Perspective transformation: Women in long-term recovery from alcohol abuse

Objective. The purpose of this study was to determine the meaning of personal transformation for twenty women in long term, stable recovery from alcohol abuse; to identify themes or patterns of this recovery, and; to determine the extent to which they experienced the phenomenon of perspective transformation. ^ Method. Volunteers were recruited by advertisement, word of mouth, and through a closed circuit web based broadcast. A descriptive, exploratory study, which analyzed perspective transformation from the standpoint of five action phases, was conducted. Data was collected using in-depth personal interviews and questionnaires. Subjects' responses were analyzed by qualitative methods. Triangulation was performed on the grouped data comparing the interviews to the data produced by the questionnaires. Quantitative analysis of questionnaire items explored behavioral changes experienced before and after alcoholism recovery. ^ Results. Five phases of recovery were identified. Phase I which involved recognition that alcohol was a problem and change might be possible took several years during which 3 major transitions occurred: (1) from often being alienated to having relationships with family and friends; (2) from daily upheavals to eventually a more peaceful existence, and; (3) from denial that alcohol was a problem to acceptance and willingness to change. Recovery was often seen in a spiritual context, which also required ongoing support. During Phase II there was an assessment of self, others, and the environment which revealed a pattern of intense unhappiness and negative feelings toward self and others with a disregard for cultural norms. Phase III revealed a period of desperation as life became unmanageable, but gradual willingness to accept support and guidance and a desire to improve self and help others. This led to improvement of existing role performance and the willingness to try out new roles. In Phase IV there was a pattern of personal growth which included: the establishment of boundaries, setting priorities, a willingness to place others' needs above their own, acceptance of responsibility, and learning to cope without alcohol, often with the use of tools learned in AA. During Phase V, many experienced knowledge of frailties but growing respect for self and others, with an improved ability to function in giving relationships. Implications for Prevention and Recovery: Early education concerning addiction and recovery may play a crucial role in prevention and early recovery, as it did for children of women in this study. Recovery requires persistent effort and organized support. ^

Molecular mechanisms of apoptosis induction in chronic lymphocytic leukemia

CLL is the most common adult leukemia in the Western World, yet very little is known about the biology of this disease. CLL cells have very high levels of NF-κB activity. Factors such as CD40 ligation and phorbol ester treatment induce NF-κB activity and also prevent apoptosis. Previous data from our laboratory demonstrated that MG-132, a proteasome inhibitor, blocked NF-κB activation and promoted apoptosis in CLL cells. These data suggested to us that NF-κB mediates survival in CLL. We examined NF-κB activity using two different chemotherapeutic agents, PS-341 and arsenic trioxide. PS-341, a proteasome inhibitor blocked NF-κB in CLL cells. This however, did not correlate with cell death. Resistant patient isolates displayed delayed Smac/DIABLO release in comparison to cytochrome c release. This suggests that IAPs are contributing to CLL cell survival and drug-resistance. Arsenic trioxide did not block NF-κB activity at therapeutic doses. However it was a potent inducer of apoptosis in CLL cells. We identified a novel mechanism by which arsenic induces increases in mitochondrial calcium to induce cytochrome c release and initiate apoptosis. Both PS-341 and arsenic trioxide are currently in Phase II clinical trials at M.D. Anderson Cancer Center. We conclude that NF-κB is not critical for PS-341 or arsenic trioxide-mediated cell death. ^

Pharmacogenetics of the human glutathione S-transferase P1 gene in the metabolism and therapeutic efficacy of cis-diamminedichloroplatinum

The human GSTP1 gene has been shown, conclusively, to be polymorphic. The three main GSTP1 alleles, GSTP1*A, GSTP1*B, and GSTP1*C, encode proteins which differ in the 3-dimensional structure of their active sites and in their function in phase II metabolism of carcinogens, mutagens, and anticancer agents. Although, it is well established that GSTP1 is over expressed in many human tumors and that the levels of GSTP1 expression correlate directly with tumor resistance to chemotherapy and inversely with patient survival, the significance of the polymorphic GSTP1 gene locus on tumor response to chemotherapy remains unclear. The goal of this project was to define the role and significance of the polymorphic GSTP1 gene locus in GSTP1-based tumor drug resistance and as a determinant of patient response to chemotherapy. The hypothesis to be tested was that the polymorphic GSTP1 gene locus will confer to tumors a differential ability to metabolize cisplatin resulting in a GSTP1 genotype-based sensitivity to cisplatin. The study examined: (a) whether the different GSTP 1 alleles confer different levels of cellular protection against cisplatin-induced cytotoxicity, (b) whether the allelic GSTP1 proteins metabolize cisplatin with different efficiencies, and (c) whether the GSTP1 genotype is a determinant of tumor response to cisplatin therapy. The results demonstrate that the GSTP1 alleles differentially protect tumors against cisplatin-induced apoptosis and clonogenic cell kill in the rank order: GSTP1*C > GSTP1*B > GSTP1*A. The same rank order was observed for the kinetics of GSTP1-catalyzed cisplatin metabolism, both in cell-free and cellular systems, to the rate-limiting monoglutathionyl-platinum metabolite, which was characterized, for the first time, by mass spectral analysis. Finally, this study demonstrates that both GSTP1 genotype and the level of GSTP1 expression significantly contribute to tumor sensitivity to cisplatin treatment. Overall, the results of this project show that the polymorphic GSTP1 gene locus plays a significant role in tumor sensitivity to cisplatin treatment. Furthermore, these studies have contributed to the overall understanding of the significance of the polymorphic GSTP1 gene locus in tumor resistance to cancer chemotherapy and have provided the basis for further investigations into how this can be utilized to optimize and individualize cancer chemotherapy for cancer patients. ^

Identification of diabetic retinopathy genes through a genome-wide association study among Mexican-Americans from Starr County, Texas

To identify genetic susceptibility loci for severe diabetic retinopathy, 286 Mexican-Americans with type 2 diabetes from Starr County, Texas completed detailed physical and ophthalmologic examinations including fundus photography for diabetic retinopathy grading. 103 individuals with moderate-to-severe non-proliferative diabetic retinopathy or proliferative diabetic retinopathy were defined as cases for this study. DNA samples extracted from study subjects were genotyped using the Affymetrix GeneChip® Human Mapping 100K Set, which includes 116,204 single nucleotide polymorphisms (SNPs) across the whole genome. Single-marker allelic tests and 2- to 8-SNP sliding-window Haplotype Trend Regression implemented in HelixTreeTM were first performed with these direct genotypes to identify genes/regions contributing to the risk of severe diabetic retinopathy. An additional 1,885,781 HapMap Phase II SNPs were imputed from the direct genotypes to expand the genomic coverage for a more detailed exploration of genetic susceptibility to diabetic retinopathy. The average estimated allelic dosage and imputed genotypes with the highest posterior probabilities were subsequently analyzed for associations using logistic regression and Fisher's Exact allelic tests, respectively. To move beyond these SNP-based approaches, 104,572 directly genotyped and 333,375 well-imputed SNPs were used to construct genetic distance matrices based on 262 retinopathy candidate genes and their 112 related biological pathways. Multivariate distance matrix regression was then used to test hypotheses with genes and pathways as the units of inference in the context of susceptibility to diabetic retinopathy. This study provides a framework for genome-wide association analyses, and implicated several genes involved in the regulation of oxidative stress, inflammatory processes, histidine metabolism, and pancreatic cancer pathways associated with severe diabetic retinopathy. Many of these loci have not previously been implicated in either diabetic retinopathy or diabetes. In summary, CDC73, IL12RB2, and SULF1 had the best evidence as candidates to influence diabetic retinopathy, possibly through novel biological mechanisms related to VEGF-mediated signaling pathway or inflammatory processes. While this study uncovered some genes for diabetic retinopathy, a comprehensive picture of the genetic architecture of diabetic retinopathy has not yet been achieved. Once fully understood, the genetics and biology of diabetic retinopathy will contribute to better strategies for diagnosis, treatment and prevention of this disease.^

Role of activation of the protein tyrosine kinase, Src, in colorectal cancer chemoresistance

Advances in therapy for colorectal cancer have been hampered by development of resistance to chemotherapy. The Src family of protein tyrosine kinases has been associated with colorectal cancer development and progression. Activation of the prototypic member of the family, Src, occurs in advanced colorectal cancer and is associated with a worse outcome. This work tests the hypotheses that Src activation contributes to chemoresistance in some colon tumors and that this resistance can be overcome by use of Src inhibitors. The aims of the proposal were to (1) determine if constitutive Src activation is sufficient to induce oxaliplatin resistance; (2) evaluate the role of reactive oxygen species (ROS) in the activation of Src after oxaliplatin treatment; (3) determine the frequency of Src activation in liver metastases after oxaliplatin treatment; and (4) evaluate the safety, preliminary efficacy, and pharmacodynamics of the combination of dasatinib with oxaliplatin-based therapy in patients with metastatic colorectal cancer. ^ Using a panel of colon cancer cell lines and murine models, I demonstrate that administration of oxaliplatin, a commonly utilized chemotherapy for colorectal cancer, results in an increased activation of Src. The activation occurs acutely in some, but not all, colorectal carcinoma cell lines. Cell lines selected for oxaliplatin resistance are further increased in Src activity. Treatment of cell lines with dasatinib, a non-selective pharmacologic inhibitor of the Src family kinases synergistically killed some, but not all cell lines. Cell lines with the highest acute activation of Src after oxaliplatin administration were the most sensitive to the combination therapy. Previous work demonstrated that siRNA to Src increased sensitivity to oxaliplatin, suggesting that the effects of dasatinib are primarily due to its ability to inhibit Src in these cell lines. ^ To examine the mechanism underlying these results, I examined the effects of reactive oxygen species (ROS), as previous studies have demonstrated that platinum chemotherapeutics result in intracellular oxidative stress. I demonstrated that oxaliplatin-induced reactive oxygen species were higher in the cell lines with Src activation, relative to those in which Src was not activated. This oxaliplatin-induced Src activation was blocked by the administration of anti-oxidants, thereby demonstrating that synergistic killing between dasatinib and oxaliplatin was associated with the ability of the latter to generate ROS. ^ In a murine model of colorectal cancer metastasis to the liver, the combination of dasatinib and oxaliplatin was more effective in reducing tumor volume than either agent alone. However, when oxaliplatin resistant cell lines were treated with a combination of oxaliplatin and AZD0530, an inhibitor in the clinic with increased specificity for Src, no additional benefit was seen, although Src was activated by oxaliplatin and Src substrates were inhibited. The indolent growth of oxaliplatin-resistant cells, unlike the growth of oxaliplatin resistant tumors in patients, precludes definitive interpretation of these results. ^ To further explore Src activation in patients with oxaliplatin exposure and resistance, an immunohistochemistry analysis of tumor tissue from resected liver metastases of colorectal cancer was performed. Utilizing a tissue microarray, staining for phosphorylated Src and FAK demonstrated strong staining of tumor relative to stromal and normal liver. In patients recently exposed to oxaliplatin, there was increased FAK activation, supporting the clinical relevance of the prior preclinical studies. ^ To pursue the potential clinical benefit of the combination of Src inhibition with oxaliplatin, a phase IB clinical trial was completed. Thirty patients with refractory metastatic colorectal cancer were treated with a combination of 5-FU, oxaliplatin, an epidermal-growth factor receptor monoclonal antibody, and dasatinib. The recommended phase II dose of dasatinib was established, and toxicities were quantified. Pharmacodynamic studies demonstrated increased phosphorylation of the Src substrate paxillin after dasatinib therapy. Tumor biopsies were obtained and Src expression levels were quantitated. Clinical benefit was seen with the combination, including a response rate of 20% and disease control rate of 56%, prompting a larger clinical study. ^ In summary, although Src is constitutively activated in metastatic colorectal cancer, administration of oxaliplatin chemotherapy can further increase its activity, through a reactive oxygen species dependent manner. Inhibition of Src in combination with oxaliplatin provides additional benefit in vitro, in preclinical animal models, and in the clinic. Further study of Src inhibition in the clinic and identification of predictive biomarkers of response will be required to further advance this promising therapeutic target. ^

Physical activity among breast and prostate cancer survivors: Barriers, facilitators and maintenance following the FRESH START trial

Research provides evidence of the positive health effects associated with regular physical activity participation in all populations. Activity may prove to be especially beneficial in those with chronic conditions such as cancer. However, the majority of cancer patients and survivors do not participate in the recommended amount of physical activity. The purpose of this dissertation was to identify factors associated with physical activity participation, describe how these factors change as result of a diet and exercise intervention, and to evaluate correlates of long term physical activity maintenance. ^ For this dissertation, I analyzed data from the FRESH START trial, a randomized, single-blind, phase II clinical trial focused on improving diet and physical activity among recently diagnosed breast and prostate cancer survivors. Analyses included both parametric and non-parametric statistical tests. Three separate studies were conducted, with sample sizes ranging from 400 to 486. ^ Common barriers to exercise, such as “no willpower,” “too busy,” and “I have pain,” were reported among breast and prostate cancer survivors; however, these barriers were not significantly associated with minutes of physical activity. Breast cancer survivors reported a greater number of total barriers to exercise as well as higher proportions reporting individual barriers, compared to prostate cancer survivors. Just less than half of participants reduced their total number of barriers to exercise from baseline to 1-year follow-up, and those who did reduce barriers reported greater increases in minutes of physical activity compared to those who reported no change in barriers to exercise. Participants in both the tailored and standardized intervention groups reported greater minutes of physical activity at 2-year follow-up compared to baseline. Overall, twelve percent of participants reached recommended levels of physical activity at both 1- and 2-year follow-up. Self-efficacy was positively associated with physical activity maintenance, and the number of total barriers to exercise was inversely associated with physical activity maintenance. ^ Results from this dissertation are novel and informative, and will help to guide future physical activity interventions among cancer survivors. Thoughtfully designed interventions may encourage greater participation in physical activity and ultimately improve overall quality of life in this population. ^

TECHNOLOGY ASSESSMENT: SMALL-VOLUME INFUSION PUMPS

"Technology assessment is a comprehensive form of policy research that examines the short- and long-term social consequences of the application or use of technology" (US Congress 1967).^ This study explored a research methodology appropriate for technology assessment (TA) within the health industry. The case studied was utilization of external Small-Volume Infusion Pumps (SVIP) at a cancer treatment and research center. Primary and secondary data were collected in three project phases. In Phase I, hospital prescription records (N = 14,979) represented SVIP adoption and utilization for the years 1982-1984. The Candidate Adoption-Use (CA-U) diffusion paradigm developed for this study was germane. Compared to classic and unorthodox curves, CA-U more accurately simulated empiric experience. The hospital SVIP 1983-1984 trends denoted assurance in prescribing chemotherapy and concomitant balloon SVIP efficacy and efficiency. Abandonment of battery pumps was predicted while exponential demand for balloon SVIP was forecast for 1985-1987. In Phase II, patients using SVIP (N = 117) were prospectively surveyed from July to October 1984; the data represented a single episode of therapy. The questionnaire and indices, specifically designed to measure the impact of SVIP, evinced face validity. Compeer group data were from pre-SVIP case reviews rather than from an inpatient sample. Statistically significant results indicated that outpatients using SVIP interacted socially more than inpatients using the alternative technology. Additionally, the hospital's education program effectively taught clients to discriminate between self care and professional SVIP services. In these contexts, there was sufficient evidence that the alternative technology restricted patients activity whereas SVIP permitted patients to function more independently and in a social lifestyle, thus adding quality to life. In Phase III, diffusion forecast and patient survey findings were combined with direct observation of clinic services to profile some economic dimensions of SVIP. These three project phases provide a foundation for executing: (1) cost effectiveness analysis of external versus internal infusors, (2) institutional resource allocation, and (3) technology deployment to epidemiology-significant communities. The models and methods tested in this research of clinical technology assessment are innovative and do assess biotechnology. ^

Sacred vocation program follow up evaluation at the Baylor healthcare system

Background: The Sacred Vocation Program (SVP) (Amick B, Karff S., 2003) helps workers find meaning, spirituality, and see their job as a sacred vocation. The SVP is based on Participatory Action Research (PAR) (Minkler & Wallerstein, 1997; Parker & Wall, 1998). This study aims to evaluate the SVP implemented at the Baylor Healthcare System, Dallas-Fort Worth. ^ Methods: The study design is a qualitative design. We used data from study participants who have participated in focus groups. During these focus groups specific questions and probes regarding the effectiveness of the SVP have been asked. We analyzed the focus groups and derived themes. ^ Results: Results of this study demonstrate SVP helps graduates feel valued and important. The SVP has improved meaningful work for employees and improved a sense of belonging for participants. The program has also increased participant spirituality. The coping techniques developed during a SVP class helps participants deal with stressful situations. The SVP faces challenges of implementation fidelity, poor communication, program viability in tough economic times and implementation of phase II. Another sustainability challenge for SVP is the perception of the program being a religious one versus a spiritual program. ^ Conclusion: Several aspects of the SVP work. The phase I of SVP is successful in improving meaningful work and a sense of belonging for participants. The coping techniques help participants deal with difficult work situations. The SVP can increase effectiveness through improvements in implementation fidelity, communication and leadership commitment. ^

A simulation study using the hybrid statistic and the meta-analysis t-test for data with matched and unmatched subjects in the interim analysis of clinical trials

An interim analysis is usually applied in later phase II or phase III trials to find convincing evidence of a significant treatment difference that may lead to trial termination at an earlier point than planned at the beginning. This can result in the saving of patient resources and shortening of drug development and approval time. In addition, ethics and economics are also the reasons to stop a trial earlier. In clinical trials of eyes, ears, knees, arms, kidneys, lungs, and other clustered treatments, data may include distribution-free random variables with matched and unmatched subjects in one study. It is important to properly include both subjects in the interim and the final analyses so that the maximum efficiency of statistical and clinical inferences can be obtained at different stages of the trials. So far, no publication has applied a statistical method for distribution-free data with matched and unmatched subjects in the interim analysis of clinical trials. In this simulation study, the hybrid statistic was used to estimate the empirical powers and the empirical type I errors among the simulated datasets with different sample sizes, different effect sizes, different correlation coefficients for matched pairs, and different data distributions, respectively, in the interim and final analysis with 4 different group sequential methods. Empirical powers and empirical type I errors were also compared to those estimated by using the meta-analysis t-test among the same simulated datasets. Results from this simulation study show that, compared to the meta-analysis t-test commonly used for data with normally distributed observations, the hybrid statistic has a greater power for data observed from normally, log-normally, and multinomially distributed random variables with matched and unmatched subjects and with outliers. Powers rose with the increase in sample size, effect size, and correlation coefficient for the matched pairs. In addition, lower type I errors were observed estimated by using the hybrid statistic, which indicates that this test is also conservative for data with outliers in the interim analysis of clinical trials.^

CHARACTERIZATION OF DIFFERENTIATION AND PROGNOSTIC BIOMARKERS ON CD8+ TUMOR-INFILTRATING LYMPHOCYTES IN METASTATIC MELANOMA

CD8+ cytotoxic T lymphocytes (CTL) frequently infiltrate tumors, yet most melanoma patients fail to undergo tumor regression. We studied the differentiation of the CD8+ tumor-infiltrating lymphocytes (TIL) from 44 metastatic melanoma patients using known T-cell differentiation markers. We also compared CD8+ TIL against the T cells from matched melanoma patients’ peripheral blood. We discovered a novel subset of CD8+ TIL co-expressing early-differentiation markers, CD27, CD28, and a late/senescent CTL differentiation marker, CD57. This CD8+CD57+ TIL expressed a cytolytic enzyme, granzyme B (GB), yet did not express another cytolytic pore-forming molecule, perforin (Perf). In contrast, the CD8+CD57+ T cells in the periphery were CD27-CD28-, and GBHi and PerfHi. We found this TIL subset was not senescent and could be induced to proliferate and differentiate into CD27-CD57+, perforinHi, mature CTL. This further differentiation was arrested by TGF-β1, an immunosuppressive cytokine known to be produced by many different kinds of tumors. Therefore, we have identified a novel subset of incompletely differentiated CD8+ TIL that resembled those found in patients with uncontrolled chronic viral infections. In a related study, we explored prognostic biomarkers in metastatic melanoma patients treated in a Phase II Adoptive Cell Therapy (ACT) trial, in which autologous TIL were expanded ex vivo with IL-2 and infused into lymphodepleted patients. We unexpectedly found a significant positive clinical association with the infused CD8+ TIL expressing B- and T- lymphocyte attentuator (BTLA), an inhibitory T-cell receptor. We found that CD8+BTLA+ TIL had a superior proliferative response to IL-2, and were more capable of autocrine IL-2 production in response to TCR stimulation compared to the CD8+BTLA- TIL. The CD8+BTLA+ TIL were less differentiated and resembled the incompletely differentiated CD8+ TIL described above. In contrast, CD8+BTLA- TIL were poorly proliferative, expressed CD45RA and killer-cell immunoglobulin-like receptors (KIRs), and exhibited a gene expression signature of T cell deletion. Surprisingly, ligation of BTLA by its cognate receptor, HVEM, enhanced the survival of CD8+BTLA+ TIL by activating Akt/PKB. Our studies provide a comprehensive characterization of CD8+ TIL differentiation in melanoma, and revealed BTLA as a novel T-cell differentiation marker along with its role in promoting T cell survival.

Signaling pathways in the transcriptional and post-translational regulation of the human glutathione S -transferase P1 gene

The human glutathione S-transferase P1 (GSTP1) protein is an endogenous inhibitor of c-jun N-terminal kinases (JNKs) and an important phase II detoxification enzyme. ^ Recent identification of a cAMP response element (CRE) in the 5 ′-region of the human GSTP1 gene and several putative phosphorylation sites for the Ser/Thr protein kinases, including, cAMP-dependent protein kinases (PKAs), protein kinases C (PKCs), and JNKs in the GSTP1 protein raised the possibility that signaling pathways may play an important role in the transcriptional and post-translational regulation of GSTP1 gene. This study examined (a) whether the signaling pathway mediated by CAMP, via the GSTP1 CRE, is involved in the transcriptional regulation of the GSTP1 gene, (b) whether signaling pathways mediated by the Ser/Thr protein kinases (PKAs, PKCs, and JNKs) induce post-translational modification, viz. phosphorylation of the GSTP1 protein, and (c) whether such phosphorylation of the GSTP1 protein alters its functions in metabolism and in JNK signaling. ^ The first major finding in this study is the establishment of the human GSTP1 gene as a novel CAMP responsive gene in which transcription is activated via an interaction between PKA activated CRE binding protein-1 (CREB-1) and the CRE in the 5′-regulatory region. ^ The second major finding in this study is the observation that the GSTP1 protein undergoes phosphorylation and functionally activated by second messenger-activated protein kinases, PKA and PKC, in tumor cells with activated signaling pathways. Following phosphorylation by PKA or PKC, the catalytic activity of the GSTP1 protein was significantly enhanced, as indicated by a decrease in its Km (2- to 3.6-fold) and an increase in Kcat/ Km (1.6- to 2.5-fold) for glutathione. Given the frequent over-expression of GSTP1 and the aberrant PKA/PKC signaling cascade observed in tumors, these findings suggest that phosphorylation of GSTP1 may contribute to the malignant progression and drug-resistant phenotype of these tumors. ^ The third major finding in this study is that the GSTP1 protein, an inhibitor of JNKs, undergoes significant phosphorylation in tumor cells with activated JNK signaling pathway and in those under oxidative stress. Following phosphorylation by JNK, the ability of GSTP1 to inhibit JNK downstream function, i.e. c-jun phosphorylation, was significantly enhanced, suggesting a feedback mechanism of regulation of JNK-mediated cellular signaling. (Abstract shortened by UMI.) ^

Enzyme activity and liver tissue PCB concentrations of chicks of northern fulmars (F. glacialis) and black-legged kittiwakes (R. tridactyla) from Kongsfjorden

Arctic seabirds are exposed to a wide range of halogenated organic contaminants (HOCs). Exposure occurs mainly through food intake, and many pollutants accumulate in lipid-rich tissues. Little is known about how HOCs are biotransformed in arctic seabirds. In this study, we characterized biotransformation enzymes in chicks of northern fulmars (Fulmarus glacialis) and black-legged kittiwakes (Rissa tridactyla) from Kongsfjorden (Svalbard, Norway). Phase I and II enzymes were analyzed at the transcriptional, translational and activity levels. For gene expression patterns, quantitative polymerase chain reactions (qPCR), using gene-sequence primers, were performed. Protein levels were analyzed using immunochemical assays of western blot with commercially available antibodies. Liver samples were analyzed for phase I and II enzyme activities using a variety of substrates including ethoxyresorufin (cytochrome (CYP)1A1/1A2), pentoxyresorufin (CYP2B), methoxyresorufin (CYP1A), benzyloxyresorufin (CYP3A), testosterone (CYP3A/CYP2B), 1-chloro-2,4-nitrobenzene (CDNB) (glutathione S-transferase (GST)) and 4-nitrophenol (uridine diphosphate glucuronyltransferase (UDPGT)). In addition, the hydroxylated (OH-) polychlorinated biphenyls (PCBs) were analyzed in the blood, liver and brain tissue, whereas the methylsulfone (MeSO2-) PCBs were analyzed in liver tissue. Results indicated the presence of phase I (CYP1A4/CYP1A5, CYP2B, and CYP3A) and phase II (GST and UDPGT) enzymes at the activity, protein and/or mRNA level in both species. Northern fulmar chicks had higher enzyme activity than black-legged kittiwake chicks. This in combination with the higher XOH-PCB to parent PCB ratios suggests that northern fulmar chicks have a different biotransformation capacity than black-legged kittiwake chicks.

(Table 1) Polychlorinated biphenyl (PCB) and PCB metabolite concentrations in ringed seals (Phoca hispida) from Svalbard and the Baltic Sea

Polychlorinated biphenyls (PCBs) may induce activity of hepatic enzymes, mainly Phase I monooxygenases and conjugating Phase II enzymes, that catalyze the metabolism of PCBs leading to formation of metabolites and to potential adverse health effects. The present study investigates the concentration and pattern of PCBs, the induction of hepatic phase I and II enzymes, and the formation of hydroxy (OH) and methylsulfonyl (CH3SO2=MeSO2) PCB metabolites in two ringed seal (Phoca hispida) populations, which are contrasted by the degree of contamination exposure, that is, highly contaminated Baltic Sea (n = 31) and less contaminated Svalbard (n = 21). Phase I enzymes were measured as ethoxyresorufin-O-deethylation (EROD), benzyloxyresorufin-O-dealkylation (BROD), methoxyresorufin-O-demethylation (MROD), and pentoxyresorufin-O-dealkylation (PROD) activities, and phase II enzymes were measured as uridine diphosphophate glucuronosyl transferase (UDPGT) and glutathione-S-transferase (GST). Geographical comparison, multivariate, and correlation analysis indicated that sum-PCB had a positive impact on Phase I enzyme and GST activities leading to biotransformation of group III (vicinal ortho-meta-H atoms and <=1 ortho-chlorine (Cl)) and IV PCBs (vicinal meta-para-H atoms and <=2 ortho-Cl). The potential precursors for the main OH-PCBs detected in plasma in the Baltic seals were group III PCBs. MeSO2-PCBs detected in liver were mainly products of group IV PCB metabolism. Both CYP1A- and CYP2B-like enzymes are suggested to be involved in the PCB biotransformation in ringed seals.

Utilización de ingredientes tradicionales y nuevos productos derivados del haba de soja en piensos de lechones blancos e ibéricos: efectos sobre la fisiología digestiva y la productividad

Los objetivos principales de esta Tesis Doctoral fueron estudiar en 4 ensayos los efectos a) del procesado del maíz y la inclusión en los piensos de ingredientes de alta calidad como harina de pescado o fuentes de lactosa en lechones blancos b) inclusión en el pienso de diferentes productos derivados del haba de soja, con diferente contenido de proteína bruta (PB), tamaño de partícula y origen en lechones blancos e ibéricos y c) inclusión en el pienso de lechones ibéricos de ingredientes de alta calidad; forma de presentación del pienso y la duración del suministro del pienso prestárter sobre los parámetros productivos, la digestibilidad de los nutrientes, y las características morfológicas de la mucosa digestiva en lechones blancos e ibéricos recién destetados. En el experimento 1, los efectos de la complejidad del pienso prestárter sobre los parámetros productivos y la digestibilidad total aparente (TTAD) de los nutrientes fueron estudiados en lechones blancos recién destetados. Se utilizaron 10 tratamientos experimentales como resultado de 5 piensos prestárter (21 a 41 d de edad) y 2 piensos estárter (42 a 62 d de edad). Los piensos prestárter consistieron en un control negativo que incluía 40% de maíz crudo, 4% de harina de pescado y 7% de lactosa, un control positivo que incluía 40% de maíz cocido, 10% de harina de pescado, y 14% de lactosa, y 3 piensos adicionales con similares ingredientes que el pienso control positivo pero en los que a) 40% de maíz cocido fue sustituido por el mismo porcentaje de maíz crudo, b) se redujo el nivel de harina de pescado del 10 al 4%, y c) se redujo el nivel de lactosa del 14 al 7%. Cada tratamiento se replicó 6 veces (6 lechones/departamento). De 42 a 62 d de edad, la mitad de cada uno de los 5 piensos prestárter recibió un pienso estándar compuesto por harina de soja- maíz crudo y manteca y la otra mitad un pienso con similar perfil nutricional pero incluyendo un 20% de maíz cocido, 5% de harina de pescado, 1.3% de lactosa, 2% de concentrado de proteína de soja obtenido por fermentación y 1% de aceite de soja en lugar de harina de soja, maíz sin procesar y manteca. La complejidad del pienso no afectó a los parámetros productivos en ninguno de los periodos estudiados, pero el índice de diarreas durante la fase prestárter fue mayor en los lechones que recibieron el pienso control negativo que en los alimentados con cualquiera de los otros piensos (P<0.05). A los 30 días de edad (piensos prestárter), la digestibilidad de la materia orgánica (MO) y de la energía bruta (EB) fue menor (P<0.001) en los lechones que consumieron el pienso control negativo que en los lechones que consumieron cualquiera de los otros piensos. Sin embrago, la digestibilidad fecal de la PB no fue afectada. A los 50 días de edad (piensos estárter), la digestibilidad de los nutrientes fue similar en ambos piesnsos. Se concluye que la utilización de niveles elevados de ingredientes de alta calidad en los piensos no mejora los parámetros productivos de los lechones blancos en ninguno de los períodos estudiados. De 21 a 41 días de edad, el índice de diarreas se redujo y la digestibilidad de los nutrientes aumentó con la utilización de piensos de mayor calidad. Por lo tanto, la utilización de piensos con niveles elevados de ingredientes de calidad para reducir problemas digestivos y por lo tanto, mejorar los parámetros productivos podría estar justificada en algunos casos. En el experimento 2, se estudiaron los efectos de la inclusión en el pienso de harina de soja con diferente contenido de PB (44 vs. 49 % PB), la micronización de la harina de soja de alta proteína (AP-HS; 49% PB) y la utilización de concentrado de proteína de soja (CPS; 65% PB) sobre los parámetros productivos y la TTAD de los nutrientes en lechones blancos recién destetados de 28 a 63 días de edad. De 28 a 49 días de edad (fase I), hubo un pienso control positivo con un 10% de CPS, un pienso control negativo con 14.8% de harina de soja estándar (R-HS; 44% de PB) y otros 4 piensos que incluían 13.3% de AP-HS de origen Americano (USA) o Argentino (ARG) y molidas groseramente (980 μm) o micronizadas (80 μm). Cada tratamiento se replicó 8 veces (6 lechones/departamento). De 49 a 63 días de edad (fase II), todos los lechones recibieron un pienso comercial común en forma de harina. En el global de la fase I, el tratamiento experimental no afectó a ninguno de los parámetros productivos estudiados. Sin embargo, de 28 a 35 días de edad, los lechones alimentados con AP-HS micronizadas tuvieron un mejor índice de conversión (IC; 1.11 vs. 0.98; P<0.05) que los alimentados con AP-HS molidas groseramente. También, de 35 a 42 días de edad, los lechones que recibieron el pienso con AP-HS micronizada tendieron (P=0.08) a consumir más pienso que los lechones que consumieron el pienso con AP-HS molida. Durante la fase II (49 a 63 días de edad), cuando todos los lechones recibieron un pienso común, no se observaron diferencias en productividad de los lechones debido al tratamiento previo. En general, la digestibilidad de los nutrientes a los 35 días de edad fue mayor para los lechones que consumieron CPS que para los lechones que consumieron R-HS con los lechones que consumieron AP-HS en una posición intermedia. La digestibilidad de la PB fue mayor (P≤0.01) para el pienso que contenía CPS que para el promedio de los 5 tratamientos en base a HS. También, la digestibilidad de la MO y de la materia seca (MS) fue mayor para el pienso que contenía AP-HS micronizada o molida groseramente que para el pienso que contenía R-HS. La micronización de la AP-HS no tuvo efecto alguno sobre la digestibilidad de los nutrientes. Se concluye que cuando el CPS sustituye en el pienso a R-HS, la digestibilidad de la PB aumenta pero no tiene efecto alguno sobre los parámetros productivos. La utilización de AP-HS en sustitución de R-HS en el pienso mejora la digestibilidad de los nutrientes pero no afecta a los parámetros productivos. La utilización de harina de soja micronizada en los piensos mejora la eficiencia alimenticia durante la primera semana post-destete pero no tiene efecto alguno sobre la digestibilidad de los nutrientes. En general, la inclusión de productos derivados del haba de soja con un alto valor añadido (CPS o AP-HS) en el pienso presenta pocas ventajas en términos productivos al uso de AP-HS en lechones blancos recién destetados. En el experimento 3, se estudiaron los mismos productos de soja y piensos similares al experimento 2 en lechones ibéricos recién destetados. Además de los parámetros productivos y la TTAD de los nutrientes, en este ensayo se estudió también la digestibilidad ileal aparente (AID) de los nutrientes, así como las características histológicas y morfometría de la mucosa ileal. Cada uno de los 6 tratamientos fue replicado 6 veces (6 lechones/departamento). De 30 a 51 días de edad la fuente de harina de soja no afectó a los parámetros productivos, pero el índice de diarreas fue mayor (P<0.001) y la TTAD y AID de los nutrientes menor en los lechones alimentados con R-HS que en los alimentados con CPS o AP-HS. Sin embargo, no se encontró ninguna diferencia para éstos parámetros entre los piensos que contenían AP-HS y CPS. La TTAD de la MO (P=0.07) y de la EB (P=0.05) tendieron a ser mayores en los piensos basados en AP-HS micronizada que en los basados en AP-HS molida. La TTAD de la EB tendió (P<0.05) a ser mayor para la AP-HS de origen USA que para la AP-HS de origen ARG. Los lechones que consumieron R-HS presentaron villi de menor longitud (P<0.01) que los lechones que consumieron AP-HS o CPS, pero no se observaron diferencias en el caso de los lechones que recibieron los piensos que contenían AP-HS o CPS. Se concluye que la inclusión de AP-HS o CPS en el pienso en sustitución de R-HS reduce el índice de diarreas y mejora la digestibilidad de los nutrientes y las características morfológicas del íleon sin afectar a los parámetros productivos. La utilización de piensos basados en productos derivados del haba de soja con mayor valor añadido (CPS o AP-HS) en sustitución de la R-HS, mejora la TTAD de todos los nutrientes y reduce el índice de diarreas si llegar afectar a los parámetros productivos. En el experimento 4 se estudiaron los efectos del contenido de PB y la complejidad del pienso, la presentación física y la duración del suministro del pienso prestárter sobre los parámetros productivos y la TTAD de los nutrientes en lechones ibéricos recién destetados de 28 a 63 días de edad. Hubo 12 tratamientos experimentales con 2 tipos de pienso (AC; calidad alta y BC: calidad media), 2 presentaciones del pienso (gránulo y harina) y 3 duraciones de suministro del pienso prestárter (7, 14 y 21 días). Desde los 7, 14 y 21 días de experimento (dependiendo del tratamiento), hasta los 35 días, todos los lechones recibieron un pienso comercial en forma de harina. Cada uno de los tratamientos fue replicado 3 veces (6 lechones/departamento). En el global del experimento, la ganancia media diaria (GMD; P<0.05) y el consumo medio diario (CMD; P<0.01) fue menor en los lechones que recibieron el pienso AC que para los que recibieron el pienso de BC, si bien el IC no se vio afectado. La granulación del pienso prestárter no afectó a los crecimientos pero mejoró la eficiencia alimenticia. La utilización del pienso prestárter de 0 a 21 días de prueba mejoró el IC (P<0.05), pero redujo la GMD (P<0.01) en comparación con la utilización de éste pienso solo durante 7 o 14 días. El índice de diarreas tendió a ser mayor (P=0.06) en los lechones alimentados con los piensos AC que en los alimentados con los piensos BC. Asimismo, el índice de diarreas fue superior en los lechones que recibieron el pienso en gránulo que los que los recibieron en harina (P<0.001). Además, el índice de diarreas fue superior en los lechones que recibieron el pienso prestárter durante 14 o 21 días que en los que lo recibieron solo durante 7 días (P<0.01). De 28 a 49 días de edad, la GMD y el IC no se vieron afectados por la complejidad del pienso, pero la presentación en gránulo o el aumento en la duración de suministro del pienso prestárter mejoró el IC (P<0.01). También, en este periodo el índice de diarreas fue mayor en lechones alimentados con piensos granulados que aquellos alimentados con piensos en harina. Asimismo, fue superior para los lechones alimentados con el pienso prestárter durante 14 o 21 días que para los que recibieron éste pienso solo durante 7 días (P<0.01). De 49 a 63 días de edad, los lechones que previamente habían recibido piensos BC crecieron más que los que recibieron piensos AC (P<0.001). Asimismo, los lechones que recibieron el pienso prestárter durante 21 días comieron (P< 0.001) y crecieron menos (P<0.05) presentando una peor eficacia alimenticia (P<0.05) que los lechones que lo recibieron solo durante 7 14 días. La digestibilidad de la MO fue mayor en los lechones alimentados con los piensos AC que en los alimentados con piensos BC (P<0.05). La granulación del pienso mejoró la digestibilidad de los principales nutrientes. Los piensos prestárter AC mejoraron la digestibilidad de los nutrientes pero no la eficiencia alimenticia en lechones ibéricos de 28 a 63 días de edad. La granulación del pienso mejoró la eficiencia alimenticia. El aumento del suministro del pienso prestárter de 7 a 21 días mejoró la eficiencia alimenticia pero redujo la GMD. Por lo tanto, la utilización de piensos granulados de alta calidad durante el periodo prestárter es recomendable en lechones ibéricos, pero solo durante la primera semana post-destete. ABSTRACT The main objectives of this PhD Thesis were to study the effects of a) heat processing (HP) of corn and inclusion of high quality ingredients of animal origin such as fish meal (FM) and dried milk products in the diet, b) inclusion of different soy products varying in crude protein (CP) content, particle size, and origin of the beans in diets for conventional white and Iberian weanling pigs, and c) effects of ingredient quality, feed form, and duration of supply of the phase I diets on growth performance, nutrient digestibility, and intestinal morphology of weanling pigs. In experiment 1, the effect of diet complexity on total tract apparent digestibility (TTAD) and growth performance was studied in piglets from 21 to 62 d of age. There were 10 experimental treatments which resulted from the combination of 5 phase I (21 to 41 d of age) and 2 phase II (42 to 62 d of age) diets. The 5 phase I diets consisted of a negative control diet that contained 40 % raw corn, 4% FM, and 7% lactose (LAC); a positive control diet that contained 40 % HP corn, 10% FM, and 14% LAC, and 3 extra diets that used similar ingredients to those of the positive control diet but in which a) 40% of HP corn was substituted by raw corn, b) 4% FM rather than 10% FM, and c) 7% LAC instead of 14% LAC were included in the diet. Each treatment was replicated 6 times (6 pigs per pen). From 42 to 62 d of age, half of the pens of each of the 5 phase I treatments received a standard soybean meal (SBM)–native corn–lard diet wheras the other half received a diet with similar nutrient profile but that included 20% HP corn, 5% FM, 1.3% lactosa, 2% fermented soy protein concentrate, and 1% soybean oil in substitution of variables amounts of non-processed corn, SBM, and lard. Dietary treatment did not affect piglet performance at any age, but the incidence of post-weaning diarrhea (PWD) was higher during phase I in piglets fed the negative control diet than in piglets fed any of the other diets (P<0.05). At 30 d of age (phase I diets), the TTAD of organic matter (OM) and gross energy (GE) was lower (P<0.001) in pigs fed the negative control diet than in pigs fed the other diets but CP digestibility was not affected. At 50 d of age (phase II diets), dietary treatment did not affect TTAD of any dietary component. It is concluded that the use of high quality ingredients at high levels in the diet did not improve growth performance of piglets at any age. From 21 to 41 d of age, PWD was reduced and nutrient digestibility was increased in pigs fed the more complex diets. Consequently, the inclusion of high levels of high quality ingredients in piglet diets to maximize growth performance might not be justified under all circumstances In experiment 2, the effect of CP content (44 vs. 49 % CP) of SBM, micronization (fine grinding) of the high CP SBM (HP-SBM; 49% CP), and soy protein concentrate (SPC; 65% CP) on TTAD and growth performance was studied in conventional white piglets from 28 to 63 d of age. From 28 to 49 d of age (phase I), there was a positive control diet that included 6.5% CP from SPC and a negative control diet that supplied the same amount of CP as regular SBM (R-SBM; 44% CP) of Argentina (ARG) origin. The other 4 diets included the same amount of dietary CP from 2 sources of HP-SBM (USA or ARG origin), either ground (990 μm) or micronized (60 μm). Each treatment was replicated 8 times (6 pigs per pen). From 49 to 63 d of age (phase II), all pigs were fed a common commercial starter diet. For the entire phase I, type of soy product included in the diet did not affect growth performance of the pigs. However, from 28 to 35 d of age pigs fed the micronized HP-SBM had better feed conversion ratio (FCR; 0.90 vs. 1.01; P<0.05) than pigs fed the ground HP-SBM. Also, from 35 to 42 d of age, average daily feed intake (ADFI) tended to be higher (P=0.08) for pigs fed the micronized HP-SBM than for pigs fed the ground HP-SBM. During phase II, when all the pigs received the same diet, no differences among treatments were observed. In general, the TTAD of nutrients at 35 d of age was higher for the SPC than for the R-SBM diet with the HP-SBM diets being intermediate. The TTAD of CP was higher (83.8% vs. 81.9%; P≤0.01) for the SPC diet than for the average of 5 SBM containing diets. Also, the digestibility of OM and dry matter (DM) was higher (P<0.01) for the HP-SBM, either ground or micronized, than for the R-SBM diet. Micronization of the HP-SBM did not affect nutrient digestibility. It is concluded that when R-SBM was substituted by SPC, CP digestibility was improved but no effects on growth performance were observed. The use of HP-SBM in substitution of R-SBM in the diet improved nutrient digestibility but did not affect piglet performance. The inclusion of micronized HP-SBM in the diet improved FCR during the first week post-weaning but did not affect TTAD of nutrients. Therefore, the inclusion of added value soy products (SPC or micronized SBM) in the diet presents little advantage in terms of growth performance over the use of HP-SBM in pigs weaned at 28 d of age. In experiment 3, the effects of the same sources of soy protein used in experiment 2 on TTAD and growth performance of crossbreed Iberian pigs from 30 to 61 d of age were studied. In addition, the apparent ileal digestibility (AID) of nutrients and mucosa ileum morphology were also determined. Dietary treatment did not affect growth performance of the pigs at any age but from 30 to 51 d of age (phase I diets), PWD was higher (P<0.001) and the TTAD and AID of all nutrients were lower for pigs fed the R-SBM diet than for pigs fed the HP-SBM or the SPC diets. However, no differences between the HP-SBM and the SPC containing diets were detected for digestibility of any dietary component. The TTAD of OM (P=0.07) and GE (P=0.05) tended to be higher for the micronized HP-SBM than for the ground HP-SBM and that of GE was higher (P<0.05) for the USA meal than for the ARG meal. Pigs fed R-SBM had lower villus height (P<0.01) than pigs fed HP-SBM or SPC but no differences in ileal mucosal morphology were detected between SPC and HP-SBM containing diets. It is concluded that feeding the HP-SBM or SPC in substitution of R-SBM reduced PWD and improved nutrient digestibility and ileal morphology in piglets as compared with feeding the R-SBM, but had no effect on growth performance. The inclusion in the diet of added value soy products (micronized SBM or SPC) in substitution of the R-SBM increased the TTAD of all nutrients and reduced PWD but had no advantage in terms of growth performance over the use of ground HP-SBM. In experiment 4, the effect of CP content and ingredient complexity, feed form, and duration of feeding of the phase I diets on growth performance and TTAD of nutrients were studied in Iberian pigs from 28 to 63 d of age. There were 12 dietary treatments with 2 type of feeds (HQ; higher quality and LQ; medium quality), 2 feed forms (pellets vs. mash), and 3 durations of supply (7, 14, and 21 d) of the phase I diets. From d 7, 14, or 21 (depending on treatment) to d 35 of experiment, all pigs received a common diet in mash form. Each treatment was replicated 3 times (6 pigs/pen). For the entire experiment, average daily gain (ADG; P<0.05) and ADFI (P<0.01) were lower with the HQ than with the LQ phase I diets but FCR was not affected. Pelleting of the phase I diets did not affect ADG but improved FCR (P<0.01). Feeding the phase I diets from d 0 to 21 improved FCR (P<0.05) but decreased ADG (P<0.01) as compared with 7 or 14 d of feeding. Post-weaning diarrhea tended to be higher (P=0.06) for pigs fed the HQ diets than for pigs fed the LQ diets and for pigs fed pellets than for pigs fed mash (P<0.001). Also, PWD was higher for pigs fed the phase I diet for 14 or 21 d than for pigs fed this diet for 7 d (P<0.01). From d 0 to 21, ADG and FCR were not affected by feed quality but feeding pellets or increasing the duration of feeding the phase I diets improved FCR (P<0.01). Also, in this period PWD was higher with pellets than with mash and for pigs fed the phase I diets for 14 or 21 d than for pigs fed this diet for only 7 d (P<0.01). From d 21 to 35, pigs previously fed the LQ diet had higher ADG than pigs fed the HQ phase I diets (P<0.001). Also, pigs that were fed the phase I diets for 21 d had lower ADG (P<0.05) and ADFI (P< 0.001) and poor FCR (P<0.05) than pigs fed these diets for 7 or 14 d. Organic matter digestibility was higher for pigs fed the HQ phase I diets than for pigs fed the LQ phase I diets (P<0.05). Pelleting improved TTAD of all nutrients (P<0.01). It is concluded that HQ phase I diets increased TTAD of nutrients but not feed efficiency of Iberian pigs from d 28 to 63 d of age. Also, pelleting improved nutrient digestibility and feed efficiency. Increasing the duration of supply of the phase I diets from 7 to 21 d improved feed efficiency but reduced ADG. Therefore, the use of LQ phase I diets in pellet form for no more than 7 d after weaning is recommended in Iberian pigs.

Epidemiology of injuries in First Division Spanish football

Abstract The aim was to examine the injuries sustained by Spanish football players in the First Division and to compare injury-related variables in the context of both competition and training. The injury data were prospectively collected from 16 teams (427 players) using a specific web-based survey during the 2008/2009 season. A total of 1293 injuries were identified (145 were recurring injuries). The overall injury incidence was 5.65 injuries per 1000 h of exposure. Injuries were much more common during competition than during training (43.53 vs. 3.55 injuries per 1000 h of exposure, P menor que 0.05). Most of the injuries (89.6%) involved the lower extremities, and overuse (65.7%) was the main cause. Muscle and tendon injuries were the most common types of injury (53.8%) among the players. The incidence of training injuries was greater during the pre-season and tended to decrease throughout the season, while the incidence of competition injuries increased throughout the season (all P menor que 0.05). In conclusion, the results of this study suggest the need for injury prevention protocols in the First Division of the Spanish Football League to reduce the number of overuse injuries in the muscles and tendons in the lower extremities. In addition, special attention should be paid during the pre-season and the competitive phase II (the last four months of the season) in order to prevent training and competition injuries, respectively.