Characterization of HDPE microparticles in sludge aerobic digestion and their influence on the process.

The occurrence of microplastics (MPs) in wastewater has been studied in the last years. The high efficiency of their removal from wastewater is linked to their transfer to the sludge. In this work, the effect of high-density polyethylene (HDPE) on aerobic digestion was evaluated and these MPs were monitored, characterizing them by three different techniques. Two parallel batch digesters were monitored. AD-Control (meaning Aerobic Digester) operated as a reference, with no external HDPE particles, whereas these polymeric fragments were introduced to the second aerobic digester (AD-HDPE) using ring pulls as microplastic support. FTIR, Raman spectroscopies and fluorescence analysis of these microparticles showed some relevant results that should be highlighted. Higher fluorescence appeared after 7 days in the digester. It coincided with an increase of active volatile suspended solids (AVSS) in the AD-HDPE, which means that an increase of the microbial activity took place. Despite the presence of HDPE particles in the sludge, the digester performance was not compromised. Besides, the HDPE particles did not affect the microbial diversity (Shannon index) of the bacterial community at the end of the experiment compared to the bacterial community of the aerobic digester control tank. Based on the analysis of the relative abundances of microbial taxa, it was concluded that HDPE had selective effects on sludge microbial community, increasing the relative abundance of Bacteroridota phylum.

Effect of combining the methanogenesis inhibitor 3-nitrooxypropanol and cottonseeds on methane emissions, feed intake, and milk production of grazing dairy cows.

No single enteric CH4 mitigating strategy has been consistently effective or is readily applicable to ruminants in grassland systems. When CH4 mitigating strategies are effective under grazing conditions, mitigation is mild to moderate at best. A study was conducted to evaluate the potential of combining two CH4 mitigation strategies deemed feasible to apply in grazing dairy cows, the methanogenesis inhibitor 3-nitrooxypropanol additive (3-NOP) and cottonseed supplementation (CTS), seeking to enhance their individual CH4 mitigating potential. Forty-eight dairy cows were evaluated in a continuous grazing study and supplemented with either a starch-based concentrate (STA) or one that contained cottonseeds (1.75 kg DM/d; CTS), and with either 19 g/d of 10% 3-NOP (Bovaer®) or the additive's carrier (placebo), in a 2 × 2 factorial arrangement of treatments. Treatments were supplied mixed with a concentrate supplement (5 kg/d as fed) and offered in two equal rations at milking. Methane emissions were measured on weeks 4 and 8 using the sulphur hexafluoride tracer gas technique over a 5-d period. The 3-NOP and CTS treatments tended to interact on absolute CH4 such that 3-NOP decreased CH4 by 13.4% with STA, but there was no mitigation with 3-NOP and CTS. Treatment interactions were also obtained for CH4 yield, where 3-NOP tended to decrease CH4 when supplied with STA, and tended to increase it with CTS. The increase in CH4 yield with the CTS diet was driven by a numerical decrease in DM intake. Methane intensity was not affected by the 3-NOP or CTS treatments. Total volatile fatty acids in ruminal fluid were not affected by 3-NOP supplementation, but a reduction in acetate and an increase in propionate proportion occurred, resulting in decreased acetate: propionate. The 3-NOP additive decreased grass intake; however, energy-corrected milk yield and milk composition were largely unaffected. Milk urea increased with 3-NOP supplementation. Combining twice daily supplementation of 3-NOP and CTS did not enhance their CH4 mitigation potential when fed to grazing dairy cows. The relatively low inhibition of CH4 production by 3-NOP compared to studies with total mixed rations may result from the mode of delivery (pulse dosed twice daily) and time gap caused by experimental handling and moving of animals to pasture after 3-NOP supplementation in the milking parlour, which could have impaired the synchrony between the additive presence in the rumen and grass intake in paddocks.

Factors associated with chronic depressive symptoms across adolescence and young adulthood: a UK birth cohort study.

AIMS: Identifying children and/or adolescents who are at highest risk for developing chronic depression is of utmost importance, so that we can develop more effective and targeted interventions to attenuate the risk trajectory of depression. To address this, the objective of this study was to identify young people with persistent depressive symptoms across adolescence and young adulthood and examine the prospective associations between factors and persistent depressive symptoms in young people. METHODS: We used data from 6711 participants in the Avon Longitudinal Study of Parents and Children. Depressive symptoms were assessed at 12.5, 13.5, 16, 17.5, 21 and 22 years with the Short Mood and Feelings Questionnaire, and we further examined the influence of multiple biological, psychological and social factors in explaining chronic depressive symptoms. RESULTS: Using latent class growth analysis, we identified four trajectories of depressive symptoms: persistent high, persistent low, persistent moderate and increasing high. After applying several logistic regression models, we found that loneliness and feeling less connected at school were the most relevant factors for chronic course of depressive symptoms. CONCLUSIONS: Our findings contribute with the identification of those children who are at highest risk for developing chronic depressive symptoms.

Microbiological and epidemiological features of respiratory syncytial virus.

The properties of the main surface proteins and the viral cycle of the respiratory syncytial virus (RSV) make it an attractive pathogen from the perspective of microbiology. The virus gets its name from the manner it infects cells, which enables it to produce syncytia, which allow the virus' genetic material to move across cells without having to release viral offspring to the cellular exterior, reducing immune system identification. This causes a disease with a high impact in both children and adults over 60, which has sparked the development of several preventive interventions based on vaccines and monoclonal antibodies for both age groups. The epidemiological characteristics of this virus, which circulates in epidemics throughout the coldest months of the year and exhibits a marked genetic and antigenic drift due to its high mutation capability, must be taken into consideration while using these preventive methods. The most important microbiological and epidemiological elements of RSV are covered in this study, along with how they have affected the creation of preventive medications and their use in the future.

[Importance of National Influenza Centers in the surveillance of highly pathogenic avian viruses. The time for One-Health is now]. / Importancia de los Centros Nacionales de Gripe en la vigilancia de virus aviares de alta patogenicidad. El momento para One-Health es ahora.

Since 1996, the highly pathogenic avian influenza subtype A(H5N1) has been causing almost uninterrupted outbreaks in wild and domestic birds, as well as cases in humans with a mortality rate close to 50%. However, the years of greatest circulation have been precisely the years following the COVID-19 pandemic, in which several cases have been recorded in humans in places where they had never appeared before, in addition to multiple cases in wild, domestic and peri-domestic mammals, which raise some concern about the risk that the virus may jump to humans through chains of transmission of greater or lesser extent. The current outbreak of A(H5N1) shows us that the One-Health concept should be more alive than ever to join efforts between professionals from different sectors of human, animal and environmental health to avoid or minimize these risks, so that reference laboratories such as the National Influenza Centers have the human and material resources to provide rapid and relevant information in the shortest possible time before emergencies of this type. The diagnostic and monitoring tools to be used in these cases must be available for any eventuality, and going beyond the basic data must be an indispensable premise to be able to carry out a detailed monitoring that serves to limit outbreaks, limit the spread of the disease, and help in the design of future pandemic vaccines against avian viruses.

Diagnostic accuracy and predictive validity of combined use of Fototest and Mini-Cog in cognitive impairment.

INTRODUCTION: The Fototest and Mini-Cog include all the domains that are necessary in a cognitive assessment. This study aims to evaluate the diagnostic accuracy of the combined use of both instruments for detecting cognitive impairment. METHODS: We performed a phase III diagnostic accuracy study with 2 independent samples: STUDY, which included 448 participants randomly allocated to 2 datasets (BASE [80%] and TEST [20%]); and EXTERNAL, which included 61 participants. The index test was consecutive administration of the Fototest and Mini-Cog, and the reference test was formal cognitive assessment. We evaluated the diagnostic accuracy of two-step vs consecutive application of the tests and simple (Comb-Simple), logistic regression (Comb-LR), and random decision tree (Comb-RDT) models of their combined use for detecting cognitive impairment (Global Deterioration Scale score ≥ 3). We performed an exploratory analysis of the BASE dataset, selecting criteria that maximise accuracy; a pre-specified analysis was used to evaluate the selected criteria in the TEST and EXTERNAL datasets. RESULTS: The diagnostic accuracy (95% confidence interval) of the combined models in the BASE dataset (Comb-Simple: 88.3 [88.5-91.4]; Comb-LR: 91.6 [88.2-94.3]; Comb-RDT 95.2 [92.5-97.2]) was significantly higher than the individual values observed for the Mini-Cog and Fototest (81.6 [77.1-85.4] and 84.9 [80.8-88.5], respectively). These results were replicated in the TEST (Comb-Simple: 88.9; Comb-LR: 95.6; Comb-RDT: 92.2) and EXTERNAL datasets (Comb-Simple: 91.8; Comb-LR: 90.2; Comb-RDT: 88.5). Two-step application had the same diagnostic accuracy than consecutive application but required less time (mean [SD] of 197.3 s [56.7] vs 233.9 s [45.2]; P < .0001). CONCLUSIONS: Combined application of the Fototest and Mini-Cog takes less than 4 minutes and improves the diagnostic accuracy of both instruments. Two-step application is more efficient as it requires less time while maintaining the same diagnostic accuracy.

Non-late-onset neutropaenia following treatment of multiple sclerosis with ocrelizumab.

Late-onset neutropaenia is defined as an absolute neutrophil count of <1.5×103cells/µL starting>4 weeks after the last dose of rituximab, in the absence of other identifiable causes. Late-onset neutropaenia is a rare adverse reaction to rituximab (observed in approximately 5% of patients). Rheumatic diseases constitute the main indication for rituximab; in these patients, neutropaenia appears after a mean of>28 days. Ocrelizumab is another monoclonal antibody that binds to CD20 (a glycosylated phosphoprotein mainly expressed on the membranes of B-lymphocytes); in January 2018, it was approved for the treatment of relapsing-remitting and primary progressive multiple sclerosis. We present a case of neutropaenia following intravenous infusion of ocrelizumab in a patient with primary progressive multiple sclerosis who presented with neutropaenic fever, herpetic stomatitis, and ecthyma gangrenosum only 20 days after infusion.

Computed tomography and predictive microbiology for non-invasive evaluation of the impact of dry-cured ham production process conditions on the behaviour of Listeria monocytogenes and Clostridium botulinum.

Variability of salt content in dry-cured ham production can pose microbiological food safety issues, especially in salt reduced and/or non-nitrified products. In this regard, computed tomography (CT) could help to non-invasively characterised the product to further adjust the production process and ensure its safety. The aim of this work was to study the application of CT to estimate aw in dry-cured ham to be used by predictive microbiology to evaluate the impact of the production process on the behaviour of Listeria monocytogenes and Clostridium botulinum. Effect of nitrite elimination and fat content of hams was also evaluated. Thirty hams with two different fat content levels were characterised analytically and using CT at different key points in the process. The safety of the process was evaluated by applying predictive microbiology using both analytical and CT data as model inputs. Results showed that nitrite and fat content had an impact on the predicted growth potential of the pathogens evaluated. After the resting period, if no nitrite is added, the time needed for 1 log increase (tinc) of L. monocytogenes would shorten by 26% and 22% in lean and fat hams, respectively. After week 12, important differences on tinc values for C. botulinum were found between both groups of hams (ca. 40% shorter in fat hams). CT can provide reliable pixel-to-pixel information for predictive microbiology to evaluate the growth of relevant pathogens, but further studies are needed to validate this combination as a tool to evaluate the safety of the production process.

Effect of polystyrene nanoplastics on the activated sludge process performance and biomass characteristics. A laboratory study with a sequencing batch reactor.

The fate and presence of nanoplastics in wastewater treatment systems is a topic of increasing interest. Furthermore, challenges related to their quantification and identification have made it difficult to set up experimental conditions and compare results between studies. In this study, the effect of 100 nm polystyrene nanoplastics on activated sludge was evaluated. A concentration of 2 µg/L was used to continuously feed a sequencing batch reactor (SBR-NPs). Under the experimental conditions used in this study, no changes were observed in the process performance of the SBR-NPs compared to the reactor used as a control. Neither nitrification nor organic matter removal efficiency, which was 96% for both SBRs, were affected by the presence of 100 nm polystyrene nanoplastics, which suggests that the tested nanoplastics were not sufficiently toxic to the biomass. Although no significant differences in the relative abundances of predominant phyla between SBR-Control and SBR-NPs were observed, a slight shift in the relative abundance of Patescibacteria (1.5 ± 0.6% and 3.7 ± 0.8% in SBR-Control and SBR-NPs, respectively, at the end of the test) occurred. The higher abundance of this phylum in SBR-NPs compared to SBR-Control may suggest that these bacteria have some sensitivity to the presence of 100 nm polystyrene nanoplastics. Furthermore, even with the absence of nitrification inhibition, it was observed stagnation of the growth of Nitrotoga bacteria in SBR-NPs, which also suggests that the polystyrene nanoplastics could have an inhibitory effect on these cells and an impact on nitrification in the long term.

Estudio retrospectivo. Influencia de la Terapia Kinesiológica Temprana en el uso de Casco Modelador Craneal / Retrospective study. Influence of early physical therapy on the need to wear a skull molding helmet

Introducción. La plagiocefalia no sinostósica es una condición de salud caracterizada por una asimetría de cráneo que tiene diversas consecuencias en el desarrollo. Los principales tratamientos son la kinesioterapia y el casco de moldeado craneal (CMC). Objetivo. Evidenciar la influencia de la kinesioterapia temprana en la necesidad de usar casco modelador craneal. Métodos. Se realizó un estudio cuantitativo, descriptivo y retrospectivo en lactantes mayores de tres meses ingresados al Centro de Rehabilitación Integral de Carabineros (CRICAR) con diagnóstico confirmado de plagiocefalia mediante la técnica de craneometría. Se recopilaron datos de 39 pacientes diagnosticados con plagiocefalia, evaluados y tratados entre 2017 y 2019. Se dividieron en dos grupos, ingreso temprano (bajo los 5,5 meses de edad cronológica) e ingreso tardío (sobre los 5,5 meses de edad cronológica). Resultados. Al realizar un análisis bivariado, se obtuvo que 9 de 20 pacientes tuvieron que usar CMC en el grupo de ingreso tardío, y solo 4 de 19 pacientes en el grupo de ingreso temprano. Al contrastar la razón de riesgo de usar CMC en el grupo expuesto versus el grupo no expuesto se obtiene que es 3 veces mayor, sin embargo, esta diferencia no es estadísticamente significativa (OR=3.06, IC95% 0.6-16.8) Conclusiones. El principal resultado de este estudio es la disminución en la diferencia de diagonales evaluadas con craneometría. Además, se ha observado que en nuestra muestra el uso de CMC es tres veces mayor cuando el ingreso a terapia kinesiológica es tardío.

Introduction. Non-synostotic plagiocephaly is health condition characterized by a skull asymmetry that has various developmental consequences. The main treatments are kinesiotherapy and cranial molding helmet (CMH). The purpose of this study is to evidence the influence of early kinesiotherapy on the need to use CMH. Methods. A quantitative, descriptive and retrospective study of infants older than three months, admitted to the Carabineros Comprehensive Rehabilitation Center (CRICAR) since January 2017 with a confirmed diagnosis of plagiocephaly by craniometry technique was performed. Data were collected from 39 patients diagnosed with plagiocephaly, evaluated and treated between 2017 and 2019. They were divided into two groups, early admission (under 5.5 months of chronological age) and late admission (over 5.5 months of chronological age). Results. When performing a bivariate analysis, we obtained that 9 out of 20 patients had to use CMC in the late admission group, and only 4 out of 19 patients had to use it in the opposite group. When contrasting the oods ratio of using CMC in the exposed group versus the non-exposed group we obtain that it is 3 times higher, however, this difference is not statistically significant (OR=3.06, IC95% 0.6-16.8). Conclusions. The main result of this study is the decrease in the difference in diagonals assessed with craniometry. In addition, it has been observed that in our sample the use of CMC is three times higher when admission to physical therapy is late.

Normative data for the Fototest from neurological patients with no cognitive impairment.

OBJECTIVES: To contribute normative data for the Fototest from neurological patients with no cognitive impairment, including disaggregated data on each domain of the test (naming, free recall, total recall, and naming fluency). MATERIAL AND METHODS: We performed a cross-sectional study in which neurological patients with no cognitive impairment were tested with the Fototest; we recorded total and domain scores. We performed a descriptive study of the total and domain scores, with data disaggregated by sex, age (over/under 65 years), and level of education (primary education completed/not completed; further study completed). RESULTS: We included a sample of 1055 patients, who were mainly women (57.1%), aged over 65 (60.6%), and had a low level of education (38.6% had not completed primary education). Sex, age, and level of education influence total Fototest score (34.6 ±â€¯5.3; P10: 28; P5: 27) and free recall (8.5 ±â€¯2.2; 6; 4), total recall (10.0 ±â€¯1.5; 8; 7), and naming fluency scores (18.7 ±â€¯4.9; 13; 12). For total score, the multivariate analysis revealed values of 1.5 ±â€¯0.3 (ß ±â€¯SD) for sex (female), -2.4 ±â€¯0.3 for age (>65), and -1.6 ±â€¯0.4 and 3.3 ±â€¯0.4 for incomplete primary education and completed post-primary education, respectively (completed primary study was used as a reference). CONCLUSIONS: We provide normative data for total and domain Fototest results for each of the groups defined according to sex, age, and level of education. We also provide a percentile distribution of scores. We hope that these normative data will translate into increases in efficiency in Fototest administration in the clinical setting.

Contrary effects of flow intermittence and land uses on organic matter decomposition in a Mediterranean river basin.

Flow interruption in intermittent rivers (IRs) generates a mosaic of terrestrial and aquatic habitats across the river network affecting ecosystem processes, as organic matter (OM) decomposition. Water use for farming in arid and semi-arid climates intensifies the dry conditions and affects local river characteristics. In that way, flow intermittence and the distribution of land uses may affect the OM processing along the river. To understand the role of IRs in global OM dynamics and how global change affecting water flow regimes determines these dynamics, it is important to estimate OM-processing rates at a basin scale. The aim of this study was to evaluate the effect of the intensity of flow intermittence on OM processing, and how this effect was modulated by local environmental factors related to land uses across a Mediterranean river basin. To do this, wood decomposition (mass loss and fungal biomass) was selected as a functional indicator. Drying duration and frequency were measured to characterize flow intermittence in different reaches along the river, as well as local environmental factors. Linear models stablished the role of factors on decomposition. The results showed that differences in decomposition rates across the river network were negatively related to the duration of flow interruption. Dissolved inorganic nitrogen associated with agriculture counteracted the negative effect of intermittence on mass loss (increasing by up to three times); but with a higher duration of dry conditions, its effect was insignificant. An increase of 20% of canopy (higher in natural areas) resulted in increases of up to 5% of mass loss. Overall, our study is relevant to understanding the interaction between flow intermittence and land uses on OM processing, especially considering the intensification of flow intermittence and its increased distribution to other regions, which is expected to be a consequence of climate warming and human activities.

Evidence of possible SARS-CoV-2 vertical transmission according to World Health Organization criteria in asymptomatic pregnant women.

OBJECTIVE: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vertical transmission has been investigated extensively. Recently, the World Health Organization (WHO) published strict criteria to classify the timing of mother-to-child transmission of SARS-CoV-2 into different categories. The aim of this study was to investigate the possibility of vertical transmission in asymptomatic SARS-CoV-2-positive women. METHODS: Pregnant women attending for delivery at a perinatology center in Mexico City, Mexico, who had a SARS-CoV-2-positive nasopharyngeal swab 24-48 h before delivery, were asymptomatic at the time of the test and had an obstetric indication for Cesarean section were eligible for inclusion in this study. Amniotic fluid was collected during Cesarean delivery, and neonatal oral and rectal swabs were collected at birth and at 24 h after birth. SARS-CoV-2 detection was carried out using real-time reverse-transcription polymerase chain reaction in all samples. Relevant medical information was retrieved from clinical records. The WHO criteria for classifying the timing of mother-to-child transmission of SARS-CoV-2 were applied to the study population. RESULTS: Forty-two SARS-CoV-2-positive asymptomatic pregnant women fulfilled the inclusion criteria. Twenty-five (59%) women developed mild disease after discharge. Neonatal death occurred in three (7%) cases, of which one had a positive SARS-CoV-2 test at birth and none had coronavirus disease 2019-related symptoms. There were five (12%) cases with strong evidence of intrauterine transmission of SARS-CoV-2, according to the WHO criteria, as amniotic fluid samples and neonatal samples at birth and at 24 h after birth were positive for SARS-CoV-2. Our results also showed that 40-60% of infected neonates would have been undetected if only one swab (oral or rectal) was tested. CONCLUSION: This study contributes evidence to reinforce the potential for vertical transmission of SARS-CoV-2 even in asymptomatic women and highlights the importance of testing more than one neonatal sample in order to increase the detection rate of SARS-CoV-2 in affected cases. © 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

SARS-CoV-2 contact tracing among disadvantaged populations during epidemic intervals should be a priority strategy: results from a pilot experiment in Barcelona.

OBJECTIVES: The aim of this study was to trace contacts of coronavirus disease 2019 (COVID-19) hospitalised patients and determine the risk factors of infection in urban areas. STUDY DESIGN: Longitudinal analysis of contacts identified from index cases. METHODS: A contact tracing study was carried out in the Northern Metropolitan area of Barcelona, Spain, during the inter-epidemic lapse of May to July 2020, a period of low SARS-CoV-2 incidence. Index cases were notified from the referral hospital. Contacts were traced and followed up for 14 days. Reverse transcription polymerase chain reaction was performed on day 0 and day 14 for contacts. RESULTS: In total, 368 contacts were identified from 81 index cases (median of seven contacts per index case), from which 308 were traced successfully. The median age of contacts was 28 years, 62% (223 of 368) were men. During the follow-up period, 100 contacts tested positive for COVID-19 (32.5% [95% confidence interval {CI} = 27.3-38.0]), with a secondary infection rate of 48.3% (95% CI = 40.8-55.9) among housemates. Clusters of index and respective contacts tended to aggregate within disadvantaged neighbourhoods (P < 0.001), and non-national index cases (N = 28, 34.1%) resulted in higher secondary infection rates compared with nationals (51.0% [95% CI = 41.0-60.9] vs 22.3% [95% CI = 16.8-28.8]; P < 0.001). CONCLUSIONS: Disadvantaged communities experience a disproportionate burden of COVID-19 and may act as infection reservoirs. Contact tracing with a cross-cutting approach among these communities is required, especially during inter-epidemic periods.

Influence of bisphenol A occurrence in wastewaters on biomass characteristics and activated sludge process performance.

In this work, the influence of bisphenol A (BPA) on biological wastewater treatment was studied. For it, two sequencing batch reactors (SBRs) were operated for three months. Both SBRs were fed with synthetic wastewater (SW), adding 1 mg·L-1 of BPA into the feed of reactor SBR-BPA, while the other one operated without BPA as a control reactor (SBR-B). In addition, batch experiments were performed with adapted and non-adapted activated sludge, simulating the reaction step of SBR-BPA, to determine the pathways for BPA removal. Results of batch experiments showed that adsorption and biodegradation were the only significant BPA removal routes. BPA removal by biodegradation was more efficient when adapted biomass was used in the tests (32.2% and 8.2% with adapted and non-adapted biomass, respectively), while BPA adsorption removal route was similar in both types of activated sludge (around 40%). Regarding the SBRs experiments, after 16 days no BPA concentration was detected in SBR-BPA effluent. In the adaptation process, SBR-BPA biomass was more sensitive to low temperatures resulting in higher effluent turbidity, COD and soluble microbial products concentrations than in SBR-B. However, once temperature increased, adapted biomass from SBR-BPA presented higher activity than SBR-B biomass, showing higher values of sludge production, microbial hydrolytic enzymatic activities and specific dynamic respiration rate. The bacterial community study revealed the increase of abundance of Proteobacteria (especially Thiothrix species) and Actinobacteria (especially Nocardioides species) phyla at the expense of Bacteroidetes and Chloroflexi phyla in SBR-BPA during its operation.

The phosphaturic mesenchymal tumor as a cause of oncogenic osteomalacia. Three cases and review of the literature. / El tumor mesenquimal fosfatúrico como causa de osteomalacia oncogénica. A propósito de 3 casos y revisión de la literatura.

INTRODUCTION: The phosphaturic mesenchymal tumour (PMT) is a very uncommon cause of oncogenic osteomalacia (OO), which is a paraneoplastic syndrome with severe clinical osteomalacia. The PMT is a neoplasia that produces the fibroblast growth factor FGF23, resulting in reduced proximal tubular phosphate reabsorption leading to hyperphosphaturia and hypophosphatemia. Our aim is to present our experience and complications in diagnosis and treatment of PMT in three patients. MATERIAL AND METHODS: We propose an observational, descriptive and retrospective study of three cases of OO secondary to PMT found in our database of bone and soft tissue tumours. The inclusion criteria were: symptoms related with OO, presence of hyperphosphaturic hypophosphatemia, elevated levels of FGF23 in blood and pathological diagnosis of PMT. RESULTS: In all cases, the disease showed asthenia, non-specific bone pain, progressive functional weakness, and pathological fractures. The average delay time in diagnosis was 7 years. All presented with hyperphosphaturic hypophosphatemia, elevated levels of alkaline phosphatase as well as FGF23. The use of Octreoscan and PET-CT were essential to find the producing tumour and its subsequent biopsy. Treatment was surgery in two cases and one case was treated by CT-guided cryotherapy with neurophysiological control. Once the surgery was performed, the blood parameters normalized. There is no recurrence. CONCLUSIONS: Phosphaturic mesenchymal tumor is a very rare entity as part of bone and soft tissue tumors, it may occur in both tissues. The phosphate-calcium homeostasis is altered due to high serum levels of FGF23 because of PMT. Delay in diagnosis is usual, leading to renal and skeletal comorbidities. To avoid this, knowledge of this entity together with high diagnostic suspicion are critical. Surgical treatment leads to normalization of serum levels and systemic symptoms.

Diagnostic accuracy and predictive validity of associated use of Fototest and Mini-Cog in cognitive impairment. / Utilidad diagnóstica y validez predictiva del uso conjunto de Fototest y Mini-Cog en deterioro cognitivo.

INTRODUCTION: The Fototest and Mini-Cog include all the domains that are necessary in a cognitive assessment. This study aims to evaluate the diagnostic accuracy of the combined use of both instruments for detecting cognitive impairment. METHODS: We performed a phase iii diagnostic accuracy study with 2 independent samples: STUDY, which included 448 participants randomly allocated to 2 datasets (BASE [80%] and TEST [20%]); and EXTERNAL, which included 61 participants. The index test was consecutive administration of the Fototest and Mini-Cog, and the reference test was formal cognitive assessment. We evaluated the diagnostic accuracy of two-step vs. consecutive application of the tests and simple (Comb-Simple), logistic regression (Comb-LR), and random decision tree (Comb-RDT) models of their combined use for detecting cognitive impairment (Global Deterioration Scale score ≥ 3). We performed an exploratory analysis of the BASE dataset, selecting criteria that maximise accuracy; a pre-specified analysis was used to evaluate the selected criteria in the TEST and EXTERNAL datasets. RESULTS: The diagnostic accuracy (95% confidence interval) of the combined models in the BASE dataset (Comb-Simple: 88.3 [88.5-91.4]; Comb-LR: 91.6 [88.2-94.3]; Comb-RDT 95.2 [92.5-97.2]) was significantly higher than the individual values observed for the Mini-Cog and Fototest (81.6 [77.1-85.4] and 84.9 [80.8-88.5], respectively). These results were replicated in the TEST (Comb-Simple: 88.9; Comb-LR: 95.6; Comb-RDT: 92.2) and EXTERNAL datasets (Comb-Simple: 91.8; Comb-LR: 90.2; Comb-RDT: 88.5). Two-step application had the same diagnostic accuracy than consecutive application but required less time (mean [SD] of 197.3 s [56.7] vs. 233.9 s [45.2]; P<.0001). CONCLUSIONS: Combined application of the Fototest and Mini-Cog takes less than 4minutes and improves the diagnostic accuracy of both instruments. Two-step application is more efficient as it requires less time while maintaining the same diagnostic accuracy.

Non-late-onset neutropaenia following treatment of multiple sclerosis with ocrelizumab.

Late-onset neutropaenia is defined as an absolute neutrophil count of <1.5×103cells/µL starting>4 weeks after the last dose of rituximab, in the absence of other identifiable causes. Late-onset neutropaenia is a rare adverse reaction to rituximab (observed in approximately 5% of patients). Rheumatic diseases constitute the main indication for rituximab; in these patients, neutropaenia appears after a mean of>28 days. Ocrelizumab is another monoclonal antibody that binds to CD20 (a glycosylated phosphoprotein mainly expressed on the membranes of B-lymphocytes); in January 2018, it was approved for the treatment of relapsing-remitting and primary progressive multiple sclerosis. We present a case of neutropaenia following intravenous infusion of ocrelizumab in a patient with primary progressive multiple sclerosis who presented with neutropaenic fever, herpetic stomatitis, and ecthyma gangrenosum only 20 days after infusion.