Introducing the H2020 AQUACROSS project: Knowledge, Assessment, and Management for AQUAtic Biodiversity and Ecosystem Services aCROSS EU policies

The AQUACROSS project was an unprecedented effort to unify policy concepts, knowledge, and management of freshwater, coastal, and marine ecosystems to support the cost-effective achievement of the targets set by the EU Biodiversity Strategy to 2020. AQUACROSS aimed to support EU efforts to enhance the resilience and stop the loss of biodiversity of aquatic ecosystems as well as to ensure the ongoing and future provision of aquatic ecosystem services. The project focused on advancing the knowledge base and application of Ecosystem-Based Management. Through elaboration of eight diverse case studies in freshwater and marine and estuarine aquatic ecosystem across Europe covering a range of environmental management problems including, eutrophication, sustainable fisheries as well as invasive alien species AQUACROSS demonstrated the application of a common framework to establish cost-effective measures and integrated Ecosystem-Based Management practices. AQUACROSS analysed the EU policy framework (i.e. goals, concepts, time frames) for aquatic ecosystems and built on knowledge stemming from different sources (i.e. WISE, BISE, Member State reporting within different policy processes, modelling) to develop innovative management tools, concepts, and business models (i.e. indicators, maps, ecosystem assessments, participatory approaches, mechanisms for promoting the delivery of ecosystem services) for aquatic ecosystems at various scales of space and time and relevant to different ecosystem types.

PM-SCL autoantibody positive scleroderma with polymyositis (mechanic's hand: clinical aid in the diagnosis)

This report concerns a 56-year-old-woman presenting PM-SCL autoantibody positive scleroderma with dermatomyositis (scleromyositis) and concomitant interstitial lung fibrosis. The recently observed overlapping syndrome is characterized by the presence of specific autoantibodies, HLA-type association and benign course. A new skin symptom ("mechanic's hands") predicts the disease, in particular the interstitial lung pathology, which is its most relevant internal manifestation.

Antibiotic-resistant acne: lessons from Europe

BACKGROUND

Propionibacterium acnes and P. granulosum are widely regarded as the aetiological agents of inflammatory acne. Their proliferation and metabolism are controlled using lengthy courses of oral and/or topical antibiotics. Despite numerous reports of skin colonization by antibiotic-resistant propionibacteria among acne patients, accurate prevalence data are available only for the U.K.

OBJECTIVES

To determine the prevalence of skin colonization by antibiotic-resistant propionibacteria among acne patients and their contacts from six European centres.

METHODS

Skin swabs were collected from 664 acne patients attending centres in the U.K., Spain, Italy, Greece, Sweden and Hungary. Phenotypes of antibiotic-resistant propionibacteria were determined by measuring the minimum inhibitory concentrations (MIC) of a panel of tetracycline and macrolide, lincosamide and streptogramin B (MLS) antibiotics. Resistance determinants were characterized by polymerase chain reaction (PCR) using primers specific for rRNA genes and erm(X), followed by nucleotide sequencing of the amplified DNA.

RESULTS

Viable propionibacteria were recovered from 622 patients. A total of 515 representative antibiotic-resistant isolates and 71 susceptible isolates to act as control strains were characterized phenotypically. The prevalence of carriage of isolates resistant to at least one antibiotic was lowest in Hungary (51%) and highest in Spain (94%). Combined resistance to clindamycin and erythromycin was much more common (highest prevalence 91% in Spain) than resistance to the tetracyclines (highest prevalence 26.4% in the U.K.). No isolates resistant to tetracycline were detected in Italy, or in Hungary. Overall, there were strong correlations with prescribing patterns. Prevalence of resistant propionibacteria on the skin of untreated contacts of the patients varied from 41% in Hungary to 86% in Spain. Of the dermatologists, 25 of 39 were colonized with resistant propionibacteria, including all those who specialized in treating acne. None of 27 physicians working in other outpatient departments harboured resistant propionibacteria.

CONCLUSIONS

The widespread use of topical formulations of erythromycin and clindamycin to treat acne has resulted in significant dissemination of cross-resistant strains of propionibacteria. Resistance rates to the orally administered tetracycline group of antibiotics were low, except in Sweden and the U.K. Resistant genotypes originally identified in the U.K. are distributed widely throughout Europe. Antibiotic-resistant propionibacteria should be considered transmissible between acne-prone individuals, and dermatologists should use stricter cross-infection control measures when assessing acne in the clinic.

Panniculitis-like T-cell lymphoma clinically manifested as alopecia

A 45-year-old women presented with multifocal scalp lesions with the clinical impression of alopecia areata. Histological findings first suggested cytophagic histiocytic panniculitis, although a 'burned-out' panniculitis-like T-cell lymphoma could not be excluded. After a 20-month follow-up period, assessment of the T-cell receptor gamma-chain gene rearrangement verified the diagnosis of subcutaneous panniculitis-like T-cell lymphoma. This case is interesting because of its isolated scalp manifestation as well as its indolent course.

Bullous pyoderma gangrenosum as a manifestation of leukemia cutis

The authors present the case of a 67-year-old patient in whom bullous pyoderma gangrenosum was the first symptom of acute myeloid leukemia. Histologically leukemic cells were found in the skin infiltrate, on the basis of which this lesion satisfied the criteria of leukemia cutis. It was underlined that in the background of such atypical bullous cases there are often hemoblastoses or their malignant transformation. Finally the connection between bullous pyoderma gangrenosum and atypical vesiculous Sweet syndrome is discussed.

Ulcus vulvae acutum

An acute vulvar ulcer was diagnosed based on a case history of a 17-year-old girl with genital ulcers. No relevant causative factors could be established. The gangrenous form of the disease, cutaneous anergy, and the cultured anaerobic pathogens suggested the possibility of an infectious pathogenesis.

Monocytic aleukemic leukemia cutis

The authors present a case of monocytic aleukemic leukemia cutis in which skin symptoms were the sole manifestation of the leukemia during the first year and a half of the disease. Diagnostic difficulties, the importance of immunohistochemical markers, and the prognosis and therapy of aleukemic leukemia cutis are discussed.

[Leukemic neutrophilic dermatosis]

A case of a 67 year-old female patient with acute myeloid leukemia is presented. As the first manifestation of the disease, the patient had symptoms of Sweet's syndrome, later signs of gangrenous pyoderma have developed. This transient form is termed as a "leukemic neutrophilic dermatosis". The authors focus on the important diagnostic and prognostic value of this entity.

[Monocytic aleukemic leukemia cutis]

The authors present a 39 year old female patient with acute monoblastic leukemia, at whom during a year and a half the disease was manifested only with specific skin symptoms (leukemia cutis). Diagnostic difficulties, importance of immunhistochemic markers, as well as diagnostic, prognostic and therapeutic role of aleukemic leukemia cutis are discussed.

The possible role of anaerobic bacteria in chronic prostatitis

Prostatis, the most common urological disease in men, afflicts between 25 and 50% of all adult men. Four clinical categories are recognized: acute and chronic bacterial prostatitis, non-bacterial prostatitis and prostatodynia. The role of Gram-positive aerobic bacteria and the different anaerobes in chronic bacterial prostatitis is still a matter of debate. During this study, the urethral discharge and the prostatic fluid obtained after prostatic massage of 50 patients with chronic prostatitis, confirmed by clinical examination and resistant to empirical quinolone therapy, were cultured under aerobic and anaerobic conditions. The parallel specimens from 24 patients exhibited high colony counts of Gram-positive and Gram-negative anaerobic bacteria, either alone (18 cases) or in combination with aerobic bacteria (6 cases). The specimens obtained after prostatic massage of the remaining 26 patients were completely negative for both aerobic and anaerobic bacteria. No Chlamydia trachomatis, Mycoplasma hominis, Ureaplasma urealyticum or Trichomonas vaginalis were isolated from these patients. Patients with chronic prostatitis who gave positive culture results for anaerobes were treated with amoxicillin/clavulanic acid or clindamycin for 3-6 weeks. After treatment, samples were again taken and cultured for all pathogens known to cause prostatitis. These post-therapeutic samples revealed a decrease or total elimination of the symptoms, and no anaerobic bacteria could be detected.

[Examination of the sentinel lymph node in malignant melanoma]

The authors report about a new "lymphatic-mapping" method (by means of patent blue staining) by which it is able to detect regional (sentinel) lymph node, into which the first metastasis is occurred. Experiences were made known with 15 patients. The by "lymphatic mapping" detected and removed sentinel lymph node has an, important role not only in determination of staging, but also in indication of prophylactic block-dissection, too.

[Diagnostic role of skin manifestation]

Onto the common integument, as the largest "screen" of our organism, symptoms of numerous inner-organic diseases may exert projection. Of them important diagnostic conclusions are to be drawn, among which several ones are essential in modern medicine as well. Set out from symptom samples observed on skin, cutaneous symptoms and connections having recent diagnostic significance come to our demonstration.

[Perianal ulceration as the leading symptom of childhood Langerhans-cell histiocytosis]

The authors present a case history for a two-year-old boy in whom the study of perianal ulcer helped to diagnose the Langerhans cell histiocytosis. The authors emphasize the diagnostic value of intertriginous ulcers in identifying the above-mentioned disease.

[Successful management of malum perforans resulting from spina bifida]

Authors observed a boy presented a protrusion positioned lumbosacral, existing since his birth. Later, on inner side of both heels ulcers began to take shape, being not curable by local treatment. Neurologic examination verified severe radicular lesion, magnetic resonance investigation showed lumbosacral lipo-meningocele. After its surgical treatment, ulcers on soles healed up. Neurotropic ulcer develops on sites exposed to pressure, being generally painless. Several sickness may lead to its development. In childhood occurrence is relatively rare. At this age mostly various closure troubles of medullary tube may stand in the background. To successful treatment of malum perforans--besides local therapy--that of underlying illness is essential as well.

Concepts of cell death and application to carcinogenesis

The occurrence of cell death as a physiologic event in multicellular organisms has been known for more than 150 yr. In 1972, the term apoptosis was introduced on morphological grounds. The hypothesis that all kinds of cell death can be categorized as either "apoptotic" or "necrotic" is not generally confirmed. Cells seem to use different pathways for suicide, as reflected by different morphology: condensation-prominent, Type I or apoptosis; autophagy-prominent, Type II; and so forth. Type II cell death was found in mammary tissue and mammary tumor cells and in a variety of other organs. For unequivocal identification of the various types of cell death, morphological, biochemical, and functional criteria may be used in combination. During tumor development in various organs of animals and humans, not only rates of cell proliferation but also rates of cell death may increase with increasing malignancy. Morphological and functional criteria (antipromotion, withdrawal of survival factors) indicate that cell death in tumors frequently is of an active nature.

[Fournier gangrene (manifestation of anogenital necrotizing fasciitis)]

In connection with a typical case, clinical features of genitaly extended Fournier gangrene--its pathogenic factors and the standpoints of treatment--are demonstrated. This infection of foudroyant nature, going on with significant mortality is held to be a characteristic form of necrotizing fasciitis, constituting main manifestation of toxic shock-like syndrome. Attention is drawn to the fact, that in case of internal diseases, predisposing factors respectively-even by adequate therapy-outcome of the infection may be lethal nowadays as well.

Active cell death induced by the anti-estrogens tamoxifen and ICI 164 384 in human mammary carcinoma cells (MCF-7) in culture: the role of autophagy

Active cell death in hormone-dependent cells was studied using cultured human mammary carcinoma cells (MCF-7) treated with the anti-estrogens (AEs) tamoxifen (TAM), 4-hydroxy-tamoxifen (OH-TAM) or ICI 164 384 (10(-8)-10(-5) M) as a model. The following results were obtained. (i) In untreated MCF-7 cells a wave of replication occurred in the first 5 days of culture. All three AEs caused a dose-dependent inhibition of cell replication. (ii) TAM and OH-TAM at 10(-5) M, but not ICI 164 384, caused lytic cell death (necrosis) within 24 h, which was not inhibited by estradiol (10(-9)-10(-6)M). (iii) Lower concentrations of TAM or OH-TAM (up to 10(-6) M) or ICI 164 384 induced a more gradual appearance of cell death beginning at day 3. This type of cell death was inhibited by estradiol (10(-9) M), indicating its active nature. (iv) Nuclei showed two distinct patterns of alteration: (a) apoptosis-like condensation and fragmentation of chromatin to crescent masses abutting the nuclear envelope; (b) condensation of the chromatin to a single, pyknotic mass in the center of the nucleus, detached from the nuclear envelope. Quantitative histological evaluation revealed the predominance of pyknosis. (v) Biochemical DNA analysis revealed that only a relatively small amount of the total DNA was finally degraded into low molecular weight fragments (20 kb and less). (vi) Active cell death, with both apoptotic and pyknotic nuclear morphology, was associated with extensive formation of autophagic vacuoles (AV).3-Methyladenine, a known inhibitor of AV formation, partially prevented cell death as detected by nuclear changes. (vii) ICI 164 384 was about 10 times more effective than TAM or OH-TAM at inhibiting DNA synthesis, but had equal potency in inducing active cell death. It is concluded that AEs have anti-proliferative and anti-survival effects on MCF-7 human mammary cancer cells in culture. These two effects are under separate control because they differ by kinetics, dose dependence and sensitivity to the various AEs. Active cell death in MCF-7 cells seems to be initiated by autophagy, in contrast to concepts of apoptosis, and thus corresponds to autophagic/ lysosomal or type II death as previously defined. This may be important because of biochemical and molecular differences between these various subtypes of active cell death.

[Polipoid melanoma]

Polypoid melanoma is a less known aggressive variant of nodular melanoma. It is characterised by earlier manifestation, exophytic growing, more frequent secundary alteration and whorse prognosis. On the basis of clinical and histological data of 14 patients, authors present characteristics of polypoid melanoma its differential-diagnosis and draw attention to the stressed importance of clinical diagnosis and treatment.

Cutaneous gangrene due to hyperparathyroidism secondary to chronic renal failure (uraemic gangrene syndrome)

Cutaneous and subcutaneous gangrene are serious sequelae of secondary or tertiary hyperparathyroidism which may accompany chronic renal failure. Based on analysis of the present typical case and a retrospective survey of similar cases in the literature, we propose the term 'uraemic gangrene syndrome' for this association. These skin lesions in chronic renal failure patients represent the most serious clinical manifestation of calciphylaxis, a condition originally described by Selye. The appearance of early skin lesions should be regarded as an indication for subtotal parathyroidectomy. The association of cutaneous gangrene with vascular calcification was first described by Bryandt and White in 1989, and was termed by these authors as 'gangrenous calcification'. A total of 80 cases of this rare complication of chronic renal disease had been reported up to early 1994. A retrospective review of these reports has strongly suggested a close interrelationship between renal failure, secondary hyperparathyroidism, vascular calcification and cutaneous gangrene. The present report concerns a characteristic case to draw attention to this syndrome which is accompanied by serious, predominantly cutaneous, changes.

Role of active cell death (apoptosis) in multi-stage carcinogenesis

Active cell death is a genetically encoded self-destruction of a cell. There occur morphologically different types of active cell death, e.g. apoptosis in the liver or autophagic cell death in human mammary carcinoma cells after tamoxifen treatment (Pre)neoplastic lesions in rat liver exhibit enhanced rates of apoptosis, which tend to increase with increasing malignancy. Tumor promoters and non-genotoxic carcinogens inhibit active cell death, thereby increasing the accumulation of (pre)neoplastic cells and accelerating the development of cancer. On the other hand promoter withdrawal, fasting or application of negative growth signals such as transforming growth factor beta 1 (TGF beta 1) enhance apoptosis and can lead to selective regression of preneoplastic lesions or tumors.

Scedosporium apiospermum infection imitating lymphocutaneous sporotrichosis in a patient with myeloblastic-monocytic leukaemia

A 63-year-old man with a history of myeloblastic-monocytic leukaemia developed partly suppurating cutaneous nodules on the lower left leg. The nodules proceeded to spread in a linear fashion up the limb, following the line of the lymphatic drainage. Mycological examination of a skin biopsy demonstrated Scedoporium apiospermum. This case highlights the potential for Scedosporium species to act as opportunistic infections in immunosuppressed humans.

Role of endocrine factors in male infertility

On the evidence of physical examination, history, and semen analysis, endocrinological alteration is suspected in the background of infertility in about one third of the husbands of couples consulting a doctor because of childless marriage. The data of 206 male patients have been processed, and in 71 cases the serum FSH, LH, prolactin and testosterone contents were examined. Statistical analysis was performed for the relationship between gonadotropic hormones and testosterone level, and between the sperm motility and the FSH level, the results of which are presented here.

[Chronic renal failure with acquired perforating dermatosis]

A 50-year-old male patient suffering from renal failure was maintained in a stable condition by means of dialysis for 6 years. Hyperkeratotic papules appeared on his extremities. Histological investigation confirmed the diagnosis of perforating collagen disease. The dermatoses that are characterized by transepithelial elimination and associated with renal failure are discussed. The authors consider that the acquired perforating dermatoses should be regarded as a single entity.

Active cell death: role in hepatocarcinogenesis and subtypes

Active cell death, the genetically programmed self-destruction of a cell, is now recognized to be a widespread phenomenon in biology that counterbalances mitosis to preserve tissue homeostasis. It is subject to the control of the growth regulatory networks in tissues. Close examination of the morphology of dying cells in liver and other tissues suggests that there are a number of morphological types of active cell death, ranging from forms dominated by nuclear changes and without signs of autophagy ("classical" apoptosis), e.g., in thymocytes and the liver, to those dominated by autophagic degradation of cytoplasm, e.g., in the mammary gland. The induction of gene expression in these diverse types of cell death is anticipated to be different. Here we review the data regarding the regulation of apoptosis in the liver by liver tumor promoter, transforming growth factor beta-1 and related peptides as well as nutrition. In the course of hepatocarcinogenesis, initiated cells as well as preneoplastic and neoplastic cell populations showed enhanced cell replication, but also enhanced apoptosis. Tumor promoter shift the balance between birth and death by increasing the rate of cell replication and by decreasing the rate of apoptosis. Thereby, liver tumor formation is accelerated. Food restriction exhibits the opposite effect and consequently, provides protection from carcinogenesis.

[Scedosporium apiospermum infection in a patient with myelomonocytic leukemia presenting as lympho-cutaneous sporotrichosis]

63 year old patient is presented with myelo-monocytic leukemia, in whom subcutaneous nodules developed at the lower limb, spreading along the lymph vessels, and partly ulcerating. By mycologic investigation Scedosporium apiospermum was disclosed. Attention is drawn to human infections brought about by opportunistic Scedosporium species.

Bacillary angiomatosis in a patient with lymphocytic leukaemia

A 78-year-old man, who suffered from chronic lymphocytic leukaemia and diabetes mellitus, but was human immunodeficiency virus (HIV)-negative, developed disseminated angiomatous papules following a cat scratch. Bacillary angiomatosis was diagnosed by light and electron microscopic demonstration of the causative bacteria in the vascular lesions. The lesions resolved completely when he was treated with erythromycin. This case demonstrates that bacillary angiomatosis can be an important cutaneous manifestation of immunodeficiency in individuals who are not infected with the human immunodeficiency virus.

[Significance of skin manifestations in current medical diagnosis]

Skin lesions may signify not only cutaneous diseases, but also pathological changes of inner organs or standing of systemic diseases. The cutaneous symptoms characteristically associated with internal diseases are known as dermatodromes. The author analyzes the general impact of these on up-to-date medical diagnostic work, with special regard to their unique role in the early diagnosis of many important organic diseases, as well as to their significance for disease prognosis and therapy.

[Bacillary angiomatosis]

In a 78 years old patient with chronic lymphoid leukemia, diabetes mellitus a cat scratch induced disseminated angiomatous papules were observed. In the lesions great number of bacilluses were observed with light -and electron microscope. As a result of antibiotic treatment the lesions regressed without trace. This opportunist infection resulting general symptoms as well, may be regarded as a cutaneous manifestation of immunodeficiency. The adequate antibiotic treatment depends on the exact diagnosis.

Systemic lupus erythematosus with pigmented skin

The authors present the case of a thirty-six-year-old woman with systemic lupus erythematosus with specific vesiculobullous symptoms. Degos dermal infarcts and Schönlein-Henoch-type purpura was observed in the course of her illness. Attention is drawn to the rarity of this symptom group, which has not been documented in previous publications. Degos lesions accompanying the systemic lupus erythematosus were benign. The effectiveness of sulfone in the treatment of vesiculobullous symptoms in this case is noted.

Waldenström's macroglobulinaemia presenting with cold urticaria and cold purpura

A case of Waldenström's macroglobulinaemia presenting with non-specific dermatological symptoms (cold urticaria and cold purpura) is described in a 37-year-old female patient. Progressive telangiectasia and spider naevi were also observed. Involvement of the skin may be explained by the presence of macroglobulins with cryoprotein-like qualities. This facilitated an early diagnosis.

[Waldenstrm macroglobulinemia presenting in the form of cold urticaria and cold purpura]

A Waldenström macroglobulinemia case, manifested in the form of non-specific skin-symptoms (cold urticaria and cold purpura) is described in a 37 years old female patient. As new skin-symptoms progressive telangiectasia and naevi aranei could be observed. Involvement of skin may be explained by macroglobulins with kryoprotein properties, making early diagnosis possible at the same time.

[Sneddon syndrome (livedo and cerebrovascular lesion)]

A typical syndrome going on with skin (livedo racemosa generalisata) and brain (ischemic vascular) involvement is presented. Symptoms of skin and nervous system are made known in detail, as well as possibility of early diagnosis and standpoint of treatment.

[Role of Chlamydia trachomatis in diseases of the urogenital system]

The authors carried out 402 examinations to detect Chlamydia trachomatis. The agent was detected by serological methods. The cultivation and serological methods proved to give significant results. Doxycyclin and Eryc capsules were successful in the therapy. The great number of positive chlamydia cases suggest to focus attention on detecting the agent on the therapy and on the prevention of the spreading of infection.

[Cutaneous gangrene secondary to nephrogenic hyperparathyroidism]

Ischemic cutaneous gangrene is described in a 44 years old woman-patient, which could be attributed to metastatic calcinosis developed on account of secondary hyperparathyroidism. Recovery was obtained by subtotal parathyroidectomy, as well as by local treatment. For naming of the characteristic syndrome mentioned above, "uremic gangrene syndrome" is recommended.

[Secondary hyperparathyroidism manifesting as cutaneous gangrene in a patient on hemodialysis (uremic gangrene syndrome)]

Ischaemic cutaneous gangrene is described in a 44-year-old female patient. It was found to be attributable to metastatic calcinosis following secondary hyperparathyroidism. Recovery was obtained by means of subtotal parathyroidectomy combined with local treatment. The designation "uremic gangrene syndrome" is recommended for this characteristic syndrome.

[Anti-androgen treatment of hirsutism with cyproterone acetate]

22 female patients suffering from idiopathic hirsutism were treated according to Hammerstein's reversed sequential scheme over 12 months. During each treatment cycle of 21 days, the daily medication consisted of 1 coated tablet containing 0.035 mg ethinyl estradiol and 2 mg cyproterone acetate (Diane-35); in addition, the patients received one i.m. injection of 300 mg cyproterone acetate (Androcur-Depot) on the first day of each cycle. This therapy resulted in improvement of the disease in 19 of our patients (86.4%). The transitory, mild side effects observed did not require interruption of the treatment. The reversed sequential scheme making use of the depot form of CPA can successfully be administered in patients with hirsutism.

[Gardner syndrome]

A syndrome going with skin-bone signs and precancerous gastrointestinal polyposis is presented. Interest of our case is given by the extension of polyposis onto the whole digestive canal, early appearances of abdominal signs accompanying polyposis, and as a new symptom polycystic lung and extended superficial naevus lipomatosus.