Hydrothermal thresholds for seed germination in winter annual forbs from old-field Mediterranean landscapes.

Under Mediterranean climates with dry-hot summers and cool-wet winters, many forbs with potential for habitat restoration are winter annuals, but there is little information about their germination. We performed laboratory germination experiments on 13 ruderal dicots native to Andalusia (southern Spain). We measured the germination of recently harvested seeds from natural populations across nine temperature treatments (from 5 to 35 °C, constant and alternate); two storage periods; and eight water stress treatments (from 0 to -1.0 MPa). We then calculated the hydrothermal thresholds for seed germination. Final germination ranged from 0-100% and results were mixed in response to temperature. Base temperature was below 6 °C, optimal temperature was around 14 °C and the ceiling temperature around 23 °C. For five species, 10 months of storage improved total germination, indicating a dormancy-breaking effect, but the other species did not respond or had their germination reduced. All species were relatively tolerant to water stress, with base water potential ranging from -0.8 to -1.8 MPa. Our results suggest that hydrothermal germination thresholds, rather than physiological dormancy, are the main drivers of germination phenology in annual forbs from Mediterranean semi-dry environments. The variation in germination responses of these forb species differs from winter annual grasses, but their seeds are all suitable for being stored before restoration.

Comparative seed germination traits in alpine and subalpine grasslands: higher elevations are associated with warmer germination temperatures.

Seed germination traits in alpine grasslands are poorly understood, despite the sensitivity of these communities to climate change. We hypothesise that germination traits predict species occurrence along the alpine-subalpine elevation gradient. Phylogenetic comparative analyses were performed using fresh seeds of 22 species from alpine and subalpine grasslands (1600-2400 m) of the Cantabrian Mountains, Spain (43° N, 5° W). Laboratory experiments were conducted to characterise germinability, optimum germination temperature and effect of cold and warm stratification on dormancy breaking. Variability in these traits was reduced by phylogenetic principal component analysis (phyl.PCA). Phylogenetic generalised least squares regression (PGLS) was used to fit a model in which species average elevation was predicted from their position on the PCA axes. Most subalpine species germinated in snow-like conditions, whereas most alpine species needed accumulation of warm temperatures. Phylogenetic signal was low. PCA1 ordered species according to overall germinability, whilst PCA2 ordered them according to preference for warm or cold germination. PCA2 significantly predicted species occurrence in the alpine-subalpine gradient, as higher elevation species tended to have warmer germination preferences. Our results show that germination traits in high-mountain grasslands are closely linked to the alpine-subalpine gradient. Alpine species, especially those from stripped and wind-edge communities, prefer warmer germination niches, suggesting that summer emergence prevents frost damage during seedling establishment. In contrast, alpine snowfield and subalpine grassland plants have cold germination niches, indicating that winter emergence may occur under snow to avoid drought stress.

Estudio de las percepciones y actitudes del personal de una unidad hospitalaria frente a enfermos terminales / Perceptions and attitudes of a respiratory unit staff facing terminal ill patients

In order to promote the humanization of health at the National Institute of Thorax, this work is proposed to make a descriptive and exploratory study of qualitative type with the intention of knowing the functions, perceptions, values and attitudes of the staff of the Respiratory Medical Surgical Unit to faced of the patients who live their process of death in hospital. We are also interested in to identifying strengths, weaknesses and needs felt by the team in caring for these terminal ill patients and the treatment use with the body of the deceased. This information will implement measures that will help to dignify the death in this Unit. It is based on 26 interviews (65 percent) of the staff who work in this unit. Interviewees described her/his work as "good" especially in the control of physical symptoms of the patient and family care issues. They admit, however, there are other needs, especially the psychological and spiritual, that they not serve very well. This is the result of a poor training received to resolve high emotional situations and to establish a therapeutic communication with the patient.

Enmarcado en el objetivo de promover la humanización de la salud en el Instituto Nacional del Tórax, este trabajo se propuso realizar un estudio descriptivo exploratorio de tipo cualitativo con la finalidad de conocer las funciones, percepciones, valores y actitudes del personal de la Unidad Médico Quirúrgico Respiratorio ante los pacientes que viven su proceso de muerte en el hospital. Nos interesaba también, identificar las fortalezas, carencias y necesidades sentidas por el equipo de trabajo en la atención de estos pacientes terminales y en el tratamiento que se realiza con el cuerpo del fallecido. Esta información permitirá implementar medidas que ayuden a dignificar la muerte en esta Unidad. Se realizaron un total de 26 entrevistas semiestructuradas, correspondientes a un 65 por ciento de los funcionarios que laboran en esta Unidad. Los participantes califican su trabajo como "bueno" especialmente en el control de síntomas físicos del paciente y atención a la familia. Reconocen sin embargo, que hay otras necesidades, especialmente las psicológicas y espirituales que no se atienden con excelencia, como consecuencia de la escasa preparación recibida para enfrentar y resolver situaciones de alto contenido emocional y establecer una comunicación terapéutica con el paciente.

Recovery of menstrual cycle after therapy for anorexia nervosa.

OBJECTIVES: Although the relation between sexual dysfunction, undernourishment and weight loss is clear, amenorrhea sometimes precedes weight loss and may persist despite later weight gain. We therefore studied the variations in anthropometric variables in women with restrictive anorexia nervosa (AN) at the time they recovered their menstrual cycle. METHOD: We undertook a longitudinal study of 40 women with AN. All were in secondary amenorrhea at the start of the outpatient treatment program. Leptin concentrations were measured during the early follicular phase after the patients had recovered their menstrual cycle and had had two regular cycles. Body composition was measured by multifrequency bioelectric impedentiometry and the lean mass, fat mass and percentage fat were recorded. RESULTS: The menstrual cycle returned in 25% of the patients with a BMI of 17 or lower, in 50% of the patients with fat percentages of 20% or lower and in 25% with fat percentages of 17% or lower. Over 20% of the patients recovered their menstrual cycle without having leptin figures above 1.85 ng/ml. DISCUSSION: Prediction of recovery of menstruation in women with AN is difficult, as anthropometric variables alone are not sufficient; other factors have also to be taken into account.

The association of incident dementia with mortality in PD.

OBJECTIVE: To evaluate the association of incident dementia with mortality in a cohort of patients with idiopathic PD who were nondemented at baseline evaluation, controlling for extrapyramidal sign (EPS) severity at each study visit. BACKGROUND: The development of dementia has been associated with reduced survival in PD. Because EPS severity is associated with both dementia and mortality in PD, the association of dementia with mortality may be confounded by disease severity. METHODS: A cohort of patients with PD was followed annually with neurologic and neuropsychological evaluations. The association of incident dementia and the total Unified PD Rating Scale (UPDRS) motor score with mortality in PD was examined using Cox proportional hazards models with time-dependent covariates. All analyses were adjusted for age at baseline, sex, years of education, ethnicity, and duration of PD. RESULTS: Of 180 PD patients, 41 (22.8%) died during a mean follow-up period of 3.9 +/- 2.2 years. Among those who died during the study period, 48.8% (20 of 41) became demented during follow-up, as compared to 23.0% (32 of 139) of those who remained alive. Both incident dementia (RR: 2.2, 95% CI: 1.1 to 4.5, p = 0.04) and the total UPDRS motor score at each study visit (RR: 1.04, 95% CI: 1.02 to 1.07, p = 0.001) were associated with mortality in PD when included in the same Cox model. CONCLUSIONS: Incident dementia has an independent effect on mortality when controlling for EPS severity. The development of dementia is associated with a twofold increased mortality risk in PD.

Antagonistas de los receptores de la angiotensina II. Una revisión farmacoterapéutica / Angiotensin II receptor antagonists: a pharmacotherapeutical review

El tratamiento con fármacos inhibidores de la enzima de conversión de la angiotensina constituye en la actualidad una de las claves del manejo de la enfermedad cardiovascular y renal aunque ciertos efectos secundarios limitan su utilización. Los antagonistas de los receptores de la angiotensina II se presentan como una alternativa a los anteriores pero con un perfil de efectos secundarios más favorable al del placebo. Las recomendaciones actuales del Joint National Committee y de la Organización Mundial de la Salud/Sociedad Internacional de Hipertensión indican los antagonistas de los receptores de la angiotensina II en aquellos casos en que existe una indicación especial de usar un inhibidor de la enzima de conversión de la angiotensina, pero un efecto secundario lo impide. Los datos de los estudios sobre la eficacia a largo plazo de los antagonistas de los receptores de la angiotensina II, como los procedentes de los ensayos recientemente publicados en pacientes con nefropatía diabética o insuficiencia cardíaca congestiva, van estableciendo el papel de estos fármacos en el tratamiento de la enfermedad cardiovascular y renal. (AU)

Motor impairment in PD: relationship to incident dementia and age.

OBJECTIVE: To analyze the relationship of specific motor impairment in idiopathic PD to incident dementia. BACKGROUND: The total Unified PD Rating Scale (UPDRS) motor score at baseline has been associated with an increased risk of developing dementia in PD. METHODS: A cohort of 214 nondemented community-dwelling patients with PD was followed annually with neurologic and neuropsychological evaluations. The association of baseline motor impairment with incident dementia was analyzed using Cox proportional hazards models. Facial expression, tremor, rigidity, and bradykinesia were analyzed as part of subscore A (indicative of dopaminergic deficiency); speech and axial impairment were analyzed as part of subscore B (indicative of predominantly nondopaminergic deficiency). The correlation between the six motor domains and age was also analyzed. RESULTS: Of 173 patients followed for at least 1 year, 50 became demented according to the Diagnostic and Statistical Manual of Mental Disorders, revised 3rd edition (DSM III-R) criteria (mean follow-up, 3.6 +/- 2. 2 years). When both subscores A and B were entered into the Cox model, subscore B was associated with incident dementia (relative risk = 1.19; 95% CI, 1.09 to 1.30; p = 0.0001), in addition to gender, age, and education, whereas subscore A was not (relative risk = 1.03; 95% CI, 0.99 to 1.07; p = 0.19). Of the six motor domains, speech and bradykinesia were associated with incident dementia (p < 0.05), and axial impairment approached significance (p = 0.06). Only axial impairment was correlated with age (correlation coefficient = 0.32; p < 0.001). CONCLUSION: The findings suggest that motor impairment mediated predominantly by nondopaminergic systems is associated with incident dementia in PD. Axial impairment may be the result of a combined effect of the disease and the aging process.

Progression of parkinsonian signs in Parkinson disease.

BACKGROUND: Current knowledge about the rate of progression of extrapyramidal signs (EPSs) in Parkinson disease (PD) is derived largely from cross-sectional studies comparing subjects at various stages of illness rather than longitudinal studies in which the subjects were followed up over time. OBJECTIVE: To longitudinally study the progression of EPSs in PD by quantifying the rate of change of EPSs and by examining each EPS (rigidity, bradykinesia, tremor, and postural instability) separately. METHODS: A community-based cohort of 237 patients with PD living in Washington Heights-Inwood in Manhattan, NY, was evaluated at baseline and at yearly intervals. The EPSs were rated using the motor portion of the Unified Parkinson's Disease Rating Scale Motor Examination. Analyses of longitudinal data were performed by applying generalized estimating equations to regression analyses. RESULTS: The total EPS score increased at an annual rate of 1.5 points (1.5%), but, among those who died, the total EPS score increased at an annual rate of 3.6 points (3.6%). Bradykinesia, rigidity, and gait and balance subscores worsened at similar annual rates of 2.0% to 3.1%, whereas the tremor subscore did not clearly worsen with time. Patients with a shorter disease duration (< or =3 years) may have progressed more rapidly than patients with longer disease duration (annual rate of change, 1.9% vs 1.4%, respectively), although this did not reach statistical significance. A high total EPS score was independently associated with dementia, low Activities of Daily Living score, and long disease duration at baseline. CONCLUSIONS: In this cohort, the progression of EPSs in PD occurred at a rate of 1.5% per year and at twice that rate among those who died. Bradykinesia, rigidity, and gait and balance impairment worsened at similar rates, whereas tremor did not, suggesting that tremor may be relatively independent of these other cardinal manifestations of PD.

Risk of Alzheimer's disease in relatives of Parkinson's disease patients with and without dementia.

OBJECTIVE: To determine whether first-degree relatives of PD patients with dementia were at increased risk for the development of AD compared with first-degree relatives of nondemented PD patients and nondemented normal subjects from the community. METHODS: A structured family history interview was administered to 146 nondemented PD patients, 120 patients with PD and dementia, and 903 normal subjects from the community to ascertain the presence of AD among parents and siblings of these subjects. Cox proportional hazards models with double censoring techniques for missing information were used to model the risk of AD among relatives. RESULTS: No increase in risk of AD was found among parents of patients with PD and dementia or parents of nondemented PD patients compared with parents of normal subjects. However, siblings of demented PD patients were three times as likely (relative risk [RR] = 3.2, 95% confidence interval [CI] = 1.1 to 9.4, p < 0.04) as siblings of normal subjects to develop AD. When only siblings >65 years of age were considered, there was a fivefold increase in risk of AD among siblings of demented PD patients compared with siblings of normal subjects (RR = 4.9, 95% CI = 1.1 to 21.4, p < 0.03). The risk of AD was also increased for female relatives, regardless of whether the woman was a relative of a demented PD patient, a nondemented PD patient, or a normal subject. Ethnicity and APOE genotype did not affect dementia status among relatives. CONCLUSIONS: The increased risk of AD in siblings of demented PD patients compared with siblings of normal subjects supports the possibility of familial aggregation of AD and PD with dementia.

Systemic iron metabolism and mortality from Parkinson's disease.

Six measures of systemic iron metabolism were used to predict mortality among 103 patients with Parkinson's disease and 353 controls followed in a longitudinal study. Adjusting for gender, education, ethnicity, presence of dementia, and extrapyramidal signs, transferrin receptor concentration was strongly associated with mortality in patients with PD but not controls. This increase in serum transferrin receptor concentration before death suggests that the previously observed perturbation in iron metabolism continues throughout the disease course.

Postmenopausal estrogen use and Parkinson's disease with and without dementia.

We investigated the effects of estrogen replacement therapy (ERT) on the risk of development of dementia in 87 women with Parkinson's disease without dementia (PDND), 80 women with Parkinson's disease with dementia (PDD), and 989 nondemented healthy women from the same community. ERT was protective for the development of dementia within the setting of PD (OR 0.22, 95% CI 0.05-1.0) and when PDD patients were compared with controls (OR 0.24, 95% CI 0.07-0.78), but did not affect the risk of PD. The results of the study suggest that a randomized clinical trial of ERT may be warranted.

Environmental risk factors for Parkinson's disease in an urban multiethnic community.

Environmental risk factors were examined using univariate and multivariate unconditional logistic regression models in 89 nondemented patients with Parkinson's disease (PD) and 188 control subjects in a multiethnic urban community. Rural living, area farming, and drinking well water were associated with PD only in African-Americans. In Hispanics, area farming was protective, whereas drinking unfiltered water was a risk factor for PD. Consideration of ethnic and cultural origin may add to the epidemiologic study of PD.

Effect of undernutrition on the distribution of progesterone in the uterus of ewes during the luteal phase of the estrous cycle.

The effect of undernutrition on ovarian and uterine venous progesterone concentrations and endometrial progesterone content on Days 5 and 10 of the estrous cycle were studied. Forty ewes were synchronized using progestagen pessaries. At pessary withdrawal, the ewes were fed diets to provide either 1.5 or 0.5 times the daily maintenance requirement (Group H, n = 20 and Group L, n = 20, respectively). Ewes fed the low nutrition diet (Group L) had higher mean peripheral progesterone concentrations than those fed the high plane diet (Group H; P < 0.05) but lower endometrial progesterone content on Day 5 (P < 0.05). Neither ovarian nor uterine venous levels were affected by nutrition on either Day 5 or 10. Progesterone concentrations in blood samples collected ipsilateral to ovaries bearing a corpus luteum (CL) were higher than in the contralateral samples (P < 0.001). It is concluded that undernutrition can produce a reduction of endometrial content of progesterone the first week after mating. Since no differences in ovarian venous concentrations were observed, it remains to be shown whether this variation is due to other variables, such as the population of endometrial progesterone receptors or other nonhormonal factors.

Risk of Parkinson's disease among first-degree relatives: A community-based study.

OBJECTIVE: To determine the relative risk (RR) and cumulative incidence of idiopathic Parkinson's disease (PD) in first-degree relatives of PD patients compared with relatives of controls from the same geographic region. DESIGN: A family history questionnaire was used to obtain information on all first-degree relatives of cases and controls. A subset of these first-degree relative was also examined. A Cox proportional hazards model with double-censoring techniques for missing information was used to model the RR for PD, adjusting for gender, ethnicity, and relationship to proband. RESULTS: A total of 1,458 first-degree relatives of 233 PD patients were 2.3 times as likely (95% CI = 1.3 to 4.0) as 7,834 relatives of 1,172 controls to develop PD. The cumulative incidence of PD to age 75 among first-degree relatives of PD patients was 2% compared with 1% among first-degree relatives of controls. The risk in male first-degree relatives was higher than in female relatives (RR = 2.0, 95% CI = 1.1 to 3.4) and the risk in relatives of Caucasians was higher than in African-Americans and Hispanics (RR = 2.4, 95% CI = 1.4 to 4.1). Risk for siblings and parents of probands was similar. CONCLUSIONS: Susceptibility to PD is increased in first-degree relatives of both sporadic and familial cases. The pattern of inheritance and the relationship between genetic and environmental risk factors warrant further study.

The apolipoprotein epsilon 4 allele in Parkinson's disease with and without dementia.

The epsilon 4 isoform of apolipoprotein E (Apo-E) may confer genetic susceptibility for familial and sporadic Alzheimer's disease (AD). Because dementia in AD and Parkinson's disease (PD) share many biologic and clinical features, we determined the Apo-E genotypes for 79 patients with PD, 22 of whom were demented, and for 44 age-matched healthy elderly controls from the same community. We hypothesized that if the dementia was similar to AD, there would be a higher allele frequency of apolipoprotein epsilon 4 (Apo epsilon 4) in demented PD patients compared with nondemented PD patients and controls. The epsilon 4 allele frequency for PD without dementia was 0.132, for PD with dementia, 0.068, and for controls, 0.102. There was no association between Apo epsilon 4 and dementia in the PD patients. We conclude that the biologic basis for dementia in PD may differ from that of AD.

Tiroides lingual: reporte de un caso / Lingual thyroid: report of a case

Se presente un caso de tiroides lingual en una escolar de 7 años de edad con función tiroidea normal. Se discute el diagnóstico y modalidades terapéuticas