Factors Associated With Long Survival in Patients With Cancer Admitted to Palliative Care: An Exploratory Study

Objective: Some patients with cancer admitted to palliative care have relatively long survivals of 1 year or more. The objective of this study was to find out factors associated with prolonged survival. Methods: Retrospective case-control study comparing the available data of patients with cancer who survived more than 1 year after admission in a palliative care service with patients with cancer who survived 6 months or less. The intended proportion was 4 controls for each case. Patients were identified through electronic records from 2012 until 2018. Results: And 1721 patients were identified. Of those patients, 111 (6.4%) survived for at least 1 year, and 363 (21.1%) were included as controls according to the established criteria. The intended proportion could not be reached; the proportion was only 3.3:1. The median survival of cases was 581 days (range: 371-2763), and the median survival of controls was 57 days (range: 1-182). In the multivariable analysis, patients with a hemoglobin ≥ 10.6 g/dL and a creatinine level >95 µmol/L had a higher probability of living more than 1 year. In contrast, patients with abnormal cognition, pain, anorexia, liver metastases, an Eastern Cooperative Oncology Group performance status >1, and a neutrophil/lymphocyte ratio ≥ 3.43 had a low probability of living more than 1 year. Conclusion: Several factors were statistically associated positively or negatively with prolonged survival. However, the data of this study should be confirmed in other studies.

Patients with Spondylodiscitis following Chemoradiotherapy for Head and Neck Cancer in a Portuguese Cancer Hospital: A Case Report

Introduction

Head and neck cancer is an umbrella term for tumor manifestations across the head and neck regions, including the oral cavity, pharynx (including the naso, oro, and hypopharynx), larynx, and sinuses. Treatment options for head and neck cancer include surgery, radiation therapy, chemotherapy, and immunotherapy, with specific treatment plans depending upon individual tumor location and staging, together with overall patient health status. Furthermore, definitive chemoradiotherapy (CRT) has emerged as a highly effective therapeutic option for locoregional advanced head and neck squamous cell cancer. However, such therapy has also been linked to the development of spondylodiscitis. Spondylodiscitis consists of an infection starting at the vertebral endplates and spreading into the intervertebral discs, typically manifesting in adults.

Case Presentation and Conclusion

This case report describes our clinical team's experience in managing three separate cases of spondylodiscitis following CRT for head and neck tumors that presented at our clinic for diagnosis and treatment in order to identify predisposing factors that underlie the link between CRT and spondylodiscitis.

Early effects of acetazolamide on hemoglobin mass and plasma volume in chronic mountain sickness at 5100 m

INTRODUCTION AND OBJECTIVES

Chronic Mountain Sickness (CMS) syndrome, combining excessive erythrocytosis and clinical symptoms in highlanders, remains a public health concern in high-altitude areas, especially in the Andes, with limited therapeutic approaches. The objectives of this study were to assess in CMS-highlanders permanently living in La Rinconada (5100-5300 m, Peru, the highest city in the world), the early efficacy of acetazolamide (ACZ) and atorvastatin to reduce hematocrit (Hct), as well as the underlying mechanisms focusing on intravascular volumes.

MATERIALS AND METHODS

Forty-one males (46±8 years of age) permanently living in La Rinconada for 15 [10-20] years and suffering from CMS were randomized between ACZ (250 mg once-daily; N = 13), atorvastatin (20 mg once-daily; N = 14) or placebo (N = 14) uptake in a double-blinded parallel study. Hematocrit (primary endpoint) as well as arterial blood gasses, total hemoglobin mass (Hb_mass) and intravascular volumes were assessed at baseline and after a mean (±SD) treatment duration of 19±2 days.

RESULTS

ACZ increased PaO₂ by +13.4% (95% CI: 4.3 to 22.5%) and decreased Hct by -5.2% (95% CI: -8.3 to -2.2%), whereas Hct remained unchanged with placebo or atorvastatin. ACZ tended to decrease Hb_mass (-2.6%, 95% CI: -5.7 to 0.5%), decreased total red blood cell volume (RBCV, -5.3%, 95% CI: -10.3 to -0.3%) and increased plasma volume (PV, +17.6%, 95% CI: 4.9 to 30.3%). Atorvastatin had no effect on intravascular volumes, while Hb_mass and RBCV increased in the placebo group (+6.1%, 95% CI: 4.2 to 7.9% and +7.0%, 95%CI: 2.7 to 11.4%, respectively).

CONCLUSIONS

Short-term ACZ uptake was effective to reduce Hct in CMS-highlanders living at extreme altitude >5,000 m and was associated with both an increase in PV and a reduction in RBCV.

Liver fat accumulation more than fibrosis causes early liver dynamic dysfunction in patients with non-alcoholic fatty liver disease

INTRODUCTION

In Non-Alcoholic Fatty Liver Disease (NAFLD), events driving early hepatic dysfunction with respect to specific metabolic pathways are still poorly known.

METHODS

We enrolled 84 subjects with obesity and/or type 2 diabetes (T2D). FibroScan® served to assess NAFLD by controlled attenuation parameter (CAP), and fibrosis by liver stiffness (LS). Patients with LS above 7 kPa were excluded. APRI and FIB-4 were used as additional serum biomarkers of fibrosis. The stable-isotope dynamic breath test was used to assess the hepatic efficiency of portal extraction (as DOB₁₅) and microsomal metabolization (as cPDR₃₀) of orally-administered (¹³C)-methacetin.

RESULTS

NAFLD occurred in 45%, 65.9%, and 91.3% of normal weight, overweight, and obese subjects, respectively. Biomarkers of liver fibrosis were comparable across subgroups, and LS was higher in obese, than in normal weight subjects. DOB₁₅ was 23.2 ± 1.5‰ in normal weight subjects, tended to decrease in overweight (19.9 ± 1.0‰) and decreased significantly in obese subjects (16.9 ± 1.3, P = 0.008 vs. normal weight). Subjects with NAFLD had lower DOB₁₅ (18.7 ± 0.9 vs. 22.1 ± 1.2, P = 0.03) but higher LS (4.7 ± 0.1 vs. 4.0 ± 0.2 kPa, P = 0.0003) than subjects without NAFLD, irrespective of fibrosis. DOB₁₅ (but not cPDR₃₀) decreased with increasing degree of NAFLD (R = -0.26; P = 0.01) and LS (R = -0.23, P = 0.03). Patients with T2D showed increased rate of NAFLD than those without T2D but similar LS, DOB₁₅ and cPDR₃₀.

CONCLUSIONS

Overweight, obesity and liver fat accumulation manifest with deranged portal extraction efficiency of methacetin into the steatotic hepatocyte. This functional alteration occurs early, and irrespective of significant fibrosis and presence of T2D.

Fibrosis nonalcoholic steatohepatitis index validation and applicability considering glycaemic severity and T2D duration

Nonalcoholic fatty liver disease (NAFLD) diagnosis without using invasive methods is extremely challenging, highlighting the need for simple indexes for this end. Recently, the fibrotic nonalcoholic steatohepatitis index (FNI) was developed and proposed as an affordable non-invasive score calculated with aspartate aminotransferase, high-density lipoprotein cholesterol and haemoglobin A1c. Herein, and given the link between NAFLD and diabetes, we aimed at validating FNI in a population with type 2 diabetes (T2D), also considering diabetes duration and glycaemic severity. The performance of FNI was higher than FIB-4 (AUROC = 0.89 vs 0.67, respectively). Additionally, using 0.1 as the rule-out cut-off of FNI, the sensitivity was 0.99 and the positive predictive value was 0.19. Both duration of diabetes and A1c did not impact FNI performance. In sum, FNI is a valuable score for predicting fibrotic nonalcoholic steatohepatitis not only for primary care units but also for diabetes specialized care.

The levonorgestrel intrauterine system for prevention of endometrial cancer in women with obesity: A cost-effectiveness study

OBJECTIVE

To estimate the cost-effectiveness of the levonorgestrel intrauterine system (LNG-IUS) as an endometrial cancer prevention strategy in women with obesity.

METHODS

A Markov decision-analytic model was used to compare 5 strategies in women with a body mass index of 30 or greater: 1) Usual care 2) LNG-IUS for 5 years 3) LNG-IUS for 7 years 4) LNG-IUS for 5 years, replaced once for a total of 10 years 5) LNG-IUS for 7 years, replaced once for a total of 14 years. Obesity was presumed to be associated with a 3-fold relative risk of endometrial cancer incidence and a 2.65-fold disease-specific mortality. The LNG-IUS was assumed to confer a 50% reduction in cancer incidence over the period of the LNG-IUS insertion. Outcomes were incremental cost-effectiveness ratios, calculated in 2019 Canadian dollars (CAD) per year of life saved. One-way and two-way sensitivity analyses were performed.

RESULTS

The LNG-IUS strategy was considered cost-effective if the cost of the intervention is less than $66,400 CAD ($50,000 US dollars) per year of life saved. The strategy becomes cost-effective if the LNG-IUS is inserted at age 57 (strategy #2), at age 52 for strategy #3, at age 51 for strategy #4 and at age 45 for strategy #5, when compared to usual care. The results are stable to variations in cost but sensitive to the estimated risk reduction of the LNG-IUS and the impact of obesity on endometrial cancer incidence and disease-specific mortality.

CONCLUSION

The LNG-IUS is a cost-effective method of endometrial cancer prevention in women with obesity.

Mapping Quantitative Trait Loci Associated With Graft (In)Compatibility in Apricot (Prunus armeniaca L.)

Graft incompatibility (GI) between the most popular Prunus rootstocks and apricot cultivars is one of the major problems for rootstock usage and improvement. Failure in producing long-leaving healthy grafts greatly affects the range of available Prunus rootstocks for apricot cultivation. Despite recent advances related to the molecular mechanisms of a graft-union formation between rootstock and scion, information on genetic control of this trait in woody plants is essentially missing because of a lack of hybrid crosses, segregating for the trait. In this study, we have employed the next-generation sequencing technology to generate the single-nucleotide polymorphism (SNP) markers and construct parental linkage maps for an apricot F₁ population "Moniqui (Mo)" × "Paviot (Pa)" segregating for ability to form successful grafts with universal Prunus rootstock "Marianna 2624". To localize genomic regions associated with this trait, we genotyped 138 individuals from the "Mo × Pa" cross and constructed medium-saturated genetic maps. The female "Mo" and male "Pa" maps were composed of 557 and 501 SNPs and organized in eight linkage groups that covered 780.2 and 690.4 cM of genetic distance, respectively. Parental maps were aligned to the Prunus persica v2.0 genome and revealed a high colinearity with the Prunus reference map. Two-year phenotypic data for characters associated with unsuccessful grafting such as necrotic line (NL), bark and wood discontinuities (BD and WD), and an overall estimate of graft (in)compatibility (GI) were collected for mapping quantitative trait loci (QTLs) on both parental maps. On the map of the graft-compatible parent "Pa", two genomic regions on LG5 (44.9-60.8 cM) and LG8 (33.2-39.2 cM) were associated with graft (in)compatibility characters at different significance level, depending on phenotypic dataset. Of these, the LG8 QTL interval was most consistent between the years and supported by two significant and two putative QTLs. To our best knowledge, this is the first report on QTLs for graft (in)compatibility in woody plants. Results of this work will provide a valuable genomic resource for apricot breeding programs and facilitate future efforts focused on candidate genes discovery for graft (in)compatibility in apricot and other Prunus species.

Biochemical Characterization and Differential Expression of PAL Genes Associated With "Translocated" Peach/Plum Graft-Incompatibility

Grafting is an ancient plant propagation technique widely used in horticultural crops, particularly in fruit trees. However, the involvement of two different species in grafting may lead to lack of affinity and severe disorders between the graft components, known as graft-incompatibility. This complex agronomic trait is traditionally classified into two categories: "localized" (weak graft unions with breaks in cambial and vascular continuity at the graft interface and absence of visual symptoms in scion leaves and shoots) and "translocated" (degeneration of the sieve tubes and phloem companion cells at the graft interface causing translocation problems in neighboring tissues, and reddening/yellowing of scion leaves). Over the decades, more attention has been given to the different mechanisms underlying the "localized" type of graft-incompatibility; whereas the phenylpropanoid-derived compounds and the differential gene expression associated with the "translocated" graft-incompatibility remain unstudied. Therefore, the aim of this study was to shed light on the biochemical and molecular mechanisms involved in the typical "translocated" graft-incompatibility of peach/plum graft-combinations. In this study, the "Summergrand" (SG) nectarine cultivar was budded on two plum rootstocks: "Adara" and "Damas GF 1869". "Translocated" symptoms of incompatibility were shown and biochemically characterized in the case of "SG/Damas GF 1869" graft-combination, 3 years after grafting. Non-structural carbohydrates (soluble sugars and starch), phenolic compounds and antioxidant activity, were significantly enhanced in the incompatible graft-combination scion. Similarly, the enzymatic activities of the antioxidant enzyme peroxidase, the phenylalanine ammonia-lyase (PAL) and polyphenol oxidase involved in the phenylpropanoid pathway were significantly affected by the incompatible rootstock "Damas GF 1869", inducing higher activities in the scion than those induced by the compatible rootstock "Adara". In addition, a positive and strong correlation was obtained between total phenol content, antioxidant capacity and the expression of the key genes involved in the phenylpropanoid pathway, PAL1 and PAL2. Regarding the "SG/Adara" graft-combination, there were neither external symptoms of "translocated" incompatibility nor significant differences in the biochemical and molecular parameters between scion and rootstock, proving it to be a compatible combination. The differential expression of PAL genes together with the biochemical factors cited above could be good markers for the "translocated" peach/plum graft-incompatibility.

Virtual genetic diagnosis for familial hypercholesterolemia powered by machine learning

AIMS

Familial hypercholesterolemia (FH) is the most common genetic disorder of lipid metabolism. The gold standard for FH diagnosis is genetic testing, available, however, only in selected university hospitals. Clinical scores - for example, the Dutch Lipid Score - are often employed as alternative, more accessible, albeit less accurate FH diagnostic tools. The aim of this study is to obtain a more reliable approach to FH diagnosis by a "virtual" genetic test using machine-learning approaches.

METHODS AND RESULTS

We used three machine-learning algorithms (a classification tree (CT), a gradient boosting machine (GBM), a neural network (NN)) to predict the presence of FH-causative genetic mutations in two independent FH cohorts: the FH Gothenburg cohort (split into training data (N = 174) and internal test (N = 74)) and the FH-CEGP Milan cohort (external test, N = 364). By evaluating their area under the receiver operating characteristic (AUROC) curves, we found that the three machine-learning algorithms performed better (AUROC 0.79 (CT), 0.83 (GBM), and 0.83 (NN) on the Gothenburg cohort, and 0.70 (CT), 0.78 (GBM), and 0.76 (NN) on the Milan cohort) than the clinical Dutch Lipid Score (AUROC 0.68 and 0.64 on the Gothenburg and Milan cohorts, respectively) in predicting carriers of FH-causative mutations.

CONCLUSION

In the diagnosis of FH-causative genetic mutations, all three machine-learning approaches we have tested outperform the Dutch Lipid Score, which is the clinical standard. We expect these machine-learning algorithms to provide the tools to implement a virtual genetic test of FH. These tools might prove particularly important for lipid clinics without access to genetic testing.

Clustering Clinical Data in R

We are currently witnessing a paradigm shift from evidence-based medicine to precision medicine, which has been made possible by the enormous development of technology. The advances in data mining algorithms will allow us to integrate trans-omics with clinical data, contributing to our understanding of pathological mechanisms and massively impacting on the clinical sciences. Cluster analysis is one of the main data mining techniques and allows for the exploration of data patterns that the human mind cannot capture.This chapter focuses on the cluster analysis of clinical data, using the statistical software, R. We outline the cluster analysis process, underlining some clinical data characteristics. Starting with the data preprocessing step, we then discuss the advantages and disadvantages of the most commonly used clustering algorithms and point to examples of their applications in clinical work. Finally, we briefly discuss how to perform validation of clusters. Throughout the chapter we highlight R packages suitable for each computational step of cluster analysis.

Skin Diseases in the Era of Highly Active Antiretroviral Therapy: A Retrospective Study of 534 Patients

BACKGROUND

With the increasing number of HIV-infected patients receiving highly active antiretroviral therapy (HAART), the shift in their dermatologic profile becomes less characteristic of AIDS-defining illnesses.

METHODS

Retrospective review of mucocutaneous pathology among patients seen at HIV-Dermatology Clinic from January 2009 to December 2013.

RESULTS

Among 534 patients, there were 68.4% males and 31.6% females, with 8.7-year average duration of infection; 82.8% were receiving HAART. Kaposi sarcoma was the only relatively frequent AIDS-defining disease. Fungal and viral infections were common, with human papilloma virus (HPV) as the most frequent overall. Benign and premalignant tumors were associated with HAART and CD4 >200/mm³ ( P < .05). Psoriasis was prevalent among patients without HAART ( P < .05). Prurigo was associated with lower CD4 count ( P < .001).

CONCLUSION

Patients receiving HAART are faced with chronic skin problems such as benign and premalignant tumors, and HPV infection adds to their neoplastic predisposition. Further research is recommended to develop protocols for treating psoriasis and screening for HPV-associated neoplasia among patients.

Inheritance of self- and graft-incompatibility traits in an F1 apricot progeny

Floral self-incompatibility affecting yearly yield in a weather-dependent manner and graft incompatibility affecting longevity of mature trees are two important traits for apricot production. However, genetic control of graft compatibility and relationship between these traits are unknown. Here, we analyzed its inheritance in an F₁ apricot progeny from a cross between self- and graft- incompatible and self- and graft-compatible cultivars. Hybrid individuals were genotyped for establishing self-incompatibility status and grafted on the plum rootstock ‘Marianna 2624’. Phenotyping of graft incompatibility was done at two time points, one month and one year after grafting. Anatomical (necrotic layer, bark and wood discontinuity for two consecutive years) and cytomorphological (cell proliferation, cell arrangement and cell shape one month after grafting) characteristics related to graft compatibility displayed continuous variation within the progeny, suggesting a polygenic inheritance. Using the Pearson correlation test, strong and significant correlations were detected between anatomical and cytomorphological traits that may reduce the number of characters for screening genotypes or progenies for graft compatibility in segregating crosses. Furthermore, no correlation existed between self- and graft incompatibility traits suggesting that they are independent inheritance traits. Hence, screening an extended hybrid population is required for pyramiding these traits in breeding programs.

Chronic Urticaria in the Real-Life Clinical Practice Setting in Portugal: Baseline Results from the Non-Interventional Multicentre AWARE Study

INTRODUCTION

There is a paucity of information regarding chronic urticaria patients' care in a real-world setting. The objective of this study was to report and evaluate the baseline characteristics of Portuguese chronic urticaria patients refractory to H1-antihistamines included in the AWARE study.

MATERIAL AND METHODS

This is a non-interventional cohort study. Adult patients with a diagnosis of chronic urticaria with symptoms for at least two months, refractory to H1-antihistamines, consulting one of the 10 participating urticaria centers throughout Portugal have been included in the study. Baseline sociodemographic data, medical history, clinical parameters, medication, weekly urticaria activity score, and dermatology quality of life index have been collected.

RESULTS

Seventy six patients were included, of which 76.3% were women. The majority of patients had a diagnosis of chronic spontaneous urticaria (88.2%) and 39.5% had angioedema. Around 91.0% of patients were medicated with non-sedative H1-antihistamines and 35.4% with a third line therapy. Median dermatology quality of life index was 5.0 and median weekly urticaria activity score was 13.0.

DISCUSSION

The baseline results suggest that patients with chronic urticaria refractory to H1-antihistamines are being under-treated in the real-world setting.

CONCLUSION

The AWARE study demonstrates the real impact of chronic urticaria on Portuguese patients refractory to H1-antihistamines treatment, and 30% report a very large or extremely large deleterious effect on their quality of life. The follow-up of these patients will allow evaluating strategies aimed at optimizing disease control.

Oxidative stress associated with rootstock-scion interactions in pear/quince combinations during early stages of graft development

Exposing a plant to stress situations, such as grafting, generally triggers antioxidant defense systems. In fruit tree grafting, quince (Cydonia oblonga) is widely used as a rootstock for pear (Pyrus communis L.), but several economically important pear cultivars are incompatible with available quince rootstocks. In this study, grafts were established using an in vitro callus graft system mimicking the events taking place in fruit trees. In vitro grown callus from pear [P. communis L. cv. 'Conference' (Co) and cv. 'William' (Wi)] and quince (C. oblonga Mill. clone 'BA29') was used to establish the compatible homografts 'Co/Co', 'Wi/Wi' and 'BA29/BA29', the compatible heterograft 'Co/BA29' and the incompatible heterograft 'Wi/BA29'. The main objective was to determine whether specific isoforms of genes involved in oxidative stress [superoxide dismutase (SOD), ascorbate peroxidase (APX) and catalase (CAT)] are differentially expressed at the graft interface from compatible and incompatible unions throughout 3 weeks after grafting. Reactive oxygen species (ROS) levels and programmed cell death were also evaluated in the course of graft development. Genes differentially expressed between compatible and incompatible heterografts were identified. Transcript levels of six antioxidant genes (SOD1, SOD3, APX3, APX6, CAT1 and CAT3) were down-regulated 10 days after grafting (DAG) in the incompatible heterograft in comparison to the compatible one. Likewise, SOD enzymatic activities were significantly higher at 1 and 10 days after wounding in the compatible cultivar 'Co' than in the incompatible one 'Wi'. These findings, together with live cell imaging of ROS-specific probes, ultrastructural mitochondrial changes and DNA fragmentation related to apoptotic processes, give indications that within incompatible rootstock/scion interfaces, either the level of ROS is increased or there is a less efficient detoxification system.

Cell-to-cell transport through plasmodesmata in tree callus cultures

One factor that contributes to a successful fruit tree grafting is the establishment of symplasmic contacts in the graft interface to facilitate the transfer of compounds between scion and stock. Using novel experimental and theoretical approaches we investigated whether the localized incompatibility, experienced in some Prunus grafts, could be related to insufficient plasmodesmal coupling at an early stage of development within one of the partners. Dye-coupling analysis using fluorescent tracers combined with confocal laser scanning microscopy were performed in cultured callus from either the plum rootstock (Prunus cerasifera Ehrh. x Prunus munsoniana W. Wight et Hedr.) cv. 'Marianna 2624' or from the apricot (Prunus armeniaca L.) cv. 'Moniqui' growing in vitro. Fluorescein was loaded into callus cells in a caged form. Following photoactivation of fluorescence within single cells, the uncaged fluorescein could be traced as it was spreading cell-to-cell revealing the existence of functional plasmodesmata. This set of experiments was performed within the 'stock' partner in callus fusions ('callus grafts') as well as in ungrafted callus. The results indicated species-related as well as developmental-related differences in plasmodesmal conductivity. The results further pointed to a novel control factor of connectivity that reaches the graft partner and changes its innate rate of communication: when combining the poorly transporting apricot cultivar with the well-transporting plum cultivar, communication between plum callus cells was much reduced, compared to that in plum homografts. For further support of the hypothesis, we carried out a quantitative analysis in which fluorescein was esterloaded into the callus. Fluorescence redistribution after photobleaching of fluorescein in individual cells gave a measure for the plasmodesmal contact between the cells. We found significant differences between the species with regard to mobile fraction and halftime of redistribution, which confirmed that callus cells are not interconnected to the same extent in Marianna 2624 and Moniqui.

Differential induction of phenylalanine ammonia-lyase gene expression in response to in vitro callus unions of Prunus spp

Phenylalanine ammonia-lyase (PAL) is a key enzyme in the synthesis of phenolic compounds, which play a prominent role in graft union formation, including the marked effects of their accumulation in incompatibility response. The purpose of this study was to assess changes in the abundance of PAL mRNA during graft union development. Partial cDNA clones encoding the enzyme were isolated from in vitro callus tissue in the apricot (Prunus armeniaca L.) cultivar Moniqui and the plum rootstock Marianna 2624 (Prunus munsoniana x Prunus cerasifera). The deduced partial amino acid sequence showed high homology with PAL genes from other plant species. We monitored PAL expression 5, 10, 15 and 20 days after the establishment of in vitro callus unions. The levels of PAL mRNA increased 5 days after grafting in both compatible and incompatible unions. Nevertheless, significant differences were observed at the transcript level through both types of combinations from the second week. The results showed a higher level of PAL transcription in graft unions of incompatible partners, where a lack of adaptation between stock and scion takes place. The level of scion-stock compatibility was related to the PAL expression pattern. In addition, cell walls of the callus cells were not stained by phloroglucinol-HCl, indicating that the increased PAL expression did not result in the formation of lignin. However, staining with Naturstoff reagent A confirmed the highest accumulation of soluble and wall-bound phenolic compounds at the graft interface of incompatible unions.

Traumatic avulsion of the triceps brachii

Traumatic avulsion of the triceps brachii tendon is a rare injury. Clinical diagnosis shows that elbow extension against gravity is not possible. Radiologically, the lateral elbow may show the presence of flecks of avulsed osseous material from the olecranon ("flake sign"), which is almost pathognomonic of this lesion. The authors of the present study present a case of avulsion fracture treated with the attachment of bone suture anchors.

Fibronectin-induced intracellular calcium rise in Entamoeba histolytica trophozoites: effect on adhesion and the actin cytoskeleton

The interaction of Entamoeba histolytica trophozoites with fibronectin (FN) promotes adhesion of the protein to the cells and its later degradation by locally released proteases. Binding to FN-covered surfaces induces, in addition, the formation of actin adhesion plates and focal contacts in the amebas. The signaling mechanisms underlying the response to FN are incompletely understood. In this paper we examined the modifications of cytosolic free calcium ([Ca2+]i) induced in the trophozoites by the interaction with FN and their effect on adhesion and the actin cytoskeleton organization. FN produced a sustained rise of [Ca2+]i that could be correlated to the incremented adhesion to FN-covered surfaces. Further increments in [Ca2+]i produced by Ca2+ ionophores A23187 or ionomycin significantly increased the adhesion of trophozoites, whereas depletion of cytoplasmic Ca2+, by treatment with the ionophores in the absence of external Ca2+ or using the chelator BAPTA/AM, blocked it almost completely. To study the role of internal calcium we used the plant lactone thapsigargin, which was found to produce a transient increase of [Ca2+]i but a low stimulatory effect on adhesion and the organization of actin plates. The shifting of soluble actin to the F-actin form and the stabilization of adhesion plates and focal contacts, seen as results, of the FN stimulus, were positively influenced by rises in [Ca2+]i and negatively affected by its decrement. Additional evidence for Ca2+ -mediated signaling in the response to FN was provided by the poor adhesion and defective actin plate organization observed in trophozoites treated with calmodulin antagonists. The results presented here suggest that FN action is mainly dependent on the influx of external Ca2+.

Intergeneric hybrids of Saccharomyces cerevisiae and Zygosaccharomyces fermentati obtained by protoplast fusion

To obtain strains that are able to efficiently produce ethanol from different carbohydrates, mainly cellulose hydrolysates, several species of the genus Candida and a Zygosaccharomyces fermentati strain were examined for their ability to utilize cellobiose and produce ethanol, as well as for their thermotolerance and the possibility of genetic manipulation. Candida obtusa and Zygosaccharomyces fermentati tolerated the maximal temperature for growth, possessed the highest cellobiase activity, and offered the possibility of genetic manipulation, although neither of them proved to be a good producer of ethanol. Intergeneric hybrids of Saccharomyces cerevisiae and Z. fermentati were obtained after protoplast fusion. They were selected as prototrophic strains, after isolation of auxotrophic mutants from Z. fermentati and fusion with an S. cerevisiae strain which was also auxotrophic. The hybrids, which appeared at a frequency of 2 X 10(-7), presented characteristics of both parents, such as resistance to certain drugs and the ability to grow with either cellobiose or lactic acid as the sole carbon source; they were very stable, even under nonselective conditions. These hybrids may have important industrial applications as good fermenting strains.