Vitamin B12 Deficiency in the aged: Laboratory Diagnosis, Prevalence and Clinical Profile

B₁₂-vitamiinin puute iäkkäillä: laboratoriodiagnostiikka, yleisyys ja yhteys sairastavuuteen Tausta: B12-vitamiinin puute on yleistä iäkkäillä ja se tulisi todeta riittävän varhaisessa vaiheessa palautumattomien vaurioiden estämiseksi. On epäselvää pitäisikö diagnostiikka kohdistaa tiettyihin riskiryhmiin vai mahdollisesti seuloa valikoimatonta vanhusväestöä. Myöskään yksimielisyyttä laboratoriotutkimusten valinnasta ei ole. Tavoitteet: Tutkimuksen tarkoituksena oli evaluoida uutta HoloTC RIA menetelmää ja tuottaa viitearvot sille, selvittää B12-vitamiinin puutteen yleisyys, yhteys sairastavuuteen ja mahdolliset riskitekijät suomalaisessa vanhusväestössä, arvioida munuaisfunktion vaikusta B12-vitamiinin puutteen laboratoriotutkimuksiin ja näiden perusteella ehdottaa suomalaiseen terveydenhuoltoon sopivaa laboratoriotutkimusstrategiaa. Aineisto ja menetelmät: Liedon iäkkäät -tutkimuksen vanhusaineisto on edustava otos yhden kunnan yli 65-vuotiaasta väestöstä, yhteensä 1260 henkilöä. Tutkittavat kävivät lääkärintarkastuksessa, ja heistä on käytettävissä runsaasti laboratoriotutkimuksia sekä tiedot sairauksista, ruokavaliosta, lääkkeiden ja vitamiinivalmisteiden käytöstä, dementiaseula ja depressiokysely. Viitearvoaineistoa varten kerättiin näytteet 84 vapaaehtoisesta terveestä aikuisesta ja menetelmäevaluaatiota varten 107 sairaalapotilaasta. Tulokset: HoloTC RIA menetelmän toistettavuus oli hyvä manuaalimenetelmäksi. 95%:n viiteväli holotranskobalamiinille oli 37-171 pmol/l. Kaikilla tutkittavilla, joilla oli muilla laboratoriotutkimuksilla osoitettu todennäköinen B12-vitamiinin puute, myös holotranskobalamiini oli viitealueen alarajaa pienempi. Suurentuneella kystatiini C-pitoisuudella osoitettu munuaisten vajaatoiminta korreloi voimakkaasti homokysteiinin (rs=0.53, p<0.001) ja metyylimalonihapon (rs=0.27, p<0.001) pitoisuuksiin, mutta ei kokonais-B12-vitamiinin (rs=- 0.04, p=0.227) tai holotranskobamiinin (rs=-0.01, p=0.817) pitoisuuksiin. Suomalaisessa vanhusväestössä B12-vitamiinin puutteen prevalenssi oli 12%. Kokonais- B12-vitamiinin pitoisuus oli matala (<150 pmol/l) 6%:lla. Miessukupuoli (OR 1.9, 95% CI 1.2-2.9), ikä ≥75 (OR 2.2, 95% CI 1.4-3.4) ja maitotuotteiden välttäminen (OR 2.3, 95% CI 1.2-4.4) lisäsivät B12-vitamiinin puutteen riskiä, mutta anemia (OR 1.3, 95% CI 0.7-2.3) tai makrosytoosi (OR 1.2, 95% CI 0.6-2.7) eivät. Päätelmät: Diagnosoimaton B12-vitamiinin puute on yleistä iäkkäillä, mutta kliinisesti merkityksellistä spesifistä riskiryhmää ei löydy. Koska anemian ja makrosytoosin puuttuminen ei poissulje B12-vitamiinin puutetta ja munuaisten vajaatoiminta heikentää metabolisten merkkiaineiden käyttökelpoisuutta, kokonais-B12-vitamiinia suositellaan ensisijaiseksi laboratoriotutkimukseksi epäiltäessä B12-vitamiinin puutetta ja tarvittaessa varmentavina tutkimuksina käytetään homokysteiiniä ja holotranskobalamiinia.

Thyroid antibody status, subclinical hypothyroidism, and the risk of coronary heart disease: an individual participant data analysis.

CONTEXT: Subclinical hypothyroidism has been associated with increased risk of coronary heart disease (CHD), particularly with thyrotropin levels of 10.0 mIU/L or greater. The measurement of thyroid antibodies helps predict the progression to overt hypothyroidism, but it is unclear whether thyroid autoimmunity independently affects CHD risk. OBJECTIVE: The objective of the study was to compare the CHD risk of subclinical hypothyroidism with and without thyroid peroxidase antibodies (TPOAbs). DATA SOURCES AND STUDY SELECTION: A MEDLINE and EMBASE search from 1950 to 2011 was conducted for prospective cohorts, reporting baseline thyroid function, antibodies, and CHD outcomes. DATA EXTRACTION: Individual data of 38 274 participants from six cohorts for CHD mortality followed up for 460 333 person-years and 33 394 participants from four cohorts for CHD events. DATA SYNTHESIS: Among 38 274 adults (median age 55 y, 63% women), 1691 (4.4%) had subclinical hypothyroidism, of whom 775 (45.8%) had positive TPOAbs. During follow-up, 1436 participants died of CHD and 3285 had CHD events. Compared with euthyroid individuals, age- and gender-adjusted risks of CHD mortality in subclinical hypothyroidism were similar among individuals with and without TPOAbs [hazard ratio (HR) 1.15, 95% confidence interval (CI) 0.87-1.53 vs HR 1.26, CI 1.01-1.58, P for interaction = .62], as were risks of CHD events (HR 1.16, CI 0.87-1.56 vs HR 1.26, CI 1.02-1.56, P for interaction = .65). Risks of CHD mortality and events increased with higher thyrotropin, but within each stratum, risks did not differ by TPOAb status. CONCLUSIONS: CHD risk associated with subclinical hypothyroidism did not differ by TPOAb status, suggesting that biomarkers of thyroid autoimmunity do not add independent prognostic information for CHD outcomes.

“La fortaleza de Arbeca. El proyecto Vilars 2000”. Investigación, recuperación y socialización del conocimiento y del patrimonio

La fortaleza de Els Vilars (Arbeca, Lleida), construida en torno al 750 cal. ANE y abandonada poco después del 350 ANE, constituye un yacimiento clave para la comprensión de la Primera Edad del Hierro y la Época Ibérica en sus fases antigua y plena en el noreste de la Península Ibérica. Sus defensas excepcionales, muralla torreada, barrera de piedras hincadas y foso, la convierten en referente de la fortificación ibérica. El proyecto "Vilars 2000" tiene por objeto la investigación, la recuperación patrimonial y la difusión pública. Se exponen los objetivos del Plan Director, así como la estrategia de obtención de recursos económicos, incidiendo en su condición de valor turístico de primer orden.

Sagittal abdominal diameter is a better predictor than body mass index for duration of laparoscopic left colectomy.

BACKGROUND: Visceral obesity (VO) increases technical difficulty in laparoscopic surgery. The body mass index (BMI) does not always correlate to intra-abdominal fat distribution. Our hypothesis was that simple anthropometric measures that reflect VO, could predict technical difficulty in laparoscopic colorectal surgery, as reflected by the operative time, more accurately than the BMI. METHODS: Charts of all consecutive patients who underwent laparoscopic left colon resection in our institution between 2007 and 2010 were reviewed retrospectively. On a preoperative CT scan, anthropometric measures were taken on an axial plane at the L4-L5 level. Demographic, operative and anthropometric CT measures were correlated with the operative time. Logistic regression analysis was performed to assess the value of anthropometric CT measures or BMI to predict the duration of the colectomy. RESULTS: 121 patients with elective left colon resection for benign (56%) or malignant disease (44%) were included. There were 74 sigmoid resections (61%), 21 left hemicolectomies (17%) and 26 low anterior resections (22%). A longer sagittal abdominal diameter (≥24.8 cm) was significantly associated with longer corrected operative time (248 vs. 228 min, p = 0.043). In multivariate analysis, greater sagittal abdominal diameter, sagittal internal diameter and abdominal perimeter were significantly associated with longer operative time. No significant association was found for the BMI neither in univariate nor in multivariate analysis. CONCLUSIONS: This study suggests that simple linear measures taken on a CT scan, such as sagittal abdominal diameter, sagittal internal diameter and abdominal perimeter, may predict longer operative time in laparoscopic left colonic resections more accurately than BMI.

Cardiovascular mechanisms of death in severe COPD exacerbation: time to think and act beyond guidelines.

Three important studies on acute exacerbations of chronic obstructive pulmonary disease (ECOPD)have been published in Thorax. Two of them, by Chang et al1(see page 764) and Hoiset et al2 (see page 775), show the importance of the cardiac biomarkers troponin T and NT-BNP (Nterminal pro-B-type natriuretic peptide) as strong predictors of the increased risk of death of patients hospitalised because of ECOPD.1 2.....

Author Rights vs Self-Archiving in Spanish Scientific Journals

The paper analyzes publishers" copyright policies and self-archiving conditions of Spanish scientific journals. Data are extracted from the directory DULCINEA that contains information of 1318 Spanish journals, of which 775 (61%) allow some form of self-archiving to be about 60% of the post-print version and allowing them 87% of the deposit of the version of record. In 72% of journals the deposit can be performed immediately after publication and in 16% after article acceptance. 72% of the journals are freely available without charge to the user this figure raises up to 86% if free access after an embargo is considered. Only 18% of the journals use Creative Commons licenses. The adoption of different open access journals model in Spain is favorable, however there is still a high percentage of journals (39%) that do not provide any information about authors and publishers rights and that difficult or inhibits reuse of published articles.

Fat oxidation over a range of exercise intensities: fitness versus fatness.

Maximal fat oxidation (MFO), as well as the exercise intensity at which it occurs (Fatmax), have been reported as lower in sedentary overweight individuals but have not been studied in trained overweight individuals. The aim of this study was to compare Fatmax and MFO in lean and overweight recreationally trained males matched for cardiorespiratory fitness (CRF) and to study the relationships between these variables, anthropometric characteristics, and CRF. Twelve recreationally trained overweight (high fatness (HiFat) group, 30.0% ± 5.3% body fat) and 12 lean males (low fatness (LoFat), 17.2% ± 5.7% body fat) matched for CRF (maximal oxygen consumption (V&#775;O2max) 39.0 ± 5.5 vs. 41.4 ± 7.6 mL·kg(-1)·min(-1), p = 0.31) and age (p = 0.93) performed a graded exercise test on a cycle ergometer. V&#775;O2max and fat and carbohydrate oxidation rates were determined using indirect calorimetry; Fatmax and MFO were determined with a mathematical model (SIN); and % body fat was assessed by air displacement plethysmography. MFO (0.38 ± 0.19 vs. 0.42 ± 0.16 g·min(-1), p = 0.58), Fatmax (46.7% ± 8.6% vs. 45.4% ± 7.2% V&#775;O2max, p = 0.71), and fat oxidation rates over a wide range of exercise intensities were not significantly different (p > 0.05) between HiFat and LoFat groups. In the overall cohort (n = 24), MFO and Fatmax were correlated with V&#775;O2max (r = 0.46, p = 0.02; r = 0.61, p = 0.002) but not with % body fat or body mass index (p > 0.05). Fat oxidation during exercise was similar in recreationally trained overweight and lean males matched for CRF. Consistently, substrate oxidation rates during exercise were not related to adiposity (% body fat) but were related to CRF. The benefits of high CRF independent of body weight and % body fat should be further highlighted in the management of obesity.

Étude de faisabilité pour une mesure fiable de la mobilité après fracture du membre inférieur chez l'enfant

Introduction : Les fractures du membre inférieur (MI) de l'enfant traitées par immobilisation plâtrée engendrent une modification significative de la mobilité exacerbée en cas d'obésité. L'accéléromètre est un outil d'évaluation du degré d'activité physique (AP) de l'enfant scientifiquement validé. Il n'a jamais fait l'objet d'étude chez un enfant ayant souffert d'une fracture du MI. Le but de ce travail était d'identifier les problèmes dans l'utilisation d'un accéléromètre comme moyen de mesure de l'AP après fracture nécessitant une décharge du MI. Une adaptation de la réhabilitation post-traumatique en fonction du BMI pourrait alors être proposée. Méthode : Identification d'enfants âgés de 8 et 15 ans, victimes d'une fracture du membre inférieur, consultant aux urgences de l'Hôpital de l'Enfance d'octobre 2013 à mai 2014 et nécessitant une décharge post-traumatique. Etaient exclus les enfants polytraumatisés ou souffrants d'un déficit mental. Données pré-requises des patients: âge, poids, taille, sexe, mécanisme de l'accident, type de fracture et traitement. Proposition de port d'un Actiwatch® Spectrum au poignet et cheville pour la période de remobilisation en décharge. Identification des avantages et problèmes liés à l'usage de l'appareil durant les premiers 30 jours de la période de réhabilitation. Importance : L'absence totale d'étude sur la mobilité post-fracture, la complexité des problèmes liés à la marche en décharge, les contraintes de l'immobilisation plâtrée et la prévalence grandissante de l'obésité pédiatrique justifient la recherche d'un moyen fiable pour quantifier la mobilité d'un enfant en décharge après traumatisme du MI. Résultats : Sur 43 fractures du MI traitées à l'HEL durant la période de l'étude, 13 enfants identifiés, dont 1 exclu pour maladie psychiatrique, 1 refus de participation, 2 transferts immédiats, 2 non inclus pour causes pratiques. Sept garçons âgés de 11 à 16 ans ont accepté le port de l'Actiwatch® pour une durée variant entre 7 et 27 jours (moyenne 15). Nombre d'activités (NA) médians de 5 enfants: 171,79 ±105,37 [cpm]* à J1 et 219,48 ±145,52 [cpm] à J5. NA totales médianes sur 24h : 114'072±44'791 [cpm] à J1 et 234'452 ±134'775 [cpm] à J5. Une dynamique de regain de mobilité est mise en évidence avec intensités maximales et minimales du nombre d'activités pour chacun. La médiane du temps de sommeil des 5 enfants était de 716± 45,5 [mn]. Les problèmes rencontrés ont été d'ordre mécanique (Un Actiwatch® fut défectueux), d'ordre pratique (un perdu et rendu tardivement, un port intermittent, une réaction allergique au bracelet à 4j de port). Conclusions La compliance à l'utilisation de l'Actiwatch® sur toute la durée de la décharge n'était pas optimale. La mobilité moyenne des enfants était objectivable de par leur dynamique, leur intensité maximale et minimale et comparables vis-à-vis de certaines études. Une différence avec les sujets en surpoids est observable. La durée de sommeil de chaque enfant suggère que l'antalgie administrée en cours de traitement est suffisante. Utiliser ce capteur de manière prolongée et sur un grand collectif d'enfants serait un moyen fiable et simple d'objectiver la dynamique de reprise de l'activité physique chez ces patients. Profil de l'étude : observation de cas.

Capillary thermal desorption unit for near real-time analysis of VOCs at sub-trace levels. Application to the analysis of environmental air contamination and breath samples

A capillary microtrap thermal desorption module is developed for near real-time analysis of volatile organic compounds (VOCs) at sub-ppbv levels in air samples. The device allows the direct injection of the thermally desorbed VOCs into a chromatographic column. It does not use a second cryotrap to focalize the adsorbed compounds before entering the separation column so reducing the formation of artifacts. The connection of the microtrap to a GC–MS allows the quantitative determination of VOCs in less than 40 min with detection limits of between 5 and 10 pptv (25 °C and 760 mmHg), which correspond to 19–43 ng m−3, using sampling volumes of 775 cm3. The microtrap is applied to the analysis of environmental air contamination in different laboratories of our faculty. The results obtained indicate that most volatile compounds are easily diffused through the air and that they also may contaminate the surrounding areas when the habitual safety precautions (e.g., working under fume hoods) are used during the manipulation of solvents. The application of the microtrap to the analysis of VOCs in breath samples suggest that 2,5-dimethylfuran may be a strong indicator of a person's smoking status

Efecto de la suplementación con ácidos grasos de cadena media sobre la evolución de peso en lechones con poco peso al nacimiento

La evolución de peso en los períodos de lactación y transición de 583 lechones fue estudiada mediante un análisis estadístico, evaluando el efecto de la suplementación con ácidos grasos de cadena media (AGCM) en lechones con poco peso al nacimiento. 188 de los 375 lechones que nacieron con un peso al nacimiento (PN) <1250 g recibieron 3mL de AGCM cada 24 h durante los primeros 3 días de vida; su peso medio al destete (día 28) fue inferior respecto al grupo control (lechones no suplementados) (-114,17 g). No obstante, 106 de los 180 lechones nacidos con un PN <1000 g fueron suplementados, y su peso medio al destete y a finales de transición (día 63) fue superior respecto al grupo control (destete: +315,16 g; día 63: +775,47 g). Finalmente, los lechones suplementados con PN<800 g tuvieron los peores resultados: su diferencia de peso medio al destete fue de -177,58 g respecto al grupo control. Por lo tanto, en esta prueba fueron estudiados los lechones con un PN entre 800 y 999 g porque el grupo suplementado al destete tuvo una diferencia de peso medio considerable respecto al grupo control:+511,58 g. Asimismo, considerando una probabilidad de error inferior a 0,05, no hubieron diferencias significativas en las diferentes categorías de PN analizadas. De todas maneras, es importante destacar el alto grado de significación en la suplementación con AGCM en lechones con PN entre 800 y 999g (P=0,059). Por otra parte, el PN del grupo suplementado con PN<1000 g fue inferior que el del grupo no suplementado con PN<1000 g; esta diferencia de PN fue significativa (P=0,004) y como consecuencia el grado de significación en la suplementación con AGCM en lechones con PN entre 800 y 999 g fue inferior al esperado. Además, en esta prueba se incluyeron algunos resultados generales y también un análisis simple de supervivencia, aunque no era el objetivo principal

A thermogravimetric analysis of the combustion of a Brazilian mineral coal

Knowledge of coal combustion kinetics is crucial for burner design. This work aims to contribute on this issue by determining the kinetics of a particular Brazilian bituminous coal. Non-isothermal thermogravimetry was applied for determining both the pre-exponential factor and the activation energy. Coal samples of 10 mg and 775 mm mean size were used in synthetic air atmospheres (21 % O2). Heating rates from 10 to 50 ºC/min were applied until the temperature reached 850 ºC, which was kept constant until burnout. The activation energy for the primary and the secondary combustion resulted, respectively, in 135.1 kJ/mol and 85.1 kJ/mol.

Aplicação de fotólise direta e UV/H2O2 a efluente sintético contendo diferentes corantes alimentícios

Food industries employ a lot of synthetic dyes in their products. Most of these dyes are very stable face to the conventional treatments. This work studied the use of advanced oxidation process (AOP) as an alternative to the conventional ones to degrade a synthetic food effluent (photolysis and UV/H2O2 in continuous reactor). The more efficient process was the UV/H2O2 and it presented decoloration and degradation energetic efficiency values equal to 30.775 kWh m-3 and 269.909 kWh m-3, respectively. The color reduction was 96.4% and COD decrease was 38.56%.

De usu et abusu methodi mathematicae in theologia revelata

Dedicatio: Hans Aulin [ruots. pr.].

Klarer Himmel

Soitinnus: lauluääni, piano.