The WHO active ageing pillars and its association with survival: Findings from a population-based study in Spain.

BACKGROUND: The World Health Organization's active ageing model is based on the optimisation of four key "pillars": health, lifelong learning, participation and security. It provides older people with a policy framework to develop their potential for well-being, which in turn, may facilitate longevity. We sought to assess the effect of active ageing on longer life expectancy by: i) operationalising the WHO active ageing framework, ii) testing the validity of the factors obtained by analysing the relationships between the pillars, and iii) exploring the impact of active ageing on survival through the health pillar. METHODS: Based on data from a sample of 801 community-dwelling older adults, we operationalised the active ageing model by taking each pillar as an individual construct using principal component analysis. The interrelationship between components and their association with survival was analysed using multiple regression models. RESULTS: A three-factor structure was obtained for each pillar, except for lifelong learning with a single component. After adjustment for age, gender and marital status, survival was only significantly associated with the physical component of health (HR = 0.66; 95% CI = 0.47-0.93; p = 0.018). In turn, this component was loaded with representative variables of comorbidity and functionality, cognitive status and lifestyles, and correlated with components of lifelong learning, social activities and institutional support. CONCLUSION: According to how the variables clustered into the components and how the components intertwined, results suggest that the variables loading on the biomedical component of the health pillar (e.g. cognitive function, health conditions or pain), may play a part on survival chances.

Inflammasome-dependent IL-1ß release depends upon membrane permeabilisation.

Interleukin-1ß (IL-1ß) is a critical regulator of the inflammatory response. IL-1ß is not secreted through the conventional ER-Golgi route of protein secretion, and to date its mechanism of release has been unknown. Crucially, its secretion depends upon the processing of a precursor form following the activation of the multimolecular inflammasome complex. Using a novel and reversible pharmacological inhibitor of the IL-1ß release process, in combination with biochemical, biophysical, and real-time single-cell confocal microscopy with macrophage cells expressing Venus-labelled IL-1ß, we have discovered that the secretion of IL-1ß after inflammasome activation requires membrane permeabilisation, and occurs in parallel with the death of the secreting cell. Thus, in macrophages the release of IL-1ß in response to inflammasome activation appears to be a secretory process independent of nonspecific leakage of proteins during cell death. The mechanism of membrane permeabilisation leading to IL-1ß release is distinct from the unconventional secretory mechanism employed by its structural homologues fibroblast growth factor 2 (FGF2) or IL-1α, a process that involves the formation of membrane pores but does not result in cell death. These discoveries reveal key processes at the initiation of an inflammatory response and deliver new insights into the mechanisms of protein release.

Bone marrow trephine biopsy involvement by lymphoma: pattern of involvement and concordance with flow cytometry, in 10 years from a single institution.

PURPOSE: To evaluate the features of bone marrow (BM) biopsy involvement by lymphoma, pattern of infiltration, morphological analysis and flow cytometry were reviewed at all lymphoma patients over a period of 10 years. METHODS/PATIENTS: 413 cases were included in the study if BM biopsy slides were available. Only 356 patients had both BM trephine biopsy and flow cytometry. RESULTS: The most frequent subtype was diffuse large B cell (31.2%), followed by follicular lymphoma (18.9%). The predominant pattern was mixed (nodular-interstitial) (9.2%). Morphological marrow infiltration was found in 138 cases, and flow cytometry identified 117 cases with BM involvement. A concordance between the two methods was detected in 305 cases (85.7%). There was discordance in 51 cases (14.3%): morphology positive/FC negative in 33 cases and morphology negative/FC positive in 18. CONCLUSIONS: Flow cytometry is slightly more useful in detecting involvement when the BM is affected, but this finding is not conclusive.

Response to a selective COX-2 inhibitor in patients with urticaria/angioedema induced by nonsteroidal anti-inflammatory drugs.

BACKGROUND: In subjects with hypersensitivity reactions with cross-intolerance to nonsteroidal anti-inflammatory drugs (NSAIDs), tolerance to selective COX-2 inhibitors has not been evaluated in large series of well-phenotyped cases. METHODS: We evaluated 252 patients with urticaria and/or angioedema caused by hypersensitivity owing to cross-intolerance to NSAIDs. In addition to the clinical history, diagnosis was confirmed by provocation to an alternative NSAID. Two groups were considered: (A) patients with cross-intolerance to NSAIDs and intolerance to paracetamol and (B) patients with cross-intolerance to NSAIDs and good tolerance to paracetamol. Etoricoxib was administered to Group A patients and to a representative sample of Group B patients. In the event of a positive response, serum tryptase levels were determined and skin biopsy was performed in five patients in each group. RESULTS: Ibuprofen was the most commonly implicated drug, followed by acetylsalicylic acid (ASA). Urticaria was the most common manifestation, followed by angioedema. Most of the patients developed symptoms within 1 h. Twenty-five percent in Group A (n = 47) and 6% in Group B (n = 50) were intolerant to etoricoxib. Skin biopsy showed mast cell activation with the release of tryptase to the extracellular space but without the increase in serum tryptase levels. CONCLUSION: Selective COX-2 inhibitors may be unsafe in subjects with urticaria and/or angioedema caused by hypersensitivity reactions to NSAIDs with cross-intolerance if they are intolerant to paracetamol. A quarter of patients who were intolerant to this drug were also intolerant to etoricoxib. In subjects with hypersensitivity to NSAIDs and intolerance to paracetamol, selective COX-2 inhibitors should be administered as a controlled, incremental dose provocation test to assess tolerance.

N-Carbamoyl-ß-alanine amidohydrolase from Agrobacterium tumefaciens C58: a promiscuous enzyme for the production of amino acids.

The availability of enzymes with a high promiscuity/specificity relationship permits the hydrolysis of several substrates with a view to obtaining a certain product or using one enzyme for several productive lines. N-Carbamoyl-ß-alanine amidohydrolase from Agrobacterium tumefaciens (Atßcar) has shown high versatility to hydrolyze different N-carbamoyl-, N-acetyl- and N-formyl-amino acids to produce different α, ß, γ and δ amino acids. We have calculated the promiscuity index for the enzyme, obtaining a value of 0.54, which indicates that it is a modestly promiscuous enzyme. Atßcar presented the highest probability of hydrolysis for N-carbamoyl-amino acids, being the enzyme more efficient for the production of α-amino acids. We have also demonstrated by mutagenesis, modelling, kinetic and binding experiments that W218 and A359 indirectly influence the plasticity of the enzyme due to interaction with the environment of R291, the key residue for catalytic activity.

[Calcified cardiac thrombus in a patient with antiphospholipid syndrome]. / Trombo cardíaco calcificado en un paciente con síndrome antifosfolípido.

Antiphospholipid syndrome is a rare clinical entity that manifests through repeated thrombotic events in young patients without cardiovascular risk factors. The most frequent clinical features are repeated fetal losses and acute cerebral ischemic events. Cardiac involvement is less frequent. We present the case of a calcified thrombus in the right ventricle with extension to the pulmonary artery in a 30-year-old woman with a history of recurrent miscarriage who was diagnosed with antiphospholipid syndrome.

[Report of a case of short bowel in an elderly patient]. / A propósito de un caso de intestino corto en un paciente de edad avanzada.

Resection of long segments of the small bowel may cause variable degrees of malabsorption. Therefore, the results of the resection will depend on the length and location of the resected segment, and on the age of the patient and the underlying disease that motivated the resection. The implementation of Nutritional Support after intestinal resection is the main stimulating factor for adaptation of the remnant bowel and is important to prevent hyponutrition. The relevance of this case is due to the fact that our 87 years old patient has a good nutritional status and good quality of life 10 years after resection was performed, his remnant bowel having adapted to physiological functions.

Disfagia mecánica por candidiasis esofágica / Mechanical dysphagia due to esophageal candidiasis

La disfagia es la dificultad en el paso de los alimentos, desde la boca, donde se forma el bolo alimenticio, hasta el estómago. Es una sensación subjetiva que aparece durante o inmediatamente después de la deglución, lo que la diferencia del globo histérico, sensación de nudo en la garganta durante todo el día. Son muchas y variadas las causas que pueden provocar este síntoma, y es la historia clínica cuidadosamente recogida la que nos va a ayudar inicialmente a discernir la etiología de la misma. La disfagia que comienza sólo para alimentos sólidos hace pensar en una obstrucción mecánica. Presentamos el caso de una paciente con disfagia mecánica causada por una etiología poco frecuente en pacientes no inmunodeprimidos, se trata de una esofagitis infecciosa por cándidas. Se han relacionado diversos factores predisponentes con la aparición de una candidiasis esofágica, aunque debe considerarse también en pacientes sin patología de base

Dysphagia is the difficulty of passing food from the mouth, where the alimentary bolus forms, to the stomach. It is a subjective sensation that appears during or immediately after swallowing. This differentiates it from the globus hystericus, the knot sensation in the throat during the whole day. There are many and varied causes that may cause this symptom. It is the carefully obtained clinical history that can help us to initially distinguish its etiology. Dysphagia that begins only for solid foods makes us think about mechanical obstruction. We present the case of a patient with mechanical dysphagia caused by non-frequent etiology in patients with normal immunity. It is an infectious esophagitis caused by candidas. Several predisposing factors have been related with the appearance of esophageal candidiasis, although it should also be considered in patients without baseline pathology