Identifying anatomic landmarks and median nerve characteristics for the analysis of persistent carpal tunnel syndrome using magnetic resonance imaging (MRI)

OBJECTIVE

Carpal tunnel syndrome (CTS) is the most common nerve entrapment neuropathy in the USA. In this study, we define anatomical landmarks to assess symptomatic and asymptomatic cohorts with persistent CTS using MRI imaging.

MATERIALS AND METHODS

Distal vs proximal incomplete release was determined using the distal most aspect of the hook of hamate and the distal wrist crease. An incomplete release showed the transverse carpal ligament (TCL) intact at either boundary. Twenty-one patients with persistent CTS were analyzed for incomplete release, median nerve enlargement and T2 signal hyperintensity, and flattening ratio using postoperative wrist MRI. These findings were compared to a ten-patient asymptomatic persistent CTS control group. Fisher's exact and a Student's two-tailed t-tests were used to determine statistical significance.

RESULTS

In the symptomatic persistent CTS group, 13 (61.9%) incomplete releases were identified, 5 (38.5%) incomplete distally, and 1 (7.7%) incomplete proximally. There was no statistical significance in the rate of incomplete releases when compared to the asymptomatic group (p = 1.00). T2 signal hyperintensity and enlargement at the site of release showed no statistical significance, (p = 0.319 and p = 0.999, respectively). The mean flattening ratio at the site of release in the symptomatic group (2.45 ± 0.7) was statistically significant compared to the asymptomatic group (1.48 ± 0.46), (p = 0.007).

CONCLUSION

Utilizing the established landmarks, the full length of the TCL can be assessed via MRI. Additionally, evaluation of the median nerve flattening ratio at the level of the incomplete release may be utilized as an aid to the clinical management of persistent CTS.

MRI-based Neuropathy Score Reporting And Data System (NS-RADS): multi-institutional wider-experience usability study of peripheral neuropathy conditions among 32 radiology readers

OBJECTIVE

To determine the inter-reader reliability and diagnostic performance of classification and severity scales of Neuropathy Score Reporting And Data System (NS-RADS) among readers of differing experience levels after limited teaching of the scoring system.

METHODS

This is a multi-institutional, cross-sectional, retrospective study of MRI cases of proven peripheral neuropathy (PN) conditions. Thirty-two radiology readers with varying experience levels were recruited from different institutions. Each reader attended and received a structured presentation that described the NS-RADS classification system containing examples and reviewed published articles on this subject. The readers were then asked to perform NS-RADS scoring with recording of category, subcategory, and most likely diagnosis. Inter-reader agreements were evaluated by Conger's kappa and diagnostic accuracy was calculated for each reader as percent correct diagnosis. A linear mixed model was used to estimate and compare accuracy between trainees and attendings.

RESULTS

Across all readers, agreement was good for NS-RADS category and moderate for subcategory. Inter-reader agreement of trainees was comparable to attendings (0.65 vs 0.65). Reader accuracy for attendings was 75% (95% CI 73%, 77%), slightly higher than for trainees (71% (69%, 72%), p = 0.0006) for nerves and comparable for muscles (attendings, 87.5% (95% CI 86.1-88.8%) and trainees, 86.6% (95% CI 85.2-87.9%), p = 0.4). NS-RADS accuracy was also higher than average accuracy for the most plausible diagnosis for attending radiologists at 67% (95% CI 63%, 71%) and for trainees at 65% (95% CI 60%, 69%) (p = 0.036).

CONCLUSION

Non-expert radiologists interpreted PN conditions with good accuracy and moderate-to-good inter-reader reliability using the NS-RADS scoring system.

CLINICAL RELEVANCE STATEMENT

The Neuropathy Score Reporting And Data System (NS-RADS) is an accurate and reliable MRI-based image scoring system for practical use for the diagnosis and grading of severity of peripheral neuromuscular disorders by both experienced and general radiologists.

KEY POINTS

• The Neuropathy Score Reporting And Data System (NS-RADS) can be used effectively by non-expert radiologists to categorize peripheral neuropathy. • Across 32 different experience-level readers, the agreement was good for NS-RADS category and moderate for NS-RADS subcategory. • NS-RADS accuracy was higher than the average accuracy for the most plausible diagnosis for both attending radiologists and trainees (at 75%, 71% and 65%, 65%, respectively).

Relationship between iron deficiency and expression of genes involved in iron metabolism in human myocardium and skeletal muscle

BACKGROUND

Iron deficiency (ID) is associated with adverse prognosis in patients with heart failure. This study aims to investigate the relationship between ID and expression of genes involved in iron metabolism in human myocardium and skeletal muscle, focusing on Transferrin 1 receptor (TfR1), the main pathway of cellular iron uptake.

METHODS

Patients undergoing elective CABG were assessed prior to surgery with echocardiography and serum iron parameters. Core needle biopsies were collected from the left and right ventricle (LV, RV), the right atrium and intercostal skeletal muscle (SM). Gene expression analyses were done by mRNA sequencing.

RESULTS

Of 69 patients (median age 69 years, 91% men), 28% had ID. 26% had HFrEF, 25% had HFpEF physiology according to echocardiographic findings and NT-proBNP levels, and 49% had normal LV function. The expression of TfR1 was increased in patients with ID compared to patients without ID in ventricular tissue (p = 0.04) and in intercostal SM (p = 0.01). The increase in TfR1 expression in LV and RV was more pronounced when analysing patients with absolute ID (S-Ferritin<100 μg/L). Analysing the correlation between various iron parameters, S-Ferritin levels showed the strongest correlation with TfR1 expression. There was no correlation with NT-proBNP levels and no difference in TfR1 expression between different HF phenotypes.

CONCLUSIONS

In patients undergoing elective CABG we found an association between ID and increased TfR1 expression in myocardium regardless of LV function, indicating physiologically upregulated TfR1 expression in the presence of ID to restore intracellular iron needs.

CLINICAL TRIAL REGISTRATION

Clinicaltrials.govNCT03671122.

Gestational nutrient restriction under extensive grazing conditions: Effects on muscle characteristics and meat quality in heavy lambs

We evaluated maternal undernutrition effects induced by a lower natural pasture allowance (gestation days 30-143) on histological-biochemical and meat traits in muscles Semitendinosus, cranial Gluteobiceps and Supraspinatus from 200-day old male and female lambs. Maternal undernutrition increased oxidative and reduced glycolytic fibers in all muscles (P ≤ 0.01). Maternal undernutrition reduced the diameter of glycolytic fibers in the cranial Gluteobiceps of exclusively female lambs (P = 0.05) and reduced the diameter of oxidative fibers in the Supraspinatus of exclusively male lambs (P = 0.02). Maternal undernutrition increased lipid content in the Supraspinatus of females (P = 0.001), reduced lactate content (P = 0.03) and WB shear force (P = 0.02) in the Semitendinosus of females, and increased cooking losses in the Semitendinosus of males (P = 0.0069). In conclusion, gestational nutrient restriction induced fetal programming effects on muscle characteristics of lambs. Moreover, our study demonstrates that maternal undernutrition influences muscle and meat characteristics in a sex and muscle-dependent way.

A-56 Predicting Performance on the Raven’s Matrices from the Findings of the Boston Longitudinal MIDUS Study

Objective

To examine the relationship between different cognitive measures and Raven’s Progressive Matrices (RPM) during midlife.

Methods

Data was derived from a de-identified MIDUS-II database (n = 328, 57.8% male, Mage = 48.14, Meducation = 15.8, 93% Caucasian). All participants were administered cognitive tests consisting of several measures of cognitive ability (Trails-B, Vocabulary, Forward & Backward-Digit-Span, and Digit-Symbol-Substitution-Test (DSST)) and RPM.

Results

Pearson correlations were conducted between cognitive performance on various measures and performance on RPM. Using a Bonferroni correction across all correlations, p-value was set at .001. Better performance on RPM was negatively associated with Trails-B (r(139) = -.446,p = .001) and positively associated with Vocabulary (r(168) = .424,p = .001), Forward-Digit-Span (r(168) = .318,p = .001), Backward-Digit-Span (r(166) = .257,p = .001), DSST (r(166) = .516,p = .001).

Conclusions

Results suggest that DSST is the strongest predictor of RPM performance, followed by Trails-B. Reasons for the strong DSST correlation suggest the shared component of sustained attention, processing speed, working memory and set shifting. A moderate association with Trails-B implies the shared components of visual-conceptualization, visual motor tracking, and working memory. Both DSST and Trails-B not only require working memory, but also visuospatial skills, suggesting the use of high-level processes may be required for successful performance on the RPM. Moreover, visuospatial skills may be more strongly related to fluid intelligence than other abilities. This suggests that visualization skills to perceive and mentally reproduce patterns, mental rotation, and flexibility of closure to detect a stimulus hidden within a complex figure are all essential in RPM performance. Future studies should focus on gender and age differences in relation to visuospatial skills, specifically the age at which these differences occur.

Preventing the recurrence of depression with a Mediterranean diet supplemented with extra-virgin olive oil. The PREDI-DEP trial: study protocol

BACKGROUND

The role of dietary patterns in the prevention of unipolar depression has been analyzed in several epidemiological studies. The primary aims of this study are to determine the effectiveness of an extra-olive oil-enriched Mediterranean diet in reducing the recurrence of depression and improving the symptoms of this condition.

METHODS

Multicenter, two-arm, parallel-group clinical trial. Arm 1, extra-virgin olive oil Mediterranean diet; Arm 2, control group without nutritional intervention. Dieticians are in charge of the nutritional intervention and regular contact with the participants. Contacts are made through our web platform ( https://predidep.es/participantes/ ) or by phone. Recurrence of depression is assessed by psychiatrists and clinical psychologists through clinical evaluations (semi-structured clinical interviews: Spanish SCID-I). Depressive symptoms are assessed with the Beck Depression Inventory. Information on quality of life, level of physical activity, dietary habits, and blood, urine and stool samples are collected after the subject has agreed to participate in the study and once a year.

DISCUSSION

To the best of our knowledge, the PREDI-DEP trial is the first ongoing randomized clinical trial designed to assess the role of the Mediterranean diet in the prevention of recurrent depression. It could be a cost-effective approach to avoid recurrence and improve the quality of life of these patients.

TRIAL REGISTRATION

The study has been prospectively registered in the U.S. National Library of Medicine ( https://clinicaltrials.gov ) with NCT number: NCT03081065.

Immunotherapy for oncogenic-driven advanced non-small cell lung cancers: Is the time ripe for a change?

Immune checkpoint inhibitors (ICIs) have been incorporated in the treatment strategy of advanced non-small cell lung cancer (NSCLC) in first- and second-line setting improving the prognosis of these patients. However, the treatment landscape has been also drastically overturned with the advent of targeted therapies in oncogenic-addicted advanced NSCLC patients. Despite ICIs represent an active and new treatment option for a wide range of advanced NSCLC patients, the efficacy and the optimal place of ICI in the treatment strategy algorithm of oncogenic-addicted tumors remains still controversial, as only a minority of trials with ICI enrol oncogenic-addicted NSCLC patients previously treated with standard therapy. Therefore, there are still several open questions about ICI in oncogenic-driven NSCLC, such as the efficacy and toxicities, which need to be addressed before considering treatment with ICI as a standard approach in this population. It is in this framework, we provide a thorough overview on this currently controversial topic.

Healthy properties of green and white teas: an update

Green tea has been consumed for centuries in Japan, China and Morocco.

Time to culture conversion in smokers with pulmonary tuberculosis

Background and objective. It has been reported that tobacco smoking slows the sterilisation of sputum culture in pulmonary tuberculosis, but the factors that could delay culture conversion in patients who smoke are not known. Our aim is to identify the factors influencing sputum culture conversion in smokers with pulmonary tuberculosis. Methods. Ninety-nine patients with a smoking history and diagnosed with pulmonary tuberculosis were analysed retrospectively. The relationship between sputum culture status at the second month and the following variables: age, gender, pack-years index, comorbid diseases, number acid-fast bacilli (AFB) in sputum smear examination, radiological findings (cavitary, extensive or limited disease), drug susceptibility pattern and initial treatment, was analysed. The Student t-test, chi-square test and logistic regression model with forward stepwise conditional methods were used for statistical analysis. A p value of &lt;0.05 was considered to be statistically significant. Results. Twenty six patients (26.2%): 18 males (22.2%) and 8 females (44%) were sputum culture positive at the end of the second month of treatment. In univariate analysis, culture conversion time was significantly associated with female gender and extensive disease, but in a logistic regression analysis was only correlated with female gender (OR=5.63 95% CI 1.21-20.64-p=0.02). Conclusion. In current smokers with pulmonary tuberculosis, the ‘time to culture’ conversion relates only to the female gender.

210 FACTORS AFFECTING SUPEROVULATION RESPONSE IN CATTLE: A RETROSPECTIVE STUDY

Superovulation, embryo collection, and transfer allow for genetic improvement resulting in more rapid enhancement of production traits. Despite these advantages, variability in the response to superovulation has been observed between and within individual animals, becoming a costly inconvenience of these techniques. The purpose of this study was to evaluate the factors that influenced the superovulatory response and the resulting quantity and quality of the ova/embryos collected during embryo flushing in the study group, with cow as the experimental unit. A retrospective study was conducted, evaluating superovulation records from 794 embryo donors collected for the first time. Individual information was classified as breed (Angus or Holstein), parity (heifers or dry cow), body condition score (BCS; 5, 6, or 7 was considered optimal and BCS <5 or >7 was considered not optimal; in a 1 to 9 scale), hormonal dose used (375 or 500 IU of FSH), ovarian response (presence of more than one corpus luteum), collection (abnormal: blood or <80% fluid recovered or normal: bicornual >80% fluid recovered) and season at collection (summer, fall, winter, spring) to determine their predictive value for the total number of ova/embryos collected: number of transferable embryos, degenerated embryos, and unfertilized oocytes (UFOs) according to the IETS standards for classification. Variables were evaluated and transformed when needed to establish normality. Binary logistic regression was used to identify predictors of ovarian response or nonresponse. A model was built for each of these dependent variables using a general linear model (GLM). Tukey's post hoc test was used to compare adjusted means between groups when there were significant factors identified by the GLM. The study found a significant difference (P = 0.024) in the percentage of cows responding to superovulation treatment in summer compared with spring (91.5% v. 98.4%). From the 755 donors that responded, the mean number (±s.e.m.) of ova/embryos collected from donors with optimal BCS was higher (P = 0.052) than those from donors with nonoptimal BCS (9.8 ± 0.37 v. 8.4 ± 0.42). The mean numbers of total ova/embryos obtained from normal collections was higher (P < 0.001) than the mean from those collections classified as abnormal (10.25 ± 0.30 v. 6.60 ± 0.62). The mean number of viable embryos from responding donors was 5.66 ± 0.18 per collection. Donors with BCS classified as optimal had significantly higher (P = 0.034) mean number (±s.e.m.) of viable embryos compared with donors with nonoptimal BCS (5.95 ± 0.23 v. 5.18 ± 0.29). For the present study, the percentage of cows treated that responded and were collected decreased in summer. The effect of ambient temperature may be reduced by evaporative cooling of donors or by avoiding collections during the hottest days of the summer. Complications during the collection are rare and can be partially avoided by using experienced technicians only. Results may improve when donors are in an appropriate nutrition status, either by supplementing those animals with low body scores or by restricting diets for those that are overweight, to improve the efficiency of the technique.

Tidal volume is a major determinant of cyclic recruitment-derecruitment in acute respiratory distress syndrome

BACKGROUND

Overdistension and cyclic recruitment-derecruitment contribute to ventilator-induced lung injury. High tidal volumes are thought to increase mortality mainly by inducing overdistension. However, experimental evidence suggests that tidal volume (VT) may also influence cyclic recruitment-derecruitment. Our main goal was to determine whether high tidal volumes increase cyclic recruitment-derecruitment in acute respiratory distress syndrome (ARDS) patients, as measured by dynamic computed tomography (CT).

METHODS

We studied 9 ARDS patients with diffuse attenuations on CT who underwent a protocol including 2 ventilatory modes: (a) VT 6 mL/kg, respiratory rate 30/min, PEEP 9 cmH2O, (b) VT 12 mL/kg, respiratory rate 15/min, PEEP 9 cmH2O. A dynamic computed tomography of 8 seconds on a fixed transverse region was performed during each ventilator mode. Cyclic recruitment-derecruitment was determined as non-aerated tissue variation between inspiration and expiration and was expressed as % of lung tissue weight.

RESULTS

VT 12 mL/kg exhibited less non-aerated tissue at expiration compared to VT 6 ml/kg (40.15 [35.94-56.00] and 45.31 [37.95-59.32], respectively, P<0.05). However, VT 12 ml/kg increased cyclic recruitment-derecruitment compared to VT 6 mL/kg (7.32 [6.58-9.29] mL/kg vs. 4.51 [3.42-5.75] mL/kg, P<0.01). Tidal hyperinflation was also larger at VT 12 mL/kg (0.55 [0.27-2.24] vs. 0.24 [0.18-0.83], P<0.01).

CONCLUSION

High tidal volume is a major determinant of cyclic recruitment-derecruitment in ARDS patients with diffuse attenuations.

Caracterización sanitaria y nutricional de colonias de abejas melíferas en forestaciones de Eucalyptus grandis

En Uruguay muchos apicultores trasladan sus colonias a las forestaciones de Eucalyptus grandis al final del verano y en otoño obteniendo importantes cosechas de miel. Sin embargo, cuando finaliza la floración las colonias se encuentran muy debilitadas, sobreviniendo una elevada mortalidad. Problemas nutricionales y sanitarios podrían explicar el debilitamiento de las colonias. Para averiguar las causas del debilitamiento se llevaron colonias de igual tamaño a una forestación de E. grandis, separadas en tres grupos diferenciados por la disponibilidad de polen. A lo largo del periodo de floración se registró: el origen botánico y el contenido de proteína cruda del polen que ingresaba en las colmenas, la proteína corporal de las abejas, la infección por Nosema ceranae y la infestación por Varroa destructor, el área de cría y la producción de miel. Los resultados más importantes hallados fueron: i) la sostenida disminución de la diversidad botánica del polen a medida que transcurría el periodo de floración de E. grandis hasta quedar únicamente el polen de esta especie; ii) el polen de E. grandis presentó valores de proteína bruta cercanos al 30%, pero fue disminuyendo paulatinamente hasta alcanzar un valor inferior a 20% al final de la floración; iii) las colonias que contaban inicialmente con reservas de polen presentaron abejas con mayor proteína corporal pocos días después de llegar a la forestación y menor infestación de N. ceranae durante la mayor parte del periodo de floración; iv) la disponibilidad de polen no incidió en la infestación de V. destructor, el área de cría y la producción de miel. El déficit nutricional de las abejas durante la floración de E. grandis podría generar las condiciones adecuadas para la multiplicación de N. ceranae. Al final de la floración del eucalipto las colonias presentaron promedialmente más del 90% de las abejas pecoreadoras infectadas con N. ceranae y 12% de V. destructor en las abejas adultas. La incidencia de ambos patógenos sobre las abejas debilitadas podría explicar la pérdida de colonias.

Whole-blastocyst culture followed by laser drilling technology enhances the efficiency of inner cell mass isolation and embryonic stem cell derivation from good- and poor-quality mouse embryos: new insights for derivation of human embryonic stem cell lines

The optimization of human embryonic stem (hES) cell line derivation methods is challenging because many worldwide laboratories have neither access to spare human embryos nor ethical approval for using supernumerary human embryos for hES cell derivation purposes. Additionally, studies performed directly on human embryos imply a waste of precious human biological material. In this study, we developed a new strategy based on the combination of whole-blastocyst culture followed by laser drilling destruction of the trophoectoderm for improving the efficiency of inner cell mass (ICM) isolation and ES cell derivation using murine embryos. Embryos were divided into good- and poor-quality embryos. We demonstrate that the efficiency of both ICM isolation and ES cell derivation using this strategy is significantly superior to whole-blastocyst culture or laser drilling technology itself. Regardless of the ICM isolation method, the ES cell establishment depends on a feeder cell growth surface. Importantly, this combined methodology can be successfully applied to poor-quality blastocysts that otherwise would not be suitable for laser drilling itself nor immunosurgery in an attempt to derive ES cell lines due to the inability to distinguish the ICM. The ES cell lines derived by this combined method were characterized and shown to maintain a typical morphology, undifferentiated phenotype, and in vitro and in vivo three germ layer differentiation potential. Finally, all ES cell lines established using either technology acquired an aneuploid karyotype after extended culture periods, suggesting that the method used for ES cell derivation does not seem to influence the karyotype of the ES cells after extended culture. This methodology may open up new avenues for further improvements for the derivation of hES cells, the majority of which are derived from frozen, poor-quality human embryos.

Socio-economic gradient in food selection and diet quality among 70-year olds

OBJECTIVE

The aim of this study was to assess social disparities in food choices and diet quality in a population of 70-year old Swedes.

DESIGN

Cross-sectional study among participants in the 2000 Gerontological and Geriatric Population Studies in Goteborg.

PARTICIPANTS

A representative population of men (n=233) and women (n=321) from Goteborg, a city on the south western coast of Sweden.

METHODS

One hour diet history interviews were performed and 35 specific foods and food groups were identified; in addition a diet quality index (DQI) was calculated. Differences in food choices and diet quality scores were tested across educational and socio-economic index categories (SEI).

RESULTS

Men with higher education and SEI had higher diet quality scores than those with lower socio-economic status, while no differences in DQI were noted in women. Further analysis of women based on their husband's occupational group also yielded no differences in diet quality. When studying individual foods, socio-economic differences were observed in women and men.

CONCLUSIONS

Selection of food varies by education and occupational status in both sexes although socio-economic disparities in diet quality were observed in men only.

Human Papillomavirus Associated with Papillary Squamous Cell Carcinoma of the Oropharynx in a Renal Transplant Recipient

The papillary squamous cell carcinoma (PSCC) is a rare variant of the head and neck squamous cell carcinoma. Established etiological factors can include tobacco smoking and heavy alcohol abuse. Moreover, human papillomavirus infection can be involved in the pathogenesis of PSCC. This tumor is more frequent in patients with immunosuppression including those who have received a transplant. Most of the cases are produced by genotype HPV-6 and HPV-16, although there is a possibility of infection by other HPV subtypes. We present a case report of a PSCC and papilloma with oropharyngeal location in which high-risk HPV type 16 and low-risk HPV type 6, respectively, were identified by PCR in a renal transplant patient.

General safety guidances in stem cell bank installations

The use of cell cultures in research and in regenerative medicine programs has increased in the past few years, and control of the risks inherent to these procedures should be increased. People who work in stem cell bank installations should be aware of the risks implied in their work and take necessary self-protection measures for the known and unidentified risks. Work in stem cell bank installations is subject to different types of risks, such as toxicologic, carcinogen and, mainly, infectious risks. Different types of safety measurements should be distinguished and secured, for example for protection of personnel, protection of the cell cultures and protection in general of humans and the environment.

Prescribed daily doses and 'risk factors' associated with the use of benzodiazepines in primary care

OBJECTIVE

To assess the extent, characteristics and determinants of benzodiazepine prescription in outpatient Primary Health Care.

METHODS

A clinical audit of a stratified random sample of Primary Health Care Centres in the seven islands and 1.6 million inhabitants region of 'Canarias' in Spain was carried out. From those centres, a random sample of 1045 clinical records was reviewed and information on diagnosis, prescription and prescribed dosages was collected in a structured questionnaire. A multivariate logistic regression analysis was performed in order to determine the 'risk factors' for the use of benzodiazepines.

RESULTS

Benzodiazepine prescription was recorded in 23.4% of all clinical records; 87.7% of these were for benzodiazepines classified as anxiolytics (N05B) and 12.3% for hypnotics (N05C2). Benzodiazepine prescription was more common for women, elderly, widowed, divorced, low educational background, housewives and retired people. Using multivariate logistic regression, the probability of benzodiazepine prescription was found to be closely related to age, gender and employment status, but not with educational level. Prescribed Daily Doses were lower than Defined Daily Doses (DDD) in 77.1% of all anxiolytic prescriptions, but were in agreement with DDD in 90% of hypnotic prescriptions. The duration of treatment recorded in the clinical records was 25+/-21 months, with a range of 1 and 144 months. General Practitioners were responsible for 67% of all benzodiazepine prescription. Anxiolytics were prescribed as a single daily dose in 57% of the cases, and only 'at supper' in 48.6%.

CONCLUSION

In the general population attending Primary Health Care Centres of the Canary Islands Health System the prescription of benzodiazepines is higher for women and the elderly, and the most common use is chronic, with a duration of over 2 years in most cases. Anxiolytics are prescribed in doses which are much lower than those used as DDD and were used only 'at night' in almost half of the cases. This could represent an overlapping of the indications with hypnotics, and explain part of the huge difference in the use of anxiolytics in Spain compared with other figures in Europe. This fact must also be taken into account when making inferences of benzodiazepine use from sales statistics, which are very imprecise measures of drug use.

Self-reported stress levels predict subsequent breast cancer in a cohort of Swedish women

The association between stress and breast cancer has been studied, mostly using case-control designs, but rarely examined prospectively. The purpose of this paper is to describe the role of stress as a predictor of subsequent breast cancer. A representative cohort of 1,462 Swedish women aged 38-60 years were followed for 24 years. Stress experience at a baseline examination in 1968-69 was analysed in relation to incidence of breast cancer with proportional hazards regression. Women reporting experience of stress during the five years preceding the first examination displayed a two-fold rate of breast cancer compared with women reporting no stress (age-adjusted relative risk 2.1; 95% CI [1.2-3.7]). This association was independent of potential confounders including reproductive and lifestyle factors. In conclusion, the significant, positive relationship between stress and breast cancer in this prospective study is based on information that is unbiased with respect to knowledge of disease, and can be regarded as more valid than results drawn from case-control studies.

Ascorbic acid in diet supplements: loss in the manufacturing process and storage

The ascorbic acid content was determined in 25 different diet supplements commercially available to the consumer in two pharmaceutical forms (pills and ampoules). These products are widely consumed by several population groups (elderly people, sportsmen, adolescents, children, etc.). High-performance liquid chromatography was used as the analytical technique. The proposed method has been validated with good linearity, reproducibility, recovery and accuracy, and can be used in routine analyses and in quality control. The ascorbic acid content in pills ranged from 15.62 to 50.16 mg/g, and in that ampoules from 2.12 to 8.83 mg/ml. Depending on the dosage rates, these levels would represent approximately 20-50% of the daily dietary intake recommended by the National Research Council. Possible losses in the manufacturing process and stability during storage for 30 days at 40 +/- 2 degrees C without light, were tested. In relation to the ascorbic acid concentrations stated on the labels, a loss of 12.0-21.9% in pills and of 11.7-18.0% in ampoules was detected. In relation to the stability conditions, the losses are of 1.8-24.8% in pills and of 10.4-19.3% in ampoules. The pasteurisation and sterilisation processes produced a mean loss of ascorbic acid in ampoules of 2.1 and 1.4%, respectively. A statistically significant direct correlation was observed between ascorbic acid loss and content in proteins, humidity, ash, and fructose. The influence of the pharmaceutical form was also tested. Data revealed that the control of losses during the manufacturing and commercialisation process of these products is necessary to ensure the intake of vitamin C from these products by the consumer.

Interleukin-7 in plasma correlates with CD4 T-cell depletion and may be associated with emergence of syncytium-inducing variants in human immunodeficiency virus type 1-positive individuals

Human immunodeficiency virus type 1 (HIV-1) primary infection is characterized by the use of CCR5 as a coreceptor for viral entry, which is associated with the non-syncytium-inducing (NSI) phenotype in lymphoid cells. Syncytium-inducing (SI) variants of HIV-1 appear in advanced stages of HIV-1 infection and are characterized by the use of CXCR4 as a coreceptor. The emergence of SI variants is accompanied by a rapid decrease in the number of T cells. However, it is unclear why SI variants emerge and what factors trigger the evolution of HIV from R5 to X4 variants. Interleukin-7 (IL-7), a cytokine produced by stromal cells of the thymus and bone marrow and by keratin, is known to play a key role in T-cell development. We evaluated IL-7 levels in plasma of healthy donors and HIV-positive patients and found significantly higher levels in HIV-positive patients. There was a negative correlation between circulating IL-7 levels and CD4(+) T-cell count in HIV-positive patients (r = -0.621; P < 0.001), suggesting that IL-7 may be involved in HIV-induced T-cell depletion and disease progression. IL-7 levels were higher in individuals who harbored SI variants and who had progressed to having CD4 cell counts of lower than 200 cells/microl than in individuals with NSI variants at a similar stage of disease. IL-7 induced T-cell proliferation and up-regulated CXCR4 expression in peripheral blood mononuclear cells in vitro. Taken together, our results suggest a role for IL-7 in the maintenance of T-cell regeneration and depletion by HIV in infected individuals and a possible relationship between IL-7 levels and the emergence of SI variants.

Chromium in basic foods of the Spanish diet: seafood, cereals, vegetables, olive oils and dairy products

In the present study, graphite furnace atomic absorption spectrometry (GFAAS) was used to determine the content of total chromium in some basic foods of the Spanish diet. The seafood samples, vegetables and olive oils were mineralized previously with HNO3 and V2O5. A procedure of slurries with Triton X-100 was applied to dairy products. The temperature-time program was optimized for every type of sample. An assessment of the analytical characteristics of the method verifies their reliability. The content of Cr ranged between 0.004 and 0.079 microg/g in seafood (fresh wt.), from 0.007 to 0.456 microg/g in cereals and vegetables (fresh wt.), between not detectable and 0.625 microg/g in dairy products and between not detectable and 0.040 microg/g in olive oils. The high consumption of these products conditions the fact that they should be significant sources of Cr in the diet.

[Use of procholinergics in the prevention of postoperative delirium in hip fracture surgery in the elderly. A randomized controlled trial]

INTRODUCTION

40 to 50% of elderly with hip fracture present delirium. The morbimortality increase in patients whose presented delirium.

OBJECTIVE

To study the use of citicoline (CDP choline) in the prevention of delirium in elderly under hip fracture surgery.

PATIENTS AND METHODS

A randomized control trial. The patients with hip fracture without dementia or an other organic brain illness. The medication were administered 24 hours before and during 4 days after surgery. The doses was 1.2 g/day. The primary outcome measure was percentage of patients with delirium measured with Abbreviated Mental Test (AMT) and Confusion Assessment Method (CAM). The Mini Mental State (MMS) was used before and 4 days after surgery. All treatment comparation was considered statistically significant at p< 0.05 calculating chi square and Wilcoxon test.

RESULTS

The sample size was 81 patients (46 placebo and 35 citicoline). The mean age was 79.45 for tested group and 79.97 for placebo. There was no statistically significant difference between groups with respect to ASA class of anesthesia. The incidence of delirium was 17.39% in placebo and 11.76% in citicoline group (p= 0.6). CAM and AMT at 1, 2, 3, 4 days post surgery was not significant in placebo and citicoline group (p= 0.8 and p= 0.34).

CONCLUSION

In the present study the citicoline did not prevent or reduce the incidence of delirium in hip fracture surgery in elderly.