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Biomedical subjects

Carlos Gutierrez

Publications and source records attributed to Carlos Gutierrez.

At least 19 recordsLinked to original sources

Syk is downstream of intercellular adhesion molecule-1 and mediates human rhinovirus activation of p38 MAPK in airway epithelial cells.

The airway epithelium is the primary target of inhaled pathogens such as human rhinovirus (HRV). Airway epithelial cells express ICAM-1, the major receptor for HRV. HRV binding to ICAM-1 mediates not only viral entry and replication but also a signaling cascade that leads to enhanced inflammatory mediator production. The specific signaling molecules and pathways activated by HRV-ICAM-1 interactions are not well characterized, although studies in human airway epithelia implicate a role for the p38 MAPK in HRV-induced cytokine production. In the current study, we report that Syk, an important immunoregulatory protein tyrosine kinase, is highly expressed by primary and cultured human airway epithelial cells and is activated in response to infection with HRV16. Biochemical studies revealed that ICAM-1 engagement by HRV and cross-linking Abs enhanced the coassociation of Syk with ICAM-1 and ezrin, a cytoskeletal linker protein. In polarized airway epithelial cells, Syk is diffusely distributed in the cytosol under basal conditions but, following engagement of ICAM-1 by cross-linking Abs, is recruited to the plasma membrane. The enhanced Syk-ICAM-1 association following HRV exposure is accompanied by Syk phosphorylation. ICAM-1 engagement by HRV and cross-linking Abs also induced phosphorylation of p38 in a Syk-dependent manner, and conversely, knockdown of Syk by short interfering (si)RNA substantially diminished p38 activation and IL-8 gene expression. Taken together, these observations identify Syk as an important mediator of the airway epithelial cell inflammatory response by modulating p38 phosphorylation and IL-8 gene expression following ICAM-1 engagement by HRV.

Animals↗

Ocular lesions associated with Trypanosoma evansi in experimentally infected goats.

Ocular lesions associated with Trypanosoma spp. infection have been described in man and many animal species. However, loss of vision has not been demonstrated in humans presenting Chagas disease or in animals affected by different trypanosome species. In order to assess the possible ocular disorders caused by Trypanosoma evansi infection, six goats were inoculated with 1 x 10(5) T. evansi and maintained for 12 months and four goats were used as control. The inoculated animals became positive at serological and parasitological tests at 1-month post-inoculation and showed a subclinical course of the disease. Unilateral superficial corneal ulceration and retinochoroiditis were observed in two inoculated animals. Data from ocular neurologic examination and electroretinography showed no significant differences between inoculated and non-inoculated goats. It could be concluded that Trypanosoma evansi can produce ocular lesion but without apparent loss of vision in goats.

Animals↗

The effect of gender combinations on outcome in human lung transplantation: the International Society of Heart and Lung Transplantation Registry experience.

BACKGROUND: In the current practice of lung transplantation, donor and recipient genders are neither directly considered nor matched. METHODS: We analyzed the potential effect of gender combinations on survival in 9,651 lung transplant recipients in the International Society of Heart and Lung Transplantation Registry (ISHLT) Registry. We compared the risk of overall and 90-day mortality by using statistical models that accounted for confounding variables. RESULTS: A Kaplan-Meier survival analysis revealed a significant difference of survival among gender combinations (log rank, p = 0.0009). The unadjusted odds ratio (OR) of 90-day mortality was significantly higher in female (F) donors to male (M) recipients (OR, 1.58; 95% confidence interval (CI), 1.22-2.04; p < 0.001) and lower in F to F (OR, 0.742; 95% CI, 0.61-0.90; p = 0.004) compared with the reference category of M to M. After adjusting for size mismatch and diagnosis in the multivariate logistic regression model, the OR of F to M was still statistically significant (F to M OR, 1.52l; 95% CI, 1.04-2.20; p = 0.028; F to F OR, 0.67; 95% CI, 0.53-0.91; p = 0.008) for 90-day mortality. A Cox proportional hazards analysis for overall survival also showed a significantly higher hazard ratio of 1.12 in F to M (95% CI, 1.01-1.23) and a lower hazard ratio of 0.92 in F to F (95% CI, 0.87-0.98). CONCLUSION: ISHLT Lung Transplant Registry data demonstrated a significant risk for F to M. Interestingly, F to F appears to be potentially beneficial in lung transplantation. Gender combinations do appear to significantly impact outcome after lung transplantation.

Adult↗

Trypanosomosis in goats: current status.

Trypanosomosis is a major constraint on ruminant livestock production in Africa, Asia, and South America. The principal host species affected varies geographically, but buffalo, cattle, camels, and horses are particularly sensitive. Natural infections with Trypanosoma congolense, T. vivax, T. brucei, and T. evansi have been described in goats. Trypanosomosis in goats produces acute, subacute, chronic, or subclinical forms, being T. vivax, T. congolense, and T. evansi, the most invasive trypanosomes for goats. However, the role of goats in the epidemiology of trypanosomosis is largely discussed and not well understood. Thus, it has commonly been assumed that trypanosomosis presents a subclinical course and that goats do not play an important role in the epidemiology of the disease. This can partially be due to parasitemia caused by trypanosomes which has been considered low in goats. However, this assumption is currently undergoing a critical reappraisal because of goats may also serve as a reservoir of trypanosome infection for other species, including the human beings in the case of T. brucei rhodesiense. The present article describes the current status of trypanosomosis in goats in Africa, Asia, and South America. Pathogenesis, clinical features, diagnosis, and treatment of the different trypanosomes are also described. The possible role in the epidemiology of the disease in the different areas is also discussed.

Animals↗

Prevalence of Trypanosoma evansi infection in equines and camels in the Punjab region, Pakistan.

A cross-sectional study has been carried out in order to determine the prevalence of Trypanosoma evansi infection in susceptible hosts in the Punjab region (Pakistan). A total of 170 equines and 150 dromedary camels were examined. Five (3.3%) and 6 (4%) camels were positive at parasitological and serological examination, respectively. None of the equines tested positive at any method. These results seem to indicate that T. evansi infection has a relatively low prevalence in the Punjab region. However, efforts must be done in order to establish control measures in affected herds and avoid dissemination of the disease.

Animals↗

Clinical, hematological, and biochemical findings in an outbreak of abortion and neonatal mortality associated with Trypanosoma evansi infection in dromedary camels.

This article presents the clinical and laboratorial findings in an outbreak of abortions and high neonatal mortality attributable to Trypanosoma evansi infection in camels. A total of 16 females were diagnosed, 2 of which showed moderate signs of chronic form, particularly hyporexia and intolerance to exercise. The main laboratorial findings were regenerative anemia (hemolytic anemia), lymphocytic and monocytic leukocytosis, hyperproteinemia, hyperglobulinemia, hypoglycemia, serum urea increased, and serum iron decreased. The most characteristic finding in the examined females would be the uremia, probably due to the higher protein metabolism.

Abortion, Veterinary↗

Role of spirometry and exhaled nitric oxide to predict exacerbations in treated asthmatics.

OBJECTIVE: To evaluate the complementary roles of exhaled nitric oxide (NO) and spirometry to predict asthma exacerbations requiring one or more tapering courses of systemic corticosteroids. METHODS: We prospectively studied 44 nonsmoking asthmatics (24 women) aged 51 +/- 21 years (mean +/- SD) who were clinically stable for 6 weeks and receiving 250 mug of fluticasone/50 mug of salmeterol or equivalent for 3 years. Total exhaled NO (FENO), small airway/alveolar NO (CANO), large airway NO flux (J'awNO), and spirometry were measured. RESULTS: Baseline FEV(1) was 2.1 +/- 0.7 L, 70 +/- 20% of predicted after 180 mug of albuterol. Twenty-two of 44 asthmatics had one or more exacerbations over 18 months, 16 of 22 asthmatics had two exacerbations, and 6 of 22 asthmatics were hospitalized, including 1 asthmatic with near-fatal asthma. When baseline FEV(1) was </= 76% predicted, exacerbations occurred in 20 of 31 asthmatics (65%). If baseline FEV(1) was > 76% of predicted, exacerbations occurred only in 2 of 13 asthmatics (15%) [p = 0.003, chi(2)]. Using a receiver operating characteristic (ROC) curve for first exacerbation, the area under the curve was 0.67 with cutoff FEV(1) of 76% of predicted (sensitivity, 0.91; specificity, 0.50; positive predictive value, 0.65; negative predictive value, 0.85; positive likelihood ratio [LR(+)], 1.8; negative likelihood ratio [LR(-)], 0.18). When baseline FENO was >/= 28 parts per billion (ppb), exacerbations occurred in 13 of 17 asthmatics (76%); if baseline FENO was < 28 ppb, exacerbations occurred in only 9 of 27 asthmatics (33%) [p = 0.005, chi(2)]. Using the ROC curve for first exacerbation, the area under the curve was 0.71 with FENO cutoff point of 28 ppb (sensitivity, 0.59; specificity, 0.82; positive predictive value, 0.77; negative predictive value, 0.87; LR(+), 3.3; LR(-), 0.5). Independent of baseline FEV(1), FENO >/= 28 ppb increased the relative risk (RR) for exacerbation by 3.4 (95% confidence interval [CI], 1.3 to 9.1; Mantel-Haenszel, p = 0.007). An abnormal increase in CANO increased RR by 3.0 (95% CI, 0.9 to 9.9; p = 0.04), and abnormal J'awNO increased RR by 2.4 (95% CI, 1.0 to 5.6; p = 0.04). Independent of baseline FENO, FEV(1) </= 76% predicted increased RR by 1.7 (95% CI, 1.0 to 2.7; p = 0.02). Combined baseline FENO >/= 28 ppb and FEV(1) </= 76% of predicted identified 13 stable asthmatics with 85% probability for future exacerbation, whereas 9 asthmatics with FENO < 28 ppb and FEV(1) > 76% of predicted had a 0% probability of exacerbation. CONCLUSION: Combining FENO and FEV(1) percentage of predicted can stratify risk for asthma exacerbation.

Adrenal Cortex Hormones↗

True versus false left ventricular aneurysm: differentiation with MR imaging--initial experience.

PURPOSE: To assess the usefulness of cardiac magnetic resonance (MR) imaging for differentiation of true from false left ventricular aneurysm in patients after myocardial infarction. MATERIALS AND METHODS: Cardiac MR images obtained in 22 sequential patients (20 men, two women; mean age, 63 years; age range, 45-75 years) with pathologically proved left ventricular true aneurysm (n = 18) or false aneurysm (n = 4) after myocardial infarction were retrospectively analyzed. The MR imaging protocol included steady-state cine imaging followed by perfusion measurement and delayed contrast-enhanced imaging with delays of 15 and 20 minutes. Differences between true and false aneurysms with regard to maximal internal width of orifice, maximal parallel internal diameter, ratio of maximal orifice to maximal internal diameter, presence of mural thrombus and delayed enhancement of pericardium, left ventricular end-diastolic volume, and left ventricular ejection fraction were analyzed by using the Mann-Whitney U test or Fisher exact test, as appropriate. RESULTS: Inferior wall location was noted in two of four patients with false aneurysm and in none of 18 patients with true aneurysm (P = .03). The remaining aneurysms were apicoanterior (two false, 10 true) or apical (eight true). False aneurysms had a ratio of maximal internal width of the orifice to maximal parallel internal diameter that was significantly lower than that of true aneurysms (0.73 vs 1.00, P < .001) and had a significantly higher left ventricular end-diastolic volume (median, 202 vs 136 mL/m(2); P = .001), as well as a nonsignificant tendency toward lower left ventricular ejection fraction (17% vs 28%, P = .15). Mural thrombus was identified in all four patients with false aneurysm and in seven of 18 patients with true aneurysm (P = .09). Delayed enhancement of pericardium was noted in all four patients with false aneurysm and in three of 18 patients with true aneurysm. Resultant sensitivity of MR imaging for the detection of false left ventricular aneurysm was four of four, specificity was 15 of 18, accuracy was 19 of 22, and positive and negative predictive values were four of seven and 15 of 15 patients, respectively. CONCLUSION: Initial experience with a small number of patients suggests that marked delayed enhancement of the pericardium is a characteristic feature of false aneurysm. Study with a larger patient sample is required to further assess this feature.

Aged↗

Pre-transplant panel reactive antibody in lung transplant recipients is associated with significantly worse post-transplant survival in a multicenter study.

BACKGROUND: The presence of antibodies to human leukocyte antigens (HLA) prior to transplantation has been linked to worse post-transplant outcomes in many solid organ transplants. The effect of these antibodies is less clear in lung transplant recipients, although previous studies have suggested an increased incidence of allograft dysfunction. METHODS: A retrospective study of all first lung transplant recipients from the University of Toronto (November 1983-July 2001, n = 380) and Duke University (April 1992-June 2000, n = 276) was performed. Demographic data, survival information, and level of last pre-transplant panel reactive antibody (PRA) were collected. PRA level was measured by the complement-dependent cell cytotoxicity assay at both centers. Survival analysis was performed using the Kaplan-Meier method, and groups were compared with the Wilcoxon rank sum test. RESULTS: Of 656 lung transplant recipients, 101 (15.4%) had a PRA greater than 0, 37 (5.6%) had a PRA greater than 10%, and 20 (3.0%) had a PRA greater than 25%. Patients with a PRA greater than 25% had decreased median survival than did the rest of the patients (1.5 vs 5.2 years) and at 1 month (70% vs 90%), 1 year (65% vs 76%), and 5 years (31% vs 50%), respectively (p = 0.006, Wilcoxon's rank sum test) test). CONCLUSION: Significant elevation of PRA prior to lung transplantation is associated with worse survival, especially in the early post-transplant period. This may be due to a direct effect of anti-HLA antibodies on the allograft. The effectiveness of treatments such as plasmapheresis and intravenous immunoglobulin prior to transplantation needs to be evaluated.

Adult↗

Upper lobe fibrosis: a novel manifestation of chronic allograft dysfunction in lung transplantation.

BACKGROUND: Lung transplantation is an established treatment modality for a number of chronic lung diseases. Long-term survival after lung transplantation is limited by chronic allograft dysfunction, usually manifested by bronchiolitis obliterans syndrome. We describe a case series with upper lobe fibrosis, a novel presentation of chronic allograft dysfunction. METHODS: We reviewed lung transplants at the Toronto General Hospital and Duke University Hospital from 1990 to 2002 and identified patients with upper lobe fibrosis. RESULTS: Thirteen of 686 patients (6 women) developed upper lobe fibrosis (Toronto, 9; Duke, 4); 12 of 13 had bilateral transplants. The median age at diagnosis was 42 years (range, 19-70). Primary diagnoses were cystic fibrosis, 6; emphysema, 4; sarcoidosis, 1; and pulmonary fibrosis, 2 patients. Radiographic diagnosis was made at a median of 700 days post-transplant (range, 150-2,920). Pulmonary function tests demonstrated predominantly a progressively worsening restrictive pattern. Open lung biopsy specimens revealed dense interstitial fibrosis, with occasional features of obliterative bronchitis, bronchiolitis obliterans obstructive pneumonia, and aspiration. Nine patients died at a median follow-up of 2,310 days (range, 266-3,740), 8 due to respiratory failure. CONCLUSION: Upper lobe fibrosis is a novel presentation of chronic allograft dysfunction in lung transplant recipients and is differentiated from bronchiolitis obliterans syndrome on the basis of physiologic and radiologic findings.

Adult↗

Bile acid aspiration and the development of bronchiolitis obliterans after lung transplantation.

BACKGROUND: Aspiration of gastroesophageal refluxate may contribute to lung transplant bronchiolitis obliterans syndrome (BOS). We investigated bile acids in bronchoalveolar lavage fluid (BALF) and studied its role in BOS. MATERIALS AND METHODS: Surveillance pulmonary function tests and BALF were evaluated in 120 lung recipients. BOS-(0p-3) was diagnosed after 6 months' survival. BOS was defined as "early" if diagnosed within 12 months after a transplant. BALF was assayed for differential cell count, bile acids, and interleukins 8 and 15. Bile acids were considered elevated if greater than normal serum levels ( or =8 micromol/L). RESULTS: Elevated BALF bile acids were measured in 20 (17%) of 120 patients. BOS was diagnosed in 36 (34%) of 107 patients and judged "early" in 21 (57%) of 36. Median BALF bile acid values were 1.6 micromol/L (range, 0-32 micromol/L) in BOS patients and 0.3 micromol/L (range, 0-16 micromol/L) in non-BOS patients ( P = .002); 2.6 micromol/L (range, 0-32 micromol/L) in early BOS patients and 0.8 micromol/L (range, 0-4.6 micromol/L) in late BOS patients, ( P = .02). Bile acids correlated with BALF IL-8 and alveolar neutrophilia (r = 0.3, P = .0004, and r = 0.3, P = .004, respectively), but not with IL-15. Freedom from BOS was significantly shortened in patients with elevated BALF bile acids (Cox-Mantel test, P = .0001). CONCLUSIONS: Aspiration of duodenogastroesophageal refluxate is prevalent after lung transplantation and is associated with the development of BOS. Elevated BALF bile acids may promote early BOS development via an inflammatory process, possibly mediated by IL-8 and alveolar neutrophilia.

Actuarial Analysis↗

Alveolar and airway sites of nitric oxide inflammation in treated asthma.

The goal of this study was to identify airway and alveolar site(s) of inflammation using exhaled nitric oxide (NO) as a marker in treated patients with asthma, including response to oral corticosteroids, and correlate these sites with expiratory airflow limitation. In 53 (24 male) patients with asthma, age 43 +/- 23 years (mean +/- SD) and all on inhaled corticosteroids, post 180 microg aerosolized albuterol, FEV(1) was 74 +/- 23% predicted and FEV(1)/FVC was 68 +/- 11%. Exhaled NO at 100 ml/second was 27 +/- 23 ppb (p < 0.001 compared with normal, 12 +/- 15 ppb). Bronchial NO maximal flux was 2.4 +/- 3.1 nl/second (p < 0.001 compared with normal, 0.85 +/- 0.55). Alveolar NO concentration was 7.0 +/- 7.4 ppb (p = 0.01 compared with the normal value, 3.2 +/- 2.0 ppb). There was no significant correlation between FEV(1) % predicted or lung elastic recoil and NO bronchial flux or alveolar concentration. However, there was a weak but significant correlation between NO bronchial flux and alveolar concentration (Spearman r = 0.50, p < 0.001). In 10 subjects with asthma on inhaled corticosteroids, 5 days of 30 mg prednisone resulted in isolated significant decreases in NO alveolar concentration, from 13 +/- 10 to 4 +/- 4 ppb (p = 0.002). Despite treatment, including inhaled corticosteroids, patients with asthma may have ongoing separate airway and alveolar sites of NO inflammation, the latter responsive to oral corticosteroids.

Administration, Inhalation↗

Bronchiolitis obliterans syndrome in lung transplant recipients: can thin-section CT findings predict disease before its clinical appearance?

PURPOSE: To determine whether there are thin-section computed tomographic (CT) features that predict bronchiolitis obliterans syndrome (BOS) in lung transplant recipients before the clinical appearance and during the early stages of the disease. MATERIALS AND METHODS: Two hundred ninety-eight thin-section CT scans obtained in 26 lung transplant recipients who did (study group) and 26 lung transplant recipients who did not (control group) develop BOS were reviewed for the presence of mosaic perfusion, bronchiectasis, bronchial wall thickening, and air trapping. BOS was defined by using the recently revised definition of the International Society for Heart and Lung Transplantation. CT scans obtained in the BOS group were divided into three groups: Group A consisted of the last scans obtained before the clinical appearance of BOS; groups B and C consisted of, respectively, the first and last scans obtained after the clinical appearance of BOS. Scans obtained in the control group were acquired during similar posttransplantation periods and matched to scans in each BOS group. Sensitivity, specificity, and positive and negative predictive values were calculated separately for each subgroup. The optimal threshold for each thin-section CT-depicted abnormality was defined by using receiver operating characteristics analysis. RESULTS: The sensitivities of air trapping for the diagnosis of BOS during the periods in which the scans in groups A, B, and C were obtained were 50%, 44%, and 64%, respectively; specificities were 80%, 100%, and 80% respectively. Sensitivities of mosaic perfusion were 4%, 20%, and 36%, respectively; specificities were 100%, 96%, and 96%, respectively. Sensitivities of bronchiectasis were 25%, 24%, and 32%, respectively; specificities were 80%, 80%, and 96%, respectively. Sensitivities of bronchial wall thickening were 4%, 24%, and 40%, respectively; specificities were 96%, 84%, and 80%, respectively. Air trapping was seen intermittently in nine (43%) of 21 patients with CT scans that depicted this finding at least once. CONCLUSION: The value of the finding of air trapping before the clinical appearance and during the early stages of BOS is lower than has been previously reported. When using the recently revised criteria for BOS, the role of thin-section CT as a screening test to evaluate patients with lung transplants appears to be limited.

Adolescent↗

Reference values of pulmonary function tests for Canadian Caucasians.

A multicentre, cross-sectional study was carried out in six centres across Canada to establish a national standard for pulmonary function tests using healthy, lifetime nonsmokers, with each centre aiming to test 10 men and 10 women from each decade from 20 to 80 years of age. Data from each centre were used to derive prediction equations for each centre, and pooled data from all centres (total: 327 women and 300 men) were used to derive Canadian predicted equations. The predictive models were compared with three widely used published models for selected tests. It was found that, in general, the equations modelled for each centre could be replaced by the models obtained when pooling all data (Canadian model). Comparisons with the published references showed good agreement and similar slopes for most tests. The results suggest that pulmonary function test results obtained from different centres in Canada were comparable and that standards currently used remain valid for Canadian Caucasians.

Adult↗

Use of the miniature anion exchange centrifugation technique to isolate Trypanosoma evansi from goats.

DEAE (anion exchanger diethylaminoethyl)-cellulose and mini Anion Exchange Centrifugation Technique (mAECT) allow salivarian trypanosomes to be separated from the blood of affected animals. The purpose of this study was to assess the mAECT in goats infected with T. evansi. Five adult Canary goats were inoculated intravenously with at least 1 x 10(5) T. evansi isolated from a dromedary camel in the Canary Islands. The goats were monitored for specific antibodies and parasite detection. The inoculated goats became infected and the parasitemia remained very low but was persistent. For mAECT columns, the DEAE gel was equilibrated with phosphate-buffered saline glucose. T. evansi was detected by its mobility with a microscope at low magnification (10 x 10). The mAECT proved to be more sensitive than blood smear and buffy coat but less sensitive than mouse inoculation. We conclude that in cases of very low parasitemia in goats, mAECT can be used when other parasite-detection tests have failed.

Animals↗

Performance of serological tests for Trypanosoma evansi in experimentally inoculated goats.

Natural Trypanosoma evansi infection in the Canary Islands has only been diagnosed in the camel population, but dissemination of the disease in other hosts has not been excluded. The objective of this work was to assess the performance of serological antibody tests in experimentally inoculated goats. Five Canarian goats were inoculated intravenously with at least 1 x 10(5) T. evansi. The animals were kept for 8 months and checked monthly for the presence of the parasite and specific antibodies. The serological tests investigated were the direct card agglutination test CATT/T. evansi and the indirect card agglutination test LATEX/T. evansi. All animals became positive in the CATT/T. evansi 1 month post-infection and remained positive with a minimum end-titer of 1/4. Similar results were obtained with the LATEX/T. evansi, although at lower end-titers (1/2). We conclude that CATT/T. evansi is adequate for assessing infection of Canarian goats by T. evansi.

Agglutination Tests↗