'Small-scale' tourism versus traditional tourism: Which will be the new key to achieve the desired sustainable tourism?

The tourism sector after COVID-19 has raised different concerns that have lead to a development towards a more sustainable model of tourism. After the health crisis, the increase in environmental awareness of tourists has become evident. In this context, the great paradigm of 'small-scale' tourism has been developed as opposed to traditional tourism. The present work seeks to contribute to sustainable development in the Spanish tourism sector, comparing a hostel in Cantabria (considered as 'small scale' /religious tourism) and a hotel in Lloret de Mar (considered as a traditional tourism) one using the Life Cycle Assessment (LCA) methodology to verify advantages and disadvantages of both types of tourism. The functional unit (FU) used was 'per guest night with breakfast included'. The results have revealed similar results for both establishments in all impact categories, as can be seen in its contribution to Climate Change (4.41 kg CO2 eq./FU caused by the hotel and 4.78 kg CO2 eq./FU by the hostel). The electricity consumption and the impact of the breakfast in the hostel were identified as main contributors to environmental burdens (with 76.72 % of the hotel's impact to climate change and 77.36 % for the hostel); hence, improvement opportunities envisaged were focused on these critical points. On the one hand, a biomass boiler, a solar water-heating system and a hybrid solar/biomass heating are considered a more sustainable alternatives related to electricity. Natural gas and diesel Consumption, respectively. On the other hand, oatmeal, Greek yoghurt and berries are good options for a breakfast with a reduced environmental impact. It is also important to implement responsible and green practices in order to achieve more environmentally sustainable alternative and traditional accommodations. Therefore, it can be concluded by stating that LCA is a tool capable of identifying and studying the processes with the highest environmental impact in order to find out the most sustainable form of tourism.

Life cycle assessment to address the environmental impacts of tourism in a Spanish tourist destination: The case of Rias Baixas (Galicia) holidays

Tourism has grown steadily in recent decades, becoming a strategic sector for the economy in many countries. However, the environmental impacts associated with tourism have also experienced an upward trend. In this sense, innovation is needed in the tourism sector, to move towards new models and strategies that integrate environmental sustainability with the social aspects of the sector. In this study, a holistic assessment of the environmental impact of tourism has been carried out using the Life Cycle Assessment (LCA) method, considering all stages of tourism activity: transportation from the place of origin to destination and back, accommodation, catering, and activities conducted. For this purpose, a case study has been carried out based on a typical trip made from Madrid to Rías Baixas (Galicia), considering a four-night stay and the performance of two activities (music festival and cultural museum) at the destination. Two alternative transportation scenarios (train or plane) have been defined to analyze the influence of the type of transportation on the overall impact. Other touristic activities such as visiting gardens or thermal baths instead of visiting a cultural museum or attending a music festival have been analyzed and it has been found that the thermal baths and the museum have the greatest environmental impacts. Transportation was the biggest contributor to most of the environmental impacts in the selected categories. On the other hand, the stay at the destination has stood out due to the impact of the consumption of food and energy used at the accommodation facility. The impact of the activities conducted at the destination is also worth highlighting. Finally, alternative scenarios for transportation have shown that the mode of transportation selected is key for lowering the overall environmental impact of the stay at the destination, highlighting the public transportation alternative, such as the train, as the most environmentally friendly option.

Bacterial etiology of community-acquired pneumonia in immunocompetent hospitalized patients and appropriateness of empirical treatment recommendations: an international point-prevalence study

An accurate knowledge of the epidemiology of community-acquired pneumonia (CAP) is key for selecting appropriate antimicrobial treatments. Very few etiological studies assessed the appropriateness of empiric guideline recommendations at a multinational level. This study aims at the following: (i) describing the bacterial etiologic distribution of CAP and (ii) assessing the appropriateness of the empirical treatment recommendations by clinical practice guidelines (CPGs) for CAP in light of the bacterial pathogens diagnosed as causative agents of CAP. Secondary analysis of the GLIMP, a point-prevalence international study which enrolled adults hospitalized with CAP in 2015. The analysis was limited to immunocompetent patients tested for bacterial CAP agents within 24 h of admission. The CAP CPGs evaluated included the following: the 2007 and 2019 American Thoracic Society/Infectious Diseases Society of America (ATS/IDSA), the European Respiratory Society (ERS), and selected country-specific CPGs. Among 2564 patients enrolled, 35.3% had an identifiable pathogen. Streptococcus pneumoniae (8.2%) was the most frequently identified pathogen, followed by Pseudomonas aeruginosa (4.1%) and Klebsiella pneumoniae (3.4%). CPGs appropriately recommend covering more than 90% of all the potential pathogens causing CAP, with the exception of patients enrolled from Germany, Pakistan, and Croatia. The 2019 ATS/IDSA CPGs appropriately recommend covering 93.6% of the cases compared with 90.3% of the ERS CPGs (p < 0.01). S. pneumoniae remains the most common pathogen in patients hospitalized with CAP. Multinational CPG recommendations for patients with CAP seem to appropriately cover the most common pathogens and should be strongly encouraged for the management of CAP patients.

D-dimer levels and risk of recurrence following provoked venous thromboembolism: findings from the RIETE registry

BACKGROUND

Patients with venous thromboembolism (VTE) secondary to transient risk factors may develop VTE recurrences after discontinuing anticoagulation. Identifying at-risk patients could help to guide the duration of therapy.

METHODS

We used the RIETE database to assess the prognostic value of d-dimer testing after discontinuing anticoagulation to identify patients at increased risk for recurrences. Transient risk factors were classified as major (postoperative) or minor (pregnancy, oestrogen use, immobilization or recent travel).

RESULTS

In December 2018, 1655 VTE patients with transient risk factors (major 460, minor 1195) underwent d-dimer measurements after discontinuing anticoagulation. Amongst patients with major risk factors, the recurrence rate was 5.74 (95% CI: 3.19-9.57) events per 100 patient-years in those with raised d-dimer levels and 2.68 (95% CI: 1.45-4.56) in those with normal levels. Amongst patients with minor risk factors, the rates were 7.79 (95% CI: 5.71-10.4) and 3.34 (95% CI: 2.39-4.53), respectively. Patients with major risk factors and raised d-dimer levels (n = 171) had a nonsignificantly higher rate of recurrences (hazard ratio [HR]: 2.14; 95% CI: 0.96-4.79) than those with normal levels. Patients with minor risk factors and raised d-dimer levels (n = 382) had a higher rate of recurrences (HR: 2.34; 95% CI: 1.51-3.63) than those with normal levels. On multivariate analysis, raised d-dimers (HR: 1.74; 95% CI: 1.09-2.77) were associated with an increased risk for recurrences in patients with minor risk factors, not in those with major risk factors.

CONCLUSIONS

Patients with raised d-dimer levels after discontinuing anticoagulant therapy for VTE provoked by a minor transient risk factor were at an increased risk for recurrences.

Coxofemoral luxation in pet rabbits: nine cases

Of the pet rabbits presented at one private practice between August 2011 and August 2016 (n=1369), 5·6% presented with a traumatic orthopaedic injury. Of these, 7·8% (n=6) presented with traumatic coxofemoral luxation, the most frequently observed type of luxation. Three cases of non-traumatic coxofemoral luxation in pet rabbits are also discussed. Eight rabbits presented with craniodorsal luxation and one with caudoventral luxation. Five rabbits were initially treated using closed reduction and an Ehmer sling under sedation. Two rabbits responded satisfactorily to closed reduction; their bandages remained in place for 10 and 14 days, and movement was cage-limited for 1 month after bandage placement. The bandage did not prevent re-luxation in three cases. Therefore, two rabbits received iliofemoral nylon sutures, and three rabbits received a femoral neck and head ostectomy. One rabbit was treated directly using open reduction and an iliofemoral nylon suture due to fractures in the same limb. One rabbit was presented in shock, coxofemoral luxation was noticed as an incidental finding and euthanasia was elected by the owner. In conclusion, of the three rabbits treated via femoral neck and head ostectomy one rabbit had an unsatisfactory outcome and two rabbits have non-assessable outcomes. The three rabbits treated with iliofemoral sutures showed satisfactory long-term outcomes and the two rabbits treated with closed reduction and an Ehmer sling showed satisfactory medium and long-term outcomes.

OnabotulinumtoxinA in chronic migraine: predictors of response. A prospective multicentre descriptive study

BACKGROUND AND PURPOSE

OnabotulinumtoxinA is a treatment specifically approved for the prophylaxis of chronic migraine in adults. The aim of this study was to assess the effectiveness of OnabotulinumtoxinA in chronic migraine after 1 year of treatment in a real-life setting and to identify clinical predictors of outcome.

METHODS

We designed a prospective multicentre study performed in 13 hospitals in Spain. Patients underwent a complete medical history and examination. They were treated with OnabotulinumtoxinA every 12 weeks for 1 year. Data about outcome, adverse events, abortive medication use, emergency room use and disability were collected at 3 and 12 months.

RESULTS

A total of 725 subjects completed the study. At 12 months, 79.3% showed >50% reduction in number of headaches per month and 94.9% reported no adverse events. Unilaterality of pain, fewer days of disability per month and milder headache at baseline were correlated with good outcome. Duration of disease <12 months increased the chances of response to treatment with OnabotulinumtoxinA (odds ratio, 1.470; 95% confidence interval, 1.123-2.174; P = 0.045).

CONCLUSIONS

This study confirmed the effectiveness of treatment with OnabotulinumtoxinA after 1 year of treatment. The chances of a good outcome may be increased by starting treatment in the first 12 months after chronic migraine diagnosis.

Steroid hormone receptors and direct effects of steroid hormones on ram spermatozoa

This study was based on the assumption that steroid hormones present in the female genital tract may have a rapid effect on ram spermatozoa by interaction with specific surface receptors. We demonstrate the presence of progesterone (PR) and estrogen (ER) receptors in ram spermatozoa, their localization changes duringin vitrocapacitation and the actions of progesterone (P4) and 17β-estradiol (E2) on ram sperm functionality. Immunolocalization assays revealed the presence of PR mainly at the equatorial region of ram spermatozoa. Western blot analyses showed three bands in ram sperm protein extracts of 40–45 kDa, compatible with those reported for PR in the human sperm membrane, and both classical estrogen receptors (66 kDa, ERα and 55 kDa, ERβ). ERα was located in the postacrosomal region of all the spermatozoa and ERβ on the apical region of 63.7% of the cells. The presence of ERβ was correlated with the percentage of non-capacitated spermatozoa evaluated by chlortetracycline staining (R = 0.848,P < 0.001). This significantly decreased afterin vitrocapacitation and nearly disappeared when acrosome reaction was induced. The addition of P4 and E2 beforein vitrocapacitation resulted in a higher (P < 0.001) acrosome-reacted sperm rate compared with the control (13.0%), noticeably greater after 3 h and when added to a high-cAMP medium (37.3% and 47.0% with E2 and P4, respectively). In conclusion, the results of this study demonstrate for the first time that ovine spermatozoa have progesterone and estrogen receptors and that both steroid hormones are related with the induction of the acrosome reaction.

FDG-PET parameters predicting mediastinal malignancy in lung cancer

Background

Staging of mediastinal lymph nodes in non-small cell lung cancer (NSCLC) is mandatory. The maximum Standard Uptake Value (SUVmax) obtained using F-18 fluorodeoxyglucose positron emission tomography (FDG-PET) is the best non-invasive technique available for this evaluation, but its performance varies from center to center. The aim of the present study was to identify FDG-PET predictors of mediastinal malignancy that are able to minimize intercenter variability and improve the selection of subsequent staging procedures.

Method

A multicenter study of NSCLC patients staged through FDG-PET and endobronchial ultrasonography with needle aspiration (EBUS-NA) was performed using therapeutic surgery with systematic nodal dissection as gold standard. Intercenter variability and predictive power for mediastinal malignancy of different FDG-PET measures were assessed, as well as the role of these measures for selecting additional staging procedures.

Results

One hundred and twenty-one NSCLC patients, of whom 94 (72%) had ≥1 hypermetabolic spots in the mediastinum, were included in the study. Mean SUVmax of the primary tumor was 12.3 (SD 6.3), and median SUVmax of the highest hypermetabolic spots in the mediastinum was 3.9 (IQR 2.4-7). Variability of FDG-PET measures between hospitals was statistically significant (p = 0.016 and p < 0.001 respectively), but lost significance when SUVmax in the mediastinum was expressed as a ratio or a subtraction from the primary tumor (SUVmax mediastinum/tumor, p = 0.083; and SUVmax mediastinum - tumor, p = 0.428 respectively). SUVmax mediastinum/tumor showed higher accuracy in the ROC analysis (AUC 0.77 CI 0.68-0.85, p < 0.001), and showed predictive power for mediastinal malignancy when using a 0.4 cutoff (OR 6.62, 95%CI 2.98-14.69). Sensitivities and negative predictive values of clinical staging through EBUS-NA attained values ranging between 57% and 92% after FDG-PET, which improved with additional techniques when the tumor had a diameter >3 cm and/or a SUVmax mediastinum/tumor ratio >0.4.

Conclusion

The SUVmax mediastinum/tumor ratio is a good predictor of regional tumor extension in NSCLC. This measure is not influenced by intercenter variability and has an accuracy of over 70% for the identification of malignancy when using a 0.4 cutoff.

Case Report of Bilateral 3-4 Metatarsal Syndactyly in a Pet Rabbit

We report the first case of spontaneous syndactyly reported in a pet rabbit. Syndactyly only caused an atypical gait in the rabbit. The radiological study revealed bilateral 3rd and 4th metatarsal bones fused in its entire length preserving normal joint surfaces resembling syndactyly type Ia. The cause of this congenital malformation was unknown.

Comparison of Diagnostic Accuracy and Impact of Magnetic Resonance Imaging and Colonoscopy for the Management of Crohn's Disease

AIMS

The objective of the current study was to compare two patient assessment strategies using colonoscopy and MRI alternatively as first- and second-line examinations.

METHODS

Clinical data, endoscopy and magnetic resonance imaging (MRI) examinations of 100 patients diagnosed with ileocolonic Crohn's disease (CD) performed within 1 week were blindly reviewed by 4 clinical investigators. Two investigators evaluated MRI followed by colonoscopy for 50 cases and the same examinations in reverse order for another 50 cases; the other 2 investigators evaluated the same cases switching the order of examinations. The assessments included the likelihood of the presence of inflammation, stenosis, fistula and abscess, and therapeutic recommendations.

RESULTS

Information from the first examination was considered sufficient for management in 80% of cases for MRI and only 34% of cases for colonoscopy (p < 0.001). Adding MRI to the information from colonoscopy changed the clinicians' confidence grade in a higher proportion of patients than adding colonoscopy to information from MRI for the diagnosis of disease activity (10 vs 4%, p = 0.03), stenosis (25 vs 9%, p < 0.001), fistula (31 vs 0%, p < 0.001) and internal abscess (27 vs 0%, p < 0.001). Indications for anti-tumour necrosis factor (TNF) therapy (51 vs 37%, F = 0.006), and surgery (12 vs 5%, F = 0.019) were more frequent after MRI than after colonoscopy as first examination. As a second examination, MRI led to change in therapy in a higher proportion of patients than colonoscopy (28 vs 8%, p < 0.001).

CONCLUSIONS

In CD, information provided by MRI has a higher impact on patient management than colonoscopy and may be considered as a first-line examination for CD assessment.

Evidence of melatonin synthesis in the ram reproductive tract

Melatonin is a ubiquitous molecule found in a wide range of fluids, one of them being ram seminal plasma, in which it can reach higher concentrations than those found in blood, suggesting an extrapineal secretion by the reproductive tract. In order to identify the source of the melatonin found in ram seminal plasma, we first tried to determine whether the melatonin levels were maintained during the day. For this purpose, melatonin concentrations were measured in seminal plasma obtained from first ejaculates of six rams at 6:00 a.m. in total darkness, at 10:00 a.m. and at 14:00 p.m. The melatonin concentration was higher (p < 0.05) in ejaculates collected at 6:00 a.m. than at 10:00 and 14:00. There was no statistical difference between the latter. To further corroborate an extrapineal secretion of melatonin, the presence of the two key enzymes involved in melatonin synthesis, arylalkylamine-N-acetyltransferase (AANAT) and N-acetylserotonin-O-methyltransferase (ASMT) was analyzed by RT-PCR, q-PCR and Western-blot in ram testes, epididymis, and accessory glands. The RT-PCR showed the presence of the m-RNA codifying both AANAT and ASTM in all the tissues under study, but the q-PCR and Western-blot revealed that gene expression of these enzymes was significantly higher in the testis (p < 0.05). Immunohistochemistry confirmed the presence of AANAT and ASMT in the testis and revealed that they were found in the Leydig cells, spermatocytes, and spermatids. Also, measurable levels of melatonin were found in testicular tissue and the tail of the epididymis. In conclusion, our study indicates that the testes are one of the likely sources of the high levels of melatonin found in ram seminal plasma, at least during the day.

Effect of divergent selection for uterine capacity on embryonic survival and development at 30 h post-mating in unilaterally ovariectomized rabbit females

<p>Uterine capacity has been proposed as an indirect way to increase litter size. The aim of this work is to study the effect of a divergent selection for uterine capacity (UC) on reproductive traits at 30 h post mating in unilaterally ovariectomized (ULO) females. A total of 62 ULO females from the high line (selected to increase UC) and 39 ULO females from the low line (selected to decrease UC) were used. Ovulation rate was estimated as the number of corpora haemorrhagica and early embryonic survival was estimated as the ratio between number of embryos and ovulation rate. No differences in ovulation rate and early embryonic survival at 30 h post mating were found between high and low lines. Selection for UC did not change the embryonic stage of development either, the majority of embryos being at 4-cell stage. Additionally, the embryos were evaluated according to morphological criteria and more than 95% of the embryos were evaluated as good or fair quality. No differences in embryonic morphological criteria between high and low lines were found either. Thus, selection for UC did not modify the early embryonic survival and development in ULO females at 30 h post mating.</p>

Thyroid stimulating hormone directly modulates cardiac electrical activity

BACKGROUND

The electrocardiogram of hypothyroid patients shows a series of abnormalities of cardiac repolarization due to a reduction of some repolarizing K(+) currents and an increase of the L-type calcium current. Experimental and clinical works call into question the unique role of T3 and T4 in these mechanisms and correlate increased serum TSH levels with the repolarization abnormalities in patients with both subclinical and overt hypothyroidism. In this context, the aim of the present study was to investigate the direct effects of TSH upon cardiac electrical properties.

METHODS

The action potential recording and the ion channel subunits mRNA expression were obtained from left ventricle of adult rats. Additionally, the repolarizing K(+) currents and the L-type Ca(2+) current (ICa-L) were recorded in isolated rat adult ventricular myocytes by the patch-clamp technique.

RESULTS

24h exposure to TSH lengthened the action potential and slightly depolarized the resting membrane potential. TSH- receptor activation causes a reduction of the amplitude of Ito and IK1 currents caused by a reduction in channels expression. However, TSH had no effect on ICa-L, IK or IKur.

CONCLUSION

These results support the idea that some of the electrical disturbances seen in hypothyroid hearts, such as the Ito and IK1 current reduction, could be caused not by low T3 but by the elevation of circulating TSH.

Evolution over a 15-year period of the clinical characteristics and outcomes of critically ill patients with severe community-acquired pneumonia

OBJECTIVES

To study the characteristics and outcomes of patients in the ICU with severe community-acquired pneumonia (SCAP) over a 15-year surveillance period.

METHODS

We conducted a retrospective cohort study of episodes of SCAP, and assessed the epidemiology, etiology, treatment and outcomes of patients admitted to the ICU, comparing three periods (1999-2003, 2004-2008 and 2009-2013).

RESULTS

A total of 458 patients were diagnosed with SCAP. The overall cumulative incidence was 37.4 episodes/1000 admissions, with a progressive increase over the three periods (P<0.001). Patients fulfilling the two major IDSA/ATS criteria at admission increased from 64.2% in the first period to 82.5% in the last period (P=0.005). Streptococcus pneumoniae was the prevalent pathogen. The incidence of bacteremia was 23.1%, and a progressive significant reduction in overall incidence was observed over the three periods (P=0.02). Globally, 91% of the patients received appropriate empiric antibiotic treatment, increasing from 78.3% in the first period to 97.7% in the last period (P<0.001). Combination antibiotic therapy (betalactam+macrolide or fluoroquinolone) increased significantly from the first period (61%) to the last period (81.3%) (P<0.001). Global ICU mortality was 25.1%, and decreased over the three periods (P=0.001).

CONCLUSIONS

Despite a progressively higher incidence and severity of SCAP in our ICU, crude ICU mortality decreased by 18%. The increased use of combined antibiotic therapy and the decreasing rates of bacteremia were associated to improved patient prognosis.

Value of endoscopy and MRI for predicting intestinal surgery in patients with Crohn's disease in the era of biologics

OBJECTIVE

Severe endoscopic lesions (SEL) in patients with colonic Crohn's disease (CD) have been linked to higher risk of colectomy. The aims of this study were to reassess the predictive value of colonoscopy compared against MRI for requirement of resection surgery in patients with CD and determine the influence of current therapeutic options.

DESIGN

In this single-centre, observational, prospective, longitudinal study, patients with an established diagnosis of CD and suspected activity were included. After baseline assessment, including colonoscopy and MRI, patients were followed until resection surgery or the end of study.

RESULTS

112 patients were eligible for analysis. Ulcers were present in 94/112 (84%) of patients at colonoscopy (SELs in 51/112 (46%)) and stenosis in 38/112 (34%). MRI identified ulcers in 79/112 (71%) of patients, stenosis in 36/112 (32%) and intra-abdominal fistulae in 20/112 (18%). Surgical resection requirements (29/112 (26%)) were not associated with the presence of SELs at colonoscopy. The presence of stenosis (p<0.001) or intra-abdominal fistulae (p<0.001) at MRI correlated with a higher risk of surgery. In the multivariate analysis, perianal disease (OR 9 (2 to 39), p=0.003), stenosis (OR 3.4 (1 to 11), p=0.04) and fistulae at MRI (OR 10.6 (2 to 46), p=0.002) increased the risk of abdominal resection surgery, while months under immunomodulators (OR 0.94 (0.90 to 0.98), p=0.002) and/or antitumor necrosis factor (anti-TNF) therapy (OR 0.97 (0.94 to 1), p=0.04) during follow-up decreased this risk.

CONCLUSIONS

Perianal disease, stenosis and/or intra-abdominal fistulae at MRI independently predict an increased risk of resection surgery in patients with CD, whereas immunosuppressants and/or anti-TNF therapy reduce such risk. Under current therapeutic strategies, the presence of SELs is not a predictor of resection surgery in patients with CD.

Organic solar cells based on bowl-shaped small-molecules

A supramolecular approach involving bowl-shape molecules as electron donors has been used for the preparation of small-molecule solar cells. The PCE values depend directly on the formation of the supramolecular complex.

Bronchial microbiome of severe COPD patients colonised by Pseudomonas aeruginosa

The bronchial microbiome in severe COPD during stability and exacerbation in patients chronically colonised by Pseudomonas aeruginosa (PA), has not been defined. Our objective was to determine the characteristics of the bronchial microbiome of severe COPD patients colonised and not colonised by P. aeruginosa and its changes during exacerbation. COPD patients with severe disease and frequent exacerbations were categorised according to chronic colonisation by P. aeruginosa. Sputum samples were obtained in stability and exacerbation, cultured, and analysed by 16S rRNA gene amplification and pyrosequencing. Sixteen patients were included, 5 of them showing chronic colonisation by P. aeruginosa. Pseudomonas genus had significantly higher relative abundance in stable colonised patients (p = 0.019), but no significant differences in biodiversity parameters were found between the two groups (Shannon, 3 (2-4) vs 3 (2-3), p = 0.699; Chao1, 124 (77-159) vs 140 (115-163), p = 0.364). In PA-colonised patients bronchial microbiome changed to a microbiome similar to non-PA-colonised patients during exacerbations. An increase in the relative abundance over 20 % during exacerbation was found for Streptococcus, Pseudomonas, Moraxella, Haemophilus, Neisseria, Achromobacter and Corynebacterium genera, which include recognised potentially pathogenic microorganisms, in 13 patients colonised and not colonised by P. aeruginosa with paired samples. These increases were not identified by culture in 5 out of 13 participants (38.5 %). Stable COPD patients with severe disease and PA-colonised showed a similar biodiversity to non-PA-colonised patients, with a higher relative abundance of Pseudomonas genus in bronchial secretions. Exacerbation in severe COPD patients showed the same microbial pattern, independently of previous colonisation by P. aeruginosa.

Maternal-fetal thyroid function at the time of birth and its relation with iodine intake

BACKGROUND

The effects of moderate variations in dietary iodine intake on maternal and fetal thyroid function are poorly understood. Recent studies question the usefulness of neonatal screening of congenital hypothyroidism as a tool for monitoring iodine deficiency. We proposed to test the hypothesis of an association between iodine intake during the last trimester of pregnancy and fetal thyroid function at the time of birth.

METHODS

The study was undertaken at term in 233 healthy pregnant women (29.7±5.6 years) and in their newborn. Inclusion of women in the study was done within the 24 hours before delivery.

RESULTS

The median maternal urinary iodine concentration was 126.5 μg/L. The maternal free triiodothyronine (FT3), although not thyrotropin (TSH) and free thyroxine (FT4), correlated significantly with the urinary iodine concentration (r=0.17, p=0.013). The cord blood TSH, FT4, and FT3 correlated positively with the maternal urinary iodine concentration at the time of delivery (r=0.24, p=0.001; r=0.16, p=0.032; and r=0.24, p=0.003, respectively). The cord blood and heel blood TSH correlated positively with the amniotic fluid iodine concentration (r=0.21, p=0.015 and r=0.15, p=0.036). The cord blood TSH correlated positively with the cord blood FT4 (r=0.21, p=0.022) and FT3 (r=0.32, p=0.017). The maternal TSH correlated significantly with the cord blood TSH (r=0.22, p=0.014) and with the heel blood TSH (r=0.13, p=0.050).

CONCLUSIONS

The results of this study show the presence of a positive association of TSH-FT4 at the time of delivery, which may be modulated by the amount of iodine consumed by the mother during pregnancy.

Improvement of the metabolic status recovers cardiac potassium channel synthesis in experimental diabetes

AIMS

The fast transient outward current, I(to,fast) , is the most extensively studied cardiac K(+) current in diabetic animals. Two hypotheses have been proposed to explain how type-1 diabetes reduces this current in cardiac muscle. The first one is a deficiency in channel expression due to a defect in the trophic effect of insulin. The second one proposes flawed glucose metabolism as the cause of the reduced I(to,fast) . Moreover, little information exists about the effects and possible mechanisms of diabetes on the other repolarizing currents of the human heart: I(to,slow) , I(Kr) , I(Ks) , I(Kur) , I(Kslow) and I(K1) .

METHODS

We recorded cardiac action potentials and K(+) currents in ventricular cells isolated from control and streptozotocin- or alloxan-induced diabetic mice and rabbits. Channel protein expression was determined by immunofluorescence.

RESULTS

Diabetes reduces the amplitude of I(to,fast) , I(to,slow) and I(Kslow) , in ventricular myocytes from mouse and rabbit, with no effect on I(ss) , I(Kr) or I(K1) . The absence of changes in the biophysical properties of the currents and the immunofluorescence experiments confirmed the reduction in channel protein synthesis. Six-hour incubation of myocytes with insulin or pyruvate recovered current amplitudes and fluorescent staining. The activation of AMP-K reduced the same K(+) currents in healthy myocytes and prevented the pyruvate-induced current recovery.

CONCLUSION

Diabetes reduces K(+) current densities in ventricular myocytes due to a defect in channel protein synthesis. Activation of AMP-K secondary to deterioration in the metabolic status of the cells is responsible for K(+) channel reductions.

Influence of the IL6 gene in susceptibility to systemic sclerosis

OBJECTIVE

Systemic sclerosis (SSc) is a genetically complex autoimmune disease; the genetic component has not been fully defined. Interleukin 6 (IL-6) plays a crucial role in immunity and fibrosis, both key aspects of SSc. We investigated the influence of IL6 gene in the susceptibility and phenotype expression of SSc.

METHODS

We performed a large metaanalysis including a total of 2749 cases and 3189 controls from 6 white populations (Germany, The Netherlands, Norway, Spain, Sweden, and United Kingdom). Three IL6 single-nucleotide polymorphisms (SNP; rs2069827, rs1800795, and rs2069840) were selected by SNP tagging and genotyped using TaqMan(®) allele discrimination technology.

RESULTS

Individual SNP metaanalysis showed no evidence of association of the 3 IL6 genetic variants with the global disease. Phenotype analyses revealed a significant association between the minor allele of rs2069840 and the limited cutaneous SSc clinical form (Bonferroni p = 0.036, OR 1.14, 95% CI 1.04-1.25). A trend of association between the minor allele of the rs1800795 and the diffuse cutaneous SSc clinical form was also evident (Bonferroni p = 0.072, OR 0.86, 95% CI 0.77-0.96). In the IL6 allelic combination analyses, the GGC allelic combination rs2069827-rs1800795-rs2069840 showed an association with overall SSc (Bonferroni p = 0.016, OR 1.13, 95% CI 1.04-1.23).

CONCLUSION

Our results suggest that the IL6 gene may influence the development of SSc and its progression.

Haloacetic acids in swimming pools: swimmer and worker exposure

For the first time, the exposure of swimmers and workers to haloacetic acids (HAAs) in indoor and outdoor pools was evaluated through the analysis of urine samples. The subjects of this study, 49 volunteers, were male and female workers as well as swimmers (adults and children) who regularly attended an indoor pool (January-June) and an outdoor one (July and August). The results showed that HAAs appeared 20-30 min after exposure and were eliminated within 3 h. After 2 h exposure, urine samples taken from workers contained dichloroacetic (DCAA) and trichloroacetic (TCAA) acids at ~300 and ~120 ng/L levels since HAAs were aerosolized in the indoor ambient, whereas only DCAA was found in some workers' urine samples from the outdoor pool but at ~50 ng/L levels, despite the fact that the outdoor pools generally had somewhat higher levels of HAAs than the indoor pools. After 1 h swimming TCAA, DCAA and MCAA were present at concentrations of ~4400, ~2300, and ~560 ng/L, respectively, in the swimmers' urine in the indoor pool; similar results were obtained from the swimmers in the outdoor pool due to accidental ingestion. Finally, exposure estimates indicate that ingestion is the major route of exposure (~94%), followed by inhalation (~5%) and dermal contribution (~1%).

Impact of Acute Hepatitis A Virus (HAV) Infection on HIV Viral Load in HIV-Infected Patients and Influence of HIV Infection on Acute HAV Infection

Purpose: To assess the effect of hepatitis A virus (HAV) infection on HIV viral load (VL) and the influence of HIV on the clinical expression of HAV infection. Methods: Single-center study of 23 HIV-positive patients and 41 HIV-negative patients diagnosed with acute HAV infection during 2008-2009. The impact of HAV on HIV VL was defined as an increase of >0.5 log10 during the event, or a detectable VL for those previously suppressed patients. Results: The impact of acute HAV on VL was observed in 37.5% patients. HIV-negative patients were younger (27 vs 34 years, P < .0001), and serum transaminases levels normalized earlier than in the HIV-positive patients (121 vs 178 days, P < .05). Conclusions: Acute HAV infection may have an impact on HIV VL. The interactions between the 2 viruses may not only prolong the HAV viremia, with a potential increase in the transmission of infection, but the impact on HIV may increase the risk of HIV transmission. Studies with higher sample size are needed to confirm our results.