Stereo-EEG-based ictal functional connectivity in patients with periventricular nodular heterotopia-related epilepsy

Nodular heterotopia (NH)-related drug-resistant epilepsy is challenging due to the deep location of the NH and the complexity of the underlying epileptogenic network. Using ictal stereo-electroencephalography (SEEG) and functional connectivity (FC) analyses in 14 patients with NH-related drug-resistant epilepsy, we aimed to determine the leading structure during seizures. For this purpose, we compared node IN and OUT strength between bipolar channels inside the heterotopia and inside gray matter, at the group level and at the individual level. At seizure onset, the channels within NH belonging to the epileptogenic and/or propagation network showed higher node OUT-strength than the channels within the gray matter (p = .03), with higher node OUT-strength than node IN-strength (p = .03). These results are in favor of a "leading" role of NH during seizure onset when involved in the epileptogenic- or propagation-zone network (50% of patients). However, when looking at the individual level, no significant difference between NH and gray matter was found, except for one patient (in two of three seizures). This result confirms the heterogeneity and the complexity of the epileptogenic network organization in NH and the need for SEEG exploration to characterize more precisely patient-specific epileptogenic network organization.

A Decade of Firearm Injuries: Have We Improved?

BACKGROUND

Firearm injuries are a growing public health issue, with marked increases coinciding with the coronavirus disease 2019 (COVID-19) pandemic. This study evaluates temporal trends over the past decade, hypothesizing that despite a growing number of injuries, mortality would be unaffected. In addition, the study characterizes the types of centers affected disproportionately by the reported firearm injury surge in 2020.

METHODS

Patients aged 18 years and older with firearm injuries from 2011-2020 were identified retrospectively using the National Trauma Data Bank (NTDB®). Trauma centers not operating for the entirety of the study period were excluded to allow for temporal comparisons. Joinpoint regression and risk-standardized mortality ratios (SMR) were used to evaluate injury counts and adjusted mortality over time. Subgroup analysis was performed to describe centers with the largest increases in firearm injuries in 2020.

RESULTS

A total of 238,674 patients, treated at 420 unique trauma centers, met inclusion criteria. Firearm injuries increased by 31.1% in 2020, compared to an annual percent change of 2.4% from 2011-2019 (p = 0.01). Subset analysis of centers with the largest changes in firearm injuries in 2020 found that they were more often level I centers, with higher historic trauma volumes and percentages of firearm injuries (p < 0.001). Unadjusted mortality decreased by 0.9% from 2011-2020, but after controlling for demographics, injury characteristics and physiology, there was no difference in adjusted mortality over the same time period. However, among patients with injury severity scores ≥25, adjusted mortality improved compared to 2011 (SMR of 0.950 in 2020, 95% CI 0.916 - 0.986).

CONCLUSIONS

Firearm injuries pose an increasing burden to trauma systems, with level I and high-volume centers seeing the largest growth in 2020. Despite increasing numbers of firearm injuries, mortality has remained unchanged over the past decade.

LEVEL OF EVIDENCE

Level III, Prognostic/Epidemiologic.

A second-order and slice-specific linear shimming technique to improve spinal cord fMRI

PURPOSE

To develop a second-order and slice-specific linear shimming technique and investigate its efficiency in the mitigation of signal loss and distortions, and the increase of temporal signal-to-noise ratio (tSNR) within the spinal cord during functional Magnetic Resonance Imaging (fMRI) of the human cervical spinal cord.

METHODS

All scans were performed on a General Electric Discovery MR750 3 T scanner, using a head, neck and spine coil and a neurovascular array. To improve B₀ homogeneity, a field map was acquired, and second-order shims (SOS) were optimized over manually defined regions of interest (ROIs). Signal loss from dephasing by susceptibility-induced gradients was reduced by optimizing slice-specific x-, y- and z-shims to maximize signal within the spinal cord. Spectral-spatial excitation pulses were used in both the slice-specific linear shimming calibration scan and fMRI acquisitions. The shimming technique's efficiency was initially tested on eight healthy volunteers by comparing tSNR between images acquired with the manufacturer's standard linear shimming and with our SOS and xyz-shimming technique. Subsequently, using an increased spatial resolution as needed for fMRI of the spinal cord, tSNR measurements were performed on resting-state fMRI images from 14 healthy participants.

RESULTS

Spinal fMRI images acquired with only the standard linear shimming suffered from severe signal loss below the C5 vertebral level. The developed shimming technique compensated for this loss especially at levels C6 and C7, while tSNR was significantly higher at all vertebral levels with SOS and xyz-shimming than without it.

CONCLUSION

A comprehensive shimming approach which includes the use of spectral-spatial excitation pulses along with both second-order and slice-specific linear shim optimization reduces regional signal loss and increases tSNR along the c-spine (C3-C7), improving the ability to record functional signals from the human spinal cord.

[Translated article] Primary Cutaneous Lymphoma Registry of the Spanish Academy of Dermatology and Venereology (AEDV): Data for the First 5 Years

BACKGROUND AND OBJECTIVE

Primary cutaneous lymphomas (PCL) are uncommon. Observations based on the first year of data from the Spanish Registry of Primary Cutaneous Lymphomas (RELCP, in its Spanish abbreviation) of the Spanish Academy of Dermatology and Venereology (AEDV) were published in February 2018. This report covers RELCP data for the first 5 years.

PATIENTS AND METHODS

RELCP data were collected prospectively and included diagnosis, treatments, tests, and the current status of patients. We compiled descriptive statistics of the data registered during the first 5 years.

RESULTS

Information on 2020 patients treated at 33 Spanish hospitals had been included in the RELCP by December 2021. Fifty-nine percent of the patients were men; the mean age was 62.2 years. The lymphomas were grouped into 4 large diagnostic categories: mycosis fungoides/Sézary syndrome, 1112 patients (55%); primary B-cell cutaneous lymphoma, 547 patients (27.1%); primary CD30⁺ lymphoproliferative disorders, 222 patients (11%), and other T-cell lymphomas, 116 patients (5.8%). Nearly 75% of the tumors were registered in stage I. After treatment, 43.5% achieved complete remission and 27% were stable at the time of writing. Treatments prescribed were topical corticosteroids (1369 [67.8%]), phototherapy (890 patients [44.1%]), surgery (412 patients [20.4%]), and radiotherapy (384 patients [19%]).

CONCLUSION

The characteristics of cutaneous lymphomas in Spain are similar to those reported for other series. The large size of the RELCP registry at 5 years has allowed us to give more precise descriptive statistics than in the first year. This registry facilitates the clinical research of the AEDV's lymphoma interest group, which has already published articles based on the RELCP data.

Primary Cutaneous Lymphoma Registry of the Spanish Academy of Dermatology and Venereology (AEDV): Data for the First 5 Years

BACKGROUND AND OBJECTIVE

Primary cutaneous lymphomas (PCL) are uncommon. Observations based on the first year of data from the Spanish Registry of Primary Cutaneous Lymphomas (RELCP, in its Spanish abbreviation) of the Spanish Academy of Dermatology and Venereology (AEDV) were published in February 2018. This report covers RELCP data for the first 5 years.

PATIENTS AND METHODS

RELCP data were collected prospectively and included diagnosis, treatments, tests, and the current status of patients. We compiled descriptive statistics of the data registered during the first 5 years.

RESULTS

Information on 2020 patients treated at 33 Spanish hospitals had been included in the RELCP by December 2021. Fifty-nine percent of the patients were men; the mean age was 62.2 years. The lymphomas were grouped into 4 large diagnostic categories: mycosis fungoides/Sézary syndrome, 1112 patients (55%); primary B-cell cutaneous lymphoma, 547 patients (27.1%); primary CD30+lymphoproliferative disorders, 222 patients (11%), and other T-cell lymphomas, 116 patients (5.8%). Nearly 75% of the tumors were registered in stage I. After treatment, 43.5% achieved complete remission and 27% were stable at the time of writing. Treatments prescribed were topical corticosteroids (1369 [67.8%]), phototherapy (890 patients [44.1%]), surgery (412 patients [20.4%]), and radiotherapy (384 patients [19%]).

CONCLUSION

The characteristics of cutaneous lymphomas in Spain are similar to those reported for other series. The large size of the RELCP registry at 5 years has allowed us to give more precise descriptive statistics than in the first year. This registry facilitates the clinical research of the AEDV's lymphoma interest group, which has already published articles based on the RELCP data.

Public Health Tracking to address the complexity of environmental health: The case of France

To address the complex relationship between environment and health, public-health professionals have recognized the benefits of building enduring interdisciplinary partnerships and of developing innovative Environmental and Public Health Tracking (EPHT) systems. In specific, EPHT can increase understanding of environmental health threats; improve comparability of risks between different areas of the world; enable transparency and trust among citizens and institutions; and inform preventive decision making. EPHT does so by sharing data and knowledge; and by identifying and supporting best practices.

In France, the concept of EPHT builds on the observation that our changing environment creates new risks that require both specific surveillance of the link between exposure and health indicators, and syndromic surveillance (SyS) of sentinel health indicators. A specific surveillance of air pollution and health has been informing French policies on air pollution for 23 years. France has also coordinated the European Apheis and Aphekom specific-surveillance projects. Using routine pollution and health data, these projects succeeded by being built on a Europe-wide collaborative network that facilitates decision-making on local and national levels.

In addition, since the 2003 heat wave France has developed syndromic surveillance for detecting the health impacts of new threats as diverse as environmental phenomena and emerging infectious diseases. France also coordinated the Triple-S project, which inventoried SyS activities in Europe; and produced guidelines for human and veterinary SyS in Member States and a proposal for a European SyS strategy. Examples of the complementarity between specific and SyS in environmental health in France include: heat and cold waves, air pollution, flooding, storms and industrial accidents. In today's world of open data, EPHT shows great promise for contributing to better informing decision makers and the population on environmental-health risks.

Key messages

Environmental and Public Health Tracking (EPHT) systems and enduring interdisciplinary partnerships provide an innovative way to address the complex relationship between environment and health. France has been in the forefront of applying innovative EPHT (Environmental and Public Health Tracking) by using complementary specific and syndromic (SyS) surveillance systems.

Update on oxidative stress and inflammation in pregnant women, unborn children (nasciturus), and newborns - Nutritional and dietary effects

The scientific background of perinatal pathology, regarding both mother and offspring, from the lipidomic perspective, has highlighted the possibility of identifying new, promising clinical markers of oxidative stress and inflammation, closely related to the normal development of unborn and newborn children, together with their application. In this regard, in recent years, significant advances have been achieved, assisted by both newly developed analytical tools and basic knowledge on the biological implications of oxylipins. Hence, in the light of this recent progress, this review aims to provide an update on the relevance of human oxylipins during pregnancy and in the unborn and newborn child, covering two fundamental aspects. Firstly, the evidence from human clinical studies and dietary intervention trials will be used to shed light on the extent to which dietary supplementation can modulate the lipidomic markers of oxidative stress and inflammation in the perinatal state, emphasizing the role of the placenta and metabolic disturbances in the mother and fetus. The second part of this article comprises a review of existing data on specific pathophysiological aspects of human reproduction, in relation to lipidomic markers in pregnant women, unborn children, and newborn children. The information reviewed here evidences the current opportunity to correct reproductive disturbances, in the framework of lipidomics, by fine-tuning dietary interventions.

Choices Behind Numbers: a Review of the Major Air Pollution Health Impact Assessments in Europe

Purpose of Review

The aim of this review is to identify the key contextual and methodological differences in health impact assessments (HIA) of ambient air pollution performed for Europe. We limited our review to multi-country reviews. An additional aim is to quantify some of these differences by applying them in a HIA template in three European cities.

Recent Findings

Several HIAs of ambient air pollution have been performed for Europe, and their key results have been largely disseminated. Different studies have, however, come up with substantial differences in attributed health effects. It is of importance to review the background contributing to these differences and to quantify their importance for decision makers who will use them.

Summary

We identified several methodological differences that could explain the discrepancy behind the number of attributable deaths or years of life lost. The main differences are due to the exposure-response functions chosen, the ways of assessing air pollution levels, the air pollution scenarios and the study population. In the quantification part, we found that using risk estimates from the European Study of Cohorts for Air Pollution Effects (ESCAPE) instead of the American Cancer Society (ACS) study could nearly double the attributable burden of ambient air pollution.

This study provides some insights into the differential results in previously published HIAs on air pollution in Europe. These results are important for stakeholders in order to make informed decisions.

Electronic supplementary material

The online version of this article (10.1007/s40572-018-0175-2) contains supplementary material, which is available to authorized users.

Patient and physician satisfaction in an observational study with methyl aminolevulinate daylight photodynamic therapy in the treatment of multiple actinic keratoses of the face and scalp in six European countries

BACKGROUND

Guidelines recommend treating actinic keratoses (AKs) as they are recognized as precursors of invasive squamous cell carcinoma.

OBJECTIVE

The objective of this study was to collect real-world clinical data on the use of methyl aminolevulinate daylight photodynamic therapy (MAL DL-PDT) for the treatment of face and scalp AK in Europe.

METHODS

A prospective, multicenter, non-interventional study was conducted in six European countries in patients receiving a single treatment of MAL DL-PDT for face and/or scalp AK. Patient-reported outcomes were assessed by patient questionnaires at baseline and at 3 months after treatment, efficacy was assessed at 3 months using a 6-point global improvement scale, and adverse events (AE) were recorded at each visit.

RESULTS

Overall, 325 patients were enrolled from 52 investigational centres, 314 of whom attended the 3-month visit. Most patients had multiple lesions (58.4% had >10 lesions) with lesions mainly located on the scalp (60.0%) and/or forehead (54.2%). AKs were predominantly grade I (39.4%) or grade II (33.2%), and 10.5% of patients had grade III lesions. The proportions of patients and physicians that were overall satisfied to very satisfied with the MAL DL-PDT treatment were 80.4% and 90.3%, respectively. The vast majority of patients (90.0%) would consider using MAL DL-PDT again if needed. Physician-assessed efficacy at 3 months was at least much improved in 83.5% of patients, with 45.9% of patients requiring no retreatment. Related AEs were reported in 15% of patients.

CONCLUSION

Use of MAL DL-PDT for multiple face and/or scalp AKs resulted in high levels of patient and physician satisfaction in clinical practice in Europe, reflecting the good efficacy and high tolerability of this convenient procedure.

The International Mood Network (IMN) Nosology Project: differentiating borderline personality from bipolar illness

OBJECTIVE

The differential diagnosis of bipolar illness vs. borderline personality is controversial. Both conditions manifest impulsive behavior, unstable interpersonal relationships, and mood symptoms. This study examines whether and which mood clinical features can differentiate between both conditions.

METHOD

A total of 260 patients (mean ± standard deviation age 41 ± 13 years, 68% female) attending to a mood clinic were examined for diagnosis of bipolar illness and borderline personality disorder using SCID-I, SCID-II, and clinical mood criteria extracted from Mood Disorder Questionnaire (MDQ). They were analyzed using diagnoses as dependent variables. Predictors of bipolar and borderline diagnoses were identified by multivariable logistic regressions, and predictive validity of models was assessed using ROC curve analysis.

RESULTS

Bipolar illness was strongly predicted by elevated mood (OR = 4.02, 95% CI: 1.80-9.15), increased goal-directed activities (OR = 3.90, 95% CI: 1.73-8.96), and episodicity of mood symptoms (OR = 3.48, 95% CI 1.49-8.39). This triad model predicted bipolar illness with 88.7% sensitivity, 81.4% specificity, and obtained an auROC of 0.91 (95% CI: 0.76-0.96) and a positive predictive value of 85.1%. For borderline personality disorder, only female gender was a statistically significant predictor (OR = 3.41, 95% CI: 1.29-13.7), and the predictive model obtained an auROC of 0.67 (95% CI: 0.53-0.74).

CONCLUSION

In a mood disorder clinic setting, manic criteria and episodic mood course distinguished bipolar illness from borderline personality disorder.

In vivo evidence of mitochondrial dysfunction and altered redox homeostasis in a genetic mouse model of propionic acidemia: Implications for the pathophysiology of this disorder

Accumulation of toxic metabolites has been described to inhibit mitochondrial enzymes, thereby inducing oxidative stress in propionic acidemia (PA), an autosomal recessive metabolic disorder caused by the deficiency of mitochondrial propionyl-CoA carboxylase. PA patients exhibit neurological deficits and multiorgan complications including cardiomyopathy. To investigate the role of mitochondrial dysfunction in the development of these alterations we have used a hypomorphic mouse model of PA that mimics the biochemical and clinical hallmarks of the disease. We have studied the tissue-specific bioenergetic signature by Reverse Phase Protein Microarrays and analysed OXPHOS complex activities, mtDNA copy number, oxidative damage, superoxide anion and hydrogen peroxide levels. The results show decreased levels and/or activity of several OXPHOS complexes in different tissues of PA mice. An increase in mitochondrial mass and OXPHOS complexes was observed in brain, possibly reflecting a compensatory mechanism including metabolic reprogramming. mtDNA depletion was present in most tissues analysed. Antioxidant enzymes were also found altered. Lipid peroxidation was present along with an increase in hydrogen peroxide and superoxide anion production. These data support the hypothesis that oxidative damage may contribute to the pathophysiology of PA, opening new avenues in the identification of therapeutic targets and paving the way for in vivo evaluation of compounds targeting mitochondrial biogenesis or reactive oxygen species production.

Effect of elite physical exercise by triathletes on seven catabolites of DNA oxidation

The oxidized nucleoside 8-hydroxy-2'-deoxyguanosine has been widely studied as a marker of DNA oxidation; however, data on the occurrence of other metabolites in plasma that are related to DNA damage are scarce. We have applied an improved, sensitive, robust, and reliable method, involving solid phase extraction and ultrahigh-performance liquid chromatography (UHPLC)-tandem mass spectrometry (MS/MS), to the precise quantitation of seven metabolites in the plasma of 15 elite triathletes after a 2-week training program. All compounds were eluted in the first 1.6 min, with limits of detection and quantification ranging between 0.001 and 0.3 ng.mL(-1) and 0.009 and 0.6 ng.mL(-1), respectively. Four compounds were detected in plasma: guanosine-3'-5'-cyclic monophosphate, 8-hydroxyguanine, 8-hydroxy-2'-deoxyguanosine, and 8-nitroguanosine. After two weeks of training, 8-hydroxyguanine exhibited the highest increase (from 0.031 ± 0.008 nM to 0.036 ± 0.012 nM) (p < 0.05), which could be related to the enhanced activity of DNA-repairing enzymes that excise this oxidized base. Increased levels of guanosine-3'-5'-cyclic monophosphate and 8-hydroxy-2'-deoxyguanosine were also observed. In contrast, levels of 8-nitroguanosine (p < 0.05) were significantly reduced, which might be a protective measure as this compound strongly stimulates the generation of superoxide radicals, and its excess is related to pathologies such as microbial (viral) infections and other inflammatory and degenerative disorders. The results obtained indicate an induced adaptive response to the increased oxidative stress related to elite training, and point to the benefits associated with regular exercise.

Alcoholic fermentation induces melatonin synthesis in orange juice

Melatonin (N-acetyl-5-methoxytryptamine) is a molecule implicated in multiple biological functions. Its level decreases with age, and the intake of foods rich in melatonin has been considered an exogenous source of this important agent. Orange is a natural source of melatonin. Melatonin synthesis occurs during alcoholic fermentation of grapes, malt and pomegranate. The amino acid tryptophan is the precursor of all 5-methoxytryptamines. Indeed, melatonin appears in a shorter time in wines when tryptophan is added before fermentation. The aim of the study was to measure melatonin content during alcoholic fermentation of orange juice and to evaluate the role of the precursor tryptophan. Identification and quantification of melatonin during the alcoholic fermentation of orange juice was carried out by UHPLC-QqQ-MS/MS. Melatonin significantly increased throughout fermentation from day 0 (3.15 ng/mL) until day 15 (21.80 ng/mL) reaching larger amounts with respect to other foods. Melatonin isomer was also analysed, but its content remained stable ranging from 11.59 to 14.18 ng/mL. The enhancement of melatonin occurred mainly in the soluble fraction. Tryptophan levels significantly dropped from 13.80 mg/L (day 0) up to 3.19 mg/L (day 15) during fermentation. Melatonin was inversely and significantly correlated with tryptophan (r = 0.907). Therefore, the enhancement in melatonin could be due to both the occurrence of tryptophan and the new synthesis by yeast. In summary, the enhancement of melatonin in novel fermented orange beverage would improve the health benefits of orange juice by increasing this bioactive compound.

Central immune overactivation in the presence of reduced plasma corticosterone contributes to swim stress-induced hyperalgesia

Although it is widely known that immunological, hormonal and nociceptive mechanisms are altered by exposure to repeated stress, the interplaying roles of each function in the development of post-stress hyperalgesia are not completely clear. Thus, we wanted to establish how interleukin 1-beta (IL-1β), corticosterone and microglia interact to contribute in the development of hyperalgesia following repeated forced swim. Rats were subjected to either forced swim, sham swim or non-conditioned. Each group was then treated with minocycline, ketoconazole, or saline. Thermal nociception was measured via the hot plate test, before and after the behavioral conditioning, whereas blood and lumbar spinal cord tissue samples were obtained at the end of the protocol. Serum levels of corticosterone, spinal tissue concentration of IL-1β and spinal OX-42 labeling (microglial marker) were determined. Rats exposed to forced swim stress developed thermal hyperalgesia along with elevated spinal tissue IL-1β, increased OX-42 labeling and relatively diminished serum corticosterone. Pre-treatment with minocycline and ketoconazole prevented the development of thermal hyperalgesia and the increase in IL-1β, without significantly modifying serum corticosterone. These results suggest that the development of forced swim-induced thermal hyperalgesia requires the simultaneous presence of increased spinal IL-1β, microglial activation, and relatively decreased serum corticosterone.

Effect of water deficit and domestic storage on the procyanidin profile, size, and aggregation process in pear-jujube (Z. jujuba) fruits

No information exists on the proanthocyanidin content of pear-jujube (Ziziphus jujuba Mill) fruit, their polymeric types and sizes, and their self-aggregation, or on the effect of different water deficit levels during the fruit maturation period on these compounds. Two trimers, two tetramers, and six B type procyanidin pentamers were identified and quantified for the first time. Water deficit increased the content of procyanidins of low molecular mass, improving their potential bioavailability and possible physiological effects on human health. The tendency of procyanidins to self-aggregate was similar in the edible portion and pit, and was not affected by water deficit. The procyanidin content of fruit from well watered trees increased during domestic cold storage, whereas the fruits from trees suffering severe water stress lost some of their procyanidin content.

Assessing the public health impacts of urban air pollution in 25 European cities: results of the Aphekom project

INTRODUCTION

The Aphekom project aimed to provide new, clear, and meaningful information on the health effects of air pollution in Europe. Among others, it assessed the health and monetary benefits of reducing short and long-term exposure to particulate matter (PM) and ozone in 25 European cities.

METHOD

Health impact assessments were performed using routine health and air quality data, and a common methodology. Two scenarios were considered: a decrease of the air pollutant levels by a fixed amount and a decrease to the World Health Organization (WHO) air quality guidelines. Results were economically valued by using a willingness to pay approach for mortality and a cost of illness approach for morbidity.

RESULTS

In the 25 cities, the largest health burden was attributable to the impacts of chronic exposure to PM2.5. Complying with the WHO guideline of 10 μg/m(3) in annual mean would add up to 22 months of life expectancy at age 30, depending on the city, corresponding to a total of 19,000 deaths delayed. The associated monetary gain would total some €31 billion annually, including savings on health expenditures, absenteeism and intangible costs such as well-being, life expectancy and quality of life.

CONCLUSION

European citizens are still exposed to concentrations exceeding the WHO recommendations. Aphekom provided robust estimates confirming that reducing urban air pollution would result in significant health and monetary gains in Europe. This work is particularly relevant now when the current EU legislation is being revised for an update in 2013.

Physical activity increases the bioavailability of flavanones after dietary aronia-citrus juice intake in triathletes

Control and triathlete volunteers (n=8 and n=15, respectively) were given 400 mL and 200 mL of aronia-citrus juice (AC-juice), respectively. The 24h urine samples were hydrolysed to determine the flavanones concentration by UPLC-QqQ-MS/MS. The flavanones metabolites in both groups of volunteers were glucuronides, sulfates, and sulfo-glucuronides, and the total excretion of flavanones increased fivefold in the triathletes compared with the control volunteers. The increase of ninefold in the homoeriodictyol of triathletes compared to control volunteers may suggest the overactivation of the microbiota metabolism caused by physical exercise. No differences concerning the bioavailability were detected between men and women in controlboth groups. The AC-juice could provide synergistic effects on health due to the increase in the bioavailability of flavanones, avoiding the deleterious effects caused by the overdosage of nutritional supplements.

A ultra-pressure liquid chromatography/triple quadrupole tandem mass spectrometry method for the analysis of 13 eicosanoids in human urine and quantitative 24 hour values in healthy volunteers in a controlled constant diet

RATIONALE

Isoprostanes (IsoPs) are a series of prostaglandin (PG)-like compounds formed non-enzymatically through free-radical-induced peroxidation of arachidonic acid. They are considered as 'gold-standard' biomarkers for oxidative stress, in general, and lipid peroxidation, in particular.

METHODS

A new qualitative and quantitative analytical method for the determination of 13 eicosanoids in human urine using solid-phase extraction (SPE) and ultra-pressure liquid chromatography coupled to tandem mass spectrometry (UPLC/MS/MS) has been developed. The SPE was optimized by comparison of the extraction efficiency and recoveries of three distinct cartridges: Strata X-AW, C18 Sep-Pak, and Oasis HLB. The UPLC/MS/MS approach in the multiple reaction monitoring (MRM) mode was developed using negative electrospray ionization (ESI).

RESULTS

The validated method provides a high-throughput assay with an adequate linearity from 0.16 to 330 ng mL(-1). The limit of detection (LOD) and limit of quantification (LOQ) for each analyte showed low intervals (0.021-0.64 ng mL(-1) and 0.042-1.28 ng mL(-1), respectively). Urinary IsoPs were determined in 24 healthy volunteers and ranged from 685 to 3480 ng 24 h(-1) and from 864 to 7511 ng 24 h(-1) in urine from women and men, respectively.

CONCLUSIONS

This analytical method could constitute a useful tool for the determination of oxidative stress biomarkers in clinical studies in which IsoPs may evidence early pathological conditions, as suggested by the determination of the baseline IsoPs content in human urine, since it improves upon the detection capacity of previously described methods. The quantity of IsoPs excreted in urine was higher than that found in previous reports due to the total hydrolysis of the conjugated forms.

Soy isoflavones and cardiovascular disease epidemiological, clinical and -omics perspectives

Cardiovascular disease (CVD) mortality rates are lower in Asian countries where dietary patterns are very different from Western diet. A number of studies have linked these lower rates to the inclusion of soy products as a staple food in those countries. Soy is the richest dietary source of isoflavones, a type of phytoestrogen associated with many potentially beneficial effects. Isoflavone-containing soy protein consumption has been linked to reduced levels of LDL cholesterol in hypercholesterolemic patients. This effect is increased with the concomitant administration of isoflavones, and seems to be also complemented by the isoflavone capacity to restore the endothelial function in patients with weak and moderated endothelial dysfunction. The effects are variable depending on individuals� � � metabolism and in particular to their ability to convert daidzein to equol that seems to be restricted to approximately 1/3 of the population. Equol production has been indeed linked to a decreased arterial stiffness and antiatherosclerotic effects via NO production. Because the relevance of isoflavones consumption on the modulation of cardiovascular risk still remains unclear, this paper aims to review the existing knowledge on the biological activity of the isoflavones on the human cardiovascular system from an epidemiological, clinical and -omics point of view.

Fatty liver disease is associated with underlying cardiovascular disease in HIV-infected persons(*)

BACKGROUND

Cardiovascular disease is an increasing concern among HIV-infected persons and their providers. We determined if fatty liver disease is a marker for underlying coronary atherosclerosis among HIV-infected persons.

METHODS

We performed a cross-sectional study in HIV-infected adults to evaluate the prevalence of and factors, including fatty liver disease, associated with subclinical coronary atherosclerosis. All participants underwent computed tomography for determination of coronary artery calcium (CAC; positive defined as a score >0) and fatty liver disease (defined as a liver-to-spleen ratio <1.0). Factors associated with CAC were determined using multivariate logistic regression models.

RESULTS

We included in the study 223 HIV-infected adults with a median age of 43 years [interquartile range (IQR) 36-50 years]; 96% were male and 49% were Caucasian. The median CD4 count was 586 cells/μL and 83% were receiving antiretroviral medications. Seventy-five (34%) had a positive CAC score and 29 (13%) subjects had fatty liver disease. Among those with CAC scores of 0, 1-100 and >100, the percentage with concurrent fatty liver disease was 8, 18 and 41%, respectively (P=0.001). In the multivariate model, CAC was associated with increasing age [odds ratio (OR) 4.3 per 10 years; P<0.01], hypertension (OR 2.6; P<0.01) and fatty liver disease (OR 3.8; P<0.01).

CONCLUSIONS

Coronary atherosclerosis as detected using CAC is prevalent among young HIV-infected persons. The detection of fatty liver disease among HIV-infected adults should prompt consideration of assessment for underlying cardiovascular disease and risk factor reduction.

Estimation de la mortalité attribuable aux particules (PM10) dans les 9 villes françaises participant au programme européen Apheis

The relationship between air pollution and mortality is now admissible with a sufficiently high level of causality proven. This link allows for health impact assessment to be carried out with a significant degree of accuracy, such as the case for the results which are presented here from the nine French cities involved in the Apheis programme. This health impact assessment is based on the methodology developed by the World Health Organization. The number of avoidable deaths is contained between categories ranging from 2.0 to 4.3, 4.0 to 8.9, and from 15.0 to 31.5 per 100,000 inhabitants according to very short term effects, short term effects and long term effects, respectively. There are two scenarios which can be envisioned for the reduction of fine particles levels which are capable of obtaining similar results for both very short term and short term effects. The first involves diminishing the daily concentrations which are above 20 microg/m3 until they reach this value, and the second entails systematically decreasing the daily levels by 5 microg/m3. The first strategy of reducing values to stabilize at 20 microg/m3 has been shown to be the one most favourable and promising for the long term effects. This strategy therefore confirms the reliability and strength of the recommendation formulated at the national level.

Retentissement de la pollution atmosphérique sur la santé

OBJECTIVES

To quantify the short term effects of air pollution on mortality and hospitalisation for cardiovascular or respiratory disorders in the nine French cities (Bordeaux, Le Havre, Lille, Lyon, Marseille, Paris, Rouen, Strasbourg and Toulouse) of the Surveillance Air et Santé program.

METHODS

Data were available on mortality and hospitalisation were available, respectively, from 1990 to 1997 and 1995 to 1999. Exposure data were the concentrations of sulphur dioxide, particles with a diameter of less than or equal to 10 mm, black smoke, nitrogen dioxide, ozone, and carbon monoxide. The analysis assessed the relationships, in each of the cities, between the daily numbers of deaths and hospitalisations and the daily levels of polluting agents, taking into account confounding factors. A combined relative risk was calculated for all the cities. The number of deaths and hospitalisations attributable to air pollution was then estimated for each of the cities, based on the relative risk.

RESULTS

Significant relationships were found for mortality, from whatever cause, and for hospitalisations for respiratory disorders in children aged under 15. If the levels of air pollution were reduced to 10 microg/m3 in the nine cities, 2800 premature deaths and 750 hospitalisations for respiratory disorders in children would be avoided, every year.

CONCLUSION

Today, it is possible to assess the benefits of reducing air pollution in terms of health in the short term. These analyses would provide a sanitary dimension to the strategies for the reduction of urban pollution on local and European level.

Apheis: public health impact of PM10 in 19 European cities

STUDY OBJECTIVE

Apheis is a public health surveillance system that aims to provide European, national, regional, and local decision makers, environmental health professionals, and the general public with up to date and easy to use information on air pollution and public health. This study presents the health impact assessment done in 19 cities of Western and Eastern European countries.

DESIGN

Apheis developed guidelines for gathering and analysing data on air pollution and the impact on public health. Apheis has analysed the acute and chronic effects of fine particles on premature mortality using the estimates developed by Aphea2 study and two American cohort studies. This health impact assessment was performed for different scenarios on the health benefits of reducing levels of particles less than 10 microm in size (PM(10)).

MAIN RESULTS

PM(10) concentrations were measured in 19 cities (range: 14-73 microg/m(3)). The population covered in this health impact assessment includes nearly 32 million inhabitants. The age standardised mortality rates (per 100 000 people) range from 456 in Toulouse to 1127 in Bucharest. Reducing long term exposure to PM(10) concentrations by 5 microg/m(3) would have "prevented" between 3300 and 7700 early deaths annually, 500 to 1000 of which are associated with short term exposure.

CONCLUSIONS

Apheis shows that current levels of air pollution in urban Europe have a non-negligible impact on public health, and that preventive measures could reduce this impact, even in cities with low levels of air pollution.

[Urban particulate air pollution: from epidemiology to health impact in public health]

Major air pollution accidents which occurred in the 1950s led to public awareness of the health hazards involved. Since that period, levels of air pollution have decreased, but several studies conducted in North America and Europe indicate that particulate air pollution is linked to increased cardiorespiratory morbidity and mortality. Despite this evidence, several questions were raised concerning the interpretation of the results (threshold effect, harvesting effect and biological plausibility). The aim of this review is to present the link between epidemiological findings and their use in health impact assessment. We review the main causal criteria applied to epidemiology in light of scientific evidence currently available. Some causality criteria are more important than others, but they all support the causal nature of the relationship between air pollution and health, and thus justify the feasibility of health impact assessment calculations. Recent studies on relative risk assessment show that even if the risk linked to worsening air quality is low, public health consequences are high. Such information must be made accessible to policy makers and the population in general so that, together with the public health workers, they can all contribute to improving air quality and health in their communities.

Short-term effects of ambient particles on mortality in the elderly: results from 28 cities in the APHEA2 project

Within the framework of the APHEA2 (Air Pollution on Health: a European Approach) project, the effects of ambient particles on mortality among persons > or = 65 yrs were investigated. Daily measurements for particles with a 50% cut-off aerodynamic diameter of 10 microm (PM10) and black smoke (BS), as well as the daily number of deaths among persons > or = 65 yrs of age, from 29 European cities, have been collected. Data on other pollutants and meteorological variables, to adjust for confounding effects and data on city characteristics, to investigate potential effect modification, were also recorded. For individual city analysis, generalised additive models extending Poisson regression, using a locally weighted regression (LOESS) smoother to control for seasonal effects, were applied. To combine individual city results and explore effect modification, second stage regression models were applied. The per cent increase (95% confidence intervals), associated with a 10 microg x m(-3) increase in PM10, in the elderly daily number of deaths was 0.8%, (0.7-0.9%) and the corresponding number for BS was 0.6%, (0.5-0.8%). The effect size was modified by the long-term average levels of nitrogen dioxide (higher levels were associated with larger effects), temperature (larger effects were observed in warmer countries), and by the proportion of the elderly in each city (a larger proportion was associated with higher effects). These results indicate that ambient particles have effects on mortality among the elderly, with relative risks comparable or slightly higher than those observed for total mortality and similar effect modification patterns. The effects among the older persons are of particular importance, since the attributable number of events will be much larger, compared to the number of deaths among the younger population.