Comparative study of four Yucca species by 2D-NMR and LC-MS.

The present study was conducted to compare leaf extracts of Y. gloriosa, Y. treculeana, Y. filamentosa and Y. aloifolia. Plant extracts were obtained by sequential extraction with 50% and 100% methanol using the pressurized liquid extraction method. General comparative analysis of Yucca extracts was performed by 2 D-NMR. The presence of various biologically active components in the extracts was shown, among which steroid saponins predominate. The use of LC-MS and LC-HRMS methods with electrospray ionization made it possible to conduct a comparative analysis of Yucca steroidal saponins. The 33 steroidal saponins of various structures were found. The presence of three characteristic saponins in all Yucca species was shown: yuccaloeside C, yuccaloeside E and yuccaloeside B. The results obtained can be used to control the quality of plant materials and products.

The RNA content of human sperm reflects prior events in spermatogenesis and potential post-fertilization effects.

Transcriptome analyses using high-throughput methodologies allow a deeper understanding of biological functions in different cell types/tissues. The present study provides an RNA-seq profiling of human sperm mRNAs and lncRNAs (messenger and long non-coding RNAs) in a well-characterized population of fertile individuals. Sperm RNA was extracted from twelve ejaculate samples under strict quality controls. Poly(A)-transcripts were sequenced and aligned to the human genome. mRNAs and lncRNAs were classified according to their mean expression values (FPKM: Fragments Per Kilobase of transcript per Million mapped reads) and integrity. Gene Ontology analysis of the Expressed and Highly Expressed mRNAs showed an involvement in diverse reproduction processes, while the Ubiquitously Expressed and Highly Stable mRNAs were mainly involved in spermatogenesis. Transcription factor enrichment analyses revealed that the Highly Expressed and Ubiquitously Expressed sperm mRNAs were primarily regulated by zinc-fingers and spermatogenesis-related proteins. Regarding the Expressed lncRNAs, only one-third of their potential targets corresponded to Expressed mRNAs and were enriched in cell-cycle regulation processes. The remaining two-thirds were absent in sperm and were enriched in embryogenesis-related processes. A significant amount of post-testicular sperm mRNAs and lncRNAs was also detected. Even though our study is solely directed to the poly-A fraction of sperm transcripts, results indicate that both sperm mRNAs and lncRNAs constitute a footprint of previous spermatogenesis events and are configured to affect the first stages of embryo development.

Healthcare Utilisation of Moluccans in the Netherlands: Equal Care for Equal Need after 60 Years of Residence in the Host Country?

BACKGROUND: In many countries, recent migrants have difficulties using healthcare to the same extent as host populations. It is uncertain whether these differences persist for long-settled migrants. This study examined healthcare utilisation of Moluccans in 2012, more than 60 years after they migrated from Indonesia to the Netherlands. METHODS: A survey was held among 715 Moluccans and 3417 Dutch persons. Differences in healthcare utilisation were assessed using regression analyses adjusting for age, gender, indicators of health, religious affiliation, and education. RESULTS: Moluccans had lower rates of healthcare use, including visits to the general practitioner (odds ratio (OR) = 0.67), outpatient medical specialist (OR = 0.50), dentist (OR = 0.65), and physiotherapist (OR = 0.56), as well as the use of paid housekeeping services (OR = 0.37). Among those who visited a healthcare service, no difference was found between Moluccans and Dutch in the frequency of visits, except for physiotherapist visits (rate ratio (RR) = 0.51). For the risk of hospitalisation, no difference was found; however, of those admitted to the hospital, the frequency of admission was lower among Moluccans than Dutch (RR = 0.74). CONCLUSIONS: Despite their long residence in the host country, equal utilisation of healthcare services has not been achieved for Moluccans in the Netherlands. Demand-based factors (e.g., family networks, health beliefs, and use of traditional medicine) may contribute to the persistence of such differences and require further investigation.

Living environment matters: relationships between neighborhood characteristics and health of the residents in a Dutch municipality.

Characteristics of an individual alone cannot exhaustively explain all the causes of poor health, and neighborhood of residence have been suggested to be one of the factors that contribute to health. However, knowledge about aspects of the neighborhood that are most important to health is limited. The main objective of this study was to explore associations between certain features of neighborhood environment and self-rated health and depressive symptoms in Maastricht (The Netherlands). A large amount of routinely collected neighborhood data were aggregated by means of factor analysis to 18 characteristics of neighborhood social and physical environment. Associations between these characteristics and self-rated health and presence of depressive symptoms were further explored in multilevel logistic regression models adjusted for individual demographic and socio-economic factors. The study sample consisted of 9,879 residents (mean age 55 years, 48 % male). Residents of unsafe communities were less likely to report good health (OR 0.88 95 % CI 0.80-0.97) and depressive symptoms (OR 0.81 95 % CI 0.69-0.97), and less cohesive environment was related to worse self-rated health (OR 0.81 95 % CI 0.72-0.92). Residents of neighborhoods with more car traffic nuisance and more disturbance from railway noise reported worse mental health (OR 0.79 95 % CI 0.68-0.92 and 0.85 95 % CI 0.73-0.99, respectively). We did not observe any association between health and quality of parking and shopping facilities, facilities for public or private transport, neighborhood aesthetics, green space, industrial nuisance, sewerage, neighbor nuisance or satisfaction with police performance. Our findings can be used to support development of integrated health policies targeting broader determinants of health. Improving safety, social cohesion and decreasing traffic nuisance in disadvantaged neighborhoods might be a promising way to improve the health of residents and reduce health inequalities.

Glycolysis and oxidative phosphorylation in neurons and astrocytes during network activity in hippocampal slices.

Network activation triggers a significant energy metabolism increase in both neurons and astrocytes. Questions of the primary neuronal energy substrate (e.g., glucose vs. lactate) as well as the relative contributions of glycolysis and oxidative phosphorylation and their cellular origin (neurons vs. astrocytes) are still a matter of debates. Using simultaneous measurements of electrophysiological and metabolic parameters during synaptic stimulation in hippocampal slices from mature mice, we show that neurons and astrocytes use both glycolysis and oxidative phosphorylation to meet their energy demands. Supplementation or replacement of glucose in artificial cerebrospinal fluid (ACSF) with pyruvate or lactate strongly modifies parameters related to network activity-triggered energy metabolism. These effects are not induced by changes in ATP content, pH(i), [Ca(2+)](i) or accumulation of reactive oxygen species. Our results suggest that during network activation, a significant fraction of NAD(P)H response (its overshoot phase) corresponds to glycolysis and the changes in cytosolic NAD(P)H and mitochondrial FAD are coupled. Our data do not support the hypothesis of a preferential utilization of astrocyte-released lactate by neurons during network activation in slices--instead, we show that during such activity glucose is an effective energy substrate for both neurons and astrocytes.

Efectos terapéuticos de la hipoterapia en la parálisis cerebral: una revisión sistemática / Therapeutic effects of hippotherapy in cerebral palsy: a systematic review

Objetivo: Revisar la evidencia científica existente respecto al tratamiento de hipoterapia en niños con parálisis cerebral en función de diferentes variables. Métodos Se ha realizado una búsqueda bibliográfica en las bases de datos Pubmed/Medline, Web of Knowledge, Cochrane, PEDro, Enfispo, y en los metabuscadores Trip Data Base y Excelencia clínica. Los términos utilizados en la búsqueda fueron: equine-assisted therapy, cerebral palsy, hippotherapy y horseback riding, combinados generalmente con el operador boleano AND. Resultados Después de eliminar artículos duplicados de las diferentes bases de datos se obtuvieron 25 artículos. Siete de ellos eran revisiones sistemáticas o metaanálisis, 7 eran ensayos clínicos y 11 estudios eran series clínicas no controladas o estudios descriptivos. La calidad de la evidencia científica proporcionada por los estudios utilizados en esta revisión sistemática fue de nivel I para 7 de ellos, de nivel III (evidencia científica proporcionada buena a regular) para otros 7 artículos, y de nivel VIII (evidencia científica proporcionada pobre) para los restantes 11 artículos. Discusión Las principales limitaciones encontradas en los estudios revisados han sido el tamaño muestral reducido, el uso de herramientas de valoración no estandarizadas y/o la heterogeneidad de los protocolos de tratamiento utilizados. Conclusión Resulta difícil encontrar evidencia científica del tratamiento de hipoterapia en niños con parálisis cerebral como consecuencia de diferentes factores, como son los reducidos tamaños muestrales utilizados por los estudios, la diversidad de escalas de valoración y de protocolos de tratamiento utilizados (AU)

Objective: To review the current scientific evidence regarding hippotherapy treatment in children with cerebral palsy through the analysis of different study variables.Methods: A bibliographic research of Pubmed/Medline, Web of Knowledge, Cochrane, PEDro,Enfispo databases and Trip Data Base and Excelencia clínica metasearchers was carried out. The terms used in the search were: Equine-Assisted Therapy, Cerebral Palsy, Hippotherapy and Horseback riding, usually combined with the Boolean operator AND. Results: After eliminating duplicated articles in the different databases, 25 articles were found. Seven of them were systematic reviews or meta-analysis, 7 articles were clinical trials and11 studies were uncontrolled clinical series or descriptive studies. The quality of scientific evidence provided by the studies used in this systematic review was level I for seven of them, level III for seven articles (scientific evidence provided good to regular) and level VIII (scientificevidence provided poor) for the remaining eleven articles. Discussion: The main limitations found in the studies reviewed have been small sample sizes, use of non-standardized assessment tools and/or heterogeneity of the treatment protocolsused. Conclusion: It is difficult to find scientific evidence regarding hippotherapy treatment in children with cerebral palsy due to different factors such as the small sample sizes used in the studies, the diversity of assessment scales and treatment protocols used (AU)

The ECG in cardiac resynchronization therapy: influence of left and right ventricular preactivation and relation to acute response.

INTRODUCTION: The aims of this study were to compare ECG signs of biventricular electrical resynchronization during cardiac resynchronization therapy (CRT) with various interventricular (VV) delays and to correlate these and other ECG characteristics with the acute hemodynamic benefit of CRT. METHODS AND RESULTS: Thirty-four patients with heart failure and a left bundle branch block (LBBB) pattern were prospectively enrolled. A 12-lead surface ECG and the relative improvement in left ventricular (LV) dP/dt(max) (the maximum rate of pressure rise) were recorded at baseline and during CRT with VV delays varying from 80 ms LV preactivation to 40 ms right ventricular (RV) preactivation. Rightward QRS-axis shift occurred in 71-80% among all VV delays. Activation reversal to dominant negative in leads I/aVL was progressively observed at increasing LV preactivation (53-65%) and less (18-22%) during RV preactivation. Activation reversal to dominant positive in leads V1/V2 was observed in 21-27% during LV preactivation and in 6-15% during RV preactivation. Higher acute response to CRT was independently predicted by a complete LBBB at baseline (regression coefficient B = 7.7 [0.3-15.0], P = 0.042), later timing of LV depolarization within the QRS at baseline (Q-LVsense: B = 0.2 [0.1-0.3], P = 0.002), and biventricular electrical resynchronization during CRT as evidenced by activation reversal in leads I/aVL (B = 9.9 [3.2-16.6], P = 0.005). CONCLUSION: ECG signs of biventricular electrical resynchronization are present over a wide range of LV preactivated VV delays but to a lesser extent during RV preactivation. The presence of complete LBBB and longer Q-LVsense at baseline and signs of biventricular electrical resynchronization during CRT predict higher acute hemodynamic response.

Noninvasive laser therapy for outpatients with chronic inflammatory disorders of cervix.

UNLABELLED: Chronic inflammation of the cervix can develop cervical stenosis with infertility and cervical congestion is related with the cervical cancer. We create a review of main etiological agents and methods of screening and diagnosis. We also make a brief review of modern therapeutic approach. CONCLUSIONS: We follow the utility of LLLT through the following aspects: evolution, indications, results of Babes-Papanicolau screening, cytology, clinical aspects. The results of the study will allow the complex system of treatment to be used in a large category of women. We appreciate that the procedure (used in our center also) will decrease the cervical pathology, the morbidity inside the treatment, the mortality through the evolution of cervical cancer. We propose the applicability for outpatients first and then as an integrated treatment method inside hospitals for a wide access.

Socio-economic inequalities in breast and cervical cancer screening practices in Europe: influence of the type of screening program.

BACKGROUND: The aim of this study was to describe inequalities in the use of breast and cervical cancer screening services according to educational level in European countries in 2002, and to determine the influence of the type of screening program on the extent of inequality. METHODS: A cross-sectional study was performed using individual-level data from the WHO World Health Survey (2002) and data regarding the implementation of cancer screening programmes. The study population consisted of women from 22 European countries, aged 25-69 years for cervical cancer screening (n =11 770) and 50-69 years for breast cancer screening (n = 4784). Dependent variables were having had a PAP smear and having had a mammography during the previous 3 years. The main independent variables were socio-economic position (SEP) and the type of screening program in the country. For each country the prevalence of screening was calculated, overall and for each level of education, and indices of relative (RII) and absolute (SII) inequality were computed by educational level. Multilevel logistic regression models were fitted. RESULTS: SEP inequalities in screening were found in countries with opportunistic screening [comparing highest with lowest educational level: RII = 1.28, 95% confidence interval (CI) 1.12-1.48 for cervical cancer; and RII = 3.11, 95% CI 1.78-5.42 for breast cancer] but not in countries with nationwide population-based programmes. Inequalities were also observed in countries with regional screening programs (RII = 1.35, 95% CI 1.10-1.65 for cervical cancer; and RII = 1.58, 95% CI 1.26-1.98 for breast cancer). CONCLUSIONS: Inequalities in the use of cancer screening according to SEP are higher in countries without population-based cancer screening programmes. These results highlight the potential benefits of population-based screening programmes.

810 nm Wavelength light: an effective therapy for transected or contused rat spinal cord.

BACKGROUND AND OBJECTIVES: Light therapy has biomodulatory effects on central and peripheral nervous tissue. Spinal cord injury (SCI) is a severe central nervous system trauma with no effective restorative therapies. The effectiveness of light therapy on SCI caused by different types of trauma was determined. STUDY DESIGN/MATERIALS AND METHODS: Two SCI models were used: a contusion model and a dorsal hemisection model. Light (810 nm) was applied transcutaneously at the lesion site immediately after injury and daily for 14 consecutive days. A laser diode with an output power of 150 mW was used for the treatment. The daily dosage at the surface of the skin overlying the lesion site was 1,589 J/cm(2) (0.3 cm(2) spot area, 2,997 seconds). Mini-ruby was used to label corticospinal tract axons, which were counted and measured from the lesion site distally. Functional recovery was assessed by footprint test for the hemisection model and open-field test for the contusion model. Rats were euthanized 3 weeks after injury. RESULTS: The average length of axonal re-growth in the rats in the light treatment (LT) groups with the hemisection (6.89+/-0.96 mm) and contusion (7.04+/-0.76 mm) injuries was significantly longer than the comparable untreated control groups (3.66+/-0.26 mm, hemisection; 2.89+/-0.84 mm, contusion). The total axon number in the LT groups was significantly higher compared to the untreated groups for both injury models (P<0.05). For the hemisection model, the LT group had a statistically significant lower angle of rotation (P<0.05) compared to the controls. For contusion model, there was a statistically significant functional recovery (P<0.05) in the LT group compared to untreated control. CONCLUSIONS: Light therapy applied non-invasively promotes axonal regeneration and functional recovery in acute SCI caused by different types of trauma. These results suggest that light is a promising therapy for human SCI.

Favorable long-term outcome of Maze surgery in patients with lone atrial fibrillation.

BACKGROUND: Rhythm control is indicated for patients suffering from symptomatic atrial fibrillation (AF), but remains difficult to establish. We investigated the long-term outcome of Cox maze III surgery in patients with symptomatic lone AF refractory to antiarrhythmic drug therapy. METHODS: Patients with a history of symptomatic paroxysmal or persistent AF refractory for at least two class I or III antiarrhythmic drugs and without structural heart disease or bradyarrhythmias were included. All patients underwent Cox maze III surgery. Complete success was defined as the absence of AF without antiarrhythmic drugs beyond 3 months after the procedure, and partial success as the absence of AF with antiarrhythmic drug use. RESULTS: A total of 29 patients were included (27 male), with a mean age of 48 +/- 6 years. At the time of surgery, 11 patients (38%) had persistent AF. After a mean follow-up of 4.8 +/- 2.4 years, 79% of patients had complete success, and 2 patients (7%) were free of AF with antiarrhythmic drugs. At the end of follow-up, left ventricular fractional shortening was significantly improved (from 31% +/- 10% to 39% +/- 8%, p = 0.002), left atrial size was unchanged, exercise capacity was within normal ranges, and quality of life was comparable with that of healthy controls. Severe complications included reoperations for postoperative bleeding (n = 3), pericardial effusion (n = 1), and mediastinitis (n = 1). In 2 patients, a pacemaker was implanted postoperatively because of sinus node dysfunction. CONCLUSIONS: Cox maze III surgery is a highly effective therapy for drug-refractory lone AF, and therefore remains an alternative to transvenous pulmonary vein ablation.

S-wave predominance of epicardial electrograms during atrial fibrillation in humans: indirect evidence for a role of the thin subepicardial layer.

OBJECTIVES: The purpose of this study was to characterize the morphology of fibrillation electrograms in patients in order to provide insight into the underlying electropathologic substrate of atrial fibrillation (AF). BACKGROUND: Electrograms recorded during AF show a high degree of spatiotemporal variation. METHODS: AF was induced by rapid atrial pacing in 25 patients undergoing cardiac surgery. A unipolar mapping array of 244 electrodes was positioned on the free wall of the right atrium to record multiple epicardial fibrillation electrograms. Local anisotropy in conduction and epicardial wavefront curvature during AF were determined by fitting the best quadratic surface on the activation times of rectangular areas of 3 x 3 electrodes. RESULTS: During AF, unipolar epicardial electrograms revealed a clear predominance of S waves. The average RS difference during type I and II AF was -0.15 +/- 0.08 and -0.22 +/- 0.08. During type III AF, the predominance of S waves was less prominent (-0.07 +/- 0.05; P < .005). In all types of AF, the degree of anisotropy in conduction was remarkably low (anisotropy ratio: 1.24 +/- 0.09), and no clear directional effect on the relative amplitude of R and S waves was found. There was a weak relationship between local curvature of wavefronts and RS difference (r = 0.23; P < .01). Computer simulations showed that the negative RS difference could result from transmural activation in an epicardial to endocardial direction. CONCLUSIONS: The clear predominance of S waves in epicardial fibrillation electrograms is not due to anisotropy and can only be partly explained by a high curvature of fibrillation waves. Predominant epicardial to endocardial activation seems to be important in producing rS electrograms on the epicardium. This finding provides indirect evidence that the thin epicardial layer of atrial myocardium plays an important role in propagation of fibrillation waves.

Papel del internista general en los trasplantes de órganos. Situación actual en España / Role of general internists in adult organ transplantation in Spain

Antecedentes: No existen datos acerca de la participación de los Internistas Generales en los trasplantes de órgano en España. Objetivo: Conocer la situación actual de la participación de los Internistas Generales y los Servicios de Medicina Interna General en los programas de trasplante en España. Materiales y métodos: Se envió una encuesta con tres preguntas concretas de elección múltiple a los responsables del área médica de los 67 grupos de trasplante de órgano (riñón, hígado, corazón y pulmón) de España. Contestaron a la encuesta un total de 43 equipos (64 %). Resultados: Sólo en 8 grupos de trasplante (18 %) existen Internistas Generales dentro del equipo habitual, un hecho además casi restringido al trasplante hepático. Un total de 18 equipos (42 %) nunca solicitan la colaboración de Medicina Interna. A la hora de las consultas a otros servicios, ningún equipo de trasplante prefiere dirigirlas a Medicina Interna respecto a otras Especialidades. El problema concreto de las Enfermedades Infecciosas es llevado por el propio equipo de trasplante o se consulta con Unidades específicas, pero nunca se consulta con Servicios de Medicina Interna General. Conclusiones: La participación de los Internistas Generales en los trasplantes de órganos de adultos en España es escasa, salvo en el caso del trasplante hepático. Las consultas a los Internistas Generales por parte de los equipos de trasplante son también escasas, salvo que los Internistas estén integrados en Unidades de Enfermedades Infecciosas (AU)