P846Discriminatory power of the grace score in non-ST segment elevation myocardial infarction in the real world: results from the portuguese registry on acute coronary syndromes

Introduction

Current clinical practice guidelines recommend risk stratification in patients with acute coronary syndrome (ACS) upon admission to the hospital. The Global Registry of Acute Coronary Events (GRACE) risk score was developed in a large multinational registry to predict both mortality and the combined events of death or reinfarction during the hospital stay and 6 months after discharge. Given the substantial regional variation and temporal changes in patient characteristics and management patterns, specially in non-ST segment elevation myocardial infarction (NSTEMI) patients, we sought to validate this risk score in a contemporary Portuguese population.

Purpose

To assess the discriminatory power of the GRACE risk score in a Portuguese contemporary cohort of patients with NSTEMI submitted to invasive strategy, regarding in-hospital mortality and the combined end-point of reinfarction and/or in-hospital mortality.

Methods

We included patients with NSTEMI submitted to coronary angiogram from the Portuguese Registry on Acute Coronary Syndrome (ProACS). For each patient, we calculated the GRACE risk score and classified them in low, intermediate or high risk, according to the cut-offs recommended in the guidelines. The discriminatory capacity of the GRACE risk score was evaluated by the area under the receiver operating characteristic [ROC] curve. The primary endpoint was defined as the occurrence of reinfarction and in-hospital mortality, and the secondary endpoint was in-hospital mortality.

A model with an AUC-ROC between 0.8 and 0.9 was considered to have a good capacity for discrimination.

Results

Among the 19.430 patients included in the ProACS between October 2010 and January 2019, we identified 7304 patients with NSTEMI that performed coronary angiogram and had the GRACE score calculated (37.6%). Patients were divided in three groups according to the GRACE score (group 1: 1–108; group 2: 109–140; group 3: 141–372), with 24.9% included in group 1, 33.0% in group 2, and 42.1% in group 3. Most patients were male (73.4%), with a mean age of 66±12 years, and 48.0% were admitted to non-percutaneous coronary intervention centers. In-hospital mortality was 1.0% and the primary endpoint occurred in 2.2% of the patients. The discriminatory capacity of the GRACE score in our population was good regarding in-hospital mortality: the area under the ROC curve was 0.83 (95% confidence interval [CI], 0.783–0.878), with the best cut-off of 148. The discriminatory capacity for the primary end-point was reasonable; the area under the ROC curve was 0.700 (95% CI 0.654–0.745), and the best cut-off was 164.

Conclusions

In our population of patients with NSTEMI submitted to an invasive strategy, the GRACE risk score presented a moderate discriminatory capacity for the occurrence of reinfarction and in-hospital, and a a good discriminatory power for in-hospital mortality.

Impact of H1N1 Influenza Vaccination on Child Morbidity in Guinea-Bissau

BACKGROUND

In addition to vaccines' specific effects, vaccines may have non-specific effects (NSEs) altering the susceptibility to unrelated infections. Non-live vaccines have been associated with negative NSEs. In 2010, a campaign with the non-live H1N1-influenza vaccine targeted children 6-59 months in Guinea-Bissau.

METHODS

Bandim Health Project runs a health and demographic surveillance system site in Guinea-Bissau. Using a Cox proportional hazards model, we compared all-cause consultation rates after vs. before the campaign, stratified by participation status.

RESULTS

Among 10 290 children eligible for the campaign, 60% had participated, 18% had not and for 22% no information was obtained. After the H1N1 campaign, the consultation rates tended to decline less for participants [HR = 0.80 (95% confidence interval, CI: 0.75; 0.85)] than for non-participants [HR = 0.68 (95% CI: 0.58; 0.79)], p = 0.06 for same effect.

CONCLUSION

The decline in the vaccinated group may have been smaller than the decline in the non-vaccinated group consistent with H1N1-vaccine increasing susceptibility to unrelated infections.

P3128Unprotected left main revascularization in patients with acute myocardial infarction: insights of a multicenter national registry

Introduction

Unlike stable coronary disease, there is no consensus about the best revascularization strategy for unprotected left main coronary artery (ULMCA) disease associated with acute myocardial infarction (MI). Recent studies have shown that percutaneous coronary intervention (PCI) is technically feasible with acceptable outcomes, making it a reasonable alternative to surgical revascularization (CABG).

Aims

To describe the practice of ULMCA revascularization in MI patients (pts) and its evolution over an 9-year period. To analyze the prognosis of this population and determine the effect of revascularization on outcome.

Methods

Retrospective, multicenter national observational study that included 19 430 MI pts from October 2010 to December 2018. Pts who presented ULMCA as culprit lesion were selected and then compared the subgroup that underwent revascularization by PCI alone versus (vs.) CABG alone. Primary endpoint (PE) was a composite of all-cause death, nonfatal re-MI and nonfatal stroke during hospital stay. Secondary endpoint (SE) was all-cause death rate at 1-year after hospital discharge.

Results

204 pts with ULMCA as culprit lesion were selected (1.1% of all pts): 77.9% male, mean age 69±12 years, 97 (47.5%) underwent CABG alone, 92 (45.1%) PCI alone, 10 (4.9%) no revascularization and 5 (2.5%) both strategies. At admission, pts undergoing PCI alone presented more frequently with ST-segment elevation, persistent chest pain, cardiogenic shock and higher values of GRACE risk score. During hospital stay, severe left ventricular (LV) systolic dysfunction (<30%), need for mechanical ventilation, sustained ventricular tachycardia and aborted cardiac sudden death were also more common in these pts. Concerning PE, global rate was 18.5% (27 deaths, 6 nonfatal re-MI and 2 nonfatal stroke). It was significantly higher in pts undergoing PCI alone (32.6% vs. 3.1%, p<0.01). After adjustment, surgical revascularization had 98% lower odds of PE occurrence compared to PCI (OR 0.02, 95% CI 0.002–0.22, p<0.01). Cardiogenic shock at admission (OR 5.06, 95% CI 1.21–21.11, p=0.03) and severe LV systolic dysfunction (OR 7.77, 95% CI 1.49–40.56, p=0.02) were also independent predictors of adverse outcome. One-year all-cause death rate was 4.9%, with no significant difference at survival curves between PCI vs. CABG (Log-Rank p=0.96).Over the 9-year, there was not a significant change in the use of one revascularization technique over the other.

Conclusions

MI with ULMCA as culprit lesion is infrequent and associated with a high rate of adverse events during hospital stay. PCI was preferred in higher risk pts but, even after adjustment, it was associated with a less favorable short-term outcome compared to surgical strategy. Nevertheless, long-term prognosis was excellent in hospital survivors with no difference between both techniques. Randomized trials are needed to determine the ideal revascularization strategy for these pts.

P6403Predictors of bleeding in elderly patients with myocardial infarction: data from the real world

Background

The population of elderly patients with acute myocardial infarction (MI) is clearly underrepresented in contemporary clinical trials. This population presents a higher risk of both cardiovascular and bleeding events, making the decision of the antithrombotic strategy particularly challenging.

Purpose

To characterize the antithrombotic therapy used in patients with MI and age ≥75 years, and to identify predictors of major bleeding and cardiovascular events in this population.

Methods

Retrospective analysis of patients with a diagnosis of MI and age ≥75 years included in the Portuguese Registry of Acute Coronary Syndromes between October 2010 and January 2018. Logistic regression analysis was used to identify predictors of major bleeding and of the combined endpoint of in-hospital mortality and reinfarction.

Results

The analysis included 17.868 patients of which 30.1% with age ≥75 years. This population had a mean age of 82±5 years, 57% were male and 36% had a diagnosis of STEMI. On admission 10% presented with Killip-Kimball (KK) class III or IV, 14% were on atrial fibrillation (AF), and the mean Hb and creatinine levels were 13±2 g/dl and 1.6±1.2 mg/dl, respectively. In comparison with younger patients, this population had higher Grace and Crusade scores (178 vs 139, and 41 vs 24, respectively). Most elderly patients (74%) underwent coronary angiography (71% by radial artery access) and 75% were submitted to percutaneous revascularization, 9% to surgery, and 1% to an hybrid strategy. Aspirin was used in 96% of patients, clopidogrel in 82%, ticagrelor in 13% (vs 25% of younger patients; p<0.001), and glycoprotein IIb/IIIa inhibitors (GPI) in 11%. Most patients were anticoagulated with enoxaparin (68 vs 56% of younger patients; p<0.001), 22% with unfractionated heparin (vs 30%; p<0.001), and 13% with fondaparinux (vs 14%; p=0.018). Complications were more common in the elderly population, including mechanical complications (1 vs 0.5%), atrioventricular block (5 vs 3%), stroke (1 vs 0.6%), major bleeding (3 vs 1%), in-hospital death (8 vs 2%) and reinfarction (2 vs 1%) (p<0.001 for all).

In multivariate logistic regression analysis, the predictors of major bleeding were diastolic blood pressure (BP) on admission <50 mmHg, maximum creatinine ≥2 mg/dl and the use of GPI. The predictors of the combined endpoint were a diagnosis of STEMI, previous history of cancer, chronic kidney disease or demencia, and the presence on admission of an heart rate <60 bpm, systolic BP <90 mmHg or ≥180 mmHg, KK class > I, AF, left bundle branch block, and left ventricle systolic dysfunction.

Conclusions

This study reflects the contemporary national reality of the management of elderly patients with MI. Overall, this population has a high risk of major bleeding, but several characteristics are associated with an even higher risk, such as the hemodynamic profile, renal function, and the use of GPI.

P03.13 Evaluation of PIK3CA mutational status in glioma molecular subgroups

BACKGROUND

Gliomas are the most common and lethal malignant tumors of central nervous system. In 2016, World Health Organization (WHO) classification included IDH mutations and 1p/19q codeletion as diagnostic criteria to define glioma entities. However, new biomarkers for diagnosis, prognosis and response to therapy are needed. In this context, PIK3CA mutations have been described as constitutive mutations, which highlights their relevance in gliomas. Here we clarified the clinical relevance of PIK3CA mutations according to the 2016 WHO classification, the potential impact on diagnosis, prognosis, response to therapy, as well as their correlation with EGFR amplification and PTEN deletion.

MATERIAL AND METHODS

A cohort of 444 adult diffuse glioma samples from Instituto Português de Oncologia Lisboa Francisco Gentil (IPOLFG) was classified according to the 2016 WHO Classification. The mutational status of exon 9 and 20 of PIK3CA was evaluated in molecular subgroups of gliomas by Sanger sequencing. PTEN deletion and EGFR amplification were identified by Fluorescent in situ hybridization (FISH).

RESULTS

PIK3CA mutations showed a higher frequency in the subgroup of gliomas with IDH mutations and 1p/19q codeletion - oligodendrogliomas (10%). In Glioblastoma (GBM) IDH-mutant and IDH-wildtype these oncogenic mutations were observed in 9% and 3% of cases, respectively. Similar results were obtained using The Cancer Genome Atlas (TCGA) data, which was 8% and 2%, respectively. H1047R and E542K were the most frequent mutations identified in the glioma molecular subgroups. Importantly, we found 3 unreported pathogenic variants in exon 20 of PIK3CA (c.3112T>C, c.2988T>C, c.3040C>T) and one polymorphic variant (c.3210A>G). In addition, PIK3CA mutations, PTEN deletion and EGFR amplification were not mutually exclusive alterations in glioma molecular subgroups. For the first time in gliomas, it was identified the rs45455192 polymorphism at a frequency of 16% in astrocytomas IDH-mutant, 24% in oligodendrogliomas and 18% in both molecular subgroups of GBM, although this polymorphism did not have prognostic value. The analysis of PIK3CA mutations in glioma recurrences showed that these mutations are maintained during glioma progression.

CONCLUSION

In two independent cohorts (IPOLFG and TCGA), it was obtained similar frequencies of PIK3CA mutations in GBM molecular subgroups. In addition, these mutations are more relevant in less aggressive gliomas (IDH-mutated and 1p/19q codeleted). These alterations seem to be important in tumor maintenance and progression, which makes this gene a potential therapeutic target. In the future, we will investigate the effect of the in vitro pharmacological inhibition of PIK3CA in GBM mutant cell lines.

Mytilus galloprovincialis CYP1A-like mRNAs reveal closer proximity of mytilid CYP1A to the eumetazoan CYP2 family

Due to the role of Cytochrome P450, Family 1, Subfamily A (CYP1A) in the detoxification of many polycyclic aromatic hydrocarbons (PAHs), there has been an effort to characterise the gene and the products from its expression in organisms that are relevant for biomonitoring and toxicity testing procedures. Nonetheless, the existence of functional homologues in aquatic invertebrates is not entirely consensual, especially in bivalve molluscs, which pose as one of the most important models for aquatic toxicologists, especially mytilids. After isolation and sequencing of CYP1A-like mRNA from the Mediterranean mussel, Mytilus galloprovincialis, phylogenetics incorporating homologues from molluscs and other eumetazoans, vertebrates included, yielded notorious similarity to sequences belonging to the CYP2 Family. Altogether, the findings further indicate that CYP1A-like CYPs may be absent in bivalves, in lieu of Families CYP2, 3 and 4, suggesting caution when interpreting data from common biomarkers of exposure to aromatic hydrocarbons that have been developed for CYP1A activity and expression in higher deuterostomes.

Spectral functions of Sr2IrO4: theory versus experiment

The spin-orbit Mott insulator Sr₂IrO₄ has attracted a lot of interest in recent years from theory and experiment due to its close connection to isostructural high-temperature copper oxide superconductors. Despite not being superconductive, its spectral features closely resemble those of the cuprates, including Fermi surface and pseudogap properties. In this article, we review and extend recent work in the theoretical description of the spectral function of pure and electron-doped Sr₂IrO₄ based on a cluster extension of dynamical mean-field theory ('oriented-cluster DMFT') and compare it to available angle-resolved photoemission data. Current theories provide surprisingly good agreement for pure and electron-doped Sr₂IrO₄, both in the paramagnetic and antiferromagnetic phases. Most notably, one obtains simple explanations for the experimentally observed steep feature around the M point and the pseudo-gap-like spectral feature in electron-doped Sr₂IrO₄.

Successful oral desensitization in children with cow's milk anaphylaxis: Clinical and laboratory evaluation up to nine-years follow-up

INTRODUCTION

Cow's milk protein allergy (CMPA) is the most common food allergy in children worldwide. Some children have severe and persistent CMPA, with near-fatal reactions after exposure to trace amounts of cow's milk-proteins (CMP). Strict avoidance diet is difficult, negatively affects quality of life and represents a conservative approach. Therefore, different therapeutic strategies are necessary.

OBJECTIVE

We aimed to assess long-term efficacy and safety of oral immunotherapy (OIT) in children with severe and long-lasting IgE-mediated CMPA.

MATERIALS AND METHODS

The authors present four case reports of patients with CMPA who underwent CMP-OIT, that have been under long-term follow-up up to nine years. We provide information about the clinical and laboratory evaluation. Skin prick tests (SPT), specific IgE and IgG4 were performed before, during, and after OIT. Immune profile after OIT was assessed by flow cytometry (lymphocyte subsets, regulatory T and B cells).

RESULTS

The success rate was 100%, and all patients currently have a free diet with minimal diary ingestion of 200mL CMP or equivalent. Specific IgE levels and SPT to CMP have progressively decreased, and specific IgG4 levels have increased. CD4⁺CD25⁺CD127^-/dim regulatory T cells were increased after OIT.

CONCLUSIONS

OIT ensured a clinical tolerance state after up to nine years, confirmed by both clinical and immune profile, allowing a diet without restrictions, with high satisfaction from patients and caregivers. We emphasize that OIT should be performed only by allergy experts in the hospital setting, and that only motivated families should be enrolled, since it is essential to ensure CMP daily intake at home.

Correction to: Toxicity prediction and assessment of an environmentally realistic pesticide mixture to Daphnia magna and Raphidocelis subcapitata

Acknowledgements This work was supported by LEAF (UID/AGR/04129/2013) and CESAM (UID/AMB/50017/2013) from FCT/MEC through national funds, and the cofunding by FEDER (POCI-01-0145-FEDER-007638), within the PT2020 Partnership Agreement and Compete2020.

Toxicity prediction and assessment of an environmentally realistic pesticide mixture to Daphnia magna and Raphidocelis subcapitata

In a regulatory perspective addressing the cumulative effect of co-occurring chemicals is the first and most important step in providing a more realistic hazard assessment of chemical cocktails to both man and environment. This study was conducted to show if joint effects on the immobilisation of the crustacean Daphnia magna and on the growth inhibition of algae Raphidocelis subcapitata follow additivity (concentration addition (CA) or independent action (IA) predictions) or if there is an interaction between chemicals in the organisms upon exposure to an environmentally realistic mixture of chlorpyrifos and terbuthylazine, with expected different molecular sites of action. A pattern of antagonism at lower doses and synergism at higher doses was found for acute immobility data, while no deviation from the additive conceptual models was observed in the algae inhibition test. Results in relation to the relevant set of regulatory acceptable concentrations (RACs) and environmental quality standards (EQSs) derived for individual chlorpyrifos and terbuthylazine were evaluated.

Interval colorectal cancer after colonoscopy

INTRODUCTION AND AIMS

Interval colorectal cancer (iCRC) can occur due to missed lesions or to a newly developed lesion. The present study aimed to assess the iCRC rate and its characteristics in our population and find possible explanations.

MATERIALS AND METHODS

A retrospective study was conducted on patients with colorectal cancer (CRC) diagnosed between January 2011 and January 2015 at our department. Demographics, endoscopic data, and tumor characteristics (location, histology, staging) were collected. We identified patients diagnosed with CCR who underwent colonoscopy at our department in the previous 10years and presented the disease (iCRC) before the date of their next recommended exam. The cases of iCRC were characterized and compared with other CRC cases. Possible explanations for the appearance of iCRC were analyzed.

RESULTS

A total of 266 patients presented with CRC, 61.7% were men, and mean patient age was 70.7years. We identified 10 patients with iCRC: 6 were men, and mean patient age was 71.1years. Mean time for iCRC diagnosis after index colonoscopy was 3.5±1.84years. Tumor was located in the right colon in 50% of the patients with iCRC and in 24.5% of the patients without iCRC (P=.091). More patients with iCRC had a family history of CRC (50%) than the patients with reference CRC (3.1%) (P=.000).

CONCLUSIONS

In our case series, 3.76% of all CRC were iCRC. There were no statistically significant differences between patients with or without iCRC, with the exception of family history of CRC.

Is early measles vaccination associated with stronger survival benefits than later measles vaccination?

Background

Measles vaccine (MV) may protect against non-measles mortality. We tested whether survival depended on age of measles vaccination.

Methods

Bandim Health Project follows children under 5 years of age through a Health and Demographic Surveillance System in rural Guinea-Bissau. Children aged 6–36 months with a vaccination card inspected were followed to the next visit or for a maximum of 6 months. In Cox proportional-hazards models adjusted for age and village cluster, we compared the survival of children vaccinated with MV early (< 9 months), as recommended (9–11 months) or late (> 12+ months) with the survival of measles-unvaccinated children. Among measles-vaccinated children, we modelled the effect of age at measles vaccination linearly to assess mortality changes per month increase in vaccination age.

Results

From 1999 to 2006, 14,813 children (31,725 observations) were included. Children vaccinated with MV had a Hazard Ratio (HR) of 0.76 (95% CI: 0.63–0.91) compared with measles-unvaccinated children; censoring measles deaths did not change the results (HR = 0.79 (0.65–0.95)). For early MV the HR was 0.68 (0.53–0.87), for MV as recommended the HR was 0.77 (0.62–0.96) and for late MV the HR was 0.86 (0.67–1.11). Limiting the analysis to measles-vaccinated children, age at measles vaccination was associated with a 2.6% (0.4–5.1%) increase in mortality per month increase in vaccination age.

Conclusion

Early MV was associated with a large survival advantage. The current policy to increase vaccination age, when measles control improves, may not optimize the impact of MV on child survival.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5866-y) contains supplementary material, which is available to authorized users.

A morphoanatomical approach to the adaptive features of the epidermis and proboscis of a marine Polychaeta: Eulalia viridis (Phyllodocida: Phyllodocidae)

Eulalia viridis is a marine Polychaeta of the rocky intertidal that, despite its simple anatomy, is an active predator of much larger invertebrates, from which it extracts pieces of soft tissue through suction. This uncanny feeding strategy triggered the pursuit for the morphological mechanisms that enable adaptation to its environment. The evaluation of the worm anatomy and microanatomy, combining electron and optical microscopy, revealed a series of particular adaptations in the epidermis and in the proboscis (the heavily muscled eversible pharynx). Besides its function in feeding, the proboscis is the main sensory organ, being equipped with numerous sensorial papillae holding chemoreceptors. Additionally, the proboscis possesses tentacles that become exposed when the organ is everted. These provide fast release of mucus and toxins, from mucocytes and special serous cells, respectively (the latter involving both merocrine and apocrine processes), whenever contact with a prey occurs. In its turn, the epidermis provides protection by cuticle and mucus secretion and has a sensorial function that may be associated to the worm's uncommon green pigment cells. Eulalia viridis presents a series of elegant adaptive tools to cope with its environment that are evolutionarily designed to counterbalance its relatively simple body plan.

Impact of weight loss achieved through a multidisciplinary intervention on appetite in patients with severe obesity

The impact of lifestyle-induced weight loss (WL) on appetite in patients with obesity remains controversial. This study aimed to assess the short- and long-term impact of WL achieved by diet and exercise on appetite in patients with obesity. Thirty-five (22 females) adults with severe obesity (body mass index: 42.5 ± 5.0 kg/m²) underwent a 2-yr WL program focusing on diet and exercise. Body weight (BW), cardiovascular fitness (V̇o_2max), appetite feelings, and plasma concentrations of insulin, active ghrelin (AG), glucagon-like peptide 1 (GLP-1), peptide YY (PYY), and cholecystokinin (CCK), in the fasting and postprandial states, were measured at baseline (B), week 4 (W4), and 1 and 2 yr (and average values for all fasting and postprandial time points computed). BW was significantly reduced and V̇o_2max (ml·kg^-1·min^-1) increased at all time points compared with B (3.5, 8.1, and 8.4% WL and 7, 11, and 8% increase at W4 and 1 and 2 yr, respectively). Basal hunger and average hunger and desire to eat were significantly increased at 1 and 2 yr. Basal fullness was significantly increased at W4, and average ratings were reduced at 1 yr. Average AG and PYY were significantly increased, and insulin was reduced, at all time points compared with B. Average GLP-1 was reduced at W4, and CCK was increased at 2 yr. After lifestyle-induced WL, patients with severe obesity will, therefore, have to deal with increased hunger in the long term. In conclusion, sustained WL at 2 yr achieved with diet and exercise is associated with increased hunger feelings and ghrelin concentration but also increased postprandial concentrations of satiety hormones.

Seasonal and sex-specific variations in haematological parameters in 4 to 5.5-month-old infants in Guinea-Bissau, West Africa

Objective

This study investigated seasonal and sex-specific variations in the haematological parameters and established reference ranges for these parameters in healthy 4 to 5.5-month-old infants in Guinea-Bissau.

Methods

Within a randomised trial of early measles vaccination, over a period of 13 months blood samples were collected from infants aged 4 to 5.5 months. Haematological parameters were determined by an automated cell counter and compared in linear regression models providing geometric mean ratios (GMR).

Results

Blood samples from 501 infants (n=248 boys, 49.5%) were obtained, and 285 (56.9%) were collected in the rainy season. Median age was 4.7 months (range 3.7 to 7.2 months). Eosinophil and platelet counts were lower in the dry season (December to May) than in the rainy season (GMR 0.79 [95% CI 0.68–0.92]) and 0.93 [0.87–1.00], respectively). The calculated reference ranges were wider and generally higher than those from a US population of comparable age, but neutrophil levels were notably lower in Guinea-Bissau.

Conclusions

The study indicated that eosinophil and platelet counts of infants were subject to seasonal variations. The reference ranges for haematological values were comparable to other African populations and corroborated that neutropenia regularly occurs in African infants.

Explorations on the ecological role of toxin secretion and delivery in jawless predatory Polychaeta

Motivated by biotechnological prospects, there is increasing evidence that we may just be scraping the tip of the iceberg of poisonous marine invertebrates, among which the Polychaeta are promising candidates for bioprospecting. Here we show that an inconspicuous phyllodocid uses toxins in its uncanny feeding strategy. The worm, a jawless active predator characterised by its bright green colour, preys on larger invertebrates (including conspecifics) by extracting tissue portions with its powerful proboscis through suction. The animal is even able to penetrate through the valves and plates of live molluscs and barnacles. Observations in situ and a series of experiments demonstrated that the worm compensates its simple anatomy with secretion of a novel toxin, or mixture of toxins, referred to by us as "phyllotoxins". These are carried by mucus and delivered via repeated contact with the tip of the proboscis until the prey is relaxed or immobilised (reversibly). Proteolytic action permeabilises material to toxins and softens tissue to enable extraction by suction. The findings show that toxins are a major ecological trait and therefore play a key role in evolutionary success and diversification of Polychaeta, demonstrating also that understanding adaptative features may become the best showcase for novel animal toxins.

National Immunization Campaigns with Oral Polio Vaccine Reduce All-Cause Mortality: A Natural Experiment within Seven Randomized Trials

BACKGROUND

A recent WHO review concluded that live BCG and measles vaccine (MV) may have beneficial non-specific effects (NSEs) reducing mortality from non-targeted diseases. NSEs of oral polio vaccine (OPV) were not examined. If OPV vaccination campaigns reduce the mortality rate, it would suggest beneficial NSEs.

SETTING

Between 2002 and 2014, Guinea-Bissau had 15 general OPV campaigns and other campaigns with OPV plus vitamin A supplementation (VAS), VAS-only, MV, and H1N1 vaccine. In this period, we conducted seven randomized controlled trials (RCTs) with mortality as main outcome.

METHODS

Within these RCTs, we assessed whether the mortality rate was lower after-campaign than before-campaign. We used Cox models with age as underlying time and further adjusted for low birth-weight, season and time trend in mortality. We calculated the adjusted mortality rate ratio (MRR) for after-campaign vs before-campaign.

RESULTS

The mortality rate was lower after OPV-only campaigns than before, the MRR being 0.81 (95% CI = 0.68-0.95). With each additional dose of campaign-OPV the mortality rate declined further (MRR = 0.87 (95% CI: 0.79-0.96) per dose) (test for trend, p = 0.005). No other type of campaign had similar beneficial effects. Depending on initial age and with follow-up to 3 years of age, the number needed to treat with campaign-OPV-only to save one life was between 68 and 230 children.

CONCLUSION

Bissau had no case of polio infection so the results suggest that campaign-OPV has beneficial NSEs. Discontinuation of OPV-campaigns in low-income countries may affect general child mortality levels negatively.

Occurrence of 15 Haplotypes of Linepithema micans (Hymenoptera: Formicidae) in Southern Brazil

The ant genus Linepithema is widely known, thanks to the pest species Linepithema humile (Mayr), which is easily mistaken for Linepithema micans (Forel) due to their morphological similarity. Like L. humile, L. micans is associated to the main grapevine pest in Brazil, Eurhizococcus brasiliensis (Wille), also known as ground pearl. Therefore, the present study uses mtDNA fragments to expand the knowledge of haplotype diversity and distribution of L. micans in the state of Rio Grande do Sul (Brazil), to understand the genetic differences of the populations identified in this study. We identified 15 haplotypes of L. micans spread across different localities. Twelve of these haplotypes were new for the species. The high haplotype diversity uncovered in Rio Grande do Sul (Brazil) for this species was predictable, as L. micans is in its native environment. Additional studies that take gene flow into account may reveal interesting aspects of diversity in these populations.

Coulomb correlations in 4d and 5d oxides from first principles-or how spin-orbit materials choose their effective orbital degeneracies

The interplay of spin-orbit coupling and Coulomb correlations has become a hot topic in condensed matter theory and is especially important in 4d and 5d transition metal oxides, like iridates or rhodates. Here, we review recent advances in dynamical mean-field theory (DMFT)-based electronic structure calculations for treating such compounds, introducing all necessary implementation details. We also discuss the evaluation of Hubbard interactions in spin-orbit materials. As an example, we perform DMFT calculations on insulating strontium iridate (Sr₂IrO₄) and its 4d metallic counterpart, strontium rhodate (Sr₂RhO₄). While a Mott-insulating state is obtained for Sr₂IrO₄ in its paramagnetic phase, the spectral properties and Fermi surfaces obtained for Sr₂RhO₄ show excellent agreement with available experimental data. Finally, we discuss the electronic structure of these two compounds by introducing the notion of effective spin-orbital degeneracy as the key quantity that determines the correlation strength. We stress that effective spin-orbital degeneracy introduces an additional axis into the conventional picture of a phase diagram based on filling and on the ratio of interactions to bandwidth, analogous to the degeneracy-controlled Mott transition in d¹ perovskites.

Regulatory T and B Cells in Asthmatic Women: Variations From Pregnancy to Postpartum

BACKGROUND AND OBJECTIVE

Allergic asthma and rhinitis are common in pregnancy. The immune mechanisms underlying the effects of asthma on pregnancy and vice versa are not completely understood. The aim of this study was to investigate changes in regulatory T and B cells in asthmatic women from late pregnancy to postpartum.

METHODS

Four groups of women were enrolled for this study: asthmatic (n=23) and healthy (n=43) third trimester-pregnant women and asthmatic (n=33) and healthy (n=35) nonpregnant women. Pregnant women were also evaluated postpartum (>6 weeks after delivery). Blood samples were taken from each woman and flow cytometry was used to characterize circulating regulatory T cells (Tregs) and regulatory B cells (Bregs). Foxp3 expression was assessed in CD4DimCD25Hi Tregs.

RESULTS

Tregs did not vary significantly from pregnancy to postpartum in asthmatic or healthy women, but CD24HiCD38Hi Bregs decreased in pregnancy and increased significantly postpartum. Foxp3 expression in Tregs was also impaired during pregnancy in both asthmatic and healthy women, but recovered postpartum. Asthmatic pregnant women had higher Foxp3 expression levels than healthy pregnant women (P=.007), probably due to the use of control medication.

CONCLUSIONS

Women with controlled asthma showed variations in regulatory cell subsets during pregnancy and postpartum. A similar pattern was observed for Foxp3 expression and CD24HiCD38Hi Bregs during this period, corroborating the interaction between Tregs and Bregs in immune responses. Considering the immunomodulatory potential of these immune mediators, more studies are needed to evaluate their relationship with asthma and rhinitis complications in pregnancy.

Bariatric surgery versus lifestyle interventions for severe obesity: 5-year changes in body weight, risk factors and comorbidities

Changes in body weight (BW), risk factors and comorbidities 5 years after Roux-en-Y gastric bypass (RYGB) or different lifestyle interventions are compared. A total of 209 (75% women) severe obese adults were non-randomly allocated to: (A) RYGB (n = 58), (B) weight loss (WL) camp (n = 30), (C) residential intermittent programme (n = 64) or (D) hospital outpatient programme (n = 57). Body weight, risk factors and comorbidities were assessed at baseline, 1 and 5 years. A total of 89 and 54% completed the 1- and 5-year follow-up. The RYGB group experienced more WL at 5 years (-23.9%, 95% CI [-27.7, -20.0]) compared with lifestyle groups: (B) (-9.2%, 95% CI [-16.9, -1.5]), (C) (-4.1%, 95% CI [-8.0, -0.1]) and (D) (-4.1 kg, 95% CI [-10.0, 1.8]) (all P < 0.001). No differences were observed between lifestyle groups, although groups B and C had significant WL after 5 years (all P < 0.05). Plasma glucose and high-density lipoprotein cholesterol were improved in the RYGB group at 5 years compared with lifestyle groups (all P < 0.05). More patients in the RYGB group experienced remission of hypertension (P < 0.05). RYGB was associated with a lower BW, improved blood parameters and hypertension remission compared with lifestyle interventions at 5 years. However, significant WL was also achieved with lifestyle interventions.

Analysis of risk factors for infant mortality in the 1992-3 and 2002-3 birth cohorts in rural Guinea-Bissau

Introduction

Though still high, the infant mortality rate in Guinea-Bissau has declined. We aimed to identify risk factors including vaccination coverage, for infant mortality in the rural population of Guinea-Bissau and assess whether these risk factors changed from 1992–3 to 2002–3.

Methods

The Bandim Health Project (BHP) continuously surveys children in rural Guinea-Bissau. We investigated the association between maternal and infant factors (especially DTP and measles coverage) and infant mortality. Hazard ratios (HR) were calculated using Cox regression. We tested for interactions with sex, age groups (defined by current vaccination schedule) and cohort to assess whether the risk factors were the same for boys and girls, in different age groups in 1992–3 and in 2002–3.

Results

The infant mortality rate declined from 148/1000 person years (PYRS) in 1992–3 to 124/1000 PYRS in 2002–3 (HR = 0.88;95%CI:0.77–0.99); this decline was significant for girls (0.77;0.64–0.94) but not for boys (0.97;0.82–1.15) (p = 0.10 for interaction). Risk factors did not differ significantly by cohort in either distribution or effect. Mortality decline was most marked among girls aged 9–11 months (0.56;0.37–0.83). There was no significant mortality decline for girls 1.5–8 months of age (0.93;0.68–1.28) (p = 0.05 for interaction). DTP and measles coverage increased from 1992–3 to 2002–3.

Conclusions

Risk factors did not change with the decline in mortality. Due to beneficial non-specific effects for girls, the increased coverage of measles vaccination may have contributed to the disproportional decline in mortality by sex and age group.

Effect of early measles vaccine on pneumococcal colonization: A randomized trial from Guinea-Bissau

BACKGROUND

Measles vaccine (MV) may have non-specific beneficial effects for child health and particularly seems to prevent respiratory infections. Streptococcus pneumoniae is the leading cause of bacterial pneumonia among children worldwide, and nasopharyngeal colonization precedes infection.

OBJECTIVE

We investigated whether providing early MV at 18 weeks of age reduced pneumococcal colonization and/or density up to 9 months of age.

METHOD

The study was conducted in 2013-2014 in Guinea-Bissau. Pneumococcal vaccine was not part of the vaccination program. Infants aged 18 weeks were block-randomized 2:1 to early or no early MV; at age 9 months, all children were offered MV as per current policy. Nasopharyngeal swabs were taken at baseline, age 6.5 months, and age 9 months. Pneumococcal density was determined by q-PCR. Prevalence ratios of pneumococcal colonization and recent antibiotic treatment (yes/no) by age 6.5 months (PR6.5) and age 9 months (PR9) were estimated using Poisson regression with robust variance estimates while the pneumococcal geometric mean ratio (GMR6.5 and GMR9) was obtained using OLS regression.

RESULTS

Analyses included 512 children; 346 early MV-children and 166 controls. At enrolment, the pneumococcal colonization prevalence was 80% (411/512). Comparing early MV-children with controls, the PR6.5 was 1.02 (95%CI = 0.94-1.10), and the PR9 was 1.04 (0.96-1.12). The GMR6.5 was 1.02 (0.55-1.89), and the GMR9 was 0.69 (0.39-1.21). Early MV-children tended to be less frequently treated with antibiotics prior to follow up (PR6.5 0.60 (0.34-1.05) and PR9 0.87 (0.50-1.53)). Antibiotic treatment was associated with considerably lower colonization rates, PR6.5 0.85 (0.71-1.01) and PR9 0.66 (0.52-0.84), as well as lower pneumococcal density, GMR6.5 0.32 (0.12-0.86) and GMR9 0.52 (0.18-1.52).

CONCLUSION

Early MV at age 18 weeks had no measurable effect on pneumococcal colonization prevalence or density. Higher consumption of antibiotics among controls may have blurred an effect of early MV.

TRIAL REGISTRATION

clinicaltrials.gov NCT01486355.

A general measles vaccination campaign in urban Guinea-Bissau: Comparing child mortality among participants and non-participants

BACKGROUND

Measles vaccination campaigns targeting children aged 9-59months are conducted every three years in Guinea-Bissau. Studies have demonstrated beneficial non-specific effects of measles vaccine. We compared mortality one year after the December 2012 measles vaccination campaign in Bissau city for children who received campaign measles vaccine with children who did not receive campaign measles vaccine.

METHODS

Field workers from Bandim Health Project registered all children living in the Bandim Health Project's study area who received measles vaccination at the campaign posts. Children not seen during the campaign were visited at home and campaign participation status was assessed. We compared mortality rates of participants vs. non-participants in Cox regression models.

RESULTS

5633 children aged 9-59months (85%) received campaign measles vaccination and 1006 (15%) did not. During the subsequent year 16 children died. Adjusted for background factors, the hazard ratio (HR) comparing measles vaccinated versus unvaccinated was 0.28 (95% CI: 0.10-0.77). The benefit was larger for girls (HR: 0.17 (0.05-0.59)) and for children who had received routine measles vaccine before the campaign (HR: 0.15 (0.04-0.63)).

CONCLUSIONS

We found indications of strong beneficial non-specific effects of receiving measles vaccine during the 2012 campaign, especially for girls and children with previous routine measles vaccination. Measles vaccination campaigns may be an effective way of improving child survival.

Molecular Profile of the Brazilian Weaver Ant Camponotus textor Forel (Hymenoptera, Formicidae)

Camponotus textor Forel is, to date, the only weaver ant recorded from Brazil, and all existing studies on the species are restricted to describing its weaving and nesting behaviors. The aim of this work is to establish the molecular profile of the species. We sampled eight different colonies by sequencing mitochondrial genes (COI, transfer DNA (tRNA), and an intergenic spacer) and the nuclear gene 28S ribosomal DNA (rDNA). We then assessed haplotype diversity and also analyzed distribution patterns of this species based on the correlation between genetic and geographic distances. Our results provide an additional tool for species identification by identifying new regions that can be used as molecular markers for barcoding (such as the intergenic spacer (IGS) and tRNA-Leu). In addition, the phylogenetic analysis revealed that C. textor has features that could be associated with deep population divergences. We identified a wide range of mitotypes and three distinct groups, suggesting a possible reduction of gene flow between colonies.

New insights of karyoevolution in the Amazonian turtles Podocnemis expansa and Podocnemis unifilis (Testudines, Podocnemidae)

BACKGROUND

Cytogenetic studies were conducted in the Brazilian Amazon turtles, Podocnemis expansa Schweigger, 1912 (PEX) and Podocnemis unifilis Troschel, 1848 (PUN) to understand their karyoevolution. Their chromosomal complements were compared using banding techniques (C, G-, Ag-NOR and Chromomycin A₃) and fluorescence in situ hybridization (FISH), and efforts were made to establish evolutionary chromosomal relationships within the Podocnemidae family.

RESULTS

Our results revealed that both species have a chromosome complement of 2n = 28. For PEX and PUN, the fundamental numbers (FNs) were 54 and 52, respectively and the karyotypic formulas (KFs) were 24 m/sm + 2st + 2a and 22 m/sm + 2st + 4a, respectively. G-banding evidenced homologies between the two species and allowed identify a heteromorphic pair (chromosome pair 10) in PUN. In PEX, constitutive heterochromatin (CH) was found in the centromeric regions of pairs 1, 2, 4, 6 and 11 and on 9p. In PUN, CH was observed in the centromeric regions of all chromosomes, and in small proximal bands on 1p, 2p, 3q, 4q, 5q, 9q, 10q and 11q. Moreover, CH amplification was seen in one of the homologs of pair 10 (the heteromorphic pair). The CMA3 staining results were consistent with the CH findings. Ag-NOR staining showed that nucleolar organizing regions (NORs) were localized in the pericentromeric region of pair 1 in both species, and this result was confirmed by the 18S rDNA FISH probe. FISH with telomeric probes identified telomeric sequences in the distal regions of all chromosomes. In addition, interstitial telomeric sequences (ITSs) were present in seven chromosome pairs of PUN, perhaps reflecting the amplification of telomere-like sequences. FISH with a probe against the transposable element (TE), Rex 6, revealed that it is dispersed in euchromatic regions of the first chromosome pairs of both species. This is the first report describing the FISH-based analysis of PEX and PUN for the 18S rDNA, Rex 6 and human telomeric sequences.

CONCLUSIONS

Our results contribute to clarifying the chromosomal homologies and rearrangement mechanisms that occurred during the evolution of these species, and may help researchers uncover new markers that will improve our understanding of the taxonomy and systematic classification of Podocnemidae.

TRIAL REGISTRATION

ISRCTN ISRCTN73824458. Registered 28 September 2014. Retrospectively registered.

Leishmania infantum antigens modulate memory cell subsets of liver resident T lymphocyte

In the recent years, the liver has been recognized as an important immune organ with major regulatory functions and immune memory, adding to the well-described vital metabolic functions. There are evidences from experimental infections performed with visceral Leishmania species that immune responses to parasite infection can be organ-specific. The liver is the compartment of acute resolving infection, with minimal tissue damage and resistance to reinfection, whereas the spleen is the compartment of parasite persistence. Control of hepatic infection in mice requires a coordinated immune response that involves the development of inflammatory granulomas. It is also described that the liver harbors populations of resident lymphocytes, which may exhibit memory characteristics. Therefore, the present study aims to address the role of the liver as an immune memory organ in the context of Leishmania infantum infection, by characterizing phenotypically resident liver T lymphocytes. The dynamics of memory T cells in L. infantum infected BALB/c mice and the effect of anti-leishmanial treatment in the differentiation of memory cell subsets were analyzed. The potential of recognition, differentiation and selection of memory lymphocytes by three L. infantum recombinant proteins were also explored. L. infantum infection generates effector and central memory T cells, but the cells did not expand when recalled, demonstrating a possible parasite silencing effect. The treatment with a leishmanicidal drug (antimoniate meglumine) increases the levels of memory and effector T cells, eliciting a more robust hepatic immune response. L. infantum parasites with a decreased sensitivity to the leishmanicidal drug favor the expansion of memory CD8⁺ T cell subset, but inhibit the proliferation of CD8⁺ T effector cells, possibly assuring their own survival. The recombinant proteins LirCyp1 and LirSOD are strongly recognized by memory cells of treated mice, indicating that these proteins might be used in a prophylactic or therapeutic vaccine formulation. Thus, L. infantum released antigens induce the development of immune memory subsets in the liver resident T cell population that specifically recognized parasite antigens, including recombinant proteins.