Development of community strategies supporting brief alcohol advice in three Latin American countries: a protocol

Brief alcohol advice offered to patients was shown to be a clinically- and cost-effective intervention to prevent and manage alcohol-related health harm. However, this intervention is not yet optimally implemented in practice. A suggested strategy to improve the implementation of brief alcohol advice is through community actions which would enhance the environment in which primary healthcare providers must deliver the intervention. However, there has been scarce research conducted to date regarding which community actions have most influence on the adoption and implementation of brief alcohol advice. The current protocol presents the development of a package of community actions to be implemented in three Latin American municipalities, in Colombia, Mexico and Peru. The community actions were based on the Institute for Health Care Improvement's framework for going to full scale, and include: (i) involvement of a Community Advisory Board, (ii) involvement of a project champion, (iii) adoption mechanisms, (iv) support systems and (v) a communication campaign. By presenting a protocol for developing community actions with input from local stakeholders, this article contributes to advancing the public health field of alcohol prevention by potentially stimulating the sustainable adoption and implementation of brief alcohol advice in routine practice.

Improving alcohol management in primary health care in Mexico: A return-on-investment analysis

INTRODUCTION

Alcohol screening, brief advice and referral to treatment (SBIRT) in primary health care is an effective strategy to decrease alcohol consumption at population level. However, there is relatively scarce evidence regarding its economic returns in non-high-income countries. The current paper aims to estimate the return-on-investment of implementing a SBIRT program in Mexican primary health-care settings.

METHODS

Empirical data was collected in a quasi-experimental study, from 17 primary health-care centres in Mexico City regarding alcohol screening delivered by 145 health-care providers. This data was combined with data from a simulation study for a period of 10 years (2008 to 2017). Economic investments were calculated from a public sector health-care perspective as clinical consultation costs (salary and material costs) and program costs (set-up, adaptation, implementation strategies). Economic return was calculated as monetary gains in the public sector health-care, estimated via simulated reductions in alcohol consumption, dependent on population coverage of alcohol interventions delivered to primary health-care patients.

RESULTS

Results showed that scaling up a SBIRT program in Mexico over a 10-year period would lead to positive return-on-investment values ranging between 21% in scenario 4 (confidence interval -8.6%, 79.5%) and 110% in scenario 5 (confidence interval 51.5%, 239.8%). Moreover, over the 10-year period, up to 16,000 alcohol-related deaths could be avoided as a result of implementing the program.

DISCUSSION AND CONCLUSIONS

SBIRT implemented at national level in Mexico may lead to substantial financial gains from a public sector health-care perspective.

Extra-Thoracic Aneurysms in Marfan Syndrome: A Systematic Review of the Literature

INTRODUCTION

Marfan syndrome (MS) most often shows as thoracic aortic aneurysm (TAA) or aortic dissection, but it may also involve other vascular territories.

OBJECTIVE

To identify those extra-thoracic vascular manifestations most frequently associated with MS.

METHODOLOGY

Systematic review of the literature with PRISMA criteria. The following databases were included: Medline, Embase, Web of Science (WOS), Cumulative Index of Nursing and Health Sciences Literature (CINHAL); Spanish database MEDESY Cochrane Central Register of Controlled Trials (CENTRAL).

RESULTS

10,008 articles were identified, leaving 155 for the first stage of data analysis (total incidence of aneurysms) and 83 for the second (descriptive data analysis). Overall, 518 aneurysms were identified: 149 in the head and neck, 94 in the extremities 275 in the aortic, iliac and visceral sectors. Mostly, they were simultaneously discovered during studies of the AAT. In the abdominal aorta, the presentation with rupture in 11 of 32 patients stands out. Resection and bypass was the most frequently used method for repair in the treated cases.

CONCLUSIONS

Although its frequency in the general population is unknown, this systematic review suggests that extra-thoracic aneurysmal arterial involvement in the MS may be more frequent than expected. We believe screening for aneurysms in other vascular sectors may be advisable, especially in patients with MS and AAT.

Reduced alcohol consumption during the COVID-19 pandemic: Analyses of 17 000 patients seeking primary health care in Colombia and Mexico

Background

During the COVID-19 pandemic, an increase of heavy alcohol use has been reported in several high-income countries. We examined changes in alcohol use during the pandemic among primary health care (PHC) patients in two middle income countries, Colombia and Mexico.

Methods

Data were collected during routine consultations in 34 PHC centres as part of a large-scale implementation study. Providers measured patients’ alcohol consumption with the three item ‘Alcohol Use Disorders Identification Test’ (AUDIT-C). Generalized linear mixed models were performed to examine changes in two dependent variables over time (pre-pandemic and during pandemic): 1) the AUDIT-C score and 2) the proportion of heavy drinking patients (8+ on AUDIT-C).

Results

Over a period of more than 600 days, data from N = 17 273 patients were collected. During the pandemic, the number of patients with their alcohol consumption measured decreased in Colombia and Mexico. Each month into the pandemic was associated with a 1.5% and 1.9% reduction in the mean AUDIT-C score in Colombia and Mexico, respectively. The proportion of heavy drinking patients declined during the pandemic in Colombia (pre-pandemic: 5.4%, 95% confidence interval (CI) = 4.8% to 6.0%; during the pandemic: 0.8%, 95% CI = 0.6% to 1.1%) but did not change in Mexico.

Conclusions

Average consumption levels declined and the prevalence of heavy drinking patterns did not increase. In addition to reduced opportunities for social drinking during the pandemic, changes in the population seeking PHC and restrictions in alcohol availability and affordability are likely drivers for lower levels of alcohol use by patients in this study.

Factors associated with primary health care providers' alcohol screening behavior in Colombia, Mexico and Peru

Background: Screening for unhealthy alcohol use in routine consultations can aid primary health care (PHC) providers in detecting patients with hazardous or harmful consumption and providing them with appropriate care. As part of larger trial testing strategies to improve implementation of alcohol screening in PHC, this study investigated the motivational (role security, therapeutic commitment, self-efficacy) and organizational context (leadership, work culture, resources, monitoring, community engagement) factors that were associated with the proportion of adult patients screened with AUDIT-C by PHC providers in Colombia, Mexico and Peru. Additionally, the study investigated whether the effect of the factors interacted with implementation strategies and the country. Methods: Pen-and-paper questionnaires were completed by 386 providers at the start of their study participation (79% female, M_age = 39.5, 37.6% doctors, 15.0% nurses, 9.6% psychologists, 37.8% other professional roles). They were allocated to one of four intervention arms: control group; short training only; short training in presence of municipal support; and standard (long) training in presence of municipal support. Providers documented their screening practice during the five-month implementation period. Data were collected between April 2019 and March 2020. Results: Negative binomial regression analysis found an inverse relationship of role security with the proportion of screened patients. Self-efficacy was associated with an increase in the proportion of screened patients only amongst Mexican providers. Support from leadership (formal leader in organization) was the only significant organizational context factor, but only in non-control arms. Conclusion: Higher self-efficacy is a relevant factor in settings where screening practice is already ongoing. Leadership support can enhance effects of implementation strategies.

Simulating the city traffic complexity induced by traffic light periods

We revisited the global traffic light optimization problem through a cellular automata model, which allows us to address the relationship between the traffic lights and car routing. We conclude that both aspects are not separable. Our results show that a good routing strategy weakens the importance of the traffic light period for mid-densities, thus limiting the parameter space where such optimization is relevant. This is confirmed by analyzing the travel time normalized by the shortest path between the origin and destination. As an unforeseen result, we report what seems to be a power-law distribution for such quantities, indicating that the travel time distribution slowly decreases for long travel times. The power-law exponent depends on the density, traffic light period, and routing strategy, which in this case is parametrized by the tendency of agents to abandon a route if it becomes stagnant. These results could have relevant consequences on how to improve the overall traffic efficiency in a particular city, thus providing insight into useful measurements, which are often counter-intuitive, which may be valuable to traffic controllers that operate through traffic light periods and phases.

Pilot-scale phycoremediation using Muriellopsis sp. for wastewater reclamation in the Atacama Desert: microalgae biomass production and pigment recovery

Municipal wastewater phycoremediation represents a promising circular economy-based process for wastewater reclamation used to recover water and produce biomass. This study aimed to evaluate a pilot-scale phycoremediation system, using the most efficient strain of microalgae for wastewater reclamation in the Atacama Desert. Nitrogen and phosphorus removal, as well as biomass growth, were compared in different microalgae treatments, namely Muriellopsis sp., Scenedesmus almeriensis, Chlamydomonas segnis, Chlorella pyrenoidosa and Chlorella vulgaris. The most efficient treatments, Muriellopsis sp. and S. almeriensis, were scaled up to 20-L bubble column reactors to evaluate nutrient removal and biomass biochemical profile for potential biotechnological application. Finally, Muriellopsis sp. was selected for a pilot-scale phycoremediation experiment (800-L raceway), which removed 84% of nitrogen, 93% of phosphorus and other chemical compounds after 4 days of treatment to meet most of the Chilean standards for irrigation water (NCh. 1333. DS. MOP No. 867/78). Faecal coliforms count was reduced by 99.9%. Furthermore, biomass productivity reached 104.25 mg·L^-1·day^-1 value with 51% protein, and pigment content of 0.6% carotenoid, with 0.3% lutein. These results indicate the potential of wastewater phycoremediation at an industrial scale for the production of irrigation water and carotenoid using Muriellopsis sp.

AB1014 CLINICAL AND LABORATORY PHENOTYPES IN PATIENTS DIAGNOSED WITH SARCOIDOSIS IN A VETERAN’S HOSPITAL

Background:

Sarcoidosis is a disease which affect any organ or tissue in the body, but is predisposed to lung involvement in up to 90% of cases. Its cause is not yet established, although a multicausal model with genetic, environmental and infectious factors is proposed.

Objectives:

Determine the clinical, paraclinical characteristics and survival of patients diagnosed with Sarcoidosis treated at the Central Military Hospital.

Methods:

Historical cohort study of patients who were diagnosed with Sarcoidosis at the Central Military Hospital in the last 5 years. A review of medical records, laboratory results and radiological studies was performed and verification of survival status free of mortality was documented by independent outcomes group. A descriptive analysis was done using standard methods and non-parametric survival was calculated using the Kaplan Meyer method with confidence interval in STATA 15.

Results:

Twenty patients with confirmatory biopsy of sarcoidosis. Average age 44 ± 15.3 years, 55% (11/20) of the patients were men. Dyspnea was the most frequent reason for consultation 50% (10/20), S. Löfgren 10% (2/20), the lung was the most frequent location 65% (13/20), mild hypercalcemia and normal enzyme converting angiotensin levels were found. 60% of patients had grade 1 commitment on the chest radiograph. 60% (12/20) of the patients received immunosuppressive treatment. The overall survival at 5 years was 92% (95% CI 57-99).

Conclusion:

Sarcoidosis is a disease of young patients with a slight predominance in men. Pulmonary involvement is the most frequent, followed by mediastinal nodal involvement. Most patients received steroid treatment at some time in their life. The long-term survival of the disease is more than 90%, which indicates its benign course.

References:

[1]Iannuzzi MC, Rybicki BA, Teirstein AS. Sarcoidosis.N Engl J Med. 2007 Nov 22;357(21):2153-65.

[2]Arkema EV, Grunewald J, Kullberg S, Eklund A, Askling J. Sarcoidosis incidence and prevalence: a nationwide register-based assessment in Sweden. Eur Respir J 2016; 48: 1690–1699.

Acknowledgments:

Not aply

Disclosure of Interests:

None declared

Does following optimized routes for single cars improve car routing?

We study the impact of deserting a pre-established path, determined by a navigation software, on the overall city traffic. To do so, we consider a cellular automaton model for vehicular traffic, where the cars travel between two randomly assigned points in the city following three different navigation strategies based on the minimization of the individual paths or travel times. We found, in general, that, above a critical car density, the transport improves in all strategies if we decrease the time that the vehicles persist in trying to follow a particular strategy when a route is blocked, namely, the mean flux increases, the individual travel times decrease, and the fluctuations of density in the streets decrease; consequently, deserting helps prevent traffic jams.

Application of electrocoagulation for the efficient pollutants removal to reuse the treated wastewater in the dyeing process of the textile industry

The possibility of using electrocoagulation for efficient removal of pollutants in the industrial liquid waste of a textile industry was studied. The performance of the process was evaluated through the analysis of color, turbidity, and chemical oxygen demand (COD). The analysis was first done with the wastewater coming from the process of dyeing linen, which is the most polluting of all effluents that reach the residual effluent pool (REP). For the analysis, the MODDE 7.0 software was used to construct a statistical model. With the results obtained from this model and the experimental measurements, response surfaces were obtained. These response surfaces predicted the behavior of electrocoagulation for different values of the studied variables (pH, current density, and treatment time). Based on the obtained results, the wastewater coming from the REP was treated using the optimum values for the operational variables. After the treatment it was possible to remove 86% color, 82% turbidity, and 59% COD. It was demonstrated that reusing the treated water in the process of wool dyeing does not have a negative effect on the quality of the dyed fabric. Thus, it is possible to implement the process in the textile industry to reduce the consumption of water.

Development and Reproduction of Chrysoperla externa (Hagen) (Neuroptera: Chrysopidae) Fed on Myzus persicae (Sulzer) (Hemiptera: Aphididae) Vectoring Potato leafroll virus (PLRV)

The aim of this study was to evaluate the biological parameters of Chrysoperla externa (Hagen) while feeding on Myzus persicae (Sulzer) acting as a vector of potato leafroll virus (PLRV). In laboratory experiments, three different diets were offered ad libitum to C. externa during the larval period: M. persicae fed on PLRV-infected potato leaves, M. persicae fed on uninfected potato leaves, and eggs of the factitious prey Anagasta kuehniella (Zeller) as the control. The following parameters were studied: the developmental time and survival rate of the larval and pupal stages, the sex ratio, the proportion of fertile females, female fecundity and egg viability, and the survival curve of the first 30 days after adult emergence. PLRV-infected aphids influenced the C. externa larval developmental time and survival compared to PLRV-uninfected aphids and A. kuehniella eggs. The pupal developmental time of C. externa was shorter when fed on aphids compared to A. kuehniella eggs, but no differences were recorded between the PLRV-infected and uninfected aphid diets. Additionally, no differences were observed for pupal survival and reproduction. However, adult survival was affected by the prey type, as 75% of C. externa control adults remained alive at an age of 30 days compared to 51 and 54% for those fed on PLRV-uninfected and infected aphids, respectively.

Toxicity and sublethal effects of six insecticides to last instar larvae and adults of the biocontrol agents Chrysoperla carnea (Stephens) (Neuroptera: Chrysopidae) and Adalia bipunctata (L.) (Coleoptera: Coccinellidae)

To further develop Integrated Pest Management (IPM) strategies against crop pests, it is important to evaluate the effects of insecticides on biological control agents. Therefore, we tested the toxicity and sublethal effects (fecundity and fertility) of flonicamid, flubendiamide, metaflumizone, spirotetramat, sulfoxaflor and deltamethrin on the natural enemies Chrysoperla carnea and Adalia bipunctata. The side effects of the active ingredients of the insecticides were evaluated with residual contact tests for the larvae and adults of these predators in the laboratory. Flonicamid, flubendiamide, metaflumizone and spirotetramat were innocuous to last instar larvae and adults of C. carnea and A. bipunctata. Sulfoxaflor was slightly toxic to adults of C. carnea and was highly toxic to the L4 larvae of A. bipunctata. For A. bipunctata, sulfoxaflor and deltamethrin were the most damaging compounds with a cumulative larval mortality of 100%. Deltamethrin was also the most toxic compound to larvae and adults of C. carnea. In accordance with the results obtained, the compounds flonicamid, flubendiamide, metaflumizone and spirotetramat might be incorporated into IPM programs in combination with these natural enemies for the control of particular greenhouse pests. Nevertheless, the use of sulfoxaflor and deltamethrin in IPM strategies should be taken into consideration when releasing either of these biological control agents, due to the toxic behavior observed under laboratory conditions. The need for developing sustainable approaches to combine the use of these insecticides and natural enemies within an IPM framework is discussed.

The effect of Chrysoperla carnea (Neuroptera: Chrysopidae) and Adalia bipunctata (Coleoptera: Coccinellidae) on the spread of cucumber mosaic virus (CMV) by Aphis gossypii (Hemiptera: Aphididae)

The effects of two aphidophagous predators, the larvae of Chrysoperla carnea and adults of Adalia bipunctata, on the spread of cucumber mosaic virus (CMV) transmitted in a non-persistent manner by the cotton aphid Aphis gossypii were studied under semi-field conditions. Natural enemies and aphids were released inside insect-proof cages (1 m × 1 m × 1 m) with a central CMV-infected cucumber plant surrounded by 48 healthy cucumber seedlings, and the spatiotemporal dynamics of the virus and vector were evaluated in the short and long term (1 and 5 days) in the presence and absence of the natural enemy. The spatial analysis by distance indices methodology together with other indices measuring the dispersal around a single focus was used to assess the spatial pattern and the degree of association between the virus and its vector. Both natural enemies significantly reduced the number of aphids in the CMV-source plant after 5 days but not after 1 day. The CMV transmission rate was generally low, especially after 1 day, due to the limited movement of aphids from the central CMV-source plant, which increased slightly after 5 days. Infected plants were mainly located around the central virus-infected source plant, and the percentage of aphid occupation and CMV-infected plants did not differ significantly in absence and presence of natural enemies. The distribution patterns of A. gossypii and CMV were only coincident close to the central plant. The complexity of multitrophic interactions and the role of aphid predators in the spread of CMV are discussed.

Functional Analysis of Two Haplotypes of the Human Endothelial Protein C Receptor Gene

Objective—

To confirm the effect of the endothelial protein receptor gene ( PROCR ) haplotypes H1 and H3 on venous thromboembolism (VTE), to study their effect on endothelial protein C receptor (EPCR) expression in human umbilical vein endothelial cells, and to investigate the functionality of H1 tagging single-nucleotide polymorphisms in an in vitro model.

Approach and Results—

Protein C (PC), activated PC, and soluble EPCR (sEPCR) levels were measured in 702 patients with VTE and 518 healthy individuals. All subjects were genotyped for PROCR H1 and H3. Human umbilical vein endothelial cells isolated from 111 umbilical cords were used to study the relation between PROCR haplotypes, PROCR mRNA, cellular distribution of EPCR, and rate of PC activation. Finally, the functionality of the intragenic PROCR H1 single-nucleotide polymorphisms was analyzed using a luciferase-based method. We confirmed that individuals carrying H1 have reduced VTE risk, increased plasma activated PC levels, and reduced plasma sEPCR levels and that individuals with the H3H3 genotype have an increased VTE risk and increased plasma sEPCR levels. In cultured human umbilical vein endothelial cells, H1 is associated with increased membrane-bound EPCR, increased rate of PC activation, and reduced sEPCR in conditioned medium, but does not significantly influence PROCR mRNA levels. In contrast, H3 is associated with reduced membrane-bound EPCR and increased sEPCR in human umbilical vein endothelial cell–conditioned medium, higher levels of a truncated mRNA isoform, and a lower rate of PC activation. Finally, we identified the g.2132T>C single-nucleotide polymorphism in intron 1 as an intragenic H1-specific functional single-nucleotide polymorphism.

Conclusions—

These results support a protective role of PROCR H1 against VTE and an increased risk of VTE associated with the H3 haplotype.

Kaolin and copper-based products applications: ecotoxicology on four natural enemies

Lethal and sublethal effects of kaolin clays and two copper-based products on four natural enemies found in olive orchards Anthocoris nemoralis (F.) (Hem. Anthocoridae), Chelonus inanitus (L.) (Hym. Braconidae), Chilocorus nigritus (F.) (Col. Coccinellidae) and Scutellysta cyanea Motschulsky (Hym. Pteromalidae) are described. Both kaolin and copper can be applied for controlling the olive fruit fly and the olive moth, two important pests of this crop. The products did not increase the mortality of any of the insects studied, with the exception of A. nemoralis. The sublethal effects, however, differed depending on the parameter evaluated and the insect studied. Both kaolin and coppers slightly, but significantly, reduced the life span of C. inanitus and S. cyanea. Number of eggs laid by A. nemoralis females were reduced, but not significantly compared to the controls. In the behavioural experiments, clear preference for remaining on kaolin-untreated surfaces when insects were able to choose was observed. Despite having some negative effects, the negative impact on natural enemies was lower than the impact caused by products commonly applied in this crop against the pests stated above. Therefore, both kaolin and copper can be considered as alternative products to be applied in olive orchards if an effective resistance management programme is to be developed. Furthermore, both of them are allowed in organic farming, in which the number of products that can be applied is more restricted.

The relationship of leukocyte anisocytosis to holotranscobalamin, a marker of cobalamin deficiency

INTRODUCTION

After measurement of the mean volumes of leukocyte subpopulations as well as the distribution widths (DW) of these volumes has become available, we investigated whether such morphometric leukocyte parameters are associated with a commonly used marker of cobalamin deficiency, i.e., holotranscobalamin (HoloTC). Further, we determined reference intervals for these parameters in an elderly population.

METHODS

Consecutive subjectively healthy and volunteering individuals ≥60 years were included. Using the UniCel DxH 800 Coulter Cellular Analysis System MoMV, mean neutrophil volume (NeMV), mean lymphocyte volume (LyMV), monocyte anisocytosis (MoV-DW), neutrophil anisocytosis (NeV-DW), and lymphocyte anisocytosis (LyV-DW) were assessed together with other parameters including HoloTC.

RESULTS

A total of 150 individuals were included in the study. Reference intervals were not dependent on age and gender. MoV-DW (P = 0.002) and NeV-DW (P = 0.02) were significantly lower, and LyMV was significantly higher (P = 0.04) in participants with a HoloTC concentration <28 pm. In contrast, MCV, MoMV, NeMV, and LyV-DW were not associated with HoloTC concentrations. The area under the curve (AUC) in the receiver operating characteristic analysis for detecting a HoloTC <28 pm was 0.81 [95% confidence interval (CI) (0.73, 0.87)] for MoV-DW and 0.73 (0.66, 0.80) for NeV-DW.

CONCLUSION

In this collective of subjectively healthy elderly individuals, monocyte anisocytosis, neutrophil anisocytosis and mean lymphocyte volume were associated with decreased HoloTC.

Differences in expression and activity of 11beta-hydroxysteroid dehydrogenase type 1 and 2 in human placentas of term pregnancies according to birth weight and gender

BACKGROUND

Fetal exposure to maternal glucocorticoids may determine fetal growth and the programing of later disorders. Availability of the glucocorticoids in the placenta is regulated by the 11beta-hydroxysteroid dehydrogenase (11beta-HSDs) enzymes. To date, there are discrepancies with regard to cortisol (F) cord blood levels in fetuses with intrauterine growth retardation in different species. Objective To study the expression and activity of 11beta-HSDs in placentas from full term small for gestational age (SGA), appropriate for gestational age (AGA) and large for gestational age (LGA) newborns, and cortisol cord blood concentration.

METHODS

Twenty-five placentas from AGA, 24 SGA and 25 LGA were collected.

RESULTS

SGA newborns had significantly lower and LGA newborns had significantly higher birth weight, birth length, head circumference, and placental weight than AGA counterparts. We observed a direct correlation between placental weight and birth weight, birth length and head circumference, and higher cord F levels in SGA newborns. The 11beta-HSD1 expression was similar among the SGA, AGA, and LGA placentas. However, within the placentas of SGA newborns, the 11beta-HSD1 mRNA levels were significantly reduced in the chorionic plate compared with basal plate. An inverse correlation between cord F levels and activity of 11beta-HSD1 in the chorionic plate of the SGA placentas was detected. The 11beta-HSD2 activity was seven- to eightfold higher compared with 11beta-HSD1 in the placentas, and there was a lower 11beta-HSD2 activity in females' SGA placentas compared with the male SGA placentas.

CONCLUSION

We observed a lower expression and activity of 11beta-HSD1 in the chorionic plate of the SGA placentas, suggesting a possible compensatory mechanism to diminish the higher cortisol fetal concentrations observed in fetuses with intrauterine growth restriction.

Insights into the role of microRNAs in cardiac diseases: from biological signalling to therapeutic targets

microRNAs have recently opened new pathways to explain gene expression and disease biology in many scenarios, including cardiac diseases. microRNAs are endogenous small non-coding RNAs that mediate post-transcriptional repression or messenger RNA degradation. By annealing to inexactly complementary sequences in the 3' untranslated region of the target messenger RNA, protein level is down-regulated. Several microRNAs appear to act cooperatively through multiple target sites in one gene and, conversely, most microRNAs can target several genes. miR-133 and miR-1 are specifically expressed in cardiac and skeletal muscle and control myogenesis, cardiac development, cardiac performance and cardiomyocyte hypertrophy (mainly by tuning transcription factors and other growth-related targets). They also modulate the expression of certain cardiac ion channels and related proteins with proarrhythmic effect. Besides them, other microRNAs have been shown to exert influence on the myocardial growth, the electrical balance and the angiogenesis processes that take place in the heart. Bioinformatics is a useful tool to identify potential targets of a given microRNA, although there is still substantial concern about their reliability. Experimental manipulation of microRNAs has provided a tantalizing basis to speculate that future research on microRNAs may yield important progress in the prevention of sudden cardiac death and in the treatment of cardiac heart failure. However, the final effect of the blockage of microRNAs in vivo remains unclear, since each of them can target hundreds of genes with different intensity. The era of the microRNAs in cardiovascular diseases has just started.

The -589C>T polymorphism in the interleukin-4 gene (IL-4) is associated with a reduced risk of myocardial infarction in young individuals

BACKGROUND

Inflammatory reactions contribute to the development of arterial disease. We investigated the role of interleukin-4 (IL-4) in the development of myocardial infarction (MI) by genotyping patients with MI and control subjects for the -589C>T (rs2243250) single nucleotide polymorphism (SNP), which tags a functional haplotype of IL-4.

METHODS AND RESULTS

Study of Myocardial Infarctions Leiden (SMILE) included 560 men with a first MI and 646 control subjects. The Valencia study included 305 patients with MI at T genotype was found [odds ratio (OR) 0.84; 95% CI 0.37-1.95 for -589TT and 0.82; 95% CI 0.62-1.07 for -589CT compared with -589CC]. In patients younger than 50 years, carriership of one or two -589T alleles was associated with a reduced risk of MI (OR 0.57: 95% CI 0.34-0.95). This result was replicated in the Valencia study, where carriers of one or two -589T alleles had a reduced risk of MI (OR 0.67: 95% CI 0.47-0.95), with a strong protective effect of the -598T allele in homozygous -589T (OR 0.33: 95% CI 0.10-1.05). In the control subjects of the Valencia study, the -589T allele was associated with reduced levels of F1+2.

CONCLUSION

Our data indicate that the IL-4 haplotype tagged by the -589T allele reduces the risk of MI in young individuals.

Compatibility of endoparasitoid Hyposoter didymator (Hymenoptera: Ichneumonidae) protected stages with five selected insecticides

Hyposoter didymator (Thunberg) (Hymenoptera: Ichneumonidae) is a koinobiont endoparasitoid that emerges from the parasitization of economically important noctuid pests. H. didymator also is considered one of the most important native biocontrol agents of noctuids in Spain. Side effects of five insecticides with very different modes of action (fipronil, imidacloprid, natural pyrethrins + piperonyl butoxide, pymetrozine, and triflumuron) at the maximum field recommended rate in Spain were evaluated on H. didymator parasitizing Spodoptera littoralis (Boisduval) larvae and pupae of the endoparasitoid. Parasitized larvae were topically treated or ingested treated artificial diet. Parasitoid cocoons were topically treated. Host mortality when parasitized larvae were treated, as well as further development of the parasitoid surviving (e.g., percentage of cocoons spun, adult emergence, hosts attacked, and numbered progeny) were determined. Toxicity after treatment of parasitized larvae differed depending on the mode of exposure and insecticide. Fipronil was always highly toxic; imidacloprid killed all host insects by ingestion, but it was less toxic to both host and parasitoids, when administered topically; natural pyrethrins + piperonyl butoxide and triflumuron showed differing degrees of toxicity, and pymetrozine was harmless. Parasitoid cocoons provided effective protection against all the insecticides, except fipronil.

The social phobia and anxiety inventory: psychometric properties in a Spanish sample

This study is a validation of the Spanish version of the Social Phobia and Anxiety Inventory using a nonclinical sample (198 participants) and a clinical sample (72 participants with social phobia). The factor structure and concurrent validity with Fear of Negative Evaluation and Social Avoidance and Distress scales were analyzed. The Social Phobia and Anxiety Inventory demonstrated good concurrent validity, showing statistically significant relationships with Fear of Negative Evaluation and Social Avoidance and Distress. Results confirmed the rationale for the division of the SPAI into two subscales. Results also demonstrated the utility of the Social Phobia and Anxiety Inventory for differentiating between a nonclinical sample and participants with a social phobia, and its adequate reliability.

Circulating activated protein C is reduced in young survivors of myocardial infarction and inversely correlates with the severity of coronary lesions

BACKGROUND

Cardiovascular risk factors for myocardial infarction (MI) are less frequent in younger than in older MI survivors. Therefore, the thrombotic component of MI may play a more important role at a young age. As activated protein C (APC) provides systemic anticoagulant and anti-inflammatory protection, a low plasma APC level may be an arterial thrombotic risk factor.

AIM

To determine whether there is an association between reduced APC levels and early MI and severe coronary lesions.

METHODS

APC was measured in 231 young MI survivors and 231 controls.

RESULTS

Low APC levels were significantly associated with MI. Compared with the fourth quartile, the odds ratio (OR) for APC values in the first quartile was 3.7 [95% confidence interval (CI) = 2.1-6.4], and 3.2 (1.5-7.0) after adjustment for cardiovascular risk factors. Moreover, each decrease of 0.43 ng mL(-1) (1 SD) in APC increased the OR 1.7 times (1.4-2.2), and 1.5 times (1.2-1.9) after adjustment for cardiovascular risk factors. Low APC levels were also associated with the number of coronary arteries affected and with the severity of coronary lesions (P < 0.001).

CONCLUSIONS

There is a significant association between low circulating APC levels and both early MI and the extent and severity of coronary atherosclerosis, which might be related to the anticoagulant and anti-inflammatory properties of APC.

Association of increased fibrinogen concentration with impaired activation of anticoagulant protein C

BACKGROUND

Low levels of activated protein C (APC) are a risk factor for venous thrombosis. The mechanisms leading to interindividual differences in APC are not totally elucidated. Protein C is activated by the thrombin-thrombomodulin complex. As thrombin binds to fibrinogen and thrombomodulin through a common region, it is conceivable that fibrinogen influences the activation of protein C. This would help to explain the association between high levels of fibrinogen and an increased thrombotic risk.

METHODS

We analyzed the association between circulating APC levels and fibrinogen concentration in 382 healthy subjects. Subsequently, we studied the effect of increasing fibrinogen concentrations on the APC generation on cultured endothelial cells.

RESULTS

An independent inverse association between circulating APC levels and fibrinogen was found [betacoefficient, -0.16; 95% confidence interval (95% CI) -0.26, -0.06; P = 0.001]. For each 100 mg dL(-1) increase in fibrinogen, the independent risk of having low APC levels (<0.7 ng mL(-1)) was almost three times higher (OR 2.8; 95% CI 1.1, 7.2; P = 0.04). Accordingly, a notable association between increasing fibrinogen concentrations and the reduction in the thrombin-thrombomodulin dependent activation of protein C on endothelial cells was found (r = -0.57; P = 0.002).

CONCLUSIONS

We present evidence of an inverse association between circulating APC and fibrinogen levels. According to this finding together with the results of our in vitro experiments, we propose that the impairment in the generation of APC on endothelial cells constitutes a new prothrombotic mechanism of fibrinogen.

The multifunctional protein C system

The protein C pathway is a major regulator of blood coagulation, since it controls the conversion of prothrombin to thrombin through a feedback inhibition mechanism. Protein C circulates in plasma as an inactive zymogen and is activated on the surface of endothelial cells by the thrombin-thrombomodulin complex, a process that can be further enhanced when protein C binds to its membrane receptor, the endothelial-cell protein C receptor. Activated protein C (APC) is then released from the complex, binds protein S and inhibits thrombin formation by inactivating coagulation factors Va and VIIIa. The importance of the protein C anticoagulant pathway is emphasized by the increased risk of venous thromboembolism (VTE) associated with protein C and protein S deficiencies, the factor V Leiden mutation, and reduced circulating APC levels. The protein C pathway also plays a significant role in inflammatory processes, since it prevents the lethal effects of E. coli-associated sepsis in animal models and improves the outcome of patients with severe sepsis. APC seems to display anti-apoptotic and neuroprotective activities. Thus, it reduces organ damage in animal models of sepsis, ischemic injury, endothelial cell injury, or stroke. Further research will hopefully widen the current therapeutic perspectives in all these illnesses, where these effects might play a crucial role in their treatment. This review will summarize the mechanisms that contribute to these biological activities of the protein C pathway.