Training depletes muscle glutathione in patients with chronic obstructive pulmonary disease and low body mass index

BACKGROUND: A physiological increase in muscle glutathione after training is not seen in patients with chronic obstructive pulmonary disease (COPD), indicating abnormal peripheral muscle adaptations to exercise. OBJECTIVE: We hypothesized that oxidative stress is primarily associated with low body mass index (BMI). METHODS: Eleven patients with preserved BMI (BMI(N): 28.2 +/- 1.2 kg.m(-2)), 9 patients with low BMI (BMI(L): 19.7 +/- 0.60 kg.m(-2)) and 5 age-matched controls (26.5 +/- 0.9 kg.m(-2)) were studied before and after 8 weeks of high-intensity endurance training. Reduced glutathione (GSH) and gamma-glutamyl cysteine synthase heavy-subunit chain mRNA expression (gammaGCS-HS mRNA) were measured in the vastus lateralis. RESULTS: After training, exercise capacity increased (DeltaVO(2)PEAK, 13 +/- 5.2%; 10 +/- 5.6% and 15 +/- 4.3% in BMI(L), BMI(N) and controls, respectively; p < 0.05 each). GSH levels decreased in BMI(L) (from 5.2 +/- 0.7 to 3.7 +/- 0.8 nmol/mg protein, DeltaGSH -1.5 +/- 0.7 nmol/mg protein, p < 0.05); no changes were seen in BMI(N) (from 5.4 +/- 0.7 to 6.7 +/- 0.9 nmol/mg protein, DeltaGSH 1.3 +/- 0.9 nmol/mg protein), whereas GSH markedly increased in controls (from 4.6 +/- 1 to 8.7 +/- 0.4 nmol/mg protein, DeltaGSH 4.1 +/- 1 nmol/mg protein, p < 0.01). DeltaGSH in BMI(L) was different from DeltaGSH in BMI(N) and controls (p < 0.05, each). Consistent changes were observed in gammaGCS-HS mRNA expression. CONCLUSIONS: GSH depletion after training in BMI(L) may suggest that oxidative stress plays a key role in muscle wasting in COPD patients.     

Lung transplantation in children following treatment for malignancy.

BACKGROUND: End-stage lung disease is a rare complication of treatment for hematologic and solid tumors in children. When present, it is generally progressive, resulting in the patient being cured of cancer only to die of respiratory failure. Lung transplantation is believed by some to be of overly high risk in this population because of the pre-existing malignancy as well as the presumed compromised immune status. METHODS: Six children (Group 1), aged 5 to 17 years (mean 12.4 years), underwent lung transplantation at our institution because of either pulmonary fibrosis or bronchiolitis obliterans following treatment for acute leukemia (n = 5) or medulloblastoma (n = 1). All patients received chemotherapy, radiation and bone marrow transplantation in the course of treatment for their malignancies. The average forced expiratory volume in 1 second (FEV(1)) was 16% of the predicted value and forced vital capacity (FVC) was 28% of predicted. These results were compared with a similar group of 13 patients undergoing lung transplantation at our institution during the same time interval (Group 2). RESULTS: There were 2 deaths in Group 1, 1 early and 1 late, for an overall survival of 67% at a mean follow-up of 4.02 years. There were no early and 7 late deaths in Group 2 for an overall survival of 46% at a mean follow-up of 4.8 years. The acute rejection rate in the first post-transplant year was 0.2 episode/patient in Group 1 and 1.8 episode/patient in Group 2 (p <0.01). No patient in Group 1 has developed post-transplant lymphoproliferative disease or a relapse of their primary malignancy. Two patients in Group 1 developed unusual infections-Aspergillus and Mycobacterium chelonae. No such infections occurred in Group 2. CONCLUSIONS: Although this represents a small series, we believe that patients with respiratory failure following treatment of a prior malignancy are suitable candidates for lung transplantation. Although they may have some relative protection from acute rejection episodes by virtue of an already compromised immunologic status while receiving standard immunosuppression, an increased propensity for opportunistic infection may exist.     

Return to work after a non-work related sick spell: the role of age, sex, economic activity and autonomous community

BACKGROUND: To describe the duration of non-work related sickness absences incidents according to age, sex, economic activity and Autonomous Community. METHODS: The sample of non-work related sick spells included 76,598 incident cases started in 2002 among workers cover by the general regime of the Social Security system, and managed by an insurance company. The median and intercuartils range were estimated by sex, age, economic activities and Autonomous Comunnity. Probability ratio of continuing out of work (PRCOW) were compared among Autonomous Comunities, after adjusting by sexo, age and economic activities, taking Navarra as reference, using a log-logistic regression model with a gamma distribution. RESULTS: The 25% of cases there were returned to work at 40 day, the 50% at 90 day; and the 75% at 26 degrees day. Extremadura (PCOW=2,7; IC95%: 2,4-3,1) and Galicia (2,6; 2,4-2,9) showed the highest differences with Navarra. There were also statistically significant differences among economic activities after adjusting by age and sex. CONCLUSIONS: Return to work after a non-work related sick spell is a complex process, which is influenced by age, sex, economic activities and autonomous community.     

Is muscular atrophy a contraindication in laparoscopic abdominal wall defect repair? A prospective study

Laparoscopic surgery for abdominal wall hernias improves short-term results as compared with open hernia surgery. However, no evidence exists to recommend this approach for pseudohernias, which are abdominal wall defects postsurgery caused by denervation and muscular atrophy. The purpose of this study is to analyze whether the laparoscopic approach benefits patients with a pseudohernia. A prospective nonrandomized, single-center clinical study was conducted of 24 patients operated on for pseudohernia. This study was designed with the basic principle of one unit, one surgeon, one mesh, and two techniques (laparoscopic or open double prosthetic repair). The primary end point was assessment of the abdominal wall according to: 1) abdominal perimeter; 2) computed tomography scan; and 3) degree of satisfaction. The secondary end points were intraoperative parameters and comorbidity. Laparoscopy offered no benefits in patients with pseudohernias. Open surgery offered no significant differences in intra- and postoperative morbidity, but if the initial weakness improved with a decrease in abdominal perimeter and visceral content, then there was more than 90 per cent satisfaction (P < 0.05). The laparoscopic approach does not improve the bulge caused by abdominal muscle atrophy. The option of a muscular and prosthetic reconstruction provides better clinical and cosmetic results.     

Antibiotic Resistance Genes in the Bacteriophage DNA Fraction of Human Fecal Samples

A group of antibiotic resistance genes (ARGs) (bla_TEM, bla_CTX-M-1, mecA, armA, qnrA, and qnrS) were analyzed by real-time quantitative PCR (qPCR) in bacteriophage DNA isolated from feces from 80 healthy humans. Seventy-seven percent of the samples were positive in phage DNA for one or more ARGs. bla_TEM, qnrA, and, bla_CTX-M-1 were the most abundant, and armA, qnrS, and mecA were less prevalent. Free bacteriophages carrying ARGs may contribute to the mobilization of ARGs in intra- and extraintestinal environments.     

Medium-term results of cryoballoon ablation of the pulmonary veins in patients with paroxysmal and persistent atrial fibrillation. First experience of a Spanish center

Purpose

Cryoballoon ablation of the pulmonary veins (CAPV) is a new technique that could have similar results to radiofrequency procedures, but with fewer complications. We analyzed the outcomes and safety of this technique in a consecutive cohort of patients with atrial fibrillation (AF).

Methods

A total of 63 patients with paroxysmal (n?=?40) or persistent (n?=?23) AF were studied. Patient follow-up was performed at 3 months and then every 6 months with 72-h continuous electrocardiographic recordings.

Results

A total of 262 pulmonary veins were treated; 60.3 % of the cases presented normal pulmonary vein drainage with 4 pulmonary veins, and 23.8 % of the cases presented a common left-sided antrum. Complete isolation of all veins was achieved in 95.2 % of cases with 10.3?±?2.8 (mean?±?standard deviation) applications per patient. Transient right phrenic nerve injury was the most common complication (4.7 %). Median follow-up was 5.5 months. The probability of being free of recurrence at 1 and 2 years was, respectively, 86.2 and 72.2 % for paroxysmal AF and 49 and 36.4 % for persistent AF (P?=?0.012). Patients with structural heart disease experienced recurrence more often than patients with a normal heart (62.5 versus 24.5 %; P?=?0.03).

Conclusions

CAPV appears to be a safe and effective procedure for the treatment of patients with AF, particularly those with paroxysmal AF and no structural heart disease.     

Reorganization of thalamocortical connections in congenitally blind humans

Cross‐modal plasticity in blind individuals has been reported over the past decades showing that nonvisual information is carried and processed by “visual” brain structures. However, despite multiple efforts, the structural underpinnings of cross‐modal plasticity in congenitally blind individuals remain unclear. We mapped thalamocortical connectivity and assessed the integrity of white matter of 10 congenitally blind individuals and 10 sighted controls. We hypothesized an aberrant thalamocortical pattern of connectivity taking place in the absence of visual stimuli from birth as a potential mechanism of cross‐modal plasticity. In addition to the impaired microstructure of visual white matter bundles, we observed structural connectivity changes between the thalamus and occipital and temporal cortices. Specifically, the thalamic territory dedicated to connections with the occipital cortex was smaller and displayed weaker connectivity in congenitally blind individuals, whereas those connecting with the temporal cortex showed greater volume and increased connectivity. The abnormal pattern of thalamocortical connectivity included the lateral and medial geniculate nuclei and the pulvinar nucleus. For the first time in humans, a remapping of structural thalamocortical connections involving both unimodal and multimodal thalamic nuclei has been demonstrated, shedding light on the possible mechanisms of cross‐modal plasticity in humans. The present findings may help understand the functional adaptations commonly observed in congenitally blind individuals.     

Certolizumab Pegol,a New Anti-TNF-α in the Armamentarium against Ocular Inflammation

Purpose: To study the efficacy and tolerance of certolizumab pegol (CZP) in active uveitis.

Methods: Retrospective case series at 4 referral centers. Patients treated with CZP for active uveitis during at least 6 months were eligible. Inflammation by SUN scores, visual acuity (VA) (logMAR), and central macular thickness (CMT) were compared from baseline until final follow-up. Quiescence was defined as 0+ to 0.5+ in anterior chamber and vitreous haze scores and no CMT increase.

Results: Four males and 3 females (14 eyes) were included, mean age 42.4?±?8.8 years. All were long-lasting chronic-relapsing uveitis with prior failure to other anti-TNF-α. After a mean follow-up of 10.4?±?4.8 months, 5/7 patients (71.4%) achieved quiescence with CZP. VA improved significantly from +0.52?±?0.68 to +0.45?±?0.68 (p?=?0.032) at 1 month and to +0.44?±?0.64 (p?=?0.035) at 6 months. No adverse events were found.

Conclusion: CZP can be an effective alternative in refractory uveitis.     

Ovulation induction treatment and risk of borderline ovarian tumors.

AIM: Research has suggested an association between the use of ovulation induction drugs and the risk of ovarian cancer. It has also been proposed that there may be pre-cancerous alterations in the ovary which themselves are the cause of infertility. The aim of the present study was to evaluate the relationship between the use of ovulation induction drugs and the appearance of borderline ovarian tumors. MATERIAL AND METHODS: This was a case-control study in which the study group comprised 42 women with a borderline ovarian tumor and the control group comprised 257 women with benign ovarian pathology. RESULTS: No differences were found between the borderline tumor and control groups (14.3% vs. 27.2%, respectively) in terms of infertility history. Nor were there any differences between the groups with respect to the type of drug used, whether clomiphene citrate (9.5% vs. 6.2%, respectively) or gonadotropins (7.1% vs. 10.1%, respectively). Analysis in terms of the number of cycles administered also failed to reveal any differences. The mean number of cycles with clomiphene citrate/gonadotropins was 2.50 +/- 1.00 and 3.00 +/- 2.64 in the borderline tumor group and 2.44 +/- 1.75 and 3.27 +/- 2.25 in the control group. CONCLUSIONS: Our series produced no evidence that ovulation induction treatment predisposes women to the development of borderline ovarian tumors.