Omentin-1 and its relationship with inflammatory factors in maternal plasma and visceral adipose tissue of women with gestational diabetes mellitus.

PURPOSE: To investigate the association of omentin-1 and inflammatory factors in serum and visceral adipose tissue (VAT) of women with gestational diabetes mellitus (GDM) compared to normal pregnant (NP) subjects. Furthermore, to examine their correlation with maternal clinical characteristics. METHODS: We compared 116 GDM women to 115 NP women, at the time of cesarean section. Circulating omentin-1 and pro-inflammatory (IL-1ß, IL-6, TNF-α), and anti-inflammatory cytokines (IL-1RA, IL-10) were examined. Moreover, their mRNA expression in VAT, along with inflammatory factors involved in the NF-κB pathway (TLR2, TLR4, NF-κB, IKκB), were examined. RESULTS: Circulating omentin-1 (p = 0.022) was lower and circulating IL-1-ß, IL-1RA, as well as IL-10 (p = 0.005, p = 0.007, and p = 0.015, respectively), were higher in GDM compared to NP women. Omentin-1 correlated negatively with pre-pregnancy and gestational BMI, and HOMA-IR in all women, but was not associated with cytokines. TLR2, TLR4, IL-1ß, IL-1RA, IL-6, IL-10 mRNA expression in VAT was lower in GDM compared with controls (p < 0.05 all). In multivariate analysis, BMI at delivery was significantly correlated to omentin-1 concentrations in all and NP subjects. In addition, omentin-1 expression was correlated to inflammatory gene expression in all, GDM and NP, women (p < 0.05 all). CONCLUSION: Serum levels and VAT gene expression of omentin-1 are not independently linked to GDM; notwithstanding, GDM women have a VAT-altered inflammatory status. In addition, no systemic association between omentin-1 and inflammatory factors was found, whereas associations between their expression in all women were observed, indicating that expression of these adipokines is linked between them regardless of GDM.

Risk Factors in Severe Anaphylaxis: Which Matters the Most, Food or Cofactors?

BACKGROUND AND OBJECTIVE: The prevalence of anaphylactic shock, the most severe manifestation of anaphylaxis, remains unknown. Risk factors and biomarkers have not been fully identified. Objective: To identify risk factors in patients who experience anaphylactic shock. METHODS: Using lipid transfer protein (LTP) allergy as a model, we compared the characteristics of patients who developed anaphylaxis and anaphylactic shock. We recorded demographics, pollen sensitization, foods ingested up to 2 hours before onset of the reaction, and the presence of cofactors. Culprit foods were identified through a compatible clinical history and positive allergology work-up (skin prick test and/or sIgE). RESULTS: We evaluated 150 reactions in 55 patients with anaphylaxis (134 reactions) and 12 with anaphylactic shock (16 reactions). Patients in the anaphylaxis group experienced twice as many reactions (mean [SD], 2.4 [2.5] for anaphylaxis vs 1.3 [1.5] for anaphylactic shock; P<.02). No relationship was found between any food group and severity of the reaction. The most frequent food involved in both groups of patients was the combination of several plant-derived foods (plant food mix), followed by peach and nuts. Indeed, in the reactions caused by plant food mix, the presence of a cofactor was observed more often than in other food groups. On the other hand, cofactors were not present in peach- and nut-related reactions. Exercise was the most frequent cofactor in all groups. CONCLUSION: In our series, the severity of the reactions was not determined by the kind of food or presence of a cofactor. Anaphylactic shock seems to be an infrequent presentation that may be associated with other individual-related factors requiring further evaluation.

Giant mature cystic teratoma of the mediastinum resected by VATS: a case report.

The incidence of mediastinal teratomas is low, it's important to recognize them between all the differential diagnoses for mediastinal tumors. The treatment is surgical resection. We report a giant mature cystic teratoma of the mediastinum in a 40-year-old woman. She presented with dyspnea, flu-like symptoms during the previous 5 days. An x-ray complemented with a chest CT scan showed a heterogeneous extrapulmonary multiloculated and predominantly fluid density tumor located at the left side of the mediastinum. The patient underwent resection by video-assisted thoracic surgery (VATS). The tumor was 15 cm in diameter with a predominant cystic component. Histologic examination revealed a mature cystic teratoma. Treatment of these tumors should attempt a complete resection. Open approaches are painful, require a longer recovery and are associated with higher morbidity. VATS has been used to treat these tumors, demonstrating the same effectiveness and advantages over open procedures.

Primary tracheal schwannoma resected in a Turner syndrome patient: a case report.

We report a case of primary tracheal schwannoma in a 31-year-old woman. She had a previous history of follicular thyroid carcinoma treated surgically and Turner syndrome. In a follow-up computed tomography scan, we found a partially obstructing intraluminal tracheal tumor, which was confirmed by bronchoscopy. The patient was treated by surgical resection and primary tracheal anastomosis. The tumor was 14 mm in diameter, with an intact capsule. Histologic analysis revealed a Schwann cell origin tumor.

Osteocalcin, under-carboxylated osteocalcin and osteopontin are not associated with gestational diabetes mellitus but are inversely associated with leptin in non-diabetic women.

OBJECTIVE: To measure serum osteocalcin (OC), under-carboxylated osteocalcin (ucOC), osteopontin (OPN), and leptin in pregnant women with gestational diabetes mellitus (GDM) and in healthy pregnant women during pregnancy and after birth and relate these markers to glucose metabolism. METHODS: This was a prospective study including 60 women with GDM and 60 subjects with normal gestation who were evaluated at gestational week 30 and 6 weeks postpartum. Serum OC, ucOC, OPN, leptin, insulin and insulin resistance were evaluated during the study. RESULTS: Bone biomarkers and leptin were similar between GDM and normal pregnancy. After delivery, OC, ucOC and OPN increased in both groups, while leptin decreased only in healthy controls. Bone markers did not correlate with insulin and insulin resistance in the two groups, but leptin was positively correlated with insulin and insulin resistance and negatively correlated with bone biomarkers only in healthy women. Furthermore, the women who developed diabetes postpartum had lower levels of OC than women with normal glucose tolerance. CONCLUSION: GDM is not associated with OC, ucOC, OPN, and leptin and does not correlate with insulin resistance. At postpartum, women who develop diabetes have lower osteocalcin concentrations. Leptin correlates with insulin resistance and bone biomarkers in non-diabetic women.

Heavy metal content in soils under different wastewater irrigation patterns in Chihuahua, Mexico.

An area near the city of Chihuahua has been traditionally irrigated with wastewater to grow forage crops. It has been hypothesized that metal levels could be found in these soils high enough to cause potential health problems to the population. The objective of this study was to determine heavy metal concentrations in different soils due to irrigation practices. Four soil types were evaluated; a soil with a past and present history of wastewater irrigation (S1), a soil with a history of wastewater irrigation until 2003 (S2), a soil with no irrigation history (S3), and a soil similar to S1 and adjacent to the river where the wastewater is transported (S11). Three soil depths were evaluated; 0-15, 15-30 and 30-50 cm. Consequently, a total of 150 soil samples were analyzed evaluating pH, EC, OM and the following elements; Na, K, Cd, Pb, Ni, Cr, Cu and Fe. The pH (P=0.000) and EC (P=0.000) were different for each soil type but no differences were noted for soil depth and the interaction. Maximum pH levels were noted in S3 with a value of 8.74 while maximum EC was observed in S1 with a value of 0.850 dSm-1. The OM level was different for soil type (P=0.000), soil depth (P=0.005) and the interaction (P=0.014). S1 and S11 obtained maximum levels of OM while minimum levels were noted in S3. Maximum OM levels were observed at the 0-15 cm depth followed by the 15-30 cm depth and finally at the 30-50 cm depth. The highest concentration of metals was as follows: K in S1 (359.3 mg kg-1); Cd in S1 (4.48 mg kg-1); Pb in S11 (155.83 mg kg-1); Ni in S1 (10.74 mg kg-1); Cu in S1 (51.36 mg kg-1); B in S3 (41.5 mg kg-1); Fe in S3 (20,313.0 mg kg-1), Cr in S3 (44.26 mg kg-1) and Na in S3 (203.0 mg kg-1). The conclusion is that some metals are present in the soils due to anthropogenic activities but others are present in natural forms.

Application of a low density support material as an alternative to prevent clogging in a three-phase fluidized-bed reactor.

A low density support material was evaluated to determine its effect on biofilm growth dynamics when treating synthetic wastewater in a three-phase fluidized-bed reactor. After two 40-day experimental runs, the results showed significant microbial activity from the very beginning of the study. The highest biofilm growth was observed during the first 10 days of operation. Biofilm kept gradually growing after the 11th day and reached a steady-state at day 21, defined by a consistent biomass attached to the particles. As an indicator of biofilm detachment effluent suspended biomass decreased as biofilm attachment increased, tending also to stabilize around day 21. During the first 10 days, chemical oxygen demand removal averaged 100 mg l(-1) representing 48% of the influent chemical oxygen demand concentration. The highest chemical oxygen demand removal efficiency (78%) was achieved between days 23 and 29, when influent chemical oxygen demand was 280 mg l(-1). The support material evaluated proved to be effective at allowing attachment of microorganisms. Due to its low density, bed fluidization was achieved under recirculation rates lower than those required to fluidize beds of higher density. The physical properties of the proposed support material allowed an appropriate equilibrium to be achieved between biomass attachment and detachment, eliminating the need for bed backwashing.

[Effect of hormone replacement with tibolone on plasma insulin and blood glucose in postmenopause]. / Efecto del reemplazo hormonal con tibolona sobre la insulina plasmática y la glucemia en la posmenopausia.

The effect of Tibolone, and estrogen-like therapeutic agent used for menopause, on insulin and glucose was investigated in 18 healthy postmenopausal women. At baseline and after 3 months of Tibolone, 2.5 mg daily, blood levels of glucose and insulin were evaluated in each participant. Fasting levels of glucose were not modified by Tibolone, whereas plasmatic insulin levels were reduced significantly (p < 0.01). High-density lipoprotein cholesterol and total cholesterol were not affected by Tibolone. From these data it may be suggested that Tibolone does not negatively influence glucose fasting levels, but reduces the already elevated insulin levels which may be due to an improvement in peripheral tissue sensitivity to insulin.

[Decrease in circulating androgens in men during senescence]. / Decremento en los andrógenos circulantes en el hombre durante la senescencia.

It has been reported that circulating androgens exhibit a decrement with aging in men; however, there are some controversial results. We have carried out a descriptive study in a group of men aged 60-70 years. In order to determine levels of androgens In serum, the results were compared with those obtained in another group in normal men 20-44 years of age. Measurements included circulating levels of testosterone(T), dehydroepiandrosterone sulfate (DHEA-S), LH, FSH, estradiol (E), ACTH, prolactin (PRL), IGF-1, and SHBG. The group of older men group showed a significative decrement of T and DHEA-S, as well as E. An increment of FSH and LH without changes of ACTH, cortisol and SHBG was demonstrated. Collaterally, PRL and IGF-1 decreased in aging men. The present data demonstrated a significant decrement of circulating androgens, both T and DHEA-S coinciding with elevation of gonadotropins. It is concluded that aging is accompanied by changes of a decrement of androgens, of gonads, and adrenal origin. Further studies will investigate the effect of testosterone replacement in aging men.

Atrioventricular septal defect: quantitative anatomy of the left ventricle.

A morphometric study was performed in 18 human hearts with atrioventricular septal defect not associated with other anomalies; 16 hearts had common atrioventricular orifices, and 2 presented separate right and left atrioventricular orifices. A total of eight parameters were analyzed, characterizing ventricular wall thickness, length and circumference of the inflow and outflow tracts, and circumference of the left orifice and aortic orifice. The data were compared with previously published patterns of normality. In addition, the volume of the aortic outflow tract was calculated. The inflow tract was shorter than the outflow tract, and the length of the diaphragmatic wall was equal to the sum of the lengths of the inflow tract and ventricular wall thickness at the level of the apex.

Swine hearts: quantitative anatomy of the right ventricle.

The right ventricle was studied in 75 anatomically normal swine hearts, using, in all, nine geometric and volumetric parameters: ventricular-wall thickness, length of the right-ventricular inflow and outflow tracts, and volume of the right-ventricular inflow and outflow tracts. The data for these parameters were compared with previously published patterns for human hearts and volumetric data were compared with patterns of normality found in human hearts. As in the human heart, the ventricular inflow tract in swine hearts was significantly shorter than the outflow tract (P < 0.0001).

[The swine heart: the papillo-tendino-valvular system of the right ventricle]. / Corazón cerdo: sistema papilo-tendino-valvular del ventrículo derecho.

The right ventricle was studied in 75 anatomically normal swine hearts. Nine parameters in the papillo-tendino valvular system and three corresponding to the tricuspid orifice, pulmonary orifice and length of the inflow tract were measured. Correlations were established between the parameters and heart weight in grams, between the different parameters themselves, and between heart weight and body weight. The results were compared with similar data from human hearts, and were considered of use to researchers planning to use the swine heart as an experimental model to study congenital or induced heart diseases, or as a reference for the clinical interpretation of spontaneous cardiac, anomalies in swine.

[Differential aspects of drug prescriptions in elderly people living in the northeast area of Granada: study of 366 individuals]. / Aspectos diferenciales sobre la prescripción de fármacos en ancianos residentes de la zona nordeste de Granada: estudio sobre 366 individuos.

BACKGROUND: The geriatric population consumes greater numbers of medicines than other age groups. We compared drug prescription and consumption in elderly persons residing in a nursing home or living in their own home. METHODS: We studied 366 elderly men and women (older than 65 years) who lived either in nursing homes or in their own home. The variables recorded were the most frequent diseases, number and types of drugs prescribed per person, and adverse reactions of the most frequently prescribed drugs. RESULTS: The most common diseases recorded among subjects living at home were arterial hypertension and rheumatic diseases; among those in nursing homes, the most common ailment was dementia. Subjects in nursing homes were prescribed more different drugs (2.8 +/- 1/person) than individuals living on their own (1.8 +/- 1/person). The percentage of adverse reactions was highest in ambulatory patients (64%) and in patients taking benzodiazepines (56%). A large proportion of all prescriptions (74.5%) were for solid galenic forms. CONCLUSIONS: We draw attention to the greater consumption of drugs by elderly persons residing in nursing homes, as well as the prescription of benzodiazepines and analgesic-antiinflammatory drugs within old age.

Morphometric data on the arterial duct in the human fetal heart.

In a total of 496 fetuses and newborns ranging in body weight from 60 to 5000 g, we performed a morphometric study of the ascending aorta, the descending aorta, the aortic isthmus, the right pulmonary artery, the left pulmonary artery and the arterial duct. In all, nine different parameters were measured in each specimen. The variations in the correlations between two measurable characteristics, namely body weight and each of the morphometric parameters, were analyzed. The minimum, normal and maximum patterns of normality for each parameter were obtained with regression equations. We compared statistically the diameter of the arterial duct with the diameter of the ascending and descending aorta, the aortic isthmus, the right pulmonary artery and the left pulmonary artery with one way analysis of variance, using Bonferroni's test in the pairwise comparisons. The diameter of the arterial duct was smaller than the diameter of the ascending and descending aortas, the aortic isthmus, the right pulmonary artery and the left pulmonary artery, and the diameter of the ascending aorta was larger than that of the descending aorta. These morphological data have immediate clinical and surgical applications in the treatment of fetal and perinatal cardiovascular disorders.

Morphometric data concerning the great arterial trunks and their branches.

In a total of 496 fetuses and newborns ranging in body weight from 60 to 5000 g, we performed a morphometric study of the vascular complex, that is the orifices of the great arterial trunks, ascending aorta, aortic arch, vessels branching from the aortic arch, the aortic isthmus, descending aorta, pulmonary trunk, orifices of the pulmonary arteries and arterial duct. In all, 17 different parameters were measured in each specimen, using several new parameters in addition to the measurements classically used in the aortic isthmus, arterial duct and pulmonary trunk. Anatomo-geometric models of these structures were developed, and stereometric formulas used to calculate the real volumes of the aortic isthmus, arterial duct and pulmonary trunk. The variations in the correlations between two measurable characteristics, that is, body weight and each of the morphometric parameters were analyzed, and the minimum, normal and maximum patterns of normality for each parameter were obtained with regression equations. The results show that the volume of the aortic isthmus increases by 0.03 ml for each millilitre increase in left ventricular volume. The isthmic volume increases by 0.32 ml for each millilitre increase in volume of the arterial duct and the volume of the pulmonary trunk increases by 6.4 ml for each increase of 1 millilitre in the volume of the aortic isthmus. The inner circumference of the aortic isthmus is greater than that of the arterial duct, whereas the former vessel is always shorter than the latter. We believe that these morphological data, when appropriately interpreted, have immediate clinical and surgical applications in the treatment of fetal and perinatal cardiovascular disorders.

[Use of aminoglycoside antibiotics in a general hospital: kinetics consequences in those patients whose blood levels are not monitored]. / Utilización de antibióticos aminoglucósidos en un hospital general: consecuencias cinéticas en aquellos pacientes en los que no se monitorizan sus niveles plasmáticos.

A surprise monitoring of plasma aminoglycoside level was carried out in our Hospital in 55 patients. Basal samples and samples one hour after i.m. or i.v. administration were obtained. A protocol sheet with personal, clinical and therapeutic data was filled for each patient. The FPIA analysis technique (CV less than 5%) was used. Only the data related to gentamicin were evaluated, because the number of patients receiving other aminoglycosides was very low (5 cases). The most usual dose and interval were 80 mg (91%) and 12 hours (69%), respectively. The administration routes were i.v. (52%) and i.m. (48%). Blood urea and/or creatinine levels were not measured in 22% of patients. The baseline gentamicin levels were subtherapeutic in 30%, therapeutical in 57%, and toxic in 13%, and 50%, 46% and 4%, respectively, for the levels after one hour. In patients with abnormal renal function a good correlation could be demonstrated (r = 0.96; p less than 0.001) between creatinine level and gentamicin 1/2 time. This correlation was absent in patients with normal renal function. When the dose of the antibiotic was adjusted to the weight of the patient, the frequency of therapeutic levels was higher (47%; p less than 0.03); in these cases, the most common administration interval was 8 hours (p less than 0.01). We emphasize the lack of control of the renal function in 22% of patients, stressing that the lack of monitoring systematically results in potentially subtherapeutic levels in more than one half of the investigated patients (57%).

[Levels of blood theophylline in patients with acute bronchospasm]. / Tasas de teofilinemia en pacientes con un broncoespasmo agudo.

Plasma theophylline levels (mcg/ml) of 93 patients with a bronchopulmonary disease (asthma and chronic obstructive lung disease) who were on theophylline (normal or retarded) treatment, were determined on admission at the emergency ward because of acute bronchospasm. Our results show that theophylline blood levels were subtherapeutical in patients treated either with normal (2.1 +/- 0.8 mcg/ml) or retarded theophylline (9.6 +/- 1.3 mcg/ml). This was probably due to insufficient dosing and/or poor patient compliance. The necessity of monitoring this type of treatment is once again evident.

Serum aspirin-esterase activity in epileptic patients receiving treatment with phenobarbital, phenytoin, carbamazepine and valproic acid.

Serum aspirin-esterase activity was studied in a group of epileptic patients under treatment with phenobarbital, phenytoin, carbamazepine and valproic acid, and a group of healthy controls. Serum rates of hydrolytic activity as well as serum esterase activity were found to be higher in epileptics (p less than 0.001) than in controls. The findings suggest that the above-mentioned antiepileptic drugs may induce plasma esterase activity, thus leading to increases in serum hydrolytic activity in epileptic subjects. On the other hand, no sex or albumin-related differences were observed in serum aspirin-esterase activity in the groups investigated.

The quantitative anatomy of the normal human heart in fetal and perinatal life.

A total of 367 human fetuses and newborn subjects weighing from 60 to 5000 g provided the material for a morphometric study of the heart. A total of 17 interventricular parameters were measured in each specimen, one of the parameters representing an innovation with regard to the classically used set of measurements. A new anatomo-geometric configuration is described for each ventricle along with a new component for the left ventricular outflow tract, designated as the aortic outflow tract. The appropriate stereometric formulas were used to calculate real ventricular volumes rather than the previously studied volumetric indices. Additionally, correlation indices were calculated for ventricular wall thickness as well as the circumferences and diameters of the atrioventricular and arterial valves. The results show that, in fetuses of up to 2700 g in body weight, ventricular wall thickness is greater in the right than in the left ventricle, although the opposite is true in fetuses weighing above 2700 g. Throughout the range of weights studied, ventricular volume was greater in the left than in the right chamber. Tricuspid and pulmonary valve circumference and diameter were consistently greater than in the mitral and aortic valves, respectively. We believe the new morphometric data and their innovative interpretation to have immediate applications in both the morphological and functional areas of cardiology.