Differences in the cluster of depressive symptoms between subjects with type 2 diabetes and individuals with a major depressive disorder and without diabetes.

BACKGROUND: Depressive disorder encompasses a wide spectrum of somatic and psychological symptoms. It is not known whether there are differences regarding the cluster of depressive symptomatology between subjects with depression with and without T2DM. PURPOSE: To explore whether the cluster of depression that prevails among depressive subjects with T2DM differs from individuals with depression, but without T2DM. METHODS: 87 T2DM patients with a pathological Beck Depression Inventory test (BDI) were compared with 50 age- and gender-matched individuals with a major depressive disorder. All 21 items expressed in the BDI were compared between the two groups. RESULTS: The score obtained after administering the BDI was comparable between patients with T2DM and significant depressive symptoms and the control group (18.8 ± 2.7 vs 18.9 ± 3.4; p = 0.9). Subjects with T2DM had higher scores compared with the control group in the following items: sadness (1.4 ± 0.9 vs 0.9 ± 0.9; p = 0.011), difficulty in concentration (1.3 ± 0.8 vs 0.8 ± 0.8; p = 0.01), indecisiveness (1.1 ± 0.8 vs 0.5 ± 0.9; p = 0.012), worries about their health (1.3 ± 0.9 vs 0.6 ± 0.9; p < 0.0001), fatigue (1.2 ± 0.6 vs 0.8 ± 0.7; p = 0.003) and loss of sexual appetite (2.7 ± 0.6 vs 1.2 ± 1.3; p = 0.0001). Suicidal ideation was significantly lower among subjects with T2DM compared with the control group (0.1 ± 0.3 vs 0.6 ± 0.8; p = 0.0001). CONCLUSIONS: Subjects with T2DM and a positive screening for depression presented a different cluster of depression compared with depressed subjects without T2DM, with a predominance of somatic-biological depressive symptoms rather than psychological-cognitive cluster and negative emotions, such as suicidal ideation.

Correction to: CSF inflammatory markers and neurocognitive function after addition of maraviroc to monotherapy darunavir/ritonavir in stable HIV patients: the CINAMMON study.

Due to a production error the bottom portion of Figure 1 was omitted. The corrected figure is given below.

CSF inflammatory markers and neurocognitive function after addition of maraviroc to monotherapy darunavir/ritonavir in stable HIV patients: the CINAMMON study.

CINAMMON is a phase IV, open-label, single-arm, pilot study assessing maraviroc (MVC) in the central nervous system (CNS) when added to darunavir/ritonavir monotherapy (DRV/r) in virologically suppressed HIV-infected subjects. CCR5 tropic participants on DRV/r were recruited. Participants remained on DRV/r for 12 week (w) (control phase). MVC 150 mg qd was added w12-w36 (intervention phase). Lumbar puncture (LP) and neurocognitive function (Cogstate) examinations scheduled at baseline, w12 and w36; MRI before w12, again at w36. Primary endpoint was CSF inflammatory marker changes during intervention phase. Secondary endpoints included changes in NC function and MRI parameters. CSF/plasma DRV/r concentrations measured at w12 and w36, MVC at w36. Nineteen patients recruited, 15 completed (17M, 2F). Dropouts: headache (2), knee problem (could not attend, 1), personal reasons (1). Mean age (range) 45.4 years (27.2-65.1), 13/19 white, 10/19 MSM. No changes in selected CSF markers were seen w12-w36. Overall NC function did not improve w12-w36: total age adjusted z score improved by 0.27 (weighted paired t test; p = 0.11); for executive function only, age adjusted z score improved by 0.54 (p = 0.03). MRI brain parameters unchanged. DRV plasma:CSF concentration ratio unchanged between w12 (132) and w36 (112; p = 0.577, Wilcoxon signed-rank). MVC plasma:CSF concentration ratio was 35 at w36. No changes in neuroinflammatory markers seen. In this small study, addition of 24w MVC 150 mg qd to stable DRV/r monotherapy showed possible improvement in executive function with no global NC effect. Learning effect cannot be excluded. This effect should be further evaluated.

Prevalence and Clinical Correlators of Undiagnosed Significant Depressive Symptoms Among Individuals with Type 2 Diabetes In A Mediterranean Population.

Objective: To determine the frequency and clinical parameters, of clinically significant depressive symptoms among a type 2 diabetes (T2DM) sample from a Mediterranean area without an established diagnosis of depressive disorder (DD). Methods: 320 subjects with T2DM were recruited randomly from Primary-Care settings and the Endocrine Department from a tertiary center in Mallorca (Spain). 91 healthy individuals matched by age, gender and BMI were used as controls. All participating patients graded by the presence of DD by using the "Beck Depression Inventory" (BDI), considering pathological a cut-off score equal or greater than 16. Results: 27.2% T2DM subjects had significant symptoms of DD compared with 12.1% in the control group (p<0.01). BDI score was higher among T2DM when compared with controls (12±9.6 vs. 7.4±5, p<0.0001). The proportion of females (68% vs. 37%, p<0.0001), subjects without an active job (68% vs. 45%, p=0.01) and singles (38% vs. 18%, p=0.007) was greater among T2DM with a BDI≥16. Subjects with criteria for DD had a higher BMI (31.99±5.96 vs. 30.53±5.62, p=0.03). Fasting plasma glucose was higher among T2DM with a BDI≥16 (162±70 vs. 147±45 mg/dl, p=0.02) as well as HbA1c levels (7.9±1.8% vs. 7.4±1.4%, p=0.01), triglycerides (203±183 vs. 161±103 mg/dl; p=0.03) and LDL-cholesterol (112±31 vs. 104±35 mg/dl; p=0.03). Gender, marital status, BMI and triglycerides were independently related to the presence of DD after a logistic regression model. Conclusions: Relevant depressive symptoms are more prevalent among Mediterranean T2DM subjects than in general population. Main clinical correlators of significant depressive symptoms are gender, marital status and BMI.

Interphotoreceptor retinoid-binding protein (IRBP) is downregulated at early stages of diabetic retinopathy.

AIMS/HYPOTHESIS: Interphotoreceptor retinoid-binding protein (IRBP) plays a major role in the visual cycle and is essential to the maintenance of photoreceptors. The aim of this study was to determine whether a decrease in IRBP production exists in the early stages of diabetic retinopathy. METHODS: Vitreous samples from diabetic patients with proliferative and non-proliferative diabetic retinopathy (PDR, NPDR), and from non-diabetic patients with macular hole (control group) were selected for IRBP quantitative assessment by proteomic analysis (fluorescence-based difference gel electrophoresis) and western blot. Human post mortem eyes (n = 16) from diabetic donors without clinically detectable retinopathy and from non-diabetic donors (n = 16) were used to determine IRBP (also known as RBP3) mRNA levels (RT-PCR) and protein content (western blot and confocal microscopy). Retinal neurodegeneration was assessed by measuring glial fibrillar acidic protein (GFAP) and the apoptotic rate. Y79 human retinoblastoma cells were used to test the effects of glucose, TNF-alpha and IL-1beta on IRBP expression and IRBP levels. RESULTS: Intravitreous IRBP concentration was significantly lower in PDR < NPDR < control in proteomic and western blot analysis. IRBP mRNA levels and IRBP protein content were significantly lower in the retinas from diabetic donors than in those from non-diabetic donors. Increased GFAP and a higher degree of apoptosis were observed in diabetic retinas compared with non-diabetic retinas. A dose-dependent downregulation of IRBP mRNA expression and IRBP content was detected with glucose, TNF-alpha and IL-1beta in cultures of Y79 human retinoblastoma cells. CONCLUSIONS/INTERPRETATION: Underproduction of IRBP is an early event in the human diabetic retina and is associated with retinal neurodegeneration. The mechanisms leading to this deficit deserve further investigation.

Influence of storage temperature on the kinetics of the changes in anthocyanins, vitamin C, and antioxidant capacity in fresh-cut strawberries stored under high-oxygen atmospheres.

Changes in the main antioxidant properties of fresh-cut strawberries stored under high-oxygen atmospheres (80 kPa O(2)) were studied at selected temperatures (5 to 20 degrees C). The suitability of zero- and 1st-order kinetics as well as a model based on Weibull distribution function to describe changes in experimental data is discussed. A non-Arrhenius approach was used to determine the temperature dependence of the estimated rate constants. A Weibull kinetic model most accurately (R(2) (adj)>or= 0.800) estimated changes in anthocyanins and antioxidant capacity of fresh-cut strawberries throughout the storage period, whereas a 1st-order model adequately fitted (R(2) (adj)>or= 0.982) the variation of vitamin C. The temperature dependency of the kinetic rate constants for each antioxidant property was successfully modeled through the non-Arrhenius approach (R(2) (adj)>or= 0.709). The T(c) obtained for anthocyanins, vitamin C, and antioxidant capacity degradation were 290, 284, and 289 K, respectively, indicating the temperature at which a marked acceleration of the losses in the antioxidant potential of strawberry wedges occurs. These findings will help to describe the variation of the antioxidant potential of fresh-cut strawberries upon storage time and temperature.

Effect of natural antibrowning agents on color and related enzymes in fresh-cut Fuji apples as an alternative to the use of ascorbic acid.

Polyphenoloxidase (PPO) and peroxidase (POD) were evaluated in fresh-cut Fuji apple slices and the effeet of the individual or combined use of ascorbic acid, 4-hexylresorcinol, N-acetylcysteine, and glutathione on their respective activities was determined. Additionally, color changes during storage at 4 degrees C were measured throughout 14 d of storage. PPO activity increased with storage time and was inhibited by the individual use of N-acetylcysteine and glutathione. POD activity in the apple slices was effectively inhibited by the combined use of ascorbic acid with any of the other antibrowning agents. On the other hand, an individual treatment with 1% N-acetylcysteine helped in maintaining the color of fresh-cut apples during 14 d of storage, whereas the use of ascorbic acid was not enough to prevent color deterioration of the apple slices from the 1st day of storage. The results obtained corroborated the effectiveness of other natural antibrowning agents over the traditional use of ascorbic acid in the control of the enzymatic browning in the fresh-cut fruit industry.

Respiratory rate and quality changes in fresh-cut pears as affected by superatmospheric oxygen.

Changes in the respiration rate of fresh-cut "Flor de Invierno" pears stored under superatmospheric oxygen concentrations were studied and compared to those observed under traditional modified atmosphere packaging conditions. Changes in package headspace O(2) and CO(2) concentrations throughout storage were curve-fitted to nonlinear equations, calculating respiration rates by combining the derivatives of the equations and the gas permeations throughout storage. Moreover, relationships between respiratory activity and quality parameters of fresh-cut Flor de Invierno pears dipped into an antioxidant solution (0.75% N-acetylcysteine and 0.75% glutathione) were assessed. CO(2) production of fresh-cut Flor de Invierno pears stored under 70 kPa O(2) atmospheres was successfully estimated with the proposed mathematical procedure. This method also proved to describe well CO(2) production rates of fresh-cut pears stored under initial 2.5 kPa O(2)+ 7 kPa CO(2) or 21 kPa O(2). In addition, a modification of Michaelis-Menten enzyme kinetics was adequate to describe the changes in estimated CO(2) production due to fermentative processes occurring under low oxygen concentrations. Superatmospheric O(2) concentrations seem to promote oxidative processes, which result into a dramatical modification of some quality attributes of fresh-cut pears.

Modeling high-intensity pulsed electric field inactivation of a lipase from Pseudomonas fluorescens.

The inactivation kinetics of a lipase from Pseudomonas fluorescens (EC 3.1.1.3.) were studied in a simulated skim milk ultrafiltrate treated with high-intensity pulsed electric fields. Samples were subjected to electric field intensities ranging from 16.4 to 27.4 kV/cm for up to 314.5 micros, thus achieving a maximum inactivation of 62.1%. The suitability of describing experimental data using mechanistic first-order kinetics and an empirical model based on the Weibull distribution function is discussed. In addition, different mathematical expressions relating the residual activity values to field strength and treatment time are supplied. A first-order fractional conversion model predicted residual activity with good accuracy (A(f) = 1.018). A mechanistic insight of the model kinetics was that experimental values were the consequence of different structural organizations of the enzyme, with uneven resistance to the pulsed electric field treatments. The Weibull model was also useful in predicting the energy density necessary to achieve lipase inactivation.

Browning evaluation of ready-to-eat apples as affected by modified atmosphere packaging.

The color and polyphenol oxidase (PPO) activity of fresh-cut Golden delicious apples were evaluated throughout cold storage under modified atmospheres. The shelf life of cut apples was extended to several weeks, especially when an initial atmosphere of 90.5% N(2) + 7% CO(2) + 2.5% O(2) and plastic pouches of 30 cm(3)/cm(2) x bar x 24 h were used. Under these conditions, a maximum 62% PPO activity depletion was observed. In all cases, the faster the initial PPO activity decays, the less the color changes. A fractional conversion first-order model was proposed for predicting color changes in minimally processed apples. Browning was better described through lightness (L) (k(L) = 0.017 - 0.07 day(-1)) and color difference (Delta E*) values (k(Delta E) = 0.015 - 0.073 day(-1)), which fitted the model with enough accuracy.

[Clinical results of double versus single mammary artery myocardiac revascularization: 15 years of follow-up]. / Resultados clínicos de la revascularización miocárdica con doble arteria mamaria frente a única: 15 años de seguimiento.

INTRODUCTION: Use of the left internal mammary artery to bypass the left anterior descending coronary artery reduces cardiac events and increases survival. However, there is some controversy as to the benefits of using both mammary arteries. OBJECTIVES: To assess the long-term outcome of the use of both mammary arteries in comparison with the use of only one. PATIENTS AND METHOD: A retrospective cohort study with a mean follow-up of 9.0 +/- 4.2 years was performed including 108 patients consecutively revascularized using both mammary arteries (II) and 108 patients randomly chosen in whom one mammary artery (I) was used for this purpose. RESULTS: Both groups were similar. There were no differences between the groups in operative morbidity or mortality. The survival at 10 years was similar (II: 84.61 +/- 4%; I: 85.18 +/- 3.8%), whereas recurrence of angina (II: 29.63 +/- 5.3%; I: 47.55 +/- 5.6%) (p = 0.012), the requirement for percutaneous angioplasty (II: 3.98 +/- 2%; I: 12.99 +/- 4.1%) (p = 0.009) and cardiologic events (II: 33.48 +/- 5.5%; I: 48.48 +/- 5.5%)(p = 0.022) were all lower in the group in which both mammary arteries were used. In the multivariate analysis, the use of both mammary arteries was an independent protective factor against angina recurrence (RR = 0.55), angioplasty (RR = 0.18) and cardiologic event (RR = 0.60). CONCLUSIONS: The use of both mammary arteries for revascularization does not increase operative morbidity. Since this procedure acts as an independent factor against angina recurrence, angioplasty and cardiologic event

Internal thoracic artery atherosclerosis after coarctation repair in an adult.

We report a rare case of a patient with an unsuitable grossly atherosclerotic and extensively calcified right internal thoracic artery found during a coronary bypass grafting operation. He had undergone an aortic coarctation repair 35 years before, with long-term systemic hypertension previous to the operation and sustained after it. It is advisable to be alert to the possibility of atherosclerotic degeneration of the internal thoracic artery in these patients.

[Reoperations of myocardial revascularization]. / Reoperaciones de revascularización miocárdica.

UNLABELLED: Coronary by-pass grafting is a well established procedure for ameliorating ischemic coronary disease. From time to time it is necessary to re-operate these patients. The objective of our paper is to present our experience in this field. Retrospective analysis of 128 patients operated on between February 1978 and November 1996, has been analyzed. The mean age was 57.4 +/- 0.7 years. 77.2 +/- 5 months elapsed between operations. Stable angina (20.4%) or unstable angina (76.3%), myocardial infarction (48%) and congestive heart failure (17%) were the predominant clinical manifestations. RESULTS: Hospital mortality was 10.9% (14 patients) and in the follow-up there were 16 deaths (14%). Perioperative myocardial infarction was the main cause of in-hospital mortality. In the follow-up there were 4 deaths due to myocardial infarction and another 4 patients died from neoplasms. Perioperative myocardial infarction was present in 9.3% (12 patients) IN CONCLUSION: a) Re-do coronary by-pass grafting is still a good procedure for solving myocardial ischemia in spite of a higher mortality and morbidity than in the original operation. b) There is no progression in the number of patients according to our experience, probably due to better techniques and the frequent actions by an intervention cardiologist. c) The long-term results are good enough, but with a higher mortality.

[Orthotopic heart transplantation in a patient with previously undiagnosed persistence of the left superior vena cava]. / Trasplante cardíaco ortotópico en un paciente con persistencia de vena cava superior izquierda no diagnosticada previamente.

The amount of transplants has gone through a remarkable increase during the last years. As a result, congenital anomalies of little prevalence appear more and more often while performing the transplants. The persistence of upper cava vein is one of them and, if not linked to other anomalies, it usually remains unnoticed. This article presents a case of an orthotopic cardiac transplant in a patient with an upper cava vein duplication not diagnosed before undergoing surgery, and it compares the way it was handled to diverse techniques previously described.

[The implantable endocavitary cardioverter-defibrillator: the initial and short-term results]. / Cardioversor-desfibrilador implantable endocavitario: resultados iniciales y a corto plazo.

Utilization of endocavitary defibrillation electrodes avoids thoracotomy used in implantable cardioverter-defibrillator procedures, reducing associated morbi-mortality. In our institution we have used this approach in 16 patients during a two years period (July 1990-July 1992). Fifteen were males, with a mean age of 56.9 +/- 10.6 (range 32-73). Nine patients suffered ischemic cardiomyopathy, 4 non ischemic cardiomyopathy and in three there was no structural heart disease. Mean ejection fraction was 44.3 +/- 18.3% (range 20-73%). Clinical arrhythmia was ventricular tachycardia in 8 cases, ventricular fibrillation in 6 cases and both types in 2. Endocavitary implantation procedure was not completed in 3 patients, thus an open trans-sternal approach was performed. In 13 patients it was completed successfully, using a total amount of 14 units (1 patient required two procedures due to sepsis in the generator pouch). Most important intraoperative incidences have been defibrillation thresholds between 20-24 J in 4 cases, displacement of defibrillation electrode from vena cava into coronary sinus in 4 cases, epicardial patch implantation via subcostal approach in 1 case and right ventricle perforation in 1 case. No operative mortality was registered. One patient suffered sudden death during follow-up. Surgical complications were few: 1 case of lead dislodgement and 1 infected wound in the generator's pouch. Non-surgical complications were also few: 1 case with superior vena cava syndrome and 1 patient with inadequate discharges. In conclusion, due to our early experience, we believe that endocavitary implantation of an implantable cardioverter-defibrillator is the procedure of choice at the present time.

[The midterm (6 years) clinical results of the Carpenter-Edwards supra-annular bioprosthesis]. / Resultados clínicos a medio plazo (6 años) de la bioprótesis de Carpentier-Edwards supraanular.

We present here the clinical results with a second-generation porcine bioprosthesis, the Carpentier-Edwards supra-annular valve (CESA). Two-hundred and twenty-two CESA bioprostheses were implanted in 189 patients during a four-year period (from 1984 to 1987), either as an isolated procedure or associated to mitral or tricuspid repair. The mid-term clinical results have been evaluated after a mean follow-up of 3.4 years, being 96% complete. There were 16 in-hospital deaths (8.4%) and 6 late, potentially valve-related, cardiac deaths (1.1% patients/year). Overall, 86.7 +/- 2% of the patients were free from cardiac death at 6 years (95.1 +/- 2% of the patients surviving the operative period). Linearized rates of valve related complications were the following: 1.4% patients/year for thromboembolism (including valve thrombosis), 0.5% patients/year for treatment-related hemorrhage and 0.7% patients/year for endocarditis. We did not found any case of either intrinsic or extrinsic valve failure, unrelated to infection of thrombosis. Two patients were reoperated, one because of valve thrombosis and the other due to prosthetic valve endocarditis (reoperation rate of 0.3% patients/year). When lethal and nonlethal valve-related complications (including in-hospital deaths) were considered all together, 75.8 +/- 8.4% of the patients remained alive and free of morbid events at 6 years. When patients were grouped according to the valve replaced (aortic, mitral and multiple), best results were found with patients submitted to isolated aortic valve replacement. We conclude that the CESA bioprosthesis has an excellent mid-term clinical performance. However, longer follow-up is necessary to know if improvement in valve design and manufacturing results in increased valve durability.