The idiopathic normal-pressure hydrocephalus Radscale: a radiological scale for structured evaluation.

BACKGROUND AND PURPOSE: Despite the important role of imaging in diagnosing idiopathic normal-pressure hydrocephalus (iNPH), a structured overall assessment of radiological signs is still lacking. The purpose of this study was to construct a radiological scale, composed of morphological signs of iNPH, and compare it with clinical symptoms. METHODS: In this prospective, population-based study of iNPH, 168 individuals (93 females) [mean age 75 (range 66-92) years] underwent computed tomography of the brain and a neurological examination with assessment of clinical symptoms according to Hellström's iNPH scale. Two radiologists, blinded to clinical data, independently evaluated and measured eight radiological parameters, i.e. Evans' index, callosal angle, size of temporal horns, narrow high-convexity sulci, dilated Sylvian fissures, focally dilated sulci, peri-ventricular hypodensities and bulging of the lateral ventricular roof. RESULTS: In a linear regression model, all parameters except ventricular roof bulging were significantly associated with clinical iNPH symptoms. The seven remaining parameters were summarized into a total iNPH Radscale score ranging from 0 to 12. There was a significant correlation (r = 0.55, P < 0.001) between the total iNPH Radscale score and clinical symptoms. The inter-rater agreement for the included radiological parameters was high (intraclass correlation, 0.74-0.97). CONCLUSION: The iNPH Radscale may become a valuable diagnostic screening tool, allowing a structured radiological assessment. A high iNPH Radscale score together with clinical symptoms should raise suspicion of iNPH, motivating further evaluation for shunt surgery.

Distinct Dual C-Cl Isotope Fractionation Patterns during Anaerobic Biodegradation of 1,2-Dichloroethane: Potential To Characterize Microbial Degradation in the Field.

This study investigates, for the first time, dual C-Cl isotope fractionation during anaerobic biodegradation of 1,2-dichloroethane (1,2-DCA) via dihaloelimination by Dehalococcoides and Dehalogenimonas-containing enrichment cultures. Isotopic fractionation of 1,2-DCA (εbulkC and εbulkCl) for Dehalococcoides (-33.0 ± 0.4‰ and -5.1 ± 0.1‰) and Dehalogenimonas-containing microcosms (-23 ± 2‰ and -12.0 ± 0.8‰) resulted in distinctly different dual element C-Cl isotope correlations (Λ = Δδ13C/Δδ37Cl ≈ εbulkC/εbulkCl), 6.8 ± 0.2 and 1.89 ± 0.02, respectively. Determined isotope effects and detected products suggest that the difference on the obtained Λ values for biodihaloelimination could be associated with a different mode of concerted bond cleavage rather than two different reaction pathways (i.e., stepwise vs concerted). Λ values of 1,2-DCA were, for the first time, determined in two field sites under reducing conditions (2.1 ± 0.1 and 2.2 ± 2.9). They were similar to the one obtained for the Dehalogenimonas-containing microcosms (1.89 ± 0.02) and very different from those reported for aerobic degradation pathways in a previous laboratory study (7.6 ± 0.1 and 0.78 ± 0.03). Thus, this study illustrates the potential of a dual isotope analysis to differentiate between aerobic and anaerobic biodegradation pathways of 1,2-DCA in the field and suggests that this approach might also be used to characterize dihaloelimination of 1,2-DCA by different bacteria, which needs to be confirmed in future studies.

Stable Carbon Isotope Fractionation During 1,2-Dichloropropane-to-Propene Transformation by an Enrichment Culture Containing Dehalogenimonas Strains and a dcpA Gene.

A stable enrichment culture derived from Besòs river estuary sediments stoichiometrically dechlorinated 1,2-dichloropropane (1,2-DCP) to propene. Sequential transfers in defined anaerobic medium with the inhibitor bromoethanesulfonate produced a sediment-free culture dechlorinating 1,2-DCP in the absence of methanogenesis. Application of previously published genus-specific primers targeting 16S rRNA gene sequences revealed the presence of a Dehalogenimonas strain, and no amplification was obtained with Dehalococcoides-specific primers. The partial sequence of the 16S rRNA amplicon was 100% identical with Dehalogenimonas alkenigignens strain IP3-3. Also, dcpA, a gene described to encode a corrinoid-containing 1,2-DCP reductive dehalogenase was detected. Resistance of the dehalogenating activity to vancomycin, exclusive conversion of vicinally chlorinated alkanes, and tolerance to short-term oxygen exposure is consistent with the hypothesis that a Dehalogenimonas strain is responsible for 1,2-DCP conversion in the culture. Quantitative PCR showed a positive correlation between the number of Dehalogenimonas 16S rRNA genes copies in the culture and consumption of 1,2-DCP. Compound specific isotope analysis revealed that the Dehalogenimonas-catalyzed carbon isotopic fractionation (εC(bulk)) of the 1,2-DCP-to-propene reaction was -15.0 ± 0.7‰ under both methanogenic and nonmethanogenic conditions. This study demonstrates that carbon isotope fractionation is a valuable approach for monitoring in situ 1,2-DCP reductive dechlorination by Dehalogenimonas strains.

Investigating isotopic markers for hazelnut geographical authentication: Promising variables and potential applications.

Hazelnuts' features and price are influenced by their geographical origin, making them susceptible to fraud, especially counterfeit claims regarding their provenance. Stable isotope analysis is a recognised approach to establish the geographical origin of foods, yet its potential in hazelnut authentication remains unexplored. In this prospective study, we assessed multiple isotopic markers in hazelnuts from different origins and evaluated the most promising variables for geographical authentication by chemometric tools. Our findings indicate that bulk δ18O, along with δ2H and δ13C in the main fatty acid methyl esters, exhibit significant potential in discriminating geographical origins, and 87Sr/86Sr analysis could serve as a proficient confirmatory tool. Though no single marker alone can differentiate between all the studied origins, employing a multi-isotopic approach based on PLS-DA models achieved up to 92.5 % accuracy in leave-10 %-out cross-validation. These findings will probably lay the groundwork for developing robust models for hazelnut geographical authentication based on larger datasets.

Indoor and outdoor BTX levels in Barcelona City metropolitan area and Catalan rural areas.

Five aromatic hydrocarbons (benzene, toluene, and three isomeric xylenes) were monitored in indoor and outdoor air of 7 public buildings and 54 private homes, located in Barcelona City metropolitan area and in several rural areas of Catalonia. The sampling was carried out over four periods: spring-summer and winter of 2000, and summer and winter of 2001. Passive ORSA 5 Dräger samplers were used for benzene, toluene, and xylenes (BTX) adsorption. BTX were extracted with carbon disulphide and analysed using a gas chromatograph coupled to a FID detector. In Barcelona metropolitan area the outdoor average concentrations of BTX were 3.5, 34.2, and 31.3 microg/m3 in urban areas, and 1.4, 9.2, and 9.2 microg/m3 in rural areas, respectively. Average indoor air concentrations of BTX were respectively 4.3, 64.8, and 47.6 microg/m3 in urban areas and 5.8, 67.0, and 51.4 microg/m3 in rural areas, respectively. A direct connection between the house and garage was one of the most influential factors for indoor BTX concentrations in rural areas. In urban areas, diffuse traffic sources were the predominant BTX source, slightly influenced by tobacco smoke in indoor air.

The metabolic syndrome: prevalence and association to leisure-time and work-related physical activity in 60-year-old men and women.

BACKGROUND AND AIM: This study examined the prevalence of the metabolic syndrome and its association to lifestyle factors in 60-year-old men and women, with special emphasis on physical activity (PA). METHODS AND RESULTS: Every third 60-year-old man and woman in the Stockholm County, Sweden, was invited to a survey of cardiovascular risk factors. Seventy-seven percent of the sample, 4228 individuals, agreed to participate (2036 men and 2192 women). Participants underwent physical examination and laboratory tests, and completed a questionnaire. After excluding 364 subjects suffering from cardiovascular disease and/or cancer, the prevalence of the metabolic syndrome was 24% and 19% in men and women, respectively. The adjusted odds ratio for having the metabolic syndrome in the high leisure-time PA group was 0.33 (95% confidence interval: 0.22-0.51) using the low leisure-time PA group as reference. However, no such inverse association was noted for work-related PA. CONCLUSIONS: This cross-sectional survey of 60-year-old men and women demonstrates a high prevalence of the metabolic syndrome. The robust inverse dose-response relationship between leisure-time PA and the metabolic syndrome emphasises the role of PA in the prevention and treatment of the metabolic syndrome.

Challenges in diagnosing normal pressure hydrocephalus: Evaluation of the diagnostic guidelines.

PURPOSE: To evaluate the present diagnostic guidelines of idiopathic normal pressure hydrocephalus (iNPH) in a sample from the general population. METHODS: A total of 168 individuals (93 females, 75 males), mean age 75 years (range 66-92) with and without symptoms of iNPH underwent a CT-scan of the brain, a neurological examination with assessment of the triad symptoms, i.e. gait disturbances, memory impairment and urgency incontinence. The participants were then diagnosed as "unlikely", "possible" and "probable" iNPH according to the American-European and the Japanese guidelines, respectively. Separately, a senior consultant in neurology diagnosed each patient based on the overall clinical picture. RESULTS: Obtaining a diagnosis of "probable iNPH" was three times more likely according to the American-European guidelines (n = 35) compared to the Japanese guidelines (n = 11) or the neurologist (n = 11). The concordance was highest (Kappa = 0.69) between the Japanese guidelines and the neurologist. CONCLUSIONS: Considerable discrepancies were found when diagnosing iNPH according to two international guidelines and a neurologist, respectively. The Japanese guidelines, which include a minimum of two triad symptoms, were most concordant with the neurologist. As a step towards widely accepted, standardized diagnostic criteria, we suggest a revision of the current guidelines, preferably into one common diagnostic system.

Fatty acid handling protein expression in adipose tissue, fatty acid composition of adipose tissue and serum, and markers of insulin resistance.

OBJECTIVE: Proteins involved in cellular fatty acid (FA) uptake and metabolism may be of relevance in the context of disturbed FA metabolism associated with insulin resistance. Therefore this study investigated relationships between FA handling protein mRNA expression in adipose tissue, FA composition of adipose tissue and serum, and markers of insulin resistance. SUBJECTS: 75 subjects with a range of insulin sensitivities recruited from a cohort of 294 healthy 63-year-old Swedish men. MEASUREMENTS: Anthropometric and biochemical variables (e.g. waist-hip-ratio (WHR) and homeostasis model assessment (HOMA) index of insulin sensitivity), FA composition of the subcutaneous (s.c.) gluteal adipose tissue, serum nonesterified FA (NEFA) and serum phospholipid compartments (by gas-liquid chromatography; n = 294), and mRNA levels of FA handling proteins (adipocyte and keratinocyte lipid binding proteins, fatty acid transport protein (FATP) -1 and -4, CD36/fatty acid translocase, plasma membrane fatty acid binding protein, and acyl-CoA synthase-1 (ACS1)) in s.c. gluteal adipose tissue (by quantitative real-time polymerase chain reaction; n = 75). RESULTS: ACS1 expression was negatively correlated with measures of insulin resistance and central obesity (ACS1 versus HOMA: r = -0.28, P<0.05; ACS1 versus WHR: r = -0.23, P<0.05), with an opposite trend for FATP4. Further analysis of ACS1 expression levels revealed correlations with adipose tissue 16:0 (r = -0.27, P<0.05) and NEFA 16:1 (r = 0.29, P<0.05), FA composition variables which in turn correlated with HOMA index (r = 0.39, P<0.001 and r = -0.23, P<0.05, respectively, n = 75). Moreover, NEFA 16:1 predicted ACS1 expression independently of HOMA, WHR and adipose tissue 16:0 in multiple regression analysis (standardized coefficient = 0.27, P<0.05). CONCLUSION: Significant associations were found between measures of insulin sensitivity, adipose tissue FA handling protein expression, and specific FA composition variables. Although causal relationships could not be identified these findings suggest a role of FA handling proteins in relation to insulin sensitivity, via their involvement in FA trafficking and metabolism. In particular they indicate links between ACS1 activity, the distribution of 16:0 and 16:1, and insulin sensitivity, which may be of physiological relevance.

Theory of genetic counseling for rare recessive traits with consanguinity.

The theory of assessing genetic risk for rare autosomal recessive traits in the face of extensive consanguinity is explored. A general lemma is proved that justifies the partition of posterior probability and recursive incorporation of it, as a means of reducing the logic of analysis to steps of manageable complexity: the conditions are that either the components should be independent or that each component, as it is added, is conditioned on the occurrence of all earlier components. An example is given of a pedigree in which the tracing of a gene by the method of expected proportions is misleading, and another that points up the importance of the posterior information. Four classes of patterns are identified and appropriate methods devised for handling them: the single consanguineous loop, multiple mutually-external loops, nested loops, and multiple closures. The latter problem may be treated in general by the use of truncated generating functions, with or without the use of matrix methods.

Use of high-performance liquid chromatography to assess airborne mycotoxins. Aflatoxins and ochratoxin A.

An HPLC analytical method combining methanol-deionised water (80:20, v/v) extraction, methanol-acetonitrile (50:50, v/v) extraction and fluorescence detection was implanted to analyse ochratoxin A and aflatoxins B1, B2, G1 and G2 of air samples collected during the usual production process in a number of workplaces of a coffee factory to assess the occupational exposure of the engaged workers. The average levels of airborne ochratoxin A and aflatoxins were less than 1.2 and 0.4 ng/m3, respectively, using 50 L air samples. When 150 L air samples were used, levels lower than 0.04 ng/m3 ochratoxin A and 0.013 ng/m3 for aflatoxins B1, B2, G1 and G2, could be detected.

Determination of chlorpyrifos in air, leaves and soil from a greenhouse by gas-chromatography with nitrogen-phosphorus detection, high-performance liquid chromatography and capillary electrophoresis.

Chlorpyrifos was determined in air, leaves and soil in a greenhouse in order to establish performance differences between gas-chromatography with nitrogen-phosphorus detection (GC-NPD) and high-performance liquid chromatographic and capillary electrophoretic methods and to assess the farm workers' risk of overexposure due to air exposure and/or skin contact with this compound. Results obtained indicate that the three analytical techniques, with the specific procedures described, can be used, although only GC-NPD provides an operative limit of detection in air. Chlorpyrifos levels in air are dependent on time and greenhouse ventilation, whereas it remains for a long time on leaf surfaces and soil. As a consequence, specific instructions can be established for farm workers in order to avoid skin and respiratory exposure to chlorpyrifos.

Determination of DDT and related compounds in blood samples from agricultural workers.

An analytical method combining a solid-phase (C18) clean-up and GC-electron-capture detection using a capillary column, was implemented to determine p,p'-DDT and its metabolites (p,p'-DDD and p,p'-DDE), as well as other organochlorine pesticides in whole blood samples from 30 farmers and 24 non-occupationally exposed workers. The average concentrations for the quantified pesticides, p,p'-DDT, p,p'-DDD and p,p'-DDE, were 0.9, 1.5 and 8.0 micrograms/l whole blood for exposed workers and 0.3, 0.5 and 3.3 micrograms/l for unexposed workers, respectively. GC-MS was used to confirm the identity of the pesticides found. Solid-phase extraction and the protocol used give a cleaner analytical matrix, not only improving sensitivity and resolution, but also allowing analyses with smaller blood samples as compared to other methods.

Low prevalence of the metabolic syndrome in wine drinkers--is it the alcohol beverage or the lifestyle?

OBJECTIVE: To study how the intake of alcohol and the choice of wine, beer, and spirits is related to lifestyle factors and the metabolic syndrome in 60-y-old men and women. DESIGN: Cross-sectional population based study. SETTING: Stockholm County, Sweden. SUBJECTS: Sixty-year-old men and women (n=4232). RESULTS: Moderate intake of wine (10-30 g/day) was associated with a lifestyle characterized by being married, having a university education, being employed, being Swedish-born, having a good quality of life according to economy, leisure time and health, compared with a group with low alcohol intake. The opposite characteristics were seen among the non-drinkers. Drinkers of spirits were more often smokers and also reported higher intake of sausage and fried potatoes compared with a group with low alcohol intake. In women, the metabolic syndrome was significantly more common in non-drinkers (20%), P<0.05, and less common among wine drinkers (8%), P<0.01, compared with a group with low alcohol intake. After adjustments, a significant lower odds ratio for the metabolic syndrome were seen in wine drinkers in women (OR=0.60, P<0.05). CONCLUSIONS: Compared with low alcohol drinkers, moderate wine drinkers exhibited a more favorable pattern according to both lifestyle factors and metabolic parameters. The close link between alcohol drinking behaviour and lifestyle habits illustrate the complex relationship between alcohol and health.

Ketoisocaproate contamination errors in protein synthesis determinations using L[1-14C]leucine.

Protein synthesis rate determinations in vivo using L-[1-14C]-leucine may be underestimated because of contamination by radioactive ketoisocaproate (KIC) resulting from leucine metabolism. The aim of this work was to set up a reliable method to determine the KIC/leucine radioactivity ratio in protein-free homogenates, and to apply it to study the extent of the protein synthesis ratio error due to KIC contamination. Cation-exchange chromatography using Dowex AG 50W-X8 resin was used to separate KIC from leucine, eluting KIC with water and leucine with 4 M ammonia. The errors found in the protein synthesis ratio were 6.20% in liver and 2.34% in jejunum.

[Double orifice mitral valve. Study with two-dimensional echocardiography]. / Doble orificio de la válvula mitral. Estudio con ecocardiografía bidimensional.

Double orifice mitral valve is a rare congenital anomaly which is frequently associated with atrioventricular defects. According to its structure it is classified as central, commissural or valvar. Diagnosis by cross-sectional echocardiography was verified in 4 patients with a double orifice mitral valve of the central type. Age of the patients at the time of diagnosis ranged from 3 months to 17 years. Three of them had an associated ostium primum atrial septal defect. The defect was observed in parasternal long-short axis views and subcostal 4 chamber axis views. The parasternal short axis gave information on the central type but subvalvular structures of the double orifice and insertion of the chords in papillary muscle were best observed in parasternal long and subcostal four chamber axis views.

[Bilateral pulmonary thromboendarterectomy in chronic pulmonary thromboembolism. A case report and review of the literature]. / Tromboendarterectomía pulmonar bilateral en el tromboembolismo pulmonar crónico. Presentación de un caso y revisión de la literatura.

A 39-years-old male patient with chronic venous insufficiency, deep venous thrombosis and recurrent pulmonary embolism in the past medical history. After syncopal event was diagnosed of bilateral chronic pulmonary embolism, pulmonary hypertension and right ventricular failure. Fibrinolytic treatment was no effective therapeutic modality. Under cardiopulmonary bypass, bilateral pulmonary thromboendarterectomy with extension into lobe arteries, plus insertion of caval filter was performed. We present our experience with this case and a review of the literature.

[Recurrent acute pericarditis associated with adult-onset Still's disease treated with pericardiectomy]. / Pericarditis aguda recidivante asociada a enfermedad de Still del adulto tratada con pericardiectomía.

Recurrent acute pericarditis associated with adult onset Still's disease is an unusual feature. We present a case with recurrent episodes of acute pericarditis with cardiac tamponade which only improved with corticosteroid therapy. Because of the severe and frequent recurrences and corticodependence development, a subtotal pericardiectomy was performed with a good outcome after a 12-month observation period.

[Scimitar syndrome in the newborn child and infant]. / El síndrome de la cimitarra en el recién nacido y en el lactante.

We present 10 symptomatic patients with scimitar syndrome. Their age was below 1 year and four were newborn babies. In 5 patients there was secundum atrial septal defect and in one there was a patent ductus arteriosus. Sixty per cent of the patients had pulmonary sequestration. The right lung was moderately or severely hypoplasic in 8 cases and seven had frequent respiratory infections. The anomalous venous drainage produced a left-to right shunt at atrium level which in our series had a value of 2.87 +/- 0.5. Five patients had pulmonary hypertension either moderate or severe. The severity of this disease in early infancy is related to the pulmonary hypertension (40%), requiring a prompt surgical correction. Eight patients were operated upon, the drainage being connected to the left atrium. The six surviving patients are asymptomatic at 12 years of follow-up. Our series is the biggest published in our country and the second in the world literature in infancy.