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Background: Inhalation is one of the main means of human exposure to polycyclic aromatic hydrocarbons (PAHs) because of their ubiquitous presence in the atmosphere. However, most studies have considered only PAHs found in the particle phase and have omitted the contribution of the gas-phase PAHs to the risk.Objective: We estimated the lifetime lung cancer risk from PAH exposure by inhalation in people living next to the largest chemical site in Southern Europe and the Mediterranean area.Methods: We determined 18 PAHs in the atmospheric gas and particle phase. We monitored the PAHs for 1 year in three locations near the chemical site in different seasons. We used toxic equivalence factors to calculate benzo[a]pyrene (BaP) equivalents (BaP-eq) for individual PAHs and applied the World Health Organization unit risk (UR) for BaP (UR = 8.7 × 10–5) to estimate lifetime cancer risks due to PAH exposures.Results: We observed some spatial and seasonal variability in PAH concentrations. The contribution of gas-phase PAHs to the total BaP-eq value was between 34% and 86%. The total estimated average lifetime lung cancer risk due to PAH exposure in the study area was 1.2 × 10–4.Conclusions: The estimated risk was higher than values recommended by the World Health Organization and U.S. Environmental Protection Agency but lower than the threshold value of 10–3 that is considered an indication of definite risk according to similar risk studies. The results also showed that risk may be underestimated if the contributions of gas-phase PAHs are not considered.

Hip fractures are a very serious socio-economic problem in western countries. Since the 1950s, orthogeriatric units have introduced improvements in the care of geriatric patients admitted to hospital because of hip fractures. During this period, these units have reduced mean hospital stays, number of complications, and both in-hospital mortality and mortality over the middle term after hospital discharge, along with improvements in the quality of care and a reduction in costs. Likewise, a recent clinical trial has reported greater functional gains among the affected patients. Studies in this field have identified the prognostic factors present upon admission or manifesting themselves during admission and that increase the risk of patient mortality or disability. In addition, improved care afforded by orthogeriatric units has proved to reduce costs. Nevertheless, a number of management issues remain to be clarified, such as the optimum anesthetic, analgesic, and thromboprophylactic protocols; the type of diagnostic and therapeutic approach best suited to patients with cognitive problems; or the efficiency of the programs used in convalescence units or in home rehabilitation care. Randomized clinical trials are needed to consolidate the evidence in this regard.

Abstract-The objective of the study was to assess the factors related to the occurrence of microalbuminuria during the follow-up of a young adult group with essential hypertension that had not been previously treated. Normo-albuminuric essential hypertensives, Ͻ50 years old, who had not been previously treated with antihypertensive drugs and who did not have diabetes mellitus were included. After the initial evaluation, patients were treated using only nonpharmacological measures (nϭ62), ␤-blockers (nϭ38), ACE inhibitors (nϭ64), calcium channel blockers (nϭ8), and several classes (nϭ15). Measurements were taken for office blood pressure, biochemical profile, and 24-hour urinary albumin excretion at the beginning of the study and were measured yearly during an average of 2.7Ϯ1.2 years of follow-up. Among the 187 patients included, 22 (11,7%) developed microalbuminuria (progressors, 4.4/100 patients/y). No differences were present between progressors and those who remained normo-albuminuric (nonprogressors) in terms of age, gender, body mass index, disease duration, blood pressure values, biochemical profile, familial history of diabetes or hypertension, smoking habits, or the presence of EKG left ventricular hypertrophy. The group with the lowest progression rate was the patients treated with ACE inhibitors (nϭ5; 2.9/100 patients/y), followed by the diet group (nϭ5; 3.3/100 patients/y) and the ␤-blockers group (nϭ5; 4.1/100 patients/y). When we excluded patients treated with calcium channel blockers or those who changed over time between different classes of treatment, no significant differences in the incidence of microalbuminuria were observed among the groups. Progressors showed higher slopes of fasting glucose (4.78Ϯ11.4 versus 0.50Ϯ6.8 mg/y, PϽ0.02) and uric acid (0.58Ϯ0.93 versus 0.05Ϯ1.10 mg/y, PϽ0.03) compared with the slopes of nonprogressors. Both the slopes for glucose and systolic blood pressure over time were associated independently with the slope of the logarithm of urinary albumin excretion when adjusted for age, gender, and treatment groups. Cox proportional hazard model for progression of microalbuminuria showed that baseline urinary albumin excretion (risk ratio [RR]ϭ1.06; confidence interval [CI] 95%, 1.01 to 1.11), slope for systolic blood pressure (RRϭ1.11; CI 95%, 1.03 to 1.20), and slope for glucose (RRϭ1.08; CI 95%, 1.03 to 1.14) were independently associated to the development of microalbuminuria. In conclusion, in a group of young adults with essential hypertension that had not been previously treated, the main factors influencing the occurrence of microalbuminuria during antihypertensive treatment were the values of microalbuminuria at baseline and the slopes for systolic blood pressure and fasting glucose. icroalbuminuria is now considered a marker of cardiovascular and renal risk in diabetic 1 and nondiabetic elderly subjects. 2 In hypertension, although the prevalence of microalbuminuria is variable and depends on the characteristics of the population studied, a clustering of cardio...

Residential proximity to environmental hazards has been related to adverse health outcomes. Respiratory health and allergies in children living near petrochemical sites have not been extensively studied. We evaluated the association between residential proximity to the petrochemical site of Tarragona (Catalonia, Spain) and the prevalence of asthma, respiratory symptoms and lung function in children. Children aged 6-7 (n=2672) and adolescents aged 13-14 (n=2524) residing near two large petrochemical sites and those living in a city with medium vehicular traffic were cross-sectionally compared with children from an area with low vehicular traffic and without industry. The prevalence of symptoms was measured using the International Study of Asthma and Allergies in Childhood written and video questionnaires. Lung function measurements were done in a subsample of 959 adolescents in the four areas. Multivariable analyses were done to estimate the effects of the residential area on symptoms and lung function adjusted for potential confounders. Crude prevalence of symptoms was similar across the studied areas. After adjustment, children and adolescents living near a petrochemical site had a statistically significant higher prevalence of respiratory hospitalizations in the previous year (Prevalence Ratio (PR)=1.49; 95%CI, 1.06-2.09) and of nocturnal cough (PR=1.29; 95%CI 1.05-1.57), respectively. Reduced lung function values among adolescents residing near the petrochemical areas were not observed. Although a higher prevalence of asthma in children and adolescents living near the petrochemical sites could not be demonstrated, as described in other studies, respiratory hospitalizations and nocturnal cough could be related to short-term exposures to pollutants. Other clinical and sub-clinical respiratory health effects in the petrochemical industry areas should be investigated.

beta1-AR expression levels were higher in circulating lymphocytes from hypertensive patients (2-DeltaDeltaCt = 2.135 +/- 0.4252*, vs. control group), but this difference was not observed when these patients were treated with blockers of the renin-angiotensin system. beta1-AR levels directly correlated (r2 = 0.5711, P = 0.0185) with urinary albumin excretion in microalbuminuric patients, which relates alterations of this receptor to cardiovascular risk. An inverse correlation was observed between the expression levels of beta2-AR and diastolic blood pressure (r2 = 0.2078, P = 0.0031), suggesting that beta2-AR levels in lymphocytes mirror their expression in vascular cells, in which beta2-AR-mediated relaxation regulates vascular resistance. mRNA levels for GRK3 were inversely correlated with systolic and diastolic blood pressure (day, night and 24 h), which suggests a protective role for GRK3 in the regulation of human blood pressure, as supported by previous findings in transgenic mice.

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Abstract-The objective of the present study was to analyze the influence of the I/D polymorphism of the ACE gene on the outcome of microalbuminuria in essential hypertensive patients who were receiving antihypertensive treatment. One hundred thirty-six essential hypertensive patients who were Ͻ50 years old and had never previously received treatment with antihypertensive drugs were included in the study. During a 3-year period, patients received nonpharmacological treatment consisting of moderate salt restriction and a low-calorie diet they were obese, with or without a regimen of antihypertensive drugs based on ␤-blockers or ACE inhibitors. Hydrochlorothiazide was added when necessary to maintain the blood pressure goal of Ͻ135/85 mm Hg. At the beginning of the study and at yearly intervals, systolic and diastolic blood pressures (SBP and DBP, respectively), 24-hour urinary albumin excretion (UAE), renal function, and biochemical profile measurements were made. The insertion/deletion (I/D) polymorphism of the ACE gene was determined through the use of polymerase chain reaction. The variables used in the statistical analysis were the measurements at the start of the study and the increase or decrease detected during the follow-up, estimated as individual specific regression line slope values. At baseline, no differences in blood pressure or UAE values were observed among genotypes. Likewise, the genotype or allele frequency was not significantly different between normoalbuminurics and microalbuminurics. After the 3 treatment years, significant reductions in SBP, DBP, and UAE were found (SBP 151.6Ϯ17.3 reduced to 137.2Ϯ14.3 mm Hg, PϽ0.001; DBP 96.6Ϯ8.9 reduced to 84.5Ϯ9.8 mm Hg, PϽ0.001; UAE 36.7Ϯ71.5 reduced to 28.3Ϯ78.6 mg/24 h, PϽ0.05). The slopes of these parameters over time did not differ significantly among genotypes. The slope of SBP was the main factor related to the slope of logUAE (PϽ0.003). A significant positive correlation coefficient between the SBP and logUAE slopes was observed for the DD patients (rϭ0.57, PϽ0.0001) but was absent in patients carrying the I allele (II rϭϪ0.03, PϭNS; I/D rϭ0.01, PϭNS). Follow-up studies should be used to achieve a better understanding of the impact of candidate gene polymorphisms on the development of hypertension-induced organ damage. Assessment of the I/D polymorphism of the ACE gene may identify subjects who require a greatly lowered blood pressure to prevent organ damage and to reduce hypertensionassociated complications and death.