Land use mix and physical activity in middle-aged and older adults: a longitudinal study examining changes in land use mix in two Dutch cohorts.

BACKGROUND: With urbanization and aging increasing in coming decades, societies face the challenge of keeping aging populations active. Land use mix (LUM) has been associated with cycling and walking, but whether changes in LUM relate to changes in cycling/walking is less known. OBJECTIVES: Our objective was to study the effect of LUM on cycling/walking in two Dutch aging cohorts using data with 10 years of follow-up. METHODS: Data from 1183 respondents from the Health and Living Conditions of the Population of Eindhoven and Surroundings (GLOBE) study and 918 respondents from the Longitudinal Aging Study Amsterdam (LASA) were linked to LUM in 1000-m sausage network buffers at three time-points. Cycling/walking outcomes were harmonized to include average minutes spent cycling/walking per week. Data was pooled and limited to respondents that did not relocate between follow-up waves. Associations between LUM and cycling/walking were estimated using a Random Effects Within-Between (REWB) model that allows for the estimation of both within and between effects. Sensitivity analyses were performed on smaller (500-m) and larger (1600-m) buffers. RESULTS: We found evidence of between-individual associations of LUM in 1000-m buffers and walking (ß: 11.10, 95% CI: 0.08; 21.12), but no evidence of within-associations in 1000-m buffers. Sensitivity analyses using 500-m buffers showed similar between-associations, but negative within-associations (ß: -35.67, 95% CI: - 68.85; - 2.49). We did not find evidence of between-individual associations of LUM in any buffer size and cycling, but did find evidence of negative within-associations between LUM in 1600-m buffers and cycling (ß: -7.49, 95% CI: - 14.31; - 0.66). DISCUSSION: Our study found evidence of positive associations between LUM and average walking time, but also some evidence of negative associations between a change in LUM and cycling/walking. LUM appears to be related to cycling/walking, but the effect of changes in LUM on cycling/walking is unclear.

Associations of neighbourhood sociodemographic characteristics with depressive and anxiety symptoms in older age: Results from a 5-wave study over 15 years.

We examined the long-term association between objective neighbourhood sociodemographic characteristics (index of socioeconomic position (SEP), average income, percent low-income earners, average house price, percent immigrants and urban density) with depressive and anxiety symptoms, covering five 3-year waves of the Longitudinal Aging Study Amsterdam (n = 3,772). Multi-level regression models assessed each neighbourhood-level characteristic separately, adjusting for individual-level covariates. A higher percentage of immigrants and higher urban density, but not other neighbourhood characteristics, were significantly associated with depressive and anxiety symptoms over time in models adjusted for individual SEP. Results of time interaction models indicated that the associations were stable over the 15-year period.

Single incision laparoscopic cholecystectomy.

BACKGROUND: As surgeons embrace the concept of increasingly less invasive surgery, techniques using only a single small incision have begun to gain traction. Multiple case series managed by a single-incision laparoscopic cholecystectomy (SILC) have been published. The objective of this study is to describe the short-term outcomes of SILC in our institution. METHODS: A retrospective review was done for 51 patients who underwent SILC between 2009-2012. The operative time, surgical technique, conversion rate, and postoperative complications were reported. RESULTS: SILC was performed for 51 patients, all women, with a mean age of 35.6 years (range=19-62). Their body mass index(BMI) ranged from 16.8-35.6 kg m2 with a mean of 20.4. Twelve patients (23.52 %) had acute cholecystitis. The mean operating time was 58.6 minutes (range=45-95 min). Incidents were encountered in 6 patients (11.76%) and were related to intraoperative bleeding. There was a single conversion to the standard laparoscopic procedure (1.9%) and in 5 cases an accessory needle grasp was used (9.8%). Two patients (3.9%)presented postoperative complications (wound infections) and the mean hospital stay was 1.6 days. CONCLUSIONS: SILC is feasible and provides a promising alternative to natural orifice transluminal endoscopic surgery for scarless laparoscopic cholecystectomy. However, routine application of this novel technique requires an evaluation of its safety and cost effectiveness in larger studies.

Perforation of Meckel's diverticulum by foreign body, a rare complication.

Meckel's diverticulum is a congenital disorder that results from an incomplete obliteration of the vitelline duct. Meckel's diverticulum may give rise to bleeding, intestinal obstruction and inflammation; however, its perforation by a foreign body is an extremely rare life-threatening complication. We report ona 37-year-old male presenting symptoms and signs of acute abdomen with an initial suspicion of acute appendicitis.However, the right diagnosis was made only during exploratory laparoscopy when the appendix was found to be normal,whereas Meckel's diverticulum was found to be inflamed and perforated by a chicken bone. The patient was treated successfully with laparoscopic resection of the diverticulum, and had an uncomplicated postoperative course.

[Amyand hernia--a rare anatomic and clinical entity diagnosed intraoperatively]. / Hernia amyand--o entitate anatomoclinica rara diagnosticata intraoperator.

The Amyand hernia is an uncommon variant of the inguinal hernia, rarely recognised before the surgical treatment because of the confusion with a strangled hernia. In spite of this, the clinical presentation seems to follow a well determined pathway, so it is possible to state that the uncorrect diagnosis is to be attributed to the ignorance of this variant of hernia. We present two consecutive case reports of acute appendicitis founded in an inguinal hernia sac. The clinical presentation depended on the inflammation extension inside the hernia sac and the presence or not of peritoneal contamination. The patients were admitted for a painful pseudotumor in the inguinal region with irreducibility, mimicking strangled inguinal hernia with acute inflammatory syndrome. Intraoperatively we have found a hernia sac with a phlegmonous/gangrenous appendix inside. Appendectomy was performed, followed by hernioplasty (retrofunicular technique) without prosthetic material). The operation followings were favorable. We conclude that amyand hernia must be considered as differential diagnosis of apparently strangled inguinal hernias. Technical precautions and antibioprophylaxy applied during surgery may prevent septic complications after hernioplasty. The hernia repair must be performed without prosthetic material and using exclusively resorbable sutures.

Synthesis, biological profile, and quantitative structure-activity relationship of a series of novel 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors.

A series of 9,9-bis(4-fluorophenyl)-3,5-dihydroxy-8-(alkyltetrazol-5-yl)- 6,8-nonadienoic acid derivatives 1 were synthesized and found to inhibit competitively the enzyme 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase. The analogues having 1N-methyltetrazol-5-yl attached to the C8-position (3a, 4a, R1 = R2 = F) are the most active in suppressing cholesterol biosynthesis in both in vitro and in vivo models: the IC50 for the chiral form of 3a is 19 nM, Ki = 4.3 x 10(-9)M when Km for HMG-CoA is 28 x 10(-6) M;1 the ED50 (oral) value corresponding to the lactone derivative (4a, BMY 22089) is approximately 0.1 mg/kg. Further, BMY 21950 is nearly 2 orders of magnitude more active in parenchymal heptaocytes, from which most of the serum cholesterol originates, than in other cell preparations (such as spleen, testes, ileum, adrenal, and ocular lens epithelial cells; Table III). This apparent tissue specificity may be highly beneficial since the blocking of cholesterol biosynthesis in other vital organs could eventually lead to undesirable side effects. In addition to the chemical synthesis and biological evaluation, a theoretical study aimed at relating the HMG-CoA reductase inhibitory potency to the three-dimensional structure of the inhibitors was undertaken. With a combination of molecular mapping and 3D-QSAR techniques, it was possible to determine a logical candidate for the conformation of the bound inhibitor and to quantitatively relate inhibitory potency to the shape and size of both the binding site and the C8-substituent.

A unique geometry of the active site of angiotensin-converting enzyme consistent with structure-activity studies.

Previous structure-activity studies of captopril and related active angiotensin-converting enzyme (ACE) inhibitors have led to the conclusion that the basic structural requirements for inhibition of ACE involve (a) a terminal carboxyl group; (b) an amido carbonyl group; and (c) different types of effective zinc (Zn) ligand functional groups. Such structural requirements common to a set of compounds acting at the same receptor have been used to define a pharmacophoric pattern of atoms or groups of atoms mutually oriented in space that is necessary for ACE inhibition from a stereochemical point of view. A unique pharmacophore model (within the resolution of approximately 0.15 A) was observed using a method for systematic search of the conformational hyperspace available to the 28 structurally different molecules under study. The method does not assume a common molecular framework, and, therefore, allows comparison of different compounds that is independent of their absolute orientation. Consequently, by placing the carboxyl binding group, the binding site for amido carbonyl, and the Zn atom site in positions determined by ideal binding geometry with the inhibitors' functional groups, it was possible to clearly specify a geometry for the active site of ACE.

An improved version of the steric difference method.

The steric difference (SD) method was developed to account for steric effects in the QSAR framework. The improved version (SD*) here reported takes into account the volume of different atoms, using some results recently obtained. The SD* method is applied to some concrete cases, and the obtained equations are compared with the results obtained from other methods. Finally, the physical significance of some steric parameters used in QSAR is discussed.

Minimal steric difference study of structural requirements for the luteinizing hormone-releasing hormone (LH-RH) receptor.

Quantitative structure-activity relation for amino acid substitution analogues of the LH-RH decapeptide were established by means of the receptor site mapping procedure based upon minimal steric differences. For a series of 17 analogues of LH-RH, obtained by substitutions of the C-terminal Gly-NH2 residue, a corelation coefficient r = 0.93 was obtained, for a series of 7 analogues, obtained by substitutions of the Leu7 residue, r = 0.95 was obtained. The shape of the LH-RH receptor regions interacting with the C-terminal of the decapetide and with the Leu7-side chain is inferred from this study.