The ability of self-rated health to predict mortality among community-dwelling elderly individuals differs according to the specific cause of death: data from the NEDICES cohort.

BACKGROUND: The biomedical and psychosocial mechanisms underlying the relationship between self-rated health (SRH) and mortality in elderly individuals remain unclear. OBJECTIVE: To assess the association between different measurements of subjective health (global, age-comparative, and time-comparative SRH) and cause-specific mortality. METHODS: Neurological Disorders in Central Spain (NEDICES) is a prospective population-based survey of the prevalence and incidence of major age-associated conditions. Data on demographic and health-related variables were collected from 5,278 subjects (≥65 years) in the baseline questionnaire. Thirteen-year mortality and cause of death were obtained from the National Death Registry. Adjusted hazard ratios (aHR) for SRH and all-cause and cause-specific mortality were estimated by Cox proportional hazard models. RESULTS: At baseline, 4,958 participants (93.9%) answered the SRH questionnaire. At the end of follow-up, 2,468 (49.8%) participants had died, of whom 723 (29.2%) died from cardiovascular diseases, 609 (24.7%) from cancer, and 359 (14.5%) from respiratory diseases. Global SRH independently predicted all-cause mortality (aHR for 'poor or very poor' vs. 'very good' category: 1.39; 95% confidence interval (CI): 1.15-1.69). Analysis of cause-specific mortality revealed that global SRH was an independent predictor for death due to respiratory diseases (aHR for 'poor or very poor' vs. 'very good' category: 2.61; 95% CI: 1.55-4.39), whereas age-comparative SRH exhibited a gradient effect on the risk of death due to stroke. Time-comparative SRH provided small additional predictive value. CONCLUSIONS: The predictive ability of SRH for mortality largely differs according to the specific cause of death, with the strongest associations found for respiratory disease and stroke mortality.

Phenotypic and functional evaluation of CD3+CD4-CD8- T cells in human CD8 immunodeficiency.

BACKGROUND: Human CD8 immunodeficiency is characterized by undetectable CD8(+) lymphocytes and an increased population of CD4(-)CD8(-) (double negative) T lymphocytes. DESIGN AND METHODS: We hypothesized that the double negative subset corresponds to the cellular population that should express CD8 and is committed to the cytotoxic T lymphocyte lineage. To assess this, we determined the phenotype and function of peripheral blood mononuclear cells and/or magnetically isolated double negative T lymphocytes from two CD8-deficient patients. To analyze the expression and co-localization with different organelles, 293T cells were transfected with plasmids bearing wild-type or mutated CD8α. RESULTS: CD8α mutated protein was retained in the cytoplasm of transfected cells. The percentages of double negative cells in patients were lower than the percentages of CD8(+) T cells in healthy controls. Double negative cells mostly had an effector or effector memory phenotype whereas naïve T cells were under-represented. A low concentration of T-cell receptor excision circles together with a skewed T-cell receptor-V repertoire were observed in the double negative population. These data suggest that, in the absence of CD8 co-receptor, the thymic positive selection functions suboptimally and a limited number of mature T-cell clones would emerge from the thymus. In vitro, the double negative cells showed a mild defect in cytotoxic function and decreased proliferative capacity. CONCLUSIONS: It is possible that the double negative cells are major histocompatibility complex class-I restricted T cells with cytolytic function. These results show for the first time in humans that the presence of the CD8 co-receptor is dispensable for cytotoxic ability, but that it affects the generation of thymic precursors committed to the cytotoxic T lymphocyte lineage and the proliferation of mature cytotoxic T cells.

[Nonbacterial thrombotic endocarditis: clinicopathologic study of a necropsy series]. / Endocarditis trombótica no bacteriana: estudio clínico-patológico de una serie necrópsica.

INTRODUCTION AND OBJECTIVES: Nonbacterial thrombotic endocarditis (NBTE) is characterized by sterile platelet and fibrin deposition on cardiac valves. In this study, our aim was to investigate the clinicopathologic characteristics of patients diagnosed with NBTE at the 12 de Octubre University Hospital in Madrid, Spain. METHODS: Patients were identified by analyzing reports of autopsies carried out at the Anatomical Pathology Department of the University Hospital between 1974 and 1977 and between 1980 and 2004. RESULTS: Out of 2041 autopsies, 22 (1.08%) showed evidence of NBTE. The patients' average age was 63.04 years, and neither sex predominated. The underlying disease was an infection in 54.5% of cases, whereas 31.8% had a neoplasm, most frequently a pancreatic adenocarcinoma or renal carcinoma. In 10 cases, there was a previous valvulopathy. The mitral valve was most frequently affected by NBTE (36.5% of cases). In most cases, the cause of death was the underlying disease, though in two patients it was directly related to NBTE (9.1%). In nine cases, an embolism occurred, principally in the spleen, the kidneys or the central nervous system. Before death, there was no suspicion of NBTE in any of these cases. CONCLUSIONS: NBTE is an uncommon disease entity that occurs not only in patients with end-stage neoplastic disease, but also in those with potentially treatable diseases. Consequently, we should raise our level of awareness of this condition so that a diagnosis can be made before the patient dies and anticoagulant treatment can be started, thereby helping to improve prognosis.

Endocarditis trombótica no bacteriana: estudio clínico-patológico de una serie necrópsica / Nonbacterial thrombotic endocarditis: clinicopathologic study of a necropsy series

Introducción y objetivos. La endocarditis trombótica no bacteriana (ETNB) se caracteriza por el depósito de trombos de plaquetas y fibrina estériles sobre válvulas cardiacas. En este estudio se pretende investigar las características clínico-patológicas de los casos de ETNB diagnosticados en el Hospital Universitario 12 de Octubre de Madrid. Métodos. Los casos se recogieron a través del análisis de los informes de las autopsias realizadas en el Departamento de Anatomía Patológica de dicho hospital en 1974-1977 y 1980-2004. Resultados. De 2.041 autopsias, 22 presentaban una ETNB (1,08%). La edad media fue de 63,04 años, sin predominio de sexo. En el 54,5% de los casos la ETNB se asociaba con una infección y en el 31,8% con neoplasias, las más frecuentes de las cuales eran el adenocarcinoma de páncreas y el carcinoma renal. En 10 casos había un daño valvular previo. La localización más frecuente de la ETNB fue la válvula mitral (36,5%). En la mayoría de los casos la muerte se debió a la enfermedad de base, aunque en 2 se relacionó con la ETNB (9,1%). Se detectaron embolias en 9 casos, principalmente en el bazo, el riñón y el sistema nervioso central. En ningún caso se sospechó la ETNB ante mortem. Conclusiones. La ETNB es una entidad poco frecuente que aparece no sólo en pacientes con enfermedades neoplásicas en estadio terminal, sino en pacientes con enfermedades potencialmente curables, por lo que debemos aumentar nuestro grado de sospecha para lograr un diagnóstico en vida e iniciar un tratamiento, la anticoagulación, que podría mejorar el pronóstico (AU)

Introduction and objectives. Nonbacterial thrombotic endocarditis (NBTE) is characterized by sterile platelet and fibrin deposition on cardiac valves. In this study, our aim was to investigate the clinicopathologic characteristics of patients diagnosed with NBTE at the 12 de Octubre University Hospital in Madrid, Spain. Methods. Patients were identified by analyzing reports of autopsies carried out at the Anatomical Pathology Department of the University Hospital between 1974 and 1977 and between 1980 and 2004. Results. Out of 2041 autopsies, 22 (1.08%) showed evidence of NBTE. The patients' average age was 63.04 years, and neither sex predominated. The underlying disease was an infection in 54.5% of cases, whereas 31.8% had a neoplasm, most frequently a pancreatic adenocarcinoma or renal carcinoma. In 10 cases, there was a previous valvulopathy. The mitral valve was most frequently affected by NBTE (36.5% of cases). In most cases, the cause of death was the underlying disease, though in two patients it was directly related to NBTE (9.1%). In nine cases, an embolism occurred, principally in the spleen, the kidneys or the central nervous system. Before death, there was no suspicion of NBTE in any of these cases. Conclusions. NBTE is an uncommon disease entity that occurs not only in patients with end-stage neoplastic disease, but also in those with potentially treatable diseases. Consequently, we should raise our level of awareness of this condition so that a diagnosis can be made before the patient dies and anticoagulant treatment can be started, thereby helping to improve prognosis (AU)