Case studies of clinical decision-making through prescriptive models based on machine learning

BACKGROUND

The development of computational methodologies to support clinical decision-making is of vital importance to reduce morbidity and mortality rates. Specifically, prescriptive analytic is a promising area to support decision-making in the monitoring, treatment and prevention of diseases. These aspects remain a challenge for medical professionals and health authorities.

MATERIALS AND METHODS

In this study, we propose a methodology for the development of prescriptive models to support decision-making in clinical settings. The prescriptive model requires a predictive model to build the prescriptions. The predictive model is developed using fuzzy cognitive maps and the particle swarm optimization algorithm, while the prescriptive model is developed with an extension of fuzzy cognitive maps that combines them with genetic algorithms. We evaluated the proposed approach in three case studies related to monitoring (warfarin dose estimation), treatment (severe dengue) and prevention (geohelminthiasis) of diseases.

RESULTS

The performance of the developed prescriptive models demonstrated the ability to estimate warfarin doses in coagulated patients, prescribe treatment for severe dengue and generate actions aimed at the prevention of geohelminthiasis. Additionally, the predictive models can predict coagulation indices, severe dengue mortality and soil-transmitted helminth infections.

CONCLUSIONS

The developed models performed well to prescribe actions aimed to monitor, treat and prevent diseases. This type of strategy allows supporting decision-making in clinical settings. However, validations in health institutions are required for their implementation.

A clinical decision-support system for dengue based on fuzzy cognitive maps

Dengue is a viral infection widely distributed in tropical and subtropical regions of the world. Dengue is characterized by high fatality rates when the diagnosis is not made promptly and effectively. To aid in the diagnosis of dengue, we propose a clinical decision-support system that classifies the clinical picture based on its severity, and using causal relationships evaluates the behavior of the clinical and laboratory variables that describe the signs and symptoms related to dengue. The system is based on a fuzzy cognitive map that is defined by the signs, symptoms and laboratory tests used in the conventional diagnosis of dengue. The evaluation of the model was performed on datasets of patients diagnosed with dengue to compare the model with other approaches. The developed model showed a good classification performance with 89.4% accuracy and could evaluate the behaviour of clinical and laboratory variables related to dengue severity (it is an explainable method). This model serves as a diagnostic aid for dengue that can be used by medical professionals in clinical settings.

Update of the PANCCO clinical practice guidelines for the treatment of ulcerative colitis in the adult population

Ulcerative colitis (US) is a chronic disease of unknown etiology. It is incurable and its clinical course is intermittent, characterized by periods of remission and relapse. The prevalence and incidence of the disease has been increasing worldwide. The update presented herein includes the participation of healthcare professionals, decision-makers, and a representative of the patients, all of whom declared their conflicts of interest. Answerable clinical questions were formulated, and the outcomes were graded. The information search was conducted on the Medline/PubMed, Embase, Epistemonikos, and LILACS databases, and covered grey literature sources, as well. The search was updated on November 30, 2020, with no restrictions regarding date or language. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) classification system was implemented to establish the strength of the recommendation and quality of evidence. A formal consensus was developed, based on the RAND/UCLA methodology and the document was peer reviewed. The short version of the Clinical Practice Guidelines for the Treatment of Ulcerative Colitis in the Adult Population is presented herein, together with the supporting evidence and respective recommendations. In mild-to-moderate UC, budesonide MMX is an option when treatment with 5-ASA fails, and before using systemic steroids. In moderate-to-severe UC, infliximab, adalimumab, vedolizumab, ustekinumab, and tofacitinib can be used as first-line therapy. If there is anti-TNF therapy failure, ustekinumab and tofacitinib provide the best results. In patients with antibiotic-refractory pouchitis, anti-TNFs are the treatment of choice.

Cobalamin cbiP mutant shows decreased tolerance to low temperature and copper stress in Listeria monocytogenes

Background

Listeria monocytogenes is a foodborne pathogen that causes listeriosis in humans. This pathogen activates multiple regulatory mechanisms in response to stress, and cobalamin biosynthesis might have a potential role in bacterial protection. Low temperature is a strategy used in the food industry to control bacteria proliferation; however, L. monocytogenes can grow in cold temperatures and overcome different stress conditions. In this study we selected L. monocytogenes List2-2, a strain with high tolerance to the combination of low temperature + copper, to understand whether the cobalamin biosynthesis pathway is part of the tolerance mechanism to this stress condition. For this, we characterized the transcription level of three cobalamin biosynthesis-related genes (cbiP, cbiB, and cysG) and the eutV gene, a transcriptional regulator encoding gene involved in ethanolamine metabolism, in L. monocytogenes strain List2-2 growing simultaneously under two environmental stressors: low temperature (8 °C) + copper (0.5 mM of CuSO₄ × 5H₂O). In addition, the gene cbiP, which encodes an essential cobyric acid synthase required in the cobalamin pathway, was deleted by homologous recombination to evaluate the impact of this gene in L. monocytogenes tolerance to a low temperature (8 °C) + different copper concentrations.

Results

By analyzing the KEGG pathway database, twenty-two genes were involved in the cobalamin biosynthesis pathway in L. monocytogenes List2-2. The expression of genes cbiP, cbiB, and cysG, and eutV increased 6 h after the exposure to low temperature + copper. The cobalamin cbiP mutant strain List2-2ΔcbiP showed less tolerance to low temperature + copper (3 mM) than the wild-type L. monocytogenes List2-2. The addition of cyanocobalamin (5 nM) to the medium reverted the phenotype observed in List2-2ΔcbiP.

Conclusion

These results indicate that cobalamin biosynthesis is necessary for L. monocytogenes growth under stress and that the cbiP gene may play a role in the survival and growth of L. monocytogenes List2-2 at low temperature + copper.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40659-022-00376-4.

Assessment of the microvasculature in poppers maculopathy

Purpose

To investigate a possible microvascular component of poppers maculopathy (PMP) using optical coherence tomography angiography (OCTA).

Methods

Twelve patients suffering from poppers maculopathy were included. Health records, optical coherence tomography (OCT), and OCTA data was gathered and compared to a healthy control group (HC). PMP lesion type was determined by manifestation in OCT. OCTA-based evaluation of retinal vascular plexus and choriocapillaris (CC) was executed. Vessel density (VD) and vessel length density (VLD) in superficial and deep capillary plexus (SCP, DCP), as well as flow deficits (FD), within the foveal avascular zone (FAZ) in CC were assessed.

Results

Median age of PMP patients was 40 (min 24; max 64) years, all male. Eleven patients presented with ellipsoid zone-type lesions; one patient showed a vitelliform-type lesion. No qualitative microvascular changes between PMP patients and HC were identified. Quantitative values for VD and VLD of SCP and DCP did not differ in between the two groups. The analysis of FDs in CC showed no deviation from PMP patients to HC.

Conclusions

No vascular anomalies in qualitative and quantitative analysis in OCTA were detected in PMP patients. The constitution of the CC within FAZ of PMP patients does not differ from HC when assessed as FD.

Dengue models based on machine learning techniques: A systematic literature review

BACKGROUND

Dengue modeling is a research topic that has increased in recent years. Early prediction and decision-making are key factors to control dengue. This Systematic Literature Review (SLR) analyzes three modeling approaches of dengue: diagnostic, epidemic, intervention. These approaches require models of prediction, prescription and optimization. This SLR establishes the state-of-the-art in dengue modeling, using machine learning, in the last years.

METHODS

Several databases were selected to search the articles. The selection was made based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. Sixty-four articles were obtained and analyzed to describe their strengths and limitations. Finally, challenges and opportunities for research on machine-learning for dengue modeling were identified.

RESULTS

Logistic regression was the most used modeling approach for the diagnosis of dengue (59.1%). The analysis of the epidemic approach showed that linear regression (17.4%) is the most used technique within the spatial analysis. Finally, the most used intervention modeling is General Linear Model with 70%.

CONCLUSIONS

We conclude that cause-effect models may improve diagnosis and understanding of dengue. Models that manage uncertainty can also be helpful, because of low data-quality in healthcare. Finally, decentralization of data, using federated learning, may decrease computational costs and allow model building without compromising data security.

Does vaporized hydrogen peroxide sterilization affect the geometrical properties of anatomic models and guides 3D printed from computed tomography images?

Background

Material extrusion is used to 3D print anatomic models and guides. Sterilization is required if a 3D printed part touches the patient during an intervention. Vaporized Hydrogen Peroxide (VHP) is one method of sterilization. There are four factors to consider when sterilizing an anatomic model or guide: sterility, biocompatibility, mechanical properties, and geometric fidelity. This project focuses on geometric fidelity for material extrusion of one polymer acrylonitrile butadiene styrene (ABS) using VHP.

Methods

De-identified computed tomography (CT) image data from 16 patients was segmented using Mimics Innovation Suite (Materialise NV, Leuven, Belgium). Eight patients had maxillary and mandibular defects depicted with the anatomic models, and eight had mandibular defects for the anatomic guides. Anatomic models and guides designed from the surfaces of CT scan reconstruction and segementation were 3D printed in medical-grade acrylonitrile butadiene styrene (ABS) material extrusion. The 16 parts underwent low-temperature sterilization with VHP. The dimensional error was estimated after sterilization by comparing scanned images of the 3D printed parts.

Results

The average of the estimated mean differences between the printed pieces before and after sterilization were − 0,011 ± 0,252 mm (95%CI − 0,011; − 0,010) for the models and 0,003 ± 0,057 mm (95%CI 0,002; 0,003) for the guides. Regarding the dimensional error of the sterilized parts compared to the original design, the estimated mean differences were − 0,082 ± 0,626 mm (95%CI − 0,083; − 0,081) for the models and 0,126 ± 0,205 mm (95%CI 0,126, 0,127) for the guides.

Conclusion

This project tested and verified dimensional stability, one of the four prerequisites for introducing vaporized hydrogen peroxide into 3D printing of anatomic models and guides; the 3D printed parts maintained dimensional stability after sterilization.

A Cyber-Physical Data Collection System Integrating Remote Sensing and Wireless Sensor Networks for Coffee Leaf Rust Diagnosis

Coffee Leaf Rust (CLR) is a fungal epidemic disease that has been affecting coffee trees around the world since the 1980s. The early diagnosis of CLR would contribute strategically to minimize the impact on the crops and, therefore, protect the farmers' profitability. In this research, a cyber-physical data-collection system was developed, by integrating Remote Sensing and Wireless Sensor Networks, to gather data, during the development of the CLR, on a test bench coffee-crop. The system is capable of automatically collecting, structuring, and locally and remotely storing reliable multi-type data from different field sensors, Red-Green-Blue (RGB) and multi-spectral cameras (RE and RGN). In addition, a data-visualization dashboard was implemented to monitor the data-collection routines in real-time. The operation of the data collection system allowed to create a three-month size dataset that can be used to train CLR diagnosis machine learning models. This result validates that the designed system can collect, store, and transfer reliable data of a test bench coffee-crop towards CLR diagnosis.

Chronic non-malignant pain (CNMP) and substance use disorders

Introduction

Chronic non-malignant pain (CNMP) is defined as pain lasting a minimum of three months. In general, chronic pain affects 20% adult worldwide population. Moreover, pain is more common in patients with depression, anxiety, and substance-use disorders and with low socioeconomic status. We aimed to better understand the influence of pain on substance use and treatment use patterns of individuals who experienced clinically recognized pain and have substance use disorder.

Methods

Patients with pain disturbances were identified in Electronic Health Records (EHR) through ICD-9 code 338*, medical written diagnoses, or diagnoses of fibromyalgia. A patient was considered to have a substance use disorder if he received treatment for illicit drug or alcohol abuse or dependence. We combined 2010–2012 (EHR) data from primary care and specialty mental health setting in a Boston healthcare system (n = 131,966 person-years) and a specialty mental health care setting in Madrid, Spain (n = 43,309 person-years).

Results

We identified that 35.3% of individuals with clinically recognized pain also report substance use disorder, compared to only 10.6% of individuals without clinically recognized pain (P < 0.01). Those with co-morbid pain and substance use disorder were significantly more likely than their specialty care counterparts without co-morbid pain and substance disorders to be seen in the emergency room (56.5% vs. 36.6%, respectively, P < 0.01).

Conclusion

The findings suggest that CNMP is associated with an increase risk of substance abuse disorder.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Association between gingival parameters and Oral health-related quality of life in Caribbean adults: a population-based cross-sectional study

BACKGROUND

Good oral health has been associated with better quality of life and general health. In the Caribbean, there have been no studies regarding the association between oral health conditions and the quality of life of the population. The main purpose of this study was to investigate the association between gingival parameters and oral health-related quality of life (OHRQoL) in Caribbean adults. A secondary aim of the study was to gain more information on factors that impact OHRQoL in this population.

METHODS

This cross-sectional, epidemiological, population-based study was conducted in community settings. After the participants with missing Oral Health Impact Profile (OHIP) data were excluded, the sample size was 1821 (weighted according to the age and gender distribution in each target population). OHIP-14 standardized questionnaires were used to collect information. In addition, a medical/oral health questionnaire including sociodemographics, general health, dental visits, oral hygiene habits and knowledge, the frequency of dental visits, prosthesis use/hygiene, and smoking was administered. A multivariate model included predictors that showed significant associations in the univariate models. Odds ratios (ORs) and 95% confidence intervals (CIs) were reported; statistical significance was set at 0.05.

RESULTS

In the multivariate analysis, current smokers (OR = 2.34, 95% CI: 1.74-3.14 vs. never smokers), those who visited the dentist only when problems arose (OR = 1.65, 95% CI: 1.13-2.40 vs. those visiting once a year), and participants with any chronic disease/condition (OR = 1.38, 95% CI: 1.06-1.78) had higher odds of being in the highest tertile for OHIP score (poorer health).

CONCLUSIONS

The present multicenter study identified potential modifiable risk factors for poor OHRQoL among adults in three Caribbean cities.

Unsupervised visual discrimination learning of complex stimuli: Accuracy, bias and generalization

Through same-different judgements, we can discriminate an immense variety of stimuli and consequently, they are critical in our everyday interaction with the environment. The quality of the judgements depends on familiarity with stimuli. A way to improve the discrimination is through learning, but to this day, we lack direct evidence of how learning shapes the same-different judgments with complex stimuli. We studied unsupervised visual discrimination learning in 42 participants, as they performed same-different judgments with two types of unfamiliar complex stimuli in the absence of labeling or individuation. Across nine daily training sessions with equiprobable same and different stimuli pairs, participants increased the sensitivity and the criterion by reducing the errors with both same and different pairs. With practice, there was a superior performance for different pairs and a bias for different response. To evaluate the process underlying this bias, we manipulated the proportion of same and different pairs, which resulted in an additional proportion-induced bias, suggesting that the bias observed with equal proportions was a stimulus processing bias. Overall, these results suggest that unsupervised discrimination learning occurs through changes in the stimulus processing that increase the sensory evidence and/or the precision of the working memory. Finally, the acquired discrimination ability was fully transferred to novel exemplars of the practiced stimuli category, in agreement with the acquisition of a category specific perceptual expertise.

Eculizumab treatment of acute antibody-mediated rejection in renal transplantation: case reports

The occurrence of acute antibody-mediated rejection (AMR), especially in more severe cases, continues to be associated with a poor prognosis for implant survival. Here, we have reported the results of treatment of two patients who developed AMR associated with thrombotic microangiopathy immediately after transplantation. We used a single dose of eculizumab at an early stage jointly with conventional modalities of steroid boluses, plasmapheresis, intravenous immunoglobulin, and rituximab. In both cases, the clinical course was favorable. Eculizumab, a monoclonal antibody with a high affinity for complement protein C5, prevents generation of the final membrane attack complex, blocking this cascade. To date, there are a few reports of the usefulness of eculizumab in AMR. Eculizumab can help to stop endothelial damage, especially in severe cases that show a risk of progression to cortical necrosis, by providing a therapeutic window until the other modalities begin to control the immune response. In our experience, the use of eculizumab can be beneficial in the treatment of AMR.

Selection strategies for dairy buffaloes: economic and genetic consequences

Buffaloes are generally raised in Brazil without milk-recording programs, and thus without genetic evaluations of any of their traits. This study evaluated the economic impacts of three different selection strategies on buffalo populations and the evolution of genetic trends, genetic variances and inbreeding coefficients resulting from each of them. The selection strategies used were as follows: (i) random selection; (ii) phenotypic selection; and (iii) progeny testing (PT). As the numbers of herds enrolled in milk-recording programs increased, phenotypic selection and PT strategies increased both monetary benefits and genetic trends. The extra costs of implementing milk recording (MR) and PT procedures were exceeded by the income resulting from better buffalo performance. Progeny testing is known to result in beneficial genetic trends and the use of artificial insemination promoted better distributions of genetic material into herds that were not enrolled in milk-recording programs. Phenotypic selection and PT increased mean milk production--a key factor in profitability. Inbreeding levels remained stable with phenotypic selection, even as the numbers of MR herds increased. Increases in the numbers of sires that were evaluated reduced the mean inbreeding coefficient in PT. Increasing the number of herds enrolled in milk-recording programs resulted in increased numbers of sires needed for PT, but this did not increase the inbreeding coefficient. In summary, phenotypic selection and PT strategies appear to be economically viable for buffalo husbandry in south-eastern Brazil under current (2007-2008) economic conditions and should be encouraged.

Evolutionary learning of hierarchical decision rules

This paper describes an approach based on evolutionary algorithms, hierarchical decision rules (HIDER), for learning rules in continuous and discrete domains. The algorithm produces a hierarchical set of rules, that is, the rules are sequentially obtained and must therefore be tried until one is found whose conditions are satisfied. Thus, the number of rules may be reduced because the rules could be inside of one another. The evolutionary algorithm uses both real and binary coding for the individuals of the population. We tested our system on real data from the UCI repository, and the results of a ten-fold cross-validation are compared to C4.5s, C4.5Rules, See5s, and See5Rules. The experiments show that HIDER works well in practice.

Improvement of Arbuscular Mycorrhiza Development by Inoculation of Soil with Phosphate-Solubilizing Rhizobacteria To Improve Rock Phosphate Bioavailability ((sup32)P) and Nutrient Cycling

The interactive effect of phosphate-solubilizing bacteria and arbuscular mycorrhizal (AM) fungi on plant use of soil P sources of low bioavailability (endogenous or added as rock phosphate [RP] material) was evaluated by using soil microcosms which integrated (sup32)P isotopic dilution techniques. The microbial inocula consisted of the AM fungus Glomus intraradices and two phosphate-solubilizing rhizobacterial isolates: Enterobacter sp. and Bacillus subtilis. These rhizobacteria behaved as "mycorrhiza helper bacteria" promoting establishment of both the indigenous and the introduced AM endophytes despite a gradual decrease in bacterial population size, which dropped from 10(sup7) at planting to 10(sup3) CFU g(sup-1) of dry rhizosphere soil at harvest. Dual inoculation with G. intraradices and B. subtilis significantly increased biomass and N and P accumulation in plant tissues. Regardless of the rhizobacterium strain and of the addition of RP, AM plants displayed lower specific activity ((sup32)P/(sup31)P) than their comparable controls, suggesting that the plants used P sources not available in their absence. The inoculated rhizobacteria may have released phosphate ions ((sup31)P), either from the added RP or from the less-available indigenous P sources, which were effectively taken up by the external AM mycelium. Soluble Ca deficiency in the test soil may have benefited P solubilization. At least 75% of the P in dually inoculated plants derived from the added RP. It appears that these mycorrhizosphere interactions between bacterial and fungal plant associates contributed to the biogeochemical P cycling, thus promoting a sustainable nutrient supply to plants.

AtHMA1 is a thapsigargin-sensitive Ca2+/heavy metal pump

The Arabidopsis thaliana AtHMA1 protein is a member of the P(IB)-ATPase family, which is implicated in heavy metal transport. However, sequence analysis reveals that AtHMA1 possesses a predicted stalk segment present in SERCA (sarcoplasmic/endoplasmic reticulum Ca(2+) ATPase)-type pumps that is involved in inhibition by thapsigargin. To analyze the ion specificity of AtHMA1, we performed functional complementation assays using mutant yeast strains defective in Ca(2+) homeostasis or heavy metal transport. The heterologous expression of AtHMA1 complemented the phenotype of both types of mutants and, interestingly, increased heavy metal tolerance of wild-type yeast. Biochemical analyses were performed to describe the activity of AtHMA1 in microsomal fractions isolated from complemented yeast. Zinc, copper, cadmium, and cobalt activate the ATPase activity of AtHMA1, which corroborates the results of metal tolerance assays. The outcome establishes the role of AtHMA1 in Cd(2+) detoxification in yeast and suggests that this pump is able to transport other heavy metals ions. Further analyses were performed to typify the active Ca(2+) transport mediated by AtHMA1. Ca(2+) transport displayed high affinity with an apparent K(m) of 370 nm and a V(max) of 1.53 nmol mg(-1) min(-1). This activity was strongly inhibited by thapsigargin (IC(50) = 16.74 nm), demonstrating the functionality of its SERCA-like stalk segment. In summary, these results demonstrate that AtHMA1 functions as a Ca(2+)/heavy metal pump. This protein is the first described plant P-type pump specifically inhibited by thapsigargin.

Fine mapping of porcine chromosome 6 QTL and LEPR effects on body composition in multiple generations of an Iberian by Landrace intercross

The leptin receptor gene (LEPR) is a candidate for traits related to growth and body composition, and is located on SSC6 in a region where fatness and meat composition quantitative trait loci (QTL) have previously been detected in several F2 experimental designs. The aims of this work were: (i) to fine map these QTL on a larger sample of animals and generations (F3 and backcross) of an Iberian×Landrace intercross and (ii) to examine the effects of LEPR alleles on body composition traits. Eleven single nucleotide polymorphisms (SNPs) were detected by sequencing LEPR coding regions in Iberian and Landrace pig samples. Three missense polymorphisms were genotyped by pyrosequencing in 33 F0, 70 F1, 418 F2, 86 F3 and 128 individuals coming from the backcross of four F2 males with 24 Landrace females. Thirteen microsatellites and one SNP were also genotyped. Traits analysed were: backfat thickness at different locations (BFT), intramuscular fat percentage (IMFP), eye muscle area (EMA), loin depth (LOD), weight of shoulder (SHW), weight of ribs (RIBW) and weight of belly bacon (BBW). Different statistical models were applied in order to evaluate the number and effects of QTL on chromosome 6 and the possible causality of the LEPR gene variants with respect to the QTL. The results support the presence of two QTL on SSC6. One, at position 60–100 cM, affects BFT and RIBW. The other and more significant maps in a narrow region (130–132 cM) and affects BFT, IMFP, EMA, LOD, SHW, RIBW and BBW. Results also support the association between LEPR alleles and BFT traits. The possible functional implications of the analysed polymorphisms are considered.

Heterosis and epistasis for teat number and fluctuating asymmetry in crosses between Jiaxing and Iberian pigs

In the framework of Wright's view of evolution, long-separate breeds of domestic animals could establish different adaptive epistatic genetic complexes that could be destroyed in crossbred animals by recombination. The objective of this study was to evaluate heterosis and recombination effects in a crossing experiment involving two distinct European and Asian breeds (Iberian and Jiaxing) in the F1 and two successive backcrosses to the Iberian line. Teat number (TN) was recorded in the right and left sides of piglets and analysed by fitting a mixed linear model including the Dickerson's crossbreeding parameters. TN in pigs is a discontinuous and often canalised trait presenting bilateral symmetry. The minor differences between sides make this trait a good candidate to evaluate fluctuating asymmetry (FA) and developmental instability. For TN, the posterior means and standard deviations (SD) of the heritability and of the relative contribution of common litter environmental effect to variance were 0.248 (0.028) and 0.057 (0.019), respectively. The respective values of the difference between breeds, heterosis and recombination effect were 9.990 (0.411), -0.506 (0.196) and 0.684 (0.232). For FA, the posterior means and SDs of the heritability and of the relative contribution of common litter environmental effect to variance were 0.023 (0.005) and 0.014 (0.005), respectively. Another significant genetic effect was a recombination effect of 0.773 (0.117). These results confirm that the rupture by recombination of coadapted genomes decreases developmental stability in domestic pigs.

A novel Cys212Tyr founder mutation in parkin and allelic heterogeneity of juvenile Parkinsonism in a population from North West Colombia

We report the molecular characterization of three multiplex families and a sporadic case of juvenile Parkinsonism identified in the province of Antioquia (Colombia). Linkage and haplotype analysis using markers in 6q25.2-27 indicated that Parkinsonism in the pedigrees is linked to the parkin gene (maximum LOD-score of 3.85) but that they carry two different mutant haplotypes. Sequence analysis revealed a novel G to A transition in exon 6 at position 736 (G736A) of parkin. This change results in a non-conservative cysteine for tyrosine substitution. All affected individuals from two families were homozygous for this mutation, which was not detected in 100 normal controls. Patients from the family carrying the second haplotype and the sporadic case were homozygous for a GT insertion in exon 3. This mutation has been previously identified in French families with juvenile Parkinsonism. The concomitant presence of founder effects and allelic heterogeneity in Antioquia might relate to the founding admixture at the origin of this population.

Neural interfaces for regenerated nerve stimulation and recording

A class of implantable, regeneration-type neural interfaces (NI's) for mammalian peripheral nerve recording and stimulation were developed using different fabrication processes and integrating purposely designed components. A typical NI comprises three main components: 1) a microfabricated silicon die incorporating a microelectrode array on multiple through-holes, 2) a polymer guidance channel housing the die, and 3) a flexible flat cable connecting the die to an external electronic circuitry. The design and fabrication of the NI's were aimed at achieving long term, reliable implants by taking into careful account the biological, electrical, and mechanical requirements of the specific implant site. Different versions of the NI were fabricated and implanted between the severed ends of the sciatic nerve in a mammalian animal model (rabbit). Morphological and histological evidence showed that nerves regenerated through the NI's and electrophysiological results demonstrated the recovery of electrical functionality. Moreover, the NI's allowed stimulation of the regenerated nerve producing a visible leg/foot contraction. The NI's presented in this paper are being further improved in the authors' laboratories with the ultimate goal of allowing the control of nerve motor and sensory functions in future prosthetic devices.

The use of isotopic dilution techniques to evaluate the interactive effects of Rhizobium genotype, mycorrhizal fungi, phosphate-solubilizing rhizobacteria and rock phosphate on nitrogen and phosphorus acquisition by Medicago sativa

A pot experiment was designed to evaluate the interactive effects of multiple microbial inoculation treatments and rock phosphate (RP) application on N and P acquisition by alfalfa plants using ¹⁵ N and ³² P isotopes. The microbial inocula consisted of a wild type (WT) Rhizobium meliloti strain, its genetically modified (GM) derivative, which had an enhanced competitiveness, the arbuscular mycorrhizal (AM) fungus Glomus mosseae (Nicol. and Gerd.) Gerd. and Trappe, and a phosphate-solubilizing rhizobacterium (Enterobacter sp.). Inoculated micro-organisms became established in the root tissues and/or in the rhizosphere soil of alfalfa plants (Medicago sativa L.). The GM Rhizobium strain did not interfere with AM formation. Inoculated phosphate-solubilizing rhizobacteria established in the alfalfa rhizosphere, but the level of establishment was lower where the natural population of phosphate-solubilizing bacteria was stimulated by AM inoculation and RP application. The stimulation of these indigenous bacteria was also greater in the rhizosphere of alfalfa nodulated by the GM Rhizobium. Improvements in N and P accumulation in alfalfa corroborate beneficial effects of the improved GM Rhizobium on AM performance, in RP-amended plants. Inoculation with Enterobacter did not improve the AM effect on N or P accumulation in the RP-added soil, but it did in the non RP-amended controls. Measurements of the ¹⁵ N∶¹⁴ N ratio in plant shoots indicated enhanced N₂ fixation rates in Rhizobium-inoculated AM-plants, over that achieved by the same Rhizobium strain in non-mycorrhizal plants. Regardless of the Rhizobium strain and of whether or not RP was added, AM-inoculated plants showed a lower specific activity (³² P∶³¹ P) than did their comparable non-mycorrhizal controls, suggesting that the plant was using otherwise unavailable P sources. The phosphate-solubilizing, AM-associated, microbiota could in fact release phosphate ions, either from the added RP or from the indigenous 'less-available' phosphate. Deficiency in Ca concentration in soil solution in the neutral test soil might benefit P solubilization. The proportion of plant P derived either from the labelled soil P (labile P pool) or from RP was similar for AM inoculated and non-mycorrhizal controls (without Enterobacter inoculation) for each Rhizobium strain, but the total P uptake, regardless of the P source, was far higher in AM-plants. Enterobacter inoculation seems to improve the use of RP in the rhizosphere of non-mycorrhizal plants inoculated with the WT Rhizobium.

Interactions between plant-growth-promoting rhizobacteria (PGPR), arbuscular mycorrhizal fungi and Rhizobium spp. in the rhizosphere of Anthyllis cytisoides, a model legume for revegetation in mediterranean semi-arid ecosystems

Arbuscular mycorrhizal (AM) fungi, Rhizobium bacteria and plant-growth-promoting rhizobacteria (PGPR) were isolated from a representative area of a desertified semi-arid ecosystem in the south-east of Spain. Microbial isolates were characterized and screened for effectiveness by a single-inoculation trial in soil microcosms. Anthyllis cytisoides L., a mycotrophic pioneer legume, dominant in the target mediterranean ecosystem, was the test plant. Several microbial cultures from existing collections were also included in the screening process. Two AM fungi (Glomus coronatum, native, and Glomus intraradices. exotic), two Rhizobium bacteria (NR4 and NR9, both native) and two PGPR (A2, native, and E, exotic) were selected. A further screening for the appropriate double and triple combinations of microbial inoculants was then performed. The parameters evaluated were biomass accumulation and allocation, N and P uptake, N₂ -fixation (¹⁵ N) and specific root length. Overall, G. coronatum, native in the field site was more effective than the exotic G. intraradices in co-inoculation treatments. In general, our results support the importance of physiological and genetic adaptation of microbes to the whole environment, thus local isolates must be involved. Many microbial combinations were effective in improving either plant development, nutrient uptake, N² -fixation or root system quality. Selective and specific functional compatibility relationships in plant response between the microbial inoculants, were observed. Despite the difficulty of selecting a multifunctional microbial inoculum, appropriate microbial combinations can be recommended for a given biotechnological input related to improvement of plant performance. This could be exploited in nursery production of target plant species endowed with optimized rhizosphere/mycorrhizosphere systems that can be tailored to help plants to establish and survive in nutrient-deficient, degraded habitats. The relevance of this microbial-based approach in the context of a reclamation strategy addressed to environmental sustainability purposes is discussed.

Specific monoclonal antibodies against leukocyte-restricted cell surface molecule CD43 react with nonhematopoietic tumor cells

CD43 is the major sialoglycoprotein found on the surface of cells of hemopoietic origin. Because CD43 is a typical member of the surface mucins, molecules that play a relevant role in tumor progression, we have addressed the expression of CD43 in nonhematopoietic tumor cells. For this purpose, we have tested a broad panel of anti-CD43 antibodies on tumors of different embryonic origins. Of the 17 anti-CD43 mAbs used, 9 reacted with leukocytes in paraffin-fixed formalin-embedded lymph node tissues. Two mAbs, BS1 and L10, stained 24 out of 31 (78%) nonhematopoietic tumors analyzed; ie., some tumors were positive for both antibodies, and others were positive for either L10 or BSL We have also found reactivity of these two anti-CD43 mAbs in 13 out of 20 metastases studied.

[Importance of the deficit of crystallization inhibitors in the etiopathogenesis of urolithiasis]

BACKGROUND

five percent of consultations at the Emergency Room of Catholic University Hospital are due to nephrolithiasis. The causes of this high frequency remain unknown.

AIM

to know the main metabolic and anatomic factors involved in the genesis of neprholithiasis.

PATIENTS AND METHODS

forty one patients (31 male) were studied presenting with a renal colic were studied as soon as the acute episode subsided and without diet modifications. Fasting blood calcium and creatinine and 24 h urine calcium, uric acid, citrate, magnesium and pH were measured and an intravenous pyelogram was performed. Twenty one subjects without a history of nephrolithiasis were used as controls.

RESULTS

Patients with nephrolithiasis did not differ from controls in urinary calcium (159 +/- 67 and 172 +/- 67 mg/24 h respectively), uricosuria (417 +/- 171 and 431 +/- 121 mg/24 h respectively) or urinary magnesium (55 +/- 19 and 62 +/- 21 mg/24 h respectively, whereas urinary citrate was lower (219 +/- 172 vs 319 +/- 179 mg/24 h in controls p < 0.05). All patients had normal renal functions, urinary acidification and intravenous pyelogram. Seven percent of patients with nephrolithiasis had hypercalciuria, 2.4% had hyperuricosuria. 68.3% had a low urinary citrate and 44.4% had low urinary magnesium.

CONCLUSIONS

in this sample, there is a strong association of nephrolithiasis with low levels of crystallization inhibitors in special with urinary citrate, a crystallization inhibitor.

Hyaline globules in uterine malignant mixed müllerian tumours. A diagnostic aid?

In order to evaluate the presence of hyaline globules (HGs) in uterine malignant mixed müllerian tumours (MMMT), and its possible diagnostic value in haematoxylin & eosin stained sections, a retrospective microscopic study of 38 cases (13 homologous and 25 heterologous) was carried out. Intra- and extracellular HGs were found in 31 MMMT (81.6%), 8 homologous (61.5%) and 23 heterologous (92%). In addition, strong alpha-1-antitrypsin immunoreactivity was also noted in the HGs of 10 cases out of 13 investigated. In initial diagnostic curettage material, HGs were observed in 18 of 22 cases (81.8%), 6 of 9 homologous (66.7%) and 12 of 13 heterologous (92.3%). In view of the high incidence of HGs in curettage specimens, their finding in haematoxylin & eosin stained sections could orientate a histopathologic preoperative diagnosis of MMMT, specially of heterologous type, and may be considered a diagnostic tool in order to indicate an early, planned therapy and staging in these neoplasms of poor prognosis.

[Autoimmune thyroid disease diagnosed during puerperium: evaluation 2 years later]

This is a 2 years follow-up study of seventeen women who were found to have mild goiter and post-partum thyroid disease two years earlier in order to establish if post-partum thyroid disease is a self-limited entity or the relapse of a chronic pre-existing disease. When first studied, the 17 women had thyroid dysfunction (15 with hyperthyroidism and 2 with hypothyroidism). Eight women had also elevated antimicrosomal antibodies (AMA) titers and 9 were negative for AMA. In the present study, all women were reexamined for the presence of goiter, and free thyroxine index (FT4I), TSH and AMA were determined. Mild (grade I-II, less than 30 g) goiter was found in 11 women. Six out seventeen women, still had altered functional tests (3 with hypothyroidism and 3 with hyperthyroidism). The elevated AMA titers seen in 8 patients in the first study, remained high in 6 (1:100-1:25600). None of the 9 patients who in the first study had negative AMA changed to positive titers. Results indicate that post-partum thyroid disease is not always a self-limited entity. The presence of elevated AMA titers in the initial post-partum period can express a chronic thyroid disease compromise. In these patients a longterm clinical and biochemical follow-up is recommended.

Classical and mixed-model analysis of an index selection experiment for fecundity in Drosophila melanogaster

A comparison of three family indices to increase number of pupas from 3-d lay in Drosophila melanogaster is reported. The three indices were Id, based exclusively on dam's information; Ihd, based additionally on dam's full-sibs' and half-sibs' information; and Ihs, which also included the sire's full-sibs' and half-sibs' records. Three lines, D, HD, and HS, were selected, each according to one of the three indices: Id, Ihd, or Ihs. Each line consisted of 10 sires and 60 dams. Each dam contributed one male offspring and three female offspring. Seven generations of selection were performed in a two-replicate experiment. The expected advance of Ihs and Ihd over Id in the seventh generation was .38 and .15 phenotypic standard deviations, respectively. The experiment was analyzed in terms of both classical ordinary least squares (OLS) and mixed-model methodology (MMM). The phenotypic trends in the first replicate were 4.06 +/- 1.74, 1.42 +/- 1.76, and .26 +/- 1.94 pupas per generation for Lines D, HD, and HS, respectively, and in the second replicate 8.52 +/- 2.40, 6.16 +/- 3.21, and 4.21 +/- 2.60, respectively. The genetic trends in the first replicate were 2.18 +/- .61, 1.08 +/- .67, and .24 +/- .68 pupas per generation and, in the second replicate, 2.51 +/- .60, .16 +/- .61, and .05 +/- .64 for Lines D, HD, and HS, respectively. Despite theoretical expectations, the Id index was consistently better than the more complex indices. Several explanations for these results are possible: 1) smaller than expected selection differential, 2) inbreeding depression, and 3) incorrect heritability used to construct the indices.(ABSTRACT TRUNCATED AT 250 WORDS)

Nigericin forms highly stable complexes with lithium and cesium

Nigericin is a monocarboxylic polyether molecule described as a mobile K+ ionophore unable to transport Li+ and Cs+ across natural or artificial membranes. This paper shows that the ion carrier molecule forms complexes of equivalent energy demands with Li+, Cs+, Na+, Rb+, and K+. This is in accordance with the similar values of the complex stability constants obtained from nigericin with the five alkali metal cations assayed. On the other hand, nigericin-alkali metal cation binding isotherms show faster rates for Li+ and Cs+ than for Na+, K+, and Rb+, in conditions where the carboxylic proton does not dissociate. Furthermore, proton NMR spectra of nigericin-Li+ and nigericin-Cs+ complexes show wide broadenings, suggesting strong cation interaction with the ionophore; in contrast, the complexes with Na+, K+, and Rb+ show only clear-cut chemical shifts. These latter results support the view that nigericin forms highly stable complexes with Li+ and Cs+ and contribute to the explanation for the inability of this ionophore to transport the former cations in conditions where it catalyzes a fast transport of K+ greater than Rb+ greater than Na+.

Field evaluation of an exoantigen-containing Babesia vaccine in Venezuela

Bovine babesiosis is endemic in Venezuela, causing significant losses in highly susceptible imported cattle. Current immunoprophylactic methods include the less desirable use of live parasites. Inactivated vaccines derived from exoantigen-containing supernatant fluids of in vitro Babesia bovis and B. bigemina cultures have been developed and constitute a major improvement in vaccine safety, stability and ease of handling. Vaccination trials conducted under field conditions provide the final evaluation of a culture-derived B. bovis-B. bigemina vaccine. During a 5-year period, approximately 8,000 cattle were vaccinated and 16 clinical trials carried out in 7 states of Venezuela. Clinical, serologic and parasitologic data were collected monthly from 10% of the animals over a 2-year period. Data were also collected from a similar number of nonvaccinated control cattle. Analysis of results from these trials demonstrated a reduction in the incidence of clinical disease among vaccinated animals and complete protection against mortality caused by babesiosis. Vaccine efficacy was measured calculating the incidence rates of disease and mortality among vaccinated and nonvaccinated cattle. Use of this inactivated vaccine offers the best combination of safety, potency and efficacy for the effective immunoprophylactic control of bovine babesiosis.

Molecular approaches to malaria and Babesisosis diagnosis

The development of additional methods for detecting and identifying Babesia and Plasmodium infections may be useful in disease monitoring, management and control efforts. The preliminary evaluate synthetic peptide-based serodiagnosis, a hydrophilic sequence (DDESEFDKEK) was selected from the published BabR gene of B. bovis. Immunization of rabbits and cattle with the hemocyanin-conjugated peptide elicited antibody responses that specifically detected both P. falciparum and B. bovis antigens by immunofluorescence and Western blots. Using a dot-ELISA with this peptide, antisera from immunized and naturally-infected cattle, and immunized rodents, were specifically detected. Reactivity was weak and correlated with peptide immunization or infection. DNA-based detection using repetitive DNA was species-specific in dot-blot formats for B. bovis DNA, and in both dot-blot and in situ formats for P. falciparum; a streamlined enzyme-linked synthetic DNA assay for P. falciparum detected 30 parasites/mm3 from patient blood using either colorimetric (2-15 h color development) or chemiluminescent detection (0.5-6-min exposures). Serodiagnostic and DNA hybridization methods may be complementary in the respective detection of both chronic and acute infections. However, recent improvements in the polymerase chain reaction (PCR) make feasible a more sensitive and uniform approach to the diagnosis of these and other infectious disease complexes, with appropriate primers and processing methods. An analysis of ribosomal DNA genes of Plasmodium and Toxoplasma identified Apicomplexa-conserved sequence regions. Specific and distinctive PCR profiles were obtained for primers spanning the internal transcribed spacer locus for each of several Plasmodium and Babesia species.

[Cervico-facial heterotopic brain tissue with a mandibular deformity]

Case report of a premature baby girl who presented with a right cervico-facial mass which caused severe respiratory difficulty. The patient underwent subtotal resection of the mass whose pathologic specimen report revealed heterotopic cerebral tissue compatible with encephalocele. A head and neck CT Scan performed could not evidence a connection between the mass and the cranial cavity, reason for which the possibility of encephalocele was disregarded. After subtotal resection of the mass, the tumor began to grow from soft palate and the patient died from respiratory complications at four months of age. Autopsy reported heterotopic cerebral tissue from neck and soft palate; right lung pneumonia and infection by CMV. Although the heterotopic cerebral tissue was reported as benign, the clinical characterization of this mass is compatible with a malignant behavior due to the aggressiveness of its growth.