Control glucémico y prevalencia de complicaciones a los 20 años de evolución en pacientes con diabetes mellitus tipo 1 sometidos a terapia intensiva desde el debut

Dels pacients amb DM1 diagnosticats entre 1985-1994 en el nostre centre, vàrem seleccionar 147 amb seguiment ininterromput des del debut i durant més de 10 anys. Vàrem revisar les dades registrades anualment relacionades amb el tractament, control glicèmic i risc cardiovascular, amb els objectius d'avaluar el Grau de control, l'existència de factors predictors, la prevalença de complicacions tardanes i la seva relació amb el control glucèmic. Vàrem objectivar que la insulinoteràpia intensiva permetia mantenir un control glucèmic adequat, i que el grau de control a l'any del diagnòstic predeia el control posterior. La prevalença de complicacions va ser inferior a la descrita prèviament.

Perfil clínico y curso evolutivo de los pacientes tratados con efalizumab tras la suspensión de su autorización por la EMEA. Estudio observacional y multicéntrico

L’objectiu de l’estudi fou avaluar el curs de la psoriasi després de la suspensió forçosa de l’efalizumab en un grup de 147 pacients procedents de 12 hospitals. Es recollí informació referida al perfil epidemiològic, al curs de la dermatosi durant el tractament i a l’evolució després de la suspensió. Durant el tractament, un 4% dels pacients fou diagnosticat d’exacerbació inflamatòria. Bona part dels pacients van ser classificats com a bons responedors, grup a priori de millor pronòstic. Tot i així, després de la suspensió, un 30% van desenvolupar rebot. La probabilitat de rebot fou independent de qualsevol dels paràmetres avaluats.

Connexin implication in the control of the murine beta-cell mass.

Diabetes develops when the insulin needs of peripheral cells exceed the availability or action of the hormone. This situation results from the death of most beta-cells in type 1 diabetes, and from an inability of the beta-cell mass to adapt to increasing insulin needs in type 2 and gestational diabetes. We analyzed several lines of transgenic mice and showed that connexins (Cxs), the transmembrane proteins that form gap junctions, are implicated in the modulation of the beta-cell mass. Specifically, we found that the native Cx36 does not alter islet size or insulin content, whereas the Cx43 isoform increases both parameters, and Cx32 has a similar effect only when combined with GH. These findings open interesting perspectives for the in vitro and in vivo regulation of the beta-cell mass.

A multi-perspective approach to performance anxiety in music students

AbstractPerforming publicly has become increasingly important in a variety of professions. This condition is associated with performance anxiety in almost all performers. Whereas some performers successfully cope with this anxiety, for others it represents a major problem and even threatens their career. Musicians and especially music students were shown to be particularly affected by performance anxiety.Therefore, the goal of this PhD thesis was to gain a better understanding of performance anxiety in university music students. More precisely, the first part of this thesis aimed at increasing knowledge on the occurrence, the experience, and the management of performance anxiety (Article 1). The second part aimed at investigating the hypothesis that there is an underlying hyperventilation problem in musicians with a high level of anxiety before a performance. This hypothesis was addressed in two ways: firstly, by investigating the association between the negative affective dimension of music performance anxiety (MPA) and self-perceived physiological symptoms that are known to co-occur with hyperventilation (Article 2) and secondly, by analyzing this association on the physiological level before a private (audience-free) and a public performance (Article 3). Article 4 places some key variables of Article 3 in a larger context by jointly analyzing the phases before, during, and after performing.The main results of the self-report data show (a) that stage fright is experienced as a problem by one-third of the surveyed students, (b) that the students express a considerable need for more help to better cope with it, and (c) that there is a positive association between negative feelings of MPA and the self-reported hyperventilation complaints before performing. This latter finding was confirmed on the physiological level in a tendency of particularly high performance-anxious musicians to hyperventilate. Furthermore, the psycho-physiological activation increased from a private to a public performance, and was higher during the performances than before or after them. The physiological activation was mainly independent of the MPA score. Finally, there was a low response coherence between the actual physiological activation and the self-reports on the instantaneous anxiety, tension, and perceived physiological activation.Given the high proportion of music students who consider stage fright as a problem and given the need for more help to better cope with it, a better understanding of this phenomenon and its inclusion in the educational process is fundamental to prevent future occupational problems. On the physiological level, breathing exercises might be a good means to decrease - but also to increase - the arousal associated with a public performance in order to meet an optimal level of arousal needed for a good performance.

A study of the cambial zone and conductive phloem of common beech (Fagus sylvatica L.) using an image analysis method. I. Influence of tree age on the structure

Quantification is a major problem when using histology to study the influence of ecological factors on tree structure. This paper presents a method to prepare and to analyse transverse sections of cambial zone and of conductive phloem in bark samples. The following paper (II) presents the automated measurement procedure. Part I here describes and discusses the preparation method, and the influence of tree age on the observed structure. Highly contrasted images of samples extracted at breast height during dormancy were analysed with an automatic image analyser. Between three young (38 years) and three old (147 years) trees, age-related differences were identified by size and shape parameters, at both cell and tissue levels. In the cambial zone, older trees had larger and more rectangular fusiform initials. In the phloem, sieve tubes were also larger, but their shape did not change and the area for sap conduction was similar in both categories. Nevertheless, alterations were limited, and demanded statistical analysis to be identified and ascertained. The physiological implications of the structural changes are discussed.

The prevalence of erectile dysfunction and its association with antiretroviral therapy in HIV-infected men: the Swiss HIV Cohort Study.

BACKGROUND: Here, we aimed to determine the prevalence of erectile dysfunction (ED) among HIV-infected men and its association with components of antiretroviral therapy. METHODS: Cross-sectional data on sexual dysfunction were collected in the Swiss HIV Cohort Study (SHCS) between December 2009 and November 2010. Multilevel logistic regression models were used to estimate the association between ED and exposure to 24 different antiretroviral drugs from four drug classes. RESULTS: During the study period, 5,194 of 5,539 eligible men in the SHCS had a follow-up visit; 4,064 men answered a question on ED for the first time. Among these men, ED was experienced often by 459 (11%), sometimes by 543 (13%), rarely by 389 (10%), never by 2,526 (62%) and 147 (4%) did not know. ED was associated with older age, an earlier HIV diagnosis and depression. No association was found with any drug class; however, ED was associated with cumulative exposure to either zalcitabine (OR 1.29 per year of use; 95% CI 1.07, 1.55) or enfuvirtide (OR 1.28; 95% CI 1.08, 1.52). CONCLUSIONS: Around 1 in 10 men in the SHCS reported often experiencing ED. We found no association between ED and any drug class, but those exposed to zalcitabine or enfurvitide (drugs no longer or rarely used) were more likely to report ED; this second association was probably not causal.

Detection of Mycobacterium tuberculosis in sputum from Suruí Indian subjects, Brazilian Amazon

This investigation aimed at the detection of Mycobacterium tuberculosis (MTB) in the sputum of Suruí Indian subjects from Amazonia, Brazil. Polymerase chain reaction analyses were positive for12 samples, five of which were also culture-positive (N = 147). Four MTB genotypes were identified, one of which showed resistance to rifampicin and isoniazid. The study also highlighted one village complex as of particular importance, considering the relatively high number of tuberculosis cases reported and of MTB isolates obtained.

How the mind constitutes itself through perceptual learning

Most theories of perception assume a rigid relationship between objects of the physical world and the corresponding mental representations. We show by a priori reasoning that this assumption is not fulfilled. We claim instead that all object-representation correspondences have to be learned. However, we cannot learn to perceive all objects that there are in the world. We arrive at these conclusions by a combinatory analysis of a fictive stimulus world and the way to cope with its complexity, which is perceptual learning. We show that successful perceptual learning requires changes in the representational states of the brain that are not derived directly from the constitution of the physical world. The mind constitutes itself through perceptual learning.

Area deprivation and mortality in the provincial capital cities of Andalusia and Catalonia (Spain)

Objective: To study the linkage between material deprivation and mortality from all causes, for men and women separately, in the capital cities of the provinces in Andalusia and Catalonia (Spain). Methods: A small-area ecological study was devised using the census section as the unit for analysis. 188 983 Deaths occurring in the capital cities of the Andalusian provinces and 109 478 deaths recorded in the Catalan capital cities were examined. Principal components factorial analysis was used to devise a material deprivation index comprising the percentage of manual labourers, unemployment and illiteracy. A hierarchical Bayesian model was used to study the relationship between mortality and area deprivation. Main results: In most cities, results show an increased male mortality risk in the most deprived areas in relation to the least depressed. In Andalusia, the relative risks between the highest and lowest deprivation decile ranged from 1.24 (Malaga) to 1.40 (Granada), with 95% credibility intervals showing a significant excess risk. In Catalonia, relative risks ranged between 1.08 (Girona) and 1.50 (Tarragona). No evidence was found for an excess of female mortality in most deprived areas in either of the autonomous communities. Conclusions: Within cities, gender-related differences were revealed when deprivation was correlated geographically with mortality rates. These differences were found from an ecological perspective. Further research is needed in order to validate these results from an individual approach. The idea to be analysed is to identify those factors that explain these differences at an individual level.

Tendencias de la mortalidad por enfermedades cardiovasculares en Andalucía entre 1975 y 2004

Background: Cardiovascular diseases are ranked among the leading causes of death in the industrialized countries. This study is aimed at ascertaining the mortality trends by ischemic heart disease (IHD) and cerebrovascular diseases (CVD) in Andalusia within the 1975-2004 period. Method: Based on the official IHD and CVD death statistics and the related populations, the gross rates (GR) and age-adjusted rates (TS) and the Potential Years of Life Lost (PYLL) were calculated. To quantify the trends and their change points, a joinpoint regression analysis was made. Results: The number of IHD deaths for females rose from 2,086 deaths in 1975 to 3,336 in 2004, the TS having dropped from 74.29 to 50.94 deaths/100,000 females, the PYLL having dropped from 173.65 years to 90.56 years/100,000 females. The number of deaths for males rose from 2,854 deaths in 1975 to 4,085 in 2004, the TS having dropped from 147, 67 to 104.96 deaths /100,000 males. The PYLL showed a like behaviour from the first to the last year of the series, showing values of 716.46 and 460.04 years / 100,000 males. For the IHD in females, the number of deaths in absolute numbers dropped from 4,712 to 4,221, the TS having dropped from 166.00 to 62.08 deaths in females, and the PYLL from 338.08 to 87.63 years / 100,000 females. For males, the number of deaths dropped from 3,714 to 2,951, the TS from 206.88 deaths /100,000 males in 1975 to 76.12 /100,000 males in 2004, and the PYLL dropping from 533.12 to 182.38 years / 100,000 males. Conclusions: The trend in mortality due to IHD was not constant either among females or males, although it has always been a downward trend, the drop being statistically significant. The drop in the CVD has been such a major one that both the absolute numbers and the gross rates are lower for the most recent years that the first years in the series studied despite the aging of Andalusia’s population.