Sex differences in patients with systemic lupus erythematosus from Northwest Spain.

To further establish potential differences according to sex in systemic lupus erythematosus (SLE) patients from Southern Europe. We assessed clinical and epidemiological data of patients diagnosed with SLE according to the 1982 American College of Rheumatology classification criteria at the single hospital for a well-defined population of Northwest Spain, between 1987 and 2006. Prevalence in December 2006 and age-standardized incidence rates in the whole period were estimated. Kaplan-Meier method was used in order to estimate the probability of survivorship. Women outnumbered men [127 (84.7%) vs. 23 (15.3%)]. The median age at the time of disease diagnosis in men was 54 years versus 43 in women (p < 0.001). Annual incidence rates were higher in women [5.9 (95% confidence interval--CI 4.9-7.0) per 100,000 population] than in men [1.1 (95% CI 0.7-1.7) per 100,000 population; p < 0.001]. Raynaud's phenomenon was more common in women (40.9 vs. 3.0%; p = 0.01). While the frequency of secondary Sjögren's syndrome was increased in women (p = 0.02), renal disease at the time of diagnosis (39.1 vs. 15.0%; p < 0.01) and over the course of the disease was more common in men (43.5 vs. 24.4%; p = 0.06). Higher frequency of thrombocytopenia (39.1 vs. 16.5%; p = 0.01) and lower frequency of anti-SSA (13.0 vs. 31.5%; p = 0.08) and anti-SSB (0 vs. 17.7%; p = 0.03) were observed in men. The 5- and 10-year survival probabilities were nonsignificantly reduced in men (91.3 and 78.3 3% vs. 94.6 and 89.2% in women). The frequency of some clinical manifestations is different in men and women with SLE. Higher awareness of these peculiarities may help to establish appropriate diagnosis and management of SLE in men.

Influence of Post-Synthesis Modifications of Ti1-xZrxO2 Nanocrystallites on Their Photocatalytic Activity for Toluene and Methylcyclohexane Degradation.

The modification of the structural and surface characteristics of Ti1-xZrxO2 nanocrystallites by postsynthesis treatments is revealed as an effective way to enhance their photocatalytic activity. Starting with the same batch of mixed oxide prepared from reverse microemulsions, different photocatalysts have been obtained by either solvothermal treatment, calcination or a combination of both. Extensive physicochemical characterization of the resulting materials shows that solvothermally treated oxides present lower crystallite size and larger surface area, although without previous calcination these samples appear to have a higher degree of structural disorder. These differences are sharply reflected in the changes in photocatalytic activity for the removal of methylcyclohexane (MCH) and toluene vapours at relatively high concentrations. Thus, the best performance for MCH elimination is obtained with the photocatalysts prepared by calcination and subsequent solvothermal treatment. Following this procedure, the resulting Ti1-xZrxO2 material presents larger surface area and high Zr surface concentration with minimal disturbance of the anatase structure. In contrast, for toluene photooxidation, the solvothermally prepared sample shows improved performance, most likely due to its larger surface area, which contributes to hinder deactivation.

The strategic interaction between firms and formulary committees: effects on the prices of new drugs.

We study the strategic interaction between the pricing decisions of a pharmaceutical firm and the reimbursement decisions of a government agency which grants reimbursement rights to patients for whom new drugs are most cost-effective. If the reimbursement decision precedes pricing, the agency only reimburses some patients if the drug's private and public health benefits diverge. This is, there are consumption externalities and the variable cost of the drug exceeds the alternative's. Contrarily, if the firm can commit to a price before reimbursement, a strategic effect implies that by setting a sufficiently high price, the firm can make the agency more willing to reimburse than without commitment.

Tailoring Multilayered BiVO4 Photoanodes by Pulsed Laser Deposition for Water Splitting.

Pulsed laser deposition (PLD) is proposed as promising technique for the fabrication of multilayered BiVO4-based photoanodes. For this purpose, bare BiVO4 films and two heterojunctions, BiVO4/SnO2 and BiVO4/WO3/SnO2, have been prepared using consecutive ablation of assorted targets in a single batch. The ease, high versatility and usefulness of this technique in engineering the internal configuration of the photoanode with stoichiometric target-to-substrate transfer are demonstrated. The obtained photocurrent densities are among the highest reported values for undoped BiVO4 without oxygen evolution catalysts (OEC). A detailed analysis of the influence of SnO2 and WO3 layers on the charge transport properties because of the changes at the internal FTO/semiconductor interface is performed through transient photocurrent measurements (TPC), showing that the BiVO4/WO3/SnO2 heterostructure attains a significant decrease in the internal losses and reaches high photocurrent values. This study is expected to open the door to the fabrication of other systems based on ternary (or even more complex) metal oxides as photoanodes for water splitting, which is a promising alternative for obtaining materials able to fulfill the different requierements in the development of more efficient systems for this process.

TRMC, XPS, and EPR characterizations of polycrystalline TiO2 porphyrin impregnated powders and their catalytic activity for 4-nitrophenol photodegradation in aqueous suspension.

Characterization of polycrystalline TiO(2) bare or porphyrin impregnated powders, used as photocatalysts for the degradation of 4-nitrophenol (4-NP) in aqueous suspension, was performed by time-resolved microwave conductivity (TRMC) measurements and electronic paramagnetic resonance (EPR) and X-ray photoelectron (XPS) spectroscopies. The presence of porphyrin sensitizers, as the metal-free or Cu [5,10,15,20-tetra (4-tert-butylphenyl)] porphyrin, impregnated onto the TiO(2) surface improved the photocatalytic activity of the bare TiO(2). TRMC measurements indicate that the number and lifetime of the photoinduced excess charge carriers increase in the presence of the macrocycles, and EPR and XPS spectroscopies support the mechanistic hypotheses based on the photoreactivity experiments.

Retrospective study of tolerance to short initiation schedules in subcutaneous immunotherapy.

With the aim of evaluating tolerance to new shorter initiation schedules in subcutaneous immunotherapy everyday clinical practice, a study was carried out using Pangramin Plus with initiation periods between 3 (Cluster) and 6 (Plus) weeks. All the information was processed retrospectively and both systemic (SR) and local (LR) adverse reactions occurring between September 2002 and February 2003 were recorded. A total of 353 patients (261 Plus and 91 Cluster) were included and 2,886 doses were administered (2,166 in initiation and 720 in maintenance). Of these, 800 were with Grass mix extract, 1,141 Grass mix + Olea, 273 Olea, 73 Dermatophagoides mix and 599 Dermatophagoides pteronyssinus. As regards adverse reactions (AR), 2.8% of patients showed SR and 4.8% LR, 1.2% of doses caused some type of reaction (SR and LR in 0.3% and 0.9%, respectively). The initiation schedule, first dose or allergens resulted in no significant differences in the frequency of adverse reactions. The Grass mix extract showed the highest frequency of AR. Sixty-seven percent of SR and 68% of LR were delayed. 64% of these reactions resolved spontaneously while the rest responded favourably to treatment. Adrenaline was administered on one occasion for immediate asthma. There were no cases of anaphylactic shock, hospitalisation or life-threatening situations. Pangramin Plus tolerance, therefore, can be classified as good, similar to conventional schedules, but with the benefits of shorter initiation schedules.

Systemic lupus erythematosus in northwestern Spain: a 20-year epidemiologic study.

To further investigate the epidemiology of systemic lupus erythematosus (SLE) in southern Europe, we assessed the incidence, prevalence, clinical spectrum of the disease, flares, and survival of patients diagnosed with SLE in the Lugo region of northwestern Spain. Between January 1987 and December 2006, 150 Lugo residents were diagnosed as having SLE according to the 1982 American College of Rheumatology criteria for the classification of SLE. Women outnumbered men (127 [84.7%] vs. 23 [15.3%]). The mean age at the time of disease diagnosis was 46.1 ± 19.6 years. The mean follow-up from the time of disease diagnosis was 7.8 ± 4.5 years. The age- and sex-adjusted annual incidence rate over the 20-year study period was 3.6 (95% confidence interval [CI], 3.0-4.2) per 100,000 population aged 15 years and older. The overall annual incidence rate over the 20-year study period in women (5.9/100,000 population aged ≥ 15 yr; 95% CI, 4.9-7.0) was higher than in men (1.1/100,000 population aged ≥ 15 yr; 95% CI, 0.7-1.7) (p < 0.001). By December 31, 2006, the overall age-adjusted SLE prevalence in the Lugo region for patients who fulfilled at least 4 of 1982 American College of Rheumatology criteria was 17.5 per 100,000 population aged 15 years and older (95% CI, 12.6-24.1). Prevalence in women (29.2/100,000 population aged ≥ 15 yr; 95% CI, 20.0-40.7) was higher than in men (5.8/100,000 population aged ≥ 15 yr; 95% CI, 2.0-12.0). The most frequent clinical manifestation was arthritis. As reported in population-based studies on SLE patients of European descent, renal disease was observed in only 27.3% of the patients. The rate of flares was 0.084/year. A younger age and the presence of nephritis at the time of disease diagnosis were associated with the development of flares during the follow-up of Lugo patients. Compared with the general population the probability of survival in patients with SLE was significantly reduced (p = 0.04). In conclusion, the present study establishes a baseline estimate of the incidence and clinical spectrum of SLE in northwestern Spain. According to our results, the incidence of SLE in northwestern Spain is slightly higher than that reported in most European regions. Patients with SLE from northwestern Spain have a later average age onset and a lower frequency of nephritis than in the African-American population. However, our data show a reduced probability of survival in Spanish patients with SLE.