The association between psychosocial risk factors and retinal microvascular signs was examined in the Multi-Ethnic Study of Atherosclerosis. Subjects were recruited from Baltimore, Maryland; Chicago, ...Illinois; Forsyth County, North Carolina; Los Angeles County, California; New York, New York; and St. Paul, Minnesota. Levels of depressive symptoms, trait anger, trait anxiety, chronic burdens, emotional support, and cynical distrust were assessed by questionnaire (from July 2000 to July 2002). Digital retinal images (from August 2002 to January 2004) from 6,147 participants were used to evaluate retinopathy and retinal vascular caliber. After controlling for potential confounding factors, the authors found that subjects without access to emotional support (Enriched Social Support Instrument score of <19 vs. ≥19) had 60% greater odds of retinopathy (odds ratio = 1.6, 95% confidence interval (CI): 1.3, 2.0). Subjects with high Spielberger trait-anxiety scale scores (≥22 vs. ≤14) and subjects with high depressive symptoms (Center for Epidemiology Studies Depression Scale score, ≥16 vs. <16) were also more likely to have retinopathy (odds ratio = 1.4, 95% CI: 1.1, 1.9 and odds ratio = 1.5, 95% CI: 1.2, 1.9), respectively. In this cross-sectional study, lack of emotional support, increased trait anxiety, and more depressive symptoms were associated with retinopathy signs, independently of other known risk factors.
Hospitals throughout the country are using innovative strategies to accommodate the surge of patients brought on by the novel H1N1 virus. One strategy has been to help decompress the amount of ...patients seeking care within emergency departments by using alternate sites of care, such as tents, parking lots, and community centers as triage, staging, and screening areas. As at any other time an individual presents on hospital property, hospitals and providers must be mindful of the requirements of the Emergency Medical Treatment and Labor Act. In this article we review the act and its implications during public health emergencies, with a particular focus on its implications on alternative sites of care.
There is increasing evidence that the microcirculation plays an important role in the pathogenesis of cardiovascular diseases. Changes in retinal vascular caliber reflect early microvascular disease ...and predict incident cardiovascular events. We performed a genome-wide association study to identify genetic variants associated with retinal vascular caliber. We analyzed data from four population-based discovery cohorts with 15,358 unrelated Caucasian individuals, who are members of the Cohort for Heart and Aging Research in Genomic Epidemiology (CHARGE) consortium, and replicated findings in four independent Caucasian cohorts (n = 6,652). All participants had retinal photography and retinal arteriolar and venular caliber measured from computer software. In the discovery cohorts, 179 single nucleotide polymorphisms (SNP) spread across five loci were significantly associated (p<5.0×10-8) with retinal venular caliber, but none showed association with arteriolar caliber. Collectively, these five loci explain 1.0%-3.2% of the variation in retinal venular caliber. Four out of these five loci were confirmed in independent replication samples. In the combined analyses, the top SNPs at each locus were: rs2287921 (19q13; p = 1.61×10-25, within the RASIP1 locus), rs225717 (6q24; p = 1.25×10-16, adjacent to the VTA1 and NMBR loci), rs10774625 (12q24; p = 2.15×10-13, in the region of ATXN2,SH2B3 and PTPN11 loci), and rs17421627 (5q14; p = 7.32×10-16, adjacent to the MEF2C locus). In two independent samples, locus 12q24 was also associated with coronary heart disease and hypertension. Our population-based genome-wide association study demonstrates four novel loci associated with retinal venular caliber, an endophenotype of the microcirculation associated with clinical cardiovascular disease. These data provide further insights into the contribution and biological mechanisms of microcirculatory changes that underlie cardiovascular disease.
Studies of cognitive functioning in patients with systemic lupus erythematosus (SLE) have found deficits even in patients without other evidence of neurologic involvement. The present study used ...scores on the 11 items of the Mini-Mental State Exam (MMSE) to classify the cognitive impairment of 93 SLE patients as suggestive of "cortical" or "subcortical" dysfunction using a validated statistical algorithm. Ninety-five percent of patients were categorized as having "subcortical" deficits, and 5% were categorized as having "cortical" deficits. When the analysis was limited to only those with total MMSE scores < or = 24, 81% were classified as "subcortical" and 19% as "cortical." These results suggest that SLE patients can have psychomotor and mental tracking deficits of a type seen in patients with subcortical brain disease, even in the absence of gross neurologic involvement.
Decreased brain ATP and phosphocreatine (PCr) concentrations and intracellular pH were compared in hypoxic 4-, 10–11, and 24–25-day-old rats. Surface coil
31P-nuclear magnetic resonance (NMR) spectra ...were acquired in vivo every minute before, during, and after 7 min of breathing 4% O
2. At all ages PCr decreased rapidly. At the two younger ages, the nucleoside triphosphate signal was still 80–85% of pre-hypoxic values, indicating 20–30% decrease in ATP, when PCr was almost fully depleted. At 24–25 days, PCr initially decreased 40–50% with an ATP loss of about 30%. Then, PCr and ATP decreased simultaneously. The decrease in brain pH was greatest at 24–25 days. More electrocortical seizure activity during hypoxia was seen at 10–11 days than at other ages. Seizure activity was seen only when ATP was less than 20% depleted and was not associated with more rapid decreases in ATP or PCr. At all ages, loss of electrocortical activity occurred when ATP was about 30% depleted. Brain creatine kinase catalyzed flux, measured by the NMR saturation transfer experiment before the hypoxic period, was 4-fold higher at 24–25 days than at 4-or 10–11 days. In conclusion, the temporally coupled depletion of PCr and ATP during hypoxia, which is characteristic of the mature brain, is seen only after the maturational increase in brain CK activity.
Cet ouvrage est le résultat d'une réflexion collective réalisée à partir de l'analyse des transformations observées, en Argentine, au niveau de la société toute entière, au début de la décennie 1990. ...L'inquiétude du futur dans ce pays est une réalité d'autant plus grande que les difficultés des temps présents, marqués par plusieurs décennies de crise, ont du mal à laisser la place à une reprise. Les années difficiles qui viennent de s'écouler ont affecté la structure même du modèle de développement argentin, remettant en cause les bases historiques du système productif. Le changement dépasse les dimensions purement économiques pour déborder sur le politique, le culturel, les relations sociales, l'insertion internationale et finalement le territoire. Avec l'objectif d'un marché commun, le Mercosur, l'Argentine, le Brésil, le Paraguay et l'Uruguay sont engagés dans la suppression des barrières douanières intérieures et dans la coordination de leurs politiques économiques. La disparition des frontières économiques nationales impose avec vigueur une profonde restructuration industrielle. Le processus intégrateur soulève la question de l'État, celle de sa force actuelle et de sa modernisation. Comment l'Argentine fera-t-elle face aux différents défis qui se présentent à elle à l'aube du troisième millénaire ? C'est à cette question qu'essaient de répondre les auteurs de ce livre.
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