Biological behavior of familial papillary thyroid microcarcinoma: Spanish multicenter study

PURPOSE

Familial papillary thyroid microcarcinoma (FPTMC) can present a more aggressive behavior than the sporadic microcarcinoma. However, few studies have analyzed this situation. The objective is to analyze the recurrence rate of FPTMC and the prognostic factors which determine that recurrence in Spain.

METHODS

Spanish multicenter longitudinal analytical observational study was conducted. Patients with FPTMC received treatment with curative intent and presented cure criteria 6 months after treatment. Recurrence rate and disease-free survival (DFS) were analyzed. Two groups were analyzed: group A (no tumor recurrence) vs. group B (tumor recurrence).

RESULTS

Ninety-four patients were analyzed. During a mean follow-up of 73.3 ± 59.3 months, 13 recurrences of FPTMC (13.83%) were detected and mean DFS was 207.9 ± 11.5 months. There were multifocality in 56%, bilateral thyroid involvement in 30%, and vascular invasion in 7.5%; that is to say, they are tumors with histological factors of poor prognosis in a high percentage of cases. The main risk factors for recurrence obtained in the multivariate analysis were the tumor size (OR: 2.574, 95% CI 1.210-5.473; p = 0.014) and the assessment of the risk of recurrence of the American Thyroid Association (ATA), both intermediate risk versus low risk (OR: 125, 95% CI 10.638-1000; p < 0.001) and high risk versus low risk (OR: 45.454, 95% CI 5.405-333.333; p < 0.001).

CONCLUSION

FPTMC has a recurrence rate higher than sporadic cases. Poor prognosis is mainly associated with the tumor size and the risk of recurrence of the ATA.

Defining a Standard Set of Patient-Reported Outcomes for Patients With Advanced Ovarian Cancer

Purpose

Advanced ovarian cancer (AOC) and its treatment cause several symptoms and impact on patients’ health-related quality of life (HRQoL). We aim to reach a consensus on the most relevant patient-reported outcome (PROs), the corresponding measures (PROMs), and measurement frequency during AOC patients’ follow-up from patients’ and healthcare professionals’ (HCP) perspective.

Methods

The project comprised five steps: 1) a literature review, 2) a focus group with patients, 3) a nominal group with HCP, 4) two round-Delphi consultations with patients and HCP, and 5) a final meeting with HCP. Delphi questionnaire was elaborated based on literature review, focus group (n=5 patients), and nominal group (n=16 HCP). The relevance of each PRO and the appropriateness (A) and feasibility (F) of the proposed PROM were assessed (Likert scale 1=strongly agree; 9=strongly disagree). The consensus was reached when at least 75% of the panelists rated it as ‘relevant’, ‘appropriate’, or ‘feasible’ (score 7-9).

Results

A total of 56 HCP [51.8% Hospital Pharmacy; 41.1% Oncology; 3.6% Nursing; and 3.6% Psycho-oncology; mean time in specialty 12.5 (8.0) years] and 10 AOC patients [mean time diagnosis 5.4 (3.0) years] participated in the 1^st round. All PROs achieved consensus regarding their relevance, except dry skin (58.0%). Agreement was reached for PRO-CTCAE to be used to assess fatigue (A:84.9%; F:75.8%), neuropathy (A:92.4%; F:77.3%), diarrhea (A:87.9%; F:88.7%), constipation (A:86.4%; F:75.8%), nausea (A:89.4%; F:75.8%), insomnia (A:81.8%; F:88.7%), abdominal bloating (A:82.2%; F:82.2%) and sexuality (A:78.8%; F:88.6%); EQ-5D to determine patients’ HRQoL (A:87.9%; F:80.3%), pain (A:87.9%; F:75.8%) and mood (A:77.7%; F:85.5%); to assess treatment adherence the Morisky-Green (A:90.9%; F:84.9%) and the dispensing register (A:80.3%; F:80.3%) were chosen. It was agreed to note in the medical record whether the patient’s treatment preferences had been considered during decision-making (A:78.8%; F:78.8%) and to use a 5-point Likert scale to assess treatment satisfaction (A:86.4%; F:86.4%). Panelists agreed (A:92.4%; F: 77.3%) to collect these PROs (1) at the time of diagnosis/relapse; (2) one month after starting treatment/change therapeutic strategy; (3) every three months during the 1^st-year of treatment; and later (4) every six months until treatment completion/change.

Conclusions

The consensus reached represents the first step towards including the patient’s perspective in AOC follow-up. The standardized collection of PROs in clinical practice may contribute to optimizing the follow-up of these patients and thus improving the quality of care.

Antimony distribution and mobility in different types of waste derived from the exploitation of stibnite ore deposits

Wastes derived from the exploitation of stibnite ore deposits were studied to determine their mineralogical, chemical, and environmental characteristics and establish the Sb distribution and the current and long-term risks of Sb mobilization. Representative samples of mine waste rocks, mine tailings, and smelting waste were studied by X-ray powder diffraction, polarized light microscopy, electron microprobe analysis, and digestion, leaching, and extraction procedures. The main Sb-bearing minerals and phases identified in the smelting waste were natrojarosite, iron (oxyhydr)oxides, mixtures of iron and antimony (oxyhydr)oxides, and tripuhyite; those in the mine tailings and mine waste rocks were iron (oxyhydr)oxides and/or mixtures of iron and antimony (oxyhydr)oxides. Iron (oxyhydr)oxides and natrojarosite had high Sb contents, with maximum values of 16.51 and 9.63 wt% Sb₂O₅, respectively. All three types of waste were characterized as toxic; the mine waste rocks and mine tailings would require pretreatment to decrease their leachable Sb content before they would be acceptable at hazardous waste landfills. Relatively little of the Sb was in desorbable forms, which accounted for <0.01 and <0.8% of the total Sb content in the smelting waste and mine waste rocks/mine tailings, respectively. Under reducing conditions, further Sb mobilization from mine waste rocks and mine tailings could occur (up to 4.6 and 3.3% of the total content, respectively), considerably increasing the risk that Sb will be introduced into the surroundings. Although the smelting waste had the highest total Sb content, it showed the lowest risk of Sb release under different environmental conditions. The significant Fe levels in the smelting waste facilitated the formation of various Fe compounds that greatly decreased the Sb mobilization from these wastes.

Study of the glial cytoarchitecture of the developing olfactory bulb of a shark using immunochemical markers of radial glia

During development of the olfactory bulb (OB), glial cells play key roles in axonal guiding/targeting, glomerular formation and synaptic plasticity. Studies in mammals have shown that radial glial cells and peripheral olfactory glia (olfactory ensheathing cells, OECs) are involved in the development of the OB. Most studies about the OB glia were carried out in mammals, but data are lacking in most non-mammalian vertebrates. In the present work, we studied the development of the OB glial system in the cartilaginous fish Scyliorhinus canicula (catshark) using antibodies against glial markers, such as glial fibrillary acidic protein (GFAP), brain lipid-binding protein (BLBP), and glutamine synthase (GS). These glial markers were expressed in cells with radial morphology lining the OB ventricle of embryos and this expression continues in ependymal cells (tanycytes) in early juveniles. Astrocyte-like cells were also observed in the granular layer and surrounding glomeruli. Numerous GS-positive cells were present in the primary olfactory pathway of embryos. In the developmental stages analysed, the olfactory nerve layer and the glomerular layer were the regions with higher GFAP, BLBP and GS immuno-reactivity. In addition, numerous BLBP-expressing cells (a marker of mammalian OECs) showing proliferative activity were present in the olfactory nerve layer. Our findings suggest that glial cells of peripheral and central origin coexist in the OB of catshark embryos and early juveniles. These results open the path for future studies about the differential roles of glial cells in the catshark OB during embryonic development and in adulthood.

Impact of an intervention for reducing waste through educational strategy: A Mexican case study, what works, and why?

Generation and inadequate management of solid waste constitute a global challenge. Projections for 2050 portend an annual increase of 3.40 billion tons of waste. This study assessed the impact of an environmental education intervention (EEI) aimed at reducing waste generation and fomenting pro-environmental behaviors in an academic public-health institution in Mexico. The EEI was implemented over 20 months using a model of behavior change. Using a mixed-method design (QUAN + qual), baseline and follow-up measurements were performed through electronic questionnaires (n = 754), focus groups (n = 20), and waste quantification. A double-difference model was performed to measure pro-environmental behaviors impact: overall and by sex, age, educational level and function within the institution. Waste quantification was performed using a quartering method and weekly monitoring. The qualitative data were studied through thematic analysis. As a result of the EEI, women reduced their use of multilayer packaging (-15.6 pp, p < 0.05) and frequent use of non-ecological materials (-17.6 pp, p < 0.05). Graduate-level participants reduced their regular and frequent use of these materials (-33.3 pp, p < 0.05, 27.6 pp, p < 0.01), while those with lower educational levels increased their ecological behavior at home (12.1 pp, p < 0.05). Waste generation dropped by 60.1% vis-a-vis the baseline measurement. Our qualitative findings showed a relationship between holding a position of power in the institution and recycling. They also revealed that available infrastructure for separating waste contributed substantially to the observed impact. With actions centered on physical structure, community practice and institutional policy components, the EEI improved the pro-environmental behaviors and perceptions of participants.

Characterization of neurogenic niches in the telencephalon of juvenile and adult sharks

Neurogenesis is a multistep process by which progenitor cells become terminally differentiated neurons. Adult neurogenesis has gathered increasing interest with the aim of developing new cell-based treatments for neurodegenerative diseases in humans. Active sites of adult neurogenesis exist from fish to mammals, although in the adult mammalian brain the number and extension of neurogenic areas is considerably reduced in comparison to non-mammalian vertebrates and they become mostly reduced to the telencephalon. Much of our understanding in this field is based in studies on mammals and zebrafish, a modern bony fish. The use of the cartilaginous fish Scyliorhinus canicula (representative of basal gnathostomes) as a model expands the comparative framework to a species that shows highly neurogenic activity in the adult brain. In this work, we studied the proliferation pattern in the telencephalon of juvenile and adult specimens of S. canicula using antibodies against the proliferation marker proliferating cell nuclear antigen (PCNA). We have characterized proliferating niches using stem cell markers (Sex determining region Y-box 2), glial markers (glial fibrillary acidic protein, brain lipid binding protein and glutamine synthase), intermediate progenitor cell markers (Dlx2 and Tbr2) and markers for migrating neuroblasts (Doublecortin). Based in the expression pattern of these markers, we demonstrate the existence of different cell subtypes within the PCNA immunoreactive zones including non-glial stem cells, glial progenitors, intermediate progenitor-like cells and migratory neuroblasts, which were widely distributed in the ventricular zone of the pallium, suggesting that the main progenitor types that constitute the neurogenic niche in mammals are already present in cartilaginous fishes.

Mitral cell development in the olfactory bulb of sharks: evidences of a conserved pattern of glutamatergic neurogenesis

In mammals, the development of the olfactory bulb (OB) relies in part on the expression of transcription factors involved in the specifications/differentiation of glutamatergic cells. In a previous study from our group, a high molecular similarity was reported between mammals and cartilaginous fishes regarding the neurogenic mechanisms underlying the development of glutamatergic cells in the telencephalon. However, information about the transcriptional program operating in the development of the glutamatergic system (mainly represented by mitral cells) in the OB is lacking in the catshark Scyliorhinus canicula, a cartilaginous fish. Using immunohistochemistry and in situ hybridization techniques, we have found that, previously to the appearance of the olfactory primordium (OP), proliferating cells expressing Pax6 with molecular hallmarks of progenitor radial glia were located in the ventrolateral pallial ventricular zone. Later in development, when the OP is recognizable, a stream of Pax6-positive cells were observed between the ventricular zone and the OP, where transcription factors involved in mitral cell development in mammals (ScTbr2, ScNeuroD, Tbr1) are expressed. Later in development, these transcription factors became expressed in a layered-like structure where ScVglut1, a marker of mitral cells, is also present. Our data suggest that the transcriptional program related with the specification/differentiation of glutamatergic cells in the telencephalon has been conserved throughout the evolution of vertebrates. These results, in combination with previous studies concerning GABAergic neurogenesis in sharks, have evidenced that the OB of mammals and sharks shares similarities in the timing and molecular programs of development.

Neuropeptide Y Y2 antagonist treated ovariectomized mice exhibit greater bone mineral density

Osteoporosis, a disease characterized by progressive bone loss and increased risk of fracture, often results from menopausal loss of estrogen in women. Neuropeptide Y has been shown to negatively regulate bone formation, with amygdala specific deletion of the Y2 receptor resulting in increased bone mass in mice. In this study, ovariectomized (OVX) mice were injected once daily with JNJ-31020028, a brain penetrant Y2 receptor small molecule antagonist to determine the effects on bone formation. Antagonist treated mice had reduced weight and showed increased whole-body bone mineral density compared to vehicle-injected mice. Micro computerized tomography (micro-CT) demonstrated increased vertebral trabecular bone volume, connectivity density and trabecular thickness. Femoral micro-CT analysis revealed increased bone volume within trabecular regions and greater trabecular number, without significant difference in other parameters or within cortical regions. A decrease was seen in serum P1NP, a measure used to confirm positive treatment outcomes in bisphosphonate treated patients. C-terminal telopeptide 1 (CTX-1), a blood biomarker of bone resorption, was decreased in treated animals. The higher bone mineral density observed following Y2 antagonist treatment, as determined by whole-body DEXA scanning, is indicative of either enhanced mineralization or reduced bone loss. Additionally, our findings that ex vivo treatment of bone marrow cells with the Y2 antagonist did not affect osteoblast and osteoclast formation suggests the inhibitor is not affecting these cells directly, and suggests a central role for compound action in this system. Our results support the involvement of Y2R signalling in bone metabolism and give credence to the hypothesis that selective pharmacological manipulation of Y2R may provide anabolic benefits for treating osteoporosis.

Differences in Adipose Tissue and Lean Mass Distribution in Patients with Collagen VI Related Myopathies Are Associated with Disease Severity and Physical Ability

Mutations in human collagen VI genes cause a spectrum of musculoskeletal conditions in children and adults collectively termed collagen VI-related myopathies (COL6-RM) characterized by a varying degree of muscle weakness and joint contractures and which include Ullrich Congenital Muscular Dystrophy (UCMD) and Bethlem Myopathy (BM). Given that collagen VI is one of the most abundant extracellular matrix proteins in adipose tissue and its emerging role in energy metabolism we hypothesized that collagen VI deficiency might be associated with alterations in adipose tissue distribution and adipokines serum profile. We analyzed body composition by means of dual-energy X-ray absorptiometry in 30 pediatric and adult COL6-RM myopathy patients representing a range of severities (UCMD, intermediate-COL6-RM, and BM). We found a distinctive pattern of regional adipose tissue accumulation which was more evident in children at the most severe end of the spectrum. In particular, the accumulation of fat in the android region was a distinguishing feature of UCMD patients. In parallel, there was a decrease in lean mass compatible with a state of sarcopenia, particularly in ambulant children with an intermediate phenotype. All children and adult patients that were sarcopenic were also obese. These changes were significantly more pronounced in children with collagen VI deficiency than in children with Duchenne Muscular Dystrophy of the same ambulatory status. High molecular weight adiponectin and leptin were significantly increased in sera from children in the intermediate and BM group. Correlation analysis showed that the parameters of fat mass were negatively associated with motor function according to several validated outcome measures. In contrast, lean mass parameters correlated positively with physical performance and quality of life. Leptin and adiponectin circulating levels correlated positively with fat mass parameters and negatively with lean mass and thus may be relevant to the disease pathogenesis and as circulating markers. Taken together our results indicate that COL6-RM are characterized by specific changes in total fat mass and distribution which associate with disease severity, motor function, and quality of life and which are clinically meaningful and thus should be taken into consideration in the management of these patients.

Late Chronic Tamponade after Intraoperative Right Ventricular Rupture Repair with Mediastinal Fat

Advanced age and female sex are known risk factors for ventricular wall rupture during open-heart procedures. We present the case of an 83-year-old female patient with an intraoperative traumatic right ventricular free wall rupture during an aortic valve replacement procedure. Pledgetted interrupted sutures reinforced with large pieces of mediastinal fat were used for rupture repair. After 6 months, the patient was readmitted with the diagnosis of a retrosternal mediastinal mass and clinical signs of cardiac tamponade that required reoperation.

Adipose tissue glycogen accumulation is associated with obesity-linked inflammation in humans

Objective

Glycogen metabolism has emerged as a mediator in the control of energy homeostasis and studies in murine models reveal that adipose tissue might contain glycogen stores. Here we investigated the physio(patho)logical role of glycogen in human adipose tissue in the context of obesity and insulin resistance.

Methods

We studied glucose metabolic flux of hypoxic human adipoctyes by nuclear magnetic resonance and mass spectrometry-based metabolic approaches. Glycogen synthesis and glycogen content in response to hypoxia was analyzed in human adipocytes and macrophages. To explore the metabolic effects of enforced glycogen deposition in adipocytes and macrophages, we overexpressed PTG, the only glycogen-associated regulatory subunit (PP1-GTS) reported in murine adipocytes. Adipose tissue gene expression analysis was performed on wild type and homozygous PTG KO male mice. Finally, glycogen metabolism gene expression and glycogen accumulation was analyzed in adipose tissue, mature adipocytes and resident macrophages from lean and obese subjects with different degrees of insulin resistance in 2 independent cohorts.

Results

We show that hypoxia modulates glucose metabolic flux in human adipocytes and macrophages and promotes glycogenesis. Enforced glycogen deposition by overexpression of PTG re-orients adipocyte secretion to a pro-inflammatory response linked to insulin resistance and monocyte/lymphocyte migration. Furthermore, glycogen accumulation is associated with inhibition of mTORC1 signaling and increased basal autophagy flux, correlating with greater leptin release in glycogen-loaded adipocytes. PTG-KO mice have reduced expression of key inflammatory genes in adipose tissue and PTG overexpression in M0 macrophages induces a pro-inflammatory and glycolytic M1 phenotype. Increased glycogen synthase expression correlates with glycogen deposition in subcutaneous adipose tissue of obese patients. Glycogen content in subcutaneous mature adipocytes is associated with BMI and leptin expression.

Conclusion

Our data establish glycogen mishandling in adipose tissue as a potential key feature of inflammatory-related metabolic stress in human obesity.

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Hypoxia redirects extracellular glucose to glycogen synthesis in human adipocytes.

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Glycogen modifies the endocrine function of adipocytes and induces insulin resistance.

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Glycogen stimulates leptin secretion through an autophagy-dependent mechanism.

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Enforced glycogen accumulation in macrophages promotes M1 polarization.

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Obesity is associated with higher GS expression and glycogen stores in adipose tissue.

Efficacy of Oral Anticoagulation in Stroke Prevention among Sinus-Rhythm Patients Who Lack Left Atrial Mechanical Contraction after Cryoablation

The customary recommendation is that oral anticoagulation be withdrawn a few months after cryoablation for atrial fibrillation, independently of left atrial mechanical contraction in patients in sinus rhythm. Recently, a 5-fold increase in stroke has been described in sinus-rhythm patients who lack atrial mechanical contraction. One aim of this study was to evaluate the efficacy of oral anticoagulation in preventing postoperative stroke in such patients. This prospective study divided 154 sinus-rhythm patients into 2 groups, depending on the presence (108 patients) or absence (46 patients) of left atrial mechanical contraction at 6 months after surgery, and monitored them annually for 5 years. Those without left atrial contraction were maintained on acenocumarol. The primary endpoint was the occurrence of ischemic stroke. The median follow-up period was 29 ± 16 months; 4 patients (2.5%), all belonging to the group with preserved atrial contraction, had ischemic stroke; the group of patients without left atrial contraction had no episodes of stroke during follow-up. Logistic binary regression analyses showed no evidence of factors independently predictive of stroke. Among anticoagulated patients in sinus rhythm without left atrial contraction, we found the incidence of stroke to be zero. In a small, nonrandomized group such as this, we cannot discount the element of chance, yet we suggest that maintaining anticoagulation might lower the incidence of stroke in this population.

Higher Virological Effectiveness of NNRTI-Based Antiretroviral Regimens Containing Nevirapine or Efavirenz Compared to a Triple NRTI Regimen As Initial Therapy in HIV-1-Infected Adults

PURPOSE

To compare outcomes of nonnucleoside reverse transcriptase inhibitors (NNRTIs) nevirapine or efavirenz versus abacavir-based regimens with a backbone of zidovudine and lamivudine as initial therapy of treatment-naive adults with HIV-1 infection in routine clinical care.

METHOD

All patients starting their first antiretroviral therapy with any of the studied regimens from January 1999 to December 2002 were included in the analysis. Rates of viral suppression (HIV-RNA below 50 copies/mL) and discontinuation of any component of the regimen were compared at 48 weeks.

RESULTS

Fifty-one patients started with one of the two NNRTI-based regimens and 49 started with the triple nucleoside regimen (3-NRTI). After 48 weeks, more patients in the NNRTI regimens (76.5%) than in the 3-NRTI (51.1%) regimen achieved a HIV-1 RNA level below the limit of detection (<1.7 log10 copies/mL; p = .008). Time to change the antiretroviral regimen was shorter with 3-NRTI (median [range]: 234 [139-329] days) than with NNRTI (346 [0-756] days) (p = .0901). More withdrawals related to drug toxicity or intolerance occurred with the 3-NRTI-based regimen.

CONCLUSION

In a routine clinical care setting, initial antiretroviral treatment with an NNRTI (nevirapine or efavirenz) plus zidovudine and lamivudine was virologically superior and safer than a 3-NRTI therapy (abacavir with the same NRTI backbone).

[Absolute power of cortical oscillations and their topographical distribution in a sample of young adults during resting wakefulness and unspecific attention]

INTRODUCTION

The EEG records neuronal membrane potential oscillations that depend on the morpho-functional characteristics of the membrane and of modifications by postsynaptic excitatory (PSEP) and inhibitory (PSIP) potentials. The quantitative EEG (qEEG) measures the absolute power (AP) of oscillations separated in frequencies, resulting from the interaction among subcortical-cortical-subcortical ensembles. The hypothesis is that neuronal networks function at a given frequency and that their APs are codes that, by becoming synchronized in diverse ensembles, generate behavior.

OBJECTIVE

To establish the spectral power of cortical oscillations under diverse study paradigms and in different populations. In particular, to identify the AP and topographical distribution of four cerebral frequency bands under resting wakefulness and activation, and to integrate results into a database to establish comparison standards.

MATERIAL AND METHODS

Undergraduate students, average age of 20.6 +/- 2.6 years, who participated voluntarily in the study. Recordings were made with a Nicolet EEG. We chose, in the first stage, closed eyes (CE) three samples of 12 s each. In the second stage, we chose pairs of 6 s samples, first with CE and then with OE. For their analysis, we applied the Welch periodogram and we plotted the average AP (AAP) and standard deviation (SD) of delta, theta, alpha, and beta per lead. Differences were compared through non-parametric tests (Wilcoxon and Dunnett T3); setting statistical significance at a = 0.05.

RESULTS

Average APs of each frequency band differ significantly in intensity and topographic distribution generating a profile of each rhythm. When opening the eyes, rhythms desynchronized significantly at different intensities in the diverse leads, except for beta in the left fronto-frontal lead.

DISCUSSION

Results indicate the existence of cortical ensembles that synchronize at a determined frequency and are modified by visual stimulation, indicating the effects of the subcortico-cortical circuits. The integrated database provides comparison standards to support diagnoses and treatments.

Depinning and dynamics of imbibition fronts in paper under increasing ambient humidity

We study the effects of ambient air humidity on the dynamics of imbibition in a paper. We observed that a quick increase of ambient air humidity leads to depinning and non-Washburn motion of wetting fronts. Specifically, we found that after depinning the wetting front moves with decreasing velocity v[proportionality](h(p)/h(D))(γ), where h(D) is the front elevation with respect to its pinned position at lower humidity h(p), while γ=/~1/3. The spatiotemporal maps of depinned front activity are established. The front motion is controlled by the dynamics of local avalanches directed at 30° to the balk flow direction. Although the roughness of the pinned wetting front is self-affine and the avalanche size distribution displays a power-law asymptotic, the roughness of the moving front becomes multiaffine a few minutes after depinning.

Entamoeba histolytica: the over expression of a mutated EhRabB protein produces a decrease of in vitro and in vivo virulence

Vesicular trafficking, which is implicated in secretion of cytolytic molecules as well as in phagocytosis, plays an important role in the pathogenic mechanism of Entamoeba histolytica, the protozoan parasite causative of human amoebiasis. Thus, Rab GTPases, that are key regulators of vesicle trafficking, should be considered as molecules involved in the parasite virulence. EhRabB is a Rab protein located in cytoplasmic vesicles that are translocated to phagocytic mouths during ingestion of target cells, suggesting that this Rab protein is involved in phagocytosis. To prove this hypothesis, we over expressed the wild type EhrabB gene and a mutant gene encoding for a protein (RabBN118I) unable to bind guanine nucleotides and therefore constitutively inactive. The over expression of the mutated protein in E. histolytica trophozoites provoked a dominant negative effect, reflected in a significant decrease of both phagocytosis and cytopathic effect as well as in a failure to produce hepatic abscesses in hamsters. These results confirm that EhRabB is involved in phagocytosis and virulence of E. histolytica.

Purification and cellular localization of the Entamoeba histolytica transcarboxylase

Genome analysis of Entamoeba histolytica predicts the presence of acetyl-CoA carboxylase. Using Western blot, histochemistry, and confocal microscopy, we demonstrated the presence of a biotin-containing protein in the cytoplasm of E. histolytica, with a molecular weight of 136 kDa and biotin-carboxylase activity. This protein probably corresponds to a transcarboxylase that catalyzes the rate-limiting reaction leading to fatty acid elongation.

Depinning and creeplike motion of wetting fronts in weakly vibrated granular media

We study the effect of weak vibrations on the imbibition of water in granular media. In our experiments, we have observed that as soon as the vibration is applied, an initially pinned wetting front advances in the direction of imbibition. We found that the front motion is governed by the avalanches of localized intermittent advances directed at 45° to the imbibition direction. When the rescaled gravitational acceleration of vertical vibrations is in the range of 0.81≤G≤0.95, we observed an almost steady motion of wetting front with a constant velocity v(cr)(G)∝exp(-1/G) during more than 20 min, whereas at lower accelerations (0.5≤G≤0.8) the front velocity decreases in time as v∝t(-δ). We suggest that the steady motion of an imbibition front in a weakly vibrated granular medium can be treated as a creep motion associated with nonthermal temporal fluctuations of packing density in a weakly vibrated granular medium.

Clonostachys rosea BAFC3874 as a Sclerotinia sclerotiorum antagonist: mechanisms involved and potential as a biocontrol agent

AIMS

To establish the modes of action of the antagonistic fungal strain Clonostachys rosea BAFC3874 isolated from suppressive soils against Sclerotinia sclerotiorum and to determine its potential as a biocontrol agent.

METHODS AND RESULTS

The antagonistic activity of C. rosea BAFC3874 was determined in vitro by dual cultures. The strain effectively antagonized S. sclerotiorum in pot-grown lettuce and soybean plants. Antifungal activity assays of C. rosea BAFC3874 grown in culture established that the strain produced antifungal compounds against S. sclerotiorum associated with secondary metabolism. High mycelial growth inhibition coincided with sclerotia production inhibition. The C. rosea strain produced a microheterogeneous mixture of peptides belonging to the peptaibiotic family. Moreover, mycoparasitism activity was observed in the dual culture.

CONCLUSIONS

Clonostachys rosea strain BAFC3874 was proved to be an effective antagonist against the aggressive soil-borne pathogen S. sclerotiorum in greenhouse experiments. The main mechanisms involve peptaibiotic metabolite production and mycoparasitism activity.

SIGNIFICANCE AND IMPACT OF THE STUDY

Clonostachys rosea BAFC3874 may be a good fungal biological control agent against S. sclerotiorum. In addition, we were also able to isolate and identify peptaibols, an unusual family of compounds in this genus of fungi.

Relative and absolute stability in perceived parenting behaviour: a longitudinal study with children and adolescents

Patterns of relative and absolute stability in parental behaviour with children and adolescents are reported. The sample comprised 523 youth (58.7% girls). Data were collected at three time periods: T1 (M age = 11.1 yr.), T2 (M age = 12.2 yr.), and T3 (M age = 13.2 yr.), each separated by one year. According to children's reports, relative consistency was moderate in both mothers and fathers, particularly as regards communication and strict control. In contrast, as children got older, parental rearing practices related to strict control and hostility decreased. There was a similarity between fathers and mothers in terms of relative and absolute stability. Relative stability was affected by the child's sex, the parenting variable, and the time period; however, the patterns of absolute stability reveal no differences by sex.

Right aortic arch with aberrant left subclavian artery and anomalous origin of right pulmonary artery from ascending aorta

The authors report a case of a neonate that was operated on with the diagnosis of right aortic arch and aberrant left subclavian artery and anomalous origin of right pulmonary artery from ascending aorta. Computed tomography (CT) scan suggested double aortic arch and cardiac catheterization suggested anomalous origin of right pulmonary artery from ascending aorta versus aorto-pulmonary window. The final diagnosis was made at the operation. There was a right aortic arch and aberrant left subclavian artery and persistent ductus arteriosus. Surgical repair consisted of section of the ductus arteriosus and reimplantation of the right pulmonary artery in the main pulmonary artery.

Cases of swine flu in kidney transplant recipients in our hospital

In late March 2009, an outbreak of influenza A virus infection was detected in Mexico with subsequent cases observed in many other countries. The pandemic was caused by an H1N1 virus that represents a quadruple reassortment of 2 swine strains, 1 human strain, and 1 avian strain of influenza. Until February 1, 2010, a total of 47 cases of influenza A (Inf A) were recorded by the Spanish Society of Nephrology in kidney transplant recipients. Herein we have reported our 3 cases (6.4%) in this registry. A 17-year-old girl with hepatorenal polycystosis received a liver and kidney transplant at 37 months previously. She displayed high fever and mild respiratory symptoms that resolved without treatment. A 38-year-old woman with chronic renal failure (CRF) of undetermined etiology received a kidney transplant 9 months previously. She was admitted with a 5-day history of febrile syndrome and respiratory symptoms, with extensive bilateral pneumonia and acute severe respiratory failure that required admission to the intensive care unit. Her evolution was satisfactory. A 38-year-old woman with CRF of undetermined etiology received a kidney transplant 2.5 months previously. She was admitted in November 2009 with a 2-week history of fever, myalgia, general malaise, cough, and expectoration. Her course was satisfactory. In these cases we determined H1N1 Inf A pandemic variant by detection of Inf A Matrix Protein 2 gene M2 and the specific H1 gene for influenza pandemic H1N1 2009 with reverse transcriptase polymerase chain reaction Inf A/H1N1 (Roche). The 3 cases of Inf A in kidney transplant recipients recorded in the province of Almeria occurred in young women shortly after kidney transplantation, and with no other risk factors apart from those associated with the transplantation itself. From the consideration of respiratory and renal situations, their courses were satisfactory.

[Adverse reactions during biological therapy for psoriasis: results of a survey of the Spanish Psoriasis Group]

BACKGROUND

Biologic therapies have been a major breakthrough in the treatment of psoriasis because they are more selective and have a better short-term and medium-term safety profile. There are reliable data to support both the efficacy and the safety of these drugs. However, it is always useful to report the clinical experience of dermatologists who are experts in the use of biologic agents to treat psoriasis, particularly with regard to their safety.

MATERIAL AND METHODS

We present the results of a survey administered to the members of Spanish Psoriasis Group and based on a series of questions referring to the clinical safety of these agents. A total of 988 patients treated with efalizumab, infliximab, etanercept, and adalimumab were reported by 15 members of the group.

RESULTS

There was a particularly high proportion of reactions (34%) to infliximab infusions. Blood test abnormalities were detected in 13.25% of patients and infections in 12.24%, with one case of pulmonary tuberculosis. Attention is drawn to the adverse effects profile of efalizumab: de novo arthritis in 5.8% and rebound in 20.9% of patients.

CONCLUSION

The safety data provided by our study should be taken into account in view of the large number of patients recruited by dermatologists experienced in the use of this type of therapy.

1/falpha noise and integrable systems

In this paper, we show that there is a family of well-known integrable systems whose spectral fluctuations decay as 1/f(4), and thus do not follow the 1/f(2) law recently conjectured for integrable systems. We present a simple theoretical justification of this fact, and propose an alternative characterization of quantum chaos versus integrability formulated directly in terms of the power spectrum of the spacings of the unfolded spectrum.

[Case report of a subcutaneous peripheral primitive neuroectodermal tumor]

Peripheral primitive neuroectodermal tumors - also known as Ewing sarcomas - are a rare type of malignant tumor the histology of which characteristically reveals the presence of small round cells. Typically, t(11;22) translocation is observed. We describe the case of a 45-year-old man with a subcutaneous peripheral primitive neuroectodermal tumor in which the t(11;22) translocation was detected. He was satisfactorily treated with surgery and radiotherapy.

Dynamical scaling of imbibition in columnar geometries

Recent experiments on imbibition in columnar geometries show interfacial fluctuations whose dynamic scaling is not compatible with the usual nonlocal model governed by surface tension that results from a macroscopic description. To explore this discrepancy, we exhaustively analyze numerical integrations of a phase-field model with dichotomic columnar disorder. We find that two distinct behaviors are possible depending on the capillary contrast between the two values of disorder. In a high-contrast case, where interface evolution is mainly dominated by the disorder, an inherent anomalous scaling is always observed. Moreover, in agreement with experimental work, the interface motion has to be described through a local model. On the other hand, in a lower-contrast case, the interface is dominated by interfacial tension and can be well modeled by a nonlocal model. We have studied both spontaneous and forced-flow imbibition situations, giving a complete set of scaling exponents in each case, as well as a comparison to the experimental results.

[Mohs micrographic surgery: our first 100 patients]

INTRODUCTION

Mohs surgery was first described by Frederic Mohs in 1941 to eliminate high-risk cutaneous tumors. The technique involves histological examination of the margins.

OBJECTIVE

The aim of this study was to describe the clinical findings and compare the grade and subclinical extension of the tumor as measured by the number of Mohs stages needed for complete elimination according to whether the tumor presented high-risk factors.

METHODS

We included 100 patients with 105 tumors. In all cases, age, sex, tumor site, tumor type, histological subtype in the case of basal cell carcinoma, size, recurrences, number of Mohs stages, and reconstruction technique were recorded.

RESULTS

The study group comprised 44 men and 56 women aged between 28 and 88 years (mean, 72.6 years). Of the tumors, 80 % corresponded to basal cell carcinoma, 12.38 % to squamous cell carcinoma, 4.76 % to dermatofibrosarcoma protuberans, 0.95 % to Merkel cell carcinoma, 0.95 % to microcystic adnexal carcinoma, and 0.95 % to lentigo maligna melanoma. Most tumors were located on the head and 60 % required more than one Mohs stage for complete elimination.

CONCLUSION

This series is characterized by a high percentage of high-risk cutaneous tumors. After assessing the risk factors independently, we found that the size of the tumor is the risk factor most closely related to grade and subclinical extension in the case of basal cell carcinoma, although similar conclusions cannot be drawn for the other types of tumor studied.

Response to Comment on "Global Genetic Change Tracks Global Climate Warming in Drosophila subobscura"

Balanyà et al. (Reports, 22 September 2006, p. 1773) build on earlier claims that chromosomal inversion polymorphisms of Drosophila subobscura are rapidly evolving in response to global warming. However, that conclusion is not adequately buttressed by their data, because they overlooked the lag between calendar and climatological dates created by the progressive lengthening of the growing season in their sampling approach.

Error growth patterns in systems with spatial chaos: from coupled map lattices to global weather models

Error growth in spatiotemporal chaotic systems is investigated by analyzing the interplay between temporal and spatial dynamics. The spatial correlation and localization of relative fluctuations grow and decay indicating two different regimes, before and after saturation by nonlinear effects. This general behavior is shown to hold both in simple coupled map lattices and in global weather models. This explains the increasing or decreasing trends previously observed in the exponential growth rate of these spatiotemporal systems.

Anti-human erythrocyte antibodies in horse-derived antivenoms used in the treatment of snakebite envenomations

This work examined the presence of antibodies reacting with human erythrocytes in horse-derived antivenoms used in the treatment of snakebite envenomations, and assessed the efficacy of various fractionation protocols in the elimination of agglutinating antibodies. A number of antivenoms produced by various fractionation protocols were tested for direct agglutination of human erythrocytes. Reactions were observed visually and microscopically, and an indirect anti-equine globulin test was also used. In addition, rabbits and mice were injected intravenously with antivenoms to observe possible intravascular hemolysis and erythrocyte sequestration. All tested antivenoms agglutinated human erythrocytes, albeit to different extent, and also gave a positive anti-globulin test. Agglutination was due to IgG(T) subclass of antibodies. Pepsin digestion of horse IgG, to obtain F(ab')(2) fragments, reduced the direct agglutination, but not the indirect anti-globulin test. Ion-exchange chromatography of IgG in a strongly basic quaternary ammonium cellulose membrane abrogated direct agglutination and reduced the indirect anti-globulin test. Binding of antivenom antibodies to erythrocytes in vivo was demonstrated in rabbits, although there was no evidence of intravascular hemolysis or erythrocyte sequestration in rabbits and mice. It is concluded that anti-human erythrocyte antibodies are present in horse-derived antivenoms, and that fractionation of horse plasma by pepsin digestion, and especially by anion-exchange chromatography, reduces the titer of these antibodies. Our in vivo experimental results do not support a role for these antibodies in early adverse reactions occurring after antivenom administration.

Learning by operant conditioning as a nonlinear self-organized process

Responses of individuals have been rewarded in fixed ratio operant conditioning experiments throughout the last 5 years. The long numerical series of performance rates so obtained have been analyzed by using Fourier spectra, obtaining 1/f noise, and wavelet techniques for the analysis of local variability. These techniques reveal that the evolution of data in each individual is nonlinear but it fluctuates showing self-organized patterns in successive time scales, which leads to a long term logarithmic growth. Based on these observations a model has been developed. It can simulate with a great accuracy the rate of response exhibited by our subjects in all time scales.

Cyclosporine A from a nonpathogenic Fusarium oxysporum suppressing Sclerotinia sclerotiorum

AIMS

To evaluate the antagonistic activity of Fusarium oxysporum nonpathogenic fungal strain S6 against the phytopathogenic fungus Sclerotinia sclerotiorum and to identify the antifungal compounds involved.

METHODS AND RESULTS

The antagonistic activity of Fusarium oxysporum strain S6 was determined in vitro by dual cultures. The metabolite responsible for the activity was isolated by chromatographic techniques, purified and identified by spectroscopic methods as cyclosporine A. The antifungal activity against the pathogen was correlated with the presence of this metabolite by a dilution assay and then quantified. Cyclosporine A caused both growth inhibition and suppression of sclerotia formation. In a greenhouse assay, a significant increase in the number of surviving soybean (Glycine max) plants was observed when S. sclerotiorum and F. oxysporum (S6) were inoculated together when compared with plants inoculated with S. sclerotiorum alone.

CONCLUSION

Fusarium oxysporum (S6) may be a good fungal biological control agent for S. sclerotiorum and cyclosporine A is the responsible metabolite involved in its antagonistic activity in vitro.

SIGNIFICANCE AND IMPACT OF THE STUDY

Cyclosporine A has not been previously described as an inhibitor of S. sclerotiorum. Its minimum inhibitory concentration (MIC) of 0.1 microg disc(-1) makes it suitable to use as a biofungicide. In vivo experiments showed that F. oxysporum (S6) is a good candidate for the biocontrol of S. sclerotiorum in soybean.

General Method for Synthesizing Pyranoid Glycals. A New Route to Allal and Gulal Derivatives

[reaction: see text] Pyranoid glycals of all configurations can be obtained from pentoses through an olefination-cyclization-elimination sequence. The elimination can be carried out with excellent yields under radical conditions or by using common reductive reagents such as Zn/Cu, TiCl(4)/LiAlH(4), or lithium naphthalenide. The proposed method is appropriate for the synthesis of glycals with allo or gulo configurations because the cyclization step is more efficient for these substrates.

Stereoselective Synthesis of 2-Deoxy-2-iodo-glycosides from Furanoses. A New Route to 2-Deoxy-glycosides and 2-Deoxy-oligosaccharides of ribo and xylo Configuration

[reaction: see text] A general procedure for the stereoselective synthesis of 2-deoxy-2-iodo-hexo- and -hepto-pyranosyl glycosides from furanoses is reported. The proposed methodology provides a new route for accessing 2-deoxy-oligosaccharides. The procedure involves three reactions: Wittig-Horner olefination to give alkenyl sulfanyl derivatives, electrophilic iodine-induced cyclization to give phenyl 2-deoxy-2-iodo-1-thio-hexo-glycosides, and glycosylation. Protected furanoses 1, 3, and 6-11, which include examples of the four possible isomeric configurations of furanoses, were reacted with diphenyl phenylsulfanylmethyl phosphine oxide to give the alkenyl sulfanyl derivatives 2, 4, and 12-16. The iodine-induced cyclization of these compounds afforded the phenyl 2-deoxy-2-iodo-1-thio-glycosides 18, 20, and 22-27 with practically complete regio- and stereoselectivity. Products of 6-endo cyclization, in which the iodine at C-2 was in a cis relationship with the alkoxy at C-3, were almost exclusively produced. Better yields were obtained for compounds with a ribo or xylo configuration than for compounds with other configurations. Compounds 18, 20, and 22-27 were found to be efficient glycosyl donors in the glycosylation of cholesterol and glucopyranoside 29a, affording the corresponding 2-deoxy-2-iodo-glycosides and 2-deoxy-2-iodo-oligosaccharides with good yields and stereoselectivities. The glycosydic bond in the major isomers was always trans to the iodine at C-2.

Emergency Nontraumatic Chest Pain: Use of Stress Echocardiography to Detect Significant Coronary Artery Stenosis

OBJECTIVE

We sought to assess the usefulness of stress echocardiography in a chest pain department.

METHODS

Consecutive patients (n = 487) with nontraumatic chest pain, with no signs of myocardial ischemia on arrival to the emergency department, 6 and 12 hours later, were recruited.

RESULTS

The sensitivity and specificity of stress echocardiography in the biased sample were 74% (95% confidence interval [CI] 63-85%) and 65% (95% CI 44-86%). After application of the method of Begg and Greenes to debias the sample, the calculated sensitivity was 24% (95% CI 19-29%) and specificity was 94% (95% CI 91-97%). After application of Diamond's method, sensitivity was 32% (95% CI 21-44%) and specificity (normalcy rate) was 99% (95% CI 88-100%).

CONCLUSIONS

Stress echocardiography is an insensitive test when used to detect significant coronary artery stenosis in patients presenting with nontraumatic chest pain with no objective signs of myocardial ischemia.

Anomalous roughening of viscous fluid fronts in spontaneous imbibition

We report experiments on spontaneous imbibition of a viscous fluid by a model porous medium in the absence of gravity. The average position of the interface satisfies Washburn's law. Scaling of the interface fluctuations suggests a dynamic exponent z approximately 3, indicative of global dynamics driven by capillary forces. The complete set of exponents clearly shows that interfaces are not self-affine, exhibiting distinct local and global scaling, both for time (beta = 0.64 +/- 0.02, beta(*) = 0.33 +/- 0.03) and space (alpha = 1.94 +/- 0.20, alpha(loc) = 0.94 +/- 0.10). These values are compatible with an intrinsic anomalous scaling scenario.

[Intubation with the GlideScope videolaryngoscope in a man with severe cervical spondylolisthesis]

We describe a new videolaryngoscopic device designed for use in cases of difficult airway. The device consists of a plastic blade with a video camera located halfway along its length. A mounted light source assembly means that bleeding ocurring in the airway will not obstruct the view. A 7-inch liquid crystal display monitor that can be transported quickly is useful in situations away from an operating room. Because the GlideScope can be introduced without moving the neck, it has been used in patients with cervical instability. We report the case of a 56-year-old man who underwent surgery for severe cervical spondylolisthesis. We describe a modified approach to managing the videolaryngoscope that facilitated maneuvering and intubation and that offers an effective alternative to techniques with other devices. The advantages and disadvantages reported in the literature are reviewed.