Accumulation of polyethylene microplastics in river biofilms and effect on the uptake, biotransformation and toxicity of the antimicrobial triclosan

The interaction of multiple stressors in freshwater ecosystems may lead to adverse effects on aquatic communities and their ecological functions. Microplastics (MPs) are a class of contaminants of emerging concern that can exert both direct and indirect ecotoxicological effects. A growing number of studies have investigated MPs-attached microbial communities, but the interaction between MPs and substrate-associated biofilm (i.e., on natural river substrates, such as stones and sediments) remains poorly studied. In this work, the combined effects of polyethylene MPs (PE-MPs) with a particle size of 10-45 μm (2 mg/L) and the antimicrobial triclosan (TCS) (20 μg/L) were investigated on river biofilms through a short-term exposure experiment (72 h). To the best of authors' knowledge, this is the first time that the combined effects of MPs and chemical contaminants in substrate-associated river biofilms were assessed. Different response parameters were evaluated, including (i) exposure assessment and ii) contaminants effects at different levels: bacterial community composition, antibiotic resistance, extracellular polymeric substances (EPS), photosynthetic efficiency (Yeff), and leucine aminopeptidase activity (LAPA). Triclosan was accumulated in river biofilms (1189-1513 ng/g dw) alongside its biotransformation product methyl-triclosan (20-29 ng/g dw). Also, PE-MPs were detected on biofilms (168-292 MP/cm2), but they had no significant influence on the bioaccumulation and biotransformation of TCS. A moderate shift in bacterial community composition was driven by TCS, regardless of PE-MPs co-exposure (e.g., increased relative abundance of Sphingomonadaceae family). Additionally, Yeff and EPS content were significantly disrupted in TCS-exposed biofilms. Therefore, the most remarkable effects on river biofilms were related to the antimicrobial TCS, whereas single PE-MPs exposure did not alter any of the evaluated parameters. These results demonstrate that biofilms might act as environmental sink of MPs. Although no interaction between PE-MPs and TCS was observed, the possible indirect impact of other MPs-adsorbed contaminants on biofilms should be further assessed.

Perspectives on scientific error

Theoretical arguments and empirical investigations indicate that a high proportion of published findings do not replicate and are likely false. The current position paper provides a broad perspective on scientific error, which may lead to replication failures. This broad perspective focuses on reform history and on opportunities for future reform. We organize our perspective along four main themes: institutional reform, methodological reform, statistical reform and publishing reform. For each theme, we illustrate potential errors by narrating the story of a fictional researcher during the research cycle. We discuss future opportunities for reform. The resulting agenda provides a resource to usher in an era that is marked by a research culture that is less error-prone and a scientific publication landscape with fewer spurious findings.

POS1427 CLINICAL COURSE IN PATIENTS WITH INTERSTITIAL PNEUMONIA WITH AUTOIMMUNE FEATURES (IPAF): REAL-LIFE DATA FROM A MULTICENTER ILD REGISTRY

Background

Several patients with Interstitial Lung Disease show autoimmune characteristics but do not meet the classification criteria for a connective tissue disease. In order to define this condition, the classification of patients with interstitial pneumonia with autoimmune features (IPAF) has been adopted (Fischer’s criteria).

Objectives

To describe the sociodemographic, clinical, functional characteristics and therapeutic management of IPAF in clinical practice and to evaluate the incidence rate of functional respiratory impairment.

Methods

A longitudinal observational study was performed (NEREA registry). Patients diagnosed with IPAF according to Fischer’s criteria were included from ILD diagnosis (Feb 2007 to Dec 2019) and followed until loss of follow-up or Jan 2021. The study was carried out by a multidisciplinary team (pneumologists and rheumatologists) in seven Hospitals of Madrid. The relative functional respiratory impairment, defined as a ≥ 5% decline in percent predicted forced vital capacity (FVC%) compared to the previous visit was set as main outcome. Respiratory function was measured at baseline and every 6-12 months. Covariates included: a) sociodemographic, b) clinical, c) radiological pattern (non-specific interstitial pneumonia [NSIP]; usual interstitial pneumonia [UIP], others); d) FVC% DLCO%; e) laboratory tests; f) therapy used. Survival techniques were used to estimate the incidence rate (IR) of relative functional respiratory impairment, expressed per 100 patient-semester with their respective confidence interval [95 % CI].

Results

79 IPAF were included, with a follow up of 462.8 patients-semester and a maximum follow-up of 12.3 years. 79% were women with a mean age of 66±11 years. Along with obesity (40%), the most frequent comorbidities at baseline were hypertension, hypercholesterolemia, followed by ischemic heart disease. Baseline FVC% and DLCO% were 88.5±22.7 and 64.2±19.3, respectively. Distribution of IPAF classification criteria was: a) clinical domain: arthritis (46.2%), Raynaud`s phenomenon (35.8%) and mechanic hands (9.3%); b) serological domain: 80.8% positive ANA at >1/320 titer; 29% RF (> 40 IU/ml); 25% positive anti-Ro; c) morphological domain: 46.8% of NSIP and 36.7% of UIP. During the study period, 77.2% of patients (n=61) received treatment: glucocorticosteroids (n=52), mycophenolate (n=25), azathioprine (n=21), rituximab (n=15) and antifibrotics (n=11).

During the follow-up, 50 patients presented 111 relative functional respiratory impairment events over time. The estimated IR was 23.9 [19.9-28.8] per 100 patient-semester, and 50% of the patients developed functional respiratory impairment at 16 months from diagnosis.

IR was similar between patient gender, baseline overall comorbidity, baseline pulmonary functional tests, and age strata, with slight difference in patients >80 years of age. Patients with baseline associated emphysema (IR: 17.6 [10-31]) or without baseline associated fibrosis (IR: 21.1 [15-28]) had lower IR compared to the opposite (IR without emphysema: 24.5[19.3-31]; IR with fibrosis emphysema: 27.5 [19.9-37.9]). As expected, IR was higher in UIP (32.2 [24-42]) compared to NSIP or any other pattern. With respect to serologic markers, patients with ANA titers >=1/320 had a higher IR (26.7 [21-33]) in comparison with those with lower or non-titers of ANA (IR: 15.7 [9.9-25.1]).

Conclusion

In a multicenter registry of Madrid, we have performed a descriptive longitudinal study. IPAF were mostly women in their sixties. The most frequent clinical criteria were arthritis and Raynaud`s phenomenon. An NSIP radiological pattern predominated. At onset, patients have a slightly diminished lung function. The incidence rate of functional deterioration was estimated in 23.9% patient-semester and 50% of the patients developed pulmonary functional deterioration at 16 months from ILD diagnosis. This Incidence rate was higher in patients with an UIP pattern, baseline fibrosis or ANA at medium-high titers.

Disclosure of Interests

None declared

Replicability, Robustness, and Reproducibility in Psychological Science

Replication-an important, uncommon, and misunderstood practice-is gaining appreciation in psychology. Achieving replicability is important for making research progress. If findings are not replicable, then prediction and theory development are stifled. If findings are replicable, then interrogation of their meaning and validity can advance knowledge. Assessing replicability can be productive for generating and testing hypotheses by actively confronting current understandings to identify weaknesses and spur innovation. For psychology, the 2010s might be characterized as a decade of active confrontation. Systematic and multi-site replication projects assessed current understandings and observed surprising failures to replicate many published findings. Replication efforts highlighted sociocultural challenges such as disincentives to conduct replications and a tendency to frame replication as a personal attack rather than a healthy scientific practice, and they raised awareness that replication contributes to self-correction. Nevertheless, innovation in doing and understanding replication and its cousins, reproducibility and robustness, has positioned psychology to improve research practices and accelerate progress. Expected final online publication date for the Annual Review of Psychology, Volume 73 is January 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

A guideline to frame stressor effects in freshwater ecosystems

Environmental policies fall short in protecting freshwater ecosystems, which are heavily threatened by human pressures and their associated stressors. One reason is that stressor effects depend on the context in which they occur and it is difficult to extrapolate patterns to predict the effect of stressors without these being contextualized in a general frame. This study aims at improving existing decision-making frameworks such as the DPSIR approach (Driver-Pressure-State-Impact-Response) or ERA (Environmental Risk Assessment) in the context of stressors. Here, we delve into stressor-impact relationships in freshwater ecosystems and develop a guideline which includes key characteristics such as stressor type, stressor duration, location, the natural levels of environmental variables to which each ecosystem is used to, among others. This guideline is intended to be useful in a wide range of ecosystem conditions and stressors. Incorporating these guidelines may favor the comparability of scientific results and may lead to a substantial advancement in the efficacy of diagnosis and predictive approaches of impacts.

POS0888 EPIDEMIOLOGICAL AND CLINICAL DIFFERENCES BETWEEN ANTI-MDA5 PHENOTYPES: DATA FROM A LARGE COHORT (MEDRA5) STUDY

Background:

Idiopathic inflammatory myopathies are a heterogenous group of systemic autoimmune diseases. Several phenotypes have been linked to specific autoantibodies. Clinically amyopathic dermatomyositis with rapidly progressive interstitial lung disease, the most severe form of ILD, is associated with the anti-MDA5 antibodies. However not all the patients with dermatomyositis and anti-MDA5 positive antibodies develop this severe condition.

Objectives:

We aim to define different phenotypes from a large cohort of patients diagnosed with dermatomyositis who were positive to anti-MDA5 antibodies.

Methods:

We retrospective analyzed the clinical and immunological data of 90 anti-MDA5 patients [50 female, 55.6%, mean (SD) age at diagnosis 47 (15.4) yrs.] with dermatomyositis recruited from a multicenter register in Spain (MEDRA5) including 30 hospitals. All the patients fulfill de International Myositis Classification Criteria (EULAR/ACR) for dermatomyositis (score >90%). Anti-MDA5 were detected by means of commercial immunoblot (EUROIMMUN©). The chi-square test was used to assess the relationships between qualitative variables. The Kruskal-Wallis test was used to compared medians between groups.

Results:

Sixty-six patients (73.3%) were diagnosed with clinically amyopathic dermatomyositis. Three different phenotypes linked with the anti-MDA5 antibody were identified. Group 1: patients with rapidly-ILD phenotype (28 patients, 31.1%), group 2: antisynthetase-like phenotype (23 patients, 25.5%), and group 3: non-ILD phenotype (39 patients, 43.3%). Clinical and immunological comparison between the groups disclosed that age at disease onset was higher (median, IQR) in patients from group 1 [53 (43-60)] vs. group 2 [46 (40-56)] or group 3 [42(41-51)] (p=0.01); disease onset was more frequent in spring in patients from group 1 (46.5%) than in the rest of the groups (21.7% and 28.9%) (p<0.01). Cancer was detected in 7 patients, only associated with myositis in 3 cases (3 years interval between cancer and dermatomyositis) without significant differences between phenotypes. Vasculitis (one case ANCA positive) was detected in 9 cases (6 limited to skin, 1 renal and 1 intestinal), 6 of them in the group 3 (statistical significance, in comparison with group 1 and 2, p<0.01). Mortality rate was higher in group 1 (51.9%, 16 out of 17 due to refractory respiratory failure) vs group 2 (12.5%) or 3 (0%) (p<0.001). Anti Ro52 positivity was more frequent in group 1 (65.4%) vs. group 2 (25%) or 3 (35.5%) (p<0.017), although it did not reach statistical significance in terms of mortality (p=0.173) or patients admitted in the intensive care unit (p=0.173). Mechanic hands were more frequent in group 2 (40.6%) than in groups 1 (25%) and 3 (34.4%) (p=0.05). Fever was significantly most frequent in group 1(52.6%) than in group 2 (21.1%) and 3 (26.3%) (p=0.001). Other clinical or immunological features such as arthritis, myositis, or the number of characteristic skin lesions among others were not more frequent in one group or another.

Conclusion:

Three different phenotypes of patients positive to anti-MDA5 were identified. The presence or not of ILD, or the different type (rapidly progressive or not) of ILD were the main feature that allow to differentiate these phenotypes, which are relevant in clinical practice.

References:

[1]Allenbach Y, Uzunhan Y, Toquet S, et al; French Myositis Network. Different phenotypes in dermatomyositis associated with anti-MDA5 antibody: Study of 121 cases. Neurology. 2020;95: e70-e78.

Acknowledgements:

List of contributors of MEDRA5 group: Aguilar-García J (Internal Medicine, Hospital Costa del Sol, Marbella), Carrión-Barberá I (Rheumatology, Hospital del Mar, Barcelona), Cobo-Ibañez T (Rheumatology, Hospital Infanta Sofía, San Sebastián de los Reyes), de Escalante-Yangüela B (Internal Medicine, Hospital Clínico Lozano Blesa, Zaragoza), Fonseca-Aizpuru EM (Internal Medicine, Hospital de Cabueñes, Gijón), González-Cubillo L (Intensive Medicine, Hospital Universitario de Cruces, Barakaldo), González-Gay MA (Rheumatology, Hospital Marqués de Valdecilla, Santander), Prieto-González S (Internal Medicine, Hospital Clinic, Barcelona), Ruiz-Román A (Rheumatology, Hospital Universitario Virgen del Rocío, Sevilla), Calero-Paniagua I (Internal Medicine, Hospital Virgen de la Luz, Cuenca), Callejas-Rubio JL (Internal Medicine, Hospital Clínico San Cecilio, Granada), Gil-Vila A (Internal Medicine, Hospital Vall d’Hebron, Barcelona), de Miguel-Campo B (Internal Medicine, Hospital Doce de Octubre, Madrid), García-Sevilla R (Pneumology, Hospital General Universitario de Alicante, Alicante), Iriarte-Fuster A (Internal Medicine, Hospital de Bellvitge, Hospitalet de Llobregat), Jovani-Casano V (Rheumatology, Hospital General Universitario de Alicante, Alicante), Lozano-Rivas N (Rheumatology, Hospital Virgen de la Arritxaca, Murcia), Martín-Gascón M (Internal Medicine, Hospital Morales Meseguer, Murcia), Martinez-González O (Rheumatology, Hospital Universitario de Salamanca, Salamanca), Monteagudo-Jiménez M (Internal Medicine, Hospital Parc Taulí, Sabadell), Mora-Ortega GM (Pneumology, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes), Moral-Moral Pedro (Internal Medicine, Hospital Universitari i Politecnic La Fe, Valencia), Pérez-De Pedro I (Interna Medicine, Hospital Regional Universitario de Málaga, Málaga), Picazo-Talavera MR (Rheumatology, Hospital del Sureste, Madrid), Rubio-Rivas M (Internal Medicine, Hospital de Bellvitge, Hospitalet de Llobregat)

Disclosure of Interests:

None declared

EDIL3 promotes epithelial-mesenchymal transition and paclitaxel resistance through its interaction with integrin αVβ3 in cancer cells

Epithelial-mesenchymal transition (EMT) has recently been associated with tumor progression, metastasis, and chemotherapy resistance in several tumor types. We performed a differential gene expression analysis comparing paclitaxel-resistant vs. paclitaxel-sensitive breast cancer cells that showed the upregulation of EDIL3 (EGF Like Repeats and Discoidin I Like Domains Protein 3). This gene codifies an extracellular matrix protein that has been identified as a novel regulator of EMT, so we studied its role in tumor progression and paclitaxel response. Our results demonstrated that EDIL3 expression levels were increased in paclitaxel-resistant breast and prostate cancer cells, and in subsets of high-grade breast and prostate tumors. Moreover, we observed that EDIL3 modulated the expression of EMT markers and this was impaired by cilengitide, which blocks the EDIL3-integrin αVβ3 interaction. EDIL3 knockdown reverted EMT and sensitized cells to paclitaxel. In contrast, EDIL3 overexpression or the culture of cells in the presence of EDIL3-enriched medium induced EMT and paclitaxel resistance. Adding cilengitide resensitized these cells to paclitaxel treatment. In summary, EDIL3 may contribute to EMT and paclitaxel resistance through autocrine or paracrine signaling in cancer cells. Blockade of EDIL3-integrin αVβ3 interaction by cilengitide restores sensitivity to paclitaxel and reverts EMT in paclitaxel-resistant cancer cells. Combinations of cilengitide and taxanes could be beneficial in the treatment of subsets of breast and prostate cancers.

Sex Differences Among Participants in the Latin American Stroke Registry

Background

Reports on sex differences in stroke outcome and risk factors are scarce in Latin America. Our objective was to analyze clinical and prognostic differences according to sex among participants in the LASE (Latin American Stroke Registry).

Methods and Results

Nineteen centers across Central and South America compiled data on demographics, vascular risk factors, clinical stroke description, ancillary tests, and functional outcomes at short‐term follow‐up of patients included from January 2012 to January 2017. For the present study, all these variables were analyzed according to sex at hospital discharge. We included 4788 patients with a median in‐hospital stay of 8 days (interquartile range, 5–8); 2677 were male (median age, 66 years) and 2111 female (median age, 60 years). Ischemic stroke occurred in 4293: 3686 as cerebral infarction (77%) and 607 as transient ischemic attack cases (12.7%); 495 patients (10.3%) corresponded to intracerebral hemorrhage. Poor functional outcome (modified Rankin scale, 3–6) was present in 1662 (34.7%) patients and 38.2% of women (P<0.001). Mortality was present in 6.8% of the registry, with 7.8% in women compared with 6.0% in men (P=0.01). Death and poor functional outcome for all‐type stroke showed a higher risk in female patients (hazard ratio, 1.3, P=0.03; and hazard ratio, 1.1, P=0.001, respectively).

Conclusions

A worse functional outcome and higher mortality rates occurred in women compared with men in the LASE, confirming sex differences issues at short‐term follow‐up.

Abriendo Futuros: An empowerment program for indigenous adolescent girls in Yucatán, Mexico

Background

Abriendo Futuros is a a girl-centered empowerment program that engages community leaders and trains older indigenous girls as mentors to run community girls’ clubs, known as safe spaces. Mentors work directly with indigenous girls to deliver program curricula tailored to the girls’ specific and unique needs to builds girls’ assets in areas such as sexual and reproductive education, gender equality, violence prevention, leadership, financial education and healthy lifestyles.

Objectives

The program aims to improve critical health, social, and cognitive skills that help girls have a voice and choice in their lives and allows them to draw the path to a healthy adult life, overcoming the risks present in their context. The program was implemented in 8 rural communities in the south of Yucatan. A total of 657 girls were enrolled over the 18-month-implementation period (2015 - 2017).

Results

A quasi-experimental evaluation was implemented in 11 communities (8 intervention and three control). Preliminary findings, using the Propensity Score Matching technique, suggest significant positive effects on intermediate outcomes such as financial literacy, attitudes towards gender norms, sexual reproductive health knowledge, social capital, and perceived exposure to physical violence. No statistically significant results were achieved in main outcomes (reduce adolescent pregnancy and school dropout). We associate this, mainly to the fact that the intervention was only at an individual level, but also to the limited sample size and the brief observation period (18 months).

Conclusions

Girl-centered programming increases access to spaces where girls meet to expand their knowledge and social networks and build assets that reduce their risks and broadens their opportunities. However, further evidence is needed on multi-level and multisector girl-centered interventions to address teenage pregnancy and other complex issues.

Key messages

The program generates a social safety net among girls and mentors that is key to the well-being of girls. Girl-centered programs have positive effects on girĺs empowerment for girls who live in vulnerable situations and unequal social contexts.

Nutrient attenuation dynamics in effluent dominated watercourses

In-stream attenuation of dissolved and particulate forms of carbon, nitrogen and phosphorus are a crucial ecosystem service, especially in watercourses downstream of chemical pollution point-sources (i.e. wastewater treatment plants). Most chemical-fate models assume that attenuation is directly proportional to the concentration of available dissolved organic carbon, and inorganic nitrogen and phosphorus compounds in watercourses, but there are multiple evidences of saturation and even inhibition of attenuation at higher concentrations. Our current comprehension of nutrient attenuation kinetics in streams remains a limiting factor for the development and calibration of predictive models of the chemical fate of these compounds in rivers, thus hindering the development and implementation of more effective regulatory strategies. Here, we assessed the in-stream attenuation of dissolved organic carbon, inorganic nitrogen (NH₄⁺, NO₂^-, NO₃^-) and phosphorus (PO₄^3-) compounds at increasing concentrations of these compounds, and analyzed the interaction between attenuation kinetics and biofilm structure and function. Specifically, the net balances of these compounds were assessed in artificial streams exposed to eight treatments following the gradient of WWTP contribution to the river flow (0, 14, 29, 43, 58, 72, 86, and 100% of WWTP effluent water). Results indicate that biological in-stream attenuation by a given biofilm of an effluent dominated watercourse might be saturated if exposed for short periods to high nutrient concentrations such as during combined sewer overflow events, but that communities can adapt if exposed long enough to high concentrations, therefore avoiding or at least minimizing saturation. More attention should be therefore given to the management of effluent-dominated watercourses, as reductions in the temporal variability of the discharged wastewater by WWTP might enhance attenuation and thus reduce water quality issues downstream.

Identification and Characterization at the Single-Cell Level of Cytokine-Producing Circulating Cells in Children With Dengue

In this study, we identified, at the single-cell level, naturally induced cytokine-producing circulating cells (CPCCs) in children with dengue virus (DENV) infection ranging clinically from mild to severe disease. Tumor necrosis factor alpha (TNF-α) and interleukin 6 (IL-6) CPCCs were detected in children with primary or secondary acute dengue virus (DENV) infection, and the pattern of these cytokines was similar to that seen in the supernatant of cultured peripheral blood mononuclear cells and partially comparable to that found in plasma. Monocytes, B cells, and myeloid dendritic cells (mDCs) were the primary CPCCs detected, and the frequency of mDCs was significantly higher in severe disease. B cells isolated from children with dengue spontaneously secreted TNF-α, IL-6, and interleukin 10, and supernatants from cultures of purified B cells induced activation of allogeneic T cells, supporting an antibody-independent function of these cells during DENV infection. Thus, CPCCs could be a new immune parameter with potential use to evaluate pathogenesis in this infection.

Who Should Do Replication Labor?

Scientists, for the most part, want to get it right. However, the social structures that govern their work undermine that aim, and this leads to nonreplicable findings in many fields. Because the social structure of science is a decentralized system, it is difficult to intervene. In this article, I discuss how we might do so, focusing on self-corrective-labor schemes (i.e., ways of distributing replication efforts within the scientific community). First, I argue that we need to implement a scheme that makes replication work outcome independent, systematic, and sustainable. Second, I use these three criteria to evaluate extant proposals, which place the responsibility for replication on original researchers, consumers of their research, students, or many labs. Third, on the basis of a philosophical analysis of the reward system of science and the benefits of the division of cognitive labor, I propose a scheme that satisfies the criteria better: the professional scheme. This scheme has two main components. First, the scientific community is organized into two groups: discovery researchers, who produce new findings, and confirmation researchers, whose primary function is to do confirmation work (i.e., replication, reproduction, meta-analysis). Second, a distinct reward system is established for confirmation researchers so that their career advancement is separated from whether they obtain positive experimental results.

Neuraxial analgesia is not associated with an increased risk of post-partum relapses in MS

Background:

Obstetrical analgesia remains a matter of controversy because of the fear of neurotoxicity of local anesthetics on demyelinated fibers or their potential relationship with subsequent relapses.

Objective:

To assess the impact of neuraxial analgesia on the risk of relapse during the first 3 months post-partum, with a focus on women who experienced relapses during pregnancy.

Methods:

We analyzed data of women followed-up prospectively during their pregnancies and at least 3 months post-partum, collected in the Pregnancy in Multiple Sclerosis (PRIMS) and Prevention of Post-Partum Relapses with Progestin and Estradiol in Multiple Sclerosis (POPARTMUS) studies between 1992–1995 and 2005–2012, respectively. The association of neuraxial analgesia with the occurrence of a post-partum relapse was estimated by logistic regression analysis.

Results:

A total of 389 women were included, 215 from PRIMS and 174 from POPARTMUS. In total, 156 women (40%) had neuraxial analgesia. Overall, 24% experienced a relapse during pregnancy and 25% in the 3 months post-partum. Women with a pregnancy relapse were more likely to have a post-partum relapse (odds ratio (OR) = 1.83, p = 0.02), independently of the use of neuraxial analgesia. There was no association between neuraxial analgesia and post-partum relapse (OR = 1.08, p = 0.78).

Conclusion:

Neuraxial analgesia was not associated with an increased risk of post-partum relapses, whatever multiple sclerosis (MS) activity during pregnancy.

Incidence, recurrence and cost of hyperglycaemic crises requiring emergency treatment in Andalusia, Spain

AIMS

Hyperglycaemic crises (diabetic ketoacidosis and hyperosmolar hyperglycaemic state) are medical emergencies in people with diabetes. We aimed to determine their incidence, recurrence and economic impact.

METHODS

An observational study of hyperglycaemic crises cases using the database maintained by the out-of-hospital emergency service, the Healthcare Emergency Public Service (EPES) during 2012. The EPES provides emergency medical services to the total population of Andalusia, Spain (8.5 million inhabitants) and records data on the incidence, resource utilization and cost of out-of-hospital medical care. Direct costs were estimated using public prices for health services updated to 2012.

RESULTS

Among 1 137 738 emergency calls requesting medical assistance, 3157 were diagnosed with hyperglycaemic crises by an emergency coordinator, representing 2.9 cases per 1000 persons with diabetes [95% confidence intervals (CI) 2.8 to 3.0]. The incidence of diabetic ketoacidosis was 2.5 cases per 1000 persons with diabetes (95% CI 2.4 to 2.6) and the incidence of hyperosmolar hyperglycaemic state was 0.4 cases per 1000 persons with diabetes (95% CI 0.4 to 0.5). In total, 17.7% (n = 440) of people had one or more hyperglycaemic crisis. The estimated total direct cost was €4 662 151, with a mean direct cost per episode of €1476.8 ± 217.8.

CONCLUSIONS

Hyperglycaemic crises require high resource utilization of emergency medical services and have a significant economic impact on the health system.

Building Capability for Clinical Pharmacology Research in Sub-Saharan Africa

A strong scientific rationale exists for conducting clinical pharmacology studies in target populations because local factors such as genetics, environment, comorbidities, and diet can affect variability in drug responses. However, clinical pharmacology studies are not widely conducted in sub-Saharan Africa, in part due to limitations in technical expertise and infrastructure. Since 2012, a novel public-private partnership model involving research institutions and a pharmaceutical company has been applied to developing increased capability for clinical pharmacology research in multiple African countries.

Effects of storage time on the motility, mortality and calcium levels of Atlantic salmon Salmo salar spermatozoa

This study estimates spermatozoa mortality, morphology, motility and intracellular calcium levels in Atlantic salmon Salmo salar milt after prolonged storage. Milt samples were preserved at 4° C for 25 days and then evaluated for mortality. Motility remained high for the first 3 days and the mortality was low during the first 5 days of storage. A decrease of >50% in calcium content was observed after 5 days of storage. When spermatozoa were activated, calcium levels increased >200% in relative fluorescence units (RFU); this rate of increase was lost when the samples were stored for extended periods of time and was only partially manifested in a zero calcium solution. The results suggest that in vitro storage of S. salar spermatozoa at 4° C for a period of 3 days preserves motility and limits mortality to levels similar to those of fresh spermatozoa. This method also maintains intracellular calcium storage critical for spermatozoa performance.

Can the behavioral sciences self-correct? A social epistemic study

Advocates of the self-corrective thesis argue that scientific method will refute false theories and find closer approximations to the truth in the long run. I discuss a contemporary interpretation of this thesis in terms of frequentist statistics in the context of the behavioral sciences. First, I identify experimental replications and systematic aggregation of evidence (meta-analysis) as the self-corrective mechanism. Then, I present a computer simulation study of scientific communities that implement this mechanism to argue that frequentist statistics may converge upon a correct estimate or not depending on the social structure of the community that uses it. Based on this study, I argue that methodological explanations of the "replicability crisis" in psychology are limited and propose an alternative explanation in terms of biases. Finally, I conclude suggesting that scientific self-correction should be understood as an interaction effect between inference methods and social structures.

Revision: Indicadores del deterioro de la calidad proteica y del valor nutritivo de la leche / Review: Indicators of damage of protein quality and nutritional value of milk

The nutritional value of milk can be negatively affected by thermal treatments. The quality of the proteins can be modified as a consequence of a set of reactions, the most important of which are the interactions between protein and carbohydrates, also known as Maillard reactions. These reactions can also occur when the storage conditions of moisture and temperature are unfavorable. The differ ent thermal treatments involved in processing milk (pasteurization, sterilization, drying, etc.) lead to different steps of the Maillard reaction and therefore to the formation of different compounds that can be useful as chemical markers of milk alteration, or more exactly of protein alteration. Estimating these markers is useful in monitoring the changes, especially those related to proteins, that happen during processing and storage. A review of the literature on the markers used to evaluate the modi fications that milk undergoes during thermal treatment and subsequent storage was carried out, focusing mainly on proteins. Special attention was paid to the analytical aspects. The chemical mark ers taken into account can be classified into two groups according to their relation with the Maillard reaction:

1. Specific markers of Maillard reaction: undesirable compounds (furosine, lisinoalanine, histidinalanine, furfurals, melanoidins); loss of nutrients (available lysine).

2. Non-markers of Maillard reaction: galactose; lactulose; protein-reducing substances; denaturation of protein; in vitro digestibility of proteins; others—pH, viscosity, free fatty acids.

Incidence and care-related costs of severe hypoglycaemia requiring emergency treatment in Andalusia (Spain): the PAUEPAD project

AIMS

Hypoglycaemia is a serious medical emergency. The need for emergency medical service care and the costs of hypoglycaemic emergencies are not completely known.

METHODS

This was a retrospective observational study using Public Company for Health Emergencies (EPES) data for hypoglycaemia in 2012. The EPES provides emergency medical services to the entire population of Andalusia, Spain (8.5 million people). Data on event type, onsite treatments, emergency room visits or hospitalization were collected. Medical costs were estimated using the public rates for healthcare services.

RESULTS

From a total of 1 137 738 emergency calls that requested medical assistance, 8683 had a primary diagnosis of hypoglycaemia (10.34 per 10 000 person-years). The incidence of severe hypoglycaemic episodes requiring emergency treatment in the estimated population with diabetes was 80 episodes per 10 000 person-years. A total of 7479 episodes (86%) required an emergency team to visit the patient's residence. The majority of cases (64%) were addressed in the residence, although 1784 (21%) cases were transferred to hospital. A total of 5564 events (65%) involved patients aged > 65 years. Overall mortality was 0.32% (28 cases). The total annual cost of attending a hypoglycaemic episode was €6 093 507, leading to an estimated mean direct cost per episode of €702 ± 565. Episodes that required hospital treatment accounted for 49% of the total costs.

CONCLUSIONS

Hypoglycaemia is a common medical emergency that is associated with high emergency medical service utilization, resulting in a significant economic impact on the health system.

Amyophatic dermatomyositis presenting as a flagellated skin eruption with positive MDA5 antibodies and thyroid cancer: a real association?

Amyopathic dermatomyositis (ADM) is characterized clinically by typical skin lesions with hypomyopathy or no muscular involvement. ADM has been recently reported to be complicated by rapidly progressive interstitial lung disease (ILD), especially in patients with positive antibodies against melanoma differentiation-associated gene 5 (MDA5). These patients may have a low risk of cancer, but no clinical, histological or laboratory markers completely specific for paraneoplastic DM have been identified to date. We report a case of flagellate erythema as the initial presentation of ADM associated with ILD, positive MDA5 antibodies and a concomitant diagnosis of thyroid cancer. We discuss the unusual clinical features and associations that make this case particularly interesting.

Role of Angiotensin II type 1 receptor on renal NAD(P)H oxidase, oxidative stress and inflammation in nitric oxide inhibition induced-hypertension

AIMS

Activation of the renin-angiotensin system (RAS), renal oxidative stress and inflammation are constantly present in experimental hypertension. Nitric oxide (NO) inhibition with N(w)-nitro-L-arginine methyl ester (L-NAME) has previously been reported to produce hypertension, increased expression of Angiotensin II (Ang II) and renal dysfunction. The use of Losartan, an Ang II type 1 receptor (AT1R) antagonist has proven to be effective reducing hypertension and renal damage; however, the mechanism by which AT1R blockade reduced kidney injury and normalizes blood pressure in this experimental model is still complete unknown. The current study was designed to test the hypothesis that AT1R activation promotes renal NAD(P)H oxidase up-regulation, oxidative stress and cytokine production during L-NAME induced-hypertension.

MAIN METHODS

Male Sprague-Dawley rats were distributed in three groups: L-NAME, receiving 70 mg/100ml of L-NAME, L-NAME+Los, receiving 70 mg/100ml of L-NAME and 40 mg/kg/day of Losartan; and Controls, receiving water instead of L-NAME or L-NAME and Losartan.

KEY FINDINGS

After two weeks, L-NAME induced high blood pressure, renal overexpression of AT1R, NAD(P)H oxidase sub-units gp91, p22 and p47, increased levels of oxidative stress, interleukin-6 (IL-6) and interleukin-17 (IL-17). Also, we found increased renal accumulation of lymphocytes and macrophages. Losartan treatment abolished the renal expression of gp91, p22, p47, oxidative stress and reduced NF-κB activation and IL-6 expression.

SIGNIFICANCE

These findings indicate that NO induced-hypertension is associated with up-regulation of NADPH oxidase, oxidative stress production and overexpression of key inflammatory mediators. These events are associated with up-regulation of AT1R, as evidenced by their reversal with AT1R blocker treatment.

First Report of Fusarium solani Causing Crown and Root Rot on Strawberry Crops in Southwestern Spain

Spain is the fourth largest strawberry (Fragaria × ananassa) producing country in the world. Since April 2010, stunted and dead strawberry plants have been detected in four strawberry fruit production fields in Huelva (southwestern Spain) affecting less than 1% of plants. Symptoms consisted of foliage wilt, plant stunting and drying, and death of older leaves. Internal vascular and cortical tissues of plant crowns showed an orange to brown discoloration. Crowns and roots of symptomatic plants were surface sterilized in 1% sodium hypochlorite for 2 min, rinsed in sterile distilled water for 2 min, and air-dried in a laminar flow cabinet. Small disinfested pieces were transferred to petri dishes containing potato dextrose agar (PDA) and incubated for 10 days at 25°C with a 12-h photoperiod. Cultures derived from single spores were obtained, and morphological characterization was performed by microscopic examination. White to pale cream colonies developed after 10 days of incubation. Unbranched monophialides with microconidia in false heads, micro- (0 to 3 septa) and macroconidia (5 to 7 septa) wide and robust in shape, and chlamydospores were consistent with descriptions of Fusarium solani (Martius) Appel & Wollenweber emend. Snyder & Hansen (2). In addition, the fungus was isolated from asymptomatic runner plants from nurseries by the same method described above, and from soil samples from six fruit-producing fields. Soil samples were analyzed by dilution plating on Fusarium-selective agar medium (1). Genomic DNA from three isolates (FPOST-81 from dead plant 'Sabrina,' TOR-11 from runner plant 'Camarosa,' and TOR-1 from soil) was obtained with a DNA extraction kit (Isolate Plant DNA MiniKit, Bioline). A portion of the translation elongation factor-1 alpha (EF-1α) gene was sequenced using EF-1/-2 primers (3) (GenBank Accession Nos. KF275032, KF275033, and KF275034). The sequence comparison revealed a 99 to 100% match with F. solani sequences in GenBank and Fusarium-ID databases. To confirm the pathogenicity of the fungi, runner strawberry plants 'Camarosa' were inoculated by dipping crowns and roots into a conidial suspension (10⁶ to 10⁷ conidia per ml) for 30 min (8 plants per F. solani isolate) or into sterile distilled water for the controls. Plants were potted in 13-cm diameter pots with peat and maintained at 25/18°C and 70/40% relative humidity (day/night) in a growth chamber with a daily 16-h photoperiod of fluorescent light. Three plants inoculated with isolates TOR-11 and FPOST-81, and four plants inoculated with isolate TOR-1, died within 10 days after inoculation. After 8 to 12 weeks, all of the remaining inoculated plants were stunted and developed symptoms similar to those observed in the field. Production of new feeder roots was lacking or scarce. Control plants remained healthy and formed feeder roots. All plants inoculated with isolates TOR-1 and FPOST-81, and 50% of plants inoculated with TOR-11, showed brown discoloration in the crown. F. solani was re-isolated from symptomatic plants at frequencies of 100% and 80 to 100% from root and crown tissues, respectively. Although F. solani has been reported as a pathogen in other crops, to our knowledge, this is the first report of the occurrence of F. solani causing disease in strawberry plants in Spain. References: (1) D. Bouhot and F. Rouxel. Ann. Phytopathol. 3:251, 1971. (2) J. F. Leslie and B. A. Summerell. The Fusarium Laboratory Manual, Blackwell Publishing, London, 2006. (3) K. O'Donnell et al. Proc. Natl. Acad. Sci. USA 95:2044, 1998.

Analysis of genetic diversity in Bolivian llama populations using microsatellites

South American camelids (SACs) have a major role in the maintenance and potential future of rural Andean human populations. More than 60% of the 3.7 million llamas living worldwide are found in Bolivia. Due to the lack of studies focusing on genetic diversity in Bolivian llamas, this analysis investigates both the genetic diversity and structure of 12 regional groups of llamas that span the greater part of the range of distribution for this species in Bolivia. The analysis of 42 microsatellite markers in the considered regional groups showed that, in general, there were high levels of polymorphism (a total of 506 detected alleles; average PIC across per marker: 0.66), which are comparable with those reported for other populations of domestic SACs. The estimated diversity parameters indicated that there was high intrapopulational genetic variation (average number of alleles and average expected heterozygosity per marker: 12.04 and 0.68, respectively) and weak genetic differentiation among populations (FST range: 0.003-0.052). In agreement with these estimates, Bolivian llamas showed a weak genetic structure and an intense gene flow between all the studied regional groups, which is due to the exchange of reproductive males between the different flocks. Interestingly, the groups for which the largest pairwise FST estimates were observed, Sud Lípez and Nor Lípez, showed a certain level of genetic differentiation that is probably due to the pattern of geographic isolation and limited communication infrastructures of these southern localities. Overall, the population parameters reported here may serve as a reference when establishing conservation policies that address Bolivian llama populations.

Towards the Improvement of Fruit-Quality Parameters in Citrus under Deficit Irrigation Strategies

Water shortage is becoming a severe problem in arid and semiarid regions worldwide, reducing the availability of agricultural land and water resources. In Spain, citrus is one of the most economically important crops, with 74,000 ha devoted to its cultivation. Since water resources are increasingly more insufficient, the efficient use of water is becoming more essential. Deficit irrigation in many agricultural crops has frequently proved to be an efficient tool for improving water-use efficiency. This paper examines the effects a deficit irrigation during the ripening period on yield and the most representative fruit quality properties. The study was conducted during two consecutive years (2009-2010) in a commercial 12-year-old orange orchard (Citrus sinensis L. Osb. cv. Navelina) grafted onto Carrizo citrange (Citrus sinensis L. Osb. × Poncirus Trifoliata L. Osb.). A regulated deficit irrigation (DI) was applied, which was fully irrigated during the flowering and fruit-growth stage, and during the ripening period it was subjected to a water-stress ratio of 0.75. A control treatment was established, this being irrigated at 100% of crop evapotranspiration. Along the water stress period, it was tested the temporal evolution of the main organoleptic and nutraceutical fruit properties (color index, the total soluble solids, titrable acidity, maturity index, rind weight, juice weight, the ratio of juice weight versus fruit weight, and the total C vitamin and flavonoids). It was not observed a descend in juice content, or fruit weight, or in the final yield. In terms of fruit organoleptic and nutraceutical properties, there were not detected negative effects in the studied properties. Furthermore, DI treatment showed higher values of maturity index than control treatment, which can be considered as a positive aspect in the fruit quality. Considering these results, we can affirm that a moderate water stress applied during the maturity period is a sustainable strategy for saving water, increasing the irrigation productivity and obtaining fruits with similar properties to those without deficit irrigation.

Value of matrix-assisted laser desorption ionization-time of flight for routine identification of viridans group streptococci causing bloodstream infections

Phenotypic tests do not always unequivocally identify some species of viridans group streptococci (VGS). sodA sequence analysis is the most accurate method for identification, although it requires specialized personnel and has not been applied systematically in clinical microbiology laboratory routines. Matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) is emerging as a rapid alternative for bacterial identification. This study assesses the ability of MALDI-TOF and the API 20 Strep system to identify VGS isolates recovered from blood cultures using sodA sequence analysis as the reference method. All clinically significant VGS isolates recovered from blood cultures between January 2007 and January 2010 were identified by sodA sequence analysis and API 20 Strep. The strains were then tested by MALDI-TOF. Agreement between API 20 Strep/MALDI-TOF and sodA sequence analysis was determined. We examined 124 clinical isolates. Sensitivities of API 20 strep and MALDI-TOF for the species level identification of VGS isolates were, respectively, as follows: 60.5% and 73.4%. Sensitivities of API 20 strep and MALDI-TOF for the group level identification were, respectively, as follows: 70% and 94.3%. The turnaround times to identify VGS isolates by sodA sequence analysis, API 20 Strep and MALDI-TOF were 12-24, 24-48 h and 15 min, respectively. API 20 Strep cannot accurately identify all isolates of VGS. MALDI-TOF appeared to be a rapid and reliable alternative for identification of VGS strains to group level, but was not able to discriminate closely related species of certain groups.

Effect of aracnotoxin from Latrodectus mactans on bovine sperm function: modulatory action of bovine oviduct cells and their secretions

Latrodectus mactans' aracnotoxin (Atx) induces changes in sperm function that could be used as a co-adjuvant in male contraceptive barrier methods. This effect includes the suppression of intracellular reactive oxygen species (ROS), an event necessary for capacitation, chemotaxis and acrosome reaction (AR). The sperm that are not trapped by the barrier method can reach the oviduct before fertilisation and be exposed to the secretions of the oviducts. This study evaluated the effect of bovine tubal explants (TU) and conditioned media (CM) from the ampullar and isthmal regions on spermatozoa exposed to Atx. Thawed bovine sperm were incubated with Atx, TU and CM from the ampullar and isthmal regions for 4 h and then DNA integrity, intracellular ROS and lysophosphatidylcholine-induced AR were determined. Spermatozoa exposed to Atx and co-incubated with TU and CM for 4 h produced an increase in sperm DNA damage, a decrease in ROS production and a decrease in %AR, compared with the control. A similar result was obtained from the co-incubation of spermatozoa with Atx. In conclusion, the effect of Atx is not modified by tubal cells or their secretions and this opens the door to future studies to evaluate the application of synthetic peptides obtained from Atx as a co-adjuvant of contraceptive barrier methods.

Glucagon-like peptide-1 secretion in women with gestational diabetes mellitus during and after pregnancy

Gestational diabetes mellitus (GDM) predisposes women to future development of Type 2 diabetes mellitus (DM2) and the two conditions share similar metabolic alterations. Recent observations suggest that a defective glucose stimulated insulin secretion by glucagon-like peptide-1 (GLP- 1) plays a role in the pathogenesis of DM2. Whether such a defect is impaired in GDM remains to be ascertained.

AIM

We have determined GLP-1 secretion in response to oral glucose tolerance test (OGTT) in GDM and normal glucose tolerance (NGT) during and after pregnancy.

MATERIALS AND METHODS

100-g-3h OGTT was performed in 12 GDM and 16 NGT women at 27.3 ± 4.1 weeks of gestation, for determination of plasma GLP-1, glucose, insulin, and C-peptide. Insulin sensitivity (ISI) and insulin secretion (first and second phase); as well as ISI-secretion index (ISSI) were also derived.

RESULTS

NGT and GDM women were comparable for age pre-pregnancy body mass index (BMI) and weight gain. GDM had higher glucose area under the curve (AUC): 27,575.5 ± 3448 vs 20,685.88 ± 2715 mg/dl min (p<0.01), but lower first-phase insulin secretion (993.12±367 vs 1376.61 ± 423, p<0.05) and ISSI compared to controls (3873.23 ± 1185 vs 6232.13 ± 1734, p<0.001). When we examined GLP-1 mean levels in relation to mean glycemic values, GLP-1 secretion was inappropriately low with respect to mean glycemic values in GDM compared to NGT. At follow-up, AUCGLP-1 was significantly lower in post-partum GDM compared to post-partum NGT women (2542 ± 273 vs 10,092 ± 7367 pmol·l-1·min-1, p<0.05, respectively).

CONCLUSIONS

Our study suggests that GLP-1 secretion in GDM women is inadequate for the prevailing glycemic levels both in pregnancy and post partum. Moreover, we cannot exclude that other important aspects of the incretin effect may be involved in GDM development.

Multiple sclerosis prevalence in Malaga, Southern Spain estimated by the capture–recapture method

Background: Although not definitively proven, there is commonly accepted to be a latitudinal gradient in the distribution of multiple sclerosis (MS), which is more frequent in temperate zones. The European Mediterranean countries are situated in a zone of median frequency, although ever increasing figures have been noted in the last decades.

Objective: The objective of this study was to assess the current prevalence rate of MS in the province of Malaga, Southern Spain.

Methods: The capture–recapture method (CRM) uses independent sources of data and permits the number of non-registered cases of a given disease to be estimated, and by doing so, to avoid ascertainment bias.

Results: Use of this method showed the estimated prevalence rate of MS in the province of Malaga, Southern Spain, to be 125/105 (95% confidence interval: 102/105–169/105), higher than the figures published previously.

Conclusions: Although we recognize that these data need to be confirmed in further studies and in other areas of the country using a similar method, we believe this study is the first to find such high figure of prevalence, being very similar to the figures reported in recent years in other southern European countries.

Polyphenolic profile and antiproliferative activity of bioaccessible fractions of zinc-fortified fruit beverages in human colon cancer cell lines

INTRODUCTION

Colorectal cancer risks could be reduced by polyphenol-rich diets that inhibit tumour cell growth.

AIMS

To determine the polyphenolic profile of four fruit beverages (FbZn, FbZnFe, FbZnM and FbZnFeM) as affected by the presence of Zn with/without Fe and with/without skimmed milk, and the digestion conditions. To evaluate the antiproliferative activity of bioaccessible fractions against Caco-2 and HT-29 cells. To clarify whether cell cycle arrest and/or apoptosis is involved in their possible antiproliferative activity.

METHODS

The polyphenolic profiles were analyzed by RP-HPLC-DAD before and after in vitro gastrointestinal digestion. Cell proliferation and viability were measured using Trypan blue test, mitochondrial enzyme activity by means MTT test, cell cycle distribution using flow cytometry and apoptosis by means Hoechst dye.

RESULTS AND DISCUSSION

The presence of zinc, iron and/or milk decreased the soluble extractable phenolic content before digestion probably by chelate formation, FbZn and FbZnFe being the samples with the highest soluble extractable phenolics. After digestion, a decrease in phenolics was observed in all zinc-fortified samples (up to 32% with respect to the original fruit beverages) - the FbZnFeM sample showing the lowest soluble extractable phenolic content, though with the lowest percentage decrease in phenolics (14%). FbZnM digest (approximately 50 microM total soluble extractable phenolics) was the sample that most inhibited Caco-2 and HT-29 cell proliferation after 24 h of incubation, without cytotoxicity. The specific combination of phytochemicals in FbZnM digest proved cytostatic and significantly suppressed proliferation through cell cycle arrest in the S-phase in both cell lines, without apoptosis.