Association of 25-hydroxyvitamin D with metabolic syndrome in patients with psoriasis: a case-control study.

Vitamin D deficiency is associated with higher cardiovascular risk and metabolic syndrome (MeS) criteria. The main objective of this study was to analyse the association of 25-hydroxyvitamin D (25-OHD) serum levels with MeS (National Cholesterol Education Program-Adult Treatment Panel-III criteria) in 46 Spanish patients with psoriasis, but without arthritis and systemic treatment, and 46 control subjects, matched by sex and age. The patients with psoriasis showed significantly lower level of 25-OHD than controls (30.5 vs. 38.3 ng/ml; p = 0.0001). Patients with MeS had significantly lower serum levels of 25-OHD than those without MeS (24.1 ± 7.5 vs. 32.8 ± 8.9, p = 0.007), and a negative correlation was found between 25-OHD and waist circumference, diastolic blood pressure, fasting glucose, and triglyceridaemia. In the control group no significant correlation between 25-OHD and MeS was found. Al-though the sample was small, our results suggest a potential protective role for 25-OHD in the metabolic profile of patients with psoriasis without arthritis.

Value of F-18-FDG PET/CT for determining malignant pleural effusion in patients with cancer

Objectif : Les épanchements pleuraux sont fréquents chez les patients porteurs de cancer et déterminer s'ils sont de nature tumorale ou non relève d'une grande importance clinique, particulièrement pour le groupe des carcinomes pulmonaires NON à petites cellules (NSCLC). Le PET/CT s'est montré d'une grande utilité et est actuellement indiscutablement reconnu comme outils nécessaire dans la prise en charge et notamment la stadification et le suivi des cancers, et particulièrement des cancers pulmonaires. Sa capacité à pouvoir distinguer les épanchements pleuraux malins des épanchements pleuraux non tumoraux, « bénins » n'est pas précisément connue et n'a pas jusqu'à présent été investiguée de manière approfondie. Matériel et méthodes : Nous avons examiné la captation du FDG (indice SUVmax) des épanchements pleuraux de 50 PET/CT réalisés chez 47 patients (29 hommes, 18 femmes, 60±16 ans) avec épanchements pleuraux et cancer connu (24 NSCLC, 7 lymphomes, 5 cancer du sein, 4 GIST, 3 mésothéliomes, 2 cancer ORL, 2 tératomes malins, 1 carcinome colorectal, 1 carcinome oesophagien, 1 mélanome). Ces résultats ont été corrélés aux résultats des examens cytopathologiques réalisés après ponction de ces mêmes épanchements dans un intervalle médian de 21 jours (interquartile range -3 to 23). L'examen du liquide d'épanchement comportait la mesure du pH, la distribution relative des différents éléments cellulaires (macrophages, neutrophils, éosinophiles, basophiles, lymphocytes, plasmocytes), la numération cellulaire et bien entendu présence de cellules tumorales. Résultats : Parmis les épanchements, 17 étaient malins (34%) (6 NSCLC, 5 lymphomes, 2 cancers mammaires, 2 mésothéliomes, 2 tératomes malins). Les SUV étaient plus élevés dans les épanchements malins que dans les épanchements bénins [3.7 (95%IC 1.8-5.6) vs. 1.7 g/ml (1.5-1.9), p = 0.001], avec une corrélation entre les épanchements malins et le SUV (coefficient de Spearman ρ = 0.50, p = 0.001). Il n'a pas été observé de corrélation entre aucun des autres paramètres cyptopathologiques ou radiologiques analysé (aire sous la courbe ROC 0.83 ± 0.06). En utilisant un seuil du SUV de 2.2-mg/l, 12 examens PET/CT étaient interprétés comme positifs and 38 comme négatifs avec une sensibilité et une spécificité, valeur prédictive positive et négative de 53%, 91%, 75% and 79% respectivement. Concernant le groupe des NSCLC seulement (n = 24), aire sous la courbe ROC était de 0.95 ± 0.04. Sept examens étaient considérés comme positifs et 17 comme négatifs avec une sensibilité, une spécificité, valeur prédictive positive et négative de 83%, 89%, 71 et 94% respectivement. Conclusion : Le PET/CT peut aider à différencier la nature bénigne ou maligne des épanchements avec une haute spécificité chez les patients avec tumeur connue, en particulier dans un contexte de carcinome NON à petites cellules.

First-line gefitinib in Caucasian EGFR mutation-positive NSCLC patients: a phase-IV, open-label, single-arm study.

BACKGROUND: Phase-IV, open-label, single-arm study (NCT01203917) to assess efficacy and safety/tolerability of first-line gefitinib in Caucasian patients with stage IIIA/B/IV, epidermal growth factor receptor (EGFR) mutation-positive non-small-cell lung cancer (NSCLC). METHODS: TREATMENT: gefitinib 250 mg day(-1) until progression. Primary endpoint: objective response rate (ORR). Secondary endpoints: disease control rate (DCR), progression-free survival (PFS), overall survival (OS) and safety/tolerability. Pre-planned exploratory objective: EGFR mutation analysis in matched tumour and plasma samples. RESULTS: Of 1060 screened patients with NSCLC (859 known mutation status; 118 positive, mutation frequency 14%), 106 with EGFR sensitising mutations were enrolled (female 70.8%; adenocarcinoma 97.2%; never-smoker 64.2%). At data cutoff: ORR 69.8% (95% confidence interval (CI) 60.5-77.7), DCR 90.6% (95% CI 83.5-94.8), median PFS 9.7 months (95% CI 8.5-11.0), median OS 19.2 months (95% CI 17.0-NC; 27% maturity). Most common adverse events (AEs; any grade): rash (44.9%), diarrhoea (30.8%); CTC (Common Toxicity Criteria) grade 3/4 AEs: 15%; SAEs: 19%. Baseline plasma 1 samples were available in 803 patients (784 known mutation status; 82 positive; mutation frequency 10%). Plasma 1 EGFR mutation test sensitivity: 65.7% (95% CI 55.8-74.7). CONCLUSION: First-line gefitinib was effective and well tolerated in Caucasian patients with EGFR mutation-positive NSCLC. Plasma samples could be considered for mutation analysis if tumour tissue is unavailable.

Detección de violencia contra la mujer en la consulta del médico de familia.

Objectives. To find out the magnitude of violence against female partners among patients who visit their family doctor. To study frequency and acceptance of its investigation by the family doctor and to assess the effectiveness of a screening question on abuse. Design. Descriptive, cross-sectional study. Setting. Primary care, 4 samples from 2 urban health centres in Jaén, Spain. Participants. Who participated 170 women randomly selected from the female consulting population. Measurements. Interviews by means of the Bradley modified test and the anxiety and depression Goldberg scales. Perceived health, frequency of detection of domestic violence, by the family doctor, and female opinions were also studied. Results. During the last year, abuse against women was detected in 22.9% of the female population consulting their family doctor (95% confidence interval [95% CI], 16.6-29.2). Abused women had a worse perception of health (odds ratio [OR] =4.2; 95% CI, 1.02-17.5) and a higher probability of depression (OR=4.7; 95% CI, 1.8-12.5) independently from the rest of variables. The question "How are the things going with your partner?" as a screening of abuse does obtain a positive probability quotient of 6.23 (95% CI, 3.6-10.9), a specificity of 89% and a negative predictive value of 90%. Of those interviewed, 96.5% would not mind if their family doctor approached the couple's relationships, a situation that occurs in 24.7% of cases. Conclusions. Some degree of abuse was detected in almost a quarter of women who consult their family doctor. Family doctors do not usually ask about family and partner relationships and environment, although for almost all women it is well appreciated and the item has an increased likelihood ratio and high negative predictive value in detecting abuse.

Energy expenditure in obese women before and during weight loss, after refeeding, and in the weight-relapse period.

In 10 moderately obese women, 24-h energy expenditure (24EE) was measured in a respiration chamber under four conditions: 1) before weight loss (body weight = 77.9 kg), 2) during weight loss (63.9 kg), 3) after realimentation (62.5 kg), and 4) 6-15 mo after the study diet with ad libitum diet (67.7 kg). The 14 +/- 8 kg (mean +/- SD) weight loss produced a decrease in 24EE of 1498 +/- 1138 kJ/d (P < 0.001), ie, a decrease of weight of 107 kJ.kg body wt-1.d-1. The subsequent 24EE (conditions 3 and 4) remained lower than the value before weight loss. A significant correlation was found between changes before and after weight regain in basal respiratory quotient (RQ) and the spontaneous rate of body-weight gain after cessation of the period of low energy intake (r = 0.89, P < 0.01); this suggests that the value of the postabsorptive RQ may be a predictor of relapse of weight gain. After discontinuation of the low energy diet, an elevated postabsorptive RQ shows that the endogenous lipid oxidation is low, a condition favoring weight gain.

Reasons for discontinuation of recommended therapies according to the patients after acute coronary syndromes.

BACKGROUND: The prescription of recommended medical therapies is a key factor to improve prognosis after acute coronary syndromes (ACS). However, reasons for cardiovascular therapies discontinuation after hospital discharge are poorly reported in previous studies. METHODS: We enrolled 3055 consecutive patients hospitalized with a main diagnosis of ACS in four Swiss university hospitals with a prospective one-year follow-up. We assessed the self-reported use of recommended therapies and the reasons for medication discontinuation according to the patient interview performed at one-year follow-up. RESULTS: 3014 (99.3%) patients were discharged with aspirin, 2983 (98.4%) with statin, 2464 (81.2%) with beta-blocker, 2738 (90.3%) with ACE inhibitors/ARB and 2597 (100%) with P2Y12 inhibitors if treated with coronary stent. At the one-year follow-up, the discontinuation percentages were 2.9% for aspirin, 6.6% for statin, 11.6% for beta-blocker, 15.1% for ACE inhibitor/ARB and 17.8% for P2Y12 inhibitors. Most patients reported having discontinued their medication based on their physicians' decision: 64 (2.1%) for aspirin, 82 (2.7%) for statin, 212 (8.6%) for beta-blocker, 251 (9.1% for ACE inhibitor/ARB) and 293 (11.4%) for P2Y12 inhibitors, while side effect, perception that medication was unnecessary and medication costs were uncommon reported reasons (<2%) according to the patients. CONCLUSIONS: Discontinuation of recommended therapies after ACS differs according the class of medication with the lowest percentages for aspirin. According to patients, most stopped their cardiovascular medication based on their physician's decision, while spontaneous discontinuation was infrequent.

Crenças em dor crônica: validação do Inventário de Atitudes frente à Dor para a língua portuguesa

Este estudo validou o Inventário de Atitudes frente à Dor - versão reduzida (IAD-breve) para a língua portuguesa. Sessenta e nove pacientes brasileiros foram avaliados. Os pacientes foram mulheres (71%), a idade média foi 50,8 anos (±15,4), a escolaridade média 7,4 anos (±4,8), e as dores mais freqüentes foram de etiologia musculoesquelética (39,1%), relacionadas ao câncer (34,8%) e neuropáticas (20,3%). A análise fatorial resultou em sete domínios (Controle, Dano-físico, Incapacidade, Cura Médica, Emoção, Medicação e Solicitude), como no instrumento original. A consistência interna, avaliada pelo µ Chronbach, variou de 0,55 a 0,89, valores considerados moderados e bons. A versão em português apresentou equivalência conceitual à versão em inglês. A disponibilidade do IAD-breve, em português, pode contribuir para a melhoria da pesquisa e prática clínica em pacientes com dor crônica.

State of Iowa Inmates at Mid-Year, 2000

This report was compiled at the request of the Department of Corrections. The statewide analysis of Iowa’s prison population at mid-year (June 30) 2000 includes the following information: l. Type of Most Serious Offense (e.g., arson, assault, burglary, etc.) 2. Offense Class of Most Serious Offense 3. Sex 4. Race/Ethnicity 5. Age (median, or middle value) 6. Inmate Custody Scores (median value) 7. Educational Level (average) 8. Reading Scores (average)

Co-morbidade fadiga e depressão em pacientes com câncer colo-retal

O estudo teve como objetivos caracterizar e identificar a comorbidade entre fadiga e depressão em pacientes com câncer colorretal. A amostra não-probabilística foi de 154 pacientes ambulatoriais (53% homens; idade média 49,6±11,7 anos; escolaridade média 8,9±5,4 anos). A fadiga foi avaliada pela Escala de Fadiga de Piper Revisada e o humor pelo Inventário de Depressão de Beck. A Fadiga foi relatada por 76 (49,4%) pacientes e foi intensa (escore total > 6) para 19,7% deles. Escores que sugerem depressão (IDB>20) foram encontrados em 11 (7,1%) pacientes. Fadiga e depressão estavam correlacionadas (r=0,395; p 0,001). A co-morbidade fadiga moderada/intensa e disforia/depressão ocorreu em 12,3%. A Fadiga estava presente na totalidade dos doentes deprimidos (100%), e a depressão ocorreu em 18% dos doentes fatigados. Fadiga e depressão são fenômenos relacionados, a sua comorbidade pode ser muito deletéria ao doente; a depressão foi mais importante para a ocorrência de fadiga do que a fadiga para a depressão.

The early Miocene rotation of the Corso-Sardinian block. New paleomagnetic constraints for the end of the motion

The paleomagnetic investigations carried out in the 70's on Oligo-Miocene volcanics of Sardinia have demonstrated that the island was turned by 35-30 degrees clockwise from 33 Ma up to 3-1-20.5 Ma and rotated counterclockwise in a few million years [De Jong et al., 1969, 1973; Bobier et Coulon, 1970; Coulon et al., 1974; Manzoni, 1974, 1975; Bellon rr nl.. 1977: Edel et Lortscher, 1977; Edel, 1979, 1980]. Since then, the end of the rotation fixed at 19 Ma by Montigny er al. [1981] was the subject of discussions and several studies associating paleomagnetism and radiometric dating were undertaken [Assorgia er al., 1994: Vigliotti et Langenheim, 1995: Deino et al., 1997; Gattacceca rt Deino, 1999]. This is a contribution to this debate that is hampered by thr important secular variation recorded in the volcanics. The only way to get our of this problem is to sample series of successive flows as completely as possible, and to reduce the effect of secular variation by the calculation of means. Sampling was performed north of Bonorva in 5 pyroclastic flows that belong to the upper ignimbritic series SI2 according to Coulon rr nl. [1974] or LBLS according to Assorgia et al. [1997] (fig. I). Ar-40/Ar-39 dating of biotites from the debris flow (MDF) has yielded an age or 18.35 +/- 0.03 Ma [Dubois, 2000]. Five of the investigated sites are located beneath the debris flow ITV, TVB, TVD, SPM85, SPM86), one site was cured in the matrix of the debris flow (MDF) and one in 4 metric blocks included in the flow (DFC). Another site was sampled in the upper ash flow (PDM) that marks the end of the pyroclastic activity, just before the marine transgression. According to micropaleontological and radiometric dating this transgression has occurred between 18.35 and 17.6 Ma [Dubois, 2000]. After removal of a soft viscous component, the thermal demagnetization generally shows a univectorial behaviour of the remanent magnetization (fig. 2a). The maximum unblocking temperatures of 580-620 degrees (tab. I) and a rapid saturation below 100 mT (fig. 3) indicate that the carrier of the characteristic magnetization is magnetite. The exception comes: from the upper site PDM in which were found two characteristic components, one with a normal polarity and low unblocking temperatures up to 350 degreesC and one with a reversed polarity and maximum unblocking temperatures at 580-600 degreesC of magnetite. After calculation of a mean direction for each flow, the mean << Al >> direction 4 degrees /57 degrees (alpha (95) = 13 degrees) computed with the mean directions for the 5 flows may be considered as weakly affected by secular variation. But the results require a more careful examination. The declinations are N to NNW beneath the debris flow. NNW in the debris flow. and NNE (or SSW) above the debris flow, The elongated distribution of the directions obtained at sites TVB and TVD. scattered from the mean direction of TV to the mean direction of MDF is interpreted as due to partial overprinting during the debris How volcanic episode, The low temperature component PDMa is likely related to the alteration seen on thin sections and is also viewed as an overprint. As NNE/SSW directions occur as well below (mean direction << B >> : 5 degrees /58 degrees) as above the debris flow (PDMb : 200 degrees/-58 degrees). the NNW directions (<< C >> : 337 degrees /64 degrees) associated with the debris flow volcanism may be interpreted as resulting from a magnetic field excursion. According to the polarity scale of Cande and Kent [1992, 1995] and the radiometric age of MDF, the directions with normal polarity (TV, TVB, TVD, SPM85. SPM86a. MDF. DFC) may represent the period 5En. while the directions with reversed polarity PDMb and SPM86b were likely acquired during the period 5Dr. Using the mean << Al >> direction, the mean << B >>, or the PDM direction (tab. I). the deviation in declination with the direction of stable Europe 6.4 degrees /58.7 degrees (alpha (95) = 8 degrees) for a selection of 4 middle Tertiary poles by Besse et Courtillot [1991] or 7 degrees /56 degrees (alpha (95) = 3 degrees) for 19 poles listed by Edel [1980] can be considered as negligible. Using the results from the uppermost ignimbritic layer of Anglona also emplaced around 18.3 Ma [Odin rt al.. 1994]. the mean direction << E >> (3 degrees /51.5 degrees) leads to the same conclusion. On the contrary, when taking into account all dated results available for the period 5En (mean direction << D >> 353 degrees /56 degrees for 45 sites) (tab. II). the deviation 13 degrees is much more significant. As the rotation of Sardinia started around 21-20.5 Ma. the assumption of a constant velocity of rotation and the deviations of the Sardinia directions with respect to the stable Europe direction locate the end of the motion between 18.3 and 17.2 or 16.7 Ma (fig. 4). During the interval 18.35-17.5 Ma, the marine transgression took place. At the same period a NE-SW shortening interpreted as resulting from the collision of Sardinia with Apulia affected different parts of the island [Letouzey et al., 1982]. Consequently, the new paleomagnetic results and the tectono-sedimentary evolution are in favour of an end of the rotation at 17.5-18 Ma.

Precauções de contato em Unidade de Terapia Intensiva: fatores facilitadores e dificultadores para adesão dos profissionais

Objetivou-se identificar os fatores que facilitam ou dificultam a adesão às precauções de contato, por parte de profissionais de um Centro de Terapia Intensiva de hospital geral. Tratou-se de um estudo transversal, realizado de maio a outubro de 2007, utilizando-se um questionário semi-estruturado para coleta de dados. Participaram do estudo 102 profissionais: técnico de enfermagem (54,9%), enfermeiro (12,7%), médico preceptor (10,8%), fisioterapeuta aprimorando (8,8%), fisioterapeuta preceptor (7,8%) e médico residente (4,9%). Os fatores dificultadores para a adesão à higienização das mãos foram o esquecimento, falta de conhecimento, distância da pia, irritação da pele e falta de materiais. O uso do capote apresentou maior dificuldade (45%) pela sua ausência no box, acondicionamento inadequado, calor, e ao seu uso coletivo. O uso de luvas foi a conduta de maior facilidade na prática cotidiana. Os resultados deste estudo apontam a necessidade de implementar medidas de precaução a fim de minimizar a disseminação de microrganismos resistentes.

Use of the frc gene as a molecular marker to characterize oxalate-oxidizing bacterial abundance and diversity structure in soil.

Oxalate catabolism, which can have both medical and environmental implications, is performed by phylogenetically diverse bacteria. The formyl-CoA-transferase gene was chosen as a molecular marker of the oxalotrophic function. Degenerated primers were deduced from an alignment of frc gene sequences available in databases. The specificity of primers was tested on a variety of frc-containing and frc-lacking bacteria. The frc-primers were then used to develop PCR-DGGE and real-time SybrGreen PCR assays in soils containing various amounts of oxalate. Some PCR products from pure cultures and from soil samples were cloned and sequenced. Data were used to generate a phylogenetic tree showing that environmental PCR products belonged to the target physiological group. The extent of diversity visualised on DGGE pattern was higher for soil samples containing carbonate resulting from oxalate catabolism. Moreover, the amount of frc gene copies in the investigated soils was detected in the range of 1.64x10(7) to 1.75x10(8)/g of dry soil under oxalogenic tree (representing 0.5 to 1.2% of total 16S rRNA gene copies), whereas the number of frc gene copies in the reference soil was 6.4x10(6) (or 0.2% of 16S rRNA gene copies). This indicates that oxalotrophic bacteria are numerous and widespread in soils and that a relationship exists between the presence of the oxalogenic trees Milicia excelsa and Afzelia africana and the relative abundance of oxalotrophic guilds in the total bacterial communities. This is obviously related to the accomplishment of the oxalate-carbonate pathway, which explains the alkalinization and calcium carbonate accumulation occurring below these trees in an otherwise acidic soil. The molecular tools developed in this study will allow in-depth understanding of the functional implication of these bacteria on carbonate accumulation as a way of atmospheric CO(2) sequestration.