Proanthocyanidins potentiate hypothalamic leptin/STAT3 signalling and Pomc gene expression in rats with diet-induced obesity.

OBJECTIVE: Dietary obesity is usually linked with hypothalamic leptin resistance, in which the primary impact is an interference in the homeostatic control of body weight and appetite. Notably, proanthocyanidins (PACs), which are the most abundant phenolic compounds present in human diet, modulate adiposity and food intake. The aim of this study was to assess whether PACs could re-establish appropriate leptin signalling in both the hypothalamus and peripheral tissues. DESIGN: Male Wistar rats were fed either a standard chow diet (STD group, n=7) or a cafeteria diet (CD) for 13 weeks. The CD-fed rats were treated with either grape-seed PAC extract (GSPE) at 25 mg per kg of body weight per day (CD+GSPE group, n=7) or with the vehicle (CD group, n=7) for the last 21 days of the study period. Specific markers for intracellular leptin signalling, inflammation and endoplasmic reticulum stress in the hypothalamus, liver, mesenteric white adipose tissue and skeletal muscle were analysed using immunoblotting and quantitative PCR. RESULTS: GSPE treatment significantly reduced the food intake but did not reverse the hyperleptinemia and body wt gain assessed. However, the animals treated with GSPE exhibited greater hypothalamic activation of signal transducer and activator of transcription-3, which was associated with a rise in the Pomc mRNA levels compared with the CD group. In addition, this restoration of leptin responsiveness was accompanied by lower local inflammation and increased Sirt1 gene expression. The effects of the GSPE treatment in the peripheral tissues were not as evident as those in the hypothalamus, although the GSPE treatment significantly restored the mRNA levels of Socs3 and Ptp1b in the skeletal muscle. CONCLUSIONS: The use of GSPE reduces hyperphagia and improves the central and peripheral leptin resistance associated with diet-induced obesity. Our results suggest that GSPE could exert these effects partially by increasing Sirt1 expression and preventing hypothalamic inflammation.

Prevalence of thyroid dysfunction in adults over age 60 years from an urban community.

Thyroid dysfunction affects a considerable portion of the elder population. The aim of the present study has been to assess the prevalence of thyroid dysfunction in adult healthy subjects over age 60 years from our population. We performed a descriptive, cross-sectional study in the setting of a sanitary area in an urban community in Madrid (Spain). Serum concentrations of thyrotropin (TSH) and free thyroxine (FT4) were determined by an electrochemiluminescency assay in all participants after antecubital venous sampling. A second examination, including the measurement of triiodothyronine and thyroid autoantibodies, was performed in subjects with abnormal results. A total of 127 women and 167 men, aged 60 to 84 years, were studied. We identified 6 subjects (all women) with hypothyroidism (2.04 %) and 19 (6 women, 13 men) with hyperthyroidism (6.46 %, 95 %CI 3.65 - 9.27 %). There were 3 cases (1.02 %) of subclinical and 3 cases (1.02 %) of overt hypothyroidism. In the hyperthyroid group only one patient (0.34 %) showed overt hyperthyroidism. TSH test did not detect erroneously any case of hypothyroidism or hyperthyroidism, although one patient with hyperthyroidism was not diagnosed by this test. FT4 test detected erroneously two cases of hypothyroidism; however, it was the only way to detect the patient with overt hyperthyroidism. In conclusion, in our population over age 60 years the prevalence of hypothyroidism was 2.04 % and that of hyperthyroidism 6.46 % (95 %CI 3.65 - 9.27 %). The total prevalence of thyroid dysfunction was, therefore, 8.50 % (95 %CI 5.31 - 11.69). Our data suggest that TSH test is probably enough to screen for thyroid dysfunction in adults over age 60 years.

[Detection of gestational diabetes with the 50-gram glucose test: prevalence and relationship with to factors]. / Detección de la diabetes gestacional con la prueba de 50 gramos de glucosa: prevalencia y relación con factores de riesgo.

Prevalence of gestational diabetes was investigated in 222 pregnant women between the 24th and 28th weeks of gestation. A glucose screening test (GST) was performed with a 50 g glucose load, followed by a blood sample 1 hour later. Patients with glycemic levels greater than or equal to 140 mg/dl (7.8 mmol/l) 1 hour after the glucose administration were considered as having a positive GST and scheduled for a full oral glucose tolerance test (OGTT), which was interpreted according to O'Sullivan and Mahan criteria. Fifty-four patients had a positive GST, and 10 of them were diagnosed as having gestational diabetes mellitus. These figures indicate a gestational diabetes prevalence of 4.5% in general population and 18.5% in women selected by GST. The fetal weight index in patients with gestational diabetes was 1.13 +/- 0.10, whereas in normal women this index was significantly lower (p less than 0.01). Patients with positive GST and normal OGTT did not have an increased risk for fetal macrosomia. GST results were significantly higher in pregnant women with advanced age (greater than or equal to 35 years) and with late menarche (greater than or equal to 16 years), but did not vary according to maternal parity. Also, these results were significantly related with the number of risk factors for gestational diabetes encountered in a given patient, but not with any of them as examined alone, except for age. We conclude that GST performed in the 24th-28th weeks of gestation reveals 4.5% undetected gestational diabetes in our population. Certain maternal features (age, menarche, number of risk factors) influence on GST results.

[A rare neurologically originated speech disorder: foreign accent syndrome]. / Una rara alteración del habla de origen neurológico: el sindrome del acento extranjero.

INTRODUCTION: Foreign accent syndrome (FAS) is an unusual neurological speech disorder documented in not more than twenty specific studies. As a consequence of a cerebral mainly subcortical injury, the patient s speech is foreign sounding to native listeners. As subject cannot avoid this foreign accent, and given its abrupt emergence, this disorder usually involves emotional consequences by loss of identity and of belonging to a speech community. CASE REPORT: In this paper, a case from Castellón de la Plana (Spain) is presented with a injury in right basal ganglia and the literature about this topic is revised. CONCLUSIONS: From the available data, we describe the main characteristics of the syndrome and discuss the possible role of basal ganglia

[Applications of functional magnetic resonance imaging in pre-surgical patients: motor, mnemonic and linguistic functions]. / Aplicaciones de la resonancia magnética funcional en pacientes prequirúrgicos: funciones motora, de memoria y lingüística.

AIMS: This paper reviews and describes cases involving useful protocols for pre-surgical evaluation in functional magnetic resonance imaging (fMRI) of the motor, mnemonic and linguistic functions. DEVELOPMENT: The application of fMRI in pre-surgical evaluation allows us to pinpoint the anatomical location of a function in relation to the lesion. This technique therefore appears as an alternative to the classical intraoperative tests, which are more aggressive and costly. The paper describes aspects and considerations of fMRI with regard to the methodology and procedure employed in its application, as well as the control of contaminating variables that can affect results. The language protocols are described in terms of lateralisation and localisation, and are divided into expressive and receptive language protocols, together with linguistic protocols for overall stimulation that allow the localisation of both expressive and receptive areas. Concerning the motor protocols, we describe the procedures for patients with and without difficulties in their movement. Lastly, we review and describe the memory protocols that give rise to bilateral stimulation in the mesial temporal areas, which allows both lateralisation and localisation of the hippocampal and parahippocampal areas that are functionally significant for the patients' memory. Each of the protocols is illustrated with cases carried out by our work team. CONCLUSIONS: The development of new protocols for pre-surgical evaluation must be guided by greater delimitation and consistency in functional stimulation, as well as analysis of the behaviour displayed.

Information-processing speed is the primary deficit underlying the poor performance of multiple sclerosis patients in the Paced Auditory Serial Addition Test (PASAT).

The aims of this study were to determine which cognitive domains are evaluated by the Paced Auditory Serial Addition Test (PASAT) and to identify which of them are responsible for the poorer performance displayed by multiple sclerosis (MS) patients in this task. A total of 30 healthy controls and 30 MS patients completed the PASAT task as well as the different tests contained in the Brief Repeatable Battery of Neuropsychological Tests (BRB-N), some Wechsler Adult Intelligence Scale (WAIS-III) subtests, the Spanish version of the Chicago Multiscale Depression Inventory (CMDI), and a new PASAT-based task (ADD1) that was specifically designed for this study. Analysis of covariance and regression-based analyses were performed to identify the predictors that are most strongly associated with the PASAT scores and the between-groups differences in the performance of this task. PASAT execution was associated with scores of the Digit Backward test, Symbol Digit Modality Test (SDMT), and measures of working memory and information-processing speed. On the other hand, differences between healthy volunteers and MS patients were mainly associated with the SDMT scores. MS patients also exhibited poorer execution than controls in the ADD1 task. Our results suggest that reduced information-processing speed (and not working memory) is the primary alteration underlying the lower scores in the PASAT task (and probably other cognitive deficits) that characterize MS patients. Based on these results, we suggest that tests that capitalize the role of information-processing speed may be of special relevance in the neuropsychological assessment of this clinical population.

Supported discharge shortens hospital stay in patients hospitalized because of an exacerbation of COPD.

This prospective, controlled, but not formally randomized study investigates the feasibility and efficiency of an alternative to standard hospitalization for patients with exacerbated chronic obstructive pulmonary disease (COPD), based upon supported discharge with nurse supervision at home. Over a 12-month period, emergency physicians, not directly involved in the study, admitted 205 patients with exacerbated COPD to the authors' respiratory unit. Patients were included in the supported discharge group (n=105) if they voluntarily chose to participate in the programme and lived in the city of Palma de Mallorca (where adequate home support could be provided). Patients not fulfilling these criteria (mainly residents outside the city) served as controls (n=100). Inpatient treatment was standardized in all patients and included oxygen therapy, bronchodilators, antibiotics and steroids. Both groups were comparable in terms of age (mean +/- SD: 70 +/- 10 versus 65 +/- 11 yr for supported discharge and control group, respectively), severity of airflow obstruction (forced expiratory volume in one second 45 +/- 18% reference versus 46 +/- 19% ref.), comorbidity and socioeconomic status. Length of hospital stay (LOS) in the supported discharge group was shorter (5.9 +/- 2.8 versus 8.0 +/- 5.1 days, p < 0.001). After discharge, a respiratory nurse visited supported discharge patients at home during 7.3 +/- 3.8 days. Only one patient (1%) required hospital readmission during this period of time. The reduced LOS resulted in a lower utilization of hospital beds at any given point in time throughout the study period. Within the framework and potential limitations of this study, the results indicate that the supported discharge programme in Spain: 1) allows a significant reduction in the length of hospital stay of patients hospitalized because of an exacerbation of chronic obstructive pulmonary disease; 2) does not result in an inappropriately increased rate of hospital readmissions; and 3) reduces the utilization of hospital resources.