Supervised Machine Learning Methods and Hyperspectral Imaging Techniques Jointly Applied for Brain Cancer Classification

Hyperspectral imaging techniques (HSI) do not require contact with patients and are non-ionizing as well as non-invasive. As a consequence, they have been extensively applied in the medical field. HSI is being combined with machine learning (ML) processes to obtain models to assist in diagnosis. In particular, the combination of these techniques has proven to be a reliable aid in the differentiation of healthy and tumor tissue during brain tumor surgery. ML algorithms such as support vector machine (SVM), random forest (RF) and convolutional neural networks (CNN) are used to make predictions and provide in-vivo visualizations that may assist neurosurgeons in being more precise, hence reducing damages to healthy tissue. In this work, thirteen in-vivo hyperspectral images from twelve different patients with high-grade gliomas (grade III and IV) have been selected to train SVM, RF and CNN classifiers. Five different classes have been defined during the experiments: healthy tissue, tumor, venous blood vessel, arterial blood vessel and dura mater. Overall accuracy (OACC) results vary from 60% to 95% depending on the training conditions. Finally, as far as the contribution of each band to the OACC is concerned, the results obtained in this work are 3.81 times greater than those reported in the literature.

The Other Side of SARS-CoV-2 Infection: Neurological Sequelae in Patients

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread around the globe causing coronavirus disease 2019 (COVID-19). Because it affects the respiratory system, common symptoms are cough and breathing difficulties with fever and fatigue. Also, some cases progress to acute respiratory distress syndrome (ARDS). The acute phase of COVID-19 has been also related to nervous system symptoms, including loss of taste and smell as well as encephalitis and cerebrovascular disorders. However, it remains unclear if neurological complications are due to the direct viral infection of the nervous system, or they appear as a consequence of the immune reaction against the virus in patients who presented pre-existing deficits or had a certain detrimental immune response. Importantly, the medium and long-term consequences of the infection by SARS-CoV-2 in the nervous system remain at present unknown. This review article aims to give an overview of the current neurological symptoms associated with COVID-19, as well as attempting to provide an insight beyond the acute affectation.

SAT0386 USEFULNESS OF THE FECAL CALPROTECTIN AS SCREENING TOOL FOR INFLAMMATORY BOWEL DISEASE IN PATIENTS WITH SPONDYLOARTHRITIS AND NO DIGESTIVE SYMPTOMS

Background:

Fecal calprotectin (FC) is a biomarker of bowel inflammation widely spread in diagnosis and follow-up of inflammatory bowel disease (IBD). It is classically estimated that 5% of patients with axial spondyloarthritis (SpA) also have IBD; coexistence of both conditions has definite impact in clinical decisions. Proactive detection of both diseases should be advisable, though appropriate screening tools are still lacking.

Objectives:

To evaluate the usefulness of FC for the diagnosis of IBD in patients diagnosed with SpA with no clinical suggestive manifestations or previous diagnosis of IBD.

Methods:

Patients from a Rheumatology clinic diagnosed with SpA who met ASAS criteria and did not present digestive symptoms suggestive of IBD were consecutively included. Demographics, clinical and analytical data of SpA (uveitis, HLA B27, acute phase reactants) at the time of inclusion, and treatment history were collected. Patients with a positive FC (> 50 mg/Kg) underwent ileocolonoscopy with biopsies of colon and terminal ileum. Patients who were recommended to avoid NSAIDs 2-4 weeks before stool collection and endoscopy.

Patients with no endoscopic findings underwent a second determination of fecal calprotectine. If persisted positive, capsule endoscopy was performed to evaluate small intestine.

Results:

98 patients included; 47% male, mean age 46.1 (20-74) years. BASDAI 3.6 ± 2.5. HLA B27 positive in 78% of patients, high ESR in 31.6%, high CRP in 9.2%. FC positive in 49 patients (50%): mean 147 mg/kg (range 0-3038).

47 underwent ileocolonoscopy: In 13 cases (26.5%), endoscopic findings were suggestive of IBD (7 Crohn’s disease and 1 ulcerative colitis). Microscopic inflammation was found in 2 additional cases. Among those 34 patients with normal ileocolonoscopy, 16 patients refused further investigations; among the remining 18 patients, a second FC was positive in 16. Capsule endoscopy showed findings suggestive of small intestine IBD in 6 additional patients.

In patients with high FC levels,those with high CRP and ESR were more likely to have IBD(29% v 16% and 29% v 12% respectively). Patients with a history ofuveitis(18% vs 12%) orpsoriasis(33% v 16%) also had a higher prevalence of IBD, although none of those differences reached statistical significance.

FC was higher insmokers(72%v 44%; p=0.03). There were no significant differences regarding HLA B27. No statistically significant differences were found in FC between patients with high FC who were diagnosed with IBD and those who were not.

Conclusion:

In our study, patients with SpA and no clinical feature suggestive of IBD who showed FC> 50 mg/kg had high prevalence of IBD, which could indicate theusefulness of FC as screening tool for IBD in patients with SpA.

Patients with SpA and other immune-mediated condition or elevated CRP, seem to be more likely to have subclinical IBD.

Disclosure of Interests:

None declared

Patients' satisfaction with anatomic polyurethane implants

This paper presents patients satisfaction using anatomical polyurethane breast implants. We performed surgery on 525 patients, 370 of which were primary and 155 were secondary to various causes such as capsular contracture, ruptured implants, volume changes, and incorrect positioning of the implant. The advantages of silicone polyurethane covers shown high level of patient satisfaction, low incidence of capsular contracture, and absence of implant rotation, and late seroma.

Brain-derived neurotrofic factor and its receptor TrkB are present, but segregated, within mature cutaneous Pacinian corpuscles of Macaca fascicularis

Some mechanoreceptors in mammals depend totally or in part on the neurotrophins brain-derived neurotrophic factor (BDNF) and neurotrophin-4 (NT-4), and their receptor TrkB, for development and maintenance. These actions are presumably exerced regulating the survival of discrete sensory neurons in the dorsal root ganglia which form mechanoreceptors at the periphery. In addition, the cells forming the mechanoreceptors also express both neurotrophins and their receptors although large differences have been described among species. Pacinian corpuscles are rapidly adapting low-threshold mechanoreceptors whose dependence from neurotrophins is not known. In the present study, we analyzed expression of TrkB and their ligands BDNF and NT-4 in the cutaneous Pacinian corpuscles of Macaca fascicularis using immunohistochemistry and fluorescent microscopy. TrkB immunoreactivity was found in Pacinian corpuscles where it co-localized with neuron-specific enolase, and occasionally with S100 protein, thus suggesting that TrkB expression is primarily into axons but also in the lamellar cells and even in the outer core. On the other hand, BDNF immunoreactivity was found the inner core cells where it co-localized with S100 protein but also in the innermost layers of the outer core; NT-4 immunostaining was not detected. These results describe for the first time the expression and distribution of a full neurotrophin system in the axon-inner core complex of mature Pacinian corpuscles. The data support previous findings demonstrating large differences in the expression of BDNF-TrkB in mammalian mechanoreceptors, and also suggest the existence of a retrograde trophic signaling mechanism to maintain morphological and functional integrity of sensory neurons supplying Pacinian corpuscles.

Calcium-activated potassium channel SK1 is widely expressed in the peripheral nervous system and sensory organs of adult zebrafish

Sensory cells contain ion channels involved in the organ-specific transduction mechanisms that convert different types of stimuli into electric energy. Here we focus on small-conductance calcium-activated potassium channel 1 (SK1) which plays an important role in all excitable cells acting as feedback regulators in after-hyperpolarization. This study was undertaken to analyze the pattern of expression of SK1 in the zebrafish peripheral nervous system and sensory organs using RT-PRC, Westernblot and immunohistochemistry. Expression of SK1 mRNA was observed at all developmental stages analyzed (from 10 to 100 days post fertilization, dpf), and the antibody used identified a protein with a molecular weight of 70kDa, at 100dpf (regarded to be adult). Cell expressing SK1 in adult animals were neurons of dorsal root and cranial nerve sensory ganglia, sympathetic neurons, sensory cells in neuromasts of the lateral line system and taste buds, crypt olfactory neurons and photoreceptors. Present results report for the first time the expression and the distribution of SK1 in the peripheral nervous system and sensory organs of adult zebrafish, and may contribute to set zebrafish as an interesting experimental model for calcium-activated potassium channels research. Moreover these findings are of potential interest because the potential role of SK as targets for the treatment of neurological diseases and sensory disorders.

Clinical responses to antidepressants among 1036 acutely depressed patients with bipolar or unipolar major affective disorders

OBJECTIVE

Whether responses to antidepressants differ in bipolar and unipolar depression remains unresolved.

METHOD

We analyzed patient characteristics and outcomes of antidepressant treatment of 1036 depressed patients with bipolar-I or bipolar-II disorder, or unipolar major depression, using bivariate and multivariate methods and survival analysis, testing the hypothesis that responses would be superior in unipolar depression.

RESULTS

Antidepressants were given to 84.8% (878/1036) of depressed patients: 58.9% of 93 bipolar-I, 80.1% of 117 bipolar-II, and 91.3% of 668 unipolar disorder cases. The 158 not given antidepressants had more manias/year, spent more months in mania and depression, and were far more likely to receive mood stabilizers or antipsychotics long term. Improvement of HDRS21 depression ratings ranked: bipolar-II (69.6%) > bipolar-I (62.9%) > unipolar (57.9%; P < 0.0001), independent of initial illness severity. Responder rates (≥50% improved without switching) ranked: bipolar-II (77.0%) > bipolar-I (71.6%) > unipolar (61.7%; P < 0.0001). Remission rates (final HDRS < 7) ranked: 54.0%, 50.6%, and 40.8% respectively (P = 0.02); 67.5% remitted within 12 weeks of treatment. Survival-computed median time to remission (15.0 weeks, overall) was shortest for bipolar-II patients (10.7 weeks). The 3-month risk of switching into mania-hypomania ranked: bipolar-II (15.8%) > bipolar-I (8.60%) > unipolar (0.56%). Multivariate modeling found bipolar diagnosis, shorter latency to remission, more recent trial year, and fewer weeks depressed before treatment to be associated with greater percent improvement of HDRS ratings.

CONCLUSION

Selective use of antidepressants with or without mood stabilizers in non-agitated, depressed bipolar disorder patients for short periods was effective with moderate risk of potentially dangerous, manic mood elevation.

Ontologies in medicinal chemistry: current status and future challenges

Recent years have seen a dramatic increase in the amount and availability of data in the diverse areas of medicinal chemistry, making it possible to achieve significant advances in fields such as the design, synthesis and biological evaluation of compounds. However, with this data explosion, the storage, management and analysis of available data to extract relevant information has become even a more complex task that offers challenging research issues to Artificial Intelligence (AI) scientists. Ontologies have emerged in AI as a key tool to formally represent and semantically organize aspects of the real world. Beyond glossaries or thesauri, ontologies facilitate communication between experts and allow the application of computational techniques to extract useful information from available data. In medicinal chemistry, multiple ontologies have been developed during the last years which contain knowledge about chemical compounds and processes of synthesis of pharmaceutical products. This article reviews the principal standards and ontologies in medicinal chemistry, analyzes their main applications and suggests future directions.

Comparison of antidepressant responses in patients with bipolar vs. unipolar depression: a meta-analytic review

BACKGROUND

Since there is considerable uncertainty about therapeutic responses to antidepressants among depressed patients diagnosed with bipolar (BP) vs. unipolar (UP) mood disorders, we have reviewed available studies that compared both types of depressed patients.

METHODS

Extensive computerized literature-searching identified reports of antidepressant studies involving both BP and UP depressed patients. We used random-effects meta-analysis to compare short-term drug responses by patient type, as well as meta-regression modeling for effects of selected covariates.

RESULTS

We identified only 10 studies meeting even liberal inclusion criteria, and they varied greatly in size and design quality. The overall difference in antidepressant responses between BP (n=863) and UP (n=2 226) disorder patients was not significant (pooled RR=1.05; CI: 0.96-1.15; P=0.34). Based on meta-regression, we also found no difference in responses based on diagnosis or subtype, subjects/study, % women, average age, or length of treatment based on meta-regression. Risk of manic-switching averaged 2.50 vs. 0.275%/week among BP vs. UP disorder patients, including co-treatment with mood stabilizers in 70% of BP patients.

COMMENTS

The findings suggest little difference in antidepressant responses by diagnostic type, sex, or other factors considered, but a substantial risk of mania and hypomania with BP disorders. However, data pertaining to the fundamental question of antidepressant response among BP vs. UP depressed patients were strikingly limited, and support only tentative conclusions. Additional, well-designed, prospective trials of matched BP and UP depression patients and controlled treatment are required.

Mania associated with antidepressant treatment: comprehensive meta-analytic review

OBJECTIVE

To review available data pertaining to risk of mania-hypomania among bipolar (BPD) and major depressive disorder (MDD) patients with vs. without exposure to antidepressant drugs (ADs) and consider effects of mood stabilizers.

METHOD

Computerized searching yielded 73 reports (109 trials, 114 521 adult patients); 35 were suitable for random effects meta-analysis, and multivariate-regression modeling included all available trials to test for effects of trial design, AD type, and mood-stabilizer use.

RESULTS

The overall risk of mania with/without ADs averaged 12.5%/7.5%. The AD-associated mania was more frequent in BPD than MDD patients, but increased more in MDD cases. Tricyclic antidepressants were riskier than serotonin-reuptake inhibitors (SRIs); data for other types of ADs were inconclusive. Mood stabilizers had minor effects probably confounded by their preferential use in mania-prone patients.

CONCLUSION

Use of ADs in adults with BPD or MDD was highly prevalent and moderately increased the risk of mania overall, with little protection by mood stabilizers.

Development of an alarm management system to manage those alarms occurred during the illness prevention and management inside and outside the hospital environment

A great amount of information is available to be exploited thanks to the use of information technologies. However, the systems that analyze this data lack the ability to alert the right clinical staff to important events, having some of the latest developments centered on the possibility of sending events from specific areas. The following system tries to solve these dependencies and offers a unique system capable of analyzing any data source and communicates the alarms through different means in an effective way.

[The challenge of Web 2.0-based <<virtual ICU>>]

Intensive medicine has the opportunity to create an interactive virtual community using Web 2.0. The main feature of this new web generation is to convert the user into an active element of the virtual world, allowing the passive, information-searching user to become one who creates, shares, participates and closely relates to it. These features make it possible for the clinical sphere, the researcher and the innovator to coincide, thus providing interaction not only among the members of the virtual community but also with citizens and patients. The creation of a Web 2.0-based <<Virtual ICU>> represents an opportunity for improvement as well as an added value for intensive medicine.

The importance of the areolar smooth muscle in augmentation mastoplasty

Publications about breast implant surgery using the periareolar incision and those about mastoplasty do not mention the areolar smooth muscle. The purpose of this article is to present the importance that suturing the areolar smooth muscle may have in the prognosis of intra-areolar incisions in breast surgery and in the areola shape changes when it contracts after surgery.

[Professional competence for the care of critical patients: beyond specialities]

OBJECTIVE

To elaborate a working document to describe the professional competence (knowledge, skills, and attitudes) required of a physician for the care of critical patients, regardless of the physician's specialty and centered on the patients' needs.

METHODS

This study was carried out through field work using qualitative methodology over the 12-month period comprising 2004. The document was elaborated in four stages: 1) conceptual delimitation; 2) selection of working definitions and classifications; 3) identification of knowledge, skills, and attitudes necessary for the management of critical patients; and 4) final draft of the competence document.

RESULTS

A total of 146 areas of competence were identified; of these, 33% were related to knowledge, 52% to skills, and the remaining 15% to attitudes.

CONCLUSIONS

This study can help to ensure that critical patients will be cared for by physicians capable of identifying their problems and managing them appropriately, regardless of the physicians' specialty background. In responding to this situation, the document recognizes the participation of physicians trained in diverse specialties in the care of the critical patient by scaling the knowledge required at different levels of care.

Polyurethane-coated silicone gel breast implants used for 18 years

This study aimed to present an update on the use of polyurethane-coated silicone gel breast implants. After 18 years of experience using these implants and 1,257 surgically treated patients, the authors can draw some new conclusions. Their postoperative follow-up evaluation of 300 patients for 5 years, 250 patients for 10 years, and 180 patients for 15 years has shown the lowest incidence of fibrous capsular contraction (1%) with these implants.

Adsorption of phenol on formaldehyde-pretreated Pinus pinaster bark: equilibrium and kinetics

This work studies phenol adsorption on Pinus pinaster bark that has been previously treated with formaldehyde in acid medium. The influence of several variables such as solid/liquid ratio, pH and initial concentration of phenol in the solution on the adsorption capacity of the bark has been analysed. A kinetic model based on phenol diffusion within the pores of the adsorbent was in agreement with the results obtained for high initial concentrations of phenol, allowing the determination of diffusion coefficients. Adsorption equilibrium data were fitted by the Freundlich and BET isotherms. From their parameters phenol adsorption capacity and intensity, as well as the specific surface (BET) of the adsorbent, were determined.

A subgroup of HOX Abd-B gene is differentially expressed in cervical cancer

The HOX genes are a family of transcription factors that bind to specific sequences of DNA in target genes regulating their expression. The role of HOX genes in adult cell differentiation is still obscure, but growing evidence suggests that they may play an important role in the development of cancer. In order to study the role of the HOX Abd-B genes in cervical cancer, we analyzed their expression in cervical tissues. Reverse transcription-polymerase chain reaction and RNA in situ hybridization were used to detect HOX Abd-B messenger RNA expression in nine normal cervical tissues and ten cervical carcinomas. The normal tissues were human papillomavirus (HPV) negative, whereas all invasive carcinomas included were HPV16 positive. In this study, we show that HOXA9, A10, A11, A13, B9, D11, and D13 genes are expressed in both the epithelium of normal tissues and neoplastic cells from squamous cervical carcinomas. Interestingly, the HOXC10 and D12 genes were not expressed in any cervical tissues; however, HOXB13, C9, C11, C12, C13, D9, and D10 genes were expressed only in the tumoral tissues but not in the normal cervix. Our findings suggest that the expression of HOXB13, D9, D10, and HOXC cluster (HOXC9, C11-C13) genes might be an important step involved in cervical cancer.

U.S. Department of Energy policies, directives, and guidance for radiological control and release of property

U.S. Department of Energy (U.S. DOE) regulates its operations with a system of rules, directives, and guidance under the Atomic Energy Act. U.S. DOE's policy is to conduct its radiological operations in a manner that ensures the health and safety of its employees, contractors, and the public. U.S. DOE uses an annual dose limit of 100 mrem (1 mSv) with an "as low as reasonably achievable" (ALARA) process to achieve radiological protection. The primary directive for radiation protection of the public and the environment is DOE Order 5400.5. It contains requirements for the protection of the public and the environment from routine operations, including controlling and releasing property. Since the publication of Order 5400.5 in 1990, U.S. DOE has issued guidance for meeting requirements under it; Guide G 441.1-xx consolidates this guidance. DOE applies a dose constraint of 25 mrem y (0.25 mSy y(-1)), plus ALARA, for the release of real property, and 1 mrem y(-1), plus ALARA, for release of personal property. Models and guidance to develop the needed documentation for release of property are easily available and user-friendly. While achieving protection of human health and the environment, U.S. DOE's dose-based release process has resulted in significant cost savings. U.S. DOE has recently adopted a management systems approach for general environmental and public protection programs. The integration of the radiation protection program into this new approach is a high priority.

Optimized Symbolic Dynamics Approach for the Analysis of the Respiratory Pattern

Traditional time domain techniques of data analysis are often not sufficient to characterize the complex dynamics of respiration. In this paper, the respiratory pattern variability is analyzed using symbolic dynamics. A group of 20 patients on weaning trials from mechanical ventilation are studied at two different pressure support ventilation levels, in order to obtain respiratory volume signals with different variability. Time series of inspiratory time, expiratory time, breathing duration, fractional inspiratory time, tidal volume and mean inspiratory flow are analyzed. Two different symbol alphabets, with three and four symbols, are considered to characterize the respiratory pattern variability. Assessment of the method is made using the 40 respiratory volume signals classified using clinical criteria into two classes: low variability (LV) or high variability (HV). A discriminant analysis using single indexes from symbolic dynamics has been able to classify the respiratory volume signals with an out-of-sample accuracy of 100%.

Outcome predictors of pneumonia in elderly patients: importance of functional assessment

OBJECTIVES

To evaluate the outcome of elderly patients with community-acquired pneumonia (CAP) seen at an acute-care hospital, analyzing the importance of CAP severity, functional status, comorbidity, and frailty.

DESIGN

Prospective observational study.

SETTING

Emergency department and geriatric medical day hospital of a university teaching hospital.

PARTICIPANTS

Ninety-nine patients aged 65 and older seen for CAP over a 6-month recruitment period.

MEASUREMENTS

Clinical data were used to calculate Pneumonia Severity Index (PSI), Barthel Index (BI), Charlson Comorbidity Index, and Hospital Admission Risk Profile (HARP). Patients were then assessed 15 days later to determine functional decline and 30 days and 18 months later for mortality and readmission. Multiple logistic regression was used to analyze outcomes.

RESULTS

Functional decline was observed in 23% of the 93 survivors. Within the 30-day period, case-fatality rate was 6% and readmission rate 11%; 18-month rates were 24% and 59%, respectively. Higher BI was a protective factor for 30-day and 18-month mortality (odds ratio (OR)=0.96, 95% confidence interval (CI)=0.94-0.98 and OR=0.97, 95% CI=0.95-0.99, respectively; P<.01), and PSI was the only predictor for functional decline (OR=1.03, 95% CI=1.01-1.05; P=.01). Indices did not predict readmission. Analyses were repeated for the 74 inpatients and indicated similar results except for 18-month mortality, which HARP predicted (OR=1.73; 95% CI=1.16-2.57; P<.01).

CONCLUSION

Functional status was an independent predictor for short- and long-term mortality in hospitalized patients whereas CAP severity predicted functional decline. Severity indices for CAP should possibly thus be adjusted in the elderly population, taking functional status assessment into account.

Relevance of genetically determined host factors to the prognosis of meningococcal disease

To assess the relevance of genetically determined host factors for the prognosis of meningococcal disease, Fc gamma receptor IIA (FcgammaRIIA), the tumor necrosis factor alpha (TNF-alpha) gene promoter region, and plasminogen-activator-inhibitor-1 (PAI-1) gene polymorphisms were studied in 145 patients with meningococcal disease and in 290 healthy controls matched by sex. Distribution of FcgammaRIIA, TNF-alpha, and PAI-1 alleles was not significantly different between patients and controls. Patients with the FcgammaRIIA-R/R 131 allotype scored > or =1 point in the Barcelona prognostic system more frequently than patients with other allotypes (odds ratio, 18.6; 95% confidence interval, 7.1-49.0, P<0.0001), and they had a higher risk of sequelae (odds ratio, 3.5; 95% confidence interval, 1.1-11.7; P=0.03). Fc gamma receptor IIA polymorphism was associated with markers of disease severity, but TNF-alpha and PAI-1 polymorphisms were not.

Are there clinical or serological differences between male and female patients with primary Sjögren's syndrome?

OBJECTIVE

Sjögren's syndrome (SS) is a chronic inflammatory autoimmune disease. It can be primary (pSS) or secondary (sSS) and is observed 90% more in women than in men, mainly in the fourth and fifth decades of life. We investigated the prevalence of serological and clinical manifestations in male and female patients with primary SS.

METHODS

We analyzed 521 female and 28 male patients with pSS between 1993 and 2001. All patients fulfilled > or = 4 of the 1993 European Community Study Group criteria.

RESULTS

Men presented higher concentrations of IgA, rheumatoid factor, and antinuclear antibodies than women. A higher percentage of women than men reported fibromyalgia, thyroidal manifestations, and carpal tunnel syndrome. There were no statistical differences between the 2 groups in relation to the presence of Raynaud's phenomenon, arthritis, erosive osteoarthritis, liver disease, or other visceral manifestations.

CONCLUSION

The pattern of SS in our cohort of patients reveals a difference between male and female patients, in contrast with earlier studies.

Unmasking influenza virus infection in patients attended to in the emergency department

Background:

Infection by the influenza virus may pass undetected in many adult patients attended to in the emergency department because its diagnosis usually relies on clinical manifestations, which can be distorted by symptoms of a preexisting disease, superposed complications or nontypical manifestations of influenza virus infection (confusing symptoms).

Patients and Methods:

We performed this observational, prospective study with an antigen detection test by indirect immunofluorescence assay (IFA) to estimate the presence of influenza virus infection in such patients. No confirmatory test was performed to validate a positive or negative IFA result. Then we compared those who were antigen positive to those who were negative and also analyzed those who were positive classified by age, comorbidity and clinical presentation. We also evaluated the use of medical and hospital resources and vaccination status. Posterior pharynx swab specimens from 136 consecutive adult patients, 74 women and 62 men with a mean age of 68.7 ± 17.9 (range: 18–97) years attended to in the emergency department of a university hospital in Barcelona during the 1999–2000 influenza epidemic were examined. Tested patients presented either a classical influenza syndrome, a deterioration of a previous condition or any abrupt onset of symptoms without an obvious cause.

Results:

Influenza A virus antigen was detected in 99 (72.8%) of the 136 patients included in the study. Confusing symptoms were present in 86 patients with laboratoryconfirmed influenza and 40 of them lacked influenza syndrome. Prostration, aching and fever out of proportion to catarrhal symptoms (disproportionate prostration) and cough were independent predictors for this diagnosis (OR = 5.14; 95% CI: 1.98–13.35, p = 0.001 and OR = 4.40, 95% CI, 1.65–11.75, p = 0.03, respectively). Among the 99 patients who tested positive, 72 were ≥ 65 years of age. This older positive group compared to the 27 also positive < 65 (non-old) had a tendency to show symptoms mediated by cytokines less frequently: malaise was present in 76.4% of the older positive patients vs 92.6% in the non-old positive ones, p = 0.07. The equivalent percentages for muscle ache were: 56.9% vs 77.8%, p = 0.06; for dysthermia: 54.2% vs 70.4%, p = 0.08; for headache: 35.2% vs 66.7%, p = 0.005, and for disproportionate prostration: 47.2% vs 66.7%, p = 0.08. Cough was more frequent in the older positive group: 94.4% vs 77.8%, p = 0.02. Older positive patients were also hospitalized and received antibiotics more frequently than the non-old positive ones: 65.3% vs 40.7%, p = 0.03 and 81.9% vs 63.0%, p = 0.046, respectively. Hospitalization was independently correlated with the presence of complications (OR = 4.5, 95% IC 1.27–15.95, p = 0.02). Patients with the highest comorbidity, evaluated with the Charlson scale, were more inadequately vaccinated than those with moderate or low comorbidity.

Conclusion:

Influenza virus infection has a great and underestimated impact in the emergency department during influenza epidemics. High frequency of confusing symptoms, which overcome classical influenza syndrome in adult people with comorbidity, may explain this effect. Disproportionate prostration and cough are symptoms that independently predict its diagnosis in the global adult population, whereas in the elderly, fever and cough should arouse this suspicion whether or not they present classic symptoms. In our setting, individuals with high comorbidity are inadequately vaccinated.

Planar waveguide lasers by proton implantation in Nd:YAG crystals

The performance of CW Nd:YAG waveguide lasers operating at 1.06 microm at room temperature is described. The waveguides were fabricated by proton implantation and the main differences in the process of fabrication were the angle of implantation and the total dose implanted. The characterization of the waveguide refractive index profile induced by proton implantation and the main laser characteristics i.e., slope efficiency and threshold are presented.

Variability analysis of the respiratory volume based on non-linear prediction methods

This work proposed and studied a method of automatically classifying respiratory volume signals as high or low variability by means of non-linear analysis of the respiratory volume. The analysis used volume signals generated by the respiratory system to construct a model of its dynamics and to estimate the quality of the predictions made with the model. Different methods of prediction evaluation, prediction horizons and embedding dimensions were also analysed. Assessment of the method was made using a database that contained 40 respiratory volume signals classified using clinical criteria into two classes: low or high variability. The results obtained using the method of surrogate data provided evidence of non-linear determinism in the respiratory volume signals. A discriminant analysis carried out using non-linear prediction variables classified the respiratory volume signals with an accuracy of 95%.

Effect of veneer side wettability on bonding quality of Eucalyptus globulus plywoods prepared using a tannin-phenol-formaldehyde adhesive

The influence of rotary peeling on the different behaviour of tight and loose sides of Eucalyptus globulus veneers has been studied. The presence of lathe checks on the loose sides favours wettability, the contact angle decreasing more rapidly on these sides than on tight sides. Additionally, pine bark tannins improved wettability due to their surfactant character. Bonding quality tests carried out on plywoods prepared using a tannin-phenol-formaldehyde adhesive showed that fracture almost invariably occurred in a glue line with at least one loose side, where wood failure appeared. This behaviour, confirmed by analysing the glue lines by means of fluorescence microscopy, was due to the large surface alterations of the loose sides which reduced mechanical strength but allowed greater penetration of the adhesive giving rise to high wood failure.

Postnatal differentiation of the immunohistochemical expression of aromatase P450 in the rat pituitary gland

At our laboratory, we have recently demonstrated the immunohistochemical expression of aromatase P450 in the pituitary glands of adult rats; this expression was seen to be sex-dependent. In order to determine whether the changes in the expression of the enzyme are related to changes in the gonadal sphere and whether the expression of the enzyme is related to the postnatal differentiation of hypophyseal cytology, in the present work we performed an immunohistochemical study in the rat pituitary gland from birth to old age. The immunohistochemical reaction to aromatase was evident and very generalized at 7 days after birth, with no large differences between the male and female animals. At 14 days the immunohistochemical reaction was decreased in the females, with no changes in the males. At 17 days, aromatase immunoreactivity in the pituitary glands of female rats was very weak whereas the males showed large numbers of reactive cells. These observations were further pronounced at 21 days and 2 months of life. At 24 months, the immunoreactivity found in the pituitary glands of the male rats had almost completely disappeared. Our results show that a postnatal differentiation in the immunohistochemical expression of aromatase occurs; this is tightly linked to sexual activity and is lost in old age. This suggests that hypophyseal aromatase would be related to the mechanisms of action of gonadal steroids on hypophyseal differentiation and secretion.

Fat Distribution and Metabolic Abnormalities in HIV-Infected Patients on First Combination Antiretroviral Therapy Including Stavudine or Zidovudine: Role of Physical Activity as a Protective Factor

Objective

To compare body composition, serum lipid profile, parameters of insulin secretion and endocrine measurements in HIV-1-infected patients whose first combination antiretroviral regimen differed only in a nucleoside reverse transcriptase inhibitor (NRTI).

Design and setting

Cross-sectional study in an AIDS clinic of a university hospital.

Patients

One-hundred-and-fifty HIV-infected patients on long-term first highly active antiretroviral therapy including stavudine (n=75) or zidovudine (n=75).

Main outcome measure

Fat wasting was assessed by physical examination. Regional fat distribution was estimated using calliper measurements of skinfold thickness at four sites. Central adiposity was assessed by measurement of waist–hip ratio. Fasting glucose, insulin, triglyceride, cholesterol and its fractions, testosterone, follicle stimulating hormone, luteinizing hormone levels, CD4 cell count and HIV viral load were determined. Daily caloric intake and physical activity level were also calculated.

Results

Total body fat was significantly lower in patients taking stavudine, whereas the lean body mass was not statistically different amongst both groups. Ninety-four patients (62.7%; 95% CI: 54.9–70.4%) had fat redistribution, being isolated lipoatrophy in 20 (13.3%; 95% CI: 7.9–18.8%), isolated lipohypertrophy in 33 (22.0%; 95% CI: 15.4–28.6%) and mixed syndrome in 41 (27.3%; 95% CI: 20.2–34.5%). There were not statistically significant differences between stavudine- and zidovudine-treated patients with respect to the overall prevalence of fat redistribution syndromes (P=0.34). The prevalence of lipoatrophy (OR=1.86; 95% CI: 0.58–6.33, P=0.37), lipohypertrophy (OR=0.65; 95% CI: 0.25–1.69, P=0.45) and mixed syndromes (OR=1.05; 95% CI: 0.43–2.54, P=0.93) was not statistically different in both groups of patients. The only independent predictor for the appearance of mixed syndrome and lipoatrophy was sedentarism (OR=4.418; 95% CI: 1.565–12.472, P=0.005) and (OR=4.515; 95% CI: 1.148–17.761, P=0.03), respectively. Independent predictors of lipohypertrophy were age (OR=1.138; 95% CI: 1.061–1.220, P<0.0001) and prior AIDS (OR=0.305; 95% CI: 0.100–0.931, P=0.04). There were no statistically significant differences between stavudine and zidovudine-based groups with respect to metabolic and hormonal parameters.

Conclusion

The use of stavudine or zidovudine in the context of the first combination antiretroviral therapy is not associated either with an increased likelihood of lipid or gonadal hormones abnormalities, and although there was a trend to a lesser body fat content in the stavudine group, there was no increase in the overall likelihood of fat redistribution syndromes with respect to zidovudine group. Physical activity is a protective factor for the development of fat redistribution syndromes.