Morphological Diversity of Turtle Hyoid Apparatus is Linked to Feeding Behavior.

The hyoid apparatus of tetrapods is highly diverse in its morphology. It plays an important role in feeding, breathing, sound production, and various other behaviors. Among turtles, the diversity of the hyoid apparatus has been recurrently linked to their habitat. The ossification of the hyoid corpus is often the main trait used in correlations with "niche" occupancy, an ossified corpus being associated with aquatic environments and a cartilaginous corpus with terrestrial life. Most studies conducted so far have focused on species belonging to Testudinoidea, the clade that occupies the biggest diversity of habitats (i.e., terrestrial, semi-terrestrial, and aquatic animals), while other turtle lineages have been largely understudied. We assessed the adult anatomy of the hyoid apparatus of 92 turtle species from all "families", together with ossification sequences from embryological series of 11 species, some described for the first time here. Using nearly 40 different discrete anatomical characters, we discuss the evolutionary patterns and the biological significance of morphological transformations in the turtle hyoid elements. Morphological changes are strongly associated to feeding modes, with several instances of convergent evolution within and outside the Testudines clade, and are not as strongly connected to habitat as previously thought. Some of the hyoid character states we describe are diagnostic of specific turtle clades, thus providing phylogenetically relevant information.

El aparato hyoideo de los tetrápodos es muy diverso en su morfología. El mismo desempeña un papel importante en la alimentación, la respiración, la producción de sonidos y otras funciones. En las tortugas, la diversidad del aparato hyoideo se ha relacionado con el hábitat. La osificación del cuerpo hyoideo es a menudo el rasgo principal utilizado en correlaciones con la ocupación de "nichos"; un cuerpo osificado se asocia con ambientes acuáticos y un cuerpo cartilaginoso con la vida terrestre. La mayoría de los estudios realizados se han centrado en especies pertenecientes a Testudinoidea, el clado que ocupa la mayor diversidad de hábitats (terrestre, semiterrestre y acuático), mientras que otros linajes de tortugas han sido poco estudiados. Evaluamos la anatomía adulta del aparato hyoideo de 92 especies de tortugas de todas las "familias", junto con secuencias de osificación de series embriológicas de once especies, algunas descritas por primera vez aquí. Utilizando casi 40 caracteres anatómicos discretos diferentes, discutimos los patrones evolutivos y el significado biológico de lastransformaciones morfológicas en los elementos hyoideos de las tortugas. Los cambios morfológicos están asociados con los modos de alimentación, con varios casos de convergencia dentro y fuera del clado Testudines; la asociación con el hábitat no es tan robusta como se ha hipotetizado. Algunos de los estados de caracteres que describimos son diagnósticos de clados de tortugas específicos, proporcionando así información filogenéticamente relevante.

Paediatric European Network for Treatment of AIDS (PENTA) guidelines for treatment of paediatric HIV-1 infection 2015: optimizing health in preparation for adult life.

The 2015 Paediatric European Network for Treatment of AIDS (PENTA) guidelines provide practical recommendations on the management of HIV-1 infection in children in Europe and are an update to those published in 2009. Aims of treatment have progressed significantly over the last decade, moving far beyond limitation of short-term morbidity and mortality to optimizing health status for adult life and minimizing the impact of chronic HIV infection on immune system development and health in general. Additionally, there is a greater need for increased awareness and minimization of long-term drug toxicity. The main updates to the previous guidelines include: an increase in the number of indications for antiretroviral therapy (ART) at all ages (higher CD4 thresholds for consideration of ART initiation and additional clinical indications), revised guidance on first- and second-line ART recommendations, including more recently available drug classes, expanded guidance on management of coinfections (including tuberculosis, hepatitis B and hepatitis C) and additional emphasis on the needs of adolescents as they approach transition to adult services. There is a new section on the current ART 'pipeline' of drug development, a comprehensive summary table of currently recommended ART with dosing recommendations. Differences between PENTA and current US and World Health Organization guidelines are highlighted and explained.

Removal of valproic acid by plasmapheresis in a patient treated for multiple sclerosis.

We present a case of a patient with multiple sclerosis who was treated with plasmapheresis and valproic acid. We used therapeutic drug monitoring to determine whether plasma concentrations of valproic acid were kept within the therapeutic window and to determine the amount of valproic acid that was removed by plasmapheresis.

Neonatal anemia and hydrops fetalis after maternal mycophenolate mofetil use.

After admitting a patient to our Neonatal Intensive Care with a severe anemia and an ear malformation, we ruled out any other cause than maternal medication use. Knowing she used mycophenolate mofetil during pregnancy, we looked for related articles. Two articles were found describing ear malformations, but no article was ever written about anemia caused by this medication. Consulting the international registers of drug effects through the National Institute for Public Health and the Environment, we found out that the anemia was never seen or reported before.