Coexistencia de artritis séptica y microcristalina: un reto diagnóstico. A propósito de 25 casos

ObjectiveSeptic arthritis is a medical emergency and crystal-induced arthritis is a risk factor for its development. If both occur simultaneously, crystal-induced arthritis may mask the diagnosis of infection and delay antibiotic therapy.MethodRetrospective analysis of patients with coexistence of septic and crystal-induced arthritis. We included only patients with isolation of crystals in synovial fluid analysis and positive culture of synovial fluid and/or blood culture.ResultsA total of 25 patients (17 men and 8 women) with a mean age of 67 years. The most commonly affected joint was the knee. In synovial fluid cytological studies, the most frequently identified crystals were monosodium urate. Risk factors included diabetes and chronic renal failure. The most frequently isolated germs were methicillin-sensitive S. aureus (48%), methicillin-resistant S. aureus (12%) and Mycobacterium tuberculosis (12%). In all, 36% of subjects required surgical drainage (excluding those caused by M. tuberculosis). Clinical outcome was favorable in 56%, although intercurrent complications were usual (40%). Mortality was 8%.ConclusionsCoexistence of septic and crystal-induced arthritis represents a diagnostic challenge and requires a high index of suspicion. Gout was the most prevalent crystal-induced arthritis. S. aureus was the most commonly causative pathogen, with a high rate of methicillin-resistant S. aureus infection. If treated early, the outcome is usually favorable, making synovial fluid microbiological study imperative.     

Recency, primacy, and memory: reappraising and standardising the serial position curve.

In this paper we consider the serial position curve in immediate verbal free recall. A large literature has argued that two components of the serial position curve, recency and primacy, reflect the functioning respectively of short-term and of long-term memory. However, there are a number of difficulties in interpreting the recency effect as a phenomenon uniquely associated with short-term memory. Moreover, the serial position curve has been used widely for clinical investigations in patients with memory deficits. This is despite the lack of norms for the measures derived from the curve. We present a set of standardised norms based on 321 Italian normal subjects. These norms are shown to be applicable both to an English speaking population, and to three groups of brain damaged-patients, namely Alzheimer's, amnesics, and frontals. The standardised norms offer a clinical and experimental tool which, coupled with a multiple single case approach, allows us to show dissociations and double dissociations among the performance patterns obtained from all three pathological groups. The paper concludes with a discussion of a possible interpretation of the recency effect as a emergent property of all types of memory system, including verbal short-term memory. Taking into account previous literature as well as our own data, the recency effect in immediate verbal free recall is here interpreted in terms of a two-component view of verbal short-term memory.     

Extracellular HIV-1 Tat protein activates phosphatidylinositol 3- and Akt/PKB kinases in CD4+ T lymphoblastoid Jurkat cells

The biological basis for the pleiotropic activity of extracellular human immunodeficiency virus (HIV)-1 Tat protein on lymphoid T cell survival is not well understood. We have here demonstrated that the addition in culture of 0.1–10 nM Tat protein to 36-h serum-starved lymphoblastoid Jurkat T cells rapidly stimulates the catalytic activity of phosphatidylinositol 3-kinase (PI 3-K). The peak of activation was observed 30 min after Tat addition. Extracellular Tat also stimulated the catalytic activity of the Akt/PKB kinase, a major target of PI 3-K lipid products. Pretreatment of serum-starved Jurkat cells with 100 nM wortmannin (WT) or 10 μM LY294002, two unrelated pharmacological inhibitors of PI 3-K, markedly suppressed the catalytic activity of both PI 3-K and Akt/PKB in Jurkat cells. Moreover, at low concentrations (0.1–1 nM), extracellular Tat showed a small but reproducible protection of Jurkat cells from apoptosis induced by serum deprivation (p < 0.05), while the combination of Tat plus 100 nM WT significantly (p < 0.05) increased the percentage of apoptosis with respect to cells left untreated or treated with Tat alone. Taken together, these data suggest that the anti-apoptotic activity of low concentrations of Tat protein on Jurkat cells is mediated by a PI 3-kinase/Akt pathway.     

Changes in EEG activity and hypothalamic temperature as indices for non-REM sleep to REM sleep transitions

A shift of physiological regulations from a homeostatic to a non-homeostatic modality characterizes the passage from non-NREM sleep (NREMS) to REM sleep (REMS). In the rat, an EEG index which allows the automatic scoring of transitions from NREMS to REMS has been proposed: the NREMS to REMS transition indicator value, NIV [J.H. Benington et al., Sleep 17 (1994) 28-36]. However, such transitions are not always followed by a REMS episode, but are often followed by an awakening. In the present study, the relationship between changes in EEG activity and hypothalamic temperature (Thy), taken as an index of autonomic activity, was studied within a window consisting of the 60s which precedes a state change from a consolidated NREMS episode. Furthermore, the probability that a transition would lead to REMS or wake was analysed. The results showed that, within this time window, both a modified NIV (NIV(60)) and the difference between Thy at the limits of the window (Thy(D)) were related to the probability of REMS onset. Both the relationship between the indices and the probability of REMS onset was sigmoid, the latter of which saturated at a probability level around 50-60%. The efficacy for the prediction of successful transitions from NREMS to REMS found using Thy(D) as an index supports the view that such a transition is a dynamic process where the physiological risk to enter REMS is weighted at a central level.     

Genetic sperm defects and consanguinity.

BACKGROUND: The existence of a genetic component to human infertility has been suggested, although neither the specific abnormalities involved, nor their genetic mechanism of transmission, are currently defined. We have examined, by transmission electron microscopy (TEM), ejaculate from 1600 males with fertility problems. Among the subjects studied, we focused on a group of patients whose family histories revealed different degrees of consanguinity, in order to evaluate the relationship between consanguinity and particular sperm alterations. METHODS AND RESULTS: A total of 64 consanguineous individuals were identified. In this group, excluding two azoospermic patients, 17 patients (27%) were found to have well recognized genetic ultrastructural defects affecting their entire sperm population: eight subjects had spermatozoa with "stunted tails", four "detached tail" spermatozoa, two "Kartagener's syndrome", two "miniacrosome" and one "round headed" spermatozoa. Since these alterations affect the total sperm population and do not respond to medical treatment, they are suspected of having a genetic origin. The remaining group of 1506 non-consanguineous patients suffered from the same genetic defects in only 15 cases (<1%). CONCLUSIONS: From the data presented, it appears that some very peculiar and rare sperm defects may have a genetic basis since they occur more frequently in consanguineous patients, and are related to different degrees of consanguinity. Since the ejaculate of the remaining patients, both consanguineous and not, showed diverse types of ultrastructural sperm anomalies that did not affect the entire sperm population, they might represent pathologies lacking a genetic basis.     

Hiv-1 tat protein suppresses the nerve growth-factor (ngf)-mediated differentiation of PC12 rat pheochromocytoma cell-line

In order to evaluate the effect of the regulatory human immunodeficiency virus-type 1 (HIV-1) Tat protein on the process of neuronal differentiation, two tat-transfected and mock-transfected PC12 cell lines were cultured in the absence or presence of 100-1000 ng/ml of nerve growth factor (NGF). As expected, NGF was able to induce a clearcut morphological differentiation of mock-transfected PC12 into sympathetic-like neurons, also reducing the percentage of cells in S phase. On the other hand, NGF was unable to reduce the percentage of PC12-tat cells in S phase and/or to induce their neuronal differentiation. Only the addition in culture of 5 mu g/ml neutralizing anti-Tat antibody plus 1000 ng/ml NGF was effective in decreasing the percentage of PC12-tat in S phase and inducing partial signs of neuronal differentiation in serum-free cultures. The ability of Tat protein to suppress the neuronal differentiation pathway controlled by NGF further contribute to the definition of its role in tumor promotion during the course of HTV-1 disease.     

Presence of micronuclei in lymphocytes of mercury exposed workers

We have investigated the presence of micronuclei in mercury exposed workers. The study group consisted of 15 workers from a mercury-producing plant, mean age 39.5 years and a mean exposed period of 12 years. At the time of testing and for the six previous months, the exposed population had urinary mercury levels below the currently accepted limit of 50 ug/g creatinine. A significant increase in the percentage of micronuclei was observed in the mercury exposed individuals when compared to the non exposed group. We have not found any correlation between the percentage of micronuclei and age, length of exposure or urinary mercury concentrations. Our results suggest a genotoxic effect of mercury, which is observed in workers exposed chronically to levels considered biologically safe for the exposed population.     

How can we evaluate interference in attentional tests? A study based on bi-variate non-parametric tolerance limits.

In attentional tasks a basic performance is often contrasted with the same task administered with some additional load, defined here as "interference". However, it is questionable how interference should be quantified. The raw difference between the interference-loaded ("complex") task and the basic task is marred by measurement artefacts. There are alternative ways, but the choice of which solution to employ appears arbitrary. Bivariate non-parametric tolerance limits were introduced as they retain the information linked to the bivariate nature of the observation, and in this study we compared the different approaches for evaluating interference using real data from 209 normal participants who performed Visual Reaction Times (basic and go / no-go) and the Stroop Test. Our analysis indicated that, among the univariate indices, the use of the complex score covaried for the basic score yields the most satisfactory evaluation of interference; however, its use can be decided only after data inspection. Bivariate non-parametric tolerance limits offer advantages in terms of generality of use.     

In vivo and in vitro modulatory effect of human immunodeficiency virus type-1 (HIV-1) Tat protein on protein kinase C activity

Extracellular HIV-1 Tat protein shows a pleiotropic activity on the survival/proliferation of different cell types, which may be relevant to the pathogenesis of the immune suppression as well as of the frequent neoplastic disorders observed during the course of HIV-1 disease. Therefore, we investigated the effect of recombinant Tat on the protein kinase C (PKC) activity in Jurkat CD4(+) T lymphoma cells by using a serine substituted specific PKC peptide substrate, which allowed the evaluation of the whole catalytic activity of both Ca++-dependent and Ca++-independent PKC isoforms. High concentrations of recombinant Tat (1 mu g/ml) induced an early (5 min) stimulation followed by a secondary (30-60 min) inhibition of PKC in whole Jurkat cell homogenates. Immuno-localization experiments showed that recombinant Tat protein was rapidly taken up by Jurkat cells within the first 5 min from the addition in culture, thus suggesting the possibility that the secondary inhibitory phase of Tat on PKC activity in Jurkat cells could be due to a direct interaction between the two proteins. Consistently, PKC immunoprecipitated from Jurkat cells or purified from rat brain was significantly inhibited by the addition of high (0.1-1 mu g) but not low (1-10 ng) doses of Tat in a cell-free in vitro assay. The inhibition of PKC catalytic activity mediated by 1 mu g of Tat was at least partially due to competition among substrates. The present data may help in understanding the opposite effects on the survival/proliferation of different cell types observed in the presence of picomolar (stimulation) vs nanomolar (inhibition) concentrations of recombinant Tat.