Dermoscopic features and patterns of poromas: a multicentre observational case-control study conducted by the International Dermoscopy Society.

BACKGROUND: Poromas are benign cutaneous sweat gland tumours that are challenging to identify. The dermoscopic features of poromas are not well characterized. OBJECTIVE: To determine the clinical-dermoscopic features of poromas. METHODS: Cross-sectional, observational study of 113 poromas and 106 matched control lesions from 16 contributors and eight countries. Blinded reviewers evaluated the clinical and dermoscopic features present in each clinical and dermoscopic image. RESULTS: Poromas were most commonly non-pigmented (85.8%), papules (35.4%) and located on non-acral sites (65.5%). In multivariate analysis, dermoscopic features associated with poroma included white interlacing areas around vessels (OR: 7.9, 95% CI: 1.9-32.5, P = 0.004), yellow structureless areas (OR: 2.5, 95% CI: 1.1-6.0, P = 0.04), milky-red globules (OR: 3.9, 95% CI: 1.4-11.1, P = 0.01) and poorly visualized vessels (OR: 33.3, 95% CI: 1.9-586.5, P = 0.02). The presence of branched vessels with rounded endings was positively associated with poromas but did not reach statistical significance (OR: 2.4, 95% CI: 0.8-6.5, P = 0.10). The presence of any of these five features was associated with a sensitivity and specificity of 62.8% and 82.0%, respectively. CONCLUSION: We identified dermoscopic features that are specific to the diagnosis of poroma. Overall, however, the prevalence of these features was low. Significant clinical and dermoscopic variability is a hallmark of these uncommon tumours, which are most prevalent on non-acral sites.

Aerobic and anaerobic enzymatic activity of orange roughy (Hoplostethus atlanticus) and alfonsino (Beryx splendens) from the Juan Fernandez seamounts area.

The aerobic and anaerobic enzymatic activity of two important commercial bathypelagic species living in the Juan Fernández seamounts was analyzed: alfonsino (Beryx splendens) and orange roughy (Hoplostethus atlanticus). These seamounts are influenced by the presence of an oxygen minimum zone (OMZ) located between 160 and 250 m depth. Both species have vertical segregation; alfonsino is able to stay in the OMZ, while orange roughy remains at greater depths. In this study, we compare the aerobic and anaerobic capacity of these species, measuring the activity of key metabolic enzymes in different body tissues (muscle, heart, brain and liver). Alfonsino has higher anaerobic potential in its white muscle due to greater lactate dehydrogenase (LDH) activity (190.2 µmol NADH min(-1) g ww(-1)), which is related to its smaller body size, but it is also a feature shared with species that migrate through OMZs. This potential and the higher muscle citrate synthase and electron transport system activities indicate that alfonsino has greater swimming activity level than orange roughy. This species has also a high MDH/LDH ratio in its heart, brain and liver, revealing a potential capacity to conduct aerobic metabolism in these organs under prolonged periods of environmental low oxygen conditions, preventing lactic acid accumulation. With these metabolic characteristics, alfonsino may have increased swimming activity to migrate and also could stay for a period of time in the OMZ. The observed differences between alfonsino and orange roughy with respect to their aerobic and anaerobic enzymatic activity are consistent with their characteristic vertical distributions and feeding behaviors.

Attentional network task in schizophrenic patients and theirs unaffected first degree relatives: a potential endofenotype.

INTRODUCTION: In recent years, reports of attentional deficits in schizophrenic patients and in their biological relatives have rapidly increased, including an important effort to search for the endophenotypes in order to link specific genes to this illness. Posner et al. developed a test, the Attention Network Test (ANT), to study the neural networks. This test provides a separate measure for each one of the three anatomically-defined attention networks (alerting, orienting and executive control). METHODOLOGY: In this paper, we investigate the attentional performance in 32 schizophrenic patients, 29 unaffected first degree relatives and 29 healthy controls using the ANT through a study of family association. We have studied the efficiency of the segregated executive control, alerting and orienting networks by measuring how response latencies (reaction time) were modified by the cue position and the flanking stimuli. We also studied the familial association of these attentional alterations. RESULTS: The ANOVA revealed main effects of flanker and cue condition and a significant interaction effect between flanker and groups studied. The schizophrenic patients and their relatives had a longer median reaction time than the control group. The probands and their relatives significantly differed from the healthy controls in terms of their conflict resolution; however, the alerting network appeared to be conserved. CONCLUSIONS: Our results support the thesis of a specific attentional deficit in schizophrenia and show the segregation of the three attentional networks. The family association of these reported alterations supports the idea of a potential endophenotype in schizophrenia.

An LCA-based model for assessing prevention versus non-prevention of construction waste in buildings.

Waste generated by the Construction Sector represents an environmental problem in many countries. To achieve increasingly eco-efficient waste management, Life Cycle Assessment (LCA) provides an objective method for the quantification of the potential impact that waste management exerts on the environment. Traditionally, LCA has focused on the evaluation of non-prevention scenarios once the waste is generated, mainly by showing the benefits of recycling vs. disposal. Consequently, the literature has hardly addressed the positive environmental impacts caused by waste prevention, that is, the reduction at source, which constitutes the preferred option of any waste management hierarchy. Therefore, this study proposes a model to simulate the environmental performance of the prevention vs. the non-prevention of construction waste production. The model is applied to an urban system of residential buildings in Spain. The results provide evidence of the environmental benefits achieved with the prevention scenario. The prevention scenario reduces the construction waste generated in the non-prevention scenarios by up to 57%. Furthermore, it allows a potential reduction of up to 4.6 and 171.1 times the impact caused by the disposal scenario; and up to 1.7 and 8.3 times those of the recycling scenario. The model can be implemented in other contexts with other reference buildings, and enables the environmental benefits of reduction strategies to be studied, thereby providing a tool to guide and support decision-making during the building design stage. Moreover, the results obtained can help professionals and policymakers to incorporate effective construction waste prevention measures in waste prevention plans and programs.

A major fish stranding caused by a natural hypoxic event in a shallow bay of the eastern South Pacific Ocean.

A massive beaching and mortality of fishes occurred in Coliumo Bay, a shallow bay located along the coast of the eastern South Pacific Ocean on 3 January 2008. This stranding was a consequence of an abrupt decrease in the dissolved oxygen concentration throughout the whole water column, due to the effect of intense upwelling along the coast off central-southern Chile. The main objectives of this study were: (1) to characterize taxonomically and biologically the fish species assemblage present in this beaching; (2) to evaluate several physiological indicators for the condition of the beached species at the time of their death; and (3) to assess the possible cause-effect mechanisms involved in the fishes death and the changes that took place in the fish community throughout the time. In this beaching, 26 fish species were identified: 23 teleosts, one myxiniform and two elasmobranchs. Most beached specimens were juveniles. Haematological and histological evidence indicate that severe hypoxia that lasted for at least 48 h was the most plausible cause of death. The main conclusion of this study is that the presence of oxygen-poor equatorial sub-surface water in the shallow coastal zone due to intense regional-scale upwelling caused the fish stranding. Although the effect of the hypoxic event was severe for the fish assemblage of Coliumo Bay, the rapid recuperation observed suggests that hypoxic events at the local spatial scale can be buffered by migration processes from the fish community inhabiting close by areas non-affected by low oxygen conditions. The effect that severe hypoxic events may have on larger spatial scales remains unknown.

Vulnerability of a top marine predator to coastal storms: a relationship between hydrodynamic drivers and stranding rates of newborn pinnipeds.

Coastal storms have increased in recent decades, affecting many species, including the South American sea lion (Otaria byronia). Reports of stranded sea lion pups are becoming common in Chile, presumably due to the increase in the frequency and intensity of coastal storms. To validate this assumption, a 10-year database was built by coupling wave generation and coastal propagation models to correlate pure wave parameters (significant wave height Hs, peak period Tp, normalized wave power Hs2 Tp) and wave parameters including the tidal level (maximum surface elevation η, modified wave power η2 Tp) with records of stranded pups in Cobquecura, the largest breeding colony in central Chile. The correlation between the number of pups stranded per day and wave parameters in the first half of January and the last half of February is poor, while they are stronger for the second half of January and the first half of February. The higher number of stranded pups coincide with coastal storms with normalized wave power values exceeding a threshold of 100 m2/s. Conversely, below this threshold there is wide dispersion between the number of strandings and wave parameters. Identifying wave parameter thresholds could be used to predict when newborn pups will be most affected by coastal storms, and thus help institutions to develop remediation techniques for animals at risk.

An estimate of the percentage of non-predatory dead variability in coastal zooplankton of the southern Humboldt Current System.

Non-predatory dead variability in zooplankton remains poorly quantified worldwide. Here, we make the first estimation of the percentage of dead organisms in coastal zooplankton communities in the Humboldt Current System (HCS) under in situ conditions. The study was conducted in four coastal sites of the southern HCS (between 36 and 37°S) over a period of one year. Percentages of dead organisms were based on the classification as live or dead of 158,220 holoplankton and 17,591 meroplankton individuals using neutral red staining technique. The percentage of dead organisms in total-zooplankton was between 4.3% in Coronel Bay (summer) and 76.9% in Llico (autumn). The percentage of dead total-holoplankton varied from 4.2% (Itata River Mouth; autumn) to 77.6% (Llico; autumn), while the percentage of dead total-meroplankton ranged from 1.5% to 56.8% in Coronel Bay and Coliumo Bay, respectively. The most abundant taxa analyzed were the copepods Acartia sp., Paracalanus sp., Calanoides sp., Cladocera, Polychaeta, and the eggs of anchoveta Engraulis ringens. Among these taxa, there was a high degree of interspecific variability in the estimation of the dead organisms. The Pearson correlation shows significant relationships between maximum temperature, and minimum salinity, with the percentage of dead individuals of Acartia sp. and Paracalanus sp. Environmental factors explaining those relationships were: the El Niño 2015-2016 event, and freshwater river runoff. The use of vital staining to estimate non-predatory death for total-zooplankton and selected sentinel species is a promising tool to establish baselines to evaluate natural perturbations (e.g. ENSO), and anthropogenic alterations in coastal pelagic ecosystems.

Microangiopathic hemolytic anemia due to ADAMTS-13 loss in idiopathic systemic capillary leak syndrome.

Essentials Idiopathic systemic capillary leak syndrome (SCLS) is characterized by episodes of vascular leakage. We present the case of a patient with SCLS who developed microangiopathic hemolytic anemia (MAHA). We propose that this anemia is the result of ADAMTS-13 loss in the third-space fluid. This suggests that MAHA can occur in patients with significant extravasation of proteins. SUMMARY: Idiopathic systemic capillary leak syndrome (SCLS) is a rare process characterized by acute and recurrent episodes of vascular leakage with severe hypotension, hypoalbuminemia, hemoconcentration and edema. Anemia and thrombocytopenia are not part of this syndrome, but here we present the case of a pediatric patient with a clinical presentation consistent with SCLS who subsequently developed microangiopathic hemolytic anemia at a time when she had significant fluid loss and anasarca. Based on serial ADAMTS-13 levels, we propose that the anemia in this patient developed as a result of ADAMTS-13 loss in the third-space fluid, a novel mechanism for acquired microangiopathic hemolytic anemia.

Monosomy 7 associated with pediatric acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS): successful management by allogeneic hematopoietic stem cell transplant (HSCT).

Pediatric acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS) with monosomy 7 is associated with poor disease-free survival when treated by conventional chemotherapy, immunosuppression or supportive measures. Hematopoietic stem cell transplant (HSCT) may improve outcomes; however, data to support this are limited. To better understand the curative potential of HSCT in these patients, all cases of AML and MDS with monosomy 7 treated by two transplant programs (1992 to present) were reviewed. A total of 16 patients were treated, all by allogeneic HSCT. Primary diagnoses were MDS (N = 5), therapy-related MDS (N = 3), AML (N = 5) and therapy-related AML (N = 3). In all, 11 patients (69%) survive event-free at 2 years with median follow-up of 986 days (range 330-2011 days). Toxicity caused deaths of the five nonsurviving patients, four of whom were transplanted with active leukemia. Allogeneic HSCT is effective therapy for childhood AML and MDS associated with monosomy 7, particularly for patients with AML in complete remission and MDS.

Modulation of human myelopoiesis by human gangliosides.

Cell surface gangliosides are potent modulators of cellular proliferation. We hypothesize that gangliosides shed by tumor cells modulate hematopoiesis and contribute to human tumor-associated suppression of hematopoiesis. To test this hypothesis, we determined the effects on myeloid colony formation by human bone marrow mononuclear cells of total gangliosides isolated from human brain and of seven highly purified individual ganglioside species (GM1, GM2, GD1a, GD1b, GD2, GD3, and GT1b). Total human brain gangliosides and certain individual species, GD1a, GD1b, and GT1b, significantly inhibited myeloid colony formation (number as well as size). The most complex molecules, GD1a, GD1b, and GT1b, were the most inhibitory, suggesting that the degree of inhibition is related to ganglioside structural complexity. To extend these findings, we also investigated certain tumor-derived (neuroblastoma) gangliosides, which we found inhibited both myeloid colony formation and 3H-thymidine incorporation by human bone marrow mononuclear cells. These data suggest a role for gangliosides, which are shed by proliferating cells, in the regulation of human hematopoiesis and may explain the bone marrow hypoplasia observed in association with many human malignancies.

Comparison of three techniques for the ex vivo elimination of T cells from human bone marrow.

The high incidence of graft-vs-host disease (GVHD) in allogeneic bone marrow transplantation (BMT) is a significant cause of morbidity and mortality, despite pharmacological prophylactic regimes. Laboratory technologies have been developed to eliminate the immunocompetent T-lymphocyte, the proposed effector cell in the GVHD reaction. In this study, three techniques for the ex vivo purging of T cells from human bone marrow (BM) were compared. BM treatment groups consisted of T-cell depletion by the monoclonal antibodies OKT3 and OKT11A plus complement (MoAb + C), soybean agglutination followed by sheep erythrocyte rosette depletion, or triple rosetting with neuraminidase-treated sheep erythrocytes. Mean final cell yields were 37.2 +/- 4.0%, 2.8 +/- 0.8%, and 2.5 +/- 1.3%, respectively, while final yields of BM progenitor cells, assayed in the double-layer soft-agar CFU-c assay, were 28.5 +/- 6.5%, 3.9 +/- 2.1%, and 10.5 +/- 3.8%, respectively. The three techniques were comparably efficient in elimination of mitogenic responses to irradiated allogeneic lymphoblastoid cells and cytotoxic lymphocyte responses of the BM. Immunofluorescence after T-cell depletion showed greater than 97.5% of all OKT3-positive cells to be eliminated by each technique. Despite the fact that all three techniques were effective in T-cell depletion, treatment with anti-T-cell MoAbs + C proved less labor-intensive and resulted in higher cell yields.

Measurement of cytotoxicity by target cell release and retention of the fluorescent dye bis-carboxyethyl-carboxyfluorescein (BCECF).

In order to utilize a newly available scanning microfluorimeter for lymphocyte-mediated cytotoxicity assays, a number of commercially available fluorescent dyes were compared for their suitability as target cell markers. One of them, bis-carboxyethyl-carboxyfluorescein (BCEFCF), was useful for assays with about 10(4) target cells and showed substantially less spontaneous leakage than other fluorescein derivatives, while still leaking more rapidly than 51Cr. For short cytotoxicity incubations (less than 2 h) with cytotoxic T lymphocytes (CTL), the corrected percentage BCECF release into the supernatant parallels that of 51Cr. For 4 h assays cytotoxicity could be quantitated by measuring the BCECF retained by target cells. Using human CTL and natural killer (NK) cells as effectors, with a variety of lymphoid cells and fibroblasts as targets in 4 h assays, the BCECF retention technique was found to give cytotoxicity values comparable to the 51Cr release assay. Cytotoxicity assays measuring BCECF fluorescence in microtiter wells with the scanning microfluorimeter offer advantages of safety, economy, and processing time compared with the 51Cr release assay.

An anti-human-T-cell monoclonal antibody with specificity for a novel determinant.

A new antihuman T cell monoclonal antibody, MAb 22, recognizes an antigen that is present on all mature T cells, but detected on only a subset of thymocytes. Dual color flow microfluorimetry (FMF) demonstrates that MAb 22 staining has concordant distribution with pan-T MAb specific for CD3 and CD5 and includes the CD4 and CD8 subsets; other FMF studies confirm T cell specificity of MAb 22 expression by cells of hematopoietic origin. The antigen recognized by MAb 22 is expressed on only a subset of thymocytes and by dual FMF is expressed at a mature thymocyte stage. Immunoprecipitation by MAb 22 demonstrates a series of molecules with a predominant 45 KD protein and associated 12 and 95 KD proteins under reducing conditions, while a 92 KD protein predominates under nonreducing conditions. Comparisons of expression on a variety of T cell lines, including a mutant line defective in the expression of the T cell receptor, by FMF analysis further distinguishes the determinant recognized by MAb 22 from those detected by MAb of defined T cell specificity.

Monoclonal antibody-toxin conjugates reactive against human T lymphocytes. A comparison of antibody linked to intact ricin toxin with antibody linked to ricin A chain.

A non-complement-binding monoclonal antibody, TA-1, recognizing determinants on human T lymphocytes, was linked to the plant seed toxin ricin, either the intact molecule or purified ricin A chain. Peripheral blood lymphocytes were pretreated with conjugate for 2 hr, washed, and then measured in vitro for T cell proliferation. Studies showed that antibody-intact ricin conjugates were up to 39-fold more inhibitory than antibody-A-chain conjugates. Killing was selective because an unreactive control antibody linked to toxin had minimal inhibitory effect. Dose response curves obtained in human studies were nearly identical to curves obtained in an animal model n which a monoclonal anti-murine T cell antibody (anti-Thy 1.1) was linked to ricin and ricin A chain. In the human system, longer exposures of peripheral blood cells to conjugates did not alter our findings. TA-1-ricin conjugates were tested against human ALL cell lines. KOPN-1, a cell line bearing the determinant reactive with TA-1 was selectively eliminated within 2 days after pretreatment with 500 ng/ml. Even 10-fold greater concentrations of TA-1-A chain were not adequate for leukemic cell destruction. These findings (1) show for the first time in a human model that monoclonal antibodies, directed against certain differentiation antigens when linked to ricin A chain are not as effective in normal or malignant cell killing as when linked to intact ricin; (2) contribute to the growing body of evidence showing that monoclonal antibody A chain conjugates do not permit the acquisition of levels of toxin sufficient to destroy target cells; and (3) are important relative to increasing interest in use of antibody-toxin conjugates for graft-versus-host disease prophylaxis in allogeneic bone marrow transplantation.

Alternative donor sources in HLA-mismatched marrow transplantation: T cell depletion of surgically resected cadaveric marrow.

Allogeneic bone marrow transplantation has been largely confined in its application to patients with an HLA-matched marrow donor, thereby limiting potential therapeutic benefits for patients with diseases amenable to treatment by marrow transplantation who lack effective alternative therapies and an identified matched marrow donor. T cells in the donor marrow generate graft-versus-host disease which is a major consideration in attempts to widen the application of allogeneic marrow transplantation to the minimally HLA-matched or mismatched setting. The method of marrow harvest influences both the number of such T cells in the donor marrow inoculum and the functional capacity of T cells in murine marrow. We have therefore evaluated surgically resected cadaveric marrow for T cell content and for T cell depletion. Surgically resected marrow is more easily depleted of T cells than aspirated marrow and clinically useful quantities of marrow have been obtained and cryopreserved in a bank of characterized donor marrow for future use in HLA minimally matched or unmatched marrow transplantation.

Successful allogeneic hematopoietic stem cell transplantation (HSCT) for Shwachman-Diamond syndrome.

Shwachman-Diamond syndrome (SDS) is a rare genetic disorder characterized by pancreatic insufficiency, short stature, skeletal abnormalities and bone marrow dysfunction. Patients with SDS have varying degrees of marrow aplasia, which can be severe or progress to leukemic transformation. While allogeneic hematopoietic stem cell transplantation (HSCT) can be curative for the hematologic disturbances of SDS, a recent review of the literature reveals few survivors. Poor outcome with HSCT is often related to excessive cardiac and other organ toxicity from transplant preparative therapy. We describe two young children with SDS who developed aplastic anemia and subsequently underwent successful allografting using a non-cardiotoxic conditioning regimen. Case 1 received marrow from an HLA-identical sibling while case 2 received partially matched umbilical cord blood from an unrelated donor. Both patients are presently alive and well with sustained donor engraftment and excellent hematopoietic function at 36 and 22 months post-HSCT.

Invasive Aspergillus sinusitis in pediatric bone marrow transplant patients. Evaluation and management.

OBJECTIVES: To evaluate the following: the incidence of invasive Aspergillus sinusitis (AS); the value of surveillance nasal cultures and screening radiologic studies in predicting AS; the clinical criteria used to decide on surgical biopsy in patients suspected of having AS; the surgical and medical management of AS; and the outcome of AS in the peritransplantation period of children who underwent bone marrow transplantation. DESIGN: Retrospective medical chart review. SETTING: Tertiary care children's hospital. PATIENTS: Eighty pediatric patients who underwent bone marrow transplantation for a variety of refractory malignant neoplasms or lymphohematopoietic disorders at the Children's National Medical Center, Washington, DC, from April 1, 1988, to September 30, 1993. INTERVENTION: Diagnostic surgical biopsies, surgical débridement, and treatment with amphotericin B. MAIN OUTCOME MEASURE: Resolution of AS and discharge from the hospital. RESULTS: Seventy-two patients had screening sinus radiographs, 27 of which showed abnormalities. Aspergillus sinusitis developed in three of the patients with abnormal screening radiographs. Fifty-eight patients had screening nasal cultures. One culture was positive for Aspergillus, and histopathologically proved AS developed in this patient. Twelve diagnostic biopsies were done in nine patients. Three biopsy specimens showed histopathologic evidence of AS. The three patients with AS were successfully treated with aggressive surgical and medical therapy and were discharged from the hospital. CONCLUSION: The incidence of AS was 4% (3/80) in the patients who underwent bone marrow transplantation. Screening radiographs, while not a good predictor of AS, have a role in evaluation of patients undergoing bone marrow transplantation to define preexisting sinus disease. Screening nasal cultures do not reliably predict AS. When AS is suspected and diagnostic biopsy is considered, the seven clinical criteria outlined in this article should be used. Survival of immunocompromised patients with AS requires early diagnosis and aggressive surgical and medical therapy.

Female sterilization using the tubal ring.

The surgical and early postoperative complications were evaluated in a study of 221 laparoscopies and 29 minilaparotomies in which tubal occlusions were performed with the application of tubal rings. For either procedure, complications were infrequent. None of the procedures had to be completed by another technique of tubal occlusion, and none of the patients required an extended hospitalization for the treatment of a complication. Among the 79 patients who have been followed up for more than 6 months, no pregnancies have been reported. The tubal ring technique appears to be safe and effective when used with either laparoscopy of minilaparotomy.

[Yoon's ring in the immediate postpartum. Preliminary report]. / El anillo de Yoon en el postparto inmediato. Reporte preliminar.

PIP: 110 women in puerperim, many of whom had had abortions and now wanted permanent fertility control, were selected for the application of Yoon's ring. The technique involved a horizontal incision of 2-4 cm, location of the Fallopian tubes, and application of the silastic ring. Complications included 2 hematomas of the tubal wall, caused by the pinchers but controlled with the ring and 1 later case of cellulitis at the incision. 98% of patients stayed 24-48 hours in the hospital. The operation seems simple, but requires gentle handling to avoid traction and ring application in the proximal 3rd of the tube to avoid complications. Short-term results were good but long term follow-up observation is necessary.^ieng

[Integral treatment of severe ovarian hyperstimulation syndrome by means of autotransfusion of ascitic fluid and intravenous infusion of albumin]. / "Tratamiento integral del síndrome de hiperestimulación ovárica severo mediante autotransfusión de ascitis e infusión intravenosa de albúmina".

Severe ovarian hyperstimulation syndrome (OHSS) is a potential life-threatening condition relationated with ovulation induction. It affects multiple systems. Little is known about it's pathophysiology. The treatment available consists in the correction of fluid, electrolyte and hematologic imbalances. In other hand, is mandatory the prevention of embolic phenomena. Ascitic fluid aspiration result in dramatic improvement of symptoms. The purpose of this study was to assess the effect of autotransfusion of ascitic fluid obtained by paracentesis and the intravenous infusion of albumin for the treatment of severe from of the OHSS.