Risk of ischemic stroke and lifetime estrogen exposure

BACKGROUND

Estrogen loss has been related to higher incidence of stroke in postmenopausal women, but randomized trials have demonstrated an increased risk of stroke in women receiving hormone replacement therapy (HRT).

OBJECTIVE

To assess the relationship between exposure to endogenous ovarian hormones and the risk of noncardioembolic ischemic stroke.

METHODS

We conducted a multicenter, age-matched, case-control study in postmenopausal women (case: nonembolic ischemic stroke; control: no stroke) comparing duration of ovarian activity or lifetime estrogen exposure, which was defined as age at menarche to age at menopause. Embolic cardiopathy and unreliable gynecologic data were exclusion criteria. Cardiovascular disease risk factors were recorded. The relationships of the principal variables to the risk of stroke were assessed using a conditional logistic regression analysis.

RESULTS

There were 430 cases and 905 controls in the study. In the multivariate analysis, hypertension (odds ratio [OR]: 2.73; 95% CI: 2.09 to 3.58; p < 0.0001), diabetes (OR: 3.38; 95% CI: 2.53 to 4.52; p < 0.0001), hyperlipidemia (OR: 1.31; 95% CI: 1.01 to 1.7; p = 0.045), lifespan of ovarian activity <34 years (OR: 1.51; 95% CI: 1.13 to 2.03; p = 0.005), and menarche at <13 years of age (OR 1.49; 95% CI: 1.15 to 1.92; p = 0.002) were independently related to an increased risk of stroke. Obesity (OR: 0.73; 95% CI: 0.56 to 0.95; p = 0.021) was related to a lower risk of stroke.

CONCLUSIONS

Longer lifetime exposure to ovarian estrogens may protect against noncardioembolic ischemic stroke. However, a very early age of exposure onset could be disadvantageous.

Presence of viral proteins in drinkable water--sufficient condition to consider water a vector of viral transmission?

In order to determine the role of water as a possible vector for transmission of the most prevalent enteric viruses affecting infantile populations, 226 water samples were collected from Facatativa's (Colombian municipality located 30km away from Bogotá) water works in the years 2000, 2002, and 2005. The samples were clarified and virus was concentrated by filtering and ultrafiltering techniques. The presence of viral protein (VP) was assessed by enzyme immunoassay method (EIA) and viral RNA presence was detected by reverse trascriptase and polymerase chain reaction (RT-PCR). Using these techniques, one sample positive for Astrovirus (HAstV) was found in a sample collected from the river that supplies the aqueduct, two samples positive for Norovirus (NV) from fresh treated potable water and 13 samples positive for Rotavirus (RV), some in water from the plant during treatment and others from treated fresh water. RT-PCR inhibitors were also found in water samples obtained from the plant and in the fresh treated water. No inhibitors were found in the river water. VP, but no nucleic acid, was detected in the water samples at different stages of treatment, thus suggesting that the virus might have been complete and infectious at some stage prior to water purification.

[Comparison of 2 techniques for inhaled anesthetic induction with sevoflurane in coronary artery revascularization]

OBJECTIVE

Our objective was to evaluate efficacy, side effects, and hemodynamic alterations during anesthetic induction with sevoflurane in patients undergoing coronary artery bypass surgery, comparing the techniques of administration with tidal volume breathing and with vital capacity breaths.

MATERIAL AND METHODS

This was a randomized controlled trial enrolling 30 patients scheduled for myocardial revascularization. Anesthetic induction with inhaled sevoflurane was performed with 2 techniques: sevoflurane administered with tidal volume breathing (n=15) and with vital capacity breaths (n=15). We assessed time until a bispectral index (BIS) of 50 or less was reached. We also recorded adverse effects and alterations in hemodynamic variables during induction.

RESULTS

The time to induction was significantly shorter in the tidal volume group. The time until reaching a BIS of 50 or less was significantly shorter in the vital capacity group. Hemodynamics were similar in both groups (no significant differences). In both groups mean arterial pressure decreased significantly from baseline (P<0.05) and systolic and diastolic blood pressures both decreased slightly, with no significant heart rate or ST segment changes. Adverse effects were few and not serious.

CONCLUSIONS

Mean arterial pressure decreased in both groups, with no significant differences. The results indicate that hemodynamic stability seems to be similar with both techniques for providing inhaled anesthetic induction with sevoflurane.

Crystal structure and relaxor-type transition in SrBi(2)Ta(2)O(9) doped with praseodymium

The effects of Pr substitution in the structure and ferroelectric response for the Sr(1-x)Pr(x)Bi(2)Ta(2)O(9) (SBT-Pr) compound have been studied. Rietveld refinement of the x-ray diffraction patterns indicates that the Pr ion progressively replaces the Sr site in the A 2(1)am space group structure. The solubility of Pr in solid solution is around 15%. The replacement induces a change in the crystal structure and, as a consequence, the dielectric properties are affected. The ferroelectric transition at T(m)∼558 K is shifted to lower temperatures, T(m)∼413 K for x = 0.15 composition. Apparently, the tilt angle (α) associated with the c-axis does not play an important role since it remains essentially constant. However, the rotation in the ab-plane (β) as well as the octahedral distortion observed are strongly related to the coupling between T(m) and x. A relaxor-type transition is observed as Pr is increased, leading to polar microregions above the nominal ferroelectric transition. The local disorder induced by the Pr ion is confirmed by the continuous increase in the diffuseness coefficient according to Isupov's model. These facts hinder the displacement of the TaO(6) octahedra with respect to Bi(2)O(2) along the polarization axis, decreasing the polarization values.

Cytotoxic proteins combined with prodigiosin obtained from Serratia marcescens have both broad and selective cytotoxic activity on tumor cells

Cytotoxic proteins and prodigiosin obtained from Serratia marcescens strains are known to induce tumor cell death, nevertheless its combination has not been studied. In this paper we evaluate the combined effects of these molecules in a panel of tumor cell lines. The results showed a marked inhibitory effect on the growth of tumor cell lines derived from tumors (i.e., melanoma) which are highly resistant to conventional anticancer drugs, while normal cells were less sensitive than tumor cells. TUNEL (TdT-mediated dUTP nick end labeling) and electrophoresis of HEp-2 cell DNA treated with MG2327 preparation [containing the P50 protein belonging to the serralysins and prodigiosin, from S. marcescens CMIB4202] showed a pattern of DNA fragments typically associated with apoptosis. Interestingly, prodigiosin enhanced by 1.6-fold the cytotoxic effect of P50 when acting in combination on HEp-2 cells. The broad cytotoxic activity of the combination on tumor cells as well as its selectivity open new frontiers in cancer therapy.

Nanoscale capacitance imaging with attofarad resolution using ac current sensing atomic force microscopy

Nanoscale capacitance imaging with attofarad resolution (∼1 aF) of a nano-structured oxide thin film, using ac current sensing atomic force microscopy, is reported. Capacitance images are shown to follow the topographic profile of the oxide closely, with nanometre vertical resolution. A comparison between experimental data and theoretical models shows that the capacitance variations observed in the measurements can be mainly associated with the capacitance probed by the tip apex and not with positional changes of stray capacitance contributions. Capacitance versus distance measurements further support this conclusion. The application of this technique to the characterization of samples with non-voltage-dependent capacitance, such as very thin dielectric films, self-assembled monolayers and biological membranes, can provide new insight into the dielectric properties at the nanoscale.

Silent ischemia after neuroprotected percutaneous carotid stenting: a diffusion-weighted MRI study

BACKGROUND AND PURPOSE

To assess by diffusion-weighted MR imaging (DWI) the efficacy of cerebral protection devices in avoiding embolization and new ischemic lesions in patients with severe internal carotid artery (ICA) stenosis undergoing carotid artery stent placement (CAS).

METHODS

One hundred sixty-two CASs in the extracranial ICA were performed with the use of distal filters. Mean age of the patients was 68.5 years (range, 33-86) and 122 patients (75.3%) were symptomatic. MR imaging was performed in all patients during the 3-day period before CAS, and DWI was obtained within 24 hours after the procedure. Ninety-five patients (58.6%) were monitored by transcranial Doppler ultrasonography for microemboli detection in the territory of the middle cerebral artery (MCA), ipsilateral to the vessel being treated.

RESULTS

Twenty-eight patients (17.3%) showed 58 new ischemic foci in DWI, and 13 patients (46.4%) had multiple foci. Location of new lesions was mainly in the vascular territory supplied by the treated vessel (19 patients; 67.9%), but also in the contralateral MCA (1 patient; 3.6%), and the posterior fossa (4 patients; 14.3%). A significant relationship (P < .03) was found between occurrence of transient ischemic attack (TIA) and appearance of new lesions. Microembolic signals (MES) were detected in 88 patients (92.6%), with no relationship between number of MES and the appearance of new ischemic foci.

CONCLUSION

New ischemic foci were observed in 17.3% of the patients undergoing neuroprotected CAS. Appearance of new ischemic lesions were only significantly related to the occurrence of TIA but not to the number of MES registered or other variables. Despite the encouraging results, the incidence of new ischemic lesions should promote research for safer techniques and devices.

Apolipoprotein D expression in substantia nigra of Parkinson disease

Apolipoprotein D (apo D), a lipocalin transporter of small hydrophobic molecules could play an important role in several neurodegenerative diseases. However, its role in those diseases remains unclear. Increments of apo D have been reported in relation with injury and degeneration in the nervous system. Recently increases of apo D level have been reported in schizophrenia, a neuropathologic disease where the oxidative stress and lipid abnormalities may be involved. Apo D could act as a sequestering molecule binding excess of arachidonic acid in cells. In order to determine the relationship between apo D expression and other neurodegenerative pathologies related to oxidative damage, we studied the presence of apo D in the substantia nigra of control and Parkinson disease (PD) subjects. We found dopaminergic neurons were not immunoreactive for apo D, control or PD subjects. However, surrounding glial cells showed immunostaining for apo D and signal increases in PD cases. These findings support the role of apolipoprotein D in neuroprotection and the importance of glia in the amount of this protein in the central nervous system.

Carbohydrate storage in five resprouting Florida scrub plants across a fire chronosequence

Most research analyzing nonstructural carbohydrate (NSC) concentrations on resprouter species in fire-controlled ecosystems has concentrated on how NSC concentrations recover immediately after fire. However, we know little of the effect of long periods without fire on NSC concentrations. In order to assess the effect of different periods of time-since-fire on resprouter species, we studied carbohydrate concentrations (total [NSC], soluble sugars [SS] and nonsoluble sugars [NSS]) in five resprouting species with contrasting trends of abundance across a chronosequence of time-since-fire (0.5-40 yr) in Florida. Carbohydrate concentrations were highest in species with specialized reserve organs. [SS] was mainly explained by factors related to plant size, whereas time-since-fire was the main factor explaining [NSS]. Changes in [NSS] and [NSC] were correlated with the time-since-fire abundance patterns. Variation in [NSS] carbohydrates can be related to the structural development of vegetation, with only those species capable of accessing full light able to accumulate carbohydrates, whereas subordinate plants show reductions in the [NSS] carbohydrate fractions. In areas with long intervals between fires, this carbohydrate reduction could affect subsequent postfire resprouting vigour, although this remains to be confirmed.

226 BASIC CHARACTERISTICS OF CAPTIVE BROWN BEAR (URSUS ARCTOS) SPERMATOZOA COLLECTED BY ELECTROEJACULATION AND FROM THE POSTMORTEM EPIDIDYMIS

The objective of the present study was to describe the basic characteristics of brown bear spermatozoa collected by electroejaculation and from the cauda epididymis after necropsy. Semen was collected during the mating season of 2004 and 2005 from five mature males, aged from 3.5 to 22 years. Animals were anesthetized with 7 to 10 mg/kg body weight of Zoletil® (tiletamine + zolazepam; Virbac, Carros, France). Bears were placed on a special stretcher in ventral recumbency. A rectal probe with three longitudinal electrodes and a diameter of 2 cm (Electrojac IV; Minitübe, Tiefenbach, Germany) was placed into the rectum. Two series of stimuli were administered with a 2–3 min rest between series. Each stimulus lasted 2 s and was administered at 2 s intervals increasing intensity of stimulation from 0 to 15V. Of 23 electroejaculation attempts, 17 ejaculates were collected and two were eliminated because of poor semen quality. Epididymal spermatozoa were collected from three animals after euthanasia by flushing cauda epididymis with the freezing medium. Two animals showed unilateral testicular hypoplasia and only one testicle was processed from each of them. Volumes were recorded and concentration was evaluated in the laboratory. Semen quality of epididymal and ejaculated samples was assessed by: progressive sperm motility (%IM); quality of movement on a scale of 0 to 5 (Q); normal acrosome status (%NAS) and normal sperm morphology (%NOR), assessed by phase contrast microscopy of glutaraldehyde fixed samples; membrane response to hypo-osmotic test (%HOST); and sperm viability estimated using eosin-nigrosin vital staining (%V). Results were evaluated by Student t-test. Mean volume of ejaculates was 0.79 ± 0.73 mL. The average concentration of samples collected by electroejaculation was 519 ± 278 × 106 sperm/mL. The average number of spermatozoa collected per ejaculate was lower than the average number of spermatozoa collected from the epididymis, 476 ± 352 × 106 vs. 640 ± 164 × 106, respectively (P > 0.05). Sperm quality was not different between epididymal and electroejaculated samples (Table 1), except that the %NORwas higher in electroejaculated samples than in epididymal samples (62 ± 16 vs. 3 ± 15; P < 0.01). Ahigh percentage of spermatozoa with abaxial midpiece attachment (78.6 ± 10.4%) was observed in all samples. All electroejaculates contained leukocytes and 53% of the ejaculates had agglutinated spermatozoa. All 15 ejaculate and all epididymal samples were frozen in TES-Tris extender containing 4% glycerol using a standard protocol for bull semen. Our results indicate that electroejaculated and epididymal brown bear spermatozoa may be of sufficient quality for use in AI programs to increase gene flow between isolated captive populations. Whether cryopreserved samples can be used for artificial breeding remains to be determined. Table 1. Quality parameters of spermatozoa from ejaculated and epididymal samples (mean ± SD) This work was supported by Zoological Society of San Diego.

Psychometric field study of the new haemophilia quality of life questionnaire for adults: The 'Hemofilia-QoL'

Although there is a worldwide interest in the assessment of health-related quality-of-life (HRQoL) in haemophilia patients, no non-disease specific instruments (for adults) are readily available. In this paper, a haemophilia-specific quality-of-life assessment measure for adults (the Hemofilia-QoL questionnaire) has been developed and tested for psychometric properties in 121 adults with haemophilia living in Spain. The Hemofilia-QoL questionnaire is a self-report modular instrument that assesses nine relevant HRQoL domains for patients with haemophilia (e.g. physical health, daily activities, joint damage, pain, treatment satisfaction, treatment difficulties, emotional functioning, mental health, relationships and social activity). Psychometric examination involved the assessment of data quality, scaling assumptions, reliability (internal consistency and test-retest) and validity (concurrent; external clinical criterion and sensitivity). The Hemofilia-QoL 36-item version questionnaire had acceptable internal consistency and retest reliability values. The questionnaire shows excellent concurrent validity (with the SF-36 Health Survey) and external clinical criterion validity (haemophilia clinical status) and sensitivity (health status changes) as well. The Hemofilia-QoL is now available for adult assessment and is ready for use in clinical research in Spain.

Airway inflammation and cough sensitivity in cough-variant asthma

BACKGROUND

Mechanisms underlying cough and bronchoconstriction in patients with cough-variant asthma (CVA) are not well established. Differences in location or degree of activation of eosinophils and allergic cytokines have been suggested as the likely causes. To address this issue, we have carried out a comparative study of airway inflammatory markers between patients with CVA and classic asthma (CA). The relationship between these markers with airway hyperresponsiveness (AHR) and cough sensitivity has also been studied.

METHODS

Twenty-seven non-smokers and steroid-naive patients with CVA (12) and CA (15) were examined. Capsaicin challenge, histamine bronchoprovocation test, nitric oxide levels in exhaled air and sputum induction were performed in all of them. Differential cell sputum recount and supernatant concentrations of eosinophil granule-derived cationic proteins (ECP), interleukin (IL)5, IL8 and tumour necrosis factor (TNF)-alpha were also measured.

RESULTS

There were no significant differences in either the inflammatory pattern of soluble markers or differential cell counts between CA and CVA. Histamine PC20 was correlated with IL-5 in CVA, whereas it was associated with sputum eosinophilia in CA. Cough sensitivity (log C5) and histamine PC20 were inversely related in CA.

CONCLUSIONS

Although the pattern of inflammatory sputum markers in patients with asthma and cough-variant asthma is similar, its relation with bronchial hyperreactivity and cough sensitivity is different in each group.

Once-daily antiretroviral therapy: Spanish Consensus Statement

BACKGROUND

Administration of antiretroviral therapy (ART) once daily is creating extraordinary interest among the members of the scientific community and also among those who receive the therapy. However, in clinical practice, some doubts remain about its use.

OBJECTIVES

This document examines the characteristics and possibilities of treatment administered once daily.

METHODS

Consensus of 248 Spanish experts in the field.

RESULTS

Once-daily dosing is considered an added value which could favour adherence and, therefore, efficacy, as well as the quality of life of certain patients, however, the objective of adequate adherence in the long term is often difficult to achieve regardless of the treatment used. In theory, any patient can receive once-daily therapy, although some patients could particularly benefit from it, e.g. those with unfavourable social or personal circumstances, including drug users, patients whose treatment must be supervised, patients receiving multiple medications, or those who need rescue therapy after multiple treatment failures. At present, it is possible to design once-daily ART using some of the combinations of drugs considered as first-choice in national and international recommendations for antiretroviral therapy, but the options are still limited. The marketing of new drugs with this characteristic could allow us to increase the number and types of patient who can benefit from once-daily regimens, including those patients who need rescue therapy.

CONCLUSIONS

Once-daily ART is a good alternative to regimens administered several times each day when a potent combination of active drugs is available.

[Effectiveness of postoperative autologous blood transfusion after knee replacement surgery and influence of preoperative hemoglobin level]

OBJECTIVE

To evaluate the effectiveness of postoperative autologous blood transfusion on reducing the need for allogenic transfusion during recovery from total knee arthroplasty until hospital discharge, and to determine whether effectiveness is related to preoperative hemoglobin level.

MATERIAL AND METHODS

Retrospective study of patients undergoing surgery at Hospital Jerez de la Frontera, Spain, in 2003, assessing the association between postoperative autologous blood transfusion, preoperative hemoglobin, and allogenic transfusion requirements.

RESULTS

A total of 107 patients were studied. Eighty-three received autologous blood transfusions after surgery and 15 (14.02%) required allogenic transfusion. The rate of allogenic transfusion was higher in association with hemoglobin levels exceeding 13 g x dL(-1) (P=0.003) and it was lower in patients who received autologous blood transfusions (P=0.046). In patients who received autologous transfusion, preoperative hemoglobin level and risk of allogenic transfusion were unrelated. When autologous transfusion was not given, allogenic transfusion risk was higher when hemoglobin concentration was less than 13 g x dL(-1) (P=0.0008). Autologous transfusion had a significant effect when hemoglobin level was less than 13 g x dL(-1) (P=0.002) but did not affect the rate of transfusion when hemoglobin was 13 g x dL(-1) or more.

CONCLUSIONS

Autologous blood transfusion is effective for reducing the need for allogenic transfusion after knee replacement surgery, particulary when a patient's hemoglobin level is less than 13 g x dL(-1).

A specific primer pair for the diagnosis and identification of Acanthamoeba astronyxis by random amplified polymorphic DNA-polymerase chain reaction

Random amplified polymorphic DNA (RAPD) is a useful tool for species identification. The obtained band patterns can be used for specific primer pair design that is useful for species identification. In this study, a distinctive 485-bp band in Acanthamoeba astronyxis band patterns was found, using the OPC20 primer (ACTTCGCCAC). The band specificity was confirmed by hybridization, using it as a probe, against all OPC20 amplifications from different Acanthamoeba species. Once the fragment was sequenced, we used it to design a specific primer pair that was useful for the identification of different isolates as A. astronyxis species.

Randomized phase II trial of carboplatin versus paclitaxel and carboplatin in platinum-sensitive recurrent advanced ovarian carcinoma: a GEICO (Grupo Espanol de Investigacion en Cancer de Ovario) study

BACKGROUND

The aim of this study was to determine whether the response rate for the paclitaxel-carboplatin combination is superior to carboplatin alone in the treatment of patients with platinum-sensitive recurrent ovarian carcinoma.

PATIENTS AND METHODS

Patients with recurrent ovarian carcinoma, 6 months after treatment with a platinum-based regimen and with no more than two previous chemotherapy lines, were randomized to receive carboplatin area under the curve (AUC) 5 (arm A) or paclitaxel 175 mg/m(2) + carboplatin AUC 5 (arm B). The primary end point was objective response, following a 'pick up the winner' design. Secondary end points included time to progression (TTP), overall survival, tolerability and quality of life (QoL).

RESULTS

Eighty-one patients were randomized and included in the intention-to-treat analysis. The response rate in arm B was 75.6% [26.8% complete response (CR) + 48.8% partial response (PR)] [95% confidence interval (CI) 59.7% to 87.6%] and 50% in arm A (20% CR + 30% PR) (95% CI 33.8% to 66.2%). No significant differences were observed in grade 3-4 hematological toxicity. Conversely, mucositis, myalgia/arthralgia and peripheral neurophaty were more frequent in arm B. Median TTP was 49.1 weeks in arm B (95% CI 36.9-61.3) and 33.7 weeks in arm A (95% CI 25.8-41.5). No significant differences were found in the QoL analysis.

CONCLUSIONS

Paclitaxel-carboplatin combination is a tolerable regimen with a higher response rate than carboplatin monotherapy in platinum-sensitive recurrent ovarian carcinoma.

Readiness to recover in adolescent anorexia nervosa: prediction of hospital admission

OBJECTIVES

To determine if motivation to change in anorexia nervosa during treatment is a predictor of hospitalisation in adolescent patients.

METHOD

The Anorexia Nervosa Stages of Change Questionnaire (ANSOCQ), the Eating Disorders Inventory-2 (EDI-2) and the Beck Depression Inventory (BDI) were administered to a group of 70 anorexia nervosa patients (mean age 15.6 years). They were all receiving treatment at a specialised Eating Disorder Unit and were at different points in the treatment programme. Admission during 6-9 month follow-up was recorded in 63 of these patients who had been admitted to the Unit. The other 7 patients were contacted by phone to determine if they had been hospitalised in another unit during the follow-up period.

RESULTS

Patients who needed hospital admission during follow-up had higher mean scores at first evaluation on some of the EDI-2 scales and on the BDI, lower ANSOCQ scores and were more likely to have been outpatients at first evaluation. In the logistic regression analysis a low ANSOCQ score and being an outpatient at first evaluation were shown to be independent predictors of hospitalisation during follow-up.

CONCLUSIONS

Low motivation to change, depressive symptomatology and some EDI-2 scales are related to the necessity of hospital admission in adolescent patients with anorexia nervosa.

Translation and psychometric testing of the Basque version of the SF-36 Health Survey

INTRODUCTION

The primary goals of this study were to adapt the Short Form-36 (SF-36) questionnaire to the Basque language and to assess the translated questionnaire's psychometric properties.

METHODS

Two pilot studies and a field study were conducted in 1999. The pathologies selected were hypertension, eating disorders, back pain, and HIV infection; blood donors were also included. The analyses conducted at item-level were: item internal consistency, item discriminant validity, equal item variance, and equal item-scale correlation. Internal consistency was measured at the scale level. Reproducibility, convergent validity and discriminant validity were also examined.

RESULTS

285 individuals took part in the study; sufficient data were obtained for 265 (93%). All items correlated higher than 0.4 with their hypothesized scales. Within each scale, item standard deviations were similar. Item-scale correlations were also similar. Cronbach's alpha coefficients varied from 0.76 to 0.92. In the test-retest reliability study, which included 54 additional individuals, all scales were above 0.50. Regarding the inter-scale correlation, the majority exceeded the 0.40 coefficient. In the correlation of similar scales of the SF-36 and the Nottingham Health Profile, intraclass correlation coefficient results ranged from 0.29 to 0.62.

CONCLUSIONS

These results confirm that this new version of the SF-36 has been translated and adapted correctly for the Basque language and that it fulfils, at least partially, the psychometric properties required for this instrument. Further studies, however, are needed to completely validate the Basque version of the SF-36.