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Undernutrition as well as low levels of vitamin B12 and folic acid are common problems among older adults. However, recommended routine nutritional status assessment tools may result in inadequate vitamin serum levels to go unnoticed. Therefore, the aim of this study is to evaluate the inadequacy of serum levels of vitamin B12 and folic acid within Mini Nutritional Assessment (MNA) classification categories among older adults. A cross-sectional study was conducted with 97 older adults residing in care homes in Portugal. Undernutrition was identified through the MNA, and serum levels of vitamin B12 and folic acid were measured using chemiluminescence. Cognitive function, depressive symptoms and functional characteristics were also assessed using the Abbreviated Mental Test Score, the Epidemiologic Studies Depression Scale and the Barthel Index, respectively. The mean age of older adults was 82.2 (6.3) years; 3.1% were undernourished and 26.8% were at undernutrition risk. In the MNA normal nutritional status group, 11.8% presented vitamin B12 deficiency (<200 pg/ml), 32.4% had low serum levels (200-400 pg/ml) and 4.4% had folic acid deficiency (<3 ng/ml). A high proportion of older adults with low serum levels of vitamin B12 presenting normal nutritional status by MNA was identified. This finding emphasizes the need to evaluate serum vitamin B12 levels, independently of the MNA results.

Study Design: A retrospective review of charts, x-rays (XRs) and computed tomography (CT) scans was performed., Objective: To evaluate the accuracy of pedicle screw placement using a novel classification system to determine potentially significant screw misplacement., Summary of Background Data: The accuracy rate of pedicle screw (PS) placement varies from 85% to 95% in the literature. This demonstrates technical ability but does not represent the impact of screw misplacement on individual patients. This study quantifies the rate of screw misplacement on a per-patient basis to highlight its effect on potential morbidity., Methods: A retrospective review of charts, XRs and low-dose CT scans of 127 patients who underwent spinal fusion with pedicle screws for spinal deformity was performed. Screws were divided into four categories: screws at risk (SAR), indeterminate misplacements (IMP), benign misplacements (BMP), accurately placed (AP)., Results: A total of 2724 screws were placed in 127 patients. A total of 2396 screws were placed accurately (87.96%). A total of 247 screws (9.07%) were BMP, 52 (1.91%) were IMP, and 29 (1.06%) were considered SAR. Per-patient analysis showed 23 (18.11%) of patients had all screws AP. Thirty-five (27.56%) had IMP and 18 (14.17%) had SAR. Risk factor analysis showed smaller Cobb angles increased likelihood of all screws being AP. Sub-analysis of adolescent idiopathic scoliotic patients showed no curve or patient characteristic that correlated with IMP or SAR. Over 40% of patients had screws with either some/major concern., Conclusion: Overall reported screw misplacement is low, but it does not reflect the potential impact on patient morbidity. Per-patient analysis reveals more concerning numbers toward screw misplacement. With increasing pedicle screw usage, the number of patients with misplaced screws will likely increase proportionally. Better strategies need to be devised for evaluation of screw placement, including establishment of a national database of deformity surgery, use of intra-operative image guidance, and reevaluation of postoperative low-dose CT imaging., Level of Evidence: 3.

Background/objectives: We aimed to quantify the association of sarcopenia with length of hospital stay (LOS) and to identify factors associated with sarcopenia among hospitalized patients., Subjects/methods: A total of 655 patients composed the study sample. A longitudinal study was conducted in a University Hospital. Sarcopenia was defined, according to European Consensus criteria, as low muscle mass (bioelectrical impedance analysis) and low muscle function (handgrip strength). Logistic regression, Kaplan-Meier and Cox adjusted proportional hazards methods were used. LOS was determined from the date of hospital admission and discharge home (event of interest)., Results: Participants were aged 18 to 90 years (24.3% sarcopenic). Factors associated with sarcopenia were male gender, age ⩾65 years, moderate or severe dependence, undernutrition and being admitted to a medical ward. Sarcopenic patients presented a lower probability of being discharged home (hazard ratio (HR), 95% confidence interval (CI)=0.71, 0.58-0.86). However, after stratifying for age groups, this effect was visible only in patients aged <65 years (HR, 95% CI= 0.66, 0.51-0.86). Moreover, sarcopenic overweight or obese patients presented a higher probability of being discharged home (HR, 95% CI=0.78, 0.61-0.99) than nonoverweight sarcopenic patients (HR, 95% CI=0.63, 0.48-0.83)., Conclusions: Being male, age ⩾65 years, presenting dependence, being undernourished and admitted to a medical ward were factors associated with sarcopenia among hospitalized adult patients. Sarcopenia is independently associated with longer LOS, although this association is stronger for patients aged <65 years. Moreover, sarcopenic overweight was associated with a higher probability of discharge home than nonoverweight sarcopenia.

Background/aim: Calcium acetate/magnesium carbonate (CaMg) is a recent phosphate binder that has been shown to have protective cardiovascular (CV) effects in animal models. The aim of this study was to evaluate the relationship between CaMg therapy and CV risk markers like pulse pressure (PP), left ventricular mass index (LVMI) and valvular calcifications compared to sevelamer or no phosphate binder (NPB) therapy in chronic hemodialysis (HD) patients., Methods: We performed a 48-month prospective study in 138 HD patients under hemodiafiltration with a dialysate Mg concentration of 0.5 mmol/l. Patients underwent treatment with CaMg or sevelamer for at least 36 months or NPB therapy. Demographic, clinical, biochemical and echocardiographic parameters were evaluated at baseline and after a 48-month period., Results: At the end of the study, patients who had taken CaMg showed a significant reduction in PP (p < 0.001), LVMI (p = 0.003), aortic (p = 0.004) and mitral valve calcifications (p = 0.03) compared with NPB patients. Patients under CaMg showed a significant reduction of PP (p < 0.001), LVMI (p = 0.01) and aortic valve calcifications (p = 0.02) compared to sevelamer patients. In a multivariable analysis, CaMg therapy was negatively associated with progression of LVMI (p = 0.02) and aortic valve calcifications (p = 0.01). Patients under CaMg showed higher serum Mg levels (0.93 ± 0.14 mmol/l) compared to patients under sevelamer (0.87 ± 0.13) or NPB patients (0.82 ± 0.12; p < 0.001)., Conclusions: In prevalent HD patients, the use of CaMg over 48 months was associated with a reduction of PP and LVMI and with a stabilization of aortic valve calcifications. These protective and promising results of this new phosphate binder need to be confirmed in randomized controlled studies., (© 2016 S. Karger AG, Basel.)

The bone is a complex connective tissue composed of many different cell types such as osteoblasts, osteoclasts, chondrocytes, mesenchymal stem/progenitor cells, hematopoietic cells and endothelial cells, among others. The interaction between them is finely balanced through the processes of bone formation and bone remodeling, which regulates the production and biological activity of many soluble factors and extracellular matrix components needed to maintain the bone homeostasis in terms of cell proliferation, differentiation and apoptosis. Osteosarcoma (OS) emerges in this complex environment as a result of poorly defined oncogenic events arising in osteogenic lineage precursors. Increasing evidence supports that similar to normal development, the bone microenvironment (BME) underlies OS initiation and progression. Here, we recapitulate the physiological processes that regulate bone homeostasis and review the current knowledge about how OS cells and BME communicate and interact, describing how these interactions affect OS cell growth, metastasis, cancer stem cell fate and therapy outcome.

Background: the question on whether undernutrition remains linked to depressive symptoms, considering the effect of deficiencies of vitamin B12 and folate, is of practical relevance because they are potentially preventable and treatable. This study aims to evaluate whether undernutrition is linked to depressive symptoms, considering the effect of vitamin B12 and folate plasma levels., Method: a cross-sectional study was conducted in a sample of 84 older adults living in care homes. Data about nutritional status using Mini-Nutritional Assessment, serum folic acid and Vitamin B12 levels, cognitive ability, functional dependency, symptoms and /or depressive behaviour was obtained. Depression symptoms were measured using the 20-item version of the Center for Epidemiologic Studies Depression scale., Results: fifty three older adults were at depression risk (63.1%). Of those, 34% were at undernutrition risk. Although a high frequency of older adults with low plasma levels of vitamin B12 (42.9%) and lower levels of folic acid (5.9%) was found, no significant differences concerning the existence of depressive symptoms were found. In the multivariable analysis, an increase in depression risk was observed amongst participants nutritionally at risk OR = 3.47 (1.05-11.46), whereas having low levels of folic acid and Vitamins B12 were not associated with depression risk., Conclusion: amongst undernourished older adults, an increase in risk of depression was observed independently of folic acid and vitamin B12 status. These results highlight the need to implement preventive strategies, particularly directed at older adults living in care home., (Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.)

Study Design: Original research., Objective: To evaluate perioperative risk factors associated with obesity in children undergoing posterior spinal fusion for adolescent idiopathic scoliosis. The authors hypothesized that patients with a high body mass index (BMI) percentile would be associated with increased morbidity as measured by various intraoperative parameters., Summary of Background Data: Few studies have evaluated the effects of increased BMI in children undergoing surgery. Adolescent idiopathic scoliosis represents 80% of idiopathic scoliosis cases and is the most common indication for surgery., Methods: Patients were divided into 3 groups: normal weight (n = 144) (5% < BMI < 85%), overweight (n = 25) (BMI > 85% to 95%), and obese (n = 38) (BMI > 95%). Patients with BMI less than 5% were excluded from this study because they were underweight. Perioperative data were collected and analyzed based on differences between groups., Results: A total of 207 patients were included in this study. There was a significant difference in the length of anesthesia (p = .032). The rate of infection was 11% in the obese group, 12% in the overweight group, and 3% in the normal weight group (p = .03)., Conclusions: Even with pedicle screw instrumentation, the researchers saw an increase in infection in overweight and obese patients. Patients should be counseled before surgery for weight loss to limit surgical complications such as possible risk of postoperative wound infection., (Copyright © 2015 Scoliosis Research Society. Published by Elsevier Inc. All rights reserved.)

Background: Undernutrition status at hospital admission is related to increased hospital costs. Handgrip strength (HGS) is an indicator of undernutrition, but the ability of HGS to predict hospitalization costs has yet to be studied., Objective: To explore whether HGS measurement at hospital admission can predict patient's hospitalization costs., Subjects/methods: A prospective study was conducted in a university hospital. Inpatient's (n=637) HGS and undernutrition status by Patient-Generated Subjective Global Assessment were ascertained. Multivariable linear regression analysis, computing HGS quartiles by sex (reference: fourth quartile, highest), was conducted in order to identify the independent predictors of hospitalization costs. Costs were evaluated through percentage deviation from the mean cost, after adjustment for patients' characteristics, disease severity and undernutrition status., Results: Being in the first or second HGS quartiles at hospital admission increased patient's hospitalization costs, respectively, by 17.5% (95% confidence interval: 2.7-32.3) and 21.4% (7.5-35.3), which translated into an increase from €375 (58-692) to €458 (161-756). After the additional adjustment for undernutrition status, being in the first or second HGS quartiles had, respectively, an economic impact of 16.6% (1.9-31.2) and 20.0% (6.2-33.8), corresponding to an increase in hospitalization expenditure from €356 (41-668) to €428 (133-724)., Conclusions: Low HGS at hospital admission is associated with increased hospitalization costs of between 16.6 and 20.0% after controlling for possible confounders, including undernutrition status. HGS is an inexpensive, noninvasive and easy-to-use method that has clinical potential to predict hospitalization costs.

Minimally invasive surgery (MIS) has been described in the treatment of adolescent idiopathic scoliosis (AIS) and adult scoliosis. The advantages of this approach include less blood loss, shorter hospital stay, earlier mobilization, less tissue disruption, and relatively less pain. However, despite these significant benefits, MIS approach has not been reported in neuromuscular scoliosis patients. This is possibly due to concerns with longer surgery time, which is further increased due to more levels fused and instrumented, challenges of pelvic fixation, size and number of incisions, and prolonged anesthesia. We modified the MIS approach utilized in our AIS patients to be implemented in our neuromuscular patients. Our technique allows easy passage of contoured rods, placement of pedicle screws without image guidance, partial/complete facet resection, and all standard reduction maneuvers. Operative time needed to complete this surgery is comparable to the standard procedure and the majority of our patients have been extubated at the end of procedure, spending 1 day in the PICU and 5-6 days in the hospital. We feel that MIS is not only a feasible but also a superior option in patients with neuromuscular scoliosis. Long-term results are unavailable; however, short-term results have shown multiple benefits of this approach and fewer limitations.

Background & Aims: Undernutrition has been associated with an increased length of hospital stay which may reflect the patient prognosis. The aim of this study was to quantify and compare the association between nutritional status and handgrip strength at hospital admission with time to discharge in cancer patients., Methods: An observational prospective study was conducted in an oncology center. Patient-Generated Subjective Global Assessment, Nutritional Risk Screening 2002 and handgrip strength were conducted in a probabilistic sample of 130 cancer patients. The association between baseline nutritional status, handgrip strength and time to discharge was evaluated using survival analysis with discharge alive as the outcome., Results: Nutritional risk ranged from 42.3 to 53.1% depending on the tool used. According to Patient-Generated Subjective Global Assessment severe undernutrition was present in 22.3% of the sample. The association between baseline data and time to discharge was stronger in patients with low handgrip strength (adjusted hazard ratio, low handgrip strength: 0.33; 95% confidence interval: 0.19-0.55), compared to undernourished patients evaluated by the other tools; Patient-Generated Subjective Global Assessment: (adjusted hazard ratio, severe undernutrition: 0.45; 95% confidence interval: 0.27-0.75) and Nutritional Risk Screening 2002: (adjusted hazard ratio, with nutritional risk: 0.55; 95% confidence interval: 0.37-0.80)., Conclusions: An approximate 3-fold decrease in probability of discharge alive was observed in patients with low handgrip strength. Decreasing handgrip strength tertiles allowed to discriminate between patients who will have longer hospital stay, as well as undernutrition and nutritional risk assessed by Patient-Generated Subjective Global Assessment and Nutritional Risk Screening 2002., (Copyright © 2013 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Background: Standards for anthropometrical assessment define that measurements must be carried out with the subject in the standing position, although this is not always possible. The effect of body position on girth measurement has not been evaluated, even though this issue is clinically relevant because it may bias nutritional assessment results. The present study aimed to evaluate the effect of body position and symmetry on girth measurement., Methods: A cross-sectional study was conducted on 102 older adults aged ≥65 years from care homes and tertiary hospitals. Right and left arm, waist, hip mid-thigh and calf girths were obtained with the subject standing or in the supine position. Mini-Nutritional Assessment Short-Form (MNA-SF) score and reference data percentiles (NHANES IV) misclassification according to girths assessed in the supine position was evaluated., Results: A high intraclass correlation coefficient (ICC > 0.97) and quartiles agreement (k > 0.89) were found between girth measurements conducted on participants in the standing and supine positions. According to MNA-SF, 23.5% of the participants were undernourished and 51% were at risk of undernutrition. A high agreement between MNA-SF score using calf circumference measured on standing or supine position was found (k = 0.96). A relevant agreement for NHANES IV girth percentiles by sex and age was also found (ICC > 0.89)., Conclusions: Agreement between girth measurements on standing and supine positions among older adults is high and differences do not have any clinically relevant impact on MNA-SF classification and reference data percentiles., (© 2013 The Authors Journal of Human Nutrition and Dietetics © 2013 The British Dietetic Association Ltd.)

Background: Hypomagnesaemia is a cardiovascular (CV) risk factor in the general population. The aim of this study was to evaluate the relationship between pre-dialysis magnesium (Mg) and CV risk markers, [including pulse pressure (PP), left ventricular mass index (LVMI) and vascular calcifications (VC)], and mortality in haemodialysis (HD) patients., Methods: We performed a 48-month prospective study in 206 patients under pre-dilution haemodiafiltration with a dialysate Mg concentration of 1 mmol/l., Results: Lower Mg concentrations were predictors of an increased PP (≥65 mm Hg) (p = 0.002) and LVMI (≥140 g/m(2)) (p = 0.03) and of a higher VC score (≥3) (p = 0.01). Patients with Mg <1.15 mmol/l had a lower survival at the end of the study (p = 0.01). Serum Mg <1.15 mmol/l was an independent predictor of all-cause (p = 0.01) and CV mortality (p = 0.02) when adjusted for multiple CV risk factors., Conclusions: Lower Mg levels seem to be associated with increased CV risk markers, like PP, LVMI and VC, and with higher mortality in HD patients., (© 2015 S. Karger AG, Basel.)

Tissue microarrays (TMAs) facilitate the survey of very large numbers of tumors. However, the manual assessment of stained TMA sections constitutes a bottleneck in the pathologist's work flow. This paper presents a computational pipeline for automatically classifying and scoring breast cancer TMA spots that have been subjected to nuclear immunostaining. Spots are classified based on a bag of visual words approach. Immunohistochemical scoring is performed by computing spot features reflecting the proportion of epithelial nuclei that are stained and the strength of that staining. These are then mapped onto an ordinal scale used by pathologists. Multilayer perceptron classifiers are compared with latent topic models and support vector machines for spot classification, and with Gaussian process ordinal regression and linear models for scoring. Intraobserver variation is also reported. The use of posterior entropy to identify uncertain cases is demonstrated. Evaluation is performed using TMA images stained for progesterone receptor.

Hypoxia-ischemia (HI) is characterized by a reduced supply of oxygen during pregnancy, which leads to both central nervous system and peripheral injuries in the foetus, resulting in impairment in its development. The purpose of this study was to investigate behavioural changes and systemic oxidative stress in adult animals that have been affected by HI during pregnancy. HI was induced by the occlusion of the maternal uterine artery with aneurysm clamps for a period of 45 min on the 18th gestational day. Animals from the sham group were submitted to same surgical procedure as the HI animals, without occlusion of the maternal uterine artery. The control group consisted of non-manipulated healthy animals. At postnatal day 90, the pups were submitted to behavioural tests followed by blood collection. HI adult animals presented an increase in anxiety behaviour and a lack of habituation compared to both sham and control groups. Oxidative damage, assessed by protein and lipid oxidation in serum, did not differ between HI and sham-operated animals. However, HI animals presented reduced activity of the glutathione peroxidase enzyme and increased formation of nitrite, indicating alterations in the systemic antioxidant repair system. Our results suggest an association among HI, systemic oxidative stress and behavioural alterations., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Study Design: Retrospective review of patients with adolescent idiopathic scoliosis (AIS)., Objective: The objective of the study was to compare perioperative parameters and outcomes between pedicle screw and hybrid instrumentation for the treatment of AIS., Summary of Background Data: Pedicle screws have been shown to allow for better correction and fewer revisions than hybrid systems. However, no study has compared perioperative parameters and their effects on patient morbidity between these 2 types of instrumentation., Methods: Fifty-six pediatric patients with AIS were included in the study. Twenty-seven patients were treated with hybrid instrumentation and 29 patients were treated with all pedicle screw (APS) instrumentation. Intraoperative and perioperative measures were compared., Results: The mean preoperative major Cobb angle was 58.7 degrees in the hybrid group and 54.5 degrees in the APS group (P = 0.222). Patients in the hybrid group required more time in the intensive care unit (2.0 vs. 1.1 d, P = 0.041), more time to initial mobilization (5.1 vs. 2.1 d, P < 0.001), and more days using patient-controlled analgesia (5.7 vs. 4.4 d, P = 0.020). The hybrid group averaged less estimated blood loss than the APS group (619.6 vs. 947.4 mL, P = 0.011). There was no difference in surgical time (P = 0.183) or length of stay (P = 0.072) between the groups. Thoracolumbosacral orthoses were used in 81.5% of patients in the hybrid group, but in no patients in the APS group (P < 0.001). Postoperative complications occurred in 37.0% of patients in the hybrid group and 17.2% of patients in the APS group (P = 0.095)., Conclusions: This study demonstrates several advantages of pedicle screw constructs over hybrid constructs in the surgical treatment of AIS. The benefits of pedicle screw systems extend directly to the patient and can lower the overall cost of treatment.

Background: Tissue microarrays (TMAs) are an important tool in translational research for examining multiple cancers for molecular and protein markers. Automatic immunohistochemical (IHC) scoring of breast TMA images remains a challenging problem., Methods: A two-stage approach that involves localization of regions of invasive and in-situ carcinoma followed by ordinal IHC scoring of nuclei in these regions is proposed. The localization stage classifies locations on a grid as tumor or non-tumor based on local image features. These classifications are then refined using an auto-context algorithm called spin-context. Spin-context uses a series of classifiers to integrate image feature information with spatial context information in the form of estimated class probabilities. This is achieved in a rotationally-invariant manner. The second stage estimates ordinal IHC scores in terms of the strength of staining and the proportion of nuclei stained. These estimates take the form of posterior probabilities, enabling images with uncertain scores to be referred for pathologist review., Results: The method was validated against manual pathologist scoring on two nuclear markers, progesterone receptor (PR) and estrogen receptor (ER). Errors for PR data were consistently lower than those achieved with ER data. Scoring was in terms of estimated proportion of cells that were positively stained (scored on an ordinal scale of 0-6) and perceived strength of staining (scored on an ordinal scale of 0-3). Average absolute differences between predicted scores and pathologist-assigned scores were 0.74 for proportion of cells and 0.35 for strength of staining (PR)., Conclusions: The use of context information via spin-context improved the precision and recall of tumor localization. The combination of the spin-context localization method with the automated scoring method resulted in reduced IHC scoring errors.

Neuroendocrine tumors (NETs) comprise a heterogeneous group of tumors that form a distinct entity. Approximately 75-80% of patients present with liver metastases at the time of their diagnosis, and 20%-25% will develop these lesions in the course of their disease. The presence of secondary deposits in the liver significantly increases the morbidity and mortality in these patients. The only potentially curative treatment is the surgical resection of the primary tumor and hepatic lesions. However, only 10% of patients presents under ideal conditions for that approach. Several techniques aimed at localized liver lesions have been applied also with interesting results in terms of survival and symptom control. The same has been demonstrated with new systemic therapies (target therapies). However, these are still under study, in order to define their true role in the management of these patients. This paper intends to address, in a general way, the various treatment options in patients with liver metastases from neuroendocrine tumors.

Background: Protein-energy wasting (PEW), associated with inflammation and overhydration, is common in haemodialysis (HD) patients and is associated with high morbidity and mortality., Objective: Assess the relationship between nutritional status, markers of inflammation and body composition through bioimpedance spectroscopy (BIS) in HD patients., Methods: This observational, cross-sectional, single centre study, carried out in an HD centre in Forte da Casa (Portugal), involved 75 patients on an HD programme. In all participating patients, the following laboratory tests were conducted: haemoglobin, albumin, C-reactive protein (CRP) and 25-hydroxyvitamin D3 [25(OH)D3]. The body mass index of all patients was calculated and a modified version of subjective global assessment (SGA) was produced for patients on dialysis. Intracellular water (ICW) and extracellular water (ECW) were measured by BIS (Body Composition Monitor®, Fresenius Medical Care®) after the HD session. In statistical analysis, Spearman's correlation was used for the univariate analysis and linear regression for the multivariate analysis (SPSS 14.0). A P value of <.05 was considered statistically significant., Results: PEW, inversely assessed through the ICW/body weight (BW) ratio, was positively related to age (P<.001), presence of diabetes (P=.004), BMI (P=.01) and CRP (P=.008) and negatively related to albumin (p=.006) and 25(OH)D3 (P=.007). Overhydration, assessed directly through the ECW/BW ratio, was positively related with CRP (P=.009) and SGA (P=.03), and negatively with 25(OH)D3 (P=.006) and BMI (P=.01). In multivariate analysis, PEW was associated with older age (P<.001), the presence of diabetes (P=.003), lower 25(OH)D3 (P=.008), higher CRP (P=.001) and lower albumin levels (P=.004). Overhydration was associated with higher CRP (P=.001) and lower levels of 25(OH)D3 (P=.003)., Conclusions: Taking these results into account, the ICW/BW and ECW/BW ratios, assessed with BIS, have proven to be good markers of the nutritional and inflammatory status of HD patients. BIS may be a useful tool for regularly assessing the nutritional and hydration status in these patients and may allow nutritional advice to be improved and adjusted.

Objectives: To correlate the radiomorphometric indices obtained using digital panoramic radiography (DPR) with bone mineral densities, evaluated by the dual-energy X-ray absorptiometry test, in a population of post-menopausal females to identify patients with asymptomatic low bone mineral densities., Methods: The morphology of the mandibular cortex was evaluated using the mandibular cortical index (MCI) and the inferior mandibular cortex width was evaluated using the mental index (MI) in 64 female patients who had undergone dual-energy X-ray absorptiometry assessment. Of these patients, 21 were diagnosed with osteopaenia and 20 with osteoporosis, and 23 were normal. Three new indices for evaluating the inferior mandibular cortex width were designed: the mental posterior index 1 (MPI1), MPI2 and MPI3. Statistical analyses were performed using the χ(2) and Kruskal-Wallis tests and the receiver operating characteristic curve., Results: There were significant differences between the normal and lower bone mineral density groups (osteopaenia and osteoporosis) for MCI (p < 0.01). In the osteoporosis group, the MI, MPI1, MPI2 and MPI3 were significantly different from the normal and osteopaenia groups (p < 0.05). The MI, MPI1, MPI2 and MPI3 showed that there is an area in the mandibular cortex, located between the mental foramen and the antegonial region, which is valid for identifying females at high risk for osteoporosis., Conclusions: The MCI, MI, MPI1, MPI2, and MPI3 radiomorphometric indices evaluated using DPR can be used to identify post-menopausal females with low bone densities and to provide adequate medical treatment for them.

Several methods based on the detection of the parasite-specific pigment haemozoin (Hz) in blood are currently being investigated as alternative diagnostic methods for malaria. Although this approach may appear attractive, the fact that in Plasmodium falciparum (P. f.) malaria, the severity of which should give it the highest diagnostic priority, the fact that most circulating intra-erythrocytic P. f. parasites contain little or no Hz raises some concern. We used flow cytometry to investigate the possibilities and limitations of the detection of intra-erythrocytic Hz in malaria infected patient blood samples and in vitro cultures. However, reliable detection of ring-forms or young trophozoites of P. f. parasites could not be achieved, although one-quarter of mature parasites could be detected after 24-48 h in culture. Our results strongly suggest that, although it may be useful for monitoring maturation, detection of intra-erythrocytic Hz by flow cytometry will not provide an optimal method for diagnosis of P. falciparum malaria., (Copyright © 2012 Elsevier B.V. All rights reserved.)

Cancer is related to a deterioration of nutritional status and quality of life (QoL), but the extent of these conditions in patients with Non Small Cell Lung Cancer (NSCLC) has not been studied. The aim of the present study was to assess the association between QoL and undernutrition in NSCLC patients. Nutritional status was evaluated with Patient Generated - Subjective Global Assessment and QoL using the European Organization for Research and Treatment of Cancer Quality of Life - C30 and also with the specific module for lung cancer patients. A consecutive sample of fifty six patients diagnosed with NSCLC was evaluated. A high proportion of patients is undernourished (35.7%), 1.8% in early stages vs 33.9% in advanced stages of disease. Undernutrition is related to measured dimensions of QoL: lack of appetite (rho=0.70), fatigue (rho=0.54), nausea and vomiting (rho=0.52) and constipation (rho=0.56). Undernourished patients have worse global health status, physical, emotional, social and role functioning. Patients with NSCLC have high frequency of undernutrition in advanced stages of disease. Undernourished patients present more symptoms, a worse global health status/QoL, physical, role, emotional and social functioning than patients without undernutrition. Undernutrition is associated with worse QoL, specifically in the parameters: appetite loss, nausea and vomiting, constipation and fatigue., (Copyright © 2010. Published by Elsevier España.)

Objective: To systematically review educational strategies for phosphorus reduction in patients with hyperphosphatemia and chronic kidney disease (CKD)., Design: Systematic review with meta-analysis., Data Sources: CENTRAL, MEDLINE, EMBASE, and mRCT databases were assessed in June 2010., Study Selection: Randomized controlled trials evaluating educational strategies related to diet in hyperphosphatemic patients with CKD. DATA EXTRACTION AND SYNTHESIS METHOD: Study characteristics, phosphorus levels, and calcium-phosphorus product levels were retrieved. Jadad scale was used for quality assessment. Mean difference (MD) and 95% confidence intervals (CIs) were calculated by random effects method., Results: Seven randomized controlled trials were retrieved with a total of 524 patients with hyperphosphatemia and CKD. Educational strategies reduced phosphorus levels with an MD of -0.72 mg/dL (95% CI: -1.11 to -0.33, P < .01). Sensitivity analysis of trials with follow-up of <4 months did not show any benefit of the intervention, but educational intervention for ≥ 4 months showed an MD of -1.07 (95% CI: -1.49 to -0.64, P < .01). Calcium-phosphorus product level was improved in 227 evaluated patients from 5 trials with an MD of -5.22 mg(2)/dL(2) (95% CI: -9.48 to -0.98, P = .02, and I(2) = 58%). Sensitivity analysis removed the source of heterogeneity and resulted in an MD of -3.02 (95% CI: -6.51 to 0.47, P = .09)., Conclusions: Education helped reduce phosphorus levels in hyperphosphatemic patients with CKD, particularly those on dialysis., (Copyright © 2011 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.)

Introduction: Critical limb ischemia is a manifestation of peripheral arterial disease and in Portugal the profile of these patients is yet unknown as well as the frequency of hospital malnutrition. The present study aims to contribute to the updating of knowledge on the nutritional status of patients with this condition., Aim: To evaluate the frequency of malnutrition in hospitalized patients with critical lower limb ischemia., Methodology: A prospective longitudinal study was conducted in the University Clinic of Vascular Surgery of Hospital Santa Maria between November 2010 and February 2011. Data were collected using PG-SGA ( Patient Generated-Subjective Global Assessment ) to assess nutritional status., Results: 71 patients were evaluated of whom 21 % ( 22 ) were identified as malnourished, 40.8 % ( 29 ) at risk of malnutrition and 28.2 % ( 20 ) with normal nutritional status. According to the data, the risk of malnutrition is higher in people aged over 75 years ( OR: 5.12, 95 % CI: 3.03-51.47 ) and diabetic ( OR: 2.73, 95 % CI: 0.88-8.46 ). Concerning to education and occupation, the retired individuals ( OR: 3.85, CI: 0.86-17.15 ) and with an education level between 1 and 4 years ( OR: 2.64, 95 %CI: 0.78-8.90 ), had an increased risk of malnutrition., Conclusion: The frequency of malnutrition in patients with critical lower limb ischemia was quite high. Data have revealed that factors associated with malnutrition in these patients are age, low level of education ( less than 4 years ), diabetes and hypertension. To assess nutritional status of these patients the most suitable protocol was NRS-2002.

Background and Objectives: Vitamin D deficiency is highly prevalent in chronic kidney disease. The aim of this study was to evaluate the effects of oral cholecalciferol supplementation on mineral metabolism, inflammation, and cardiac dimension parameters in long-term hemodialysis (HD) patients., Design, Setting, Participants, & Measurements: This 1-year prospective study included 158 HD patients. Serum levels of 25-hydroxyvitamin D [25(OH)D], 1,25-dihydroxyvitamin D [1,25(OH)(2)D], intact parathyroid hormone, and plasma brain natriuretic peptide as well as circulating bone metabolism and inflammation parameters were measured before and after supplementation. Baseline 25(OH)D and 1,25(OH)(2)D levels were measured twice (end of winter and of summer, respectively). Therapy with paricalcitol, sevelamer, and darbepoietin was evaluated., Results: There was an increase in serum 25(OH)D and 1,25(OH)(2)D levels after supplementation. Conversely, serum calcium, phosphorus, and intact parathyroid hormone were decreased. There was a reduction in the dosage and in the number of patients who were treated with paricalcitol and sevelamer. Darbepoietin use was also reduced, with no modification of hemoglobin values. Serum albumin increased and C-reactive protein decreased during the study. Brain natriuretic peptide levels and left ventricular mass index were significantly reduced at the end of the supplementation., Conclusions: Oral cholecalciferol supplementation in HD patients seems to be an easy and cost-effective therapeutic measure. It allows reduction of vitamin D deficiency, better control of mineral metabolism with less use of active vitamin D, attenuation of inflammation, reduced dosing of erythropoiesis-stimulating agents, and possibly improvement of cardiac dysfunction.

Purpose: to describe adverse perinatal outcomes in patients with fetal blood flow centralization, using the relationship between the pulsatility indexes of the middle cerebral and umbilical arteries (MCAPI/UAPI), and between the resistance indexes of the middle cerebral and umbilical arteries (MCARI/UARI), as well as to compare both diagnostic indexes., Methods: 151 pregnant women with diagnosis of blood flow centralization, attended to at the maternity hospital of Universidade Estadual de Campinas, whose delivery occurred up to 15 days after the ultrasonographic diagnosis, were included. It was considered as adverse perinatal outcomes: Apgar index lower than 7 at the fifth minute, permanence in neonatal ICU, small fetus for the gestational age, severe fetal suffering, perinatal death, hypoglycemia, polycythemia, necrotizing enterocolitis, brain hemorrhage, lung hemorrhage, anemia, septicemia, hyaline membrane disease, convulsive syndromes, hyperreflexia syndrome and kidney insufficiency. Rates of the perinatal adverse outcomes (PAO) for the brain-placentary ratios have been compared, using Fisher's exact or Pearson's chi2 tests, at 5% significance level. Adverse perinatal outcomes according to the gestational age have been evaluated using the Cochrane-Armitage test for trend., Results: the adverse perinatal outcomes for the group with the two indexes altered were: 62.5% of the newborns needed to be placed in an ICU, 75.2% were small for the gestational age (SGA), 35.3% were under severe fetal suffering, 84.4% had hypoglycemia, 8.3% polycythemia, 4.2% necrotizing enterocolitis, and 2.1% brain hemorrhage. There has been significant association between the MCAPI/UAPI and MCARI/UARI ratios along the gestational age, and the need for neonatal intensive care, small fetuses for the gestational age, septicemia, necrotizing enterocolitis, kidney insufficiency, hyaline membrane disease, and anemia. There has been no significant difference between the two indexes of adverse perinatal outcome.

Background: High levels of total plasma homocysteine are potentially harmful in the elderly., Objective: To investigated the effects of oral riboflavin supplementation on plasma total homocysteine, ferritin, uric acid and C-reactive protein concentration in elderly people with a low riboflavin status. We performed a four-week randomized, placebo-controlled, double-blind trial of riboflavin supplementation in seven Portuguese day social centers., Design: Eighty-eight individuals (66.7% female), aged between 60 and 94 years, volunteered to participate in the study following interview. Forty-two subjects, with an erythrocyte glutathione reductase activation coefficient (EGRAC) >or= 1.2, were included in the intervention trial. All subjects gave informed consent. Study subjects were administered 10 mg riboflavin (n=21) or placebo (n=21) each day for 28 days., Results: Riboflavin supplementation significantly decreased plasma tHcy (P=0.005) and EGRAC (P=0.014), but not plasma ferritin, uric acid or C-reactive protein., Conclusions: In this elderly group, we found that 10 mg/day oral riboflavin supplementation lowered plasma homocysteine concentrations in subjects with low riboflavin status.

Background: Decreased vitamin D serum levels have been recently related to arterial stiffening and vascular calcifications in haemodialysis (HD) patients, but the pathophysiology of this association is not yet clear. The aim of this study was to evaluate the relationship between vascular calcifications, cardiovascular risk factors [including brain natriuretic peptide (BNP), pulse pressure (PP) and left ventricular mass index] and 25-hydroxyvitamin D3 (25(OH)D3) and 1,25-dihydroxyvitamin D3 [1,25(OH)(2)D3] serum levels., Methods: We performed a cross-sectional study with 223 prevalent HD patients, 48% females, 27% diabetics, with the mean age of 62.7 +/- 15.3 years and the mean HD time of 42.9 +/- 39.3 months. Forty-seven percent of the patients were taking active forms of vitamin D., Results: Serum levels of [25(OH)D3] were low (21.6 +/- 12.2 ng/mL) and negatively correlated with age (r = -0.31, P < 0.001), diabetes mellitus (DM) (r = -0.20, P = 0.004), C-reactive protein (r = -0.25, P < 0.001), log(10) BNP (r = -0.22, P = 0.002), PP > 65 mmHg (r = -0.21, P = 0.003) and vascular calcifications (r = -0.26, P < 0.001). Levels of [25(OH)D3] were positively correlated with [1,25(OH)(2)D3] (r = 0.25, P < 0.001) and albumin (r = 0.23, P = 0.001). On multivariate analysis, levels of [25(OH)D3] were independently associated with DM (P < 0.001), lower albumin levels (P = 0.003), higher BNP values (P = 0.005), PP > 65 mmHg (P = 0.006) and a higher vascular calcification score (>or= 3) (P = 0.002)., Conclusions: These results suggest that lower levels of [25(OH)D3] are a cardiovascular risk marker in HD patients, since they are strongly associated with higher BNP levels, increased PP and with the presence of vascular calcifications. The exact role of [25(OH)D3] deficiency on cardiovascular morbi-mortality needs to be clarified in large randomized controlled trials.

Background: Because the choice of the most appropriate nutritional screening tool in cancer patients remains an important issue, the aim of the present study was to compare the screening value of three undernutrition screening tools in cancer patients., Methods: In a probabilistic sample of 50% in-patients from an oncology hospital, the screening values of Malnutrition Screening Tool (MST) and Malnutrition Universal Screening Tool (MUST) were calculated using the Nutritional Risk Screening 2002 (NRS-2002) as the reference method in identifying nutritionally-at-risk patients. Their ability to predict a high length-of-hospital stay (LOS), defined as > or =7 days, was assessed., Results: A total of 130 patients were assessed. MUST identified the highest proportion of nutritionally-at-risk patients (43.8%), followed by 28.5% using NRS-2002 and 17.7% using MST. They all identified head and neck cancer patients as the most at risk of nutritional problems. The odds of having a longer LOS were higher for MUST estimates [odds ratio (OR) = 3.24, 95% confidence interval (CI) = 1.50-7.00] than for NRS-2002 (OR = 2.47, 95% CI = 1.05-5.80)., Conclusion: MUST had the highest agreement with NRS-2002 in hospitalized cancer patients and better identified patients at-risk for a longer LOS.

Background: Assessment of diastolic function using conventional Doppler techniques is limited by their significant dependence on volume load status. Whether new echocardiographic methods are load-independent in evaluating left ventricular systolic and diastolic function remains controversial., Objective: The aim of this study was to identify load-independent echocardiographic parameters for systolic and diastolic function in end-stage renal disease (ESRD) patients undergoing hemodialysis (HD) and to evaluate agreement between the new methods., Methods: We studied 20 clinically stable patients with ESRD on HD for >4 months (mean age 51+/-12 years, 14 men, four with coronary disease). All had a transthoracic echocardiogram immediately before and after HD. Cardiac chamber volumes, left ventricular ejection fraction, and transmitral Doppler flow (E/A ratio) were determined according to American Society of Echocardiography guidelines. Pulsed tissue Doppler imaging (TDI) was used to record septal and lateral mitral annular velocities. Longitudinal systolic (Sm), early diastolic (Em) and late diastolic (Am) myocardial velocities and strain were determined by color TDI and also by speckle tracking imaging (STI), using apical views. The ratio between the rapid filling wave E and mitral early diastolic filling velocity (E/Em) and the Am/Em ratio were calculated, using spectral Doppler, pulsed TDI, color TDI, and STI., Results: Mean ultrafiltration volume was 2800+/-820 ml (range 1200-4200 ml). Left atrial (LA) and left ventricular (LV) end-diastolic volumes and transmitral pulsed Doppler flow decreased significantly after HD. Early diastolic myocardial velocities also decreased significantly, regardless of the evaluation method. Filling pressure ratios were high and remained unchanged after HD. LV ejection fraction was >44% in all patients and did not change after HD. Systolic myocardial velocities, by any method, and global and longitudinal strain were also similar before and after HD., Conclusion: Large acute changes in volume load were associated with significant variations in early diastolic myocardial longitudinal velocities, thus demonstrating the dependence of Em on volume load. By contrast, E/Em ratios appeared to be load-independent, as were systolic function parameters. Pulsed TDI, color TDI, and STI yielded similar results for the assessment of diastolic and systolic myocardial parameters.

Aim: The aim of our study was to evaluate the inadequacy of voluntary energy and nutrient intake on the first day of hospital admission., Patients and Methods: A cross-sectional study was carried out in two terciary care hospitals, with a probabilistic sample of 50% of in-patients. Dietary intake was evaluated by a 24-hour dietary recall, and undernutrition was screened through the Nutritional Risk Screening 2002 tool. The overall frequency of inadequate energy and nutrient intake was estimated using Dietary Reference Intakes., Results: Energy and nutrient intakes from 258 patients showed very low values for both men and women. No significant differences were found for energy and nutrient intakes across age groups (< 65 years and > or = 65 years). When the proportion of study subjects with inadequate nutrient intakes was analysed, a high degree of inadequacy was found. The degree of inadequacy was higher for fibre, niacin, folate, vitamin B12, magnesium and zinc. No significant differences were found for energy and nutrients studied and for intakes below 1/3 of dietary recommendations from nutritionally-at-risk (n = 89) and well nourished (n = 169) patients., Conclusion: Voluntary nutrient and energy intakes in the first 24 hour of hospital admission are highly inadequate. No differences were found between undernourished and well-nourished patients or patients < 65 years and > or = 65 years.

Objective: To investigate if handgrip strength (HGS) could be used as a single screening procedure in identifying patients who are classified as being undernourished or nutritionally-at-risk at hospital admission., Design: Cross-sectional study. In the second day of hospital admission, HGS was evaluated and results were compared with Nutritional Risk Screening (NRS-2002)., Setting: Two public hospitals in Porto, Portugal, a university and a district one., Subjects: A probabilistic sample of 50% in-patients from each hospital of 314 patients (age range of 18-96) was studied. Patients were considered eligible if they were >or=18 years old and able to give informed consent. Hand pain, upper limb deformities, incapacity to perform muscle strength measurements and pregnancy were considered further exclusion criteria., Results: Patients identified as undernourished by NRS-2002 (37.9%) were older, shorter and lighter, with a lower functional capacity, a longer length of stay and a lower HGS (P<0.001). When comparing patients with lower HGS (first quartile) with those with the highest HGS (fourth quartile), this parameter revealed good sensitivity (86.7%) and specificity (70.2%) and a k=0.56. Multivariate analysis showed that patients with higher HGS had an independent decreased risk of being at nutritional risk (P for trend <0.001) odds ratio=0.19 (95% confidence interval=0.08-0.48). Our entire sample of hospitalized patients was -1.96 Z-score below the HGS cutoff of distribution data for healthy individuals., Conclusions: HGS identifies a high proportion of nutritionally-at-risk patients and can be a reliable first screening tool for nutritional risk in hospitals.

The purpose of this study was to compare MRI scanogram with traditional radiographic methods for measurement of limb length. The authors hypothesized that MRI scanogram would be as reliable and accurate as radiographic scanogram in measurement of limb length without exposing patients to ionizing radiation. Twelve cadaveric femurs were measured using AP conventional radiographic scanogram, CT scanogram, MRI scanogram, and electronic caliper. Three orthopaedists performed two separate measurements using each technique. Intraobserver and interobserver variability was assessed for each of the three radiographic techniques. Accuracy was assessed by comparison of radiographic measurements to electronic caliper measurements of femur length. The reliability of all three radiographic limb length measurement techniques was excellent (ICC > 0.99). The accuracy of plain radiographic scanogram was slightly superior to CT scanogram and MRI scanogram. The mean absolute differences for radiographic, CT, and MRI scanograms compared with the gold standard, direct caliper measurement, were 0.52 mm, 0.68 mm, and 2.90 mm, respectively. All three scanogram techniques showed excellent reliability and accuracy. Radiographic scanogram remains the gold standard for leg length measurement. MRI scanogram is slightly less accurate compared with radiographic scanogram, but it does not use ionizing radiation. MRI scanogram merits clinical study and comparison with the traditional radiographic scanogram method for measurement of limb length.

Two cases are presented of a nasolabial cyst (NC) on which a radiographic contrast medium was used in order to define the real extension of the lesion. Use of contrast is important for visualizing the definite extensions of NC primarily in cases when plain radiographs may not show any detectable changes and CT can not be used.

We evaluated the influence of individually estimated portion sizes on the estimate of nutrient related risk of colorectal cancer, using data from a Portuguese hospital based case-control study on diet and colorectal cancer. A total of 100 patients with colorectal adenocarcinoma (aged 15-92 years) and 211 controls (aged 36-89 years) were included. Two data sets were created for nutrient analysis, the first one allowed estimates of food intake using data on portion size as collected with visual aids during the interview. The second estimate substituted respondents' estimate with a standard portion size, as used in the semi-quantitative (SQ) food frequency approach. The two analytic approaches yielded similar energy and nutrient intakes in cases and controls. The percent range of concordance is acceptable, in the same quartile varying from 44 to 82% (mean: 56%) and very good in the same or adjacent (+/-1) quartile (mean: 91%, range: 85-97%). The two estimates lead to a similar pattern of multivariate odd's ratio, however the SQ estimates resulted in more significant findings. We conclude that little extra information is gained by including individual portion size information when assessing diet-related risk of colorectal cancer.

The temporal evolution of pH values in precipitation over Europe during the period 1986-1997 is examined using panel data. The use of panel data techniques allows us to determine the temporal evolution of groups of stations rather than analyzing the temporal behavior of each of them. The analysis reveals three different temporal patterns: Peripheral, Central and French. We find a significant increasing trend (P < 0.00001) in both Peripheral and Central patterns. The annual increases are +0.057 pH-units yr(-1) and +0.022 pH-units yr(-1) respectively. However the French pattern is characterized by a significant decreasing trend (P < 0.004) and the annual decrease is -0.022 pH-units yr(-1). The standard errors of panel data estimates are around 47% smaller than those of classical pooling and 32% smaller than aggregate time-series regression. The use of panel data produces higher R2 values than classical pooling and aggregate data. This technique takes into account the individual heterogeneity, allows a larger number of data points and improves the efficiency of the estimates. In general, the policies of governments to reduce pollutant emissions seem to be effective.

We examined cytokine-mediated neuronal death in neuron-astrocyte cultures from second trimester human fetal cerebrum. In these cultures, high-output inducible nitric oxide synthase (NOS) and tumor necrosis factor-alpha (TNFalpha) are expressed in astrocytes after exposure to IL-1beta/IFNgamma. Neuronal cell death was evident at >/=48 h following cytokine stimulation. Neutralizing anti-TNFalpha antiserum inhibited ( approximately 48%) neurotoxicity in IL-1beta/IFNgamma-treated cultures, demonstrating a role for endogenously produced TNFalpha. Interestingly, the degree of neuroprotection conferred by superoxide dismutase or N-methyl D-aspartate (NMDA) receptor antagonists in these cultures was smaller and variable. Similarly, the effect of the NOS inhibitor, N(G)-monomethyl L-arginine (NMMA) on IL-1beta/IFNgamma-induced neuronal death was variable, showing no statistically significant effect when results from more than 30 independent cultures were averaged. Neurons die by apoptosis in cytokine-treated human fetal CNS cultures as shown by the characteristic nuclear morphology as well as positive labeling for TUNEL. Our results demonstrate a potent neurotoxicity mediated by the cytokine combination IL-1beta/IFNgamma in primary human neuron-astrocyte cultures and a crucial role for endogenous TNFalpha in mediating neurotoxicity in this system. These results firmly establish the neurotoxic potential of the inflammatory cytokines IL-1beta and TNFalpha in the human CNS., (Copyright 1999 Wiley-Liss, Inc.)

Because IL-1 is implicated in the pathogenesis of multiple sclerosis, and IFNs are known to alter disease course, we sought to determine whether IFNs can regulate the expression of IL-1 and IL-1R antagonist (IL-1Ra) in primary cultures of human microglia and astrocytes. We found that IL-1 and IL-1Ra are products of microglia but not astrocytes, and IFN-beta and IFN-gamma differentially modulate LPS- and cytokine-induced IL-1 and IL-1Ra. IFN-beta induces IL-1Ra and augments LPS- and IL-4-induced IL-1Ra, but suppresses LPS- and IL-1-induced IL-1, shifting the balance toward the expression of the IL-1Ra. Like IFN-beta, IFN-gamma suppresses the expression of both LPS and IL-1-induced IL-1beta. However, IFN-gamma also suppresses the expression of IFN-beta- and IL-4-induced IL-1Ra so that IFN-gamma may enhance or suppress IL-1 activity depending on the other cytokines present. IL-4 has similar effects to IFN-beta; however, other anti-inflammatory cytokines, did not regulate IL-1 or IL-1Ra in human microglia. Our data demonstrate a novel suppressive effect of IFN-beta and IL-4 on IL-1 activity in human microglia, suggesting that IFN-beta, a therapeutic agent used for multiple sclerosis, could have wider applications in the treatment of other central nervous system disorders in which IL-1 activity has been implicated in the pathogenesis.

Cardiac troponin-T is a subunit of the myofibrillar regulatory troponintropomiosin complex, with sufficient specificity to myocardium. In normal conditions it is absent from serum and its presence indicates lesion of the cardiac cells. The authors evaluated the analytical and clinical performance of an immunoassay for cardiac troponin-T, before its introduction in their own laboratory routine. They concluded that the test had good analytical performance, with some difficulties in practicability that can be surpassed by using a rapid bedside test for troponin-T in urgency departments, already approved by FDA in USA and available in Portugal. The diagnostic specificity and sensitivity was better than the one of the classic enzymatic markers for Acute Myocardial Infarction (AMI) but it is necessary to establish clear clinical protocols that allow its use in AMI.

This work studied in vitro the interaction of aqueous and hydroalcoholic extracts of Valeriana officinalis L. and compounds that are present in the extracts (amino acids and valerenic acid) with the GABAA (gamma-aminobutyric acid) receptor, using the [3H] muscimol binding technique to crude synaptic membranes from rat brain cortices. Both extracts displaced [3H]muscimol bound and this effect is probably due only to their amino acid content, specially GABA. This fact explains the in vitro effect of valerian extracts on GABAA receptor but not their sedative effect.