Food for all? Wildfire ash fuels growth of diverse eukaryotic plankton.

In December 2017, one of the largest wildfires in California history, the Thomas Fire, created a large smoke and ash plume that extended over the northeastern Pacific Ocean. Here, we explore the impact of Thomas Fire ash deposition on seawater chemistry and the growth and composition of natural microbial communities. Experiments conducted in coastal California waters during the Thomas Fire revealed that leaching of ash in seawater resulted in significant additions of dissolved nutrients including inorganic nitrogen (nitrate, nitrite and ammonium), silicic acid, metals (iron, nickel, cobalt and copper), organic nitrogen and organic carbon. After exposure to ash leachate at high (0.25 g ash l-1) and low (0.08 g ash l-1) concentrations for 4 days, natural microbial communities had 59-154% higher particulate organic carbon concentrations than communities without ash leachate additions. Additionally, a diverse assemblage of eukaryotic microbes (protists) responded to the ash leachate with taxa from 11 different taxonomic divisions increasing in relative abundance compared with control treatments. Our results suggest that large fire events can be important atmospheric sources of nutrients (particularly nitrogen) to coastal marine systems, where, through leaching of various nutrients, ash may act as a 'food for all' in protist communities.

Adsorptive exchange of coccolith biominerals facilitates viral infection.

Marine coccolithophores are globally distributed, unicellular phytoplankton that produce nanopatterned, calcite biominerals (coccoliths). These biominerals are synthesized internally, deposited into an extracellular coccosphere, and routinely released into the external medium, where they profoundly affect the global carbon cycle. The cellular costs and benefits of calcification remain unresolved. Here, we show observational and experimental evidence, supported by biophysical modeling, that free coccoliths are highly adsorptive biominerals that readily interact with cells to form chimeric coccospheres and with viruses to form "viroliths," which facilitate infection. Adsorption to cells is mediated by organic matter associated with the coccolith base plate and varies with biomineral morphology. Biomineral hitchhiking increases host-virus encounters by nearly an order of magnitude and can be the dominant mode of infection under stormy conditions, fundamentally altering how we view biomineral-cell-virus interactions in the environment.

Evaluation of belimumab treatment in patients with systemic lupus erythematosus in a clinical practice setting: Results from a 24-month OBSErve study in Argentina.

OBJECTIVE: To describe clinical effectiveness of belimumab for systemic lupus erythematosus (SLE) in real-world practice in Argentina. METHODS: This retrospective, observational study analysed medical record data of patients with SLE treated with belimumab in 15 centres in Argentina. Primary endpoint: overall clinical response (assessed on a scale similar to the 6-point Physician Global Assessment) at months 6, 12, 18 and 24, all versus index (belimumab initiation). Secondary endpoints: improvement in disease activity (SELENA-SLEDAI), SLE manifestations, and corticosteroid dose change. RESULTS: Records for 81 patients (91% female) were analysed. Clinical improvements were reported for 95%, 95%, 98% and 100% patients at 6, 12, 18, and 24 months post index, respectively. Mean SELENA-SLEDAI score decreased from 11.21 at index to 4.76, 3.77, 3.86 and 2.17 at 6, 12, 18, and 24 months post index, respectively. Number of flares decreased from 1.05 at index to 0.21, 0.09, 0.22 and 0.30 at 6, 12, 18, and 24 months post index, respectively. Mean corticosteroid dose was 14.59 mg/day at index, and 6.45, 5.18, 5.17 and 4.78 mg/day at 6, 12, 18, and 24 months post index, respectively. CONCLUSIONS: Real-world patients with SLE treated with belimumab in Argentina demonstrated clinical improvements and reductions in corticosteroid dose.

Molecular and biochemical basis for the loss of bioluminescence in the dinoflagellate Noctiluca scintillans along the west coast of the USA.

The globally distributed heterotrophic dinoflagellate Noctiluca scintillans (Macartney) Kofoid & Swezy is well known for its dense blooms and prominent displays of bioluminescence. Intriguingly, along the west coast of the USA its blooms are not bioluminescent. We investigated the basis for the regional loss of bioluminescence using molecular, cellular and biochemical analyses of isolates from different geographic regions. Prominent differences of the non-bioluminescent strains were: (1) the fused luciferase and luciferin binding protein gene (lcf/lbp) was present but its transcripts were undetectable; (2) lcf/lbp contained multiple potentially deleterious mutations; (3) the substrate luciferin was absent, based on the lack of luciferin blue autofluorescence and the absence of luciferin derived metabolites; (4) although the cells possessed scintillons, the vesicles that contain the luminescent chemistry, electron microscopy revealed additional scintillon-like vesicles with an atypical internal structure; (5) cells isolated from the California coast were 43% smaller in size than bioluminescent cells from the Gulf of Mexico. Phylogenetic analyses based on the large subunit of rDNA did not show divergence of the non-bioluminescent population in relation to other bioluminescent N. scintillans from the Pacific Ocean and Arabian Sea. Our study demonstrates that gene silencing and the lack of the luciferin substrate have resulted in the loss of a significant dinoflagellate functional trait over large spatial scales in the ocean. As the bioluminescence system of dinoflagellates is well characterized, non-bioluminescent N. scintillans is an ideal model to explore the evolutionary and ecological mechanisms that lead to intraspecific functional divergence in natural dinoflagellate populations.

Intraspecific Differences in Biogeochemical Responses to Thermal Change in the Coccolithophore Emiliania huxleyi.

The species concept in marine phytoplankton is defined based on genomic, morphological, and functional properties. Reports of intraspecific diversity are widespread across major phytoplankton groups but the impacts of this variation on ecological and biogeochemical processes are often overlooked. Intraspecific diversity is well known within coccolithophores, which play an important role in the marine carbon cycle via production of particulate inorganic carbon. In this study, we investigated strain-specific responses to temperature in terms of morphology, carbon production, and carbonate mineralogy using a combination of microscopy, elemental analysis, flow cytometry, and nuclear magnetic resonance. Two strains of the cosmopolitan coccolithophore E. huxleyi isolated from different regions (subtropical, CCMP371; temperate, CCMP3266) were cultured under a range of temperature conditions (10°C, 15°C, and 20°C) using batch cultures and sampled during both exponential and stationary growth. Results for both strains showed that growth rates decreased at lower temperatures while coccosphere size increased. Between 15°C and 20°C, both strains produced similar amounts of total carbon, but differed in allocation of that carbon between particulate inorganic carbon (PIC) and particulate organic carbon (POC), though temperature effects were not detected. Between 10°C and 20°C, temperature effects on daily production of PIC and POC, as well as the cellular quota of POC were detected in CCMP3266. Strain-specific differences in coccolith shedding rates were found during exponential growth. In addition, daily shedding rates were negatively related to temperature in CCMP371 but not in CCMP3266. Despite differences in rates of particulate inorganic carbon production, both strains were found to produce coccoliths composed entirely of pure calcite, as established by solid-state 13C and 43Ca NMR and X-ray diffraction measurements. These results highlight the limitations of the species concept and the need for a trait-based system to better quantify diversity within marine phytoplankton communities.

Molecular detection of bioluminescent dinoflagellates in surface waters of the Patagonian shelf during early austral 2008.

We investigated the distribution of bioluminescent dinoflagellates in the Patagonian Shelf region using "universal" PCR primers for the dinoflagellate luciferase gene. Luciferase gene sequences and single cell PCR tests, in conjunction with taxonomic identification by microscopy, allowed us to identify and quantify bioluminescent dinoflagellates. We compared these data to coincidental discrete optical measurements of stimulable bioluminescence intensity. Molecular detection of the luciferase gene showed that bioluminescent dinoflagellates were widespread across the majority of the Patagonian Shelf region. Their presence was comparatively underestimated by optical bioluminescence measurements, whose magnitude was affected by interspecific differences in bioluminescence intensity and by the presence of other bioluminescent organisms. Molecular and microscopy data showed that the complex hydrography of the area played an important role in determining the distribution and composition of dinoflagellate populations. Dinoflagellates were absent south of the Falkland Islands where the cold, nutrient-rich, and well-mixed waters of the Falklands Current favoured diatoms instead. Diverse populations of dinoflagellates were present in the warmer, more stratified waters of the Patagonian Shelf and Falklands Current as it warmed northwards. Here, the dinoflagellate population composition could be related to distinct water masses. Our results provide new insight into the prevalence of bioluminescent dinoflagellates in Patagonian Shelf waters and demonstrate that a molecular approach to the detection of bioluminescent dinoflagellates in natural waters is a promising tool for ecological studies of these organisms.

The effect of nitrate and phosphate availability on Emiliania huxleyi (NZEH) physiology under different CO2 scenarios.

Growth and calcification of the marine coccolithophorid Emiliania huxleyi is affected by ocean acidification and macronutrients limitation and its response varies between strains. Here we investigated the physiological performance of a highly calcified E. huxleyi strain, NZEH, in a multiparametric experiment. Cells were exposed to different CO2 levels (ranging from 250 to 1314 µatm) under three nutrient conditions [nutrient replete (R), nitrate limited (-N), and phosphate limited (-P)]. We focused on calcite and organic carbon quotas and on nitrate and phosphate utilization by analyzing the activity of nitrate reductase (NRase) and alkaline phosphatase (APase), respectively. Particulate inorganic (PIC) and organic (POC) carbon quotas increased with increasing CO2 under R conditions but a different pattern was observed under nutrient limitation. The PIC:POC ratio decreased with increasing CO2 in nutrient limited cultures. Coccolith length increased with CO2 under all nutrient conditions but the coccosphere volume varied depending on the nutrient treatment. Maximum APase activity was found at 561 µatm of CO2 (pH 7.92) in -P cultures and in R conditions, NRase activity increased linearly with CO2. These results suggest that E. huxleyi's competitive ability for nutrient uptake might be altered in future high-CO2 oceans. The combined dataset will be useful in model parameterizations of the carbon cycle and ocean acidification.

Responses of the Emiliania huxleyi proteome to ocean acidification.

Ocean acidification due to rising atmospheric CO2 is expected to affect the physiology of important calcifying marine organisms, but the nature and magnitude of change is yet to be established. In coccolithophores, different species and strains display varying calcification responses to ocean acidification, but the underlying biochemical properties remain unknown. We employed an approach combining tandem mass-spectrometry with isobaric tagging (iTRAQ) and multiple database searching to identify proteins that were differentially expressed in cells of the marine coccolithophore species Emiliania huxleyi (strain NZEH) between two CO2 conditions: 395 (∼current day) and ∼1340 p.p.m.v. CO2. Cells exposed to the higher CO2 condition contained more cellular particulate inorganic carbon (CaCO3) and particulate organic nitrogen and carbon than those maintained in present-day conditions. These results are linked with the observation that cells grew slower under elevated CO2, indicating cell cycle disruption. Under high CO2 conditions, coccospheres were larger and cells possessed bigger coccoliths that did not show any signs of malformation compared to those from cells grown under present-day CO2 levels. No differences in calcification rate, particulate organic carbon production or cellular organic carbon: nitrogen ratios were observed. Results were not related to nutrient limitation or acclimation status of cells. At least 46 homologous protein groups from a variety of functional processes were quantified in these experiments, of which four (histones H2A, H3, H4 and a chloroplastic 30S ribosomal protein S7) showed down-regulation in all replicates exposed to high CO2, perhaps reflecting the decrease in growth rate. We present evidence of cellular stress responses but proteins associated with many key metabolic processes remained unaltered. Our results therefore suggest that this E. huxleyi strain possesses some acclimation mechanisms to tolerate future CO2 scenarios, although the observed decline in growth rate may be an overriding factor affecting the success of this ecotype in future oceans.

DISTRIBUTION AND GENETIC DIVERSITY OF THE LUCIFERASE GENE WITHIN MARINE DINOFLAGELLATES(1).

Dinoflagellates are the most abundant protists that produce bioluminescence. Currently, there is an incomplete knowledge of the identity of bioluminescent species arising from inter- and intraspecific variability in bioluminescence properties. In this study, PCR primers were designed to amplify the dinoflagellate luciferase gene (lcf) from genetically distant bioluminescent species. One of the primer pairs was "universal," whereas others amplified longer gene sequences from subsets of taxa. The primers were used to study the distribution of lcf and assess bioluminescence potential in dinoflagellate strains representing a wide variety of taxa as well as multiple strains of selected species. Strains of normally bioluminescent species always contained lcf even when they were found not to produce light, thus demonstrating the utility of this methodology as a powerful tool for identifying bioluminescent species. Bioluminescence and lcf were confined to the Gonyaulacales, Noctilucales, and Peridiniales. Considerable variation was observed among genera, or even species within some genera, that contained this gene. Partial sequences of lcf were obtained for the genera Ceratocorys, Ceratium, Fragilidium, and Protoperidinium as well as from previously untested species or gene regions of Alexandrium and Gonyaulax. The sequences revealed high variation among gene copies that obscured the boundaries between species or even genera, some of which could be explained by the presence of two genetic variants within the same species of Alexandrium. Highly divergent sequences within Alexandrium and Ceratium show a more diverse composition of lcf than previously known.

Shotgun proteomic analysis of Emiliania huxleyi, a marine phytoplankton species of major biogeochemical importance.

Emiliania huxleyi is a unicellular marine phytoplankton species known to play a significant role in global biogeochemistry. Through the dual roles of photosynthesis and production of calcium carbonate (calcification), carbon is transferred from the atmosphere to ocean sediments. Almost nothing is known about the molecular mechanisms that control calcification, a process that is tightly regulated within the cell. To initiate proteomic studies on this important and phylogenetically remote organism, we have devised efficient protein extraction protocols and developed a bioinformatics pipeline that allows the statistically robust assignment of proteins from MS/MS data using preexisting EST sequences. The bioinformatics tool, termed BUDAPEST (Bioinformatics Utility for Data Analysis of Proteomics using ESTs), is fully automated and was used to search against data generated from three strains. BUDAPEST increased the number of identifications over standard protein database searches from 37 to 99 proteins when data were amalgamated. Proteins involved in diverse cellular processes were uncovered. For example, experimental evidence was obtained for a novel type I polyketide synthase and for various photosystem components. The proteomic and bioinformatic approaches developed in this study are of wider applicability, particularly to the oceanographic community where genomic sequence data for species of interest are currently scarce.

Ocean fertilization: a potential means of geoengineering?

The oceans sequester carbon from the atmosphere partly as a result of biological productivity. Over much of the ocean surface, this productivity is limited by essential nutrients and we discuss whether it is likely that sequestration can be enhanced by supplying limiting nutrients. Various methods of supply have been suggested and we discuss the efficacy of each and the potential side effects that may develop as a result. Our conclusion is that these methods have the potential to enhance sequestration but that the current level of knowledge from the observations and modelling carried out to date does not provide a sound foundation on which to make clear predictions or recommendations. For ocean fertilization to become a viable option to sequester CO2, we need more extensive and targeted fieldwork and better mathematical models of ocean biogeochemical processes. Models are needed both to interpret field observations and to make reliable predictions about the side effects of large-scale fertilization. They would also be an essential tool with which to verify that sequestration has effectively taken place. There is considerable urgency to address climate change mitigation and this demands that new fieldwork plans are developed rapidly. In contrast to previous experiments, these must focus on the specific objective which is to assess the possibilities of CO2 sequestration through fertilization.

Phytoplankton calcification in a high-CO2 world.

Ocean acidification in response to rising atmospheric CO2 partial pressures is widely expected to reduce calcification by marine organisms. From the mid-Mesozoic, coccolithophores have been major calcium carbonate producers in the world's oceans, today accounting for about a third of the total marine CaCO3 production. Here, we present laboratory evidence that calcification and net primary production in the coccolithophore species Emiliania huxleyi are significantly increased by high CO2 partial pressures. Field evidence from the deep ocean is consistent with these laboratory conclusions, indicating that over the past 220 years there has been a 40% increase in average coccolith mass. Our findings show that coccolithophores are already responding and will probably continue to respond to rising atmospheric CO2 partial pressures, which has important implications for biogeochemical modeling of future oceans and climate.

MICROSATELLITE GENOTYPING OF SINGLE CELLS OF THE DINOFLAGELLATE SPECIES LINGULODINIUM POLYEDRUM (DINOPHYCEAE): A NOVEL APPROACH FOR MARINE MICROBIAL POPULATION GENETIC STUDIES(1).

In recent years, two new approaches have been introduced in genetic studies of phytoplankton species. One is the application of highly polymorphic microsatellite markers, which allow detailed population genetic studies; the other is the development of methods that enable the direct genetic characterization of single cells as an alternative to clonal cultures. The aim of this study was to combine these two approaches in a method that would allow microsatellite genotyping of single phytoplankton cells, providing a novel tool for high-resolution population genetic studies. The dinoflagellate species Lingulodinium polyedrum (F. Stein) J. D. Dodge was selected as a model organism to develop this novel approach. The method we describe here is based on several key developments: (i) a simple and efficient DNA extraction method for single cells, (ii) the characterization of microsatellite markers for L. polyedrum, (iii) a protocol for the species identification of single cells through the analysis of partial rRNA gene sequences, and (iv) a two-step multiplex PCR protocol for the simultaneous amplification of microsatellite markers and partial rRNA gene sequences from single cells. Our protocol allowed the amplification of up to six microsatellite loci together with either the complete ITS1-5.8S-ITS2 region or a partial 18S region of the ribosomal gene of L. polyedrum from single motile cells and resting cysts. This article describes and evaluates the developed approach and discusses its significance for population genetic studies of L. polyedrum and other phytoplankton species.

Microsatellite cross-amplification in coccolithophores: application in population diversity studies.

The development and isolation of microsatellites entails a significant input of time and money. Therefore there is an interest in using existing microsatellites on species from which markers have not yet been developed. Conservation of six previously identified microsatellite loci in the marine coccolithophorid species Emiliana huxleyi was found in a survey of two bloom forming coccolithophorid species--Gephyrocapsa oceanica and Coccolithus pelagicus. The number of alleles per locus varied from 1 to 8, and half of the microsatellite loci tested showed 4 or more alleles. The microsatellite markers used in this study may be applied to other coccolithophorid species for population analysis, eliminating the time-consuming, costly development of microsatellite markers for other coccolithophorid species.

[Patients over-using a primary care centre: their social, demographic and clinical characteristics, and their use of health service facilities]. / Pacientes hiperfrecuentadores de un centro de atención primaria: características sociodemográficas, clínicas y de utilización de los servicios sanitarios.

OBJECTIVES: To find the social and clinical characteristics of patients over-using (OUP) our centre. To find how much these patients use the health services. DESIGN: Observational, descriptive study. SETTING: Urban primary care centre (36 408 inhabitants). PARTICIPANTS: Patients over 15 seen at the centre during the year 2000, who exceeded in their number of attendances the mean plus two standard deviations for their age group. MAIN MEASUREMENTS: The records of OUPS were reviewed to analyse their social and demographic characteristics, kinds of attendance, reasons for consultation, further tests, medication, referrals, and time off work this year. RESULTS: The sample was of 954 OUPs, 50.9% of whom were male with an average age of 50.54 (SD, 19.68). 86.3% had some risk factor recorded (34% hypertension, 32.4% mental health, 27.7% obesity, 25.7% tobacco dependency, 17.7% diabetes mellitus). They generated a mean of 9.6 visits to the doctor per year, with 95% CI (8.09-11.19), with the most common reason for attendance the monitoring of acute pathology (19.29%), followed by monitoring of chronic pathology (14.32%). There was an average of 1 analysis per OUP per year, and 0.68 image tests per OUP per year (48.38% were simple x-rays). 46.8% of the medication prescribed were analgesics. Average time off work was 0.5 periods off per OUP per year, with a mean period of 49.4 days off (SD, 113.69). They engendered an average of 4.15 nursing visits per OUP per year, 95% CI (2.60-5.70), with monitoring of chronic pathology the most common reason for consultation. 30.3% of OUP had a visit to hospital casualty recorded, with osteo-muscular pathology the most common reason for consultation (34.29%). Mean referrals were 0.88 OUP per year, with traumatology being the department to which most referrals were made (13.92%). CONCLUSIONS: OUP are middle-aged, have associated chronic pathology and use programmed appointments a lot. The additional tests conducted matched the centre's procedures for monitoring chronic pathologies. The most common reason for attendance at casualty was traumatology, as was the specialist clinic to which most referrals were made.

Hiperfosfatasia. ¿Una displasia ósea o una verdadera enfermedad metabólica ósea? A propósito de un caso / Hyperphosphatasia. Bone dysplasia or a renal bone metabolic disease?

En este artículo presentamos el caso de una niña de 4 años de edad con hiperfosfatasia, una enfermedad caracterizada por elevación de la fosfatasa alcalina por un defecto enzimático, con alteraciones en la formación de hueso membranoso dando lugar a macrohuesos en el cráneo, huesos largos, costilla y columna. La paciente que se revisa presentaba además una hipercalcemia, hallazgo para el cual no encontraron una explicación clara, pero que sin embargo, constituye una asociación que no ha sido descrita en la literatura. Presentamos finalmente una revisión de los casos de hiperfosfatasia informados hasta ahora en la literatura y planteamos la necesidad de clasificar mejor las enfermedades óseas e incluirla como una enfermedad metabólica ósea y no una displasia (AU)

[Analysis of indications and diagnosis of the gastroscopies requested by primary care physicians]. / Análisis de las indicaciones y diagnósticos de las gastroscopias solicitadas por médicos de atención primaria.

OBJECTIVES: To analyse the pathology diagnosed on the basis of the gastroscopies requested from a primary care centre (PCC). Assessment and treatment of Helicobacter pylori (HP) infection. DESIGN: Retrospective and descriptive. SETTING: Urban PCC. PATIENTS: Those over 14 who had a gastroscopy for a diagnostic purpose, requested by their primary care doctor during 1997. MEASUREMENTS: Review of clinical records and gastroscopy reports analysing: personal data, reasons for request, prior treatment, diagnoses, treatment to eradicate HP, later referral to the digestion specialist and waiting-time for the gastroscopy. RESULTS: 206 gastroscopies were performed, 139 for epigastralgia (67%) and 73 for heartburn (35%). 161 patients (78%) had had previous treatment, with alkalines used in 94 cases (45%). The most common diagnoses were: 54 normal (26%), 60 hiatus hernias (30%), 43 oesophagitis (21%), 18 duodenal ulcers (9%) and 4 gastric ulcers (2%). The Helicobacter pylori study was positive in 67 cases, with triple treatment (amoxycillin, clarithromycin and omeprazole) to eradicate it given for 7 days in 36 cases (54%). Referral to the specialist of 3% of the patients. Waiting-time for the performance of the gastroscopy: 60 days (SD: 35). CONCLUSIONS: Gastroscopy is a diagnostic method habitually used in our PCC. The pathology diagnosed is mainly treated in primary care. Given the current controversy about actions at determined clinical entities, standardisation of criteria used by professionals at different care levels is very important. This standardisation should affect the indications of the examinations, and the treatment and follow-up of the pathologies. The reduction in waiting-time for a gastroscopy could possibly modify the prescription and duration of the prior treatment.

Análisis de las indicaciones y diagnósticos de las gastroscopias solicitadas por médicos de atención primaria / Analysis of the indications and diagnoses of the gastroscopies requested by primary care doctors

Objetivo. Analizar la patología diagnosticada a partir de las gastroscopias (GC) solicitadas desde un centro de atención primaria (CAP). Valoración y tratamiento de la infección por Helicobacter pylori (HP). Diseño. Descriptivo, retrospectivo. Emplazamiento. CAP urbano. Pacientes. Mayores de 14 años a quienes se realizó una GC con finalidad diagnóstica, solicitada por su médico de atención primaria (AP), durante 1997. Mediciones. Revisión de historias clínicas y de informes de las GC analizando: datos de filiación, motivo de solicitud, tratamiento previo, diagnósticos, tratamiento erradicador de HP, derivación posterior al digestólogo y tiempo de espera para la realización de la GC. Resultados. Realización de 206 GC principalmente por epigastralgia en 139 pacientes (67 por ciento) y pirosis en 73 (35 por ciento). Tratamiento previo en 161 pacientes (78 por ciento) utilizándose los alcalinos en 94 casos (45 por ciento). Diagnósticos más frecuentes: 54 normales (26 por ciento), 60 hernias de hiato (30 por ciento), 43 esofagitis (21 por ciento), 18 úlceras duodenales (9 por ciento) y 4 gástricas (2 por ciento). Estudio de HP positivo en 67 casos, realizándose tratamiento erradicador triple (amoxicilina, claritromicina y omeprazol) durante 7 días en 36 de ellos (54 por ciento). Derivación al especialista del 3 por ciento de los pacientes. Tiempo de espera para la realización de la GC: 60 días (DE, 35). Conclusiones. La GC es un método diagnóstico de uso habitual en nuestro CAP y la patología diagnosticada es asumida mayoritariamente desde el ámbito de la AP. Dada la controversia existente de actuación en determinadas entidades clínicas, es muy importante la estandarización de criterios de los profesionales de los distintos niveles asistenciales en las indicaciones de las exploraciones, así como en el tratamiento y seguimiento de las patologías. La reducción de la espera para la realización de la GC posiblemente podría modificar la prescripción y duración del tratamiento previo (AU)

[Ischemic colitis associated with antithrombin deficiency]. / Colitis isquémica asociada a déficit de antitrombina III.

Colonic ischemia is one of the more common disorders of the colon in elderly people; the ischemic colitis can affect young people too. The splenic flexure, the descending colon and the sigmoid are the parts most commonly involved. Only in some cases it is possible to identify the specific cause of colonic ischemia. We report a case of ischemic colitis associated with antithrombin III deficiency.