Postnatal genetic and neurodevelopmental assessment in infants born at term with severely low birth weight of non-placental origin

OBJECTIVE

To determine the frequency of genetic syndromes and childhood neurodevelopmental impairment in non-malformed infants born at term with severely low birth weight and no evidence of placental insufficiency.

METHODS

This case series was constructed from the data of infants delivered at term between 2013 and 2018 with severely low birth weight, defined as birth weight more than 2.5 SD below the mean, with normal maternal and fetal Doppler (umbilical artery, fetal middle cerebral artery, cerebroplacental ratio and uterine artery) and no maternal hypertensive disorder during pregnancy or fetal structural anomaly on prenatal ultrasound examination. Clinical exome sequencing and copy number variation (CNV) analysis were performed using DNA extracted from the children's saliva. Cognitive and psychomotor development was evaluated using the Bayley Scales of Infant and Toddler Development, 3rd edition or the Wechsler Intelligence Scale for Children, 5th edition tests, according to the child's age at testing.

RESULTS

Among the 36 405 infants born within the study period, 274 (0.75%) had a birth weight below -2.5 SD, of whom 98 met the inclusion criteria. Among the 63 families contacted, seven (11%) reported a postnatal diagnosis of a genetic syndrome and a further 18 consented to participate in the study. Median gestational age at delivery was 38.0 (interquartile range (IQR), 37.3-38.5) weeks and median birth weight was 2020 (IQR, 1908-2248) g. All 18 children showed a normal result on clinical exome sequencing and CNV analysis, but six (33%) obtained a low score on neurodevelopmental testing.

CONCLUSION

Non-malformed severely small term infants with no clinical or Doppler signs of placental insufficiency present a high rate of genetic syndromes and neurodevelopmental impairment during childhood. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Laboratory evaluation of eleven rapid diagnostic tests for serological diagnosis of Chagas disease in Colombia

BACKGROUND

Chagas disease is a public health challenge in Colombia, where only an estimated 1.2% of people at risk have accessed diagnosis, while less than 0.5% of affected people have obtained treatment. The development of simplified diagnostic algorithms would enable progress in access to diagnosis; however, the current diagnostic algorithm relies on at least two laboratory-based tests that require qualified personnel, processing equipment, and infrastructure, which are still generally lacking at the primary care level. Rapid diagnostic tests (RDTs) for Chagas disease could simplify diagnosis, but their performance in the epidemiological context of Colombia is not well known.

METHODOLOGY

A retrospective analytical observational study of RDTs was performed to estimate the operational characteristics of 11 commercially available RDTs designed for in vitro detection of anti-T. cruzi IgG antibodies. The study was performed under controlled laboratory conditions using human serum samples.

PRINCIPAL FINDINGS

Eleven RDTs were assessed, ten using 585 serum samples and one using 551 serum samples. Employing the current national diagnostic algorithm as a reference standard for serological diagnosis of chronic infection, the sensitivity of the assessed RDTs ranged from 75.5% to 99.0% (95% CI 70.5-100), while specificity ranged from 70.9% to 100% (95% CI 65.3-100). Most tests (7/11, 63.6%) had sensitivity above 90%, and almost all (10/11, 90.9%) had specificity above 90%. Five RDTs had both sensitivity and specificity above 90%.

CONCLUSIONS/SIGNIFICANCE

The evaluation of these 11 commercially available RDTs under controlled laboratory conditions is a first step in the assessment of the diagnostic performance of RDTs in Colombia. As a next step, field studies will be conducted on available RDTs with sensitivity and specificity greater than 90% in this study, to evaluate performance in real world conditions, with the final goal to allow simplified diagnostic algorithms.

An overview of the trypanosomatid (Kinetoplastida: Trypanosomatidae) parasites infecting several mammal species in Colombia

BACKGROUND

Trypanosomatids are among the most critical parasites for public health due to their impact on human, animal, and plant health. Diseases associated with these pathogens manifest mainly in poor and vulnerable populations, where social, environmental, and biological factors modulate the case incidence and geographical distribution.

METHODS

We used Sanger and amplicon-based next-generation sequencing (NGS) in samples from different mammals to identify trypanosomatid infections in several departments in Colombia. A total of 174 DNA samples (18 humans, 83 dogs, and 73 wild mammals) were analyzed by conventional PCR using a fragment of the heat shock protein 70 (Hsp70) gene and Sanger sequenced the positive samples. Twenty-seven samples were sent for amplicon-based NGS using the same gene fragment. Data obtained were used to perform diversity analyses.

RESULTS

One hundred and thirteen samples were positive for PCR by Hsp70 fragment; these corresponded to 22.1% Leishmania spp., 18.6% L. amazonensis, 9.7% L. braziliensis, 14.2% L. infantum, 8% L. panamensis, and 27.4% Trypanosoma cruzi. Comparison of the identified species by the two sequencing technologies used resulted in 97% concordance. Alpha and beta diversity indices were significant, mainly for dogs; there was an interesting index of coinfection events in the analyzed samples: different Leishmania species and the simultaneous presence of T. cruzi and even T. rangeli in one of the samples analyzed. Moreover, a low presence of L. braziliensis was observed in samples from wild mammals. Interestingly, to our knowledge, this is the first report of Leishmania detection in Hydrochaeris hydrochaeris (capybara) in Colombia.

CONCLUSIONS

The Hsp70 fragment used in this study is an optimal molecular marker for trypanosomatid identification in many hosts and allows the identification of different species in the same sample when amplicon-based sequencing is used. However, the use of this fragment for molecular diagnosis through conventional PCR should be carefully interpreted because of this same capacity to identify several parasites. This point is of pivotal importance in highly endemic countries across South America because of the co-circulation of different genera from the Trypanosomatidae family. The findings show an interesting starting point for One Health approaches in which coevolution and vector-host interactions can be studied.

Amplicon-based next-generation sequencing reveals the co-existence of multiple Leishmania species in patients with visceral leishmaniasis

Visceral leishmaniasis (VL) is a mammalian protozoal disease propagated in the Americas by female phlebotomine sandflies, mainly caused by Leishmania infantum. However, in recent years, cases of VL caused by different Leishmania species, such as L. amazonensis and L. colombiensis, have been reported in the continent. This study used an amplicon-based next-generation sequencing approach to identify VL aetiologic species using high-depth sequencing targeting a region on the Heat Shock Protein 70 gene. In this first approach, six samples from five patients diagnosed with VL were selected and analysed to identify DNA of Leishmania spp. All samples harboured DNA of L. infantum; five samples were found to be co-infected with other Leishmania spp. or with Trypanosoma cruzi, and just one sample was mono-infected with L. infantum. This study demonstrates the usefulness of this methodology to identify trypanosomatid co-infections in clinical samples, which presents an interesting study panorama considering their biological, clinical and epidemiological implications.

Intraoperative irradiation in breast cancer: preliminary results in 80 patients as partial breast irradiation or anticipated boost prior to hypo-fractionated whole breast irradiation

Purpose

To present the first results of intraoperative irradiation (IORT) in breast cancer with a low-energy photon system used as partial breast irradiation (PBI) or as an anticipated boost before whole breast hypo-fractionated irradiation (IORT + WBI), concerning tolerance, side effects, quality of life, and patient-reported outcomes.

Materials and methods

Eighty patients treated with an Intrabeam^® system of 50 kV X-rays received a 20 Gy dose intraoperatively were included. Moderate daily hypofractionation of 2.7 Gy in 15 fractions up to 40.5 Gy was administered if high-risk factors were present. Acute post-operative toxicity, surgery complications, chronic toxicity, patient-reported cosmesis and Breast-Q questionnaire were performed at follow-up visits.

Results

Thirty-one patients were treated as PBI and the remaining 49 as IORT + WBI. Only the IORT + WBI group presented acute toxicity, mainly mild acute dermatitis (11 patients) and one subacute mastitis. A total of 20 patients presented fibrosis (18 patients grade I, 2 patients grade II), 15 (30.5%) patients in the IORT + WBI group and 3 (9.6%) patients in the group of PBI. The cosmesis evaluation in 73 patients resulted poor, fair, good or excellent in 2, 7, 38 and 26 patients, respectively. In PBI group Breast-Q scored higher, especially in terms of their psychosocial well-being (78 vs 65) and satisfaction with radiation-induced toxicity (77 vs 72, respectively) compared to IORT + WBI group.

Conclusion

IORT is a well-tolerated procedure with low toxicity, good cosmesis and favorable patient-reported outcomes mainly when administered as PBI.

P–543 Inhibition of cell proliferation and extracellular matrix formation in human uterine leiomyomas by 5-aza–2’-deoxycitidine via Wnt/ β-catenin pathway

Study question

Is DNA methylation reversion through DNA methyltransferases (DNMT) inhibitors, such as 5-aza–2’-deoxycitidine, a potential therapeutic option for treatment of patients with uterine leiomyomas (UL)?

Summary answer

5-aza–2’-deoxycitidine reduces proliferation and extracellular matrix (ECM) formation by inhibition of Wnt/ β-catenin pathway on UL cells, suggesting DNMT inhibitors as an option to treat UL. What is known already: UL is a multifactorial disease with an unclear pathogenesis and inaccurate treatment. Aberrant DNA methylation have been found in UL compared to myometrium (MM) tissue, showing hypermethylation of tumor suppressor genes, which contributes to the development of this tumor. The use of DNMT inhibitors, such as 5-aza–2’-deoxycytidine (5-aza-CdR), has been suggested to treat tumors in which altered methylation pattern is related to tumor progression, as occurs in UL. Based on this, we aimed to evaluate whether DNA methylation reversion through 5-aza-CdR reduces cell proliferation and ECM formation in UL cells, being a potential option for UL medical treatment.

Study design, size, duration

Prospective study comparing UL versus MM tissue and human uterine leiomyoma primary (HULP) cells treated with/without 5-aza-CdR at 0 µM (control), 2 µM, 5 µM and 10 µM for 72 hours. UL and MM tissue were collected from women without any hormonal treatment for the last 3 months (n = 16) undergoing myomectomy or hysterectomy due to symptomatic leiomyoma pathology. Participants were recruited between January 2019 and February 2020 at Hospital Universitario y Politecnico La Fe (Spain).

Participants/materials, setting, methods

Samples were collected from Caucasian premenopausal women aged 31–48 years, with a body mass index of < 30 and without hormonal treatment. DNMT1 gene expression was analysed in UL vs MM tissue by qRT-PCR and activity of DNMT was measured in UL and MM tissue and cells by ELISA. 5-aza-CdR effect on proliferation was assessed by CellTiter test and Western blot (WB), apoptosis and ECM analyzed by WB and Wnt/ β-catenin pathway by qRT-PCR and WB. Main results and the role of chance: DNMT1 gene expression was increased in UL compared to MM tissue (fold change [FC]=2.49, p-value [p]=0.0295). Similarly, DNMT activity was increased in both UL compared to MM tissue and HULP cells versus MM cells (6.50 vs 3.76 OD/h/mg, p = 0.026; 211.30 vs 63.67 OD/h/mg, p = 0.284, respectively). After 5-aza-CdR treatment, cell viability of HULP cells was reduced in a dose dependent manner, being statistically significant at 10 µM (85.25%, p = 0.0001). Accordantly, PCNA protein expression was significantly decreased at 10 µM in HULP cells (FC = 0.695, p = 0.034), demonstrating cell proliferation inhibition. Additionally, 5-aza-CdR inhibited ECM protein expression in HULP cells in a dose-dependent manner being statistically significant at 10 µM for COLLAGEN I (FC = 0.654, p = 0.023) and PAI–1 (FC = 0.654, p = 0.023), and at 2 µM and 10 µM for FIBRONECTIN (FC = 0.812, p = 0.020; FC = 0.733, p = 0.035; respectively). Final targets of Wnt/ β-catenin pathway were decreased after 5-aza-CdR treatment, protein expression of WISP1 was significantly inhibited at 10 µM (FC = 0.699, p = 0.026), while expression levels of Wnt/ β-catenin target genes C-MYC (FC = 0.745, p = 0.028 at 2 µM; FC = 0.728, p = 0.019 at 10 µM) and MMP7 (FC = 0.520, p = 0.003 at 5 µM, FC = 0.577, p = 0.007 at 10 µM) were also significantly downregulated in HULP-treated cells vs untreated cells. Limitations, reasons for caution: This study has strict inclusion criteria to diminish epigenetic variability, thereby we should be cautious extrapolating our results to general population. Besides, this is a proof of concept with the inherent cell culture limitations. Further studies are necessary to determine 5-aza-CdR dose and adverse effects on UL in vivo.

Wider implications of the findings: 5-aza-CdR treatment reduces cell proliferation and ECM formation through Wnt/ β-catenin pathway inhibition, suggesting that inhibition of DNA methylation could be a promising new therapeutic approach to treat UL.

Trial registration number

Not applicable

Cannabinoid hyperemesis syndrome, a treatment discussion

Introduction

Cannabinoid hyperemesis syndrome (CHS), is characterized by recurrent episodes of severe nausea and intractable vomiting, preceded by chronic use of cannabis. A pathognomonic characteristic is compulsive bathing in hot water. The resolution of the problem occurs when cannabis use is stopped. However, patients are often reluctant to discontinue cannabis. Treatment with anti-emetic medication is ineffective. Case series suggested haloperidol as a potential treatment. Other antipsychotics as olanzapine has been used as anti-emetic treatment in chemotherapy.

Objectives

To describe three cases of patients with CHS whom showed a successful response to olanzapine, even when, haloperidol had failed.

Aims

To present an alternative treatment for CHS which can offer benefits over haloperidol.

Methods

We present three cases of patients who suffered from CHS and were admitted to emergency department. All patients were treated with olanzapine after conventional anti-hemetic treatment failure. One patient was also unsuccessfully treated with haloperidol.

Results

All three patients showed a good response to olanzapine treatment. Different presentations were effective: velotab and intramuscular. Their nausea, vomits and agitation were ameliorated. They could be discharge after maintained remission of symptoms.

Conclusions

Olanzapine should be considered as an adequate treatment for CHS. Its suitable receptorial profile, its availability in different routes of administration and its side effects profile could offer some benefits over haloperidol.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Maps of Tethys' Thermophysical Properties

On 11^th April 2015 Cassini's Composite Infrared Spectrometer (CIRS) made a series of observations of Tethys' daytime anti-Saturn hemisphere over a nine-hour time period. During this time the sub-spacecraft position was remarkably stable (0.3° S to 3.9° S; 153.2° W to 221.8° W), and so these observations provide unprecedented coverage of diurnal temperature variations on Tethys' anti-Saturn hemisphere. In 2012 a thermal anomaly was discovered at low latitudes on Tethys' leading hemisphere; it appears cooler during the day and warmer at night than its surroundings (Howett et al., 2012) and is spatially correlated with a decrease in the IR3/UV3 visible color ratio (Schenk et al., 2011). The cause of this anomaly is believed to be surface alteration by high-energy electrons, which preferentially bombard low-latitudes of Tethys' leading hemisphere (Schenk et al., 2011; Howett et al., 2012; Paranicas et al. 2014; Schaible et al., 2017). The thermal anomaly was quickly dubbed "Pac-Man" due to its resemblance to the 1980s video game icon. We use these daytime 2015 CIRS data, along with two sets of nighttime CIRS observations of Tethys (from 27 June 2007 and 17 August 2015) to make maps of bolometric Bond albedo and thermal inertia variations across the anti-Saturn hemisphere of Tethys (including the edge of its Pac-Man region). These maps confirm the presence of the Pac-Man thermal anomaly and show that while Tethys' bolometric Bond albedo varies negligibly outside and inside the anomaly (0.69±0.02 inside, compared to 0.71±0.04 outside) the thermal inertia varies dramatically (29±10 J m^-2 K^-1 s^-1/2 inside, compared to 9±4 J m^-2 K^-1 s^-1/2 outside). These thermal inertias are in keeping with previously published values: 25±3 J m^-2 K^-1 s^-1/2 inside, and 5±1 J m^-2 K^-1 s^-1/2 outside the anomaly (Howett et al., 2012). A detailed analysis shows that on smaller spatial-scales the bolometric Bond albedo does vary: increasing to a peak value at 180° W. For longitudes between ~100° W and ~160° W the thermal inertia increases from northern to southern latitudes, while the reverse is true for bolometric Bond albedo. The thermal inertia on Tethys generally increases towards the center of its leading hemisphere but also displays other notable small-scale variations. These thermal inertia and bolometric Bond albedo variations are perhaps due to differences in competing surface modification by E ring grains and high-energy electrons which both bombard Tethys' leading hemisphere (but in different ways). A comparison between the observed temperatures and our best thermal model fits shows notable discrepancies in the morning warming curve, which may provide evidence of regional variations in surface roughness effects, perhaps again due to variations in surface alteration mechanisms.

Milk digestion in the young rabbit: methodology and first results

This study aims to determine the digestibility of milk by the young rabbit (21-25 d old), taking into account the increment of digesta content and urine excretion. Nineteen litters of 9 young rabbits 21 to 25 d old were used: 12 litters (S group) fed exclusively with milk using controlled suckling, and 7 litters (Control group) with free suckling and access to the pelleted feed of the doe. The faecal digestibility of milk dry matter (DM) was measured between 21 and 25 d of age, for S litters housed from 15 d of age in a metabolism cage separately from their mother. Between 21 and 25 d, the milk intake, faeces and urine excretion were controlled daily, and the mean increment in digesta content was measured by comparing digesta weight of the whole tract at 21 and 25 d of age (one kit per litter). The increment in digesta content from 21 to 25 d averaged 77% (+8.5 g), sourcing mainly from stomach and caecum contents increase (+57 and +120% respectively). The mean increase for the dry content of the gut (from 21 to 25 d) was 1.75 g DM/kit, and was considered as non-digested to calculate the digestibility coefficient of the milk. The milk intake averaged 30 g/d/kit (7.9 g DM/d kit). No faecal excretion was recorded between 21 and 25 d. From the milk intake and increment in digesta content, the corrected digestibility of the milk dry matter reached 94% (minimum=92.9%, maximum=95.6%). The daily urine excretion averaged 5.1 mL/kit, corresponding to 1.2 g DM/kit. Therefore, the corrected DM retention coefficient of the milk was 79.5%. The quantity of nitrogen excreted in urine was low (0.06 g/d kits), thus the corrected nitrogen retention coefficient for milk reached 82% and the nitrogen retained (corrected) reached 0.44 g/d kit. Accordingly, the amount in metabolisable protein for the milk was 90 g/kg (fresh). The corrected energy retention coefficient was estimated to 95.8%, for a crude energy concentration estimated at 28.14 MJ/kg DM for the milk. Thus, the energy retained (corrected) reached 223 kJ/d kit and the content in metabolisable energy for the milk was 26.94 MJ/kg DM.

Eye-Hand Coordination Assessment Metrics Using a Multi-Platform Haptic System with Eye-Tracking and Motion Capture Feedback

In this paper, we discuss the possibility to determine assessment metrics for eye-hand coordination, using a mapping between a robotic haptic device to a virtual environment, and correlating it with the eye-gaze and upper arm movements. Our goal is to develop, implement and refine a system that will assess and improve eye-hand coordination in individuals with disabilities. A detailed analysis of patterns was conducted by therapists in order to select various levels of difficulty that could be included in the system, and which would yield the greatest benefit in terms of assessment of coordination as well as in training. Participants were instructed to use a haptic device (Omni) to follow the trajectories. This was completed while video data were collected using a Vicon motion capture system. Readings of traced trajectories, time, and upper limb motions were recorded for further analysis. One of the patterns was chosen to develop a multi-platform haptic system to be virtually rendered with any haptic device and a Graphic User Interface (GUI) with options to guide the user along the chosen pattern using a haptic tunnel calculated by using B-splines. Two types of haptic tunnels are presented and evaluated: one that follows the mid path of the pattern, and one that takes the smoothest path through the pattern. Finally, the Pearson coefficient was chosen as a metric to correlate the haptic device and the eye-gaze coordinates recorded simultaneously while the user traces a path.

A hexagon in Saturn's northern stratosphere surrounding the emerging summertime polar vortex

Saturn's polar stratosphere exhibits the seasonal growth and dissipation of broad, warm vortices poleward of ~75° latitude, which are strongest in the summer and absent in winter. The longevity of the exploration of the Saturn system by Cassini allows the use of infrared spectroscopy to trace the formation of the North Polar Stratospheric Vortex (NPSV), a region of enhanced temperatures and elevated hydrocarbon abundances at millibar pressures. We constrain the timescales of stratospheric vortex formation and dissipation in both hemispheres. Although the NPSV formed during late northern spring, by the end of Cassini's reconnaissance (shortly after northern summer solstice), it still did not display the contrasts in temperature and composition that were evident at the south pole during southern summer. The newly formed NPSV was bounded by a strengthening stratospheric thermal gradient near 78°N. The emergent boundary was hexagonal, suggesting that the Rossby wave responsible for Saturn's long-lived polar hexagon-which was previously expected to be trapped in the troposphere-can influence the stratospheric temperatures some 300 km above Saturn's clouds.

Direct and correlated responses to selection in two lines of rabbits selected for feed efficiency under ad libitum and restricted feeding: III. Digestion and excretion of nitrogen and minerals

Two rabbit lines have been created to result in better feed efficiency: the ConsoResidual line was selected for a lower residual feed intake under ad libitum feeding, and the ADGrestrict line was selected for higher ADG under restricted feeding (-20% of ad libitum). The present study aimed to analyze the digestion and excretion of N and minerals from 29 to 63 d of age of these 2 lines compared with an unselected control line (G0) under 2 feeding levels (ad libitum or restricted). The ADGrestrict line had greater digestibility compared with G0 (+1.3% for OM and N; < 0.05), and the ConsoResidual line had intermediate values. There was no genetic line effect on the digestibility of N and P and on minerals concentrations (P, Zn, and Cu) in the feces and in the urine. The N balance was improved for the 2 selected lines (+5%; < 0.05), leading to a reduced N output through the feces (0.06 g/d compared with G0; < 0.001) and the urine (-0.07 g/d; < 0.05) and to an improved N retention ratio (+3% compared with G0). Over the whole fattening period (d 29-63), significant differences were observed among lines only when fed ad libitum, with 13% greater DM fecal output and 5% greater N fecal output for G0. The N excretion in urine was 2 g less in the 2 selected lines, leading to a reduction of total N release of 4.4 g (compared with G0). The P excretion in feces (12 g) or urine (0.1 g) did not differ among the 3 lines. Over the whole fattening period and for ad libitum-fed rabbits, the 5% improvement in feed efficiency ( < 0.01) for the 2 selected lines corresponded to 400 g less feed intake (-8%) and to 20 g less N intake. The fecal excretion of the ADGrestrict and ConsoResidual lines were reduced by 200 g DM ( < 0.01), corresponding to 417 g fresh matter and 5 g of N. The excretion in minerals (P, Zn, and Cu) was not affected by the line. The feeding level strongly reduced the fecal and urine outputs (-50 and -60%, respectively; < 0.001). Higher digestibility coefficients ( < 0.001) were found in restricted-fed rabbits for OM (+6%), N (+8%), and P (+11%). The N balance was substantially improved by the restriction, with 40% less total (feces + urine) N excretion ( < 0.001). The P balance was improved by the restriction (0.469 vs. 0.360). Over the fattening period, the P fecal output was 37% less (-6 g) with 24% less feed intake and the Zn and Cu outputs were reduced by 27 (-130 mg) and 29% (-30 mg), respectively.

Clozapine induced diarrhea

Introduction

Clozapine (CZP) is the only antipsychotic approved for resistant schizophrenia 1. Due to its side effects, CZP is not the first therapeutic option in a psychotic episode. Its anticholinergic effects often cause constipation, however, diarrhea have also been described in literature.

Objectives

We describe a patient with two episodes of severe diarrhea after clozapine initiation, which lead to CZP discontinuation.

Aims

Discuss about the differential diagnosis of diarrhea in CZP patients and the needing of a further studies for clarify the more appropriate management in CZP induced diarrhea.

Methods

We present a case report of a 46 years man diagnosed with schizoaffective disorder who presented two episodes of severe diarrhea with fever, which forced his transfer to internal medicine and UCI after CZP initiation.

Results

At the first episode analytical, radiological and histological findings led to Crohn's disease diagnosis, which required budesonide and mesalazine treatment. In the second episode, the digestive team concluded that the episode was due to clozapine toxicity despite the controversial findings (clostridium toxin and Crohn's compatible biopsies)

Conclusions

Diarrhea caused by CZP has been controversial in the literature. However due to the severity of digestive episodes and the paucity of alternative treatments further studies for a better understanding of its physiopathology are warranted.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Polydipsia and intermittent hyponatremia

Introduction

Hyponatraemia occurs in 4% of schizophrenic patients. Dilutional hyponatraemia, due to inappropriate retention of water and excretion of sodium, occurs with different psychotropic medications and could lead to hippocampal dysfunction. This complication is usually asymptomatic but can cause severe problems, as lethargy and confusion, difficult to diagnose in mentally ill patients.

Objectives

To describe a case of a patient with psychotropic poli-therapy, admitted three times due to hyponatremia and the pharmacological changes that improved his condition.

Aims

To broadcast the intermittent hyponatraemia and polydipsia (PIP), a not rare condition, suffered by treated schizophrenic patients and discuss its physiopathology and treatment thorough a case report.

Methods

A 56-year schizophrenic male was admitted for presenting disorganized behavior, agitation, auditory hallucinations, disorientation, ataxia, vomits and urinary retention. He was on clomipramine, haloperidol and clotiapine (recently added), quetiapine, fluphenazine and clonazepam. After water restriction his symptoms improved and he was discharged. Twenty-five days later, he was readmitted for presenting the same symptoms and after water restriction, he was discharged. Five days later, he was again admitted and transferred to the psychiatric ward.

Results

Haloperidol, fluphenazine and clomipramine were replaced by clozapine. These changes lead him to normalize the hypoosmolality and reduce his water-voracity. Endocrinology team did not label this episode of SIADH due to its borderline blood and urine parameters.

Conclusions

Hyponatremia is frequent in schizophrenic patients and may have severe consequences. Therefore, a prompt recognition and treatment is warranted.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Direct and correlated responses to selection in two lines of rabbits selected for feed efficiency under ad libitum and restricted feeding: I. Production traits and gut microbiota characteristics

To get insights into selection criteria for feed efficiency, 2 rabbit lines have been created: the ConsoResidual line was selected for residual feed intake (RFI) with ad libitum feeding and the ADGrestrict line was selected for ADG under restricted feeding (-20% of voluntary intake). The first objective of this study was to evaluate, after 9 generations of selection, the direct and correlated responses to selection on production traits in the 2 lines for traits recorded during growth. Second, applying the 2 feeding conditions used for selection to both selected lines plus the control unselected line (generation 0, G0) in a 2 × 3 factorial trial, the line performances were compared and the gut microbiota of the lines was characterized. The correlated responses in feed conversion ratio (FCR) were remarkably equivalent in both selected lines (-2.74 genetic σ) but correlated responses in other traits were notably different. In the ConsoResidual line, selection for decreased RFI resulted in a small negative correlated response in BW at 63 d old (BW63) and in a null response in ADG. In the ADGrestrict line, on the contrary, the correlated response in BW63 was substantial (+1.59 σ). The 2 selected lines had a FCR reduced by 0.2 point compared with the G0 line, and the same difference was found in both feeding regimens ( < 0.001). Indeed, selection on ADG would lead to heavier animals with no significant reduction of feed costs, whereas selection on RFI leads to lower feed costs and no increase of animal BW under ad libitum feeding. Altogether, our results do not suggest any genotype × environment interaction in the response to feeding regimens. The intestinal microbial communities from efficient rabbits differed from their unselected counterparts in terms of fermentation end products and microbial phylotypes, suggesting a central role of these microbes in the better feed efficiency of the rabbits.

Analysis of risk factors for hydrocephalus development in newborn infants with germinal matrix hemorrhage

AIM

The aim of this study was to analyze risk factors for the development of hydrocephalus in newborn infants with germinal matrix (GM) hemorrhage.

METHODS

The study comprised 271 patients admitted to Carlos Haya University Hospital in Malaga with GM hemorrhage. The following data were recorded: gestational age, gender, twin birth, head circumference at birth, weight at birth, and Papile grade. Severe obstetrical (abruption, chorioamnionitis, pregnancy-induced hypertension, tocolytic treatment) and neonatal disorders (respiratory distress syndrome, neonatal infection, coagulation disorder, patent ductus arteriosus, necrotizing enterocolitis) were also recorded. Symptomatic hydrocephalus was diagnosed in the event of a progressive increase in head circumference and ventricular indices requiring shunting.

RESULTS

Of the 271 patients, 139 (51%) developed posthemorrhagic ventriculomegaly; 47 patients (17%) developed symptomatic hydrocephalus and needed shunt implantation. We found a significant relationship between the development of symptomatic hydrocephalus and Papile grade, lower gestational age, lower birth weight, twin birth, and neonatal infection.

CONCLUSION

Awareness of risk factors for the development of hydrocephalus in newborn infants with GM hemorrhage should be emphasized in order to enable an early diagnosis of ventriculomegaly and symptomatic hydrocephalus and thus make a correct therapeutic decision.

Differentiation of equine induced pluripotent stem cells into a keratinocyte lineage

REASONS FOR PERFORMING STUDY

Skin trauma in horses often leads to the development of chronic nonhealing wounds that lack a keratinocyte cover, vital for healing. Reports in mouse and man confirm the possibility of generating functional keratinocytes from induced pluripotent stem cells (iPSC), thus presenting myriad potential applications for wound management or treatment of skin disease. Similarly, differentiation of equine iPSC (eiPSC) into a keratinocyte lineage should provide opportunities for the advancement of veterinary regenerative medicine.

OBJECTIVES

The purpose of this study was to develop an efficient method for the differentiation of eiPSC into a keratinocyte lineage. It was hypothesised that eiPSC can form differentiated keratinocytes (eiPSC-KC) comparable with primary equine keratinocytes (PEK) in their morphological and functional characteristics.

STUDY DESIGN

Experimental in vitro study.

METHODS

Equine iPSC established using a nonviral system were treated for 30 days with retinoic acid and bone morphogenetic protein-4 to induce directed differentiation into iPSC-KC. Temporospatial gene and protein expression by eiPSC-KC was measured at weekly intervals of differentiation and in response to calcium switch. Proliferative and migratory capacities of eiPSC-KC were compared with those of PEK.

RESULTS

Equine iPSC, upon directed differentiation, showed loss of pluripotency genes and progressive increase in pancytokeratin expression indicating ectodermal specification into keratinocytes. High differentiation efficiency was achieved, with 82.5% of eiPSC expressing keratin 14, a marker of epidermal-specific basal stem cells, after 30 days of directed differentiation. Moreover, the proliferative capacity of eiPSC-KC was superior, while the migratory capacity (measured as the ability to epithelise in vitro wounds) was comparable with that of PEK.

CONCLUSIONS

This proof of concept study suggests that eiPSC can successfully be differentiated into equine keratinocytes (eiPSC-KC) with features that are promising to the development of a stem cell-based skin construct, with the potential to regenerate lost or damaged skin.

Immune potential of allogeneic equine induced pluripotent stem cells

REASONS FOR PERFORMING STUDY

Induced pluripotent stem cells (iPSC) have brought immense hope to cellular therapy and regenerative medicine. However, the antigenicity of iPSC has not been well documented and remains a hurdle for clinical applications. Expression of major histocompatibility complex (MHC) molecules by human and murine iPSC is downregulated, making these cells potentially safe for transplantation. No such data are available for any large animal model.

OBJECTIVES

To measure expression of MHC molecules on equine iPSC (eiPSC) and describe their antigenicity using intradermal testing. The hypothesis was that allogeneic eiPSC weakly express MHC molecules and would not elicit a rejection response when injected intradermally.

STUDY DESIGN

Experimental study involving both in vitro and in vivo components.

METHODS

Two green fluorescent protein-expressing eiPSC lines were analysed by flow cytometry for MHC expression. One line was then transplanted intradermally, along with appropriate controls, into 2 unrelated experimental horses. Blood was collected pre- and 7 days post transplantation. The wheals formed at the sites of injection were measured at regular intervals beginning at 0.25 h until 4 weeks. Tissue samples of the injected sites were obtained at 2, 3, 7 and 30 days post transplantation and analysed by histopathology and immunofluorescence.

RESULTS

Both eiPSC lines weakly expressed MHC molecules. eiPSC were detectable up to 7 days following allogeneic transplantation and elicited no apparent systemic response. Injection of eiPSC caused small wheal formation at the skin surface. Skin sections revealed CD4(+) and CD8(+) mononuclear cells up to 30 days post transplantation.

CONCLUSIONS

These data suggest that while transplantation of allogeneic eiPSC elicits a moderate cellular response, it does not cause acute rejection. The feasibility of banking allogeneic iPSC for regenerative medicine applications should be explored.

Modulation of malaria-induced immunopathology by concurrent gastrointestinal nematode infection in mice

We investigated malaria-associated pathology in mice co-infected with Heligmosomoides polygyrus (Hp) and Plasmodium chabaudi AS (Pc). Despite higher peak parasitemia, co-infected wild-type (WT) C57BL/6 mice displayed similar body weight losses, malarial anaemia, and tissue damage but less severe hypothermia and hypoglycaemia, and earlier reticulocytosis than Pc-infected WT mice. Co-infected STAT6(-/-) mice, deficient in nematode-induced Th2 responses, experienced similar peak parasitemias and generally suffered malaria-associated pathology to a similar degree as co-infected WT mice. These data indicate a complex relationship amongst helminths, malaria and host immune responses resulting in modulation of some but not all aspects of malaria-associated pathology.

Mitogenic effect contributes to increased virulence of Streptococcus suis sequence type 7 to cause streptococcal toxic shock-like syndrome

Streptococcus suis serotype 2 sequence type 7 strains emerged in 1996 and caused a streptococcal toxic shock-like syndrome in 1998 and 2005 in China. Evidence indicated that the virulence of S. suis sequence type 7 had increased, but the mechanism was unknown. The sequence type 7 strain SC84, isolated from a patient with streptococcal toxic shock-like syndrome during the Sichuan outbreak, and the sequence type 1 strain 31533, a typical highly pathogenic strain isolated from a diseased pig, were used in comparative studies. In this study we show the mechanisms underlying cytokine production differed between the two types of strains. The S. suis sequence type 7 strain SC84 possesses a stronger capacity to stimulate T cells, naive T cells and peripheral blood mononuclear cell proliferation than does S. suis sequence type 1 strain 31533. The T cell response to both strains was dependent upon the presence of antigen-presenting cells. Histo-incompatible antigen-presenting cells were sufficient to provide the accessory signals to naive T cell stimulated by the two strains, indicating that both sequence type 7 and 1 strains possess mitogens; however, the mitogenic effect was different. Therefore, we propose that the difference in the mitogenic effect of sequence type 7 strain SC84 compared with the sequence type 1 strain 31533 of S. suis may be associated with the clinical, epidemiological and microbiological difference, where the ST 7 strains have a larger mitogenic effect.

Two simultaneous hepatitis B virus epidemics among injecting drug users and men who have sex with men in Buenos Aires, Argentina: characterization of the first D/A recombinant from the American continent

Previous studies have revealed that hepatitis B virus (HBV)/D and HBV/F predominate among blood donors from Buenos Aires, Argentina. In the present study, blood samples from two high-risk groups were analysed: 160 corresponding to street- and hospital-recruited injecting drug users [81.2% showing the 'anti-hepatitis B core antigen (anti-HBc) only' serological pattern] and 20 to hepatitis B surface antigen (HBsAg)(+)/anti-HBc(+) men who have sex with men. HBV genotypes were assigned by polymerase chain reaction amplification followed by restriction fragment length polymorphism and confirmed by nucleotide sequencing of two different coding regions. HBV DNA was detected in 27 injecting drug users (16.9%, occult infection prevalence: 7.7%), and 14 men who have sex with men (70%). HBV/A prevailed among injecting drug users (81.8%) while HBV/F was predominant among men who have sex with men (57.1%). The high predominance of HBV/A among injecting drug users is in sharp contrast to its low prevalence among blood donors (P = 0.0006) and men who have sex with men (P = 0.0137). Interestingly, all HBV/A S gene sequences obtained from street-recruited injecting drug users encoded the rare serotype ayw1 and failed to cluster within any of the known A subgenotypes. Moreover, one of the HBV strains from a hospital-recruited injecting drug user was fully sequenced and found to be the first completely characterized D/A recombinant genome from the American continent. Data suggest that two simultaneous and independent HBV epidemics took place in Buenos Aires: one spreading among injecting drug users and another one sexually transmitted among the homosexual and heterosexual population.

A prospective study of a new protocol for 'in situ' diagnosis of central venous catheter related bacteraemia

59 patients with suspected central venous catheter related bacteraemia (CRB), while receiving parenteral nutrition, were studied prospectively. 41 (Group 1) were managed conservatively: cultures were taken from the catheter hub lumen, skin at the catheter entry site and peripheral blood; the catheter was then heparinised and locked for 24-48 h. The catheter was withdrawn only if cultures were positive; otherwise parenteral nutrition was resumed. In 18 patients the catheter was immediately withdrawn (Group 2) and the same cultures plus tip culture were performed. 13 patients of Group 1 with positive hub or skin cultures, had their catheters removed and 12 had blood cultures matching for the same micro-organism. Negative skin and hub cultures had a negative predictive value for CRB of 96%. A positive hub culture had a 100% positive predictive value for CRB. CRB was diagnosed in 11 patients out of the 18 in whom catheters were withdrawn immediately (Group 2). Thus, 1 out of 41 catheters and 7 out of 18 catheters were removed unnecessarily in Groups 1 and 2 respectively (p = 0.001, Fisher's test). In all, 24 CRBs were documented and 15 were due to coagulase negative staphylococci. The catheter hub was the commonest origin of CRB followed by the infusate and the skin. In febrile patients on parenteral nutrition, negative skin and hub cultures accurately predict or rule out CRB and should be used more often to avoid withdrawal of sterile catheters.

Epidemiologic impact of blood culture practices and antibiotic consumption on pneumococcal bacteraemia in children

This study examined the roles of two different diagnostic approaches to children with fever of unknown origin in determining the patterns of pneumococcal bacteraemia in two Spanish regions by comparing their main epidemiologic characteristics. Whereas a blood culture is routinely obtained in this setting in Navarre, this is not generally the case in Majorca. Additionally, the potential role of antibiotic consumption in each region was also analysed. Cumulative incidences in children under the age of 14 years were 26.6 per 100,000 child-years in Navarre (121.1 in children <2 years of age) and 7.3 per 100,000 child-years in Majorca (33.3 in children <2 years of age). In contrast, the incidences per 1,000 blood cultures were similar in both regions. The relative risks of occult bacteraemia, bacteraemic pneumonia and meningitis among the children of Navarre compared to Majorcan children were 11.8, 2.6 and 0.8, respectively. The risk for less virulent (vaccine serotypes plus 6A, 19A and 23A) and for more virulent serotypes (1 and 7) was 4.9 and 3.1 times higher in Navarre, respectively. The number of 7-valent pneumococcal conjugate vaccine (PCV7) doses administered between 2003 and 2004 were also higher in Navarre. Conversely, antibiotic resistance and paediatric prescriptions for broad-spectrum antibiotics were greater in Majorca. Although the most salient differences between both regions, including the effectiveness of pneumococcal conjugate vaccine in Navarre, appeared to be confounded by the higher frequency of blood cultures taken there, certain differences in serotype composition may be explained by the higher antibiotic consumption in Majorca.

[Prospective study on conciliation of medication in orthopaedic patients]

OBJECTIVES

To identify and resolve discrepancies between the medications prescribed when patients are admitted to hospital and the medication usually taken by selected patients, adapting the prescriptions to the pharmacotherapeutic guidelines and the clinical con- dition of the patient.

METHOD

A prospective study in which patients over the age of 65 with at least one chronic disease in addition to the reason for hospitalisation in the orthopaedic department were selected. Pharmacists reviewed the treatments 24-48 hours after hospitalisation, comparing the order for medication sent to the pharmacy with the clinical history and patient interview. The following data were collected : patient name, age, gender, reason for hospitalisation, comorbidities, drugs, discrepancies, recommendation and acceptance.

RESULTS

During a four-month period, 84 patients were included (23.5% of all the patients admitted to the orthopaedic service), aged 75.40 +/- 10.63 years. 47.6% presented three or more chronic diseases and took 8.14 +/- 2.95 drugs. A total of 120 discrepancies were detected in 60 patients (71.43% of those selected): 71 unjustified discrepancies and 49 justified discrepancies. Among the unjustified discrepancies, the majority were due to the omission of a drug followed by dosing errors, frequency, timetables, route or method of administration. The acceptance of the pharmaceutical recommendation was 88.73%.

CONCLUSIONS

The action of the pharmacist, as part of the multidisciplinary team, resolved the discrepancies in the medication on admitting the patients selected.

High prevalence of human papillomavirus 16 in penile carcinoma

In order to analyze the incidence and prevalence of Human Papillomavirus (HPV) in penile carcinoma, we studied 49 patients with penile carcinoma. Formalin-fixed, paraffin-embedded tissue samples were collected from 64 samples of penile carcinoma from the Hospital General Universitario (Albacete, Spain). Cases were histologically classified and the polymerase chain reaction (PCR) method was used to detect the presence of HPV. Two sets of consensus primers were used, the My09/My11, and the GP5+/GP6+. All positive cases were sequenced in order to establish the implicated genotype. Our results showed that 38 of the 49 cases were positive for HPV (77,5%). HPV16 appeared in 32 (84,2 %) of the 38 positive cases and HPV18 in 4 (10,5%). Our data demonstrate that the My09/My11 primers are more sensitive than GP5+/GP6+ primers, although the combination of the two sets of primers notably increased the total number of HPV positive cases detected.

Distribution of killer-cell immunoglobulin-like receptor (KIR) in Comoros and Southeast France

Killer-cell immunoglobulin-like receptors (KIRs) expressed by natural killer cells are cell surface molecules able to recognize groups of HLA class I alleles. The number and distribution of KIR genes vary among individuals and populations. The aim of this study is to analyse the KIR gene content in a Comorian population in order to investigate genetic relationships with other populations and to reconstruct past migration events. The Comorian population consisted of 54 unrelated immigrants living in France and a control population consisted of 38 individuals from Southeast France. We investigated the presence or absence of 15 KIR genes, two pseudogenes expressed and non-expressed forms of KIR2DL5 and the two major subtype full-length and deleted forms of KIR2DS4. All individuals were typed positive for the framework genes, i.e. KIR2DL4, KIR3DL2 and KIR3DL3, and the two pseudogenes KIR3DP1 and KIR2DP1. The frequencies of full-length KIR2DS4 (*00101/00102/002) were lower in the French population (F = 29%) than in the Comorian population (F = 72%) (P(c) < 0.05). No significant differences were found for other KIR genes. A total of 11 genotypes were identified in the Southeast French population and 22 genotypes in the Comorian population. The most common genotype (2DL1, 2DL3, 2DL4, 3DL1, 3DL2, 3DL3 and 2DS4) accounted for 41% in the Comorian population and 34% in the Southeast French population. Principal component analysis using KIR gene data from 20 populations was performed to determine genetic differences and relations between populations. The Comorian population exhibited closest kinship with Africans and Asians. As KIR gene content is heterogeneous among ethnic groups, it can probably be used to assess the genetic relationships among populations from different geographic areas.

Efficacy and potential for resistance selection of antipseudomonal treatments in a mouse model of lung infection by hypermutable Pseudomonas aeruginosa

Hypermutable Pseudomonas aeruginosa strains are found with high frequency in the lungs of patients with chronic infections and are associated with high antibiotic resistance rates. The in vivo consequences of hypermutation for treatment in a mouse model of lung infection using strain PAO1 and its hypermutable derivative PAOdeltamutS are investigated. Groups of 30 mice were treated for 3 days with humanized regimens of ciprofloxacin (CIP), tobramycin (TOB), CIP plus TOB, or placebo, and mortality, total lung bacterial load, and 4x- and 16x-MIC mutants were recorded. The rates of mutation and the initial in vivo frequencies of mutants (at the onset of treatment) were also estimated and the in vitro- and in vivo-selected mutants characterized. Since both strains had identical MICs, the same pharmacokinetic/pharmacodynamic (PK/PD) parameters were obtained: area under the 24-h concentration-time curve (fAUC)/MIC = 385 for CIP and maximum concentration of drug in serum (fC(max))/MIC = 19 for TOB. Despite adequate PK/PD parameters, persistence of high bacterial numbers and amplification (50,000-fold) of resistant mutants (MexCD-OprJ hyperexpression) were documented with CIP treatment for PAOdeltamutS, in contrast to complete resistance suppression for PAO1 (P < 0.01), showing that conventional PK/PD parameters may not be applicable to infections by hypermutable strains. On the other hand, the efficacy of TOB monotherapy in terms of mortality reduction and bacterial load was very low regardless of the strain but not due to resistance development, since mutants were not selected for PAO1 and were only modestly amplified for PAOdeltamutS. Finally, the CIP-plus-TOB combination was synergistic, further reducing mortality and bacterial load and completely preventing resistance even for PAOdeltamutS (P < 0.01 compared to monotherapy), showing that it is possible to suppress resistance selection in infections by hypermutable P. aeruginosa using appropriate combined regimens.

Cassini encounters Enceladus: background and the discovery of a south polar hot spot

The Cassini spacecraft completed three close flybys of Saturn's enigmatic moon Enceladus between February and July 2005. On the third and closest flyby, on 14 July 2005, multiple Cassini instruments detected evidence for ongoing endogenic activity in a region centered on Enceladus' south pole. The polar region is the source of a plume of gas and dust, which probably emanates from prominent warm troughs seen on the surface. Cassini's Composite Infrared Spectrometer (CIRS) detected 3 to 7 gigawatts of thermal emission from the south polar troughs at temperatures up to 145 kelvin or higher, making Enceladus only the third known solid planetary body-after Earth and Io-that is sufficiently geologically active for its internal heat to be detected by remote sensing. If the plume is generated by the sublimation of water ice and if the sublimation source is visible to CIRS, then sublimation temperatures of at least 180 kelvin are required.