Differences in the impact of heat waves according to urban and peri-urban factors in Madrid

Aside from climatic factors, the impact of heat waves on mortality depends on the demographic and socio-economic structure of the population as well as variables relating to local housing. Hence, this study's main aim was to ascertain whether there might be a differential impact of heat waves on daily mortality by area of residence. The study is a time-series analysis (2000-2009) of daily mortality and minimum and maximum daily temperatures (°C) in five geographical areas of the Madrid region. The impact of such waves on heat-related mortality due to natural causes (ICD-10: A00- R99), circulatory causes (ICD-10: I00-I99) and respiratory causes (ICD-10: J00-J99) was obtained by calculating the relative risk (RR) and attributable risk (AR), using GLM models with the Poisson link and controlling for trend, seasonalities and the autoregressive nature of the series. Furthermore, we also evaluated other external variables, such as the percentage of the population aged over 65 years and the percentage of old housing. No heat-related mortality threshold temperature with statistical significance was detected in the northern and eastern areas. While the threshold temperatures in the central and southern areas were very similar and close to the 90th percentile, the threshold in the western area corresponded to the 97th percentile. Attributable mortality proved to be highest in the central area with 85 heat wave-related deaths per annum. External factors found to influence the impact of heat on mortality in Madrid were the size of the population aged over 65 years and the age of residential housing. Demographic structure and the percentage of old housing play a key role in modulating the impact of heat waves. This study concludes that the areas in which heat acts earliest are those having a higher degree of population ageing.

ESTADO DE ÁNIMO Y CALIDAD DE VIDA EN MUJERES ADULTAS PRACTICANTES DE PÁDEL

El objetivo de este estudio es analizar la percepción del nivel de calidad de vida y determinar el perfil de estado de ánimo de las mujeres deportistas que practican pádel y compararlo con los resultados obtenidos por las mujeres sedentarias. Las participantes del estudio fueron 60 mujeres extremeñas (Edad  media = 40,43 ± 5,73 años), divididas en dos grupos, distinguiendo entre mujeres deportistas que practican pádel y mujeres sedentarias. Se utilizó el Cuestionario Internacional de Actividad Física para dividir a las participantes en dos grupos (deportistas y sedentarias) y posteriormente se aplicó cuestionario del Perfil de Estado de Ánimo y el test EuroQol-5D para conocer la percepción de calidad de vida. Los resultados de este trabajo mostraron valores significativamente más elevados en el todas las dimensiones del estado de ánimo en las mujeres deportistas. Sin embargo, no parece que la práctica de pádel influya significativamente en las dimensiones de calidad de vida excepción de la medida en la escala visual analógica, que es superior en las mujeres practicantes de pádel

Time trend in the impact of heat waves on daily mortality in Spain for a period of over thirty years (1983-2013)

Many of the studies that analyze the future impact of climate change on mortality assume that the temperature that constitutes a heat wave will not change over time. This is unlikely, however, given the process of adapting to heat changes, prevention plans, and improvements in social and health infrastructure. The objective of this study is to analyze whether, during the 1983-2013 period, there has been a temporal change in the maximum daily temperatures that constitute a heat wave (T_threshold) in Spain, and to investigate whether there has been variation in the attributable risk (AR) associated with mortality due to high temperatures in this period. This study uses daily mortality data for natural causes except accidents CIEX: A00-R99 in municipalities of over 10,000 inhabitants in 10 Spanish provinces and maximum temperature data from observatories located in province capitals. The time series is divided into three periods: 1983-1992, 1993-2003 and 2004-2013. For each period and each province, the value of T_threshold was calculated using scatter-plot diagram of the daily mortality pre-whitened series. For each period and each province capitals, it has been calculated the number of heat waves and quantifying the impact on mortality through generalized linear model (GLM) methodology with the Poisson regression link. These models permits obtained the relative risks (RR) and attributable risks (AR). Via a meta-analysis, using the Global RR and AR were calculated the heat impact for the total of the 10 provinces. The results show that in the first two periods RR remained constant RR: 1.14 (CI95%: 1.09 1.19) and RR: 1.14 (CI95%: 1.10 1.18), while the third period shows a sharp decrease with respect to the prior two periods RR: 1.01 (CI95%: 1.00 1.01); the difference is statistically significant. In Spain there has been a sharp decrease in mortality attributable to heat over the past 10 years. The observed variation in RR puts into question the results of numerous studies that analyze the future impact of heat on mortality in different temporal scenarios and show it to be constant over time.

Impact on mortality of biomass combustion from wildfires in Spain: A regional analysis

Studies that analyse the impact on mortality of particulate matter (PM) produced by biomass combustion from wildfires mostly focus on a single city or on cities in different countries, with very few concentrating on one country as a whole. Accordingly, the aim of this paper was to analyse the impact that PM has on daily mortality in Spain on days with biomass combustion from wildfires. To analyse natural PM advections the Ministry of Agriculture and Fishing, Food & Environment divides Spain into 9 geographical regions. One province representative of each region for was selected analysis purposes, with provincial daily natural-cause mortality across the period 2004-2009 as the dependent variable, and daily mean PM concentrations in the provincial capital as the independent variable. We controlled for the effect of other chemical pollutants (NO₂ and O₃), maximum daily temperature on heat-wave days, day of the week, trends, seasonalities and the autoregressive nature of the series, using generalised linear models with the Poisson regression link to calculate relative risks (RRs) and the increase in RR (IRR) of PM-related mortality. The analysis was performed for days with and without biomass advections (DBA and DNBA respectively), with a breakdown by year, summer, and the remainder of the year (i.e., excluding summer). The results indicated that daily mean PM concentrations were higher on DBA than on DNBA, with statistically significant differences in most provinces. Furthermore, PM₁₀ was associated with higher daily mortality on DBA in regions where wildfires were most frequent, but not in the remaining provinces. This translated as an IRR per 10μg/m³ of PM of 7.93 (2.36-13.81) in the North-west, 3.76 (1.36-6.22) in the Centre and 4.46 (2.99-5.94) in the South-west, values which in all cases were statistically higher than those obtained on DNBA. The increase in PM caused by biomass advections from wildfires is linked to a significant IRR of mortality in Spain. Hence, the fact that wildfires are likely to become increasingly frequent in the context of climate change makes this type of analysis particularly necessary.

Demonstration of Single-Barium-Ion Sensitivity for Neutrinoless Double-Beta Decay Using Single-Molecule Fluorescence Imaging

A new method to tag the barium daughter in the double-beta decay of ^{136}Xe is reported. Using the technique of single molecule fluorescent imaging (SMFI), individual barium dication (Ba^{++}) resolution at a transparent scanning surface is demonstrated. A single-step photobleach confirms the single ion interpretation. Individual ions are localized with superresolution (∼2  nm), and detected with a statistical significance of 12.9σ over backgrounds. This lays the foundation for a new and potentially background-free neutrinoless double-beta decay technology, based on SMFI coupled to high pressure xenon gas time projection chambers.

Spatial variability in threshold temperatures of heat wave mortality: impact assessment on prevention plans

Spain's current heat wave prevention plans are activated according to administrative areas. This study analyses the determination of threshold temperatures for triggering prevention-plan activation by reference to isoclimatic areas, and describes the public health benefits. We subdivided the study area - the Madrid Autonomous Region (MAR) - into three, distinct, isoclimatic areas: 'North', 'Central' and 'South', and grouped daily natural-cause mortality (ICD-10: A00-R99) in towns of over 10,000 inhabitants (2000-2009 period) accordingly. Using these three areas rather than the MAR as a whole would have resulted in a possible decrease in mortality of 73 persons (38-108) in the North area, and in aborting unnecessary activation of the plan 153 times in the Central area and 417 times in the South area. Our results indicate that extrapolating this methodology would bring benefits associated with a reduction in attributable mortality and improved effectiveness of public health interventions.

The Sleep-Wake Cycle in the Nicotinic Alpha-9 Acetylcholine Receptor Subunit Knock-Out Mice

There is a neural matrix controlling the sleep-wake cycle (SWC) embedded within high ranking integrative mechanisms in the central nervous system. Nicotinic alpha-9 acetylcholine receptor subunit (alpha-9 nAChR) participate in physiological processes occurring in sensory, endocrine and immune systems. There is a relationship between the SWC architecture, body homeostasis and sensory afferents so that disruption of afferent signaling is expected to affect the temporal organization of sleep and wake states. The analysis of the SWC of 9 nAChR knock-out animals may help to reveal the contribution of alpha-9 nAChR to sleep chronobiological determinants. Here we explore the polysomnogram in chronically implanted alpha-9 nAChR knock-out (KO) and wild-type (WT) individuals of the hybrid CBA/Sv129 mouse strain. Records were obtained in isolation chambers under a stable 12:12 light:dark cycle (LD). To unmask the 24-h modulation of the SWC a skeleton photoperiod (SP) protocol was performed. Under LD the daily quota (in %) of wakefulness (W), NREM sleep and REM sleep obtained in KO and WT animals were 45, 48 and 7, and 46, 46 and 8 respectively. Both groups exhibit nocturnal phase preference of W as well as diurnal and unimodal phase preference of NREM and REM sleep. The acrophase mean angles of KO vs. WT genotypes were not different (Zeitgeber Time: 6.5 vs. 14.9 for W, 4.3 vs. 2.8 for NREM sleep and 5.3 vs. 3.4 for REM sleep, respectively). Transference to SP do not affect daily state quotas, phase preferences and acrophases among genotypes. Unmasking phenomena of the SWC such as wake increment during the rest phase under SP was evident only among WT mice suggesting the involvement of retinal structures containing alpha-9 nAChR in masking processes. Furthermore, KO animals exhibit longer NREM and REM sleep episodes that is independent of illumination conditions. Consolidated diurnal NREM sleep contributed to obtain higher values of NREM sleep delta-EEG activity among KO mice during rest phase. In conclusion, circadian and sleep homeostatic aspects of the SWC are operative among alpha-9 nAChR KO animals. We propose that alpha-9 nAChR participate in retinal signaling processes responsible of the positive masking of sleep by light.

[Response to ABVD chemotherapeutic protocol in patients with early stage Hodgkin’s lymphoma]

BACKGROUND

Recent trials show that > 90% of patients with early stage Hodgkin`s Lymphoma (ESHL) can be cured, especially when using the ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) chemotherapeutic (CT) protocol. The use of radiotherapy (RT) is variable and can be selected according to the presence of specific risk factors, including PET-CT, as recently reported.

AIM

To report the experience in the treatment of ESHL.

MATERIAL AND METHODS

Retrospective and descriptive analysis of patients with ESHL treated at the Red de Salud UC-Christus between 2011-2015.

RESULTS

Twenty-two patients were treated. In 73%, the tumor was of nodular sclerosis histologic type. Most patients (95%) were in stage II, and 78% had a favorable prognosis according to the Deutsche Hodgkin Studiengruppe (GHSG) criteria. All patients were stratified using PET-CT and treated using the ABVD CT protocol, for 4-6 cycles. Only 5 patients received RT. There was no change of conduct after interim-PET-CT results. Ninety one percent of patients achieved complete response and there were two cases of refractory disease. Both cases underwent hematopoietic stem cell transplantation. After 17 months of median follow-up, 91% of patients are relapse-free, and only one patient died (5%).

CONCLUSIONS

ABVD offers excellent results for ESHL patients. The benefit of PET-CT should be evaluated with prospective protocols, aiming to select patients needing RT or to reduce the number of CT cycles.

Association between environmental factors and emergency hospital admissions due to Alzheimer's disease in Madrid

INTRODUCTION

There are scarce studies of time series that analysed the short-term association between emergency hospital admissions due to Alzheimer's disease (AD) and environmental factors. The objective is to analyse the effect of heat waves, noise and air pollutants on urgent hospital admissions due to AD in Madrid.

METHODS

Longitudinal ecological time series study was performed. The dependent variable was the emergency AD hospital admissions occurred in Madrid during the period 2001-2009. Independent variables were: Daily mean concentrations (μg/m3) of air pollutants (PM_2.5 and PM₁₀; O3 and NO2); maximum daily temperature (°C) and daily and night noise levels (dB(A)). Relative Risk (RR) for an increment in interquartile range, and Attributable Risk (AR) values were calculated through GLM with Poisson link.

RESULTS

Our findings indicated that only PM_2.5 concentrations at lag 2 with a RR: 1.38 (95% CI: 1.15-1.65); AR 27.5% (95% CI: 13.0-39.4); and heat wave days at lag 3 with a RR: 1.30 (95% CI: 1.12-1.52); AR 23.1% (95% CI: 10.7-34.2) were associated with AD hospital admissions.

CONCLUSION

A reduction in AD patients' exposure levels to PM_2.5 and special care of such patients during heat wave periods could result in a decrease in both emergency AD admissions and the related health care costs.

Ageing studies of TPB in noble gas detectors for dark matter and neutrinoless ββ decay searches

Noble gases (Xe, Ar, Kr) are very attractive as detector media in Dark Matter search and neutrinoless double-beta decay experiments. However, the detection of their scintillation light (in the VUV spectral region) requires shifting the VUV light to visible light, where standard photosensors are more efficient. Tetraphenyl butadiene (TPB) is widely used as wavelength shifter, absorbing the VUV light and re-emitting in the blue region (~430nm). TPB is an organic molecule that may degrade due to exposure to environmental agents and also to ultraviolet light. In this work, we present TPB ageing studies due to exposure to VUV light, aiming at quantifying the reduction of the absolute fluorescence yield of TPB coatings of several thicknesses (130nm, 260nm, 390nm, 1600nm), exposed to various doses of VUV light at 170nm (similar to the Xe scintillation). In our setup, the VUV light is produced from a vacuum monochromator coupled to a deuterium lamp. The VUV exposure in our setup is compared to the exposure obtained in the electroluminescent gaseous Xe TPC of the NEXT-100 experiment for neutrinoless double-beta decay search.

Short-term association between environmental factors and hospital admissions due to dementia in Madrid

BACKGROUND

Spain has one of the highest proportions of dementia in the world among the population aged 60 years or over. Recent studies link various environmental factors to neurocognitive-type diseases. This study sought to analyse whether urban risk factors such as traffic noise, pollutants and heat waves might have a short-term impact on exacerbation of symptoms of dementia, leading to emergency hospital admission.

MATERIAL AND METHODS

We conducted a longitudinal ecological time-series study, with the dependent variable being the number of daily dementia-related emergency (DDE) hospital admissions to Madrid municipal hospitals (ICD-10 codes 290.0-290.2, 290.4-290.9, 294.1-294) from 01 to 01-2001 to 31-12-2009, as obtained from the Hospital Morbidity Survey (National Statistics Institute). The measures used were as follows: for noise pollution, Leqd, equivalent diurnal noise level (from 8 to 22h), and Leqn, equivalent nocturnal noise level (from 22 to 8h) in dB(A); for chemical pollution, mean daily NO2, PM2.5, PM1 as provided by the Madrid Municipal Air Quality Monitoring Grid; and lastly, maximum daily temperature (°C), as supplied by the State Meteorological Agency. Scatterplot diagrams were plotted to assess the type of functional relationship existing between the main variable of analysis and the environmental variables. The lags of the environmental variables were calculated to analyse the timing of the effect. Poisson regression models were fitted, controlling for trends and seasonalities, to quantify relative risk (RR).

RESULTS

During the study period, there were 1175 DDE hospital admissions. These admissions displayed a linear functional relationship without a threshold in the case of Leqd. The RR of DDE admissions was 1.15 (1.11-1.20) for an increase of 1dB in Leqd, with impact at lag 0. In the case of maximum daily temperature, there was a threshold temperature of 34°C, with an increase of 1°C over this threshold posing an RR of 1.19 (1.09-1.30) at lag 1. The only pollutant to show an association with DDE hospital admissions was O3 at lag 5, with an RR of 1.09 (1.04-1.15) for an increase of 10µg/m³ CONCLUSIONS: Diurnal traffic noise, heat waves and tropospheric ozone may exacerbate the symptoms of dementia to the point of requiring emergency admission to hospital. Lowering exposure levels to these environmental factors could reduce dementia-related admissions in Madrid.

Temporal Organization of the Sleep-Wake Cycle under Food Entrainment in the Rat

STUDY OBJECTIVES

To analyze the temporal organization of the sleep-wake cycle under food entrainment in the rat.

METHODS

Eighteen male Sprague-Dawley rats were chronically implanted for polysomnographic recording. During the baseline (BL) protocol, rats were recorded under a 12:12 light-dark (LD) schedule in individual isolation chambers with food and water ad libitum. Food entrainment was performed by means of a 4-h food restriction (FR) protocol starting at photic zeitgeber time 5. Eight animals underwent a 3-h phase advance of the FR protocol (A-FR). We compared the mean curves and acrophases of wakefulness, NREM sleep, and REM sleep under photic and food entrainment and after a phase advance in scheduled food delivery. We further evaluated the dynamics of REM sleep homeostasis and the NREM sleep EEG delta wave profile.

RESULTS

A prominent food-anticipatory arousal interval was observed after nine or more days of FR, characterized by increased wakefulness and suppression of REM sleep propensity and dampening of NREM sleep EEG delta activity. REM sleep exhibited a robust nocturnal phase preference under FR that was not explained by a nocturnal REM sleep rebound. The mean curve of sleep-wake states and NREM sleep EEG delta activity remained phase-locked to the timing of meals during the A-FR protocol.

CONCLUSIONS

Our results support the hypothesis that under food entrainment, the sleep-wake cycle is coupled to a food-entrainable oscillator (FEO). Our findings suggest an unexpected interaction between FEO output and NREM sleep EEG delta activity generators.

On the probability of the existence of fixed-size components in random geometric graphs

In this work we give precise asymptotic expressions for the probability of the existence of fixed-size components at the threshold of connectivity for random geometric graphs.

Mortality attributable to extreme temperatures in Spain: A comparative analysis by city

BACKGROUND

The Low Temperature Days (LTD) have attracted far less attention than that of High Temperature Days (HTD), though its impact on mortality is at least comparable. This lower degree of attention may perhaps be due to the fact that its influence on mortality is less pronounced and longer-term, and that there are other concomitant infectious winters factors. In a climate-change scenario, the studies undertaken to date report differing results. The aim of this study was to analyse mortality attributable to both thermal extremes in Spain's 52 provinces across the period 2000-2009, and estimate the related economic cost to show the benefit or "profitability" of implementing prevention plans against LTD.

METHODS

Previous studies enabled us: to obtain the maximum daily temperature above which HTD occurred and the minimum daily temperature below which LTD occurred in the 52 provincial capitals analysed across the same study period; and to calculate the relative and attributable risks (%) associated with daily mortality in each capital. These measures of association were then used to make different calculations to obtain the daily mean mortality attributable to both thermal extremes. To this end, we obtained a summary of the number of degrees whereby the temperature exceeded (excess °C) or fell short (deficit °C) of the threshold temperature for each capital, and calculated the respective number of extreme temperatures days. The economic estimates rated the prevention plans as being 68% effective.

RESULTS

Over the period considered, the number of HTD (4373) was higher than the number of LTD (3006) for Spain as a whole. Notwithstanding this, in every provincial capital the mean daily mortality attributable to heat was lower (3deaths/day) than that attributable to cold (3.48deaths/day). In terms of the economic impact of the activation of prevention plans against LTD, these could be assumed to avoid 2.37 deaths on each LTD, which translated as a saving of €0.29M. Similarly, in the case of heat, 2.04 deaths could be assumed to be avoided each day on which the prevention plan against HTD was activated, amounting to a saving of €0.25M. While the economic cost of cold-related mortality across the ten-year period 2000-2009 was €871.7M, that attributable to heat could be put at €1093.2M.

CONCLUSION

The effect of extreme temperatures on daily mortality was similar across the study period for Spain overall. The lower number of days with LTD meant, however, that daily cold-related mortality was higher than daily heat-related mortality, thereby making prevention plans against LTD more "profitable" prevention plans against HTD in terms of avoidable mortality.

Geographical variation in relative risks associated with cold waves in Spain: The need for a cold wave prevention plan

In general, there are few studies that analyse the impact of low temperatures on mortality and fewer still that use cold-wave-definition thresholds based on epidemiological and non-climatological criteria. Such a threshold definition, which took into account population features such as socio-economic and demographic characteristics, made it possible for a specific threshold temperature to be obtained for each of Spain's 52 provincial capitals in this study. Using generalised linear models with the Poisson regression link, and controlling for trend, autocorrelations and seasonalities of the series, and influenza epidemics, we obtained the impact of low temperatures on mortality in each provincial capital by calculating the relative risks (RRs) and attributable risks (ARs) for natural as well as circulatory and respiratory causes. The study showed higher minimum temperature thresholds in coastal areas, and an overall impact of cold on mortality in Spain due to natural causes RR=1.13 (95% CI: 1.11-1.16), circulatory causes RR=1.18 (95% CI: 1.15-1.22) and respiratory causes RR=1.24 (95% CI: 1.20-1.29) slightly greater than that obtained to date for heat. From a public health standpoint, there is a need for specific cold wave prevention plans at a regional level which would enable mortality attributable to low temperatures to be reduced. These plans have shown themselves to be effective in decreasing heat-related mortality, and we feel that they are essential for reducing cold-related effects on morbidity and mortality.

Geographical variation in relative risks associated with heat: Update of Spain's Heat Wave Prevention Plan

A decade after the implementation of prevention plans designed to minimise the impact of high temperatures on health, some countries have decided to update these plans in order to improve the weakness detected in these ten years of operation. In the case of Spain, this update has fundamentally consisted of changing the so-called "threshold" or "trigger" temperatures used to activate the plan, by switching from temperature values based on climatological criteria to others obtained by epidemiological studies conducted on a provincial scale. This study reports the results of these "trigger" temperatures for each of Spain's 52 provincial capitals, as well as the impact of heat on mortality by reference to the relative risks (RRs) and attributable risks (ARs) calculated for natural as well as circulatory and respiratory causes. The results obtained for threshold temperatures and RRs show a more uniform behaviour pattern than those obtained using temperature values based on climatological criteria; plus a clear decrease in RRs of heat-associated mortality due to the three causes considered, at both a provincial and regional level as well as for Spain as a whole. The updating of prevention plans is regarded as crucial for optimising the operation of these plans in terms of reducing the effect of high temperatures on population health.

Comparison of the effects of extreme temperatures on daily mortality in Madrid (Spain), by age group: The need for a cold wave prevention plan

A number of studies have shown that there is a time trend towards a reduction in the effects of heat on mortality. In the case of cold, however, there is practically no research of this type and so there is no clearly defined time trend of the impact of cold on mortality. Furthermore, no other specific studies have yet analysed the time trend of the impact of both thermal extremes by age group. We analysed data on daily mortality due to natural causes (ICD-10: A00-R99) in the city of Madrid across the period 2001-2009 and calculated the impact of extreme temperatures on mortality using Poisson regression models for specific age groups. The groups of age selected coinciding with the pre-existing age-groups analyzed in previous papers. For heat waves the groups of age used were: <10 years, 10-17 years, 18-44 years, 45-64 years, 65-74 years and over-75 years. For cold waves the groups of age used were: <1 year; 1-5 years, 6-17 years, 18-44 years, 45-64 years, 65-74 years and over-75 years. <1, 1-17, 18-44, 45-66, 65-74 and over-75 years. We controlled for confounding variables, such as air pollution, noise, influenza, pollen, pressure and relative humidity, trend of the series, as well as seasonalities and autoregressive components of the series. The results of these models were compared to those obtained for the same city during the period 1986-1997 and published in different studies. Our results show a lightly reduction in the effects of heat, especially in the over-45-year age group. In the case of cold, the behaviour pattern was the opposite, with an increase in its effect. Heat adaptation and socio-economic and public-health prevention and action measures may be behind this amelioration in the effects of heat, whereas the absence of such actions in respect of low temperatures may account for the increase in the effects of cold on mortality. From a public health point of view, the implementation of cold wave prevention plans covering all age groups is thus called for.

Evolution of maple syrup urine disease in patients diagnosed by newborn screening versus late diagnosis

Maple syrup urine disease (MSUD) is a rare metabolic disorder for which the newborn screening (NBS) is possible but it has not been yet implemented for most Spanish regions. In the present study, we assess the clinical features and outcome of 14 MSUD Spanish patients with similar treatment protocol diagnosed either by NBS or by clinical symptoms. Eight patients were detected by NBS, four classic and four moderate MSUD. The average age at detection was 4.6 days, the mean plasmatic concentration of leucine at diagnosis was 1807 μM; the average number of days with leucine >1000 μM was 0.7 (0-4) and the mean number of total hospitalizations was 1.6 (0-5). Mean follow-up time was 70 months. They had good evolution: all remain asymptomatic, but 2 patients have attention deficit and hyperactivity disorder. Six patients with late diagnosis of classic MSUD were followed during 41 months. All presented with acute encephalopathy during the first month of life, mean leucine levels of 2355 μM, mean number of days with leucine >1000 μM of 6.6 (1-13) and mean number of total hospitalizations of 5.3 (4-7). Only two patients have a psychomotor development index in the lower limit (80 and 83). For all patients a good genotype-phenotype correlation was found and four novel mutations were identified: p.A311H, p.T84S, p.T397L, pL398P. Our study support that NBS improves prognosis of MSUD patients. But early diagnosis and an aggressive treatment together with a close monitoring of leucine levels improve neurological evolution in MSUD patients, even for those not detected by NBS.

[Invasive fungal disease (IFD) by filamentous fungi in the Valparaíso Region, Chile, since implementation of rapid laboratory diagnosis]

INTRODUCTION

Invasive fungal diseases (IFD) by filamentous fungi are a common cause of morbidity and mortality in immunocompromised patients, especially those with myeloid leukemia. In 2011 a protocol for the rapid diagnosis of IFD by filamentous fungi was implemented in Valparaiso Region.

OBJECTIVES

To describe cases of IFD by filamentous fungi of the Valparaíso Region, since the implementation of rapid diagnosis and to compare results with the period 2004-2009.

MATERIALS AND METHOD

Descriptive and prospective study conducted in two public hospitals: Carlos van Buren at Valparaiso and Gustavo Fricke at Viña del Mar. We selected patients with a diagnosis of filamentous fungal diseases considering the EORTC/MSG criteria. Demographics, underlying diseases, risk factors for EFI, galactomannan (GM) results in blood and bronchoalveolar lavage, cultures and biopsies, treatment and overall lethality rates at 30 days were registered.

RESULTS

Eighteen patients were detected, 6 with proven and 12 probable IFD. Nine were diagnosed by GM, 8 by culture and two with both methods. In cases which the agent (9/18) was isolated from Rhizopus oryzae was the most frequent. When comparing overall lethality with the period 2004-2009, there was a reduction of 47.8%, which was statistically significant.

CONCLUSIONS

Compared to data previously published in the region, demographic and comorbidities of patients with IFD caused by filamentous fungi are similar, however the currently rapid diagnosis protocol has improved survival of patients and lethality experienced overall decrease.

Influence of advections of particulate matter from biomass combustion on specific-cause mortality in Madrid in the period 2004-2009

Approximately, 20 % of particulate and aerosol emissions into the urban atmosphere are of natural origin (including wildfires and Saharan dust). During these natural episodes, PM10 and PM2.5 levels usually exceed World Health Organisation (WHO) health protection thresholds. This study sought to evaluate the possible effect of advections of particulate matter from biomass fuel combustion on daily specific-cause mortality among the general population and the segment aged ≥ 75 years in Madrid. Ecological time-series study in the city of Madrid from January 01, 2004 to December 31, 2009. The dependent variable analysed was daily mortality due to natural (ICD-10:A00-R99), circulatory (ICD-10:I00-I99), and respiratory (ICD-10:J00-J99) causes in the population, both general and aged ≥ 75 years. The following independent and control variables were considered: a) daily mean PM2.5 and PM10 concentrations; b) maximum daily temperature; c) daily mean O3 and NO2 concentrations; d) advection of particulate matter from biomass combustion ( http://www.calima.ws/ ), using a dichotomous variable and e) linear trend and seasonalities. We conducted a descriptive analysis, performed a test of means and, to ascertain relative risk, fitted a model using autoregressive Poisson regression and stratifying by days with and without biomass advection, in both populations. Of the 2192 days analysed, biomass advection occurred on 56, with mean PM2.5 and PM10 values registering a significant increase during these days. PM10 had a greater impact on organic mortality with advection (RRall ages = 1.035 [1.011-1.060]; RR  ≥  75 years = 1.066 [1.031-1.103]) than did PM2.5 without advection (RRall ages = 1.017 [1.009-1.025]; RR  ≥  75 years = 1.012 [1.003-1.022]). Among specific causes, respiratory-though not circulatory-causes were associated with PM10 on days with advection in ≥ 75 year age group. PM10, rather than PM2.5, were associated with an increase in natural cause mortality on days with advection of particulate matter from biomass combustion, particularly in the ≥ 75 year age group.

Isolation and characterization of 20 polymorphic microsatellite loci in the migratory freshwater fish Leporinus obtusidens (Characiformes: Anostomidae) using 454 shotgun pyrosequencing

Twenty polymorphic microsatellite markers were developed for the Neotropical fish Leporinus obtusidens using a next generation sequencing approach and tested in two other characifomes species, Schizodon platae and Prochilodus lineatus. Microsatellite loci alleles in L. obtusidens ranged between 2 and 20 alleles per locus (mean = 5·7), with expected heterozygosity values ranging from 0·097 to 0·956 (mean = 0·578) and observed heterozygosity values ranging from 0·000 to 0·800 (mean = 0·400) in a sample of 20 specimens from the lower Paraná River (Argentina). Most of these markers will be a valuable tool for captive breeding and stocking programmes, as well as for analyses of population connectivity and genetic structure in this broadly distributed Neotropical migratory fish.

The TITAN-AMI multicenter registry evaluating the usage of Titan2 stent in patients with ST segment elevation myocardial infarction. Final result at 12-month follow-up

AIM

Primary percutaneous coronary intervention with stent implantation is the recommended treatment for patients with ST elevation myocardial infarction (STEMI). Data from randomised trials showed good performance by a titanium-nitric-oxide coated stent in this context. The aim of this study was to confirm these data.

METHODS

A multicentre registry was compiled in 23 hospitals in Spain in an all-comers population. We selected patients with STEMI from a global Titan AMI registry that included patients with acute coronary syndrome. Primary endpoint was the composite of cardiac death, non-fatal myocardial infarction, stent thrombosis and target lesion revascularisation, at 12-month follow-up.

RESULTS

The study included 893 patients with STEMI. We included all possibilities for PCI: 86.6% primary, 5% facilitated after successful fibrinolysis and 8.4% rescue PCI after failed fibrinolysis. The primary endpoint was reached in 8.4% of the patients: cardiac death 2.7%, reinfarction 3.4%, target lesion revascularisation 3.5% and definite or probable stent thrombosis 2.8%. The majority of stent thromboses presented in the first 30 days after PCI.

CONCLUSION

A bioactive stent (titanium-nitric-oxide coated stent) is a possible alternative for the treatment of patients with STEMI. One-year follow-up showed better results than those presented by a regular bare-metal stent or first-generation drug-eluting stent in terms of stent thrombosis.

The impact of extremely high temperatures on mortality and mortality cost

The aim of this study was to determine the temperature threshold that triggers an increase in heat-induced mortality in Zaragoza, Spain to determine the impact of extreme heat on mortality and in-hospital cost. A longitudinal ecological study was conducted according to an autoregressive integrated moving average model of a time series for daily deaths and to determine the relative risk of mortality for each degree that the temperature threshold was exceeded. Mortality showed a statistically significant increase when the daily maximum temperature exceeded 38 °C. A Relative Risk was 1.28 with a 95 % confidence interval (95 %CI:1.08-1.57) This threshold temperature didn't change over time. A total of 107 (95 %CI:42-173) heat-attributable deaths were estimated for the period 2002-2006, and the in-hospital estimated cost of these deaths reach € 426,087(95 %CI.€ 167,249-€ 688,907). The articulation of preventive measures to minimize the impact of extreme heat on human health is necessary because of the mortality-temperature relationship.

On the role of Rab5 in cell migration

Uncontrolled endosome trafficking is a common feature of certain cancer cells, which has been acknowledged during the last decade. Migration and invasiveness of metastatic tumor cells are both regulated by components of the endocytic machinery, including Rab proteins. Rab GTPases are essential in processes of endosome fusion, as well as targeting, tethering and transport along the cytoskeleton. In addition to this canonical role, some Rabs depict other functions, such as controlling cell proliferation, apoptosis, adhesion and motility. Here, we review our current knowledge on the role of Rab5, a key regulator of early endosome dynamics, in migration of normal and tumor cells. Rab5 promotes cell migration in vitro and in vivo by mechanisms described at different levels. One such mechanism is by controlling the rates of integrin internalization and recycling, thereby affecting its activation and availability at the cell surface. On the other hand, Rab5 promotes focal adhesion disassembly and modulates downstream pathways of integrin signaling, involving proteins such as Ras and Rho family GTPases. In this context, identification of upstream regulators and downstream effectors of Rab5, and their study represents a big challenge in order to understand how cancer cells depend on endosome control, in order to acquire more aggressive traits that lead to metastatic disease.

Caveolin-1 in cell migration and metastasis

Caveolin-1 is a member of the caveolin family that has been ascribed a dual role in cancer. In early stages of disease the protein functions predominantly as a tumor suppressor, whereas at later stages, caveolin-1 expression is associated with tumor progression and metastasis. Here, some mechanisms associated with caveolin-1-dependent tumor suppression will be briefly discussed before focusing on the role of this protein and particularly phosphorylation of tyrosine-14 in promoting cell migration, invasion and metastasis. Models are provided summarizing possible explanations for these dramatic changes in function, as well as mechanisms by which this may be achieved.

Caveolin-1 in cell migration and metastasis

Caveolin-1 is a member of the caveolin family that has been ascribed a dual role in cancer. In early stages of disease the protein functions predominantly as a tumor suppressor, whereas at later stages, caveolin-1 expression is associated with tumor progression and metastasis. Here, some mechanisms associated with caveolin-1-dependent tumor suppression will be briefly discussed before focusing on the role of this protein and particularly phosphorylation of tyrosine-14 in promoting cell migration, invasion and metastasis. Models are provided summarizing possible explanations for these dramatic changes in function, as well as mechanisms by which this may be achieved.

Assessment of the natural sources of particulate matter on the opencast mines air quality

Particulate matter is the main air pollutant in open pit mining areas. Preferred models that simulate the dispersion of the particles have been used to assess the environmental impact of the mining activities. Results obtained through simulation have been compared with the particle concentration measured in several sites and a coefficient of determination R(2)<0.78 has been reported. This result indicates that in the open pit mining areas there may be additional sources of particulate matter that have not been considered in the modeling process. This work proposes that the unconsidered sources of emissions are of regional scope such as the re-suspension particulate matter due to the wind action over uncovered surfaces. Furthermore, this work proposes to estimate the impact of such emissions on air quality as a function of the present and past meteorological conditions. A statistical multiple regression model was implemented in one of the world's largest open pit coal mining regions which is located in northern Colombia. Data from 9 particle-concentration monitoring stations and 3 meteorological stations obtained from 2009 to 2012 were statistically compared. Results confirmed the existence of a high linear relation (R(2)>0.95) between meteorological variables and particulate matter concentration being humidity, humidity of the previous day and temperature, the meteorological variables that contributed most significantly in the variance of the particulate matter concentration measured in the mining area while the contribution of the AERMOD estimations to the short term TSP (Total Suspended Particles) measured concentrations was negligible (<5%). The multiple regression model was used to identify the meteorological condition that leads to pollution episodes. It was found that conditions drier than 54% lead to pollution episodes while humidities greater than 70% maintain safe air quality conditions in the mining region in northern Colombia.

Asymmetric grazing incidence small angle x-ray scattering and anisotropic domain wall motion in obliquely grown nanocrystalline Co films

Strong asymmetries have been observed in grazing incidence small angle x-ray scattering (GISAXS) in situ patterns obtained from 30 nm-thick nanocrystalline Co films prepared by oblique sputtering (15°-75° off-sample normal). These asymmetries have been qualitatively simulated by a simple model consisting of an ensemble of 8 nm-wide inclined Co nanocolumns. It is found that narrow inclined features appear in the diffuse background resembling those characteristic of faceted systems, which can be used to obtain straightforward non-destructive estimations of buried nanocolumnar grains inclination, even for oblique angles below 45°, when the stronger and broader asymmetric features of the pattern are not yet fully formed. Furthermore, using magneto-optical microscopy, a marked change in the magnetic domain's nucleation and growth process has been observed in the sample prepared at 75°, with the stronger GISAXS asymmetries. Easy axis magnetization reversal starts by a random and homogeneous nucleation of small (∼μm) elongated domains aligned with the nanocolumn's long axis and proceeds through the preferred propagation of head-to-head domain walls (DWs) along the applied field direction. This peculiar magnetic behavior indicates that the strongly anisotropic nanostructuring created by the oblique growth process is equivalent, from a magnetic point of view, to an array of self-assembled buried nanowires. These results show how GISAXS and magneto-optical microscopy can be combined as a powerful tool for correlating the morphology and magnetism of thin nanostructured systems.

Diagnosis of tuberculosis infection by interferon-gamma release assays in patients with psoriasis

OBJECTIVE

In this study, we have performed a direct comparison between both T-cell based assays (QFN-G-IT and T-SPOT.TB) and TST in patients with psoriasis taking different immunosuppressant drug-regimens.

METHODS

We have prospectively studied 103 patients with moderate-to-severe psoriasis who required latent tuberculosis infection (LTBI) screening before starting systemic immunosuppressive treatment or during its sustained use.

RESULTS

Overall number of positive results was 16.5%, 17.5% and 8.7% using T-SPOT.TB, QFN-G-IT and TST, respectively. Differences in the percentage of positive results between TST with T-SPOT.TB and QFN-G-IT were significant (p = 0.005 and p = 0.008, respectively). A total of 24.3% of the subjects enrolled were positive for at least one of the three tests performed. Sixteen patients with negative TST (17%) were positive for one of the two IGRAs. We obtained seven indeterminate results by T-SPOT.TB and two by QFN-G-IT. Seven patients with negative TST presented indeterminate results by either of two IFN-γ assays. Positive TST, T-SPOT.TB and QFN-G-IT results were not affected by clinical therapeutic profile.

CONCLUSIONS

Our results reveal that in vitro assays are useful methods for LTBI diagnosis in patients with psoriasis, suggesting that they might be less influenced by immunosuppression than TST.

Variability of Bacillus thuringiensis strains by ERIC-PCR and biofilm formation

Bacillus thuringiensis (Bt) is a soil-dwelling bacterium of great interest for agronomical research because of its use as biological pesticide. There are some limitations regarding the subspecies classification. Phenotyping and genotyping studies are important to ascertain its variability. The diversity of 40 environmental strains, isolated from different regions in Mexico, was analyzed by ERIC-PCR and the ability of biofilm formation. Thirty-nine different fingerprinting patterns revealed enough data to discriminate among the 40 strains. A total of 24 polymorphic fragments with sizes between 139 and 1,468 bp were amplified. Almost all (95 %) strains showed biofilm formation after 96 h of incubation. At 96 h of incubation the biofilm-forming strains from the CINVESTAV collection showed a more heterogeneous ability as biofilms producers. Results showed a large intra-species genomic variability in Bt. However, some strains could be correlated as they were found within clusters depending on the location of isolation.

IP-10 is an accurate biomarker for the diagnosis of tuberculosis in children

OBJECTIVE

Performance of IFN-γ assays in children is compromised. Therefore, we investigated the utility of IP-10 for the detection of active tuberculosis (TB) and latent tuberculosis infection (LTBI) diagnosis in children; comparing its positivity with QuantiFERON-TB Gold In-Tube (QFN-G-IT) and T-SPOT.TB.

METHODS

We studied 230 children from three groups: active TB, screening (healthy children without known exposure to active TB patient screened at school or by their paediatrician) and contact-tracing studies. IFN-γ release was determined by QFN-G-IT and T-SPOT.TB. IP-10 was detected in QFN-G-IT supernatants by ELISA.

RESULTS

When combining QFN-G-IT and IP-10 assays, positive results improved significantly from 38.3% in QFN-G-IT and 33.9% in IP-10 to 41.3%. Age and type of contact were significant risk factors associated with positive QFN-G-IT and IP-10 results. IP-10 levels after antigen-specific stimulation were significantly higher in comparison to IFN-γ levels. Correlation between the three assays was good (κ = 0.717-0.783).

CONCLUSIONS

IP-10 cytokine is expressed in response to TB specific-antigens used in QFN-G-IT. In conclusion, the use of IFN-γ T-cell based assays in combination with an additional IP-10 assay detection could be useful for diagnosing active TB and LTBI in children.

Noise levels and cardiovascular mortality: a case-crossover analysis

BACKGROUND

The relationship between occupational noise and cardiovascular outcomes has been widely investigated. Regarding environmental noise levels, the attention is focused on road traffic noise due to the large number of exposed persons and the large periods of exposure. There are few studies assessing the short-term effects of traffic noise on cardiovascular outcomes. The aim of this study was to quantify the short-term effects of urban noise levels on age-specific cardiovascular mortality.

METHODS

A case-crossover design was used. Daily mortality counts in Madrid city due to cardiovascular causes (ICD codes: 390-459) from 1 January 2003 to 31 December 2005 were obtained. Data noise levels were collected as diurnal equivalent noise (Leqd8-22 h), night equivalent noise (Leqn22-8 h), and daily equivalent noise (Leq24 h). Confounding variables as daily levels of air pollutants, temperature, and relative humidity data were controlled. Overdispersed Poisson regression models were adjusted to control for both seasonality and time trends. Estimated effects are reported as percentage increase in the relative risk (IRR) associated with an increase of 1 dBA.

RESULTS

The strongest associations between all noise exposure levels and cardiovascular mortality were reported at lag 1: IRR 4.5% (95% CI 0.6, 8.7%), IRR 3.9% (95% CI 0.6, 7.3%), and IRR 6.2% (95% CI 2.1, 10.6%) for Leqd, Leqn, and Leq24, respectively. Analysing by age-specific groups at lag 1, statistically significant associations were found for those aged ≥65: 4.5% (95% CI 0.3, 8.9%), 3.4% (95% CI 0.1, 6.9%), and 6.6% (95% CI 2.2, 11.1%) for Leqd, Leqn, and Leq24, with no substantial changes in the effects of noise exposure levels at lag 1 after adjusting for PM2.5 and NO2.

CONCLUSION

The association found between noise exposure levels and cardiovascular mortality suggests a joint effect of diurnal and night-time noise levels. Our results also reveal independent effects of noise exposure levels and the air pollutants analysed. This strongly suggests the need to seriously consider the high noise exposure levels reported as an important public health issue.

Divergence of acoustic signals in a widely distributed frog: relevance of inter-male interactions

Divergence of acoustic signals in a geographic scale results from diverse evolutionary forces acting in parallel and affecting directly inter-male vocal interactions among disjunct populations. Pleurodema thaul is a frog having an extensive latitudinal distribution in Chile along which males' advertisement calls exhibit an important variation. Using the playback paradigm we studied the evoked vocal responses of males of three populations of P. thaul in Chile, from northern, central and southern distribution. In each population, males were stimulated with standard synthetic calls having the acoustic structure of local and foreign populations. Males of both northern and central populations displayed strong vocal responses when were confronted with the synthetic call of their own populations, giving weaker responses to the call of the southern population. The southern population gave stronger responses to calls of the northern population than to the local call. Furthermore, males in all populations were stimulated with synthetic calls for which the dominant frequency, pulse rate and modulation depth were varied parametrically. Individuals from the northern and central populations gave lower responses to a synthetic call devoid of amplitude modulation relative to stimuli containing modulation depths between 30–100%, whereas the southern population responded similarly to all stimuli in this series. Geographic variation in the evoked vocal responses of males of P. thaul underlines the importance of inter-male interactions in driving the divergence of the acoustic traits and contributes evidence for a role of intra-sexual selection in the evolution of the sound communication system of this anuran.

Properties of capsaicinoids for the control of fungi and oomycetes pathogenic to pepper

Capsaicinoids are pungent compounds found in pepper (Capsicum spp.) fruits. Capsaicin showed antimicrobial activity in plate assays against seven isolates of five species of fungi and nine isolates of two species of oomycetes. The general trend was that oomycetes were more inhibited than fungi. Assays of capsaicin biosynthetic precursors suggest that the lateral chain of capsaicinoids has more inhibitory activity than the phenolic part. In planta tests of capsaicinoids (capsaicin and N-vanillylnonanamide) applied to the roots demonstrated that these compounds conferred protection against the pathogenic fungus Verticillium dahliae and induced both chitinase activity and expression of several defence-related genes, such as CASC1, CACHI2 and CABGLU. N-Vanillylnonanamide infiltrated into cotyledons confers systemic protection to the upper leaves of pepper against the fungal pathogen Botrytis cinerea. In wild-type tomato plants such cotyledon infiltration has no protective effect, but is effective in the Never-ripe tomato mutant impaired in ethylene response. A similar effect was observed in tomato after salicylic acid infiltration.

MNA® Mini Nutritional Assessment as a nutritional screening tool for hospitalized older adults; rationales and feasibility

The high prevalence of malnutrition in the growing population of older adults makes malnutrition screening critical, especially in hospitalized elderly patients. The aim of our study was to evaluate the use of the MNA® Mini Nutritional Assessment in hospitalized older adults for rapid evaluation of nutritional risk. A prospective cohort study was made of 106 patients 65 years old or older admitted to an internal medicine ward of a tertiary-care teaching hospital to evaluate the use of the short form, or screening phase, of the MNA-SF. In the first 48 hours of admission, the full MNA questionnaire was administered and laboratory tests and a dermatologic evaluation were made. The MNA score showed that 77% of the patients were at risk of malnutrition or were frankly malnourished. Low blood levels of albumin, cholesterol and vitamins A and D showed a statistically significant association with malnutrition or risk of malnutrition. Separate evaluation of the MNA-SF showed that it was accurate, sensitive and had predictive value for the screening process. Routine use of the MNA-SF questionnaire by admission nurses to screen patients is recommended. Patients with MNA-SF scores of 11 or lower should be specifically assessed by the nutritional intervention team.

Induced resistance to Botrytis cinerea in Capsicum annuum by a Fusarium crude elicitor fraction, free of proteins

Fusarium oxysporum f. sp. lycopersici (FOL) induces resistance in pepper against the airborne pathogen Botrytis cinerea and the soil-borne pathogen Verticillium dahliae. However, its practical use is limited due to its pathogenicity to other crops. In this study we tested several fractions of a heat-sterilised crude FOL-elicitor preparation to protect pepper against B. cinerea and V. dahliae. Only the protein-free insoluble fraction of the preparation reduced B. cinerea infection. However, none of the fractions reduce V. dahliae symptoms. The insoluble protein-free fraction induced expression of defence genes in the plant, namely a chitinase (CACHI2), a peroxidase (CAPO1), a sesquiterpene cyclase (CASC1) and a basic PR1 (CABPR1). Even though the CASC1 gene was not induced directly after treatment with the insoluble fraction in the leaves, it was induced after B. cinerea inoculation, showing a priming effect. The insoluble protein-free FOL-elicitor protected pepper against the airborne pathogen through a mechanism that involves induced responses in the plant, but different to the living FOL.

Large negative thermal expansion of the Co subnetwork measured by EXAFS in highly disordered Nd₁-xCox thin films with perpendicular magnetic anisotropy

We have measured a negative thermal expansion (NTE) of the Co subnetwork in amorphous Nd1-xCox (0.78 < x < 0.84) thin films of the order of 1% in volume using linearly polarized EXAFS spectroscopy at RT and 10 K. The expansion, which is anisotropic, is uncorrelated with the perpendicular magnetic anisotropy (PMA) observed in all the films, but correlated with the method used to deposit them. The atomic environments of the Nd atoms resulted in such a strong disorder that Nd-Nd and Nd-Co environments were invisible to EXAFS, and only Co-Co atomic environments were detected. The information on the Nd subnetwork was obtained through its magnetic moment measured by XMCD. These measurements demonstrate an increasing interaction of neodymium atoms with their particular local crystal field as the temperature decreased, suggesting possible structural modifications at their sites. Since the magnetic moment of the cobalt subnetwork remains essentially constant with the temperature, it is proposed that its detected NTE may be caused by the mechanical response of the amorphous network to structural transformations at the Nd sites. These results support that the PMA in RE-TM alloys is localized at the RE sites. The complete absence of EXAFS oscillations in the Nd L3 EXAFS spectra is remarkable: it means that the coherence length of the photoemitted electrons in disordered matter can be strongly reduced from that expected by atomic calculations to the point of being less than first neighbor distances, which is contrary to the common belief that first neighbors are always visible by EXAFS.