The Gall Associates of Asphondylia poss. swaedicola Kieffer & Jörgensen (Diptera: Cecidomyiidae) on Suaeda divaricata Moq. (Amaranthaceae) in the Semiarid Argentina and Summary of Parasitic Hymenoptera Associated with Suaeda Worldwide.

We report on Asphondylia poss. swaedicola Kieffer & Jörgensen inducing apical stem galls on Suaeda divaricata Moquin-Tandon in the Monte region of Argentina. The putative inquiline gelechiid Scrobipalpula patagonica Povolný is confirmed as an associate of A. poss. swaedicola galls. The following hymenopteran parasitoids are associated with this system: Torymus nr swaedicola (Kieffer & Jörgensen), Aprostocetus sp., Horismenus sp., Bracon (Bracon) sp., Chelonus (Microchelonus) sp., Apanteles sp., Zaeucoila robusta (Ashmead), and Goniozus nigrifemur Ashmead. The Horismenus sp., Z. robusta, and G. nigrifemur are reported as associates of Suaeda for the first time. A total of 28 genera and 31 species of parasitoids known to be associated with Suaeda spp. worldwide and their associations are tabulated.

Identification of early transcriptome-based biomarkers related to lipid metabolism in peripheral blood mononuclear cells of rats nutritionally programmed for improved metabolic health.

Moderate maternal calorie restriction during lactation protects rat offspring against obesity development in adulthood, due to an improved ability to handle and store excess dietary fuel. We used this model to identify early transcriptome-based biomarkers of metabolic health using peripheral blood mononuclear cells (PBMCs), an easily accessible surrogate tissue, by focusing on molecular markers of lipid handling. Male and female offspring of control and 20 % calorie-restricted lactating dams (CR) were studied. At weaning, a set of pups was killed, and PBMCs were isolated for whole-genome microarray analysis. The remaining pups were killed at 6 months of age. CR gave lower body weight, food intake and fat accumulation, and improved levels of insulin and leptin throughout life, particularly in females. Microarray analysis of weaned rat PBMCs identified 278 genes significantly differentially expressed between control and CR. Among lipid metabolism-related genes, expression of Cpt1a, Lipe and Star was increased and Fasn, Lrp1 and Rxrb decreased in CR versus control, with changes fully confirmed by qPCR. Among them, Cpt1a, Fasn and Star emerged as particularly interesting. Transcript levels of Cpt1a in PBMCs correlated with their levels in WAT and liver at both ages examined; Fasn expression levels in PBMCs at an early age correlated with their expression levels in WAT; and early changes in Star expression levels in PBMCs correlated with their expression levels in liver and were sustained in adulthood. These findings reveal the possibility of using transcript levels of lipid metabolism-related genes in PBMCs as early biomarkers of metabolic health status.

[Morbidity and mortality conferences in anaesthesia and intensive care: experience feedback from Nancy university hospital]. / Revues de morbi-mortalité (RMM) en anesthésie-réanimation : retour d'expérience au CHU de Nancy.

OBJECTIVES: Assessment of the morbidity mortality conferences (MMC) durableness in the Anaesthesiology and Surgical Intensive Care Department of the Urban Hospitals of Nancy University Hospital; evaluation of the proportion of medical education in the corrective actions implemented, and research for improvement ways. PATIENTS: All the cases of death and near-death in the operating room and all the cases deemed to be instructive or useful for security improvement. METHOD: Retrospective analysis of MMC activity since its initiation in 2005. RESULTS: Durability of MMC and good attendance rate have been sustained over time. As in the USA, MMCs result firstly in resident's education and continued medical education actions. Medical education actions represent 75% of all corrective measures, followed by changes in practices (62%), in procedures (48%) and in organisation (5%). DISCUSSION: The development process of a culture of the safety has been initiated and perpetuated. Some ways of improvement have been proposed: MMC must certainly be widened as well regarding to the categories of addressees, as the topics (any event deemed to be noteworthy for the safety of care) or the time scale of the analysis. Others propositions: preparation of the presentations with a colleague experienced in MMC; participation of external MMC experts; monitoring of local markers of security of care and of corrective measures efficiency; inclusion of MMC cases presentation in the trainees pedagogic objectives.

Phlegmasia cerulea dolens of the lower extremities secondary to thrombosis of an inferior vena caval aneurysm.

We present the clinical case of a 34-year-old male with an aneurysm of the inferior vena cava in which thrombosis led to a picture of bilateral phlegmasia cerulean dolens of the lower extremities. A clear and precise diagnosis was achieved by angio CT which allowed initial conservative management with good immediate and short term outcome. To our knowledge only 23 cases of aneurysm of the inferior vena cava have been reported in the literature worldwide making it difficult to establish a diagnostic and therapeutic algorithm for these cases. Nine cases were presented with thrombosis and in the other 14 the diagnosis was incidental. They mimic a pararenal mass requiring differential diagnosis with retroperitoneal neoplasms.

Quiste adventicial de arteria poplítea y su relación con la articulación de la rodilla. Histología y resonancia magnética / Adventitial cyst of the popliteal artery and its relation to the knee joint. Histology and magnetic resonance imaging

Introducción. El quiste adventicial de arteria poplítea es una causa poco frecuente de síntomas isquémicos de extremidades inferiores. No obstante, es importante considerarlo en el diagnóstico diferencial de individuos jóvenes afectos de claudicación intermitente gemelar. Pese a que la etiología y patogenia de esta entidad permanece todavía incierta, un correcto diagnóstico permite al especialista restaurar el flujo sanguíneo normal de la extremidad. Caso clínico. Paciente de 57 años con claudicación intermitente y portador de un quiste adventicial de arteria poplítea, en el que su comunicación con la articulación de la rodilla puede demostrarse por resonancia magnética y confirmarse por cirugía. Conclusión. La resonancia magnética es una prueba diagnóstica que pudo mostrar claramente esta patología y reforzar la hipótesis sinovial

Introduction. Adventitial cysts of the popliteal artery are an infrequent cause of ischaemic symptoms in the lower extremities. It is, however, important to take them into account in the differential diagnosis in young individuals with intermittent claudication in the calf muscles. Although the causation and pathogenesis of this condition remain uncertain, a correct diagnosis allows the specialist to restore normal blood flow in the extremity. Case report.We studied the case of a 57-year-old patient with intermittent claudication and an adventitial cyst of the popliteal artery, which magnetic resonance imaging showed to be communicating with the knee joint, and this was later confirmed by surgery. Conclusions. Use of magnetic resonance imaging as a diagnostic test was able to clearly demonstrate the existence of this pathology and lend support to the synovial hypothesis

Effect of oestrogen plus progestin on the incidence of diabetes in postmenopausal women: results from the Women's Health Initiative Hormone Trial.

AIMS/HYPOTHESIS: Studies examining the effect of postmenopausal hormone therapy on concentrations of glucose, insulin and diabetes incidence have been inconclusive, in part because many of the studies were too small. We examined the effect of oestrogen plus progestin on diabetes incidence and insulin resistance. METHODS: The study was a randomised, double-blind trial comparing the effect of daily 0.625 mg conjugated equine oestrogens plus 2.5 mg medroxyprogesterone acetate with that of placebo during 5.6 years of follow-up. The participants were 15,641 postmenopausal women enrolled in the Women's Health Initiative Hormone Trial. These women were aged 50 to 79 and all had an intact uterus. Diabetes incidence was ascertained by self-report of treatment with insulin or oral hypoglycaemic medication. Fasting glucose, insulin, and lipoproteins were measured in a random sample at baseline and at 1 and 3 years. RESULTS: The cumulative incidence of treated diabetes was 3.5% in the hormone therapy group and 4.2% in the placebo group (hazard ratio 0.79, 95% CI 0.67-0.93, p=0.004). There was little change in the hazard ratio after adjustment for changes in BMI and waist circumference. During the first year of follow-up, changes in fasting glucose and insulin indicated a significant fall in insulin resistance in actively treated women compared to the control subjects (Year 1 to baseline between-group difference -0.22+/-0.10, p=0.03). INTERPRETATIONS/CONCLUSION: These data suggest that combined therapy with oestrogen and progestin reduces the incidence of diabetes, possibly mediated by a decrease in insulin resistance unrelated to body size. Future studies of alternative postmenopausal hormone therapy regimens and selective oestrogen agonists and/or antagonists should consider the effects of these regimens on insulin resistance and diabetes.

Aneurismas de aorta abdominal. Influencia de la presión atmosférica y la estación anual en su rotura / Abdominal aortic aneurysms. The influence exerted by atmospheric pressure and the season of the year on their rupture

Introducción. Existen varios factores que se han relacionado con la rotura de los aneurismas de aorta abdominal. Uno de estos factores son las variaciones estacionales, y dentro de éstas, los cambios de las presiones barométricas. Objetivo. Analizar si existe relación entre la variación de la presión atmosférica o las estaciones anuales y la rotura de aneurismas de aorta abdominal. Pacientes y métodos. Estudio retrospectivo de pacientes intervenidos en nuestro servicio de aneurisma de aorta abdominal roto (AAAR) en los últimos cinco años. En cada paciente se determinó: presión atmosférica media (Pmed) del mes anterior, la semana anterior y el mismo mes en el que se produjo la rotura. Además, se determinó el número de aneurismas rotos según la estación. Se empleó la correlación de Pearson para relacionar la variación de la presión atmosférica y la estación anual con el número de AAAR. Resultados. Pacientes intervenidos: 51; edad media: 73 años (r = 51-87). Mes con mayor número de roturas: noviembre (8). Meses con menos roturas: febrero y marzo (1). Estaciones anuales con mayor número de roturas: primavera y otoño. Al analizar los resultados, únicamente se observa correlación entre el número de roturas y la disminución de la presión atmosférica la semana anterior a la rotura (p = 0,006; r = -0,744). No existe correlación con el resto de los parámetros analizados. Conclusiones. Existe una relación entre el aumento de la incidencia de AAAR y la disminución de la presión atmosférica la semana anterior a la rotura del aneurisma (AU)

Androgen deprivation in men with prostate cancer is associated with an increased rate of bone loss.

The objective of this work was to determine the effect of androgen deprivation therapy (ADT) on rates of bone mineral density (BMD) loss in men with prostate cancer. It was a prospective study comparing men receiving ADT to age matched controls for 2 y. Subjects received a history, physical exam, bone mineral density measurement, and laboratory evaluation every 6 months. Thirty-nine subjects receiving continuous ADT for prostate cancer (subjects) were compared to 39 age-matched controls not receiving ADT (controls). Twenty-three subjects and 30 controls completed the study through 24 months. Men in the ADT group demonstrated greater rates of bone mineral density loss than men in the control group at every site except the lumbar spine. Twenty-four month per cent of bone mineral density loss is presented as mean+/-standard error (s.e.). At the distal forearm, the ADT group value was -9.4%+/-1.0% and -4.4%+/-0.3% for controls (P<0.0005). The ADT group femoral neck values were -1.9%+/-0.7% and 0.6%+/-0.5% in the control group (P=0.0016). The ADT group total hip value was -1.5%+/-1.0% and 0.8%+/-0.5% in the control group (P=0.0018). The ADT group trochanter value was -2.0%+/-1.3% and -0.1%+/-0.5% in the control group (P=0.0019). The ADT group lumbar spine value was -0.2%+/-0.8 % and 1.1%+/-0.6% in the control group (P=0.079). Our data demonstrate greater rates of bone mineral density loss in men receiving androgen deprivation therapy for prostate cancer.

Serum thyroglobulin measurement. Utility in clinical practice.

Serum thyroglobulin measurement has greatly facilitated the clinical management of patients with differentiated thyroid cancer and a variety of other thyroid disorders. Thyroglobulin autoantibodies remain a significant obstacle to the clinical use of thyroglobulin measurement. The interpretation of any given thyroglobulin value requires the careful synthesis of all pertinent clinical and laboratory data available to the clinician. The diagnostic use of rhTSH-stimulated thyroglobulin levels has greatly facilitated the follow-up of low-risk patients with thyroid cancer. Although the measurement of thyroglobulin mRNA from peripheral blood is likely to affect the future management of these patients, it is expected that serum thyroglobulin measurement will continue to have a principal role in the care of patients with differentiated thyroid cancer.

Platinum-group elements: quantification in collected exhaust fumes and studies of catalyst surfaces.

Automotive catalytic converters, in which Pt, Pd and Rh (platinum-group elements; PGEs) are the active components for eliminating several noxious components from exhaust fumes, have become the main source of environmental urban pollution by PGEs. This work reports on the catalyst morphology through changes in catalyst surface by scanning electron microscopy/energy dispersive X-ray spectroscopy (SEM/EDX) and laser-induced breakdown spectrometry (LIBS) from fresh to aged catalytic converters. The distribution of these elements in the fresh catalysts analysed (Pt-Pd-Rh gasoline catalyst) is not uniform and occurs mainly in a longitudinal direction. This heterogeneity seems to be greater for Pt and Pd. PGEs released by the catalysts, fresh and aged 30,000 km, were studied in parallel. Whole raw exhaust fumes from four catalysts of three different types were also examined. Two of these were gasoline catalysts (Pt-Pd Rh and Pd-Rh) and the other two were diesel catalysts (Pt). Samples were collected following the 91,441 EUDC driving cycle for light-duty vehicle testing. The results show that at 0 km the samples collected first have the highest content of particulate PGEs and although the general tendency is for the release to decrease with increasing number of samples taken, exceptions are frequent. At 30,000 km the released PGEs in gasoline and diesel catalysts decreased significantly. For fresh gasoline catalysts the mean of the total amount released was approximately 100, 250 and 50 ng km(-1) for Pt, Pd and Rh, respectively. In diesel catalysts the Pt release varied in the range 400-800 ng km-1. After ageing the catalysts up to 30,000 km, the gasoline catalysts released amounts of Pt between 6 and 8 ng km(-1), Pd between 12 and 16 ng km(-1) and Rh between 3 and 12 ng km(-1). In diesel catalysts the Pt release varied in the range 108-150 ng km(-1). The soluble portion of PGEs in the HNO3 collector solution represented less than 5% of the total amount for fresh catalysts. For 30,000 km the total amount of soluble PGEs released was similar or slightly higher than for 0 km.

The significance of orbital anatomy and periocular wrinkling when performing laser skin resurfacing.

Knowledge of orbital anatomy and the interaction of muscle contractions, gravitational forces and photoagingis fundamental in understanding the limitations of carbon dioxide (CO2) laser skin resurfacing when rejuvenating the skin of the periocular area. Laser resurfacing does not change the mimetic behavior of the facial muscles nor does it influence gravitational forces. When resurfacing periocular tissue, the creation of scleral show and ectropion are a potential consequence when there is an over zealous attempt at improving the sagging malar fat pad and eyelid laxity by performing an excess amount of laser passes at the lateral portion of the lower eyelid. This results in an inadvertent widening of the palpebral fissure due to the lateral pull of the Orbicularis oculi. Retrospectively, 85 patients were studied, who had undergone periorbital resurfacing with a CO2 laser using anew treatment approach. The Sharplan 40C CO2 Feather Touchlaser was programmed with a circular scanning pattern and used just for the shoulders of the wrinkles. A final laser pass was performed with the same program over the entire lower eyelid skin surface, excluding the outer lateral portion (e.g. a truncated triangle-like area),corresponding to the lateral canthus. Only a single laser pass was delivered to the lateral canthal triangle to avoid widening the lateral opening of the eyelid, which might lead to the potential complications of scleral show and ectropion. When the area of the crows' feet is to be treated, three passes on the skin of this entire lateral orbital surface are completed by moving laterally and upward toward the hairline. Patients examined on days 1, 7, 15, 30, 60, and one year after laser resurfacing showed good results. At two months after treatment, the clinical improvement was rated by the patient and physician as being "very good" in 81 of the 85 patients reviewed. These patients underwent laser resurfacing without complications. The proposed technique of periocular resurfacing prevents complications of scleral show and laxity in the lateral eyelid opening and even ectropion, because treatment conforms to the osseo-muscular anatomical relationship of eyelid structures.

HIV and tuberculosis in a rural hospital in Kenya.

OBJECTIVE: To document the incidence and prevalence of HIV infection and TB in patients attending a rural Kenyan hospital. DESIGN: A retrospective analysis of newly diagnosed HIV and TB-infected patients, HIV and TB-related admissions, and results of blood donor screening for HIV from 1993 to 1997. SETTING: PCEA Chogoria Hospital, Eastern Province, Kenya. SUBJECTS: Patients diagnosed with HIV infection and/or TB; all blood donors. INTERVENTION: Diagnosis of pulmonary TB by Ziehl-Neelsen staining of sputum smears; diagnosis of smear negative and extrapulmonary TB based on consistent clinical and radiological features; HIV-1 and HIV-2 testing of patients clinically suspected to be infected and all blood donors. MAIN OUTCOME MEASURES: Patients diagnosed with HIV and/or TB from 1993 to 1997; the number of HIV and TB related admissions and the associated mortality rates. RESULTS: A rising incidence of newly diagnosed HIV patients is documented, and an increasing number of TB patients are co-infected with HIV. The number of HIV inpatient episodes is increasing, against a background of falling inpatient and outpatient episodes. HIV seroprevalence among blood donors is stable at 3-4%. The proportion of TB patients suffering from extrapulmonary TB is increasing (p=0.011), probably as a result of the increase in HIV. CONCLUSION: The HIV epidemic is having an increasing impact on rural Kenyans' health, although background seroprevalence rates are apparently stable. TB patients co-infected with HIV are placing a growing burden on health care resources. All health care facilities face a challenge as to how best to use limited resources to combat both these deadly diseases.

Acute Herpes zoster in Tayside: demographic and treatment details in immunocompetent patients 1989-1992.

Medical records of 105 patients admitted to Tayside hospitals with acute Herpes zoster without underlying immunosuppression were examined retrospectively for the period 1984-1992. In this elderly population (median age: 79 years) there was a female preponderance (70.5%), most admissions were for trigeminal zoster (49.5%) and length of stay ranged from 1-70 days (median: 11 days), indicating significant morbidity. There was a wide variation in both pre-admission and inpatient treatment; 53.3% of patients did not receive any anti-viral therapy prior to admission, and prescribing patterns for in-patients revealed marked differences, according to the dermatome affected. Idoxuridine 5% solution was prescribed by 15.24% of General Practitioners. Given the significant morbidity and associated costs of Herpes zoster, and that existing anti-viral agents exert maximal benefit when administered early in the course of the disease, recommendations are made with respect to appropriate therapy, and auditing current management of this serious illness, which is expected to increase in prevalence as the population ages.

Non-tuberculous mycobacteria in cystic fibrosis.

BACKGROUND: The clinical significance of the presence of non-tuberculous mycobacteria in the sputum of patients with cystic fibrosis is unclear. A retrospective case-control study was performed to assess possible risk factors for non-tuberculous mycobacteria and its impact on clinical status in patients with cystic fibrosis. METHODS: The records of all patients attending the Leeds cystic fibrosis clinics who were positive for non-tuberculous mycobacteria were examined. Each case was matched with two controls for sex, age, and respiratory function at the time of the first non-tuberculous mycobacteria isolate. Details of respiratory function, nutritional status, antibiotic and corticosteroid therapy, Shwachman-Kulczycki (S-K) score, Northern chest radiographic score, and the frequency of isolation of other bacteria and fungi were collected from two years before to two years after the first non-tuberculous mycobacteria isolate. The patients' genotype and the presence of diabetes mellitus were also recorded. RESULTS: Non-tuberculous mycobacteria were isolated from 14 patients out of a cystic fibrosis population of 372 (prevalence = 3.8%). No significant effect of non-tuberculous mycobacteria was seen on respiratory function, nutritional status, or S-K score. There was a significant association with the number of intravenous antibiotic courses received before the first isolate with cases receiving, on average, twice as many courses as controls (cases 6.64, controls 2.86, 95% CI for difference 1.7 to 5.9). No significant difference was seen between cases and controls for Northern scores, previous steroid therapy, or the incidence of diabetes mellitus. CONCLUSIONS: Non-tuberculous mycobacteria infection in patients with cystic fibrosis is uncommon and its clinical impact appears to be minimal over a two year period. Frequent intravenous antibiotic usage is a possible risk factor for colonisation with non-tuberculous mycobacteria.