosteroids) and those with longer ITP duration (>10 years from diagnosis) had a worse response. Non-splenectomized patients had a better early response rate than those splenectomized. Rituximab was well tolerated, with two fever episodes following infusion and two reports of skin rash. Rituximab induced clinical responses in multi-treated refractory ITP patients with little toxicity and should be considered as an early therapeutic option in this setting, even as an alternative to splenectomy in selected patients. ( view less ) Daniel R Carrasco,Tim Fenton,Kumar Sukhdeo,Marina Protopopova,Miriam Enos,Mingjian J You,Dolores Di Vizio,Dolores Divicio,Cristina Nogueira,Jayne Stommel,Geraldine S Pinkus,Christopher Fletcher,Jason L Hornick,Webster K Cavenee,Frank B Furnari,Ronald A Depinho Histiocytic sarcoma (HS) is a rare malignant proliferation of histiocytes of uncertain molecular pathogenesis. Here, genetic analysis of coincident loss of Pten and Ink4a/Arf tumor suppressors in the mouse revealed a neoplastic phenotype dominated by a premalignant expansion of biphenotypic myeloly... ( view more )mphoid cells followed by the development of HS. Pten protein loss occurred only in the histiocytic portion of tumors, suggesting a stepwise genetic inactivation in the generation of HS. Similarly, human HS showed genetic or epigenetic inactivation of PTEN, p16(INK4A), and p14(ARF), supporting the relevance of this genetically engineered mouse model of HS. These genetic and translational observations establish a cooperative role of Pten and Ink4a/Arf in the development of HS and provide mechanistic insights into the pathogenesis of human HS. ( view less ) Jeffrey A Lieberman,Dolores Malaspina,L Fredrik Jarskog Schizophrenia, which has both genetic and environmental causes, is associated with persistent symptoms and severe functional disability. The illness lies dormant during the premorbid phase and begins to express itself during adolescence or early adulthood. Clinical progression and deterioration rea... ( view more )ches a plateau in which the patient is said to be in the chronic phase of illness and at which point restoration of prior functioning is unlikely. The severe deficits associated with schizophrenia are often the result of progression of illness due to lack of appropriate treatment. However, recent advances in neuropsychiatry have led to very early identification of individuals at risk for psychosis, even during the prodromal stage when psychosis has not yet manifested clinically. While research has demonstrated that the efficacy of antipsychotics is limited when used during the chronic phase of illness, these medications can effectively control symptoms and prevent progression of illness when used during the early stages of illness. The evidence of neural degeneration in the pathophysiology of schizophrenic illness suggests that there may be treatment opportunities through neural protection. Neuroprotection, which refers to treatment that helps maintain central nervous system functionality in response to neurobiologic stress, may be responsible for prevention of disease progression and deterioration. In this monograph, Jeffrey L. Lieberman, MD, introduces the phases of schizophrenic illness in relation to the concepts of progression and deterioration. Next, Dolores Malaspina, MD, reviews the neurodevelopmental and neurodegenerative components of schizophrenia. Finally, L. Fredrik Jarskog, MD, focuses on the neuroprotective aspects of therapeutic interventions in schizophrenia. ( view less ) Dolors Costa,Ana Carrió,Irene Madrigal,Amparo Arias,Alexandra Valera,Dolors Colomer,Josep Lluís Aguilar,Montse Teixido,Mireia Camós,Francisco Cervantes,Elías Campo The BCR/ABL gene fusion, the hallmark of chronic myelogenous leukemia (CML) is generated in 2-10% of patients by a variant Ph translocation involving 9q34, 22q11.2, and one or more additional genomic regions. The objective of this study was the characterization by conventional and molecular cytogen... ( view more )etics of complex variant Ph translocations present at diagnosis. FISH studies were performed in 7 cases using the LSI BCR/ABL ES probe allowing the detection of the fusion BCR/ABL gene on the Ph chromosome in all of them and 9q34 deletions in 2 cases. Three cryptic complex rearrangements were detected by FISH studies. The third and the fourth chromosome regions involved in the 8 complex variant translocations were: 1q21, 1p36, 5q31, 11q13, 12q13, 12p13, and 20q12. In conclusion, FISH studies have been useful in the detection of the BCR/ABL rearrangements and 9q34 deletions, and to identify complex rearrangements that differ from the ones previously established by conventional cytogenetics. ( view less ) Dolores Marín,Dolores Linde,María Fernández Lobato Xanthophyllomyces dendrorhous grown in different media shows amylolytic activity, consisting in an extracellular exo-acting enzyme able to hydrolysed alpha,1-4 glycosidic bonds from soluble starch, which also cleaves maltose and malto-oligosaccharides. The enzyme was purified, using basically a cou... ( view more )ple of chromatography process on DEAE-Sephacel. It is a glycoprotein with a molecular weight estimated to be 60.2 kDa based on its mobility in SDS-PAGE and 115 kDa based on gel filtration. N-linked carbohydrate accounts for 12% of the total mass. It exhibited optimum activity at pH 5.5 and 45 degrees C. Thermostability analysis indicated that it was stable to thermal treatment up to 50 degrees C; 50% of the activity was maintained after 3 h. The rate parameters measured for the hydrolysis of starch and various chain length malto-oligosaccharides shows high catalytic efficiency, calculated by the relationship V(cat)/K(m), for malto-oligosaccharides, such as maltotriose (873 mM(-1) min(-1)), or maltoheptose (698 mM(-1) min(-1)). The new enzyme hydrolysed soluble starch with nearly 3.5- and 1.4-fold lower efficiency than that for maltotriose and maltose, respectively. No activity was found on heterogeneous substrates, such as sucrose and aryl alpha-glucoside, or on isomalto-oligosaccharides. In accordance to substrate specificity profile, the new enzyme was classified as an alpha-glucosidase. ( view less ) Dolores Aumente,Dolores Santos Buelga,John C Lukas,Pedro Gomez,Antonio Torres,Maria José García OBJECTIVE: To develop and a priori validate a methotrexate population pharmacokinetic model in children with acute lymphoblastic leukaemia (ALL), receiving high-dose methotrexate followed by folinic acid rescue, identifying the covariates that could explain part of the pharmacokinetic variability o... ( view more )f methotrexate. METHODS: The study was carried out in 49 children (aged 6 months to 17 years) who received high-dose methotrexate (3 g/m(2) per course) in long-term treatment. In an index group (37 individuals; 1236 methotrexate plasma concentrations), a population pharmacokinetic model was developed using a nonlinear mixed-effects model. The remaining patients' data (12 individuals; 278 methotrexate plasma concentrations) were used for model validation. Age, sex, total bodyweight (TBW), height, body surface area, lowest urine pH during infusion, serum creatinine, ALT, AST, folinic acid dose and length of rescue were analysed as possible covariates. The final predictive performance of the pharmacokinetic model was tested using standardised mean prediction errors. RESULTS: The final population pharmacokinetic model (two-compartmental) included only age and total bodyweight as influencing clearance (CL) and volume of distribution of central compartment (V(1)). For children aged < or =10 years: CL (L/h) = 0.287 . TBW(0.876); V(1) (L) = 0.465 . TBW, and for children aged >10 years: CL (L/h) = 0.149 . TBW; V(1) (L) = 0.437 . TBW. From the base to the final model, the inter-individual variabilities for CL and V(1) were significantly reduced in both age groups (30-50%). The coefficients of variation of the pharmacokinetic parameters were <30%, while residual and inter-occasional coefficients maintained values close to 40%. Validation of the proposed model revealed the suitability of the model. CONCLUSION: A methotrexate population pharmacokinetic model has been developed for ALL children. The proposed model could be used in Bayesian algorithms with a limited sampling strategy to estimate the systemic exposure of individual patients to methotrexate and adapt both folinic acid rescue and methotrexate dosing accordingly. ( view less ) Ana Pedraza,María Dolores Sicilia,Soledad Rubio,Dolores Pérez-Bendito An aggregation parameter-based methodology for determining acid and neutral drugs in pharmaceutical dosage forms is presented. The method is based on competitive self-assembly in ternary dye-surfactant-drug aqueous mixtures. Dyes bearing charge of opposite sign to that of surfactants bind to surfac... ( view more )tant to form mixed dye-surfactant aggregates, which are monitored from changes in the spectra features of the dye. The drug competes with the dye to interact with the surfactant to form drug-surfactant aggregates, which results in a decrease in the surfactant to dye binding degree proportional to the drug concentration in the aqueous solution. Coomassie Brilliant Blue G (CBBG) and didodecyldimethylammonium bromide (DDABr) were the dye and surfactant reactant used, respectively. The suitability of the surfactant to dye binding degree (SDBD) method to determine drugs with very different molecular structure: propionic (flurbiprofen, ibuprofen, naproxen and ketoprofen) and acetic (diclofenac, felbinac and zomepirac) acids, indolines (indomethacin and sulindac), glycyrrhetinic acid derivatives (carbenoxolone and enoxolone), salicylates (diflunisal and phenyl salicylate), oxicams (meloxicam, piroxicam and tenoxicam), pyrazolones (phenylbutazone and sulfinpyrazone) and hydrocortisones (dexamethasone and prednisolone) has been proved. The proposed method was successfully applied to the determination of drugs in commercial formulates (effervescent granulates, tablets, suppositories, gels and blisters) with a minimum sample treatment (dilution of liquid samples and dissolution of solid samples). ( view less ) Antonia Moral,María Dolores Sicilia,Soledad Rubio,Dolores Pérez-Bendito Supramolecular sorbents (hemimicelles/admicelles) are proposed for the extraction/preconcentration of bisphenols from aqueous environmental samples prior to their liquid chromatography/fluorimetric determination. A comparative study on the use of cetyltrimethylammonium bromide (CTABr)-coated silica... ( view more ) and sodium dodecyl sulphate (SDS)-coated gamma-alumina as sorbent materials, is presented. Bisphenol A (BPA) and bisphenol F (BPF) were quantitatively retained on CTABr admicelles. Addition of tetrabutylammonium chloride (TBAC) to water samples was required to completely retain bisphenols on SDS-gamma-alumina. Retention on both sorbents occurred through hydrophobic and pi-cation interactions between the quaternary ammonium head group of the cationic amphiphile (CTABr or TBAC) and the aromatic rings of the target analytes. TBAC-SDS-gamma-alumina was the sorbent selected for the SPE of bisphenols on the basis of the lower elution volume required (1 ml of methanol) and the greater breakthrough volume allowed (400 ml), which permitted to reach practical detection limits of 10 and 15 ng/l for BPF and BPA, respectively. The proposed method was used to quantify bisphenol A and bisphenol B in wastewater samples from four sewage treatment plants. Recoveries obtained ranged between about 99 and 105% for raw wastewater and between 96 and 106% for treated wastewater. ( view less )
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