The course of inflammatory bowel disease during pregnancy and postpartum: a prospective European ECCO-EpiCom Study of 209 pregnant women.

BACKGROUND: The impact of pregnancy on the course of IBD is still controversial. AIM: To investigate the impact of pregnancy on IBD and to search for factors with potential impact on remission. METHODS: Pregnant IBD women from 12 European countries were enrolled between January 2003 and December 2006 and compared at conception (1:1) with nonpregnant IBD women. Data on disease course were prospectively collected at each trimester during pregnancy and in the postpartum (6 months) using a standardised questionnaire. RESULTS: A total of 209 pregnant IBD women were included: 92 with Crohn's disease (CD; median age 31 years, range 17-40) and 117 with ulcerative colitis (UC; median age 32 years, range 19-42). No statistically significant difference in disease course during pregnancy and postpartum was observed between pregnant and nonpregnant CD women. Longer disease duration in CD and immunosuppressive therapy were found to be risk factors for activity during pregnancy. Pregnant UC women were more likely than nonpregnant UC women to relapse both during pregnancy (RR 2.19; 95% CI: 1.25-3.97, 0.004) and postpartum (RR 6.22; 95% CI: 2.05-79.3, P = 0.0004). During pregnancy, relapse was mainly observed in the first (RR 8.80; 95% CI 2.05-79.3, P < 0.0004) and the second trimester (RR 2.84, 95% CI 1.2-7.45, P = 0.0098). CONCLUSIONS: Pregnant women with Crohn's disease had a similar disease course both during pregnancy and after delivery as the nonpregnant women. In contrast, pregnant women with ulcerative colitis were at higher risk of relapse during pregnancy and in the postpartum than nonpregnant ulcerative colitis women.

Epidemiology of incident heart failure in a contemporary elderly cohort: the health, aging, and body composition study.

BACKGROUND: The race- and sex-specific epidemiology of incident heart failure (HF) among a contemporary elderly cohort are not well described. METHODS: We studied 2934 participants without HF enrolled in the Health, Aging, and Body Composition Study (mean [SD] age, 73.6 [2.9] years; 47.9% men; 58.6% white; and 41.4% black) and assessed the incidence of HF, population-attributable risk (PAR) of independent risk factors for HF, and outcomes of incident HF. RESULTS: During a median follow-up of 7.1 years, 258 participants (8.8%) developed HF (13.6 cases per 1000 person-years; 95% confidence interval, 12.1-15.4). Men and black participants were more likely to develop HF. No significant sex-based differences were observed in risk factors. Coronary heart disease (PAR, 23.9% for white participants and 29.5% for black participants) and uncontrolled blood pressure (PAR, 21.3% for white participants and 30.1% for black participants) carried the highest PAR in both races. Among black participants, 6 of 8 risk factors assessed (smoking, increased heart rate, coronary heart disease, left ventricular hypertrophy, uncontrolled blood pressure, and reduced glomerular filtration rate) had more than 5% higher PAR compared with that among white participants, leading to a higher overall proportion of HF attributable to modifiable risk factors in black participants vs white participants (67.8% vs 48.9%). Participants who developed HF had higher annual mortality (18.0% vs 2.7%). No racial difference in survival after HF was noted; however, rehospitalization rates were higher among black participants (62.1 vs 30.3 hospitalizations per 100 person-years, P < .001). CONCLUSIONS: Incident HF is common in older persons; a large proportion of HF risk is attributed to modifiable risk factors. Racial differences in risk factors for HF and in hospitalization rates after HF need to be considered in prevention and treatment efforts.

Morea olim Peloponnesus / per Gerardum Mercatorem

Échelle(s) : Miliaria Italica communia, 50 [= 2,7 cm]

Intra-arterial hepatic fotemustine for the treatment of liver metastases from uveal melanoma: experience in 101 patients.

BACKGROUND: Exclusive liver metastases occur in up to 40% of patients with uveal melanoma associated with a median survival of 2-7 months. Single agent response rates with commonly available chemotherapy are below 10%. We have investigated the use of fotemustine via direct intra-arterial hepatic (i.a.h.) administration in patients with uveal melanoma metastases. PATIENTS AND METHODS: A total of 101 patients from seven centers were treated with i.a.h. fotemustine, administered intra-arterially weekly for a 4-week induction period, and then as a maintenance treatment every 3 weeks until disease progression, unacceptable toxicity or patient refusal. RESULTS: A median of eight fotemustine infusions per patient were delivered (range 1-26). Catheter related complications occurred in 23% of patients; however, this required treatment discontinuation in only 10% of the patients. The overall response rate was 36% with a median overall survival of 15 months and a 2-year survival rate of 29%. LDH, time between diagnosis and treatment start and gender were significant predictors of survival. CONCLUSIONS: Locoregional treatment with fotemustine is well tolerated and seems to improve outcome of this poor prognosis patient population. Median survival rates are among the longest reported and one-third of the patients are still alive at 2 years.

Wide-pulse-high-frequency neuromuscular stimulation of triceps surae induces greater muscle fatigue compared with conventional stimulation.

We compared the extent and origin of muscle fatigue induced by short-pulse-low-frequency [conventional (CONV)] and wide-pulse-high-frequency (WPHF) neuromuscular electrical stimulation. We expected CONV contractions to mainly originate from depolarization of axonal terminal branches (spatially determined muscle fiber recruitment) and WPHF contractions to be partly produced via a central pathway (motor unit recruitment according to size principle). Greater neuromuscular fatigue was, therefore, expected following CONV compared with WPHF. Fourteen healthy subjects underwent 20 WPHF (1 ms-100 Hz) and CONV (50 μs-25 Hz) evoked isometric triceps surae contractions (work/rest periods 20:40 s) at an initial target of 10% of maximal voluntary contraction (MVC) force. Force-time integral of the 20 evoked contractions (FTI) was used as main index of muscle fatigue; MVC force loss was also quantified. Central and peripheral fatigue were assessed by voluntary activation level and paired stimulation amplitudes, respectively. FTI in WPHF was significantly lower than in CONV (21,717 ± 11,541 vs. 37,958 ± 9,898 N·s P<0,001). The reductions in MVC force (WPHF: -7.0 ± 2.7%; CONV: -6.2 ± 2.5%; P < 0.01) and paired stimulation amplitude (WPHF: -8.0 ± 4.0%; CONV: -7.4 ± 6.1%; P < 0.001) were similar between conditions, whereas no change was observed for voluntary activation level (P > 0.05). Overall, our results showed a different motor unit recruitment pattern between the two neuromuscular electrical stimulation modalities with a lower FTI indicating greater muscle fatigue for WPHF, possibly limiting the presumed benefits for rehabilitation programs.

VERS UN ACCÈS UNIVERSEL

Avec près de 33 millions de personnes qui vivent avec le VIH et 2,7 millions de nouvelles infections en 2007, l’épidémie de VIH continue de représenter une menace majeure pour la santé mondiale. Bien que les engagements politiques et fi nanciers et les activités des pays aient permis d’élargir l’accès aux services ces dernières années, le nombre réel de nouvelles infections demeure élevé et continue de dépasser l’augmentation annuelle du nombre de patients qui reçoivent un traitement. Le rapport de situation 2009 donne des informations actualisées sur les progrès accomplis pour étendre les interventions prioritaires du secteur de la santé en matière de prévention, de traitement et de soins du VIH en 2008 en vue de l’accès universel, objectif adopté par la communauté internationale.

Motor Vehicle Accident Fatalities for the Week Ending, July 20, 2007

Record of the Fatalities for Motor Vehicle Accidents in Iowa per week.

Flora de Cabo Verde: Plantas Vasculares - 32. Cucurbitaceae

Ervas anuais ou perenes, escandentes, trepadoras ou prostradas, com gavinhas, raramente ervas erectas sem gavinhas. Folhas alternas, palminerveas, simples ou pedadamente compostas. Gavinhas distalmente 2-fidas ou proximalmente 2-7-fidas, raras vezes reduzidas a espinhos ou ausentes, em geral urna por nó. Flores unissexuadas, monóicas ou dióicas, axilares, diversamente dispostas, as Q geralmente solitarias. Probrácteas por vezes presentes na base dos pedúnculos. Tubo-receptáculo (hipanto) curto a tubular, em geral -i-lobado, lobos geralmente pequenos. Pétalas em geral 5, livres ou diversamente unidas, corola na maioria dos casos regular. Androceu basicamente com 5 estames, diversamente modificado, em geral com 2 duplos estames e 1 estame simples, livres ou f unidos; tecas das anteras frequentemente convolutas; estaminódios com frequência presentes nas flores Q. Ovário ínfero, 1-locular ou por vezes 34ocular, geralmente formado a partir de 3 carpelos unidos; placentacão parietal, raramente axilar, placentas com frequência intrusivas; óvulos anatrópicos, horizontais, pêndulos ou ascendentes; estilete 1, com 2 ou geralmente 3 lobos estigmáticos. ou 3 estiletes. Fruto seco ou carnudo, cápsula, baga ou pepónio de casca dura, diversamente deiscente ou indeiscente, I -polispérmico, raras vezes tuna sâmara 1-spérmica. Sementes frequentemente achatadas, por vezex aladas: embrião grande; endosperma ausente. Familia pantropical de cerca de 600 espécies, algumas economicamente importantes como plantas alimenticias.

Sex differences in the neurobiology of fear conditioning and extinction: a preliminary fMRI study of shared sex differences with stress-arousal circuitry.

BACKGROUND: The amygdala, hippocampus, medial prefrontal cortex (mPFC) and brain-stem subregions are implicated in fear conditioning and extinction, and are brain regions known to be sexually dimorphic. We used functional magnetic resonance imaging (fMRI) to investigate sex differences in brain activity in these regions during fear conditioning and extinction. METHODS: Subjects were 12 healthy men comparable to 12 healthy women who underwent a 2-day experiment in a 3 T MR scanner. Fear conditioning and extinction learning occurred on day 1 and extinction recall occurred on day 2. The conditioned stimuli were visual cues and the unconditioned stimulus was a mild electric shock. Skin conductance responses (SCR) were recorded throughout the experiment as an index of the conditioned response. fMRI data (blood-oxygen-level-dependent [BOLD] signal changes) were analyzed using SPM8. RESULTS: Findings showed no significant sex differences in SCR during any experimental phases. However, during fear conditioning, there were significantly greater BOLD-signal changes in the right amygdala, right rostral anterior cingulate (rACC) and dorsal anterior cingulate cortex (dACC) in women compared with men. In contrast, men showed significantly greater signal changes in bilateral rACC during extinction recall. CONCLUSIONS: These results indicate sex differences in brain activation within the fear circuitry of healthy subjects despite similar peripheral autonomic responses. Furthermore, we found that regions where sex differences were previously reported in response to stress, also exhibited sex differences during fear conditioning and extinction.

Pienviljelys ja maatalouspolitiikka

Puhe Pienviljelijäin Keskusliiton kokouksessa Turussa 2.7.1950

Pregnancy outcome following maternal exposure to statins: a multicentre prospective study.

OBJECTIVE: This contribution addresses the risk associated with exposure to statins during pregnancy. DESIGN: Multicentre observational prospective controlled study. SETTING: European Network of Teratology Information Services. POPULATION: Pregnant women who contacted one of 11 participating centres, seeking advice about exposure to statins during pregnancy, or to agents known to be nonteratogenic. METHODS: Pregnancies exposed during first trimester to statins were followed up prospectively, and their outcomes were compared with a matched control group. MAIN OUTCOME MEASURES: Rates of major birth defects, live births, miscarriages, elective terminations, preterm deliveries and gestational age and birthweight at delivery. RESULTS: We collected observations from 249 exposed pregnancies and 249 controls. The difference in the rate of major birth defects between the statin-exposed and the control groups was small and statistically nonsignificant (4.1% versus 2.7% odds ratio [OR] 1.5; 95% confidence interval [95% CI] 0.5-4.5, P = 0.43). In an adjusted Cox model, the difference between miscarriage rates was also small and not significant (hazard ratio 1.36, 95% CI 0.63-2.93, P = 0.43). Premature birth was more frequent in exposed pregnancies (16.1% versus 8.5%; OR 2.1, 95% CI 1.1-3.8, P = 0.019). Nonetheless, median gestational age at birth (39 weeks, interquartile range [IQR] 37-40 versus 39 weeks, IQR 38-40, P = 0.27) and birth weight (3280 g, IQR 2835-3590 versus 3250 g, IQR 2880-3630, P = 0.95) did not differ between exposed and non-exposed pregnancies. CONCLUSIONS: This study did not detect a teratogenic effect of statins. Its statistical power remains insufficient to challenge current recommendations of treatment discontinuation during pregnancy.

Flebotomíneos (Diptera, Psychodidae) em reservas florestais da área metropolitana de São Luís, Maranhão, Brasil

Estudou-se a diversidade, a abundância relativa e a sazonalidade das espécies de flebotomíneos em duas reservas de floresta primária alterada, a reserva florestal do Sacavém (RFS) e reserva florestal do Itaqui (RFI), localizadas na área metropolitana de São Luís, capital do estado do Maranhão. Os flebotomíneos foram capturados com armadilhas luminosas tipo CDC, instaladas na borda e no centro da mata, a 1,5 metros de altura, das 18h00 às 6h00, uma vez por mês, durante um ano. No total foram capturados 1.356 indivíduos de 23 espécies dos gêneros Lutzomyia (21) e Brumptomyia (2). Na RFS foram capturados 1.061 espécimes, resultando num esforço de captura de 2,5 indivíduos/hora/armadilha e o predomínio de L. longipalpis (44,8%), seguida por L. antunesi (36,4%), L. sordelli (5,9%), L. flaviscutellata (3,9%) e L. whitmani (2,1%). O maior número de espécies (11) e indivíduos (60,1%) ocorreu na estação chuvosa. Na RFI foram obtidos 295 espécimes, o esforço de captura foi 0,2 indivíduos/hora/armadilha, com o predomínio de L. flaviscutellata (58,6%), L. sordelli (14,6%), L. longipalpis (7,1%), L. evandroi (6,4%), L. longipennis (3%), L. trinidadensis (2,7%) e L. whitmani (1,7%). As espécies foram mais numerosas na estiagem (11) e os espécimes durante a estação chuvosa (54,6%).