Melanoma Registry of the Spanish Academy of Dermatology and Venereology (REGESMEL): Description and Data in its First Year of Operation

INTRODUCTION

The incidence of melanoma is rising in Spain. The prognostic stages of patients with melanoma are determined by various biological factors, such as tumor thickness, ulceration, or the presence of regional or distant metastases. The Spanish Academy of Dermatology and Venereology (AEDV) has encouraged the creation of a Spanish Melanoma Registry (REGESMEL) to evaluate other individual and health system-related factors that may impact the prognosis of patients with melanoma. The aim of this article is to introduce REGESMEL and provide basic descriptive data for its first year of operation.

METHODS

REGESMEL is a prospective, multicentre cohort of consecutive patients with invasive cutaneous melanoma that collects demographic and staging data as well as individual and healthcare-related baseline data. It also records the medical and surgical treatment received by patients.

RESULTS

A total of 450 cases of invasive cutaneous melanoma from 19 participant centres were included, with a predominance of thin melanomas≤1mm thick (54.7%), mainly located on the posterior trunk (35.2%). Selective sentinel lymph node biopsy was performed in 40.7% of cases. Most cases of melanoma were suspected by the patient (30.4%), or his/her dermatologist (29.6%). Patients received care mainly in public health centers (85.2%), with tele-dermatology resources being used in 21.6% of the cases.

CONCLUSIONS

The distribution of the pathological and demographic variables of melanoma cases is consistent with data from former studies. REGESMEL has already recruited patients from 15 Spanish provinces and given its potential representativeness, it renders the Registry as an important tool to address a wide range of research questions.

First report of fatal fungemia due Fusarium oxysporum in a patient with COVID-19 in Ecuador

Filamentous fungal infections are an important cause of systemic infections in immunocompromised patients. Fusarium genus members potentially cause disseminated infections, especially in patients with catheters, due to the ability to adhere to these devices. We describe a case of fatal fungemia due to Fusarium oxysporum in a patient with COVID-19 in Ecuador. The genus identification was carried out with conventional techniques and species identification by molecular and phylogenetic techniques through sequencing of the ITS region.

Tailoring modifications in labrenzin synthesis: a-la-carte production of pathway intermediates

Pederin-family polyketides today constitute a group of more than 30 molecules being produced as natural products by different microorganisms across multitude of ecological niches. They are mostly known for their extreme cytotoxic activity and the decades of long exploration as potential antitumor drugs. The difference in their potency and biological activity lies in the tailoring modifications of the core molecule. Despite the isolation of many pederin-like molecules until the date, only marine bacterium Labrenzia sp. PHM005 was reported as a cultivable producer and able to be genetically modified. Here, we study the role of tailoring enzymes from the lab gene cluster responsible for methylation and hydroxylation of labrenzin core molecule. We managed to produce a spectrum of differently tailored labrenzin analogs for the development of future drugs. This work constitutes one-step forward in understanding the biosynthesis of pederin-family polyketides and provides the tools to modify and overproduce these anticancer drugs in a-la-carte manner in Labrenzia sp. PHM005, but also in other producers in the future.

Xicotli Data: a project to retrieve plant-bee interactions from citizen science

Background

Xicotli data is the short name given to the dataset generated within the project framework "Integration of Biodiversity Data for the Management and Conservation of Wild Bee-Plant Interactions in Mexico (2021-2023)", as xicotli is the generic word for a bee in Nahuatl. The team comprised eco-informaticians, ecologists and taxonomists of both native bees and flora. The generated dataset contains so far 4,532 curated records of the plants, which are potential hosts of species of three focal families of bees native to Mexico: Apidae, Halictidae and Megachilidae and morphological and ecological data of the plant-bee interactions. This dataset was integrated and mobilised from citizen observations available at naturalista.mx (iNat), which were compiled through the iNaturalist project.

New information

The new information obtained with the Xicotli data project was: Taxonomic information about bee species curated by taxonomists based on the information contained in iNaturalist;Taxonomic identification of the host plants by a botanist from the photos compiled by the Xicotli Data project;Data on the ecomorphological traits of bees and plants based on expert knowledge and literature. All the data were integrated into the Xicotli Data Project via the creation of new "observation fields". The visibility of the information originally contained in iNaturalist was maximized and can be consulted directly on the iNaturalist platform.

Death in the Scottish curriculum: Denying or confronting?

The important role of schools in supporting children experiencing bereavement is established, yet less is known about how school curricula include death as part of life and this limits our understanding of the systemic structures that shape children's knowledge and experience of death. To address this gap, this paper discusses an analysis of the Scottish curriculum to explore the extent to which death features in compulsory education for children aged 3 to 15 years. The findings show that whilst death is present across the curricula, certain types of 'knowing' death are promoted, largely situated across religious teaching, which may limit children's engagement with the multiple and complex ways in which death features across individual, social, physical, and relational domains. By integrating the concepts of death systems and death ambivalence, the paper develops new knowledge on the interplay between curricula and sense making around death in children's lives that has practical utility.

Searching for a prognostic index in lupus nephritis

BACKGROUND

Currently we do not have an ideal biomarker in lupus nephritis (LN) that should help us to identify those patients with SLE at risk of developing LN or to determine those patients at risk of renal progression. We aimed to evaluate the development of a prognostic index for LN, through the evaluation of clinical, analytical and histological factors used in a cohort of lupus. We have proposed to determine which factors, 6 months after the diagnosis of LN, could help us to define which patients will have a worse evolution of the disease and may be, more aggressive treatment and closer follow-up.

METHODS

A retrospective study to identify prognostic factors was carried out. We have included patients over 18 years of age with a clinical diagnosis of systemic lupus erythematosus (SLE) and kidney involvement confirmed by biopsy, who are followed up in our centre during the last 20 years. A multi-step statistical approach will be used in order to obtain a limited set of parameters, optimally selected and weighted, that show a satisfactory ability to discriminate between patients with different levels of prognosis.

RESULTS

We analysed 92 patients with LN, although only 73 have been able to be classified according to whether or not they have presented poor renal evolution. The age of onset (44 vs. 32; p = 0.024), the value of serum creatinine (1.41 vs. 1.04; p = 0.041), greater frequency of thrombocytopenia (30 vs. 7%; p = 0.038), higher score in the renal chronicity index (2.47 vs. 1.04; p = 0.015), proliferative histological type (100%) and higher frequency of interstitial fibrosis (67 vs. 32%; p = 0.017) and tubular atrophy (67 vs. 32%; p = 0.018) was observed between two groups. The multivariate analysis allowed us to select the best predictive model for poor outcome at 6 months based on different adjustment and discrimination parameters.

CONCLUSION

We have developed a prognostic index of poor renal evolution in patients with LN that combines demographic, clinical, analytical and histopathological factors, easy to use in routine clinical practice and that could be an effective tool in the early detection and management.

Evaluation of the role of lisdexamfetamine on attention-deficit/hyperactivity disorder common psychiatric comorbidities: mechanistic insights on binge eating disorder and depression

Introduction

Attention-deficit/hyperactivity disorder (ADHD) is a psychiatric condition in which children suffer from inattentiveness, hyperactivity, and or impulsivity. ADHD patients frequently present comorbid psychiatric disorders: in adults, the most common are depression, substance-related disorders, anxiety, and eating disorders. Children and adolescents present conduct disorders, learning disorders, anxiety and depression. Since ADHD and its psychiatric comorbidities share similarities, a partial overlap of their pathophysiological mechanisms has been suggested. ADHD, can be treated with lisdexamfetamine (LDX), a prodrug indicated by the FDA as treatment for binge eating disorder (BED) and ADHD.

Objectives

To evaluate, through a systems biology-based in silico method, the efficacy of LDX as first-line ADHD treatment to improve ADHD psychiatric comorbidities. Furthermore, we explored the molecular mechanisms behind LDX’s action.

Methods

We used the systems biology- and artificial intelligence-based Therapeutic Performance Mapping System (TPMS) technology to characterise and model ADHD comorbidities. Artificial neural networks (ANNs) algorithms were used to identify specific relationships between protein sets. Finally, we modelled the mechanisms of LDX for the most relevant comorbidities by using sampling methods and comorbidity-specific virtual patients in each case.

Results

This study predicts a strong relationship between LDX’s targets and proteins involved in BED and depression (Fig 1). Our results could be explained not only by LDX role in neurotransmitter regulation, but also by modulation of neuroplasticity (BDNF/NTRK2, GSK3), neuroinflammation (interleukins, inflammasome), oxidative stress (NOS2, SOD), and the hypothalamic-pituitary-adrenal (HPA) axis (CRH, CRHR1).

Conclusions

These findings could be used in pre-clinical and clinical future investigations to assess optimal treatment for ADHD patients with psychiatric comorbidities.

Disclosure

JRGC: speaker for Takeda and Shire, research funding from Shire and Lumbeck, collaborations with Laboratoires Servier JQ: speaker or scientific advisor for Takeda, Janssen, Rubio. Investigation funding: Instituto de Salud Carlos III. PR, CM, TPR: full-ti

In vivo production of pederin by labrenzin pathway expansion

Pederin is a potent polyketide toxin that causes severe skin lesions in humans after contact with insects of genus Paederus. Due to its potent anticancer activities, pederin family compounds have raised the interest of pharmaceutical industry. Despite the extensive studies on the cluster of biosynthetic genes responsible for the production of pederin, it has not yet been possible to isolate and cultivate its bacterial endosymbiont producer. However, the marine bacterium Labrenzia sp. PHM005 was recently reported to produce labrenzin, the closest pederin analog. By cloning a synthetic pedO gene encoding one of the three O-methyltraferase of the pederin cluster into Labrenzia sp. PHM005 we have been able to produce pederin for the first time by fermentation in the new recombinant strain.

[Osteoarticular infections in children: five-year experience]

BACKGROUND

Osteoarticular infections (IOA) are considered infectious emergencies. The main microorganisms isolated are Staphylococcus aureus and Streptococcus pyogenes.

AIM

To describe demographic and clinical characteristics of patients from 2 months to 15 years old, hospitalized between the years 2012 and 2017 with IOA diagnosis.

METHODS

Retrospective study in a pediatric hospital. Clinical records of hospitalized patients with IOA were reviewed.

RESULTS

146 met inclusion criteria. 60.3% of the patients were male, median age 3 years 11 months. The main symptom at admission was joint pain (90%) and the median CRP was 43 mg/L. 48% of the patients had microbiological identification; 67.8% were positive for Staphylococcus aureus (10.2% SAMR). 94.5% of the sample received empirical antistaphylococcal beta-lactam treatment and 70,5% had a surgical intervention. Clinical response was observed 72 hours of beginning of treatment, and a decreased in inflammatory laboratory markers was observed at 4.7 days. 88% of patients attended without complications.

CONCLUSIONS

IOA infections are more common in boys, S. aureus is the main isolated pathogen, so we suggest to initiate the antimicrobial scheme with an antistaphylococcal beta-lactam, adding broad spectrum antimicrobial in children under 5 years. After 5 days of treatment, clinical resolution and decreased inflammatory laboratory parameters were observed.

Identification of trans-AT polyketide clusters in two marine bacteria reveals cryptic similarities between distinct symbiosis factors

Glutarimide-containing polyketides are known as potent antitumoral and antimetastatic agents. The associated gene clusters have only been identified in a few Streptomyces producers and Burkholderia gladioli symbiont. The new glutarimide-family polyketides, denominated sesbanimides D, E and F along with the previously known sesbanimide A and C, were isolated from two marine alphaproteobacteria Stappia indica PHM037 and Labrenzia aggregata PHM038. Structures of the isolated compounds were elucidated based on 1D and 2D homo and heteronuclear NMR analyses and ESI-MS spectrometry. All compounds exhibited strong antitumor activity in lung, breast and colorectal cancer cell lines. Subsequent whole genome sequencing and genome mining revealed the presence of the trans-AT PKS gene cluster responsible for the sesbanimide biosynthesis, described as sbn cluster. Strikingly, the modular architecture of downstream mixed type PKS/NRPS, SbnQ, revealed high similarity to PedH in pederin and Lab13 in labrenzin gene clusters, although those clusters are responsible for the production of structurally completely different molecules. The unexpected presence of SbnQ homologues in unrelated polyketide gene clusters across phylogenetically distant bacteria, raises intriguing questions about the evolutionary relationship between glutarimide-like and pederin-like pathways, as well as the functionality of their synthetic products.

Pigment profiles of Spanish extra virgin olive oils by ultra-high-performance liquid chromatography coupled to high-resolution mass spectrometry

This work studies the natural pigment profiles (chlorophylls and carotenoids) of Spanish Extra Virgin Olive Oils (EVOO) produced in different Spanish regions. The simultaneous qualitative and quantitative analysis of EVOO natural pigments has been performed by ultra-high-performance liquid chromatography coupled to high-resolution mass spectrometry (UHPLC-HRMS) using atmospheric pressure chemical ionisation (APCI). The results showed a similar natural pigment pattern for all the analysed EVOOs, although the total pigments content differed significantly. Moreover, the chlorophyll/carotenoid ratio was close to 1, while the lutein/β-carotene ratio was higher than 1, showing that lutein is the most abundant carotenoid in the studied Spanish EVOOs. Data from multivariate statistical approach demonstrated that the olive variety does not discriminate between EVOO samples. However, they were classified based on their origin allowing good differentiation of samples from the Basque Country and Canary Islands from the rest of regions. The results of this study show the differences of the nature and pigments concentration of Spanish EVOO samples, parameters that are of significance for reliable characterisation.

Changes in invertebrate community composition allow for consistent interpretation of biodiversity loss in ecological status assessment

Biological communities change in response to human alteration. The response of individual taxa and the community can be used to establish preventive criteria to halt further biodiversity deterioration. Here we explore how consistent are the boundaries between Good and Moderate ecological status derived from classification systems used in North-NW Spain: NORThern Spain Indicators system (NORTI), River type specific multimetric (METI) and Iberian Bio-monitoring Working Party (IBMWP), by using common interpretation of normative definitions of Water Framework Directive. We applied the three classifications to a monitoring dataset of Nalón River basin, comprising samples from different stream types and reference conditions. We applied Threshold Indicator Taxa ANalysis to the invertebrate community along the most relevant environmental pressures and biological impairment gradients represented by the Ecological Quality Ratio (EQR) scores of the classification systems. Only NORTI provided a true community ecological threshold and the change point (cp) 95% quantile (Q95%) range of 0.760 was assumed to be the boundary from Good to Moderate (G/M) status, used to standardize the number of taxa loss in all systems. Since the average number of taxa at reference sites was 34, the estimated loss of sensitive taxa was up to 97.1% in IBMWP, 73.5% in METI and 52.9% in NORTI when passing from Good to Moderate status, revealing very permissive boundaries. The loss of common sensitive taxa in NORTI at Q95% was used as G/M threshold and applied to the other classifications, resulting all in a common biodiversity loss of 21% of sensitive taxa richness at values of NORTI-EQR = 0.760, METI-EQR = 0.818 and IBMWP-EQR = 0.753. Results indicate that significant community changes along pressure gradients allow for establishing quantitative criteria consistent with normative definitions. This understanding derived from Directive monitoring programs can assess the risk that invertebrate communities face in terms of species loss derived from anthropogenic pressures.

Why do bugs perish? Range size and local vulnerability traits as surrogates of Odonata extinction risk

Despite claims of an insect decline worldwide, our understanding of extinction risk in insects is incomplete. Using bionomic data of all odonate (603 dragonflies and damselflies) North American species, we assessed (i) regional extinction risk and whether this is related to local extirpation; (ii) whether these two patterns are similar altitudinally and latitudinally; and (iii) the areas of conservation concern. We used geographic range size as a predictor of regional extinction risk and body size, thermal limits and habitat association as predictors of local extirpation. We found that (i) greater regional extinction risk is related to narrow thermal limits, lotic habitat use and large body size (this in damselflies but not dragonflies); (ii) southern species are more climate tolerant but with more limited geographic range size than northern species; and (iii) two priority areas for odonate conservation are the cold temperate to sub-boreal northeastern USA and the transversal neo-volcanic system. Our approach can be used to estimate insect extinction risk as it compensates for the lack of abundance data.

Genome of Labrenzia sp. PHM005 Reveals a Complete and Active Trans-AT PKS Gene Cluster for the Biosynthesis of Labrenzin

The complete genome of the strain Labrenzia sp. PHM005, a free-living producer of a pederin analog 18-O-demethyl pederin, hereinafter labrenzin, has been sequenced. This strain contains two replicons comprising a circular chromosome of 6,167,349 bp and a circular plasmid (named p1BIR) of 19,450 bp. A putative gene cluster responsible for the synthesis of labrenzin (lab cluster) has been identified showing that it encodes a trans-AT mixed type PKS/NRPS biosynthetic pathway that is responsible for the synthesis of pederin and possibly an onnamide analog. The putative boundaries of the lab gene cluster were determined by genetic comparisons with other related strains, suggesting that the cluster consists of a 79-kb region comprising 3 genes encoding multidomain hybrid polyketide synthase/non-ribosomal peptide synthetase (PKS/NRPS) proteins (PKS4, PKS/NRPS13, and PKS/NRPS15), and 16 auxiliary enzymes. Transcriptomic analyses suggest that all the genes of the cluster are expressed in our culture conditions (i.e., in minimal medium in the absence of any specific inducer) at detectable levels. We have developed genetic tools to facilitate the manipulation of this strain and the functional characterization of the cluster genes. We have created a site-directed mutant unable to produce pederin, demonstrating experimentally for the first time the role of the cluster in the synthesis of pederin. This work paves the way to unravel the clues of the biosynthesis of pederin family compounds and opens the door to modify and overproduce these anticancer drugs for industrial and pharmaceutical purposes.

Valorisation of biowaste digestate through solid state fermentation to produce biopesticides from Bacillus thuringiensis

The main goal of this work is the production of a biopesticide through solid-state fermentation of biowaste digestate inoculated with Bacillus thuringiensis (Bt) at pilot scale using different configurations of reactors. Fermentations were carried out using insulated and non-insulated, stirred and non-stirred reactors at different scales (10, 22 and 100 L) in order to assess the influence of the reactor configuration on the biopesticide production process. A maximum temperature of 60 °C was reached in 10-L insulated non-stirred reactors where increments of Bt viable cells and spores with respect to initial values of 1.9 and 171.6 respectively, were attained. In contrast, when temperature was regulated by using 22-L non-insulated stirred reactors the increment of viable cells and spores were 0.8 and 1.9, respectively, at a stable temperature of 27 °C. When the non-insulated stirred reactor was scaled up to 100-L, the increase of viable cells and spore counts were 1.2 and 3.8 respectively, with an average temperature of 28 °C. These results demonstrated that the election of a proper reactor configuration is important when considering the development of a new SSF process, especially when dealing with non-conventional substrates as digestate.

Bacterial Production of a Pederin Analogue by a Free-Living Marine Alphaproteobacterium

The polyketide pederin family are cytotoxic compounds isolated from insects, lichen, and marine sponges. During the past decade, different uncultivable bacteria symbionts have been proposed as the real producers of these compounds, such as those found in insects, lichen, and marine sponges, and their trans-AT polyketide synthase gene clusters have been identified. Herein we report the isolation and biological activities of a new analogue of the pederin family, compound 1, from the culture of a marine heterotrophic alphaproteobacterium, Labrenzia sp. PHM005. This is the first report of the production of a pederin-type compound by a free-living marine bacteria that could be cultured in the laboratory.

Diagnosis and treatment for clinically localized prostate cancer. Adherence to the European Association of Urology clinical guidelines in a nationwide population-based study - GESCAP group

OBJECTIVE

To assess the adherence to European Association of Urology (EAU) guidelines in the management of prostate cancer (PCa) in Spain.

PATIENTS AND METHODS

Epidemiological, population-based, study including a national representative sample of 3,918 incident patients with histopathological confirmation during 2010; 95% of the patient's sample was followed up for at least one year. Diagnosis along with treatment related variables (for localized PCa -low, intermediate, high and locally-advanced by D'Amico risk stratification) was recorded. Differences between groups were tested with Chi-squared and Kruskal-Wallis tests.

RESULTS

Mean (SD) age of PCa patients was 68.48 (8.18). Regarding diagnostic by biopsy procedures, 64.56% of all patients had 8-12 cores in first biopsy and 46.5% of the patients over 75 years, with PSA<10ng/mL were biopsied. Staging by Computer Tomography (CT) or Bone Scan (BS) was used for determining tumor extension in 60.09% of high-risk cases and was applied differentially depending on patients' age; 3,293 (84.05%) patients received a treatment for localized PCa. Radical prostatectomy was done in 1,277 patients and 206 out of these patients also had a lymphadenectomy, being 4.64% low-risk, 22.81% intermediate-risk and 36.00% high-risk patients; 86.08% of 1,082 patients who had radiotherapy were treated with 3D or IMRT and 35.77% received a dose ≥75Gy; 419 patients were treated with brachytherapy (BT): 54.81% were low-risk patients, 22.84% intermediate-risk and 12.98% high-risk. Hormonotherapy (HT, n=521) was applied as single therapy in 9.46% of low-risk and 17.92% of intermediate-risk patients. Additionally, HT was combined with RT in 14.34% of lower-risk patients and 58.26% of high-risk patients, and 67.19% low-intermediate risk with RT and/or BT received neoadjuvant/concomitant/adjuvant HT. Finally, 83.75% of high-risk patients undergoing RT and/or BT also received HT.

CONCLUSIONS

Although EAU guidelines for PCa management are easily available in Europe, the adherence to their recommendations is low, finding the highest discrepancies in the need for a prostate biopsy and the diagnostic methods. Improve information and educational programs could allow a higher adherence to the guidelines and reduce the variability in daily practice. (Controlled-trials.com: ISRCTN19893319).

Streptenols F-I Isolated from the Marine-Derived Streptomyces misionensis BAT-10-03-023

A marine-derived bacterium, Streptomyces misionensis BAT-10-03-123, has produced four new streptenol derivatives, F, G, H, and I (1-4), as well as the known streptenols A and C (5 and 6). Their planar structures were elucidated by detailed analysis of spectroscopic data. The absolute configurations of the new streptenol compounds were determined by chemical and spectroscopic methods, including Mosher's ester method. All of the compounds were tested for cytotoxicity against four selected cancer cell lines.

Omalizumab in the Treatment of Chronic Inducible Urticaria

Omalizumab is a recombinant humanized monoclonal antibody that inhibits immunoglobulin E. It has been approved for the treatment of severe asthma and chronic spontaneous urticaria refractory to other treatments. Its use in the management of chronic inducible urticaria (a type triggered by certain stimuli) is still considered off-label, although this use has been discussed in some consensus papers. This review brings together case reports and case series describing the use of omalizumab to treat chronic inducible urticaria. We analyze the most important aspects of the cases and the outcomes reported. The results seem to position omalizumab as a potentially effective, safe treatment alternative in some cases of chronic inducible urticaria.

Perception of lactose intolerance impairs health-related quality of life

BACKGROUND/OBJECTIVES

Chronic conditions impair perception of well-being. Malabsorption of lactose is the most frequent form of malabsorption and manifests as lactose intolerance. There is a lack of information regarding their impact on self-perception of health. The objective of this study is to determine the subjective impact of self-reported lactose intolerance or objective lactose malabsorption on patient health by using a patient-reported outcome to measure health-related quality of life (HRQOL) and modification of lactose-containing food diet.

SUBJECTS/METHODS

A 3-year prospective, cross-sectional study was performed in patients referred for a lactose hydrogen breath test. Patients were asked about their subjective opinion relative to their lactose tolerance and completed a validated, specific questionnaire to determine symptoms of intolerance during habitual consumption of dairy. A 50-g lactose breath test was then performed. Patients were grouped as absorbers vs malabsorbers and tolerant vs intolerants.

RESULTS

A total of 580 patients were included (median age 30 years, 419 female). Overall, 324 patients (56%) considered themselves lactose intolerant and that perception was associated with avoidance of dairy consumption (55% vs only 9% of self-defined tolerants). Self-perception of intolerance was associated with lower HRQOL scores (median, 60 vs 70, P<0.01). In contrast, lactose objective malabsorption was not clearly associated with dairy avoidance (41% of malabsorbers avoided dairy vs 31% of absorbers). However, HRQOL scores were also significantly lower in malabsorbers than in absorbers (60 vs 70 respectively, P<0.001).

CONCLUSIONS

Subjective perception of lactose intolerance affects the decision to avoid dairy even more than objective malabsorption. However, both self-perception of lactose intolerance and objective lactose malabsorption are associated with poorer perceived quality of life.

Treatment trends for clinically localised prostate cancer. National population analysis: GESCAP group

OBJECTIVES

To describe the established therapies for localised prostate cancer (PC) in Spain and to assess compliance with the 2010 UAE guidelines.

PATIENTS AND METHODS

This was an epidemiological, observational, prospective and multicentre study. Of the 3,918 patients diagnosed with PC during 2010, only those patients with localised PC were included. Follow-up was ultimately conducted for a minimum of one year from the diagnosis for 3,713 patients (94.77%). The treatment groups assessed were as follows: radical prostatectomy, radiation therapy, hormone therapy, brachytherapy, active surveillance or observation and experimental local treatment (cryotherapy or other treatment). Compliance with the recommendations of the EAU guidelines was studied, describing the treatment groups according to D'Amico risk stratification criteria (localised [low, intermediate and high risk] and locally advanced), age, PSA and Gleason score.

RESULTS

By applying the D'Amico criteria, we included 3,641 (92.93%) patients. Based on the UAE recommendations: 1) 68.87% of the patients at low-intermediate risk aged≤65 years underwent radical prostatectomy; 2) 34.51% of the patients>65 years at high risk with locally advanced disease were administered radiation therapy and hormone therapy; 3) 30.36% of the patients at high risk with locally advanced disease were only treated with hormone therapy; 4) 15.20% of the patients at low risk were only treated with brachytherapy; 5) active surveillance or observation was selected for 2.44% of the patients aged≤65 years and for 10.63% of the patients at low-intermediate risk who were>65 years. Lastly, 86.5% of the patients at low risk underwent a single treatment, and 43.62% of the patients at high risk with locally advanced disease underwent combined treatments.

CONCLUSIONS

This is the first national European study to evaluate the therapeutic management of localised PC based on the risk group to which the patient belonged. Most young patients (≤65 years) with low-intermediate risk localised PC were treated with surgery, which adheres to the recommendations of the 2010 UAE guidelines. Various therapeutic combinations have been employed for patients with high-risk, locally advanced localised tumours, revealing the need for a multidisciplinary approach (Controlled-trials.com number: ISRCTN19893319).

Relation between periodontal disease and arterial stiffness

BACKGROUND AND OBJECTIVE

Periodontal disease has been described as playing a role in the atherosclerosis process, and its relation with intimal thickness and vascular endothelial function (EF) has been investigated. The present study sought to determine whether there are differences in parameters of arterial stiffness and EF between patients with and without severe periodontal disease (SPD).

MATERIAL AND METHODS

Patients referred to the School of Dentistry University of Buenos Aires, were assessed. Demographic characteristics, atherogenic risk factors and concomitant pathologies were recorded. Patients with known cardiovascular pathology were excluded. Using carotid Doppler ultrasound an operator assessed arterial stiffness parameters: compliance, elastic modulus (EM), β stiffness index (βSI) and vascular EF by brachial artery flow-mediated dilatation. The patients were divided into two groups: with and without SPD.

RESULTS

Forty patients were included; 60% were women; 15 were in the SPD group and 25 in the group without SPD. Respective results of the studied variables were: age 56.53 ± 17.58 vs. 51.12 ± 12.97 years (NS); probing depth 2.53 ± 1.30 (95% CI 1.81-3.25) vs. 1.25 ± 0.51 (95% CI 1.31-1.73) p = 0.02; clinical attachment level 4.80 ± 2.00 (95% CI 3.69-5.91) vs. 1.72 ± 0.93 (95% CI 1.33-2.11) p = 0.001; intimal thickness 0.10 ± 0.17 (95% CI 0.095-0.11) vs. 0.82 ± 0.18 (95% CI 0.074-0.98) (NS); EM 48.33 ± 12.53 vs. 38.86 ± 7.69 (p = 0.005); βSI 4.21 ± 1.03 vs. 3.64 ± 1.02 (p = 0.004); EF 16.13 ± 5.02 vs. 22.76 ± 4.50 (p = 0.0003). Correlation between: EM and clinical attachment level r = 0.58 (p < 0.001), βSI and clinical attachment level r = 0.66 (p < 0.001), EF and clinical attachment level 0.59 (p < 0.001).

CONCLUSIONS

Parameters of arterial stiffness and EF were worse in patients with SPD and correlated moderately with clinical attachment level. Correlation with compliance and EF was negative.

[Clostridium difficile associated diarrhea in children]

INTRODUCTION

Clostridium difficile is the most commonly isolated organism in antimicrobial and health care-associated diarrhea and is growing in relevance in community-acquired infections. It is a Gram-positive bacillus acquired via the fecal-oral route in the community and in hospital setting.

EPIDEMIOLOGY

0.6 to 2.1% worldwide incidence, mortality ~ 1-5%. COLONIZATION: High rates of asymptomatic colonization in healthy people, 37% in children: its presence in stools is of controversial significance. Risk factors in children are prior exposure to antibiotics, recent hospitalization, immunosuppression or inflammatory bowel disease.

CLINICAL MANIFESTATIONS

Secondary to intestinal involvement due to toxin production, ranging from asymptomatic colonization to fulminant disease.

DIAGNOSIS

Clinical diagnostic criteria plus high sensitivity and specificity laboratory certification. Recommendations AAP (American Academy of Pediatrics): under 1 year, avoid routine study, only in Hirschsprung disease and/or nosocomial outbreak, 1-3 year, a (+) result suggests C. difficile associated diarrhea (CDAD) is possible, and in children older than 3 years interpretation is equal to adults.

MANAGEMENT

Antimicrobial suspension, oral metronidazole as first line in mild to moderate CDAD, and oral or enema vancomycin or associated with intravenous metronidazole only in severe cases. Duration 10 days.

PREVENTION

Antimicrobial control programs and environmental management.

CONCLUSION

Given the increasing complexity of pediatric patients it is important to deepen the knowledge on this microorganism and its clinical manifestations, as its incidence, morbidity and mortality are increasing.

Continuous-flow system and monitoring tools for the dielectrophoretic integration of nanowires in light sensor arrays

Although nanowires (NWs) may improve the performance of many optoelectronic devices such as light emitters and photodetectors, the mass commercialization of these devices is limited by the difficult task of finding reliable and reproducible methods to integrate the NWs on foreign substrates. This work shows the fabrication of zinc oxide NWs photodetectors on conventional glass using transparent conductive electrodes to effectively integrate the NWs at specific locations by dielectrophoresis (DEP). The paper describes the careful preparation of NW dispersions by sedimentation and the dielectrophoretic alignment of NWs in a home-made system. This system includes an impedance technique for the assessment of the alignment quality in real time. Following this procedure, ultraviolet photodetectors based on the electrical contacts formed by the DEP process on the transparent electrodes are fabricated. This cost-effective mean of contacting NWs enables front-and back-illumination operation modes, the latter eliminating shadowing effects caused by the deposition of metals. The electro-optical characterization of the devices shows uniform responsivities in the order of 106 A W(-1) below 390 nm under both modes, as well as, time responses of a few seconds.

Electrical stunning effectiveness with current levels lower than 1 A in lambs and kid goats

An experiment with 360 lambs grouped into three Spanish commercial categories, (Pascual, 13-16 kg; Recental, 9-13 kg and Lechal <7 kg carcass weight) and kid goats (7 kg) was performed to assess stunning effectiveness after head-only (HO) and head-to-body (HB) electrical stunning with intensity currents of 0.3, 0.5 and 0.7 Amperes (A) compared to 1.0 A. After stunning, all animals showed tonic-clonic muscular activity and epileptiform EEG, absence of rhythmic breathing, corneal reflex, spontaneous blinking and pain sensibility. The quiescent EEG occurred earlier (P < 0.05) in HB compared to HO in all categories. More animals recovered corneal reflex and rhythmic breathing before onset of the quiescent activity after HO (from 15 to 50%) compared to HB (from 0 to 15%) (P < 0.05). Concluding, HO and HB electrical stunning with 0.3, 0.5 and 0.7 A induce effective stunning similar to 1.0 A in lambs and kid goats. After stunning and sticking, brain failure occurs earlier in HB than HO system.

Sediment toxicity and bioaccumulation assessment in abandoned copper and mercury mining areas of the Nalón River basin (Spain)

Sediment toxicity and metal bioaccumulation were assessed at sites affected by historical copper (Cu) and mercury (Hg) mining activities in the Nalón River basin, Asturias, Spain. Toxicity assessment of stream sediments was based on a 28-day oligochaete Tubifex tubifex sediment bioassay, which allowed the classification of sites into three levels of toxicity: 11 sites were classified as nontoxic (including Cu mine sites), three sites as potentially toxic, and seven sites as toxic (all located in Hg mine districts). The greatest levels of arsenic (As), chromium, Hg, lead (Pb), and zinc (Zn) in T. tubifex were measured at sites affected by Hg mining and the highest Cu levels in tissues at Cu mining sites. Chronic toxicity responses were best explained by As and Hg sediment concentrations and by As, Pb, and Zn tissue residues. Residue levels of As, Hg, Zn, and Pb were successfully used to predict sediment chronic toxicity and estimate effective tissue residues.

[Vascular rings, our experience with 18 cases]

AIM

Vascular rings are a rare cause of compression of the trachea and/or the esophagus, causing stridor and/or severe dysphagia. We present our experience in the diagnosis and management of vascular rings.

METHODS

Retrospective study in which we analyzed clinical history, diagnosis and management of 18 patients diagnosed with vascular ring between January 1985 and December 2013. We evaluate endoscopy as a diagnostic method.

RESULTS

A total of 18 patients were included, with a median age of 2 years. 83.3% (15/18) had some type of symptom: 46.7% (7/15) had respiratory symptoms such as respiratory distress, stridor, recurrent respiratory infections, bronchospasm with wheezing or asthma in older children; 20% (3/15) had digestive symptoms such as dysphagia, vomiting and regurgitation; and 33.3% (5/15) combined respiratory and digestive symptoms. The remaining patients, 16.7% (3/18) were asymptomatic and the diagnosis was casual. The most common types of vascular rings were double aortic arch (27.8%) and aberrant subclavian right artery (27.8%). In 3 cases (16.7%) a Kommerell diverticulum was associated. 44.4% (n = 8) was operated on, the remaining did not present symp- toms which justify the intervention (n = 10). 37.5% of patients had postoperative complications (iatrogenic recurrent paralysis and persistent tracheomalacia). There was no mortality in our series. The median follow-up was 6.4 years. At the moment, 88.9% of patients are asymptomatic, and 33.3% have been definitely discharged.

CONCLUSIONS

Vascular rings are rare, and usually presented with common symptoms in childhood. Therefore, in front of a longstanding and recurrent respiratory symptoms, or dysphagia, we should think of a vascular ring. Not all subjects are candidates for surgical correction; therefore a multidisciplinary evaluation is essential.

Effect of water deficit and domestic storage on the procyanidin profile, size, and aggregation process in pear-jujube (Z. jujuba) fruits

No information exists on the proanthocyanidin content of pear-jujube (Ziziphus jujuba Mill) fruit, their polymeric types and sizes, and their self-aggregation, or on the effect of different water deficit levels during the fruit maturation period on these compounds. Two trimers, two tetramers, and six B type procyanidin pentamers were identified and quantified for the first time. Water deficit increased the content of procyanidins of low molecular mass, improving their potential bioavailability and possible physiological effects on human health. The tendency of procyanidins to self-aggregate was similar in the edible portion and pit, and was not affected by water deficit. The procyanidin content of fruit from well watered trees increased during domestic cold storage, whereas the fruits from trees suffering severe water stress lost some of their procyanidin content.

Leaf mechanisms for drought resistance in Zizyphus jujuba trees

No information exists on the mechanisms developed at the level of leaf water relations by pear-jujube trees (Zizyphus jujuba Mill.) to confront drought. For this reason, the purpose of the present study was to analyse its leaf water relations in order to clarify the resistance mechanisms (avoidance and tolerance) developed in response to a water stress and during recovery. Field-grown 7-year-old pear-jujube trees (cv. Grande de Albatera) were subjected to three irrigation treatments. Control (T0) plants were drip irrigated (112% ETo) in order to guarantee non-limiting soil water conditions, T1 plants (deficit irrigation, 64% ETo) were drip irrigated according to the criteria used by the grower and T2 plants irrigated as T0 but subjected to water withholding for 36 days and a subsequent re-irrigation at the levels used in T0 for 14 days, during the summer of 2011. The results indicated that pear-jujube plants confront water stress by developing stress avoidance and stress tolerance mechanisms. From the beginning of deficit irrigation (T1) and water withholding (T2) to when maximum water stress levels were achieved, leaf turgor was maintained allowing substantial gas exchange levels and, consequently, good leaf productivity. This leaf turgor maintenance was mainly due to two simultaneous and complementary mechanisms. Leaf conductance and the duration of maximum stomatal opening in water stressed plants decreased in order to control water loss via transpiration, contributing to maintain leaf turgor (stress avoidance mechanisms). Also, the gradual recovery of g(l) observed after rewatering the plants can be considered as a mechanism for promoting leaf rehydration. In addition, from the beginning of the stress period, active osmotic adjustment operated, also contributing to the maintenance of leaf turgor (stress tolerance mechanism). The high RWC(a) levels and the possibility of increasing the accumulation of water in the apoplasm in response to water stress, supporting a steeper gradient in water potential between the leaf and the soil, which can be considered another drought tolerance characteristic in pear-jujube.