Outcome of patients with acute coronary syndrome in hospitals of different sizes. A report from the AMIS Plus Registry.

To assess the impact of admission to different hospital types on early and 1-year outcomes in patients with acute coronary syndrome (ACS). Between 1997 and 2009, 31 010 ACS patients from 76 Swiss hospitals were enrolled in the AMIS Plus registry. Large tertiary institutions with continuous (24 hour/7 day) cardiac catheterisation facilities were classified as type A hospitals, and all others as type B. For 1-year outcomes, a subgroup of patients admitted after 2005 were studied. Eleven type A hospitals admitted 15987 (52%) patients and 65 type B hospitals 15023 (48%) patients. Patients admitted into B hospitals were older, more frequently female, diabetic, hypertensive, had more severe comorbidities and more frequent non-ST segment elevation (NSTE)-ACS/unstable angina (UA). STE-ACS patients admitted into B hospitals received more thrombolysis, but less percutaneous coronary intervention (PCI). Crude in-hospital mortality and major adverse cardiac events (MACE) were higher in patients from B hospitals. Crude 1-year mortality of 3747 ACS patients followed up was higher in patients admitted into B hospitals, but no differences were found for MACE. After adjustment for age, risk factors, type of ACS and comorbidities, hospital type was not an independent predictor of in-hospital mortality, in-hospital MACE, 1-year MACE or mortality. Admission indicated a crude outcome in favour of hospitalisation during duty-hours while 1-year outcome could not document a significant effect. ACS patients admitted to smaller regional Swiss hospitals were older, had more severe comorbidities, more NSTE-ACS and received less intensive treatment compared with the patients initially admitted to large tertiary institutions. However, hospital type was not an independent predictor of early and mid-term outcomes in these patients. Furthermore, our data suggest that Swiss hospitals have been functioning as an efficient network for the past 12 years.

Sylvatic population of Triatoma infestans from the Bolivian Chaco: from field collection to characterization

A sylvatic Triatoma infestans DM (dark morph) population detected in the Bolivian Chaco was characterized and compared with various domestic ones. The degree of differentiation of DM was clearly within the T. infestans intra-specific level. Nevertheless marked chromatic and morphometric differences as well as differences in antennal pattern, chromosome banding and randomly amplified polymorphic DNA support the hypothesis of a distinct population. Continuous exchange of insects between wild and domestic habitats seems unlikely in the Chaco.

Population genetic analysis of Colombian Trypanosoma cruzi isolates revealed by enzyme electrophoretic profiles

Although Colombia presents an enormous biological diversity, few studies have been conducted on the population genetics of Trypanosoma cruzi. This study was carried out with 23 Colombian stocks of this protozoa analyzed for 13 isoenzymatic loci. The Hardy-Weinberg equilibrium, the genetic diversity and heterogeneity, the genetic relationships and the possible spatial structure of these 23 Colombian stocks of T. cruzi were estimated. The majority of results obtained are in agreement with a clonal population structure. Nevertheless, two aspects expected in a clonal structure were not discovered in the Colombian T. cruzi stocks. There was an absence of given zymodemes over-represented from a geographical point of view and the presumed temporal stabilizing selective phenomena was not observed either in the Colombian stocks sampled several times through the years of the study. Some hypotheses are discussed in order to explain the results found.

Population biology of Allocreadium lobatum Wallin, 1909 (Digenea: Allocreadiidae) in the creek chub, Semotilus atromaculatus, mitchill (Osteichthyes: Cyprinadae), in a Nebraska Creek, USA

Allocreadium lobatum Wallin, 1909 has been reported in cyprinid species of freshwater fish in Canada and in the United States. The population biology of A. lobatum in the host Semotilus atromaculatus Mitchill was studied from May through December 1991, in a USA creek. Overall prevalence (64%) and mean intensity (4.4 ± 0.4) were greater than previously reported while abundance, reported for the first time, was 2.8 ± 0.3. Several trends in A. lobatum population biology as a function of S. atromaculatus length were identified. Mean intensity and abundance of A. lobatum increased with host size and significant differences in prevalence and A. lobatum lengths were found to correlate with host lengths.

Usefulness of microsatellite typing in population genetic studies of Trypanosoma cruzi

Through microsatellite analysis of 53 monoclonal populations of Trypanosoma cruzi, we found a remarkable degree of genetic polymorphism with no single multilocus genotype being observed more than once. The microsatellite profile proved to be stable during 70 generations of the CL Brener clone in culture. The microsatellite profiling presented also high diagnostic sensitivity since DNA amplifications could be achieved with less than 100 fg DNA, corresponding to half parasite total DNA content. Based on these technical attributes the microsatellite assay turns out to be an important tool for direct typing T. cruzi in biological samples. By using this approach we were able to type T. cruzi in feces of artificially infected bugs and in single cells sorted by FACS. The microsatellites have shown to be excellent markers for T. cruzi phylogenetic reconstruction. We used maximum parsimony based on the minimum number of mutational steps to build an unrooted Wagner network, which confirms previous conclusions based on the analysis of the D7 domain of the LSU rDNA gene that T. cruzi is composed by two major groups. We also obtained evidence that strains belonging to rRNA group 2 are subdivided into two genetically distant clusters, and that one of these clusters is more related to rRNA group 1/2. These results suggest different origins for these strains.

ALK rearrangement in a selected population of advanced non small cell lung cancer patients. FISH and inmunohistochemistry diagnostic methods, prevalence and clinical outcomes

Anaplastic lymphoma kinase (ALK) rearrangements represents a new driver oncogenic event in non-small cell lung cancer (NSCLC). ALK positive patients account for a 1-7% of NSCLC patients. The objective of this study is to know the prevalence and clinical characteristics of ALK positive patients in a cohort of NSCLC patients and to compare inmunohistochemistry with D5F3 monoclonal antibody with gold standard method fluorescence in situ hybridation

Anti-basal ganglia antibodies and Tourette's syndrome: a voxel-based morphometry and diffusion tensor imaging study in an adult population.

Anti-basal ganglia antibodies (ABGAs) have been suggested to be a hallmark of autoimmunity in Gilles de la Tourette's syndrome (GTS), possibly related to prior exposure to streptococcal infection. In order to detect whether the presence of ABGAs was associated with subtle structural changes in GTS, whole-brain analysis using independent sets of T(1) and diffusion tensor imaging MRI-based methods were performed on 22 adults with GTS with (n = 9) and without (n = 13) detectable ABGAs in the serum. Voxel-based morphometry analysis failed to detect any significant difference in grey matter density between ABGA-positive and ABGA-negative groups in caudate nuclei, putamina, thalami and frontal lobes. These results suggest that ABGA synthesis is not related to structural changes in grey and white matter (detectable with these methods) within frontostriatal circuits.

Prospective evaluation of risk of vertebral fractures using quantitative ultrasound measurements and bone mineral density in a population-based sample of postmenopausal women: results of the Basel Osteoporosis Study.

OBJECTIVE: Prospective studies have shown that quantitative ultrasound (QUS) techniques predict the risk of fracture of the proximal femur with similar standardised risk ratios to dual-energy x-ray absorptiometry (DXA). Few studies have investigated these devices for the prediction of vertebral fractures. The Basel Osteoporosis Study (BOS) is a population-based prospective study to assess the performance of QUS devices and DXA in predicting incident vertebral fractures. METHODS: 432 women aged 60-80 years were followed-up for 3 years. Incident vertebral fractures were assessed radiologically. Bone measurements using DXA (spine and hip) and QUS measurements (calcaneus and proximal phalanges) were performed. Measurements were assessed for their value in predicting incident vertebral fractures using logistic regression. RESULTS: QUS measurements at the calcaneus and DXA measurements discriminated between women with and without incident vertebral fracture, (20% height reduction). The relative risks (RRs) for vertebral fracture, adjusted for age, were 2.3 for the Stiffness Index (SI) and 2.8 for the Quantitative Ultrasound Index (QUI) at the calcaneus and 2.0 for bone mineral density at the lumbar spine. The predictive value (AUC (95% CI)) of QUS measurements at the calcaneus remained highly significant (0.70 for SI, 0.72 for the QUI, and 0.67 for DXA at the lumbar spine) even after adjustment for other confounding variables. CONCLUSIONS: QUS of the calcaneus and bone mineral density measurements were shown to be significant predictors of incident vertebral fracture. The RRs for QUS measurements at the calcaneus are of similar magnitude as for DXA measurements.

Quantitave and qualitative interferences of pentoxifillyne on hepatic Schistosoma mansoni granulomas: effects on extracellular matrix and eosinophil population

Mast cells and eosinophils actively participate in tissue repair and are prominent components of Schistosoma mansoni granulomas. Since pentoxifillyne (PTX) is an immunomodulatory and antifibrotic substance, we aimed to characterize, by morphological techniques, the effect of this drug on fibrosis developed inside murine hepatic schistosomal granulomatous reaction, beyond the quantification of eosinophil and mast cell populations. The drug (1 mg/100 g animal weight) was administrated from 35 to 90 days post-infection, when the animals were killed. The intragranulomatous interstitial collagen network was analyzed by confocal laser scanning microscopy, the number of eosinophils and mast cells was quantified and the results were validated by t-student test. Treatment did not interfere on the granuloma evolution but caused a significant decrease in the total and involutive number of hepatic granulomas (p = 0.01 and 0.001, respectivelly), and in the intragranulomatous accumulation of eosinophils (p = 0.0001). Otherwise, the number of mast cells was not significantly altered (p = 0.9); however, it was positively correlated with the number of granulomatous structures (r = 0.955). In conclusion, PTX does not affect development and collagen deposition in S. mansoni murine granuloma, but decreases the intragranulomatous eosinophil accumulation possibly due to its immunomodulatory capability, interfering in cellular recruitment and/or differentiation.

Obésité en Suisse: percentiles d'indice de masse corporelle (IMC) d'une population d'enfants et d'adolescents nés en 1980 à Lausanne et écart avec les normes suisses (1955)

OBJECTIVES: The objective of this study is to calculate the percentiles of BMI of a cohort of 1,203 children and adolescents, representing the 95% of the pupils of the school, born in 1980 followed longitudinally between 5 and 16 years. We compare these percentiles with those of the first swiss study, calculated on a cohort born in 1954-1956. METHODS: The percentiles were calculated with the method of Cole, on the basis of weight and height measured during the controls by the school health service, at a non-periodic mean interval of 14 months. RESULTS: The gap between the BMI percentiles of the two cohorts is near zero for the third percentiles, weak but progressively growing with age up to two units of BMI for the 50th percentiles. For the percentiles 97 the difference, straight away present at five years, grows regularly up to 11 years, and remains thereafter for the girls at 4.3 units of BMI, while growing more up to 6.8 units of BMI at 15 years for the boys. The percentages of children and adolescents of the present study with overweight, in accordance with the thresholds of Cole, constant for the girls at 14%, increase for the five to 11.5 years old boys from 13.4% to 17.6% for the 11.5 to 16 years old. The percentage of obesity is 2.7% for the girls, and increase for the same categories for the boys from a percentage of 1.7% to 2.3% for the boys. CONCLUSIONS: The changes during this quarter of century are important, especially for the boys. We can postulate thereafter a very early change in the energy balance. A chronic increase of the food supply, linked or not with a decrease of the physical activity, would be an explanation.

Identification of an expanded population of activated CD4(+) CD25(+) T cells expressing CD45RO and IL-7R in kidney transplant recipients

Recent studies have shown that CD4+ CD25+ T cells belong to two functionally different T lymphocytes, i.e. regulatory T cells (Treg) or activated T cells (Tact), which can be distinguished based on the expression of CD45RO and IL-7R: Treg (FoxP3+) are CD45RO+ IL-7R- , whereas Tact (FoxP3- ) are CD45RO+ IL- 7R+. In order to determine if a CD4+ CD25+ CD45RO+ IL-7R+ activated T cell population might be identified in kidney transplant recipients, we studied 27 healthy subjects (HS) and 23 kidney recipients, of whom 17 had stable graft function under standard immunosuppression (IS), 5 had biopsy-proven chronic humoral rejection (CHR), and one was a stable "tolerant" patient who had discontinued IS for more than 2 years. Phenotypical analysis by flow cytometry and functional assays by MLR were performed. Overall, the Tact population was found to be significantly increased in 87% of the transplant recipients (mean: 18.8±10.1% of CD4+ CD25+ T cells) compared to HS (mean: 4.5±2.0%; P<0.0001). In the 5 patients with CHR, this Tact population was highly expanded (31.3±9.3%; P<0.0001), whereas it was comparable to HS in the "tolerant" recipient (4.7%). Intermediate levels (16.0±6.9%; P<0.0001) were found in the 17 stable recipients. In CHR, the proliferative capacity of the Tact population was found to be 5-fold higher when stimulated by irradiated donor PBMC as compared to a stimulation by irradiated 3rd party PBMC. After kidney transplantation, an expanded circulating CD4+ CD25+ T cell population characterized by the expression of CD45RO and IL-7R was found in most recipients, particularly in those with CHR. In a patient with long-term operational tolerance, this Tact population was similar to HS. Measuring circulating Tact may become a useful monitoring tool after transplantation.

Hyperhomocysteinemia is independently associed with albuminuria in the population-based CoLaus study

L'homocystéine est un molécule potentiellement atherogénique et est considéré comme facteur de risque indépendant pour les maladies cardiovasculaires. Pour les patients avec une maladie rénale chronique ou en général avec une fonction rénale diminuée le taux d'homocystéine dans le sérum est élevé. L'acide urique est associé avec un risque augmenté de développer une maladie rénale et prédit la mortalité pour les patients avec une maladie rénale chronique. Le but de cette étude était d'évaluer l'association entre des taux sériques d'homocystéine élevés est la présence d'une fonction rénale diminuée, exprimé par une filtration glomérulaire diminuée ou une albuminurie dans une sélection de la population de Lausanne. Nous avons aussi investigué l'effet de l'acide urique sur cette relation. Pour évaluer si l'association entre l'homocystéine est l'albuminurie pourra être causal, nous avons en même temps investigué l'association entra l'albuminurie est le polymorphisme du gène de la methylènetetrafolate réductase (MTHFR) fortement corrélé avec les taux sériques de l'homocystéine. L'étude CoLaus est transversale et basée sur la population. Elle représente une sélection aléatoire, non stratifié de la population générale de la ville de Lausanne, Suisse, âgée 35-75 ans (n=56.694). 5913 personnes étaient incluses dans l'analyse. La prévalence de l'albuminurie augmente dans les catégories de taux sériques croissants d'homocystéine. L'acide urique est associé avec la concentration sérique de l'homocystéine. Hyperhomocystéinémie et des taux sérique d'acide urique augmentés sont associés avec l'albuminurie, indépendant de l'hypertonie et du diabète. Dans cette étude basée sur une large population, l'association entre des taux sérique elevés d'homocystéine et la prévalence augmentée de l'albuminurie est indépendante de la fonction glomérulaire, indiquant que cette association n'est pas simplement la conséquence de la fonction rénale réduite. Hyperhomocystéinémie est associé avec un risque doublé pour une albuminurie, ce qu'est similaire au risque associé à l'hypertonie ou au diabète type 2. Cette association est indépendante de l'acide urique. Ce résultat suggère que l'hyperhomocystéinémie est un marqueur indépendant des la dysfonction rénale. Individus avec le polymorphisme du MTHFR associé avec des concentrations sériques élevées d'homocystéine sont associé avec un risque augmenté pour une albuminurie. Tous ces résultats supportent l'hypothèse que l'homocystéine cause des dommages rénaux.

Neuroendocrine Tumors (NETs): A population-based study of incidence and survival in Girona province, 1994-2004

Els tumors neuroendocrins (TNEs) són un grup de neoplàsies poc freqüents i heterogènies i amb un ampli espectre d’agressivitat. Hi ha molt poca informació epidemiològica a nivell mundial, l’objectiu d’aquest estudi ha estat el de reportar-ne les dades a la província de Girona. Hem inclòs tots els codis de la ICD-O3 que codifiquen un TNE, període 1994-2002. Hem identificat 698 tumors. Es reporten les dades tant de la casuística com les taxes d’incidència i supervivència de cada TNE per separat. Els resultats són consistents amb les publicacions europees. El fet d’haver reportat la incidència i la supervivència dels TNEs a Girona contribueix a un millor coneixement d’aquestes neoplàsies.