POS0805 TREATMENT OF GIANT CELL ARTERITIS WITH TOCILIZUMAB: A RETROSPECTIVE COHORT STUDY OF 119 PATIENTS

Background:

Giant cell arteritis (GCA) is an inflammatory condition of medium- and large-sized arteries. Prospective clinical trials have demonstrated the efficacy of tocilizumab (TCZ) for treatment of patients with GCA (1). However, there is a limited data on the use of TCZ in routine clinical practice.

Objectives:

To evaluate the efficacy and safety of TCZ in a retrospective cohort study of patients with GCA treated with TCZ.

Methods:

Patients with GCA treated with TCZ at 4 clinical centers of a single tertiary care institution (2000-2020) were identified. The diagnosis of GCA was confirmed by at least one of the following modalities: 1. Arterial biopsy 2. Large vessel imaging 3. Clinical diagnosis of GCA meeting ACR classification criteria and established by a rheumatologist. Patient demographics, clinical presentation, laboratory studies, treatment course and adverse events were abstracted from the medical record; only patients with at least 6 months of follow-up after TCZ initiation were included. Kaplan-Meier methods were used to estimate time to TCZ discontinuation and time to first relapse after TCZ discontinuation. Poisson regression models were used to compare relapse rates before and after TCZ initiation.

Results:

The study cohort included 119 patients [61% female; mean (SD) age at GCA diagnosis 70.3 (8.2) years]. The majority of patients (89%) had a biopsy-proven and/or imaging-based diagnosis of GCA, while 13 (11%) had a clinical diagnosis of GCA. In addition to glucocorticoids, 40 (34%) patients received other immunosuppressive agents prior to TCZ. The method of initial TCZ administration was subcutaneous (162mg/ml) weekly in 48 (41%), subcutaneous every other week in 20 (17%), monthly 4mg/kg infusions in 34 (29%), monthly 8mg/kg infusions in 14 (12%) and non-standard dosing in 3 remaining patients. The median (IQR) duration from GCA diagnosis to TCZ initiation was 4.8 (1.2-22.0) months and the median (IQR) duration of TCZ treatment was 18 (11-28) months. The mean (SD) dose of prednisone at TCZ initiation was 31 (19) mg/day and was reduced to a mean (SD) dose of 3.9 (6.7) mg/day at TCZ discontinuation/last follow-up visit. The relapse rate per year decreased 43% from 0.77 to 0.44 after the initiation of TCZ (RR=0.57; 95% CI: 0.44-0.75; p<0.001). The mean (SD) ESR and CRP decreased from 22 (20) mm/hour to 6 (9.2) mm/hour and from 19.1 (25) mg/L to 5.4 (16.6) mg/L, respectively from TCZ initiation to TCZ discontinuation/last follow-up visit. At 2 years of follow-up, 67% of patients had discontinued glucocorticoids. At last follow up, 46 patients had discontinued TCZ, only 14 of which were due to adverse events. The median time to TCZ discontinuation was 2.9 years. Only 17% (95%CI: 10-24%) had discontinued by 1 year after TCZ initiation and 38% (95% CI: 26-47%) had discontinued by 2 years. The most common adverse events were infections and cytopenias. While on TCZ, 1 patient developed new onset vision loss related to GCA and 1 patient, without history of diverticulitis, had bowel perforation. Among those discontinuing TCZ, 61% had relapsed at least once by 1 year after TCZ discontinuation.

Conclusion:

In this large single institution cohort of patients with GCA, TCZ use resulted in a significantly reduced relapse rate and reduction in glucocorticoid dosage. Overall, patients tolerated long-term use with only 12% discontinuing due to adverse events. However, over half of patients stopping TCZ had a subsequent flare; highlighting ongoing use may be required beyond two years in several patients with GCA to maintain remission.

References:

[1]Stone JH, et al. Trial of Tocilizumab in Giant-Cell Arteritis. N Engl J Med. 2017 Jul 27;377(4):317-328. doi: 10.1056/NEJMoa1613849. PMID: 28745999.

[2]Calderón-Goercke M, et al. Tocilizumab in giant cell arteritis. Observational, open-label multicenter study of 134 patients in clinical practice. Semin Arthritis Rheum. 2019 Aug;49(1):126-135. doi: 10.1016/j.semarthrit.2019.01.003. Epub 2019 Jan 5. PMID: 30655091.

Disclosure of Interests:

Jigisha Rakholiya: None declared, Matthew Koster: None declared, Hannah Langenfeld: None declared, Cynthia S. Crowson: None declared, Andy Abril: None declared, Pankaj Bansal: None declared, Lester Mertz: None declared, Alicia Rodriguez-Pla: None declared, Rahul Sehgal: None declared, Benjamin Wang: None declared, Kenneth J Warrington Grant/research support from: Research support: Kiniksa, Eli Lilly

AB0237 ARE THERE DIFFERENCES IN CLINICAL PROFILE AND TREATMENT AMONG 2 DIFFERENT INTERCONTINENTAL COHORTS OF PATIENTS WITH RHEUMATOID ARTHRITIS-ASSOCIATED INTERSTITIAL LUNG DISEASE?

Background:

Rheumatoid Arthritis (RA) is characterized by persistent joint synovitis causing progressive destruction of the cartilage and bone. Interstitial lung disease (ILD) is a frequent extra-articular manifestation of RA. Clinical profiles of patients with RA-associated ILD may vary.

Objectives:

To describe the clinical characteristics and radiological patterns and evaluate the different clinical profile between two different cohorts of patients (pts) with RA- associated ILD.

Methods:

Retrospective cohort study. We collected clinical and epidemiological data of pts seen in outpatient clinic from a Hospital from Barcelona, Spain and another from Jacksonville, Florida, USA. Pts who met the RA ACR/EULAR 2010 criteria and the ILD American Thoracic Society /European Respiratory Society 2013 classification criteria were selected. The study was approved by both local committees.

Results:

A total of 63 pts were included, 37 from Barcelona and 26 from Jacksonville. Forty-one pts (65%) were women with a median age of 68 years. General characteristics are summarized in Table. Thirty-eight pts (60.3%) were former smokers, but only 9 pts (14.3%) were current smokers. Fifty-two pts (82.5%) were Caucasian, 9.5% Mestizo, 3.2% Maghreb and 1.6% Indian. Most were overweight with mean BMI of 28.6 (SD 5.4). The Barcelona cohort showed more erosive disease than the pts from Jacksonville (26 vs 5 pts, p= 0.00). Seven pts had ILD diagnosis before RA. 4.82 (range 0-33) years was the median evolution from RA diagnosis until ILD diagnosis. Most common type of ILD was usual interstitial pneumonia (UIP) in 40% of pts, followed by nonspecific interstitial pneumonia (NSIP) in 25% of pts. Respiratory bronchiolitis was significantly more common in Barcelona cohort, while unspecific pattern in Jacksonville cohort (Table). A total of 71.4% were under GC treatment, methotrexate was used in 23 pts (36.5%), leflunomide in 14 (22.2%) and hydroxychloroquine in 7 pts (11.1%) prior to diagnosis of ILD. 6 out of 26 pts from Jacksonville were under MMF. TNF-α inhibitors were the most commonly used bDMARD in both cohorts as a first-line option prior to ILD diagnosis. Currently, half of the patients (50.8%) were under bDMARD. Current use of bDMARD was more often in US cohort (80.7%) than in Barcelona cohort (29.7%). Rituximab (RTX) was the most common bDMARD currently used (17 pts). Jacksonville pts were more commonly treated with RTX, while Barcelona pts were more commonly treated with Abatacept.

Conclusion:

Globally pts with RA-associated ILD have similar clinical profile in both centers, however, we found some differences in radiological patterns and treatment strategies between both cohorts. Those differences could be explained in part by sociodemographic differences, diagnostic and therapeutic approach and/or access for health care among others.

Totaln=63 %Barcelona cohortn= 37Jacksonvillecohortn=26P valueCaucasian, patients (%)52 (82.5%)31 (83.8)21 (77.8)0,49Time RA evolution, mean years (SD)10.58 (8.01)11.63 (7)9 (9.24)0.80Time ILD evolution, mean years (SD)3.89 (3.20)3.86(3.28)4 (3.12)0.28Erosive disease, patients (%)31 (49.2)26 (72,2)5 (18.5)0,00Rheumatoid nodules, patients (%)8 (12,7)7 (18,9)1 (3.8)0,12Current scDMARDs treatment, patients (%)35 (55.55)31 (49.20)4 (6.34)0,002Current bDMARD treatment, patients (%)32 (50.8%)11 (17.5)21 (33.3)0,001ILD typeUsual interstitial pneumonia (UIP), patients (%)25 (40.3)14 (37.8)11 (44)0,08Nonspecific interstitial pneumonia (NSIP), patients (%)16 (25.8)14 (37.8)2 (8)0,23Respiratory bronchiolitis–interstitial lung disease (RB), patients (%)7 (11.3)7 (18.9)00,039Cryptogenic organizing pneumonia (OP), patients (%)4 (6.5)2 (5.4)2 (8)0,43Unspecific, patients (%)8 (12.9)08 (32)0,004

Disclosure of Interests:

Ana Belén Azuaga-Piñango: None declared, Yan Li: None declared, Raul Castellanos-Moreira Speakers bureau: Lilly, MSD, Sanofi, UCB, Virginia Ruiz Speakers bureau: Lilly, Pfizer, Raimón Sanmartí Speakers bureau: Abbvie, Eli Lilly, BMS, Roche and Pfizer, Isabel Mira-Avendano: None declared, Andy Abril: None declared, Jose A. Gómez-Puerta Speakers bureau: Abbvie, BMS, GSK, Lilly, Pfizer, Roche

Integral assessment of pollution in the Suquía River (Córdoba, Argentina) as a contribution to lotic ecosystem restoration programs

The Suquía River lower-middle basin (Córdoba, Argentina) is subject to a strong anthropic impact because it receives pollutants from different sources (industries, wastewaters, heavy traffic, agricultural land use, etc.) We have assessed the degree of watershed degradation of Suquía River lower-middle sections through the analysis of different ecosystem compartments (air, water, riparian soil, sediments and biota), in order to provide useful data to be considered in future river restoration programs. Four study sites were selected along the river (La Calera city, Córdoba city, Corazón de María village and Río Primero city) which were sampled during the low- and high-water flow periods. We analyzed: a) chemical and physical characteristics of water, sediments, and riparian soil; b) heavy metal content of water and sediments, and c) semi-volatile organic compounds in air. Besides, pollutant bioindicators such as fish assemblages, lichens (Usnea amblyoclada), vascular plants (Tradescantia pallida), and microorganisms (fecal coliform and Escherichia coli) were used to further assess the status of the river. All analyzed ecological compartments were affected by water pollution, particularly, fish assemblages, sediments and riparian soils by heavy metal and coliform bacteria. Moreover, we detected a possible contribution of sulfur and a high pollutant content in air that merit further research about other air-water exchanges. Accordingly, we strongly suggest that an action to restore or remediate the anthropic effect on the Suquía River be extended to all possible compartments along the river.

Urinary 1-hydroxypyrene and PAH exposure in 4-year-old Spanish children

AIMS

Exposure to polycyclic aromatic hydrocarbons (PAH), among the main compounds present in polluted urban air, is of concern for children's health. Childhood exposure to PAH was assessed by urinary monitoring of 1-hydroxypyrene (1-OHP), a pyrene metabolite, investigating its association with exposure to air pollution and other factors related to PAH in air.

METHODS

A group of 174 4-year-old children were recruited and a questionnaire on their indoor and outdoor residential environment was completed by parents. At the same time, environmental measurements of traffic-related air pollution (NO2) were carried out. A urine sample was collected from each child in order to analyze 1-OHP using HPLC with fluorescence detection, correcting for creatinine concentrations. Non-parametric tests and regression analyses were used to identify environmental factors that influence 1-OHP excretion.

RESULTS

Mean urinary 1-OHP concentration was 0.061 micromol/mol creatinine, ranging from 0.004 to 0.314 micromol/mol. Non-parametric tests and regression analysis showed positive and significant associations (P<or=0.05) between 1-OHP and predicted residential exposure to NO2 (which was based on outdoor environmental measurements and geo-statistical analysis), self-reported residential vehicle traffic, passive smoking and cooking appliance. 1-OHP levels tended to be higher among children living in urban areas (0.062 micromol/mol vs. 0.058 micromol/mol for children living in rural areas) but differences were not significant (P=0.20).

CONCLUSION

In Southern Spain, concentrations of urinary 1-OHP were in the lower range of those generally reported for children living in non-polluted areas in Western Europe and the USA. Traffic-related air pollution, passive smoking and cooking appliance influenced urinary 1-OHP level in the children, which should be prevented due to the health consequences of the inadvertent exposure to PAH during development.

Sphingomonas phyllosphaerae sp. nov., from the phyllosphere of Acacia caven in Argentina

Two bacterial strains (FA1 and FA2(T)) were isolated from the phyllosphere of a leguminous tree, Acacia caven, in central Argentina. The strains were Gram-negative, strictly aerobic, rod-shaped, motile and formed yellow-pigmented colonies on nutrient agar. The two-primer RAPD patterns of the two strains were identical, suggesting that they belong to the same species. The complete 16S rRNA gene sequences of the two strains were obtained and comparisons demonstrated that they cluster phylogenetically with the species of the genus Sphingomonas sensu stricto. Strain FA2(T) was most closely related (97.6 %) to Sphingomonas adhaesiva. 16S rRNA gene sequence similarities to all other established Sphingomonas species ranged from 94.4 % (to Sphingomonas echinoides) to 97.6 % (to S. adhaesiva). Strains FA1 and FA2(T) were catalase-positive and oxidase-negative. Aesculin was hydrolysed, gelatin and urea were not. beta-Galactosidase was produced. From 51 compounds tested 21 were used as single sources of carbon. The major respiratory lipoquinone was ubiquinone-10. The predominant cellular fatty acids were 16 : 0, 18 : 1omega7c and 16 : 1omega7c (from summed feature 3). Hydroxy fatty acids 14 : 0 2-OH and 15 : 0 iso 2-OH were present as well (from summed feature 4). The polar lipids detected in strain FA2(T) were diphosphatidylglycerol, phosphatidylglycerol, phosphatidylethanolamine, phosphatidylcholine, sphingoglycolipid and two unidentified phospholipids. The DNA G+C content of strain FA2(T) was 61 mol%. DNA-DNA hybridization experiments showed 27.6 % relatedness between strain FA2(T) and S. adhaesiva DSM 7418(T). Based upon phenotypic and molecular evidence, a novel species of the genus Sphingomonas is proposed, Sphingomonas phyllosphaerae sp. nov., with strain FA2(T) (=LMG 21958(T)=CECT 5832(T)) as the type strain.

Nodulation of Lupinus albus by strains of Ochrobactrum lupini sp. nov

The nodulation of legumes has for more than a century been considered an exclusive capacity of a group of microorganisms commonly known as rhizobia and belonging to the alpha-Proteobacteria. However, in the last 3 years four nonrhizobial species, belonging to alpha and beta subclasses of the Proteobacteria, have been described as legume-nodulating bacteria. In the present study, two fast-growing strains, LUP21 and LUP23, were isolated from nodules of Lupinus honoratus. The phylogenetic analysis based on the 16S and 23S rRNA gene sequences showed that the isolates belong to the genus Ochrobactrum. The strains were able to reinfect Lupinus plants. A plasmid profile analysis showed the presence of three plasmids. The nodD and nifH genes were located on these plasmids, and their sequences were obtained. These sequences showed a close resemblance to the nodD and nifH genes of rhizobial species, suggesting that the nodD and nifH genes carried by strain LUP21T were acquired by horizontal gene transfer. A polyphasic study including phenotypic, chemotaxonomic, and molecular features of the strains isolated in this study showed that they belong to a new species of the genus Ochrobactrum for which we propose the name Ochrobactrum lupini sp. nov. Strain LUP21T (LMG 20667T) is the type strain.

Pseudomonas argentinensis sp. nov., a novel yellow pigment-producing bacterial species, isolated from rhizospheric soil in Córdoba, Argentina

During a study in the Argentinian region of Chaco (Córdoba), some strains were isolated from the rhizosphere of grasses growing in semi-desertic arid soils. Two of these strains, one isolated from the rhizospheric soil of Chloris ciliata (strain CH01T) and the other from Pappophorum caespitosum (strain PA01), were Gram-negative, strictly aerobic rods, which formed yellow round colonies on nutrient agar. They produced a water-insoluble yellow pigment, and a fluorescent pigment was also detected. A polyphasic taxonomic approach was used to characterize the strains. Comparison of the 16S rRNA gene sequences showed a similarity of 99·3 % between them, and phylogenetic analysis revealed that the strains belong to the genus Pseudomonas, within the γ-subclass of the Proteobacteria. The closest related species is Pseudomonas straminea IAM 1598T (similarity of 99·0 % to strain CH01T and 98·8 % to strain PA01), clustering in a separate branch with the various methods of tree building used. Strains CH01T and PA01 both had a single polar flagellum, like other yellow pigment-producing pseudomonads related to them. Both strains produced catalase and oxidase. Similar to P. straminea, they did not hydrolyse gelatin or casein. The G+C DNA contents determined were 57·5 mol% for CH01T and 58·0 mol% for PA01. DNA–DNA hybridization results showed 81 % relatedness between them, and only 40–44 % relatedness with respect to the type strain of P. straminea. These results, together with other phenotypic characteristics, support the conclusion that both isolates belong to the same species, and should be described as representing a novel species within the genus Pseudomonas, for which the name Pseudomonas argentinensis sp. nov. is proposed. The type strain is CH01T (=LMG 22563T=CECT 7010T).

Paenibacillus rhizosphaerae sp. nov., isolated from the rhizosphere of Cicer arietinum

Two sporulating bacterial strains designated CECAP06T and CECAP16 were isolated from the rhizosphere of the legume Cicer arietinum in Argentina. Almost-complete 16S rRNA gene sequences identified the isolates as a Paenibacillus species. It was most closely related to Paenibacillus cineris LMG 18439T (99·6 % sequence similarity), Paenibacillus favisporus LMG 20987T (99·4 % sequence similarity) and Paenibacillus azoreducens DSM 13822T (97·7 % sequence similarity). The cells of this novel species were motile, sporulating, rod-shaped, Gram-positive and strictly aerobic. The predominant fatty acids were anteiso-C15 : 0, C16 : 0 and iso-C16 : 0. The DNA G+C content of strains CECAP06T and CECAP16 was 51·3 and 50·9 mol%, respectively. Growth was observed from many carbohydrates, but gas production was not observed from glucose. Catalase and oxidase activities were present. The isolates produced β-galactosidase and hydrolysed aesculin. Gelatinase, caseinase and urease were not produced. The results of DNA–DNA hybridization showed that the strains from this study constitute a novel species of the genus Paenibacillus, for which the name Paenibacillus rhizosphaerae sp. nov. is proposed. The type strain is CECAP06T (=LMG 21955T=CECT 5831T).

Mesorhizobium chacoense sp. nov., a novel species that nodulates Prosopis alba in the Chaco Arido region (Argentina)

Low-molecular-weight RNA analysis was performed for the identification and classification of 20 Argentinian strains isolated from the root nodules of Prosopis alba. SDS-PAGE of total cellular proteins, determination of the DNA base composition, DNA-DNA reassociation experiments and physiological and biochemical tests were also carried out for these strains and the whole 16S rRNA gene was sequenced from one of the strains, strain LMG 19008T. Results of the genotypic and phenotypic characterization showed that the strains isolated in this study belong to a group that clustered in the genus Mesorhizobium. The results of DNA-DNA hybridizations showed that this group is a novel species of this genus. The name Mesorhizobium chacoense sp. nov. is proposed for this species. The type strain is LMG 19008T (= CECT 5336T).

Evaluation of thyroid function in lithium-naive bipolar patients

A high prevalence of thyroid hypofunction has been found in bipolar patients. However, the samples used in previous studies included a high percentage of patients in treatment with lithium and carbamazepine. Since the use of these drugs may explain the high prevalence of thyroid disturbances found in bipolar patients, we designed the present study to assess thyroid function in a sample of bipolar patients who had not been treated previously with lithium or carbamazepine. Patients included in the sample met Research Diagnostic Criteria for bipolar affective disorder. Assessment included determination of serum levels for total tyroxine (T4), total triiodothyronine (T3), and thyrotropin both basally and in response to infusion of 500 mg of Protilerin. The rate of thyroid hypofunction in the total sample (9.2%) was considerably lower than that reported in other studies with bipolar patients undergoing lithium therapy. Five patients (9.2%) showed some thyroid hyperfunction parameter. Our results do not show significant differences in thyroid function indices between long-term and short-term duration of illness, between outpatients and inpatients, between high and low number of episodes, and between rapid- and non-rapid-cycling cases. Comparison between bipolar I and bipolar II patients shows a statistically significant difference in the values of TSH levels, with the bipolar II group having a higher mean value. Our data suggest that thyroid dysfunction is not related to gender, duration of illness, number of episodes, or rapid-cycling course of illness. The higher TRH-stimulated TSH levels in the bipolar II group could be considered a differential biological feature.

[Effect of the addition of specific lectin on the symbiosis of Rhizobium leguminosarum and Phaseolus vulgaris]

The effect of specific lectin addition on Rhizobium leguminosarum-Phaseolus vulgaris symbiosis characteristics was studied. Two alternatives were selected for comparison: a) P. vulgaris seedling roots treated with lectin were inoculated with R. leguminosarum and b) P. vulgaris seedling roots were inoculated with R. leguminosarum incubated with lectin for 3 h and 72 h. The following parameters were evaluated: number and dry weight of nodules and dry matter and nitrogen content of shoot. In lectin treatments, the weight of nodules (from 13% to 35%), dry matter (from 6% to 18%) and nitrogen content (from 5% to 28%) increased significantly. The results suggest a stimulation in the formation of functional-nodules, specially in root (a) and Rhizobium (b) 72 h treatments. That is consistent with a model in which the lectin functions as an extracellular matrix component of the root interacting with roots and Rhizobium s.p. receptors.

Polyarticular blastomycotic arthritis

Blastomycotic arthritis usually presents as acute monoarticular septic arthritis resembling a bacterial process. Only 2 cases in the literature have subsequently developed arthritis in a second joint. We describe the case of an elderly woman with polyarticular blastomycotic arthritis associated with lung, skin, and bone involvement. The organism was identified in the synovial fluid and skin biopsies. Our patient underwent open drainage and aspiration of the involved joints and received antimycotic therapy.

[Effect of inoculation with Azospirillum spp on forage grasses in highland pastures of the Sierras de Córdoba, Argentian]

A field assay was performed in an impoverished hill grassland of the Sierras of Córdoba, with the objective of evaluating the effects of Azospirillum spp on gramineous plants. Native grasses were inoculated with different strains of Azospirillum lipoferum and Azospirillum brasilense, during two consecutive years. The inoculation effect on yield, nitrogen content and number of Azospirillum spp was evaluated in three annual harvests. The first and the second inoculation increased significantly the diazotroph number of the grasses with respect to the controls. This positive effect on the rhizophere population did not correlate with a significant increase in the forage quantity and quality as was expected.

[Inoculation of chickpeas with Rhizobium sp. native to the province of Córdoba, Argentina]

Native strains of Rhizobium were selected from a chickpea growing area with the purpose of producing inoculants tolerant to environmental conditions of the province of Córdoba. The strains were selected for nitrogen fixing capacity and specificity with four plant genotypes using the following parameters: number of nodules, plant biomass and nitrogen content. Native population of Rhizobium spp in the province of Córdoba showed better competition ability than foreign strains with similar response to different plant genotypes.

[Infectivity and effectiveness of different strains of Frankia spp. on Atriplex cordobensis plants]

Frankia is an actinomycete that fixes atmospheric nitrogen in actinorhizal symbiosis (in non-legume plants). Atriplex cordobensis is an important Chaco Arido forage species due to the high nitrogen content. The aim of this paper was to isolate plant endophytes to be utilized as an inoculum in adapted species. A. cordobensis seedlings of 30 days were inoculated with isolated strains of Atriplex cordobensis, Colletia hystrix, Trevoa trinervis, Talguenea quinquenervia and 4-6 strains of Retanilla ephedra, courtesy of the University of Chile. A complete randomized design with 9 replications was performed. The infective ability of the strains was established through the re-isolation of the endophytes in QMOD artificial medium. The infectivity was evaluated by means of: plant aerial part length, leaf number, number and length of internodes, dry weight and total nitrogen content. The symbiotic effectivity, inoculation response and fixed nitrogen quantity were calculated. All strains treated on A. cordobensis presented Frankia typical morphological characteristics. A. cordobensis and C. hystrix showed the best nitrogen fixing effectivity, T. quinquenervia had a good aerial development but its fixing nitrogen ability was low, as a plant growth promoting rhizobacteria (PGPR). All strains were infective and A. cordobensis and C. hystrix apported the highest nitrogen amount to the plants.

[The Rhizobium-Prosopis symbiosis in the Argentinian Chaco Arido]

Low productivity soils can be improved by incorporation of adapted legumes species able to increase the nitrogen fixation when associated to Rhizobium strains. Two fast-growing Rhizobium strains were isolated from nodules of Prosopis alba. Infectivity and effectivity of the strains were assessed under controlled conditions, measuring the following parameters: nodule number, dry weight, nitrogen percentage and fixed nitrogen. P. flexuosa strains showed high infective capacity (144 nodules/plant) but low effectivity (21.4 mg fixed nitrogen in 75 days). Although nodule number in P. alba was lower (23 nodules/plant) nitrogen fixation was higher (119.5 mg fixed nitrogen in 75 days) as compared with P. flexuosa. The isolated strains might be used as nitrogen donors in aride soils; they might be helpful to forestation of these ecosystems.

[Histrionic personality disorder in a psychiatry department at a general hospital]

The personality disturbances imply problem within the psychiatric assistance, both for its difficult delimitation and classification and for the limited results and bad use obtained from therapeutic resources. We studied 402 patients psychiatric service of a general hospital over a period approximately 2 years, 70 (17.5%) were diagnosed DSM-III with Personality disturbances: 44 females (62.9%) and 26 males (37.1%), of an age group between 18 and 67 years old. The most frequent diagnosis was of histrionic of the personality followed by unspecific and border-line. Within the histrionic disturbance of the personality there was a clear predominance of women, whereas in the others types, no significant differences were observed.

Vestibular response in denatured rape oil intoxication

During the spring of 1981 a massive intoxication broke out in Spain, which is presently attributed to the ingestion of denatured rape oil, and which has been called 'Toxic Syndrome' (TS). We studied 51 patients affected by the TS one year after the onset of their disease, analyzing their vestibular responses in the caloric test with the help of an analog-digital computer. A significant decrease in the number of nystagmic beats of the affected patients can be observed, while the rest of the parameters studied show similar values to those found simultaneously in 30 normal subjects. It is suggested that these differences are yet another manifestation of the polyneuropathy found in intoxication by denatured rape oil.

Spontaneous cholecystocutaneous fistula

We have reported a case of spontaneous cholecystocutaneous fistula that opened externally at the site of a healed surgical scar in the right upper quadrant.