A Sustainable Material for Sheep's Cheese Wedges Stored under Different Atmosphere Conditions

This study is based on the need to improve packaging sustainability in the food industry. Its aim was to assess the performance of a recyclable plastic material for semi-hard sheep's cheese wedges packaging as an alternative to conventional non-sustainable plastic materials. Four different packaging treatments (air, vacuum, and CO2/N2 gas mixtures 50/50 and 80/20% (v/v)) were studied. Changes in gas headspace composition, sensory properties, cheese gross composition, weight loss, pH, colour, and texture profile were investigated at 5 ± 1 °C storage for 56 days. The sensory analysis indicated that vacuum packaging scored the worst in paste appearance and holes, and air atmosphere the worst in flavour; it was concluded that cheeses were unfit from day 14-21 onwards. Air and vacuum packaging were responsible for most of the significant changes identified in the texture profile analysis, and most of these happened in the early stages of storage. The colour parameters a* and b* differentiated the air packaging from the rest of the conditions. As in previous studies using conventional plastic materials, modified atmosphere packaging, either CO2/N2 50/50 or 80/20% (v/v), was the most effective preserving technique to ensure the quality of this type of cheese when comparing air and vacuum packaging treatments.

FODMAP Content Like-by-like Comparison in Spanish Gluten-free and Gluten-containing Cereal-based Products

Gluten-free foods (GF) availability on supermarket shelves is growing and it is expected to continue expanding in the years ahead. These foods have been linked to a lower content of fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs), molecules that trigger gastrointestinal symptoms in sensitive persons. In this study, the FODMAP content of 25 cereal-based GF foods in Spain (breakfast cereals, pasta, bread, biscuits, bakery products, and dough and puff pastry) and 25 gluten-containing equivalents (GC) available in the same supermarket were analysed and compared. Lactose, fructose, glucose, sorbitol, mannitol, raffinose, stachyose and fructans were quantified. In a like-by-like analysis, GF foods were found to generally contain fewer FODMAPs than their GC counterparts. The ingredients used in the manufacture of GF cereal-based foods may contribute to this fact. When the individually wrapped size was considered, the proportion of samples classified as high-FODMAPs in GC and GF foods showed a trend towards fewer samples in the GF. However, not all the GF samples were low-FODMAP. Altogether, our findings provide essential information for FODMAP content databases of GF products in Spain.

Non-convulsive status epilepticus as the initial manifestation in a family with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL)

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an autosomal dominant small-vessel disease caused by mutations of the NOTCH3 gene. It typically presents with migraine, recurrent brain ischaemia, and cognitive disorders. Seizures rarely present as the initial manifestation, with non-convulsive status epilepticus being even less frequent. We present a series of 3 related patients with this arteriopathy, 2 of whom presented status epilepticus as a manifestation of the disease.

Impact of an enhanced screening program on the detection of non-AIDS neoplasias in patients with human immunodeficiency virus infection

BACKGROUND

The incidence of non-AIDS defining cancer (NADC) is higher in people living with HIV (PLWH) than in the general population, and it is already one of the leading causes of death in the HIV-infected population. It is estimated that the situation will be aggravated by the progressive aging of PLWH. Early diagnosis through intensive cancer screening may improve the ability for therapeutic interventions and could be critical in reducing mortality, but it might also increase expenditure and harms associated with adverse events. The aim of this study is to evaluate an enhanced screening program for early diagnosis of cancer in PLWH compared to standard practice. The specific objectives are (1) to compare the frequency of cancer diagnosed at an early stage, (2) to analyze safety of the enhanced program: adverse events and unnecessary interventions, (3) to analyze the cost-utility of the program, and (4) to estimate the overall and site-specific incidence of NADC in PLWH.

METHODS

We will conduct a multicenter, non-blinded, randomized, controlled trial, comparing two parallel arms: conventional vs enhanced screening. Data will be recorded in an electronic data collection notebook. Conventional intervention group will follow the standard of care screening in the participating centers, according to the European AIDS Clinical Society recommendations, and the enhanced intervention group will follow an expanded screening aimed to early detection of lung, liver, anal, cervical, breast, prostate, colorectal, and skin cancer. The trial will be conducted within the framework of the Spanish AIDS Research Network Cohort (CoRIS).

DISCUSSION

The trial will evaluate the efficacy, safety, and efficiency of an enhanced screening program for the early diagnosis of cancer in HIV patients compared to standard of care practice. The information provided will be relevant since there are currently no studies on expanded cancer screening strategies in patients with HIV, and available data estimating cost effectiveness or cost-utility of such as programs are scarce. An enhanced program for NADC screening in patients with HIV could lead to early diagnosis and improve the prognosis of these patients, with an acceptable rate of unnecessary interventions, but it is critical to demonstrate that the benefits clearly outweigh the harms, before the strategy could be implemented.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04735445. Registered on 25 June 2019.

Music therapy and Sanfilippo syndrome: an analysis of psychological and physiological variables of three case studies

Introduction

Mucopolysaccharidosis type III (MPS III) or Sanfilippo syndrome is a neurodegenerative disease caused by the accumulation of mucopolysaccharides in the body. As the symptoms are wide ranging, it is a challenge to provide a diagnosis and psychological treatment for affected children.

Method

The main objective of this study was to describe a form of music therapy treatment applied to three children diagnosed with MPS III. The psychological variables were evaluated by an ad hoc observation recording template, and the physiological variables were measured with a digital meter before and after each session. The perception of the parents was also considered through a semi-structured interview.

Results

An improvement in the psychological variables was shown in all cases. Changes in the physiological variables were also noted, although they varied according to each child. The parents report some benefit of music therapy and they share difficulty in assessing the extent of benefits of the music therapy.

Discussion

Findings indicate that music therapy can be a useful form of treatment with multiple benefits for children with conditions such as MPS III or similar conditions. However, further research is needed in this area and in the development of specific ways of evaluating music therapy.

Atremorine in Parkinson's disease: From dopaminergic neuroprotection to pharmacogenomics

Atremorine is a novel bioproduct obtained by nondenaturing biotechnological processes from a genetic species of Vicia faba. Atremorine is a potent dopamine (DA) enhancer with powerful effects on the neuronal dopaminergic system, acting as a neuroprotective agent in Parkinson's disease (PD). Over 97% of PD patients respond to a single dose of Atremorine (5 g, p.o.) 1 h after administration. This response is gender-, time-, dose-, and genotype-dependent, with optimal doses ranging from 5 to 20 g/day, depending upon disease severity and concomitant medication. Drug-free patients show an increase in DA levels from 12.14 ± 0.34 pg/ml to 6463.21 ± 1306.90 pg/ml; and patients chronically treated with anti-PD drugs show an increase in DA levels from 1321.53 ± 389.94 pg/ml to 16,028.54 ± 4783.98 pg/ml, indicating that Atremorine potentiates the dopaminergic effects of conventional anti-PD drugs. Atremorine also influences the levels of other neurotransmitters (adrenaline, noradrenaline) and hormones which are regulated by DA (e.g., prolactin, PRL), with no effect on serotonin or histamine. The variability in Atremorine-induced DA response is highly attributable to pharmacogenetic factors. Polymorphic variants in pathogenic (SNCA, NUCKS1, ITGA8, GPNMB, GCH1, BCKDK, APOE, LRRK2, ACMSD), mechanistic (DRD2), metabolic (CYP2D6, CYP2C9, CYP2C19, CYP3A4/5, NAT2), transporter (ABCB1, SLC6A2, SLC6A3, SLC6A4) and pleiotropic genes (APOE) influence the DA response to Atremorine and its psychomotor and brain effects. Atremorine enhances DNA methylation and displays epigenetic activity via modulation of the pharmacoepigenetic network. Atremorine is a novel neuroprotective agent for dopaminergic neurons with potential prophylactic and therapeutic activity in PD.

Influence of dopamine, noradrenaline, and serotonin transporters on the pharmacogenetics of Atremorine in Parkinson's disease

Atremorine is a potent dopamine (DA) enhancer obtained by nondenaturing biotechnological processes from a genetic species of Vicia faba. Atremorine affects the neuronal dopaminergic system by acting as a neuroprotective agent against Parkinson's disease (PD). PD patients (N = 127) responded to a single dose of Atremorine (5 g, p.o.) 1 h after administration in a sex-, time-, dose-, and genotype-dependent fashion. Drug-free patients (N = 81) showed an increase in DA levels from 12.14 ± 0.34 pg/ml to 6463.21 ± 1306.90 pg/ml; and patients chronically treated with anti-PD drugs (N = 46) showed an increase in DA levels from 1321.53 ± 389.94 pg/ml to 16,028.54 ± 4783.98 pg/ml, indicating that Atremorine potentiates the dopaminergic effect of conventional anti-PD drugs. The variability in Atremorine-induced DA response is strongly attributable to pharmacogenetic factors. Polymorphic variants in pathogenic, mechanistic, metabolic, transporter, and pleiotropic genes influence the DA response to Atremorine. Genetic variation in the DA (SLC6A3; rs460000), noradrenaline (NA) (SLC6A2; rs12708954, rs3785143, rs5569), and serotonin (5-HT) transporter (SLC6A4; rs2020934, rs2020936, rs4251417, rs6354) genes exert a genotype-dependent Atremorine-induced DA response in PD, with potential impact on the DA-related pharmacogenetic outcome and minimum effects on NA and 5-HT levels.

Ketogenic diet and cognition in neurological diseases: a systematic review

CONTEXT

In recent years, the ketogenic diet has gained special relevance as a possible therapeutic alternative to some neurological and chronic diseases.

OBJECTIVE

The aim of this systematic review was to answer the following question: Does a ketogenic diet improve cognitive skills in patients with Alzheimer's disease, Parkinson's disease, refractory epilepsy, and type 1 glucose deficiency syndrome? To define the research question, the PICOS criteria were used, following the guidelines of the PRISMA method.

DATA SOURCES

Medline/PubMed, Elsevier Science Direct, Dialnet, EBSCOhost, Mediagraphic, Sage Journals, ProQuest, and Wiley Online Library databases were used.

DATA EXTRACTION

After applying inclusion and exclusion criteria in accordance with the PRISMA method, a total of 63 entries published between 2004 and 2019 were used.

DATA ANALYSIS

The records extracted were analyzed from a qualitative approach, so no statistical analysis was carried out.

CONCLUSION

Although scientific literature on the subject is scarce and there has tended to be a lack of scientific rigor, the studies reviewed confirmed the effectiveness of this diet in improving the cognitive symptomatology of the aforementioned diseases.

Non-convulsive status epilepticus as the initial manifestation in a family with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL)

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an autosomal dominant small-vessel disease caused by mutations of the NOTCH3 gene. It typically presents with migraine, recurrent brain ischaemia, and cognitive disorders. Seizures rarely present as the initial manifestation, with non-convulsive status epilepticus being even less frequent. We present a series of 3 related patients with this arteriopathy, 2 of whom presented status epilepticus as a manifestation of the disease.

FODMAP Intake in Spanish Population: Open Approach for Risk Assessment

Fermentable oligo-, di- and monosaccharides and polyols’ (FODMAP) were related with intestinal complications. The present study aimed to determine the FODMAP consumption of Spanish children, adolescents and adults, analyzing the real FODMAP risk of foods, and to set an open methodology for the measurement of this intake in other regions as well as nutrient intake assurance. Total fructan analysis was performed analytically in eighty-seven food samples. Daily intake of FODMAPs, fiber and micronutrients was calculated by combining the food composition for selected fermentable carbohydrates with the national food consumption stratified by age in an open software. Spanish child and adolescent total FODMAP consumption was settled as 33.4 ± 92.4 and 27.3 ± 69.0 g/day, respectively. Both intakes were higher than that of the adult population (21.4 ± 56.7 g/day). The most important food sources of lactose, excess of fructose and total fructan, considering their content and dietary intake were different between age groups. The contribution of these foods to dietary calcium and fiber and the consequent risk of deficiency if they are withdrawn was highlighted. We demonstrated the relevance of stratifying the total FODMAP intake by age. An open approach for FODMAP intake quantification and nutrient control was provided.

Neuroprotection with Natural Antioxidants and Nutraceuticals in the Context of Brain Cell Degeneration: The Epigenetic Connection

Bioactive antioxidant agents present in selected plants are known to provide the first line of biological defense against oxidative stress. In particular, soluble vitamin C, E, carotenoids and phenolic compounds have demonstrated crucial biological effects in cells against oxidative damage, preventing prevalent chronic diseases, such as diabetes, cancer and cardiovascular disease. The reported wide range of effects that included anti-aging, anti-atherosclerosis, anti-inflammatory and anticancer activity were studied against degenerative pathologies of the brain. Vitamins and different phytochemicals are important epigenetic modifiers that prevent neurodegeneration. In order to explore the potential antioxidant sources in functional foods and nutraceuticals against neurodegeneration, the present paper aims to show a comprehensive assessment of antioxidant activity at chemical and cellular levels. The effects of the different bioactive compounds available and their antioxidant activity through an epigenetic point of view are also discussed.

A theory-based randomized controlled trial in promoting fruit and vegetable intake among schoolchildren: PROFRUVE study

PURPOSE

The main objective of the PROFRUVE study was to evaluate the effectiveness of a TPB-based intervention program at increasing fruit and vegetable (FV) consumption in schoolchildren aged 7-10.

METHODS

Eight eligible classrooms were randomly assigned to the intervention (classrooms n = 4; children n = 90) or control group (classrooms n = 4; children n = 95). The intervention group received 14 sessions of 1 h during an academic year (from October to June) but the control group did not. Sessions were based on the Theory of Planned Behavior (TPB) and focused on modifying FV intake. FV consumption was evaluated before, shortly after and 1 year after intervention ended using validated 7-day food records.

RESULTS

FV intake increased significantly in the intervention group (+ 0.45 servings/day; 95% CI 0.17-0.74; p = 0.001) but not in the control group (+ 0.01 servings/day; 95% CI -0.20-0.22; p = 0.409) shortly after the intervention. Long-term measurement showed that 1 year after intervention finished, the intervention group maintained the effect (+ 0.52 servings/day from baseline; 95% CI 0.22-0.78; p = 0.003). Linear mixed model also showed that nested groups by classrooms differ from intervention and control groups regarding FV intake change (p = 0.002). Multiple linear regression showed that receiving the intervention (B = 0.345, p = 0.045) and FV baseline intake (B = - 0.383, p = 0.000) were associated with FV intake change after adjusting the model by age, gender and family social economic status (SES) (R² = 0.196).

CONCLUSIONS

The intervention program based on TPB seemed to be moderately effective in increasing FV intake and successful in maintaining the effect of the reached increase. Moreover, baseline FV intake determined the effect size of the intervention.

TRIAL REGISTRATION

This study was registered at ClinicalTrials.gov. Identifier: NCT03400891. Data registered 17/01/2018.

Fate of Mycobacterium avium subsp. paratuberculosis and changes in bacterial diversity populations in dairy slurry after chemical treatments

AIMS

A major drawback of using dairy slurry as fertilizer is that it may contains pathogens such as Mycobacterium avium subsp. paratuberculosis (MAP), and it could represent a risk to animal and public health. Thus, the aim of this study was to evaluate the fate of MAP and bacterial communities in dairy slurry after chemical treatments.

METHODS AND RESULTS

Cattle slurry, naturally contaminated with MAP, was collected from a dairy herd and divided into 32 glass bottles which were assigned to eight different treatments (control, 3·0% CaO, 0·5% NaOH; 0·087%, 0·11% and 0·14% H₂ SO₄ ; and 1·0 and 2·5% KMnO₄ ). Treated dairy slurry samples were evaluated at 0, 1, 3, 7, 15, 30 and 60-days following treatment application for viable MAP and dairy slurry pH, and in addition temperature in this material was monitored continuously. Bacterial counts were estimated at each sampling time. A Bayesian zero-inflated Poisson mixed model was fitted to assess the effect of each treatment on the count of MAP cells. Model results indicated that only the 3·0% CaO treatment had a statistically important negative effect on MAP counts during the study period. For most treatments, MAP was undetectable immediately after chemical treatment but re-appeared over time, in some replicates at low concentrations. However, in those cases MAP counts were not statistically different than the control treatment. Regarding the fate of the other bacterial populations, the Firmicutes phylum was the dominant population in the un-treated slurry while Clostridia class members were among the most prevalent bacteria after the application of most chemical treatments.

CONCLUSION

Only 3% CaO treatment had a statistically important negative effect on MAP viability in cattle slurry.

SIGNIFICANCE AND IMPACT OF THE STUDY

This study provides evidence of MAP partial control in dairy slurry. This information should be considered as a best management practice to reduce MAP and other pathogens for slurry management on dairy farms.

A randomised controlled trial of a program based on the theory of planned behavior to promote fruit and vegetable intake among schoolchildren: PROFRUVE study protocol

BACKGROUND

The PROFRUVE study is a controlled intervention based on the Theory of Planned Behavior (TPB), which follows those behavioral theories that have proved to be the most effective at changing infant fruit and vegetable (FV) intake pattern. The main purpose of the study is to evaluate the effectiveness of an intervention program in increasing FV consumption in schoolchildren aged 8 to 10 and based on TPB.

METHODS

Eligible classrooms within schools from Vitoria-Gasteiz (Basque Country, Spain) will be randomly assigned to the intervention (classrooms n = 4; children n = 86) or control (classrooms n = 4; children n = 86) group. The intervention group will receive 14 sessions of 60 min during an academic year (October to June). These sessions, designed by a multidisciplinary team, are based on TPB and are directed at modifying determinants of behavior (attitudes, subjective norms, perceived behavioral control and intention of consumption), and intake of FV itself. Both the process and the evolution of consumption and determinants of behavior will be evaluated (before, during, shortly after and a year after) using validated surveys, 7 day food records, 24 h reminders and questionnaires.

DISCUSSION

This study will provide a valid and useful tool to achieve changes in the consumption of FV at school level. A negative result will be helpful in redefining new strategies in the framework of changing habits in the consumption of FV.

TRIAL REGISTRATION

This study has been retrospectively registered at ClinicalTrials.gov. Identifier: NCT03400891 . Data registered: 17/01/2018.

A decade of the Catalonian Arthroplasty Register (RACat): Variability, exhaustivity, and survival of prostheses between 2005 and 2014

BACKGROUND AND AIM

The Catalonian Arthroplasty Register (RACat) is a public health-based population register used to analyse and evaluate hip and knee replacements in Catalonia. The aim of this study is to present the outcomes after 10 years in operation (January 2005-December 2014).

METHODOLOGY

Using the information from the RACat and the minimum basic data set at hospital discharge, an analysis was made of the quality and exhaustivity of the data, as well as a descriptive analysis of the patients, prostheses, and care process. Survival was also analysed by calculating the accumulated incidence of revisions (according to the cause of intervention in hip replacements and conservation or sacrifice of the posterior cruciate ligament in knee replacement). The relationship between revision risk and the fixation technique of the prosthesis is also analysed, using competitive risk models adjusted for gender, age, and comorbidities.

RESULTS

The main reason for the primary hip and knee replacement surgery was arthrosis. The accumulated incidence of revisions at 10 years was 3.9% in hip replacements caused by arthrosis, and 2.3% in those caused by fracture. Conservation of the posterior cruciate ligament was achieved in 4.4% of knee replacements, with sacrifice in 5.1%.

DISCUSSION

The RACat is consolidated as a tool for the evaluation of joint replacements, with great potential in the analysis of medium and long-term efficacy, the study of the variability in clinical practice, and post-marketing surveillance.

Cathodoluminescence study of Mg activation in non-polar and semi-polar faces of undoped/Mg-doped GaN core-shell nanorods

Spectrally and spatially resolved cathodoluminescence (CL) measurements were carried out at 80 K on undoped/Mg-doped GaN core-shell nanorods grown by selective area growth metalorganic vapor phase epitaxy in order to investigate locally the optical activity of the Mg dopants. A study of the luminescence emission distribution over the different regions of the nanorods is presented. We have investigated the CL fingerprints of the Mg incorporation into the non-polar lateral prismatic facets and the semi-polar facets of the pyramidal tips. The amount of Mg incorporation/activation was varied by using several Mg/Ga flow ratios and post-growth annealing treatment. For lower Mg/Ga flow ratios, the annealed nanorods clearly display a donor-acceptor pair band emission peaking at 3.26-3.27 eV and up to 4 LO phonon replicas, which can be considered as a reliable indicator of effective p-type Mg doping in the nanorod shell. For higher Mg/Ga flow ratios, a substantial enhancement of the yellow luminescence emission as well as several emission subbands are observed, which suggests an increase of disorder and the presence of defects as a consequence of the excess Mg doping.

Modelling and kinetics studies of a corn-rape blend combustion in an oxy-fuel atmosphere

A kinetic oxy-combustion study of a previously optimized lignocellulose blend is proposed. Kinetic and diffusion control mechanism are considered. The proposed correlations fit properly with the experimental results and diffusion effects are identified as be important enough to be taken into account. Afterwards, with the results obtained in the kinetic study, a detailed consecutive and parallel kinetic scheme is proposed for modelling the oxy-combustion of the blend. A discussion of the temperature and concentration profiles are included. Variation of products final distribution is considered. Smaller particles than 0.001 m are proposed for reducing temperature and concentration profiles and obtaining a good final product distribution. CO2-char reaction is identified as one of the most important step to be optimized for obtaining the lowest final residue. In this study, char is mainly oxidised at 950 K and this situation is attributed to an optimized blending of the bioresidues.

Assessment of stigma associated with tuberculosis in Mexico

BACKGROUND

Stigma is a major barrier to health care access and impacts the quality of life for individuals affected by tuberculosis (TB). Assessing TB stigma is essential to addressing health disparities. However, no such instrument was available in Mexico at the time of our study. This study examined the adaptability of the TB and human immunodeficiency virus (HIV) stigma scales previously used in Thailand.

METHODS

The original scale, developed in English, was linguistically adapted to Spanish and administered to 217 individuals affected by TB in five states in Mexico. The TB-HIV stigma subscales were designed to assess individual and community perspectives. Additional data collected included general information and socio-demographics. Assessment of psychometric properties included basic statistical tests, evaluation of Cronbach's alpha and factor analysis.

RESULTS

We found no significant statistical differences associated with higher stigma scores by location, age, marital status, education and stigma scores. Factor analysis did not create any new factors. Internal consistency reliability coefficients were satisfactory (Cronbach α = 0.876-0.912).

CONCLUSION

The use of the stigma scales has implications for 1) health improvements, 2) research on stigma and health disparities, and 3) TB and HIV stigma interventions. Further research is needed to examine transferability among larger and randomly selected Spanish-speaking populations.

[Quality of life-associated factors at one year after total hip and knee replacement: a multicentre study in Catalonia]

AIMS

To assess the health related quality of life (HRQOL) and associated factors of patients before, and one year after, total knee (TKA) and hip (THA) arthroplasty.

METHODS

A quasi-experimental prospective study conducted in hospitals with different levels of complexity and volume in Catalonia, and on patients with an indication of a TKA or THA. Demographic and psychosocial variables were recorded, and the SF-36 and WOMAC, and a question on perception of change after surgery were administered to patients by telephone interview. The standardised differences (effect size) of perceived change using the SF-36 and WOMAC scores before and after surgery were calculated. The factors associated with HRQOL one year after surgery were analysed using adjusted general linear models.

RESULTS

Although there was an overall improvement in most HRQOL domains of patients (n=672), 9% saw little improvement after surgery, with their scores at baseline and follow-up being very similar (small size effect: 0.0-0.4). Women, patients with low social support, with lower scores (worse) in perceived mental health and baseline HRQOL, and who declared that their condition was more severe, perceived a poorer HRQOL one year after surgery (P<.05).

CONCLUSIONS

Factors associated to a worse prognosis one year after an arthroplasty have been identified and are consistent with other published studies. The assessment of HRQOL can be a key instrument for identifying possible patients without improvement, in order to assess alternatives to an intervention, or apply other interventions in order to improve the efficiency of the healthcare process.

[Arthroplasty registers as post-marketing surveillance systems: the Catalan Arthroplasty Register]

OBJECTIVE

The aim is to present the functioning and results of the Catalan Arthroplasty Registry (RACat).

MATERIAL AND METHOD

The RACat arose by the initiative of the Catalan Society of Orthopaedic Surgery and Traumatology, the Catalan Health Service (CHS) and the Catalan Agency for Health Information Assessment and Quality. Publicly funded hospitals sent information through the Internet (CHS Applications website) on knee and hip arthroplasties: patient identification, hospital, joint (hip/knee), type (primary/revision), side of operation, date of surgery and prosthesis (manufacturer's name and reference number). The quality of the data is analysed regularly. We estimate the risk of replacement by the Kaplan-Meier method.

RESULTS

A total of 52 hospitals out of 62 send data to RACat, and information on 36,951 knee and 26,477 hip arthroplasties is available. Data quality improved between 2005 and 2010. In 2010 coverage exceeded 70%, with side of operation 97%, and prostheses identification of 80%. The risk of replacement at three years was 3.3% (95% CI:3.1-3.6) for knee, 2.9% (95% CI:2.5-3.3) for total hip, and 2.5% (95% CI:2.0-3.1) for partial hip.

DISCUSSION

Risk of replacement is higher than that observed in other registers, although data quality and its improvement over time should be taken into account.

CONCLUSIONS

The information available in the RACat will help to establish a standard that will enable hospitals to compare results.

Detection of markers of cardiovascular and renal risk in Cuba: Isle of Youth Study (ISYS)

Chronic vascular diseases constitute a growing global health problem.

OBJECTIVES

To (a) determine marker positivity for renovascular damage in the total adult population of the Isle of Youth, Cuba; (b) describe marker association with common risk factors for renal and related chronic vascular conditions, and (c) identify best predictors of renovascular damage.

METHODS

Previous informed consent was obtained, the population studied was 55,646, and subjects were aged ≥20 years. Blood pressure, weight and height were measured and a questionnaire applied. Urine markers for renovascular damage (hematuria, proteinuria and microalbuminuria) were also determined.

RESULTS

Positive markers were detected in 21.3%: hematuria (12.6%), microalbuminuria (6.8%), proteinuria (0.9%), and proteinuria + hematuria (0.9%). Risk factors were highly prevalent: 15.1% were aged ≥60 years; 32.3% overweight, 13.9% obese, and 25.1% smokers. Prevalence of high blood pressure (30%), diabetes mellitus (5.4%) and cardiovascular disease (5%) was also high, while cerebrovascular disease registered 0.9%. Markers were more prevalent in older people and in those suffering from diabetes mellitus, high blood pressure, cardiovascular and cerebrovascular disease, overweight or obesity. Risk factor regression tree analysis identified hypertension as the best predictor of renovascular damage.

CONCLUSIONS

Adult population-wide screening revealed hidden morbidity and permitted better risk stratification. Results serve to inform community-based multidisciplinary and intersectoral disease prevention and management.

Foodborne and indicator bacteria in farmed molluscan shellfish before and after depuration

Galicia's coast (northwestern Spain) is a major producer of bivalve molluscs. Over an 18-month period, the presence of Salmonella, Aeromonas, Plesiomonas shigelloides, Vibrio parahaemolyticus, and Clostridium botulinum was determined by PCR methods in mussels (22 batches) and infaunal bivalves (31 batches of clams and cockles) before and after depuration. All batches were harvested from Galician class B harvesting areas where bivalve molluscs must not exceed 4,600 Escherichia coli per 100 g of flesh and liquor in 90% of the samples. Virulence-associated genes of Salmonella (invA), Aeromonas (aerA, hlyA, alt, ast, and laf), P. shigelloides (hugA), V. parahaemolyticus (tdh and trh), and C. botulinum (BoNT) were not detected. The pR72H chromosomal DNA fragment, which is conservative in V. parahaemolyticus strains, was detected in five (4.7%) samples. A number of 192 suspect isolates did not fit the description of clinical Aeromonas phenospecies, pathogenic Vibrio spp., or P. shigelloides. The effectiveness of commercial depuration in reducing bacterial indicators was also examined. E. coli was reduced to < or = 230/100 g of flesh and liquor in 90.9% of mussel lots but in only 70.9% of infaunal bivalve lots. For total coliform elimination, mussels were also more effective. Total counts significantly (P < 0.005) correlated with numbers of Pseudomonas, Aeromonas, and Vibrio. Our data indicate that Salmonella and pathogenic bacteria indigenous to estuarine environments do not appear to be significant hazards in Galician molluscan shellfish. A reason for concern, however, is that clearance of E. coli to acceptable levels was not always achieved especially in infaunal bivalves.

Continuous and Localized Mn Implantation of ZnO

We present results derived from continuous and localized 35 keV (55)Mn(+) ion implantations into ZnO. Localized implantations were carried out by using self-ordered alumina membranes as masks leading to ordered arrays of implanted volumes on the substrate surfaces. Defects and vacancies in the small implantation volumes of ZnO were generated due to the implantation processes besides the creation of new phases. Rapid thermal annealing was applied in the case of continuous implantation. The samples were characterized by HRSEM, GIXRD, Raman spectroscopy and RBS/C. Magnetic characterization of the samples pointed out appreciable differences among the samples obtained by the different implantation methods. This fact was mainly attributed to the different volume/surface ratios present in the implanted zones as well as to the increase of Mn atom concentrations along the grain frontiers in the nanostructured surfaces. The samples also showed a ferromagnetic transition phase at temperature value higher than room temperature.

[Cardiovascular risk in subjects with high probability of metabolic syndrome and insulin resistance. DESIRE study]

INTRODUCTION AND OBJECTIVES

The metabolic syndrome is an association of closely related alterations. The main objective of this study is to know the frequency of the metabolic syndrome and insulin resistance, and their role as cardiovascular risk indicators in an adult population assigned to Primary Care centers in Spain.

METHODS

Subjects > or = 45 years with basal glycemia > or = 90 mg/dl and abdominal circumference > or = 94 cm (men) or > or = 80 cm (women). ATP III modified-criteria were used for the metabolic syndrome and HOMA index > 3.29 was used for insulin resistance. Cardiovascular risk was estimated by the Framingham and SCORE models.

RESULTS

A total of 2,341 subjects (62 +/- 10 years; 44.6% males) were included. Frequency of metabolic syndrome and insulin resistance was 54.6% (52.5; 56.8) and 56.6% (54.5; 58.7) respectively. Metabolic syndrome was associated to a higher cardiovascular risk score with both Framingham (16 [15; 16] vs 11 [11; 12] p < 0.0001) and SCORE (2.7 [2.4; 3] vs 2.4 [2.1; 2.8]; p = 0.006) models. The results were similar for the presence of insulin resistance.

CONCLUSIONS

Metabolic syndrome and insulin resistance are cardiovascular risk predictors. Early identification of metabolic syndrome by the use of simple clinical measures (basal glycemia and waist circumference) would make the intervention on the different disorders of metabolic syndrome possible.

Pyrolysis of mixtures of sewage sludge and manure: a comparison of the results obtained in the laboratory (semi-pilot) and in a pilot plant

A pilot-scale pyrolysis process was carried out for the treatment of a mixture of two types of waste, sewage sludge and cattle manure, comparing the results with others obtained under laboratory conditions (semi-pilot scale). The aim of this study was to obtain the energetic valorization of the products. Owing to the specific characteristics of the plant, two products were obtained from the process: gas and carbonized solid. As no liquid fraction was obtained, the gas fraction is a greater percentage made up of both condensable and non-condensable compounds, which were obtained separately at the laboratory scale. The pilot plant was designed so that the gases produced by thermolysis were burnt continuously in a combustion chamber, while the carbonized fraction was fed in batches for co-combustion. To determine composition and combustion ability, the gas and solid products from the pilot process were characterized by chromatographic analysis of the gaseous fraction and chemical analysis and programmed-temperature combustion of the carbonized solid. The composition of the combustion gases, rich in light hydrocarbons, and the carbon present in the carbonized fraction enable the energetic valorization of these products. The combustion gases were subjected to a cleaning process and their composition analysed twice: before and after the gas cleaning treatment. The study led to a positive assessment of the possible use of the process products as fuel, provided that the combustion gases are treated. As most of the sulphur and chlorine from the original waste are mainly concentrated in the solid fraction, the use of char as a fuel will depend on the effectiveness of clean-up techniques for combustion gases. During gas cleansing, neutralizing with sodium bicarbonate proved effective, especially for the acidic compounds HCl, HF and SO(2).

Influence of the application of sewage sludge on the degradation of pesticides in the soil

A study was made of the influence of the application of sewage sludge on the degradation of pesticides in the soil. Two kinds of sludge were used, with different characteristics, one from an urban treatment plant and one from a food processing plant. Three organophosphorus insecticides, fenitrothion, diazinon and dimethoate, were studied. The relative importance was determined of the chemical and biological degradation processes, which involved experiments on soil and sterile soil samples. A comparative study was also made of the degradation of pesticide residues and the evolution of the microbial population. The application of sludge seems to have a complex effect on the degradation of pesticides, determined by the bioavailability and biodegradability of their active ingredient. The biodegradation of pesticide residues brings about alterations in the microorganism population of the soil.

Application of vernier thinning techniques to segmented annular arrays

Due to the aperture periodicity, the inter-element spacing of two-dimensional squared arrays is maintained near lambda/2 in order to avoid grating lobes. This condition gives rise to severe problems derived from the huge number of array elements and from their little size that causes the signal to noise ratio to bring down. Vernier techniques have been proposed to lower the number of active elements, but the drastic reduction of the ultrasonic energy is still a great problem for the image contrast. In this work, vernier techniques for segmented annular (SA) arrays are theoretically studied. SA arrays produce lower grating lobes than squared arrays and, therefore, allow the element size to be increased beyond the lambda/2 constraint. Using larger elements, SA arrays have advantage to squared arrays because they have larger active area and smaller thinning order for the same complexity (number of channels) of the image system. Theoretical results of the vernier techniques applied to SA arrays in both radial and tangential directions are presented and compared with the equivalent squared array.

[Travelling immigrants]

OBJECTIVES

To characterise travelling immigrants and the international movements they undertake. To identify the risk journeys that this population makes and to assess the international preventive activities for them compared with those for autochthonous travellers.

DESIGN

Retrospective, observational study.

SETTING

Unit of International Health (UIH) Santa Coloma de Gramenet (Barcelona), in the Barcelonès Nord i Maresme Health Area, Primary Care Division of the Catalan Institute of Health.

PARTICIPANTS

Patients seen between June 1999 and June 2002 (n=1163) at the UIH. They were divided into two groups, depending on their origins: those born inside (autochthonous group; no=1019) or outside (immigrant group; n1=144) the European Union.

MAIN MEASUREMENTS

Age, country of origin, length of residence in Spain, interval between consultation and journey, reason for journey, destination, duration of the journey, kind of journey, stay in rural or isolated area, exposure to malaria, vaccinations and anti-malaria chemoprophylaxis prescribed, and overall risk of journey.

RESULTS

Immigrants spent more time abroad than autochthonous people (mean 43.5 days; 95% CI, 37.9-49.1; and 15.8 days, 95% CI, 14.9-16.7, respectively; P<.0001). Periods between the journey and the consultation at the UIH were generally similar in the two groups (mean of 26.8 days for immigrants and 30.41 days for autochthonous people; ns), although the immigrants consulted more often in periods of less than 15 and 7 days (P<.005). 31.9% of immigrants stayed in areas of high malaria transmission (95% CI, 24.4%-39.6%) vs 21.3% (95% CI, 18.8%-23.8%) of autochthonous people (P=.04). Overall, immigrants made more risk journeys than autochthonous people (54.8% vs 43.1%; P<.01). No significant differences between the two groups were found in terms of quality in the administration of the international vaccinations prescribed. Compliance with the guidelines for anti-malaria chemoprophylaxis was less in the immigrant group than in the autochthonous one (36% vs 84%; P<.005).

CONCLUSIONS

The immigrant group in our environment needs to be thought of as a risk group for catching and importing tropical diseases during their international movements. They form a population for whom international preventive measures should be prioritized.

Current Status and Newly Discovered Natural Hosts of Tomato infectious chlorosis virus and Tomato chlorosis virus in Spain

Tomato chlorosis virus (ToCV) and Tomato infectious chlorosis virus (TICV) are emergent whitefly-transmitted criniviruses. ToCV and TICV were detected in Spain in 2000 (2) and 2001 (1), respectively. Both viruses infect tomato (Lycopersicon esculentum Mill) crops and cause symptoms of foliar chlorosis. ToCV is prevalent along the southern and eastern regions of Spain (provinces of Sevilla, Málaga, Almería, Murcia, Alicante, and Castellón), Balearic (Mallorca), and the Canary Islands (Tenerife and Gran Canaria). However, TICV only has been detected in the provinces of Murcia, Alicante, and Castellón in Spain. During the summer and autumn of 2002, abnormal interveinal reddening, yellowing symptoms, or both, were observed in plants of Chenopodium album L., C. murale L., and Solanum nigrum L. growing in or around tomato fields in Murcia and Almería provinces. To study the alternative hosts that may serve as virus reservoirs in areas where these viruses are prevalent, 62 samples of 42 common weed species were analyzed by reverse transcription-polymerase chain reaction using specific primers for ToCV and TICV (1). The 439-bp ToCV-specific DNA fragment was amplified in two S. nigrum samples from Alicante and Murcia provinces, and the 501-bp TICV-specific DNA fragment was amplified in one C. murale sample from Murcia, as well as in three C. album samples from Murcia and Alicante provinces. The DNA fragment amplified from the ToCV isolate was sequenced and showed 99 to 98% identity with the ToCV isolates (GenBank Accession Nos. AY048854 and AF234029) from Italy and Portugal, respectively. The DNA fragment amplified from TICV isolates were sequenced and showed 98% identity with the TICV isolate from Spain (GenBank Accession No. AF479662), confirming the diagnosis. Although the number of samples is not sufficient to conclude that we know, in a precise way, the role of weed reservoirs in TICV and ToCV epidemics in Spain, this study might contribute to a better understanding of the epidemiology of these viruses. To our knowledge this is the first report of these weeds as natural hosts of ToCV and TICV in Spain. References: (1) M. I. Font et al. Plant Dis. 86:696, 2002. (2) J. Navas-Castillo et al. Plant Dis. 84:835, 2000.