Genetic variation near IRS1 associates with reduced adiposity and an impaired metabolic profile.

Genome-wide association studies have identified 32 loci influencing body mass index, but this measure does not distinguish lean from fat mass. To identify adiposity loci, we meta-analyzed associations between ∼2.5 million SNPs and body fat percentage from 36,626 individuals and followed up the 14 most significant (P < 10(-6)) independent loci in 39,576 individuals. We confirmed a previously established adiposity locus in FTO (P = 3 × 10(-26)) and identified two new loci associated with body fat percentage, one near IRS1 (P = 4 × 10(-11)) and one near SPRY2 (P = 3 × 10(-8)). Both loci contain genes with potential links to adipocyte physiology. Notably, the body-fat-decreasing allele near IRS1 is associated with decreased IRS1 expression and with an impaired metabolic profile, including an increased visceral to subcutaneous fat ratio, insulin resistance, dyslipidemia, risk of diabetes and coronary artery disease and decreased adiponectin levels. Our findings provide new insights into adiposity and insulin resistance.

A Genome-Wide Association Study of Upper Aerodigestive Tract Cancers Conducted within the INHANCE Consortium

Genome-wide association studies (GWAS) have been successful in identifying common genetic variation involved in susceptibility to etiologically complex disease. We conducted a GWAS to identify common genetic variation involved in susceptibility to upper aero-digestive tract (UADT) cancers. Genome-wide genotyping was carried out using the Illumina HumanHap300 beadchips in 2,091 UADT cancer cases and 3,513 controls from two large European multi-centre UADT cancer studies, as well as 4,821 generic controls. The 19 top-ranked variants were investigated further in an additional 6,514 UADT cancer cases and 7,892 controls of European descent from an additional 13 UADT cancer studies participating in the INHANCE consortium. Five common variants presented evidence for significant association in the combined analysis (p≤5×10−7). Two novel variants were identified, a 4q21 variant (rs1494961, p = 1×10−8) located near DNA repair related genes HEL308 and FAM175A (or Abraxas) and a 12q24 variant (rs4767364, p = 2×10−8) located in an extended linkage disequilibrium region that contains multiple genes including the aldehyde dehydrogenase 2 (ALDH2) gene. Three remaining variants are located in the ADH gene cluster and were identified previously in a candidate gene study involving some of these samples. The association between these three variants and UADT cancers was independently replicated in 5,092 UADT cancer cases and 6,794 controls non-overlapping samples presented here (rs1573496-ADH7, p = 5×10−8; rs1229984-ADH1B, p = 7×10−9; and rs698-ADH1C, p = 0.02). These results implicate two variants at 4q21 and 12q24 and further highlight three ADH variants in UADT cancer susceptibility.

Dietary fibre intake and risks of cancers of the colon and rectum in the European prospective investigation into cancer and nutrition (EPIC).

BACKGROUND Earlier analyses within the EPIC study showed that dietary fibre intake was inversely associated with colorectal cancer risk, but results from some large cohort studies do not support this finding. We explored whether the association remained after longer follow-up with a near threefold increase in colorectal cancer cases, and if the association varied by gender and tumour location. METHODOLOGY/PRINCIPAL FINDINGS After a mean follow-up of 11.0 years, 4,517 incident cases of colorectal cancer were documented. Total, cereal, fruit, and vegetable fibre intakes were estimated from dietary questionnaires at baseline. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards models stratified by age, sex, and centre, and adjusted for total energy intake, body mass index, physical activity, smoking, education, menopausal status, hormone replacement therapy, oral contraceptive use, and intakes of alcohol, folate, red and processed meats, and calcium. After multivariable adjustments, total dietary fibre was inversely associated with colorectal cancer (HR per 10 g/day increase in fibre 0.87, 95% CI: 0.79-0.96). Similar linear associations were observed for colon and rectal cancers. The association between total dietary fibre and risk of colorectal cancer risk did not differ by age, sex, or anthropometric, lifestyle, and dietary variables. Fibre from cereals and fibre from fruit and vegetables were similarly associated with colon cancer; but for rectal cancer, the inverse association was only evident for fibre from cereals. CONCLUSIONS/SIGNIFICANCE Our results strengthen the evidence for the role of high dietary fibre intake in colorectal cancer prevention.

Are there positive emotions in short-term dynamic psychotherapy or is it all Freude-less ?

Psychodynamic therapists are often suspicious of positive emotions and consider them to be nothing more than a form of denial or of another defense aiming to diminish painful or difficult affects. Positive emotions seem to exist only through the absence of negative emotions or as something that may happen outside of therapy. On the other hand, clinicians also agree that psychoanalytic work could not be successful without such positive emotions as interest, pleasure, surprise and creativity. Contemporary psychoanalytic thinking and new research findings in the area of relationship regulation are likely to give positive emotions an increasingly prominent place in dynamically oriented therapies. With today's emphasis on the therapeutic relationship and intersubjectivity, the time appears right to integrate positive emotions more formally into psychodynamic clinical theories.

Leishmania (Viannia) naiffi: rare enough to be neglected?

In the Brazilian Amazon, American tegumentary leishmaniasis (ATL) is endemic and presents a wide spectrum of clinical manifestations due, in part, to the circulation of at least seven Leishmaniaspecies. Few reports of Leishmania (Viannia) naiffiinfection suggest that its occurrence is uncommon and the reported cases present a benign clinical course and a good response to treatment. This study aimed to strengthen the clinical and epidemiological importance of L. (V.) naiffiin the Amazon Region (Manaus, state of Amazonas) and to report therapeutic failure in patients infected with this species. Thirty Leishmania spp samples isolated from cutaneous lesions were characterised by multilocus enzyme electrophoresis. As expected, the most common species was Leishmania (V.) guyanensis (20 cases). However, a relevant number ofL. (V.) naiffi patients (8 cases) was observed, thus demonstrating that this species is not uncommon in the region. No patient infected withL. (V.) naiffievolved to spontaneous cure until the start of treatment, which indicated that this species may not have a self-limiting nature. In addition, two of the patients experienced a poor response to antimonial or pentamidine therapy. Thus, either ATL cases due to L. (V.) naifficannot be as uncommon as previously thought or this species is currently expanding in this region.

Tree line shifts in the Swiss Alps: Climate change or land abandonment?

Questions: Did the forest area in the Swiss Alps increase between 1985 and 1997? Does the forest expansion near the tree line represent an invasion into abandoned grasslands (ingrowth) or a true upward shift of the local tree line? What land cover / land use classes did primarily regenerate to forest, and what forest structural types did primarily regenerate? And, what are possible drivers of forest regeneration in the tree line ecotone, climate and/or land use change? Location: Swiss Alps. Methods: Forest expansion was quantified using data from the repeated Swiss land use statistics GEOSTAT. A moving window algorithm was developed to distinguish between forest ingrowth and upward shift. To test a possible climate change influence, the resulting upward shifts were compared to a potential regional tree line. Results: A significant increase of forest cover was found between 1650 to and 2450 m. Above 1650 m, 10% of the new forest areas were identified as true upward shifts whereas 90% represented ingrowth, and we identified both land use and climate change as likely drivers. Most upward shift activities were found to occur within a band of 300 m below the potential regional tree line, indicating land use as the most likely driver. Only 4% of the upward shifts were identified to rise above the potential regional tree line, thus indicating climate change. Conclusions: Land abandonment was the most dominant driver for the establishment of new forest areas, even at the tree line ecotone. However, a small fraction of upwards shift can be attributed to the recent climate warming, a fraction that is likely to increase further if climate continues to warm, and with a longer time-span between warming and measurement of forest cover.

Behavioral aspects of investment fund's markets: are good managers lucky or skilled?

It is generally accepted that financial markets are efficient in the long run a lthough there may be some deviations in the short run. It is also accepted that a good portfolio manager is the one who beats the market persistently along time, this type of manager could not exist if markets were perfectly efficient According to this in a pure efficient market we should find that managers know that they can not beat the market so they would undertake only pure passive management strategies. Assuming a certain degree of inefficiency in the short run, a market may show some managers who tr y to beat the market by undertaking active strategies. From Fama’s efficient markets theory we can state that these active managers may beat the market occasionally although they will not be able to enhance significantly their performance in the long run. On the other hand, in an inefficient market it would be expected to find a higher level of activity related with the higher probability of beating the market. In this paper we follow two objectives: first, we set a basis to analyse the level of efficiency in an asset invest- ment funds market by measuring performance, strategies activity and it’s persistence for a certain group of funds during the period of study. Second, we analyse individual performance persistence in order to determine the existence of skilled managers. The CAPM model is taken as theoretical background and the use of the Sharpe’s ratio as a suitable performance measure in a limited information environment leads to a group performance measurement proposal. The empiri- cal study takes quarterly data from 1999-2007 period, for the whole population of the Spanish asset investment funds market, provided by the CNMV (Comisión Nacional del Mercado de Valores). This period of study has been chosen to ensure a wide enough range of efficient market observation so it would allow us to set a proper basis to compare with the following period. As a result we develop a model that allows us to measure efficiency in a given asset mutual funds market, based on the level of strategy’s activity undertaken by managers. We also observe persistence in individual performance for a certain group of funds

Generalized low-density codes with BCH constituents for full-diversity near-outage performance

A new graph-based construction of generalized low density codes (GLD-Tanner) with binary BCH constituents is described. The proposed family of GLD codes is optimal on block erasure channels and quasi-optimal on block fading channels. Optimality is considered in the outage probability sense. Aclassical GLD code for ergodic channels (e.g., the AWGN channel,the i.i.d. Rayleigh fading channel, and the i.i.d. binary erasure channel) is built by connecting bitnodes and subcode nodes via a unique random edge permutation. In the proposed construction of full-diversity GLD codes (referred to as root GLD), bitnodes are divided into 4 classes, subcodes are divided into 2 classes, and finally both sides of the Tanner graph are linked via 4 random edge permutations. The study focuses on non-ergodic channels with two states and can be easily extended to channels with 3 states or more.

Non-random fertilization in mice correlates with the MHC and something else

One evolutionary explanation for the success of sexual reproduction assumes that sex is an advantage in the coevolutionary arms race between pathogens and hosts. Accordingly, an important criterion in mate choice and maternal selection thereafter could be the allelic specificity at polymorphic loci involved in parasite-host interactions, e.g. the MHC (major histocompatibility complex). The MHC has been found to influence mate choice and selective abortions in mice and humans. However, it could also influence the fertilization process itself, i.e. (i) the oocyte's choice for the fertilizing sperm, and (ii) the outcome of the second meiotic division after the sperm has entered the egg. We tested both hypotheses in an in vitro fertilization experiment with two inbred mouse strains congenic for their MHC. The genotypes of the resulting blastocysts were determined by polymerase chain reaction. We found nonrandom MHC combinations in the blastocysts which may result from both possible choice mechanisms. The outcome changed significantly over time, indicating that a choice for MHC combinations during fertilization may be influenced by one or several external factors.

Effect of age on intraoperative cerebrovascular autoregulation and near-infrared spectroscopy-derived cerebral oxygenation.

Background. Age is an important risk factor for perioperative cerebral complications such as stroke, postoperative cognitive dysfunction, and delirium. We explored the hypothesis that intraoperative cerebrovascular autoregulation is less efficient and brain tissue oxygenation lower in elderly patients, thus, increasing the vulnerability of elderly brains to systemic insults such as hypotension.Methods. We monitored intraoperative cerebral perfusion in 50 patients aged 18-40 and 77 patients >65 yr at two Swiss university hospitals. Mean arterial pressure (MAP) was measured continuously using a plethysmographic method. An index of cerebrovascular autoregulation (Mx) was calculated based on changes in transcranial Doppler flow velocity due to changes in MAP. Cerebral oxygenation was assessed by the tissue oxygenation index (TOI) using near-infrared spectroscopy. End-tidal CO(2), O(2), and sevoflurane concentrations and peripheral oxygen saturation were recorded continuously. Standardized anaesthesia was administered in all patients (thiopental, sevoflurane, fentanyl, atracurium).Results. Autoregulation was less efficient in patients aged >65 yr [by 0.10 (SE 0.04; P=0.020)] in a multivariable linear regression analysis. This difference was not attributable to differences in MAP, end-tidal CO2, or higher doses of sevoflurane. TOI was not significantly associated with age, sevoflurane dose, or Mx but increased with increasing flow velocity [by 0.09 (SE 0.04; P=0.028)] and increasing MAP [by 0.11 (SE 0.05; P=0.043)].Conclusions. Our results do not support the hypothesis that older patients' brains are more vulnerable to systemic insults. The difference of autoregulation between the two groups was small and most likely clinically insignificant.

A Single High Dose of Oral Vitamin D3 Is Not Enough to Correct Insufficiency and Deficiency in a Rheumatologic Population

Introduction: Vitamin D plays a major role in bone metabolism and neuromuscular function. Supplementation with vitamin D is effective to reduce the risk of fall and of fracture. However adherence to oral daily vitamin D supplementation is low. Screening and correcting vitamin D insufficiency in a general rheumatologic population could improve both morbidity and quality of life in these patients with chronic painful disorders and at high risk of osteoporosis. After determining the prevalence of vitamin D deficiency in this population, we evaluated if supplementation with a single high dose of oral 25-OH vitamin D3 was sufficient to correct this abnormality. Methods: During one month (November 2009), levels of 25-OH vitamin D were systematically determined in our rheumatology outpatient clinic and classified into three groups: vitamin D deficiency (<10 μg/l), vitamin D insufficiency (10 to 30 μg/l) or normal vitamin D (>30 μg/l). Patients with insufficiency or deficiency received respectively a single high dose of 300000 IU or 600000 IU oral vitamin D3. In addition, all patients with osteoporosis were prescribed daily supplement of calcium (1 g) and vitamin D (800 IU). 25-OH vitamin D levels were reevaluated after 3 months. Results: Vitamin D levels were initially determined in 292 patients (mean age 53, 211 women, 87% Caucasian). 77% had inflammatory rheumatologic disease (IRD), 20% osteoporosis (OP) and 12% degenerative disease (DD). Vitamin D deficiency was present in 20 (6.8%), while 225 (77.1%) had insufficiency. Of the 245 patients with levels <30 μg/l, a new determination of vitamin D level was available in 173 (71%) at 3 months. Conclusion: Vitamin D insufficiency is highly prevalent in our rheumatologic population (84%), and is not adequately corrected by a single high dose of oral vitamin D3 in more than half of the patients with IRD and DD. In patients with OP, despite association of a single high dose with daily oral vitamin D supplementation, 40% of patients are still deficient when reevaluated at 3 months.

Estudo de caso: o uso da língua portuguesa por jovens provindos de outros países no domínio privado, público e educativo

A afluência de imigrantes a Portugal, nas últimas três décadas transformou radicalmente todo o tecido social português, caracterizando-se hoje pela sua heterogeneidade. Até ao início da década de 90 do século XX, os fluxos migratórios provinham essencialmente dos Países de Língua Oficial Portuguesa, com maior incidência de Cabo Verde, Brasil e Angola. É nessa década que se registam movimentos bastante significativos de imigrantes provenientes da Europa Central e Oriental, principalmente da Ucrânia, Rússia, Roménia e Moldávia, assim como da Ásia, destacando-se os naturais da China, Índia, Paquistão e das antigas repúblicas soviéticas. De acordo com a análise apresentada pelo Instituto Nacional de Estatística em Dezembro de 2006, residiam de forma legal em Portugal 329 898 cidadãos de nacionalidade estrangeira, sendo as maiores comunidades de Cabo Verde (57 349), Brasil (41 728) e Angola (28 854). A sociedade portuguesa do século XXI, distancia-se cada vez mais do conceito de monolinguismo, tal como se evidencia no Projecto Gulbenkian “Diversidade Linguística na Escola Portuguesa”, que, segundo o estudo feito, onze por cento dos alunos residentes na área da Grande Lisboa nasceram fora de Portugal e têm como línguas maternas cinquenta e oito idiomas. É urgente uma intervenção diferente no que corresponde a esta nova realidade linguística em Portugal e sobretudo no que concerne à integração do “outro”, reconhecendo e respeitando as várias línguas maternas e culturas, como também a sua preservação a fim de possibilitar o desenvolvimento íntegro e harmonioso da identidade. A heterogeneidade da actual sociedade portuguesa impõe um olhar atento para com esta nova realidade no país, sobretudo em muitas das escolas onde a par do uso da língua portuguesa outras línguas são também usadas como forma de comunicação entre os mesmos pares, situação esta perfeitamente desajustada da realidade escolar madeirense Estudo de caso: O uso da Língua Portuguesa por jovens oriundos de outros países nos domínios privado, público e educativo. 10 de inícios da década de 90 do século XX, à excepção dos alunos provenientes da Venezuela, os denominados luso-descendentes. A escola mudara, tudo se alterara, havia que tentar perceber o que estava a ocorrer, um novo Mundo “invadira” as turmas, prontas a aprender, a saber, a descobrir. Era preciso preencher o silêncio expectante. Aprender uma nova língua, a portuguesa, decorrente da obrigatoriedade implícita de tratar-se da língua oficial, obrigava a repensar o ensino, a continuamente desvendar novos caminhos possibilitadores de encontro entre a língua materna e a segunda, de reencontro com a identidade linguística e cultural que não se quer perdidas, só tornado possível na diferença. A par de uma escola que se apresentava de forma diferente, cuja intervenção teria de ser oposta à de então, uma vez que a aprendizagem do português era feita como língua segunda (L2), muitas foram e são as inquietações, um turbilhão de interrogações decorriam deste contacto constante de uma língua que se diz minha, fonte de partilha com outros jovens. O uso da língua portuguesa confinar-se-á unicamente à escola com os professores e colegas ou despoletará curiosidades, vontades, interesses, motivados por objectivos confinados ao percurso e à história humana? Muitas são as interrogações que ocorrem, muitos são também os momentos de sabedoria mútua de línguas e países a desvendar num contínuo ininterrupto e é essa constante procura que determina a busca de respostas. Entre muitas interrogações uma afigurava-se de forma latente, quiçá fonte de resposta para outras interrogações inerentes à língua portuguesa como língua segunda. A sua utilização por parte dos alunos de outras nacionalidades nos domínios privado, público e educativo engloba domínios diversos capazes de informar acerca do uso dessa mesma língua. Importa no entanto reforçar que estes alunos constituem um grupo heterogéneo sob diversos pontos de vista: etário, linguístico e cultural. Do ponto de vista linguístico a população que tem o português como língua segunda abrange alunos falantes de diferentes línguas maternas, umas mais próximas, outras mais afastadas do português, propiciando diferentes graus de transferência de conhecimentos linguísticos e de experiências comunicativas, como também em diferentes estádios de aquisição e que fora da escola o usam em maior ou menor número de contextos e com um grau de frequência desigual. Estudo de caso: O uso da Língua Portuguesa por jovens oriundos de outros países nos domínios privado, público e educativo. 11 Dispõem também de diferentes capacidades individuais para discriminar, segmentar e produzir sequências linguísticas. Já do ponto de vista cultural apresentam diferentes hábitos de aprendizagem, bem como diferentes representações e expectativas face à escola. Todos estes factores determinarão ritmos de progressão distintos no que respeita à aprendizagem do português como língua segunda. As oportunidades de aprendizagem e de uso que cada indivíduo tem ao longo da vida, determinantes no processo de aquisição, desenvolvimento e aprendizagem de uma língua, variam bastante de indivíduo para indivíduo. Os alunos podem viver num mesmo contexto no entanto razões variadíssimas determinarão diferentes oportunidades de aprendizagem e de uso. Viver-se num contexto de imersão não é suficiente para que todos tenham o mesmo grau de exposição a material linguístico rico e variado da L2. Essas oportunidades também se relacionam com a distância linguística entre língua primeira (L1) e a língua segunda, quanto mais afastadas são as duas línguas mais os falantes da L2 se refugiam na sua língua materna, assim como também se associam aos hábitos culturais da comunidade e da família.

Estudo de caso : o uso da língua portuguesa por jovens provindos de outros países no domínio privado, público e educativo

A afluência de imigrantes a Portugal, nas últimas três décadas transformou radicalmente todo o tecido social português, caracterizando-se hoje pela sua heterogeneidade. Até ao início da década de 90 do século XX, os fluxos migratórios provinham essencialmente dos Países de Língua Oficial Portuguesa, com maior incidência de Cabo Verde, Brasil e Angola. É nessa década que se registam movimentos bastante significativos de imigrantes provenientes da Europa Central e Oriental, principalmente da Ucrânia, Rússia, Roménia e Moldávia, assim como da Ásia, destacando-se os naturais da China, Índia, Paquistão e das antigas repúblicas soviéticas. De acordo com a análise apresentada pelo Instituto Nacional de Estatística em Dezembro de 2006, residiam de forma legal em Portugal 329 898 cidadãos de nacionalidade estrangeira, sendo as maiores comunidades de Cabo Verde (57 349), Brasil (41 728) e Angola (28 854). A sociedade portuguesa do século XXI, distancia-se cada vez mais do conceito de monolinguismo, tal como se evidencia no Projecto Gulbenkian “Diversidade Linguística na Escola Portuguesa”, que, segundo o estudo feito, onze por cento dos alunos residentes na área da Grande Lisboa nasceram fora de Portugal e têm como línguas maternas cinquenta e oito idiomas. É urgente uma intervenção diferente no que corresponde a esta nova realidade linguística em Portugal e sobretudo no que concerne à integração do “outro”, reconhecendo e respeitando as várias línguas maternas e culturas, como também a sua preservação a fim de possibilitar o desenvolvimento íntegro e harmonioso da identidade. A heterogeneidade da actual sociedade portuguesa impõe um olhar atento para com esta nova realidade no país, sobretudo em muitas das escolas onde a par do uso da língua portuguesa outras línguas são também usadas como forma de comunicação entre os mesmos pares, situação esta perfeitamente desajustada da realidade escolar madeirense Estudo de caso: O uso da Língua Portuguesa por jovens oriundos de outros países nos domínios privado, público e educativo. 10 de inícios da década de 90 do século XX, à excepção dos alunos provenientes da Venezuela, os denominados luso-descendentes. A escola mudara, tudo se alterara, havia que tentar perceber o que estava a ocorrer, um novo Mundo “invadira” as turmas, prontas a aprender, a saber, a descobrir. Era preciso preencher o silêncio expectante. Aprender uma nova língua, a portuguesa, decorrente da obrigatoriedade implícita de tratar-se da língua oficial, obrigava a repensar o ensino, a continuamente desvendar novos caminhos possibilitadores de encontro entre a língua materna e a segunda, de reencontro com a identidade linguística e cultural que não se quer perdidas, só tornado possível na diferença. A par de uma escola que se apresentava de forma diferente, cuja intervenção teria de ser oposta à de então, uma vez que a aprendizagem do português era feita como língua segunda (L2), muitas foram e são as inquietações, um turbilhão de interrogações decorriam deste contacto constante de uma língua que se diz minha, fonte de partilha com outros jovens. O uso da língua portuguesa confinar-se-á unicamente à escola com os professores e colegas ou despoletará curiosidades, vontades, interesses, motivados por objectivos confinados ao percurso e à história humana? Muitas são as interrogações que ocorrem, muitos são também os momentos de sabedoria mútua de línguas e países a desvendar num contínuo ininterrupto e é essa constante procura que determina a busca de respostas. Entre muitas interrogações uma afigurava-se de forma latente, quiçá fonte de resposta para outras interrogações inerentes à língua portuguesa como língua segunda. A sua utilização por parte dos alunos de outras nacionalidades nos domínios privado, público e educativo engloba domínios diversos capazes de informar acerca do uso dessa mesma língua. Importa no entanto reforçar que estes alunos constituem um grupo heterogéneo sob diversos pontos de vista: etário, linguístico e cultural. Do ponto de vista linguístico a população que tem o português como língua segunda abrange alunos falantes de diferentes línguas maternas, umas mais próximas, outras mais afastadas do português, propiciando diferentes graus de transferência de conhecimentos linguísticos e de experiências comunicativas, como também em diferentes estádios de aquisição e que fora da escola o usam em maior ou menor número de contextos e com um grau de frequência desigual. Estudo de caso: O uso da Língua Portuguesa por jovens oriundos de outros países nos domínios privado, público e educativo. 11 Dispõem também de diferentes capacidades individuais para discriminar, segmentar e produzir sequências linguísticas. Já do ponto de vista cultural apresentam diferentes hábitos de aprendizagem, bem como diferentes representações e expectativas face à escola. Todos estes factores determinarão ritmos de progressão distintos no que respeita à aprendizagem do português como língua segunda. As oportunidades de aprendizagem e de uso que cada indivíduo tem ao longo da vida, determinantes no processo de aquisição, desenvolvimento e aprendizagem de uma língua, variam bastante de indivíduo para indivíduo. Os alunos podem viver num mesmo contexto no entanto razões variadíssimas determinarão diferentes oportunidades de aprendizagem e de uso. Viver-se num contexto de imersão não é suficiente para que todos tenham o mesmo grau de exposição a material linguístico rico e variado da L2. Essas oportunidades também se relacionam com a distância linguística entre língua primeira (L1) e a língua segunda, quanto mais afastadas são as duas línguas mais os falantes da L2 se refugiam na sua língua materna, assim como também se associam aos hábitos culturais da comunidade e da família.

A single high dose of oral Vitamin D3 is not enough to correct insufficiency and deficiency in a rheumatologic population

Introduction: Vitamin D plays a major role in bone metabolism and neuromuscular function. Supplementation with vitamin D is effective to reduce the risk of fall and of fracture. However adherence to oral daily vitamin D supplementation is low. Screening and correcting vitamin D insufficiency in a general rheumatologic population could improve both morbidity and quality of life in these patients with chronic painful disorders and at high risk of osteoporosis. After determining the prevalence of vitamin D deficiency in this population, we evaluated if supplementation with a single high dose of oral 25-OH vitamin D3 was sufficient to correct this abnormality. Methods: During one month (November 2009), levels of 25-OH vitamin D were systematically determined in our rheumatology outpatient clinic and classified into three groups: vitamin D deficiency (<10 µg/l), vitamin D insufficiency (10 to 30µg/l) or normal vitamin D (>30 µg/l). Patients with insufficiency or deficiency received respectively a single high dose of 300'000 IU or 600'000 IU oral vitamin D3. In addition, all patients with osteoporosis were prescribed daily supplement of calcium (1g) and vitamin D (800 IU). 25-OH vitamin D levels were reevaluated after 3 months. Results: Vitamin D levels were initially determined in 292 patients (mean age 53, 211 women, 87% Caucasian). 77% had inflammatory rheumatologic disease (IRD), 20% osteoporosis (OP) and 12% degenerative disease (DD). Vitamin D deficiency was present in 20 (6.8%), while 225 (77.1%) had insufficiency. Of the 245 patients with levels <30µg/l, a new determination of vitamin D level was available in 173 (71%) at 3 months (table 1). Conclusion: Vitamin D insufficiency is highly prevalent in our rheumatologic population (84%), and is not adequately corrected by a single high dose of oral vitamin D3 in more than half of the patients with IRD and DD. In patients with OP, despite association of a single high dose with daily oral vitamin D supplementation, 40% of patients are still deficient when reevaluated at 3 months.

Bortezomib(Velcade (R))-Thalidomide-Dexamethasone (VTD) Is Superior to Thalidomide-Dexamethasone (TD) In Patients with Multiple Myeloma (MM) Progressing or Relapsing After Autologous Transplantation.

Introduction: The Thalidomide-Dexamethasone (TD) regimen has provided encouraging results in relapsed MM. To improve results, bortezomib (Velcade) has been added to the combination in previous phase II studies, the so called VTD regimen. In January 2006, the European Group for Blood and Marrow Transplantation (EBMT) and the Intergroupe Francophone du Myélome (IFM) initiated a prospective, randomized, parallel-group, open-label phase III, multicenter study, comparing VTD (arm A) with TD (arm B) for MM patients progressing or relapsing after autologous transplantation. Patients and Methods: Inclusion criteria: patients in first progression or relapse after at least one autologous transplantation, including those who had received bortezomib or thalidomide before transplant. Exclusion criteria: subjects with neuropathy above grade 1 or non secretory MM. Primary study end point was time to progression (TTP). Secondary end points included safety, response rate, progression-free survival (PFS) and overall survival (OS). Treatment was scheduled as follows: bortezomib 1.3 mg/m2 was given as an i.v bolus on Days 1, 4, 8 and 11 followed by a 10-Day rest period (days 12 to 21) for 8 cycles (6 months) and then on Days 1, 8, 15, 22 followed by a 20-Day rest period (days 23 to 42) for 4 cycles (6 months). In both arms, thalidomide was scheduled at 200 mg/Day orally for one year and dexamethasone 40 mg/Day orally four days every three weeks for one year. Patients reaching remission could proceed to a new stem cell harvest. However, transplantation, either autologous or allogeneic, could only be performed in patients who completed the planned one year treatment period. Response was assessed by EBMT criteria, with additional category of near complete remission (nCR). Adverse events were graded by the NCI-CTCAE, Version 3.0.The trial was based on a group sequential design, with 4 planned interim analyses and one final analysis that allowed stopping for efficacy as well as futility. The overall alpha and power were set equal to 0.025 and 0.90 respectively. The test for decision making was based on the comparison in terms of the ratio of the cause-specific hazards of relapse/progression, estimated in a Cox model stratified on the number of previous autologous transplantations. Relapse/progression cumulative incidence was estimated using the proper nonparametric estimator, the comparison was done by the Gray test. PFS and OS probabilities were estimated by the Kaplan-Meier curves, the comparison was performed by the Log-Rank test. An interim safety analysis was performed when the first hundred patients had been included. The safety committee recommended to continue the trial. Results: As of 1st July 2010, 269 patients had been enrolled in the study, 139 in France (IFM 2005-04 study), 21 in Italy, 38 in Germany, 19 in Switzerland (a SAKK study), 23 in Belgium, 8 in Austria, 8 in the Czech republic, 11 in Hungary, 1 in the UK and 1 in Israel. One hundred and sixty nine patients were males and 100 females; the median age was 61 yrs (range 29-76). One hundred and thirty six patients were randomized to receive VTD and 133 to receive TD. The current analysis is based on 246 patients (124 in arm A, 122 in arm B) included in the second interim analysis, carried out when 134 events were observed. Following this analysis, the trial was stopped because of significant superiority of VTD over TD. The remaining patients were too premature to contribute to the analysis. The number of previous autologous transplants was one in 63 vs 60 and two or more in 61 vs 62 patients in arm A vs B respectively. The median follow-up was 25 months. The median TTP was 20 months vs 15 months respectively in arm A and B, with cumulative incidence of relapse/progression at 2 years equal to 52% (95% CI: 42%-64%) vs 70% (95% CI: 61%-81%) (p=0.0004, Gray test). The same superiority of arm A was also observed when stratifying on the number of previous autologous transplantations. At 2 years, PFS was 39% (95% CI: 30%-51%) vs 23% (95% CI: 16%-34%) (A vs B, p=0.0006, Log-Rank test). OS in the first two years was comparable in the two groups. Conclusion: VTD resulted in significantly longer TTP and PFS in patients relapsing after ASCT. Analysis of response and safety data are on going and results will be presented at the meeting. Protocol EU-DRACT number: 2005-001628-35.