Effects of aerobic conditioning on cardiovascular sympathetic response to and recovery from challenge.

Exercise has widely documented cardioprotective effects, but the mechanisms behind these effects are still poorly understood. Here, we test the hypothesis that aerobic training lowers cardiovascular sympathetic responses to and speeds recovery from challenge. We conducted a randomized, controlled trial contrasting aerobic versus strength training on indices of cardiac (pre-ejection period, PEP) and vascular (low-frequency blood pressure variability, LF-BPV) sympathetic responses to and recovery from psychological and orthostatic challenge in 149 young, healthy, sedentary adults. Aerobic and strength training did not alter PEP or LF-BPV reactivity to or recovery from challenge. These findings, from a large randomized, controlled trial using an intent-to-treat design, show that moderate aerobic exercise training has no effect on PEP and LF-BPV reactivity to or recovery from psychological or orthostatic challenge. In healthy young adults, the cardioprotective effects of exercise training are unlikely to be mediated by changes in sympathetic activity.

Comparación de dos ecuaciones para estimar el filtrado glomerular / Comparison between two equations to estimated glomerular filtration rate

Antecedentes. Existen diversas fórmulas para calcular el filtrado glomerular estimado (FGe), dos de las más difundidas son la MDRD (Modification of Diet in Renal Disease) y la CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration). A diferencia de la fórmula MDRD, la ecuación CKD-EPI incluyó sujetos con filtrado glomerular normal. Hemos estudiado la comparabilidad de ambas ecuaciones. Pacientes y métodos. Se calculó el FGe por la ecuación MDRD y CKD-EPI en 20.000 sujetos a partir de los datos obtenidos del sexo, edad y creatinina sérica. Resultados. La edad media de los pacientes fue de 73,5±8,3 años. El FGe según las ecuaciones MDRD y CKD-EPI fue de 70,1±29,0 y 68,1±23,8mL/min/1,73 m2 (p<0,001; coeficiente de correlación: 0,926) respectivamente. En los varones el FGe según las fórmulas MDRD y CKD-EPI fue de 71,3±30,2 y 68,1±24,2mL/min/1,73 m2 (p<0,001); y en las mujeres de 69,0±27,7 y 68,0±23,3mL/min/1,73 m2 (p<0,001) respectivamente. En los sujetos con ≥70 años el FGe medio calculado por MDRD fue 3,1mL/min/1,73 m2 superior al obtenido por CKD-EPI (p<0,001). Sin embargo, en los pacientes <70 años, ambas ecuaciones ofrecieron resultados similares. Las prevalencias de los estadios 1-2, 3, 4 y 5 de enfermedad renal crónica (ERC) fueron muy similares (MDRD: 67, 25, 6 y 3%, y CKD-EPI: 68, 24, 6 y 3%). Tomando como referencia el FGe calculado según MDRD, los resultados de la ecuación CKD-EPI obligaron a reclasificar a 528 pacientes (2,6% del total; estadio 1-2: 0,8%; estadio 3: 7,5%; estadio 4; 4,6% y estadio 5; 0%). Conclusiones. La ecuación CKD-EPI en la población estudiada ofrece valores ligeramente inferiores a los obtenidos con la fórmula MDRD, si bien el número de sujetos clasificados en los diferentes estadios de ERC fue muy similar(AU)

Background. There are several formulae to calculate estimated glomerular filtration rate (eGF). Two of those used most are MDRD study equation (Modification of Diet in Renal Disease) and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI). On the contrary to the MDRD formula, the CKD-EPI equation included subjects with normal glomerular filtration rate. Our objective has been to compare the results obtained by both equations. Patients and methods. FGE was calculated using the MDRD and CKD-EPI equation in 20000 subjects based on the data for gender, age and serum creatinine. Results. Mean age of patients was 73.5±8.3 years. The eGF by the MDRD and CKD-EPI equations was 70.1±29.0 and 68.1±23.8mL/min/1.73m2 (P<0.001, correlation coefficient: 0.926). For men, it was 71.3±30.2 and 68.1±24.2mL/min/1.73m2 (P<0.001) and for women it was 69.0±27.7 and 68.0±23.3mL/min/1.73m2 (P<0.001), respectively. In subjects ≥70 years, the eGF by MDRD was 3.1mL/min/1.73m2, superior that by CKD-EPI (P<0.001). However, in patients <70 years, both equations had similar results. The prevalences of stages 1-2, 3, 4 and 5 for chronic renal disease were very similar (MDRD: 67, 25, 6 and 3%, and CKD-EPI: 68, 24, 6 and 3%). If the reference variable used the eGF by MDRD, the eGF by CKD-EPI reclassified 528 patients (2.6% of the total) into four stages of CKD (stage 1-2: 0.8%; stage 3: 7.5%; stage 4: 4.6% and stage 5: 0%). Conclusions. The CKD-EPI equation applied to our population shows slightly lower levels than the MDRD. By stages, the new equation reduces the number of subjects in stage 3(AU)

[Comparison between two equations to estimated glomerular filtration rate]. / Comparación de dos ecuaciones para estimar el filtrado glomerular.

BACKGROUND: There are several formulae to calculate estimated glomerular filtration rate (eGF). Two of those used most are MDRD study equation (Modification of Diet in Renal Disease) and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI). On the contrary to the MDRD formula, the CKD-EPI equation included subjects with normal glomerular filtration rate. Our objective has been to compare the results obtained by both equations. PATIENTS AND METHODS: FGE was calculated using the MDRD and CKD-EPI equation in 20000 subjects based on the data for gender, age and serum creatinine. RESULTS: Mean age of patients was 73.5 ± 8.3 years. The eGF by the MDRD and CKD-EPI equations was 70.1 ± 29.0 and 68.1 ± 23.8 mL/min/1.73 m(2) (P<0.001, correlation coefficient: 0.926). For men, it was 71.3 ± 30.2 and 68.1 ± 24.2 mL/min/1.73 m(2) (P<0.001) and for women it was 69.0 ± 27.7 and 68.0 ± 23.3 mL/min/1.73 m(2) (P<0.001), respectively. In subjects ≥ 70 years, the eGF by MDRD was 3.1 mL/min/1.73 m(2), superior that by CKD-EPI (P<0.001). However, in patients <70 years, both equations had similar results. The prevalences of stages 1-2, 3, 4 and 5 for chronic renal disease were very similar (MDRD: 67, 25, 6 and 3%, and CKD-EPI: 68, 24, 6 and 3%). If the reference variable used the eGF by MDRD, the eGF by CKD-EPI reclassified 528 patients (2.6% of the total) into four stages of CKD (stage 1-2: 0.8%; stage 3: 7.5%; stage 4: 4.6% and stage 5: 0%). CONCLUSIONS: The CKD-EPI equation applied to our population shows slightly lower levels than the MDRD. By stages, the new equation reduces the number of subjects in stage 3.

Analyzing growth trajectories.

Growth trajectories play a central role in life course epidemiology, often providing fundamental indicators of prenatal or childhood development, as well as an array of potential determinants of adult health outcomes. Statistical methods for the analysis of growth trajectories have been widely studied, but many challenging problems remain. Repeated measurements of length, weight and head circumference, for example, may be available on most subjects in a study, but usually only sparse temporal sampling of such variables is feasible. It can thus be challenging to gain a detailed understanding of growth patterns, and smoothing techniques are inevitably needed. Moreover, the problem is exacerbated by the presence of large fluctuations in growth velocity during early infancy, and high variability between subjects. Existing approaches, however, can be inflexible because of a reliance on parametric models, require computationally intensive methods that are unsuitable for exploratory analyses, or are only capable of examining each variable separately. This article proposes some new nonparametric approaches to analyzing sparse data on growth trajectories, with flexibility and ease of implementation being key features. The methods are illustrated using data on participants in the Collaborative Perinatal Project.

[Condylomatous lesions of the uterine cervix: LLETZ conization]. / Lesiones condilomatosas de cérvix uterino: conización LLETZ.

Eight cases are reported about women with the diagnosis of HPV related lesions; a "dot-blot" hybridization technique with radioactive probes was done with each of them, also a conization with a diathermic loop (LLETZ) and a post operative follow-up with methods such as Pap smear, colposcopy and hybridization. We think the way we manage HPV related lesions has the advantage of an accurate diagnosis, with the exact envolved HPV type, and it discards the possibility of an infiltrating carcinoma, after studying the conization sample. Hybridization techniques are complementary to Pap smear in order to know the infective viral type and to exclude a possible occult infection in the post-operative period. LLETZ conization ended up as a quick and easy technique with no postoperative problems and with a proved efficiency, since neither recurrences were found (with citology) nor viral DNA was detected, the technique is not too complicated and takes about 30 minutes.

Maternal serum alpha-fetoprotein screening for neural tube defects. Report of a program with more than 30000 screened pregnancies.

Maternal serum alphafetoprotein (MSAFP) screening has been set up in Asturias, in the north of Spain, in 1987 in order to make possible the prenatal diagnosis of neural tube defects (NTD) to overall pregnancy population. This large study shows the high sensitivity and specificity of MSAFP screening when it is done with absolute control of all variables such as gestational age, pregnant woman's weight, diabetes, etc. On the other hand, this study also shows a poor sensitivity second level ultrasound for the early diagnosis of NTD in the presence of spina bifidas with no bulge. We have also observed that the incidence of NTD in Asturias remained constant in the last six years, around 1.5-1.6 per 1000 pregnancies. However, due to MSAFP screening, there has been a decline in the prevalence of children born with these defects. We conclude that MSAFP screening is the best tool to identify and reduce NTD in our Region (Spain).

Blood group and blood-group-related antigens in normal pancreas and pancreas cancer: enhanced expression of precursor type 1, Tn and sialyl-Tn in pancreas cancer.

Expression of blood-group antigens A, B, Le(a), sialyl-Le(a) (sLe(a)), Le(b), Le(x), Le(y), precursor type I, Tn and sialyl-Tn (sTn) was examined in non-neoplastic pancreas (n = 37) and pancreas cancer (n = 21) using mouse monoclonal antibodies (MAbs). Immunohistochemical assays were performed on sections of paraffin-embedded tissues using the avidin-biotin complex method. In normal pancreas, antibodies detecting Le(a), sLe(a) and Tn reacted with ductal epithelium, and antibodies detecting A and B reacted with acini and ducts, independently of secretor status. Le(x) was weakly expressed in ducts and acini, and sTn could not be detected in normal pancreas. Expression of Le(b), Le(y) and precursor type I was regulated by secretor status: Le(b) and Le(y) were expressed in ducts of secretor and Le(a-b-) individuals, but not in ducts of non-secretors; precursor type I was weakly expressed in acini and ducts of non-secretors and Le(a-b-) individuals, and was absent in acini and ducts of secretors. The following alterations in the expression of blood-group antigens were observed in pancreas cancer: (1) enhanced expression of Le(x), Tn and sTn; (2) enhanced expression of precursor type I independently of secretor status; (3) loss of regulation of Le(b) by the secretor gene; (4) decreased expression of Le(y). The weak expression of precursor type I. Tn and sTn in non-neoplastic pancreas, and their stronger expression in pancreas cancer, suggests that up-regulation of their expression is associated with malignant transformation of pancreatic duct cells.

Parosteal osteogenic sarcoma of bone with coexistent low- and high-grade sarcomatous components.

We report a case of parosteal osteogenic sarcoma with unusual histologic features; the intramedullary component is high-grade fibrosarcomatous osteogenic sarcoma, while the peripheral juxtacortical component is low-grade osteoblastic osteogenic sarcoma.

Endometriosis of the prostate.

Endometriosis occurred within the prostate of a 78-year-old man after a long course of estrogen therapy. The presence of endometrial tissue in the region of the urethral crest has potential histogenic and therapeutic implications for some of the neoplasms that arise in this area.