Real world effectiveness of standard of care triple therapy versus two-drug combinations for treatment of people living with HIV

Background

Since 1996, the standard of care (SOC) therapy for HIV treatment has consisted of a backbone of two nucleoside analogue reverse transcriptase inhibitors (NRTI) paired with a third agent. Use of two-drug combinations (2DC) has been considered for selected patients to avoid toxicities associated with the use of NRTIs. This study aimed to compare the real-world outcomes of integrase strand transfer inhibitor (INSTI)-containing triple therapy (TT) to dolutegravir- (DTG) and/or boosted protease inhibitor (bPI)-based 2DC in a large Spanish cohort of HIV patients.

Methods

A retrospective analysis was performed using data from the VACH cohort, a prospective multicentre Spanish cohort of adult HIV patients. All treatment experienced patients initiating a TT of an INSTI combined with two NRTIs or a 2DC-containing DTG and/or a bPI between 01/01/2012 and 01/06/2017 were included. The unit of analysis was patient-regimens. The overall sample analysis was complemented with two sub-analyses. The first sub-analysis focused on patients treated with a backbone plus DTG compared to those treated with DTG+ one other antiretroviral. The second sub-analysis focused on patients with HIV RNA<50 copies/mL at baseline, irrespective of the regimen used. The following endpoints were assessed: time to discontinuation for any reason, time to switch due to virologic failure, and time to switch due to toxicity (reasons for discontinuation according to clinician report in the database). Time-to-event analyses were conducted using Kaplan–Meier survival curves and Cox regression models.

Results

Overall 7,481 patients were included in the analysis, contributing to 9,243 patient-regimens. Patient characteristics at baseline differed among groups, with the 2DC group being significantly older and having a higher proportion of women, a longer time on ART and a higher number of previous virologic failures. Median (95% Confidence Interval [C.I.]) time to switch was 2.5 years (2.3, 2.7) in 2DC group versus 2.9 years (2.7, 3.0) in TT. Adjusted hazard ratios (95% C.I.) for discontinuation due to any reason, virologic failure and toxicity in the 2DC vs TT group were 1.29 (1.15; 1.44), 2.06 (1.54; 2.77) and 1.18 (0.94; 1.48), respectively. Results were consistent in the two sub-analyses.

Conclusion

In this analysis, time to discontinuation and probability of remaining free of virologic failure were significantly higher in patients on INSTI-based TT compared to DTG- and/or bPI-containing 2DC, with no differences in toxicity.

Using AnABlast for intergenic sORF prediction in the Caenorhabditis elegans genome

Motivation

Short bioactive peptides encoded by small open reading frames (sORFs) play important roles in eukaryotes. Bioinformatics prediction of ORFs is an early step in a genome sequence analysis, but sORFs encoding short peptides, often using non-AUG initiation codons, are not easily discriminated from false ORFs occurring by chance.

Results

AnABlast is a computational tool designed to highlight putative protein-coding regions in genomic DNA sequences. This protein-coding finder is independent of ORF length and reading frame shifts, thus making of AnABlast a potentially useful tool to predict sORFs. Using this algorithm, here, we report the identification of 82 putative new intergenic sORFs in the Caenorhabditis elegans genome. Sequence similarity, motif presence, expression data and RNA interference experiments support that the underlined sORFs likely encode functional peptides, encouraging the use of AnABlast as a new approach for the accurate prediction of intergenic sORFs in annotated eukaryotic genomes.

Availability and implementation

AnABlast is freely available at http://www.bioinfocabd.upo.es/ab/. The C.elegans genome browser with AnABlast results, annotated genes and all data used in this study is available at http://www.bioinfocabd.upo.es/celegans.

Supplementary information

Supplementary data are available at Bioinformatics online.

Abstract 2906: eEF1A2 interacts with and inhibits PKR to enhance cancer cell survival

Human translation elongation factor 1α2, encoded by the eEF1A2 gene, is a pro-oncogenic protein absent from the majority of body tissues (with exception of brain, heart and skeletal muscle1), but expressed in many cancers1-3, where it provides tumor cells with improved fitness and survival. Though its canonical function is delivering aminoacyl-tRNAs to the ribosome, other “moonlighting” functions such as enhancing sphingosine kinase4,5 or antioxidant (most probably through peroxiredoxin-1 stimulation) activities6 have been described for the elongation factor. Recently, we have reported that eEF1A2 is the target for plitidepsin, a marine-derived cyclic depsipeptide currently under development for the treatment of relapsed or refractory multiple myeloma patients7. We have also confirmed that eEF1A2 interacted with previously described partners as PRDX1 and SPHK and enhanced their pro-survival activities8. Here we investigated the role of new “moonlighting functions” of eEF1A2 in the maintenance of the tumor phenotype and survival of cancer cells. Through co-immunoprecipitation and HPLC/MS we have uncovered the interaction between eEF1A2 and dsRNA-activated protein kinase (PKR, EIF2AK2). We have analyzed the kinase activity of PKR in the presence of eEF1A2, demonstrating that PKR activity is inhibited when complexed with eEF1A2. This complex is disrupted after plitidepsin binding to eEF1A2, rendering PKR active. Once activated, the kinase triggers a MAPK cascade and the NF-κB signaling pathway, leading to the activation of the extrinsic apoptotic pathway and the death of the tumor cell. Taken together, these results show that the fitness boost that the moonlighting functions of eEF1A2 provide to cancer cells, which are important for their growth and survival, constitutes an Achilles heel that can be purposely exploited in anticancer therapy. 1 Abbas, W., Kumar, A. & Herbein, G. Front Oncol 5, 75 (2015). 2 Anand, N. et al. Nature genetics 31, 301-305 (2002). 3 Li, Z. et al. PloS one 5, e10755 (2010). 4 Leclercq, T. M., Moretti, P. A., Vadas, M. A. & Pitson, S. M. J Biol Chem 283, 9606-9614 (2008). 5 Leclercq, T. M., Moretti, P. A. & Pitson, S. M. Oncogene 30, 372-378 (2011). 6 Chang, R. & Wang, E. J Cell Biochem 100, 267-278 (2007). 7 Losada, A. et al. Sci Rep 6, 35100 (2016) 8 Losada, A. et al. Abstract #1165, AACR Annual Meeting (2017)

Citation Format: Juan F. Martínez-Leal, Alejandro Losada, Maria Jose Muñoz, Marta Martinez-Diez, Juan Manuel Dominguez, Carlos M. Galmarini. eEF1A2 interacts with and inhibits PKR to enhance cancer cell survival [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 2906.

Oxidative stress prediction: A preliminary approach using a response surface based technique

A response surface was built to predict the lipid peroxidation level, generated in an iron-ascorbate in vitro model, of any organ, which is correlated with the oxidative stress injury in biological membranes. Oxidative stress studies are numerous, usually performed on laboratory animals. However, ethical concerns require validated methods to reduce the use of laboratory animals. The response surface described here is a validated method to replace animals. Tissue samples of rabbit liver, kidney, heart, skeletal muscle and brain were oxidized with different concentrations of FeCl₃ (0.1 to 8mM) and ascorbate (0.1mM), during different periods of time (0 to 90min) at 37°C. Experimental data obtained, with lipid content and antioxidant activity of each organ, allowed constructing a multidimensional surface capable of predicting, by interpolation, the lipid peroxidation level of any organ defined by its antioxidant activity and fat content, when exposed to different oxidant conditions. To check the predictive potential of the technique, two more experiments were carried out. First, in vitro oxidation data from lung tissue were collected. Second, the antioxidant capacity of kidney homogenates was modified by adding melatonin. Then, the response surface generated could predict lipid peroxidation levels produced in these new situations. The potential of this technique could be reinforced using collaborative databases to reduce the number of animals in experimental procedures.

Abstract 1165: Plitidepsin targets the moonlighting functions of eEF1A2 in cancer cells

Plitidepsin, a cyclic depsipeptide of marine origin, has shown potent anticancer activity in preclinical assays and recently finished with positive results a pivotal phase III trial (clinicaltrials.gov identifier: NCT01102426) for the treatment of multiple myeloma patients. We have recently found that eukaryotic elongation factor 1A2 (eEF1A2), one of the two isoforms of the alpha subunit of eEF1, is the pharmacological target of plitidepsin. Although it shares 96% homology with eEF1A1 (the other isoform), they display an exclusive pattern of expression, being eEF1A2 solely expressed in brain and muscle in healthy individuals. However, it has been found that many tumors abnormally overexpress this protein, including multiple myeloma, prostate, pancreatic, ovarian, breast, lung and liver cancers. Furthermore, although eEF1A2 canonical function consists in the delivery of aminoacyl-tRNAs to the A site in the ribosome, it has been shown to have pro-oncogenic moonlighting activities, including inhibition of apoptosis, protein degradation by the proteasome, heat shock response, cytoskeleton organization and regulation of oxidative stress. We now investigated several of the pro-oncogenic activities of eEF1A2 to analyze the impact that plitidepsin could have preventing them. Indeed, we observed that plitidepsin interfered with the interaction between eEF1A2 and Peroxiredoxin 1 (PRDX1), a complex that allosterically enhances the enzymatic activity of PRDX1. This way, plitidepsin would diminish PRDX1 antioxidant activity, possibly originating the oxidative stress that has been described in the bibliography as one of the first effects triggered by the drug in cancer cells. PRDX1 only interacts with the GDP-bound form of eEF1A2, while plitidepsin exclusively binds to the GTP-bound form, most probably sequestering this protein from the pool that could interact with and activate PRDX1. Furthermore, we have confirmed that eEF1A2 interacts with Sphingosine kinase 1 (SPHK1), a complex that has been described in the bibliography as having enhanced SPHK1 activity. SPHK1 phosphorylates sphingosine producing sphingosine-1-P, second messenger that binds to its receptors in the cell membrane and conveys growth and survival signals to the cell. We could see that plitidepsin treatment reduced the production of sphingosine-1-P in HeLa cells, destabilizing the equilibrium towards the pro-apoptotic ceramide/sphingosine side and promoting cell death. Thus, through its binding to eEF1A2, plitidepsin derails a series of its moonlighting functions that are essential for the survival of tumor cells, driving them into apoptosis.

Citation Format: Alejandro Losada, Maria Jose Muñoz, Juan F. Martínez-Leal, Juan M. Domínguez, Carlos M. Galmarini. Plitidepsin targets the moonlighting functions of eEF1A2 in cancer cells [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 1165. doi:10.1158/1538-7445.AM2017-1165

Predicting muscle fatigue: a response surface approximation based on proper generalized decomposition technique

A novel technique is proposed to predict force reduction in skeletal muscle due to fatigue under the influence of electrical stimulus parameters and muscle physiological characteristics. Twelve New Zealand white rabbits were divided in four groups ([Formula: see text]) to obtain the active force evolution of in vitro Extensor Digitorum Longus muscles for an hour of repeated contractions under different electrical stimulation patterns. Left and right muscles were tested, and a total of 24 samples were used to construct a response surface based in the proper generalized decomposition. After the response surface development, one additional rabbit was used to check the predictive potential of the technique. This multidimensional surface takes into account not only the decay of the maximum repeated peak force, but also the shape evolution of each contraction, muscle weight, electrical input signal and stimulation protocol. This new approach of the fatigue simulation challenge allows to predict, inside the multispace surface generated, the muscle response considering other stimulation patterns, different tissue weight, etc.

A Cartographic Tool for Managing African Swine Fever in Eurasia: Mapping Wild Boar Distribution Based on the Quality of Available Habitats

The current African swine fever (ASF) epidemic in Eurasia represents a risk for the swine industry with devastating socio-economic and political consequences. Wild boar appears to be a key factor in maintaining the disease in endemic areas (mainly the Russian Federation) and spreading the disease across borders, including within the European Union. To help predict and interpret the dynamics of ASF infection, we developed a standardized distribution map based on global land cover vegetation (GLOBCOVER) that quantifies the quality of available habitats (QAH) for wild boar across Eurasia as an indirect index for quantifying numbers of wild boar. QAHs were estimated using a seven-level scale based on expert opinion and found to correlate closely with georeferenced presence of wild boar (n = 22 362): the highest wild boar densities (74.47%) were found in areas at the two highest QAH levels, while the lowest densities (5.66%) were found in areas at the lowest QAH levels. Mapping notifications from 2007 to 2016 onto the QAH map showed that in endemic areas, 60% of ASF notifications occurred in domestic pigs, mostly in agricultural landscapes (QAHs 1.75 and 1) containing low-biosecurity domestic pig farms. In the EU, in contrast, 95% of ASF notifications occurred in wild boar, within natural landscapes (QAH 2). These results suggest that the QAH map can be a useful epi-tool for defining risk scenarios and identifying potential travel corridors for ASF. This tool will help inform resource allocation decisions and improve prevention, control and surveillance of ASF and potentially of other diseases affecting swine and wild boar in Eurasia.

Update on the Risk of Introduction of African Swine Fever by Wild Boar into Disease-Free European Union Countries

Despite efforts to prevent the appearance and spread of African swine fever (ASF) in the European Union, several Member States are now affected (Lithuania, Poland, Latvia and Estonia). Disease appearance in 2014 was associated with multiple entrances linked to wild boar movement from endemic areas (EFSA Journal, 8, 2015, 1556), but the risk of new introductions remains high (Gallardo et al., Porcine Health Management, 1, and 21) as ASF continues to be active in endemic countries (Russian Federation, Belarus and Ukraine). Since 2014, the number of ASF notifications has increased substantially, particularly in wild boar (WB), in parallel with slow but constant geographical advance of the disease. This situation suggests a real risk of further disease spread into other Member States, posing a great threat to pig production in the EU. Following the principles of the risk-based veterinary surveillance, this article applies a methodology developed by De la Torre et al. (Transboundary and Emerging Diseases, 62, and 272) to assess the relative risk of new introductions of ASF by natural movements of WB according to the current epidemiological situation. This update incorporates the most recent available data and an improved version of the most important risk estimator: an optimized cartographic tool of WB distribution to analyse wild boar suitable habitat. The highest relative risk values were estimated for Slovakia (5) and Romania (5), followed by Finland (4), Czech Republic (3) and Germany (3). Relative risk for Romania and Finland is associated mainly with disease entrance from endemic areas such as the Russian Federation and Ukraine, where the disease is currently spreading; relative risk for Germany and Czech Republic is associated mainly with the potential progress of the disease through the EU, and relative risk for Slovakia is associated with both pathways. WB habitat is the most important risk estimator, whereas WB density is the least significant, suggesting that WB presence is more relevant than density. These results can provide actionable advice for dealing with risk. They can be directly used to inform risk-based national strategies and identify countries that may need to pay greater attention to surveillance or conduct additional evaluations at the subnational level.

Virulence genes, antibiotic resistance and integrons in Escherichia coli strains isolated from synanthropic birds from Spain

The aim of this study was to determine the presence of virulence genes and antibiotic resistance profiles in 164 Escherichia coli strains isolated from birds (feral pigeons, hybrid ducks, house sparrows and spotless starlings) inhabiting urban and rural environments. A total of eight atypical enteropathogenic E. coli strains were identified: one in a house sparrow, four in feral pigeons and three in spotless starlings. Antibiotic resistance was present in 32.9% (54) of E. coli strains. The dominant type of resistance was to tetracycline (21.3%), ampicillin (19.5%) and sulfamethoxazole (18.9%). Five isolates had class 1 integrons containing gene cassettes encoding for dihydrofolate reductase A (dfrA) and aminoglycoside adenyltransferase A (aadA), one in a feral pigeon and four in spotless starlings. To our knowledge, the present study constitutes the first detection of virulence genes from E. coli in spotless starlings and house sparrows, and is also the first identification worldwide of integrons containing antibiotic resistance gene cassettes in E. coli strains from spotless starlings and pigeons.

Reproductive Ratio for the Local Spread of African Swine Fever in Wild Boars in the Russian Federation

African swine fever (ASF) has caused the swine industry of the Russian Federation substantial economic losses over the last 7 years, and the disease spread from there to a number of neighbouring countries. Wild boar has been involved in the spread of the disease both at local and at transboundary levels. Understanding ASF dynamics in wild boars is prerequisite to preventing the spread and to designing and applying effective surveillance and control plans. The reproductive ratio (R₀ ) is an epidemiological indicator commonly used to quantify the extent of disease spread. Here, it was estimated in nine spatio-temporal clusters of ASF in wild boar cases in the Russian Federation (2007-2013). Clusters were defined by exploring the maximum distance of association of ASF cases using K Ripley analysis and spatio-temporal scan statistics. A maximum spatial association of 133 km in wild boar cases was identified which is within de the conventional radius of surveillance zone (100-150 km). The mean range value of R₀  = 1.58 (1.13-3.77) was lower compared to values previously estimated for ASF transmission within farms but similar to early estimates between farm (R₀  = 2-3), in domestic pigs using notification data in the Russian Federation. Results obtained provide quantitative knowledge on the epidemiology of ASF in wild boars in the Russian Federation. They identify the ASF transmission rate value in affected natural wild populations, for the first time, which could provide basis for modelling ASF transmission and suggest that current surveillance radius should be reviewed to make surveillance in wild nature more targeted and effective.

Association of genetic variants of membrane receptors related to recognition and induction of immune response with Helicobacter pylori infection in Ecuadorian individuals

Helicobacter pylori (Hp) has a worldwide distribution showing its higher prevalence of infection in developing countries. Toll-like receptors (TLRs) and C-type lectin receptors (CLRs) are proteins that recognize pathogen-associated molecular patterns (PAMPs) and initiate an innate immune response by promoting growth and differentiation of specialized hematopoietic cells for host defense. Gastric infections led by Hp induce a Th-1 cellular immune response, regulated mainly by the expression of IFN-γ. In this retrospective case-control study, we evaluated the TLR1 1805T/G, TLR2 2029C/T, TLR4 896A/G, CD209 -336A/G and IFNGR1 -56C/T polymorphisms and their relationship with susceptibility to Hp infection. TLR1 1805T/G showed statistical differences when the control (Hp-) and infected (Hp+) groups (P = 0.041*) were compared; the TLR1 1805G allele had a protective effect towards infection (OR = 0.1; 95% CI = 0.01-0.88, P = 0.033*). Similarly, the IFNGR1 -56C/T polymorphism showed statistical differences between Hp+ and Hp- (P = 0.018*), and the IFNGR1 -56TT genotype exhibited significant risk to Hp infection (OR = 2.9, 95% CI = 1.27-6.54, P = 0.018*). In conclusion, the pro-inflammatory TLR1 1805T and IFNGR1 -56T alleles are related with susceptibility to Hp infection in Ecuadorian individuals. The presence of these polymorphisms in individuals with chronic infection increases the risk of cellular damage and diminishes the cellular immune response efficiency towards colonizing agents.

Assessing the Risk of African Swine Fever Introduction into the European Union by Wild Boar

The presence of African swine fever (ASF) in the Caucasus region and Russian Federation has increased concerns that wild boars may introduce the ASF virus into the European Union (EU). This study describes a semi-quantitative approach for evaluating the risk of ASF introduction into the EU by wild boar movements based on the following risk estimators: the susceptible population of (1) wild boars and (2) domestic pigs in the country of origin; the outbreak density in (3) wild boars and (4) domestic pigs in the countries of origin, the (5) suitable habitat for wild boars along the EU border; and the distance between the EU border and the nearest ASF outbreak in (6) wild boars or (7) domestic pigs. Sensitivity analysis was performed to identify the most influential risk estimators. The highest risk was found to be concentrated in Finland, Romania, Latvia and Poland, and wild boar habitat and outbreak density were the two most important risk estimators. Animal health authorities in at-risk countries should be aware of these risk estimators and should communicate closely with wild boar hunters and pig farmers to rapidly detect and control ASF.

Prevalence of malnutrition and its etiological factors in hospitals

BACKGROUND

Malnutrition among inpatients is highly prevalent, and has a negative impact on their clinical outcome. The Working Group for the Study of Malnutrition in Hospitals in Catalonia was created to generate consensus guidelines for the prevention and/or treatment of malnutrition in hospitals in Catalonia, Spain.

AIMS

The objectives of the study were to determine the prevalence of malnutrition on admission to hospital in Catalonia and to assess relationships between malnutrition, social and demographic data, overall costs, and mortality.

METHODS

Prospective and multicenter study conducted with 796 patients from 11 hospitals representative of the hospitalized population in Catalonia. Nutritional status was evaluated using the Nutritional Risk Screening 2002 method.

RESULTS

Overall, 28.9% of the patients are malnourished or at nutritional risk. Elderly patients, non-manual workers, those admitted to hospital as emergencies and with higher co-morbidities had higher risk of malnutrition. The type of hospital (second level vs. tertiary or University referral) to which they were admitted was also a factor predisposing to malnutrition. Length of hospital stay was longer in malnourished patients (10.5 vs. 7.7 days, p < 0.0001). The need for a convalescent home on leaving hospital was higher as well as the risk of mortality (8.6% malnourished vs. 1.3% nonmalnourished, p < 0.0001).

CONCLUSIONS

The prevalence of malnutrition is high in patients on admission to hospital in our community, resulting in elevated overall costs and higher risk of mortality. Age, social class and characteristics of the Unit and the Hospital are the main factors involved in hospital malnutrition.

Vector-borne pathogen spread through ticks on migratory birds: a probabilistic spatial risk model for South-Western europe

Tick-borne pathogens can spread easily through the movements of infested birds. An important example is viruses that pose a threat to humans and that are carried in Hyalomma ticks that move from Africa into south-western Europe. This study evaluates the probability of arrival of migrating birds from Africa into Spain and the environmental suitability of different regions of Spain for the survival of tick stages introduced by these birds. This evaluation produced a spatial risk index measuring the probability that foreign tick populations will survive in the target area. Periods of highest risk were observed for large areas of Spain, from the second fortnight of April to the second fortnight of May. Although birds may arrive as early as January and massive migrations may take place in March, the environmental suitability for Hyalomma marginatum ticks is low in these periods and high mortality of the spread stages (nymphs) is expected. This study introduces new methods of objective analysis based on spatial and process-driven models for both ticks and hosts and critically evaluates the usefulness of spatial spreading methods for assessing the risk of tick-borne pathogens.

Prevalence of malnutrition and its etiological factors in hospitals

BACKGROUND

Malnutrition among inpatients is highly prevalent, and has a negative impact on their clinical outcome. The Working Group for the Study of Malnutrition in Hospitals in Catalonia was created to generate consensus guidelines for the prevention and/or treatment of malnutrition in hospitals in Catalonia, Spain.

AIMS

The objectives of the study were to determine the prevalence of malnutrition on admission to hospital in Catalonia and to assess relationships between malnutrition, social and demographic data, overall costs, and mortality.

METHODS

Prospective and multicenter study conducted with 796 patients from 11 hospitals representative of the hospitalized population in Catalonia. Nutritional status was evaluated using the Nutritional Risk Screening 2002 method.

RESULTS

Overall, 28.9% of the patients are malnourished or at nutritional risk. Elderly patients, non-manual workers, those admitted to hospital as emergencies and with higher co-morbidities had higher risk of malnutrition. The type of hospital (second level vs. tertiary or University referral) to which they were admitted was also a factor predisposing to malnutrition. Length of hospital stay was longer in malnourished patients (10.5 vs. 7.7 days, p < 0.0001). The need for a convalescent home on leaving hospital was higher as well as the risk of mortality (8.6% malnourished vs. 1.3% nonmalnourished, p < 0.0001).

CONCLUSIONS

The prevalence of malnutrition is high in patients on admission to hospital in our community, resulting in elevated overall costs and higher risk of mortality. Age, social class and characteristics of the Unit and the Hospital are the main factors involved in hospital malnutrition.

Impact of climate change on risk of incursion of Crimean-Congo haemorrhagic fever virus in livestock in Europe through migratory birds

AIMS

To predict the risk of incursion of Crimean-Congo haemorrhagic fever virus (CCHFV) in livestock in Europe introduced through immature Hyalomma marginatum ticks on migratory birds under current conditions and in the decade 2075-2084 under a climate-change scenario.

METHODS AND RESULTS

A spatial risk map of Europe comprising 14 282 grid cells (25 × 25 km) was constructed using three data sources: (i) ranges and abundances of four species of bird which migrate from sub-Saharan Africa to Europe each spring, namely Willow warbler (Phylloscopus trochilus), Northern wheatear (Oenanthe oenanthe), Tree pipit (Anthus trivialis) and Common quail (Coturnix coturnix); (ii) UK Met Office HadRM3 spring temperatures for prediction of moulting success of immature H. marginatum ticks and (iii) livestock densities. On average, the number of grid cells in Europe predicted to have at least one CCHFV incursion in livestock in spring was 1·04 per year for the decade 2005-2014 and 1·03 per year for the decade 2075-2084. In general with the assumed climate-change scenario, the risk increased in northern Europe but decreased in central and southern Europe, although there is considerable local variation in the trends.

CONCLUSIONS

The absolute risk of incursion of CCHFV in livestock through ticks introduced by four abundant species of migratory bird (totalling 120 million individual birds) is very low. Climate change has opposing effects, increasing the success of the moult of the nymphal ticks into adults but decreasing the projected abundance of birds by 34% in this model.

SIGNIFICANCE AND IMPACT OF THE STUDY

For Europe, climate change is not predicted to increase the overall risk of incursion of CCHFV in livestock through infected ticks introduced by these four migratory bird species.

Neurodevelopmental liability to schizophrenia: the complex mediating role of age at onset and premorbid adjustment

Large individual variation in the clinical presentation of schizophrenia-spectrum disorders raises key questions regarding their aetiological underpinnings. In this respect, age at onset of the disorder is a particularly interesting marker of liability, as it has been reported to be associated with other signs of developmental compromise, such as male gender, increased presence of familial history of psychosis and poor premorbid adjustment, as well as a more severe clinical outcome in terms of cognition and symptomatology. The association between these variables has encouraged a neurodevelopmental perspective of the aetiological mechanisms involved in the pathophysiology of schizophrenia. However, the complex relationships within neurobiological liability markers, and between these markers and clinical outcome, remain to be understood. In the present study, we used a path-analytic approach to explore: i) the fit of the model to observed data; and both ii) direct and iii) indirect associations between the variables. In a sample of 106 patients with schizophrenia-spectrum disorders, we found a good fit of the model to the observed data, providing further evidence that supports a neurodevelopmental pathway to the disease in a subgroup of patients. However, the most parsimonious model showed complex relationships, where age at onset and premorbid functioning acted as mediators between gender, familial history of psychosis and clinical outcome. These findings refine earlier explanations of the neurobiological basis of schizophrenia, with potential applications in genetic studies based on more homogeneous forms of the disease. We further discuss the putative implications of our results in clinical practice and prevention policies.

Cannabis use and age at onset of psychosis: further evidence of interaction with COMT Val158Met polymorphism

OBJECTIVE

To examine, in a sample of young psychiatric patients, (n = 157, mean age 17.01 years (SD = 3.6)) whether i) age at first cannabis use and age at emergence of psychiatric disorders are related and ii) such a relationship is modulated by the Val158Met polymorphism in the COMT gene.

METHOD

Cannabis use profiles and COMT Val158Met genotypes were obtained from 80 inpatients with schizophrenia-spectrum disorders and 77 inpatients with other non-psychotic disorders.

RESULTS

First, age at first cannabis use correlates with age at onset in both schizophrenia-spectrum and other psychiatric disorder groups: those who started using cannabis earlier had an earlier age at onset of psychiatric disorders. Second, the distribution of the Val158Met genotypes was not different either between diagnosis groups or between cannabis users and non-users. Third, an interaction between Val158Met genotypes and cannabis use was observed specifically on age at emergence of psychotic disorders, with Val/Val genotype carriers showing an earlier age at onset than Met carriers.

CONCLUSION

Our results suggest the importance of brain maturation timing in which exposure to cannabis occurs. The COMT Val158Met genotype seems to modulate the association between cannabis and age at onset of psychotic disorders. These results are consistent with previous studies.

Chromatin and alternative splicing

Alternative splicing affects more than 90% of human genes. Coupling between transcription and splicing has become crucial in the complex network underlying alternative splicing regulation. Because chromatin is the real template for nuclear transcription, changes in its structure, but also in the "reading" and "writing" of the histone code, could modulate splicing choices. Here, we discuss the evidence supporting these ideas, from the first proposal of chromatin affecting alternative splicing, performed 20 years ago, to the latest findings including genome-wide evidence that nucleosomes are preferentially positioned in exons. We focus on two recent reports from our laboratories that add new evidence to this field. The first report shows that a physiological stimulus such as neuron depolarization promotes intragenic histone acetylation (H3K9ac) and chromatin relaxation, causing the skipping of exon 18 of the neural cell adhesion molecule gene. In the second report, we show how specific histone modifications can be created at targeted gene regions as a way to affect alternative splicing: Using small interfering RNAs (siRNAs), we increased the levels of H3K9me2 and H3K27me3 in the proximity of alternative exon 33 of the human fibronectin gene, favoring its inclusion into mature messenger RNA (mRNA) through a mechanism that recalls RNA-mediated transcriptional gene silencing.

First case of highly pathogenic avian influenza in poultry in Spain

In October 2009, highly pathogenic avian influenza virus (HPAIV) was isolated for the first time in poultry in Spain. Sequencing analysis revealed that it was an H7N7 HPAIV. The progenitors of H7 HPAIV strains involved in recent European poultry outbreaks were simultaneously circulating in wild birds. The infected Spanish farm is located close to a reservoir abundant in wild birds. Epidemiological investigation found no links to other poultry holdings and those located in the control area were negative for AIV. Previous spatial risk analyses had identified the area where the infected holding is located to beat high relative risk for the introduction and presence of H5N1 HPAIV by wild birds. We suggest a risk-based surveillance scheme that targets smaller geographical units but maintains the number of wild birds being sampled, as early detection of potentially pathogenic AIV is crucial in preventing spread to poultry.

Evaluation of three immunochromatographic assays for detection of Legionella pneumophila serogroup 1 antigen in urine samples

The Uni-Gold, the SAS and the Binax NOW immunochromatographic test (ICT) urinary antigen assays for the qualitative detection of Legionella pneumophila serogroup 1 were compared using 39 unfrozen and nonconcentrated urine samples from patients with Legionnaires disease (LD). The Uni-Gold antigen test detected the urinary antigen in 41% (16/39), the SAS antigen test in 61.5% (24/39), and the Binax NOW antigen test in 74.3% (29/39). The Binax NOW ICT assay showed the best results when detecting L. pneumophila urinary antigen.

The feasibility of developing a risk assessment for the impact of climate change on the emergence of Crimean-Congo haemorrhagic fever in livestock in Europe: a review

Crimean-Congo haemorrhagic fever virus (CCHFV) is one of the most widespread of all medically important arboviruses with ticks of the Hyalomma spp. serving as the main vectors. Infection of livestock by CCHFV serves as a route of exposure to humans, as a reservoir of disease and as a route of importation. This study discusses the pathways and data requirements for a qualitative risk assessment for the emergence of CCHFV in livestock in Europe. A risk map approach is proposed based on layers that include the potential routes of release (e.g. by migrating birds carrying infected ticks) together with the main components for exposure, namely the distributions of the tick vectors, the small vertebrate host reservoirs and the livestock. A layer on landscape fragmentation serves as a surrogate for proximity of livestock to the tick cycle. Although the impact of climate change on the emergence of CCHF is not clear, comparing the distribution of risk factors in each layer currently with those predicted in the 2080s with climate change can be used to speculate how potential high-risk areas may shift. According to the risk pathway, transstadial and/or transovarial transmission in the tick vector are crucial for CCHFV spread. Vector competence and tick vector switching, however, remain critical factors for CCHFV colonization of new regions in Europe. The species of migratory bird is also an important consideration in the release assessment with greater abundance and biodiversity of ground-dwelling birds in southern Europe than in northern Europe.

Purely intramedullary spinal cord primitive neuroectodermal tumor: case report and review of the literature

INTRODUCTION

Primitive neuroectodermal tumors (PNETs) are malign neoplasms of the central nervous system which mainly locate in cerebellum (medulloblastoma). Primary intraspinal PNETs are rare. Within this group, we have found ten cases of purely intramedullary PNETs (IPNETs). In this report, we describe a new IPNET case and review the literature about these infrequent intramedullary tumors.

CASE REPORT

A 17 month-old boy showed progressive decrease of motion in his lower extremities. Spine magnetic resonance imaging revealed an intramedullary expansive lesion from T3 to T10. A near-total removal was performed. The pathological diagnosis was PNET. Subsequent chemotherapy was recommended. Six months after operation, holocord progression has occurred.

CONCLUSION

IPNETs are uncommon tumors affecting children and young adults. They are characterized by recurrence, progression or intracranial dissemination. Outcome is dismal: most patients die within two years in spite of surgical resection followed by radiotherapy and chemotherapy.

A swimming pool-related outbreak of pharyngoconjunctival fever in children due to adenovirus type 4, Gipuzkoa, Spain, 2008

An outbreak of pharyngoconjunctival fever affecting 59 children was detected in a municipality of northern Spain in July 2008. The outbreak was related to insufficient doses of water disinfectant in the municipal swimming pool. Adenovirus was detected in the pharyngeal swabs of five of six affected children and the four strains that were sequenced were all Adenovirus type 4.

Risk of introduction of H5N1 HPAI from Europe to Spain by wild water birds in autumn

Highly pathogenic avian influenza (HPAI) subtype H5N1 continues to circulate across Eurasia and Africa since its unprecedented rapid spread in 2005. Diffusion by wild bird movements has been evidenced in the European Union in 2006 and 2007. Spain is an important wintering quarter for aquatic birds from northern latitudes, so identifying the critical areas and species where an outbreak is prone to happen is necessary. This work presents an assessment of the risk of introduction of H5N1 HPAI in Spain by aquatic wild birds estimating a relative risk value per province. For this purpose, an assessment of the release and exposure to the risk of infection with H5N1 HPAI of 25 selected water bird species has been carried out. Parameters considered in the assessment include H5N1 HPAI notifications from 2006 to 2008 and factors that favour the occurrence or persistence of H5N1 HPAI (wetlands' surface, low temperatures), together with aquatic wild birds' movements parameters (departure, destination, stop-overs, abundance) and parameters relative to the susceptible population in Spain: poultry density and wild aquatic abundance. Results show the relative risk for each Spanish province of experiencing H5N1 HPAI introduced by wild aquatic birds helping to identify higher risk areas.

An experimental study of the mouse skin behaviour: Damage and inelastic aspects

Samples of male and female mice skin were tested under monotonic and cyclic loading to mechanically characterize the tissue for large deformations. Cyclic tests have shown a typical Mullins effect widely known for elastomers and other soft tissues. No statistical difference was found in the maximum stretch of the sample after the fifth loading cycle for male (1.26 +/- 0.035) and female (1.18 +/- 0.083). However, larger dispersion was obtained for the maximum stress for both genders, 0.61 +/- 0.16 MPa for male and 0.78 +/- 0.32 MPa for female. Results show the presence of inelastic strain and stress softening in the skin at large deformations. They also have shown how stress softening and residual strain change with the magnitude of the applied load. Good correlation was observed between the residual strain and the maximum strain previously attained by the sample during loading for all samples. However, the correlation was different between genders.

A genetic fusion GDNF-C fragment of tetanus toxin prolongs survival in a symptomatic mouse ALS model

PURPOSE

Amyotrophic Lateral Sclerosis (ALS) is a paralyzing disorder that kills individuals within three to five years of onset without any possibility for effective treatment. One proposed therapy has been the use of neurotrophic factors to inhibit the apoptosis of motorneurones. At the present, one way to deliver neurotrophic factors after intramuscular injection to the motor neurones is through the use of adenoviral vectors. An alternative strategy is the use of the atoxic C fragment of tetanus toxin (TTC) as a neurotrophic factor carrier for motorneurones.

METHODS

We have produced the recombinant protein fusion Glial Derived Neurotrophic Factor and C fragment of tetanus toxin (GDNF-TTC) and we have tested its antiapoptotic activity in degeneration culture cells and in the symptomatic SOD;{G93A} transgenic animal model for ALS.

RESULTS

We demonstrated that GDNF-TTC induces the neuronal survival Akt kinase pathway in mouse cortical culture neurons and~maintains its antiapoptotic neuronal activity in Neuro2A cells. Moreover, we have found that genetic fusion is able to increase survival by 9 days and improves life quality in symptomatic ALS animal models.

CONCLUSION

These results suggest that recombinant GDNF-TTC fusion protein intramuscular injections provide a potential therapy for ALS treatment.

Endoscopic-assisted osteotomies for the treatment of craniosynostosis

INTRODUCTION

The development of multidisciplinar units for Craniofacial Surgery has led to better postoperative results and a considerable decrease in morbidity in the treatment of complex craniofacial patients.

MATERIALS AND METHODS

Standard correction of craniosynostosis involves calvarial remodeling, often considerable blood losses that need to be replaced and lengthy hospital stay. The use of minimally invasive techniques for the correction of some of these malformations are widespread and allows the surgeon to minimize the incidence of complications by means of a decreased surgical time, blood salvage, and shortening of postoperative hospitalization in comparison to conventional craniofacial techniques.

DISCUSSION AND CONCLUSION

Simple and milder craniosynostosis are best approached by endoscopy-assisted osteotomies and render the best results. Extended procedures other than simple suturectomies have been described for more severe patients. Different osteotomies resembling standard fronto-orbital have been developed for the correction, and the use of postoperative cranial orthesis may improve the final cosmetic appearance. Thus, endoscopic-assisted procedures differ from the simple strategy of single suture resection that rendered insufficient results in the past, and different approaches can be tailored to solve these cases in patients in the setting of a case-to-case bases.

[Positional plagiocephaly. Diagnosis and treatment]

INTRODUCTION

Positional plagiocephaly is nowadays the most frequent consultation at pediatric neurosurgical departments in Spain and western countries. Another important issue is the confusion existing in literature regarding terminology, physiopathology, differential diagnosis with true synostosis and, of course, proper recommendations for treatment.

OBJECTIVES

To clarify all these concepts and present a protocol that was recently asked by the Health Administration of the Community of Madrid.

PROTOCOL

Pretends to achieve coordination among paediatricians and neurosurgeons, as much as to offer precise information about data concerning this entity for parents, paediatricians and neurosurgeons.

MATERIAL AND METHODS

Previous consensus is reached about some data. Children are classified in three categories of deformation (mild; moderate; severe), according to measurements on digital photography. Diagnosis and treatment follows two phases: Paediatric phase (up to 5 months of age) and Neurosurgical phase (from 5 months on). Children would be referred to neurosurgical consultation only after being treated with postural changes and physiotherapy by the age of 5 months. Reasons are explained in the protocol that defines also functions and responsibilities for each speciality.

CONCLUSION

Treatment proposed here is staged, starting with postural changes and physiotherapy, followed by orthotic cranial devices and finally surgical treatment.

Risk assessment applied to Spain's prevention strategy against highly pathogenic avian influenza virus H5N1

Notifiable avian influenza (NAI) had never been reported in Spain, until July 2006 when a dead Great Crested Grebe (Podiceps cristatus) was found positive to the highly pathogenic H5N1 subtype as part of the active wild bird surveillance plan. The current program of the Spanish Ministry of Agriculture, Fisheries, and Food (MAPA)'s strategic preventive plan against NAI is divided in the following parts: identification of risk areas and risk wild bird species, increased biosecurity measures, early detection of infection with surveillance intensification and development of rapid diagnostic tests, and other policies, which include continuing education and training to ensure early detection of the disease. In 2003 an active surveillance plan was introduced for domestic fowl; the plan was extended to wild birds in 2004. A total of 18,780 samples in poultry and 3687 samples in wild birds had been analyzed through December 2005 to detect the presence and spread of avian influenza subtypes H5 and H7. In the present work we suggest some contributions to be implemented in MAPA's action plan: 1) the identification of risks because of migratory birds, within the risk assessment of the introduction of NAI virus in Spain and 2) an interactive digital simulator of the disease developed for continuing education and training.

Isolation and development of haematopoietic progenitor cells from peripheral blood of adult and newborn pigs

Pluripotent stem cells (PSCs), already described in human beings, are fibroblast-like cells that exhibit a CD34 marker specific for haematopoietic stem cells. In this work we have demonstrated the presence of PSCs in the peripheral blood of pigs, a species frequently used in transplantation studies as an animal model for human diseases. Differentiation into haematopoietic colonies (granulomacrophagic colonies, erythroid colonies and mixed colonies) has been carried out with the peripheral blood of adult and newborn pigs, using solely human commercial media. Peripheral blood mononuclear cells (PBMNCs) were cultured in semisolid methylcellulose based media enriched with recombinant human cytokines, achieving granulomacrophagic-colony forming unit (GM-CFU) and mixed-colony forming unit (Mix-CFU) growth with erythroblastic lineage proliferation in the presence of erythropoietin (Epo). In all the samples CFU growth was associated with the presence of recombinant human cytokine. No evidence of proliferation in control plates without cytokines was found. From liquid medium culture, a population of macrophages and CD34+ fibroblast like cells were retrieved 21 days after sowing. These findings allow us to think about the direct application of this simple and standardised method in several work fields such as the study of pharmacological effects of many drugs over the haematopoietic line and in the study of new strategies in cellular therapy for some human diseases.

Study and culture of haematopoietic progenitor cells from peripheral blood in rats, hamsters and mice

The aim of this work was to isolate and cultivate a subpopulation of pluripotent stem cells present in peripheral blood of different animal species, frequently used in laboratory studies (mice, rats and hamsters). Pluripotent stem cells (PSCs), already described in human beings, are fibroblast-like cells that exhibit a CD34 marker, specific for haematopoietic stem cells. Commonly used human commercial media were investigated for culturing animal PSCs. These findings suggest that this simple and standardized methodology may be applicable in several fields such as the study of the pharmacological effects of drugs on the haematopoietic line and the study of new strategies in cellular therapy for some human diseases.

Use of nonlinear mixed effect modeling for the intestinal absorption data: Application to ritonavir in the rat

The aim of this study is to investigate in situ the mechanisms involved in the gastrointestinal absorption of ritonavir in the rat, as an animal model for preclinical studies of anti-HIV agents in vivo. Four ritonavir solutions (40, 27, 13 and 7 microM) in the presence of 1% dimethylsulfoxide (DMSO) were perfused in the small intestine of anaesthetised rats. Effects of DMSO on the intestinal permeability were investigated using solutions containing antipyrine 1.33 mM and ritonavir 7 microM with and without 1% of DMSO. Antipyrine and ritonavir transport was not modified in the presence of 1% of DMSO. The population pharmacokinetic parameters of the ritonavir intestinal transport were obtained by means of nonlinear mixed effect modelling approach according to a nonlinear absorption and nonlinear secretion. The absorption and secretion kinetic parameters for ritonavir were: Vm=47.6 microM/h; Km=8.77 microM; Vms=3.66 microM/h and Kms=0 microM. The interindividual variability found to ritonavir Vm 13.1%, and the residual variability was 8.98%. The Kms value support the saturation of the carrier at the range of concentrations of ritonavir assayed. The interindividual variability value of the Vm could explain, at least in part, the variability in absorption rate constants observed.

Conservation of purified protein derivative RT-23 tuberculin

OBJECTIVE

Recommendations that purified protein derivative (PPD) RT-23 tuberculin should not be kept and used more than 24 to 48 hours after opening are rarely complied with. The aim of this study was to determine whether using PPD RT-23 tuberculin from vials that had been open for a longer time could affect results of tuberculin tests and whether the solution could become contaminated.

METHODS

A prospective cross-sectional study was carried out. Two tuberculin tests were simultaneously administered, one in each forearm, to adult contacts of patients with active tuberculosis, one test using a recently opened vial of tuberculin (control) and the other using tuberculin that had been opened a week before (first phase) or a month before (second phase) (study tuberculin). Leftover tuberculin from several of the vials was cultured.

RESULTS

For the 127 patients in the first group (tuberculin opened 1 week), the mean (SD) diameter of the induration was 6.2 (6.9) mm for the study tuberculin and 6.3 (6.9) mm for the control (P=.3). For the 83 patients in the second group (tuberculin opened 1 month), the mean diameter of the induration was 5.5 (7.3) mm for the study tuberculin and 5.7 (7.3) mm for the control (P=.5). There were no differences between the number of positive tests found. None of the cultured tuberculins produced bacterial growth.

CONCLUSIONS

PPD RT-23 tuberculin does not appear to lose potency or sterility when vials have been opened for a week or a month.

Gliomas del tronco encefálico

Brainstem gliomas have been increasingly understood in the last two decades and they are nowadays regarded as an heterogeneous group of tumors with tendency towards the pediatric age, where they account for 10-20% of brain neoplasms. Besides the well known diffuse tumor, several subtypes, with a different biological behaviour, amenable to surgical resection and better prognosis, have been identified, giving rise to many classifications and terms. In the other way, attention has been recently paid to adult brainstem gliomas in contrast to pediatric tumors. Based on a review of the literature, we describe the different subtypes of brainstem gliomas, with particular interest on therapeutic approaches and differences between pediatric and adult tumors, employing iconography from our series.

Fronto-orbital remodeling without orbito-naso-frontal bandeau

INTRODUCTION

Fronto-orbital bilateral advance is the procedure of choice for the treatment of craniosynostosis affecting most of the anterior area of the skull and orbitomalar regions. The aim of the technique is to achieve a supra-orbital bilateral bar and a frontal bone. We have introduced a modification in order to simplify the technique.

PATIENTS AND METHODS

From November 1998 to January 2002, 18 patients with craniosynostosis have been surgically treated using our technique. The mean age when the treatment was performed was 6.93 months (range 3 to 22 months). Brain computed tomography (CT) scans and three-dimensional (3-D) reconstruction of CT scans were performed before and after treatment.

SURGICAL TECHNIQUE

A bifrontal craniotomy was performed taking the osteotomy up to the supraorbital rim. A new frontal bone was obtained from another region of the cranium creating new orbital edges. The osteosynthesis was conducted using absorbable materials.

RESULTS

The follow-up of the patients ranged from 3 months to 3 years. All patients were studied using CT scans and 3-D reconstruction of CT after treatment, which demonstrated the persistence of the fronto-orbital advance. No secondary complications related to the new technique were found in any of the patients.

CONCLUSIONS

The frontal-orbital advance obtained was stable. The technique was simplified by not creating a supraorbital bar and by reducing the bone fixation points. The manipulation of both frontal lobes and orbital globes was negligible. The aesthetic results were excellent.

[Congenital brain tumors: nine cases and review of the literature]

OBJECTIVE

To review congenital brain tumors patients younger than 2 months diagnosed in our Department.

PATIENTS AND METHODS

Nine congenital brain tumors were diagnosed between 1983 and 2001 among a consecutive serie of 484 paediatric cerebral tumors (patients less than 15 years). Clinical and radiological findings and prognostic factors are analyzed.

RESULTS

There were two teratomas, two glioblastomas, one xanthogranuloma affecting cavernous sinus, one supratentorial PNET and one medulloblastoma and one oligodendroglioma. In one case histological diagnosis was not possible. In four cases antenatal diagnosis was done by means of ultrasonography and MRI. Seven patients were operated on, with one intraoperative exitus. Five patients died due to tumoral progression in the first two months after surgery. Another case was considered not amenable for surgical resection, and thus was not operated. He died in the fifth day of life. Three patients are alive 14, 36 and 72 months after surgery, one with severe psicomotor delay, another one with normal mental status but dependent on seizures medication and the last one with mild mental delay. In the last case of our serie intrauterine death happened by 33(rd )week and histological diagnosis was not possible.

CONCLUSIONS

Prognosis for congenital brain tumors depends on the operative morbidity and tumor histology. However final prognosis in these patients is still discouraging, despite early surgery and operative and anaesthetic improvements.

Intraventricular cavernoma in pediatric age

INTRODUCTION

Cavernomas rarely occur in the ventricular system. Only 10 pediatric cases out of 46 well-documented cases have been published.

CASE REPORT

We report the case of an 11-year-old girl operated on for a voluminous cavernoma at the ventricular trigone which was diagnosed after absence seizures.

CONCLUSION

Interestingly, the case we report showed a hypointense rim on T2-weighted magnetic resonance images which has not been a common finding in the cases previously reported.

Surgical treatment of trigonocephalies and associated hypoteleorbitism

Premature closure of metopic suture is a relatively uncommon form of craniosyostosis with an estimated incidence of 0,3 per 1000 live births, comprising about 7% of surgical craniosynostosis referred to craniofacial centers. A broad phenotypical spectrum spreads from minor metopic ridges to severe trigonocephaly with pterional indentation supraorbital bar retrusion, temporal and parietal compensating bossings and hypotelorism. Most of the cases arise spontaneously although autosomal dominant inheritance has been described and association with cromosomal abnormalities and different syndromes has been widely reported. Surgical correction has been attempted with good cosmetic results using several variations of the standard frontoorbitary advance. However there is still a number of questions to be solved in relation to this entity, mainly on its pathogenesis, but also on its development, natural history and treatment. Direct surgical approach to associated hypotelorism is a matter of argument when considering the reestablishment of normal interorbitary distances. We have conducted a retrospective analysis of our serie consisting of twenty-eight cases of trigonocephalies. Surgical correction of hypotelorism was attempted in eleven cases while the resting seven children remained "not treated". The objective was to review the functional outcome and cosmetic results comparing the different techniques applied to the frontal bone and to observe evolution of the hypoteleorbitism after the treatment with or without osteotomies and grafting of the nasoethmoidal area.

Poly(A) site choice during mRNA 3'-end formation in the Schizosaccharomyces pombe wos2 gene

In the fission yeast Schizosaccharomyces pombe, the wos2 gene encodes p23, a highly conserved protein which functions as a co-chaperone for the heat shock protein Hsp90. This p23 protein binds to Hsp90, but its activities and regulatory mechanisms are still unclear. Northern analysis has shown that the wos2 gene produces three transcripts of about 1.1, 0.9 and 0.8 kb, which are expressed differentially depending on the growth temperature. The largest and the smallest transcripts were most abundant at 25 degrees C, whereas the 0.9-kb transcript predominated at 37 degrees C. A time-course analysis indicated that this 0.9-kb species rapidly increased in abundance after a shift from 25 degrees C to 37 degrees C, reaching a maximum after 15 min. A shift back to 25 degrees C resulted in a decline in the amount of this transcript, albeit at a slower rate. Expression analysis of wos2:ura4 and nmt1:wos2 constructs showed that the 3' untranslated region of wos2 alone directs the formation of these multiple, discrete wos2 mRNAs. Sequence analysis of cDNAs derived from these mRNAs showed that the use of different polyadenylation sites results in the production of the three differently sized wos2 transcripts. In the case of the 0.9- and 0.8-kb mRNA species, these sites lie in a predicted hairpin loop in the mRNA, suggesting that polyadenylation signals in wos2 transcripts may be mediated by RNA secondary structure. The possibility that differential thermal stability of these hairpin structures could influence polyadenylation site choice during formation of the 3'-ends of the mRNAs is discussed.

[Endoscopic treatment of suprasellar arachnoid cysts]

Arachnoid cysts account for only 1% of all intracranial space-occupying lesions. In adults suprasellar cysts represent 9% of all the arachnoid cysts while in pediatric population this percentage reaches 15%. In spite of being a problem relatively common in daily neurosurgical practice there are still a number of questions to be solved concerning pathogenesis and evolution, natural history and treatment. Located in the suprasellar cistern and closely related to the ventricular system, suprasellar arachnoid cysts conform a perfect indication for endoscopic treatment. The development and spreading of neuroendoscopic techniques have surpassed the standard microsurgical approaches as an elective treatment. However there is still controversy on the management of associated hydrocephalus, need for cystoperitoneal shunt after endoscopic fenestration or the superiority of ventriculocystocisternostomy over simple ventriculocystostomy. The authors present a serie of seven consecutive patients with "de novo" diagnosis of suprasellar arachnoid cyst. In every case the treatment consisted in endoscopic fenestration and removal of the cyst membranes, with or without associated ventriculostomy of the IIIrd ventricle. Preoperative symptoms improved in all the patients and five out of seven remain shunt free. One patient maintains a cystoperitoneal shunt and another one, previously shunted, remains shunt dependent. The clinical presentation and postoperative evolution are commented with discussion on the alternative therapeutic options from the endoscopic point of view.

Evaluation of the application of pig slurry to an experimental crop using agronomic and ecotoxicological approaches

The agronomic and ecotoxicological effects of the application of pig (Sus scrofa) slurry during a maize (Zea mays L.) crop cycle under conditions of forced irrigation were evaluated. The 0.2-ha experimental area, of typical xerofluvent soil and of known vulnerability to nitrate (NO3-) contamination, was divided into 12 plots and provided with water measurement instruments (TDR-probes, vertical tensiometers, and ceramic candles). Samples of soil, water, soil organisms, and the crop were subjected to analytical, agronomic, and biological test procedures. The following fertilizer treatments were applied to triplicate plots: urea (U;170 kg N ha(-1)), and an optimized (P1; 162 kg N ha(-1)) and triple (P3; 486 kg N ha(-1)) dose of pig slurry. Unfertilized plots (P0) served as controls. Calculation was made of seasonal drainage and leached NO3- and sodium losses during the experimental period. Conductivity, heavy metal concentration, hardness, pH, and redox potential were determined in soil solutions. The ecotoxicological evaluation of the soil solution and matrix was based on ecotoxicity bioassays and the quantification of organic and inorganic compounds [phenols, indols, polychlorinated biphenyls (PCBs)]. The results suggest that the P3 treatment is highly contaminating due to the leaching of nitrates and increased soil salinity. Despite the fact that a Folsomia candida reproduction test indicated chronic ecotoxicological effects on the soil in plots treated with P1 and P3, the absence of organic compounds suggests that these effects may be attributable to contaminants not considered in this study.

Spanish intercomparisons for individual monitoring

The Spanish Nuclear Safety Council (CSN) carries out an intercomparison programme for individual monitoring every 5 years. The objective is to acquire valuable information on the performance of the dosimetry systems of the participating Spanish approved dosimetry services and to assess precision and accuracy as quality indicators of overall dosimetry performance. CSN has carried out two intercomparison programmes, the last one in 1995, in which 18 approved dosimetry services participated. The dosemeters were exposed to photon fields (137Cs gamma rays and two X ray beams of different qualities), at two standard laboratories in Spain. The irradiations were done for evaluating personal dose equivalent, Hp(10), using the ICRU 47 phantom. Presently, CSN is carrying out a new intercomparison, which will be finished in 2001. Twenty-three dosimetry services will participate; 22 from Spain and one from Cuba. The irradiations will be done in reference photon radiation fields.

Ecotoxicological evaluation of pig slurry

Swine sewage could be source of nutrients and pollutants. This work estimates the environmental risk in nine samples from different farm treatment systems based on the evaluation of their effects in Daphnia magna acute test, and on the assessment of Cu, Zn and ammonia as main contributors. NH3 and Cu were responsible for LC50 results (1-5% of dilution). Organic compounds were quantified through several extraction methods (SPMDs, SPE and solvent extraction). A more exhaustive extraction was performed in an additional sample, which showed indole and phenol recoveries much higher than the previous ones. This method also includes PCBs (430 ppb) and fatty acids (approximately =150 ppm) quantification.

[Neurocutaneous melanosis]

Neurocutaneous melanosis (NCM) is a rare congenital syndrome characterized by large or multiple congenital melanocytic nevi and excessive proliferation of melanotic cells in the leptomeninges. We report the case of a girl with a giant hairy nevus and numerous small nevi since birth. Within the first 2 years of life she developed clinical features of increased intracranial pressure and West s syndrome. At 2 years of age she presented a right facial palsy and myelopathy. Brain and spinal magnetic resonance imaging demonstrated meningeal infiltration. Diagnosis of NCM was established by a detailed cytologic analyses of the cerebrospinal fluid that revealed melanocytic cells. She received palliative treatment. The girl died 2 months after. Patients with large or multiple congenital melanocytic nevi should be carefully followed up with clinical examination and neuroimaging to detect NCM. At present there is no curative treatment. The association of NCM and West s syndrome has not been previously described.