Local terrestrial snails as natural intermediate hosts of the zoonotic parasite Angiostrongylus cantonensis in the new European endemic area of Valencia, Spain

AIM

The rat lungworm, Angiostrongylus cantonensis, has recently been found in the city of Valencia, parasitizing rats, Rattus norvegicus and Rattus rattus, its natural definitive hosts. This is the first finding of this zoonotic nematode in continental Europe. After informing local and national health authorities, the collection of local terrestrial snails took place with the aim of elucidating their potential role as intermediate hosts of A. cantonensis.

METHODS AND RESULTS

A total of 145 terrestrial snails, belonging to the species Cernuella virgata, Cornu aspersum, Eobania vermiculata, Otala punctata, Pseudotachea splendida, Rumina decollata and Theba pisana, were randomly collected between May and December 2022 in public gardens, parks and orchards in six districts of Valencia, in five of which A. cantonensis had been reported previously in rats. Once collected and identified, the snails were frozen at -20°C. Subsequently, the DNA was isolated and screened by PCR using specific primers targeting the A. cantonensis COI gene. Seven individual snails, belonging to the species C. virgata, C. aspersum and T. pisana, were positive, for an overall prevalence of 4.8%. The PCR product from one of them was sequenced by Sanger sequencing.

CONCLUSIONS

The three positive terrestrial snail species are among the edible species that are frequently included in various dishes in Spain. C. virgata is reported as a previously unrecorded intermediate host and should be added to the list of more than 200 species of terrestrial snails that have been reported worldwide as intermediate hosts of the rat lungworm. Considering that these terrestrial snails may release infective larvae of A. cantonensis on leafy green vegetables on which they feed and during their handling and preparation for consumption, prophylactic measures to prevent human neuroangiostrongyliasis in Valencia and other regions to which this zoonotic parasite may spread are recommended.

Keratoplastiken im Kindes- und Jugendalter

Hintergrund Die Voraussetzungen für das langfristige Überleben einer perforierenden Keratoplastik sind im Säuglings- und Kindesalter aufgrund immunologischer Besonderheiten, der eingeschränkten Untersuchbarkeit sowie reduzierter Compliance und Therapieadhärenz à priori ungünstig. Jedoch stellt eine Hornhautübertragung oftmals die einzige Möglichkeit zur Prävention einer Amblyopie dar und ist somit alternativlos. Wir untersuchten das Indikationsspektrum, das Transplantatüberleben und das Komplikationsspektrum in einem bizentrischen Register aller Keratoplastiken im Kindesalter.

Material und Methoden Aus den elektronischen Transplantatregistern der beiden Zentren wurden alle Patienten recherchiert, die zum Zeitpunkt der jeweils 1. Keratoplastik das 18. Lebensjahr noch nicht vollendet hatten. Aus den Krankenakten wurden die Indikation, etwaiges Transplantatversagen, die Sehschärfe, Verlust des Augapfels und weitere Komplikationen systematisch recherchiert.

Ergebnisse Es wurden insgesamt 104 Augen von 95 Patienten (54 % weiblich) identifiziert. Das Durchschnittsalter bei der Operation betrug im Median 14 Jahre (Quartile 8 und 16 Jahre). Die Nachbeobachtungszeit lag im Median bei 2,7 Jahren. Es zeigten sich folgende Indikationen: Keratokonus (39 %), perforierende Verletzung (18 %), nicht herpetische Hornhautnarben (12 %), herpetische Hornhautnarben (6 %), Sklerokornea (3 %), Verätzung (3 %) und die heterogene Gruppe der sonstigen Indikationen (19 %). Das nach Kaplan-Meier geschätzte klare Transplantatüberleben reichte zum Zeitpunkt der Durchschnittsnachbeobachtungszeit von 100 % (Keratokonus) bis 35 % (Sklerokornea). Ein Verlust des Augapfels war ausschließlich nach perforierender Verletzung (n = 2) zu verzeichnen. Nach 1 Jahr sind in der Kaplan-Meier-Schätzung alle Transplantate in der Gruppe der Säuglinge eingetrübt. In der Gruppe der Kleinkinder bis Jugendlichen sind 90 % der Transplantate zu diesem Zeitpunkt noch klar.

Schlussfolgerungen Die Prognose der Keratoplastik im Kindesalter hängt sowohl von der initialen Indikation und damit indirekt von der Grunderkrankung als auch vom Alter ab. Eine besonders schlechte Prognose zeigte die Gruppe der Säuglinge mit einem nur sehr kurzen Transplantatüberleben. Bei den Indikationen zeigte die Gruppe der Kinder mit Keratokonus die besten Ergebnisse. Als prognostisch ungünstig erwiesen sich Sklerokornea sowie perforierende Augenverletzungen.

Polarity of GaN

Convergent beam electron diffraction (CBED) was applied to study polarity of GaN heterolayers grown by MOCVD on sapphire and SiC substrates and also mechano-chemically polished bulk GaN platelet crystals grown from Ga melt under hydrostatic pressure of N. Heterolayers of GaN grown on both types of substrates showed (0001) Ga polarity, e.g. Ga to N along c-axis. Mechano-chemical etching of bulk GaN platelet crystals leaves one surface smooth and the opposite surface rough with visible damage caused by mechanical polishing. CBED studies showed that the smooth surface has (0001) N polarity, confirming our earlier studies.

[Pustules from the cow barn]

A 54-year-old cattle farmer presented with crusty purulent plaques in the neck area. The clinical picture and microscopical proof of hyphae in the skin smear combined with Wood's lamp testing led to the diagnosis of Tinea barbae, a mycological infection of the skin transmitted by cattle (typically Trichophyton verrucosum). Therapy with itraconazole 200 mg q.d. p.o. and miconazole ointment 1×/day over 2 weeks was successful. This case report and its image are designed to bring attention to this rarely diagnosed pathology.

Approaching the evolutionary advantage of ancillary types of haemoglobin in Daphnia magna by simulation of oxygen supply

The planktonic crustacean Daphnia magna synthesizes haemoglobin (Hb) macromolecules of variant subunit composition and oxygen affinity. This is one of the strategies by which the animals cope with variations in environmental conditions such as ambient oxygen tension. The enrichment of high-affinity Hb molecules in the haemolymph of hypoxia-exposed animals is thought to reduce Hb synthesis costs due to an enhanced transport efficiency of these molecules in comparison to the low-affinity Hb molecules. How great this economic advantage is, and under which conditions this benefit disappears, is still not fully understood. Here we implemented a rigorously simplified model of the daphnid body and described the transport of oxygen from the environment via the haemolymph to the tissues in terms of the convection–diffusion–reaction equation. The model was validated by comparing various model predictions with experimental data. A sensitivity analysis was used to evaluate the influence of parameter uncertainties on the model predictions. Cost–benefit analysis revealed in which way at the system's level the increase in Hb oxygen affinity improves the oxygen loading at the respiratory surfaces and impairs the release of oxygen to the tissues. The benefit arising from the improved oxygen loading exceeds the disadvantage of impaired unloading only under conditions where the ambient oxygen tension is critically low and the Hb concentration is high. The low-affinity Hb, on the other hand, provides an advantage given that the Hb concentration is low and the ambient oxygen tension is well above the critical level. Computer-aided modelling and simulation therefore provide valuable mechanistic insights into the driving forces that could have shaped the evolution of globin genes in daphnids.

ENZIAN-Score, eine Klassifikation der tief infiltrierenden Endometriose

The ENZIAN-Score is presented as a new instrument to classify the deep infiltrating endometriosis. Especially the retroperitoneal part of the severe endometriosis is focussed on. In analogy to an oncological staging four different stages are pronounced. The localisation and the expansion of the endometriosis nodule was indicated to different subgroups. The still used rAFS-score is of no clinical evidence, as we pointed out in a retrospective study of our patients with severe intestinal endometriosis.

Mayer-von Rokitansky-Kuster-Hauser syndrome in association with a hitherto undescribed variant of the Holt-Oram syndrome with an aorto-pulmonary window

We report on the association of Mayer-von Rokitansky-Küster-Hauser syndrome (MRKHS) with a unique form of Holt-Oram syndrome (HOS) with an aorto-pulmonary window. A 24-year-old Turkish woman was referred to our hospital because of primary amenorrhoea. Both her vagina and uterus were absent, and the diagnosis of MRKHS was established. Laparoscopic creation of a neovagina by the modified Vecchietti technique was performed. A rare congenital malformation of the heart, namely an aorto-pulmonary window, had required cardiac surgery when the patient was a 6-month-old infant. This cardiac malformation plus associated upper limb anomalies led to the clinical diagnosis of HOS. To the best of our knowledge, this is only the second report in the scientific literature on the concurrence of MRKHS and HOS, and the first published case of HOS with an aorto-pulmonary window as the cardiac malformation.

Simplified microvascular suture techniques for rat liver transplantation as a microsurgical model with arterial blood supply

The methods for liver transplantation in the rat mainly used do not include reconstruction of the arterial blood supply to the liver. Furthermore, to ensure a short anhepatic phase these methods almost all entail specially developed cuff anastomoses in the recipient operation instead of the conventional microvascular suture technique. Thus an acceptable survival rate can be attained in the experimental animals. This detailed description of simplified microvascular suture techniques is intended to present an alternative to the cuff anastomoses used almost exclusively. In the donor operation with this method, the liver is dissected with an arterial pedicle including the abdominal segment of the aorta, and the liver is flushed in situ not only via the portal vein, but also via the hepatic artery. The organ is implanted in the recipient animal using simplified microvascular suture reconstruction of the arterial blood supply to the liver. Use of telescopic spectacles with 2-fold magnification has proven to be adequate for the entire procedure. With mastery of this method of rat liver transplantation, the average duration of the anhepatic phase is about 20 min, substantially below the 30-min limit which is critical for the survival of the experimental animals. The donor operation requires about 60 min, and the recipient operation 70 to 80 min. With this method, the spectrum of investigations on liver transplantation which are possible in the rat is substantially extended in that clinical conditions can be reproduced very much more exactly by combination of portal and arterial in-situ flushing in the donor operation and rearterialization of the transplant in the recipient operation, as compared to the transplanted rat liver being supplied only with portal venous blood.

Terminal ileitis with sealed perforation?a rare complication of intestinal endometriosis: case report and short review of the literature

INTRODUCTION

Perforation is a rare complication of intestinal endometriosis. We report on a 38-year-old patient with previously known rectovaginal and ileocecal endometriosis who was referred with an acute abdomen.

CASE REPORT

On abdominal plain film an ileus of small intestine was diagnosed. The patient had fever, and the C-reactive protein was markedly increased. Upon emergency laparotomy an acute terminal ileitis with omentum-sealed perforation and a stenosis of the anterior wall of the rectum due to endometriosis were found. Partial resection of the ileum with end-to-end anastomosis, appendectomy, and short segmental rectum resection were performed. The postoperative course was uneventful. Histological examination corroborated the intraoperative diagnosis of fistulas, perforation and deep ulceration of the intestine consistent with transmural endometriosis.

DISCUSSION

For proper care of these patients excellent cooperation between gynecologists and general surgeons is desirable. A short review of the literature concerning intestinal endometriosis is given.

Easy and effective--web-based information systems designed and maintained by physicians: experience with two gynecological projects

It is well established that medical information sources develop continuously from printed media to digital online sources. To demonstrate effectiveness and feasibility of decentralized performed web-based information sources for health professionals, two projects are described. The information platform of the German Working Group for Information Technologies in Gynecology and Obstetrics (AIG) and the information source concerning the German Registry for in vitro fertilization (DIR) were implemented using ordinary software and standard computer equipment. Only minimal resources and training were necessary to perform safe and reliable web-based information sources with a high correlation of effectiveness in costs and time exposure.

Endometriose und Malignom

Malignant tumors arising from endometriosis are rare. A frequency of about 1% has been reported with in 80% the ovary, and in 20% extragonadal sites being affected. The most common extragonadal manifestations are the rectosigmoid and the rectovaginal septum. For extragonadal malignant tumors arising from endometriosis, complete resection followed by post-operative radiotherapy, possibly plus adjuvant progestin therapy, is the treatment of choice. Endometriosis-associated ovarian carcinomas are likely to present with lower stage disease and predominantly lower grade tumors. While their treatment follows that of common ovarian cancer, a poorer response to chemotherapy must be considered. As unopposed estrogen replacement therapy has been identified as a risk factor for the development of endometriosis-associated cancer, it is not recommended for hormone replacement therapy in women with a history of endometriosis. Loss of heterozygosity and mutations of the PTEN tumor suppressor gene may be early events of tumorigenesis. Endometriosis and its malignant transformation, perhaps, may serve as a suitable model in this regard. According to recent studies, endometriosis is associated with an increased relative risk of non-Hodgkin lymphoma.

Die aktuellen IT-Systeme in der gynäkologischen Onkologie

Information technology has been integrated in gynecological oncology treatment. Therefore, new software has been established in hospitals and out-patient clinics. A German law concerning data collection in oncology has attempted to unify different strategies. All intentions to establish new documentation systems for tumor diseases need a standardized basic data set. Nevertheless, local governmental health organizations are not yet prepared to implement a global information system such as prenatal and perinatal care databases. Financial support and political work is therefore needed.