Objective
The impact of endogenous immunoglobulin isotypes on the prognosis of patients with severe sepsis has not been sufficiently explored. The aim of this study was to evaluate the association ...between immunoglobulin levels in plasma and survival in patients with this condition.
Design and patients
A prospective multicentre cohort study was conducted. A total of 172 adult patients admitted to the intensive care unit (ICU) with severe sepsis or septic shock were recruited. Patients were classified based on deciles of immunoglobulin concentrations at diagnosis of sepsis. Categorical variables were created and tested for their association with survival during hospitalization in the ICU.
Results
Overall, 42 patients died in the ICU during the study. Kaplan–Meier analysis showed that immunoglobulin concentrations below 300 mg dL−1 for IgG1, 35 mg dL−1 for IgM and 150 mg dL−1 for IgA were associated with shorter survival times. Multivariate regression analysis showed that IgG1 < 300 mg dL−1 was a risk factor for mortality odds ratio (OR) 2.50, 95% confidence interval (CI) 1.04–6.03; P = 0.042. The combined presence of IgG1, IgM and IgA levels below the described thresholds had a synergistic impact on mortality risk (OR 5.27, 95% CI 1.41–19.69; P = 0.013). A similar effect was observed for combined low levels of IgG1 and IgA (OR 4.10, 95% CI 1.28–13.12; P = 0.018) and also of IgG1 and IgM (OR 3.10. 95% CI 1.13–8.49; P = 0.028).
Conclusions
The combined presence of low levels of the endogenous immunoglobulins IgG1, IgM and IgA in plasma is associated with reduced survival in patients with severe sepsis or septic shock. Assessment of the concentrations of these immunoglobulins could improve the results of treatment with exogenous immunoglobulins in patients with sepsis.
Uveal melanoma represents the most common intraocular neoplasia among adults. Brachytherapy (interventional radiotherapy; IRT) has a great advantage, when compared with enucleation, both in terms of ...organ and function sparing. The Collaborative Ocular Melanoma Study introduced into clinical practice a standardised procedure that allowed the equivalence of IRT with enucleation in terms of overall survival to be demonstrated. IRT is carried out by placing a plaque in direct contact with the sclera under the uveal melanoma. Several radioactive sources may be used, including 106-ruthenium, 125-iodine, 103-palladium and 90-strontium. It is a multidisciplinary procedure requiring the collaboration of interventional radiation oncologists and ophthalmologists in the operating theatre and medical physicists for an accurate treatment time calculation. It also relies on ultrasound imaging to identify the lesion and verifiy the correct plaque placement. An emerging tool of paramount importance could be the use of artificial intelligence and predictive models to identify those patients at higher risk of developing late side-effects and therefore who may deserve preventive and supportive therapies.
This study was undertaken to assess the effects of fish oil (FO) substitution by a mixture of alternative vegetable oils (VO) on Seriola dumerili culture performance. A 154‐day feeding experiment was ...conducted using juveniles (39.2 ± 1.6 g average weight). Three isolipidic and isoenergetic meal‐based diets were formulated varying their lipid component. The control diet contained 100% FO (FO100), whereas diets VO50 and VO100 included 1/2 of oil blend and all the oil from blend of palm oil (PO) and linseed oil (LO) as substitute for FO, respectively. Dietary regime did not significantly affect growth performance, biometric indices, feed efficiency, plasma chemistry and liver and muscle lipid contents. Nonetheless, dietary VO inclusion impacted on the fatty acid profile of target tissues, especially in the liver. Fatty acid profiles of the fillets reflected those of the dietary oils except that there was apparent selective utilization of palmitic acid (C16:0) and oleic acid (C18:1n‐9) and apparent selective retention of long‐chain polyunsaturated fatty acids, especially eicosapentaenoic acid (EPA, C20:5n‐3) and docosahexaenoic acid (DHA, C22:6n‐3). The nutritional value and the potential ability to prevent the development of coronary heart diseases of the flesh lipid fraction decreased with gradual FO substitution.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Summary
Background
Green kiwifruit allergy is on the rise. However, no surveys testing purified major kiwi allergens have been carried out in a large population, including both kiwi‐sensitized skin ...prick test (SPT)‐positive and truly kiwi‐allergic patients.
Objective
To isolate major kiwifruit allergens, and to explore their relevance by in vitro and in vivo methods in a large kiwi‐sensitized and ‐allergic population.
Methods
A large group (n=92) of kiwi‐sensitized patients with different clinical symptoms were selected, and double‐blind, placebo‐controlled, food challenges to kiwi were performed in 52 of them. The three major IgE‐binding proteins from kiwifruit extracts were isolated and characterized by N‐terminal amino acid sequencing and molecular size and glycosylation analysis. The allergenic potency of the three kiwi allergens, and of avocado Pers a 1 as a model allergen associated with the latex‐fruit syndrome, was tested by specific IgE quantitation, immunodetection assays and SPTs.
Results
The isolated kiwifruit allergens were identified as actinidin Act d 1, glycosylated thaumatin‐like Act d 2 and a novel 40 kDa glycoprotein designated as Act d 3.02. Specific IgE to each of the three allergens was found in over 60% of sera from kiwi‐sensitized patients, and Act d 1 and Act d 2 induced positive SPT responses in over 50% of the tested patients. A significant link between IgE levels to Act d 1 and Act d 3 and anaphylaxis was uncovered. Avocado Pers a 1 showed an in vitro sensitization prevalence of around 45%, but a low in vivo reactivity.
Conclusion
Act d 1, Act d 2 and Act d 3 are major allergens in the population studied. Severe symptoms after kiwi ingestion are associated with high IgE levels to Act d 1 and Act d 3.
Background
Pelvic recurrences from previously irradiated gynecological cancer lack solid evidence for recommendation on salvage.
Methods
A total of 58 patients were included in this clinical ...analysis. Salvage surgery was performed for locoregional relapse within previously irradiated pelvic area after initial surgery and adjuvant radiotherapy or radical external beam radiotherapy. The primary tumor diagnosis included cervical cancer (
n
= 47, 81%), uterine cancer (
n
= 4, 7%), and other types (
n
= 7, 12%). Thirty-three patients received adjuvant IOERT (1984–2000) at a median dose of 15 Gy (range 10–20 Gy) and 25 patients received adjuvant PHDRB (2001–2016) at a median dose of 32 Gy (range 24–40 Gy) in 6, 8, or 10 b.i.d. fractions.
Results
The median follow-up was 5.6 years (range 0.5–14.2 years). Twenty-nine (50.0%) patients had positive surgical margins. Grade ≥ 3 toxic events were recorded in 34 (58.6%) patients. The local control rate at 2 years was 51% and remained stable up to 14 years. Disease-free survival rates at 2, 5, and 10 years were 17.2, 15.5, and 15.5%, respectively. Overall survival rates at 2, 5, and 10 years were 58.1, 17.8, and 17.8%, respectively.
Conclusions
IOERT and PHDRB account for an effective salvage in oligorecurrent gynecological tumors. Patients with previous pelvic radiation suitable for salvage surgery and at risk of inadequate margins could benefit from adjuvant reirradiation in form of IOERT or PHDRB. However, the rate of severe grade ≥ 3 toxicity associated with the entire treatment program is relevant and needs to be closely counterbalanced against the expected therapeutic gain.
Peach allergy has two different patterns: central Europe with oral allergy syndrome (OAS) related to a primary sensitization to birch pollen Bet v 1 and profilins and southern Europe with mostly ...systemic symptoms, in many cases due to sensitization to lipid-transfer proteins. Thirty peach-allergic patients with positive skin and food challenge tests and 29 control subjects were included. Skin prick tests (SPT) with inhalant allergens, commercial peach and apple extracts and native Pru p 3 were performed. In vitro specific immunoglobulin (Ig) E to grass pollen, birch pollen, peach, apple, rBet v 1, rBet v 2 and rPhl p 12 was determined by CAP, and rBet v 1, rMal d 1, rMal d 4, rMal d 3 and rPru p 3 using the ADVIA-Centaur platform. Basophil activation test (BAT) with commercial peach extract, commercial apple extract, nPru p 3, rMal d 3, rMal d 1 and rMal d 4 was also performed. Pru p 3 was the major allergen in the patient group from northern Spain. Sensitization to this allergen was found in 100% of the patients with systemic symptoms or contact urticaria. Only 60% of OAS patients were sensitized to Pru p 3, being all of them sensitized to profilins and 60% of them to allergens of the Bet v 1 family. Specific IgE determination and BAT using recombinant allergens (rPru p 3) show specificity and sensitivity values close to 100%. Most peach-allergic patients coming from the north of Spain present systemic symptoms after ingestion of peach, Pru p 3 being the main allergen. Patients with OAS present profilin-Bet v 1-related sensitization. Thus, in the north of Spain our patients show a mixed central-south Europe pattern with LTP-profilin-Bet v 1 sensitization depending on the symptoms presented. The use of natural and recombinant plant allergens, allows establishing the sensitization patterns to the different allergens studied.
Summary
Background
Peach is the most important fruit related to food allergy in the Mediterranean area. Pru p 3, its lipid transfer protein, has been described as the principal allergen responsible ...for cross‐reactivities with other foods and pollen and the severity of clinical symptoms. However, the involvement of other allergenic families cannot be ruled out. Thaumatin‐like proteins (TLPs) have been described as food allergen in several fruits, such as apple, cherry, kiwi and banana, and pollen.
Objective
To identify members of the TLP family in peach fruit and to characterize putative allergens.
Methods
Through two‐dimensional (2D) electrophoresis of peach extract and immunodetections with a pool of peach‐allergic patients, IgE‐binding spots were identified and the corresponding proteins purified and characterized as allergens by in vitro and in vivo assays.
Three isoforms, belonging to the TLP family, were purified by different chromatographic systems and characterized by N‐terminal amino acid sequences, molecular weight determination (MALDI) and enzymatic activity analysis (β‐1,3‐gluconase test and inhibition growth of fungi). In the same way, their IgE‐binding capacity and allergenic activity were tested by ELISA assays, basophil activation tests and skin prick tests (SPT).
Results
Two peach‐TLPs, Pru p 2.0101 and Pru p 2.0201, were identified as IgE‐binding spots by 2D electrophoresis. Another peach‐TLP, Pru p 2.0301, was cloned and produced as recombinant protein in a yeast system. The three isoforms were purified and characterized as TLPs by immunoblotting with anti‐chestnut TLP antibodies and anti‐plant N‐asparagine complex glycan (anti‐cross‐reactive carbohydrate determinant). All of them showed β‐1,3‐glucanase activity and inhibition of fungal growth. The three TLPs were recognized by around 50% of the sera from 31 patients analysed in ELISA experiments. All three gave a positive response to an SPT and/or in basophil activation experiments.
Conclusion
Three isoforms, belonging to the TLP family, were identified in peach as principal allergens. Their prevalence, observed in in vitro, ex vivo and in vivo analyses, suggests that they are important allergens and should therefore be included in the routine diagnosis of peach allergy, at least in the Mediterranean area.
Cite this as: A. Palacín, L. Tordesillas, P. Gamboa, R. Sanchez‐Monge, J. Cuesta‐Herranz, M. L. Sanz, D. Barber, G. Salcedo and A. Díaz‐Perales, Clinical & Experimental Allergy, 2010 (40) 1422–1430.
Summary
Background
Artemisia vulgaris is a widespread weed in the Mediterranean area and several allergens have been detected in its pollen. One of them, Art v 3, belongs to the lipid‐transfer ...protein (LTP) family and its prevalence in Artemisia‐sensitized patients or its relationship with other LTP allergens is not clear.
Objective
To assess the pattern of sensitization to an array of mugwort allergens in a Mediterranean population, and to study the cross‐reactivity of Art v 3 with Pru p 3 and Par j 1, relevant LTP allergens in the area.
Methods
Skin prick test was performed with whole extracts (A. vulgaris, Parietaria judaica and peach) and pure natural allergens Art v 1, Art v 3, Art v 60 kDa and Par j 1 in 24 mugwort‐allergic patients from a Mediterranean area. In vitro assays included measurement of specific IgE and ELISA inhibition among LTP allergens.
Results
The three Artemisia allergens elicited a positive skin response in 70–80% of the patients. Seven patients were clearly sensitized to Par j 1 and 11 to Pru p 3. There was no correlation between Par j 1 and Pru p 3 sensitization, but a highly significant correlation was found between peach extract and Art v 3 as regards the skin response. No IgE cross‐reactivity was observed between Art v 3/Par j 1 or Pru p 3/Par j 1. In contrast, Art v 3 significantly inhibited the binding to Pru p 3 of IgE from three patients' sera out of six studied, but Pru p 3 was not able to inhibit the IgE binding to Art v 3.
Conclusion
Art v 3 is a major mugwort allergen and in some patients with IgE to both Art v 3 and Pru p 3, Art v 3 behaves as the primary sensitizing agent.
Background: Most studies show a steep increase in asthma prevalence in the last decades, although few studies had applied the same methodology. Recent reports point out the possibility that the ...epidemic has come to an end. We have studied the prevalence of asthma in a very large sample of children, repeating the study eight years apart.
Methods: Repeated cross‐sectional studies using the International Study of Asthma and Allergies in Childhood (ISAAC) protocol in a sample of Spanish schoolchildren 6–7 (parent‐reported) and 13–14 (self‐reported) years old in 1994–95 (phase I) and 2002–2003 (phase III). The number of participants was 42 417 in phase I and 42 813 in phase III. The participation rate was over 87% (13–14 years) and 70% (6–7 years).
Results: The prevalence of wheezing in the previous year in children aged 13–14 years was 9.0 and 9.3% for boys and 9.6 and 9.2% for girls for phases I and III, respectively. Children 6–7 years of age showed a substantial increase in wheezing in the previous year (7.0 and 10.7% for boys and 5.3 and 8.2% for girls). Other symptoms and severity indexes followed the same patterns.
Conclusions: In the last 8 years, the prevalence of asthma has not changed in 13–14‐year‐old Spanish children but has increased substantially in 6–7‐year olds.
A 154‐day trial was performed to assess the use of an alternative protein blend (corn gluten, krill and meat meal) as a substitute for fishmeal in diets for juvenile yellowtail, using four isolipidic ...(140 g/kg) and isoenergetic diets (24 MJ/kg) with the same digestible protein content (50%). The control diet was FM100, without replacement, and in FM66, FM33 and FM0, fishmeal was replaced at 33 g/kg, 66 g/kg and 100 g/kg, respectively. At the end of the experiment, no differences in growth parameters were observed. Fish fed the FM0 diet exhibited the lowest survival (23%). This high mortality may be due to different factors, such as a dietary amino acid imbalance or some antinutrient factors contained in the alternative ingredients. Feed intake, feed conversion ratio, digestible protein intake and protein efficiency ratio were similar in all diets. However, digestible energy intake and protein efficiency retention were lowest in fish fed the FM0 diet. Apparent digestibility coefficients for protein, energy and amino acids diminished as a substitution for fishmeal increased. Significant differences were observed in the diet whole‐fish body profile amino acid retention (AAR) ratio for the seven essential amino acids. In summary, total fishmeal replacement by the blend assayed was not feasible for yellowtail. The FM66 diet resulted in good growth, high survival and good nutrient efficiency.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
PDF
