Publications by authors named "Franco Garcia"

20 Publications

  • Page 1 of 1

Impact of Age on Consent in a Geriatric Orthopaedic Trauma Patient Population.

Geriatr Orthop Surg Rehabil 2021 30;12:21514593211003065. Epub 2021 Mar 30.

Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School Orthopedic Trauma Initiative, Boston, MA, USA.

Introduction: Persistent misconceptions of frailty and dementia in geriatric patients impact physician-patient communication and leave patients vulnerable to disempowerment. Physicians may inappropriately focus the discussion of treatment options to health care proxies instead of patients. Our study explores the consenting process in a decision-making capable orthogeriatric trauma patient population to determine if there is a relationship between increased patient age and surgical consent by health care proxy.

Methods: Patients aged 65 and older who underwent operative orthopaedic fracture fixation between 1 of 2 Level 1 Trauma Centers were retrospectively reviewed. Decision-making capable status was defined as an absence of patient history of cognitive impairment and a negative patient pre-surgical Confusion Assessment Method (CAM) and Mini-Cog Assessment screen. Provider of surgical consent was the main outcome and was determined by signature on the consent form.

Results: 510 patients were included, and 276 (54.1%) patients were deemed capable of consent. In 27 (9.8%) of 276 decision-capable patients, physicians obtained consent from health care proxies. 20 of these 27 patients (74.1%) were 80 years of age or older. However, in patients aged 70 to 79, only 7 health care proxies provided consent. (p = 0.07). For every unit increase in age, the log odds of proxy consent increased by .0008 (p < 0.001). Age (p < 0.001), income level (p = 0.03), and physical presence of proxy at consult (p < 0.001) were factors associated with significantly increased utilization of health care proxy provided consent. Language other than English was a significant predictor of proxy-provided consent (p = 0.035). 48 (22%) decision-making incapable patients provided their own surgical consent.

Discussion: The positive linear association between age and health care proxy provided consent in cognitively intact geriatric orthopaedic patients indicates that increased patient age impacts the consenting process. Increased physician vigilance and adoption of institutional consenting guidelines can reinforce appropriate respect of geriatric patients' consenting capacity.
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http://dx.doi.org/10.1177/21514593211003065DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8020399PMC
March 2021

Distinct Regulation of Dopamine D3 Receptor in the Basolateral Amygdala and Dentate Gyrus during the Reinstatement of Cocaine CPP Induced by Drug Priming and Social Stress.

Int J Mol Sci 2021 Mar 18;22(6). Epub 2021 Mar 18.

Group of Cellular and Molecular Pharmacology, Department of Pharmacology, University of Murcia, 30120 Murcia, Spain.

Relapse in the seeking and intake of cocaine is one of the main challenges when treating its addiction. Among the triggering factors for the recurrence of cocaine use are the re-exposure to the drug and stressful events. Cocaine relapse engages the activity of memory-related nuclei, such as the basolateral amygdala (BLA) and the hippocampal dentate gyrus (DG), which are responsible for emotional and episodic memories. Moreover, D3 receptor (D3R) antagonists have recently arisen as a potential treatment for preventing drug relapse. Thus, we have assessed the impact of D3R blockade in the expression of some dopaminergic markers and the activity of the mTOR pathway, which is modulated by D3R, in the BLA and DG during the reinstatement of cocaine-induced conditioned place preference (CPP) evoked by drug priming and social stress. Reinstatement of cocaine CPP paralleled an increasing trend in D3R and dopamine transporter (DAT) levels in the BLA. Social stress, but not drug-induced reactivation of cocaine memories, was prevented by systemic administration of SB-277011-A (a selective D3R antagonist), which was able, however, to impede D3R and DAT up-regulation in the BLA during CPP reinstatement evoked by both stress and cocaine. Concomitant with cocaine CPP reactivation, a diminution in mTOR phosphorylation (activation) in the BLA and DG occurred, which was inhibited by D3R blockade in both nuclei before the social stress episode and only in the BLA when CPP reinstatement was provoked by a cocaine prime. Our data, while supporting a main role for D3R signalling in the BLA in the reactivation of cocaine memories evoked by social stress, indicate that different neural circuits and signalling mechanisms might mediate in the reinstatement of cocaine-seeking behaviours depending upon the triggering stimuli.
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http://dx.doi.org/10.3390/ijms22063100DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8002864PMC
March 2021

Incidence and Management of Effusions Before and After CD19-Directed Chimeric Antigen Receptor (CAR) T Cell Therapy in Large B Cell Lymphoma.

Transplant Cell Ther 2021 Mar 27;27(3):242.e1-242.e6. Epub 2020 Dec 27.

Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, Florida; Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida. Electronic address:

In patients with lymphoma, third-space fluid accumulations may develop or worsen during cytokine release syndrome (CRS) associated with chimeric antigen receptor (CAR) T cell therapy. Pre-existing symptomatic pleural effusions were excluded by the ZUMA-1 trial of axicabtagene ciloleucel for large B cell lymphoma (LBCL) and variants. The incidence and management of effusions during CAR T cell therapy for LBCL are unknown. We performed a single-center retrospective study evaluating 148 patients receiving CD19-directed CAR T cell therapy for LBCL between May 2015 and September 2019. We retrospectively identified patients who had radiographic pleural, pericardial, or peritoneal effusions that were present prior to the time of CAR T infusion (pre-CAR T) or that newly developed during the first 30 days after CAR T-cell infusion (post-CAR T). Of 148 patients, 19 patients had a pre-CAR T effusion, 17 patients without pre-existing effusion developed a new infusion after CAR T, and 112 patients had no effusions. Comparing pre-CAR T effusions to new effusions post-CAR T, pre-CAR T effusions were more often malignant (84% versus 12%), persistent beyond 30 days (95% versus 18%), and required interventional drainage after CAR T infusion (79% versus 0%). Compared to patients with no effusion, patients with pre-CAR T therapy effusions had a higher frequency of high-risk baseline characteristics, such as bulky disease and high International Prognostic Index. Similarly, patients with pre-CAR T therapy effusions had a higher rate of toxicity with grade 3 or higher CRS occurring in 32% of patients. On multivariate analysis adjusting for age, Eastern Cooperative Oncology Group status, bulky disease, albumin, and lactate dehydrogenase, a pre-CAR T therapy effusion was associated with reduced overall survival (hazard ratio, 2.34; 95% confidence interval, 1.09 to 5.03; P = .03). Moreover, there was higher non-relapse mortality (11% versus 1%; P = .005). Post-CAR T effusions were not associated with significant difference in survival. Effusions commonly complicate CAR T cell therapy for lymphoma. Malignant effusions that occur prior to CAR T therapy are frequently persistent and require therapeutic intervention, and patients have a higher rate of toxicity and death. Effusions that newly occur after CAR T therapy can generally be managed medically and tend not to persist.
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http://dx.doi.org/10.1016/j.jtct.2020.12.025DOI Listing
March 2021

Association of nutrition status and hospital-acquired infections in older adult orthopedic trauma patients.

JPEN J Parenter Enteral Nutr 2021 Mar 4. Epub 2021 Mar 4.

Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, Massachusetts, USA.

Background: Malnutrition is linked to suboptimal outcomes following elective surgery. Trauma patients do not typically have an opportunity for preoperative nutrition optimization and may be at risk for malnutrition. Our goal was to investigate whether nutrition status is associated with development of hospital-acquired infections (HAIs) in older adult, orthopedic trauma patients.

Methods: We performed a retrospective analysis of data between January 1, 2017, and August 30, 2018, from the Massachusetts General Hospital Geriatric Inpatient Fracture Trauma Service. Admission nutrition status was assessed using the Mini Nutritional Assessment (MNA) and HAIs were validated through the American College of Surgeons National Surgical Quality Improvement Project database. To investigate whether nutrition status is associated with HAIs, we performed a multivariable logistic regression analysis controlling for age, sex, Charlson Comorbidity Index, glomerular filtration rate, and type of anesthesia.

Results: Four hundred sixty-one patients comprised the analytic cohort. Multivariable regression analysis demonstrated that each unit increment in MNA score was associated with a 13% reduction in risk of HAI (odds ratio, 0.87; 95% CI, 0.79-0.97). Furthermore, adjusting for timing of perioperative antibiotics, perioperative transfusions, or development of pressure injury during hospitalization did not materially change these results.

Conclusion: Our results demonstrate that malnutrition is highly prevalent in older adult, orthopedic trauma patients and that nutrition status may influence the risk of developing HAIs in this cohort of patients. Further studies are needed to determine whether optimizing perioperative nutrition in older adult, orthopedic trauma patients can reduce infectious complications and improve overall health outcomes.
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http://dx.doi.org/10.1002/jpen.2096DOI Listing
March 2021

Blockade of D3 receptor prevents changes in DAT and D3R expression in the mesolimbic dopaminergic circuit produced by social stress- and cocaine prime-induced reinstatement of cocaine-CPP.

J Psychopharmacol 2020 11 10;34(11):1300-1315. Epub 2020 Jul 10.

Group of Cellular and Molecular Pharmacology, Department of Pharmacology, University of Murcia, Campus de Ciencias de la Salud, Murcia, Spain.

Background: Cocaine may cause persistent changes in the brain, which are more apparent in DA transporter (DAT) and DA receptor availability within the nucleus accumbens (NAc). On the other hand, the DA D3 receptor (D3R) has emerged as a promising pharmacotherapeutic target for substance use disorders.

Aims: This study aims to assess the impact of selective D3R antagonism on DAT and D3R after reinstatement of cocaine preference (CPP) induced by an acute session of social defeat stress (SDS) and a cocaine prime in mice after a period of abstinence.

Methods: Male mice were conditioned with 25 mg/kg of cocaine for 4 days. After 60 days of extinction training mice were pretreated with the selective D3R antagonist SB-277011A before the re-exposure to a priming dose of cocaine or to a single SDS session. CPP scores were determined and levels of DAT, D3R, phospho Akt (pAkt) and phospho mTOR (pmTOR) were assessed in the NAc shell.

Results: An increase in DAT and D3R expression was seen in the NAc after both a cocaine prime- and SDS-induced reinstatement of CPP. Pretreatment with SB-277011A blocked elevated DAT and D3R expression as well as SDS-induced reinstatement. By contrast, the blockade of D3R did not modified the cocaine prime-induced CPP. Changes in DAT and D3R expression do not seem to occur via the canonic pathway involving Akt/mTOR.

Conclusions: Our results suggest that the selective D3R antagonist ability to inhibit DAT and D3R up-regulation could represent a possible mechanism for its behavioral effects in cocaine-memories reinstatement induced by social stress.
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http://dx.doi.org/10.1177/0269881120936468DOI Listing
November 2020

Pilot Randomized Trial of a Transdisciplinary Geriatric and Palliative Care Intervention for Older Adults With Cancer.

J Natl Compr Canc Netw 2020 05;18(5):591-598

1Department of Medicine, Division of Hematology and Oncology, and.

Background: Oncologists often struggle with managing the unique care needs of older adults with cancer. This study sought to determine the feasibility of delivering a transdisciplinary intervention targeting the geriatric-specific (physical function and comorbidity) and palliative care (symptoms and prognostic understanding) needs of older adults with advanced cancer.

Methods: Patients aged ≥65 years with incurable gastrointestinal or lung cancer were randomly assigned to a transdisciplinary intervention or usual care. Those in the intervention arm received 2 visits with a geriatrician, who addressed patients' palliative care needs and conducted a geriatric assessment. We predefined the intervention as feasible if >70% of eligible patients enrolled in the study and >75% of eligible patients completed study visits and surveys. At baseline and week 12, we assessed patients' quality of life (QoL), symptoms, and communication confidence. We calculated mean change scores in outcomes and estimated intervention effect sizes (ES; Cohen's d) for changes from baseline to week 12, with 0.2 indicating a small effect, 0.5 a medium effect, and 0.8 a large effect.

Results: From February 2017 through June 2018, we randomized 62 patients (55.9% enrollment rate [most common reason for refusal was feeling too ill]; median age, 72.3 years; cancer types: 56.5% gastrointestinal, 43.5% lung). Among intervention patients, 82.1% attended the first visit and 79.6% attended both. Overall, 89.7% completed all study surveys. Compared with usual care, intervention patients had less QoL decrement (-0.77 vs -3.84; ES = 0.21), reduced number of moderate/severe symptoms (-0.69 vs +1.04; ES = 0.58), and improved communication confidence (+1.06 vs -0.80; ES = 0.38).

Conclusions: In this pilot trial, enrollment exceeded 55%, and >75% of enrollees completed all study visits and surveys. The transdisciplinary intervention targeting older patients' unique care needs showed encouraging ES estimates for enhancing patients' QoL, symptom burden, and communication confidence.
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http://dx.doi.org/10.6004/jnccn.2019.7386DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7851750PMC
May 2020

Clinical Performance of (1,3) Beta-D Glucan for the Diagnosis of Pneumocystis Pneumonia (PCP) in Cancer Patients Tested With PCP Polymerase Chain Reaction.

Clin Infect Dis 2019 09;69(8):1303-1309

Infectious Diseases Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.

Background: Serum (1,3)-beta-D glucan (BDG) is increasingly used to guide the management of suspected Pneumocystis pneumonia (PCP). BDG lacks specificity for PCP, and its clinical performance in high-risk cancer patients has not been fully assessed. Polymerase chain reaction (PCR) for PCP detection is highly sensitive, but cannot differentiate between colonization and infection. We evaluated the diagnostic performance of serum BDG in conjunction with PCP PCR on respiratory samples in patients with cancer and unexplained lung infiltrates.

Methods: We performed a retrospective analysis of adult patients evaluated for PCP at our institution from 2012 to 2015, using serum BDG and PCP PCR. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the serum BDG at different thresholds were evaluated using PCP PCR alone or in conjunction with clinical presentation in PCP PCR-positive patients.

Results: With PCP PCR alone as the reference method, BDG (≥80 pg/mL) had a sensitivity of 69.8%, specificity of 81.2%, PPV of 34.6%, and NPV of 95.2% for PCP. At ≥200 pg/mL in patients with a positive PCR and a compatible PCP clinical syndrome, BDG had a sensitivity of 70%, specificity of 100%, PPV of 100%, and NPV of 52.0% for PCP.

Conclusions: Patients negative by both BDG and PCR were unlikely to have PCP. In patients with a compatible clinical syndrome for PCP, higher BDG values (>200 pg/mL) were consistently associated with clinically-significant PCP infections among PCP PCR-positive oncology patients.
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http://dx.doi.org/10.1093/cid/ciy1072DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6763633PMC
September 2019

Evaluating characteristics of PROSPERO records as predictors of eventual publication of non-Cochrane systematic reviews: a meta-epidemiological study protocol.

Syst Rev 2018 03 9;7(1):43. Epub 2018 Mar 9.

Department of Dermatology, Reina Sofía University Hospital, Menendez Pidal Ave, 14004, Córdoba, Spain.

Background: Epidemiology and the reporting characteristics of systematic reviews (SRs) and meta-analyses (MAs) are well known. However, no study has analyzed the influence of protocol features on the probability that a study's results will be finally reported, thereby indirectly assessing the reporting bias of International Prospective Register of Systematic Reviews (PROSPERO) registration records.

Objective: The objective of this study is to explore which factors are associated with a higher probability that results derived from a non-Cochrane PROSPERO registration record for a systematic review will be finally reported as an original article in a scientific journal.

Methods/design: The PROSPERO repository will be web scraped to automatically and iteratively obtain all completed non-Cochrane registration records stored from February 2011 to December 2017. Downloaded records will be screened, and those with less than 90% fulfilled or are duplicated (i.e., those sharing titles and reviewers) will be excluded. Manual and human-supervised automatic methods will be used for data extraction, depending on the data source (fields of PROSPERO registration records, bibliometric databases, etc.). Records will be classified into published, discontinued, and abandoned review subgroups. All articles derived from published reviews will be obtained through multiple parallel searches using the full protocol "title" and/or "list reviewers" in MEDLINE/PubMed databases and Google Scholar. Reviewer, author, article, and journal metadata will be obtained using different sources. R and Python programming and analysis languages will be used to describe the datasets; perform text mining, machine learning, and deep learning analyses; and visualize the data. We will report the study according to the recommendations for meta-epidemiological studies adapted from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement for SRs and MAs.

Discussion: This meta-epidemiological study will explore, for the first time, characteristics of PROSPERO records that may be associated with the publication of a completed systematic review. The evidence may help to improve review workflow performance in terms of research topic selection, decision-making regarding team selection, planning relationships with funding sources, implementing literature search strategies, and efficient data extraction and analysis. We expect to make our results, datasets, and R and Python code scripts publicly available during the third quarter of 2018.
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http://dx.doi.org/10.1186/s13643-018-0709-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5845292PMC
March 2018

Immunotherapy-induced autoimmune diabetes and concomitant hypophysitis.

Pituitary 2018 10;21(5):556-557

NYU Langone Health, New York, NY, USA.

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http://dx.doi.org/10.1007/s11102-018-0880-8DOI Listing
October 2018

Diagnosis of Extrapulmonary Legionellosis in Allogeneic Hematopoietic Cell Transplant Recipients by Direct 16S Ribosomal Ribonucleic Acid Sequencing and Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry.

Open Forum Infect Dis 2017 13;4(3):ofx140. Epub 2017 Jul 13.

Infectious Diseases Service, Department of Medicine.

Identifying extrapulmonary legionellosis is difficult due to the lack of clinical suspicion and limitations of conventional microbiologic methods. We present a case series of hematopoietic cell transplant recipients with extrapulmonary legionellosis diagnosed via molecular diagnostics: 16S ribosomal ribonucleic acid gene Sanger sequencing and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry.
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http://dx.doi.org/10.1093/ofid/ofx140DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5570015PMC
July 2017

Prevalence and intensity of soil-transmitted helminthiasis, prevalence of malaria and nutritional status of school going children in honduras.

PLoS Negl Trop Dis 2014 Oct 16;8(10):e3248. Epub 2014 Oct 16.

Population Risks, Ministry of Health of Honduras, Tegucigalpa, Francisco Morazan, Honduras.

Background: Many small studies have been done in Honduras estimating soil-transmitted helminthiasis (STH) prevalence but a country-wide study was last done in 2005. The country has the highest burden of malaria among all Central American countries. The present study was done to estimate country-wide STH prevalence and intensity, malaria prevalence and nutritional status in school going children.

Methods And Findings: A cross-sectional study was conducted following PAHO/WHO guidelines to select a sample of school going children of 3rd to 5th grades, representative of ecological regions in the country. A survey questionnaire was filled; anthropometric measurements, stool sample for STH and blood sample for malaria were taken. Kato-Katz method was used for STH prevalence and intensity and rapid diagnostic tests, microscopy, and polymerase chain reaction (PCR) were used for malaria parasite detection. A total of 2554 students were studied of which 43.5% had one or more STH. Trichuriasis was the most prevalent (34%) followed by ascariasis (22.3%) and hookworm (0.9%). Ecological regions II (59.7%) and VI (55.6%) in the north had the highest STH prevalence rates while IV had the lowest (10.6%). Prevalence of one or more high intensity STH was low (1.6%). Plasmodium vivax was detected by PCR in only 5 students (0.2%), all of which belonged to the same municipality; no P. falciparum infection was detected. The majority of children (83%) had normal body mass index for their respective age but a significant proportion were overweight (10.42%) and obese (4.35%).

Conclusions: Biannual deworming campaigns would be necessary in ecological regions II and VI, where STH prevalence is >50%. High prevalence of obesity in school going children is a worrying trend and portends of future increase in obesity related diseases. Malaria prevalence, both symptomatic and asymptomatic, was low and provides evidence for Honduras to embark on elimination of the disease.
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http://dx.doi.org/10.1371/journal.pntd.0003248DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4199552PMC
October 2014

Biological activity of nine recombinant AtRALF peptides: implications for their perception and function in Arabidopsis.

Plant Physiol Biochem 2014 Feb 14;75:45-54. Epub 2013 Dec 14.

Laboratório de Bioquímica de Proteínas, Departamento de Ciências Biológicas, Escola Superior de Agricultura Luiz de Queiroz, Universidade de São Paulo - USP, Piracicaba, SP 13418-900, Brazil. Electronic address:

RALF is a small (5 kDa) and ubiquitous plant peptide signal. It was first isolated from tobacco leaf protein extracts owing to its capacity to alkalinize the extracellular media of cell suspensions. RALFs inhibit root growth and hypocotyl elongation, and a role for RALFs in cell expansion has also been proposed. Arabidopsis has 37 RALF isoforms (AtRALF), but only a small group of nine has high primary structure identity to the original RALF peptide isolated from tobacco. Herein, we report the heterologous production of these nine peptides in Escherichia coli and the evaluation of their activity in five biological assays. All AtRALF peptides produced showed strong alkalinizing activities, with the exception of the pollen-specific isoform AtRALF4. Although it exhibited no inhibitory activity in the root growth and hypocotyl elongation assays, AtRALF4 is a strong inhibitor of pollen germination. Our data demonstrate that the divergence in the tissue specificity and gene expression patterns of the different AtRALFs does not change the fact that their main role seems to be the regulation of cell expansion. Furthermore, different activities in the alkalinization assays upon the addition of two consecutive and saturating doses of the peptides suggest that the peptides are likely being sensed by specific receptors.
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http://dx.doi.org/10.1016/j.plaphy.2013.12.005DOI Listing
February 2014

Mycotic coronary aneurysm: report of two cases.

Arq Bras Cardiol 2011 Nov;97(5):e105-7

Clinica Cardiovascular Santa Maria, Medellin, Colombia.

The number of percutaneous interventions with stent implantation has increased dramatically in recent years, although the frequent use of this device in reports of infections is extremely rare. In this article we report two cases of mycotic aneurysm after implantation of stents with different clinical presentations and outcomes.
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http://dx.doi.org/10.1590/s0066-782x2011001400015DOI Listing
November 2011

Genetic diversity in cultivated carioca common beans based on molecular marker analysis.

Genet Mol Biol 2011 Jan 1;34(1):88-102. Epub 2011 Mar 1.

Centro de Recursos Genéticos Vegetais, Instituto Agronômico de Campinas, Campinas, SP, Brazil.

A wide array of molecular markers has been used to investigate the genetic diversity among common bean species. However, the best combination of markers for studying such diversity among common bean cultivars has yet to be determined. Few reports have examined the genetic diversity of the carioca bean, commercially one of the most important common beans in Brazil. In this study, we examined the usefulness of two molecular marker systems (simple sequence repeats - SSRs and amplified fragment length polymorphisms - AFLPs) for assessing the genetic diversity of carioca beans. The amount of information provided by Roger's modified genetic distance was used to analyze SSR data and Jaccards similarity coefficient was used for AFLP data. Seventy SSRs were polymorphic and 20 AFLP primer combinations produced 635 polymorphic bands. Molecular analysis showed that carioca genotypes were quite diverse. AFLPs revealed greater genetic differentiation and variation within the carioca genotypes (Gst = 98% and Fst = 0.83, respectively) than SSRs and provided better resolution for clustering the carioca genotypes. SSRs and AFLPs were both suitable for assessing the genetic diversity of Brazilian carioca genotypes since the number of markers used in each system provided a low coefficient of variation. However, fingerprint profiles were generated faster with AFLPs, making them a better choice for assessing genetic diversity in the carioca germplasm.
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http://dx.doi.org/10.1590/S1415-47572011000100017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3085381PMC
January 2011

[Aging of the population and incidence of primary acquired hemopathies in the Autonomous Community of Aragón].

Rev Esp Salud Publica 1998 Nov-Dec;72(6):559-70

Servicio de Hematología-Hemoterapia Hospital Miguel Servet, Zaragoza.

Background: Aging probably comprises one of the major factors contributing to the onset of acquired primary blood diseases (APBD's) most of which are of a chronic type. The purpose of this study is to analyze the rate of occurrence (RO) of HPA in a population of 522,621 inhabitants (Males: 252,721; Females: 269,900) showing a negative vegetative growth (-1.4/10(5) inhabitants/year), said occurrence being dealt with separately for the population under age 60 and the population over age 60.

Methods: In January-December, 1994, a estimate was made of the HPA rate of occurrence and rate of analyses among the patients from the area in question, dealing separately with those under age 60 and over age 60. The diagnostic criteria applied were Monoclonal Gammopathies of Undetermined Significance (MGUS's) in keeping with Kyle's criteria. Multiple Myeloma (MM) and Chronic Lymphatic Leukemia (CLL) in keeping with the Myeloma Task Force criteria. Non-Hodgkin's Lymphoma (NHL) and Hodgkin's Disease (HD) in keeping with the REAL classification, Myelodisplasic Syndromes (MS's) and Acute Leukemia (AL) in keeping with the FAB classification, Chronic Myeloproliferative Syndromes (CMS's) in keeping with the PVSG. For calculating the rates of occurrence, descriptive epidemiological methods were used.

Results: The highest rates of blood analyses as the result of suspected APH's fell within the over 60 age group (p < 0.0001). During the length of time analyzed, a total of 302 APH's (< 60/> or = years: 100/202, p < 0.0001) were diagnosis, being worthy of special mention: 84 MGUS's; 21 MM's; 57 NHL's; 26 CLL's; 33 CMS's; 11 AL's and 14 HD's. The spread by gender was: Males: 177; Females 125. Average age: 63.54 years (age range 19-92). The rates of occurrence (cases/10(5) inhabitants/year) were (< age 60/> or = age 60): overall: 31.31/178.86; MGUS: 7.37/52.87; MM: 1.84/13.21; NHL: 5.53/34.36; CLL: 1.53/18.50; MS: 0.62/27.31; CMS: 5.52/16.74; AL: 1.53/5.29; HD: 3.68/1.76.

Conclusions: The highest rate of analyses as the result of suspected APH was found among those over 60 years of age. The overall occurrence of APH is significantly higher in those over age 60, as well as for each type of APH taken into account, except for AL and HD. The highest rate of occurrence is that of MGUS, NHL and MS's, especially in males.
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March 1999

[Which are the true incidence rates of primary hematological disorders acquired in our population?].

Sangre (Barc) 1998 Oct;43(5):356-64

Departamento de Medicina Preventiva y Salud Pública, Universidad de Zaragoza.

Purpose: To define demographic and epidemiological characteristics of primary haematological disorders (PMHD) in patients referred to a haematology department in 1,240 beds general hospital.

Patients And Methods:

Period Of Study: 01/94-12/94. We have performed a study in patients older than 14, to determine the age adjusted incidence rates of PHD in the assigned population: 439,279 inh (M: 210,139; F: 229,140), with a negative-vegetative growth (-1.39/10(3) inh/y). A total of 1,242 new cases was received, 302 of them were diagnosed of PHD. Epidemiological method: incidence rates (IR), age and sex adjusted incidence rates (AIR), truncated standardized incidence rates (TSIR) and confidence interval (CI) were calculated.

Statistical Method: Normal distribution, descriptive and frequency distribution analysis were performed along with chi 2 test.

Results: Demographic data: mean age (+/- SD): 63.54 y +/- 15.81; range 19-92. M/F: 177/125, males mean age 62.85 +/- 16.29, females: 64.52 +/- 15.11. The PHD distribution was: MGUS 84 cases; NHL 57; MDS 33; CLL 26; CMPD 26; MM 21; HD 14; AL 11; ITP 10; CML 9; AIHA 5; hypoplastic anaemia 3; and cryoglobulinaemia 3. AIR (cases/10(5) inhab/y): Consulting rate 261.79. The PHD incidence rate was 31.00 (M: 38.01; F: 25.51). In patients under 60 y the AIR of PMDH was 31.31 (M: 36.42, F: 26.25), and in those older than 60 y the AIR was increasing, with 178.86 (M: 247.21, F: 128.52). The AIR for subtypes was: MGUS, 8.01 (M: 3.56, F: 1.93); CLL 2.28 (M: 2.69, F: 1.95); CMPD 3.17 (M: 2.83, F: 3.51); MM 1.92 (M: 2.43, F: 1.49); HD 2.27 (M: 3.54, F: 1.04); AL 1.41 (M: 1.54, F: 1.30); ITP 1.15 (M: 1.20, F: 1.12); CML 1.09 (M: 1.19, F: 1.01); AIHA 0.61 (M: 0.55, F: 0.69); hypoplastic anaemia 0.24 (M: 0.19, F: 0.30); cryoglobulinaemia 0.34 (M: 0.55, F: 0.14).

Remarks: The elderly have increased incidence of PHD. The AIR is higher in males and in older than 60 y, unless for CMPD. Most frequent PHD were MGUS and NHL.
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October 1998

[Meningitis in La Rioja].

Rev Enferm 1983 May-Jun;6(58-59):10-4

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September 1983