Predictive value of three thermal comfort indices in low temperatures on cardiovascular morbidity in the Iberian peninsula.

The natural environment has been considered an important determinant of cardiovascular morbidity. This work seeks to assess the impact of the winter thermal environment on hospital admissions from diseases of the circulatory system by using three biometeorological indices in five regions of the Iberian Peninsula. A theoretical index based on a thermophysiological model (Universal Thermal Climate Index [UTCI]) and two experimental biometeorological ones (Net Effective Temperature [NET] and Apparent Temperature [AT]) were estimated in two metropolitan areas of Portugal (Porto and Lisbon) and in three provinces of Spain (Madrid, Barcelona and Valencia). Subsequently, their relationship with hospital admissions, adjusted by NO2 concentration, time, and day of the week, was analyzed using a Generalized Additive Model. As the estimation method, a semi-parametric quasi-Poisson regression was used. Around 53% of the hospitalizations occurred during the cold periods. The admissions rate followed an upward trend over the 9-year period in both capitals (Madrid and Lisbon) as well as in Barcelona. An inverse and statistically significant relationship was found between thermal comfort and hospital admissions in the five regions (p < 0.001). The highest relative risk (RR) was found after a cumulative 7-day exposure in Lisbon, where there was a 1.4% increase in hospital admissions for each NET and AT degree Celsius, and 1.0% for each UTCI degree Celsius. In conclusion, low air temperatures are a significant risk factor for hospital admissions from diseases of the circulatory system in the Iberian Peninsula, regardless of the index calculated.

Cocaine in Hospital Admissions for Diseases of the Circulatory System and as the Underlying Cause of Death: Analysis and Discussion.

Cocaine is a cardiotoxic drug which has been associated with morbi-mortality due to cardiovascular diseases (CVD). This study aims to: (1) analyze the hospitalizations due to cardiovascular processes and the presence of cocaine among the toxic habits of patients; and (2) discuss the forensic difficulties in sudden cardiac death (SCD) in the presence of cocaine. Hospital discharges due to CVD reporting cocaine consumption as a secondary diagnosis between 2003 and 2013 in Spain were analyzed. Subsequently, a review of judicial autopsies (SCD in cocaine users) was carried out to illustrate the forensic difficulties in the determination of the manner and underlying cause of death when cocaine use is involved. The average CVD morbidity rate was 1104.4 per 100,000 population. The most common main diagnoses of which cocaine use was recorded as a secondary diagnosis were rheumatic fever, ischemic heart disease and cerebrovascular disease in male patients between 15 and 44 years. The cardiovascular findings in the autopsies of cocaine users vary, and determining the mechanism that triggered the death in forensic practice is a challenge. The presence of cocaine among the toxic habits of young patients admitted for CVD in Spain is increasing. In our opinion, criteria must be unified to establish the manner and underlying cause of death in SCD and toxicological analysis can be a key part in the process.

Papel de la temperatura aparente y de los contaminantes atmosféricos en los ingresos por infarto agudo de miocardio en el norte de España / Role of apparent temperature and air pollutants in hospital admissions for acute myocardial infarction in the North of Spain

Introducción y objetivos: El papel del entorno en la salud cardiovascular ha ganado protagonismo en el contexto del cambio global. Este trabajo persigue analizar la relación de la temperatura aparente (TA) y los contaminantes atmosféricos con los ingresos por infarto agudo de miocardio (IAM) y realizar un análisis temporal de la enfermedad y la mortalidad asociada. Métodos: Se desarrolló un estudio de serie temporal de los ingresos por IAM en Cantabria entre 2001 y 2015. La asociación entre las variables ambientales (entre ellas, se estimó un índice biometeorológico, la TA) y los ingresos por IAM se analizó mediante una regresión de cuasi-Poisson, y se creó un modelo no lineal de retardo distribuido dentro de un modelo generalizado aditivo, con el fin de atender el efecto retardado y la presencia de relaciones no lineales de las variables ambientales. Resultados: La tasa de incidencia y la mortalidad por IAM siguieron una tendencia descendente durante el periodo de estudio (CC=-0,714; p=0,0002). Los ingresos por IAM tenían un patrón anual con máximos en invierno (p=0,005); había diferencias intrasemanales, y los mínimos se registraron durante el fin de semana (p=0,000005). Se encontró una asociación inversa entre la TA y el número de ingresos por IAM y una relación directa y estadísticamente significativa con las concentraciones de partículas de diámetro<10 μm en la atmósfera. Conclusiones: Hay una tendencia descendente en los IAM en el periodo 2007-2015. La mortalidad asociada con los ingresos por este diagnóstico se ha reducido. La TA y las partículas de diámetro <10 μm en la atmósfera son factores predictores de esta enfermedad

Introduction and objectives: The role of the environment on cardiovascular health is becoming more prominent in the context of global change. The aim of this study was to analyze the relationship between apparent temperature (AT) and air pollutants and acute myocardial infarction (AMI) and to study the temporal pattern of this disease and its associated mortality. Methods: We performed a time-series study of admissions for AMI in Cantabria between 2001 and 2015. The association between environmental variables (including a biometeorological index, AT) and AMI was analyzed using a quasi-Poisson regression model. To assess potential delayed and non-linear effects of these variables on AMI, a lag non-linear model was fitted in a generalized additive model. Results: The incidence rate and the mortality followed a downward trend during the study period (CC=-0.714; P=.0002). An annual pattern was found in hospital admissions (P=.005), with the highest values being registered in winter; a weekly trend was also identified, reaching a minimum during the weekends (P=.000005). There was an inverse association between AT and the number of hospital admissions due to AMI and a direct association with particulate matter with a diameter smaller than 10 μm. Conclusions: Hospital admissions for AMI followed a downward trend between 2007 and 2015. Mortality associated with admissions due to this diagnosis has decreased. Predictive factors for this disease were AT and particulate matter with a diameter smaller than 10 μm

Role of Apparent Temperature and Air Pollutants in Hospital Admissions for Acute Myocardial Infarction in the North of Spain.

INTRODUCTION AND OBJECTIVES: The role of the environment on cardiovascular health is becoming more prominent in the context of global change. The aim of this study was to analyze the relationship between apparent temperature (AT) and air pollutants and acute myocardial infarction (AMI) and to study the temporal pattern of this disease and its associated mortality. METHODS: We performed a time-series study of admissions for AMI in Cantabria between 2001 and 2015. The association between environmental variables (including a biometeorological index, AT) and AMI was analyzed using a quasi-Poisson regression model. To assess potential delayed and non-linear effects of these variables on AMI, a lag non-linear model was fitted in a generalized additive model. RESULTS: The incidence rate and the mortality followed a downward trend during the study period (CC=-0.714; P=.0002). An annual pattern was found in hospital admissions (P=.005), with the highest values being registered in winter; a weekly trend was also identified, reaching a minimum during the weekends (P=.000005). There was an inverse association between AT and the number of hospital admissions due to AMI and a direct association with particulate matter with a diameter smaller than 10 µm. CONCLUSIONS: Hospital admissions for AMI followed a downward trend between 2007 and 2015. Mortality associated with admissions due to this diagnosis has decreased. Predictive factors for this disease were AT and particulate matter with a diameter smaller than 10 µm.

Pulmonary Langerhans cell histiocytosis "de novo" after lung transplantation.

A pulmonary Langerhans cell histiocytosis is presented in a 40 year-old woman two years after bilateral lung transplantation for emphysema without any signs of Langerhans cells proliferation in the explanted lungs. A microsatellite molecular analysis showed the proliferating cells were generated in a recipient cellular clone. The patient did not quit smoking after transplantation. No signs of disease were detected in the implanted lungs before surgery. Strict control of immunosupressive drug levels stabilized the disease. A "de novo" monoclonal origin of stem cells, probably from the bone marrow is suggested. The reason she did not develop disease in the native lungs is unknown, although we suggest an interaction between tobacco or some other antigens and local cellular receptors.

Characterization of the Iberian Y chromosome haplogroup R-DF27 in Northern Spain.

The European paternal lineage R-DF27 has been proposed as a haplogroup of Iberian origin due to its maximum frequencies in the Iberian Peninsula. In this study, the distribution and structure of DF27 were characterized in 591 unrelated male individuals from four key populations of the north area of the Iberian Peninsula through the analysis of 12 Y-SNPs that define DF27 main sublineages. Additionally, Y-SNP allele frequencies were also gathered from the reference populations in the 1000 Genomes Project to compare and obtain a better landscape of the distribution of DF27. Our results reveal frequencies over 35% of DF27 haplogroup in the four North Iberian populations analyzed and high frequencies for its subhaplogroups. Considering the low frequency of DF27 and its sublineages in most populations outside of the Iberian Peninsula, this haplogroup seems to have geographical significance; thus, indicating a possible Iberian patrilineal origin of vestiges bearing this haplogroup. The dataset presented here contributes with new data to better understand the complex genetic variability of the Y chromosome in the Iberian Peninsula, that can be applied in Forensic Genetics.

The expanded mtDNA phylogeny of the Franco-Cantabrian region upholds the pre-neolithic genetic substrate of Basques.

The European genetic landscape has been shaped by several human migrations occurred since Paleolithic times. The accumulation of archaeological records and the concordance of different lines of genetic evidence during the last two decades have triggered an interesting debate concerning the role of ancient settlers from the Franco-Cantabrian region in the postglacial resettlement of Europe. Among the Franco-Cantabrian populations, Basques are regarded as one of the oldest and more intriguing human groups of Europe. Recent data on complete mitochondrial DNA genomes focused on macrohaplogroup R0 revealed that Basques harbor some autochthonous lineages, suggesting a genetic continuity since pre-Neolithic times. However, excluding haplogroup H, the most representative lineage of macrohaplogroup R0, the majority of maternal lineages of this area remains virtually unexplored, so that further refinement of the mtDNA phylogeny based on analyses at the highest level of resolution is crucial for a better understanding of the European prehistory. We thus explored the maternal ancestry of 548 autochthonous individuals from various Franco-Cantabrian populations and sequenced 76 mitogenomes of the most representative lineages. Interestingly, we identified three mtDNA haplogroups, U5b1f, J1c5c1 and V22, that proved to be representative of Franco-Cantabria, notably of the Basque population. The seclusion and diversity of these female genetic lineages support a local origin in the Franco-Cantabrian area during the Mesolithic of southwestern Europe, ~10,000 years before present (YBP), with signals of expansions at ~3,500 YBP. These findings provide robust evidence of a partial genetic continuity between contemporary autochthonous populations from the Franco-Cantabrian region, specifically the Basques, and Paleolithic/Mesolithic hunter-gatherer groups. Furthermore, our results raise the current proportion (≈ 15%) of the Franco-Cantabrian maternal gene pool with a putative pre-Neolithic origin to ≈ 35%, further supporting the notion of a predominant Paleolithic genetic substrate in extant European populations.

Chimerism analysis in transplant patients: a hypothesis-free approach in the absence of reference genotypes.

INTRODUCTION: During routine analysis of chimerism in bone marrow transplant patients pre-transplant genotype of the recipient or the donor might lack. We aimed to develop a new method to analyze DNA results suitable when reference genotypes are not available. METHODS: The method was based on the balance between heterozygotes. It was implemented in a standard computer spreadsheet, and considered the hypothetical donor-recipient genotype combinations. Hypotheses with peak height ratios and allele sharing tendency above a critical threshold were accepted. The results were compared with those obtained with prior knowledge of reference genotypes. RESULTS: The algorithm predicted correctly the proportion of donor/recipient chimerism, even in the absence of reference genotypes. In fact, the predicted values were closely correlated (r(2)>0.98) and free of systematic bias (slope 0.98-1.04), in comparison with the reference values obtained with prior knowledge of the donor and recipient genetic profiles. CONCLUSIONS: This study constitutes a proof-of-concept of the application of the heterozygote balance for the quantitative study of chimerism. The algorithm computes post-transplant chimerism in an easy and time-efficient way, even when the donor and recipient reference genotypes are unavailable. Therefore, it can be a useful tool for laboratories involved in chimerism analysis.

New population and phylogenetic features of the internal variation within mitochondrial DNA macro-haplogroup R0.

BACKGROUND: R0 embraces the most common mitochondrial DNA (mtDNA) lineage in West Eurasia, namely, haplogroup H (approximately 40%). R0 sub-lineages are badly defined in the control region and therefore, the analysis of diagnostic coding region polymorphisms is needed in order to gain resolution in population and medical studies. METHODOLOGY/PRINCIPAL FINDINGS: We sequenced the first hypervariable segment (HVS-I) of 518 individuals from different North Iberian regions. The mtDNAs belonging to R0 (approximately 57%) were further genotyped for a set of 71 coding region SNPs characterizing major and minor branches of R0. We found that the North Iberian Peninsula shows moderate levels of population stratification; for instance, haplogroup V reaches the highest frequency in Cantabria (north-central Iberia), but lower in Galicia (northwest Iberia) and Catalonia (northeast Iberia). When compared to other European and Middle East populations, haplogroups H1, H3 and H5a show frequency peaks in the Franco-Cantabrian region, declining from West towards the East and South Europe. In addition, we have characterized, by way of complete genome sequencing, a new autochthonous clade of haplogroup H in the Basque country, named H2a5. Its coalescence age, 15.6+/-8 thousand years ago (kya), dates to the period immediately after the Last Glacial Maximum (LGM). CONCLUSIONS/SIGNIFICANCE: In contrast to other H lineages that experienced re-expansion outside the Franco-Cantabrian refuge after the LGM (e.g. H1 and H3), H2a5 most likely remained confined to this area till present days.

A GEP-ISFG collaborative study on the optimization of an X-STR decaplex: data on 15 Iberian and Latin American populations.

In a collaborative work carried out by the Spanish and Portuguese ISFG Working Group (GEP-ISFG), a polymerase chain reaction multiplex was optimized in order to type ten X-chromosome short tandem repeats (STRs) in a single reaction, including: DXS8378, DXS9902, DXS7132, DXS9898, DXS6809, DXS6789, DXS7133, GATA172D05, GATA31E08, and DXS7423. Using this X-decaplex, each 17 of the participating laboratories typed a population sample of approximately 200 unrelated individuals (100 males and 100 females). In this work, we report the allele frequencies for the ten X-STRs in 15 samples from Argentina (Buenos Aires, Córdoba, Río Negro, Entre Ríos, and Misiones), Brazil (São Paulo, Rio de Janeiro, Paraná, and Mato Grosso do Sul), Colombia (Antioquia), Costa Rica, Portugal (Northern and Central regions), and Spain (Galicia and Cantabria). Gene diversities were calculated for the ten markers in each population and all values were above 56%. The average diversity per locus varied between 66%, for DXS7133, and 82%, for DXS6809. For this set of STRs, a high discrimination power was obtained in all populations, both in males (> or =1 in 5 x 10(5)) and females (> or =1 in 3 x 10(9)), as well as high mean exclusion chance in father/daughter duos (> or =99.953%) and in father/mother/daughter trios (> or =99.999%). Genetic distance analysis showed no significant differences between northern and central Portugal or between the two Spanish samples from Galicia and Cantabria. Inside Brazil, significant differences were found between Rio de Janeiro and the other three populations, as well as between São Paulo and Paraná. For the five Argentinean samples, significant distances were only observed when comparing Misiones with Entre Ríos and with Río Negro, the only two samples that do not differ significantly from Costa Rica. Antioquia differed from all other samples, except the one from Río Negro.

Results of the GEP-ISFG collaborative study on the Y chromosome STRs GATA A10, GATA C4, GATA H4, DYS437, DYS438, DYS439, DYS460 and DYS461: population data.

The Spanish and Portuguese ISFG Working Group (GEP-ISFG) carried out a collaborative exercise in order to asses the performance of two Y chromosome STR tetraplexes, which include the loci DYS461, GATA C4, DYS437 and DYS438 (GEPY I), and DYS460, GATA A10, GATA H4 and DYS439 (GEPY II). The groups that reported correct results in all the systems were also asked to analyse a population sample in order to evaluate the informative content of these STRs in different populations. A total of 1020 males out of 13 population samples from Argentina, Brazil, Costa Rica, Macao, Mozambique, Portugal and Spain were analysed for all the loci included in the present study. Haplotype and allele frequencies of these eight Y-STRs were estimated in all samples. The lowest haplotype diversity was found in the Lara (Argentina) population (95.44%) and the highest (99.90%) in Macao (China). Pairwise haplotype analysis showed the relative homogeneity of the Iberian origin samples, in accordance with what was previously found in the European populations for other Y-STR haplotypes (http://www.ystr.org). As expected, the four non-Caucasian samples, Macao (Chinese), Mozambique (Africans), Costa Rica (Africans) and Argentina (Lara, Amerindians), show highly significant Phist values in the pairwise comparisons with all the Caucasian samples.

Results of the GEP-ISFG collaborative study on two Y-STRs tetraplexes: GEPY I (DYS461, GATA C4, DYS437 and DYS438) and GEPY II (DYS460, GATA A10, GATA H4 and DYS439).

A collaborative exercise was carried out by the Spanish and Portuguese ISFG Working Group (GEP-ISFG) in order to evaluate the performance of two Y-chromosome STR PCR tetraplexes, which include the loci DYS461, GATA C4, DYS437 and DYS438 (GEPY I), and DYS460, GATA A10, GATA H4 and DYS439 (GEPY II). The participating laboratories were asked to type three samples for the eight markers, using a specific amplification protocol. In addition, two control samples, with known haplotypes, were provided. The results obtained by the 13 different participating laboratories were identical, except for two laboratories that failed to type correctly the same two samples for GATA C4. By sequence analyses, two different GATA C4 allele structures were found. One control sample (allele 21) and two questioned samples (allele 22, correctly typed by all the laboratories, and allele 25) presented the following repeat structure: (TCTA)4(TGTA)2(TCTA)2(TGTA)2(TCTA)n, but different from the one found for allele 26 in one sample included in this exercise, as well as in the second control sample (allele 23), namely (TCTA)4(TGTA)2(TCTA)2(TGTA)2(TCTA)2(TGTA)2(TCTA)n. The collaborative exercise results proved that both Y-tetraplexes produce good amplification results, with the advantage of being efficiently typed using different separation and detection methodologies. However, since GATA C4 repeat presents a complex structure, with alleles differing in sequence structure, efficient denaturing conditions should be followed in order to avoid typing errors due to sizing problems.