Therapeutic efficacy of unilateral subthalamotomy in Parkinson's disease: results in 89 patients followed for up to 36 months

BACKGROUND

Stereotactic thermocoagulative lesions of the subthalamic nucleus (STN) have been shown to induce significant motor improvement in patients with Parkinson's disease (PD).

PATIENTS AND METHODS

89 patients with PD were treated with unilateral subthalamotomy. 68 patients were available for evaluations after 12 months, 36 at 24 months and 25 at 36 months.

RESULTS

The Unified Parkinson's Disease Rating Scale (UPDRS) motor scores improved significantly contralaterally to the lesion in the "off" and "on" states throughout the follow-up, except for the "on" state at the last evaluation. Axial features and signs ipsilateral to the lesion progressed steadily throughout the study. Levodopa daily doses were significantly reduced by 45%, 36% and 28% at 12, 24 and 36 months post-surgery. 14 patients (15%) developed postoperative hemichorea-ballism which required pallidotomy in eight. These 14 patients had significantly higher dyskinesia scores (levodopa induced) preoperatively than the entire cohort.

CONCLUSION

Unilateral subthalamotomy was associated with significant and sustained motor benefit contralateral to the lesion. Further work is needed to ascertain what factors led to severe, persistent chorea-ballism in a subset of patients. Subthalamotomy may be considered an option in circumstances when deep brain stimulation is not viable.

Autoimmune thyroid disease in primary Sjögren's syndrome

PURPOSE

To evaluate the prevalence of autoimmune thyroid disease and thyroid dysfunction in patients with primary Sjögren's syndrome.

PATIENTS AND METHODS

Thyroid function of 33 patients with primary Sjögren's syndrome was clinically and biochemically evaluated. Thyroid hormones and autoantibodies against thyroid peroxidase, thyroglobulin, and thyroid hormones were measured.

RESULTS

Autoimmune thyroid disease and thyroid dysfunction were found in 15 cases (45%): autoimmune thyroiditis in 8 (24%); autoimmune hyperthyroidism in 2 (6%); and reversible iodine-induced hypothyroidism in the remaining 5 (15%). One or more of the evaluated autoantibodies were detected in 8 euthyroid patients (24%). Overall, the prevalence of autoantibodies against thyroid peroxidase, thyroglobulin, thyroxine, and triiodothyronine was 45%, 18%, 42%, and 36%, respectively.

CONCLUSIONS

The high prevalence of autoimmune thyroid disease and thyroid dysfunction found in primary Sjögren's syndrome, using sensitive immunologic and thyroid function tests, suggest that both diseases are more frequently associated than it was previously thought, and should be sought clinically and by laboratory tests in all patients with primary Sjögren's syndrome.

An epizootic of avian pox in endemic short-toed larks (Calandrella rufescens) and Berthelot's pipits (Anthus berthelotti) in the Canary Islands, Spain

Between January 2002 and November 2003, 50% (n = 395) of short-toed larks (Calandrella rufescens) and 28% (n = 139) of Berthelot's pipits (Anthus berthelotti) examined on the islands of Fuerteventura and Lanzarote, Canary Islands, had gross lesions compatible with avian pox. However, Spanish sparrows (Passer hispaniolensis, n = 128) and trumpeter finches (Bucanetes githagineus, n = 228), which inhabit the same steppe habitats associated with goat husbandry, did not have poxlike lesions. Histopathology and electron microscopy confirmed poxvirus in the lesions, whereas serology using standard, fowl poxvirus-and pigeon poxvirus-based diagnostic agar gel immunodiffusion techniques was negative, likely because of the limited (74.6% pipit; 74.9% lark) similarity between the viruses in our species and fowlpox virus on which the serologic tests rely. On the basis of polymerase chain reaction analyses, the virus isolated from dried lesions of C. rufescens has 80.5% similarity with the virus isolated from A. berthelotti and 91.3% similarity with canarypox, whereas A. berthelotti poxvirus has only 80% similarity with canarypox. We have two distinct and possibly new avian poxviruses. Both poultry and the wild birds on the farms were heavily infested by fleas, which may have acted as vectors in transmission of poxvirus. Disease prevalence in these Canary Island passerines is higher than that described in song birds in Hawaii that are now threatened, endangered, or extinct. Environmental and biological factors contributing to increased disease susceptibility of these isolated populations must be investigated.

Bacillus subtilis LrpC is a sequence-independent DNA-binding and DNA-bending protein which bridges DNA

Genetic evidence suggests that the Bacillus subtilis lrpC gene product participates in cell growth and sporulation. The purified LrpC protein, which has a predicted molecular mass of 16.4 kDa, is a tetramer in solution. LrpC binds with higher affinity ( K (app) approximately 80 nM) to intrinsically curved DNA than to non-curved DNA ( K (app) approximately 700 nM). DNase I footprinting and the supercoiling of relaxed circular plasmid DNA in the presence of topoisomerase I revealed that LrpC induces DNA bending and constrains DNA supercoils in vitro. The LrpC protein cooperatively increases DNA binding of the bona fide DNA-binding and DNA-bending protein Hbsu. LrpC forms inter- and intramolecular bridges on linear and supercoiled DNA molecules, resulting in a large network and DNA compactation. Collectively, these findings suggest that LrpC is an architectural protein and that its activities could provide a means to modulate DNA transactions.

Dietary protein level regulates expression of the mitochondrial branched-chain aminotransferase in rats

The first step in the degradation of branched-chain amino acids (BCAA) is transamination catalyzed by the branched-chain aminotransferase (BCAT), which is located in extrahepatic tissues. Studies of the effect of dietary protein on BCAT activity have given contradictory results. Therefore, we established the levels of BCAT activity and mitochondrial BCAT (BCATm) mRNA expression in different organs and tissues of rats. We then determined the effect of different levels of dietary protein in well-nourished rats, the effect of feeding a 0.5% casein diet for 5 wk (protein-malnourished rats) and nutritional rehabilitation of these rats with different levels of dietary protein on BCAT activity and BCATm mRNA expression in selected tissues. Finally, the response of tissue BCAT activity and BCATm mRNA levels in rats fed a 10% casein diet and injected with glucagon (4 d) or hydrocortisone (7 d) was determined. The highest concentration of BCATm mRNA was found in stomach, followed by kidney, heart, muscle, brain, skin and lung. Low levels were found in intestine, and no BCATm mRNA was detectable in liver. Although BCAT activity was significantly higher in muscle, kidney and brain from rats adapted to consume a 50% casein diet for 7 h/d for 10 d than in rats fed 6, 18 or 35% casein diets, only muscle had significantly higher levels of BCATm mRNA. In protein-malnourished rats, BCAT activity and BCATm mRNA expression in kidney, muscle and heart were not different from those of rats with free access to an 18% casein diet. Nutritional rehabilitation of the protein-malnourished rats with 50% casein for 21 d significantly increased the BCAT activity and BCATm mRNA expression in muscle. Neither hydrocortisone nor glucagon injection affected BCAT activity or BCATm mRNA concentrations in rat kidney, muscle or heart. We conclude that the nutritional regulation of BCATm is extrahepatic, tissue specific and may involve transcriptional and post-translational mechanisms.

Association between bone mineral density and polymorphisms of the VDR, ERalpha, COL1A1 and CTR genes in Spanish postmenopausal women

Bone mineral density (BMD), the major determinant of osteoporotic fracture risk, has a strong genetic component, and several candidate gene polymorphisms have been implicated in the regulation of this process. In view of the reported associations between the BMD and polymorphisms in the collagen type I alpha 1 gene (COL1A1), vitamin D receptor (VDR), estrogen receptor (ER)alpha and calcitonin receptor (CTR) genes, an association study was performed between VDR, COL1A1, CTR and ER genotypes and lumbar spine, femoral neck and Ward's triangle BMD in postmenopausal Spanish women. We statistically controlled for many confounding factors, such as height, weight, age, years since menopause, use of hormone replacement therapy (HRT), tobacco consumption, use of oral contraceptives, calcium dietary intake or exercise practice. No association between COL1A1 or ER genotypes and BMD was detected. However, we described a statistically significant association between a personal history of fractures and COL1A1 genotype. The ss genotype was found to be over-represented between those women who had a personal history of fractures. The analyses of the VDR polymorphisms showed that FF subjects reached the highest values of BMD at the three measured sites, whereas Ff individuals had an intermediate BMD and ff women had the lowest values. However, the VDR-BsmI gene polymorphism was not found to be associated with adjusted BMD. For the CTR polymorphisms, our study showed that women with the aa genotype had a lower adjusted BMD at the femoral neck. In conclusion, in our postmenopausal Spanish women cohort we found a statistically significant association beteween the VDR and CTR gene polymorphisms and the BMD. However, we did not find any association between the ER and COL1A1 gene and the BMD. The COL1A1 gene was found to be associated with the prevalence of osteoporotic fractures. Of all the studied gene polymorphisms, the FokI VDR gene polymorphism seems to be the strongest BMD genetic determinant of postmenopausal Spanish women.

Langerhans' cell histiocytosis on the vulva

BACKGROUND

Langerhans' cell histiocytosis (LCH) affecting the vulva alone is rare. At present, there are 51 published cases of LCH affecting the genital area. Of these, only 7 had LCH located in the genital area alone; in these cases, there was no subsequent systemic spread of the disease. A report of the 8th such case is presented with a review of the previous 7 cases.

CASE

A 40-year-old white woman presented with a several-month history of pruritic and ulcerous lesions on the vagina which had then spread to the vulva. No tiredness, general malaise, or associated temperature was observed. Physical examination disclosed an erythematous plaque on the labia minora, which was bilateral and slightly infiltrated. The rest of the physical examination brought no other disorders of interest to light. Histological findings were characteristic of LCH. Four cycles of iv vincristine (2 mg/m cycle) 15 days apart did not obtain objective or symptomatic improvement in the vulvar lesions. Therefore, a local and partial extirpation of both labia minora was performed. Eighteen months after surgery, the patient has no symptoms or signs of local recurrence or systemic spread.

CONCLUSIONS

Although the occurrence of LCH on the vulva is very unusual, we must bear this possibility in mind when a woman presents atypical chronic lesions on the genital mucosa. In such cases, it is necessary to perform a biopsy on the mucosa, rule out the possibility of systemic disease, and review the patient periodically in order to forestall a possible spread of the disease at any time.

Synthesis and reactivity of bridging and terminal hydrosulfido palladium and platinum complexes. Crystal structures of [NBu4]2[(Pt(c6F5)2(mu-SH)]2], [Pt(C6F5)2(PPh3)[S(H)AgPPh3]], and [Pt(C6F5)2(PPh3)[S(AuPPh3)2]]

The reactions of the hydroxo complexes [M(2)R(4)(mu-OH)(2)](2)(-) (M = Pd, R = C(6)F(5), C(6)Cl(5); M = Pt, R = C(6)F(5)), [[PdR(PPh(3))(mu-OH)](2)] (R = C(6)F(5), C(6)Cl(5)), and [[Pt(C(6)F(5))(2)](2)(mu-OH)(mu-pz)](2-) (pz = pyrazolate) with H(2)S yield the corresponding hydrosulfido complexes [M(2)(C(6)F(5))(4)(mu-SH)(2)](2-), [[PdR(PPh(3))(mu-SH)](2)], and [[Pt(C(6)F(5))(2)](2)(mu-SH)(mu-pz)](2-), respectively. The monomeric hydrosulfido complexes [M(C(6)F(5))(2)(SH)(PPh(3))](-) (M = Pd, Pt) have been prepared by reactions of the corresponding binuclear hydrosulfido complexes [M(2)(C(6)F(5))(4)(mu-SH)(2)](2-) with PPh(3) in the molar ratio 1:2, and they can be used as metalloligands toward Ag(PPh(3))(+) to form the heterodinuclear complex [(C(6)F(5))(2)(PPh(3))[S(H)AgPPh(3)]], and toward Au(PPh(3))(+) yielding the heterotrinuclear complexes [M(C(6)F(5))(2)(PPh(3))[S(AuPPh(3))(2)]]. The crystal structures of [NBu(4)](2)[[Pt(C(6)F(5))(2)(mu-SH)](2)], [Pt(C(6)F(5))(2)(PPh(3))[S(H)AgPPh(3)]], and [Pt(C(6)F(5))(2)(PPh(3))[S(AuPPh(3))(2)]] have been established by X-ray diffraction and show no short metal-metal interactions between the metallic centers.

Distribution of Aleutian mink disease virus contamination in the environment of infected mink farms

Control and eradication of Aleutian Mink Disease Virus (AMDV) are a major concern for fur-bearing animal production. Despite notably reducing disease prevalence, current control programs are unable to prevent the reinfection of farms, and environmental AMDV persistence seems to play a major role regarding this issue. In this study 114 samples from different areas and elements of seven infected mink farms were analyzed by qPCR in order to evaluate the environmental distribution of AMDV load. Samples were classified into nine categories, depending on the type of sample and degree of proximity to the animals, the main source of infection. Two different commercial DNA extraction kits were employed in parallel for all samples. qPCR analysis showed 69.3% positive samples with one kit and 81.6% with the other, and significant differences between the two DNA extraction methods were found regarding AMDV DNA recovery. Regarding sample categorization, all categories showed a high percentage of AMDV positive samples (31%-100%). Quantification of positive samples showed a decrease in AMDV load from animal barns to the periphery of the farm. In addition, those elements in direct contact with animals, the street clothes and vehicles of farm workers and personal protective equipment used for sampling showed a high viral load, and statistical analysis revealed significant differences in AMDV load between the first and last categories. These results indicate high environmental contamination of positive farms, which is helpful for future considerations about cleaning and disinfection procedures and biosecurity protocols.

Comparison of the effects of mesquite pod and Leucaena extracts with phytoestrogens on the reproductive physiology and sexual behavior in the male rat

Mesquite (Prosopis sp.) and Leucaena leucocephala are widespread legumes, widely used to feed several livestock species and as food source for human populations in several countries. Both mesquite and Leucaena contain several phytoestrogens which might have potential estrogenic effects. Thus, the aim of this study was to evaluate the effects of mesquite pod and Leucaena extracts on several aspects of behavior and reproductive physiology of the male rat. The effects of the extracts were compared with those of estradiol (E2) and of two isoflavones: daidzein (DAI) and genistein (GEN). The following treatments were given to groups of intact male rats: vehicle; mesquite pod extract; Leucaena extract; E2; DAI; GEN. The results indicate that mesquite pod and Leucaena extracts disrupt male sexual behavior in a similar way to DAI and GEN, but less than E2. The main disruptor of sexual behavior was E2, however after 40 and 50days of administration, both extracts and phytoestrogens disrupted sexual behavior in a similar way to E2. The extracts also increased testicular germ cell apoptosis, decreased sperm quality, testicular weight, and testosterone levels, as phytoestrogens did, although these effects were less than those caused by estradiol. The number of seminiferous tubules with TUNEL-positive germ cells increased in extracts treated groups in a similar way to phytoestrogens groups, and E2 caused the greatest effect. The number of TUNEL-positive cells per tubule increased only in Leucaena extract and E2 groups, but not in mesquite- and phytoestrogens-treated groups. Spermatocytes and round spermatids were the TUNEL-positive cells observed in all experimental groups. This effect was associated with smaller testicular weights without atrophy in experimental groups compared with control. Testicular atrophy was only observed in estradiol-treated males. Testosterone decreased in males of all experimental groups, compared with control, this androgen was undetectable in E2 treated males. These results suggest that mesquite pod and Leucaena extracts cause effects similar to those of phytoestrogens in male rat reproduction, these effects were lower than those caused by E2.

Feline leukemia virus outbreak in the critically endangered Iberian lynx (Lynx pardinus): high-throughput sequencing of envelope variable region A and experimental transmission

The Iberian lynx is the most endangered felid species. During winter/spring 2006/7, a feline leukemia virus (FeLV) outbreak of unexpected virulence killed about 2/3 of the infected Iberian lynxes. All FeLV-positive animals were co-infected with feline hemoplasmas. To further characterize the Iberian lynx FeLV strain and evaluate its potential virulence, the FeLV envelope gene variable region A (VRA) mutant spectrum was analyzed using the Roche 454 sequencing technology, and an in vivo transmission study of lynx blood to specified-pathogen-free cats was performed. VRA mutations indicated weak apolipoprotein B mRNA editing enzyme and catalytic polypeptide-like cytidine deaminase (APOBEC) restriction of FeLV replication, and variants characteristic of aggressive FeLV strains, such as FeLV-C or FeLV-A/61C, were not detected. Cats exposed to FeLV/Candidatus Mycoplasma haemominutum-positive lynx blood did not show a particularly severe outcome of infection. The results underscore the special susceptibility of Iberian lynxes to infectious diseases.

Optimal reactive power compensation in electrical distribution systems with distributed resources. Review

In this paper an exhaustive bibliographical revision of the mathematical methods used for the optimal selection and location of reactive power compensating elements is developed, the results obtained by different authors for different objective functions are analyzed and a scientific problem in the conflict that the electric variables show when analyzed individually is identified; thus demonstrating the need to analyze this problem in a multi-criteria way and taking into account topologies of distribution grids with distributed generation and energy storage. This research demonstrates that reactive power compensation in distribution grids with distributed resources is a problem that must be analyzed from multiple criteria that consider several objective functions to be optimized; thus achieving a global solution that contemplates an optimal location and dimensioning of reactive power compensating elements that contribute to the joint improvement of the voltage profiles, minimization of power losses, harmonic mitigation, increased line capacity, voltage stability and power factor improvement, all of them to a minimum investment cost. A theoretical heuristic is also proposed to solve the described problem, based on the multicriteria optimization method.

B-mode, utero-ovarian and intratumoural transvaginal colour Doppler ultrasonography for differential diagnosis of ovarian tumours

OBJECTIVES

The aim of this study was to evaluate and compare the use of B-mode transvaginal, utero-ovarian Doppler and intratumoural colour Doppler imaging in the diagnosis of ovarian tumours in order to establish whether they are organic or functional, and malignant or benign in nature prior to surgery.

STUDY DESIGN

A series of 213 women between the ages of 15 and 87 presenting ovarian tumours were examined with pulsed and colour Doppler and the functional state of the ovary at the time of the exploration was also established. Size and morphology were evaluated through a new scoring system called sonographic index. This score is calculated as the sum of the points corresponding to tumoural volume (< or = 8 ml = 1 point; > 8 ml and < or = 100 ml = 2 points; > 100 ml = 3 points) and the points corresponding to morphological characteristics (negative echogenicity = 1 point; mixed echogenicity = 2 points; multilocular morphology = 3 points; complex morphology = 4 points; positive echogenicity = 5 points) varying between 2 and 8 points. The flow velocity waveform (FVW) of the utero-ovarian and intratumoural arteries were obtained and analyzed after assessing their resistance indices. Other parameters studied were the presence and location of the colour signal in the intratumoural arteries.

RESULTS

Of the total, 84 of the tumours were found to be functional and had disappeared by the time later examinations took place. Surgery was performed in 129 of the patients, and posterior histopathological studies permitted classifying the tumours as benign in 107 cases and malignant in 22. The sonographic index was significantly higher in the organic (4.9 +/- 1.5) and malignant (6.9 +/- 1.0) tumours than in the functional (3.6 +/- 1.5) and the benign (4.1 +/- 1.2) tumours. The utero-ovarian and intratumoural blood flow RIs in the malignant tumours (0.48 +/- 0.12 and 0.43 +/- 0.08, respectively) was significantly lower than in the benign tumours (0.83 +/- 0.12 and 0.58 +/- 0.15, respectively). There were no significant differences in the utero-ovarian and intratumoural blood flow RIs when organic and functional tumours were compared. In all of the malignant tumours a colour signal was identified; it was centrally located in 90% of the cases. A colour signal was observed in 83% of the functional tumours, and in 52% of the organic benign tumours. In the benign tumours the colour signal was peripherally located in 98% of the cases. The variables for sensitivity, specificity, positive predictive value, negative predictive value and precision when organic tumours were diagnosed were 82.9, 65.5, 78.7, 71.4 and 76.1 for a sonographic index where the score was > or = 4; the values for the utero-ovarian RI were 48.4, 90.4, 88.4, 53.6 and 65.1 (cut-off 0.55 > or = RI > or = 0.90); the values for the intratumoural RI were 56.5, 68.6, 54.2, 70.6 and 63.8 (cut-off < or = 0.55). When malignancy was diagnosed these variables were 95.5, 82.2, 38.2, 99.4 and 83.6 for the sonographic index (score > or = 6); 90.9, 98.9, 90.0, 98.9 and 98.1 for the utero-ovarian RI (cut-off < or = 0.55) and 80.0, 66.7, 33.3, 94.1 and 69.0 for the intratumoural RI (cut-off < or = 0.50). The number of false positives diagnosed on the basis of the intratumoural RI decreased when cases that had been evaluated during the luteal phase were excluded from the study. Notwithstanding, the phase of the cycle does not seem to interfere with the diagnosis when utero-ovarian Doppler imaging is used.

CONCLUSIONS

B-mode transvaginal ultrasonography and utero-ovarian Doppler velocimetry seem to complement each other to aid in differentiating between organic and functional ovarian tumours. Transvaginal ultrasonography and Doppler imaging provide good results for the diagnosis of malignancy, although the utero-ovarian RI reduces the number of false positives that occur with ultrasonography. Our group, therefore, believes that the combined use of these techniques is beneficial in the clinical d

Organ Donation: A Comparison of Donating and Nondonating Families

The family interview to determine the wishes of the deceased during life about organ donation is not only a legal requirement, it is also the stage at which most potential donors are lost. Minimizing these losses necessitates awareness of all the variables involved in the family interview so that, before starting the interview, one understands the important key points affecting the outcome. We showed that some variables among 268 interviews are susceptible to intervention: the information and treatment perceived by the family members during the hospital stay and the preparation of the interview, such that a suitable number of the closest members of the family with a decision capacity is always present. Other noncontrollable factors that are important in the final decision included the social and demographic level, the prosocial attitude of the deceased, and prior knowledge and opinions about organ donation. Informative events within the hospital to improve the predisposition and collaboration of health care professionals were key to improving the public's perception of organ donation and achieving greater confidence in health care centers and their staff. Furthermore, the family interview must be planned by the transplant coordinators to limit improvisation.

Association between dietary antioxidant quality score (DAQs) and bone mineral density in Spanish women

BACKGROUND

Several lines of evidence suggest a tight association between oxidative stress and the pathogenesis of osteoporosis in humans. The intake of antioxidants may influence Bone Mineral Density by acting as free radical scavengers, preventing oxidation-induced damage to bone cells.

OBJECTIVE

The aim of this study was to assess the association between the Dietary Antioxidant Quality Score and bone mineral density in a sample of healthy women.

METHODS

A total of 280 women were grouped into three major groups: women aged ≤ 35 years; women aged 36-45, and finally women aged >45 years. Calcaneous Bone Mineral Density (g/cm²) was measured by dual energy X-ray absorptiometry. Data on the eating habits of each participant were collected with a structured 24-hour diet recall questionnaire. A Dietary Antioxidant Quality Score was used to calculate antioxidant-nutrient intake.

RESULTS

A significant and positive association was observed among Bone Mineral Density and dietary intake of vitamin C and selenium. Zinc intake was significantly related to Bone Mineral Density in the youngest group. Low antioxidant consumers were considered individuals whose Dietary Antioxidant Quality Score was lower or equal than the median (3.5), and high antioxidant consumers were those whose Dietary Antioxidant Quality Score were higher than 3.5. Bone Mineral Density was higher in the participants defined as high antioxidant consumers in all aged groups.

CONCLUSION

The study showed that there is an association between Bone Mineral Density and the Dietary Antioxidant Quality Score in all the women studied. Therefore, new therapies for osteoporosis based on higher dietary antioxidant intakes might be developed basing on the results obtained in this study.