Microbiome of Penaeus vannamei Larvae and Potential Biomarkers Associated With High and Low Survival in Shrimp Hatchery Tanks Affected by Acute Hepatopancreatic Necrosis Disease.

Acute hepatopancreatic necrosis disease (AHPND) is an emerging bacterial disease of cultured shrimp caused mainly by Vibrio parahaemolyticus, which harbors the lethal PirAB toxin genes. Although Penaeus vannamei (P. vannamei) postlarvae are susceptible to AHPND, the changes in the bacterial communities through the larval stages affected by the disease are unknown. We characterized, through high-throughput sequencing, the microbiome of P. vannamei larvae infected with AHPND-causing bacteria through the larval stages and compared the microbiome of larvae collected from high- and low-survival tanks. A total of 64 tanks from a commercial hatchery were sampled at mysis 3, postlarvae 4, postlarvae 7, and postlarvae 10 stages. PirAB toxin genes were detected by PCR and confirmed by histopathology analysis in 58 tanks. Seven from the 58 AHPND-positive tanks exhibited a survival rate higher than 60% at harvest, despite the AHPND affectation, being selected for further analysis, whereas 51 tanks exhibited survival rates lower than 60%. A random sample of 7 out of these 51 AHPND-positive tanks was also selected. Samples collected from the selected tanks were processed for the microbiome analysis. The V3-V4 hypervariable regions of the 16S ribosomal RNA (rRNA) gene of the samples collected from both the groups were sequenced. The Shannon diversity index was significantly lower at the low-survival tanks. The microbiomes were significantly different between high- and low-survival tanks at M3, PL4, PL7, but not at PL10. Differential abundance analysis determined that biomarkers associated with high and low survival in shrimp hatchery tanks affected with AHPND. The genera Bacillus, Vibrio, Yangia, Roseobacter, Tenacibaculum, Bdellovibrio, Mameliella, and Cognatishimia, among others, were enriched in the high-survival tanks. On the other hand, Gilvibacter, Marinibacterium, Spongiimonas, Catenococcus, and Sneathiella, among others, were enriched in the low-survival tanks. The results can be used to develop applications to prevent losses in shrimp hatchery tanks affected by AHPND.

Armillaria mexicana, a newly described species from Mexico.

Armillaria mexicana (Agaricales, Physalacriaceae) is described as a new species based on morphology, DNA sequence data, and phylogenetic analyses. It clearly differs from previously reported Armillaria species in North, Central, and South America. It is characterized by the absence of fibulae in the basidioma, abundant cheilocystidia, and ellipsoidal, hyaline basidiospores that are apparently smooth under light microscope, but slightly to moderately rugulose under scanning electron microscope. It is differentiated from other Armillaria species by macromorphological characters, including annulus structure, pileus and stipe coloration, and other structures. DNA sequence data (nuc rDNA internal transcribed spacers [ITS1-5.8S-ITS2 = ITS], 28S D-domain, 3' end of 28S intergenic spacer 1, and translation elongation factor 1-α [TEF1]) show that A. mexicana sequences are quite distinct from sequences of analogous Armillaria species in GenBank. In addition, sequences of ITS of the A. mexicana ex-type culture reveal an ITS1 of 1299 bp and an ITS2 of 582 bp, the longest ITS regions reported thus far in fungi. Phylogenetic analysis based on TEF1 sequences place A. mexicana in a well-separated, monophyletic clade basal to the polyphyletic A. mellea complex.

Insights into the phylogeny of Northern Hemisphere Armillaria: Neighbor-net and Bayesian analyses of translation elongation factor 1-α gene sequences.

Armillaria possesses several intriguing characteristics that have inspired wide interest in understanding phylogenetic relationships within and among species of this genus. Nuclear ribosomal DNA sequence-based analyses of Armillaria provide only limited information for phylogenetic studies among widely divergent taxa. More recent studies have shown that translation elongation factor 1-α (tef1) sequences are highly informative for phylogenetic analysis of Armillaria species within diverse global regions. This study used Neighbor-net and coalescence-based Bayesian analyses to examine phylogenetic relationships of newly determined and existing tef1 sequences derived from diverse Armillaria species from across the Northern Hemisphere, with Southern Hemisphere Armillaria species included for reference. Based on the Bayesian analysis of tef1 sequences, Armillaria species from the Northern Hemisphere are generally contained within the following four superclades, which are named according to the specific epithet of the most frequently cited species within the superclade: (i) Socialis/Tabescens (exannulate) superclade including Eurasian A. ectypa, North American A. socialis (A. tabescens), and Eurasian A. socialis (A. tabescens) clades; (ii) Mellea superclade including undescribed annulate North American Armillaria sp. (Mexico) and four separate clades of A. mellea (Europe and Iran, eastern Asia, and two groups from North America); (iii) Gallica superclade including Armillaria Nag E (Japan), multiple clades of A. gallica (Asia and Europe), A. calvescens (eastern North America), A. cepistipes (North America), A. altimontana (western USA), A. nabsnona (North America and Japan), and at least two A. gallica clades (North America); and (iv) Solidipes/Ostoyae superclade including two A. solidipes/ostoyae clades (North America), A. gemina (eastern USA), A. solidipes/ostoyae (Eurasia), A. cepistipes (Europe and Japan), A. sinapina (North America and Japan), and A. borealis (Eurasia) clade 2. Of note is that A. borealis (Eurasia) clade 1 appears basal to the Solidipes/Ostoyae and Gallica superclades. The Neighbor-net analysis showed similar phylogenetic relationships. This study further demonstrates the utility of tef1 for global phylogenetic studies of Armillaria species and provides critical insights into multiple taxonomic issues that warrant further study.

Cáncer de la vesícula biliar. Experiencia de 10 años del Instituto Nacional del Cáncer / Gallbladder carcinoma. A 10 years' experience at National Cancer Institute

36 casos de cáncer vesicular, 3,6 casos nuevos por año, 75% fueron mujeres. La edad media fue 59,5 años. Los factores de riesgo fueron litiasis vesicular en 87%, obesidad 8%, pólipo vesícula 2% y sin factor de riesgo 3%. Ninguno de los pacientes presento antecedentes patológicos familiares. El 100% los pacientes fueron inicialmente intervenidos en otros servicios quirúrgicos del país y luego fueron remitidos a nuestra institución para mejor tratamiento en dichos servicios. Se realizó colecistectomía simple en 26 casos, colecistectomía parcial en 2 casos, colecistectomía + drenaje externo en 3 de los casos, colecistectomía + biopsia ganglionar en 3 casos, y solo biopsia en 2 casos por enfermedad diseminada. El 14% de los pacientes presentó ictericia + coluria + acolia. La estatificación al ingreso fue un estadio IV b en un 83%, IV a 11 % y III b 6 %. A los resultados de anatomía patológica se pudo constatar que el adenocarcinoma predomino en 82% ante el carcinoma escamoso 12% y mal diferenciado 6%.El tratamiento propuesto por el equipo multidisciplinario ya en nuestra institución fue en 7 casos cirugía, quimioterapia exclusiva en 1 caso, quimioterapia paliativa en 5 pacientes, cuidados paliativos exclusivos en 18 casos. Vale la pena mencionar que 5 pacientes se negaron a tratamiento alguno solicitando el alta voluntaria. Cabe destacar que un paciente de la serie el cual recibió tratamiento quirúrgico (linfadenectomia radical+ resección hepática IV Y V) más quimioterapia y radioterapia adyuvante tuvo una sobrevida de 4 años, el resto de los pacientes ingresaron con mal pronóstico y la sobrevida promedio no fue más de 6 meses.

There were found 36 cases of gallbladder cancer, an average of 3.6 new cases per year, 75% were women. The mean age was 59.5 years (40-80 r). As a major risk factor for gallstone disease found in 87%, 8% obesity, gallbladder polyp 2% without risk factor none 3% of patients presented family medical history associated with this pathology. The 100% patients were initially operated in other surgical services in the country and then were referred to our institution for better treatment in these services simple cholecystectomy was performed in 26 cases partial. Cholecystectomy in 2 cases, cholecystectomy + external drainage in 3 cases, cholecystectomy + lymph node biopsy in 3 cases, only biopsy in 2 cases for disseminated disease. 14% of patients had jaundice, choluria + acholia. The stratification at admission was a stage IV b by 83% to 11% IV and III b 6%. A pathology results it was found that the predominant Adenocarcinoma in 82% to 12% and scamous 6% poorly differentiated carcinoma. The proposed by the multidisciplinary team and in our institution treatment was surgery in 7 cases, exclusive chemotherapy in 1 case, palliative chemotherapy in 5 patients, palliative care exclusive in 18 cases. It is worth mentioning that 5 patients refused any treatment requesting voluntary discharge. Notably, one patient in the series which received surgical treatment (radical hepatic resection + lymphadenectomy IV and V) plus radiotherapy and adjuvant chemotherapy had a survival of 4 years.

[Terrestrial flora of Malpelo Island, Colombia, Eastern Tropical Pacific]. / Flora terrestre de la isla Malpelo (Colombia), Pacífico Oriental Tropical.

Malpelo Island is located 380km off the mainland continental coast of Colombia, in the Pacific Ocean. Several geological, ecological, and zoological studies, both marine and terrestrial, have been conducted in this island. Despite some marginal comments on some publications, no single specific survey has been devoted to botany so far. In order to make a floristic inventory of the terrestrial flora of this island, three field trips were made in 2010 to collect vascular plants, mosses, and lichens, as well as data on their distribution within the island. We collected and identified 25 species of lichens, two species of vascular plants and one moss. Lichens were the most diverse group found, including records of four new genera (Endocarpon, Fuscidea, Lecanographa and Verrucaria) and 13 new species for Colombia. The high lichen richness on Malpelo might be explained by their efficient form of asexual reproduction (soredia and isidia), that may have facilitated their transport to the island by migrating birds or wind. Once on the island, it is possible that lichens persist by being chemically protected against herbivores. The great number of new generic and species records for Colombia is explained by the low number of studies in saxicolous lichens conducted so far in the country, particularly on coastal areas and remote islands. Only two species of vascular plants were collected, a grass, Paspalum sp., and a fern, Pityrogramma calomelanos, and both of them correspond to new determinations for Malpelo. A moss species previously reported but with no positive identification was collected and identified as Octoblepharum albidum. Other species previously reported, for example, some species of shrubs, were not observed. The low number of vascular plants is probably due to a combination of soil conditions and herbivory by land crabs. This study is the first complete inventory of the flora of Malpelo and is a starting and reference point for future comparisons among islands in the Eastern

Flora terrestre de la isla Malpelo (Colombia), Pacífico Oriental Tropical / Terrestrial flora of Malpelo Island, Colombia, Eastern Tropical Pacific

Malpelo Island is located 380km off the mainland continental coast of Colombia, in the Pacific Ocean. Several geological, ecological, and zoological studies, both marine and terrestrial, have been conducted in this island. Despite some marginal comments on some publications, no single specific survey has been devoted to botany so far. In order to make a floristic inventory of the terrestrial flora of this island, three field trips were made in 2010 to collect vascular plants, mosses, and lichens, as well as data on their distribution within the island. We collected and identified 25 species of lichens, two species of vascular plants and one moss. Lichens were the most diverse group found, including records of four new genera (Endocarpon, Fuscidea, Lecanographa and Verrucaria) and 13 new species for Colombia. The high lichen richness on Malpelo might be explained by their efficient form of asexual reproduction (soredia and isidia), that may have facilitated their transport to the island by migrating birds or wind. Once on the island, it is possible that lichens persist by being chemically protected against herbivores. The great number of new generic and species records for Colombia is explained by the low number of studies in saxicolous lichens conducted so far in the country, particularly on coastal areas and remote islands. Only two species of vascular plants were collected, a grass, Paspalum sp., and a fern, Pityrogramma calomelanos, and both of them correspond to new determinations for Malpelo. A moss species previously reported but with no positive identification was collected and identified as Octoblepharum albidum. Other species previously reported, for example, some species of shrubs, were not observed. The low number of vascular plants is probably due to a combination of soil conditions and herbivory by land crabs. This study is the first complete inventory of the flora of Malpelo and is a starting and reference point for future comparisons among islands in the Eastern Tropical Pacific. Rev. Biol. Trop. 62 (1): 327-336. Epub 2014 March 01.

La isla Malpelo se encuentra en el Pacífico colombiano, a unos 380km de la costa continental. La Isla ha sido objeto de algunos estudios geológicos, ecológicos y faunísticos, tanto marinos como terrestres, pero ningún estudio estrictamente botánico. Con el fin de realizar un inventario de la flora terrestre de Malpelo, se realizaron tres salidas de campo durante el 2010, en las que se recolectaron plantas vasculares, musgos y líquenes, y se tomaron datos sobre su distribución en la Isla. El grupo más diverso correspondió a los líquenes, con 25 especies, incluidos cuatro nuevos géneros para Colombia, Endocarpon, Fuscidea, Lecanographa y Verrucaria, y 15 nuevos registros de especies para Colombia. La alta riqueza de especies de líquenes en la Isla puede deberse a la forma de reproducción asexual de estos organismos, que pudieron haber sido transportados hasta Malpelo por aves migratorias o por viento; además, pueden estar protegidos químicamente de la herbivoría por cangrejos terrestres. La gran cantidad de registros nuevos para Colombia se explica por la poca cantidad de trabajos en líquenes saxícolas en el país, sobre todo en zonas costeras e insulares. Solo se registraron dos especies de plantas vasculares, una gramínea, Paspalum sp., y un helecho, Pityrogramma calomelanos. También se recolectó una especie de musgo, Octoblepharum albidum. La escasez de plantas vasculares probablemente se deba a la combinación de condiciones de los suelos y a la herbivoría por cangrejos terrestres. El presente estudio es el primero en darle relevancia a la flora terrestre de Malpelo y constituye un punto de referencia y comparación para estudios semejantes en otras islas del Pacífico Oriental Tropical.

Effect of false-positive results on reattendance at breast cancer screening programmes in Spain.

BACKGROUND: Mammography is the only breast screening method, we are aware of today, which is able to reduce mortality from breast cancer. Nevertheless, this procedure carries an inherent risk of false-positive screening mammogram. The association between these results and reattendance at the next scheduled screening mammogram is controversial. The aim of this study was to examine the effect of a false-positive screening mammogram and women's characteristics on reattendance in eight regional population-based breast cancer screening programmes in Spain. METHODS: This study included 1 383 032 women aged 44-67 years who were initially screened for breast cancer between 1990 and 2004. To investigate factors associated with reattendance, logistic regression models were used. RESULTS: The mean age of women at first screening was 53.6 years (SD = 6.1 years). Of 120 800 women with a false-positive screening mammogram, 78.3% returned for a subsequent screening mammogram compared with 81.9% of those with a negative result (P < 0.001). Multivariate analysis showed that women with a false-positive result at first screening mammogram were less likely to reattend (OR = 0.71; 95% CI 0.70-0.73) and that the likelihood was lower in those who had undergone invasive additional tests (OR = 0.56; 95% CI 0.53-0.59). CONCLUSION: A false-positive screening mammogram in the first screening negatively affected attendance at the subsequent screening. The results of this study could be useful to improve the screening process and to increase women's compliance.

Cost-effectiveness of early detection of breast cancer in Catalonia (Spain).

BACKGROUND: Breast cancer (BC) causes more deaths than any other cancer among women in Catalonia. Early detection has contributed to the observed decline in BC mortality. However, there is debate on the optimal screening strategy. We performed an economic evaluation of 20 screening strategies taking into account the cost over time of screening and subsequent medical costs, including diagnostic confirmation, initial treatment, follow-up and advanced care. METHODS: We used a probabilistic model to estimate the effect and costs over time of each scenario. The effect was measured as years of life (YL), quality-adjusted life years (QALY), and lives extended (LE). Costs of screening and treatment were obtained from the Early Detection Program and hospital databases of the IMAS-Hospital del Mar in Barcelona. The incremental cost-effectiveness ratio (ICER) was used to compare the relative costs and outcomes of different scenarios. RESULTS: Strategies that start at ages 40 or 45 and end at 69 predominate when the effect is measured as YL or QALYs. Biennial strategies 50-69, 45-69 or annual 45-69, 40-69 and 40-74 were selected as cost-effective for both effect measures (YL or QALYs). The ICER increases considerably when moving from biennial to annual scenarios. Moving from no screening to biennial 50-69 years represented an ICER of 4,469€ per QALY. CONCLUSIONS: A reduced number of screening strategies have been selected for consideration by researchers, decision makers and policy planners. Mathematical models are useful to assess the impact and costs of BC screening in a specific geographical area.

Effect of start age of breast cancer screening mammography on the risk of false-positive results.

OBJECTIVE: To estimate the false-positive (FP) risk according to the start age of mammography screening (45-46 or 50-51 years). METHOD: Data from eight regions of the Spanish breast cancer screening programme from 1990 to 2006 were included (1,565,364 women). Discrete time-hazard models were used to ascertain the effect of age and time-related, programme-related and personal variables on FP leading to any further procedure and to invasive procedures (FPI). In a subset we estimated the differential FP risk of starting screening at 45-46 years (175,656 women) or 50-51 (251,275). RESULTS: A start age of 45-46 versus 50-51 years increased both FP (OR=1.20; 95%CI: 1.13-1.26) and FPI risks (OR=1.43 (95%CI: 1.18-1.73).Other factors increasing FP risk were premenopausal status (FP OR=1.26; 95%CI: 1.23-1.29 and FPI OR=1.22; 95%CI: 1.13-1.31), prior invasive procedures (FP OR=1.52; 95%CI: 1.47-1.57 and FPI (OR=2.08; 95%CI: 1.89-2.28) and family history (FP OR=1.16; 95%CI: 1.12-1.20 and FPI OR=1.26; 95%CI: 1.13-1.41). FP risk was increased by double reading (OR=1.36; 95%CI: 1.23-1.51) and FPI risk by double views (OR=1.34; 95%CI: 1.18-1.52). Both the cumulative FP and FPI risks were higher in women commencing screening at 45-46 years versus 50-51 years (33.30% versus 20.39% and 2.68% versus 1.76%). CONCLUSIONS: Starting screening earlier increases the cumulative risk of FP and FPI.

Reduction in false-positive results after introduction of digital mammography: analysis from four population-based breast cancer screening programs in Spain.

PURPOSE: To evaluate the effect of the introduction of digital mammography on the recall rate, detection rate, false-positive rate, and rates of invasive procedures in a cohort of women from four population-based breast cancer screening programs in Spain. MATERIALS AND METHODS: The study was approved by the ethics committee; informed consent was not required. A total of 242,838 mammograms (171,191 screen film [screen-film mammography group] and 71,647 digital [digital mammography group]) obtained in 103,613 women aged 45-69 years were included. False-positive results for any additional procedure and for invasive procedures, the breast cancer rate, and the positive predictive value in each group were compared by using Pearson χ(2) test. The effect of the mammographic technology used (screen-film or digital) on the false-positive results and cancer detection risk was evaluated with multivariate logistic regression models, adjusted according to women's and the screening program's characteristics and time trends. RESULTS: The false-positive rate was higher for screen-film than for digital mammography (7.6% and 5.7%, respectively; P < .001). False-positive results after an invasive procedure were significantly higher for screen-film than for digital mammography (1.9% and 0.7%, respectively; P < .001). No significant differences were observed in the overall cancer detection rate between the two groups (0.45% and 0.43% in the screen-film and digital mammography groups, respectively; P = .59). The adjusted risk of a false-positive result was higher for screen-film than for digital mammography (odds ratio = 1.32). The adjusted risk was also lower for the digital mammography group when time trends were taken into account. CONCLUSION: The lower false-positive risk with use of digital mammography should be taken into account when balancing the risks and benefits of breast cancer screening.

Variaciones en la estimación de la prevalencia de artrosis de rodilla según los criterios diagnósticos utilizados en los estudios poblacionales / Impact of the distinct diagnostic criteria used in population-based studies on estimation of the prevalence of knee osteoarthritis

ObjetivoEvaluar el impacto en la estimación de la prevalencia de artrosis de rodilla de las variaciones en los criterios diagnósticos utilizados en los estudios poblacionales.MétodosSe realizó una búsqueda de estudios poblacionales sobre artrosis de rodilla realizados en población general no institucionalizada de Europa o Estados Unidos.ResultadosSe seleccionaron 8 artículos, 6 europeos y 2 de Estados Unidos. La definición de enfermedad se basó en criterios sintomáticos (dolor), criterios radiológicos (escala de Kellgren y Lawrence) o la combinación de ambos, según el estudio. La prevalencia fue del 2,0 al 42,4% cuando se usaban criterios sintomáticos, del 16,3 al 33,0% cuando se usaban criterios radiológicos, y del 1,5 al 15,9% cuando se combinaban. La prevalencia era mayor en las mujeres y aumentaba con la edad, a excepción de algunas prevalencias estimadas a partir de síntomas, en las cuales se observa una disminución a partir de los 80 años de edad.ConclusionesNo hay consenso en los criterios utilizados para diagnosticar la artrosis de rodilla en los estudios poblacionales de prevalencia. Esto se refleja en una gran variabilidad en la prevalencia de artrosis de rodilla según el criterio diagnóstico, aparte de la edad y del sexo. Las prevalencias fueron mayores cuando se utilizó aisladamente la evidencia radiológica, seguida de los criterios sintomáticos y de la combinación de ambos(AU)

ObjectiveTo assess the impact of the distinct diagnostic criteria used in population-based studies on estimation of the prevalence of knee osteoarthritis.MethodsWe performed a search for population-based studies of the prevalence of knee osteoarthritis carried out in the general noninstitutionalized population in Europe or the USA.ResultsEight articles were selected, six from Europe and two from the USA. Depending on the study, definition of knee osteoarthritis was based on symptomatic criteria (pain), radiological criteria (the Kellgren and Lawrence scale) or a combination of both symptomatic and radiological criteria. Prevalence estimates ranged from 2.0 to 42.4% with symptomatic criteria, from 16.3 to 33.0% with radiological criteria, and from 1.5 to 15.9% when both criteria were combined. The prevalence was higher for women and increased with age, with the exception of some prevalences estimated through symptoms, which decreased in ages older than 80 years.ConclusionsThere is a lack of consensus on the criteria used to diagnose knee osteoarthritis in population-based studies of prevalence. Consequently, prevalence estimates vary widely, depending on the diagnostic criteria used, and not only by age and sex. The prevalence was higher when radiological evidence alone was used, followed by symptomatic criteria and by combinations of both(AU)

Unmet needs and waiting list prioritization for knee arthroplasty.

BACKGROUND: There is a high volume of unmet needs for knee arthroplasty in the population despite the increase in surgery rates. Given the long waiting times to have a knee arthroplasty, some governments have proposed prioritization systems for patients on waiting lists based on their level of need. QUESTIONS/PURPOSES: We therefore estimated the needs and demand of knee arthroplasty in four regions of Spain during a 5-year period. METHODS: We developed a discrete event simulation model to reproduce the process of knee arthroplasty. The prioritization system was compared with the usual waiting list management strategy (by waiting time only). RESULTS: Under the prioritization system, patients saved an average of 4.5 months (95% confidence interval, 4.4-4.6 months) adjusted by level of need. The proportion of patients who experienced excessive waiting times was small and was associated with low levels of priority. The 5-year projection of the volume of unmet needs for knee arthroplasty remained stable; however, although the volume of need for the first knee arthroplasty decreased by 12%, the volume of need for an arthroplasty in the contralateral knee increased by 50%. CONCLUSIONS: The data suggested the prioritization system was more beneficial than assigning surgery by waiting time only. The 5-year projection of the volume of unmet needs for knee arthroplasty remained stable, despite the increase in the need for contralateral knee arthroplasty. LEVEL OF EVIDENCE: Level II, economic and decision analyses. See Guidelines for Authors for a complete description of levels of evidence.

[Impact of the distinct diagnostic criteria used in population-based studies on estimation of the prevalence of knee osteoarthritis]. / Variaciones en la estimación de la prevalencia de artrosis de rodilla según los criterios diagnósticos utilizados en los estudios poblacionales.

OBJECTIVE: To assess the impact of the distinct diagnostic criteria used in population-based studies on estimation of the prevalence of knee osteoarthritis. METHODS: We performed a search for population-based studies of the prevalence of knee osteoarthritis carried out in the general noninstitutionalized population in Europe or the USA. RESULTS: Eight articles were selected, six from Europe and two from the USA. Depending on the study, definition of knee osteoarthritis was based on symptomatic criteria (pain), radiological criteria (the Kellgren and Lawrence scale) or a combination of both symptomatic and radiological criteria. Prevalence estimates ranged from 2.0 to 42.4% with symptomatic criteria, from 16.3 to 33.0% with radiological criteria, and from 1.5 to 15.9% when both criteria were combined. The prevalence was higher for women and increased with age, with the exception of some prevalences estimated through symptoms, which decreased in ages older than 80 years. CONCLUSIONS: There is a lack of consensus on the criteria used to diagnose knee osteoarthritis in population-based studies of prevalence. Consequently, prevalence estimates vary widely, depending on the diagnostic criteria used, and not only by age and sex. The prevalence was higher when radiological evidence alone was used, followed by symptomatic criteria and by combinations of both.

Glycine regulates the production of pro-inflammatory cytokines in lean and monosodium glutamate-obese mice.

Fat tissue plays an important role in the regulation of inflammatory processes. Increased visceral fat has been associated with a higher production of cytokines that triggers a low-grade inflammatory response, which eventually may contribute to the development of insulin resistance. In the present study, we investigated whether glycine, an amino acid that represses the expression in vitro of pro-inflammatory cytokines in Kupffer and 3T3-L1 cells, can affect in vivo cytokine production in lean and monosodium glutamate-induced obese mice (MSG/Ob mice). Our data demonstrate that glycine treatment in lean mice suppressed TNF-alpha transcriptional expression in fat tissue, and serum protein levels of IL-6 were suppressed, while adiponectin levels were increased. In MSG/Ob mice, glycine suppressed TNF-alpha and IL-6 gene expression in fat tissue and significantly reduced protein levels of IL-6, resistin and leptin. To determine the role of peroxisome proliferator-activated receptor-gamma (PPAR-gamma) in the modulation of this inflammatory response evoked by glycine, we examined its expression levels in fat tissue. Glycine clearly increased PPAR-gamma expression in lean mice but not in MSG/Ob mice. Finally, to identify alterations in glucose metabolism by glycine, we also examined insulin levels and other biochemical parameters during an oral glucose tolerance test. Glycine significantly reduced glucose tolerance and raised insulin levels in lean but not in obese mice. In conclusion, our findings suggest that glycine suppresses the pro-inflammatory cytokines production and increases adiponectin secretion in vivo through the activation of PPAR-gamma. Glycine might prevent insulin resistance and associated inflammatory diseases.

Discrete-event simulation applied to analysis of waiting lists. Evaluation of a prioritization system for cataract surgery.

OBJECTIVES: To outline the methods used to build a discrete-event simulation model for use in decision-making in the context of waiting list management strategies for cataract surgery by comparing a waiting list prioritization system with the routinely used first-in, first-out (FIFO) discipline. METHODS: The setting was the Spanish health system. The model reproduced the process of cataract, from incidence of need of surgery (meeting indication criteria), through demand, inclusion on a waiting list, and surgery. "Nonexpressed Need" represented the population that, even with need, would not be included on a waiting list. Parameters were estimated from administrative data and research databases. The impact of introducing a prioritization system on the waiting list compared with the FIFO system was assessed. For all patients entering the waiting list, the main outcome variable was waiting time weighted by priority score. A sensitivity analysis with different scenarios of mean waiting time was used to compare the two alternatives. RESULTS: The prioritization system shortened waiting time (weighted by priority score) by 1.55 months (95% CI: 1.47 to 1.62) compared with the FIFO system. This difference was statistically significant for all scenarios (which were defined from a waiting time of 4 months to 24 months under the FIFO system). A tendency to greater time savings in scenarios with longer waiting times was observed. CONCLUSIONS: Discrete-event simulation is useful in decision-making when assessing health services. Introducing a waiting list prioritization system produced greater benefit than allocating surgery by waiting time only. Use of the simulation model would allow the impact of proposed policies to reduce waiting lists or assign resources more efficiently to be tested.

Geographical variations in the benefit of applying a prioritization system for cataract surgery in different regions of Spain.

BACKGROUND: In Spain, there are substantial variations in the utilization of health resources among regions. Because the need for surgery differs in patients with appropriate surgical indication, introducing a prioritization system might be beneficial. Our objective was to assess geographical variations in the impact of applying a prioritization system in patients on the waiting list for cataract surgery in different regions of Spain by using a discrete-event simulation model. METHODS: A discrete-event simulation model to evaluate demand and waiting time for cataract surgery was constructed. The model was reproduced and validated in five regions of Spain and was fed administrative data (population census, surgery rates, waiting list information) and data from research studies (incidence of cataract). The benefit of introducing a prioritization system was contrasted with the usual first-in, first-out (FIFO) discipline. The prioritization system included clinical, functional and social criteria. Priority scores ranged between 0 and 100, with greater values indicating higher priority. The measure of results was the waiting time weighted by the priority score of each patient who had passed through the waiting list. Benefit was calculated as the difference in time weighted by priority score between operating according to waiting time or to priority. RESULTS: The mean waiting time for patients undergoing surgery according to the FIFO discipline varied from 1.97 months (95% CI 1.85; 2.09) in the Basque Country to 10.02 months (95% CI 9.91; 10.12) in the Canary Islands. When the prioritization system was applied, the mean waiting time was reduced to a minimum of 0.73 months weighted by priority score (95% CI 0.68; 0.78) in the Basque Country and a maximum of 5.63 months (95% CI 5.57; 5.69) in the Canary Islands. The waiting time weighted by priority score saved by the prioritization system varied from 1.12 months (95% CI 1.07; 1.16) in Andalusia to 2.73 months (95% CI 2.67; 2.80) in Aragon. CONCLUSION: The prioritization system reduced the impact of the variations found among the regions studied, thus improving equity. Prioritization allocates the available resources within each region more efficiently and reduces the waiting time of patients with greater need. Prioritization was more beneficial than allocating surgery by waiting time alone.

Determining the lifetime density function using a continuous approach.

OBJECTIVE: To apply a continuous hazard function approach to calculate the lifetime density function (LDF) at any age, and to compare the life expectancies derived from the LDF with those obtained with standard life table (SLT) methods. METHODS: Age-specific mortality rates were modeled through a continuous hazard function. To construct the cumulative hazard function, appropriate integration limits were considered as continuous random variables. The LDF at any age was defined on the basis of the elemental relationships with the cumulative hazard function. Life expectancies were calculated for a particular set of mortality data using the SLT approach and the expectancy of the LDF defined. APPLICATIONS AND COMPARISONS: The proposed approach was applied using mortality data from the 2001 census of Catalonia (Spain). A Gompertz function was used to model the observed age-specific mortality rates, which fitted the observed data closely. The LDF and the life expectancy, median and standard deviation of the LDF were derived using mathematical software. All differences, in percentages, between the life expectancies obtained from the two methods were 1.1% or less. CONCLUSIONS: The LDF gives a wider interpretation of life duration, by extending a deterministic value like life expectancy to a fully informative measure like the LDF.

Time-trend and variations in the proportion of second-eye cataract surgery.

BACKGROUND: Despite recommendations for greater use of second-eye cataract surgery and the bilateral progression of the disease, there is a substantial proportion of unmet need for this treatment. Few studies have explored the factors associated with second-eye cataract surgery utilisation. The objective of our study was to estimate the proportion of second-eye cataract surgery, evaluate its time-trend, and explore differences in utilisation by patients' gender, age, and region of residence. METHODS: All senile cataract surgeries performed between 1999 and 2002 in the public health system of Catalonia (Spain) were obtained from the Minimum Data Set. The proportion of second-eye surgery from November 2000 to December 2002 was calculated. The time-trend of this proportion was characterised through linear regression models with the logarithmic transformation of time. RESULTS: The proportion of second-eye surgery was 30.0% and showed an increasing trend from 24.8% (95% Confidence Interval [CI] 21.6; 26.1) in November 2000 to 31.8% (95% CI 31.4; 33.6) in December 2002. This proportion was 1.9% (95% CI 0.9; 2.9) higher in women (p < 0.001) and held constant across time. Male patients aged less than 60 had the lowest proportion (22.6%; 95% CI 22.4; 22.9) and females between 70 and 79 had the highest proportion (27.4%; 95% CI 26.9; 27.9). The time-trend for the proportion of second-eye surgery in those aged over 80 years was greater than for younger ages, showing an increase of 9% at the end of the period for both males and females. Variations between regions decreased over time because regions with the lowest initial proportions of second-eye surgery (approximately 17%) showed a greater increase over the study period. CONCLUSION: We predict greater utilization of second-eye surgery in patients aged 70 to 79 years and in women. A greater increase in the utilisation rates of second-eye surgery is expected in the regions with lower proportions and in older patients. The observed trend suggests that there will be a substantial proportion of unmet need for bilateral surgery.

Hypoglycemic activity of a new carbohydrate isolated from the roots of Psacalium peltatum.

A new ulopyranose isolated from aqueous extract of roots and rhizomas of Psacalium peltatum has been determined to have hypoglycemic activity at doses of 100 mg/kg, comparable to that of tolbutamide and insulin in alloxan diabetic mice. The skeletal structure of the new compound was established by spectral analysis.

Application of biological dressings from radiosterilized amnios with cobalt 60 and serologic studies on the handling of burns in pediatric patients.

We present the use of biological dressing (amnios) as an alternative for skin replacement due to burn accidents. With the use of serologic tests, it is guaranteed to be free of the possibility of transmitting infectious diseases. The amnios is sterilized with 60Co gamma radiation. In this way, amnios is free of bacteria and fungi. In addition, with the use of serologic tests at the moment of the childbirth and 6 months later, we can be sure that it won't transmit the syphilis, AIDS, hepatitis b and c viruses. This treatment was applied to 12 children with burns of 1 degree and 2 degrees degree (7 girls and 5 boys) that required hospitalization. The application is very simple. It does not require of anesthesic procedure, or the use of surgical room. The pain decreased notoriously, and the procedure can be repeated as frequently as necessary. Once the dressing is applied, it does not require any type of surgical cleaning. The scaring process begins at the borders and under the dressing, where there is a new tissue. It decreases: 1) the possibility of infection, and therefore reduces the consumption of antibiotic; 2) the use of analgesics; 3) the time of scaring and 4) the number of days of hospitalization.