Hierarchical settlement behaviours of coral larvae to common coralline algae.

Natural regeneration of degraded reefs relies on the recruitment of larvae to restore populations. Intervention strategies are being developed to enhance this process through aquaculture production of coral larvae and their deployment as spat. Larval settlement relies on cues associated with crustose coralline algae (CCA) that are known to induce attachment and metamorphosis. To understand processes underpinning recruitment, we tested larval settlement responses of 15 coral species, to 15 species of CCA from the Great Barrier Reef (GBR). CCA in the family Lithophyllaceae were overall the best inducer across most coral species, with Titanoderma cf. tessellatum being the most effective species that induced at least 50% settlement in 14 of the coral species (mean 81%). Taxonomic level associations were found, with species of Porolithon inducing high settlement in the genus Acropora; while a previously understudied CCA, Sporolithon sp., was a strong inducer for the Lobophyllidae. Habitat-specific associations were detected, with CCA collected from similar light environment as the coral inducing higher levels of settlement. This study revealed the intimate relationships between coral larvae and CCA and provides optimal coral-algal species pairings that could be utilized to increase the success of larval settlement to generate healthy spat for reef restoration.

Assessing the role of historical temperature regime and algal symbionts on the heat tolerance of coral juveniles.

The rate of coral reef degradation from climate change is accelerating and, as a consequence, a number of interventions to increase coral resilience and accelerate recovery are under consideration. Acropora spathulata coral colonies that survived mass bleaching in 2016 and 2017 were sourced from a bleaching-impacted and warmer northern reef on the Great Barrier Reef (GBR). These individuals were reproductively crossed with colonies collected from a recently bleached but historically cooler central GBR reef to produce pure and crossbred offspring groups (warm-warm, warm-cool and cool-warm). We tested whether corals from the warmer reef produced more thermally tolerant hybrid and purebred offspring compared with crosses produced with colonies sourced from the cooler reef and whether different symbiont taxa affect heat tolerance. Juveniles were infected with Symbiodinium tridacnidorum, Cladocopium goreaui and Durusdinium trenchii and survival, bleaching and growth were assessed at 27.5°C and 31°C. The contribution of host genetic background and symbiont identity varied across fitness traits. Offspring with either both or one parent from the northern population exhibited a 13- to 26-fold increase in survival odds relative to all other treatments where survival probability was significantly influenced by familial cross identity at 31°C but not 27.5°C (Kaplan-Meier P=0.001 versus 0.2). If in symbiosis with D. trenchii, a warm sire and cool dam provided the best odds of juvenile survival. Bleaching was predominantly driven by Symbiodiniaceae treatment, where juveniles hosting D. trenchii bleached significantly less than the other treatments at 31°C. The greatest overall fold-benefits in growth and survival at 31°C occurred in having at least one warm dam and in symbiosis with D. trenchii Juveniles associated with D. trenchii grew the most at 31°C, but at 27.5°C, growth was fastest in juveniles associated with C. goreaui In conclusion, selective breeding with warmer GBR corals in combination with algal symbiont manipulation can assist in increasing thermal tolerance on cooler but warming reefs. Such interventions have the potential to improve coral fitness in warming oceans.This article has an associated First Person interview with the first author of the paper.

Author Correction: Some coral diseases track climate oscillations in the Caribbean.

A correction to this article has been published and is linked from the HTML and PDF versions of this paper. The error has not been fixed in the paper.

Some coral diseases track climate oscillations in the Caribbean.

Disease outbreaks continue to reduce coral populations worldwide. Understanding coral diseases and their relationships with environmental drivers is necessary to forecast disease outbreaks, and to predict future changes in coral populations. Yet, the temporal dynamics of coral diseases are rarely reported. Here we evaluate trends and periodicities in the records of three common coral diseases (white-band disease, yellow-band disease, and dark-spot syndrome) that were surveyed between 1997 and 2014 at 2082 sites throughout the Caribbean. The relationship between the periodicities of disease prevalence and El Niño Southern Oscillation (ENSO) cycles was examined using cross-wavelet analyses and convergent cross mapping (CCM). The prevalence of the diseases peaked every two to four years, and matched periodicities in ENSO conditions. CCM models suggested that environmental conditions associated with recent ENSO cycles may have influenced the patterns in disease prevalence. We also found no increasing trends in disease prevalence through time. Instead, our work suggests that the prevalence of coral diseases is dynamic and complex. The gradual increase in sea-surface temperature, a consequence of increasing greenhouse gas emissions, progressively raises the modal temperature threshold of each ENSO cycle. These dynamic cycles and the increasing modal temperatures appear to influence the dynamics of coral diseases.

Relationships between the history of thermal stress and the relative risk of diseases of Caribbean corals.

The putative increase in coral diseases in the Caribbean has led to extensive declines in coral populations. Coral diseases are a consequence of the complex interactions among the coral hosts, the pathogens, and the environment. Yet, the relative influence that each of these components has on the prevalence of coral diseases is unclear. Also unknown is the extent to which historical thermal-stress events have influenced the prevalence of contemporary coral diseases and the potential adjustment of coral populations to thermal stress. We used a Bayesian approach to test the hypothesis that in 2012 the relative risk of four signs of coral disease (white signs, dark spots, black bands, and yellow signs) differed at reef locations with different thermal histories. We undertook an extensive spatial study of coral diseases at four locations in the Caribbean region (10(3) km), two with and two without a history of frequent thermal anomalies (approximately 4-6 years) over the last 143 years (1870-2012). Locations that historically experienced frequent thermal anomalies had a significantly higher risk of corals displaying white signs, and had a lower risk of corals displaying dark spots, than locations that did not historically experience frequent thermal anomalies. By contrast, there was no relationship between the history of thermal stress and the relative risk of corals displaying black bands and yellow signs, at least at the spatial scale of our observations.

Tumour-infiltrating lymphocytes predict for outcome in HPV-positive oropharyngeal cancer.

BACKGROUND: Human papillomavirus (HPV)-positive oropharyngeal cancer (OPSCC) is associated with improved survival compared with HPV-negative disease. However, a minority of HPV-positive patients have poor prognosis. Currently, there is no generally accepted strategy for identifying these patients. METHODS: We retrospectively analysed 270 consecutively treated OPSCC patients from three centres for effects of clinical, pathological, immunological, and molecular features on disease mortality. We used Cox regression to examine associations between factors and OPSCC death, and developed a prognostic model for 3-year mortality using logistic regression analysis. RESULTS: Patients with HPV-positive tumours showed improved survival (hazard ratio (HR), 0.33 (0.21-0.53)). High levels of tumour-infiltrating lymphocytes (TILs) stratified HPV-positive patients into high-risk and low-risk groups (3-year survival; HPV-positive/TIL(high)=96%, HPV-positive/TIL(low)=59%). Survival of HPV-positive/TIL(low) patients did not differ from HPV-negative patients (HR, 1.01; P=0.98). We developed a prognostic model for HPV-positive tumours using a 'training' cohort from one centre; the combination of TIL levels, heavy smoking, and T-stage were significant (AUROC=0·87). This model was validated on patients from the other centres (detection rate 67%; false-positive rate 5.6%; AUROC=0·82). INTERPRETATION: Our data suggest that an immune response, reflected by TIL levels in the primary tumour, has an important role in the improved survival seen in most HPV-positive patients, and is relevant for the clinical evaluation of HPV-positive OPSCC.

Unusual presentation of cervical spine metastases to the ENT surgeon.

OBJECTIVE: Cervical spine metastases account for 10 per cent of all spinal metastases. We report three cases of cervical spine metastases whose unusual primary presentation was with ENT-related symptoms. METHODS: The three patients reported herein did not have a confirmed diagnosis of malignancy at presentation. The first patient presented with stridor, the second presented with dysphagia and the third presented with dysphonia. All patients complained of significant neck pain that preceded and was concomitant to the other symptoms. Clinical suspicion of cervical spine involvement led to radiological investigation with computed tomography, which showed metastatic lesions in the craniovertebral junction and cervical spine region. Histological confirmation of malignancy was obtained for two of the three patients. The condition proved uniformly fatal in the weeks following diagnosis. A review of the literature on this condition was conducted using PubMed and Medline databases. CONCLUSION: Cervical spine pathology may present initially to the ENT surgeon. A high degree of suspicion of cervical spine involvement should be maintained in elderly patients with persistent or progressive neck pain, with or without other ENT symptoms. Adequate radiological imaging will usually confirm the diagnosis.

A survey of UK dental health professionals using a medicines information service: what questions do they ask and do they get useful answers?

Dentists prescribe a limited range of medicines but it is important that they consider the effects of all medicines their patients are taking when providing dental care. In the UK, a national medicines information (UKMi) service funded by the National Health Service is available to advise health professionals on prescribing and to support evidence-based practice. This paper presents the results of a survey of 151 dental health professionals who contacted the UKMi service for advice. Enquiries most commonly involved antibiotics (32%), but dental health professionals also asked for advice on legal issues relating to medicines (10%), and on managing patients receiving bisphosphonates (9%), local anaesthetics (6%) and antiplatelet drugs (5%). One hundred and forty-six (97%) enquirers used the advice provided: for managing current patients, planning the care of future patients, for continuing professional development and teaching others. Two thirds of enquirers used the information provided to check if current or proposed management was appropriate, one half to change therapy and over one quarter to identify, manage or avoid adverse effects or drug interactions.

Hoarseness of voice in an AIDS patient: a rare presenting feature of disseminated histoplasmosis.

Laryngeal histoplasmosis is very rare among patients with HIV and very few cases have so far been documented. We report a case of laryngeal histoplasmosis in a patient with no prior AIDS defining diagnosis, which mimicked epithelial neoplasia, and was treated successfully with oral fluconazole.

A rare case of dysphagia: hypopharyngeal amyloidosis masquerading as a post-cricoid tumour.

Amyloidoses are a group of disorders in which deposition of abnormal amounts of protein complexes (amyloid) occurs in a variety of tissues. The upper aerodigestive tract may be affected, particularly the larynx, but hypopharyngeal involvement is rarely reported. We present a unique case of amyloidosis of the post-cricoid region causing dysphagia. This case report highlights the need for otolaryngologists to consider the possibility of submucosal amyloid deposition, in the absence of mucosal lesions, in patients who present with dysphagia secondary to an obstructive lesion of the post cricoid region.

The combination of epidermal growth factor and transforming growth factor-beta induces novel phenotypic changes in mouse liver stem cell lines.

Mouse liver stem cell (oval cell) lines were investigated in order to determine the role which two families of growth and differentiation factors (GDFs), epidermal growth factor (EGF) family and transforming growth factor beta (TGF-beta) family, play in liver regeneration. EGF family members, including EGF, amphiregulin, betacellulin, heparin-binding epidermal growth factor, and TGF-alpha, were mitogenic for oval cell lines while TGF-beta family members, including TGF-beta1, TGF-beta2 and TGF-beta3, inhibited mitogenesis and induced apoptosis in oval cell lines. Surprisingly, the combination of EGF family members and TGF-ss family members resulted in neither proliferation nor apoptosis but instead in a novel cellular response, cellular scattering in tissue culture and morphological differentiation in Matrigel. Analysis of the signal transduction pathways activated by exposure of oval cell lines to either EGF, EGF+TGF-beta, or TGF-beta indicated that novel combinations of intracellular signals result following stimulation of the cells with the combination of EGF+TGF-beta. These data reveal that the dynamics of synergistic GDF action following tissue injury and regeneration results in a new level of complexity not obvious from the study of individual GDFs.

Is the binding of the lectin Helix pomatia agglutinin (HPA) of prognostic relevance in tumours of the upper aerodigestive tract?

The lectin Helix pomatia agglutinin (HPA) has been used as a prognostic indicator in a number of clinical studies including those of breast, colorectal and gastric cancer. Binding of HPA to tissue sections was associated with a bad prognosis indicating that the carbohydrate residue recognized by this lectin is linked to metastasis. In order to investigate whether HPA binding is also of prognostic relevance in squamous cell carcinomas of the upper aerodigestive tract, 53 tumours of this region were stained with HPA. Almost all tumours (95%) bound HPA to various degrees and hence HPA binding is of no prognostic relevance in this group of tumours. These findings indicate a fundamental difference in the role of carbohydrate residues in metastasis between squamous cell carcinoma (as in our study) and in tumours derived from glandular tissues such as breast, colon and stomach.

A survey to determine the extent of previous symptoms and surgery on patients presenting with nasal polyps.

The aim of our study was to investigate the prevalence of surgery on the nose prior to first time diagnosis of nasal polyps. We interviewed 60 patients who presented to the ENT Department at the Royal South Hants Hospital Southampton and were diagnosed as suffering from nasal polyps for the first time. Patients who suffered from cystic fibrosis or known primary ciliary dyskinesia were excluded. The average length of time of nasal blockage as the main symptom prior to the diagnosis of nasal polyps was less than two years. Out of the 60 patients six (10 per cent) had had previous nasal surgery. Out of these six patients, only four patients had a previous procedure on the nose that could be considered to be related to the later diagnosis of nasal polyps. Only one patient had had radiological investigation of his sinuses in the past. We conclude that polypoid nasal disease is a de novo diagnosis with a relatively short history in the majority of patients and not preceded by a long history of ENT investigations nor surgery on the nose.

Adult floppy epiglottis: a simple surgical remedy.

Epiglottic prolapse during inspiration is an unusual cause of upper airway obstruction. We present a case of a previously fit, 73-year-old, male with upper airway obstruction secondary to a floppy epiglottis. We describe a simple method of treatment without the need for partial or total excision of the epiglottis or tracheostomy.