Identifying gaps in the cascade of care for latent TB infection in a low-incidence setting

BACKGROUND: The End TB Strategy calls for the global scale-up of treatment for latent TB infection (LTBI). We aimed to evaluate a nurse-led care programme for LTBI by identifying gaps in the care cascade in a low-incidence TB setting.METHODS: We included people at risk of TB over a 15-year period. We define three main outcomes in the LTBI care cascade: 1) attendance at the first appointment, 2) completion of the evaluation process, and 3) completion of treatment.RESULTS: We identified 6,126 individuals (2,369 TB contacts, 1,749 biological therapy candidates, and 2,008 transplant candidates). Overall, 5,938 (96.9%) attended, 5,872/5,938 (98.9%) completed the evaluation and 1,624/1,847 (87.9%) completed treatment. Pre-biological (aOR 2.32, 95% CI 1.54-3.49) and pre-transplant (aOR 1.82, 95% CI 1.20-2.76) candidates were more likely to attend the first appointment, while age was associated with completing the evaluation process (aOR 1.02, 95% CI 1.003-1.04). Female sex (aOR 1.47, 95% CI 1.08-1.99) was associated with completing the treatment.CONCLUSION: Successful assessment and treatment of LTBI is achievable when delivered as a part of a comprehensive, nurse-led, patient-centred programme in specialist TB clinics.

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.

Vancomycin sorption on activated sludge Gram+ bacteria rather than on EPS; 3D Confocal Laser Scanning Microscopy time-lapse imaging

Antibiotics-bacteria interactions depend on antibiotic concentration at the scale of bacteria. This study investigates how vancomycin penetrates into activated sludge flocs and can be sorbed on the bacteria and extracellular polymeric substances (EPS). The 3D structure of flocs was imaged using EPS autofluorescence. The green fluorescent BODIPY^® FL vancomycin was introduced in a microscopic chamber containing activated sludge and penetration of vancomycin into the flocs by diffusion was observed using time-lapse microscopy. The penetration depended on the floc structure, as long and large pores could go through the whole flocs making preferential path. The antibiotic concentration into the flocs was also found to depend on the sorption rate. BODIPY^® FL vancomycin was found to bind preferentially into Gram⁺ bacteria than on EPS. The vancomycin adsorption constant on bacteria according to the linear adsorption model, Kd_bacteria was estimated to be 5 times higher (SD 2.6) than the adsorption constant on EPS Kd_EPS. These results suggest that antibiotic removal by sorption into wastewater treatment plants could change according to the amount of bacteria in the sludge. Moreover, antibiotic concentration at the scale of bacteria could be significantly higher than the concentration in the bulk solution and this should be taken into account when studying antibiotic activity or biodegradation.

Nutrients versus emerging contaminants-Or a dynamic match between subsidy and stress effects on stream biofilms

Freshwater ecosystems are threatened by multiple anthropogenic stressors, which might be differentiated into two types: those that reduce biological activity at all concentrations (toxic contaminants), and those that subsidize biological activity at low concentrations and reduce it at high concentrations (assimilable contaminants). When occurring in mixtures, these contaminants can have either antagonistic, neutral or synergistic effects; but little is known on their joint effects. We assessed the interaction effects of a mixture of assimilable and toxic contaminants on stream biofilms in a manipulative experiment using artificial streams, and following a factorial design with three nutrient levels (low, medium or high) and either presence or absence of a mixture of emerging contaminants (ciprofloxacin, erythromycin, diclofenac, methylparaben, and sulfamethoxazole). We measured biofilm biomass, basal fluorescence, gross primary production and community respiration. Our initial hypotheses were that biofilm biomass and activity would: increase with medium nutrient concentrations (subsidy effect), but decrease with high nutrient concentrations (stress effect) (i); decrease with emerging contaminants, with the minimum decrease at medium nutrient concentrations (antagonistic interaction between nutrients subsidy and stress by emerging contaminants) and the maximum decrease at high nutrient concentrations (synergistic interaction between nutrients and emerging contaminants stress) (ii). All the measured variables responded linearly to the available nutrients, with no toxic effect at high nutrient concentrations. Emerging contaminants only caused weak toxic effects in some of the measured variables, and only after 3-4 weeks of exposure. Therefore, only antagonistic interactions were observed between nutrients and emerging contaminants, as medium and high nutrient concentrations partly compensated the harmful effects of emerging contaminants during the first weeks of the experiment. Our results show that contaminants with a subsidy effect can alleviate the effects of toxic contaminants, and that long-term experiments are required to detect stress effects of emerging contaminants at environmentally relevant concentrations.

Prevalence of vertebral fractures and minor vertebral deformities evaluated by DXA-assisted vertebral fracture assessment (VFA) in a population-based study of postmenopausal women: the FRODOS study

Population-based studies performed with vertebral fracture assessment (VFA) morphometric technology are lacking in postmenopausal osteoporosis. In this study, we show a lower than expected prevalence of vertebral fractures, a high prevalence of minor vertebral deformities, and a clear association with clinical and densitometric parameters indicating the usefulness of this approach.

INTRODUCTION

Adequate epidemiological data on the prevalence of vertebral fractures (VF) is essential in studies of postmenopausal osteoporosis. Routine DXA-assisted VFA may be useful to determine the presence of VF. However, population-based studies performed with this technology are lacking. We aimed to assess the prevalence of VF and minor deformities in 2,968 postmenopausal women aged 59-70 years from a population-based cohort.

METHODS

VFA and bone mineral density (BMD) measurements were conducted, and McCloskey criteria (vertebral heights under 3 SD from reference values) confirmed with the Genant method were used to define VF. Additionally, minor vertebral deformities (vertebral heights between -2 and -2.99 SD) were evaluated.

RESULTS

The prevalence of VF was 4.3%, and 17% of the participants had minor vertebral deformities. Low BMD was frequently observed in women with VF, with 4%, and 42% of participants showing osteoporosis and osteopenia. Minor vertebral deformities were observed in nearly 40% of women with VF. Multivariate logistic regression analysis showed that age, history of previous fracture, osteoporotic BMD, receiving anti-osteoporotic treatment, and current use of glucocorticoids were significantly associated with VF.

CONCLUSIONS

Although the VFA approach showed a lower than expected prevalence of VF in our cohort, its association with clinical and densitometric parameters may be useful to identify women at risk for developing fragility fractures and may therefore justify its use in longitudinal studies. The high prevalence of minor vertebral deformities detected in patients with VF indicates the need to evaluate this type of deformity as a risk factor for further skeletal fractures.

Monitoring of slaughterhouse wastewater biodegradation in a SBR using fluorescence and UV-Visible absorbance

The aim of this study was to demonstrate that the effectiveness of slaughterhouse wastewater treatment by activated sludge could be enhanced through the use of optical techniques, such as UV-Visible absorbance and fluorescence spectroscopy, to estimate the hydraulic retention time necessary to remove the biodegradable chemical oxygen demand (COD). Two experiments were conducted. First, a batch aerobic degradation was performed on four wastewater samples collected from four different cattle processing sites in order to study the changes in the spectroscopic properties of wastewater during biodegradation. Second, a sequencing batch reactor was used in order to confirm that the wastewater fluorescence could be successfully used to monitor wastewater biodegradation in a pilot-scale experiment. Residual blood was the main source of organic matter in the wastewater samples. The absorbance at 416 nm, related to porphyrins, was correlated to the COD during wastewater biodegradation. The tryptophan-like/fulvic-like fluorescence intensity ratio was related to the extent of biodegradation. The COD removal efficiency ranged from 74% to 94% with an hydraulic retention time (HRT) of 23 h. A ratio of tryptophan-like/fulvic-like fluorescence intensities higher than 1.2 indicated incomplete biodegradation of the wastewater and the need to increase the HRT.

An antibiotic-resistant class 3 integron in an Enterobacter cloacae isolate from hospital effluent

Hospital effluents are involved in dissemination of antibiotic-resistant integrons. We describe here a new class 3 integron, In3-5, detected in an Enterobacter cloacae isolate retrieved from a random French hospital effluent sample collected in 2009. In3-5 carries two gene cassettes: the new blaOXA -256 and an aac(6')-Ib variant, respectively conferring resistance to β-lactams and aminoglycosides. In3-5 is located on an IncQ-like backbone plasmid. Class 3 integrons could thus be involved in the dissemination of antibiotic resistance in both clinical settings and the environment, and could participate in the exchange of antibiotic-resistance genes between these two ecosystems.

Impact of copper and cadmium on aerobic and anaerobic digestibility of sonicated sludge

The effects of the introduction of a sludge reduction process such as ultrasound on batch aerobic and anaerobic biodegradability after exposition to two metals (copper and cadmium) were investigated. The specific energy of ultrasonic treatment applied to the sludge was 200,000 kJ kg TS(-1). Ultrasonic treatment led to floc size reduction and to organic matter solubilization. Low copper (< 5 mg L(-1)) and cadmium (< 1 mg L(-1)) concentration improved aerobic biodegradability. For high metal concentration the maximal instantaneous biogas production rate q(max) inhibition by copper and cadmium was modeled by a saturation-type relationship under aerobic and anaerobic conditions. Under aerobic conditions, respiration inhibition was not affected by sonication. Cadmium inhibition (74%) was more than copper (58%). The positive effect of sonication on CO2 production was maintained after metal introduction. Under anaerobic conditions, metal introduction cancelled out the positive effect of the treatment. The sonicated sludge was 16% less sensitive to copper inhibition but 10% more sensitive to cadmium inhibition compared to non sonicated sludge.

Techno-economic evaluation of thermal treatment, ozonation and sonication for the reduction of wastewater biomass volume before aerobic or anaerobic digestion

Aerobic and anaerobic digestions were compared with different sludge reduction processes such as ultrasonic, ozone, and thermal treatments. Each treatment was tested under the following conditions to improve batch aerobic or anaerobic digestion: ultrasound (200,000kJkgTS(0)(-1)), thermal (40 degrees C, 60 degrees C, 90 degrees C for 90 min, 120 degrees C 15 min, 1 bar), and ozonation (0.1gO(3)gTS(0)(-1)). The different pretreatments induced organic matter solubilisation and intrinsic sludge reduction (total suspended solids): ultrasound (47%), thermal 90 degrees C (16%), ozone (15%), thermal 60 degrees C (9%), thermal 40 degrees C (5%), autoclave (120 degrees C) (4.2%). TSS (and also VSS) solubilisation were found to be highly correlated to the pretreatment ability to break the flocs rather than to specific energy input. The total values of TSS reduction ranged from 57% to 71% under aerobic conditions and from 66% to 86% under anaerobic conditions. TSS solubilisation after pretreatment can be considered as a predictive parameter of sludge volume reduction enhancement after aerobic or anaerobic digestion while specific energy input did not show anything or negligible impact. In our experimental conditions, ultrasound and ozone led to the best TSS removal improvement after both aerobic (30% and 20%) and anaerobic digestion (20%). Ultrasonic and ozone pretreatments prior to aerobic or anaerobic digestion led to the best reduction of the specific energy required for removing 1 kg of TSS compared to the control. Anaerobic digestion was globally more effective (compare to aerobic digestion) in enhancing sludge production reduction.

Stratégies d'élimination de l'azote d'un effluent urbain dans un réacteur discontinu séquentiel (SBR)

Le traitement des effluents urbains par réacteurs discontinus séquentiels (SBR : Sequencing Batch Reactor) constitue une solution alternative aux traitements par systèmes à boue activée en effectuant le traitement du carbone, la séparation liquide solide et l'élimination des nutriments au sein d'un bassin unique grâce à une gestion adéquate des cycles temporels de réaction. L'alternance de phases aérées et anoxiques suivie d'une période de décantation conduit en théorie à l'élimination quasi totale des ions nitrate formés lors de la phase de nitrification aérobie. Cependant, selon la charge appliquée, le carbone totalement dégradé lors de la phase préliminaire d'aération ne peut servir de source de carbone pour la dénitrification exogène.

Afin d'accélérer la dénitrification, plusieurs solutions sont possibles : l'une consiste à allonger la deuxième phase d'anoxie suffisamment longtemps pour traiter les ions nitrate résiduels au cours d'un processus de dénitrification endogène, l'autre à diminuer le temps de réaction aérobie tout en augmentant la fréquence des séquences aérobie/anoxie afin de conserver du carbone résiduel lors de la dénitrification. Une troisième solution réside dans l'ajout d'une source de carbone exogène suite à l'étape de nitrification de manière à permettre une assimilation plus rapide et plus efficace des ions nitrate formés (dénitrification exogène).

L'article compare les résultats d'abattement sur le carbone et l'azote d'une eau usée urbaine en utilisant les trois types de fonctionnement. Il en résulte la définition d'une stratégie globale de contrôle du procédé, chacun des scénarii pouvant être privilégié en fonction de la qualité de l'effluent de départ et des contraintes de traitement.

[Vascular risk factors in primary open angle glaucoma]

PURPOSE

To determine whether cardiovascular risk factors distribution differ between primary open-angle glaucoma (POAG) and control subjects. To assess the strength of this association in POAG. To analyze the most frequent pathology in this group of patients for a better selection of medical treatment.

METHODS

Observational cross-sectional study in patients with a diagnosis of POAG. Fifty glaucoma patients were selected with consecutive sampling between those who had been admitted to an tertiary hospital by any reason and compared with fifty admitted to the same hospital patients without POAG diagnosis in the same period of time. The variables age, sex, the reason for admission to hospital classified by diagnosis related group (DRG) and diagnostic mayor criteria (DMC), treatment for glaucoma, stroke, diabetes mellitus, high blood pressure, ischaemic cardiopathy, Raynaud phenomenon, low blood pressure, hypercholesterolemia and tobacco were investigated.

RESULTS

An association was found between POAG and stroke (prevalence ratio=2.16;CI al 95%=1.01-2.20; p=0.074*), low blood pressure (prevalence ratio=5; CI=1.14-2.63; p=0.092*) and high blood pressure (prevalence ratio=1.35; p=0.16) but it didn't reach to the statistical level of signification. No association with the remaining variables was found with this size sample. The most frequent reason for hospital admission in the study group were respiratory and circulatory system disease. Circulatory (24 y 22% respectively)with the pneumonia the most frequent DRG (10%). In the control group, the most frequent reason were circulatory and respiratory system disease (24 y 16% respectively). The chronic obstructive airway disease (COAD) was the most frequent DRG in this group (6%). The vascular risk factors most frequently found in both of the groups was high blood pressure (54 and 40% ) and the stroke (26-12%). The medical glaucoma treatment in these patients were the beta-blockers only (24.3%) or in association (18.9%).

CONCLUSIONS

POAG is associated with stroke and blood pressure variations (high and low). The respiratory (pneumonia and COAD) and circulatory system diseases (congestive heart failure-CHF- and ischaemic cardiopathy) are the most frequently mortality cause in this group of patients. The most frequent medical therapy used for glaucoma are the beta-blockers which are contraindicated in COAD and CHF patients.

[Complications in the evolution of haemangiomas and vascular malformations]

The differentiation of haemangiomas and vascular malformations is histological, clinical and prognostic. Although the majority of haemangiomas evolve towards spontaneous resolution, as many as 10% of cases can develop complications with ulceration, pain and haemorrhaging. Besides, the localisation of haemangiomas in the head and neck, next to vital structures, can compromise their functions. Hence, compression of the airway might be a vital emergency. Periorbital haemangiomas can give rise to amblyopia due to sensory deprivation or due to a restrictive strabismus. Lumbosacral haemangiomas must be studied with Nuclear Magnetic Resonance because of their frequent association with alterations in the midline at the level of the spine, anus, genitals or kidneys. Amongst visceral haemangiomas, hepatic haemangiomas are the most serious due to their association with congestive cardiac insufficiency. The association of extensive facial haemangiomas with anomalies of the central nervous system, vascular, cardiac, ocular and sternal anomalies, is denominated PHACE syndrome and is frequently complicated by mental deficiency, convulsions or ictus. Vascular malformations of trigeminal localisation are associated in up to 15% of cases with glaucoma or choroidal or leptomeningeal haemangiomas (Sturge-Weber syndrome). Combined vascular malformations localised in the extremities can become complicated with thrombophlebitis, regional osteolysis and even distant thromboembolisms (Klippel-Treneaunay Syndrome). On the other hand, there is a coagulopathy due to consumption (Kassabach-Merrit Syndrome) that can complicate some vascular tumours such as the Kaposiform haemangioendothelioma and the tufted angioma. Finally, the complications of the treatments employed are reviewed.

Setting-up a control simulation strategy for a sequencing batch reactor (SBR): application to municipal wastewater

The use of a simulation model for setting up a control strategy for a sequencing batch reactor necessary for treating municipal wastewater is described. The model used is the ASM no 1 model. The objective of the pollution control treatment is the removal of carbon and nitrogen; the optimisation is concerned with the improvement in the biological removal of nitrogen. After experimental identification of the initialisation variables, the model enables different SBR control scenarios to be tested (time variation for each process) leading to the total elimination of nitrogen. The best simulation was tested in a laboratory reactor. On that scale, it was noted that denitrification is an endogenous process. Lastly, the control strategy was tested on a semi-industrial pilot working in a pollution control plant. Other control scenarios can be devised and tested by simulation, in order to improve the productivity of the reactor.

Clinical predictors of fetal and maternal outcome in systemic lupus erythematosus: a prospective study of 103 pregnancies

OBJECTIVE

Our aim was to assess the outcome of pregnancy in a cohort of patients with SLE and to evaluate clinical and laboratory markers for fetal outcome and maternal flares.

METHODS

Sixty patients with 103 pregnancies were evaluated prospectively between 1984 and 1999.

RESULTS

There were 68 live births, 15 spontaneous abortions, 12 stillbirths and eight therapeutic abortions. Of liveborn infant births, 19 were premature, 24 had suffered intrauterine growth restriction and one had neonatal lupus. Maternal lupus flares occurred in 33% of pregnancies, mostly in the second trimester (26%) and in the post-partum period (51%). Flares during pregnancy showed a statistically significant association with discontinuation of chloroquine treatment, a history of more than three flares before gestation, and a SLEDAI (Systemic Lupus Erythematosus Disease Activity Index) score of >or=5 in these flares. Antiphospholipid antibodies, C3 hypocomplementaemia and hypertension during pregnancy were significantly associated with fetal loss, prematurity and intrauterine growth restriction.

CONCLUSIONS

Patients with more active SLE and those with aPL antibodies and hypertension should be monitored and managed carefully during pregnancy.

Use of image analysis and rheological studies for the control of settleability of filamentous bacteria: application in SBR reactor

To monitor the ability of flocs to settle in Sequencing Batch Reactor sludge, two methods were tested during two operation cycles. Firstly, an automated image analysis procedure has been tested to quantify the floc size and the length and number of filaments. Secondly, rheological measurements (Bingham viscosity and shear stress) have been used to characterise the dispersion of the sludge which can reflect the cohesive strength of aggregates and so the influence of filamentous bacteria on rheological properties. These results were compared with settling parameters such as Sludge Volume Index or settling velocity. Correlations between the measured parameters with image analysis and parameters such as Sludge Volume Index have been obtained. If it is more difficult to analyze rheological results, it seems however that the thixotropy and the Bingham viscosity distinguish poor settlement owing to some filamentous bulking. The first results are promising, although they require confirmation in the long term.

New metabolites in the degradation of fluorene by Arthrobacter sp. strain F101

Identification of new metabolites and demonstration of key enzyme activities support and extend the pathways previously reported for fluorene metabolism by Arthrobacter sp. strain F101. Washed-cell suspensions of strain F101 with fluorene accumulated 9-fluorenone, 4-hydroxy-9-fluorenone, 3-hydroxy-1-indanone, 1-indanone, 2-indanone, 3-(2-hydroxyphenyl) propionate, and a compound tentatively identified as a formyl indanone. Incubations with 2-indanone produced 3-isochromanone. The growth yield with fluorene as a sole source of carbon and energy corresponded to an assimilation of about 34% of fluorene carbon. About 7.4% was transformed into 9-fluorenol, 9-fluorenone, and 4-hydroxy-9-fluorenone. Crude extracts from fluorene-induced cells showed 3,4-dihydrocoumarin hydrolase and catechol 2,3-dioxygenase activities. These results and biodegradation experiments with the identified metabolites indicate that metabolism of fluorene by Arthrobacter sp. strain F101 proceeds through three independent pathways. Two productive routes are initiated by dioxygenation at positions 1,2 and 3,4, respectively. meta cleavage followed by an aldolase reaction and loss of C-1 yield the detected indanones. Subsequent biological Baeyer-Villiger reactions produce the aromatic lactones 3,4-dihydrocoumarin and 3-isochromanone. Enzymatic hydrolysis of the former gives 3-(2-hydroxyphenyl) propionate, which could be a substrate for a beta oxidation cycle, to give salicylate. Further oxidation of the latter via catechol and 2-hydroxymuconic semialdehyde connects with the central metabolism, allowing the utilization of all fluorene carbons. Identification of 4-hydroxy-9-fluorenone is consistent with an alternative pathway initiated by monooxygenation at C-9 to give 9-fluorenol and then 9-fluorenone. Although dioxygenation at 3,4 positions of the ketone apparently occurs, this reaction fails to furnish a subsequent productive oxidation of this compound.

Bioassay-directed chemical analysis of genotoxic components in urban airborne particulate matter from Barcelona (Spain)

Organic extracts of airborne particulate matter, collected in the city of Barcelona, were subjected to three-level, bioassay-directed, chemical fractionation, including gel permeation chromatography (GPC) and normal-phase (NP) and reversed-phase (RP) liquid chromatography (LC). The chemical characterization, directed by the Salmonella microsome mutagenicity assay (TA98, TA98NR and TA98/1,8DNP6 +/- S9), was carried out by capillary GC (CGC) coupled to selective detection systems, and by GC-MS techniques. The results obtained with the nitroreductase deficient strains show the important contribution of nitroaromatic compounds. Detailed chemical analysis of the mutagenic fractions led to the identification of 82 aromatic compounds and revealed the large contribution of chemical classes that are more polar than polycyclic aromatic hydrocarbons such as aromatic ketones, quinones and aldehydes.

Sources and seasonal variability of mutagenic agents in the Barcelona City aerosol

Organic extracts (dichloromethane) isolated from airborne particulate matter, collected in two sampling sites located in the Barcelona City, were mutagenic in the Salmonella typhimurium (TA98 +/-S9) bioassay. The highest direct-acting mutagenicity (69-78 rev m-3) was detected during fall and spring, which corresponds to the highest levels of mutagenic nitroarenes (248 to 350 pg m-3). On the other hand, the highest level of indirect-acting mutagenicity was obtained in summer, paralleling with the highest concentrations of polycyclic aromatic ketones and polycyclic aromatic quinones. Furthermore, the sources of PAH in the urban particulate matter were estimated from the ratio of the less reactive components (i.e. benzofluranthenes/benzo[e]pyrene, indeno[1,2,3-cd]pyrene/benzo[ghi]perylene, methylphenantherenes/phenanthrene) and reflected a predominance of pyrolytic mobile sources (i.e. vehicular emissions). Nevertheless, a contribution of stationary sources in winter was also apparent. Finally, the seasonal variability of polycyclic aromatic ketones, quinones, aromatic lactones and aldehydes reflected a major contribution of the atmospheric transformation processes from related PAH rather than a direct emission from combustion sources.

Nail-patella syndrome and pre-eclampsia

We present here the first described case of Nail-patella syndrome (NPS) and pregnancy. Complications occurred during the pregnancy with the onset of preeclampsia at 22 weeks, leading to intrauterine fetal death at 24 weeks. The nephropathy of the NPS began clinically during the course of gestation. Postpartum, it persisted as isolated proteinuria, which became a nephrotic syndrome 18 months later.

Prenatal diagnosis of exencephaly

This paper presents a sonographic diagnosis of exencephaly made during the last trimester of gestation. The sonogram showed the absence of bones in the cranial vault together with the presence of a disorganized cerebral mass, with loss of its normal anatomy. Post-partum examination of the newborn confirmed the findings of the sonogram. We briefly review the characteristics of exencephaly, its aetiology, and its relationship to anencephaly.

Isolation and characterization of a fluorene-degrading bacterium: identification of ring oxidation and ring fission products

An Arthrobacter sp. strain, F101, able to use fluorene as the sole source of carbon and energy, was isolated from sludge from an oil refinery wastewater treatment plant. During growth in the presence of fluorene, four major metabolites were detected and isolated by thin-layer chromatography and high-performance liquid chromatography. 9-Fluorenol, 9H-fluoren-9-one, and 3,4-dihydrocoumarin were identified by UV spectra, mass spectrometry, and 300-MHz proton nuclear magnetic resonance. The fourth metabolite has been characterized, but precise identification was not possible. Since strain F101 is not able to grow with fluorenone, two different pathways of fluorene biodegradation are suggested: one supports cell growth and produces 3,4-dihydrocoumarin as an intermediate and probably the unidentified metabolite, and the other produces 9-fluorenol and 9H-fluoren-9-one and appears to be a dead-end route.