Eight months of continuous positive airway pressure (CPAP) decrease tumor necrosis factor alpha (TNFA) in men with obstructive sleep apnea syndrome

Objectives: The aim of this study was to assess serum tumor necrosis factor alpha (TNFA) concentrations 8months of continuous positive airway pressure (CPAP) therapy. Design: This study used prospective, observational clinical trial. Patients: Sixty-six patients with newly diagnosed sleep apnea syndrome (12 women, 54 men), age 52.3 ± 9.8 (mean ± SD) with a body mass index of 29.7 ± 4.4 and an apnea-hypopnea index of 39.7 ± 26.8, were studied. Intervention: CPAP was administered for a mean of 7.8 ± 1.3months. Measurements and results: TNFA concentrations using an ultrasensitive ELISA assay at baseline and follow-up. TNFA decreased in men with high (5.2 ± 1.7h/night, −0.46 ± 1.1ng/l, p = 0.001) and with low (2.5 ± 1.0h/night −0.63 ± 0.77ng/l, p = 0.001) adherence but not in women. Average number of hours of CPAP use correlated positively with delta TNFA (R 2 0.08, p = 0.04) Conclusion: Long-term CPAP positively affects TNFA even in men with poor adherence to CPA

Cytotoxicity of titanium and silicon dioxide nanoparticles

Different TiO 2 and SiO 2 nanoparticles have been tested concerning their toxicity on selected mammalian cell lines. Various powders and suspensions, all of which consist of titanium or silicon dioxide nanoparticles have been examined. These particles differ in the crystal structure, the size and the BET-surface area. There was also a classification in fixed particles and in particles easily accessible in solution. With focus on the possible adsorption of the nanoparticles into the human organism, via skin and via respiratory tract, the effects on fibroblasts (NIH-3T3) and on a human lung adenocarcinoma epithelial cell line were examined. Additionally, the particles were tested with HEP-G2 cells, which are often used as model cell line for biocompatibility tests, and PC-12 cells, a rat adrenal pheochromocytoma cell line. The viability of the cells was examined by the MTT-test. The viability results were found to partly depend on the type of cells used. The experimental results show that the adhesion of the cells on the different powders strongly depends on the type of cell lines as well as on the type of powder. It was found that the lower viability of some cells on the powder coatings is not only caused by a cytotoxicity effect of the powders, but is also due to a lower adhesion of the cells on the particle surfaces. Furthermore, it could be shown that the physical properties of the powders cannot be easily correlated to any observed biological effect. While some powders show a significant suppression of the cell growth, others with similar physical properties indicate no toxic effect

N-terminal pro-B-type natriuretic peptide and functional capacity in patients with obstructive sleep apnea

The obstructive sleep apnea syndrome (OSAS) is associated with cardiovascular abnormalities including left ventricular hypertrophy, left ventricular diastolic dysfunction, and endothelial dysfunction. The present study evaluated whether N-terminal pro-B-type natriuretic peptide (NT-proBNP) and peak oxygen consumption (peak VO2), both integral markers of cardiovascular function, are related to OSAS severity. In addition, we tested whether NT-proBNP levels depend on body composition in OSAS patients, similar to what has been reported in patients without OSAS. Eighty-nine patients with untreated OSAS underwent NT-proBNP measurement, dual X-ray absorptiometry, and cardiopulmonary exercise testing. In a representative subgroup (n = 32), transthoracic echocardiography was performed. The severity of OSAS was classified based on apnea-hypopnea index (AHI) values as mild (AHI 5-15h−1), moderate (AHI 15-30h−1), and severe (AHI >30h−1). OSAS was mild in 19 (21%), moderate in 21 (24%), and severe in 49 (55%) patients. NT-proBNP levels did not differ among patients with mild [30 (10-57)], moderate [37 (14-55)], and severe [24 (13-49) pg/ml; p = 0.8] OSAS and were not related to body mass index (r = 0.07; p = 0.5), percent lean body mass (r = −0.17; p = 0.1), and percent fat mass (r = 0.18; p = 0.1). Percent predicted peak VO2 was on average normal and did not differ among patients with mild (115 ± 26), moderate (112 ± 23), and severe OSAS (106 ± 29%; p = 0.4). Body weight-indexed peak VO2 did not differ among patients with mild (31.9 ± 10.3), moderate (32.1 ± 7.9), and severe OSAS (30.0 ± 9.9ml kg−1 min−1; p = 0.6) either. Lower NT-proBNP (β = −0.2; p = 0.02) was independently but weakly associated with higher body weight-indexed peak VO2. In the echocardiography subgroup, NT-proBNP was not significantly related to left ventricular mass index (r = 0.26; p = 0.2). In conclusion, NT-proBNP and peak VO2 are not related to OSAS severity, and NT-proBNP poorly reflects left ventricular hypertrophy in OSAS. The lack of a relationship between NT-proBNP and OSAS severity is not due to a significant influence of body composition on NT-proBNP. There is an association between higher NT-proBNP and lower peak VO2, indicating that NT-proBNP is a marker of cardiorespiratory fitness in patients with OSAS. However, the association is too weak to be clinically usefu

Reformbedarf: Es braucht eine höhere Dosis Geriatrie!

Wer heute mit dem Medizinstudium startet, wird bei der Pensionierung in einer Schweiz arbeiten, in der es viel mehr ältere Menschen geben wird als heute. 2060 werden etwa 1,1 Mio. über 80-jährige Menschen in der Schweiz leben, zum Vergleich sind es heute etwa 400 000

Potasio elevado, sin T picuda

Introduction. The identification and treatment of patients with hyperkalemia is necessary to prevent the development of arrhythmias. Pseudohyperkalemia is most commonly due to specimen haemolysis and is often recognised by laboratory scientists who subsequently report test results with cautionary warnings. The authors present a case of pseudohyperkalemia in a patient with chronic lymphocytic leukaemia. Report case: the technical factors and method of transport are a potential cause of pseudohyperkalemia. Pseudohyperkalemia has been associated with hyperleukoctosis, in cancer patient populations, more commonly in CLL in adults, but also acute lymphoblastics leukemia in children. This places the patient at risk of unnecessary and potentially dangerous treatments. Conclusion: Physicians should consider pseudohyperkalemia as the underlying cause of elevated potassium levels in patients with malignant leucocytosis who do not have signs or symptom of systemic hyperkalemia.Introducción. La identificación y el tratamiento de pacientes con hiperpotasemia son necesarios para prevenir el desarrollo de arritmias. La pseudohiperpotasemia se debe más comúnmente a la hemólisis de la muestra y a menudo es reconocida por los laboratoristas que posteriormente informan los resultados de las pruebas con advertencias de precaución. Los autores presentan un caso de pseudohiperpotasemia en un paciente con leucemia linfocítica crónica. Reporte de caso: los factores técnicos y el método de transporte son una causa potencial de pseudohiperpotasemia. La pseudohiperpotasemia se ha asociado también con hiperleucoctosis, en poblaciones de pacientes con cáncer, más comúnmente en Leucemia linfocítica crónica en adultos, pero también con leucemia linfoblástica aguda en niños. Esto pone al paciente en riesgo de tratamientos innecesarios y potencialmente peligrosos. Conclusión: Los médicos deben considerar la pseudohiperpotasemia como la causa subyacente de los niveles elevados de potasio en pacientes con leucocitosis maligna que no presentan signos o síntomas de hiperpotasemia sistémica

F.I.T.AL. (Function – Information – Training) therapy for everyday life to improve instrumental activities of daily living in people with mild cognitive impairment : protocol for a randomised feasibility study

Background: Instrumental activities of daily living (IADL) are key to independently participate in social life for people with mild cognitive impairment (MCI). There is currently no recommended pharmacological treatment available to reduce the impact of cognitive loss on functioning in people with MCI. The primary aim of this protocol is to evaluate the feasibility and acceptability of the F.I.T.AL. individually-tailored, multi-component intervention, aimed at stabilizing or even improve IADL functioning. The secondary aim is to explore the preliminary efficacy of F.I.T.AL. Methods: A two-arm randomized feasibility trial will be conducted at two memory clinics in Switzerland. Thirty-two people with MCI, aged 60 and over, together with their caregivers, will be recruited and randomly assigned to either the multi-component intervention or to the control intervention. The multi-component intervention F.I.T.AL., developed in a multi-step approach including patient and public involvement, will be conducted for six months. The intervention includes components of cognitive training strategy, physical exercise, and information and support. The control intervention will be comprised of only the information and support portion. Primarily feasibility and acceptability outcomes will be investigated. Feasibility outcomes will include: (1) Recruitment, using the number of eligible individuals; (2) Enrollment, by calculating the proportion of eligible individuals randomised; (3) Retention, assessed by the drop-out rate; and (4) Completeness of outcome measures. Acceptability and adherence outcomes will include: (1) Attendance rates; (2) Adherence to the intervention protocol, in terms of number and duration of completed intervention sessions; and, (3) Intervention intensity. The secondary outcomes will comprise: (1) The German version of the Amsterdam IADL questionnaire; (2) Physical function (i.e. endurance, lower extremity strength, balance, mobility, gait speed, functional mobility, physical activtity); (3) Cognitive function (i.e. global cognition, memory, executive function, attention); and, (4) Perceived social support. Discussion: F.I.T.AL. was designed to target IADL functioning in people with MCI, using a multi-step and multi-professional approach that includes patient and public involvement. It is anticipated that F.I.T.AL. will be feasible, acceptable and also have the potential to stabilize or even improve IADL performance

Cyclooxygenase 2: understanding the pathophysiological role through genetically altered mouse models

El pdf del artículo es la versión post-print.Cyclooxygenase (COX) -1 and –2 catalyze the first step in the biosynthesis of prostanoids. COX-1 is constitutively expressed in many tissues and seems to be involved in the house keeping function of prostanoids. COX-2, the inducible isoform, accounts for the elevated production of prostaglandins in response to various inflammatory stimuli, hormones and growth factors. COX-2 expression has been also associated with cell growth regulation, tissue remodelling and carcinogenesis. More of these characteristics have been elucidate through using COX selective inhibitors. Recent advances in transgenic and gene-targeting approaches allow a sophisticated manipulation of the mouse genome by gene addition, gene deletion or gene modifications. The development of COX-2 genetically altered mice has provided models to elucidate the physiological and pathophysiological roles of this enzyme.This work was supported by grants from Instituto de Salud Carlos III (Red de Centros C03/01), Generalitat Valenciana (GRUPOS03/072), Ministerio de Educación y Ciencia (SAF2004-00957) and Comunidad de Madrid (CAM2004-GR/SAL/0388).Peer reviewe

Cross-cultural adaptation and validation of the Amsterdam Instrumental Activities of Daily Living questionnaire short version German for Switzerland

Background Instrumental Activities of Daily Living (IADL) limitations are associated with reduced health-related quality of life for people with mild cognitive impairment (MCI). For these people, the assessment of IADL is crucial to the diagnostic process, as well as for the evaluation of new interventions addressing MCI. The Amsterdam IADL Questionnaire Short Version (A-IADL-Q-SV) is an established assessment tool with good psychometric properties that has been shown to be robust to cultural differences in Western countries. The aims of this study were to: (1) cross-culturally adapt and validate the A-IADL-Q-SV for the German-speaking population of Switzerland; (2) investigate its cultural comparability; and (3) evaluate further psychometric properties. Methods The A-IADL-Q-SV German was pretested on clinicians and participants in a memory clinic setting. The psychometric properties and cultural comparability of the questionnaire were investigated in memory clinic settings including participants with MCI or mild dementia, as well as participants with normal cognition recruited from the community. Item response theory (IRT) was applied to investigate measurement invariance by means of differential item functioning to assess item bias. Additionally, the test–retest reliability on scale level, the construct validity through hypothesis testing and the discriminant validity of the A-IADL-Q-SV German were evaluated. Results Ninety-six informants of participants with normal cognition, MCI or mild dementia completed the A-IADL-Q-SV German. The basic assumptions for IRT scoring were met. No meaningful differential item functioning for culture was detected between the Swiss and Dutch reference samples. High test–retest reliability on scale level (ICC 0.93; 95% CI 0.9–0.96) was found. More than 75% of the observed correlations between the A-IADL-Q-SV German and clinical measures of cognition and functional status were found to be in the direction and of the magnitude hypothesized. The A-IADL-Q-SV German was shown to be able to discriminate between participants with normal cognition and MCI, as well as MCI and mild dementia. Conclusions The A-IADL-Q-SV German is a psychometrically robust measurement tool for a Swiss population with normal cognition, MCI and mild dementia. Thus, it provides a valuable tool to assess IADL functioning in clinical practices and research settings in Switzerland

Ritual plants of Muslim graveyards in northern Israel

This article surveys the botanical composition of 40 Muslim graveyards in northern Israel, accompanied by an ethnobotanical study of the folkloristic traditions of the use of these plants in cemeteries. Three groups of plants were found to be repeated systematically and were also recognized for their ritual importance: aromatics herbs (especially Salvia fruticosa and Rosmarinus officinalis), white flowered plants (mainly Narcissus tazetta, Urginea maritima, Iris spp. and Pancratium spp.) and Cupressus sempervirens as the leading cemetery tree. As endemic use we can indicate the essential role of S. fruticosa as the main plant used in all human rites of passage symbolizing the human life cycle. The rosemary is of European origin while the use of basil is of Indian influence. The use of white flowers as cemeteries plants reflects an old European influence and almost the same species are used or their congeners. Most of the trees and shrubs that are planted in Muslim cemeteries in Israel have the same use in ancient as well in modern European cultures. In conclusion, our findings on the occurrence of plants in graveyards reflect the geographic situation of Israel as a crossroads in the cultural arena between Asia and Europe. Most of the traditions are common to the whole Middle East showing high relatedness to the classical world as well as to the present-day Europe