Hair cortisol concentrations in a Spanish sample of healthy adults

BACKGROUND

Hair cortisol concentration (HCC), as a novel promising method to retrospectively measure hypothalamic-pituitary-adrenal (HPA) axis activation, is being increasingly studied. We tested the relationships between HCC and a range of possible confounding variables in a Spanish sample of healthy adults and pregnant women.

METHODS

The number of healthy adults who participated in the study was 529, being 270 males and 259 females, with a combined mean age of 37.88 years (SD = 15.66). Additionally, a separate sample of 62 pregnant women was also recruited with a mean age of 32.95 (SD = 3.67), and in the first trimester of pregnancy. Each participant was interviewed before the study to obtain sociodemographic and lifestyle variables, and a hair sample was taken from the posterior vertex of the head, cut as close to the scalp as possible. Assuming the average growth rate of head hair is 1 cm per month, a 3-cm segment was analysed, in order to measure the cortisol concentrations from a three-month period. For the pregnant women, hair samples for each trimester of pregnancy were analysed.

RESULTS

The mean hair cortisol concentration was 127.91 (111.52) pg/mg for the general sample. The variables of age, education, employment status, use of hair dyes, use of oral contraceptives, and physical exercise had a significant relation to HCC. When adjusted for further variables, only education and physical exercise remained statistically significant. When including the use of oral contraceptives and only with respect to females, only physical exercise remains statistically significant. For the subsample of pregnant woman, the mean hair cortisol concentration was 334.51 (409.77) pg/mg for the first trimester, 302.18 (270.24) pg/mg for the second trimester, and 331.31 (295.46) pg/mg for the third trimester of pregnancy. None of the assessed confounding variables (age, body mass index, previous miscarriages, employment status, hair dyes, dependent children and physical exercise), except education level, was related to HCC.

CONCLUSIONS

In this sample of healthy Spaniards, results suggested an association between HCC and physical exercise and educational level. In pregnant women, the prevalence of HCC was higher than in non-pregnant woman, and was related to educational level. This study emphasises the need to determine the relationship between HCC and confounders such as sociodemographic and lifestyle variables in the general population and specific groups formed by individuals such as pregnant women.

Development of Central Serous Chorioretinopathy following Chalazion Removal with Intralesional Triamcinolone Injection: A Case Report

We report a case of central serous chorioretinopathy (CSC) that developed 1 month after an intralesional injection of triamcinolone acetonide that was administered during removal of a chalazion. The subretinal fluid and ipsilateral visual acuity (VA) worsened with initial observation. The edema resolved with verteporfin photodynamic therapy (PDT) 1 month after diagnosis, but VA did not improve during short-term follow-up. We conclude that CSC can occur as a complication of low-dose intrapalpebral corticosteroid administration and provide another example of the therapeutic role of PDT in the management of this disease.

Combined bilateral ophthalmic artery occlusion & central retinal vein occlusion from presumed giant cell arteritis

Purpose

To report on a severe case of presumed giant cell arteritis (GCA) presenting with partial and complete ophthalmic artery occlusion along with bilateral central retinal vein occlusions (CRVO).

Observations

A 73-year-old female presented with bilateral complete vision loss of sudden onset. The patient also experienced a mild frontal headache prior to onset of vision loss. Fundus examination revealed bilateral central retinal artery occlusion (CRAO) and CRVO. Subsequent fluorescein angiography indicated partial right ophthalmic artery occlusion and complete left ophthalmic artery occlusion. Acute phase reactants were elevated. The patient was clinically diagnosed with GCA and intravenous (IV) steroids were initiated. Four days later, a temporal artery biopsy (TAB) was performed and resulted as negative for granulomatous inflammation. The patient did not regain vision and remained with no light perception (NLP) in both eyes.

Conclusions

and Importance: This case highlights the discrepancy between clinical diagnosis and pathologic tissue diagnosis in a patient that presented with such extensive ocular vasculitic disease. Such extensive bilateral disease has not been reported. In addition, there are few studies regarding the effect of pulse-dosed IV steroids on TAB results. This case report suggests that the gradual histologic changes that occur over one or two weeks while on oral steroids may occur over three to four days while on high dose IV steroids, necessitating early biopsy.

Changes in serum interleukin-8 (IL-8) levels reflect and predict response to anti-PD-1 treatment in melanoma and non-small-cell lung cancer patients

Background

Surrogate biomarkers of efficacy are needed for anti-PD1/PD-L1 therapy, given the existence of delayed responses and pseudo-progressions. We evaluated changes in serum IL-8 levels as a biomarker of response to anti-PD-1 blockade in melanoma and non-small-cell lung cancer (NSCLC) patients.

Patients and methods

Metastatic melanoma and NSCLC patients treated with nivolumab or pembrolizumab alone or nivolumab plus ipilimumab were studied. Serum was collected at baseline; at 2-4 weeks after the first dose; and at the time-points of response evaluation. Serum IL-8 levels were determined by sandwich ELISA. Changes in serum IL-8 levels were compared with the Wilcoxon test and their strength of association with response was assessed with the Mann-Whitney test. Accuracy of changes in IL-8 levels to predict response was estimated using receiver operation characteristics curves.

Results

Twenty-nine melanoma patients treated with nivolumab or pembrolizumab were studied. In responding patients, serum IL-8 levels significantly decreased between baseline and best response (P <0.001), and significantly increased upon progression (P =  0.004). In non-responders, IL-8 levels significantly increased between baseline and progression (P =  0.013). Early changes in serum IL-8 levels (2-4 weeks after treatment initiation) were strongly associated with response (P <0.001). These observations were validated in 19 NSCLC patients treated with nivolumab or pembrolizumab (P =  0.001), and in 15 melanoma patients treated with nivolumab plus ipilimumab (P <0.001). Early decreases in serum IL-8 levels were associated with longer overall survival in melanoma (P =  0.001) and NSCLC (P =  0.015) patients. Serum IL-8 levels also correctly reflected true response in three cancer patients presenting pseudoprogression.

Conclusions

Changes in serum IL-8 levels could be used to monitor and predict clinical benefit from immune checkpoint blockade in melanoma and NSCLC patients.

Factors associated with imaging in patients with early breast cancer after initial treatment

Background

Overuse of surveillance imaging in patients after curative treatment for early breast cancer (ebc) was recently identified as one of the Choosing Wisely Canada initiatives to improve the quality of cancer care. We undertook a population-level examination of imaging practices in Ontario as they existed before the launch of that initiative.

Methods

Patients diagnosed with ebc between 2006 and 2010 in Ontario were identified from the Ontario Cancer Registry. Records were linked deterministically to provincial health care databases to obtain comprehensive follow-up. We identified all advanced imaging exams [aies: computed tomography (ct), bone scan, positron-emission tomography] and basic imaging exams (bies: ultrasonography, chest radiography) occurring within the first 2 years after curative treatment. Poisson regression was used to assess associations between patient or provider characteristics and the rate of aies.

Results

Of 30,006 women with ebc, 58.6% received at least 1 bie, and 30.6% received at least 1 aie in year 1 after treatment. In year 2, 52.7% received at least 1 bie, and 25.7% received at least 1 aie. The most common aies were chest cts and bone scans. The rate of aies increased with older age, higher disease stage, comorbidity, chemotherapy exposure, and prior staging investigations (p < 0.001). Imaging was ordered mainly by medical oncologists (38%), followed by primary care physicians (23%), surgeons (13%), and emergency room physicians (7%).

Conclusions

Despite recommendations against its use, imaging is common in ebc survivors. Understanding the factors associated with aie use helps to identify areas for further research and is required to lower imaging rates and to improve survivorship care.

Open versus robotic-assisted transabdominal preperitoneal (R-TAPP) inguinal hernia repair: a multicenter matched analysis of clinical outcomes

PURPOSE

To compare the perioperative outcomes of initial, consecutive robotic-assisted transabdominal preperitoneal (R-TAPP) inguinal hernia repair (IHR) cases with consecutive open cases completed by the same surgeons.

METHODS

Multicenter, retrospective, comparative study of perioperative results from open and robotic IHR using standard univariate and multivariate regression analyses for propensity score matched (1:1) cohorts.

RESULTS

Seven general surgeons at six institutions contributed 602 consecutive open IHR and 652 consecutive R-TAPP IHR cases. Baseline patient characteristics in the unmatched groups were similar with the exception of previous abdominal surgery and all baseline characteristics were comparable in the matched cohorts. In matched analyses, postoperative complications prior to discharge were comparable. However, from post discharge through 30 days, fewer patients experienced complications in the R-TAPP group than in the open group [4.3% vs 7.7% (p = 0.047)]. The R-TAPP group had no reoperations post discharge through 30 days of follow-up compared with five patients (1.1%) in the open group (p = 0.062), respectively. Multivariate logistic regression analysis which demonstrated patient age > 65 years and the open approach were risk factors for complications within 30 days post discharge in the matched group [age > 65 years: odds ratio (OR) = 3.33 (95% CI 1.89, 5.87; p < 0.0001); open approach: OR = 1.89 (95% CI 1.05, 3.38; p = 0.031)].

CONCLUSIONS

In this matched analysis, R-TAPP provides similar postoperative complications prior to discharge and a lower rate of postoperative complications through 30 days compared to open repair. R-TAPP is a promising and reproducible approach, and may facilitate adoption of minimally invasive repairs of inguinal hernias.

Clinical Significance of Preoperative Serum Levels of CA 125 and TAG-72 in Ovarian Carcinoma

In a prospective study we evaluated in 48 patients with primary ovarian carcinoma the prognostic value of the preoperative circulating serum levels of CA 125 and TAG-72. Serum levels of CA 125 were above the cutoff level of 35 U/ml in 68% of patients, TAG-72 levels were higher than 6 U/ml in 50% of patients, while the simultaneous use of the two markers increased the sensitivity to 75%. Pretreatment CA 125 and TAG-72 levels were significantly lower (p < 0.05, for both) in patients with well differentiated tumors than in those with moderate or poor differentiation. Similarly, both marker levels were significantly higher (p < 0.001) in patients with residual disease after cytoreductive surgery than in those with no residual tumor. In addition, the CA 125 levels were also higher in initial stages (I-II) than in more advanced stages (III-IV) (p < 0.05), whereas TAG-72 levels were higher (p < 0.05) in patients with mucinous or endometrioid tumors than in those with serous carcinomas. The results further indicated that high preoperative serum levels of CA 125 and TAG-72 were associated with a shorter overall survival (p < 0.001 and p < 0.01, respectively). Finally, separate Cox multivariate analysis showed that preoperative CA 125 and TAG-72 serum levels were, after stage, the strongest factors to predict overall survival (p < 0.0001, p < 0.05 and p < 0.005, respectively) in patients with ovarian carcinoma.

Tissue-Type Plasminogen Activator (tPA) Content in Colorectal Cancer and in Surrounding Mucosa: Relationship with Clinicopathologic Parameters and Prognostic Significance

The aim of this study was to evaluate the cytosolic tissue-type plasminogen activator (tPA) content in colorectal cancer, its possible relationship with the clinicopathologic parameters of tumors, and its prognostic significance. We have therefore examined by immunoenzymatic assay the cytosolic tPA content in tumors and paired surrounding normal mucosa samples from 162 colorectal cancer patients. Cytosolic tPA levels were significantly higher in surrounding normal mucosa samples than in neoplastic tissues (4.01±5.07 vs 2.63±5.82 ng/mg protein; p<0.0001). By contrast, no significant correlation was found between tPA content and clinicopathologic tumor parameters such as location, Dukes’ stage, histologic grade, and DNA content or S-phase fraction. However, the results indicated that a high cytosolic tPA content (>0.75 ng/mg protein) in tumors predicted for a shorter relapse-free and overall survival (both p<0.05) in 123 resectable colorectal cancer patients who were prospectively evaluated during a mean follow-up period of 32.2 months. This suggests that tPA may give additional information to that provided by other biochemical markers currently used in colorectal cancer.

Treatment of retinal pigment epithelial detachment secondary to exudative age-related macular degeneration

Purpose

This pilot study evaluated the combination of photodynamic therapy (PDT) and anti-vascular endothelial growth factor (anti-VEGF) as a treatment in patients with a pigment epithelial detachment (PED) due to exudative age-related degeneration (AMD).

Methods

We analyzed seven consecutive patients between September 1, 2015 and September 1, 2017 with a PED secondary to exudative AMD who were treated with full fluence standard PDT and a series of monthly intravitreal anti-VEGF injections. Follow-up ranged between 3 and 24 months. Variables collected for the purpose of this study included baseline best-corrected visual acuity converted to logMAR (logarithm of minimum angle of resolution), central macular thickness, and maximum PED height. This information was then reviewed at subsequent follow-ups.

Results

The PED completely resolved in 4/7 eyes while three patients had a significant improvement in PED size with a corresponding improvement in visual acuity. Initial PED heights ranged from 147 to 423 μm and was reduced by an average of 255.7 μm (83.2% average reduction, range -143 to - 405 μm). Initial CMT ranged from 223 to 719 μm and was reduced by an average of 225.7 μm (54.4% average reduction, range -88 to - 529 μm). Mean logMAR VA improved from 0.669 (Snellen equivalent 20/93, [20/40 to 20/200]) to 0.269 (Snellen equivalent 20/37, [20/25 to 20/80]) at last follow-up. No complications were observed in our patients.

Conclusions and Importance

PED in the setting of exudative AMD showed an excellent response to a combined multimodal approach that includes PDT with intravitreal anti-VEGF injection followed by a monthly anti-VEGF schedule. Most importantly, visual acuity showed a significant improvement from baseline. If confirmed by future studies, this would offer another treatment avenue for this difficult-to-treat consequence of exudative AMD.

Effect of the Alkanoyl Group Position at the Glycerol Backbone on the Monolayer Characteristics Demonstrated by 2-Monopalmitoyl-rac-glycerol

The influence of the position of the aliphatic chain at the glycerol backbone has been basically unknown. Solely the results of 2-monopalmitoyl-rac-glycerol obtained at ≥13 °C indicated an essential influence of the position of the palmitoyl group at the glycerol backbone, substantiated by a disordered packing of the alkyl chains. Therefore, the present study extends the comprehensive characterization of 2-monopalmitoyl-rac-glycerol monolayers to the low-temperature range for highlighting the effect of the position of the aliphatic chain at the glycerol backbone of monoalkanoylglycerolester monolayers. Systematic studies of the thermodynamic behavior, the morphological features, and the 2D lattice structures of 2-monopalmitoyl-rac-glycerol monolayers at ≤10 °C allow useful conclusions. Large differences between the π-A isotherms of 1- and 2-monopalmitoyl-rac-glycerol monolayers and their thermodynamic analysis indicate that the change of the substitution from position 1 to position 2 of glycerol backbone is consistent with a shortening of the alkyl chain by roughly two CH₂ groups. Quantum chemical calculations of the molecular structure and packing calculations are in reasonable agreement with the thermodynamic results. Considerable diversity in the mesoscopic domain topography exists between the monoalkanoylglycerol esters with the aliphatic chain positioned at the end of the glycerol backbone (1-position) and those with the aliphatic chain in the middle of the glycerol backbone (2-position). The new faceted shape of the 2-monopalmitoyl-rac-glycerol domains, before they develop branched fractal-like structures at the edges, is the essential difference to the round or cardioid-like 1-monoalkanoylglycerol domains. In the low-temperature range, well-defined orthorhombic lattice structures exist at all surface pressures. Comparing all GIXD data from the three racemic compounds (1-monostearoyl-rac-glycerol, 1-monopalmitoyl-rac-glycerol, and 2-monopalmitoyl-rac-glycerol) shows that 2-monopalmitoyl-rac-glycerol behaves as 1-monomyristoyl-rac-glycerol, i.e., the shift from position 1 to position 2 of the glycerol backbone is equivalent to a shortening of the alkyl chain.

Variability in biological behaviour, pathogenicity, protectotype and induction of virus neutralizing antibodies by different vaccination programmes to infectious bronchitis virus genotype Q1 strains from Chile

In the period from July 2008 to 2010, a disease episode resulting in serious economic losses in the major production area of the Chilean poultry industry was reported. These losses were associated with respiratory problems, increase of condemnations, drops in egg production and nephritis in breeders, laying hens and broilers due to infections with infectious bronchitis virus (IBV). Twenty-five IBV isolates were genotyped and four strains were selected for further testing by pathotyping and protectotyping. Twenty-four IBV isolates were of the Q1 genotype. The experiments also included comparing the ability of six vaccination programmes to induce virus neutralizing antibodies (VNA) in layers against four selected Chilean strains. Despite the high genetic homology in the S1 gene between the four strains, the heterogeneity in biological behaviour of these different Q1 strains was substantial. These differences were seen in embryonated eggs, in cell culture, in pathogenicity and in level of cross-protection by IBV Massachusetts (Mass) vaccination. This variability underlines the importance of testing more than one strain per serotype or genotype to determine the characteristics of a certain serotype of genotype. The combination of Mass and 793B vaccine provided a high level of protection to the respiratory tract and the kidney for each strain tested in the young birds. The combination of broad live priming using Mass and 793B vaccines and boosting with multiple inactivated IBV antigens induced the highest level of VNA against Q1 strains, which might be indicative for higher levels of protection against Q1 challenge in laying birds.

Respiratory viral co-infections manipulate host immune responses to reduce disease severity

Patients with respiratory infections are frequently co-infected by more than one virus, but it is unknown how co-infection alters immune responses and disease outcomes compared to infection by the individual viruses. Our lab recently found that infection of mice with a mild rhinovirus pathogen (RV1B) two days before a more virulent virus (influenza A virus, PR8, or pneumonia virus of mice, PVM) reduced disease severity. In this study, we expanded these observations to determine how the timing of RV1B co-infection affects protection. Mice were inoculated with RV1B simultaneously with or two days after inoculation with PR8 or PVM. RV1B inoculated simultaneously with PR8 or PVM reduced disease whereas RV1B inoculated two days after PR8 and PVM increased the severity of PR8 and PVM. Next, mice were inoculated with RV1B two days before PR8 and then euthanized on days 4, 7 and 10 to quantify viral loads in the lungs. By day 7, co-infected mice had cleared PR8 while mice inoculated with PR8 alone had detectable virus. To identify immune cell populations that correspond with disease protection, groups of mice were inoculated with RV1B or mock two days before PR8 or PVM and flow cytometry analysis was performed on whole lungs on days 0, 2, 4, and 6 after the second virus. Co-infection by RV1B generated a stronger early innate response that contracted sooner than infection by PR8 or PVM alone. RV1B and PVM co-infection also had a stronger CD4 and CD8 T cell response later in infection. These data provide evidence that protection conferred by co-infection may be attributed to an earlier inflammatory cell response that contracts sooner, leading to faster clearance of the pathogenic virus while reducing immune-mediated pathology.

Restraint or not restraint. Involuntary transport from home of schizophrenic patients

Introduction

Although physical restraint (PR) is a non-rarely practice on psychiatry there are few studies that focus the attention on the risk factors for this intervention. PR is a legitimacy practice when is needed and well applied but is not free from side effects. Knowing risk factors might be useful to improve the application of PR.

Objectives

Study the risk factors involved with the use of PR at patient's home in individuals with schizophrenia before the involuntary transport (IT) to a psychiatric facility.

Methods

Is a descriptive and observational study of 267 psychotic patients that were assisted by a psychiatric home care unit (EMSE) in Barcelona during their IT. The sample was divided in two groups, depending on the need of PR. Socio-demographic data were collected as well as positive and negative syndrome scale (PANSS), WHO disability assessment schedule (WHO/DAS), global assessment of functioning scale (GAF), Scale to assess unawareness of mental disorder (SUMD). Aggressiveness was assessed by PANSS-EC consisting of 5 items: excitement, tension, hostility, uncooperativeness and poor impulse.

Results

From the 267 psychotic patients 109 required PR. 154 were male and the average of age was 47. The results were significant in the PR group versus no PR for PANSS-EC (P = 0.000), as well as WHO/DAS (P = 0.017), GAF (P = 0.042), Positive PANSS (P = 0.000), age (P = 0.001) and substance use (P = 0.012). Were no significant for gender, insight or Negative PANSS.

Conclusions

Aggressiveness and violence were the most important PR related factors followed by positive symptoms, age, substance use and global functioning.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Improving the forecast for biodiversity under climate change

New biological models are incorporating the realistic processes underlying biological responses to climate change and other human-caused disturbances. However, these more realistic models require detailed information, which is lacking for most species on Earth. Current monitoring efforts mainly document changes in biodiversity, rather than collecting the mechanistic data needed to predict future changes. We describe and prioritize the biological information needed to inform more realistic projections of species' responses to climate change. We also highlight how trait-based approaches and adaptive modeling can leverage sparse data to make broader predictions. We outline a global effort to collect the data necessary to better understand, anticipate, and reduce the damaging effects of climate change on biodiversity.