Marked association between obesity and glomerular hyperfiltration: a cross-sectional study in an African population.

BACKGROUND: Obesity and African American ethnicity are established independent risk factors for the development of chronic kidney disease. No data exist about the association between obesity and renal hemodynamics in the African region. STUDY DESIGN: Cross-sectional study. SETTING & PARTICIPANTS: 301 nondiabetic participants (97 lean, 108 overweight, and 96 obese) of African descent with a positive family history of hypertension from the Seychelles islands. PREDICTOR: Body mass index (BMI). OUTCOMES: Glomerular hyperfiltration, glomerular filtration rate (GFR), effective renal plasma flow (ERPF), and filtration fraction. MEASUREMENTS: GFR and ERPF were measured using inulin and para-aminohippurate clearances, respectively. Participants' baseline demographics, laboratory data, and blood pressure were measured using standard techniques. RESULTS: The prevalence of glomerular hyperfiltration (defined as GFR >or=140 mL/min) increased across BMI categories (7.2%, 14.8%, and 27.1% for lean, overweight, and obese participants, respectively; P < 0.001). Higher BMI was associated with higher median GFR (99, 110, and 117 mL/min for lean, overweight, and obese participants, respectively; P < 0.001), ERPF (424, 462, and 477 mL/min, respectively; P = 0.01), and filtration fraction (0.23, 0.24, and 0.25; P < 0.001). Multivariate analyses adjusting for age, sex, blood pressure, fasting glucose level, and urinary sodium excretion and accounting for familial correlations confirmed the associations between high BMI (>25 kg/m(2)) and increased GFR, ERPF, and filtration fraction. No association between BMI categories and GFR was found with adjustment for body surface area. LIMITATIONS: Participants had a positive family history of hypertension. CONCLUSION: Overweight and obesity are associated with increased GFR, ERPF, and filtration fraction and a high prevalence of glomerular hyperfiltration in nondiabetic individuals of African descent. The absence of associations between BMI categories and GFR indexed for body surface area raises questions regarding the appropriateness of indexing GFR for body surface area in overweight populations.

Acquisitions de la littérature en médecine interne générale ambulatoire en 2010 [2010 findings from literature on general internal ambulatory medicine].

From our reading over the current year 2010 we have singled out 8 items which seem to us significant for the practice of medicine. Small doses of colchicine are useful in the treatment of gout. No efficacious treatment for muscular cramps can be recommended. A cervical collar can be usefully prescribed for the treatment of cervical radiculopathy. A single dose of azithromycin can be envisaged as a third line treatment of syphilis. High doses of vitamin D should not be prescribed for the prevention of fractures in elderly women because of the risks of falling. The wearing of bifocals can be associated with these risks. A clinical score is available to help with the diagnosis of thoracic pain. The NT-pro BNP is of limited use for the follow-up of patients suffering from heart failure.

Radiation therapy duration influences overall survival in patients with cervical carcinoma.

OBJECTIVE: This article analyses the influence of treatment duration on survival in patients with invasive carcinoma of the cervix treated by radical radiation therapy. METHOD: Three hundred and sixty patients with FIGO stage IB-IIIB carcinoma of the cervix were treated in Lausanne (Switzerland) with external radiation and brachytherapy as first line therapy. Median therapy duration was 45 days. Patients were classified according to the duration of the therapies, taking 60 days (the 75th percentile) as an arbitrary cut-off. RESULTS: The 5-year survival was 61% (S.E. = 3%) for the therapy duration group of less than 60 days and 53% (S.E. = 7%) for the group of more than 60 days. In terms of univariate hazard ratio (HR), the relative difference between the two groups corresponds to a 50% increase of deaths (HR = 1.53, 95% CI = 1.03-2.28) for the longer therapy duration group (P = 0.044). In a multivariate analysis, the magnitude of estimated relative hazards for the longer therapies are confirmed though significance was reduced (HR = 1.52, 95% CI = 0.94-2.45, P = 0.084). CONCLUSION: These findings suggest that short treatment duration is a factor associated with longer survival in carcinoma of the cervix.

[Lettre autographe signée de Giuseppe Verdi adressée à Du Locle, Gênes, 21 avril 1871]

Comprend aussi une lettre autographe signée de Joséphine Verdi (en français)

Albert Lewin: Pandora y el Holandés Errante. La potencialidad semiológica de un mito griego

Albert Lewin, conocido director de cine de Hollywood influenciado por el movimiento surrealista, une el mito de Pandora con la leyenda del Holandés errante para crear una historia de amor ejemplar, una historia de amor loco que va más allá de los límites de la racionalidad. Y, como que para creer en este tipo de amor no es la razón stricto sensu la que nos ha de guiar, construye un mundo de signos, un mundo semiológico complejo que este artículo ayuda a descifrar.

[Illustrations de Art de chevalerie] / [Non identifié] ; Johann Hacobi von Wallhausen, aut. du texte

Comprend : [Frontispice : éléments d'architecture, figures de deux soldats en armure, scène de charge de cavalerie.] [Cote : Res Z Fontanieu 103 (5)] ; [Pl. dépl. en reg. p.68 (ou 446) : art équestre. Manière de monter à cheval.] [Cote : Res Z Fontanieu 103 (5)] ; [Pl. dépl. en reg. p.72 (ou 452) : art équestre. Manière de faire tourner le cheval en une ronde ou dans une figure serpentine.] [Cote : Res Z Fontanieu 103 (5)] ; [Pl. dépl. en reg. p.78 (ou 460) : art équestre. Manière de faire monter une côte à un cheval, de lui faire sauter un obstacle.] [Cote : Res Z Fontanieu 103 (5)] ; [Pl. dépl. en reg. p.80 (ou 464) : art équestre. Manière de faire traverser un fleuve à un cheval, de lui faire traverser un pont étroit et de lui faire dominer sa peur du feu. ] [Cote : Res Z Fontanieu 103 (5)] ; [Pl. dépl. en reg. p.84 (ou 470) : art équestre. Manière de combattre avec un lance sur un cheval.] [Cote : Res Z Fontanieu 103 (5)] ; [Pl. dépl. en reg. p.86 (ou 474) : art équestre. Manière de combattre avec un lance ou avec une épéesur un cheval.] [Cote : Res Z Fontanieu 103 (5)] ; [Pl. dépl. en reg. p.88 (ou 478) : art équestre. Manière de combattre avec des arquebuses sur un cheval.] [Cote : Res Z Fontanieu 103 (5)] ; [Pl. dépl. en reg. p.90 (ou 482) : art équestre. Manière de combattre avec des arquebuses ou des épées sur un cheval.] [Cote : Res Z Fontanieu 103 (5)] ; [Pl. dépl. en reg. p.94 (ou 488) : art équestre. Manière de combattre entre un fantassin et un cavalier.] [Cote : Res Z Fontanieu 103 (5)] ; [Pl. dépl. en reg. p.96 (ou 492) : art équestre. Manière de combattre entre un fantassin et un cavalier ou entre deux cavalier armés d'épées.] [Cote : Res Z Fontanieu 103 (5)] ; [Pl. dépl. en reg. p.100 (ou 498) : art équestre. Manière de combattre entre cavaliers.] [Cote : Res Z Fontanieu 103 (5)] ; [Pl. dépl. en reg. p.102 (ou 502) : art équestre. Manière de combattre entre deux adversaires à pied.] [Cote : Res Z Fontanieu 103 (5)] ; [Pl. dépl. en reg. p.106 (ou 508) : art équestre. Scène de batailel avec charge de cavalerie.] [Cote : Res Z Fontanieu 103 (5)] ; [Vigentte p.512 : marque d'imprimeur.] [Cote : Res Z Fontanieu 103 (5)]

Sunitinib-eluting beads for chemoembolization: methods for in vitro evaluation of drug release.

Drug-eluting microspheres are used for embolization of hypervascular tumors and allow for local controlled drug release. Although the drug release from the microspheres relies on fast ion-exchange, so far only slow-releasing in vitro dissolution methods have been correlated to in vivo data. Three in vitro release methods are assessed in this study for their potential to predict slow in vivo release of sunitinib from chemoembolization spheres to the plasma, and fast local in vivo release obtained in an earlier study in rabbits. Release in an orbital shaker was slow (t50%=4.5h, 84% release) compared to fast release in USP 4 flow-through implant cells (t50%=1h, 100% release). Sunitinib release in saline from microspheres enclosed in dialysis inserts was prolonged and incomplete (t50%=9 days, 68% release) due to low drug diffusion through the dialysis membrane. The slow-release profile fitted best to low sunitinib plasma AUC following injection of sunitinib-eluting spheres. Although limited by lack of standardization, release in the orbital shaker fitted best to local in vivo sunitinib concentrations. Drug release in USP flow-through implant cells was too fast to correlate with local concentrations, although this method is preferred to discriminate between different sphere types.

Mapeamento digital de atributos: granulometria e matéria orgânica do solo utilizando espectroscopia de de reflectância difusa

A espectroscopia de reflectância difusa (ERD) pode ser utilizada como alternativa para quantificação de atributos como granulometria e matéria orgânica do solo (MOS). Essa técnica pode ser opção para quantificar esses atributos em grande volume de amostras de solos, visto ser rápida, com menor custo e sem a geração de resíduos químicos. O objetivo deste estudo foi desenvolver modelos usando análise de regressão linear múltipla para predizer o teor de argila, areia, silte e MOS, utilizando dados de ERD em uma área de relevo e geologia complexa localizada na região central do Rio Grande do Sul. No estudo, foram utilizadas 303 amostras coletadas na profundidade de 0,00-0,20 m para determinar os teores de argila, areia, silte e MOS por meio da análise laboratorial e de reflectância espectral. O desempenho dos modelos de predição apresentaram bons resultados, com capacidade de explicação da variância de 77 e 72 % para areia e argila, respectivamente. Mesmo com a complexidade geológica e pedológica, os resultados evidenciaram que a técnica é promissora, sendo possível a aplicação dessa técnica para predição da granulometria e teor de MOS.

Polyanalgesic Consensus Conference-2012: Recommendations to Reduce Morbidity and Mortality in Intrathecal Drug Delivery in the Treatment of Chronic Pain.

Introduction:  Targeted intrathecal drug infusion to treat moderate to severe chronic pain has become a standard part of treatment algorithms when more conservative options fail. This therapy is well established in the literature, has shown efficacy, and is an important tool for the treatment of both cancer and noncancer pain; however, it has become clear in recent years that intrathecal drug delivery is associated with risks for serious morbidity and mortality. Methods:  The Polyanalgesic Consensus Conference is a meeting of experienced implanting physicians who strive to improve care in those receiving implantable devices. Employing data generated through an extensive literature search combined with clinical experience, this work group formulated recommendations regarding awareness, education, and mitigation of the morbidity and mortality associated with intrathecal therapy to establish best practices for targeted intrathecal drug delivery systems. Results:  Best practices for improved patient care and outcomes with targeted intrathecal infusion are recommended to minimize the risk of morbidity and mortality. Areas of focus include respiratory depression, infection, granuloma, device-related complications, endocrinopathies, and human error. Specific guidance is given with each of these issues and the general use of the therapy. Conclusions:  Targeted intrathecal drug delivery systems are associated with risks for morbidity and mortality that can be devastating. The panel has given guidance to treating physicians and healthcare providers to reduce the incidence of these problems and to improve outcomes when problems occur.