Seasonal Variation in Onset of Myocardial Infarction—A 7‐year single‐center study in Italy

Like many other serious acute cardiovascular and cerebrovascular events, acute myocardial infarction (AMI) shows seasonal variation, being most frequent in the winter. We sought to investigate whether age, gender, and hypertension influence this pattern. We studied 4014 (2259 male and 1755 female) consecutive patients with AMI presenting to St. Anna Hospital of Ferrara, Italy between January 1998 and December 2004. Some 1131 (28.2%) of the AMI occurred in persons <65 yrs of age, and 2883 (71.8%) in those ≥65 yrs of age. AMI was over‐represented in males (82% in the <65 yr group vs. 56.6% in the ≥65 yr group (χ²=13.99; p<0.001). Hypertension had been previously documented in 964 (24%) of the cases. There were 691 (17.2%) fatal case outcomes; fatal outcomes were significantly higher among the 3054 normotensive (n=614 or 20.1%) than the 964 hypertensive cases (n=77 or 8%; χ²=74.94, p<0.001). AMIs were most frequent in the winter (n=1076 or 26.8% of all the events) and least in the summer (n=924 or 23.0% of all the events; χ²=12.36, p=0.007). The greatest number of AMIs occurred in December (n=379 or 9.44%), and the lowest number in September (n=293 or 7.3%; χ²=11.1, p=0.001). Inferential chronobiological (Cosinor) analysis identified a significant annual pattern in AMI in those ≥65 yrs of age, with a peak between December and February—January for the total sample (p<0.005), January for the sample of males (p=0.014), February for fatal infarctions (p=0.017), and December for non‐fatal infarctions (p=0.006). No such temporal variations were detected in any of these categories in those <65 yrs of age. The annual pattern in AMI was also verified by Cosinor analysis in the following hypertensive subgroups: hypertensive males (n=552: January, p=0.014), non‐fatal infarctions in hypertensive patients (n=887: January, p=0.018), and elderly normotensives (n=1556: November, p=0.007).     

Does Circadian and Seasonal Variation in Occurrence of Acute Aortic Dissection Influence in‐Hospital Outcomes?

The risk of acute aortic dissection (AAD) exhibits chronobiological variations with peak onset in the morning and in winter. However, it is not known whether the time of day or season of the year of the AAD affects clinical outcomes. We studied 1,032 patients enrolled in the International Registry of Acute Aortic Dissection from January 1997 to December 2001. For circadian and seasonal analysis, the time and date of symptom onset were available for 741 and 1,007 patients, respectively, and were grouped into four 6 h periods (morning, afternoon, evening, and night) and four seasons (winter, spring, summer, and autumn). The χ² test for goodness of fit was used to evaluate non‐uniformity of the time of day and time of year for critical in‐hospital clinical events, including death. While highest incidence of AAD occurred in the morning and winter, clinical events (including mortality) were similar during the four different periods of the 24 h (χ²=1.9, p=0.60) and seasonal (χ²=1.2, p=0.75) periods.     

A Prospective Study of Seasonal Variation in Shift‐Work Tolerance

Seasonal effects on shift‐work tolerance were assessed using the Standardized Shiftwork Index and the 21‐item Hamilton Depression Scale. Participants (N=88) mainly worked a two‐day, two‐night, four‐off rotation with 12 h shifts changing at 06∶00 and 18∶00 h in Vancouver, Canada. At this latitude (～49° N), daylength varies seasonally from ～16 to ～8 h, and both daily commutes occur in the dark in mid‐winter and in sunlight in mid‐summer. Questionnaires were completed twice, near the summer and winter solstices (order counterbalanced). Outcome variables were mood, general psychological health, sleep quality, chronic fatigue, physical health, job satisfaction, and social and domestic disruption. Of these, general psychological health and mood were significantly worse in winter, while sleep was more disturbed in summer. In winter, 31% exceeded the cutoff for psychological distress, and >70% scored in the higher than normal range for depressive symptoms. In summer, the proportions dropped to 19% and 53%, respectively. Measures of physical health and psychosocial well‐being showed no seasonal effects. Relationships among explanatory and outcome variables, assessed by linear regression and canonical correlations, were also stable across season. Neuroticism was the strongest predictor of tolerance to shift work. Age was predictive only of sleep disturbance in both summer and winter. These results indicate that time of year can affect important outcome measures in shift‐work assessment and intervention studies. The high average scores on measures of psychological distress and depression in winter suggest that at northern latitudes, some shift schedules may increase the risk of seasonal‐type depression.     

Variation in the Ichnofauna of the Collio Formation (Lower Permian) in the South-Alpine Region (Northern Italy)

In the Collio Formation (Lower Permian) of the South-Apine region (North Italy) paleobiodiversity consists of tetrapod footprints, invertebrate traces and rarer plants, and is characterized by an absolute poverty of taxa that becomes more acute from the lower to the upper part of the Collio Formation. Regionally, the drop in diversity can be explained by joint tectonic and climatic change; humid evergreen environments became mainly dry. Examination of ichnofossil distribution supports this hypothesis.     

School’s Out: Seasonal Variation in the Movement Patterns of School Children

School children are core groups in the transmission of many common infectious diseases, and are likely to play a key role in the spatial dispersal of disease across multiple scales. However, there is currently little detailed information about the spatial movements of this epidemiologically important age group. To address this knowledge gap, we collaborated with eight secondary schools to conduct a survey of movement patterns of school pupils in primary and secondary schools in the United Kingdom. We found evidence of a significant change in behaviour between term time and holidays, with term time weekdays characterised by predominately local movements, and holidays seeing much broader variation in travel patterns. Studies that use mathematical models to examine epidemic transmission and control often use adult commuting data as a proxy for population movements. We show that while these data share some features with the movement patterns reported by school children, there are some crucial differences between the movements of children and adult commuters during both term-time and holidays.     

Second primary malignancies in patients with non-melanoma skin cancer: Results from a cancer registry–based study in Emilia Romagna,north-east Italy

Backgroundprevious research on the risk of subsequent, primary non-cutaneous malignancies among patients with non-melanoma skin cancers (NMSCs) led to conflicting results. We aimed to investigate a possible link between NMSC and second primary malignancies by using the population-based data available in cancer registries.Methodsthis observational study retrospectively assessed the risk of occurrence of both synchronous and methachronous second primary tumours in a cohort of cancer patients whose first diagnosis was NMSC. The cohort came from the network of general cancer registries of the Emilia-Romagna Region, northeast Italy, in the period between 1978 and 2012, and was compared with the general population living in the same area. Two main indexes were used: i) Standardized Incidence Ratio (SIR), calculated as the ratio between the observed and the expected number of second cancers and ii) Excess Absolute Risk (EAR), expressing the absolute excess or deficit of second cancer incidence.Resultsin the period analysed (1978–2012, 72,503,157 person/years, PYs), 89,912 primary NMSC were found in 76,414 patients. Among them, 14,195 developed a second primary cancer in the subsequent 501,763 follow-up PYs. NMSC patients showed an overall SIR of 1.22 (CI 95% 1.20-1,24) and an EAR of 5.11 cases/1000 PYs (CI 95% 4.48–5.74).Conclusionsthe study results showed that NMSC patients had an increase in relative risk and, at least for some tumours, in absolute risk of developing a second cancer when compared with the general population. Genetic, environmental and personal risk factors may influence this finding.     

Analysis of the N-Acetyltransferase 2 Gene Polymorphism in the Patients with Chronic Obstructive Pulmonary Disease and in Populations of the Volga–Ural Region

Restriction fragment-length polymorphism of the gene coding for N-acetyltransferase 2 (NAT2) was typed in populations of the Volga–Ural region (Bashkirs, Tatars, Chuvashes, Udmurts, and Russians) as well as in patients with chronic obstructive pulmonary disease (COPD) and in healthy individuals. Rapid and slow acetylator phenotypes were determined based on the presence or absence of the KpnI, TaqI, and BamHI restriction endonuclease recognition sites. The proportion of slow acetylators in the populations examined varied from 40.00% in Bashkirs to 64.15% in Chuvashes with statistically significant difference between these two ethnic groups (² = 5.7; P = 0.02). Overall, in the Volga–Ural populations slow acetylators represented 56.25% of the subjects examined. This value was similar to those presented in other studies of Caucasoid populations. In the COPD patients a statistically significant decrease of the slow acetylator frequency to 48.28% compared to healthy individuals (62.18%) was observed (² = 4.60; P = 0.036). The data obtained suggest a possible association between the drug resistance in the COPD patients with the rapid acetylator phenotype, which can lead to the development of the chronic form of the disease.     

Analysis of the potential fungal biodeteriogen effects in the “Doctorate Library” of the University of Perugia,Italy

Historical collections held in ancient archives and libraries constitute a cultural and artistic heritage of inestimable value. These collections contain a series of organic materials which may alter and perish in time, especially if they are conserved in inadequate environmental conditions and without any specific precautionary devices to protect them from damage caused by chemical, biological and physical factors. It is essential to prevent ‘at risk’ situations to conserve library and archive heritage. Early detection of fungal spores and moulds in conservation environments will permit us to intervene at the infection site at the right moment and also to detect the micro‐environments where climatic parameters are not suitable for conservation purposes.

The aim of this study is to examine potentially biodeteriogen fungal micro‐flora in the environment of the “Doctorate Library”, one of the most important buildings of the University of Perugia, which contains frescos and library collection of great value. The study was carried out through quantitative and qualitative analysis of airborne fungal species and through the evaluation of viable aerobiological particles as potential agents of biodeterioration. The airspore monitoring was made using the active method (by Personal Volumetric Air Sampler Spore Trap, Burkard Company Ltd.) and the passive one (by sedimentation technique on Petri dishes). The results obtained by both methods allowed us to detect numerous potentially biodeteriogen species, to determine their quantity and influence and to evaluate the levels of their variability in time.     

“I Can't Find Anything Wrong: It Must Be a Pulmonary Embolism”: Diagnosing Suspected Pulmonary Embolism in Primary Care,a Qualitative Study

Background

Before using any prediction rule oriented towards pulmonary embolism (PE), family physicians (FPs) should have some suspicion of this diagnosis. The diagnostic reasoning process leading to the suspicion of PE is not well described in primary care.

Objective

to explore the diagnostic reasoning of FPs when pulmonary embolism is suspected.

Method

Semi-structured qualitative interviews with 28 FPs. The regional hospital supplied data of all their cases of pulmonary embolism from June to November 2011. The patient''s FP was identified where he/she had been the physician who had sent the patient to the emergency unit. The first consecutive 14 FPs who agreed to participate made up the first group. A second group was chosen using a purposeful sampling method. The topic guide focused on the circumstances leading to the suspicion of PE. A thematic analysis was performed, by three researchers, using a grounded theory coding paradigm.

Results

In the FPs'' experience, the suspicion of pulmonary embolism arose out of four considerations: the absence of indicative clinical signs for diagnoses other than PE, a sudden change in the condition of the patient, a gut feeling that something was seriously wrong and an earlier failure to diagnose PE. The FPs interviewed did not use rules in their diagnostic process.

Conclusion

This study illustrated the diagnostic role of gut feelings in the specific context of suspected pulmonary embolism in primary care. The FPs used the sense of alarm as a tool to prevent the diagnostic error of missing a PE. The diagnostic accuracy of gut feelings has yet to be evaluated.     

Seasonal Modulation of the 8‐and 24‐Hour Rhythms of Ondansetron Tolerance in Mice

Ondansetron (Zophren®) is a serotonin 5HT₃-receptor antagonist used primarily to control nausea and vomiting caused by cytotoxic chemo‐and radio‐therapy. Tolerance to this drug shows both 24 and 8 h periodicities. In this framework, this study aimed to determine whether these ondansetron tolerance rhythms are modulated by season. The chronotoxic effect of a fixed dose (3.5 mg/kg, i.p.) of the drug was investigated with reference to both time of the day and year dependencies. Season‐related studies were performed on 560 male Swiss mice, 10 to 12 wks old, synchronized with L:D=12:12 for three weeks. During a 1 yr span (2005), four 24 h studies were performed with a single dosing time at 1, 7, 13, and 19 hours after light onset (HALO), respectively. Tolerance was assessed daily during a 40‐day span after acute ondansetron treatment. Both χ² test and cosinor methods were used to analyze the time series data. Statistically significant dosing time‐dependent changes were validated in both yearly and daily time scales. The 24 h mean survival rate peaked in spring (92%) compared to fall (72%), the 20% difference being statistically significant (χ² test with p<0.05 and cosinor with p<0.0001 for seasonal rhythm detection and with a peak time, Ø,=April 3±6.6 days). A 24 h rhythm was also detected in each of the seasonal time points. However, the curve pattern was monophasic in fall as well as spring. In fall, a large amplitude (A) circadian rhythm was detected that peaked at 19 HALO, while in the spring, a small circadian rhythm was detected that peaked at 1 HALO. The curve pattern was biphasic in summer (with large A) and in winter (with a small A). The existence of two peaks of equal magnitude in winter (100% survival rate) and in summer (100% and 90%) suggests the presence of both circadian and ultradian rhythms rather than an ultradian component of the 24 h period. The seasonal modulation of ondansetron circadian chronotolerance seems to involve several rhythm parameters: season‐related changes in the 24 h mean (M), amplitude (A), acrophase location (Ø), as well as bimodal curve patterns including the coexistence of rhythms with respectively 24 and 8 h periods in winter and summer. In conclusion, tolerance to ondansetron varies not only according to the 24 and 8 h periods but also according to seasons, which suggests the complexity of ondansetron toxicity rhythms. Seasonal modulation of ondansetron tolerance may also influence the strategies of chemo‐and chrono‐therapy, and it is therefore necessary to take it into account in clinical drug‐delivery protocols to minimize side effects of cytotoxic anticancer and antiemetic agents.     

Seasonal Variation in Ischemic Stroke Incidence and Association with Climate: A Six‐Year Population‐Based Study

Questions about the seasonality of stroke remain controversial. Using a nationwide population‐based dataset, this study presents a time series analysis of seasonal patterns in ischemic stroke occurrence, along with their association with climate in Taiwan. Using data from the Taiwan National Health Insurance Research Database, a total of 168,977 visits to emergency departments between 1998 and 2003 for ischemic stroke were identified for patients ranging between 20 and 84 yrs of age. Monthly stroke incidences were calculated for 72 months, by sex and stroke subtype, and for the age groups 20–54, 55–64, 65–74, and ≥75 yrs per 100,000 of the population. We performed auto‐regressive integrated moving average (ARIMA) analysis to investigate the presence of seasonality and any association with climate for acute ischemic stroke events. We found no significant seasonal variation in the incidence of ischemic stroke for any age or sex groups. Furthermore, after adjusting for seasonality, month, and trend, the ARIMA regression model revealed only associations between ischemic stroke incidence and atmospheric pressure. We conclude that seasonality of ischemic stroke does not exist in Taiwan. Ischemic stroke incidence is, however, significantly related to atmospheric pressure.     

Biological succession on silicone fouling‐release surfaces: Long‐term exposure tests in the harbour of ischia,Italy

A static test site was set up in the Harbour of Ischia (Gulf of Naples, Italy) to investigate the antifouling effectiveness of newly developed non‐polluting coatings. Two‐year exposure experiments were performed on sets of panels coated with silicone‐based coatings, and results were compared both to sets of panels coated with toxic agents, and non‐toxic epoxydic compounds. Abiotic factors, strength of adhesion of the temporal dynamics of succession of foulers were analyzed throughout the period of immersion. Brown algae constantly represented the “border point”; between the early community, dominated by sume, micro‐ and macroalgae, and the late community, mainly represented by bryozoans and molluscs, as well as polychaetes, sponges and tunicates. Brown algae, such as Ectocarpus siliculosus, tunicates (mainly Botryllus schlossen) and polychaetes (Hydroides elegans, Pileolaria pseudomilitaris) were demonstrated to be key species, triggering the community and influencing its development. Light was the main abiotic factor discriminating the community on the two sides of panels exposed to different irradiances. The best performing coatings (silicone easy release coatings without additives) substantially influenced community structure, shifting it to the earliest stages of colonization. Silicone coatings proved to be unsuitable for colonization by organisms typical of mature communities, due to their low energy surfaces. The results of the present paper demonstrate that silicone coatings technology represents an alternative to the use of biocidal antifouling paints.     

KiSS‐1: A Likely Candidate for the Photoperiodic Control of Reproduction in Seasonal Breeders

In seasonal species, photoperiod exerts tight regulation of reproduction to ensure that birth occurs at the most favorable time of yr. A distinct photoneuroendocrine circuit composed of the retina, suprachiasmatic nucleus (SCN) of the hypothalamus, and pineal gland transduces daylength into a rhythmic secretion of melatonin. The duration of the night‐time rise of this hormone conveys daylength information to the organism. Melatonin is known to mediate the control of seasonal reproduction, but how it modulates sexual activity is far from understood. Recent data indicate that the product of the KiSS‐1 gene is a potent stimulator of the hypothalamic‐pituitary‐gonadal axis and may play, together with its receptor GPR54, a central role in the neuroendocrine regulation of gonadotropin secretion. This article briefly reviews these findings and presents arguments that KiSS‐1 could take part in the seasonal control of reproduction.     

Analysis of Polymorphisms of the Huntington Disease Gene in Ethnic Populations of the Volga–Ural Region

Eleven populations of the Volga–Ural region were analyzed with respect to three intragenic polymorphisms of the Huntington disease gene (IT15), including highly polymorphic (CAG)_n and moderately polymorphic (CCG)_n of exon 1 and neutral del2642 of exon 58. In the case of (CAG)_n, 101 genotypes were observed, with genotype number varying from 15 in Southeastern Bashkirs to 34 in Mari. Allele diversity R_S ranged from 9.70 in Southeastern Bashkirs to 18.00 in Chuvash, averaging 13.79 ± 2.12. The (CAG)_n allele frequency distribution was unimodal and had a maximum at (CAG)₁₇. In the case of (CCG)_n, six alleles with 6–12 repeats were observed. R_S was 4.13 ± 0.44, ranging from 3.73 in Udmurts to 4.99 in Tatars. In the case of del2642, allele del– was detected at a frequency 0.830 in Mari to 0.932 in Udmurts. Of all Volga–Ural ethnic populations, Finno-Ugric ones proved to be most heterogeneous with respect to the three polymorphisms, whereas Turkic populations and, in particular, Bashkirs were homogeneous. Microdifferentiation of the Volga–Ural populations corresponded to the European type.     

Analysis of Apolipoprotein E Gene Polymorphism in Populations of the Volga–Ural Region

Polymorphism at the apolipoprotein E gene (apoE) in populations of the Volga–Ural region was studied by means of polymerase chain reaction. In the region examined the population-specific patterns of the apoE alleles and genotypes frequency distribution were established. The results obtained were compared with the literature data on the apoE polymorphism in other world populations. Substantial heterogeneity of different ethnic populations in respect to the apoE genotypes distribution and frequency was revealed.     

Molecular Genetic Analysis of the DXS52Polymorphism in Populations of the Volga–Ural Region

The DXS52polymorphic locus mapping to the 5"-region of the blood-clotting factor VIII gene on the X chromosome was genotyped in seven Volga–Ural ethnic groups (Bashkirs, Tatars, Chuvashes, Maris, Mordovians, Udmurts, and Komis). A total of 47 different genotypes and 15 allelic variants of this locus were described. Substantial intra- and interpopulation heterogeneity of the ethnic groups studied in respect to frequency and distribution of the DXS52alleles and genotypes was demonstrated. The unimodal DXS52allele frequency distribution pattern with the peak at 1690 bp was typical to Mordovians and Komis. Chuvashes and Maris, as well as Udmurts, were characterized by bimodal frequency distribution patterns, with the peaks at 1690 and 670 bp, and 1690 and 1390 bp, respectively. Moreover, Bashkirs and Tatars displayed trimodal DXS52allele frequency distribution patterns with the peaks at 1690, 1390, and 670 bp. The DXS52allele frequency distribution patterns described in populations of the Volga– Ural region were found to be remarkably different from those established for the mixed Moscow population and the population of Western Europe. These data indicate that the DXS52locus is highly informative, and this polymorphic system can serve as a molecular marker for population genetic studies.     

Diurnal Variation of Plasma Brain‐Derived Neurotrophic Factor (BDNF) in Humans: An Analysis of Sex Differences

Scant information is available on the diurnal variation of peripheral neurotrophic factors, including brain‐derived neurotrophic factor (BDNF), in human beings. We explored plasma and serum BDNF levels at three different clock times in a study of 28 healthy subjects of both sexes. Statistically significant diurnal variation in plasma BDNF level was detected in men, with the peak at 08:00 h and nadir at 22:00 h. At this time, the plasma BDNF concentration of men was significantly lower than that of women (p=.02). However, no diurnal variation was found either in plasma BDNF of women, in either the follicular or luteal phases of the menstrual cycle, or in serum BDNF level in both men and women. These findings support the concept of rhythmic variation in plasma BDNF regulation that seems to be sex‐related. (Author correspondence: dmarazzi@psico.med.unipi.it)     

Spatial–Temporal Variation in Orchid Bee Communities (Hymenoptera: Apidae) in Remnants of Arboreal Caatinga in the Chapada Diamantina Region, State of Bahia, Brazil

The spatial and temporal distribution of organisms is a fundamental aspect of biological communities. The present study focused on three remnants of arboreal Caatinga in northeastern Brazil between May, 2009 and April, 2010. A total of 627 euglossine males were captured in traps baited with artificial aromatic compounds. The specimens belonged to 14 species and four genera: Euglossa Latreille, Eulaema Lepeletier, Eufriesea Cockerell, and Exaerete Hoffmannsegg. Eulaema nigrita Lepeletier (41.6), Euglossa carolina Nemésio (15.3%), Eulaema marcii Nemésio (13.6%), and Euglossa melanotricha Moure (12.8%) were the most common species sampled. The distribution of collected specimens per fragment was as follows: Braúna (280?ha)??259 individuals belonging to 14 species; Cambuí (179?ha)??161 individuals from eight species; and Pindoba (100?ha)??207 individuals represented by seven species. Braúna had the highest diversity (H???=?1.91) and estimated species richness. The largest fragment was the main source of the observed variation in species richness and abundance, indicating a non-random pattern of spatial distribution. The analysis of environmental factors indicated that seasonal variation in these factors was the principal determinant of species occurrence and abundance.