Low calcidiol levels and risk of progression of aortic calcification

In this observational study, we found a positive relationship between low calcidiol levels and the risk of aortic calcification progression. A 10-ng/mL increase of calcidiol was associated with a decrease in the risk of progression by 44%. This figure was higher than that observed if we increased age by 10 years.

INTRODUCTION

The aim of this study was to investigate the relationship between serum calcidiol levels and the onset and progression of aortic calcifications in a community-based sample of ambulatory subjects.

METHODS

Three hundred two men and women aged 50 and over underwent two lateral X-rays and were followed up for 4 years. Abdominal aortic calcifications were classified as absent, mild-moderate, and severe. The biochemical measurements of serum calcium, phosphorus, parathyroid hormone, total alkaline phosphatase, tartrate-resistant acid phosphatase, creatinine, calcidiol, calcitriol, and osteocalcin were determined. Subjects who had received anti-osteoporotic treatments were excluded from the analysis.

RESULTS

Subjects with progression of aortic calcifications had significantly lower serum calcidiol levels than those without progression. In the multivariate analysis, using the agreed upon serum levels for calcidiol (>30 ng/mL) as the reference, those subjects with calcidiol levels between 10 and 20 ng/mL showed a higher risk of progression of aortic calcification (odds ratio (OR) = 3.95; 95% confidence interval (CI) = 1.16 to 13.40). An even higher OR was observed in subjects with calcidiol values <10 ng/mL (OR = 4.10; 95% CI = 1.12 to 14.99). In addition, an increase by 1 ng/mL in osteocalcin levels was associated with a 17% reduction of the risk of aortic calcification progression.

CONCLUSIONS

An increase by 10 ng/mL of calcidiol was associated with a decrease in the risk of aortic calcifications progression by 44%. This figure was even higher than that observed if we increased age by 10 years. Levels of calcidiol higher than 30 ng/mL seem to be desirable to reduce the progression of aortic calcification and to maintain bone turnover.

Effect of lipoarabinomannan from Mycobacterium avium subsp avium in Freund's incomplete adjuvant on the immune response of cattle

The aim of the present study was to determine whether lipoarabinomannan (LAM), in combination with Freund's incomplete adjuvant (FIA), was able to improve cell-mediated and antibody-mediated immune responses against ovalbumin (OVA) in cattle. Twenty-three calves were assigned to four treatment groups, which were subcutaneously immunized with either OVA plus FIA, OVA plus FIA and LAM from Mycobacterium avium subsp avium, FIA plus LAM, or FIA alone. Lymphoproliferation, IFN-γ production and cell subpopulations on peripheral blood mononuclear cells before and 15 days after treatment were evaluated. Delayed hypersensitivity was evaluated on day 57. Specific humoral immune response was measured by ELISA. Inoculation with LAM induced higher levels of lymphoproliferation and IFN-γ production in response to ConA and OVA (P < 0.05). Specific antibody titers were similar in both OVA-immunized groups. Interestingly, our results showed that the use of LAM in vaccine preparations improved specific cell immune response evaluated by lymphoproliferation and IFN-γ production by at least 50 and 25%, respectively, in cattle without interfering with tuberculosis and paratuberculosis diagnosis.

[Foreseeable variation in parameters measured at implant and follow-up of permanent pacemaker active fixation electrodes]

OBJECTIVES

To analyze the variations in the parameters relative to active fixation electrodes at the time of implantation and over subsequent follow-up during 6 months of the acute phase of implantation.

DESIGN

A descriptive, analytical, prospective, observational cohort study was made of consecutive cases over a period of 8 months (April-December 2010).

SETTING

Pacing unit of an Intensive Care Unit.

PATIENTS OR PARTICIPANTS

Patients undergoing permanent pacemaker implantation with active fixation electrodes, implanted in both atrium and ventricle, Interventions: Measurement of variables described with a threshold analyzer during electrode fixation and at different times during the study, Main compared variables: threshold, impedance and intrinsic activity (both atrial and ventricular) before and after fixation, at 48 hours, at one month and 6 months, Comparisons were made using the Student t-test for paired data, assuming significance for p<0,05, and ANOVA to analyze the successive changes over ambulatory follow-up.

RESULTS

We analyzed 40 patients, with 19 atrial and 40 ventricular electrodes, In fixation, the electrodes showed significant variation in the impedance values of the atrial lead (1,188,53 ± 397,26 vs 610,69 ± 326,30 ohms, p<0,0001) and ventricular lead (1,512,93 ± 718,07 vs 768,80 ± 224,90 ohms, p>0,0001), In the first 48 hours it was coupled with a decrease in ventricular (0,86 ± 0,35 vs 0,48 ± 0,23 volts, p = 0,0001) and atrial pacing threshold (1,10 ± 0,39 vs 0,43 ± 0,23 volts, p = 0,0003), and p-wave sensing (3,61 ± 2,25 vs 2,32 ± 1,09 mV, p = 0,0463), Over follow-up we found the parameters to be stable, with no significant changes.

CONCLUSIONS

After active lead fixation, a fall in impedance of the antrial and ventricular is expected, Over the next 48 hours improvement in atrial and ventricular threshold may occur, in contrast to the sensitivity of the intrinsic activity, which reached significance at the P wave measured after 48 hours, These values stabilize over patient follow-up and do not differ significantly in the studied acute patient course.

Ancient DNA from an Early Neolithic Iberian population supports a pioneer colonization by first farmers

The Neolithic transition has been widely debated particularly regarding the extent to which this revolution implied a demographic expansion from the Near East. We attempted to shed some light on this process in northeastern Iberia by combining ancient DNA (aDNA) data from Early Neolithic settlers and published DNA data from Middle Neolithic and modern samples from the same region. We successfully extracted and amplified mitochondrial DNA from 13 human specimens, found at three archaeological sites dated back to the Cardial culture in the Early Neolithic (Can Sadurní and Chaves) and to the Late Early Neolithic (Sant Pau del Camp). We found that haplogroups with a low frequency in modern populations-N* and X1-are found at higher frequencies in our Early Neolithic population (∼31%). Genetic differentiation between Early and Middle Neolithic populations was significant (F(ST) ∼0.13, P<10(-5)), suggesting that genetic drift played an important role at this time. To improve our understanding of the Neolithic demographic processes, we used a Bayesian coalescence-based simulation approach to identify the most likely of three demographic scenarios that might explain the genetic data. The three scenarios were chosen to reflect archaeological knowledge and previous genetic studies using similar inferential approaches. We found that models that ignore population structure, as previously used in aDNA studies, are unlikely to explain the data. Our results are compatible with a pioneer colonization of northeastern Iberia at the Early Neolithic characterized by the arrival of small genetically distinctive groups, showing cultural and genetic connections with the Near East.

Melanism in guinea fowl (Numida meleagris) is associated with a deletion of Phenylalanine-256 in the MC1R gene

We have characterized a deletion in the MC1R gene causing the loss of one amino acid (p.Phe256del), which is perfectly associated with melanism in guinea fowl (Numida meleagris). Co-segregation of the p.Phe256del with melanism was confirmed in 25 offspring born from a cross of two heterozygote birds; therefore we suggest that this mutation is responsible for the black phenotype. Interestingly, this is the first case of recessive melanism linked to MC1R.

Calciphylaxis and bilateral optic neuropathy

A 51-year-old woman on hemodialysis for chronic renal failure complained of visual loss in her right eye. Right optic disc edema was observed on fundus examination. An arteritic optic neuropathy was suspected. However, a first biopsy did not reveal any inflammatory cells. Two months later, the patient experienced sudden visual loss in her left eye and presented with necrotic cutaneous lesions at the distal phalanges of several fingers of the right hand. Necrotic lesions also appeared on the inner aspect of the thighs. Biopsy of the cutaneous lesions revealed calcification in the wall of a small artery. A new biopsy of the temporal artery showed large calcium deposits in the artery's tunica media. The diagnosis of optic neuropathy secondary to calciphylaxis was made. A temporal artery biopsy should be repeated if the first one is inconclusive. An early diagnosis leading to appropriate treatment may help to prevent an irreversible loss of vision in these patients.

Cost-effectiveness of sacral neuromodulation compared to botulinum neurotoxin a or continued medical management in refractory overactive bladder

OBJECTIVES

This study assessed the cost-effectiveness and health-care budget impact of sacral neuromodulation (SNM) in refractory idiopathic OAB-wet patients in Spain.

METHODS

A 10-year Markov analytic model was developed to estimate quality-adjusted life-years (QALYs) gained and incontinence episode avoided associated with SNM therapy compared with botulinum neurotoxin A (BoNT-A) or continued optimized medical treatment (OMT).

RESULTS

At 10 years, the cumulative costs of SNM, BoNT-A, and OMT were €29,166, €29,458, and €29,370, respectively, whereas the QALYs for SNM, BoNT-A, and OMT are 6.89, 6.38, and 5.12, respectively. Consequently, incremental cost-effectiveness ratios (ICERs) for SNM demonstrate that although the initial costs for SNM are higher than those for the other treatments, decreasing follow-up costs coupled with consistently greater effectiveness in the long term make SNM the economically dominant option at 10 years. Sensitivity analyses suggest that 99.7% and 99.9% (for SNM vs. BoNT-A and OMT, respectively) of the 1000 Monte Carlo iterations fall within the €30,000 cost-effectiveness threshold, considered to be acceptable in Spain. The 10-year incremental cost per incontinence episode avoided for SNM also makes this therapy the dominant option compared to BoNT-A or OMT. Additionally, the estimated budget impact of the gradually increased referral for SNM for the management of OAB patients in Spain is small.

CONCLUSIONS

As a treatment option for refractory idiopathic OAB, at 10 years, SNM provides a considerable possibility of symptom and quality-of-life improvement and is cost-effective compared to BoNT-A or continued OMT.

Factors associated with initial participation in a population-based screening for colorectal cancer in Catalonia, Spain: a mixed-methods study

OBJECTIVE

To identify barriers and facilitators associated with participation in the first round of a population-based program for colorectal cancer (CRC) in Catalonia, Spain and to identify strategies for motivating and supporting behavioral change.

MATERIAL AND METHODS

A two-part, mixed-methods design was used. In first place, a prospective study of individuals aged 50-69 years (n=1961) was conducted in 2006-2007. Secondly, focus groups were undertaken with participants and non-participants of the CRC screening, in 2008.

RESULTS

Intention to participate was an important determinant of participation (82.9% vs 65.9%, OR=2.56, 95%CI:1.95-3.36) in addition to knowledge about CRC and its early detection. Respondents who reported that CRC may be asymptomatic in early stages enrolled in the screening program more frequently than those who thought CRC is always symptomatic (49.4% vs 44.8%, OR:1.82; 95%CI:1.3-2.6). Barriers for participation mentioned in focus groups were competing perceived for other health problems and other demands as well as misunderstanding about personal relevance of the screening.

CONCLUSION

Individuals' perceptions of CRC are amenable to change through education-based interventions. Increasing public knowledge related to the burden of CRC and its preventive potential may be an effective way for improving participation in a population-based screening program.

Trends in principal cancer risk factors in Spain

Using data furnished by successive national health surveys, this article describes trends in the prevalence of smoking, physical inactivity, obesity, consumption of fruit and vegetables, and excessive alcohol consumption in Spain. For most of these factors, trends are shown since the end of the 1980s, and in the case of smoking, since the end of the 1970s. The findings indicate decreases in smoking--except among women aged 45-64 years--physical inactivity and high-risk alcohol consumption, and increases in consumption of fruit and vegetables, and obesity. The inclusion of these risk factors in cancer prevention strategies continues to be a matter of priority, in some cases because they display high prevalences despite their downward trend, as occurs with smoking among men and physical inactivity in the overall population, and in others because they display an upward trend, e.g. smoking among women aged 45-64 years and obesity in the overall population.

Life-stage variation in insecticide resistance of the western flower thrips (Thysanoptera: Thripidae)

The life-stage variations in insecticide resistance of western flower thrips, Frankliniella occidentalis (Pergande) (Thysanoptera: Thripidae), to selective insecticides (acrinathrin, formetanate, and methiocarb) were studied using resistant laboratory strains. In each strain, the second-instar larva was less susceptible to the insecticides tested than the adults. The lower the resistance level of the adults, the higher the difference between larva and adult susceptibility: 32-fold to methiocarb, 15.4-fold to formetanate, and 180-fold to acrinathrin in the reference strain. In laboratory-selected resistant strains, these differences were much lower: 5.8-fold to methiocarb, 4.8-fold to formetanate, and 2.0-fold to acrinathrin. In selected strains, higher resistance levels for each insecticide were found, both for larvae and adults, compared with the reference strain. These results show that after insecticide resistance selection in adults, the resistance is carried over to the larvae, but at lower levels.

El ángulo escafolunar, otro factor pronóstico de la seudoartrosis del escafoides

Se realiza un estudio retrospectivo de las seudoartrosis del escafoides carpiano, que no afectan al polo proximal, intervenidas en el HU La Princesa entre enero de 1996 y junio de 2008.

Material y método: Se estudiaron 40 pacientes intervenidos según las técnicas de Matti-Russe o Fisk-Fernández. En ninguno de los casos se trataba de reintervenciones, no existían cambios degenerativos del carpo, ni datos radiológicos de necrosis del fragmento proximal. Diez pacientes fueron tratados según la técnica de Matti-Russe y los otros 30 mediante la de Fisk-Fernández. Se realizó un protocolo de trabajo que estudió: datos de filiación, tiempo transcurrido hasta la cirugía, ángulo escafolunar pre y postquirúrgico, estadificación según las clasificaciones de Alnot y patrón degenerativo SNAC, técnica quirúrgica, material de osteosíntesis, tiempo transcurrido hasta la consolidación, reincorporación a su trabajo y existencia de complicaciones.

Resultados y conclusiones: La consolidación ósea se consiguió en 36 casos (90%) en un tiempo medio de 3 meses. Hay mayor número de pacientes tratados mediante la técnica de Fisk-Fernández; clasificados en los grupos de peor pronóstico radiológico (ángulo escafolunar alterado) y con mayor tiempo de evolución desde el traumatismo. No se apreciaron diferencias entre los materiales de osteosíntesis empleados. La técnica de Fisk-Fernández consigue Herbertmejorar el ángulo escafolunar, pero no un menor tiempo de consolidación.

[Parturient at full term with inferior vena cava thrombosis: anesthesia during surgical delivery]

Emergency cesarean section is a high-risk situation because of potential maternal-fetal complications. We report a case in which risk increased due to a massive thrombus in the mother's left common femoral vein extending to the vena cava. A 31-year-old woman with no relevant medical history in the 41st week of pregnancy was scheduled for induction. Two days before the planned induction she was admitted to the emergency department, where she was diagnosed with deep vein thrombosis in the left lower limb. She was transferred to the postanesthetic recovery unit, where a multidisciplinary team (from gynecology, hematology, interventional radiology, and anesthesiology) discussed various therapeutic options (thrombectomy, vena cava filter, or anticoagulation by intravenous infusion of unfractionated heparin). Given that deep vein thrombosis coincided with obstetric delivery, it was crucial to decide on anesthetic and therapeutic approaches that would assure maternal and fetal safety and prevent such complications as massive pulmonary thromboembolism.