Unilateral segmental presentation and a novel EPHB4 gene variant in capillary malformation-arteriovenous malformation type 2

Capillary malformation-arteriovenous malformation is a rare autosomal dominant disorder associated with EPHB4 loss-of-function mutations. We report the unique presentation of a 6-year-old girl with multiple capillary malformations in a unilateral segmental distribution affecting the right hemiface, right upper chest, and right arm associated with overgrowth. Targeted next-generation sequencing on a tissue sample revealed a novel heterozygotic variant in the EPHB4 gene (NM_004444.5 (EPHB4): c.715T>A, p.[Cys239Ser]). This case highlights a distinct presentation of CM-AVM type 2 and showcases a new variant in EPHB4 not previously reported in the literature.

Mission, Organization and Future Direction of the Serological Sciences Network for COVID-19 (SeroNet) Epidemiologic Cohort Studies

Global efforts are needed to elucidate the epidemiology of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), the underlying cause of coronavirus disease 2019 (COVID-19) including seroprevalence, risk factors and long-term sequelae, as well as immune responses following vaccination across populations and the social dimensions of prevention and treatment strategies. In the U.S., the National Cancer Institute in partnership with the National Institute of Allergy and Infectious Diseases, established the SARS-CoV-2 Serological Sciences Network (SeroNet) as the nation’s largest coordinated effort to study COVID-19. The network is comprised of multidisciplinary researchers bridging gaps and fostering collaborations between immunologists, epidemiologists, virologists, clinicians and clinical laboratories, social and behavioral scientists, policy makers, data scientists, and community members. In total, 49 institutions form the SeroNet consortium to study individuals with cancer, autoimmune disease, inflammatory bowel diseases, cardiovascular diseases, HIV, transplant recipients, as well as otherwise healthy pregnant women, children, college students, and high-risk occupational workers (including health care workers and first responders). Several studies focus on underrepresented populations, including ethnic minorities and rural communities. To support integrative data analyses across SeroNet studies, efforts are underway to define common data elements for standardized serology measurements, cellular and molecular assays, self-reported data, treatment, and clinical outcomes. In this paper, we discuss the overarching framework for SeroNet epidemiology studies, critical research questions under investigation, and data accessibility for the worldwide scientific community. Lessons learned will help inform preparedness and responsiveness to future emerging diseases.

Groundwater contamination in coastal urban areas: Anthropogenic pressure and natural attenuation processes. Example of Recife (PE State, NE Brazil)

In a context of increasing land use pressure (over-exploitation, surface-water contamination) and repeated droughts, identifying the processes affecting groundwater quality in coastal megacities of the tropical and arid countries will condition their long-term social and environmental sustainability. The present study focuses on the Brazilian Recife Metropolitan Region (RMR), which is a highly urbanized area (3,743,854 inhabitants in 2010) on the Atlantic coast located next to an estuarial zone and overlying a multi-layered sedimentary system featured by a variable sediment texture and organic content. It investigates the contamination and redox status patterns conditioning potential attenuation within the shallow aquifers that constitute the interface between the city and the strategic deeper semi-confined aquifers. These latter are increasingly exploited, leading to high drawdown in potenciometric levels of 20-30m and up to 70m in some high well density places, and potentially connected to the surface through leakage. From a multi-tracer approach (major ions, major gases, δ(11)B, δ(18)O-SO4, δ(34)S-SO4) carried out during two field campaigns in September 2012 and March 2013 (sampling of 19 wells and 3 surface waters), it has been possible to assess the contamination sources and the redox processes. The increasing trend for mineralization from inland to coastal and estuarial wells (from 119 to around 10,000μS/cm) is at first attributed to water-rock interactions combined with natural and human-induced potentiometric gradients. Secondly, along with this trend, one finds an environmental pressure gradient related to sewage and/or surface-channel network impacts (typically depleted δ(11)B within the range of 10-15‰) that are purveyors of chloride, nitrate, ammonium and sulfate. Nitrate, ammonium and sulfate (ranging from 0 to 1.70mmol/L, from 0 to 0,65mmol/L, from 0.03 to 3.91mmol/L respectively are also potentially produced or consumed through various redox processes (pyrite oxidation, denitrification, dissimilatory nitrate reduction to ammonium) within the system, as is apparent within a patchwork of biogeochemical reactors. Furthermore, intensive pumping in the coastal area with its high well density punctually leads to temporary well salinization ([Cl] reaching temporarily 79mmol/L). Our results, summarized as a conceptual scheme based on environmental conditions, is a suitable basis for implementing sustainable management in coastal sedimentary hydrosystems influenced by highly urbanized conditions.

Spectrum of enteropathogens detected by the FilmArray GI Panel in a multicentre study of community-acquired gastroenteritis

The European, multicentre, quarterly point-prevalence study of community-acquired diarrhoea (EUCODI) analysed stool samples received at ten participating clinical microbiology laboratories (Austria, Finland, France, Germany, Greece, Ireland, Italy, Portugal, Romania, and the UK) in 2014. On four specified days, each local laboratory submitted samples from ≤20 consecutive patients to the Austrian Study Centre for further testing with the FilmArray GI Panel (BioFire Diagnostics, Salt Lake City, UT, USA). Of the 709 samples from as many patients received, 325 (45.8%) tested negative, 268 (37.8%) yielded only one organism, and 116 (16.4%) yielded multiple organisms. Positivity rates ranged from 41% (30 of 73 samples) in France to 74% (59 of 80 samples) in Romania. With the exception of Entamoeba histolytica and Vibrio cholerae, all of the 22 targeted pathogens were detected at least once. Enteropathogenic Escherichia coli, Campylobacter species, toxigenic Clostridium difficile, enteroaggregative E. coli, norovirus and enterotoxigenic E. coli were the six most commonly detected pathogens. When tested according to local protocols, seven of 128 positive samples (5.5%) yielded multiple organisms. Overall, the FilmArray GI Panel detected at least one organism in 54.2% (384/709) of the samples, as compared with 18.1% (128/709) when testing was performed with conventional techniques locally. This underlines the considerable potential of multiplex PCR to improve routine stool diagnostics in community-acquired diarrhoea. Classic culture methods directed at the isolation of specific pathogens are increasingly becoming second-line tools, being deployed when rapid molecular tests give positive results. This optimizes the yield from stool examinations and dramatically improves the timeliness of diagnosis.

Bone mineral density in women with non-metastatic breast cancer: Effect of intravenous bisphosphonates given before adjuvant therapies

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Background: Adjuvant therapies shown survival improve of non-metastatic breast cancer (NMBC) patients, but they also decrease bone mineral density (BMD). Bisphosphonates are effective agents for the management of osteoporosis. Intravenous zoledronate, which is approved for the treatment of malignant hypercalcemia, multiple myeloma, and skeletal metastases, can suppress bone resorption and are often considered first-line therapy for the treatment of osteoporosis. We have analyzed the effects of chemotherapy on BMD of women with NMBC who received before adjuvant therapies intravenous bisphosphonates (zoledronic acid). Methods: We prospectively studied the effects of a single intravenous zoledronic acid dose (4 mg), on BMD of 74 women with NMBC (stage I-III), administred previous to the adjuvant therapies. The patients were referred to the Medical Oncology Service of University Hospital of Canary Islands between 2003 y 2006. Lumbar and hip BMD (g/cm2) was measured at diagnosis and after chemotherapy. The results were compared with a group of 80 patients with NMBC who received adjuvant therapy without intravenous bisphosphonates. Results: Breast cancer patients the median age was 52 ± 10 years old and the body mass index was 28,2 ± 5.5 kg/m2. At baseline there were not differences in BMD between the group that received bisphosphonates and the group with only chemotherapy at any of lumbar or femoral bone sites. In our study, the BMD after chemotherapy and intravenous bisphosphonates (n=74) significantly increased at femoral neck (0.805 ± 0.01, 0,826± 0.12; p=0.002) and trochanter (0.709 ± 0.01, 0.724 ± 0.01; p=0.002) and remained stable at lumbar, intertrochanter, total hip and Ward’s triangle; whether the group without bisphosphonates significantly decreased at lumbar (1.014 ± 0; 0.995 ± 0, p=0.0001), trochanter (0.701± 0; 0.690 ± 0, p=0,046), intertrochanter (1,095 ± 0; 1.078 ± 0, p=0.0001) and total hip (0,924 ± 0; 0.915 ± 0, p=0.046) areas (table). Conclusions: Women with NMBC are affected by early bone loss after adjuvant chemotherapy. Bisphosphonates intravenous (zoledronic acid) given before adjuvant therapy might be an effective treatment for this bone loss, increasing BMD or remaining stable.

No significant financial relationships to disclose.

Questionnaires to Assess Urinary and Anal Incontinence: Review and Recommendations

PURPOSE

We reviewed and provide recommendations about the most scientifically robust and appropriate questionnaires for evaluating symptoms and the quality of life impact of urinary and/or anal incontinence, and vaginal and pelvic floor problems. We also investigated the use of these questionnaires in randomized, controlled trials of treatment strategies.

MATERIALS AND METHODS

The Symptom and Quality of Life Committee of the International Consultation on Incontinence performed a systematic review of questionnaires related to urinary and anal incontinence, and vaginal and pelvic floor problems, searching MEDLINE, The Cochrane Library and other electronic databases between 2001 and 2004.

RESULTS

A total of 23 robust and relevant questionnaires could be recommended in clinical practice and research. The development of questionnaires to assess anal incontinence, and pelvic floor and vaginal problems has been limited with some promising measures but with none achieving the highest level of rigor. From 2001 to 2004 there were 150 published randomized trials of treatments for incontinence. Increasingly trials of incontinence are using recommended measures (38% of those for urinary incontinence and 22% of those for anal incontinence used the highest quality questionnaires in 2001 to 2004) but none of vaginal and pelvic floor problems used recommended questionnaires.

CONCLUSIONS

With increasing acknowledgment of the value of patient based assessment much attention has been given to the development of questionnaires to assess symptoms and quality of life. Sufficient measures are now available for urinary incontinence, and researchers and clinicians are encouraged to use the 18 achieving the highest level of rigor and their validated translations. In contrast, the development of questionnaires for anal incontinence and pelvic/vaginal problems is in its infancy and further study in this area is needed. Randomized trials of treatments for incontinence should use only questionnaires achieving the highest level of scientific rigor.

Risk factors for disease progression in patients with lower urinary tract symptoms/benign prostatic hyperplasia (LUTS/BPH): a systematic analysis of expert opinion

Disease progression has become an important issue for the management of lower urinary tract symptoms/benign prostatic hyperplasia (LUTS/BPH). Although several risk factors have been identified, no specific patient risk profiles have been established that can be useful in the day-to-day management of LUTS/BPH. In this study, an international panel of urologists developed a risk classification based on the attribution of a risk score to 243 unique patient profiles. From the perspective of clinical decision making, it was concluded that postvoid residual, symptom severity and maximum flow rate are the most relevant determinants of the risk of disease progression.

Integrating risk profiles for disease progression in the treatment choice for patients with lower urinary tract symptoms/benign prostatic hyperplasia: a combined analysis of external evidence and clinical expertise

The RAND appropriateness method was used to explore the relevance of risk factors for disease progression in the treatment choice for patients with lower urinary tract symptoms/benign prostatic hyperplasia (LUTS/BPH). A total of, 12 international experts assessed the appropriateness of various treatments for 243 risk profiles. Highest appropriateness rates were found for alpha1-adrenoceptor antagonists (68% of profiles) and combination therapy (46%). A large prostate volume was the dominant argument in favour of 5alpha-reductase inhibitors and combination therapy, but was irrelevant for the choice of surgery. Considerable postvoid residual, severe symptoms and poor maximum flow rate were the most important factors in favour of surgery.

Limits for the central production of Theta+ and Xi(--)pentaquarks in 920-GeV pA collisions

We have searched for Theta+(1540) and Xi(--)(1862) pentaquark candidates in proton-induced reactions on C, Ti, and W targets at midrapidity and square root of s = 41.6 GeV. In 2 x 10(8) inelastic events we find no evidence for narrow (sigma approximately 5 MeV) signals in the Theta+ --> pK0(S) and Xi(--) --> Xi- pi- channels; our 95% C.L. upper limits (UL) for the inclusive production cross section times branching fraction B dsigma/dy/(y approximately 0) are (4-16) mub/N for a Theta+ mass between 1521 and 1555 MeV, and 2.5 mub/N for the Xi(--). The UL of the yield ratio of Theta+/Lambda(1520) < (3-12)% is significantly lower than model predictions. Our UL of B Xi(--)/Xi(1530)0 < 4% is at variance with the results that have provided the first evidence for the Xi(--).

Aggressive behavior of papillary microcarcinoma in a patient with Graves' disease initially presenting as cystic neck mass

Prognosis of papillary carcinoma of the thyroid associated with Graves' disease is controversial; nevertheless, tumors smaller than 1 cm (microcarcinoma) are usually considered to render a good prognosis. We describe a patient with Graves' disease who developed a lateral cystic neck mass that was later confirmed to be a metastatic lymph node from papillary thyroid microcarcinoma. Contrary to having a good prognosis with a microcarcinoma, our patient developed bilateral lung metastases. The possible role of thyroid stimulating immunoglobulins in the aggressive course of the tumor is discussed.

Long-term therapy with policosanol improves treadmill exercise-ECG testing performance of coronary heart disease patients

This study examined the effects of long-term lipid-lowering therapy with policosanol on the clinical evolution, and exercise-ECG testing responses of 45 coronary heart disease (CHD) patients with myocardial ischemia, documented by exercise 201T1-myocardial perfusion scintigraphy, in an overall randomized, double-blind, placebo-controlled trial, made for different test endpoints. Fifteen patients were treated with 5 mg of policosanol twice daily; another 15 patients were administered the same drug dose plus 125 mg aspirin; and the other 15 patients received placebo plus equal aspirin dose. They were followed for 20 months, previous baseline observations, with treadmill exercise-ECG, besides serum lipid test. Beneficial changes on proportions among the 2 policosanol groups and the placebo group, showed an increment on functional capacity class, a decrement on rest and exercise angina, and a significant decrease in cardiac events, and in ischemic ST segment response, especially in the policosanol plus aspirin group (p = 0.05, X2(2df) = 5.8; p = 0.04, p = 0.02; Fisher). After treatment, sets of mean changes revealed an increase on maximum oxygen uptake, and a decline on double product simultaneously in both policosanol groups (p < or = 0.02, p < or = 0.002; Pillais, Hotellings' T2), while the placebo group was impaired. Aerobic functional capacity percent showed an increment in policosanol groups (p < or = 0.05, paired T). Lipid levels improved as other endpoints already reported. A supposed ergogenic effect of octacosanol, policosanol's main active compound, was not detected with this design. These results show that policosanol-treated CHD patients improved clinical evolution, and exercise-ECG responses, owing to the amelioration of myocardial ischemia, even more when administered with aspirin.

[Nephrotic syndrome. What is new since the 1988 study?]

The authors make a retrospective review of 53 new cases of Nephrotic Syndrome followed up in the Nephrology Unit from November 1988 to March 1994, bearing in mind the evaluation of casual changes of the disease standard regarding a previous study of 1988. Epidemiological, clinical, therapeutical and evolutional aspects were studied. Forty-four cases of primary Nephrotic Syndrome (83%) were identified, 61.4% of which behaved as cortico-sensitive, 25% as cortico-dependent, and 13.6% as cortico-resistant; 8 cases (15%) of Nephrotic Syndrome secondary to infection, Systemic Lupus Erythematosus and Amyloidosis, and 1 case of congenital Nephrotic Syndrome (2%). The theory that the high number of cortico-dependent is, probably, related with a higher severity in the relapse diagnosis and/or changes in the children's standard of living is admissible. It was also observed that at present there is a lower number of hospital discharges, related to more careful attitudes adopted regarding the evolution of the disease.

Model for voluntary wine and alcohol consumption in rats

It has been suggested that moderate consumption of ethanol and wine has a protective effect on human health. Animal models used to date for alcohol consumption can not mimic real situations in humans because the consumption is forced and/or excessive. The present study proposes to determine the effects of a voluntary and ad lib consumption model more similar to that of human behavior. Male Wistar rats had free access to either standard diet and water or the same diet plus red wine, sweet wine, or a solution equivalent to red wine (13.5% ethanol) or to sweet wine (20% ethanol + 130 g/L sucrose) for 30 days or 6 months. Daily wine consumption was 15.8 +/- 0.9 and 2.0 +/- 0.2 ml/day for sweet and red wines, respectively. The consumption of each of the alcoholic solutions was similar to that of the wine they were simulating. Drinking wine or ethanol did not affect food and water intakes or growth rate. Plasma metabolites were not substantially affected by consumption of wine or ethanol. Although moderate and high wine consumption did not change the activity of plasma marker enzymes of tissue damage, the consumption of the 2 alcoholic solutions caused a long-term increase in the activity of aspartate aminotransferase. It seems that wine consumption protects the organism from hepatic lesions induced by ethanol alone.

Mercury in hair for a child population from Tarragona Province, Spain

Mercury concentrations were determined in scalp hair of 233 school children aged 6-16 years. The study was carried out in three communities (Flix, Tarragona and Tortosa) from Tarragona Province (Southern Catalonia, Spain). The influence of the variables place of residence, age, sex, fish and seafood consumption, number of dental amalgam fillings, hair color, parents' occupation, and smoking habits of the household members was also examined. The geometric mean mercury concentration in hair was 0.77 microgram/g. The place of residence, sex, and the frequency in consuming fish and seafood were the variables that significantly affected hair mercury concentrations. Girls had more mercury in their hair than boys, whereas hair mercury levels were significantly correlated with the frequency in the fish and seafood consumption, with the levels being more elevated when the fish and seafood consumption was also higher. Hair mercury concentrations were also affected by the place of residence, with school children of Flix showing lower mercury concentrations than those found in children from Tarragona and Tortosa. The remaining variables had no influence on hair mercury levels.

Effect of policosanol on hyperlipidemia and coronary heart disease in middle-aged patients. A 14-month pilot study

To find out the long-term lipid-lowering efficacy of policosanol in low dose and its influence in the evolution of coronary heart disease (CHD), a pilot clinical randomized single-blind, placebo-controlled trial was conducted on 23 middle-aged outpatients, with well documented diagnosis of chronic CHD and primary or marginal hyperlipidemia. Twelve patients received policosanol tablets of 1 mg twice daily, and 11 patients placebo in the same fashion, followed with rest and stress electrocardiogram (ECG), and serum lipid blood samples by 14 months. The treated group showed significant reduction of total cholesterol in 14.8% (p < or = 0.001) and of low density lipoprotein (LDL) in 15.6% (p < or = 0.05), against non significant increase of 3% and 5.5%, respectively, in the placebo group. No patient had new coronary events in both groups, but 5 of 12 treated patients exhibited a clinical tendency to improve their CHD, in comparison with no one in the placebo group (p < or = 0.05). These findings show the effectiveness of low dose of policosanol lowering total cholesterol and LDL levels and suggest a CHD improvement in middle-aged patients with primary or marginal hyperlipidemia.

Prospective randomized trial of mechanical bowel preparation in patients undergoing elective colorectal surgery

A total of 149 patients admitted for elective colorectal surgery were randomly allocated to receive preoperative mechanical bowel preparation (group 1) or no mechanical bowel preparation (group 2). All patients received antimicrobial prophylaxis with cephalothin and metronidazole. The overall incidence of wound infection was 17.4 per cent (24 per cent for group 1, 12 per cent for group 2) and that of dehiscence 7.4 per cent (10 per cent for group 1, 5 per cent for group 2). The incidence of wound infection was significantly higher in group 1 (P < 0.05) but that of anastomotic dehiscence did not differ significantly between groups. Mechanical bowel preparation is unnecessary and may be harmful in terms of preventing wound infection and anastomotic dehiscence in patients undergoing elective colorectal surgery.

Quality in obstetrics using a telematic system

A telematic based system for antenatal care has been developed to be used in service integration between primary and secondary health care units. The system is based on low cost platforms and has a user friendly human computer interface. This system will provide better integration and coordination between the health care providers involved, improving the quality of the services. This experiment is being funded in the framework of the EC.Project-A 2007-EPIC. Quality indicators, agreed in the "European concensus conference of quality indicators for perinatal care", organized in conjunction with OBSQID project (AIM.2125) were integrated in the system. Data collection has started and the outcome will be used to validate the indicators on a transeuropean basis under the framework of the OBSQID Project.

On the Formation of AlPO4-Based Molecular-Sieves in the Presence of Cyclohexylamine

The hydrothermal synthesis of the AlPO4-17, SAPO-44, MnAPSO-44 and intermediate solid phases [samples (APO)N, (APSO)N and Mn (APSO)N] in the presence of cyclohexylamine (cha) is described. (APO)N, (APSO)N and Mn (APSO)N represent unknown, layer-type, crystalline phases with different chemical compositions. These phases are predominantly formed at a high cha concentration and low crystallization temperature. All synthesized materials contain protonated cha in their structure, but only in AlPO4-17, (APO)N,(APSO)N and Mn (APSO)N is the -OH group also found. The calcination of the unknown phases leads to the loss of crystallinity and causes a complete breakdown of the crystal structure above 270°C.

[Thyroid clinical dysfunction in patients chronically treated with amiodarone]

This is a prospective study of 132 patients, without previous thyroid dysfunction, chronically treated with amiodarone for cardiac arrhythmias, to determine the incidence of thyroid dysfunction. Age was 62 +/- 11 years (mean +/- SD); 54 were female and 78 male. The arrhythmia was supraventricular in 66%, ventricular in 26.5%, and both in 7.5%. Amiodarone dose was 2,390 +/- 65 mg/week, and follow-up 20 +/- 9 months (minimum 9 months). Thyroid status was evaluated at the onset and at regular intervals during follow-up by means of clinical indexes defined by Crooks et al and Billewicz et al. During follow-up 4 patients developed diagnostic indexes (two hyperthyroid and two hypothyroid) and seven more developed suggestive symptoms without reaching a diagnostic index. Biochemical serum determinations of thyroid function proved dysfunction in the four with diagnostic indexes, and were normal in the other seven. The prevalence of new thyroid dysfunction in patients chronically treated with amiodarone in our population is 3%, with equal incidence of hyper and hypofunction. This is the expected incidence for an area with adequate dietary iodine intake. The use of clinical indexes of thyroid dysfunction appear as a useful and economical means of following thyroid function in these patients, saving a large number of biochemical tests.

Periodontal treatment needs in 12-16-yr-old children from Santo Domingo

The purpose of this study was to determine the periodontal treatment needs, using the CPITN, in 12-16 yr-old children from private and public schools from Santo Domingo, Dominican Republic. A total of 1080 children was studied (540 in private schools and 540 in public schools). More children from private schools were seen without signs of periodontal disease than in public schools. More children from private schools showed no need for treatment. There was no statistical difference between children from private and public schools regarding the treatment need categories I and III. However, for the treatment need II category (oral hygiene-scaling), the children from public schools showed a slight increase in need over the private schoolchildren. Combining private and public schools, 12.9% of the 1080 children examined needed no treatment, 5.9% needed treatment I, 80.8% needed treatment II, and 0.4% needed treatment III.