The Mediterranean diet and incidence of hypertension: the Seguimiento Universidad de Navarra (SUN) Study

The Mediterranean diet is receiving increasing attention in cardiovascular epidemiology. The association of adherence to the Mediterranean diet with the incidence of hypertension was evaluated among 9,408 men and women enrolled in a dynamic Spanish prospective cohort study during 1999–2005. Dietary intake was assessed at baseline with a validated semiquantitative food frequency questionnaire, and a 9-point Mediterranean diet score was constructed. During a median follow-up period of 4.2 years (range, 1.9–7.9), 501 incident cases of hypertension were identified. After adjustment for major hypertension risk factors and nutritional covariates, adherence to the Mediterranean diet was not associated with hypertension (the hazard ratio was 1.10 (95% confidence interval (CI): 0.81, 1.41) for moderate adherence and 1.12 (95% CI: 0.79, 1.60) for high adherence). However, it was associated with reduced changes in mean levels of systolic blood pressure (moderate adherence, 2.4 mm Hg (95% CI: 4.0, 0.8); high adherence, 3.1 mm Hg (95% CI: 5.4, 0.8)) and diastolic blood pressure (moderate adherence, 1.3 mm Hg (95% CI: 2.5, 0.1); high adherence, 1.9 mm Hg (95% CI: 3.6, 0.1)) after 6 years of follow-up. These results suggest that adhering to a Mediterranean-type diet could contribute to the prevention of age-related changes in blood pressure

Inappropriate Hospital Admission According to Patient Intrinsic Risk Factors: an Epidemiological Approach

Background: Inappropriate hospital admissions compromise the efficiency of the health care system. This work analyzes, for the first time, the prevalence of inappropriate admission and its association with clinical and epidemiological patient characteristics. Objectives: To estimate the prevalence, associated risk factors, and economic impact of inappropriate hospital admissions. Design and Participants: This was a cross-sectional observational study of all hospitalized patients in a high complexity hospital of over 901 beds capacity in Spain. The prevalence of inappropriate admission and its causes, the association of inappropriateness with patients’ intrinsic risk factors (IRFs), and associated financial costs were analyzed with the Appropriateness Evaluation Protocol in a multivariate model. Main Measures and Key Results: A total of 593 patients were analyzed, and a prevalence of inappropriate admissions of 11.9% (95% CI: 9.5 to 14.9) was found. The highest number of IRFs for developing health care-related complications was associated with inappropriateness, which was more common among patients with 1 IRF (OR [95% CI]: 9.68 [3.6 to 26.2.] versus absence of IRFs) and among those with surgical admissions (OR [95% CI]: 1.89 [1.1 to 3.3] versus medical admissions). The prognosis of terminal disease reduced the risk (OR [95% CI]: 0.28 [0.1 to 0.9] versus a prognosis of full recovery based on baseline condition). Inappropriate admissions were responsible for 559 days of avoidable hospitalization, equivalent to €17,604.6 daily and €139,076.4 in total, mostly attributable to inappropriate emergency admissions (€96,805.3). Conclusions: The prevalence of inappropriate admissions is similar to the incidence found in previous studies and is a useful indicator in monitoring this kind of overuse. Patients with a moderate number of comorbidities were subject to a higher level of inappropriateness. Inappropriate admission had a substantial and avoidable financial impact

Consumo de alcohol e incidencia de hipertensión en una cohorte mediterránea: el estudio SUN

Introduction and objectives. To assess prospectively the association between alcohol consumption, including alcoholic beverage preference and days of consumption per week, and the risk of hypertension in a Mediterranean cohort. Methods. We prospectively followed 9,963 Spanish men and women initially without hypertension. Self-reported and validated data on diet and hypertension diagnoses were collected. Results. During follow-up (median [interquartile range], 4.2 [2.5-6.1] years), 554 incident cases of hypertension were identified over a total of 43,562 person-years. The hazard ratio for hypertension among those who consumed alcohol on ≥5 days per week was 1.28 (95% confidence interval, 0.97-1.7) compared to abstainers. Among those who drank alcohol ≥5 days per week, the hazard ratio for hypertension associated with consuming ≥1 drink per day was 1.45 (95% confidence interval, 1.06-2) compared with abstainers. The consumption of beer or spirits, but not wine, was associated with an increased risk of hypertension. The hazard ratio associated with consuming >0.5 drinks of beer or spirits per day was 1.53 (95% confidence interval, 1.18-1.99) compared with abstainers. In contrast, there was a nonsignificant inverse association between red wine intake and the risk of hypertension. Conclusions. In this Mediterranean population, the consumption of beer or spirits, but not wine, was associated with a higher risk of developing hypertension. However, the weekly pattern of alcohol consumption did not have a significant impact on the risk of hypertension

Aspirin, non-aspirin analgesics and the risk of hypertension in the SUN cohort.

The use of aspirin and non-aspirin analgesics has been associated with changes in blood pressure. The aim of this study was to investigate prospectively the association between the regular use of aspirin and non-aspirin analgesics and the incidence of hypertension. METHODS: The SUN project is an ongoing, continuously expanding, prospective cohort of Spanish university graduates initially free of hypertension, cardiovascular disease, diabetes and cancer; 9986 (mean age 36 years) were recruited during 1999-2005 and followed up for a mean of 51 months. Regular aspirin and non-aspirin analgesic use and the presence of other risk factors for hypertension were assessed by questionnaire at baseline, and the incidence of hypertension was assessed using biennial follow-up questionnaires. RESULTS: In total, 543 new cases of hypertension were identified during follow-up. Regular aspirin use (i.e. 2 or more days/week) was associated with a higher risk of hypertension (hazard ratio=1.45; 95% confidence interval, 1.02-2.04) after adjustment for various confounding factors. Regular use of non-aspirin analgesic drugs was also associated with a higher risk of hypertension (hazard ratio=1.69; 95% confidence interval, 1.28-2.23). CONCLUSIONS: The regular use of aspirin and non-aspirin analgesics were both associated with an increased risk of developing hypertension, independently of other risk factors

Onion-like Fe3O4/MgO/CoFe2O4 magnetic nanoparticles: new ways to control magnetic coupling between soft/hard phases

The control of the magnetization inversion dynamics is one of the main challenges driving the design of new nanostructured magnetic materials for magnetoelectronic applications. Nanoparticles with onion-like architecture offer a unique opportunity to expand the possibilities allowing to combine different phases at the nanoscale and also modulate the coupling between magnetic phases by introducing spacers in the same structure. Here we report the fabrication, by a three-step high temperature decomposition method, of Fe3O4/MgO/CoFe2O4 onio-like nanoparticles and their detailed structural analysis, elemental compositional maps and magnetic response. The core/shell/shell nanoparticles present epitaxial growth and cubic shape with overall size of (29+-6) nm. These nanoparticles are formed by cubic iron oxide core of (22+-4) nm covered by two shells, the inner of magnesium oxide and the outer of cobalt ferrite of ~1 and ~2.5 nm of thickness, respectively. The magnetization measurements show a single reversion magnetization curve and the enhancement of the coercivity field, from HC~608 Oe for the Fe3O4/MgO to HC~5890 Oe to the Fe3O4/MgO/CoFe2O4 nanoparticles at T=5 K, ascribed to the coupling between both ferrimagnetic phases with a coupling constant of =2 erg/cm2. The system also exhibits exchange bias effect, where the exchange bias field increases up to HEB~2850 Oe at 5 K accompanied with the broadening of the magnetization loop of HC~6650 Oe. This exchange bias effect originates from the freezing of the surface spins below the freezing temperature TF=32 K that pinned the magnetic moment of the cobalt ferrite shell.Comment: 39 pages, 8 figure

Efficient generation of highly crystalline carbon quantum dots via electrooxidation of ethanol for rapid photodegradation of organic dyes

Achieving versatile routes to generate crystalline carbon-based nanostructures has become a fervent pursuit in photocatalysis-related fields. We demonstrate that the direct electrooxidation of ethanol, performed on Ni foam, yields ultra-small and highly crystalline graphene-like structures named carbon quantum dots (CQDs). We perform simulations of various sp2 and sp3 domains in order to understand the optical properties of CQDs by accounting their contribution as absorbance/luminescent centers in the overall optical response. Experiments and simulations reveal that absorbance bands for as-synthesized CQDs are dominated by small sp2 domains comprised of r7 aromatic-rings. After 48 h synthesis, the dispersion transition from yellow to red, exhibiting new and red shifted absorbance bands. Furthermore, fluorescence emission is governed by medium-sized sp 2 domains (with aromatic ring counts r12) and oxygen-containing groups. These oxygen-rich groups within the CQDs, confirmed by FT-IR and XPS, are responsible for the fast photodegradation of organic dyes, with B90% of methylene blue (MB) being degraded within the first 5 min of light exposure. Our work provides crucial insights about the electrochemical synthesis and overall optical properties of carbon nanostructures, while being effective and reliable toward the degradation of contaminants in water

The impact of habitat quality inside protected areas on distribution of the Dominican Republic’s last endemic non-volant land mammals

The Hispaniolan solenodon, Solenodon paradoxus, and Hispaniolan hutia, Plagiodontia aedium, are the Dominican Republic’s only surviving endemic non-volant land mammals, and are high priorities for conservation. The country has an extensive protected area (PA) network designed to maintain habitats and benefit biodiversity, but which faces significant anthropogenic threats likely to detrimentally impact both species. We examined how differences in habitats, forest structure, topography, and human activity influence presence of solenodons and hutias across the Dominican Republic. Systematic surveys of seven PAs were undertaken to record indirect signs, with presence-absence data analyzed using a multi-model inference approach incorporating ecological variables from both field and GIS data. Solenodons were detected relatively frequently, whereas detections of hutias were uncommon. Lower elevations, increased surrounding tree cover, canopy closure, and reduced levels of low vegetation are all associated with increased probability of detecting solenodons, whereas agriculture and mangrove represent poor-quality habitat. Increased canopy closure, tree basal area (indicating older-growth forest), and increased rock substrate (providing more den sites) are associated with increased probability of detecting hutias. Our findings indicated that human activities within PAs are likely to negatively affect both species, and conservation activities should focus on preventing encroachment and conversion of forest to agriculture to maintain high-quality forest habitats. El solenodonte de la Hispaniola, Solenodon paradoxus, y la hutia de la Hispaniola, Plagiodontia aedium, son los únicos mamíferos endémicos terrestres no voladores que sobreviven en la República Dominicana, su conservación es de alta prioridad. El país tiene una extensa red de áreas protegidas (AP) diseñada para mantener hábitats y beneficiar la biodiversidad, pero se enfrenta a amenazas antropogénicas. Sin embargo, no existen datos cuantitativos para evaluar las presiones antropogénicas que amenazan a los solenodontes y las hutias. Examinamos cómo las diferencias en los hábitats, la estructura del bosque, la topografía y la actividad humana influyen la presencia de solenodontes y hutias en toda la República Dominicana. Se realizaron encuestas sistemáticas de siete AP para registrar los signos indirectos de ambas especies, los datos de presencia/ausencia fueron analizados mediante inferencia multimodelo que incorpora variables ecológicas de los datos de campo y Sistema de Información Geográfica. Los Solenodontes se detectaron relativamente frecuentemente, mientras que las detecciones de hutias fueron menos comunes. Las elevaciones más bajas, el aumento de la cubierta arbórea circundante, el cierre del dosel y los niveles reducidos de vegetación baja se asocian con una mayor probabilidad de detectar solenodones. Mientras que la agricultura y los manglares representan un hábitat de mala calidad para el solenodonte. Aumento del cierre del dosel, área basal del árbol (que indica un bosque más antiguo) y un sustrato con mayor proporcion de roca (que proporciona más sitios para madrigueras) se asocian con una mayor probabilidad de detectar hutias. Nuestros hallazgos indican que las actividades humanas dentro de las AP pueden afectar negativamente a ambas especies. Las actividades de conservación deberían enfocarse en mantener hábitats forestales de alta calidad por medio de prevenir la invasión y la conversión de los bosques a agricultura

Clinical utility of intralesional methotrexate to distinguish crateriform keratinocytic tumors before surgery

Clinical utility of intralesional methotrexate to distinguish crateriform keratinocytic tumors before surgeryDear Editors,Keratoacanthoma (KA) and cutaneous squamous cell carci-noma (CSCC) may adopt an identical crateriform morpho-logy. Nowadays, the debate about whether KA is a distinct entity, or a low-grade variant of cutaneous squamous cell carcinoma (CSCC) still persists. Since CSCC is a more ag-gressive neoplasm, misdiagnosing crateriform lesions may have a negative impact on the patient's prognosis. Evaluating a partial biopsy is extremely challenging to confidently dis-tinguish KA from CSCC [1]. No distinctive gene expression profiles have been identified and no pathognomonic criteria to unequivocally differentiate between KA and CSCC exist [2]. Consequently, the surgical approach remains the gold standard in the management of crateriform tumors, especi-ally those arising on the face

Effects of dexmedetomidine on subthalamic local field potentials in parkinson's disease

Background: Dexmedetomidine is frequently used for sedation during deep brain stimulator implantation in patients with Parkinson's disease, but its effect on subthalamic nucleus activity is not well known. The aim of this study was to quantify the effect of increasing doses of dexmedetomidine in this population. Methods: Controlled clinical trial assessing changes in subthalamic activity with increasing doses of dexmedetomidine (from 0.2 to 0.6 μg kg-1 h-1) in a non-operating theatre setting. We recorded local field potentials in 12 patients with Parkinson's disease with bilateral deep brain stimulators (24 nuclei) and compared basal activity in the nuclei of each patient and activity recorded with different doses. Plasma levels of dexmedetomidine were obtained and correlated with the dose administered. Results: With dexmedetomidine infusion, patients became clinically sedated, and at higher doses (0.5-0.6 μg kg-1 h-1) a significant decrease in the characteristic Parkinsonian subthalamic activity was observed (P<0.05 in beta activity). All subjects awoke to external stimulus over a median of 1 (range: 0-9) min, showing full restoration of subthalamic activity. Dexmedetomidine dose administered and plasma levels showed a positive correlation (repeated measures correlation coefficient=0.504; P<0.001). Conclusions: Patients needing some degree of sedation throughout subthalamic deep brain stimulator implantation for Parkinson's disease can probably receive dexmedetomidine up to 0.6 μg kg-1 h-1 without significant alteration of their characteristic subthalamic activity. If patients achieve a 'sedated' state, subthalamic activity decreases, but they can be easily awakened with a non-pharmacological external stimulus and recover baseline subthalamic activity patterns in less than 10 min

Effect of sugammadex on processed EEG parameters in patients undergoing robot-assisted radical prostatectomy

Background: Sugammadex has been associated with increases in the bispectral index (BIS). We evaluated the effects of sugammadex administration on quantitative electroencephalographic (EEG) and electromyographic (EMG) measures. Methods: We performed a prospective observational study of adult male patients undergoing robot-assisted radical prostatectomy. All patients received a sevoflurane-based general anaesthetic and a continuous infusion of rocuronium, which was reversed with 2 mg kg1 of sugammadex i.v. BIS, EEG, and EMG measures were captured with the BIS Vista™ monitor. Results: Twenty-five patients were included in this study. Compared with baseline, BIS increased at 4e6 min (b coefficient: 3.63; 95% confidence interval [CI]: 2.22e5.04; P<0.001), spectral edge frequency 95 (SEF95) increased at 2e4 min (b coefficient: 0.29; 95% CI: 0.05e0.52; P¼0.016) and 4e6 min (b coefficient: 0.71; 95% CI: 0.47e0.94; P<0.001), and EMG increased at 4e6 min (b coefficient: 1.91; 95% CI: 1.00e2.81; P<0.001) after sugammadex administration. Compared with baseline, increased beta power was observed at 2e4 min (b coefficient: 93; 95% CI: 1e185; P¼0.046) and 4e6 min (b coefficient: 208; 95% CI: 116e300; P<0.001), and decreased delta power was observed at 4e6 min (b coefficient: 526.72; 95% CI: 778 to 276; P<0.001) after sugammadex administration. Neither SEF95 nor frequency band data analysis adjusted for EMG showed substantial differences. None of the patients showed clinical signs of awakening. Conclusions: After neuromuscular block reversal with 2 mg kg1 sugammadex, BIS, SEF95, EMG, and beta power showed small but statistically significant increases over time, while delta power decreased