Contribution à la connaissance du métabolisme secondaire des Thymelaeaceae et investigation phytochimique de l'une d'elles: "Gnidia involucrata" Steud. ex A. Rich

Dans le but de mieux connaître le métabolisme secondaire de la famille des Thymelaeaceae et de découvrir de nouveaux composés naturels à intérêt thérapeutique, 30 extraits provenant de 8 espèces africaines ont été soumis à un criblage chimique et biologique. Les cibles biologiques suivantes ont servi à l?évaluation de l?activité des extraits étudiés : la moisissure phytopathogène Cladosporium cucumerinum, la levure commensale Candida albicans, la bactérie opportuniste Bacillus subtilis, la larve du moustique vecteur de la fièvre jaune Aedes aegypti et l?hôte intermédiaire mollusque de la schistosomiase urinaire Biomphalaria glabrata. Les propriétés antiradicalaires et inhibitrices de l?acétylcholinestérase de ces extraits ont également été dépistées. Des analyses sur CCM avec révélation chimique, ainsi que des expériences LC/DAD-UV, ont permis demettre en évidence la présence de tanins, de flavonoïdes et de xanthones dans les extraits polaires. Sur la base des résultats de ces analyses préliminaires, l?investigation phytochimique des extraits méthanoliques des racines et des parties aériennes de Gnidia involucrata a été entreprise. Cette démarche a permis l?isolement de 8 composés naturels et leur caractérisation complète au moyen de méthodes spectroscopiques (UV, MS, CD, 1H- et 13C-NMR). Les activités de ces produits purs ont été évaluées et il est apparu qu?ils possédaient presque tous des propriétés antiradicalaires intéressantes, supérieures à celles du BHT, un antioxydant de synthèse (E 321) utilisé dans l?industrie alimentaire. Deux benzophénones simples, respectivement O- et C-glucosylées, ont été isolées des parties aériennes de G. involucrata au côté de la mangiférine, une C-glycosylxanthone ubiquitaire. Ces découvertes sont remarquables à plusieurs titres : (1) les benzophénones simples (nonprénylées) sont très rares dans la nature ; (2) c?est la première fois qu?une Oglycosylbenzophénone a été décrite ; (3) aucune xanthone n?avait été mise en évidence auparavant dans la famille et (4) les benzophénones semblent ne pas être que des produits intermédiaires dans la biosynthèse des xanthones. Trois 3,8??-biflavanones du type GB ont été isolées des racines et des parties aériennes de la même plante, dont deux stéréoisomères se trouvant en mélange. Une analyse LC/CD a permis d?attribuer les configurations absolues des quatre carbones asymétriques de chaque molécule. Cette classe de métabolites secondaires est réputée pour ses propriétés analgésiques et sa présence chez les Thymelaeaceae est prometteuse. Des techniques couplées de pointe ont été utilisées dans ce travail et ont montré leur apport inestimable dans le domaine de la recherche phytochimique. Une analyse LC/ MSn a ainsi permis de mettre en évidence on-line trois C-glycosylflavones ? l?isoorientine, l?isovitexine et la vitexine ? dans les extraits méthanoliques bruts de G. involucrata. De plus, les parties aériennes de cette même plante ont servi de matériel pour le développement d?une nouvelle méthode d?analyse d?extraits bruts : la LC/1H-NMR time-slice. Cette approche consiste à « découper » le temps d?analyse par des interruptions régulières du flux LC, durant lesquelles les données NMR nécessaires sont acquises. Le problème de la faible sensibilité relative de la LC/NMR a été partiellement résolu par ce biais et a permis d?envisager l?utilisation de la NMR au sein de systèmes de couplages multiples en série avec d?autres méthodes spectrales (UV, MS, IR, CD,?).<br/><br/>With the aim of acquiring a better knowledge of the secondary metabolism of the family Thymelaeaceae and of the discovering of new natural therapeutics, 30 extracts from 8 African plant species were submitted to chemical and biological screening. The following biological targets were used to estimate the activity of the extracts under study: the phytopathogenic fungus Cladosporium cucumerinum, the commensal yeast Candida albicans, the opportunistic bacteria Bacillus subtilis, larvae of the yellow fever-transmitting mosquito Aedes aegypti and the intermediate snail host of urinary schistosomiasis Biomphalaria glabrata. The antiradical and acetylcholinesterase-inhibiting properties of these extracts were also investigated. TLC analyses followed by chemical detection, together with LC/DAD-UV experiments, showed the presence of tannins, flavonoids and xanthones in the polar extracts. On the basis of these results, a phytochemical investigation of the methanol extracts of the roots and the aerial parts of Gnidia involucrata was undertaken. This procedure led to the isolation of 8 natural products, which were then characterised by spectroscopic means (UV, MS, CD, 1H- and 13C-NMR). The activities of the pure compounds were then further evaluated: almost all of them exhibited very interesting antiradical properties, superior to those of BHT, a synthetic antioxidant (E 321) used in the food industry. Two simple benzophenones, one O- and one C-glycosylated, were isolated from the aerial parts of G. involucrata, together with mangiferin, a ubiquitous C-glycosylxanthone. These findings are of multiple importance: (1) simple (non-prenylated) benzophenones are very rare in nature; (2) it is the first time that an O-glycosylbenzophenone has been described; (3) no xanthones have been previously reported in the family and (4) benzophenones do not seem to be exclusive intermediates in the biosynthesis of xanthones. Three 3,8??-biflavanones of the GB type were isolated from the roots and the aerial parts of the same plant, among them two stereoisomers in mixture. A LC/CD analysis allowed the assignment of the absolute configurations of all four stereocenters in both molecules. This class of secondary metabolite is well known for its analgesic properties and its presence in the Thymelaeaceae is very promising. Advanced hyphenated techniques were used in this work and showed their inestimable contribution to the field of phytochemical research. A LC/MSn analysis, for example, allowed the on-line characterisation of three C-glycosylflavones ? isoorientin, isovitexin and vitexin ? in the crude methanol extracts of G. involucrata. Furthermore, the aerial parts of this plant were used as material for the development of a new analytical method for crude plant extracts: time-slice LC/1H-NMR. This approach consisted in "slicing" the analytical procedure by interrupting the LC flow at given intervals, during which the necessary NMR data were acquired. The relative lack of sensitivity of LC/NMR was partially surmounted by this means, allowing one to envisage the use of NMR in a multiple hyphenated system, together with other spectroscopic methods (UV, MS, IR, CD,?)

Prevalencia de la discapacidad en España por comunidades autónomas: el papel de los factores individuales y del entorno geográfico en su variabilidad

Fundamento: La prevalencia de discapacidad en la población general presenta una gran variabilidad geográfica, de manera que identificar aquellos factores que pudieran explicarla será importante para la planificación de políticas sociales. En este trabajo se analiza la variabilidad de la discapacidad por comunidades autónomas desde una doble vertiente, los factores individuales y del entorno. Métodos: Los datos proceden principalmente de la Encuesta de Discapacidad, Deficiencias y Estado de Salud de 1999 y del Inebase, ambas del Instituto Nacional de Estadística (INE). Se calculó la prevalencia de discapacidad simple y ajustada por edad de las CCAA. Se analizan los factores individuales asociados a la discapacidad mediante una regresión logística y los factores individuales y de la comunidad autónoma conjuntamente con una regresión logística de dos niveles. Resultados: La prevalencia de discapacidad muestra una diferencia máxima de 5,75 puntos entre las comunidades autónomas. En la regresión logística la comunidad de residencia fue estadísticamente significativa (OR: 3,35 en la de mayor prevalencia respecto a la de menor) junto con otras variables individuales: edad (OR de 40-64= 1,78 OR de 65-79= 1,87 y OR de >79= 3,34), sexo (OR mujer= 0,66), situación laboral (OR sin trabajo=2,25 OR amas casa/estudiante=1,39 y OR otros=2,03), estado de salud (OR regular= 1,69 OR malo/muy malo= 2,05) y enfermedades crónicas (OR 1-3=1,56 OR4-6=1,82 OR>6=2,59). En la regresión de dos niveles las variables individuales explican poca varianza (s=0,261) y ninguna de las variables relativas a las CCAA mejora el modelo. Conclusiones: Las características individuales no explican suficientemente la variabilidad de la discapacidad entre CCAA y no se han identificado variables del entorno que sean significativas.

Effects of nitrogen supply on wheat and on soil nitrate

Field experiments were conducted at two locations during two growing seasons in the Ebro Valley (Spain), to evaluate the effects of N fertilization on yield and quality of Mediterranean-type wheat in irrigated conditions. Seven N treatments and a control were investigated. The average grain yields ranged from 2117 to 5551 kg ha-1 depending on the year and location. Grain protein ranged from 14.25 to 16.9%, and other quality parameters such as the dough strength (W) also varied with year and location, confirming the suitability of Mediterranean-type wheat and the climate for the production of good bread-making quality wheat. However, grain yields are normally low and both yields and quality can be greatly affected by the variability of this type of climate, even under irrigation. Under these conditions, grain yield increases were mainly due to an increase in the number of grains per m2 without a reduction in the N content per spike, suggesting that N in the grain was not source-limited, possibly due to the lower grain yields and relatively high soil nitrate concentrations. In soils with lower initial soil NO-3N contents, better grain yields could be achieved by applying a N fertilizer rate of about 100 kg N ha-1, whereas in soils with high initial NO-3N contents, no N or a maximum rate of 50 kg N ha-1 is needed to obtain a good grain quality, showing the possibility of producing high-quality wheat with a low amount of N fertilizer and thus increasing the sustainability of the cropping system.

Pregnancy outcome following maternal exposure to mirtazapine: a multicenter, prospective study.

This multicenter, observational prospective cohort study addresses the risk associated with exposure to mirtazapine during pregnancy. Pregnancy outcomes after exposure to mirtazapine were compared with 2 matched control groups: (1) exposure to any selective serotonin reuptake inhibitor (SSRI, control subjects with a psychiatric condition) and (2) no exposure to medication known to be teratogenic or any antidepressant (general control subjects). Data were collected by members of the European Network of Teratology Information Services between 1995 and 2011. Observations from 357 exposed pregnancies were compared with 357 pregnancies from each control group. The rate of major birth defects between the mirtazapine and the SSRI group did not differ significantly (4.5% vs 4.2%; odds ratio [OR], 1.1; 95% confidence interval [95% CI], 0.5-2.3; P = 0.9). A trend toward a higher rate of birth defects in the mirtazapine group compared with general control subjects (4.5% vs 1.9%; OR, 2.4; 95% CI, 0.9-6.3; P = 0.08) reached statistical significance after exclusion of chromosomal or genetic anomalies (4.1% vs 1.3%; OR, 3.3; 95% CI, 1.04-10.3; P = 0.03), but this difference became again nonsignificant if cases of exposure not comprising the first trimester were excluded from the analysis (3.4% vs 1.9%; OR, 1.8; 95% CI, 0.6-5.0; P = 0.26). The crude miscarriage rate did not differ significantly between the mirtazapine, the SSRI, and the general control groups (12.1% vs 12.0% vs 9.3%; P = 0.44). However, a higher rate of elective pregnancy termination was observed in the mirtazapine group compared with SSRI and general control subjects (7.8% vs 3.4% vs 5.6%; P = 0.03). This study did not observe a statistically significant difference in the rate of major birth defects after first-trimester exposure between mirtazapine, SSRI-exposed, and nonexposed pregnancies. A marginally higher rate of birth defects was, however, observed in the mirtazapine and SSRI groups compared with the low rate of birth defects in our general control subjects. Overall pregnancy outcome after mirtazapine exposure was similar to that of the SSRI-exposed control group.

Increased risk of cardiovascular disease (CVD) with age in HIV-positive men : a comparison of the D:A:D CVD risk equation and general population CVD risk equations

OBJECTIVES: The aim of the study was to statistically model the relative increased risk of cardiovascular disease (CVD) per year older in Data collection on Adverse events of anti-HIV Drugs (D:A:D) and to compare this with the relative increased risk of CVD per year older in general population risk equations. METHODS: We analysed three endpoints: myocardial infarction (MI), coronary heart disease (CHD: MI or invasive coronary procedure) and CVD (CHD or stroke). We fitted a number of parametric age effects, adjusting for known risk factors and antiretroviral therapy (ART) use. The best-fitting age effect was determined using the Akaike information criterion. We compared the ageing effect from D:A:D with that from the general population risk equations: the Framingham Heart Study, CUORE and ASSIGN risk scores. RESULTS: A total of 24 323 men were included in analyses. Crude MI, CHD and CVD event rates per 1000 person-years increased from 2.29, 3.11 and 3.65 in those aged 40-45 years to 6.53, 11.91 and 15.89 in those aged 60-65 years, respectively. The best-fitting models included inverse age for MI and age + age(2) for CHD and CVD. In D:A:D there was a slowly accelerating increased risk of CHD and CVD per year older, which appeared to be only modest yet was consistently raised compared with the risk in the general population. The relative risk of MI with age was not different between D:A:D and the general population. CONCLUSIONS: We found only limited evidence of accelerating increased risk of CVD with age in D:A:D compared with the general population. The absolute risk of CVD associated with HIV infection remains uncertain.

Generalist hydrocarbon-degrading bacterial communities in the oil-polluted water column of the North Sea.

The aim of this work was to determine the effect of light crude oil on bacterial communities during an experimental oil spill in the North Sea and in mesocosms (simulating a heavy, enclosed oil spill), and to isolate and characterize hydrocarbon-degrading bacteria from the water column. No oil-induced changes in bacterial community (3 m below the sea surface) were observed 32 h after the experimental spill at sea. In contrast, there was a decrease in the dominant SAR11 phylotype and an increase in Pseudoalteromonas spp. in the oiled mesocosms (investigated by 16S rRNA gene analysis using denaturing gradient gel electrophoresis), as a consequence of the longer incubation, closer proximity of the samples to oil, and the lack of replenishment with seawater. A total of 216 strains were isolated from hydrocarbon enrichment cultures, predominantly belonging to the genus Pseudoaltero monas; most strains grew on PAHs, branched and straight-chain alkanes, as well as many other carbon sources. No obligate hydrocarbonoclastic bacteria were isolated or detected, highlighting the potential importance of cosmopolitan marine generalists like Pseudoalteromonas spp. in degrading hydrocarbons in the water column beneath an oil slick, and revealing the susceptibility to oil pollution of SAR11, the most abundant bacterial clade in the surface ocean.

High Throughput Purification of Combinatorial Libraries by Preparative LC/MS

Viime vuosien nopea kehitys on kiihdyttänyt uusien lääkkeiden kehittämisprosessia. Kombinatorinen kemia on tehnyt mahdolliseksi syntetisoida suuria kokoelmia rakenteeltaan toisistaan poikkeavia molekyylejä, nk. kombinatorisia kirjastoja, biologista seulontaa varten. Siinä molekyylien rakenteeseen liittyvä aktiivisuus tutkitaan useilla erilaisilla biologisilla testeillä mahdollisten "osumien" löytämiseksi, joista osasta saatetaan myöhemmin kehittää uusia lääkeaineita. Jotta biologisten tutkimusten tulokset olisivat luotettavia, on syntetisoitujen komponenttien oltava mahdollisimman puhtaita. Tämän vuoksi tarvitaan HTP-puhdistusta korkealaatuisten komponenttien ja luotettavan biologisen tiedon takaamiseksi. Jatkuvasti kasvavat tuotantovaatimukset ovat johtaneet näiden puhdistustekniikoiden automatisointiin ja rinnakkaistamiseen. Preparatiivinen LC/MS soveltuu kombinatoristen kirjastojen nopeaan ja tehokkaaseen puhdistamiseen. Monet tekijät, esimerkiksi erotuskolonnin ominaisuudet sekä virtausgradientti, vaikuttavat preparatiivisen LC/MS puhdistusprosessin tehokkuuteen. Nämä parametrit on optimoitava parhaan tuloksen saamiseksi. Tässä työssä tutkittiin emäksisiä komponentteja erilaisissa virtausolosuhteissa. Menetelmä kombinatoristen kirjastojen puhtaustason määrittämiseksi LC/MS-puhdistuksen jälkeen optimoitiin ja määritettiin puhtaus joillekin komponenteille eri kirjastoista ennen puhdistusta.

What does your neighbourhood say about you? : a study of life expectancy in 1.3 million Swiss neighbourhoods

BACKGROUND: Switzerland had the highest life expectancy at 82.8 years among the Organisation for Economic Co-operation and Development (OECD) countries in 2011. Geographical variation of life expectancy and its relation to the socioeconomic position of neighbourhoods are, however, not well understood. METHODS: We analysed the Swiss National Cohort, which linked the 2000 census with mortality records 2000-2008 to estimate life expectancy across neighbourhoods. A neighbourhood index of socioeconomic position (SEP) based on the median rent, education and occupation of household heads and crowding was calculated for 1.3 million overlapping neighbourhoods of 50 households. We used skew-normal regression models, including the index and additionally marital status, education, nationality, religion and occupation to calculate crude and adjusted estimates of life expectancy at age 30 years. RESULTS: Based on over 4.5 million individuals and over 400,000 deaths, estimates of life expectancy at age 30 in neighbourhoods ranged from 46.9 to 54.2 years in men and from 53.5 to 57.2 years in women. The correlation between life expectancy and neighbourhood SEP was strong (r=0.95 in men and r=0.94 women, both p values <0.0001). In a comparison of the lowest with the highest percentile of neighbourhood SEP, the crude difference in life expectancy from skew-normal regression was 4.5 years in men and 2.5 years in women. The corresponding adjusted differences were 2.8 and 1.9 years, respectively (all p values <0.0001). CONCLUSIONS: Although life expectancy is high in Switzerland, there is substantial geographical variation and life expectancy is strongly associated with the social standing of neighbourhoods.

National Survey of Noncommunicable Diseases in Seychelles, 2013-2014 (Seychelles Heart Study IV) : methods and main findings

This report provides information on selected summary results of the National Survey of Noncommunicable Diseases in Seychelles in 2013‐2014 (Seychelles Heart Study IV). The survey is also referred shortly as the "2013 Survey" in this report. Overall crude results were reported in a comprehensive report in November 2014. Further detailed analyses and recommendations on particular topics will be performed separately.

Estudi de la producció i de la qualitat farratgera de les pastures de la finca dels Cingles de l'Avenc (Tavertet). 2011

A Catalunya, la protecció i gestió de zones d’especial interès natural ha estat majoritàriament realitzada pel conjunt de les administracions públiques. Tot i així, en els últims anys han sorgit un conjunt d’iniciatives privades que a través d’acords de custòdia han passat a tenir un paper actiu en la protecció i gestió d’algunes finques amb un alt valor natural. És el cas de la finca els Cingles de l’Avenc, on s’ha dut a terme aquest treball, en la qual es pretén desenvolupar una activitat ramadera compatible amb la conservació dels valors naturals de la finca. L’objectiu principal d’aquest treball és conèixer la producció i qualitat farratgera dels diferents tipus de pastures que hi ha a la finca, i establir la càrrega ramadera que poden admetre. Aquest estudi ha tingut una durada de 3 anys i en aquest treball es presenten els resultats del 2011 i es fa l’anàlisi dels resultats dels 3 anys (2009, 2010, i 2011). L’estudi s’ha portat a terme en els 4 tipus principals de pastures que hi ha a la finca: joncedes, pastures mesòfiles, prats de dall i pastures sembrades. S’han utilitzat 11 parcel·les permanents excloses de la pastura, establertes l’any 2009, que inclouen la diversitat de tipus i zones de pastura. S’ha realitzat un mostreig de la biomassa mensual, d’abril a novembre, que ha consistit en dallar 4 quadrats de 50 x 50 cm, i s’ha calculat la producció anual. S’ha determinat la qualitat farratgera de l’herba de 4 moments de l’any: maig, juny, juliol i octubre. Després dels tres anys d’estudi hem obtingut que les pastures sembrades i els prats de dall són els més productius (1.067 g/m2.any i 1.005 g/m2.any, respectivament). La producció de les pastures mesòfiles i de les joncedes són més baixes (554 g/m2.any i 291 g/m2.any, respectivament). La qualitat farratgera de les pastures és bona a totes les comunitats, amb valors mitjans de proteïna digerible de 6,63%, de fibra bruta de 29,13%, de lignina de 7,29% i de 0,69 (ENL/1,700) unitats farratgeres. La producció anual global obtinguda a la finca durant aquests tres anys permet suportar una càrrega ramadera admissible d’unes 208 UBG (Unitats de Bestiar Gros. 1 U.B.G equival a 1 vaca a partir de 2 anys).

Brown algal phlorotannins: Improving and applying chemical methods

Phlorotannins are the least studied group of tannins and are found only in brown algae. Hitherto the roles of phlorotannins, e.g. in plant-herbivore interactions, have been studied by quantifying the total contents of the soluble phlorotannins with a variety of methods. Little attention has been given to either quantitative variation in cell-wall-bound and exuded phlorotannins or to qualitative variation in individual compounds. A quantification procedure was developed to measure the amount of cell-wall-bound phlorotannins. The quantification of soluble phlorotannins was adjusted for both large- and small-scale samples and used to estimate the amounts of exuded phlorotannins using bladder wrack (Fucus vesiculosus) as a model species. In addition, separation of individual soluble phlorotannins to produce a phlorotannin profile from the phenolic crude extract was achieved by high-performance liquid chromatography (HPLC). Along with these methodological studies, attention was focused on the factors in the procedure which generated variation in the yield of phlorotannins. The objective was to enhance the efficiency of the sample preparation procedure. To resolve the problem of rapid oxidation of phlorotannins in HPLC analyses, ascorbic acid was added to the extractant. The widely used colourimetric method was found to produce a variation in the yield that was dependent upon the pH and concentration of the sample. Using these developed, adjusted and modified methods, the phenotypic plasticity of phlorotannins was studied with respect to nutrient availability and herbivory. An increase in nutrients decreased the total amount of soluble phlorotannins but did not affect the cell-wall-bound phlorotannins, the exudation of phlorotannins or the phlorotannin profile achieved with HPLC. The presence of the snail Thedoxus fluviatilis on the thallus induced production of soluble phlorotannins, and grazing by the herbivorous isopod Idotea baltica increased the exudation of phlorotannins. To study whether the among-population variations in phlorotannin contents arise from the genetic divergence or from the plastic response of algae, or both, algae from separate populations were reared in a common garden. Genetic variation among local populations was found in both the phlorotannin profile and the content of total phlorotannins. Phlorotannins were also genetically variable within populations. This suggests that local algal populations have diverged in their contents of phlorotannins, and that they may respond to natural selection and evolve both quantitatively and qualitatively.

Fast and economic immobilization methods described for non-commercial Pseudomonas lipases

There is an increasing interest to seek new enzyme preparations for the development of new products derived from bioprocesses to obtain alternative bio-based materials. In this context, four non-commercial lipases from Pseudomonas species were prepared, immobilized on different low-cost supports, and examined for potential biotechnological applications. Results: To reduce costs of eventual scaling-up, the new lipases were obtained directly from crude cell extracts or from growth culture supernatants, and immobilized by simple adsorption on Accurel EP100, Accurel MP1000 and Celite (R) 545. The enzymes evaluated were LipA and LipC from Pseudomonas sp. 42A2, a thermostable mutant of LipC, and LipI. 3 from Pseudomonas CR611, which were produced in either homologous or heterologous hosts. Best immobilization results were obtained on Accurel EP100 for LipA and on Accurel MP1000 for LipC and its thermostable variant. Lip I. 3, requiring a refolding step, was poorly immobilized on all supports tested ( best results for Accurel MP1000). To test the behavior of immobilized lipases, they were assayed in triolein transesterification, where the best results were observed for lipases immobilized on Accurel MP1000. Conclusions: The suggested protocol does not require protein purification and uses crude enzymes immobilized by a fast adsorption technique on low-cost supports, which makes the method suitable for an eventual scaling up aimed at biotechnological applications. Therefore, a fast, simple and economic method for lipase preparation and immobilization has been set up. The low price of the supports tested and the simplicity of the procedure, skipping the tedious and expensive purification steps, will contribute to cost reduction in biotechnological lipase-catalyzed processes.

Future development of gastrointestinal cancer incidence and mortality rates in Switzerland: a tumour registry- and population-based projection up to 2030.

QUESTIONS UNDER STUDY: Since tumour burden consumes substantial healthcare resources, precise cancer incidence estimations are pivotal to define future needs of national healthcare. This study aimed to estimate incidence and mortality rates of oesophageal, gastric, pancreatic, hepatic and colorectal cancers up to 2030 in Switzerland. METHODS: Swiss Statistics provides national incidences and mortality rates of various cancers, and models of future developments of the Swiss population. Cancer incidences and mortality rates from 1985 to 2009 were analysed to estimate trends and to predict incidence and mortality rates up to 2029. Linear regressions and Joinpoint analyses were performed to estimate the future trends of incidences and mortality rates. RESULTS: Crude incidences of oesophageal, pancreas, liver and colorectal cancers have steadily increased since 1985, and will continue to increase. Gastric cancer incidence and mortality rates reveal an ongoing decrease. Pancreatic and liver cancer crude mortality rates will keep increasing, whereas colorectal cancer mortality on the contrary will fall. Mortality from oesophageal cancer will plateau or minimally increase. If we consider European population-standardised incidence rates, oesophageal, pancreatic and colorectal cancer incidences are steady. Gastric cancers are diminishing and liver cancers will follow an increasing trend. Standardised mortality rates show a diminution for all but liver cancer. CONCLUSIONS: The oncological burden of gastrointestinal cancer will significantly increase in Switzerland during the next two decades. The crude mortality rates globally show an ongoing increase except for gastric and colorectal cancers. Enlarged healthcare resources to take care of these complex patient groups properly will be needed.

Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4.4 million participants.

One of the global targets for non-communicable diseases is to halt, by 2025, the rise in the age-standardised adult prevalence of diabetes at its 2010 levels. We aimed to estimate worldwide trends in diabetes, how likely it is for countries to achieve the global target, and how changes in prevalence, together with population growth and ageing, are affecting the number of adults with diabetes. We pooled data from population-based studies that had collected data on diabetes through measurement of its biomarkers. We used a Bayesian hierarchical model to estimate trends in diabetes prevalence-defined as fasting plasma glucose of 7.0 mmol/L or higher, or history of diagnosis with diabetes, or use of insulin or oral hypoglycaemic drugs-in 200 countries and territories in 21 regions, by sex and from 1980 to 2014. We also calculated the posterior probability of meeting the global diabetes target if post-2000 trends continue. We used data from 751 studies including 4,372,000 adults from 146 of the 200 countries we make estimates for. Global age-standardised diabetes prevalence increased from 4.3% (95% credible interval 2.4-7.0) in 1980 to 9.0% (7.2-11.1) in 2014 in men, and from 5.0% (2.9-7.9) to 7.9% (6.4-9.7) in women. The number of adults with diabetes in the world increased from 108 million in 1980 to 422 million in 2014 (28.5% due to the rise in prevalence, 39.7% due to population growth and ageing, and 31.8% due to interaction of these two factors). Age-standardised adult diabetes prevalence in 2014 was lowest in northwestern Europe, and highest in Polynesia and Micronesia, at nearly 25%, followed by Melanesia and the Middle East and north Africa. Between 1980 and 2014 there was little change in age-standardised diabetes prevalence in adult women in continental western Europe, although crude prevalence rose because of ageing of the population. By contrast, age-standardised adult prevalence rose by 15 percentage points in men and women in Polynesia and Micronesia. In 2014, American Samoa had the highest national prevalence of diabetes (>30% in both sexes), with age-standardised adult prevalence also higher than 25% in some other islands in Polynesia and Micronesia. If post-2000 trends continue, the probability of meeting the global target of halting the rise in the prevalence of diabetes by 2025 at the 2010 level worldwide is lower than 1% for men and is 1% for women. Only nine countries for men and 29 countries for women, mostly in western Europe, have a 50% or higher probability of meeting the global target. Since 1980, age-standardised diabetes prevalence in adults has increased, or at best remained unchanged, in every country. Together with population growth and ageing, this rise has led to a near quadrupling of the number of adults with diabetes worldwide. The burden of diabetes, both in terms of prevalence and number of adults affected, has increased faster in low-income and middle-income countries than in high-income countries. Wellcome Trust.

Population-based incidence of myeloid malignancies: fifteen years of epidemiological data in the province of Girona, Spain

Myeloid malignancies (MMs) are a heterogeneous group of hematologic malignancies presenting different incidence, prognosis and survival.1–3 Changing classifications (FAB 1994, WHO 2001 and WHO 2008) and few available epidemiological data complicate incidence comparisons.4,5 Taking this into account, the aims of the present study were: a) to calculate the incidence rates and trends of MMs in the Province of Girona, northeastern Spain, between 1994 and 2008 according to the WHO 2001 classification; and b) to predict the number of MMs cases in Spain during 2013. Data were extracted from the population-based Girona Cancer Registry (GCR) located in the north-east of Catalonia, Spain, and covering a population of 731,864 inhabitants (2008 census). Cases were registered according to the rules of the European Network for Cancer Registries and the Manual for Coding and Reporting Haematological Malignancies (HAEMACARE project). To ensure the complete coverage of MMs in the GCR, and especially myeloproliferative neoplasms (MPN) and myelodysplastic syndromes (MDS), a retrospective search was performed. The ICD-O-2 (1990) codes were converted into their corresponding ICD-O-3 (2000) codes, including MDS, polycythemia vera (PV) and essential thrombocythemia (ET) as malignant diseases. Results of crude rate (CR) and European standardized incidence rate (ASRE) were expressed per 100,000 inhabitants/year