Siderophores and competition for iron govern myxobacterial predation dynamics.

Bacterial predators are decisive organisms that shape microbial ecosystems. In this study, we investigated the role of iron and siderophores during the predatory interaction between two rhizosphere bacteria: Myxococcus xanthus, an epibiotic predator, and Sinorhizobium meliloti, a bacterium that establishes nitrogen-fixing symbiosis with legumes. The results show that iron enhances the motility of the predator and facilitates its predatory capability, and that intoxication by iron is not used by the predator to prey, although oxidative stress increases in both bacteria during predation. However, competition for iron plays an important role in the outcome of predatory interactions. Using combinations of predator and prey mutants (non-producers and overproducers of siderophores), we have investigated the importance of competition for iron in predation. The results demonstrate that the competitor that, via the production of siderophores, obtains sufficient iron for growth and depletes metal availability for the opponent will prevail in the interaction. Consequently, iron fluctuations in soils may modify the composition of microbial communities by altering the activity of myxobacterial predators. In addition, siderophore overproduction during predation can alter soil properties, affecting the productivity and sustainability of agricultural operations.

HPV infection in oral cancer, our experience: prevalence, clinical implications, and current vaccination program in Spain.

Background: Oral cancer is the 11th most common type of cancer in the world, with established major risk factors as tobacco and alcohol, and recently included high-risk human papillomavirus types 16 and 18. HPV types 16 and 18 are the etiologic agents of cervical cancers and a proportion of oropharyngeal cancers. However, the picture of HPV and the clinical implications of oral cancers are not clear with most reports combining oral cancer data with head and neck cancers. It has been confirmed as a favorable prognostic factor in oropharyngeal cancer. However, the prognostic value of HPV in oral squamous cell carcinoma is still unclear. Material and Methods: The main objective of this article is to present the evidence encountered following a bibliographical review of recent publications specifically related to oral cancer and its differences from oropharyngeal cancer. The secondary goals are to present the findings of a five-year retrospective observational study of the prevalence of HPV infection in oral cancer patients treated by the Oral and Maxillofacial Surgery Department at La Paz University Hospital (Madrid, Spain), and finally, we to evaluate and compare our country's HPV prevention program in comparison to other European countries. Results: According to the review of the literature, HPV positive oral squamous cell carcinoma is associated with significantly decreased overall survival and distant control. Bibliographic review suggest HPV infection can be used as a negative prognostic factor in oral squamous cell carcinoma. Conclusions: As regards diagnostic testing for HPV, it should be extended to as many cases of oral cavity squamous cell carcinoma as possible, especially in those with risk factors. The current vaccination program in Spain does not have adequate coverage and is significantly under the level of other European Union countries; it should be expanded and catch-up strategies should be included. Key words:HPV, OSSC, Papillomavirus, oral carcinoma, prevention.

Transcriptomic response of Sinorhizobium meliloti to the predatory attack of Myxococcus xanthus.

Bacterial predation impacts microbial community structures, which can have both positive and negative effects on plant and animal health and on environmental sustainability. Myxococcus xanthus is an epibiotic soil predator with a broad range of prey, including Sinorhizobium meliloti, which establishes nitrogen-fixing symbiosis with legumes. During the M. xanthus-S. meliloti interaction, the predator must adapt its transcriptome to kill and lyse the target (predatosome), and the prey must orchestrate a transcriptional response (defensome) to protect itself against the biotic stress caused by the predatory attack. Here, we describe the transcriptional changes taking place in S. meliloti in response to myxobacterial predation. The results indicate that the predator induces massive changes in the prey transcriptome with up-regulation of protein synthesis and secretion, energy generation, and fatty acid (FA) synthesis, while down-regulating genes required for FA degradation and carbohydrate transport and metabolism. The reconstruction of up-regulated pathways suggests that S. meliloti modifies the cell envelop by increasing the production of different surface polysaccharides (SPSs) and membrane lipids. Besides the barrier role of SPSs, additional mechanisms involving the activity of efflux pumps and the peptide uptake transporter BacA, together with the production of H2O2 and formaldehyde have been unveiled. Also, the induction of the iron-uptake machinery in both predator and prey reflects a strong competition for this metal. With this research we complete the characterization of the complex transcriptional changes that occur during the M. xanthus-S. meliloti interaction, which can impact the establishment of beneficial symbiosis with legumes.

Exploring physical activity in Central Chile during the Early Ceramic Period and Late Intermediate Period (200-1450 CE).

OBJECTIVES: We explore physical activity in early farming societies of Central Chile during the Early Ceramic and Late Intermediate Periods (200-1450 CE), a time of technological changes and intensification of food production. The existence of differences in entheseal changes (EC) between females and males is evaluated in two periods with different subsistence strategies. MATERIAL AND METHODS: EC were recorded with method in the upper and lower limbs of 56 male and female adult individuals from the Early Ceramic Period (ECP) and Late Intermediate Period (LIP). Hierarchical multiple factor analysis and hierarchical clustering on principal components were performed using an exploratory approach. RESULTS: In all the analyzed limbs, the EC scores are higher in males than females, which may be explained by sexual dimorphism. A constant overlap in the variability of the EC among males and females is observed. However, the EC scores show a different pattern of variability when comparing ECP females with LIP females. The results show that the scores increase in the latter. In contrast, when comparing ECP males with LIP males scores decrease in the later period. DISCUSSION: Physical activity in the societies of Central Chile with incipient agriculture did not vary by sex or during the timeframe studied. Nevertheless, the interaction between sex-period and the variability pattern of the EC from one period to another suggests different ways of doing similar physical activities or different emphases for similar biomechanical actions.

Venous Thromboembolism in Patients With Autoimmune Disorders: Findings From the RIETE Registry.

Patients with autoimmune disorders are at an increased risk of venous thromboembolism (VTE), but this association has not been consistently evaluated. We used the RIETE (Registro Informatizado Enfermedad Trombo Embólica) database to compare the rates of VTE recurrences, major bleeding, and death during the course of anticoagulation, according to the presence or absence of autoimmune disorders. Of 71 625 patients with VTE recruited in February 2018, 1800 (2.5%) had autoimmune disorders. Median duration of anticoagulant therapy was slightly longer in patients with autoimmune disorders (median, 190 vs 182 days; P = .001). On multivariable analysis, patients with autoimmune disorders had a similar risk of VTE recurrences (hazard ratio [HR]: 0.93; 95% confidence interval [CI]: 0.68-1.27) or major bleeding (HR: 1.07; 95% CI: 0.82-1.40) and a lower risk to die (HR: 0.66; 95% CI: 0.54-0.81) than those without autoimmune disorders. Patients with giant cell arteritis had the highest rates of major bleeding (8.6 events per 100 patient-years) and the lowest rate of recurrences (zero). In other subgroups, the rates of both events were more balanced. During anticoagulation, patients with or without autoimmune disorders had similar rates of VTE recurrences or major bleeding. However, there were some differences between subgroups of patients with autoimmune disorders.

Vitrificación de ovocitos en pacientes oncológicas: experiencia en clínica ivi chile y revisión de la literatura / Vitrification of oocytes in oncological patients: experience in clinica ivi chile and review of literature

La sobrevida de pacientes con cáncer ha mejorado con el tiempo, especialmente en pacientes en edad fértil. La criopreservación de los ovocitos a través de la estimulación ovárica controlada (EOC) es la técnica más frecuente de preservación de la fertilidad. El objetivo del presente estudio es realizar un análisis descriptivo de los ciclos de pacientes que, previo al tratamiento de cáncer, realizaron un tratamiento de preservación de fertilidad. Se analizaron datos demográficos como edad, diagnóstico de ingreso y resultados clínicos, tales como tipo de protocolo de estimulación utilizado, número de ovocitos obtenidos, duración de la estimulación y momento de inicio en el ciclo. Resultados: La edad promedio fue 28.9 años. La duración media de la estimulación fue de 12 días, con un promedio de ovocitos obtenidos en total de 12. Se utilizaron 2 protocolos de estimulación ovárica, obteniendo mejores resultados con el esquema de antagonistas de GnRH asociado a letrozole y doble gatillante. Respecto al momento del ciclo en que se inició la estimulación ovárica, no hubo diferencias. Conclusiones: Es posible realizar preservación de la fertilidad previo a un tratamiento oncológico con buenos resultados en pacientes jóvenes, por lo que sugerimos realizarlo en todos los pacientes con diagnóstico oncológico antes el tratamiento del cáncer. Es recomendable comenzar la estimulación ovárica en cualquier fase del ciclo ya que se obtienen los mismos resultados y permite un pronto inicio de la terapia oncológica.

Survival of patients with cancer has been improving over time, especially in young patient with fertility intention. Cryopreservation of oocytes through controlled ovarian stimulation (EOC) is the most frequent technique of fertility preservation. We analyzed the data obtained from oncological patients who attended IVI Chile between January 2008 and May 2017 in search of fertility preservation. Demographic data were obtained: age, diagnosis of admission, type of stimulation protocol used, number of oocytes obtained, duration of stimulation and pregnancy rate. Results: The average age: 28,9 years; average duration of stimulation:12 days. Number of oocytes obtained in total: 12. Two ovarian stimulation protocols were used. The one with the best results was the protocol with GnRH antagonists associated with letrozole and double triggering. Regarding the moment of the cycle where to start ovarian stimulation, there were no differences. Conclusions: It is possible to carry out a fertility preservation treatment prior to an oncological treatment with good results in young patients, so we suggest the preservation of fertility in all patients with an oncological diagnosis before oncological treatment. It is recommended to start ovarian stimulation at any phase of the cycle since the same results are obtained.

Sinorhizobium fredii HH103 RirA Is Required for Oxidative Stress Resistance and Efficient Symbiosis with Soybean.

Members of Rhizobiaceae contain a homologue of the iron-responsive regulatory protein RirA. In different bacteria, RirA acts as a repressor of iron uptake systems under iron-replete conditions and contributes to ameliorate cell damage during oxidative stress. In Rhizobium leguminosarum and Sinorhizobium meliloti, mutations in rirA do not impair symbiotic nitrogen fixation. In this study, a rirA mutant of broad host range S. fredii HH103 has been constructed (SVQ780) and its free-living and symbiotic phenotypes evaluated. No production of siderophores could be detected in either the wild-type or SVQ780. The rirA mutant exhibited a growth advantage under iron-deficient conditions and hypersensitivity to hydrogen peroxide in iron-rich medium. Transcription of rirA in HH103 is subject to autoregulation and inactivation of the gene upregulates fbpA, a gene putatively involved in iron transport. The S. fredii rirA mutant was able to nodulate soybean plants, but symbiotic nitrogen fixation was impaired. Nodules induced by the mutant were poorly infected compared to those induced by the wild-type. Genetic complementation reversed the mutant's hypersensitivity to H2O2, expression of fbpA, and symbiotic deficiency in soybean plants. This is the first report that demonstrates a role for RirA in the Rhizobium-legume symbiosis.

Encapsulation of specific Salmonella Enteritidis phage f3αSE on alginate-spheres as a method for protection and dosification

Background: Bacteriophages have been proposed as an alternative to control pathogenic bacteria resistant to antibiotics. However, they are not extensively used due to different factors such as vulnerability under environmental conditions and the lack of efficient administration methods. A potential solution is the encapsulation of bacteriophages in hydrogel polymers to increase their viability and as a controlled release method. This work describes the use of alginate-Ca+2 matrixes as mechanisms for protection and dosification of the phage f3αSE which has been successfully used to prevent infections produced by Salmonella Enteritidis. Results: The viability of the pure phage is reduced in near 100% after 1-h incubation at pH 2 or 3. However, the encapsulated phage remains active in 80, 6% at pH 3, while no differences were observed at pH 2, 4 or 7. Exposition of f3αSE to different T° showed that the viability of this phage decreased with increased T° to near 15% at 60°C, while the encapsulated phage remains with 50% viability at same temperature. Finally, the encapsulation of phages showed to extend their presence for 100 h in the medium compared to non-encapsulated phages in a water flow system, which simulate automatic birdbath used in poultry industry, maintaining the phage concentration between 102 and 104 PFU/mL during 250 h. Conclusions: Encapsulation in alginate-Ca+2 spheres can be a good alternative to extend viability of phages and can be used as a phage method dosification method in water flow systems.

Lung cancer and urbanization level in a region of Southern Europe: influence of socio-economic and environmental factors.

BACKGROUND: This study analysed the distribution of lung cancer deaths in areas with different urbanization levels in the Madrid Region and whether such differences persisted when deprivation and air pollution were considered. METHODS: This was a population-based cross-sectional study covering lung cancer deaths (2001-07). The exposure indicators were: a deprivation index based on 2001 census data; and the daily mean NO2 measurement (2002-07), both at the census tract level. Analysis was stratified by sex and age group and the Poisson regression models were applied to obtain rate ratios (RRs). RESULTS: After adjustment for age, deprivation index and NO2, mortality was similar in the city and Greater Madrid areas and lower in the rural area for the over-64 age group (RR: 0.84 in men and RR: 0.66 in women, with respect to the city of Madrid), and significantly lower in the Greater Madrid area (RR: 0.84 in men and RR: 0.74 in women) and in the rural area (RR: 0.73 in men and RR: 0.51 in women) with respect to the city of Madrid for the under-65 age group. CONCLUSIONS: The most urbanized areas of the Madrid Region are characterized by higher lung cancer mortality.

Versatility of nasolabial flaps in oral cavity reconstructions.

OBJECTIVES: Describe the techniques involved and the results obtained witn nasolabial flaps in small and medium-sized defects of the oral cavity. The procedure is an easy resconstructive option with a high success rate and with very good aesthetic and functional outcomes. STUDY DESIGN: A retrospective analysis of 16 nasolabial flap reconstructions in 15 oncological patients with oral cavity defects undergoing single-stage surgical interventions. We evaluate the tumor type, its location, size, the resective and reconstructive techniques involved, as well as any complications. RESULTS: Out of 15 patients, 9 were male and 6 female, with ages ranging from 60-85 years. The primary tumor was located in the mandibular or maxillary gingiva in 7 patients, the lateral margin of the tongue in 5, the floor of the mouth in 3 and the mandibular symphysis in a single patient. The tumors were of a small to medium size. All patients underwent intraoral resections. In most cases, a cervical dissection was performed. All flaps were completed as single-stage surgical interventions, with 14 unilateral and 2 bilateral procedures. Five patients had received radiotherapy treatment for previous tumors. During the follow up period, which ranged from 4 months to 8 years, only one patient required their flap to be thinned, there were two incidents of surgical wound dehiscence, two hematomas and one orocutaneous fistula, none of which affected the survival of the flap. CONCLUSIONS: The nasolabial flap proves highly versatile in oral cavity reconstructions, coupled with a minimal morbidity of the donor region and good aesthetic and functional results. Its high vascularity allows for cervical dissections to be carried out or even for radiotherapy to be administered prior to it. It is straightforward, safe, and carrying it out as a single-stage intervention makes it the ideal surgical option for small to medium intraoral defects in edentulous patients with other comorbidities.

Cascarilla de cacao venezolano como materia prima de infusiones / Husk of Venezuelan cocoa as raw material of infusions

En la industria del cacao se subutilizan materiales que pudieran ser ingredientes en la elaboración de productos novedosos, uno de ellos es la cascarilla de cacao. Estudios previos le atribuyen a dicho material una alta capacidad antioxidante, lo que sumado a su relativo bajo costo, lo hacen un atractivo ingrediente para la elaboración de infusiones, pero antes de promoverlo como tal, se necesita garantizar su calidad. En este estudio se evaluó la composición química, la calidad microbiológica de la cascarilla de cacao, así como también aquellos parámetros que determinan su uso como materia prima en la preparación de infusiones. Las semillas de cacao fueron cultivadas en dos estados en Venezuela. A la cascarilla de cacao se le determinó el contenido de humedad, proteínas, grasa, cenizas, carbohidratos, minerales, calidad microbiológica, ocratoxina A y las propiedades como antioxidante, contenido de materias extrañas, cenizas insolubles en HCL y extracto acuoso. Los métodos aplicados se basan en normas nacionales e internacionales. Se determinaron diferencias significativas entre las muestras mediante la aplicación de ANOVA. Un bajo contenido de humedad pero alto en cenizas, una calidad microbiológica ajustada a la norma y la ausencia de ocratoxina A se observaron en la totalidad de las muestras analizadas. El bajo contenido de materias extrañas y alto valor del extracto acuoso y alto contenido de polifenoles con actividad antioxidante permite recomendar la cascarilla del cacao como materia prima para preparar infusiones.

In the cocoa bean industry, some by-products go underutilized. Some of these components could provide other innovative products, and such is the case with the husk of the cocoa bean. Previous studies have attributed the husk with a high antioxidant capacity, which added to its relative low cost, makes it an attractive ingredient for the production of infusions. However, prior to promoting it as such, its quality needs to be guaranteed. This study evaluated the chemical composition of the husk of cocoa, its microbiologic quality and other parameters in order to be considered raw material in the preparation of infusions. The cocoa was cultivated in two different states in Venezuela. Moisture, protein, fat, ash, carbohydrates, microbiologic quality and ochratoxin A as well antioxidant properties, content of foreign matter, insoluble ash in HCL and aqueous extract were evaluated in the husk of cocoa seeds. Applied methods were in compliance with national and international norms. Significant differences were determined between the samples through the ANOVA application. A low level in moisture content, but high in ash, along with a microbiologic quality that met the norm, and an absence of ochratoxin A were observed in the totality of the analyzed samples. Low levels of foreign matter, the high value of its aqueous extract and high phenolic compounds content with antioxidant activity allow for the recommendation of the husk of cocoa as raw material for the preparation of infusions.

[Measurement of hepatitis C virus RNA 12 weeks after treatment predicts sustained virological response in HIV-HCV co-infected patients]. / La valoración de RNA del virus de la hepatitis C realizada a las 12 semanas de finalizar el tratamiento predice la respuesta virológica sostenida en enfermos con coinfección por VIH y VHC.

OBJECTIVE: The aim of this study was to assess whether measurement of hepatitis C virus RNA (HCV-RNA) at 12 weeks post-treatment could predict sustained virological response (SVR) to antiviral therapy for chronic hepatitis C (pegylated interferon alfa-2a and ribavirin) in HIV-co-infected patients. PATIENTS AND METHODS: HIV-HCV co-infected patients were included if they completed a full course of anti-HCV therapy, achieved an end-of-treatment response and complied with the week +12 and +24 post-treatment follow-up schedule for serum HCV-RNA determination (Real-time HCV (Abbott, Wiesbaden, Germany) (lower limit of detection, 12 IU/ml). RESULTS: Forty out of 66 patients (61%) showed an end-of-treatment response. They were assessed in a follow-up visit at +12 and at +24 weeks post-treatment. Serum HCV-RNA was undetectable in 28 of them at +12 weeks, and 100% of these remained undetectable at 24 weeks post-treatment (the gold standard of (SVR). The positive predictive value was 100% (95% confidence interval, 98.21-100%). CONCLUSION: Post-treatment follow-up to identify virological relapse could be shortened to 12 weeks, providing a new definition of sustained virological response.

FadD is required for utilization of endogenous fatty acids released from membrane lipids.

FadD is an acyl coenzyme A (CoA) synthetase responsible for the activation of exogenous long-chain fatty acids (LCFA) into acyl-CoAs. Mutation of fadD in the symbiotic nitrogen-fixing bacterium Sinorhizobium meliloti promotes swarming motility and leads to defects in nodulation of alfalfa plants. In this study, we found that S. meliloti fadD mutants accumulated a mixture of free fatty acids during the stationary phase of growth. The composition of the free fatty acid pool and the results obtained after specific labeling of esterified fatty acids with a Δ5-desaturase (Δ5-Des) were in agreement with membrane phospholipids being the origin of the released fatty acids. Escherichia coli fadD mutants also accumulated free fatty acids released from membrane lipids in the stationary phase. This phenomenon did not occur in a mutant of E. coli with a deficient FadL fatty acid transporter, suggesting that the accumulation of fatty acids in fadD mutants occurs inside the cell. Our results indicate that, besides the activation of exogenous LCFA, in bacteria FadD plays a major role in the activation of endogenous fatty acids released from membrane lipids. Furthermore, expression analysis performed with S. meliloti revealed that a functional FadD is required for the upregulation of genes involved in fatty acid degradation and suggested that in the wild-type strain, the fatty acids released from membrane lipids are degraded by ß-oxidation in the stationary phase of growth.

Haemodynamic derangement in human immunodeficiency virus-infected patients with hepatitis C virus-related cirrhosis: the role of bacterial translocation.

BACKGROUND AND AIMS: Analysis of the influence of the effects of increased intestinal permeability on haemodynamic alterations in human immunodeficiency virus (HIV)-infected patients with decompensated hepatitis C virus (HCV)-related liver disease. METHODS: Forty HIV/HCV co-infected patients and 40 HCV mono-infected patients, 20 of them with compensated cirrhosis and 20 with a previous decompensation, and 20 healthy controls, were studied. Intestinal permeability was determined by serum levels of lipopolysaccharide-binding protein (LBP). Monocyte expression of toll-like receptor 4 (TLR-4), serum levels of interleukin (IL)-6 and soluble receptors of tumour necrosis factor (sTNFRI) were analysed. Cardiac index, systemic vascular resistance (SVR), plasma renin activity (PRA) and aldosterone concentration were also determined in cirrhotic patients. RESULTS: Serum levels of LBP, TLR-4, IL-6 and sTNFRI were significantly higher in HIV-HCV co-infected and HCV mono-infected patients with decompensated cirrhosis compared with those with compensated liver disease. Significantly lower values of SVR and higher values of cardiac index, PRA and aldosterone concentration were observed in patients with decompensated cirrhosis compared with those with compensated liver disease, particularly in those with elevated levels of IL-6. There were no significant differences between HIV/HCV co-infected and HCV mono-infected patients. CONCLUSIONS: Higher intestinal permeability and consequent macrophage activation is observed in patients with cirrhosis; this permeability is even higher in those with portal hypertension. Serum values of IL-6 are associated with the characteristic haemodynamic derangement observed in advanced phases of cirrhosis. HIV/HCV co-infected cirrhotic patients present inflammatory and systemic haemodynamic alterations similar to those observed in HCV mono-infected patients.

Bacterial translocation in HIV-infected patients with HCV cirrhosis: implication in hemodynamic alterations and mortality.

OBJECTIVE: Analysis of the influence of portal hypertension on intestinal permeability in HIV-infected patients with hepatitis C virus (HCV)-related cirrhosis and of the prognostic significance of consequent macrophage activation. METHODS: Twenty HIV-monoinfected patients, 70 patients with HIV-HCV coinfection, 20 of them with compensated and 50 with decompensated cirrhosis, and 20 healthy controls were evaluated for intestinal permeability [measured by lipopolysaccharide-binding protein (LBP) serum levels], macrophage activation [soluble CD14, soluble tumour necrosis factor receptor 55 Kd, and interleukin 6 (IL-6)], and activation of the rennin-angiotensin-aldosterone axis. Patients with decompensated cirrhosis were monitored for a median period of 429 days to analyze the prognostic factors implicated in survival. RESULTS: Patients with decompensated cirrhosis show increased LBP levels compared with HIV-monoinfected patients. Patients with increased LBP concentration showed elevated soluble CD14, soluble tumour necrosis factor receptor 55 Kd, and IL-6 levels. Twenty-two patients died, from liver-related causes, during the follow-up, and 2 more underwent liver transplantation. Child-Pugh index, CD4 T-cell count, plasma aldosterone and serum IL-6 concentrations independently predicted liver-related mortality. CONCLUSIONS: Increased intestinal permeability, as measured by serum LBP levels, observed in patients with HIV infection is significantly higher in patients with decompensated liver cirrhosis. Proinflammatory cytokines (IL-6) are prognostic markers of HIV-HCV-coinfected patients with decompensated cirrhosis.

Clinical and prognostic significance of parotid scintigraphy in 405 patients with primary Sjogren's syndrome.

OBJECTIVE: To evaluate the association between the degree of involvement shown by parotid scintigraphy at diagnosis and the disease expression, outcomes, and prognosis of primary Sjögren's syndrome (SS). METHODS: All patients consecutively diagnosed with primary SS in our department between 1984 and 2008 were evaluated. The scintigraphic stages were classified into class 4 (severe involvement), class 2-3 (mild to moderate involvement), and class 1 (normal results). RESULTS: A total of 405 patients with primary SS underwent parotid scintigraphy at diagnosis (47 had class 1 involvement, 314 had class 2-3, and 44 had class 4). Patients with class 4 had a higher frequency of parotid enlargement (p < 0.001), systemic involvement (p = 0.007), high titers of antinuclear antibody (p = 0.016), positive rheumatoid factor (p = 0.002), anti-Ro/SSA (p = 0.001), anti-La/SSB (p = 0.001), low C4 levels (p = 0.001), and low CH50 (p = 0.001) in comparison with the other 2 groups. A higher rate of lymphoma development was observed in patients with class 4 involvement. Adjusted multivariate Cox regression analysis showed a hazard ratio (HR) of 10.51 (p = 0.002) and Kaplan-Meier analysis a log-rank of 0.0005. Mortality was 5-fold higher in patients with class 4 involvement. Adjusted multivariate Cox regression analysis showed an HR of 5.33 (p = 0.001) and Kaplan-Meier analysis a log-rank of 0.033. CONCLUSION: Patients with SS presenting with severe scintigraphic involvement at diagnosis had a more pronounced autoimmune expression, a higher risk of developing systemic features and lymphoma, and a lower survival rate. Study of the degree of salivary gland dysfunction at diagnosis by parotid scintigraphy offers valuable clinical information on the prognosis and outcome of primary SS.

Bronchial impaction of an implant screwdriver after accidental aspiration: report of a case and revision of the literature.

BACKGROUND: Adverse outcomes resulting from aspiration or ingestion of instruments and materials can occur in any dental procedure. Clinical manifestation depends on the location, the obstructive potential of the foreign body, and the temporal factor since the accidental incident. Accidental inhalation of dental appliances can be an even more serious event than ingestion and must always be treated as an emergency situation. CASE REPORT: A 62-year-old woman was admitted to our hospital with the suspicion of ingestion of a screwdriver implants. In spite of the clinically asymptomatic presentation, chest radiography in posteroanterior and lateral projections showed a radiopaque dental instrument impacted on the right main inferior bronchus. Rigid bronchoscope was successful to remove the dental instrument under general anesthesia, and the patient was discharged 24 h later. CONCLUSION: Aspiration and ingestion of dental foreign objects are infrequent, but they can occur at large multidisciplinary dental procedures. These episodes have the potential to result in acute medical and life-threatening emergencies since the beginning of the event or at a late stage in proceeding in the underdiagnosed patient. Prevention of such incidents is, therefore, the best approach via the mandatory use of precautions during all dental procedures, and in case of suspicion with no retrievable material, patient must always be submitted to a radiographic study.

Sjögren syndrome or sjögren disease? The histological and immunological bias caused by the 2002 criteria.

The current 2002 classification criteria do not cover the broad clinical and immunological heterogeneity of primary Sjögren syndrome (SS), since five of the six criteria focus exclusively on glandular involvement and the remaining criterion is the mandatory presence of anti-Ro/La antibodies. The aim of this study was to analyze the clinical features of patients with a well-established diagnosis of primary SS who do not fulfill the 2002 classification criteria. Five hundred seven patients diagnosed with primary SS (1993 criteria) were consecutively included and followed up. Two hundred twenty-one (44%) patients did not fulfill the 2002 criteria. These patients were older at diagnosis (p < 0.001) and had a lower frequency of parotid enlargement (p = 0.002), fever (p = 0.041), arthritis (p = 0.041), vasculitis (p = 0.050), peripheral neuropathy (p = 0.002), cranial nerve involvement (p = 0.015), raised erythrocyte sedimentation rate ( ESR) levels (p < 0.001), anemia (p < 0.001), leukopenia (p = 0.037), hypergammaglobulinemia (p < 0.001), positive rheumatoid factor ( RF; p = 0.002), and cryoglobulinemia (p = 0.049) in comparison with those fulfilling 2002 criteria. However, there were no significant differences in the prevalence of sicca features, diagnostic tests, overall systemic involvement, antinuclear antibodies , complement levels, development of B-cell lymphoma, or survival. Patients with anti-Ro antibodies had the highest frequencies of systemic features, hematological abnormalities, and altered immunological markers. In conclusion, patients fulfilling the 2002 criteria, who have either a specific histological diagnosis (lymphocytic infiltration) or highly specific autoantibodies (Ro/La), might well be considered to have Sjögren "disease." In contrast, etiopathogenic mechanisms other than lymphocytic-mediated epithelial damage could be involved in patients with negative Ro and negative biopsy, in whom the term Sjögren "syndrome" seems more adequate.

Comparative evaluation of three culture methods for the isolation of mycobacteria from clinical samples.

We assessed the capacity of two liquid-medium culture methods with automated incubation and reading systems (MB/BacT ALERT 3D System and BACTEC MGIT 960 System) and one solid-medium culture method (Löwenstein- Jensen) to detect mycobacteria in different types of clinical samples. Out of 1,770 cultured clinical samples (1,519 of respiratory origin and 251 of nonrespiratory origin), mycobacteria were isolated in 156 samples (135 M. tuberculosis complex, 8 M. chelonae, 6 M. kansasii, 4 M. fortuitum, 2 M. gordonae, and 1 M. marinum) by at least one of the methods used. The BACTEC MGIT 960 System proved to be the most sensitive method (86.5%), especially in the detection of M. tuberculosis complex (89.1%). However, Löwenstein- Jensen culture was the most sensitive (76.2%) to detect nontuberculous mycobacteria. The BACTEC MGIT 960 System showed the lowest mean detection time for mycobacterial growth (15.3 days), significantly shorter than the other two methods. Highest sensitivity (95.5%) and specificity (99.6%) values were obtained using the BACTEC MGIT 960 System with the Löwenstein-Jensen culture method, which was also the only combination capable of detecting 100% of the nontuberculous mycobacteria.