Exposure to UV Radiation in Lifeguards on Barcelona's Beaches: An Underestimated Occupational Risk

BACKGROUND

The development of skin cancer is closely related to high exposure to UV radiation. Lifeguards are at an increased risk of excessive sun exposure.

OBJECTIVES

The main objective of this study was to measure the exposure of Barcelona's beach lifeguards to UV radiation.

METHODS

Measurements in the work chair were taken every 30min on a typical working day from 10:45 am to 19:15 pm. These measurements were carried out on four different days. These data were used to calculate the erythematous doses received during working hours, as well as those potentially received throughout the summer season. Vitamin D production was also estimated for the four days that the radiation received was measured, and the amount generated was calculated for the entire summer season.

RESULTS

Exposure to UV radiation among Barcelona lifeguards far exceeds safety limits. In some locations, the exposure to UVB radiation is more than 16 times the minimum erythematous dose for phototype II skin.

LIMITATIONS

This study assessed the radiation received during only four days. However, is a much higher number than most of the published papers.

CONCLUSION

Although the health risks of excessive exposure to UV radiation are known, Barcelona's beach lifeguards are insufficiently protected.

Exposure to UV Radiation in Lifeguards on Barcelona's Beaches: An Underestimated Occupational Risk

BACKGROUND

The development of skin cancer is closely related to high exposure to UV radiation. Lifeguards are at an increased risk of excessive sun exposure.

OBJECTIVES

The main objective of this study was to measure the exposure of Barcelona's beach lifeguards to UV radiation.

METHODS

Measurements in the work chair were taken every 30min on a typical working day from 10:45 am to 19:15 pm. These measurements were carried out on four different days. These data were used to calculate the erythematous doses received during working hours, as well as those potentially received throughout the summer season. Vitamin D production was also estimated for the four days that the radiation received was measured, and the amount generated was calculated for the entire summer season.

RESULTS

Exposure to UV radiation among Barcelona lifeguards far exceeds safety limits. In some locations, the exposure to UVB radiation is more than 16 times the minimum erythematous dose for phototype II skin.

LIMITATIONS

This study assessed the radiation received during only four days. However, is a much higher number than most of the published papers.

CONCLUSION

Although the health risks of excessive exposure to UV radiation are known, Barcelona's beach lifeguards are insufficiently protected.

Synchronous primary cutaneous melanomas: a descriptive study of their clinical features, histology, genetic background of the patients and clinical outcomes

BACKGROUND

Around 0.5% cutaneous melanoma (CM) patients will present with synchronous melanomas when first seen. Moreover, 26%-40% of patients with multiple primary melanomas present with synchronous lesions.

OBJECTIVES

To assess the prevalence, clinical and histopathological characteristics, germline mutations and outcome in patients with synchronous melanoma.

METHODS

Clinical and histopathological data from 4703 melanoma patients were included. Clinical, histological and genetic mutational status information was analyzed. Kaplan-Meier curves were used to investigate survival outcomes.

RESULTS

A total of 144 patients (3.06%) presented simultaneously with 2 or more primary melanomas. During follow-up, 25.7% of patients with synchronous melanoma developed a new primary melanoma compared to 8.6% of patients diagnosed with single melanoma (p < 0.001). Germinal CDKN2A mutations were identified in 10.7% of patients with synchronous melanomas and genetic variants in MC1R in 72%. No significant differences in all survival outcomes between patients with synchronous melanomas and single melanomas were found.

CONCLUSION

Synchronous melanomas are more frequent than previously reported and are more frequent in older patients compared to single melanomas. Moreover, these patients have a higher risk of developing a new primary melanoma during follow-up and have higher rates of germline susceptibility variants. Nevertheless, these findings were not associated with worse outcomes.

Corrigendum: Helicobacter pylori cagA+ Is Associated with Milder Duodenal Histological Changes in Chilean Celiac Patients

[This corrects the article on p. 376 in vol. 7, PMID: 28879170.].

Helicobacter pylori cagA+ Is Associated with Milder Duodenal Histological Changes in Chilean Celiac Patients

HIGHLIGHTS

What is already known about this subject?

Celiac disease (CD) has a high clinical and histological diversity and the mechanisms underlying this phenomenon remain elusive.

H. pylori is a bacterium that chronically infect gastric and duodenal mucosa activating both a Th1/Th17 and T-reg pathways.

The role of H. pylori (and the effect of their virulence factors) in CD have not yet completely elucidated.

What are the new findings?

cagA+ H. pylori strains are associated to milder histological damage in infected CD patients.

In active-CD patients the presence of cagA+ H. pylori is associated to an increase in T-reg markers, contrasting with a downregulation in cagA+ infected potential-CD individuals.

How might it impact on clinical practice in the foreseeable future?

The identification of microbiological factors that could modulate inflammation and clinical expression of CD may be used in the future as preventive strategies or as supplementary treatment in patients that cannot achieve complete remission, contributing to the better care of these patients.

Background: Mechanisms underlying the high clinical and histological diversity of celiac disease (CD) remain elusive. Helicobacter pylori (Hp) chronically infects gastric and duodenal mucosa and has been associated with protection against some immune-mediated conditions, but its role (specifically of cagA+ strains) in CD is unclear.

Objective: To assess the relationship between gastric Hp infection (cagA+ strains) and duodenal histological damage in patients with CD.

Design: Case-control study including patients with active-CD, potential-CD and non-celiac individuals. Clinical presentation, HLA genotype, Hp/cagA gene detection in gastric mucosa, duodenal histology, Foxp3 positive cells and TGF-β expression in duodenal lamina propria were analyzed.

Results: We recruited 116 patients, 29 active-CD, 37 potential-CD, and 50 non-CD controls. Hp detection was similar in the three groups (~30–40%), but cagA+ strains were more common in infected potential-CD than in active-CD (10/11 vs. 4/10; p = 0.020) and non-CD (10/20; p = 0.025). Among active-CD patients, Foxp3 positivity was significantly higher in subjects with cagA+ Hp+ compared to cagA- Hp+ (p < 0.01) and Hp- (p < 0.01). In cagA+ Hp+ individuals, Foxp3 positivity was also higher comparing active- to potential-CD (p < 0.01). TGF-β expression in duodenum was similar in active-CD with cagA+ Hp+ compared to Hp- and was significantly downregulated in cagA+ potential-CD subjects compared to other groups.

Conclusion: Hp infection rates were similar among individuals with/without CD, but infection with cagA+ strains was associated with milder histological damage in celiac patients infected by Hp, and in active-CD cases with higher expression of T-reg markers. Results suggest that infection by cagA+ Hp may be protective for CD progression, or conversely, that these strains are prone to colonize intestinal mucosa with less severe damage.

Cerebral Hemodynamics Patterns by Transcranial Doppler in Patients With Acute Liver Failure

INTRODUCTION

About half of patients with acute liver failure (ALF) show clinical signs of cerebral edema and intracranial hypertension. Neuroimaging diagnostics and electroencephalography have poor correlation with intracranial pressure measurement.

OBJECTIVE

The objective of this study was to characterize the cerebral hemodynamics patterns with transcranial Doppler (TCD) sonography in patients with ALF.

METHOD

We studied 21 patients diagnosed with ALF, admitted to the intensive care unit (ICU) at the Centro de Investigaciones Médico Quirúrgicas of Cuba. All of these patients had a TCD performed on arrival at ICU, evaluating the following: systolic (SV), diastolic (DV), and medium (MV) flows velocities and pulsatility index (PI) in right middle cerebral artery (RMCA) via temporal windows.

RESULTS

The sonographic patterns of cerebral hemodynamics were as follows: low-flow, 12 patients (57.1%); high resistance, 5 patients (23.8%); and hyperemic, 4 patients (19%). Patients who died while waiting had lower MV RMCA (56.1 vs 58.1 cm/s) and higher PI (1.71 vs 1.41) than patients who could undergo transplantation (P = .800 and P = .787, respectively).

CONCLUSIONS

In patients diagnosed with ALF admitted to the ICU the predominating cerebral hemodynamic pattern was low-flow with resistance increase. The TCD was shown to be a useful tool in the initial evaluation for prognosis and treatment.

Peroneal tendon dislocation

INTRODUCTION

Peroneal tendon instability goes often mis- or undiagnosed in the acute setting of evaluation of ankle sprains. The current article provides a concise overview regarding peroneal tendon instability.

METHODS

A proper history, clinical assessment and imaging help to establish the correct diagnosis. Conventional radiography, ultrasound, magnetic resonance imaging and sometimes computed tomography may help to elucidate the pattern of injury.

RESULTS

Nonoperative treatment can be considered in the acute setting. However, high failure rates up to 50 % have been reported in the literature. This is even better reflected in the chronic stage of peroneal instability, in which most of the patients need surgical treatment. In contrast, surgical treatment attempts to restore structural stabilization of the peroneal tendon and retinacular complex. The simple reconstruction and repair of the damaged retinacular structures and tendons achieve excellent results. In patients with structural abnormalities of the retromalleolar groove, groove-deepening procedures may be considered. Most of chronic personal tendon instabilities need to be addressed by surgery due to the frustrating results obtained by nonoperative measures. However, reconstruction of the tendinous and retinacular structures can yield good-to-excellent outcomes.

DQ2, DQ7 and DQ8 Distribution and Clinical Manifestations in Celiac Cases and Their First-Degree Relatives

HLA-linked genes are relevant to celiac disease (CD); the potential genetic differences present worldwide are not fully understood. Previous results suggest that the distribution of HLA-DQ2/DQ7/DQ8 in Chile may differ from that in Europe and North America. In celiac patients and their first-degree relatives (FDRS), we assessed their clinical, serological and histological characteristics, determined HLA-DQ2, HLA-DQ7 and HLA-DQ8 alleles and genotypes, and evaluated the relations between them. A total of 222 individuals were assessed (56 cases, 166 FDRs). 16.9% of FDRs were tTG positive; 53.6% of them showed overweight/obesity and 3% undernourishment; they spontaneously declared being asymptomatic, but detailed questioning revealed that 60.7% experienced symptoms, which had not been investigated. DQ2 was present in 53.9% and 43.9.0% of cases and FDRs (p < 0.05). The most frequent genotype distribution was DQ2/DQ7 (fr 0.392 (cases) and 0.248 (FDRs), respectively, p < 0.02). The next most common genotypes were HLA-DQ2/DQ8 (fr 0.236 in FDRs and 0.176 in cases, p < 0.05). 3.92% cases were not HLA-DQ2/DQ8 carriers. Among tTG positive FDRs, 57.4%, 22.3% and 20.2% carried DQ2, DQ7 and DQ8, respectively. In cases, 72.7% of the biopsies classified Marsh ≥ 3 carried at least one DQ2; 91.7% of DQ2/DQ2 and 88.3% of DQ2/DQ7 were Marsh ≥ 3. Thus, DQ2 frequency is lower than reported; the higher frequency found for DQ8 and DQ7 concur with recent publications from Argentine and Brazil. These results suggest that although CD may manifest clinically in ways similar to those described in other populations, some genetic peculiarities in this region deserve further study.

Treatment of ankle osteoarthritis: arthrodesis versus total ankle replacement

While ankle arthrodesis has remained the gold standard treatment for symptomatic primary, secondary, and posttraumatic ankle arthritis, more recently, total ankle replacement (TAR) has seen considerable improvement in terms of biomechanics, function, and complication rates. However, while in the long-term degeneration of the adjacent joints is almost always found on radiographs after ankle arthrodesis, the longevity of TAR is still insufficient and does not match that of total knee and hip joints. The current review article focuses on the treatment of ankle arthritis by means of arthrodesis and TAR.

Misalignment of total ankle components can induce high joint contact pressures

BACKGROUND

A major cause of the limited longevity of total ankle replacements is premature polyethylene component wear, which can be induced by high joint contact pressures. We implemented a computational model to parametrically explore the hypothesis that intercomponent positioning deviating from the manufacturer's recommendations can result in pressure distributions that may predispose to wear of the polyethylene insert. We also investigated the hypothesis that a modern mobile-bearing design may be able to better compensate for imposed misalignments compared with an early two-component design.

METHODS

Two finite element models of total ankle replacement prostheses were built to quantify peak and average contact pressures on the polyethylene insert surfaces. Models were validated by biomechanical testing of the two implant designs with use of pressure-sensitive film. The validated models were configured to replicate three potential misalignments with the most

CLINICAL RELEVANCE

version of the tibial component, version of the talar component, and relative component rotation of the two-component design. The misalignments were simulated with use of the computer model with physiologically relevant boundary loads.

RESULTS

With use of the manufacturer's guidelines for positioning of the two-component design, the predicted average joint contact pressures exceeded the yield stress of polyethylene (18 to 20 MPa). Pressure magnitudes increased as implant alignment was systematically deviated from this reference position. The three-component design showed lower-magnitude contact pressures in the standard position (<10 MPa) and was generally less sensitive to misalignment. Both implant systems were sensitive to version misalignment.

CONCLUSIONS

In the tested implants, a highly congruent mobile-bearing total ankle replacement design yields more evenly distributed and lower-magnitude joint contact pressures than a less congruent design. Although the mobile-bearing implant reduced susceptibility to aberrant joint contact characteristics that were induced by misalignment, predicted average contact stresses reached the yield stress of polyethylene for imposed version misalignments of >5 degrees.

Non-operative treatment of large anterior glenoid rim fractures after traumatic anterior dislocation of the shoulder

The generally-accepted treatment for large, displaced fractures of the glenoid associated with traumatic anterior dislocation of the shoulder is operative repair. In this study, 14 consecutive patients with large (> 5 mm), displaced (> 2 mm) anteroinferior glenoid rim fractures were treated non-operatively if post-reduction radiographs showed a centred glenohumeral joint. After a mean follow-up of 5.6 years (2.8 to 8.4), the mean Constant score and subjective shoulder value were 98% (90% to 100%) and 97% (90% to 100%), respectively. There were no redislocations or subluxations, and the apprehension test was negative. All fragments healed with an average intra-articular step of 3.0 mm (0.5 to 11). No patient had symptoms of osteoarthritis, which was mild in two shoulders and moderate in one. Traumatic anterior dislocation of the shoulder, associated with a large displaced glenoid rim fracture can be successfully treated non-operatively, providing the glenohumeral joint is concentrically reduced on the anteroposterior radiograph.

Glyphosate resistance in a Chilean Lolium multiflorum

Lolium multiflorum (Italian ryegrass) has recently demonstrated itself to be poorly controlled with glyphosate in cereal crops of South Chile. The concentration of glyphosate necessary to reduce shoot length by 50% (ED50) in seedlings, after eight days of root contact was 7.3-fold in the resistant Vil-1 than in the susceptible (S) biotype. The obtained spray retention values were higher on S than the resistant (Vil-1) biotype. Contact angles measured on the adaxial surface of S and Vil-1 were similar. However, on the abaxial surface contact angles were of 63 degrees on Vil-1 as compared to 42 degrees on S. A greater glyphosate uptake was observed through the abaxial surface of S. Regarding translocation, glyphosate accumulated mainly in the tip of the treated leaf of Vil-1, 24 h after treatment. It was afterwards also well distributed to the rest of the leaves and roots, as in the susceptible biotype. Nevertheless, 14C-glyphosate remained higher in the foliar apex of Vil-1. Hence, resistance to glyphosate by the Vil-1 Lolium multflorum biotype seems to involve a lower uptake through the abaxial leaf surface and a different migration pattern.

The inferior colliculus of the rat: A quantitative analysis of monaural frequency response areas

Frequency response areas (FRAs) were measured for 237 single units in the inferior colliculus (IC) of urethane-anesthetized pigmented rats using monaural pure-tone stimulation. Based on qualitative criteria [J Neurosci 21 (2001) 7303], FRAs were classified as V-shaped in 69% of neurons, non-V-shaped in 29%, and unclassifiable in the remaining 2%. Non-V-shaped FRAs were heterogeneous, comprising a number of subtypes including narrow, closed, low- and high-tilt, multipeaked, U-shaped, mosaic and inhibitory. To complement this subjective classification, we applied quantitative measures used by others (e.g. [J Neurophysiol 84 (2000) 1012]), including the inverse slope of the upper and lower FRA borders, Q-values, and other measures of bandwidth. The results suggest that FRAs in the rat IC are best described as forming a continuous distribution among subtypes, rather than clustering into discrete categories. Moreover, there is a broad range of frequency tuning characteristics and FRA types across the entire frequency spectrum. Within this general pattern, however, there are some frequency-specific differences in FRA type distribution. The relative proportion of V-shaped FRAs was greatest at the high and low ends of the auditory range, with the highest proportion of non-V-shaped FRAs in the mid-range from 6 to 12 kHz. For most neurons with multipeaked FRAs, the peak frequencies were not harmonically related. Frequency tuning in the pigmented rat IC is generally similar to that in other species. Comparison of Q values across auditory nuclei shows little evidence that FRAs are sharpened at levels above the auditory nerve. Rather, there is a broad range of frequency tuning properties at each level.

Arthroscopic treatment of shoulder stiffness

The optimal treatment of shoulder stiffness remains controversial. The current authors reviewed the results of arthroscopic capsular release of 45 stiff shoulders in 45 patients that was done after the patients did not respond to conservative treatment. There were nine idiopathic frozen shoulders, 21 that had postoperative stiffness, and 15 shoulders with stiffness after trauma. At a mean followup of 26 months (minimum, 12 months), arthroscopic capsular release improved the subjective shoulder value from 25% to 68% and the age- and gender-adjusted Constant-Murley score from 41% to 75%. Pain improved from 4.7 to 10.9 of 15 points. Active, pain-free anterior elevation increased from 90 degrees to 128 degrees and external rotation increased from 14 degrees to 31 degrees. The quality of sleep improved from 0.5 to 1.6 on a two-point scale. The only improvement that did not reach statistical significance was the improvement in the ability to work. A retrospective analysis of the results stratified according to the etiology of stiffness showed that the outcome after treatment of idiopathic stiffness was better than after postoperative stiffness and that the results of treatment for posttraumatic stiffness were least favorable. The difference between preoperative state and followup, however, was not statistically significantly different from one group to another. All groups improved significantly and to a similar degree but the final outcome was related to the initial degree of disability. Arthroscopic release is an effective method for treatment of shoulder stiffness; however, the ultimate outcome is related directly to the severity of stiffness regardless of the etiology.

Differences between coding and non-coding regions in the Trichomonas vaginalis genome: an actin gene as a locus model(1)

The sequence of a cloned genomic fragment of Trichomonas vaginalis containing a complete actin gene was determined. An uninterrupted open reading frame of 1128 nucleotides was found that codes for an actin gene. Two overlapped consensus promoter sequences for T. vaginalis were found 12 nucleotides upstream the actin initiation codon. In addition to actin, two incomplete open reading frames were found at the 5' and 3' ends of the clone. These two sequences are expressed and showed similarity to adenylate cyclase genes and a yeast hypothetical protein. The overall sequence showed a higher G+C content and a lower frequency of repeated sequences in the coding regions when compared with the non-coding regions. A similar unequal nucleotide distribution was found in various T. vaginalis genes retrieved from data bases.

[Percutaneous transluminal treatment of stenoses and obstructions in the venous system using vascular endoprostheses (stents)]

Benign and malignant obstructions of the superior and inferior V. cava and large central veins are often difficult to treat by conservative and surgical means. In this overview we report a new technique which keeps obstructed veins patent by means of percutaneously-inserted metal endoprostheses. The technique allows rapid and lasting relief of the clinical signs of venous inflow obstruction. The high clinical success rate and longterm patency of 70 to 100% in malignant stenoses, and close to 100% in benign obstruction, makes this technique the method of choice for treating superior and inferior inflow obstructions secondary to diseases of the V. cava and the pelvic and brachiocephalic veins. Patients suffering from malignancies benefit in particular from rapid improvement of their quality of life using an effective method with a low complication rate. Vascular stents may also be used in venous outflow stenosis of hemodialysis shunts. However, because of the high recurrence rate secondary to intimal hyperplasia, particularly in peripheral stenoses in the region of the arm, we recommend a conservative attitude. The use of stents is only indicated after one or more trials with conventional balloon angioplasty.

[The palliative treatment of venous stenoses in tumor patients with self-expanding vascular prostheses]

During 53 months 14 patients with tumour-induced obstructions of the superior vena cava (n = 8), the inferior vena cava (n = 2) and iliac veins (n = 4) were treated with self-expandable metallic stents. 21 Wall stents and 5 Gianturco double stents were applied. The follow-up lasted from 2 weeks to 16 months (range = 5.7 months). All patients showed a marked relief of inflow obstruction after stent placement. 6 of 7 patients, who died of their disease during follow-up, were asymptomatic regarding vein obstruction until their death (3 weeks to 16 months). In 6 of 7 still living patients no re-obstruction occurred during follow-up (2 to 16 months). Patency rate was 82%. These results suggest that self-expanding stents are a successful palliative therapy of malignant vein obstructions.

[Colorectal carcinoma following radiotherapy of gynecological carcinoma]

To assess the risk of radiation-induced cancer of the colon we studied 196 patients with a history of radiation treatment for cancer of the female genital system. After a median follow-up of 12.4 years (range 10-15 years) corresponding to 1172 patient-years, 94 (48%) patients were still alive. 84 (89%) of these patients were evaluated for a second primary cancer to the colon. In 38 (45%) colonoscopic examination was performed. 3 patients were found to have a second primary cancer to the colon compared with 0.32 expected (relative risk 9.3) on the basis of rates from the Zürich Tumor Registry. Due to partial long-term survival, patient non-compliance and non-feasibility of colonoscopic examination, only one fourth of all patients initially treated by radiotherapy for cancers of the female genital system were suitable for colon screening. For these high risk women, colorectal tumor screening should be integrated into a gynecologic tumor follow-up.