Spermatological Characterization of the Cestode Meggittina gerbilli (Cyclophyllidea: Catenotaeniidae), a Parasite of Gerbils, Gerbillus gerbillus and Gerbillus campestris (Rodentia: Muridae) in Tunisia

Ultrastructural characters of spermiogenesis and the mature spermatozoon of the cestode Meggittina gerbilli (Cyclophyllidea: Catenotaeniidae), a parasite of the Lesser Egyptian gerbil (Gerbillus gerbillus) and the North African gerbil (Gerbillus campestris) (Rodentia: Muridae) in the Djebel Dahar (South of Tunisia), were studied using transmission electron microscopy. The spermiogenesis of M. gerbilli is of Bâ and Marchand's type III, which is mainly characterized by a proximodistal fusion of a single flagellum with a cytoplasmic extension. In this catenotaeniid, the proximal fusion is preceded by a 90° rotation of the flagellum. The spermatozoon is a Levron et al. type VI, which presents a single axoneme with the 9 + '1' trepaxonematan pattern, a periaxonemal sheath, two crest-like bodies, twisted cortical microtubules, and a spiraled nucleus. The obtained results show similarities with the remaining studied catenotaeniids, namely Catenotaenia pusilla and Skrjabinotaenia lobata. The results are compared and discussed according to several characteristics found in the catenotaeniids and other studied cyclophyllideans.

Evaluation of a school-based sun safety education program in Reunion Island, 2016-2017

BACKGROUND

Sun exposure, especially during childhood, is the main environmental risk factor for skin cancers. This study evaluated the impact of the school-based sun safety education program "Living with the Sun" on the knowledge and behavior of primary school children regarding sun safety in Reunion Island.

METHODS

This multicenter, comparative intervention study was conducted in selected primary schools of Reunion during the 2016-2017 school year. The intervention consisted of an in-class slide-show presentation on sun safety, a teaching guide, and school trips during which children were offered sunscreen and were requested to wear sunglasses, a T-shirt, and a cap. The children completed a questionnaire before and after the intervention. The percentage of children wearing a cap in school playgrounds at the end of the school year was compared between paired intervention and control schools.

RESULTS

Seven hundred children from 7 Reunionese schools completed the questionnaire before and after the intervention. There was a statistically significant improvement in children's knowledge of sun safety, with differences between schools, teachers, school levels, and questionnaire responses. The percentage of children wearing a cap at the end of the school year was significantly higher in intervention schools compared to control schools.

CONCLUSIONS

Children's knowledge and behavior regarding sun safety improved significantly as a result of the intervention.

Data on New Intermediate and Accidental Hosts Naturally Infected with Angiostrongylus cantonensis in La Gomera and Gran Canaria (Canary Islands, Spain)

Angiostrongylus cantonensis is a metastrongyloid nematode and the etiologic agent of angiostrongyliasis, a disease characterized by eosinophilic meningitis. This emerging zoonotic parasite has undergone great expansion, including in some regions of Europe and America. In the Canary Islands, the parasite was first discovered parasitizing Rattus rattus on the island of Tenerife in 2010. To date, the distribution of this parasite in the Canary Islands has been restricted to the northern zone and the main cities of Tenerife. Using molecular tools for the sentinel species present in the Canary Islands, this study confirmed the presence of the nematode on two other islands in the Canary Archipelago: La Gomera and Gran Canaria. Furthermore, this emerging parasite was detected, besides in the common definitive host R. rattus, in wild Mus musculus and Felis catus and in four terrestrial gastropod species, Limacus flavus, Milax gagates, Insulivitrina emmersoni, and Insulivitrina oromii, two of them endemic to La Gomera, for the first time, increasing the number of non-definitive host species. This study reinforces the expansion character of A. cantonensis and highlights the importance of knowledge about sentinel species for identifying new transmission locations that help prevent and control the transmission of the parasite and, thus, prevent public health problems.

A Review of Sperm Ultrastructural Characters in the Opecoelidae (Digenea) and Their Phylogenetic Implications, with New Data on Peracreadium characis, a Parasite of Diplodus puntazzo in Tunisia

The spermatozoon ultrastructure of Peracreadium characis (Stossich, 1886) (Digenea: Opecoelidae), an intestinal parasite of the sheephead bream Diplodus puntazzo (Walbaum, 1792) (Sparidae), is described by means of transmission electron microscopy (TEM). The mature spermatozoon possesses two axonemes of the 9+'1' trepaxonematan pattern, an anterior electron-dense material, two mitochondria, a nucleus and parallel cortical microtubules distributed in two bundles. The absence of external ornamentation of the plasma membrane and spine-like bodies are the noteworthy characters that distinguish the spermatozoon of P. characis from those of most opecoelids. In fact, only Helicometra fasciata lacks external ornamentation in the spermatozoon. A comparative study with the remaining opecoelids described so far reveals similarities in the ultrastructural organization of their sperm cells. In addition, the current data on sperm ultrastructure in species of the recognized opecoelid subfamilies are compared, namely the Hamacreadiinae, Helicometrinae, Opecoelinae, Opistholebetinae and Plagioporinae.

Morphologic and genetic characterization of Pterygodermatites (Mesopectines) valladaresi n. sp. (Nematoda, Rictulariidae), a parasite of the mouse Mus musculus (Rodentia, Muridae) from the Canary Islands (Spain)

A new rictulariid nematode Pterygodermatites (Mesopectines) valladaresi n. sp., parasite of the house mouse Mus musculus (Rodentia: Muridae) in the Canary Islands (Spain) is described by means of light and scanning electron microscopy. The new species belongs to the subgenus Mesopectines characterized by a more or less dorsal orientation of the buccal capsule, the presence of three oesophageal teeth, the morphology of the oral denticles and the Spirurida type of arrangement of caudal papillae in males. The most discriminant characteristics between the new species and the existing species in the subgenus Mesopectines are (a) the number of cuticular projection pairs (62-64), (b) the size of right and left spicules (respectively, 62-90 µm and 123-139 µm), (c) the number of midventral fans in males (3-4), (d) the number of prevulvar/total cuticular projection pairs (38-42/63-71), (e) the posterior differentiation of combs into spines in relation to the position of the vulva and (f) the anterior position of the vulva in relation to the oesophagus-intestine junction in females. Parasitized hosts and geographical distribution are also useful criteria to distinguish P. (Me.) valladaresi n. sp. from the remaining species of the subgenus. In addition, the cox1 sequence of the new species is provided and compared with available data of related species.

ULTRASTRUCTURE OF EGG ENVELOPES AND EARLY EMBRYOS OF ROHDELLA AMAZONICA (TREMATODA: ASPIDOGASTREA) PARASITIC IN BANDED PUFFER FISH, COLOMESUS PSITTACUS

Egg structure and early embryonic development of the aspidogastrean, Rohdella amazonica, a basal trematode, were studied by transmission electron microscopy (TEM) to gain insight into functional, developmental, and phylogenetic characteristics. Gravid worms were removed from the intestine of naturally infected banded puffer fish Colomesus psittacus, collected from the Bay of Marajó, Paracauari River (Pará, Brazil) and processed by standard TEM methods. By the time of pronuclear fusion, the fertilized zygote was already enclosed in a thick, electron-dense pre-operculate eggshell and an underlying layer of vitellocytes that fused into a vitelline syncytium as they were still secreting their shell granules. When cleavage commenced, a small number of macromeres moved to the area just underneath the eggshell, where they fused to form a single syncytial embryonic envelope. Simultaneously, the smaller blastomeres continued to divide as they maintained contact with each other, but remained separate from the vitelline syncytium. Concurrent with these cellular changes, a thickened knob expanded at one pole of the eggshell and began to form an opercular suture. By the time the operculum was fully formed, the vitelline syncytium had mostly degenerated, while the smaller blastomeres had become cohesive as a single mass that preceded the differentiation and morphogenesis of the cotylocidium larva. The general pattern of cleavage and eggshell formation resembles that of other trematodes and polylecithal cestodes, but the single embryonic envelope has been reported only in a few basal taxa. The only other aspidogastrean studied in detail to date is very similar, indicating close phylogenetic affinity and conservatism within this basal neodermatan and neoophoran group.

ULTRASTRUCTURE AND CYTOCHEMISTRY OF LATE EMBRYOS AND COTYLOCIDIUM LARVAE OF ROHDELLA AMAZONICA (TREMATODA: ASPIDOGASTREA), FROM THE TROPICAL ESTUARINE FISH, COLOMESUS PSITTACUS

Developmental ultrastructure of late embryos and cotylocidium larval morphogenesis of Rohdella amazonica, an aspidogastrean parasite of fish, were studied to reveal the functional aspects of larvigenesis within the egg as well as phylogenetically relevant characteristics of the embryos and larvae in this basal trematode group. Gravid worms were removed from the intestine of naturally infected banded puffer fish Colomesus psittacus, collected from the Bay of Marajó, Paracauari River (Pará, Brazil) and processed by standard methods of transmission electron microscopy (TEM) and cytochemistry. During late cleavage and rearrangement of the blastomeres, the vitelline syncytium that plays a role in eggshell formation and nutrient provision to the embryo completes its apoptotic degeneration as the embryonic mass grows substantially. Early larval morphogenesis involves cellular positioning that defines the anteroposterior polarity of the differentiating larva. Progressing through larvigenesis, the anterior end forms a muscular oral sucker surrounding the mouth, which leads inward into the pharynx and expanding digestive cavity. At the posterior end, a large disc forms as a precursor to the eventual ventral disc. The fully formed cotylocidium, still within the eggshell, is flexed ventrally, bringing the 2 poles into near juxtaposition. The neodermatan tegument with outwardly projecting small microvilli becomes fully formed, as myocytons, a protonephridial system, and 2 glandular regions occupy the body's interior. The ultrastructural features described here are very similar to those reported for Aspidogaster limacoides from fish and somewhat similar to those reported for Cotylogaster occidentalis from molluscs, but differ from the more diverse larvae of neodermatan taxa that have been studied more extensively.

Ultrastructural and molecular study of the microsporidian Toguebayea baccigeri n. gen., n. sp., a hyperparasite of the digenean trematode Bacciger israelensis (Faustulidae), a parasite of Boops boops (Teleostei, Sparidae)

A new microsporidian Toguebayea baccigeri n. gen., n. sp., hyperparasite of Bacciger israelensis (Digenea, Faustulidae), parasite of Boops boops (Teleostei, Sparidae) is described by means of transmission electron microscopy. The phylogenetic analysis, based on the SSU rDNA gene, places the new species in the clade containing mainly crustacean-infecting microsporidia of the genus Cucumispora, within superclade V (Marinosporidia) sensu Vossbrinck et al., 2014. Mature spores of T. baccigeri are ovoid, uninucleated and measure 2.5 × 1.4 μm. The number of coils of the polar tube is 8–10. The polaroplast is composed of an external lamellar part and an internal vesicular or granular part. The main differences that distinguish the new genus and new species from the closely related microsporidia include hyperparasitism in a digenean host infecting a marine fish, the geographic distribution (coast of Tunisia), presence of one nucleus at all developmental stages, disporoblastic sporogony, and the absence of sporophorous vacuoles.

Ecological Analysis of the Helminth Community of Microtus lusitanicus (Gerbe, 1879) (Rodentia) in Asturias (NW Spain)

The Lusitanian pine vole, Microtus lusitanicus, an endemic fossorial rodent of the Iberian Peninsula, has a burrowing behaviour and prefers to live underground. It feeds on bark and roots causing severe damage to trees. In Asturias (NW Spain), where M. lusitanicus is considered a pest in several orchards, a faunistic-ecological study was carried out to describe the helminth community of this species and the main factors that could influence its helminth component species. For this purpose, our own collection of 710 voles from several orchards of various locations in Asturias was used. Eight helminth species, four cestodes and four nematodes, were found. Statistical non-parametric tests were used to analyse the effects of extrinsic and intrinsic factors on the diversity of the helminth community and species prevalence and abundance. The results show the influence of climate variables, the year and season of capture, as well as host age, on the diversity of the helminth community and the infection parameters of some helminth species, underlining the importance of their life cycles. In addition to shedding light on the helminth community of this rodent in Asturias, the results obtained could be used to improve the biological methods applied to fight the M. lusitanicus pest.

First Coronavirus Active Survey in Rodents From the Canary Islands

Since the beginning of the 21st century five new coronaviruses inducing respiratory diseases in humans have been reported. These emergences has promoted research on coronaviruses in wildlife. We started the first eco-epidemiological study to screen the presence of coronaviruses circulating in mice and rats of four Canary Islands. Between 2015 and 2019, we obtained fecal samples of three rodent species (150 Mus musculus, 109 Rattus rattus and 1 Rattus norvegicus) captured in urban and rural areas. Fecal samples were analyzed by nRT-PCR and the resulting sequences were compared to known diversity using Bayesian phylogenetic methods. We only found coronavirus RNA in house mice from El Hierro (10.53%), Tenerife (7.02%) and Lanzarote (5.26%) islands. All coronaviruses detected belong to the species Murine coronavirus belonging to the genus Betacoronavirus and subgenus Embecovirus, being all positive house mice captured in anthropogenic environment. The phylogenetic analysis shows that murine coronaviruses from the Canary Islands are related to European murine coronaviruses. Albeit data are still scarce in the region, the most probable origin of M. coronavirus present in the Canary Islands is continental Europe. According to temporal Bayesian phylogenetics, the differentiation between Canary and continental viruses seems to be quite recent. Moreover, murine coronaviruses from El Hierro, Tenerife and Lanzarote islands tend to segregate in different clades. This enlightens the potential role of rodents or other possibly invasive species in disseminating infectious diseases to remote places through exchanges with the continent. It is important to consider these aspects in the sanitary control of islands, for health and biodiversity preservation concerns.

Surgical treatment of proximal humeral fractures with the transosseous suture fixation

BACKGROUND

The surgical treatment of displaced proximal humeral fractures is commonly affected by implant-related complications. We evaluated the functional and radiographic results of transosseous suture fixation in a series of displaced proximal humeral fractures (PHF).

METHODS

Sixty-four patients were retrospectively classified by age, sex, and the Neer fracture classification. Two-part greater tuberosity (2pGT) displaced fractures and 3-part (varus and valgus) and 4-part valgus impacted fractures were managed with fragment reduction and transosseous suture fixation. Patients with minimum follow-up of 24 months and assessed with the Constant-Murley score (CMS) were included. Radiological and medical complications, as well as reinterventions were also recorded.

RESULTS

Forty-six patients with a mean follow-up of 58 (24-132) and a mean age of 58 years old were analyzed. Patients with 2pGT (n = 10) fractures had a CMS of 76 points (59-89); patients with 3-part fractures (n = 22) had a score of 67 points (13-91); and those with 4-part fractures (n = 14) had a score of 64 (24-76) points. The overall complication rate was 6 out of 46, and 4 patients required reintervention for different reasons. Patients presenting with 3-part varus fractures had significantly lower functional outcomes scores (p = 0.007). Humeral head osteonecrosis was present in 9 patients and significantly affected the functional outcomes (p < 0.05). However, only three out of nine patients with osteonecrosis required subsequent surgery at the indicated follow-up.

CONCLUSIONS

The fracture reduction and transosseous fixation technique represents a safe technique with low complication and reintervention rates. The presence of humeral head necrosis did not lead to subsequent surgical intervention because no hardware had protruded.

LEVEL OF EVIDENCE

Level IV, retrospective study.

First spermatological data on the digenean genus Ityogonimus derived from the description of sperm characters of Ityogonimus ocreatus (Brachylaimidae: Ityogoniminae)

The present study describes the ultrastructural organization of the spermatozoa of the brachylaimid digenean Ityogonimus ocreatus (Ityogoniminae) by means of transmission electron microscopy (TEM). Live digeneans were collected from the digestive tract of an Iberian mole Talpa occidentalis (Eulipotyphla, Talpidae) captured accidentally during a vole pest control campaign in Priesca (Asturias, Spain). The TEM study reveals that the I. ocreatus sperm are filiform, tapered at both extremities, and have two 9+'1' trepaxonematan axonemes, external ornamentation of the plasma membrane associated with cortical microtubules, spine-like bodies, two bundles of parallel cortical microtubules and one mitochondrion overlapping the anterior part of the nucleus. The external ornamentation of the plasma membrane is located in the posterior part of the anterior region. The maximum number of parallel cortical microtubules (45) is located in the anterior part of the sperm cells. Our results are compared with the available data on the family Brachylaimidae, especially on the other Ityogoniminae studied to date (Scaphiostomum palaearcticum).

Pathogenic Leptospira species in rodents from Corsica (France)

Leptospirosis is a worldwide emerging zoonotic disease caused by Leptospira species, that in some patients develop severe forms with high mortality. In France, Corsica is the area where the highest incidences have been reported. The present study was focused on the analysis of pathogenic Leptospira species in rodents of Corsica, as these micromammals are the main natural reservoirs of the bacteria, in order to identify the circulating species and to locate possible risk focuses of transmission, as no previous study on the presence of Leptospira species has been carried out in the island. Rattus rattus, Rattus norvegicus, Apodemus sylvaticus and Mus musculus domesticus were captured in the proximity of water sources along Corsica, the detection of pathogenic Leptospira species was carried out by amplification of the LipL32 gene. The bacteria were found in all the rodent species analyzed and widely. The general prevalence was 10.4%, reaching the maximum value in Bastia (45%). Leptospira interrogans and Leptospira borgpetersenii were identified by phylogenetic analysis, but also two sequences which corresponded to an unnamed Leptospira species, only previously found in rodents of New Caledonia. The high incidence of human leptospirosis in Corsica could be partially explained by the wide distribution of pathogenic Leptospira species identified in this study. Also, the presence of an unknown pathogenic species of Leptospira in an area with high prevalence, may be involved in the higher incidence of Leptospirosis in this island, however, the zoonotic capacity of this species remains unknown. The results obtained are interesting for public health since all positive samples were found near water sources and one of the routes of transmission of leptospirosis is contact with contaminated water. This information could help the competent entities to take preventive measures, reducing the incidence of human leptospirosis in Corsica.

Sperm characters in the Hemiuridae (Digenea): first data on Aphanurus stossichii (Aphanurinae) and Ectenurus lepidus (Dinurinae)

The present work provides the first ultrastructural analysis of spermatozoa of two digeneans (Aphanurus stossichii (Monticelli, 1891) and Ectenurus lepidus Looss, 1907) belonging to the unexplored subfamilies of the Hemiuridae, namely, the Aphanurinae and the Dinurinae. In March 2019, these hemiurids were collected respectively from the digestive tract of the bogue Boops boops (Teleostei, Sparidae) and the Atlantic horse mackerel Trachurus trachurus (Teleostei, Carangidae) captured in the coastal zone of the Mediterranean Sea, off La Chebba (Tunisia). The ultrastructural study reveals that both spermatozoa exhibit the Bakhoum et al.'s type II of the digenean sperm cells characterized by the presence of two 9+'1' axonemes, an external ornamentation of the plasma membrane not associated with cortical microtubules and located in the anterior part of the spermatozoon, a single bundle of cortical microtubules, the maximum number of cortical microtubules located in a middle part of the sperm cell, and one mitochondrion. Moreover, they share several ultrastructural features with the studied spermatozoa of Hemiuridae such as the presence of two axonemes with the 9+'1' trepaxonematan pattern, a reduced number of parallel cortical microtubules organized into one field with their maximum number located in the median (A. stossichii) or posterior (E. lepidus) part of the spermatozoon, an external ornamentation of the plasma membrane in the anterior part of the spermatozoon, one mitochondrion, a nucleus, and a small amount of glycogen granules. However, the two studied hemiurids could be distinguished by the morphology of the anterior and posterior spermatozoon extremities and the presence of mitochondrial matrix granules in A. stossichii.

Dermatological manifestations in Noonan syndrome: a prospective multicentric study of 129 patients positive for mutation

BACKGROUND

Data on dermatological manifestations of Noonan syndrome (NS) remain heterogeneous and are based on limited dermatological expertise.

OBJECTIVES

To describe the dermatological manifestations of NS, compare them with the literature findings, and test for dermatological phenotype-genotype correlations with or without the presence of PTPN11 mutations.

METHODS

We performed a large 4-year, prospective, multicentric, collaborative dermatological and genetic study.

RESULTS

Overall, 129 patients with NS were enrolled, including 65 patients with PTPN11-NS, 34 patients with PTPN11-NS with multiple lentigines (NSML), and 30 patients with NS who had a mutation other than PTPN11. Easy bruising was the most frequent dermatological finding in PTPN11-NS, present in 53·8% of patients. Multiple lentigines and café-au-lait macules (n ≥ 3) were present in 94% and 80% of cases of NSML linked to specific mutations of PTPN11, respectively. Atypical forms of NSML could be associated with NS with RAF1 or NRAS mutations. In univariate analysis, patients without a PTPN11 mutation showed (i) a significantly higher frequency of keratinization disorders (P = 0·001), including keratosis pilaris (P = 0·005), ulerythema ophryogenes (P = 0·0001) and palmar and/or plantar hyperkeratosis (P = 0·06, trend association), and (ii) a significantly higher frequency of scarce scalp hair (P = 0·035) and scarce or absent eyelashes (P = 0·06, trend association) than those with PTPN11 mutations.

CONCLUSIONS

The cutaneous phenotype of NS with a PTPN11 mutation is generally mild and nonspecific, whereas the absence of a PTPN11 mutation is associated with a high frequency of keratinization disorders and hair abnormalities.

Functional ultrastructure and cytochemistry of vitellogenesis and mature vitellocytes of the digenean Cainocreadium labracis (Dujardin, 1845), parasite of Dicentrarchus labrax (L., 1758)

Vitellogenesis and vitellocytes of Cainocreadium labracis were studied by transmission electron microscopy (TEM) and TEM cytochemistry. Four developmental stages were distinguished during vitellogenesis: (I) stem cell of high nucleo-cytoplasmic ratio; (II) early differentiation with chief activity focused on the beginning of protein synthesis and shell globule formation; (III) advanced differentiation with rapid intensification of protein synthesis, progressive fusion of single shell globules into large globule clusters, and formation of unsaturated lipid droplets surrounded by β-glycogen particles; and (IV) mature vitellocyte. Early vitellogenesis with vitellocyte maturation consists of: (1) increase in cell volume; (2) increased development of large, parallel cisternae of GER with production of proteinaceous granules; (3) development of small Golgi complexes that package granules; and (4) within vacuoles, progressive enlargement of proteinaceous granules into shell globule clusters formed during vitellogenesis. Three types of inclusions accumulate in large amounts in mature vitelline cells: (1) shell globule clusters, important component in the formation of egg shell; (2) numerous unsaturated lipid droplets. Though fewer, there are also diphasic droplets consisting of saturated and unsaturated lipids in the same droplet, and (3) a relatively small amount of β-glycogen particles, usually surround a few groups of lipid droplets. The β-glycogen and lipid droplets are nutritive reserves for embryogenesis. General pattern and functional ultrastructure of vitellogenesis greatly resemble those observed in some lower cestodes, such as bothriocephalideans and diphyllobothrideans. Variations and differences in the amount of lipids and of glycogen during vitellogenesis in lower cestodes and other trematodes are compared and discussed.

First finding of Ityogonimus lorum and I. ocreatus co-infection in the Iberian mole, Talpa occidentalis

The Ityogonimus lorum-I. ocreatus co-infection is reported for the first time in the Iberian mole Talpa occidentalis in Asturias (NW Spain). Both Ityogonimus species are stenoxenous helminths of insectivores of the genus Talpa and they have often been found parasitizing the Iberian mole and also the European mole T. europaea, but a mixed infection had not been previously reported. The present study also highlights the main differential morphometric characteristics between I. lorum and I. ocreatus such as the body length, the ventral sucker diameter, the ratio between suckers and the distance between suckers.

Spermatological characteristics of the family Glypthelminthidae (Digenea, Plagiorchioidea) inferred from the ultrastructural study of Glypthelmins staffordi Tubangui, 1928

The present study describes the ultrastructural organization of the mature spermatozoon of the digenean Glypthelmins staffordi (Glypthelminthidae) by means of transmission electron microscopy. Live digeneans were collected from the Chinese edible frog (Hoplobatrachus rugulosus) in Udon Thani Province (Thailand). The ultrastructural study reveals that the mature spermatozoon of G. staffordi is a filiform cell, which is tapered at both extremities. It exhibits the Bakhoum et al.'s type IV of spermatozoon of digeneans characterized by the 9+'1' axonemes of trepaxonematan Platyhelminthes, the presence of the association "external ornamentation-cortical microtubules", the external ornamentation located in the posterior part of the anterior region, the arrangement of parallel cortical microtubules in two bundles and with its maximum number located in the anterior part of the sperm cell, and the presence of two mitochondria. Other characteristics are the presence of spine-like bodies, a posterior extremity containing only the nucleus, and the presence of a large amount of glycogen granules. Results of the present study are particularly compared with the existing data in other families of the Plagiorchioidea, namely the Brachycoeliidae, the Haematoloechidae, the Omphalometridae and the Plagiorchiidae.

Dermatological manifestations in cardiofaciocutaneous syndrome: a prospective multicentric study of 45 mutation-positive patients

BACKGROUND

Data on dermatological manifestations of cardiofaciocutaneous syndrome (CFCS) remain heterogeneous and almost without expert dermatological classification.

OBJECTIVES

To describe the dermatological manifestations of CFCS; to compare them with the literature findings; to assess those discriminating CFCS from other RASopathies, including Noonan syndrome (NS) and Costello syndrome (CS); and to test for dermatological phenotype-genotype correlations.

METHODS

We performed a 4-year, large, prospective, multicentric, collaborative dermatological and genetic study.

RESULTS

Forty-five patients were enrolled. Hair abnormalities were ubiquitous, including scarcity or absence of eyebrows and wavy or curly hair in 73% and 69% of patients, respectively. Keratosis pilaris (KP), ulerythema ophryogenes (UO), palmoplantar hyperkeratosis (PPHK) and multiple melanocytic naevi (MMN; over 50 naevi) were noted in 82%, 44%, 27% and 29% of patients, respectively. Scarcity or absence of eyebrows, association of UO and PPHK, diffuse KP and MMN best differentiated CFCS from NS and CS. Oral acitretin may be highly beneficial for therapeutic management of PPHK, whereas treatment of UO by topical sirolimus 1% failed. No significant dermatological phenotype-genotype correlation was determined.

CONCLUSIONS

A thorough knowledge of CFCS skin manifestations would help in making a positive diagnosis and differentiating CFCS from CS and NS.

Severe parasitism by Versteria mustelae (Gmelin, 1790) in the critically endangered European mink Mustela lutreola (Linnaeus, 1761) in Spain

The riparian European mink (Mustela lutreola), currently surviving in only three unconnected sites in Europe, is now listed as a critically endangered species in the IUCN Red List of Threatened Species. Habitat loss and degradation, anthropogenic mortality, interaction with the feral American mink (Neovison vison), and infectious diseases are among the main causes of its decline. In the Spanish Foral Community of Navarra, where the highest density of M. lutreola in its western population has been detected, different studies and conservation measures are ongoing, including health studies on European mink, and invasive American mink control. We report here a case of severe parasitism with progressive physiological exhaustion in an aged free-ranging European mink female, which was accidentally captured and subsequently died in a live-trap targeting American mink. Checking of the small intestine revealed the presence of 17 entangled Versteria mustelae worms. To our knowledge, this is the first description of hyperinfestation by tapeworms in this species.

Reinvestigation of the sperm ultrastructure of Hypoderaeum conoideum (Digenea: Echinostomatidae)

Spermatological characteristics of the digenean Hypoderaeum conoideum (Echinostomatidae) collected from Anas platyrhynchos in the Lac d'Annecy (France) were reinvestigated using transmission electron microscopy. The previous study on this species only describes the presence of two axonemes of unequal lengths, a mitochondrion, a posterior nucleus, and the disposition of cortical microtubules. The present ultrastructural study reveals that the mature spermatozoon of H. conoideum is a filiform cell tapered at both extremities. The sperm cell exhibits the characteristics of a digenean spermatozoa type V, namely two axonemes of the 9 + '1' pattern of trepaxonematan Platyhelminthes, external ornamentation of the plasma membrane associated with cortical microtubules, and located in the anterior part of the proximal region of the sperm cell, lateral expansions, two bundles of parallel cortical microtubules, maximum number of cortical microtubules in the anterior part of the spermatozoon, and presence of two mitochondria. In addition, the sperm cell of H. conoideum shows spine-like bodies and a posterior extremity with only the nucleus. The ultrastructural characters of the spermatozoon of H. conoideum are compared with those of other digeneans belonging to the superfamily Echinostomatoidea.

Echinococcus multilocularis (Cestoda, Cyclophyllidea, Taeniidae): functional ultrastructure of the penetration glands and nerve cells within the oncosphere

The fine structure of the infective hexacanths of Echinococcus multilocularis was examined with particular emphasis on the functional ultrastructure of penetration glands and nerve cells directly involved in the mechanism of initial host infection. The oncosphere contains two types of penetration glands, PG1 and PG2, that differ slightly in size and form a large U-shaped bi-nucleated syncytial structure. The arms of each gland at each end of the U, directed towards the hook region, exit into the tegument peripheral layer between the median and lateral hook pairs. The lobate nuclei of PG1 and PG2 contain prominent spherical nucleoli surrounded by several large electron-dense islands of heterochromatin. The syncytial cytoplasm of both types of glands is rich in free ribosomes, polysomes, several mitochondria, and heavy accumulations of discoid secretory granules of moderate to high electron density. The secretory granules, sg1 and sg2, differ in their ultrastructure and electron density; the sg2 are much smaller and more flattened in shape. A common characteristic for sg1 and sg2, evident under high magnification, is their high electron density and discoidal shape, with two bi-concave surfaces. Both sg1 and sg2 are frequently grouped in characteristic parallel stacks, the "rouleau"-shaped assemblages with sometimes six to ten granules. Two nerve cells of neurosecretory type are situated in the central part of the hexacanth, each one in a deep U-shaped invagination between the two penetration glands. The nuclei of nerve cells contain several large heterochromatin islands closely adjacent to their nuclear membranes. Their cytoplasm is characterized by having membrane-bound, dense-cored neurosecretory-like granules not only in nerve cell perikarya but also in the elongated nerve processes frequently adjacent to gland arms and to both somatic or body musculature, including the complex system of hook muscles. The results of the present study, when supported with literature data on oncospheres of other cestode species, allow for a better understanding of the important role and coordinated functions of three structural components, i.e., oncospheral hooks, penetration glands, and nerve cells, in the mechanism of intermediate host infection. Presence or absence of nerve cells in oncospheres of various cestodes is reviewed, and perspectives on the value and application of research on functional morphology of oncospheres are discussed.

Ultrastructure of digenean trematode eggs (Platyhelminthes: Neoophora): A review emphasizing new comparative data on four European Microphalloidea

Despite their tremendous diversity and their medical and veterinary importance, details of egg ultrastructure among the digenean trematodes has been studied rather little. The available literature is spread over several decades and several species, but has not been adequately reviewed to reveal patterns of similarity and divergence. We present this review to synthesize and analyse what is known from the available literature reporting studies using both transmission electron microscopy (TEM) and scanning electron microscopy (SEM). To support our general review of existing literature, we also have synthesized our own previously published descriptions, and present herein our new previously unpublished data. From these new electron micrographs, we provide a comparative analysis of the intrauterine eggs of four digenean species, representing four genera and three families of the superfamily Microphalloidea, collected from four different host wildlife species in four European countries: 1) Mediogonimus jourdanei (Prosthogonimidae) from Myodes glareolus (Mammalia: Rodentia), collected in France; 2) Maritrema feliui (Microphallidae) from Crocidura russula (Mammalia: Soricimorpha), collected in Spain; 3) Brandesia turgida (Pleurogenidae) from Pelophylax ridibundus (Amphibia: Anura: Ranidae), collected in Russia; and 4) Prosotocus confusus (Pleurogenidae) from Rana lessonae (Amphibia: Anura: Ranidae), collected in Belarus. All were studied by preparing whole worms by various techniques for TEM, so that eggs could be studied in situ within the uterus of the parent worm. Based on the literature review and the new data presented here, we describe basic similarities in patterns of embryogenesis and egg formation among all trematode species, but substantial variations in timing of larvigenesis, sculpturing of egg shell surfaces, and some other features, especially including accessory cocoon coverings outside the egg shells of B. turgida and P. confusus. In the future, many more studies are needed to explore egg ultrastructure in other digenean taxa, to explore potential phylogenetic patterns in egg development and structure, and to correlate structure with function in the life cycle.

Gastrografin may reduce time to oral diet in prolonged post-operative ileus: a pooled analysis of two randomized trials

BACKGROUND

Gastrografin has been suggested as a rescue therapy for prolonged post-operative ileus (PPOI) but trial data has been inconclusive. This study aimed to determine the benefit of gastrografin use in patients with PPOI by pooling the results of two recent randomized controlled trials assessing the efficacy of gastrografin compared to placebo given at time of PPOI diagnosis.

METHODS

Anonymized, individual patient data from patients undergoing elective bowel resection for any indication were included, stoma closure was excluded. The primary outcome was duration of PPOI. Secondary outcomes were time to tolerate oral diet, passage of flatus/stool, requirement and duration of nasogastric tube, length of post-operative stay and rate of post-operative complications.

RESULTS

Individual patient data were pooled for analysis (53 gastrografin, 55 placebo). Gastrografin trended towards a reduction in PPOI duration compared to placebo, respectively, median 96 h (interquartile range, IQR, 78 h) versus median 120 h (IQR, 84 h), however, this result was non-significant (P = 0.11). In addition, no significant difference was detected between the two groups for time to passage of flatus/stool (P = 0.36) and overall length of stay (P = 0.35). Gastrografin conferred a significantly faster time to tolerate an oral diet compared to placebo (median 84 h versus median 107 h, P = 0.04). There was no difference in post-operative complications between the two interventions (P > 0.05).

CONCLUSION

Gastrografin did not significantly reduce PPOI duration or length of stay after abdominal surgery, but did reduce time to tolerate a solid diet. Further studies are required to clarify the role of gastrografin in PPOI.

Echinococcus multilocularis (Cestoda, Cyclophyllidea, Taeniidae): origin, differentiation and functional ultrastructure of the oncospheral tegument and hook region membrane

Both the oncospheral tegument and the hook region membrane (HRM) of Echinococcus multilocularis hexacanths originate from a syncytial binucleate complex that appears in the early stage of morphogenesis and organogenesis of the hexacanth larva. The primordium of this binucleate complex forms a binucleate syncytial cap or "calotte" situated beneath the inner envelope at one pole of the developing embryo. During oncospheral differentiation, the binucleate perikaryon of the syncytial cap is sunk progressively deeper into the central part of the embryo, but remains always connected with the distal cytoplasm by a tendrillar cytoplasmic connection or bridge. Following migration or sinking of the binucleate perikaryon, numerous cytoplasmic vesicles appear in the distal cytoplasm. These vesicles fuse progressively together and form a single large cavity or lacuna. The walls of this cavity are becoming at this point the walls of two delaminated layers: (1) the distal anucleated cytoplasmic layer is transformed into the oncospheral tegument and (2) the proximal thin cytoplasmic layer is transformed into the "hook region membrane". This delamination of the initially compact layer of distal cytoplasm into two layers seems to be closely associated with differentiation of oncospheral hooks, the elongating blades of which protrude progressively into a newly formed cavity. The pressure of hook blades on the hook region membrane appears to facilitate its further separation from the basal layer of distal cytoplasm which is transformed into the peripheral layer of oncospheral tegument. In the mature oncosphere, the surface of this peripheral layer forms a regular brush border of cytoplasmic processes or microvilli and represents the true body covering of the hexacanth. The very thin cytoplasmic connection between the peripheral layer of tegument and binucleate perikaryon appears only very seldom in the ultrathin sections as a narrow cytoplasmic strand and has a plasma membrane that is reinforced by a single row of cortical microtubules. The HRM covers only one pole of the oncosphere and is attached to the oncosphere surface. The HRM is clearly visible in the mature oncosphere and is draped over the hook blades, the sharp points of which are protected by moderately electron-dense caps. Comparison of the above morphology with that of TEM study of the tegument of adult cestodes shows a great similarity as well as homology in the body covering of both larval and adult cestodes.

Does gastric conditioning decrease the incidence of cervical oesophagogastric anastomotic leakage?

INTRODUCTION

Oesophageal reconstruction by gastroplasty with cervical anastomosis has a higher incidence of dehiscence. The aim of the study is to analyse the incidence of anastomotic leakage in patients undergoing gastroplasty with cervical anastomosis following angiographic ischaemic conditioning of the gastric conduit.

METHODS

Prospective analysis of patients who underwent gastric conditioning two weeks prior to oesophageal reconstruction, from January 2001 to January 2014. The conditioning was performed by angiographic embolization of the left and right gastric artery, and splenic artery. The main variable analysed was the incidence of anastomotic leakage in patients undergoing gastroplasty with cervical anastomosis. Secondary variables analysed were the result of the conditioning, complications arising from that procedure and in the postoperative period, and mean length of postconditioning and postoperative hospital stay.

RESULTS

Gastric conditioning was indicated in 97 patients, with neoplasia being the most frequent aetiology motivating the oesophageal reconstruction (76%). 96 procedures were successfully carried out, arterial embolization was complete in 80 (83%). The morbidity rate was 13%, with no mortality. Postoperative morbidity was 45%; the most frequent complications associated with the surgery were respiratory problems. Six (7%) patients experienced cervical fistula, and all received conservative treatment. The rate of postoperative mortality was 7%.

CONCLUSIONS

In our serie the incidence of anastomotic leakage in patients undergoing gastroplasty with cervical anastomosis following angiographic ischaemic conditioning is 7%. Angiographic ischaemic conditioning is a procedure with acceptable morbidity.

Ultrastructure of the spermatozoon of Macvicaria obovata (Digenea: Opecoelidae), a parasite of Sparus aurata(Pisces: Teleostei) from the Gulf of Gabès, Mediterranean Sea

The ultrastructural organization of the spermatozoon of the digenean Macvicaria obovata (Opecoelidae) is described by transmission electron microscopy. Alive digeneans were collected from the digestive tract of Sparus aurata (Teleostei, Sparidae), caught from the Gulf of Gabès in Chebba, Tunisia (Eastern Mediterranean Sea). The male gamete of M. obovata is a filiform cell, tapered at both extremities and exhibits typical characters such as two axonemes of different lengths showing the 9+'1' trepaxonematan pattern, a nucleus, mitochondria, two bundles of parallel cortical microtubules, external ornamentation of the plasma membrane, spine-like bodies and granules of glycogen. Cortical microtubules are absent in the anterior spermatozoon extremity and appear after the disappearance of the electron-dense material. The first mitochondrion is of moniliform type and it is associated with the external ornamentation of the plasma membrane and spine-like bodies. The second mitochondrion is more posteriorly located, reaching the nuclear region. The present study provides new data on the mature male gamete of M. obovata that may be useful for the understanding of digenean relationships and phylogenetic studies.

Do we publish what we preach? Analysis of the European Society for Surgery of the Shoulder and Elbow Congress publication rates

Background

Scientific congresses have become the most expedient method to communicate novel findings on any research topic. However, an important question is whether this information will be published in peer-reviewed journals. Our aim was to determine the publication rate of the abstracts presented at the European Society for Surgery of the Shoulder and Elbow Congress and analyze factors that may influence this rate.

Methods

A total of 398 abstracts reported in the Abstract Book from the 2008 European Society for Surgery of the Shoulder and Elbow Congress were examined and categorized by oral and poster presentations, topic, and the number of authors listed. A search in PubMed and Google Scholar for subsequent peer-reviewed publications was performed in September 2015. The time to publication after the meeting had been held; the type of journal and its impact factor at the time to publication were recorded for those abstracts that reached peer-reviewed journal publication.

Results

The overall publication rate for the 2008 European Society for Surgery of the Shoulder and Elbow oral and poster presentations was 45.20% after 7 years. The mean time to publication was 18.53 months, and the mean impact factor value was 2.32. Oral presentations were significantly better represented in journals than posters (64.40 vs. 35.40%, p < 0.001). Abstracts with a greater number of authors listed had better publication rates (p < 0.001).

Conclusion

Less than half of the oral presentations and posters at the 21st European Society for Surgery of the Shoulder and Elbow Congress were published in peer-reviewed journals. Oral presentations with a higher number of authors had an increased likelihood of being published.

Origin, differentiation and functional ultrastructure of egg envelopes in the cestode Echinococcus multilocularis Leuckart, 1863 (Cyclophyllidea: Taeniidae)

The origin, differentiation and functional ultrastructure of oncospheral or egg envelopes in Echinococcus multilocularis Leuckart, 1863 were studied by transmission electron microscopy (TEM) and cytochemistry. The purpose of our study is to describe the formation of the four primary embryonic envelopes, namely vitelline capsule, outer envelope, inner envelope and oncospheral membrane, and their transformation into the oncospheral or egg envelopes surrounding the mature hexacanth. This transformation takes place in the preoncospheral phase of embryonic development. The vitelline capsule and oncospheral membrane are thin membranes, while the outer and inner envelopes are thick cytoplasmic layers formed by two specific types of blastomeres: the outer envelope by cytoplasmic fusion of two macromeres and the inner envelope by cytoplasmic fusion of three mesomeres. Both outer and inner envelopes are therefore cellular in origin and syncytial in nature. During the advanced phase of embryonic development, the outer and inner envelopes undergo great modifications. The outer envelope remains as a metabolically active layer involved in the storage of glycogen and lipids for the final stages of egg development and survival. The inner envelope is the most important protective layer because of its thick layer of embryophoric blocks that assures oncospheral protection and survival. This embryophore is the principal layer of mature eggs, affording physical and physiological protection for the differentiated embryo or oncosphere, since the outer envelope is stripped from the egg before it is liberated. The embryophore is very thick and impermeable, consisting of polygonal blocks of an inert keratin-like protein held together by a cementing substance. The embryophore therefore assures extreme resistance of eggs, enabling them to withstand a wide range of environmental temperatures and physicochemical conditions.

Failure of conservative treatment with Gastrografin® for adhesive small bowel obstruction after colorectal surgery

PURPOSE

The aim of this study was to identify risk factors related with failure of conservative management of adhesive small bowel obstruction (ASBO) in patients with previous colorectal surgery.

METHODS

Patients admitted with the diagnosis of ASBO after previous colorectal resection, were included. All patients underwent administration of Gastrografin®. Abdominal radiography was done after 24 h, to confirm the presence of contrast in colon (incomplete obstruction) or not (complete obstruction). Several factors were investigated to study their relationship with the failure of conservative management. Failure of conservative management was considered when emergency operation was needed to solve ASBO.

RESULTS

Incomplete obstruction was observed in 174 episodes (93.0%) while in 13 (7.0%) was complete. One hundred seventy-one ASBO episodes (91.4%) responded successfully to nonoperative treatment and 16 (8.6%) required emergency surgery. Five patients needed bowel resection. Results on the diagnostic test with Gastrografin® showed a sensitivity of 75%, specificity of 99%, positive predictive value 92%, and negative predictive value 98%. Age over 75 years was the only predictive factor for failure of conservative management. The median waiting time from the radiologic confirmation of complete obstruction to surgery was higher in patients requiring bowel resection when compared to those who did not need resection.

CONCLUSIONS

The use of Gastrografin® in ASBO after colorectal resection is a safe and useful tool for the indication of conservative management. Age over 75 years is a predictive factor for need of surgery. Surgery should be performed no later than the following 24 h of confirmed complete obstruction.

Advances in Spermatological Characters in the Digenea: Review and Proposal of Spermatozoa Models and Their Phylogenetic Importance

The wide biodiversity and economic importance of digeneans have motivated a great deal of research in the last decade, focussing on their phylogenetic positions. Molecular research was instrumental for our understanding of phylogeny in the Digenea, but spermatological studies have also provided many results, which are potentially useful for phylogeny; however, the complete spermatological data set has never been reviewed in a whole phylogenetic perspective. Spermatological data are now available for more than 100 species, belonging to 15 superfamilies and 46 families. In this paper, we try to summarize the current knowledge about sperm structure in the digeneans and propose a classification of digenean spermatozoa into five basic models. The main ultrastructural characters used are (1) the type of axoneme, (2) the lateral expansion, (3) the association 'external ornamentation of the plasma membrane + cortical microtubules', (4) the field of cortical microtubules and its number, (5) the location of the external ornamentation, (6) the location of the maximum number of cortical microtubules and (7) the number of mitochondria. We also outline the most interesting features for phylogenetic inference and their possible value in the context of digenean systematics, phylogeny and evolution. Associations between sperm models and superfamilies were found as follows: Type 1 in the Schistosomatoidea; Type 2 in the Hemiuroidea; Type 3 in the Opecoeloidea, Lepocreadioidea, Haploporoidea and Opisthorchioidea; Type 4 in the Gorgoderoidea, Microphalloidea, Plagiorchioidea and Gymnophalloidea; Type 5 in the Echinostomatoidea, Microscaphidioidea, Paramphistomoidea, Pronocephaloidea and Brachylaimoidea.