Effects of Aging and Cardiovascular Disease Risk Factors on the Expression of Sirtuins in the Human Corpus Cavernosum.

INTRODUCTION: Sirtuin (SIRT)1 was recently identified in human corpus cavernosum (CC). We hypothesized that other sirtuins could also be expressed in the CC. Expression of these enzymes in tissues is affected by aging, the main independent risk factor for erectile dysfunction besides other cardiovascular disease risk factors (CVDRF), such as diabetes or obesity. AIM: The aim of this study was to characterize the expression of SIRT1-3 and SIRT5-7 in human CC relatively to age and CVDRF. METHODS: Samples of CC collected from patients submitted to programmed surgeries or organ donors were divided in three groups according to age and presence of CVDRF. Expression of SIRT1-3 and SIRT5-7 mRNAs was assessed by real-time polymerase chain reaction. Cellular localization and semi-quantification of sirtuins proteins were performed by immunofluorescence and Western blotting (WB), respectively. Nuclear factor kappa B (NFkB)-p65, inducible (iNOS) and endothelial nitric oxide synthase (eNOS) levels were also assayed by WB. MAIN OUTCOME MEASURES: The main outcome measure was to characterize the expression of SIRT1-3 and SIRT5-7 in human CC. RESULTS: SIRT1-3 and SIRT5-7 mRNAs were detected in all individuals, without statistical differences among groups, excepting SIRT7 that decreased four times in aged groups relatively to young (P = 0.013). WB analysis demonstrated that aged individuals with CVDRF presented higher levels of SIRT7 protein relatively to young (P = 0.0495) and lower levels of SIRT3 protein relatively to healthy aged (P = 0.0077). Expression of NFkB-p65 and iNOS were higher in aged than in young individuals (P = 0.0185; P = 0.004, respectively). No differences in other sirtuins or total eNOS were seen among groups although phospho eNOS Ser(1177) levels decreased in groups of aged men relatively to young (P = 0.0043; P = 0.0099). CONCLUSIONS: Our results demonstrate for the first time expression of SIRT2-3 and SIRT5-7 in the human CC. Aged individuals with CVDRF presented an increase in SIRT7 protein levels and a decrease in mitochondrial SIRT3. This finding suggests that CVDRF induces the loss of antioxidant defense mechanisms leading to endothelial injury.

Seroprevalence of Protective Antibodies Against Influenza and the Reduction of the Influenza Incidence Rate: An Annual Repeated Cross-Sectional Study From 2014 to 2019.

BACKGROUND: Seroepidemiological studies provide estimates of population-level immunity, prevalence/incidence of infections, and evaluation of vaccination programs. We assessed the seroprevalence of protective antibodies against influenza and evaluated the correlation of seroprevalence with the cumulative annual influenza incidence rate. METHODS: We conducted an annual repeated cross-sectional seroepidemiological survey, during June-August, from 2014 to 2019, in Portugal. A total of 4326 sera from all age groups, sex, and regions was tested by hemagglutination inhibition assay. Seroprevalence and geometric mean titers (GMT) of protective antibodies against influenza were assessed by age group, sex, and vaccine status (65+ years old). The association between summer annual seroprevalence and the difference of influenza incidence rates between one season and the previous one was measured by Pearson correlation coefficient (r). RESULTS: Significant differences in seroprevalence of protective antibodies against influenza were observed in the population. Higher seroprevalence and GMT for A(H1N1)pdm09 and A(H3N2) were observed in children (5-14); influenza B seroprevalence in adults 65+ was 1.6-4.4 times than in children (0-4). Vaccinated participants (65+) showed significant higher seroprevalence/GMT for influenza. A strong negative and significant correlation was found between seroprevalence and ILI incidence rate for A(H1N1)pdm09 in children between 5 and 14 (r = -0.84; 95% CI, -0.98 to -0.07); a weak negative correlation was observed for A(H3N2) and B/Yamagata (r ≤ -0.1). CONCLUSIONS: The study provides new insight into the anti-influenza antibodies seroprevalence measured in summer on the ILI incidence rate in the next season and the need for adjusted preventive health care measures to prevent influenza infection and transmission.

Congenital Cervical Hemivertebrae and Block Vertebrae in a 43-Year-Old Male.

Congenital deformities of the spine are a consequence of anomalous vertebral development in the embryo and may be identified at birth or remain unnoticed until adulthood. Minor bony malformations of all types occur in up to 12% of the general population and are usually not apparent. In contrast, congenital spinal malformations that result in progressive spinal deformity are relatively rare. Klippel-Feil syndrome is a complex heterogeneous entity that results in cervical vertebral fusion and sometimes can occur associated to hemivertebra. We present a case of a 43-year-old male who presented to the emergency department after a fall. The patient had severe cervicalgia and generalized loss of active movement and sensation on his limbs. On physical examination, the patient presented reduced cervical range of motion and tetraplegia. Cervical magnetic resonance imaging revealed complete atlanto-occipital assimilation, left C3 hemivertebra with partial fusion in the right lateral portion of C2 and C4. Finally, there was a C5-C6 fusion. Surgical cervical stabilization was attempted but the procedure was aborted due to lack of space for placing the anterior plate safely. During hospitalization, the patient wore a cervical collar and started a rehabilitation program including muscle strengthening, balance, and gait training. The rehabilitation treatment led to a favorable clinical evolution. At discharge, the patient maintained a slight deficit of strength in his left upper and lower extremities, but he was functionally autonomous and was able to walk with a walker.

Outpatient and Home-Based Treatment: Effective Settings for Hip Fracture Rehabilitation in Elderly Patients.

Femoral neck fractures are a major source of disability in the elderly. Rehabilitation is fundamental to recover pre-fracture functionality. We conducted an observational cohort study with the aim of comparing the efficacy of rehabilitation programs in different therapeutic settings. We included elderly patients who had undergone surgical stabilization of a hip fracture. The participants were divided into 3 groups: group 1, outpatient rehabilitation; group 2, inpatient rehabilitation; group 3, home-based rehabilitation. Patients were evaluated at baseline, at three months, and at six months after fracture. Our outcome measures were the Barthel Index (BI), Functional Ambulation Categories, passive and active range of motion of hip flexion and abduction, and muscle strength in hip flexion, abduction, and knee extension. At six months, all three groups showed an average statistically significant improvement (p < 0.05) in all outcome measures compared to the baseline. Considering the between-group analysis, final BI was significantly higher in outpatient than inpatient-treated patients (p = 0.018), but no statistical difference was found between outpatient and home-based patients. Our findings suggest that rehabilitation leads to significant functional recovery after hip fracture in elderly patients. Both outpatient and home-based rehabilitation seem to be reasonable options for hip fracture rehabilitation.