Resistance to freezing and frozen storage of Streptococcus thermophilus is related to membrane fatty acid composition

The resistance to freezing and frozen storage of Streptococcus thermophilus was related to the fatty acid composition of the cell membrane. The effects of four experimental factors were investigated on the fatty acid concentrations and on the recovery of acidification activity of S. thermophilus stored at -20 degrees C by using a complete experimental design: incorporating oleic acid in the culture medium, fermentation pH, addition of glycerol as cryoprotective agent and duration of storage. The acidification activity decreased during the freezing and the frozen storage of S. thermophilus. The storage time slightly enhanced the unsaturated fatty acid concentrations. The addition of glycerol did not modify the fatty acid composition but increased the resistance to frozen storage. The addition of oleic acid and the decrease of the fermentation pH enhanced the ratio unsaturated:saturated fatty acids and improved the recovery of the acidification activity. These results indicate that the resistance to frozen storage was closely related to the membrane fatty acid composition. We interpreted this as an adaptation of S. thermophilus to the addition of oleic acid and the unfavorable growth conditions that corresponded to a low fermentation pH.

Method of quantifying the loss of acidification activity of lactic acid starters during freezing and frozen storage

We have developed a method to quantify the resistance to freezing and frozen storage of lactic acid starters, based on measuring the time necessary to reach the maximum acidification rate in milk (tm) using the Cinac system. Depending on the operating conditions, tm increased during the freezing step and storage. The loss of acidification activity during freezing was quantified by the difference (delta tm) between the tm values of the concentrated cell suspension before and after freezing. During storage at -20 degrees C, linear relationships between tm and the storage time were established. Their slope, k, allowed the quantitation of the decrease in acidification activity during 9-14 weeks of frozen storage. The method was applied to determine the resistance to freezing and frozen storage of four strains of lactic acid bacteria and to quantify the cryoprotective effect of glycerol.

Rapidly cooled horse spermatozoa: Loss of viability is due to osmotic imbalance during thawing, not intracellular ice formation

The cellular damage that spermatozoa encounter at rapid rates of cooling has often been attributed to the formation of intracellular ice. However, no direct evidence of intracellular ice has been presented. An alternative mechanism has been proposed by Morris (2006) that cell damage is a result of an osmotic imbalance encountered during thawing. This paper examines whether intracellular ice forms during rapid cooling or if an alternative mechanism is present. Horse spermatozoa were cooled at a range of cooling rates from 0.3 to 3,000 degrees C/min in the presence of a cryoprotectant. The ultrastructure of the samples was examined by Cryo Scanning Electron Microscopy (CryoSEM) and freeze substitution, to determine whether intracellular ice formed and to examine alternative mechanisms of cell injury during rapid cooling. No intracellular ice formation was detected at any cooling rate. Differential scanning Calorimetry (DSC) was employed to examine the amount of ice formed at different rate of cooling. It is concluded that cell damage to horse spermatozoa, at cooling rates of up to 3,000 degrees C/min, is not caused by intracellular ice formation. Spermatozoa that have been cooled at high rates are subjected to an osmotic shock when they are thawed.

Operating conditions that affect the resistance of lactic acid bacteria to freezing and frozen storage

Thermophilic lactic acid bacteria exhibit different survival rates during freezing and frozen storage, depending on the processing conditions. We used a Plackett and Burman experimental design to study the effects of 13 experimental factors, at two levels, on the resistance of Streptococcus thermophilus and Lactobacillus delbrueckii subsp. bulgaricus to freezing and frozen storage. The resistance was evaluated by quantifying the decrease of acidification activity during freezing and throughout 8 weeks of storage. Acidification activity after freezing and frozen storage was affected by 12 experimental factors. Only the thawing temperature did not show any significant effect. S. thermophilus was more resistant than L. bulgaricus and the cryoprotective effect of glycerol during freezing and storage was confirmed. The temperature and duration of the cryoprotection step influenced acidification activity following the freezing step: the lower the temperature and the shorter the duration, the higher the activity. Acidification activity after storage was affected by several experimental factors involved in the fermentation stage: use of NaOH instead of NH4OH for pH control, addition of Tween 80 in the culture medium, and faster cooling led to better cryotolerance. Resistance to freezing and frozen storage was improved by using a high freezing rate and a low storage temperature. Finally, this study revealed that the conditions under which lactic acid bacteria are prepared should be well controlled to improve their preservation and to limit the variability between batches and between species.

The influence of different tibial stem designs in load sharing and stability at the cement-bone interface in revision TKA

Total Knee Arthroplasty (TKA) changes mechanical loading of the knee joint. Bone loss in the tibia is commonly encountered at the time of the revision TKA. Restoration of lost bone support and joint stability are the primary challenges in revision TKA. Normally, these defects are treated with non-living structures like metallic augments or bone grafts (autografts or allografts). Alone, neither of these structures can provide the initial support and stability for revision implants. In the latter, the use of intramedullary stems can provide the necessary load sharing and protect the remaining host bone and graft from excessive stress, increasing component stability. The purpose of this study was to evaluate comparatively load sharing (cortical rim, cancellous bone and stem) and stability at the cement-bone interface under the tibial tray induced by the use of cemented and press-fit tibial component stem extensions. Furthermore the study of the desirable option in cases where the bone defect is cavitary (cancellous bone defect contained by an intact cortical rim) or uncontained bone defect (bone loss involving the supporting cortical rim) was carried out. Because in vitro evaluation of these biomechanical parameters is difficult we used finite element (FE) models to overcome this. The biomechanical results suggest an identical behaviour in case of cavitary defects for both types of stems assessed. In the case of uncontained defect treated with bulk allografts the cemented stem may be a prudent clinical option.

Tumor necrosis factor during pregnancy and at the onset of labor and spontaneous abortion

OBJECTIVE

The aim of this study was to evaluate the production of tumor necrosis factor (TNF) by peripheral blood cells during pregnancy, at the onset of labor and of spontaneous abortion (SA), as well as in non-pregnant women with and without a history of recurrent spontaneous abortions (RSA).

STUDY DESIGN

The peripheral blood cells TNF production was evaluated in 28 women in the 1st trimester of pregnancy, 21 in the 2nd, and 30 in the 3rd, 47 at term labor; 43, at the onset of SA; 19 healthy and 19 RSA non-pregnant women. The statistical method used was the Mann-Whitney test.

RESULTS

We observed (1) lack of TNF detection in the 1st gestational trimester; (2) increase of TNF production with gestational age, with the highest values being observed at labor (P<0.05); (3) high TNF production at the onset of SA; (4) no difference in the TNF production by healthy and RSA non-pregnant women.

CONCLUSIONS

The suppression of TNF production during the 1st trimester of pregnancy seems to favor the normal development of pregnancy. It remains to be investigated whether the assessment of TNF production is a valuable prognostic parameter for the occurrence of abortion.

Ligilactobacillus salivarius functionalities, applications, and manufacturing challenges

Ligilactobacillus salivarius is a lactic acid bacteria that has been gaining attention as a promising probiotic. Numerous strains exhibit functional properties with health benefits such as antimicrobial activity, immunological effects, and the ability to modulate the intestinal microbiota. However, just a small number of them are manufactured at an industrial scale and included in commercial products. The under exploitation of L. salivarius strains that remain in the freezer of companies is due to their incapacity to overcome the environmental stresses induced by production and stabilization processes.The present study summarizes the functionalities and applications of L. salivarius reported to date. It aims also at providing a critical evaluation of the literature available on the manufacturing steps of L. salivarius concentrates, the bacterial quality after each step of the process, and the putative degradation and preservation mechanisms. Here, we highlight the principal issues and future research challenges for improving the production and long-term preservation at the industrial scale of this microorganism, and probably of other probiotics.Key points• L. salivarius beneficial properties and commercialized products.• Production conditions and viability of L. salivarius after stabilization processes.• Prospects for identifying preservation mechanisms to improve L. salivarius stability.

Revision total knee arthroplasty: the influence of femoral stems in load sharing and stability

Restoration of lost bone support and joint stability are the primary challenges in revision total knee arthroplasty (TKA). Normally, the defects type 2B and type 3 are associated with several damaged metaphyseal bone and loss of cortical bone. Structural allografts have been used for the treatment of large, contained, or uncontained osseous defect in revision TKA. Disadvantages of using structural allografts include late resorption or nonunion and risk of disease transmission. Alone, the structural allograft can not provide the initial support for revision implants. In these cases the stems are frequently used to provide the necessary load sharing and increase initial component stability. When evaluating whether stems should be cemented or press-fit, there isn't a simple answer, since there are no clear advantages or disadvantages for each approach. The aim of this study was to evaluate load sharing and stability at bone graft-cement interface under femoral component with use of cemented and press-fit stems after allograft incorporation with host bone. The difficulties encountered or the impossibility on the evaluation of these biomechanical parameters in-vitro make the use of finite element (FE) models a way through this evaluation. The FE results suggest that a press-fit stem could be the adequate choice if structural allografts in femur revision are used.

Stabilization of frozen Lactobacillus delbrueckii subsp. bulgaricus in glycerol suspensions: Freezing kinetics and storage temperature effects

The interactions between freezing kinetics and subsequent storage temperatures and their effects on the biological activity of lactic acid bacteria have not been examined in studies to date. This paper investigates the effects of three freezing protocols and two storage temperatures on the viability and acidification activity of Lactobacillus delbrueckii subsp. bulgaricus CFL1 in the presence of glycerol. Samples were examined at -196 degrees C and -20 degrees C by freeze fracture and freeze substitution electron microscopy. Differential scanning calorimetry was used to measure proportions of ice and glass transition temperatures for each freezing condition tested. Following storage at low temperatures (-196 degrees C and -80 degrees C), the viability and acidification activity of L. delbrueckii subsp. bulgaricus decreased after freezing and were strongly dependent on freezing kinetics. High cooling rates obtained by direct immersion in liquid nitrogen resulted in the minimum loss of acidification activity and viability. The amount of ice formed in the freeze-concentrated matrix was determined by the freezing protocol, but no intracellular ice was observed in cells suspended in glycerol at any cooling rate. For samples stored at -20 degrees C, the maximum loss of viability and acidification activity was observed with rapidly cooled cells. By scanning electron microscopy, these cells were not observed to contain intracellular ice, and they were observed to be plasmolyzed. It is suggested that the cell damage which occurs in rapidly cooled cells during storage at high subzero temperatures is caused by an osmotic imbalance during warming, not the formation of intracellular ice.

A low membrane lipid phase transition temperature is associated with a high cryotolerance of Lactobacillus delbrueckii subspecies bulgaricus CFL1

The mechanisms of cellular damage that lactic acid bacteria incur during freeze-thaw processes have not been elucidated to date. Fourier transform infrared spectroscopy was used to investigate in situ the lipid phase transition behavior of the membrane of Lactobacillus delbrueckii ssp. bulgaricus CFL1 cells during the freeze-thaw process. Our objective was to relate the lipid membrane behavior to membrane integrity losses during freezing and to cell-freezing resistance. Cells were produced by using 2 different culture media: de Man, Rogosa, and Sharpe (MRS) broth (complex medium) or mild whey-based medium (minimal medium commonly used in the dairy industry), to obtain different membrane lipid compositions corresponding to different recovery rates of cell viability and functionality after freezing. The lipid membrane behavior studied by Fourier transform infrared spectroscopy was found to be different according to the cell lipid composition and cryotolerance. Freeze-resistant cells, exhibiting a higher content of unsaturated and cyclic fatty acids, presented a lower lipid phase transition temperature (Ts) during freezing (Ts=-8°C), occurring within the same temperature range as the ice nucleation, than freeze-sensitive cells (Ts=+22°C). A subzero value of lipid phase transition allowed the maintenance of the cell membrane in a relatively fluid state during freezing, thus facilitating water flux from the cell and the concomitant volume reduction following ice formation in the extracellular medium. In addition, the lipid phase transition of freeze-resistant cells occurred within a short temperature range, which could be ascribed to a reduced number of fatty acids, representing more than 80% of the total. This short lipid phase transition could be associated with a limited phenomenon of lateral phase separation and membrane permeabilization. This work highlights that membrane phase transitions occurring during freeze-thawing play a fundamental role in the cryotolerance of Lb. delbrueckii ssp. bulgaricus CFL1 cells.

Finite Element and Experimental Cortex Strains of the Intact and Implanted Tibia

Finite Element (FE) models for the simulation of intact and implanted bone find their main purpose in accurately reproducing the associated mechanical behavior. FE models can be used for preclinical testing of joint replacement implants, where some biomechanical aspects are difficult, if not possible, to simulate and investigate in vitro. To predict mechanical failure or damage, the models should accurately predict stresses and strains. Commercially available synthetic femur models have been extensively used to validate finite element models, but despite the vast literature available on the characteristics of synthetic tibia, numerical and experimental validation of the intact and implant assemblies of tibia are very limited or lacking. In the current study, four FE models of synthetic tibia, intact and reconstructed, were compared against experimental bone strain data, and an overall agreement within 10% between experimental and FE strains was obtained. Finite element and experimental (strain gauge) models of intact and implanted synthetic tibia were validated based on the comparison of cortex bone strains. The study also includes the analysis carried out on standard tibial components with cemented and noncemented stems of the P.F.C Sigma Modular Knee System. The overall agreement within 10% previously established was achieved, indicating that FE models could be successfully validated. The obtained results include a statistical analysis where the root-mean-square-error values were always <10%. FE models can successfully reproduce bone strains under most relevant acting loads upon the condylar surface of the tibia. Moreover, FE models, once properly validated, can be used for preclinical testing of tibial knee replacement, including misalignment of the implants in the proximal tibia after surgery, simulation of long-term failure according to the damage accumulation failure scenario, and other related biomechanical aspects.

Experimental validation of intact and implanted distal femur finite element models

Four finite element (FE) models of intact and distal femur of knee replacements were validated relative to measured bone strains. FE models of linear tetrahedrons were used. Femoral replacements with cemented stemless, cemented and noncemented femoral stems of the PFC Sigma Modular Knee System were analyzed. Bone strains were recorded at ten locations on the cortex. The magnitude of the FE bone strains corresponded to the mean measured strains, with an overall agreement of 10%. Linear regression between the FE and mean experimental strains produced slopes between 0.94 and 1.06 and R(2) values between 0.92 and 0.99. RSME values were less than 12%. The FE models were able to adequately replicate the mechanical behavior of distal femur reconstructions.

Biomechanical evaluation of proximal tibia behaviour with the use of femoral stems in revision TKA: an in vitro and finite element analysis

BACKGROUND

Recognized failure mechanisms after revision total knee arthroplasty include failure of fixation, instability and loosening. Thus, extended stems have been used to improve fixation and stability. In clinical cases where the stem is only applied in the femur, a question concerning the structural aspect of tibia may arise: Does a stemmed femur changes the structural behaviour of proximal tibia? It seems, that question has not yet been fully answered and the use of stems in the opposite bone structure requires further analysis.

METHODS

Proximal cortex strains were measured with tri-axial strain gauges in synthetic tibias for three different types of implanted femurs, with two constrained implants. To assess the strains at the cancellous bone under the tibial tray, it was considered a closest physiological load condition with the use of finite element models.

FINDINGS

No significant differences of the mean of the tibial cortex strains for the stemmed femur relatively to the stemless femur were observed. The R(2) and slopes values of the linear regressions between experimental and finite element strains were close to one indicating good correlations. The strain behaviour of cancellous bone under the tibial tray is not completely immune to the use of femoral stem extensions. However, the level of this alteration is relatively small when compared with the strain magnitudes.

INTERPRETATION

The main insight given by the present study could probably lie in the fact that the use of femoral stems does not contribute to an increase of the risk of failure of the tibia.

Rupestris stem pitting associated virus isolates are composed by mixtures of genomic variants which share a highly conserved coat protein

Broad spectrum primers were used to amplify a fragment comprising the CP gene and putative ORF6 by RT-PCR from ds-RNA templates originating from 46 Portuguese varieties, totalling 190 samples, including some wild Vitis ssp sylvestris vines, and 2 vines from Slovenia. SSCP analysis was used as a preliminary screen to avoid cloning and sequencing very similar variants. Four groups of variants were recognized. In pair wise comparisons between nucleotide sequences the minimal homology found was 81%. In case of the cultivated varieties, no relationship could be seen between the phylogenetic groups and geographic origin or grape variety. Several isolates were found harbouring mixed infections with genomic variants from different groups, but the mixing did not lead to an extensive recombination between them. The deduced amino-acid sequences revealed a conserved CP subjected to strong purifying selection pressure. Analysis of the selection pressure operating on the putative ORF6 suggests that this ORF does not exist. Previously produced polyclonal antiserum raised against the recombinant CP of RSPaV expressed in Escherichia coli was shown to be able to detect all four groups of variants of RSPaV included in this study, which might enable the diagnosis of the virus on a serological basis.

Genomic variability of prune dwarf virus as affected by agricultural practice

Twelve new sequences of the coat protein gene of Prune dwarf virus (PDV) variants, obtained from almond trees, are presented. Comparison with previously reported sequences of the same region, obtained from other hosts (plum, cherry and peach) revealed not only the existence of a wider range of variants of PDV than formerly predicted, but also the frequent presence of a mixture of variants in each sample. In spite of the heterogeneity found in almond, the amino acid composition of the domain at the N terminus of the coat protein maintained the potential to form an amphipathic helix, and hence the capacity to serve the previously suggested function of binding the viral RNA during particle formation. Except for synonymous substitutions, measures of nucleotide diversity calculated for the two groups, respectively 13 sequences from almond and 14 sequences from other hosts, were found to be significantly different, with the almond group showing a much higher variability. Analysis of the dendrogram constructed based in all 27 PDV CP sequences did not reveal host specificity, in agreement with previous findings. However, a clear divergence between almond and other hosts sequences could be found. It is discussed that the observed differences between almond and other hosts variants may derive from differences in agricultural practices.

Clinical impact of COVID-19 on people with substance use disorders

Background

People with substance use disorders are considered at increased risk of COVID-19 and its more serious complications, however data on the impact of COVID-19 are lacking. The study aimed to describe the clinical characteristics and outcomes of COVID-19 on people with substance use disorders.

Methods

an observational study was carried out including patients aged ≥ years with COVID-19 pneumonia admitted to an urban hospital during March 12 to June 21,2020.

Results

Among 2078 patients admitted, 27 (1.3%) were people with substance use disorders: 23(85.2%) were men with a median age of 56.1 + 10.3 years and. The main SUD were alcohol in 18(66.7%) patients, heroine in 6(22.2%) and cocaine in 3(11.1%) and 24(88.8%) patients were on ongoing substance use disorder treatment. One or more comorbidities associated to COVID-19 risk were observed in 18(66.6%) of patients. During a median length of stay of 10 days (IQR:7-19), severe pneumonia developed in 7(25.9%) patients, acute respiratory distress syndrome in 5 (18.5%) and none died.

Conclusion

Larger sample sizes and sero-epidemiological studies are needed to confirm the low incidence of severe COVID-19 on patients with SUD.

Biomechanical evaluation of different reconstructive techniques of proximal tibia in revision total knee arthroplasty: An in-vitro and finite element analysis

BACKGROUND

Bone loss and subsequent defects are often encountered in revision total knee arthroplasty. In particular, when the cortical rim of proximal tibia is breached, the surgical decision on the reconstructive options to be taken is challenging due to the variety of defects and the lack of data from clinical or experimental studies that can support it. The purpose of this study is to assess how different reconstructive techniques, when applied to an identical defect and bone condition, can be associated to dissimilar longevity of the revision procedure, and the role of a stem in this longevity.

METHODS

Proximal cortex strains and implant stability were measured in ten reconstructive techniques replicated with synthetic tibiae. The cancellous bone strains under each construct were assessed with finite element models which were validated against experimental strains.

FINDINGS

The measured strains and stability showed that the proximal cortex is not immune to the different reconstructive techniques when applied to an identical defect. The largest cancellous strain differences between modular and non-modular techniques indicate a distinct risk between reconstructive techniques, associated to the supporting capacity of cancellous bone at long term.

INTERPRETATION

The main finding of the present study is the observation that modular augments increases, on a long term basis, the potential risk of bone resorption relative to the non-modular techniques. In addition, the use of a press-fit stem in the scope of non-modular techniques can lead to improved stability and load transfer, which can contribute positively to the life expectancy of these techniques.

A new press-fit stem concept to reduce the risk of end-of-stem pain at revision TKA: a pre-clinical study

PURPOSE

Revision total knee arthroplasty presents numerous technical challenges, with lower patient outcomes compared with those obtained in primary surgery. Extended stems have been used in revision total knee arthroplasty to improve component alignment and fixation. Hybrid fixation with cemented tibial tray and press-fit stem has shown good results. One of the disadvantages of this technique is pain related to the presence of a cementless diaphyseal engaging stem, often designated as end-of-stem pain. Patients with this pain have reported a decrease in overall satisfaction, as well as demonstrate a lower clinical outcome score. Clinical findings suggest that stem material and design are important factors in the development of end-of-stem pain. Therefore, a question can be raised: can a novel press-fit stem concept minimize bone strain changes at the stem tip? The hypothesis here considered lies upon the fact, that if periosteal cortex strain changes are minimized at the stem tip comparatively to the intact situation, the risk of end-of-stem pain might be minimized.

SCOPE

This pre-clinical study was accomplished using synthetic tibiae to experimentally predict the periosteal cortex strains at the proximal and stem tip regions, with a commercial press-fit stem and a new stem concept.

CONCLUSIONS

The results demonstrated that the new stem concept has the ability to minimize strain changes induced by the stem tip at the distal periosteal cortex and consequently, at the periosteal layer of bone tissue, which is highly pain sensitive, probably contributing to the reduction of the risk of end-of-stem pain.

Simulation of Physiological Loading in Total Hip Replacements

The determination of biomechanical force systems of implanted femurs to obtain adequate strain measurements has been neglected in many published studies. Due to geometric alterations induced by surgery and those inherent to the design of the prosthesis, the loading system changes because the lever arms are modified. This paper discusses the determination of adequate loading of the implanted femur based on the intact femur-loading configuration. Four reconstructions with Lubinus SPII, Charnley Roundback, Müller Straight and Stanmore prostheses were used in the study. Pseudophysiologic and nonphysiologic implanted system forces were generated and assessed with finite element analysis. Using an equilibrium system of forces composed by the Fx (medially direction) component of the hip contact force and the bending moments Mx (median plane) and My (coronal plane) allowed adequate, pseudo-physiological loading of the implanted femur. We suggest that at least the bending moment at the coronal plane must be restored in the implanted femur-loading configuration.

Ultrastructure of Helicobacter trogontum in culture and in the gastrointestinal tract of gnotobiotic mice

Helicobacter trogontum is a micro-aerophilic urease-positive bacterium that has recently been isolated from the intestinal mucosa of rats. The purpose of this investigation was to study the ultrastructural details of this micro-organism in both pure culture and in the gastrointestinal tract of germ-free mice infected with H. trogontum. The micro-organism was a fusiform to slightly spiral gram-negative cell, 4-6 microm long and 0.6-0.7 microm wide, with four to seven bipolar sheathed flagella. The cytoplasm presented several irregular and also globular granules. On each side of the polar regions of the cells, there was a highly electron-dense band, the 'polar membrane'. Coccoidal forms were seen in old cultures. H. trogontum showed several ultrastructural characteristics of the Helicobacter genus and much resemblance to H. rappini and H. bilis. H. trogontum mainly colonised the large bowel of the gnotobiotic mice where it could be seen in the lumen and also inside the enterocytes. Vacuolation of the ileal epithelial cells, loss of microvilli and pronounced desquamation of the enterocytes of the caecum were observed in the bowel colonised by the bacterium. These observations raise the possibility that H. trogontum could cause some harm to the host at least in particular circumstances such as when it colonises the gastrointestinal tract of a germ-free host.

Expanding the genetic spectrum of ANOS1 mutations in patients with congenital hypogonadotropic hypogonadism

STUDY QUESTION

What is the prevalence and functional consequence of ANOS1 (KAL1) mutations in a group of men with congenital hypogonadotropic hypogonadism (CHH)?

SUMMARY ANSWER

Three of forty-two (7.1%) patients presented ANOS1 mutations, including a novel splice site mutation leading to exon skipping and a novel contiguous gene deletion associated with ichthyosis.

WHAT IS KNOWN ALREADY

CHH is characterized by lack of pubertal development and infertility, due to deficient production, secretion or action of GnRH, and can be associated with anosmia/hyposmia (Kallmann syndrome, KS) or with a normal sense of smell (normosmic CHH). Mutations in the anosmin-1 (ANOS1) gene are responsible for the X-linked recessive form of KS.

STUDY DESIGN, SIZE, DURATION

This cross-sectional study included 42 unrelated men with CHH (20 with KS and 22 with normosmic CHH).

PARTICIPANTS/MATERIALS, SETTING, METHODS

Patients were screened for mutations in the ANOS1 gene by DNA sequencing. Identified mutations were further investigated by RT-PCR analysis and multiplex ligation-dependent probe amplification (MLPA) analysis.

MAIN RESULTS AND THE ROLE OF CHANCE

Hemizygous mutations were identified in three (7.1%) KS cases: a novel splice acceptor site mutation (c.542-1G>C), leading to skipping of exon 5 in the ANOS1 transcript in a patient with self-reported normosmia (but hyposmic upon testing); a recurrent nonsense mutation (c.571C>T, p.Arg191*); and a novel 4.8 Mb deletion involving ANOS1 and eight other genes (VCX3B, VCX2, PNPLA4, VCX, STS, HDHD1, VCX3A and NLGN4X) in KS associated with ichthyosis.

LIMITATIONS, REASONS FOR CAUTION

Objective olfactory testing was not performed in all cases of self-reported normosmia and this may have underestimated the olfactory deficits.

WIDER IMPLICATIONS OF THE FINDINGS

This study further expands the spectrum of known genetic defects associated with CHH and suggests that patients with self-reported normal olfactory function should not be excluded from ANOS1 genetic testing.

STUDY FUNDING/COMPETING INTEREST(S)

This study was funded by the Portuguese Foundation for Science and Technology. The authors have no conflicts of interest.

TRIAL REGISTRATION NUMBER

N/A.

Pyoderma gangrenosum associated with sclerosing cholangitis, type 1 diabetes mellitus and ulcerative colitis

We describe the case of a 22-year-old black female with type 1 diabetes mellitus diagnosed when she was 12 years old. She first presented (March 1994) with pustules and ulcerations on the upper and lower limbs, trunk and scalp at the age 17. The diagnosis of pyoderma gangrenosum was made. Since presentation, changes in liver function were detected and subsequent study led to the diagnosis of sclerosing cholangitis. The diagnosis of ulcerative colitis was made after colonoscopy. Partial response was obtained with minocycline and clofazimine, but treatment with 5-aminosalicylic acid achieved no improvement of the ulcerations. Liver transplantation, followed by immunosuppressive therapy led to complete regression of the cutaneous lesions.

[Androgen deprivation therapy and morbid obesity: do they share cardiovascular risk through metabolic syndrome?]

BACKGROUND

Although the use of androgen deprivation therapy (ADT) has resulted in improved survival in men with advanced prostate cancer, the resulting hypogonadism is associated with profound adverse effects comparable to those found in morbid obesity, being cardiovascular risk among the most lethal.

OBJECTIVES

Evaluate metabolic syndrome, metabolic abnormalities and cardiovascular risk in patients with prostate cancer under ADT, not under ADT and morbid obese men.

METHODS

This is a cross-sectional study that involves 79 men presenting prostate cancer, of whom 54 under ADT and 25 not under ADT and 91 morbidly obese patients paired by sex and age. To define metabolic syndrome, we used the International Diabetes Federation (IDF) criteria. Metabolic abnormalities, metabolic markers and Framingham score to predict the ten year coronary heart disease risk were compared among patients under ADT, not under ADT and morbid obese.

RESULTS

Patients under ADT presented significantly greater occurrence of diabetes and central obesity and higher levels of total cholesterol and low density lipoprotein (LDL) compared to eugonadal men. The mean cardiovascular risk was significantly higher in patients under ADT (39.97±12.53% vs. 26.09±14.80%; p=0.021). Morbidly obese subjects had increased ten year coronary heart disease risk; comparable to patients under ADT (p=0.054).

CONCLUSION

This study suggests that patients under ADT show higher prevalence of metabolic abnormalities and cardiovascular risk similar to those found in morbidly obese subjects. It is possible that both processes share cardiovascular risk through metabolic syndrome.

Femoral revision knee Arthroplasty with Metaphyseal sleeves: the use of a stem is not mandatory of a structural point of view

PURPOSE

Although metaphyseal sleeves are usually used with stems, little is known about the exact contribution/need of the stem for the initial sleeve-bone interface stability, particularly in the femur, if the intramedullary canal is deformed or bowed. The aim of the present study is (1) to determine the contribution of the diaphyseal-stem on sleeve-femur interface stability and (2) to determine experimentally the strain shielding effect on the metaphyseal femur with and without diaphyseal-stem. It is hypothesised that diaphyseal-stem addition increases the sleeve-femur interface stability and the strain-shielding effect on the metaphyseal femur relatively to the stemless condition.

MATERIAL AND METHODS

The study was developed through a combined experimental and finite-element analysis approach. Five synthetic femurs were used to measure cortex strain (triaxial-rosette-gages) behaviour and implant cortex micromotions (Digital Image Correlation) for three techniques: only femoral-component, stemless-sleeve and stemmed-sleeve. Paired t-tests were performed to evaluate the statistical significance of the difference of cortex strains and micromotions. Finite-element models were developed to assess the cancellous bone strain behaviour and sleeve-bone interface micromotions; these models were validated against the measurements.

RESULTS

Cortex strains are significantly reduced (p < 0.05) on the stemmed-sleeve with a 150 μstrain mean reduction at the medial and lateral distal sides which compares with a 60 μstrain mean reduction (p > 0.05) on the stemless condition. Both techniques presented a mean cancellous bone strain reduction of 700 μstrain (50%) at the distal region and a mean increase of 2500 μstrain (4x) at the sleeve proximal region relative to the model only with the femoral component. Both techniques presented sleeve-bone micromotions amplitude below 50-150 μm, suitable for bone ingrowth.

CONCLUSIONS

The use of a supplemental diaphyseal-stem potentiates the risk of cortex bone resorption as compared to the stemless-sleeve condition; however, the stem is not essential for the enhancement of the initial sleeve-bone stability and has minor effect on the cancellous bone strain behaviour. Based on a purely structural point view, it appears that the use of a diaphyseal-femoral-stem with the metaphyseal sleeve is not mandatory in the revision TKA, which is particularly relevant in cases where the use of stems is impracticable.

The role of afforestation species as a driver of Hg accumulation in organic horizons of forest soils from a Mediterranean mountain area in SW Europe

Forest areas are a primary sink of atmospheric mercury (Hg) within terrestrial ecosystems, whereas forest vegetation plays a key role in atmospheric Hg transfer to soil horizons. This study assessed variations in total Hg contents (Hg_T) and accumulation (Hg_Res) in the soil organic horizons of a forest area in NE Portugal, where post-wildfire afforestation led to the substitution of the native deciduous species (Quercus pyrenaica) by fast-growing coniferous species (Pseudotsuga menziesii and Pinus nigra). The study also evaluated, for each species, the links between Hg contents and other biophilic elements of soil organic matter (C, N, S) present in organic subhorizons (OL, OF, OH). Mean Hg_T in the organic horizons of the different tree species follow the sequence: P. nigra (88 μg kg^-1) < Q.pyrenaica (101 μg kg^-1) <P. menziesii (141 μg kg^-1). The highest Hg_Res for the entire organic horizon was found under P. menziesii (471 μg m^-2), followed by P. nigra (253 μg m^-2) and Q. pyrenaica (189 μg m^-2). Among the organic subhorizons, values of Hg_T and Hg_Res follow the sequence OL < OF < OH, which is consistent with the degree of organic matter humification. Indeed, Hg_T and Hg_Res correlated significantly with the C/N and C/S ratios for all species and organic subhorizons, suggesting that the quality of organic matter may influence strongly the Hg fate in these forest soils. Soils from P. menziesii plots have shown an Hg_Res 2.5 times higher than in plots dominated by the native Q. pyrenaica. Hg accumulation in the organic horizons, promoted in the coniferous species, may increase the risk of Hg mobilization due to wildfires and forest management practices. Therefore, forest management plans should select cautiously the tree species for afforestation in order to minimize adverse environmental effects caused by changes in the biogeochemical cycle of contaminants such as Hg.