CDK9 inhibition as an effective therapy for small cell lung cancer.

Treatment-naïve small cell lung cancer (SCLC) is typically susceptible to standard-of-care chemotherapy consisting of cisplatin and etoposide recently combined with PD-L1 inhibitors. Yet, in most cases, SCLC patients develop resistance to first-line therapy and alternative therapies are urgently required to overcome this resistance. In this study, we tested the efficacy of dinaciclib, an FDA-orphan drug and inhibitor of the cyclin-dependent kinase (CDK) 9, among other CDKs, in SCLC. Furthermore, we report on a newly developed, highly specific CDK9 inhibitor, VC-1, with tumour-killing activity in SCLC. CDK9 inhibition displayed high killing potential in a panel of mouse and human SCLC cell lines. Mechanistically, CDK9 inhibition led to a reduction in MCL-1 and cFLIP anti-apoptotic proteins and killed cells, almost exclusively, by intrinsic apoptosis. While CDK9 inhibition did not synergise with chemotherapy, it displayed high efficacy in chemotherapy-resistant cells. In vivo, CDK9 inhibition effectively reduced tumour growth and improved survival in both autochthonous and syngeneic SCLC models. Together, this study shows that CDK9 inhibition is a promising therapeutic agent against SCLC and could be applied to chemo-refractory or resistant SCLC.

A new genus of caryophyllidean tapeworms (Cestoda) from Mystus catfishes (Bagridae) in India: cleaning up taxonomic chaos.

A new genus, Mystocestus, is proposed to accommodate a new species, Mystocestus anindoi n. g., n. sp. from Mystus vittatus (Bloch) (type host) in West Bengal and Mystus cavasius (Hamilton) (Siluriformes: Bagridae) in Maharashtra, India. The new genus is most similar to Lucknowia Gupta, 1961 in the shape of the body, which is elongate, slightly tapering towards the anterior end, and scolex, which is digitiform, but differs in the shape of the ovary, which is H-shaped (vs. inverted A-shaped in Lucknowia), the absence of a seminal receptacle (present in Lucknowia) and exclusively cortical vitelline follicles (vs. some follicles in the medulla in the latter genus). Molecular data support the erection of the new genus and place it close to Bovienia Fuhrmann, 1931, species of which can be easily distinguished by exclusively lateral vitelline follicles (lateral and median in the new genus), the presence of a seminal receptacle (absent in Mystocestus) and scolex shape (digitiform, with blunt or slightly concave anterior edge in the new genus vs. small, unspecialized or spatulate in Bovienia). The convoluted taxonomy of tapeworms placed in Mystoides Mathur, 1992 is critically reviewed to clean up taxonomic chaos in Indo-Malayan caryophyllideans. Mystoides was erected in an unpublished PhD thesis and thus its generic name becomes unavailable and also, its type species is conspecific with Lucknowia fossilisi Gupta, 1961 from the stinging catfish, Heteropneustes fossilis (Bloch). Other species of this genus are also conspecific with L. fossilisi. In addition, specific names of most of these taxa are unavailable because they were described in unpublished theses or conference abstracts. Based on recent revisions of Indo-Malayan caryophyllideans, the following nine genera with 15 species are considered valid (numbers of species of individual genera are provided in parentheses): Bovienia (3), Djombangia (1), Lucknowia (2), Lytocestus (2), Mystocestus (1), Pseudocaryophyllaeus (2) (all family Lytocestidae); Adenoscolex (1), Lobulovarium (2), Paracaryophyllaeus (1) (all family Caryophyllaeidae).

Impaired intention-to-treat survival after listing for liver transplantation in children with biliary atresia compared to other chronic liver diseases: 20 years' experience from the Nordic countries.

Biliary atresia (BA) is the most common indication for LT in children. We investigated whether this diagnosis per se, compared to other chronic liver diseases (OCLD), had an influence on patient survival. Data from 421 Scandinavian children, 194 with BA and 227 with OCLD, listed for LT between 1990 and 2010 were analyzed. The intention-to-treat survival and influencing risk factors were studied. Patients with BA had higher risk of death after listing than patients with OCLD. The youngest (<1 year) and smallest (<10 kg) children with the highest bilirubin (>510 µmol/L), highest INR (>1.6), and highest PELD score (>20) listed during 1990s had the worst outcome. Given the same PELD score, patients with BA had higher risk of death than patients with OCLD. For adolescents, low weight/BMI was the only prognostic marker. Impaired intention-to-treat survival in patients with BA was mainly explained by more advanced liver disease in younger ages and higher proportion of young children in the BA group rather than diagnosis per se. PELD score predicted death, but seemed to underestimate the severity of liver disease in patients with BA. Poor nutritional status and severe cholestasis had negative impact on survival, supporting the "sickest children first" allocation policy and correction of malnutrition before surgery.

The bigger, the better? About the size of decompressive hemicraniectomies.

INTRODUCTION: Decompressive hemicraniectomy (DHC) is a treatment option in refractory ICP elevation and malignant infarction. A minimum diameter of 12 cm has been widely accepted as mandatory for effective decompression for ICP control. Complete hemispheric exposure is frequently advocated to further reduce the risk of parenchymal shear stress, hemorrhage and swelling. At the same time, superior efficacy and comparable risk profile of a more extensive decompression have yet to be established. MATERIAL AND METHODS: We reviewed 74 patients with comprehensive clinical data sets undergoing DHC from 2008 to 2013 at our institution. With a minimum threshold of 12 cm in AP diameter being observed in all cases, patients were grouped according to the absolute size of maximum AP diameter (<18 cm, ≥ 18 cm) and surface estimate (<180 cm(2), ≥ 180 cm(2)). Surgical technique, efficacy of ICP control, surgical complications and early clinical course were recorded. RESULTS: Baseline demographics were comparable in both groups. Surgery was effective in relieving or preventing intracranial hypertension in all patients, irrespective of craniectomy size. With smaller craniectomies, immediate surgical and secondary complications such as parenchymal herniation, hemorrhage, or swelling did not occur more frequently. CONCLUSION: Due to the heterogeneity of underlying disease, a conclusion as to effect of craniectomy size on long-term outcome cannot be made based on this study. However, if the obligatory lower threshold of 12 cm for DHC size and decompression to the temporal base are observed, a smaller craniectomy is equally effective in relieving intracranial hypertension. While not inadvertently associated with a more favorable surgical risk profile, it does not increase the risk for early secondary complications such as parenchymal shear stress, hemorrhage and swelling.

Sexual reassignment surgery in female-to-male transsexuals: an algorithm for subcutaneous mastectomy.

INTRODUCTION: Subcutaneous mastectomy is one of the first steps in sexual reassignment in female-to-male transsexuals (FTMTS). The main goal is to masculinize the chest by removing the female contour. In this study, we introduce an algorithm to facilitate choosing the appropriate mastectomy technique depending on morphological aspects. PATIENTS AND METHODS: The records of 173 patients (346 mastectomies) from January 2008 to December 2013 were retrospectively reviewed. The authors conducted four different surgical techniques depending on breast volume, grade of ptosis and skin elasticity. The outcome parameters such as complication rate, patient satisfaction with the aesthetic result, nipple sensitivity and surgical correction rate were obtained and related to the employed technique. RESULTS: From January 2008 to December 2013, we performed 346 mastectomies, of which 48 breasts (13.9%) were treated by a semicircular incision in combination with water-jet-assisted liposuction, 66 breasts (19.1%) by an additional circumferential mastopexy, 170 breasts (49.1%) by an inferior pedicled mammaplasty and 62 breasts (17.9%) by mastectomy with free nipple grafting. The mean operation time lasted 103.6 min. The overall complication rate was 11.8%. Secondary revisions were necessary in 9%. Of the patients, 88% rated the aesthetic results as "very good" or "good." Nipple sensitivity was rated as "very good" or "good" in 80.3% of the breasts. CONCLUSION: FTMTS are a well-informed patient population and therefore increasingly more demanding for aesthetic outcomes. If possible, the most scar-saving procedure should be preferred. With ascending degrees of ptosis, a larger skin envelope and lesser elastic skin, an extended-incision technique is required. The presented surgical algorithm facilitates the selection of the appropriate mastectomy technique and shows a high patient satisfaction with the aesthetic result, a preservation of nipple sensitivity and a low rate of complications and secondary aesthetic corrections.

[Surgical treatment of gynecomastia: an algorithm]. / Chirurgische Therapie der Gynäkomastie: Ein Algorithmus.

INTRODUCTIONS: Gynecomastia is a persistent benign uni- or bilateral enlargement of the male breast ranging from small to excessive findings with marked skin redundancy. In this paper we introduce an algorithm to facilitate the selection of the appropriate surgical technique according to the presented morphological aspects. PATIENTS AND METHODS: The records of 118 patients (217 breasts) with gynecomastia from 01/2009 to 08/2012 were retrospectively reviewed. The authors conducted three different surgical techniques depending on four severity grades. The outcome parameters complication rate, patient satisfaction with the aesthetic result, nipple sensitivity and the need to re-operate were observed and related to the employed technique. RESULTS: In 167 (77%) breasts with moderate breast enlargement without skin redundancy (Grade I-IIa by Simon's classification) a subcutaneous semicircular periareolar mastectomy was performed in combination with water-jet assisted liposuction. In 40 (18%) breasts with skin redundancy (Grade IIb) a circumferential mastopexy was performed additionally. An inferior pedicled mammaplasty was used in 10 (5%) severe cases (Grade III). Complication rate was 4.1%. Surgical corrections were necessary in 17 breasts (7.8%). The patient survey revealed a high satisfaction level: 88% of the patients rated the aesthetic results as "very good" or "good", nipple sensitivity was rated as "very good" or "good" by 83%. CONCLUSION: Surgical treatment of gynecomastia should ensure minimal scarring while respecting the aesthetic unit. The selection of the appropriate surgical method depends on the severity grade, the presence of skin redundancy and the volume of the male breast glandular tissue. The presented algorithm rarely leads to complications, is simple to perform and shows a high satisfaction rate and a preservation of the nipple sensitivity.

Bronchopleural fistula after pneumonectomy: interdisciplinary surgical closure by an ipsilateral pedicled latissimus dorsi flap supported by video-assisted thoracoscopy.

Post-pneumonectomy bronchopleural fistula (BPF) remains a rare but often life-threatening complication and therapeutic challenge. Traditional surgical procedures include chronic open drainage, attempts at direct stump closure, thoracoplasty with or without chest wall muscle transposition and trans-sternal bronchial closure. We describe a case with successful closure of a chronic BPF after pneumonectomy by intrathoracic transposition of a pedicled latissimus dorsi muscle flap circumferentially fixed on the surrounding pleural tissue under continuous video-assisted thoracoscopic overview. The postoperative course was without complications; no tumour, empyema or fistula re-occurred. In this article we want to present the potential advantages of video-assisted thoracoscopic support and interdisciplinary teamwork to improve the outcome of patients with BPFs after pneumonectomy.

Early implant healing: promotion of platelet activation and cytokine release by topographical, chemical and biomimetical titanium surface modifications in vitro.

OBJECTIVES: Platelet releasate has been shown to promote osteogenetic cell proliferation and differentiation. Topography and chemistry of biomaterials have high impact on platelet activation. More specifically, the bioactive cell adhesive peptide sequence Arg-Gly-Asp (RGD) triggers platelet activation mediated by the α(IIb) ß(3) integrin receptor. Accordingly, topographical, chemical and biomimetical (immobilized RGD peptide) modifications of titanium (Ti) surfaces may enhance early platelet activation and bony healing of implants. Therefore, the aim of the study was to evaluate platelet activation with subsequent platelet-derived cytokine release by accordingly modified Ti surfaces. MATERIALS AND METHODS: Pre-treated (PT; mean roughness [R(a)]=0.04 µm, contact angle [CA]=91°), acid-etched (A, R(a) =0.83 µm, CA=106°), large grit-sandblasted, acid-etched (SLA, R(a) =3.2 µm, CA=109°) as well as hydrophilically modified acid-etched (modA, R(a) =0.83 µm, CA=0) and modified large grit-sandblasted, acid-etched (modSLA, R(a) =3.2 µm; CA=0°) titanium surfaces were investigated. Additionally, RGD peptides were chemically immobilized on PT, A and SLA surfaces (PT-RGD [CA=18°], A-RGD [CA=0°], SLA-RGD [CA=0°]). The different Ti surfaces were incubated with platelet concentrate of three healthy volunteers at room temperature for 15 min and for 30 min. High thrombogenous collagen served as the control group. Out of the supernatant, platelet consumption was assessed via platelet count (PC). Cytokine release was quantified via the level of platelet-derived growth factor (PDGF) and vascular endothelial growth factor (VEGF). RESULTS: After 15 min, especially the rough SLA surface showed a strong decrease in PC and a strong increase in VEGF and PDGF levels. After 30 min, high platelet consumption as well as high levels of VEGF and PDGF were measured for unspecifically modified (modA) and especially for biomimetic, specifically modified (PT-RGD, A-RGD) surfaces, indicating a delayed effect of the surface modifications on platelet activation. DISCUSSION: Modifications of surface roughness modifications appear to influence early platelet activation and cytokine release after 15 min whereas surface chemistry modifications with increased hydrophilic properties and surface modifications via RGD peptide on plainer surfaces lead to a further, more specific promotion of platelet activation and degranulation after 30 min. The observed effect could be valuable for critical clinical situations like compromised bone sites.

Processive behaviour of kinesin observed using micro-fabricated cantilevers.

The mechanical characterization of biomolecular motors requires force sensors with sub-piconewton resolution. The coupling of a nanoscale motor to this type of microscale sensors introduces structural deformations in the motor according to the thermally activated degrees of freedom of the sensor. At present, no simple solution is available to reduce these effects. Here, we exploit the advantages of micro-fabricated cantilevers to produce a force sensor with essentially one degree of freedom and a spring constant of 0.03 pN nm(-1) for the study of the molecular motor protein kinesin-1. During processive runs, the cantilever constrains the movement of the cargo binding domain of kinesin in a straight line, parallel to the microtubule track, and excludes specific reaction coordinates such as cargo rotation. In these conditions, we measured a step size of 8.0 ± 0.4 nm and a maximal unloaded velocity of 820 ± 80 nm s(-1) at saturated adenosine triphosphate (ATP) concentration. We concluded that the motor does not need to rotate its tail as it moves through consecutive stepping cycles.

[The oculocardiac reflex in blepharoplasties]. / Der okulokardiale Reflex bei Blepharoplastiken.

The oculocardiac reflex (OCR) is a well-known phenomenon in ophthalmic surgery, but is rarely described in aesthetic blepharoplasty surgery. It was first mentioned in 1908 by Ascher and Dagnini. Since then, ophthalmologists and anaesthesiologists have regarded the onset of the oculocardiac reflex as a significant intraoperative problem, which is undermined by several case reports that describe dysrhythmias which have haved caused morbidity and death. Per definition the OCR is caused by ocular manipulation and involves intraoperative bradycardia by a change of 20 beats/minute compared to the preoperative heart rate or any dysrhythmia during the manipulation via a trigeminal-vagal-mediated reflex arc. Having operated on a 48-year-old, healthy woman in our clinic, who underwent a cardiac arrest during the blepharoplasty procedure, followed by a successful resuscitation, we investigated the onset of the OCR in our blepharoplasty patients within the last 3 years. The onset of the OCR was noted in 22 of 110 (20 %) blepharoplasty patients, mainly affecting younger, low-weighted patients operated under local anaesthesia. Awareness and treatment of this potentially life-threatening oculocardiac reflex are necessary. In most cases the onset of the reflex may be avoided by a gentle operation technique and by refraining from severe traction to the muscle or fat pad. The best treatment of a profound bradycardia caused by the OCR is to release tension to the muscle or fat pad in order to permit the heart rate to return to normal. Intraoperative monitoring is of utmost importance.

[Cost analysis of conservative versus operative therapy of macromastia]. / Kostenanalyse der konservativen versus operativen therapie der makromastie.

Macromastia causes back and neck pain, scaphodynia, intertrigo of the inframammary crease up to dysaesthesia. Typical complaints of patients with macromastia are physical burden, psychological irritation and aesthetic deformity, often resulting in social isolation. Despite the demonstrable success of reduction mammaplasty to eliminate not only the symptoms of macromastia but the cause of the ailment, conservative therapy is still favoured by insurance companies and bearing of costs for surgical therapy therefore is rejected. Expenses of conservative treatment as well as costs related to appeal and lawsuits against insurance decisions exceed the case-based lump sum of reduction mammaplasty manifold. Conservative treatments do not eliminate the causes of the illness. Therefore the rejection of a medically indicated reduction mammaplasty has to be regarded as unfavourable and economically inefficient.

Diagnostic management of benign and malignant pheochromocytoma.

As rare and thus often overlooked hormone-secreting tumors, pheochromocytomas pose a particular diagnostic challenge. Difficulties involve biochemical confirmation, localizing, and detection of malignancy. Measurement of free plasma metanephrines, genetic testing and specific imaging procedures--such as MIBG and octreotide scintigraphy or fluorodopamine PET--represent a considerable progress, and the management of benign pheochromocytomas has become very effective. However, a comparable improvement in the prognosis of malignant chromaffin cell tumors, which occur in approximately 10-15% of all cases, has not yet been achieved. Here, telomerase catalytic subunit (hTERT) activity and heat shock protein 90 expression could serve both as molecular markers allowing an earlier diagnosis of malignancy and as therapeutic targets. Familial syndromes should be considered both in benign and malignant pheochromocytoma, and should be tested for prior to surgery in selected patient groups.

Minimally invasive kidney transplantation: the first experience.

Minimally invasive procedures in recent years have gained widespread acceptance. Within the field of transplantation, laparoscopic living donor nephrectomy (LLDN), requiring a 6- to 10-cm incision, is now considered the optimal procedure. According to recent MEDLINE searches, no minimally invasive technique has been reported for kidney transplantation. Considering the rapid evolution of minimally invasive surgery during the last decade, there is little reason to believe that kidney transplantation in future will be excluded from this development. A novel minimally invasive technique for kidney transplantation (MIKT) is presented, restricted to a 7- to 9-cm incision and minimal dissection/tissue trauma. The kidney is meticulously prepared on the back table and placed in a fitted lateral, retroperitoneal pouch. All three anastomoses are performed with the kidney in its final "in situ" position, and ureter reimplantation is done by extravesical technique. Twenty-one patients have been transplanted by MIKT and followed in a prospective manner, along with a matched control group subjected to conventional kidney transplantation. Our results indicate that MIKT may be executed safely and quickly. Beneficial effects on postoperative pain/analgesia, recovery, and complications are suggested by this first MIKT experience. The technical solutions of MIKT are per se not unique. However, the incision is minimal and not larger than the one required for LLDN. Minimally invasive surgery seems particularly attractive in the immunosuppressed population, and even more so with the recent introduction of potent antiproliferative drugs.

[Merkel cell carcinoma -- a case report with regard to the current treatment concepts]. / Das Merkel-Zell-Karzinom -- Eine Falldarstellung unter Berücksichtigung der aktuellen Behandlungskonzepte.

A 54-year-old female patient was admitted due to a slow growing, painless resistance on the dorsum of the left hand. The intraoperative aspect of the tumor showed a yellow to white doughy tissue mass infiltrating the metacarpal musculature and bone. After immunohistopathological staining, the diagnosis of a Merkel cell carcinoma was confirmed. A high frequency of local recurrences (25 to 77 %) and lymph node metastases (50 %) are characteristic features of Merkel cell carcinoma. In 30 % of the cases, the disease has a fatal outcome. In primary Merkel cell tumors, surgical excision is the basic therapy, although this carcinoma is highly radiosensitive. Thus, besides surgical treatment, radiation should be included into the treatment concept. In the presented case, after radical excision of the tumor and sentinel-lymphnode biopsy, the patient has been free of local recurrence and metastases for 13 months.

Fibroblast growth factor-20 promotes the differentiation of Nurr1-overexpressing neural stem cells into tyrosine hydroxylase-positive neurons.

Stem cells are currently considered as alternative cell resources for restorative transplantation strategies in Parkinson's disease. However, the mechanisms that induce differentiation of a stem cell toward the dopaminergic phenotype are still partly unknown thus hampering the production of dopaminergic neurons from stem cells. In the past, FGF-20 has been found to promote the survival of ventral mesencephalic (VM) dopaminergic (DA) neurons in culture. We hereby provide evidence that FGF-20, a growth factor of the FGF family, is expressed in the adult and 6-OHDA-lesioned striatum and substantia nigra, but is not expressed by VM glia or DA neurons, suggesting that FGF-20 may work on DA neurons in a paracrine- or target-derived manner. We also found that co-culture of Nurr1-NSCs with Schwann cells overexpressing FGF-20 induced the acquisition of a neuronal morphology by the NSCs and the expression of tyrosine hydroxylase (TH) as assessed by immunocytochemistry, cell ELISA, and Western blot analysis. RT-PCR showed, that both, Schwann cells and Nurr1-NSCs (differentiated or not), expressed the FGF-1 receptor suggesting that both direct and indirect actions of FGF-20 are possible. We show that differentiated Nurr1 cells retained both neuronal morphology and TH expression after transplantation into the striatum of 6-OHDA-lesioned postnatal or adult rats, but that neuritogenesis was only observed after postnatal grafts. Thus, our results suggest that FGF-20 promotes the differentiation of Nurr1-NSCs into TH-positive neurons and that additional factors are required for the efficient differentiation of DA neurons in the adult brain.

Photodynamic therapy mediated induction of accelerated re-endothelialisation following injury to the arterial wall: implications for the prevention of postinterventional restenosis.

OBJECTIVE: Accelerated re-endothelialisation may inhibit the development of restenosis. Basic Fibroblast Growth Factor (bFGF) plays a key role for early proliferative activity in the artery following injury. Therefore, this study was devised to examine the effect of photodynamic therapy (PDT) on post-injury re-endothelialisation in vivo, and bFGF-mRNA expression in endothelial cells (EC) in vitro. MATERIALS AND METHODS: Rat carotid arteries were balloon-injured prior to PDT. Arteries were analysed after 1, 3, 5, 14 and 30 days. Morphometric measurements were undertaken following injection of 0.5% Evans Blue which stains non-endothelialised surfaces only. To identify EC, immunohistochemistry (CD-31) was performed. Proliferation was assessed by fluorescence cell counting. PCR quantification of bFGF-mRNA expression and proliferation were assessed in bovine aortic EC which were plated on isolated, PDT-treated EC-derived extracellular matrix at (12), 24, 48 (72 h). RESULTS: Three days following PDT, arteries displayed significantly increased endothelial lining (p = 0.02), which was more pronounced at 5 (p = 0.03) and 14 days (p = 0.02). At 30 days no relevant differences between PDT and control were noted. EC proliferation on PDT-treated matrix was significantly increased at 24, 48, and 72 h (p = 0.0004), whereas bFGF-mRNA expression was significantly increased at 24 h only (p = 0.007). CONCLUSION: Post-injury PDT appears to accelerate re-endothelialisation. Expression of bFGF-mRNA, however, although increased shortly after PDT, may not be responsible for a constant stimulation of EC proliferation.

Monitoring the effects of platelet glycoprotein IIb/IIIa antagonists with a microtiter plate method for detection of platelet aggregation.

Measurement of platelet aggregation in platelet-rich plasma (PRP) is a fundamental tool in platelet studies, despite the fact that the technique required for this is time-consuming, may need large volumes of blood, and require particular skill and special equipment. The use of a microplate reader seems useful to perform platelet aggregation more rapidly and with less material. So, the aim of the present study was to validate a simple and rapid method which enables performance of kinetic measurements of platelet aggregation directly in a microtiter plate reader. Platelet aggregation was carried out in 96-well, flat-bottomed microtiter plates. Samples of PRP (140 microl/well) were placed in a microtiter plate. Agonists (10 microl/well) were added using an electronic multichannel dispenser directly before the reading was started. Measurements of the optical density were performed at 650 nm using a THERMOmax microplate reader (Molecular Devices, Sunnyvale, USA). During the run time the plate was incubated at 37 degrees C and was mixed with the automix function of the reader. The technique was verified by comparing dose-response curves of platelet agonists and glycoprotein IIb/IIIa antagonists, obtained with the standard aggregometer and with the microtiter plate reader. Platelet aggregation in microtiter plates is simple and rapid. It offers the advantages of lowering the test volumes and the possibility to perform about 90 tests simultaneously. The method was successfully applied to measure platelet inhibition by glycoprotein IIb/IIIa antagonists.

Identity of Cysticercoides menidiae Chandler, 1935 (Cestoda: Dilepididae).

Cysticercoides menidiae Chandler, 1935, described as a metacestode of an unknown dilepidid cestode from the intestinal wall and mesenteries of the silversides Menidia menidia (Pisces: Atherinidae), from Galveston Bay, Texas, was found to be conspecific with Ascodilepis transfuga (Krabbe, 1869), a tapeworm described from the spoonbill. Platalea ajaja Linnaeus (syn. Ajaja ajaja), from Brazil. Consequently. C. menidiae becomes a junior synonym of A. transfuga.