Prevalence of chronic cough, its risk factors and population attributable risk in the Burden of Obstructive Lung Disease (BOLD) study: a multinational cross-sectional study.

Background: Chronic cough is a common respiratory symptom with an impact on daily activities and quality of life. Global prevalence data are scarce and derive mainly from European and Asian countries and studies with outcomes other than chronic cough. In this study, we aimed to estimate the prevalence of chronic cough across a large number of study sites as well as to identify its main risk factors using a standardised protocol and definition. Methods: We analysed cross-sectional data from 33,983 adults (≥40 years), recruited between Jan 2, 2003 and Dec 26, 2016, in 41 sites (34 countries) from the Burden of Obstructive Lung Disease (BOLD) study. We estimated the prevalence of chronic cough for each site accounting for sampling design. To identify risk factors, we conducted multivariable logistic regression analysis within each site and then pooled estimates using random-effects meta-analysis. We also calculated the population attributable risk (PAR) associated with each of the identifed risk factors. Findings: The prevalence of chronic cough varied from 3% in India (rural Pune) to 24% in the United States of America (Lexington,KY). Chronic cough was more common among females, both current and passive smokers, those working in a dusty job, those with a history of tuberculosis, those who were obese, those with a low level of education and those with hypertension or airflow limitation. The most influential risk factors were current smoking and working in a dusty job. Interpretation: Our findings suggested that the prevalence of chronic cough varies widely across sites in different world regions. Cigarette smoking and exposure to dust in the workplace are its major risk factors. Funding: Wellcome Trust.

Minimally Invasive Concomitant Aortic And Mitral Valve Surgery - Initial Experience Of A Single Centre.

INTRODUCTION: Valve surgery through a median sternotomy has been the standard approach, but in the past decade various minimally invasive procedures have gained increasing traction among physicians and patients. MATERIALS AND METHODS: We present a series of three patients submitted to minimally invasive combined aortic and mitral valve surgery, performed through right lateral thoracotomy. RESULTS: We report no postoperative complication or mortality. Mean length of stay was 5 days, with a self-reported pain score 2/5 (mild/annoying pain). CONCLUSIONS: We report our initial experience, describing surgical technique and postoperative results, showing this technique to be safe, reproductible and comparable to conventional surgery.

Tricuspid repair in mitral regurgitation surgery: a systematic review and meta-analysis.

BACKGROUND: Concomitant tricuspid repair in MR surgery is indicated in patients with severa tricuspid regurgitation, however, concomitant repair in less-than-severe TR patients is still a matter of debate. METHODS: In December 2021, we systematically searched PubMed, Embase and Cochrane databases for randomised control trials (RCTs) comparing isolated MR surgery versus MR surgery with concomitant TR annuloplasty. Four studies were included, resulting in 651 patients (323 in the prophylactic tricuspid intervention group and 328 in the no tricuspid intervention group). RESULTS: Our meta-analysis showed a similar all-cause mortality and perioperative mortality for concomitant prophylactic tricuspid repair when compared with no tricuspid intervention (pooled odds ratio (OR), 0.54; 95% confidence interval (CI): 0.25-1.15, P = 0.11; I2 = 0% and pooled OR, 0.54; 95% CI: 0.25-1.15, P = 0.11; I2 = 0%, respectively) in patients undergoing MV surgery. despite a significantly lower TR progression (pooled OR, 0.06; 95% CI: 0.02-0.24, P < 0.01; I2 = 0%). Additionally, similar New York Heart Association (NYHA) classes III and IV were identified in both concomitant prophylactic tricuspid repair and no tricuspid intervention, despite a lower trend in the tricuspid intervention group (pooled OR, 0.63; 95% CI: 0.38-1.06, P = 0.08; I2 = 0%). CONCLUSIONS: Our pooled analyses suggested that TV repair at the time of MV surgery in patients with moderate or less-than-moderate TR did not impact on perioperative or postoperative all-cause mortality, despite reducing TR severity and TR progression following the intervention.

Tobacco effects on ocular surface, meibomian glands, and corneal epithelium and the benefits of treatment with a lipid-based lubricant.

PURPOSE: Our aim was to evaluate the ocular surface in chronic smokers and to assess the benefit of sodium hyaluronate (SH) versus semi-fluorinated alkane (SFA) eyedrops on tear film, meibomian glands, and corneal epithelial thickness (CET). METHODS: This prospective randomized single-blinded study included smokers, who applied one eyedrop of Hyabak® on one eye (SH group) and one eyedrop of EvoTears® on the fellow eye (SFA group) 4 times daily for 2 months, and age-matched non-smokers. Ocular surface parameters, including tear film break-up time (TBUT) test and corneal fluorescein staining (CFS) score, lipid layer thickness (LLT), meibography (LipiView®), and CET measurements (Zeiss Cirrus HD-5000®), were assessed at baseline and after treatment. RESULTS: Seventy-eight eyes were included in the smokers group (39 in the SH subgroup and 39 in the SFA subgroup) and 42 eyes in the control group. At baseline, the smokers group had a higher prevalence of dry eye (100% vs 0%, p < 0.001) and of meibomian gland dysfunction (MGD) and lower CET measurements than controls (p < 0.05). TBUT, CFS, and LLT (controls vs SFA group: 64.02 ± 1.87 nm vs 49.56 ± 4.33 nm, p = 0.05) improved in the SFA subgroup after treatment, but not in the SH subgroup, and became equivalent to those of controls. Prevalence of dry eye decreased in the smokers group after treatment (controls vs SH group vs SFA group: 0% vs 12.82% vs 16.26%, p > 0.05). Meibomian gland morphological parameters and CET did not improve after treatment (p < 0.05). CONCLUSIONS: Smoking is associated with dry eye, MGD, and corneal epithelial thinning that seem to be only partially reversible with topical lubricants, preferably SFA.

Bronchobiliary fistula after stenting of biliary duct as the management of iatrogenic bile duct injury during elective cholecystectomy.

BACKGROUND: Bronchobiliary fistula is a rare and complex entity defined by an abnormal communication between the biliary and bronchial systems. The etiopathogenesis is not completely understood, but the most common factors implicated are hepatobiliary tumors, biliary obstruction, iatrogenic damage or trauma. METHODS: Here we present a case of a 69-year-old man that developed a bronchobiliary fistula and a pulmonary abscess after migration of a bile duct stent placed as part of the treatment of an iatrogenic bile duct injury that occurred during elective cholecystectomy. RESULTS: A conservative approach, that included broad-spectrum antibiotic, removal of the stent, and sphincterotomy, was enough for the closure of the fistula and resolution of the symptoms. CONCLUSION: We emphasize the importance of prompt recognition of this entity and a concerted therapeutic strategy to optimize the probability of success, avoiding the destructive consequences of the bile in the pulmonary parenchyma and septic complications.

Early surgical intervention versus conservative management of asymptomatic severe aortic stenosis: a systematic review and meta-analysis.

OBJECTIVE: Timing of intervention for patients with asymptomatic severe aortic stenosis (AS) remains controversial. To compare the outcomes of early aortic valve replacement (AVR) versus watchful waiting (WW) in patients with asymptomatic severe AS. METHODS: We systematically searched PubMed, Embase and Cochrane databases, in December 2021, for studies comparing early AVR with WW in the treatment of asymptomatic severe AS. Random-effects meta-analysis was performed. RESULTS: Twelve studies were included in which two were randomised clinical trials. A total of 4130 patients were included, providing a 1092 pooled death events. Our meta-analysis showed a significantly lower all-cause mortality for the early AVR compared with WW group, although with a high amount of heterogeneity between studies in the magnitude of the effect (pooled OR 0.40; 95% CI 0.35 to 0.45, p<0.01; I²=61%). An early surgery strategy displayed a significantly lower cardiovascular mortality (pooled OR 0.33; 95% CI 0.19 to 0.56, p<0.01; I²=64%) and heart failure hospitalisation (pooled OR 0.19; 95% CI 0.10 to 0.39, p<0.01, I²=7%). However, both groups had similar rates of stroke (pooled OR 1.30; 95% CI 0.73 to 2.29, p=0.36, I²=0%) and myocardial infarction (pooled OR 0.49; 95% CI 0.19 to 1.27, p=0.14, I²= 0%). CONCLUSIONS: This study suggests that for patients with asymptomatic severe AS an early surgical intervention compared with a conservative WW strategy was associated with a lower heart failure hospitalisation and a similar rate of stroke or myocardial infarction, although with significant risk of bias. PROSPERO REGISTRATION NUMBER: CRD42021291144.

Caracterização demográfica, clínica e terapêutica dos casos de pneumonia hospitalar não associada à ventilação mecânica / Demographic, clinical and therapeutic characterization of the cases of hospital-acquired non-ventilator associated pneumonia

Objetivo: Caracterizar os indivíduos adultos internados que desenvolveram Pneumonia Hospitalar Não Associada à Ventilação Mecânica, segundo variáveis demográficas, clínicas e terapêuticas. Métodos: Estudo transversal e descritivo, realizado em hospital terciário do norte do Paraná; considerando as fichas de notificação das Infecções Relacionadas à Assistência à Saúde da Comissão de Controle de Infecção Hospitalar, com idade maior ou igual a 18 anos, internados no período de janeiro de 2017 a dezembro de 2018. Resultados: Em relação ao sexo houve similaridade, com maior prevalência em pacientes acima de 60 anos e com o tempo de permanência prolongado; as variáveis clínicas resultaram em 50,6% de pacientes com hemocultura associada à pneumonia negativa, destes,53,6% evoluíram a óbito. Quanto às culturas de secreção traqueal, obteve-se maior índice de Acinetobacter baumanni, com a utilização do antimicrobiano piperacilina sódica + tazobactam sódico. Conclusão: Os casos de Pneumonia Hospitalar Não Associada à Ventilação Mecânica ocorreram na mesma proporção entre os sexos, com prevalência em idosos e evolução de óbito de mais da metade dos indivíduos. O perfil clínico das secreções traqueais, hemocultura de Staphylo spp, revela que o microrganismo Acinetobacter baumanni foi o mais prevalente, tendo como escolha terapêutica de antimicrobiano a classe das cefalosporinas. Descritores: Pneumonia. Infecção Hospitalar. Pneumonia Associada à Assistência à Saúde. Enfermagem.

Objective: To characterize the hospitalized adult individuals thatdeveloped hospital-acquired non-ventilator associated pneumonia, according to demographic, clinical and therapeutic variables.Methods: A cross-sectional and descriptive study, carried out at a tertiary-level hospital in northern Paraná; considering the notification forms of Healthcare-Associated Infectionsfrom theHospital Infection Control Commissionin patients aged at least 18years old, admitted from January2017 to December2018.Results: There was similarity in relation to gender, with higher prevalence in patients over 60years old and with prolonged hospitalization time; the clinical variables resulted in 50.6% of patients with negative blood cultures associated with pneumonia, with 53.6% of them evolving to death. Regarding the tracheal secretioncultures, a higher index of Acinetobacter baumanniwas obtained, with use of the piperacillin sodium+tazobactam sodiumantimicrobial.Conclusion:The cases of hospital-acquired non-ventilator associated pneumoniaoccurred in the same proportion between the genders, with prevalence in older adults and evolution of death in more than half of the individuals. The clinical profile of the tracheal secretions andStaphylosppblood cultures reveals that the Acinetobacter baumannimicroorganism was the most prevalent, with thecephalosporins class as the antimicrobial therapeutic choice.Descriptors:Pneumonia. Cross Infection. Health-Care Associated Pneumonia. Nursing.

Acute promyelocytic leukemia in a long-standing HIV-positive patient: Case report and literature review.

The use of antiretroviral therapy has drastically improved the life quality and prognosis of people living with the human immunodeficiency virus (HIV). The risk of acute myeloid leukemia (AML) currently does not appear to be significantly increased compared to the general population. Acute promyelocytic leukemia (APL), infrequent in people with HIV, is a distinct subtype of AML with unique molecular pathogenesis, clinical manifestations, and treatment. Herein we describe a fatal case of APL hypogranular variant in an HIV-positive patient presenting with hyperleukocytosis. Also, we conducted a literature review of the ten cases reported so far.

Colored Texture Analysis Fuzzy Entropy Methods with a Dermoscopic Application.

Texture analysis is a subject of intensive focus in research due to its significant role in the field of image processing. However, few studies focus on colored texture analysis and even fewer use information theory concepts. Entropy measures have been proven competent for gray scale images. However, to the best of our knowledge, there are no well-established entropy methods that deal with colored images yet. Therefore, we propose the recent colored bidimensional fuzzy entropy measure, FuzEnC2D, and introduce its new multi-channel approaches, FuzEnV2D and FuzEnM2D, for the analysis of colored images. We investigate their sensitivity to parameters and ability to identify images with different irregularity degrees, and therefore different textures. Moreover, we study their behavior with colored Brodatz images in different color spaces. After verifying the results with test images, we employ the three methods for analyzing dermoscopic images of malignant melanoma and benign melanocytic nevi. FuzEnC2D, FuzEnV2D, and FuzEnM2D illustrate a good differentiation ability between the two-similar in appearance-pigmented skin lesions. The results outperform those of a well-known texture analysis measure. Our work provides the first entropy measure studying colored images using both single and multi-channel approaches.

PACAP/GCGa Is an Important Modulator of the Amphioxus CNS-Hatschek's Pit Axis, the Homolog of the Vertebrate Hypothalamic-Pituitary Axis in the Basal Chordates.

The Hatschek's pit in the cephalochordate amphioxus, an invertebrate deuterostome basal to chordates is suggested to be the functional homolog structure of the vertebrate adenohypophysis based on anatomy and expression of homologous neuroendocrine genes. However, the endocrine potential of the cephalochordate Hatschek's pit remains to be demonstrated as well as the physiological actions of the secreted neuropeptides. In this study, we have explored the distribution and characterize the potential function of the amphioxus PACAP/GCG precursor, which is the ortholog of the hypothalamic PACAP neuropeptide in vertebrates. In amphioxi, two PACAP/GCG transcripts PACAP/GCGa and PACAP/GCGbc that are alternative isoforms of a single gene with different peptide coding potentials were isolated. Immunofluorescence staining detected their expression around the nucleus of Rohde, supporting that this structure may be homologous of the neurosecretory cells of the vertebrate hypothalamus where abundant PACAP is found. PACAP/GCGa was also detected in the infundibulum-like downgrowth approaching the Hatschek's pit, indicating diffusion of PACAP/GCGa from the CNS to the pit via the infundibulum-like downgrowth. Under a high salinity challenge, PACAP/GCGa was upregulated in amphioxi head and PACAP/GCGa treatment increased expression of GHl in Hatschek's pit in a dose-dependent manner, suggesting that PACAP/GCGa may be involved in the regulation of GHl via hypothalamic-pituitary (HP)-like axis similar as in the vertebrates. Our results support that the amphioxus Hatschek's pit is likely to be the functional homolog of pituitary gland in vertebrates.

Anatomical profiles validate gall morphospecies under similar morphotypes.

Plant galls are generated by the stimuli of gall-inducing organisms on their hosts, creating gall morphotypes that vary in color, shape, size, and tissue organization. Herein, we propose to compare the structural features of gall morphotypes on the superhost Croton floribundus (Euphorbiaceae) in order to recognize gall morphospecies, i.e., galls with similar shapes but different internal structures. Non-galled leaves and galls were analyzed macroscopically, histologically, and histochemically for the detection of primary metabolites, and the results obtained were used for statistical analyses of similarity. Among the eight gall morphospecies, four are globoid, two are lenticular, one is fusiform and one is marginal leaf rolling. Stomatal differentiation and the occurrence of different types of trichomes were impaired in some gall morphospecies. Three patterns of organization of the ground system are recognized, ranging from the maintenance of mesophyll cells that differentiate into palisade and spongy cells dorsiventrally to the formation of a complex cortex with three morphofunctional layers. The marginal leaf rolling galls have the simplest anatomical structures, quite similar to those of the non-galled host leaf, while lenticular, globoid (types I to IV), and fusiform galls are anatomically more complex. Herein, we report on eight gall morphospecies occurring on C. floribundus, which are distinguished by morpho-anatomical attributes and show the disruption of the morphogenetic patterns of the host leaf toward the morphogenesis of unique gall features.

COMMUNITY-ACQUIRED THORACIC EMPYEMA - DOES MICROBIOLOGICAL IDENTIFICATION MATTER?

OBJECTIVES: To describe the clinical characteristics, comorbidities and clinical outcome of hospitalized patients with the diagnosis of community acquired thoracic empyema in our hospital, with particular emphasis on the impact of identification of the causative agent. METHODS: We performed a retrospective review of the clinical files of hospitalized adult patients diagnosed with community acquired thoracic empyema between 2012 and 2016. RESULTS: A total of 81 patients (64 men and 17 women), with a mean age of 54.6+-17.3 years, were included in this study. It was possible to identify the microbiological agent in 59.3% (n=48) of the patients. The median length of hospital stay was 29 days (P25=20 and P75=44.5) and a tendency to longer duration was seen in patients with a microbiological isolation (32 days vs 23 days; p=0.056). No significant difference was observed between patients with and without microbiological isolation, regarding the mortality. CONCLUSION: In this group of patients a positive pleural fluid culture tends to be associated with longer lengths of hospital stay, which may lead to speculation that they were more advanced infectious processes at the time of diagnosis.

CARDIAC PAPILLARY FIBROELASTOMA: A CASE WITH UNPRECEDENTED SPREAD.

INTRODUCTION: Papillary fibroelastomas (PFE) are a rare primary cardiac neoplasm, out of which multifocal PFE constitute a small minority of cases. These benign masses are commonly found on valvular surfaces, particularly the aortic valve. CLINICAL CASE: We present a patient with a history of embolic stroke and intra-cardiac masses. Multimodal imaging revealed multiple nodules with extensive intra-cardiac distribution. All nodules were successfully removed without valve dysfunction. CONCLUSION: This is a unique case of multiple PFE involving intracardiac cavities as well as all valvular structures.

Safety of intravitreal triamcinolone and its impact on optic nerve morphology in patients treated for diabetic macular edema.

PURPOSE: To assess the impact of one intravitreal injection (IVT) of Triamcinolone Acetonide (TA) on intraocular pressure (IOP) and optic nerve structural parameters in patients treated for Diabetic Macular Edema (DME). METHODS: This retrospective study included patients with DME that were naïve to intraocular steroids and underwent one IVT of TA of 4 mg/0.1 mL and age-matched controls with DME without criteria for IVT. Patients records were reviewed for IOP (at baseline and a month after IVT) and optic nerve parameters measured by optical coherence tomography (up to 6 months before and 6 months after IVT). Exclusion criteria included glaucoma and treatment with hypotensive agents. RESULTS: Twenty-six eyes were included in the Control Group and 29 in the IVT Group, with a mean age of 65.10 ± 10.08 and 67.30 ± 4.71 years, respectively (p = 0.06). At baseline, IOP and optic nerve measurements were equivalent between groups (p > 0.05). One month after IVT, mean IOP measurements in IVT Group were higher than those of controls (17.84 ± 4.50 vs 11.59 ± 3.09 mmHg, p < 0.001). Ocular hypertension (OHT) developed in 17.24% of cases and reversed with topical medication. After one IVT, vertical cup/disc ratio was higher (0.57 ± 0.25 vs 0.60 ± 0.14, p = 0.04) and retinal nerve fiber layer thickness was globally lower (mean: 91.03 ± 4.25 vs 81.33 ± 19.10 µm, p = 0.001) in the IVT Group. CONCLUSION: Our results confirmed that intravitreal TA results in IOP increase. This seems to negatively affect optic nerve morphology, even in patients without OHT or adequately treated with hypotensive agents.

Comparative evaluation of visual outcomes after bilateral implantation of an advanced or conventional monofocal intraocular lens.

PURPOSE: To assess the clinical outcomes and patient satisfaction of the Tecnis Eyhance, an advanced monofocal intraocular lens (IOL), compared to a conventional monofocal IOL. DESIGN: Retrospective case-control study. METHODS: This study included 120 eyes of 60 patients (30 patients in each group) who underwent bilateral cataract surgery either with the implantation of conventional monofocal IOLs (Tecnis PCB00), as a control group, or advanced monofocal IOLs (Tecnis Eyhance ICB00). Ophthalmological evaluation included the measurement of binocular corrected distance visual acuity (CDVA), monocular and binocular uncorrected distance visual acuity (UDVA), and uncorrected intermediate VA (UIVA). In addition the binocular defocus curve was analyzed. Furthermore a subjective questionnaire (Catquest-9SF) was used to assess vision and life quality. RESULTS: The average binocular UDVA was 20/22 in the ICB00 group and 20/20 in the PCB00 model (p = 0.62). The average monocular UIVA was 20/32 in the ICB00 group and 20/40 in the control group (p < 0.001). We found the binocular UIVA, had a mean value of 20/30 in the ICB00, compared to 20/40 in the control group (p < 0.001). The reported dysphotopsia was not significantly different between both groups (p = 0.56). Regarding the life quality questionnaire, the ICB00 group showed less difficulty in activities requiring intermediate vision. CONCLUSION: Our results demonstrated a significant improvement in visual acuity for intermediate distance in the ICB00 group compared to the control group, without compromising distance visual acuity. We also found a greater capability for intermediate distance activities (namely for computer use and reading price tags) when comparing ICB00 patients with the control group.

Combined lung-kidney transplantation: First case in Portugal.

A significant dysfunction of another organ is usually considered an absolute contraindication for lung transplantation, unless multiorgan transplantation is indicated and practical, as is the case of combined lung-kidney transplantation. Few cases of combined lung-kidney transplantation have been described in the literature; however, it is known that, in certain cases, it is the only way to offer an opportunity to selected patients with renal and lung dysfunction. The authors are not aware of any previously published case of a patient receiving both extracorporeal membrane oxygenation and continuous venovenous hemodiafiltration as a bridge for combined kidney-lung transplantation. The authors present the first case of combined lung-kidney transplantation performed in Portugal.

Three-Dimensional Multiscale Fuzzy Entropy: Validation and Application to Idiopathic Pulmonary Fibrosis.

Idiopathic Pulmonary Fibrosis (IPF) is a chronic, severe, and progressive lung disease with short life expectancy. Based on information theory and entropy measurement, a three-dimensional multiscale fuzzy entropy (MFE 3D) algorithm is proposed to identify IPF patients from their computed tomography (CT) volumetric data. First, the validation of the algorithm was performed by analyzing several volumetric synthetic noises (white, blue, brown, and pink), MIX(p) processes-based volumes, and texture-based volumes. The entropy values obtained by MFE 3D were consistent with the values obtained using the one, and two-dimensional versions, validating its use in biomedical data. Hence, MFE 3D was applied to CT scans to identify the existence of IPF within two different groups, one of healthy subjects (26) and another of IPF patients (26). Statistical differences were found (p < 0.05) between the entropy values of each group in 5 scale factors out of 10. These results demonstrate that MFE 3D could be an interesting metric to identify IPF in CT scans.

Gall traits and galling insect survival in a multi-enemy context / Características de las agallas, y supervivencia de insectos que producen agallas, en el contexto de enemigos múltiples

Introduction: The enemy hypothesis postulates that gall traits protect galling insects against natural enemies. Galls show a huge range of sizes, colors and ornaments, which vary even intraspecifically. However, galling insects are targets of various organisms that attack them directly or indirectly. In this context, to consider only one gall trait to investigate gall structure acting against only one guild of enemies can conceal an understanding of the community-level interactions. Objective: Herein, we take these ideas into consideration to investigate the conspicuous galls induced by Palaeomystella oligophaga Becker and Adamski 2008 (Lepidoptera) on Macairea radula (Bonpl.) (Melastomataceae) as a model system. We characterize this system through categorization of the different enemy guilds present in the community. We identified them to the lowest taxonomic level possible and determined the kind of interaction responsible for galling insects' deaths. Considering the enemy hypothesis and the selection of secondary characteristics, we also aimed to determine which of the multiple gall traits influence the survival success of galling insects in a multi-enemy context. Methods: We inspected galls and characterized the enemy guilds affecting the galling insect and the mortality rates produced by each one of them. Next, we tested whether the distinct gall traits measured (parenchyma thickness, color, projections) promote galling insect survival with respect to each enemy. Results: The mortality induced by indirect enemies (organisms that interact with gall tissues and can interact secondarily with galling insect) was 47.3 %, being higher than that caused by parasitoids and predators (31.5 %). Despite the gall's structural complexity, live galling insects showed the smallest occurrence (21.2 %). Parenchyma thickness was negatively related to Calliephialtes parasitoids, Gelechiidae cecidophages and predation signals. Conclusions: We demonstrated that the attacks to gall tissues by the cecidophages represented the highest threat to P. oligophaga survival, being higher than the mortality caused by direct enemies. That is, the gall traits were not as efficient as supposed to protect the galling insect from the attack of natural enemies. Nevertheless, we also demonstrated that parenchyma thickness can be negatively related to some organisms, especially direct enemies. Other traits hypothesized as defensive (e.g. projections, coloration) may simply play no role.

Introducción: La hipótesis del enemigo postula que las características de la agalla protegen al agallero contra los enemigos naturales. Las agallas muestran una gran variedad de tamaños, colores y adornos, que varían incluso de forma intraespecífica. Sin embargo, los agalleros son objetivos de varios organismos que los atacan directa o indirectamente. En este contexto, considerar solo una característica para investigar la estructura de la agalla actúando contra un solo gremio de enemigos puede ocultar una comprensión de las interacciones a nivel comunitario. Objetivos: Para investigar las ideas presentadas usamos las agallas conspicuas inducidas por Palaeomystella oligophaga Becker y Adamski 2008 (Lepidoptera) en Macairea radula (Bonpl.) (Meslastomataceae) como sistema modelo. Describimos este sistema a través de la categorización de los diferentes gremios enemigos presentes en la comunidad. Los identificamos al nivel taxonómico más bajo posible y determinamos el tipo de interacción responsable de la muerte de los agalleros. Teniendo en cuenta la hipótesis del enemigo y la selección de características secundarias, también buscamos determinar cuáles de las múltiples caracteristicas de la agalla influyen en el éxito de supervivencia de los agalleros en un contexto de enemigos múltiples. Métodos: Inspeccionamos las agallas y caracterizamos los gremios enemigos que afectan al agallero y las tasas de mortalidad producidas por cada uno de ellos. Luego, probamos si las distintas caracteristicas de las agallas medidas (grosor del parénquima, color, proyecciones) promueven la supervivencia de los agalleros con respecto a cada enemigo. Resultados: La mortalidad indirecta inducida por los cecidofagos fue del 47.3 %, superior a la causada por los parasitoides y los depredadores (31.5 %). Apesar de la complejidad estructural de la agalla, los agalleros vivos mostraron la menor presencia (21.2 %). El grosor del parénquima se relacionó negativamente con los parasitoides de Calliephialtes, los cecidófagos de Gelechiidae y la depredación. Conclusiones: Demostramos que los ataques a los tejidos biliares por cecidófagos representaron la mayor amenaza para la supervivencia de P. oligophaga. Esto es interesante porque, de acuerdo con la hipótesis del enemigo, la estructura de las agallas debería proporcionar protección para los insectos agalleros en lugar de atraer a los insectos que se alimentan de la agalla misma. Sin embargo, también demostramos que el grosor del parénquima puede estar relacionado negativamente con algunos organismos, especialmente los enemigos directos. Otras caracteristicas hipotéticas como defensivas (por ejemplo, proyecciones, coloración) pueden simplemente no desempeñar ningún papel.

Specific Evolution and Gene Family Expansion of Complement 3 and Regulatory Factor H in Fish.

The complement system comprises a large family of plasma proteins that play a central role in innate and adaptive immunity. To better understand the evolution of the complement system in vertebrates and the contribution of complement to fish immunity comprehensive in silico and expression analysis of the gene repertoire was made. Particular attention was given to C3 and the evolutionary related proteins C4 and C5 and to one of the main regulatory factors of C3b, factor H (Cfh). Phylogenetic and gene linkage analysis confirmed the standing hypothesis that the ancestral c3/c4/c5 gene duplicated early. The duplication of C3 (C3.1 and C3.2) and C4 (C4.1 and C4.2) was likely a consequence of the (1R and 2R) genome tetraploidization events at the origin of the vertebrates. In fish, gene number was not conserved and multiple c3 and cfh sequence related genes were encountered, and phylogenetic analysis of each gene generated two main clusters. Duplication of c3 and cfh genes occurred across the teleosts in a species-specific manner. In common, with other immune gene families the c3 gene expansion in fish emerged through a process of tandem gene duplication. Gilthead sea bream (Sparus aurata), had nine c3 gene transcripts highly expressed in liver although as reported in other fish, extra-hepatic expression also occurs. Differences in the sequence and protein domains of the nine deduced C3 proteins in the gilthead sea bream and the presence of specific cysteine and N-glycosylation residues within each isoform was indicative of functional diversity associated with structure. The diversity of C3 and other complement proteins as well as Cfh in teleosts suggests they may have an enhanced capacity to activate complement through direct interaction of C3 isoforms with pathogenic agents.