Beyond the effects of HIV infection and integrase inhibitors-based therapies on oral bacteriome

Oral microbiome is the second largest microbial community in humans after gut. Human immunodeficiency virus (HIV) infection triggers an impairment of the immune system which could favour the growth and the colonization of pathogens in the oral cavity, and this dysbiosis has been associated with oral manifestations that worsen the quality of life of these patients. Antiretroviral therapy (ART) could also drive changes in specific oral bacterial taxa associated with such periodontal diseases. Integrase strand transfer inhibitors (INSTIs), therapy of choice in the treatment of naive HIV-patients, are able to reverse the impact of HIV infection on systemic inflammation, gut permeability, and gut bacterial diversity/richness. The objective of this study was to analyse the effects of HIV infection per se and INSTIs on salivary bacteriome composition, taking into consideration other factors such as smoking, that could also have a significant impact on oral microbiome. To accomplish this objective, 26 non-HIV-infected volunteers and 30 HIV-infected patients (15 naive and 15 under INSTIs-regimen) were recruited. Salivary samples were collected to measure lysozyme levels. Oral bacteriome composition was analysed using 16S rRNA gene sequencing. Naive HIV-infected patients showed statistically higher levels of lysozyme compared to controls (p < 0.001) and INSTIs-treated patients (p < 0.05). Our study was unable to detect differences in α nor β-diversity among the three groups analysed, although significant differences in the abundance of some bacterial taxonomical orders were detected (higher abundance in the phylum Pseudomonadota, in the order Acholeplasmatales, and in the genera Ezakiella and Acholeplasma in the naive group compared to controls; and higher abundance in the phylum Mycoplasmatota, in the order Acholeplasmatales, and in the genera Acholeplasma and uncultured Eubacteriaceae bacterium in the INTIs-treated HIV-infected patients compared to controls). These differences seem to be partially independent of smoking habit. HIV infection and INSTIs effects on oral microbiota seem not to be very potent, probably due to the modulation of other factors such as smoking and the greatest outward exposure of the oral cavity.

Integrase Inhibitors Partially Restore Bacterial Translocation, Inflammation and Gut Permeability Induced by HIV Infection: Impact on Gut Microbiota

Introduction

Human immunodeficiency virus (HIV) infection can be considered a chronic disease thanks to the extended use of antiretroviral treatment (ART). In this context, low-grade chronic inflammation related to gut microbiota (GM) dysbiosis and bacterial translocation (BT) among other factors has been observed despite the use of ART. In addition, different ART regimens have demonstrated differential impacts on GM. However, the role of novel integrase strand transfer inhibitors (INSTIs) has not been investigated yet. The aim of this study was to analyse the effects of INSTIs in first-line of treatment on markers of BT, inflammation, cardiovascular risk, gut permeability and GM composition and derived short-chain fatty acids.

Methods

Twenty-six non-HIV-infected volunteers and 30 HIV-infected patients (15 naïve and 15 under INSTIs regimen) were recruited. Blood samples were extracted to analyse biochemical parameters and markers of BT, inflammation, cardiovascular risk, gut permeability and bacterial metabolism. GM composition was analysed using 16S rRNA gene sequencing.

Results

Our results showed that HIV infection increased BT, inflammation, cardiovascular risk and gut permeability, whereas INSTIs counteracted these effects. Regarding GM, the reduction in bacterial richness induced by HIV infection was restored by INSTIs. Beta diversity revealed that HIV-infected people were separated from the control group independently of treatment.

Conclusions

Current antiretroviral regimens based on INSTIs are able to reverse the impact of HIV infection on BT, systemic inflammation, gut permeability and bacterial diversity/richness, reaching similar levels to those observed in an uninfected/control population. These results suggest a protective role of INSTIs in disease progression, subsequent immune activation and in the development of future age-related complications such as cardiovascular events.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40121-022-00654-4.

Epidemiological, Clinical, and Microbiological Characteristics in a Large Series of Patients Affected by Dermacentor-Borne-Necrosis-Erythema-Lymphadenopathy from a Unique Centre from Spain

During recent decades, a tick-borne rickettsial syndrome, characterized by eschar and painful lymphadenopathy after Dermacentor marginatus-bite, has been described as an emerging rickettsiosis in Europe. Our group named it DEBONEL (Dermacentor-borne-necrosis-erythema-lymphadenopathy), regarding the vector and the main infection signs. Other groups called it TIBOLA (tick-borne-lymphadenophathy) and, later, SENLAT (scalp-eschar-and-neck-lymphadenopathy-after-tick-bite), expanding, in the latter, the etiological spectrum to other pathogens. Objective: To investigate the etiology of DEBONEL agents in our area, and to compare their epidemiological/clinical/microbiological characteristics. During 2001-2020, 216 patients clinically diagnosed of DEBONEL (the largest series from one center) in La Rioja (northern Spain) were examined. Rickettsia spp. were amplified in 14/104 (13.46%) blood samples, 69/142 (48.59%) eschar swabs, 7/7 (100%) biopsies, and 71/71 (100%) D. marginatus from patients. For samples in which Rickettsia was undetected, no other microorganisms were found. 'Candidatus Rickettsia rioja', Rickettsia slovaca, Rickettsia raoultii, and Rickettsia DmS1 genotype were detected in 91, 66, 4, and 3 patients, respectively. DEBONEL should be considered in patients with clinical manifestations herein described in areas associated to Dermacentor. The most frequently involved agent in our environment is 'Ca. R. rioja'. The finding of Rickettsia sp. DmS1 in ticks attached to DEBONEL patients suggests the implication of other rickettsia genotypes.

Corrigendum: ACE Gene Variants Rise the Risk of Severe COVID-19 in Patients With Hypertension, Dyslipidemia or Diabetes: A Spanish Pilot Study

[This corrects the article DOI: 10.3389/fendo.2021.688071.].

ACE Gene Variants Rise the Risk of Severe COVID-19 in Patients With Hypertension, Dyslipidemia or Diabetes: A Spanish Pilot Study

Coronavirus disease 19 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection continues to scale and threaten human health and public safety. It is essential to identify those risk factors that lead to a poor prognosis of the disease. A predisposing host genetic background could be one of these factors that explain the interindividual variability to COVID-19 severity. Thus, we have studied whether the rs4341 and rs4343 polymorphisms of the angiotensin converting enzyme (ACE) gene, key regulator of the renin-aldosterone-angiotensin system (RAAS), could explain the different outcomes of 128 COVID-19 patients with diverse degree of severity (33 asymptomatic or mildly symptomatic, 66 hospitalized in the general ward, and 29 admitted to the ICU). We found that G allele of rs4341 and rs4343 was associated with severe COVID-19 in hypertensive patients, independently of gender (p<0.05). G-carrier genotypes of both polymorphisms were also associated with higher mortality (p< 0.05) and higher severity of COVID-19 in dyslipidemic (p<0.05) and type 2 diabetic patients (p< 0.01). The association of G alleles with disease severity was adjusted for age, sex, BMI and number of comorbidities, suggesting that both the metabolic comorbidities and the G allele act synergistically on COVID-19 outcome. Although we did not find a direct association between serum ACE levels and COVID-19 severity, we found higher levels of ACE in the serum of patients with the GG genotype of rs4341 and rs4343 (p<0.05), what could explain the higher susceptibility to develop severe forms of the disease in patients with the GG genotype, in addition to hypertension and dyslipidemia. In conclusion, our preliminary study suggests that the G-containing genotypes of rs4341 and rs4343 confer an additional risk of adverse COVID-19 prognosis. Thus, rs4341 and rs4343 polymorphisms of ACE could be predictive markers of severity of COVID-19 in those patients with hypertension, dyslipidemia or diabetes. The knowledge of these genetic data could contribute to precision management of SARS-CoV-2 infected patients when admitted to hospital.

[Prevalence and distribution of hepatitis B virus genotype D in Galicia (northwest of Spain): influence of age, sex and origin]

OBJECTIVE

Phylogenetically, hepatitis B virus (HBV) is classified into genotypes and subgenotypes used for epidemiological studies. The aim of this study is to know the distribution of HBV subgenotypes D in our environment.

METHODS

From 401 patients HBV surface antigen positive, HBV DNA-positive, partial HBV-DNA S gene was amplified, sequenced and analysed using geno2pheno (hbv) (Max-Planck Institute) on line application.

RESULTS

We found 259 (64.6%) patients with HBV genotype D: 53 not subgenotypable, 9 (4%) D1, 61 (30%) D2, 15 (7%) D3 and 121 (59%) D4. Patients with D1 subgenotype were, on average, 23 years younger (p = 0.0001), with a higher proportion of women (p < 0.05).

CONCLUSIONS

HBV subgenotype D4 was the most prevalent in our area. Patients with D1 subgenotype came from abroad were younger than the other subgenotypes and mostly women. These results show the interest of conducting studies at HBV subgenotype level.

Postpartum triage, services provided, and length of stay for infants born at 35 weeks gestation

OBJECTIVES

The aim of this article is to (1) compare the care setting to which 35-week infants are initially triaged postpartum to the level of services subsequently provided; and (2) identify factors known at delivery or immediately postpartum associated with services received and length of stay during the birth hospitalization.

STUDY DESIGN

In this multicenter retrospective study of 35-week infants born between 2007 and 2008, service capabilities of the initial postpartum care setting were categorized as level 1 or neonatal intensive care unit (NICU) using American Academy of Pediatrics definitions. Subsequent services actually provided were categorized as routine care, level 1, or >level 1.

RESULTS

Over half of 431 studied infants were sent to a level 1 nursery postpartum. Of these, over 90% ultimately received routine care or level 1 services. Of 200 infants triaged to a NICU, the majority received only routine care or level 1 services. The great majority of infants requiring > level 1 services were identified promptly postpartum. Initial triage to the NICU was associated with significantly (p < 0.05) increased length of stay despite provision of similar services.

CONCLUSIONS

This study suggests a need for improved triage of 35-week infants and provides tools for this purpose. Validation of the models presented here is warranted.

Feasibility of an electronic stethoscope system for monitoring neonatal bowel sounds

OBJECTIVE

Bowel dysfunction remains a major problem in neonates. Traditional auscultation of bowel sounds as a diagnostic aid in neonatal gastrointestinal complications is limited by skill and inability to document and reassess. Consequently, we built a unique prototype to investigate the feasibility of an electronic monitoring system for continuous assessment of bowel sounds.

METHOD

We attained approval by the Institutional Review Boards for the investigational study to test our system. The system incorporated a prototype stethoscope head with a built-in microphone connected to a digital recorder. Recordings made over extended periods were evaluated for quality. We also considered the acoustic environment of the hospital, where the stethoscope was used. The stethoscope head was attached to the abdomen with a hydrogel patch designed especially for this purpose. We used the system to obtain recordings from eight healthy, full-term babies. A scoring system was used to determine loudness, clarity, and ease of recognition comparing it to the traditional stethoscope. The recording duration was initially two hours and was increased to a maximum of eight hours.

RESULTS

Median duration of attachment was three hours (3.75, 2.68). Based on the scoring, the bowel sound recording was perceived to be as loud and clear in sound reproduction as a traditional stethoscope. We determined that room noise and other noises were significant forms of interference in the recordings, which at times prevented analysis. However, no sound quality drift was noted in the recordings and no patient discomfort was noted. Minimal erythema was observed over the fixation site which subsided within one hour.

CONCLUSION

We demonstrated the long-term recording of infant bowel sounds. Our contributions included a prototype stethoscope head, which was affixed using a specially designed hydrogel adhesive patch. Such a recording can be reviewed and reassessed, which is new technology and an improvement over current practice. The use of this system should also, theoretically, reduce risk of infection. Based on our research we concluded that while automatic assessment of bowel sounds is feasible over an extended period, there will be times when analysis is not possible. One limitation is noise interference. Our larger goals include producing a meaningful vital sign to characterize bowel sounds that can be produced in real-time, as well as providing automatic control for patient feeding pumps.

Theoretical and experimental study on RF tumor ablation with internally cooled electrodes: when does the roll-off occur?

The Cool-tip is one of the most widely employed electrodes in radiofrequency (RF) ablation (RFA) of hepatic tumors. This electrode creates reliable geometry and coagulation zones. Despite the advantages of this electrode, during the ablation is produced a phenomenon called roll-off in which impedance increases, energy deposition completely stops and the lesion size cannot be increased. Consequently, the thermal lesion size is smaller and the tumors which can be ablated are smaller too. In this research we studied theoretical and experimentally the electrical-thermal performance of the Cool-tip electrode during RFA of hepatic tissue. Mainly, we were interested in the occurrence of the roll-off and its relationship with the tissue temperatures around the electrode. The theoretical model included the vaporization of the tissue and the variation of the thermal and electrical conductivities with temperature. The model was solved numerically using COMSOL Multiphysics software. For the experimental part we conducted a study in ex vivo liver tissue. The experimental and theoretical results showed that the roll-off is totally related when temperatures around 100 °C surrounds the tissue close to the center of the Cool-tip. The knowledge of this fact brings a powerful tool to analyze alternative methods or techniques to avoid the roll-off.

Nicotine-induced plasma corticosterone is attenuated by social interactions in male and female adolescent rats

Most smokers begin smoking during adolescence, a period during which social reward is highly influential. Initial exposure to nicotine can produce anxiogenic effects that may be influenced by social context. This study examined play behavior and plasma corticosterone following nicotine administration (0.6 mg/kg, s.c.) in both male and female adolescent (PND39) Sprague-Dawley rats in either isolate or social contexts. In blood samples collected immediately following the 15-min test session, nicotine increased plasma corticosterone relative to saline in both male and female isolate rats, but failed to do so in both males and females placed together in same-sex pairs. Nicotine also attenuated several indices of play behavior including nape attacks, pins and social contact. In isolate rats, nicotine selectively increased locomotor activity in females; however, when administered to social pairs, nicotine decreased locomotion in both sexes. These findings suggest that the presence of a social partner may decrease the initial negative, stress-activating effects of nicotine, perhaps leading to increased nicotine reward.

Experimental and theoretical study of an internally cooled bipolar electrode for RF coagulation of biological tissues

Although some types of bipolar electrodes have been broadly employed in clinical practice to coagulate biological tissue by means of radiofrequency (RF) currents, there is still scanty available information about their electrical-thermal behaviour. We are focused on internally cooled bipolar electrodes. The goal of our study was to know more about the behavior of this kind of electrodes. For that, we planned an experimental and theoretical model. The experimental study was based on bovine hepatic ex vivo tissue and the theoretical model was based on the Finite Element Method (FEM). In order to check the feasibility of the theoretical model, we assessed both theoretically and experimentally the effect of the internal cooling characteristics of the bipolar electrode (flow rate and coolant temperature) on the impedance progress during RF heating and coagulation zone dimensions. The experimental and theoretical results were in good agreement, which suggests that the theoretical model could be useful to improve the design of cooled bipolar electrodes.

[Evolution of Enterobacteriaceae resistance to antibiotics in Reunion Island: emergence of extended-spectrum beta-lactamases]

AIM OF THE STUDY

The antibiotic resistance of enterobacteriacae knows a worldwide worrying evolution with an increase of the extended spectrum betalactamases (ESBL) that spread into the community. Few publications describe this problem in the Indian Ocean area. The aim of this study is first to identify in Félix Guyon Hospital (Reunion Island) the emergent antibiotics resistance for enterobacteriaceae between 1997/1998 and 2006/2007 periods, at second, to update the prophylactic and therapeutic measures for handling the risk linked to multiresistant enterobacteriaceae in our hospital and third, to assess the risk in Reunion Island and especially at the community level.

METHODS

The antibiotic susceptibility of 7814 enterobacteriaceae strains collected among patients, during 1997/1998 and 2006/2007 periods, were analysed as well as the consumption of the third generation cephalosporins, imipenem and fluoroquinolones.

RESULTS

Within a span of time of 10 years, an important increase (+57 %) of the resistance prevalence of enterobacteriaceae is observed. The resistance by the ESBL production mechanism is predominant especially for Enterobacter cloacae and Escherichia coli. An important use of broad spectrum antibiotics is correlated with this resistance evolution.

CONCLUSION

The emergence of ESBL-producing enterobacteriaceae in our hospital is impairing both therapeutic and health care. It requires a much better control of antibiotics prescriptions and therefore, an important multidisciplinary implication. A proof molecular analysis would allow to evaluate the risk more precisely, especially at the community level.

Treatment of wastewater containing high phenol concentrations using stabilisation ponds enriched with activated sludge

Treatment of wastewater containing high phenol concentrations (up to 4,000 mg/l, 1,600 kg/ha.d) in laboratory-scale stabilisation ponds enriched with activated sludge was studied. Phenol was biodegraded efficiently, even when fed as the sole carbon source. At influent concentrations of 1,000, 1,300, 1,600, 1,900, 2,500, 3,000 and 4,000 mg/l of phenol (loading rates of 400, 520, 640, 760, 1,000, 1,200 and 1,600 kg phenol/ha.d), the phenol removal efficiencies were 92, 89, 81, 81, 76, 65 and 22%, respectively. At 4,000 mg/l of phenol, the enriched ponds were significantly inhibited. The maximum phenol removal rate observed was 780 kg/ha.d, which is 7.7 times higher than the maximum value reported for attached-growth waste stabilisation ponds. All along the experiments, the enriched ponds showed removal rates 1.8-20.5 times higher than the values observed in control pond (not enriched). The results suggest that enrichment is an effective method to increase xenobiotic removal rates of stabilisation ponds.

Microbial characterization of organic carrier colonization during a model biofiltration experiment

AIMS

Dynamic microbial characterization of the colonization of organic carrier during a model biofiltration experiment using methanol as air pollutant.

METHODS AND RESULTS

A model biofilter was used in order to characterize the micro-organisms involved in the colonization of a model organic carrier. The model system consisted of closed vial as biofilter, peanut shells as lignocellulosic carrier and methanol as air pollutant. The micro-organisms involved in biofiltration were identified and characterized for their lignocellulolytic and methylotrophic activities. Fungi presented a higher lignocellulolytic activity than bacteria. A steady-state was reached after 15 to 20 days.

CONCLUSIONS

The consortium naturally associated to peanut shells is limited to few aerobic bacteria and lignocellulolytic fungi. This consortium was able to degrade methanol without external nutrient supply.

SIGNIFICANCE AND IMPACT OF THE STUDY

To our knowledge, this is the first paper that focuses on carrier degradation processes and the micro-organisms involved during the start-up period of a biofiltration process.

Degradation of the main components of cellulose-paint thinner by the mould Scopulariopsis brevicaulis cultured on rice hulls

AIMS

Biodegradation of the main components of the cellulose-paint thinner (toluene, acetone, isopropanol and xylenes) by Scopulariopsis brevicaulis, isolated from a thinner biodegradation microbial consortium was investigated.

METHODS AND RESULTS

Our results showed that 90% of S. brevicaulis conidia survived after 4 weeks in a cellulose-paint thinner saturated atmosphere. The mould was able to grow under these environmental conditions with a low development of conidia. The biodegradation potential of S. brevicaulis was established with and without support material (rice hulls). Biodegradation without support was very limited, <10% for all the components quantified. There was notable thinner biodegradation when the fungus was grown on rice hulls.

CONCLUSIONS

Our results suggest the potential use of fungi in biofiltration systems employed in biodegradation of the main components of the cellulose-paint thinner.

SIGNIFICANCE AND IMPACT OF THE STUDY

This is the first report of volatile organic compounds biodegradation by this fungal species.

Phenol removal in upgraded facultative waste stabilisation ponds

Treatment of wastewater containing phenol using laboratory scale waste stabilisation ponds enriched with activated sludge was studied. After enrichment, the efficiency of these ponds under high phenol loading rates (i.e. up to 408 kg phenol ha(-1) day(-1)) was studied. At phenol loading rates of 6, 52, 312, 636 and 972 COD ha(-1) day(-1), the phenol removal efficiencies were 77, 69, 76, 59 and 52%, respectively. The results suggest that enrichment is an effective potential method to increase the removal capability of facultative ponds, not only or easily biodegradable compounds but also for xenobiotics.

An innovative application of anatomic electromagnetic voltage mapping in a patient with Ebstein's anomaly undergoing permanent pacemaker implantation

A novel application of the Biosense CARTO System anatomic electromagnetic voltage mapping is presented, utilized as a guide for permanent pacemaker placement. The technique is illustrated in the successful implantation of an atrial lead in a patient with Ebstein's anomaly characterized by a severely dilated right atrium and extremely low-amplitude voltage signals, requiring a DDD pacemaker. Electromagnetic voltage mapping can be used in selected patients with structural heart disease to determine the optimal site for permanent pacemaker lead placement.

Analysis of charges and complications of permanent pacemaker implantation in the cardiac catheterization laboratory versus the operating room

During the last two decades, an increasing number of permanent pacemakers have been implanted outside of the operating room (OR) by nonsurgeons. Previous investigators have demonstrated that pacemakers can be safely implanted in the cardiac catheterization laboratory with no increase in complications or infections. This is the first study of its kind to simultaneously evaluate cost, length of hospitalization, and complications between pacemakers implanted in the OR by surgeons with those implanted in the catheterization laboratory by an electrophysiologist. A total of 254 consecutive pacemaker implants were analyzed over a 2-year period. The OR group consisted of 122 patients with a mean age of 64 +/- 21 years versus 132 patients in the catheterization laboratory group with a mean age of 65 +/- 17 years. The indication and type of pacemaker implanted were similar among both groups with 78% of OR patients and 73% of catheterization laboratory patients receiving dual chamber devices. The average cost for pacemaker implantation in our study was significantly higher in the OR group $5,464 +/- $1,670 versus $2,682 +/- $8 for the catheterization laboratory group (P < 0.001). There was a reduction in preimplant days in the catheterization laboratory group 3.16 +/- 12.40 days versus 5.65 +/- 9.54 days in the OR group (P < 0.05). Complications were minimal and there were no significant differences between the two groups. This study confirms that pacemakers can be safely implanted in the catheterization laboratory by nonsurgeons with no increase in complications and a significant reduction in hospital costs.

[Characteristics of infantile asthma in patients seen in primary care]

OBJECTIVE

To compare an asthmatic and non-asthmatic group of children by looking at determined characteristics.

DESIGN

Study of cases and paired one-to-one controls by age and gender.

SETTING

Primary Care.

PATIENTS AND OTHER PARTICIPANTS

Children aged 0 to 13 and attended at one particular Paediatrics clinic were studied (1,100 children). All those children diagnosed with asthma in accordance with the standard procedure in the Health District were considered as cases (142). The control group was chosen at random from the age and gender files.

MEASUREMENTS AND MAIN RESULTS

A telephone poll with closed questions was carried out by three researchers who were "blind" to whether they were dealing with case or control. Statistically significant differences were found for family background of allergic Rhinitis (cases, 43.2%; controls, 30.4%; p = 0.04), atopic eczema (cases, 36.3%; controls, 14.7%; p < 0.001) and bronchial asthma (cases, 59.8%; controls, 33.3%; p < 0.001). Statistically significant differences were also found for personal case histories of allergic Rhinitis (cases, 36.3%; controls, 2%; p < 0.001) and atopic eczema (cases, 23.5%; controls, 10.7%; p = 0.021); and in the presence of animals (dog and/or cat) in the home (cases, 13.7%; controls, 25.5%; p = 0.04). No statistically significant differences were found for background of breast-feeding, age of starting school, present passive smoking or the existence of older siblings.

CONCLUSIONS

The results obtained show that the association of atopic illnesses, such as Rhinitis and Eczema, and the existence of family background of asthma and atopy are more common in the asthmatic patient.

Effect of aerobic pretreatment with Aspergillus terreus on the anaerobic digestion of olive-mill wastewater

A kinetic study was carried out on the anaerobic digestion of olive-mill wastewater (OMW) and OMW that was previously fermented with Aspergillus terreus. The bioreactors used were batch fed and contained saponite as support for the mediating bacteria. The anaerobic digestion process followed first-order kinetics, from which the kinetic constant A was calculated using a non-linear regression. This kinetic parameter was influenced by the pretreatment carried out, and was 3.7 times higher for pretreated OMW than for untreated OMW. The anaerobic processing of pretreated OMW seemingly involved no inhibition phenomena as the biotoxicity and the total phenolic compound content (analysed by HPLC) were reduced by 71.2% and 77.9% respectively as a result of the pretreatment. Finally, the yield coefficient of methane production was 0.345 litres of methane (at standard temperature and pressure)/g of chemical oxygen demand, that is, 23% higher than that provided by untreated wastewater.

Efficacy of surfactant therapy in infants managed with CPAP

Surfactant rescue therapy can be utilized effectively early in the course of respiratory distress syndrome (RDS) in infants weighing > 1,000 g and treated exclusively with continuous positive airway pressure (CPAP) therapy. Thirteen infants (BW, 1,774 +/- 580 g; GA, 31 +/- 3 weeks) comprising the CPAP/SURFACTANT group were compared with 12 infants (BW, 1,753 +/- 556 g; GA, 31 +/- 2 weeks) who comprised the intermittent mandatory ventilation (IMV)/surfactant group, and with 14 infants (BW, 1,776 +/- 332 g; GA, 32 +/- 2 weeks) treated with CPAP before surfactant was clinically available. A 5 mL/kg dose of Exosurf Neonatal (Burroughs-Wellcome) was administered to infants intratracheally when the FiO2 requirement reached 0.40 to maintain the PO2 above 50 torr. Infants in the CPAP/surfactant group were intubated solely for surfactant administration and extubated within 18 +/- 6 min of treatment. The CPAP/surfactant group was treated at a mean age of 12.3 +/- 9.3 h, and the IMV/surfactant group at 10.2 +/- 9.8 h. Alveolar-arterial oxygen gradient (AaDO2), oxygenation index (OI), and mean airway pressure (MAP) were determined immediately before and after surfactant therapy, and at comparable times for the CPAP-only group. A significant difference was found in pre-treatment AaDO2, OI and MAP between the CPAP/surfactant group and IMV/surfactant group, but not between the CPAP/surfactant group and the CPAP-only group. Similarly, a significant difference in AaDO2, OI and MAP continued post-treatment was noted. However, a significant difference was also found at this time between the CPAP/surfactant group and the CPAP-only group. In addition, a significant difference was noted in AaDO2 and OI pre- and post-treatment within each surfactant-treated group. Furthermore, in the CPAP-only group AaDO2 and OI actually worsened (212 +/- 70 vs. 239 +/- 68; 4.0 +/- 1 vs. 4.5 +/- 2, respectively). There was a significant reduction in the duration of oxygen therapy (3 +/- 2 vs. 5 +/- 2 vs. 4.5 +/- 2 days, respectively) as well as in the total days of hospitalization (30 +/- 10 vs. 42 +/- 15 vs. 43 +/- 12 days, respectively). We conclude that in this small group of infants surfactant administration was effective and safe. It appeared to improve the course of RDS and shorten the duration of oxygen exposure and days of hospitalization.

Clinical and anatomopathological study of 2000 cryptorchid testes

OBJECTIVE

To establish whether age at the time of surgery and location of the testes help to determine the anatomopathological lesions.

PATIENTS AND METHODS

Between 1972 and 1992 surgery was performed on 2000 testes in 1342 children, 658 of whom had bilateral cryptorchidism. The clinical, surgical and anatomopathological records were reviewed.

RESULTS

Parametric and non-parametric tests failed to reveal any relation between the tubular fertility index or tubular diameter and the time of surgery or testicular location.

CONCLUSION

We cannot recommend a particular age at which surgery should be performed, in relation to the anatomopathological damage.

[The coordination of care for the spina bifida patient. 8 years of experience]

We have analyzed some factors which can show the special health care given to spina bifida patients in two periods, from 1971, when the set Hospital was set up, to 1985 and from 1985 to 1991. In 1985 the position of medical coordinator for spina bifida was created, and at the same time, a spina bifida consultancy was set up. This consultancy was created to improve this coordination and to analyze urological problems. In the first period, there were 54 affected in our Hospital. Now there are 68 patients. The most important goal achieved with this coordination is the improvement in the relationship between the patient, family and doctor, based on a personalized attention, even though this is a difficult subject to quantify. Since 1985 we have seen a lower number of visits to the consultancies in general, but mainly in neurosurgery, urology and orthopedics, a mean of 119 in first period and 45 in the second period. The number of consultancy visits has been the same since the consultancy was set up (46 per year). The number of patients admitted to in hospital was also decreasing. The spina bifida consultancy involves only an hours work a week, the urology ward has been integrated into this, and this avoids the handicapped having to attend other specialized wards so often. The consultancy structure lets us send urine analyses results by post or recover the test results on the same day they are done. Analysing the number of X-ray examinations performed on those patients, the coordinators value is evident: we got a lower number of X-ray examinations, especially invasive, e.g. cystographies and urographies, the latter because they have been replaced by echographies.

[Collagenous colitis associated with rheumatoid arthritis]

A patient diagnosed as having well-tolerated rheumatoid arthritis and diarrhea is described. The female patient in question was diagnosed as suffering from collagenous colitis by means of a colon biopsy. The association of this clinical state with immunological disease is discussed.

[Results of biofeedback on incontinence caused by anorectal atresia]

Eight patients with anorectal incontinence because of anorectal atresia, aged between seven and seventeen years, following surgical treatment with Romualdi-Soave procedure in seven cases and with PSARP in one case, have received biofeedback training to improve their continence. Clinical evaluation has been performed with a new numeric punctuation method that allows a quantitative and precise appraisal of incontinence (Incontinence Punctuation: IP). From a clinical point of view, biofeedback training has increased 4.16 points IP in patients in whom the method has been effective. It has prolonged the mean duration of voluntary contraction in 5.9 sec. and elevated in 13.6 mm. Hg. the maximal pressure contraction. In two patients, clinical evolution and manometry measurements indicated surgical treatment and PSARP was performed, improving IP in 5.5 points. We considered biofeedback training, when indicated, an adequate and innocuous technique to achieve an important clinical continence improvement in these patients.

[Fractionated bone marrow transplantation in a case of severe combined immunodeficiency]

Authors present a male infant affected by severe combined immunodeficiency with a high percentage of circulating B lymphocytes. Pathogenetic mechanism underlying our patient's disease seems to be an intrinsic defect in the lymphoid stem cell. As no histocompatible donor could be found, an hemiallogeneic bone marrow transplantation of maternal origin, fractionated with soybean agglutinin, was performed. The patient died 27 days after transplantation. At this time the percentage of T cells in his peripheral blood rose to near normal values, and the percentage of B cells normalized, karyotype analysis demonstrated circulating cells of female origin. Necropsy showed a spleen with lymphoid follicles and germinal centres but no signs of graft-versus-host could be found. Fractionated bone marrow could be of paramount importance in the treatment of these patients, since it could circumvent graft-versus-host disease.

[Complete laryngotracheoesophageal cleft. Report of a new case and review of the literature (author's transl)]

A new case of complete laryngotracheoesophageal cleft with transposition of great arteries, dolicoureters, biliary atresia and mucoviscidosis which presented a severe respiratory distress since birth is reported. The 12 cases published in the literature are reviewed and a scheme for management of this anomaly is presented.

[Transformation of a rib plasmocytoma into an amyloid tumor (author's transl)]

The appearance of amyloidosis during the course of multiple myeloma is a well known fact and has an overall incidence of 6 to 15%. However, the total transformation of a plasmocytoma into a voluminous amyloid tumor is a very rare event. A female patient was diagnosed of lambda light chain disease after developing a conspicuous rib plasmocytoma over the same region where a pathological fracture had appeared three years before. She was treated with discontinuous courses of melphalan and methyl-prednisolone, and developed a reversible nephrotic syndrome and a pathological fracture of the right clavicle. At necropsy there was generalized amyloidosis and complete substitution of the rib plasmocytoma by amyloid substance, with another important accumulation of amyloid in the region of the clavicular fracture. The present concepts on amyloidogenesis in multiple myeloma are reviewed, and the peculiarities of the present case together with the possible role of initiating factors and the effects of therapy are discussed. The case herein reported appears to represent a human model of focal amyloidogenesis in myeloma.

[Treatment of peritoneal hydatidosis with mebendazole. Preliminary study (author's transl)]

Authors present three cases of peritoneal hydatidosis, two of which are due to spontaneous rupture of hepatic hydatid cysts and the other due to operative rupture of ovarian hydatid cyst. A dose of 1 g./day of mebendazole was administered for 11 months with 30 day break periods every three months. Mebendazole has proved effective in the treatment of secondary echinococcosis. In authors judgement this may be an effective treatment for peritoneal spreading if mebendazole is used at an early stage since they have verified the absence of dissemination in one of the cases and an inactive dissemination in other one. If treatment is applied later, regression is achieved too, but more slowly. Immunological and ecographical results are reported in detail as well as surgical and pathologic findings. A cautious interpretation of these preliminary results is advised since data on long-term results are lacking.

Neutrophil chemotactic defect and hypogammaglobulinemia

A 15-months-old boy developed agranulocytosis after administration of Chloramphenicol and Aminopyrine. In spite of total hematological recovery, the patient's immunological study disclosed a persistent neutrophil chemotactic defect and hypogammaglobulinemia. Other studies of specific and non-specific immunity were normal. Neutrophil adherence, random and random stimulated mobility were always within the normal range. The presence of chemotactic inhibitors was discarded. In vitro incubation of his neutrophils with Cytochalasin B at 0.1 micrograms/ml final concentration, reversed the chemotactic abnormality suggesting a possible cell membrane defect.

Cellular immunodeficiency with immunoglobulins: treatment with a thymus implant in millipore diffusion chambers

A 14 month old male affected by cellular immunodeficiency with immunoglobulins underwent implantation of a thymus enclosed in Millipore diffusion chambers. Five days after the implant the percentage of T lymphocytes forming spontaneous rosettes reached normal levels. One month later responsiveness to PHA was demonstrated in the patient's lymphocytes and IgG and IgM serum levels showed a marked increase. Positive skin tests were elicited 6 month's post-implant. An inguinal lymph node biopsy showed developing primary follicles and germinal centers. The patient's condition improved significantly. One year after the implant the patient died from irreversible neurological deterioration. It is suggested that partial immunological reconstitution was achieved by thymic humoral factors.