Revisiting the historical scenario of a disease dissemination using genetic data and Approximate Bayesian Computation methodology: The case of Pseudocercospora fijiensis invasion in Africa.

The reconstruction of geographic and demographic scenarios of dissemination for invasive pathogens of crops is a key step toward improving the management of emerging infectious diseases. Nowadays, the reconstruction of biological invasions typically uses the information of both genetic and historical information to test for different hypotheses of colonization. The Approximate Bayesian Computation framework and its recent Random Forest development (ABC-RF) have been successfully used in evolutionary biology to decipher multiple histories of biological invasions. Yet, for some organisms, typically plant pathogens, historical data may not be reliable notably because of the difficulty to identify the organism and the delay between the introduction and the first mention. We investigated the history of the invasion of Africa by the fungal pathogen of banana Pseudocercospora fijiensis, by testing the historical hypothesis against other plausible hypotheses. We analyzed the genetic structure of eight populations from six eastern and western African countries, using 20 microsatellite markers and tested competing scenarios of population foundation using the ABC-RF methodology. We do find evidence for an invasion front consistent with the historical hypothesis, but also for the existence of another front never mentioned in historical records. We question the historical introduction point of the disease on the continent. Crucially, our results illustrate that even if ABC-RF inferences may sometimes fail to infer a single, well-supported scenario of invasion, they can be helpful in rejecting unlikely scenarios, which can prove much useful to shed light on disease dissemination routes.

Application of a fast and sensitive method for the determination of contaminants of emerging concern in wastewater using a quick, easy, cheap, effective, rugged and safe-based extraction and liquid chromatography coupled to mass spectrometry.

The inefficiency of wastewater treatment plants (WWTPs) to remove contaminants of emerging concern (CECs) leads to their continuous release to the environment. Consequently, CECs are present at low concentrations in the treated wastewater (TWW), producing unpredicted and unwanted effects on living organisms as they are discharged into water receiving bodies. This work presents a fast and reliable method for the determination of CECs in TWW based on the innovative application of a QuEChERS (quick, easy, cheap, effective, rugged and safe) method for water extraction and determination by sensitive liquid chromatography coupled to quadrupole-linear ion trap tandem mass spectrometry (LC-QqLIT-MS/MS). The scope of the proposed QuEChERS-based method allows the monitoring of 107 CECs, including pharmaceuticals (58), antibiotics (16) and pesticides (33). The proposed method was successfully validated in urban TWW at two concentration levels (50 and 500 ng L-1) and it is a feasible alternative to conventional and time-consuming solid-phase extraction (SPE) methodologies. 89% of the CECs presented mean recovery values in the 70-120% range with relative standard deviations (RSDs) always < 20% (intra and inter-day precision), and limits of quantification (LOQs) in the range 5-500 ng L-1 (89% of the compounds showed a LOQ ≤ 50 ng L-1). The applicability of the method was demonstrated by the analysis of urban TWW samples (7 sampling events). In total, 35 CECs (23 pharmaceuticals, 2 antibiotics and 10 pesticides) were detected in the monitored samples with concentrations ranging from 5 to 677 ng L-1.

Empleo de malla en U de una pieza y sutura barbada durante la colposacropexia laparoscópica / The use of one-piece U-shaped mesh and barbed sutures in laparoscopic sacrocolpopexy

INTRODUCCIÓN: La colposacropexia laparoscópica (CL) para el manejo del prolapso de órganos pélvicos, es una cirugía compleja que requiere experticia. La complejidad radica en los requerimientos de sutura intracorpórea y en las dificultades para la manipulación intracorpórea de la malla. La sutura barbada (SB) simplifica la sutura intracorpórea y no requiere anudado. Adicionalmente las mallas en U de una sola pieza (MU-P) pueden facilitar su manipulación, estabilización y el ajuste de tensión. Describimos nuestra técnica quirúrgica de CL empleando ambos materiales y valoramos su factibilidad, seguridad y efectividad en una serie prospectiva de pacientes. Materiales y MÉTODOS: Un total de 7 pacientes con prolapso de órganos pélvicos sintomático fueron intervenidas mediante CL empleando MU-P fijada con SB. A todas ellas se les realizó historia uroginecológica, clasificación del prolapso de órganos pélvicos según Baden-Walker y se les administró el cuestionario de calidad de vida específico de prolapso. Se empleó la MU-P de polipropileno, macroporo, no absorbible (Uplift (R)). La rama posterior de la malla se fijó en los músculos elevadores con sendos puntos de sutura no absorbible. Dos hilos de SB (V-Loc (R)), atadas en su extremo se emplearon para fijar la rama anterior de la malla en la vagina con dos líneas de sutura continua en sentidos opuestos con inicio en el punto central y más profundo de la disección vaginal. Se emplearon tackers no metálicos del kit de Uplift(R) para la promontofijación y SB para el cierre del peritoneo. RESULTADOS: La mediana de edad fue 60 años, la mediana de tiempo de fijación de la rama anterior de la malla con SB fue de 23 minutos (rango 21,30 - 26,40 min), la mediana de la estancia hospitalaria fue de 3 días y el sangrado intraoperatoria fue mínimo. Observamos que la MU-P se autoestabiliza al desplegarse longitudinalmente en la cavidad minimizando los requerimientos del asistente quirúrgico. La promontofijación independiente de cada rama de la malla (posterior y anterior) permite un ajuste de tensión más anatómico. La fijación de la malla a la vagina mediante nuestra técnica empleando la SB resulta rápida y sencilla. No se registraron complicaciones intraoperatorias y no se han evidenciado erosiones vaginales ni recurrencias durante el seguimiento (mediana 14 meses. ) Todas las pacientes presentaron mejoría clínica del prolapso y están satisfechas con la cirugía. CONCLUSIONES: La CL empleando MU-P y SB es factible, segura, efectiva y podría simplificar la cirugía

INTRODUCTION: Laparoscopic sacrocolpopexy (LS) is considered a safe and effective surgery for the treatment of pelvic organ prolapse (POP), but it requires expertise in laparoscopic surgery. The complexity of the intervention is due to the requirements of intracorporeal sutures and the manipulation of the mesh inside the cavity, which may be cumbersome. The barbed sutures (BS) simplify intracorporeal suturing and do not require knotting. Additionally, one-piece U-mesh (OP-UM) may facilitate handling, stabilization and tension adjustment. We describe our LS surgical technique using both materials to assess its feasibility, safety and effectiveness in a prospective series of PATIENTS: MATERIALS AND METHODS: A total of 7 patients with symptomatic pelvic organ prolapse were included. Urogynecological history, classification of the pelvic organ prolapse according to Baden-Walker and the application of the Prolapse Quality of Life questionnaire were performed in all cases. The non-absorbable polypropylene OP-UM (UpliftTM) was used. The posterior side of the single sling is sutured to the elevator anus muscles with two non-absorbable stitches. Two strands of BS (V-LocTM), tied at their ends, were used to attach the mesh to the vagina in two lines of continuous sutures in opposite directions. Self-anchoring tackers were used for promontofixation and BS for peritoneal closure. RESULTS: The median age was 60 years, the median time of the anterior branch mesh BS fixation was 23 minutes (range 21,30 - 26,40 min), intraoperative bleeding was minimal, and the median hospital stay was 3 days. No intraoperative complications were recorded, and no mesh erosions or recurrences were observed at a median follow-up of 14 months (range 3-25 months). All patients presented clinical improvement of the prolapse and were satisfied with surgery. We observed that the OP-UM self-stabilizes when it extends longitudinally into the abdominal cavity, reducing the need of the surgical assistant. The independent promontofixation of each part of the mesh (posterior and anterior) allows a more anatomical tension adjustment. Fixing the mesh to the vagina is fast and simple with our BS technique. CONCLUSIONS: The use of OP-UM and BS during LS is feasible, safe, effective and could simplify this surgical technique

The use of one-piece U-shaped mesh and barbed sutures in laparoscopic sacrocolpopexy. / Empleo de malla en U de una pieza y sutura barbada durante la colposacropexia laparoscópica.

INTRODUCTION: Laparoscopic sacrocolpopexy (LS) is considered a safe and effective surgery for the treatment of pelvic organ prolapse (POP), but it requires expertise in laparoscopic surgery. The complexity of the intervention is due to the requirements of intracorporeal sutures and the manipulation of the mesh inside the cavity, which may be cumbersome. The barbed sutures (BS) simplify intracorporeal suturing and do not require knotting. Additionally, one-piece U-mesh (OP-UM) may facilitate handling, stabilization and tension adjustment. We describe our LS surgical technique using both materials to assess its feasibility, safety and effectiveness in a prospective series of patients. MATERIALS AND METHODS: A total of 7 patients with symptomatic pelvic organ prolapse were included. Urogynecological history, classification of the pelvic organ prolapse according to Baden-Walker and the application of the Prolapse Quality of Life questionnaire were performed in all cases. The non-absorbable polypropylene OP-UM (Uplift ™) was used. The posterior side of the single sling is sutured to the elevator anus muscles with two non-absorbable stitches. Two strands of BS (V-Loc™), tied at their ends, were used to attach the mesh to the vagina in two lines of continuous sutures in opposite directions. Self-anchoring tackers were used for promontofixation and BS for peritoneal closure. RESULTS: The median age was 60 years, the median time of the anterior branch mesh BS fixation was 23minutes (range 21,30 - 26,40min), intraoperative bleeding was minimal, and the median hospital stay was 3 days. No intraoperative complications were recorded, and no mesh erosions or recurrences were observed at a median follow-up of 14 months (range 3-25 months). All patients presented clinical improvement of the prolapse and were satisfied with surgery. We observed that the OP-UM self-stabilizes when it extends longitudinally into the abdominal cavity, reducing the need of the surgical assistant. The independent promontofixation of each part of the mesh (posterior and anterior) allows a more anatomical tension adjustment. Fixing the mesh to the vagina is fast and simple with our BS technique. CONCLUSIONS: The use of OP-UM and BS during LS is feasible, safe, effective and could simplify this surgical technique.

Preserving fertility in women with endometrial cancer: two clinical cases.

Endometrial cancer is diagnosed increasingly in young women who wish to have children, and treatments intended to preserve fertility in these patients are becoming more common. The authors describe two women with endometrial cancer who were diagnosed and treated at our center and who needed assisted human reproductive technology, and review current knowledge based on similar cases.

Longitudinal clines in the frequency distribution of 'super-clones' in an aphid crop pest.

Parthenogenesis is the main mode of reproduction of aphids. Their populations are therefore composed of clones whose frequency distribution varies in space and time. Previous population genetic studies on aphids have highlighted the existence of highly abundant clones ('super-clones'), distributed over large geographic areas and persisting over time. Whether the abundance of 'super-clones' results from their ecological success or from stochastic forces, such as drift and migration, is an open question. Here, we looked for the existence of clines in clonal frequency along a climatic gradient in the cereal aphid Rhopalosiphum padi (Linnaeus, 1758) and examined the possible influence of geographical distance and environmental variables in the buildup and maintenance of such clonal clines. We investigated the spatial distribution of the commonest genotypes of R. padi by sampling populations along an east-west transect in maize fields in the northern half of France in both spring and late summer. Individual aphids were genotyped at several polymorphic loci, allowing the assessment of frequency distributions of multilocus genotypes (MLGs) across the cropping season. We found several MLGs showing longitudinal clines in their frequency distribution in both spring and summer. In particular, two dominant asexual genotypes of R. padi showed inverted geographical clines, which could suggest divergent adaptations to environmental conditions. We concluded that while the distribution of some 'super-clones' of R. padi seems most likely driven by the action of migration and genetic drift, selection could be also involved in the establishment of longitudinal clines of others.

Adaptation and validation of the Spanish version of the Spinal Cord Lesion-related Coping Strategies Questionnaire (SCL CSQ-S).

STUDY DESIGN: Cross-sectional validation study. OBJECTIVES: To adapt the Spinal Cord Lesion-related Coping Strategies Questionnaire into the Spanish language (SCL CSQ-S) and to examine the relationship between coping strategies, global quality of life and psychological adaptation. SETTING: Data were collected through individuals with spinal cord injury (SCI) now living in the community who completed their routine follow-up assessment at the Institute Guttmann in Barcelona, Spain. METHODS: Forward and backward translation into Spanish of the English version of the questionnaire. Questionnaires of global Quality of Life, Community Integration, Coping, Depression, Anxiety and Functional Independence were administered to 349 adults with paraplegia and 162 adults with tetraplegia. Statistical analysis included confirmatory factor analysis and regression analysis. RESULTS: The factorial structure of the questionnaire was partly verified. The original correlated, three-factor model sufficiently fit the data obtained in this study: χ(2)(48)=109.46; P<0.001; Comparative Fit Index=0.96; Tucker-Lewis Index=0.96; Root Mean Square Error of Approximation=0.050 (0.038-0.062); Akaike information criterion=13.46. Items were found to be good indicators of their respective latent factors, showing adequate factorial charge ranges (between 0.41 and 0.75). The reliability coefficient (Cronbach's α) for the Acceptance subscale was 0.74, for Social reliance 0.76 and for Fighting spirit 0.69. Coping strategies as measured by SCL-CSQ-S contributed to the prediction of outcomes related to adaptation to disability. CONCLUSION: The results of the study show some evidence for the robustness of the structure of SCL CSQ-S and show that the Spanish version of the questionnaire largely replicate previous results. Coping strategies, especially Acceptance, are related to adaptation to injury.

Climate and agricultural context shape reproductive mode variation in an aphid crop pest.

In aphids, reproductive mode is generally assumed to be selected for by winter climate. Sexual lineages produce frost-resistant eggs, conferring an advantage in regions with cold winters, while asexual lineages predominate in regions with mild winters. However, habitat and resource heterogeneities are known to exert a strong influence on sex maintenance and might modulate the effect of climate on aphid reproductive strategies. We carried out a hierarchical sampling in northern France to investigate whether reproductive mode variation of the aphid Rhopalosiphum padi is driven by winter climate conditions, by habitat and resource heterogeneities represented by a range of host plants or by both factors. We confirmed the coexistence in R. padi populations of two genetic clusters associated with distinct reproductive strategies. Asexual lineages predominated, whatever the surveyed year and location. However, we detected a between-year variation in the local contribution of both clusters, presumably associated with preceding winter severity. No evidence for host-driven niche differentiation was found in the field on six Poaceae among sexual and asexual lineages. Two dominant multilocus genotypes ( approximately 70% of the sample), having persisted over a 10-year period, were equally abundant on different plant species and locations, indicating their large ecological tolerance. Our results fit theoretical predictions of the influence of winter climate on the balance between sexual and asexual lineages. They also highlight the importance of current agricultural practices which seem to favour a small number of asexual generalist genotypes and their migration across large areas of monotonous environments.

Síndrome paraneoplásico cerebeloso asociado con carcinoma de ovario / Paraneoplastic syndrome with cerebellar degeneration associated with ovarian carcinoma

Presentamos el caso de una paciente afectada de un síndrome paraneoplásico con degeneración cerebelosa, como primera manifestación de un tumor ovárico en la que todos los estudios resultaron normales, a excepción de la presencia de un autoanticuerpo anti-Yo, que reconoce antígenos citoplasmáticos de las células de Purkinje del cerebelo. La sospecha de un tumor ovárico fue confirmada microscópicamente tras la extirpación de los dos anejos. (AU)

Long-Term GH therapy: epidemiology and auxologic outcome.

OBJECTIVES: Epidemiologic and auxologic characteristics of patients treated with GH during childhood and adolescence and entered in a national registry in Catalonia were studied between 1988 and 1997. At the end of 1997, prevalence was 53.2 treatments/100,000 inhabitants aged 0-14 years. Maximum annual incidence rates were observed in 1990 and 1991 (34.0-35.6 cases/100,000 inhabitants aged 0-14 years). STUDY DESIGN: Analysis of treatments terminated in 1993 (n = 548) revealed, for the three principal reasons for cessation of treatment ('near-final height', 'adequate height but further growth potential', and 'poor growth response'), that males began and ended treatment at older ages with a better auxologic situation in SDS than girls at the beginning and end of therapy in the first two subgroups, with a similar duration of therapy. Severe GH deficiency (GHD) [both multiple pituitary hormone deficiency (MPHD) and the most severe isolated GHD (IGHD-A)] was more frequent in the group ending treatment at 'near-final height', whereas cessation of therapy because of 'poor growth response' was more frequent in the group with 'other causes of short stature' and no demonstrable GHD by routine tests. In the near-final height group, after excluding Turner's syndrome, MPHD and GHD cases secondary to brain tumors and GH deficiencies associated with malformative syndromes, positive linear correlations were observed between HSDS at the end of treatment and HSDS at the beginning, predicted adult height SDS (PAHSDS) and target height SDS (THSDS). Multiple regression analysis showed that in this group of patients, 41.4% of the variability in HSDS increment can be explained by the equation: HSDS increment = -0.33 + 0.29 THSDS - 0.68 HSDS at the beginning of treatment. RESULTS: The outcome showed a reasonable use of GH, since good-response cases generally continued treatment until final height whereas therapy was suspended in doubtful cases.

Air-gun pellet injuries to the head and neck in children.

Air-gun pellet injuries to the head and neck are seldom reported in pediatric practice, although they typically occur in children. The adult skeleton stops these projectiles, but they can easily transverse the thin bones of children. If unnoticed, these apparently trivial injuries may have catastrophic consequences. We report three children who sustained a central nervous system injury resulting from a shot by a compressed-air gun. The true nature and extent of the lesion in two infants was established only by neuroradiological investigations. We also briefly review the management and prevention of this type of injury.

[Coarctation of the abdominal aorta. Treatment by stent placement]. / Coartación aórtica abdominal. Tratamiento mediante implantación de stent.

We report a nine-year-old boy referred for evaluation of suspected coarctation of the aorta. He presented with hypertension and absent femoral pulses. A 50 mmHg gradient was detected in the abdominal aorta by color flow doppler echocardiography but the level of coarctation was impossible to locate. The diagnosis was made by magnetic resonance imaging and aortography, showing segmentary hypoplasia in the upper abdominal segment of the descending aorta, immediately below the celiac axis and above the renal arteries. Treatment consisted in placement of a stent Palmaz, which was effective in significantly decreasing the gradient. Some clinical aspects and different therapeutic strategies for this unusual case are discussed.

[Effectiveness and safety of topiramate in treatment-resistant bipolar disorder]. / Efectividad y seguridad del topiramato en el trastorno bipolar resistente.

INTRODUCTION: This study was conducted to evaluate the effectiveness and safety of topiramate as add-on therapy for treatment-resistant bipolar disorder. METHODS: Twenty-one DSM-IV bipolar patients, considered resistant to treatment with lithium, carbamazepine or valproate, gave informed consent to receive increasing doses of the novel anticonvulsant topiramate as adjunctive therapy for their manic (n= 9), depressive (n= 6), hypomanic (n= 3), mixed (n= 2) or schizoaffective manic (n= 1) symptoms. The dosage of other mood stabilizer drugs remained unchanged throughout the 6-week follow-up. Outcome measures included the YMRS, HDRS-17, and CGI scales. Fifteen out of 21 patients completed the 6-week follow-up. RESULTS: Six patients (40% of completers, 29% by intention-to-treat) were considered responders to topiramate (> 50% reduction in YMRS or HDRS-17 and a decrease of 2 points in CGI). The drug was less effective in intially depressed patients. Topiramate was well tolerated and only one patient discontinued due to side-effects. The most common adverse effect was paresthesia (n= 2). Ten patients experienced moderate weight loss during the follow-up. The mean topiramate dose at endpoint was 158 mg/day. CONCLUSIONS: These preliminary results suggest that topiramate may be a useful therapy for bipolar disorders, with promising results even in the most treatment-refractory patients.

Efectividad y seguridad del topiramato en el trastorno bipolar resistente / Effectiveness and safety of topiramate in treatment-resistant bipolar disorder

Introducción: Se describe un estudio abierto de serie de casos diseñado para evaluar la efectividad y seguridad de topiramato como tratamiento coadyuvante del trastorno bipolar fármacorresistente. Pacientes y método: Se reclutaron 21 pacientes con trastorno bipolar según criterios DSM-IV, considerados resistentes a litio, carbamacepina o valproico. Los pacientes dieron consentimiento informado para realizar el tratamiento coadyuvante con topiramato para su sintomatología maníaca (n= 9), depresiva (n= 6), hipomaníaca (n= 3), mixta (n= 2) o esquizoafectiva bipolar maníaca (n= 1). El estudio duró seis semanas durante las cuales el tratamiento eutimizante concomitante se mantuvo constante. Se evaluaron semanalmente a los pacientes con las escalas YMRS, HDRS-17 y CGI. Resultados: De los 21 pacientes iniciales, 15 completaron la totalidad del estudio. Seis pacientes (40 por ciento de los que terminaron el estudio, 29 por ciento por intención de tratar) fueron considerados como respondedores al tratamiento (reducción > 50 por ciento en la escala YMRS o HDRS-17 y disminución de dos o más puntos en la CGI). El tratamiento fue menos efectivo en aquellos pacientes con depresión inicial. El topiramato fue bien tolerado y sólo un paciente abandonó debido a efectos secundarios. El efecto adverso más frecuente fueron las parestesias (n= 2). Diez pacientes experimentaron descenso moderado de peso durante el estudio. La dosis media de topiramato al final del estudio fue de 158 mg/día. Conclusiones: Estos resultados preliminares sugieren que topiramato puede ser útil en el tratamiento del trastorno bipolar, con resultados prometedores incluso en los pacientes más refractarios a otras terapéuticas (AU)

Biological characterization of a formulated allergoid from Dermatophagoides pteronyssinus.

A comparative study between the biological properties of the allergen Dermatophagoides pteronyssinus (Dp) and its formulated allergoid (DpHCHO) was performed. After immunizing rats with Dp or DpHCHO the serum level time course of IgE and IgG was determined by passive cutaneous anaphylaxis (PCA) and indirect-ELISA, respectively. The avidity for IgE (PCA and PCA-inhibition) or IgG (indirect ELISA and ELISA inhibition) and the ability to induce anaphylactic shock were also determined. Serum IgE pattern differs between Dp and DpHCHO while IgG levels were greater after DpHCHO. The allergoid has lost the ability to bind IgE while its avidity for IgG falls 5-6 times. The allergoid, but not the allergen, fails to induce anaphylactic shock. A schedule for assaying the biological characteristics of allergoids is presented.

Specific IgG and IgE responses to Dermatophagoides pteronyssinus in Sprague-Dawley rats.

Specific IgG and IgE antibodies against the mite Dermatophagoides pteronyssinus (Dp) have been determined in the serum of Sprague Dawley (SD) rats by enzyme linked immunosorbent assay (ELISA) and passive cutaneous anaphylaxis (PCA), respectively. Immunization of rats with Dp produces a rapid increase of serum specific IgE antibody levels which decrease when specific IgG antibodies start rising. The results indicate that the SD rat is a good model to induce a humoral immune response to allergen Dp.

Effect of adjuvants on IgG and IgE response to ovalbumin in rats.

Specific and total IgG and IgE serum levels were measured in Sprague-Dawley rats after immunization with ovalbumin (OA). OA was administered in an aqueous solution, suspended in alum or in Complete Freund's Adjuvant (CFA) with or without simultaneous administration of Bordetella pertussis (Bp). Control groups received only saline, alum or CFA. Specific IgG, total IgG and total IgE were determined by ELISA methods. Specific IgE was biologically evaluated. The highest specific IgG and IgE antibody responses were obtained with OA suspended in alum, while Bp failed to potentiate this response. The low specific response seen with OA suspended in CFA was potentiated when Bp was simultaneously dosed. Total IgE levels were increased in those groups receiving Bp. The contribution of specific IgG or IgE response to the total IgG or IgE levels was not distinguished with this experimental procedure. It can be concluded that immunization with OA suspended in alum induces appreciable increases in specific IgG and IgE antibodies without significantly affecting total IgG and IgE levels.

Chronic inflammation induced by type I collagen in rats.

In this study we attempt to investigate if collagen type 1 from bovine Achilles tendon is capable of causing an inflammatory response. Thus, we immunized rats with a collagen emulsion injected in the right hind paw, via subplantar, and intradermally on the back. Seven days later, the rats were reimmunized by intradermal injection on the base of the tail with an identical emulsion. The inflammatory response was assessed by measuring the hind paw swelling of the rats every seven days for two months. We also analysed the levels of anticollagen antibodies in each rat during the experimental period. An indirect microELISA method was developed to determine collagen-specific-antibodies in rat serum. We observed a chronic inflammation in 41% of immunized rats. This pathology results in local swelling in the hind paw that remained for at least two months. This model was accompanied with the production of antibodies against collagen that appeared on day 14 after induction and remained during the study period (56 days). A positive correlation between swelling and antibody titre was observed.