Ultra-short celiac disease exhibits differential genetic and immunophenotypic features compared to conventional celiac disease.

BACKGROUND: Ultra-short coeliac disease (USCD) is a novel celiac disease (CD) subtype limited to the duodenal bulb (D1). HLA haplotypes and flow cytometry have not been assessed yet. AIMS: To compare genetic, clinical, serologic, histopathologic and inmmunophenotypic parameters between USCD and conventional celiac disease (CCD) patients. METHODS: Prospective single-center study in children and adult patients undergoing duodenal biopsies on a gluten-containing diet. Biopsies for histology and flow cytometry were taken separately from D1 and distal duodenum. Biopsies in seronegative patients with celiac lymphogram were repeated after 2 years on a gluten-free diet. RESULTS: Among 505 included patients, 127 were diagnosed with CD, of whom 7 (5.5%) showed USCD. HLADQ2 was significantly less common in USCD compared to CCD (71% vs. 95%, p 0.003). Likewise, USCD patients showed more frequent non-significant seronegativity (28% vs. 8%, p 0.07) and significantly lower titrations (7-15IU/ml) of tissue transglutaminase antibodies (tTG-IgA) (60% vs. 13%, p<0.001). Biopsies from D1 revealed significant less NK cells down-expression in USCD patients (1.4 vs. 5, p 0.04). CONCLUSIONS: Up to 5.5% of CD patients showed USCD. A lower frequency of HLADQ2, along with less serum tTG-IgA titration and duodenal NK cell suppression, were differential features of USCD.

Microbial invasions in sludge anaerobic digesters.

Among processes that control microbial community assembly, microbial invasion has received little attention until recently, especially in the field of anaerobic digestion. However, knowledge of the principles regulating the taxonomic and functional stability of microbial communities is key to truly develop better predictive models and effective management strategies for the anaerobic digestion process. To date, available studies focus on microbial invasions in digesters feed with activated sludge from municipal wastewater treatment plants. Herein, this review summarizes the importance of invasions for anaerobic digestion management, the ecological theories about microbial invasions, the traits of activated sludge microorganisms entering the digesters, and the resident communities of anaerobic reactors that are relevant for invasions and the current knowledge about the success and impacts of invasions, and discusses the research needs on this topic. The initial data indicate that the impact of invasions is low and only a small percentage of the mostly aerobic microorganisms present in the activated sludge feed are able to become stablished in the anaerobic digesters. However, there are still numerous unknowns about microbial invasions in anaerobic digestion including the influence of anaerobic feedstocks or process perturbances that new approaches on microbial ecology could unveil. KEY POINTS: • Microbial invasions are key processes to develop better strategies for digesters management. • Knowledge on pathogen invasions can improve anaerobic digestion microbial safety. • To date, the number of successful invasions on anaerobic digesters from activated sludge organisms is low. • Feed organisms detected in digesters are mostly inactive residual populations. • Need to expand the range of invaders and operational scenarios studied.

Halotolerance mechanisms of the methanotroph Methylomicrobium alcaliphilum.

Methylomicrobium alcaliphilum is an alkaliphilic and halotolerant methanotroph. The physiological responses of M. alcaliphilum to high NaCl concentrations, were studied using RNA sequencing and metabolic modeling. This study revealed that M. alcaliphilum possesses an unusual respiratory chain, in which complex I is replaced by a Na+ extruding NQR complex (highly upregulated under high salinity conditions) and a Na+ driven adenosine triphosphate (ATP) synthase coexists with a conventional H+ driven ATP synthase. A thermodynamic and metabolic model showing the interplay between these different components is presented. Ectoine is the main osmoprotector used by the cells. Ectoine synthesis is activated by the transcription of an ect operon that contains five genes, including the ectoine hydroxylase coding ectD gene. Enzymatic tests revealed that the product of ectD does not have catalytic activity. A new Genome Scale Metabolic Model for M. alcaliphilum revealed a higher flux in the oxidative branch of the pentose phosphate pathway leading to NADPH production and contributing to resistance to oxidative stress.

Adaptation of granular sludge microbial communities to nitrate, sulfide, and/or p-cresol removal.

Effluents from petroleum refineries contain a toxic mixture of sulfide, nitrogen, and phenolic compounds that require adequate treatment for their removal. Biological denitrification processes are a cost-effective option for the treatment of these effluents, but the knowledge on the microbial interactions in simultaneous sulfide and phenol oxidation in denitrifying reactors is still very limited. In this work, microbial community structure and macrostructure of granular biomass were studied in three denitrifying reactors treating a mixture of inorganic (sulfide) and organic (p-cresol) electron donors for their simultaneous removal. The differences in the available substrates resulted in different community assemblies that supported high removal efficiencies, indicating the community adaptation capacity to the fluctuating compositions of industrial effluents. The three reactors were dominated by nitrate reducing and denitrifying bacteria where Thiobacillus spp. were the prevalent denitrifying organisms. The toxicity and lack of adequate substrates caused the endogenous decay of the biomass, leading to release of organic matter that maintained a diverse although not very abundant group of heterotrophs. The endogenous digestion of the granules caused the degradation of its macrostructure, which should be considered to further develop the denitrification process in sulfur-based granular reactors for treatment of industrial wastewater with toxic compounds.

Performance and microbial features of the partial nitritation-anammox process treating fish canning wastewater with variable salt concentrations.

The partial nitritation-anammox (PN-AMX) process applied to wastewaters with high NaCl concentration was studied until now using simulated media, without considering the effect of organic matter concentration and the shift in microbial populations. This research work presents results on the application of this process to the treatment of saline industrial wastewater. Obtained results indicated that the PN-AMX process has the capability to recover its initial activity after a sudden/acute salt inhibition event (up to 16 g NaCl/L). With a progressive salt concentration increase for 150 days, the PN-AMX process was able to remove the 80% of the nitrogen at 7-9 g NaCl/L. The microbiological data indicated that NaCl and ammonia concentrations and temperature are important factors shaping PN-AMX communities. Thus, the NOB abundance (Nitrospira) decreases with the increase of the salt concentration, while heterotrophic denitrifiers are able to outcompete anammox after a peak of organic matter in the feeding.

Current Concentrations of Zn, Cu, and As in Piggery Wastewater Compromise Nutrient Removals in Microalgae-Bacteria Photobioreactors Due to Altered Microbial Communities.

The treatment of pig manure is a major environmental issue, and photobioreactors containing consortia of microalgae and bacteria have proven to be a promising and sustainable treatment alternative. This work studies the effect of Cu, Zn and As, three toxic elements frequently present in piggery wastewater, on the performance and microbiome of photobioreactors. After dopage with Zn (100 mg/L), Cu (100 mg/L), and As (500 µg/L), the high biomass uptake of Zn (69-81%) and Cu (81-83%) decreased the carbon removal in the photobioreactors, inhibited the growth of Chlorella sp., and affected heterotrophic bacterial populations. The biomass As uptake result was low (19%) and actually promoted microalgae growth. The presence of Cu and As decreased nitrogen removal, reducing the abundance of denitrifying bacterial populations. The results showed that metal(loid)s significantly affected 24 bacterial genera and that they did not recover after exposure. Therefore, this study makes an important contribution on the impact of the presence of metal(loid)s in piggery wastewater that compromises the overall performance of PBRs, and so, the environmental and health impact of treated effluents.

Esophageal eosinophilic infiltration responds to proton pump inhibition in most adults.

BACKGROUND & AIMS: Despite consensus recommendations, eosinophilic esophagitis (EoE) is commonly diagnosed upon esophageal eosinophilic infiltration (EEI; based on ≥ 15 eosinophils per high power field; eo/HPF). We evaluated the prevalence of EEI before and after proton pump inhibitor (PPI) therapy and assessed the accuracy of EEI and pH monitoring analyses. METHODS: Biopsies were taken from the upper-middle esophagus of 712 adults with upper gastrointestinal symptoms who were referred for endoscopy due to upper gastrointestinal symptoms. Patients with EEI were treated with rabeprazole (20 mg, twice daily) for 2 months. EoE was defined by persistent symptoms and >15 eo/HPF following PPI therapy. RESULTS: Thirty-five patients (4.9%) had EEI, of whom 55% had a history of allergies, and 70% had food impaction or dysphagia as their primary complaint. Twenty-six EEI patients (75%) achieved clinicopathological remission with PPI therapy; of these, 17 had GERD-like profile (EEI <35 eo/HPF and objective evidence of reflux, based on endoscopy or pH monitoring), and 9 had EoE-like profile (EEI 35-165 eo/HPF, typical EoE symptoms and endoscopic findings). The PPI response was 50% in the EoE-like profile patients. The PPI-response was 50% in EoE-like profile patients. Likewise, PPI-responsive EEI occurred with normal (33%) and pathologic (80%) pH monitoring. Higher histologic cut-off values improved specificity and positive predictive for EoE (35%-35% for >20 eo/HPF; 46%-39% for >24 eo/HPF; 65%-50% for 35 eo/HPF). CONCLUSIONS: In adults with EEI, 75% of unselected patients and 50% with an EoE phenotype respond to PPI therapy; pH monitoring is poorly predictive of response. Patients with PPI-responsive EEI >35 eo/HPF are phenotypically undistinguishable from EoE patients. EoE might be overestimated without clinical and pathologic follow-up of patient response to PPI.

Effect of operational parameters, environmental conditions, and biotic interactions on bacterial communities present in urban wastewater treatment photobioreactors.

The effects of water depth, operational and environmental conditions on bacterial communities were analyzed in microalgal-bacterial outdoor photobioreactors treating urban wastewaters from March to August 2014. Three raceway photobioreactors inoculated with Scenedesmus sp. and with different water depths (20, 12, and 5 cm) were used at different dilution rates (0.15, 0.3, 0.4, and 0.5 d-1). A thin-layer reactor with 2 cm water depth and operated at 0.3 d-1 was used as a control. The results showed that biomass productivity increased as water depth decreased. The highest biomass productivity was 0.196 gL-1d-1, 0.245 gL-1d-1, and 0.457 gL-1d-1 for 20, 12, and 5 cm depth raceway photobioreactors, respectively. These values were lower than the maximum productivity registered in the control reactor (1.59 gL-1d-1). Bacterial communities, analyzed by high-throughput 16S rRNA sequencing, were not affected by water depth. A decrease in community evenness was related to a decrease in nutrient removal. Hetetrotrophs and phototrophs, mainly from the family Rhodobacteraceae, dominated bacterial diversity. The community changed due to increasing temperatures, irradiance, and organic carbon, ammonia, and phosphate contents in the photobioreactor-influent as well as, microalgae inhibition and higher organic carbon in the effluent. The photobioreactors shared a core-biome that contained five clusters of co-occurring microorganisms. The bacteria from the different clusters were taxonomically and ecologically different but functionally redundant. Overall, the drivers of the community changes could be related to abiotic variables and complex biological interactions, likely mediated by microalgae excretion of organic substances and the microorganisms' competence for substrates.

Air-side ammonia stripping coupled to anaerobic digestion indirectly impacts anaerobic microbiome.

Air-side stripping without a prior solid-liquid phase separation step is a feasible and promising process to control ammonia concentration in thermophilic digesters. During the process, part of the anaerobic biomass is exposed to high temperature, high pH and aerobic conditions. However, there are no studies assessing the effects of those harsh conditions on the microbial communities of thermophilic digesters. To fill this knowledge gap, the microbiomes of two thermophilic digesters (55°C), fed with a mixture of pig manure and nitrogen-rich co-substrates, were investigated under different organic loading rates (OLR: 1.1-5.2 g COD l-1  day-1 ), ammonia concentrations (0.2-1.5 g free ammonia nitrogen l-1 ) and stripping frequencies (3-5 times per week). The bacterial communities were dominated by Firmicutes and Bacteroidetes phyla, while the predominant methanogens were Methanosarcina sp archaea. Increasing co-substrate fraction, OLR and free ammonia nitrogen (FAN) favoured the presence of genera Ruminiclostridium, Clostridium and Tepidimicrobium and of hydrogenotrophic methanogens, mainly Methanoculleus archaea. The data indicated that the use of air-side stripping did not adversely affect thermophilic microbial communities, but indirectly modulated them by controlling FAN concentrations in the digester. These results demonstrate the viability at microbial community level of air side-stream stripping process as an adequate technology for the ammonia control during anaerobic co-digestion of nitrogen-rich substrates.

Organic overloading affects the microbial interactions during anaerobic digestion in sewage sludge reactors.

There is still a lack of information about microbial interactions of anaerobic digestion microbiome during process disturbance which limits our ability to predict the mechanisms that drive community dynamics on these events. This paper aims to determine how an organic overloading affects these interactions and to characterize in detail the microbiome structure and diversity in sewage sludge anaerobic reactors during an acidosis event. Two identical sewage sludge anaerobic reactors were subjected to an organic loading shock by adding glycerol waste. As consequence, volatile fatty acids accumulated after only 24 h (up to 2.5 g/L) while Bacteroidales and Methanomicrobiales became displaced by Firmicutes and Methanosaeta sp, showing that reactor acidosis can occur without an immediate decline of this methanogen. Network analysis revealed 9 clusters of co-occurring microorganisms with different behaviors during overloading. At first, Veillonellaceae family, the main glycerol degrading, associated with Candidatus Cloacimonetes, volatile fatty acids fermenters, increased their relative abundance in detriment of the syntrophic bacteria; although as conditions become more acidic, these groups were displaced by other fermenters like Porphyromonadaceae and Chitinophagaceae. Eventually, the methanogenesis failed 72 h after organic overloading, when pH reached values lower than 6. Overall, our results showed a succession of functionally redundant microorganisms, most likely because of niche specialization during organic overloading. The detailed temporal analysis elucidated the processes governing the dynamics anaerobic digestion microbiome, a knowledge required to develop anaerobic digestion management strategies based on its microbiome during process disturbances.

Thermal hydrolysis of sewage sludge partially removes organic micropollutants but does not enhance their anaerobic biotransformation.

Pretreatment technologies prior to anaerobic digestion (AD) have been developed with the aim of enhancing biogas productivity and reducing the presence of pathogens in digested sludge. Among them, thermal hydrolysis (TH) appears as the most promising one. In wastewater treatment plants (WWTPs) sludge is the end point of many organic micropollutants (OMPs), which was proved to lead to important environmental and human risks since sludge is commonly used in agriculture. The objective of this work is to determine the fate OMPs in TH and subsequent AD. Sewage sludge was pretreated in a TH pilot plant at 170 °C for 20 min. Afterwards, two anaerobic digesters with a working volume of 14 L fed with fresh and pretreated sludge were operated in parallel in mesophilic conditions. TH proved to be an effective technology to partially or totally remove the dissolved fraction of OMPs as well as the fraction sorbed into those suspended solids that are solubilised after this pretreatment. However, it did not affect the OMPs sorbed concentration into solids that are not solubilised. Globally, the OMPs removal efficiency during TH appears to be linked to the solids solubilisation during this process. Afterwards, the OMPs biotransformation efficiency in AD of fresh and pretreated sludge was determined. Noticeable differences between the microbiome of both reactors was determined, but the anaerobic biotransformation was not substantially different for most of the OMPs. However, it affected musk fragrances, which presented considerably lower biotransformation efficiency in the reactor fed with pretreated sludge. Therefore, TH was proved effective in partially removing OMPs but not in enhancing their bioavailability and subsequent anaerobic biotransformation.

[Hypertrichosis cubiti in a girl with precocious puberty: Case report]. / Hipertricosis cubital en una paciente con pubarquia precoz: Caso clmico.

Hypertrichosis cubiti is a localized increase in hair density, length and thickness. It is an uncommon and benign entity with very few patients described in the medical literature (more or less than half a hundred). Half of the described patients associate other defects or malformations and the other half are purely aesthetic cases. Early pubarche in girls is defined as the onset of pubic hair before 8 years of age. We present a six-year-old patient with the association not previously described of hypertrichosis cubiti and precocious pubarche.

La hipertricosis cubital es un aumento localizado de la densidad, longitud y espesor del vello. Es una entidad benigna con muy escasos pacientes descritos en la literatura médica (alrededor de medio centenar). La mitad de los casos descritos asocian otros defectos o malformaciones, y la otra mitad son problemas puramente estéticos. La pubarquia precoz en niñas se define como el inicio del vello púbico antes de los 8 años de edad. Se presenta a una paciente de 6 años con la asociación no descrita previamente de hipertricosis cubital y pubarquia precoz.

[Osgood-Schlatter disease in adolescent athlete. Case report]. / Enfermedad de Osgood-Schlatter en un adolescente deportista. Caso clínico.

Knee pain is one of the most frequent musculoskeletal symptoms in young physically active males. Common entities of clinical diagnosis as osteochondritis/apophysitis and others that need complementary studies should be considered in the differential diagnosis. We present the case of a 12-year-old male athlete with continuous pain in his right knee that intensifies with physical activity and with direct pressure. Diagnosis of Osgood-Schlatter disease is made by exploratory data, pain-to-finger palpation on the anterior tibial tuberosity, and is confirmed by radiology. This entity is described as well as the main pathologies derived from overuse to make differential diagnosis and to stress preventive measures regarding a correct orientation in the sport activity.

El dolor de rodilla es uno de los síntomas musculoesqueléticos más frecuentes en jóvenes físicamente activos y aparece, sobre todo, en adolescentes varones. Dentro del diagnóstico diferencial, hay que considerar entidades habituales de diagnóstico clínico, como la osteocondrosis apofisaria, y también otras en las que se precisan estudios complementarios. Se presenta el caso de un varón deportista de 12 años con dolor continuo en la rodilla derecha que se intensificaba con la actividad física y la presión directa. Se hizo el diagnóstico de enfermedad de Osgood-Schlatter mediante los datos exploratorios, reproducción del dolor ante la palpación a punta de dedo sobre la tuberosidad tibial anterior, y se confirmó mediante radiología. Se describe esta entidad y otras derivadas de la sobreutilización en la actividad física con las que hacer diagnóstico diferencial; se insiste en las medidas preventivas en cuanto a una correcta orientación en la actividad deportiva.

Microbial Communities Are Well Adapted to Disturbances in Energy Input.

Although microbial systems are well suited for studying concepts in ecological theory, little is known about how microbial communities respond to long-term periodic perturbations beyond diel oscillations. Taking advantage of an ongoing microcosm experiment, we studied how methanotrophic microbial communities adapted to disturbances in energy input over a 20-day cycle period. Sequencing of bacterial 16S rRNA genes together with quantification of microbial abundance and ecosystem function were used to explore the long-term dynamics (510 days) of methanotrophic communities under continuous versus cyclic chemical energy supply. We observed that microbial communities appeared inherently well adapted to disturbances in energy input and that changes in community structure in both treatments were more dependent on internal dynamics than on external forcing. The results also showed that the rare biosphere was critical to seeding the internal community dynamics, perhaps due to cross-feeding or other strategies. We conclude that in our experimental system, internal feedbacks were more important than external drivers in shaping the community dynamics over time, suggesting that ecosystems can maintain their function despite inherently unstable community dynamics. IMPORTANCE Within the broader ecological context, biological communities are often viewed as stable and as only experiencing succession or replacement when subject to external perturbations, such as changes in food availability or the introduction of exotic species. Our findings indicate that microbial communities can exhibit strong internal dynamics that may be more important in shaping community succession than external drivers. Dynamic "unstable" communities may be important for ecosystem functional stability, with rare organisms playing an important role in community restructuring. Understanding the mechanisms responsible for internal community dynamics will certainly be required for understanding and manipulating microbiomes in both host-associated and natural ecosystems.

Maternal assessment of recommendations on the newborn infant care upon hospital discharge.

INTRODUCTION: It is common for pediatricians to provide parents with information on how to look after their newborn baby at the time of discharge from the hospital. The objectives of this study are to determine the level of satisfaction regarding such information, to be aware of what additional information parents would have liked to receive, and to establish which factors may impact any additional information request. POPULATION AND METHODS: Descriptive study evaluating the opinion of women at 5-15 days post- partum regarding such information. RESULTS: A hundred and seventy-six surveys were collected. Of these, 68.8% respondents had attended childbirth classes. Sixty-one point four percent referred to have looked for advice on the newborn infant care, mostly on the Internet and in books. Seventy-four point four percent considered that the information provided sufficed. Most commonly, information was requested on breastfeeding (33.3%), bottle feeding (20.0%), and umbilical cord care (11.1%). Mothers who requested more information attended childbirth classes more frequently (significant) and searched for information during pregnancy (not significant). In addition, this group significantly assigned a lower score to the opportunity to ask questions and the level of trust on the pediatrician. CONCLUSIONS: Maternal satisfaction regarding the information provided is adequate; and most mothers do not request additional information. The topic on which they most frequently request additional information is breastfeeding. The decision to request information does not depend on maternal age, maternal education, employment condition, or having other children. Likewise, mothers have questions that are not satisfactorily answered during childbirth classes.