Traditional rural dietary pattern and all-cause mortality in a prospective cohort study of elderly Costa Ricans: the Costa Rican Longevity and Healthy Aging Study (CRELES).

BACKGROUND: Costa Rica is experiencing a fast demographic aging. Healthy diets may help to ameliorate the burden of aging-related conditions. OBJECTIVE: This study aimed to investigate the association of a traditional dietary pattern and 2 of its major components (beans and rice) with all-cause mortality among elderly Costa Ricans. METHODS: The Costa Rican Longevity and Healthy Aging Study (CRELES), a prospective cohort study of 2827 elderly Costa Ricans (60+ y at baseline), started in 2004. We used a food frequency questionnaire (FFQ) to assess usual diet. We calculated dietary patterns using principal component analysis. Multivariate energy-adjusted proportional-hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS: Over a 15-y follow-up, encompassing 24,304 person-years, 1667 deaths occurred. The traditional Costa Rican dietary pattern was more frequent in rural parts of the country, and it was inversely associated with all-cause mortality. Subjects in the fifth quintile of intake had 18% lower all-cause mortality than those in the first quintile (HR: 0.82; 95% CI: 0.69, 0.98; P-trend = 0.01), particularly among males (HR: 0.73; 95% CI: 0.56, 0.95). Bean intake was associated with lower all-cause mortality among all subjects (HR: 0.79; 95% CI: 0.68, 0.91, highest compared with lowest tertile) and in sex-stratified analysis. Rice consumption was inversely associated with all-cause mortality solely among males (HR: 0.75; 95% CI: 0.60, 0.94, highest compared with lowest tertile). CONCLUSIONS: Our results suggest that a traditional Costa Rican rural dietary pattern is associated with lower all-cause mortality in elderly Costa Ricans. Beans, a major component of this traditional dietary pattern, was also associated with lower all-cause mortality. These findings could have important implications for public health, given the nutritional transition and the reduction of intake of traditional diets in Latin American countries.

2023-24 dengue outbreak in Valle del Cauca, Colombia caused by multiple virus serotypes and lineages.

Global dengue cases rapidly rose to record levels in 2023-24. We investigated this trend in Valle del Cauca, Colombia to determine if specific dengue virus serotypes or lineages were responsible for the large outbreak. We detected all four serotypes and multiple lineages, suggesting that other factors, such as climatic conditions, are likely responsible.

Pediatric kidney dimensions and risk of persistent albuminuria in Mexican adolescents.

In Mexico, chronic kidney disease of unknown origin is highly prevalent. Screening studies in adolescents have shown persistent microalbuminuria (pACR), adaptive podocytopathy and decreased kidney volume (KV). Here, we sought to develop normality tables of kidney dimensions by ultrasound in the Mexican state of Aguascalientes pediatric population (0 to 18y) and evaluate the relationship between the KV and pACR among the region's adolescents in a cross-sectional study. Kidney length (KL) and KV were determined by ultrasound. Our findings were compared with those in international literature of different populations where tables and graphs of normal kidney dimensions by ultrasound were reported. We compared organ dimensions in individuals above the age of 11 without albuminuria with those in patients with pACR recruited through screening studies in adolescents in Aguascalientes. This included 1068 individuals to construct percentile tables and graphs of the KL. Kidney dimensions were significantly lower when compared with all international comparisons. From a total 14,805 screen individuals, we compared 218 adolescents with pACR and 377 individuals without significant albuminuria. The Total KV adjusted to body surface (TKVBS) was significantly associated with pACR (odds ratio 1.03, 95% confidence interval 1.02-1.03). The upper quartile of TKVBS was highly associated with pACR (7.57, 4.13-13.87), hypertension (2.53, 1.66-3.86), and hyperfiltration (26 vs 11.5%). Thus, TKVBS is directly associated with pACR while greater KV, arterial hypertension, and hyperfiltration in patients with pACR suggest that the increase in volume is secondary to kidney hypertrophy. Additionally, the adaptative podocytopathy with low fibrosis seen on kidney biopsy which was performed in a subset of patients, and the smaller kidney dimensions in our population point to prenatal oligonephronia as the primary cause of the detected kidney disease.

Frailty as a predictor of mortality: a comparative cohort study of older adults in Costa Rica and the United States.

BACKGROUND: Frailty is a common condition among older adults that results from aging-related declines in multiple systems. Frailty increases older adults' vulnerability to negative health outcomes, including loss of mobility, falls, hospitalizations, and mortality. The aim of this study is to examine the association between frailty and mortality in older adults from Costa Rica and the United States. METHODS: This prospective cohort study uses secondary nationally-representative data of community-dwelling older adults from the Costa Rican Longevity and Healthy Aging Study (CRELES, n = 1,790) and the National Health & Aging Trends Study (NHATS, n = 6,680). Frailty status was assessed using Physical Frailty Phenotype, which includes the following five criteria: shrinking, exhaustion, low physical activity, muscle weakness, and slow gait. We used Cox proportional hazard models to examine the association between frailty and all-cause mortality, including sociodemographic characteristics and health behaviors as covariates in the models. Mortality follow-up time was right censored at 8 years from the date at baseline interview. RESULTS: The death hazard for frail compared to non-frail older adults was three-fold in Costa Rica (HR = 3.14, 95% CI: 2.13-4.62) and four-fold in the White US (HR = 4.02, 95% CI: 3.04-5.32). Older age, being male, and smoking increased mortality risk in both countries. High education was a protective factor in the US, whereas being married/in union was a protective factor in Costa Rica. In the US, White older adults had a lower risk of death compared to all other races and ethnicities. CONCLUSIONS: Results indicate that frailty can have a differential impact on mortality depending on the country. Access to universal health care across the life course in Costa Rica and higher levels of stress and social isolation in the US may explain differences observed in end-of-life trajectories among frail older adults.

Neoadjuvant Trastuzumab and Pertuzumab in Combination with Standard Chemotherapy for HER2-Positive Early Breast Cancer: Real-World Practice in Cuba.

PURPOSE: Dual HER2 blockade chemotherapy is the standard of care for localized HER2+ breast cancer (BC). However, despite the efficacy of neoadjuvant therapy, relapses occurring in around 10% of patients highlight the need to improve its clinical approach. Therefore, this study aimed to evaluate the effectiveness/safety of neoadjuvant therapy with subcutaneous (SC) trastuzumab- pertuzumab chemotherapy (real world) to extend the evidence, which comes mainly from clinical trials (selected population; intravenous [IV] trastuzumab). MATERIALS AND METHODS: A prospective, longitudinal, observational study in a Cuban hospital. POPULATION: women aged ≥18 years with histologically confirmed HER2+ early-stage BC (2017-2021) eligible for neoadjuvant treatment (IV pertuzumab, SC trastuzumab, taxane-based chemotherapy). The aim was to determine the pathological complete response (pCR) rate to this scheme, its safety, and the impact of patient's characteristics on the outcomes. RESULTS: Eighty-seven women were included: n=29 (DPT [docetaxel-IV pertuzumab- SC trastuzumab 600 mg; 4 cycles]); n=58 (ddAC-DPT [dose-dense anthracycline-based scheme+DPT]; 8 cycles). The median age was 57 years (range 30-83), ECOG 0: 97%. Time from diagnosis to treatment (median) was 28 days. The overall pCR rate was 62.1% (55.2%, DPT; 66.5%, ddAC-DPT; p =0.351); HR+, 47.7% vs. HR-, 76.7% (p=0.006). There were no statistically significant differences based on nodal status, stage, or Ki-67 levels. Overall, 94.2% of patients experienced ≥1 adverse event related to treatment, all of them grade 1-3 and more common with ddAC-DPT. The main cause of treatment delays (n=19; ddAC-DPT, 16; DPT, 3) was treatment-related toxicities. CONCLUSION: Neoadjuvant trastuzumab (SC) and pertuzumab plus chemotherapy for HER2+ early-stage BC showed benefits in a real-life setting, with an acceptable safety profile.

Computed tomography and histological evaluation of xenogenic and biomimetic bone grafts in three-wall alveolar defects in minipigs.

OBJECTIVES: This study aimed to compare the performance of a xenograft (XG) and a biomimetic synthetic graft (SG) in three-wall alveolar defects in minipigs by means of 3D computerised tomography and histology. MATERIALS AND METHODS: Eight minipigs were used. A total of eight defects were created in the jaw of each animal, three of which were grafted with XGs, three with SGs, and two were left empty as a negative control. The allocation of the different grafts was randomised. Four animals were euthanised at 6 weeks and four at 12 weeks. The grafted volume was then measured by spiral computed tomography to assess volume preservation. Additionally, a histological analysis was performed in undecalcified samples by backscattered scanning electron microscopy and optical microscopy after Masson's trichrome staining. RESULTS: A linear mixed-effects model was applied considering four fixed factors (bone graft type, regeneration time, anatomic position, and maxilla/mandible) and one random factor (animal). The SG exhibited significantly larger grafted volume (19%) than the XG. The anterior sites preserved better the grafted volume than the posterior ones. Finally, regeneration time had a positive effect on the grafted volume. Histological observations revealed excellent osseointegration and osteoconductive properties for both biomaterials. Some concavities found in the spheroidal morphologies of SGs were associated with osteoclastic resorption. CONCLUSIONS: Both biomaterials met the requirements for bone grafting, i.e. biocompatibility, osseointegration, and osteoconduction. Granule morphology was identified as an important factor to ensure a good volume preservation. CLINICAL RELEVANCE: Whereas both biomaterials showed excellent osteoconduction, SGs resulted in better volume preservation.

Incidence of pulmonary embolism in patients with non-invasive respiratory support during COVID-19 outbreak.

While the incidence of thrombotic complications in critically ill patients is very high, in patients under non-invasive respiratory support (NIS) is still unknown. The specific incidence of thrombotic events in each of the clinical scenarios within the broad spectrum of severity of COVID-19, is not clearly established, and this has not allowed the implementation of thromboprophylaxis or anticoagulation for routine care in COVID-19. Patients admitted in a semi-critical unit treated initially with NIS, especially Continuous-Positive Airway Pressure (CPAP), were included in the study. The cumulative incidence of pulmonary embolism was analyzed and compared between patients with good response to NIS and patients with clinical deterioration that required orotracheal intubation. 93 patients were included and 16% required mechanical ventilation (MV) after the NIS. The crude cumulative incidence of the PE was 14% (95%, CI 8-22) for all group. In patients that required orotracheal intubation and MV, the cumulative incidence was significantly higher [33% (95%, CI 16-58)] compared to patients that continued with non-invasive support [11% (CI 5-18)] (Log-Rank, p = 0.013). Patients that required mechanical ventilation were at higher risk of PE for a HR of 4.3 (95%CI 1.2-16). In conclusion, cumulative incidence of PE is remarkably higher in critically patients with a potential impact in COVID-19 evolution. In this context, patients under NIS are a very high-risk group for developing PE without a clear strategy regarding thromboprophylaxis.

Reconstrucción mamaria inmediata en el Instituto Nacional de Oncología y Radiobiología de Cuba / Immediate Breast Reconstruction at the National Institute of Oncology and Radiobiology of Cuba

RESUMEN Introducción: La reconstrucción mamaria inmediata disminuye el impacto psicológico del cáncer de mama y mejora la calidad de vida de las pacientes. Objetivo: Evaluar la simetría en la reconstrucción mamaria inmediata en el Instituto Nacional de Oncología y Radiobiología de Cuba. Método: Se realizó un estudio analítico y prospectivo, de cohorte incidente, en el Servicio de Cirugía Reconstructiva del Instituto Nacional de Oncología y Radiobiología de 2014 al 2017. Se incluyeron 41 pacientes que consintieron participar en el estudio. Se recogieron variables demográficas y onco-reconstructivas. Se utilizó un software creado en la institución para evaluar la simetría mamaria. Los datos se recogieron de la historia clínica. Se aplicaron el test de Chi-cuadrado corregido y la razón de momios para el análisis estadístico. Resultados: El 30,2 por ciento de mujeres reconstruidas pertenecieron al grupo de 30 a 39 años; el 46,3 por ciento tenían sobrepeso. La mejor simetría se encontró con las técnicas oncoplásticas (31,7 por ciento), seguida de la mastectomía ahorradora de piel. La técnica de expansión tisular con la mastectomía presentó mayores complicaciones (63,6 por ciento) y menor simetría. La necrosis parcial de piel fue la mayor complicación en 7,3 por ciento y estuvo relacionadas con las técnicas ahorradoras de piel. Conclusiones: Evaluar de forma objetiva la simetría mamaria permitió conocer la efectividad de las técnicas quirúrgicas reconstructivas. Con las técnicas de cirugía oncoplástica y mastectomía ahorradora de piel se obtuvieron los mejores resultados estéticos y pocas complicaciones. La expansión mamaria inmediata con una mastectomía radical modificada no ofrece ninguna ventaja(AU)

ABSTRACT Introduction: Immediate breast reconstruction reduces the psychological impact of breast cancer and improves the quality of life of patients. Objective: To assess symmetry in immediate breast reconstruction at the of Cuba. Method: An analytical and prospective study of incident cohort was carried out in the reconstructive surgery service at the National Institute of Oncology and Radiobiology (INOR), from 2014 to 2017. Forty-one patients who consented to participate in the study were included. Demographic and oncoreconstructive variables were collected. A software created in the institution was used to assess breast symmetry. The data were collected from the medical histories. The corrected chi-square test and odds ratio were applied for statistical analysis. Results: 30.2 percent of women who received reconstruction belonged to the age group 30-39 years; 46.3 percent were overweight. The best symmetry was found with oncoplastic techniques (31.7 percent), followed by skin-sparing mastectomy. The tissue expansion technique with mastectomy presented greater complications (63.6 percent) and less symmetry. Partial skin necrosis was the major complication, accounting for 7.3 percent of the cases, and was related to skin-sparing techniques. Conclusions: Objectively evaluating breast symmetry allowed us to know the effectiveness of reconstructive surgical techniques. With oncoplastic surgery and skin-sparing mastectomy techniques, the best aesthetic outcomes and few complications were obtained. Immediate breast expansion with a modified radical mastectomy offers no benefit(AU)

[Evolution of hand hygiene adherence of health professionals of specialized care.] / Evolución de la adherencia a la higiene de manos en un hospital de la Comunidad de Madrid.

OBJECTIVE: Hand hygiene (HH) is essential for the prevention of health care-associated infections (HAIs). Compliance rates documented in Spain and internationally are low, although improvement is possible using some strategies and training. The aim of this study was to know the evolution of the adherence to the 5 moments for hand hygiene of the health professionals of the Hospital Universitario Fundación Alcorcón and to propose measures to implement it. METHODS: A direct observation study about the compliance of the 5 moments for HH in this hospital for seven years was carried out. Different professional groups received training, using the traditional method and simulation learning. The data was summarized using percentages and absolute frequencies. They were analyzed using SPSS version 21 for Windows. RESULTS: Adherence increased from 37% in 2011 to 57.8% in 2019. Compliance in the 5 moments was higher after patient contact than before it. Nurses were one of the groups with the highest compliance. CONCLUSIONS: Even though they have improved, compliance rates need to be maintained and to increase especially in moments as crucial as before an aseptic procedure. Training and the implementation of strategies are key.

OBJETIVO: La higiene de manos (HM) es fundamental para la prevención de las infecciones relacionadas con la atención sanitaria (IRAS). Los índices de cumplimiento documentados, tanto en España como internacionalmente, son bajos, aunque una mejoría es posible utilizando algunas estrategias y formación. El objetivo de este estudio fue conocer la evolución de la adherencia a los 5 momentos de higiene de manos de los profesionales sanitarios del Hospital Universitario Fundación Alcorcón, y plantear medidas para implementarla. METODOS: Se realizó un estudio de observación directa sobre el cumplimiento de los 5 momentos de HM en este hospital durante siete años. Diferentes colectivos profesionales recibieron formación, utilizando el método tradicional y aprendizaje mediante simulación. Se realizó un análisis descriptivo, con frecuencias absolutas y relativas. Se analizaron mediante SPSS versión 21 para Windows. RESULTADOS: La adherencia aumentó de un 37% en 2011 a un 57,8% en 2019. El cumplimiento en los 5 momentos fue más alto después del contacto con el paciente que antes de este. El personal de enfermería fue uno de grupos con mayor cumplimiento. CONCLUSIONES: Aunque han mejorado, se necesita mantener los niveles de cumplimiento, y aumentarlos sobre todo en momentos tan cruciales como antes de realizar una técnica aséptica. La formación y la implementación de estrategias son clave.

ACV y covid-19: una revisión de los estudios observacionales publicados en época de pandemia / Stroke and COVID-19: A review of observational studies published during the pandemic

RESUMEN INTRODUCCIÓN: En marzo 2020 la Organización Mundial de la Salud decretó la pandemia por covid-19. Se han informado casos de ACV relacionados con esta infección viral. OBJETIVOS: Conocer la experiencia de diferentes partes del mundo respecto al ACV y covid-19 con el fin de mejorar el reconocimiento y saber qué hacer cuando se empiecen a presentar estos pacientes en nuestro medio. MÉTODOS: Se hizo una revisión de los estudios observacionales disponibles utilizando PubMed, Scopus, así como otras fuentes de literatura gris para las publicaciones sobre ACV y covid-19. Se identificaron datos demográficos, tiempo de aparición del ACV desde el diagnóstico de covid-19. Principales hallazgos radiológicos, laboratorios y pronóstico. RESULTADOS: Se obtuvieron ocho estudios, con 43 sujetos que tuvieron ACV isquémico e infección por SARS-CoV-2. La edad promedio fue de 67,4 años, siendo en su mayoría hombres (58,1%).Un hallazgo importante fue el número de casos de ACV con oclusión de vaso grande en 22 de 31 casos reportados (71%). La mediana de NIHSS fue de 14,5 puntos. Se presentó una mortalidad del 27,5% de los sujetos con ACV El estadio más frecuente por covid-19 fue el de condición severa 58,3%. La aparición del ACV luego de la infección por SARS-CoV-2 fue de 10,6 días en promedio. En los laboratorios se identificó una elevación del fibrinógeno (92%), dímero-D (76%) y LDH (82%) respectivamente. El tratamiento recibido de forma más frecuente para el ACV fue la antiagregación, en 51%, mientras que las terapias de reperfusión se hicieron en el 30% de los casos. La mayoría de los pacientes (93%) presentaron síntomas de covid-19, solo 3 pacientes (7%) no presentaron síntomas típicos de esta enfermedad, sin embargo tuvieron alteración del estado de conciencia asociado al ACV CONCLUSIÓN: Los estados de inflamación e hipercoagulabilidad que se presentan durante la infección por SARS-CoV-2 probablemente están en relación con el desarrollo de ACV, lo cual en este caso podrá explicar el gran número de oclusiones de vaso grande. Los marcadores de inflamación generalmente están presentes. Establecer códigos protegidos de ACV es una medida a efectuar en nuestro medio.

SUMMARY INTRODUCTION: In March 2020, COVID-19 was declared a pandemic by the World Health Organization and cases of stroke related to the virus soon were reported. OBJECTIVES: To become aware of the experiences different parts of the world have encountered with stroke and COVID 19 in order to enhance our knowledge, improve recognition and response to patients in our clinical setting. METHODS: A review of the available observational studies was done using PubMed, Scopus and other sources of gray literature for the publications on stroke and COVID-19. Demographic data, time of stroke onset since the diagnosis of COVID-19, main radiological findings, lab tests and prognosis were identified. RESULTS: Eight studies were selected with 43 subjects who had ischemic stroke and SARS-CoV-2 infection. The average age was 67.4 years, being mostly men (58%). An important finding was the number of stroke cases with large vessel occlusion, with 22 of 31 cases reported (71%). The NIHSS median was 14.5 points, and 27.5% of subjects with stroke and COVID-19 died. The most frequent disease severity for COVID-19 was "severe", accounting for 58% of the cases. The onset of stroke after SARS-CoV-2 infection was 10.6 days on average. In the laboratories an elevation of fibrinogen (92%), D-Dimer (76%) and LDH (82%) were respectively identified. The most frequent treatment received for stroke were antiplatelet medications (51%), while reperfusion therapy was done in 30% of cases. Most patients presented to the hospital with typical symptoms of COVID-19 (93%), (7%) 3 patients did not have respiratory symptoms, however they presented with a decreased level of consciousness associated with stroke findings. CONCLUSION: Inflammation and hypercoagulability, both present during the infection by SARS-CoV-2, are probably related to the development of a stroke, which in this case could explain the large number of large vessel occlusions. Protected stroke code is a protocol that should be implemented in our region.

Evolución de la adherencia a la higiene de manos en un hospital de la Comunidad de Madrid / Evolution of hand hygiene adherence of health professionals of specialized care

OBJETIVO: La higiene de manos (HM) es fundamental para la prevención de las infecciones relacionadas con la atención sanitaria (IRAS). Los índices de cumplimiento documentados, tanto en España como internacionalmente, son bajos, aunque una mejoría es posible utilizando algunas estrategias y formación. El objetivo de este estudio fue conocer la evolución de la adherencia a los 5 momentos de higiene de manos de los profesionales sanitarios del Hospital Universitario Fundación Alcorcón, y plantear medidas para implementarla. MÉTODOS: Se realizó un estudio de observación directa sobre el cumplimiento de los 5 momentos de HM en este hospital durante siete años. Diferentes colectivos profesionales recibieron formación, utilizando el método tradicional y aprendizaje mediante simulación. Se realizó un análisis descriptivo, con frecuencias absolutas y relativas. Se analizaron mediante SPSS versión 21 para Windows. RESULTADOS: La adherencia aumentó de un 37% en 2011 a un 57,8% en 2019. El cumplimiento en los 5 momentos fue más alto después del contacto con el paciente que antes de este. El personal de enfermería fue uno de grupos con mayor cumplimiento. CONCLUSIONES: Aunque han mejorado, se necesita mantener los niveles de cumplimiento, y aumentarlos sobre todo en momentos tan cruciales como antes de realizar una técnica aséptica. La formación y la implementación de estrategias son clave

OBJECTIVE: Hand hygiene (HH) is essential for the prevention of health care-associated infections (HAIs). Compliance rates documented in Spain and internationally are low, although improvement is possible using some strategies and training. The aim of this study was to know the evolution of the adherence to the 5 moments for hand hygiene of the health professionals of the Hospital Universitario Fundación Alcorcón and to propose measures to implement it. METHODS: A direct observation study about the compliance of the 5 moments for HH in this hospital for seven years was carried out. Different professional groups received training, using the traditional method and simulation learning. The data was summarized using percentages and absolute frequencies. They were analyzed using SPSS version 21 for Windows. RESULTS: Adherence increased from 37% in 2011 to 57.8% in 2019. Compliance in the 5 moments was higher after patient contact than before it. Nurses were one of the groups with the highest compliance. CONCLUSIONS: Even though they have improved, compliance rates need to be maintained and to increase especially in moments as crucial as before an aseptic procedure. Training and the implementation of strategies are key

Feasibility of a physical activity intervention for obese, socioculturally diverse endometrial cancer survivors.

PURPOSE: Determine the feasibility of a 12-week physical activity intervention for obese, socioculturally diverse endometrial cancer survivors and to evaluate whether the intervention improves physical activity behavior, physical function, waist circumference, and quality of life. METHODS: Obese endometrial cancer survivors from Bronx, NY were assigned to either a 12-week physical activity intervention of behavioral counseling, physical activity and home-based walking (n=25), or wait-list control group (n=15). Mixed-design ANOVA (2 groups×2 time points) were analyzed to determine differences between the intervention and the control for the Yale Physical Activity Survey, six-minute walk test, 30-second chair stand test, waist circumference, and Functional Assessment of Cancer Therapy-Endometrial questionnaire. Data are presented as mean±standard deviation. RESULTS: The sample was diverse (38% non-Hispanic black, 38% Hispanic, 19% non-Hispanic white). Mean Body Mass Index was 37.3±6.5kg·m(-2). Although recruitment rate was low (20% of 140 contacted), 15 of 25 participants in the intervention group attended 75-100% of scheduled sessions. Participants reported walking 118±79min/week at home. There were large effect sizes for the improvements in the six-minute walk test (22±17m vs. 1±22m, d=1.10), waist circumference (-5.3±5.3cm vs. 2.6±6.7cm, d=-1.32), quality of life (10±12 vs. -1±11, d=0.86) and walking self-efficacy (24±30% vs. 1±55%, d=0.87) compared to the control group. CONCLUSIONS: The intervention appeared feasible in this population. The results show promising effects on several outcomes that should be confirmed in a larger randomized control trial, with more robust recruitment strategies.

Do Low Molecular Weight Agents Cause More Severe Asthma than High Molecular Weight Agents?

INTRODUCTION: The aim of this study was to analyse whether patients with occupational asthma (OA) caused by low molecular weight (LMW) agents differed from patients with OA caused by high molecular weight (HMW) with regard to risk factors, asthma presentation and severity, and response to various diagnostic tests. METHODS: Seventy-eight patients with OA diagnosed by positive specific inhalation challenge (SIC) were included. Anthropometric characteristics, atopic status, occupation, latency periods, asthma severity according to the Global Initiative for Asthma (GINA) control classification, lung function tests and SIC results were analysed. RESULTS: OA was induced by an HMW agent in 23 patients (29%) and by an LMW agent in 55 (71%). A logistic regression analysis confirmed that patients with OA caused by LMW agents had a significantly higher risk of severity according to the GINA classification after adjusting for potential confounders (OR = 3.579, 95% CI 1.136-11.280; p = 0.029). During the SIC, most patients with OA caused by HMW agents presented an early reaction (82%), while in patients with OA caused by LMW agents the response was mainly late (73%) (p = 0.0001). Similarly, patients with OA caused by LMW agents experienced a greater degree of bronchial hyperresponsiveness, measured as the difference in the methacholine dose-response ratio (DRR) before and after SIC (1.77, range 0-16), compared with patients with OA caused by HMW agents (0.87, range 0-72), (p = 0.024). CONCLUSIONS: OA caused by LMW agents may be more severe than that caused by HMW agents. The severity of the condition may be determined by the different mechanisms of action of these agents.

Coffee Consumption Increases the Antioxidant Capacity of Plasma and Has No Effect on the Lipid Profile or Vascular Function in Healthy Adults in a Randomized Controlled Trial.

BACKGROUND: Coffee, a source of antioxidants, has controversial effects on cardiovascular health. OBJECTIVE: We evaluated the bioavailability of chlorogenic acids (CGAs) in 2 coffees and the effects of their consumption on the plasma antioxidant capacity (AC), the serum lipid profile, and the vascular function in healthy adults. METHODS: Thirty-eight men and 37 women with a mean ± SD age of 38.5 ± 9 y and body mass index of 24.1 ± 2.6 kg/m(2) were randomly assigned to 3 groups: a control group that did not consume coffee or a placebo and 2 groups that consumed 400 mL coffee/d for 8 wk containing a medium (MCCGA; 420 mg) or high (HCCGA; 780 mg) CGA content. Both were low in diterpenes (0.83 mg/d) and caffeine (193 mg/d). Plasma caffeic and ferulic acid concentrations were measured by GC, and the plasma AC was evaluated with use of the ferric-reducing antioxidant power method. The serum lipid profile, nitric oxide (NO) plasma metabolites, vascular endothelial function (flow-mediated dilation; FMD), and blood pressure (BP) were evaluated. RESULTS: After coffee consumption (1 h and 8 wk), caffeic and ferulic acid concentrations increased in the coffee-drinking groups, although the values of the 2 groups were significantly different (P < 0.001); caffeic and ferulic acid concentrations were undetectable in the control group. At 1 h after consumption, the plasma AC in the control group was significantly lower than the baseline value (-2%) and significantly increased in the MCCGA (6%) and HCCGA (5%) groups (P < 0.05). After 8 wk, no significant differences in the lipid, FMD, BP, or NO plasma metabolite values were observed between the groups. CONCLUSIONS: Both coffees, which contained CGAs and were low in diterpenes and caffeine, provided bioavailable CGAs and had a positive acute effect on the plasma AC in healthy adults and no effect on blood lipids or vascular function. The group that did not drink coffee showed no improvement in serum lipid profile, FMD, BP, or NO plasma metabolites. This trial was registered at registroclinico.sld.cu as RPCEC00000168.

Diagnostic yield of specific inhalation challenge in hypersensitivity pneumonitis.

Reliable methods are needed to diagnose hypersensitivity pneumonitis. The aim of the study was to establish the diagnostic yield of specific inhalation challenge (SIC) in patients with hypersensitivity pneumonitis. All patients with suspected hypersensitivity pneumonitis in whom SIC was performed (n=113) were included. SIC was considered positive when patients showed a decrease of >15% in forced vital capacity (FVC) or >20% in diffusing capacity of the lung for carbon dioxide, or a decrease of 10% to 15% in FVC accompanied by a temperature increase of 0.5°C within 24 h of inhalation of the antigen. SIC was positive to the agents tested in 68 patients: 64 received a diagnosis of hypersensitivity pneumonitis and SIC results were considered false-positive in the remaining four patients. In the SIC-negative group (n=45), 24 patients received a diagnosis of hypersensitivity pneumonitis and SIC results were considered false-negative, and 21 patients were diagnosed with other respiratory diseases. The sensitivity and specificity of the test were 72.7% and 84%, respectively. Having hypersensitivity pneumonitis caused by an antigen other than birds or fungi predicted a false-negative result (p=0.001). In hypersensitivity pneumonitis, positive SIC testing virtually confirms the diagnosis, whereas negative testing does not rule it out, especially when the antigenic sources are not birds or fungi.

Neumonitis por hipersensibilidad a isocianatos. Características clínico-radiológicas y de función pulmonar / Hypersensitivity Pneumonitis Due to Isocyanates: Lung Function, Clinical and Radiological Characteristics

El objetivo del presente trabajo fue describir las características clínico-radiológicas y de función pulmonar de la neumonitis por hipersensibilidad por exposición a isocianatos (NHI). Se estudiaron todos los pacientes con diagnóstico de NHI (n=5) durante los años 1995-2010. En todos ellos se realizó TC torácica y estudio de función pulmonar completo. El diagnóstico se realizó mediante prueba de provocación bronquial específica (PPBE) positiva. Se observó un predominio de varones y una variabilidad de patrones en las alteraciones radiológicas. La PPBE fue positiva por descenso de la FVC o de la DLCO en todos los casos excepto en un paciente, en que se estableció por criterios clínicos. Tan solo en un paciente se constató una IgG positiva a isocianatos. La presentación radiológica de la NHI puede ser distinta de las NH más frecuentes en nuestro medio y cursan con menor afectación clínica en la PPBE(AU)

The objective of this present study was to describe the clinical-radiological and lung function characteristics of hypersensitivity pneumonitis due to exposure to isocyanates (HPI). Included for study were all those patients diagnosed with HPI (n=5) from 1995 to 2010. In all cases, chest CT and complete lung function studies were done. The diagnosis was made with positive specific bronchial provocation tests (BPT). A predominance of males and pattern variability in the radiological alterations were observed. The BPT was positive due to a decline in FVC or DLCO in all cases except in one patient in whom the diagnosis was established with clinical criteria. Positive IgG to isocyanates was confirmed in only one patient. The radiological presentation of HPI may be different from the more common HP in our setting and run their course with less clinical affectation on the BPT(AU)

Amplifying genetic logic gates.

Organisms must process information encoded via developmental and environmental signals to survive and reproduce. Researchers have also engineered synthetic genetic logic to realize simpler, independent control of biological processes. We developed a three-terminal device architecture, termed the transcriptor, that uses bacteriophage serine integrases to control the flow of RNA polymerase along DNA. Integrase-mediated inversion or deletion of DNA encoding transcription terminators or a promoter modulates transcription rates. We realized permanent amplifying AND, NAND, OR, XOR, NOR, and XNOR gates actuated across common control signal ranges and sequential logic supporting autonomous cell-cell communication of DNA encoding distinct logic-gate states. The single-layer digital logic architecture developed here enables engineering of amplifying logic gates to control transcription rates within and across diverse organisms.

Hypersensitivity pneumonitis due to isocyanates: lung function, clinical and radiological characteristics.

The objective of this present study was to describe the clinical-radiological and lung function characteristics of hypersensitivity pneumonitis due to exposure to isocyanates (HPI). Included for study were all those patients diagnosed with HPI (n = 5) from 1995-2010. In all cases, chest CT and complete lung function studies were done. The diagnosis was made with positive specific bronchial provocation tests (BPT). A predominance of males and pattern variability in the radiological alterations were observed. The BPT was positive due to a decline in FVC or DL(CO) in all cases except in one patient in whom the diagnosis was established with clinical criteria. Positive IgG to isocyanates was confirmed in only one patient. The radiological presentation of HPI may be different from the more common HP in our setting and run their course with less clinical affectation on the BPT.

Engineered cell-cell communication via DNA messaging.

BACKGROUND: Evolution has selected for organisms that benefit from genetically encoded cell-cell communication. Engineers have begun to repurpose elements of natural communication systems to realize programmed pattern formation and coordinate other population-level behaviors. However, existing engineered systems rely on system-specific small molecules to send molecular messages among cells. Thus, the information transmission capacity of current engineered biological communication systems is physically limited by specific biomolecules that are capable of sending only a single message, typically "regulate transcription." RESULTS: We have engineered a cell-cell communication platform using bacteriophage M13 gene products to autonomously package and deliver heterologous DNA messages of varying lengths and encoded functions. We demonstrate the decoupling of messages from a common communication channel via the autonomous transmission of various arbitrary genetic messages. Further, we increase the range of engineered DNA messaging across semisolid media by linking message transmission or receipt to active cellular chemotaxis. CONCLUSIONS: We demonstrate decoupling of a communication channel from message transmission within engineered biological systems via the autonomous targeted transduction of user-specified heterologous DNA messages. We also demonstrate that bacteriophage M13 particle production and message transduction occurs among chemotactic bacteria. We use chemotaxis to improve the range of DNA messaging, increasing both transmission distance and communication bit rates relative to existing small molecule-based communication systems. We postulate that integration of different engineered cell-cell communication platforms will allow for more complex spatial programming of dynamic cellular consortia.