As and S speciation in a submarine sulfide mine tailings deposit and its environmental significance: The study case of Portmán Bay (SE Spain).

The dumping of an estimated amount of 57 million tons of hazardous sulfide mine waste from 1957 to 1990 into Portmán's Bay (SE Spain) caused one of the most severe cases of persistent anthropogenic impact in Europe's costal and marine environments. The resulting mine tailings deposit completely infilled Portmán's Bay and extended seawards on the continental shelf, bearing high levels of metals and As. The present work, where Synchrotron XAS, XRF core scanner and other data are combined, reveals the simultaneous presence of arsenopyrite (FeAsS), scorodite (FeAsO4·2H2O), orpiment (As2S3) and realgar (AsS) in the submarine extension of the mine tailings deposit. In addition to arsenopyrite weathering and scorodite formation, the, the presence of realgar and orpiment is discussed, considering both potential sourcing from the exploited ores and in situ precipitation from a combination of inorganic and biologically mediated geochemical processes. Whereas the formation of scorodite relates to the oxidation of arsenopyrite, we hypothesize that the presence of orpiment and realgar is associated to scorodite dissolution and subsequent precipitation of these two minerals within the mine tailings deposit under moderately reducing conditions. The occurrence of organic debris and reduced organic sulfur compounds evidences the activity of sulfate-reducing bacteria (SRB) and provides a plausible explanation to the reactions leading to the formation of authigenic realgar and orpiment. The precipitation of these two minerals in the mine tailings, according to our hypothesis, has important consequences for As mobility since this process would reduce the release of As into the surrounding environment. Our work provides for the first time valuable hints on As speciation in a massive submarine sulfide mine tailings deposit, which is highly relevant for similar situations worldwide.

Rivaroxaban para el tratamiento de la trombocitopenia inducida por heparina: caso clínico / Treatment of heparin-induced thrombocytopenia with rivaroxaban: case report

Heparin-induced thrombocytopenia (HIT) is immune-mediated. It occurs more frequently with unfractionated heparin (UFH) than with low molecular weight heparins (LMWH). It is associated with thromboembolic rather than hemorrhagic events, as opposed to thrombocytopenia of other etiologies. The key in therapy is the cessation of heparin and the start of another anticoagulant. We report a 58 years old female with HIT secondary to the use of Enoxaparin who was successfully managed with Rivaroxaban. Our goal is to report a novel therapy and provide the evidence that supports its use.

[Treatment of heparin-induced thrombocytopenia with rivaroxaban. Case report]. / Rivaroxaban para el tratamiento de la trombocitopenia inducida por heparina. Caso clínico.

Heparin-induced thrombocytopenia (HIT) is immune-mediated. It occurs more frequently with unfractionated heparin (UFH) than with low molecular weight heparins (LMWH). It is associated with thromboembolic rather than hemorrhagic events, as opposed to thrombocytopenia of other etiologies. The key in therapy is the cessation of heparin and the start of another anticoagulant. We report a 58 years old female with HIT secondary to the use of Enoxaparin who was successfully managed with Rivaroxaban. Our goal is to report a novel therapy and provide the evidence that supports its use.

Hernia de Amyand, reporte de un caso / Amyand's hernia, a case report

Introducción: La hernia de Amyand es la presencia del apéndice cecal en el interior de una hernia inguinal, observándose en el 0,5-1% del total de hernioplastías en los adultos. Presentación del caso: Mujer de 81 años ingresó al servicio de urgencias por dolor en fosa iliaca derecha de una semana de evolución, de intensidad progresiva, asociado a aumento de volumen inguinal derecho, redondo de 10 centímetros de diámetro, sensible a la palpación, no reductible y sin signos de irritación peritoneal. Se decidió realizar intervención quirúrgica por sospecha de hernia inguinal derecha complicada, evidenciándose contenido purulento entre asas intestinales, el cual se drenó, descubriéndose el apéndice cecal en el interior del saco herniario, de aspecto necrótico y perforado, procediéndose a realizar apendicectomía más hernioplastia. La paciente evoluciona en el postoperatorio con cuadro bronquial obstructivo, el cual se trató con antibioticoterapia, respondiendo favorablemente, otorgándose el alta 13 días después de la cirugía. Discusión: El 6,7% de las causas de abdomen agudo en adultos mayores se deben a cuadros apendiculares, mientras que un 13,3% se deben a hernias complicadas. Sin embargo es extremadamente infrecuente encontrar el apéndice cecal inflamado intraherniano, lo que ocurre aproximadamente en el 0,1% de todas las apendicectomías. El cuadro clínico consiste en síntomas inespecíficos con confirmación usualmente intraoperatoria. Se ha descrito el diagnóstico pre-quirúrgico imagenologico con tomografía computarizada (TC). El tratamiento consiste en dos procedimientos: apendicectomía con aseo de la cavidad y la reparación del defecto herniario.

Introduction: Amyand's hernia is the presence of cecal appendix within an inguinal hernia, observed in 0.5-1% of total hernioplasties in adults. Case Report: 81 year old woman admitted to the emergency room for pain in the right iliac fossa, one week of evolution, progressive in intensity associated with an increase in right round inguinal volume, 10 centimeters (cm) in diameter, sensitive to palpation, non reducible without signs Peritoneal irritation. It was decided to undergo surgery for suspicion of complicated right inguinal hernia, showing purulent contents between the intestinal loops, which managed to drain, discovering the cecal appendix in the sack of necrotic and perforated inguinal hernia, proceeding to the subsequent appendectomy of hernioplasty. Postoperatively, the patient developed bronchial obstruction, which was treated with antibiotics, responding favorably, granting discharge 13 days after surgery. Discussion: 6.7% of the causes of acute abdominal pain in older adults are due to appendiceal pictures, while 13.3% are due to complicated hernias. However it is extremely rare to find the intraherniano inflamed cecal appendix, which occurs in approximately 0.1% of all appendectomies. The clinical picture is nonspecific symptoms usually intraoperative confirmation. It described the pre-surgical diagnosis imaging with computed tomography (CT). Treatment consists of two procedures: appendectomy with toilet cavity and repair of the hernia defect

[Subdural empyema secondary to sinusitis. A pediatric case report]. / Empiema subdural secundario a sinusitis. Descripción de un caso pediátrico.

We present the case of 9 year old male referred to the A and E service with right ocular proptosis and progressive migraine in the context of a sinusitis diagnosed two days earlier by compatible clinical and radiological tests, and receiving treatment with amoxicillin-clavulanic acid. Physcial exploration revealed right ocular proptosis with a slight limitation for conjugate gaze. Facing the suspicion of a possible neurological complication of the sinusitis, cranial computer aided tomography (CAT) was carried out, with right frontal subdural empyema observed. He was admitted for intravenous antibiotic treatment with cefotaxime, vancomicin and metronidazole. He was evaluated by child Neurosurgery, Maxillofacial Surgery and Otorhinolaryngology (ORL) services; the decision was taken to only drain the primary focus, while an expectant neurosurgical attitude was maintained. The patient evolved favourably with a progressive disappearance of the symptoms. Periodical magnetic resonances were carried out, which showed a clear improvement up until the complete resolution of the empyema. Following four weeks of antibiotherapy iv., and after clinical and radiological normalization, the patient was discharged.

Resonance, criticality, and emergence in city traffic investigated in cellular automaton models.

The complex behavior that occurs when traffic lights are synchronized is studied for a row of interacting cars. The system is modeled through a cellular automaton. Two strategies are considered: all lights in phase and a "green wave" with a propagating green signal. It is found that the mean velocity near the resonant condition follows a critical scaling law. For the green wave, it is shown that the mean velocity scaling law holds even for random separation between traffic lights and is not dependent on the density. This independence on car density is broken when random perturbations are considered in the car velocity. Random velocity perturbations also have the effect of leading the system to an emergent state, where cars move in clusters, but with an average velocity which is independent of traffic light switching for large injection rates.

Intestinal parasitism in Peruvian children and molecular characterization of Cryptosporidium species.

Intestinal parasitism was studied in children of Trujillo (Peru) to create a prevention and control program. Fecal samples of 489 children were examined. The general prevalence of intestinal parasitosis was found to be 68%. The most frequent pathogenic enteroparasites were Giardia lamblia (26.4%), Cyclospora cayetanensis (13%), Hymenolepis nana (2%), Hymenolepis diminuta (1.6%), and Cryptosporidium spp. (1%). All these parasites appeared both in diarrheic and nondiarrheic children, except Cryptosporidium, which invariably caused diarrhea. Multiple parasitism was frequent, 45.6% of the children presenting two, three, or four intestinal parasites. Cryptosporidium was the only parasite that was not associated with the others. Only five children were affected of cryptosporidiosis, presenting explosive diarrhea, nausea, and vomiting. Cryptosporidium species and genotypes involved in the infantile cryptosporidiosis were determined by polymerase chain reaction-restriction fragment length polymorphism. Four children were parasitized by Cryptosporidium hominis and only one by Cryptosporidium parvum. Our results confirm that anthroponotic transmission of Cryptosporidium is predominant in Peru.

[Nonpenetrating deep trabeculectomy treated with mitomycin C, without implant. A prospective evaluation of 55 cases]. / Trabéculo-sclérectomie non perforante avec mitomycine C, sans implant. Evaluation prospective sur 55 cas.

PURPOSE: Since 1998 we have been conducting a prospective study of nonpenetrating deep trabeculectomy with chronic open-angle glaucoma to evaluate the efficiency of the technique. MATERIAL AND METHODS: The study was carried out in 55 eyes of 41 patients who suffered from open-angle glaucoma. After performing a superior scleral flap, mitomycin diluted to 0.01% was applied for 3 minutes, then the 4 x 4-mm superficial scleral flap was dissected at two-thirds deepness until reaching the cornea. The Schlemm canal and the external trabecula were surgically removed and the two points of the Schlemm canal were catheterized with a trabeculotome to ensure that the ablation was well done. If it was not, it was completed by using a trabeculotome as a guide. Postoperatively, if the filtering bleb tended to decrease or ocular pressure began to increase, the operated trabecular region was reopened with Yag laser. The filtering bleb characteristics were correlated with the normalization of intraocular pressure in the first 30 cases. RESULTS: Preoperative pressure without treatment was 32 mmHg. Postoperative intraocular pressure without treatment was 20 mmHg or less in 79% of the eyes after 4 months, 77.5% after 6 months, 75% after 8 months and 61% after 12 months. By adding a local hypotension treatment in monotherapy, a pressure of 20 mmHg or less was obtained in 79% of the cases after 12 months. No severe complications were observed. The presence of a filtering bleb is an important factor in the normalization of postoperative pressure (p=0.0048). CONCLUSIONS: This surgical technique provides a substantial decrease in intraocular pressure and very few complications after 12 months of follow-up.

Proteínas Hedgehog: expresión y función en el timo / Hedgehog proteins: expression and function in the thymus

Evidencias crecientes demuestran que los morfógenos clásicos, altamente conservados durante la evolución y tradicionalmente implicados en el desarrollo embrionario, donde determinan diferenciación celular y patrones de desarrollo, son expresados en tejidos adultos, como son la médula ósea y el sistema inmunitario. Estas moléculas podrían ser piezas importantes del rompecabezas que orquesta la diferenciación y la homeostasis del sistema inmune, aunque sea sólo recientemente cuando estamos comenzando a entender donde encajan en el entramado del sistema inmune. En esta revisión, describimos la ruta de señalización de las proteínas Hedgehog (Hh) centrándonos en su implicación en la diferenciación de las células T y su posible conexión con otros morfógenos, como son las proteínas morfogénicas del hueso (Bone Morphogenetic Proteins, BMPs) (AU)

Distinct mechanisms contribute to generate and change the CD4:CD8 cell ratio during thymus development: a role for the Notch ligand, Jagged1.

In adult life, the high CD4:CD8 cell ratio observed in peripheral lymphoid organs originates in the thymus. Our results show that the low peripheral CD4:CD8 cell ratio seen during fetal life also has an intrathymic origin. This distinct production of CD4(+)CD8(-) and CD4(-)CD8(+) thymocytes is regulated by the developmental age of the thymic stroma. The differential expression of Notch receptors and their ligands, especially Jagged1, throughout thymus development plays a key role in the generation of the different CD4:CD8 cell ratios. We also show that the intrathymic CD4:CD8 cell ratio sharply changes from fetal to adult values around birth. Differences in the proliferation and emigration rates of the mature thymocyte subsets contribute to this change.

Hedgehog signaling regulates differentiation from double-negative to double-positive thymocyte.

The hedgehog (Hh) signaling pathway is involved in the development of many tissues. Here we show that sonic hedgehog (Shh) is involved in thymocyte development. Our data suggest that termination of Hh signaling is necessary for differentiation from CD4-CD8-double-negative (DN) to CD4+CD8+ double-positive (DP) thymocyte. Shh is produced by the thymic stroma, and Patched and Smoothened (Smo), the transmembrane receptors for Shh, are expressed in DN thymocytes. A neutralizing monoclonal antibody against Shh increases differentiation of DN to DP thymocytes, and Shh protein arrests thymocyte differentiation at the CD25+ DN stage, after T cell receptor beta (TCRbeta) gene rearrangement. We show that one consequence of pre-TCR signaling is downregulation of Smo, allowing DN thymocytes to proliferate and differentiate.

Effect of melatonin treatment on 24-h variations in responses to mitogens and lymphocyte subset populations in rat submaxillary lymph nodes.

Wistar male rats were injected s.c. with melatonin (30 microg) or vehicle, 1 h before lights off, for 11 days. Ten days after beginning melatonin treatment, rats received Freund's complete adjuvant or its vehicle s.c., and after 2 days, they were sacrificed at six different time intervals throughout a 24-h cycle. The mitogenic effect of lipopolysaccharide (LPS) and concanavalin A (Con A), the activity of ornithine decarboxylase (ODC) and the relative size of lymphocyte subset populations were measured in submaxillary lymph nodes. In control rats, the mitogenic effects of LPS and Con A and ODC activity peaked during the afternoon. Injection of Freund's adjuvant induced a 10-h shift in the diurnal rhythm of the mitogenic effect of LPS to attain maximal values at night. Melatonin pretreatment blunted the daily variations in the mitogenic activity of Con A or LPS and, when given to Freund's adjuvant-injected rats, augmented mesor and amplitude of diurnal rhythm in ODC activity. Maxima in B cell number occurred at night whereas those of T and B-T cell number occurred during the afternoon. During the early phase of immunization tested, the number of B cells augmented and the amplitude of its diurnal rhythmicity increased both after immunization and following melatonin pretreatment. Maxima of 24-h rhythms in CD4+ and CD4+/CD8+ cell populations occurred during the afternoon while those of CD8+ cells occurred at late night. Melatonin significantly augmented CD4+ cell number and decreased CD8+ cell number; it therefore augmented the CD4+:CD8+ ratio. The results suggest that pretreatment with a pharmacological dose of melatonin exerts immunomodulating effects at an early, preclinical, phase of Freund's adjuvant-induced arthritis in rats.

Analysis of the human neonatal thymus: evidence for a transient thymic involution.

The neonatal period is marked by the impairment of the major components of both innate and adaptive immunity. We report a severe depletion of cortical CD4+CD8+ double-positive thymocytes in the human neonatal thymus. This drastic reduction in immature double-positive cells, largely provoked by an increased rate of cell death, could be observed as early as 1 day after birth, delaying the recovery of the normal proportion of this thymocyte subset until the end of the first month of postnatal life. Serum cortisol levels were not increased in newborn donors, indicating that the neonatal thymic involution is a physiological rather than a stress-associated pathological event occurring in the perinatal period. Newborn thymuses also showed increased proportions of both primitive CD34+CD1- precursor cells and mature TCRalphabetahighCD69-CD1-CD45RO+/RAdull and CD45ROdull/RA+ cells, which presumably correspond to recirculating T lymphocytes into the thymus. A notable reinforcement of the subcapsular epithelial cell layer as well as an increase in the intralobular extracellular matrix network accompanied modifications in the thymocyte population. Additionally neonatal thymic dendritic cells were found to be more effective than dendritic cells isolated from children's thymuses at stimulating proliferative responses in allogeneic T cells. All these findings can account for several alterations affecting the peripheral pool of T lymphocytes in the perinatal period.

Role of glucocorticoids in early T-cell differentiation.

The results of the T-cell differentiation in the progeny of adrenalectomized pregnant rats (Adx fetuses), an experimental model that ensures the absence of glucocorticoids (GCs) during the first stages of development, are summarized. In Adx thymuses there is an accelerated maturation of thymocytes that is reversed by in vivo GC replacement. In addition, Adx thymuses show decreased cell content, which correlates with both the increased numbers of apoptotic cells and an early migration of DP (CD4+CD8+) and SP (both CD4+CD8- and CD4-CD8+) thymocytes to the spleen. As shown by in vitro recolonization assays, accelerated T-cell differentiation is a consequence of changes in the biology of lymphoid precursors occurring in the fetal liver of Adx fetuses. They arrive at the thymic primordium earlier and mature faster than the fetal liver lymphoid progenitors from Sham control fetuses. After the establishment of a fetal hypothalamus-pituitary-gland-adrenal-gland (HPA) axis, there is a gradual normalization of the T-cell development Adx fetuses.

Early maturation of T-cell progenitors in the absence of glucocorticoids.

In the present work, we demonstrated that both fetal liver and thymic T-cell precursors express glucocorticoid receptors (GRs) indirectly suggesting a role for glucocorticoids (GCs) in the earliest events of T-cell differentiation. To evaluate this issue, we analyzed the thymic ontogeny in the progeny of adrenalectomized pregnant rats (Adx fetuses), an in vivo experimental model, which ensures the absence of circulating GCs until the establishment of the fetal hypothalamus-pituitary-adrenal (HPA) axis. In the absence of maternal GCs, T-cell development was significantly accelerated, the process being reversed by in vivo GC replacement. Mature single positive thymocytes (both CD4 and CD8) appeared in 16-day old fetal Adx thymus when in the control fetuses, most thymocytes still remained in the double-negative (DN) CD4(-)CD8(-) cell compartment. In addition, emigration of T-cell receptor (TcR)alphabeta positive cells to the spleen also occurred earlier in Adx fetuses than in control ones. In vitro recolonization of cultured deoxiguanosine-treated mouse fetal thymus lobes with 13-day-old fetal liver cell suspensions from both Adx and control fetuses demonstrated changes in the developmental capabilities of fetal liver T-cell precursors from embryos grown in the absence of GCs. Furthermore, a precocious lymphoid colonization of the thymic primordium from Adx fetuses was evidenced by ultrastructural analysis of both Adx and Sham early thymus. Both findings accounted for the accelerated T-cell differentiation observed in Adx fetuses. Together, these results support a role for GCs not only in the thymic cell death, but also in the early steps of T-cell differentiation.

Partial blockade of T-cell differentiation during ontogeny and marked alterations of the thymic microenvironment in transgenic mice with impaired glucocorticoid receptor function.

Glucocorticoids (GCs) are widely known to be potent modulators of the immune system. The role of GCs in thymopoiesis as well as the integration of the thymus with the neuroendocrine system is, however, poorly understood. In the present work, we have studied, in transgenic mice with an impaired GC function, the alterations which occur in both T-cell differentiation and thymic stroma maturation, throughout ontogeny as well as in adult condition, analyzing their possible rebounding on the status of adult splenic T lymphocyte populations. These transgenic mice have been described to present a significant decrease (60-70%) of thymic and splenic GC receptor binding capacity but maintain normal their basal plasma ACTH and corticosterone levels. The animals showed a partial blockade of T-cell differentiation and decreased percentages of apoptotic cells during fetal development but not in adult life, when thymic cellularity was significantly increased although thymocyte apoptosis response was not affected. In contrast, thymic stroma was profoundly altered from early fetal stages and large epithelium-free areas appeared in adult thymus. On the other hand, our study revealed a reduction of the splenic TcRalphabeta population accompanied by an increase in the CD4/CD8 ratio. The analysis of different adhesion molecules as well as activation markers demonstrated that most of them (CD5, CD11a, CD11b, CD69 and MHC Class II) were normally expressed in transgenic lymphocytes, whereas CD44 and CD62L expression was altered indicating the existence of an increased proportion of primed T-cells in these animals. In view of the mutual interdependence of thymic stroma and thymocyte maturation, the partial blockade of T-cell differentiation during ontogeny and the profound alterations of the stromal cell compartment in transgenic mice with impaired GR function suggest a key role for GCs in coordinating the physiological dialogue between the developing thymocytes and their microenvironment.

Glucocorticoid-mediated regulation of thymic dendritic cell function.

The possible effects of glucocorticoids (GC) on the biology of thymic dendritic cells (DC) have been analyzed. Both DC and GC seem to be involved in intrathymic T cell selection but possible relationships, if any, between them remain currently unknown. For the first time, we have proved the expression of GC receptors in thymic DC. Moreover, our data demonstrate that in vitro dexamethasone (Dex) treatment barely affects the viability of mature thymic DC, which are largely resistant to its apoptotic effect. Dex-treated thymic DC also show a slightly reduced surface expression of some adhesion and co-stimulatory molecules in correlation with diminished allostimulatory properties. Furthermore, the production of both IL-1beta and tumor necrosis factor (TNF)-alpha, but not that of IL-6 and IL-10, diminished in the mixed leukocyte reaction established with Dex-treated thymic DC. However, the addition of recombinant rat IL-1beta and TNF-alpha, alone or in combination, did not recover the allostimulatory capacity. Taken together, these results support certain GC-mediated regulation of the activity of thymic DC which could be relevant for the biology of the thymus gland.

Early differentiation of thymic dendritic cells in the absence of glucocorticoids.

The possible role of glucocorticoids (GCs) in the maturation of thymic dendritic cells (DCs) during early ontogeny was analyzed in the progeny of adrenalectomized pregnant rats (Adx foetuses). This experimental model ensured the lack of GCs until establishment of foetal hypothalamus-pituitary gland-adrenal (HPA) axis, and showed profound modifications of the development of thymus gland. In the absence of maternal GCs, there was a high percentage of DCs, many of them exhibiting a mature phenotype, in the 15-16 day-old Adx foetal thymus, which sharply decreased to reach control values on foetal day 17. On the other hand, the absolute number of DCs of Sham foetal rats increased throughout ontogeny, whereas the high numbers found in 15-16 day-old Adx foetuses significantly diminished in the following days. This process was closely correlated with the thymocyte life span, previously demonstrated, and the early appearance of DCs in the spleen. Our results demonstrate that like for other cell components of rat thymus, DC maturation is accelerated in an early foetal microenvironment devoid of glucocorticoids.

Development of rat CD45+ 13-day-old fetal liver cells in SCID mouse fetal thymic organ cultures.

A phenotypic analysis of the lympho-hemopoietic cells which occur in the liver of 13-day-old fetal rats was achieved by flow cytometry in an attempt to further characterize the rat lymphoid progenitor cells. A small fraction of rat 13-day-old fetal liver (r13FL) cells, which weakly expressed the leukocyte common antigen CD45, constituted a homogeneous Thy-1(hi), CD71(-), CD44(+), MHC class I+, CD43(+) cell subpopulation negative for CD45RC, CD3, TCRalphabeta, TCRgammadelta, CD2, CD5, CD4, CD8, CD25, CD28, NKR-P1a and sIg. On the contrary, the CD45(-) cells were a heterogeneous cell subset which expressed Thy-1, CD71 and CD44 at distinct levels. After MACS separation, the CD45(+) r13FL cells, but not the CD45(-) cell subset, in vitro repopulated 14-day-old SCID mouse fetal thymic lobes providing rat T cells, both TCRalphabeta and TCRgammadelta, NK cells, and thymic dendritic cells but not B lymphocytes. Interestingly, NKR-P1a(lo) TCRalphabeta+ or TCRgammadelta+ cells developed in the xenogeneic cultures, and a rare CD4(+)CD8(+) double-positive subpopulation among the TCRgammadelta-expressing cells accumulated in the oldest cultures. These results are discussed from the double perspective of the nature of the precursor cells which colonize the fetal thymus and the relevance of the xenogeneic SCID mouse fetal thymic microenvironment for supporting rat lymphopoiesis.