Mortality risk factors in patients with zygomycosis: a retrospective and multicentre study of 25 cases

AIM

To investigate mortality risk factors in patients with zygomycosis.

PATIENTS AND METHODS

Retrospective case history review of patients diagnosed with proven zygomicosis in 17 centres in Spain. We compared demographics and risk factors in patients who survived, and in those who died.

RESULTS

We identified twenty-five patients with proven zygomycosis. The primary site of infection was rhino-orbito-cerebral (28%) and disseminated (20%) or cutaneous/soft infections (20%) of the patients. Eleven patients (44%) received preemptive or empirical antifungal treatment; of these patients, 4 received liposomal amphotericin B, 1 received amphotericin B lipid complex, and 6 received other antifungals. The overall mortality rate was 72%. In the univariate analysis factors associated with an increased risk of death were the presence of a haematological malignancy (P=.03), neutropenia (P=.03) and monocytopenia (P=.008).

CONCLUSION

Our study supports previous research that has documented a high mortality rate among patients with invasive zygomycosis, especially among those with an underlying haematological malignancy, and the need for a rapid initiation of an effective antifungal treatment.

B-Myb is critical for proper DNA duplication during an unperturbed S phase in mouse embryonic stem cells

A common feature of early embryo cells from the inner cell mass (ICM) and of ESCs is an absolute dependence on an atypical cell cycle in which the G1 phase is shortened to preserve their self-renewing and pluripotent nature. The transcription factor B-Myb has been attributed a role in proliferation, in particular during the G2/M phases of the cell cycle. Intriguingly, B-Myb levels in ICM/ESCs are greater than 100 times compared with those in normal proliferating cells, suggesting a particularly important function for this transcription factor in pluripotent stem cells. B-Myb is essential for embryo development beyond the preimplantation stage, but its role in ICM/ESCs remains unclear. Using a combination of mouse genetics, single DNA fiber analyses and high-resolution three-dimensional (3D) imaging, we demonstrate that B-Myb has no influence on the expression of pluripotency factors, but instead B-Myb ablation leads to stalling of replication forks and superactivation of replication factories that result in disorganization of the replication program and an increase in double-strand breaks. These effects are partly due to aberrant transcriptional regulation of cell cycle proliferation factors, namely c-Myc and FoxM1, which dictate normal S phase progression. We conclude that B-Myb acts crucially during the S phase in ESCs by facilitating proper progression of replication, thereby protecting the cells from genomic damage. Our findings have particular relevance in the light of the potential therapeutic application of ESCs and the need to maintain their genomic integrity.

Neoadjuvant bevacizumab treatment for colorectal liver metastasis: A retrospective study

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Background: Patients with colorectal cancer (CRC) and liver metastases have a poor prognosis and may benefit from perioperative chemotherapy and disease resection. Bevacizumab is proven to improve outcomes in patients with metastatic CRC.

Methods: This is a retrospective chart review performed in colorectal patients with liver metastases. All the patients were > 18 years old and have undergone bevacizumab therapy as neoadjuvant treatment.

Results: 20 patients were analyzed. Baseline characteristics: median age 54.8 (49.2-65.8) years; male 45%; ECOG 0/1 40%/60%, 13 patients had metastatic disease at the time of their initial diagnosis. Median time from diagnosis of metastasis to surgery was 7.1 (5.4-9.6) months. Primary tumour locations were rectum (21.4%), colon (64.3%) and colon and rectum (14.3%). 80% and 20% of the patients received one and two lines of treatment before surgery, respectively. Mean cycles were 7.3±3.4 and 3.5±1.8 in first and second line, respectively. In 95% of the patients resection was curative. Mean number of resected metastasis was 3.4±2.8. 90%·of the patients achieved complete resection (R0) and 10% incomplete resection (R1). All the synchronous primary tumours (15) were resected. Among 16 valuable patients for pathological response, 1 (6.3%) experienced a pCR, 11 (68.8%) major response and 4 (25%) minor response. The median DFS was 12.2 months. The median OS was 48.9 months. Only one patient experienced grade 3-4 toxicity (rectal haemorraghe). Most frequent surgical complications were anastomotic filtration (8.7%) and wound infection (8.7%). Most frequent hepatic toxicities after surgery were steatohepatitis (25%) and sinusoidal dilatation (20%).

Conclusions: These data provide evidence that neoadjuvant chemotherapy including bevacizumab can be safely administered in patients with mCRC.

No significant financial relationships to disclose.

Evaluation of the trypanocidal, cytotoxic and genotoxic activity of styrylquinoline analogs

Styrylquinolines isolated from Galipea longiflora have shown leishmanicidal, trypanocidal, nematocidal and antimalarial activity. Here, we propose to use analogs of these styrylquinolines to enhance the activity against Trypanosoma cruzi. Three compounds in a reduced and oxidized state were synthesized, and the activity against epimastigotes and trypomastigotes was evaluated. in addition, the cytotoxic activity and genotoxic effect were also determined. The results indicated that epimastigotes from different T. cruzi I stocks were highly sensitive to the three compounds. The PQM4 compound presented promising activity against trypomastigotes and low cytotoxic and genotoxic effects. Finally, we observed that the doublebond reduction of the lateral chain of the three carbons made on these compounds improved the activity and substantially diminished the toxicity of the compounds.

[Influence of the atmospheric pressure and other variable weather on the incidence of the subarachnoid hemorrhage]

Spontaneous subarachnoid hemorrhage is a pathology usually related to risk factors, such as arterial hypertension and/or nicotine poisoning. Nevertheless, other variables exist, like meteorological changes, that although the experience aims as possible responsible for an increase of the incidence, are still not established like such.

OBJECTIVE

It is to investigate the influence of the meteorological changes, either seasonal variations or changes of atmospheric pressure, in the incidence of the subarachnoid hemorrhage.

METHOD

All the cases of spontaneous subarachnoid hemorrhage are considered from the 1st of January from 1997 to the 31st of March of 2008, making a medical registry of demographic aspects (age, sex) and antecedents (arterial hypertension, diabetes mellitus, cerebral ischemia, nicotine poisoning), as well as numbers of atmospheric pressure (in hectopascales, hPa), daily temperature and relative humidity, throughout this period, with a calculation of the maximum, average and minimum values, as well as pressure differentials between consecutive days.

RESULTS

The analysis of the 173 gathered cases showed a predominance of the subarachnoid hemorrhage in female, specially the aneurismal ones, being arterial hypertension, the main factor of related risk. Significant differences between the days with and without hemorrhage were not demonstrated, in relation to the variation of atmospheric pressure (p 0.463), pressure temperature (p 0.381) and relative humidity (p 0.595) throughout the day.

CONCLUSION

In our element, the variations of atmospheric pressure are not related to an increase of incidence of the subarachnoid hemorrhage. Instead of this, cases of subarachnoid hemorrhage take place with changes of hardly 1.7 (1-3) hPa in the day, without observing a clear seasonal tendency.

Bulk soil and rhizosphere bacterial community PCR-DGGE profiles and beta-galactosidase activity as indicators of biological quality in soils contaminated by heavy metals and cultivated with Silene vulgaris (Moench) Garcke

The biological quality of two heavy metal contaminated soils (soil C: Typic Calcixerept, pH 8.3 and soil H: Typic Haploxeraf, pH 7.3) was investigated after growing the metal-tolerant plant Silene vulgaris (Moench) Garcke for two vegetative periods. The activity of the enzyme beta-galactosidase, which is sensitive to the presence of contaminants in soil, and the polymerase chain reaction-denaturing gradient gel electrophoresis (PCR-DGGE) profiles of 16S rRNA gene fragments of culturable bacteria from bulk soil and rhizosphere were determined. The microbial enzymatic activity was higher in planted soils than in bare soils at the contamination level of 600 mg of total heavy metals kg(-1) soil. After growing S. vulgaris, beta-galactosidase activity was almost recovered in the calcareous soil. In this soil new bands appeared in the PCR-DGGE profiles of the rhizosphere bacterial community as a response to the exposure to heavy metals.

Mortality of vertebrates in irrigation canals in an area of west-central Spain

Mortality patterns of vertebrates in irrigation canals have been poorly studied despite their potential impact on wildlife. Concrete irrigation canals in a cropland area in west-central Spain were monitored over 13 months to assess their impact on small fauna. A total of 134 vertebrates were found dead. Most were amphibians (86.46%) or mammals (20.90%), though fishes, reptiles and a bird were also recorded. Mortality peaked in autumn months. Corrective measurements are needed to reduce this cause of non-natural mortality.

Hematopoietic lineage commitment: miRNAs add specificity to a widely expressed transcription factor

MicroRNAs are important regulators of normal and malignant hematopoiesis. A paper by Lu et al. in this issue of Developmental Cell demonstrates how one microRNA, miR-150, plays a critical role in commitment of the erythroid-megakaryocyte progenitor by modulating the level of the widely expressed transcription factor MYB (or c-Myb).

Acute pseudoaneurysm of the femoral artery after repeated trauma in full-contact karate practice

Traumatic pseudoaneurysms of the deep femoral artery are only encountered infrequently in sports medical literature. We present the case of a male who, after practising full-contact karate, experienced pain and oedema in the right thigh. The ultrasound results and the arteriography showed the presence of a pseudoaneurysm in a branch of the deep femoral artery. Traumatic pseudoaneurysms of the deep femoral artery are normally secondary to endovascular interventions or to mycotic infections in injecting drug users. The majority appear asymptomatically as a pulsatile mass, although on occasions clinical signs of compression (pain, neurological or venous symptoms) may occur or, if the aneurysm bursts, hypovolemic shock.

Incidence and clinical significance of hyperamylasemia after endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of pancreatic lesions: a prospective and controlled study

BACKGROUND AND STUDY AIM

Acute pancreatitis as a complication of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of pancreatic lesions is rarely observed. However, there is little information on the incidence of hyperamylasemia after EUS-FNA of the pancreas and its clinical significance. This study aimed to supply this lack of information.

PATIENTS AND METHODS

Patients who underwent EUS-FNA of a pancreatic lesion between October 2004 and October 2005 were studied prospectively. Exclusion criteria were: (i) platelet count under 50,000/mm (3) and/or prothrombin time < 50 %; (ii) performance of surgery, endoscopic retrograde cholangiopancreatography (ERCP), a percutaneous biopsy attempt, or another invasive procedure within 7 days before EUS-FNA; (iii) lack of informed consent. Serum amylase levels were determined before and 8 and 24 h after the procedure. Hyperamylasemia was defined by amylase levels above 104 UI/L (and higher than baseline levels) 8 h after the procedure. Acute pancreatitis was defined by upper abdominal pain (with or without nausea and/or vomiting) accompanied by elevation of serum amylase or lipase to at least twice baseline levels.

RESULTS

A total of 100 patients underwent EUS-FNA of a pancreatic lesion (58 men, 42 women; mean age 60 +/- 13 years). Eleven patients (11 %) showed hyperamylasemia 8 h after the puncture (298 +/- 293 UI/L, range 105 - 1044 UI/L), but only two of them developed acute mild pancreatitis after EUS-FNA. Hyperamylasemia was not related either to the type of lesion (cystic or solid) or to its location, the duration of the procedure, or the number of passes performed.

CONCLUSIONS

Pancreatitis after pancreatic EUS-FNA occurs in 2 % of patients, with some more cases of silent hyperamylasemia. This complication may have to be included in the information given to patients for their informed consent.

Salmonella Kottbus outbreak in infants in Gran Canaria (Spain), caused by bottled water, August-November 2006

Since October 2006, the Spanish National Reference Laboratory has reported a series of isolations of Salmonella Kottbus on the island of Gran Canaria.

Copper deficiency with pancytopenia due to enteral nutrition through jejunostomy

Copper deficiency is a rare complication of enteral nutrition. Haematologic abnormalities such as neutropenia and anaemia, but not pancytopenia, have been described associated to copper deficiency. We report the case of a patient requiring long term enteral nutrition through jejunostomy who developed copper deficiency and pancytopenia. In 1991, a 47-year-old woman was admitted with severe gastroesophageal mucositis after an attempted suicide with caustic intake. Enteral nutrition with a commercial, polymeric, fiber-containing formula was started. Twenty-eight months later, the patient developed anemia and neutropenia that did not respond to combined iron and parenteral vitamin B(12) supplementation. In 1996 the patient showed pancytopenia and low serum levels of copper and ceruloplasmin. Pancytopenia improved after copper supplementation. Possible mechanism causing copper deficiency and pancytopenia are discussed. We conclude that assessment of copper status is advisable in patients receiving long-term enteral nutrition by jejunostomy.

Allele frequencies of six miniSTR loci (D10S1248, D14S1434, D22S1045, D4S2364, D2S441 and D1S1677) in a Spanish population

Allele frequencies and forensic parameters for six miniSTR autosomal loci (D10S1248, D14S1434, D22S1045, D4S2364, D2S441 and D1S1677) were obtained from a sample of 264 unrelated individuals from Spain. No significant deviations from Hardy-Weinberg expectations were found. Due to the small PCR products (<125 bp), the use of these non-CODIS (NC) miniSTRs can increase the probability that a degraded sample can be typed. Additionally, these systems can be used in routine paternity analyses where more markers are needed to increase the power of exclusion or in complex paternity cases (e.g. involving closely related individuals).