Insights from the first phylogenomic analysis of flat wasps (Hymenoptera, Bethylidae) reveal two new subfamilies.

Despite significant advances in alpha level taxonomy in the past few decades, the higher-level phylogeny of flat wasps (Hymenoptera, Bethylidae) remains poorly explored. Herein we provide the first phylogenomic assessment of the family based on data from ultraconserved elements for 96 species in 61 genera of the family, with material from 29 countries and all biogeographic regions. Dataset cutoffs including ultraconserved element loci recovered for 50 and 70% of terminals resulted in matrices with 1513 and 451 loci, which were analysed in both parsimony and maximum likelihood frameworks. We also provide the first analyses of divergence dating for the family based on the calibration of 12 nodes. All analyses recovered the Bethylidae as a monophyletic group and estimated the origin of the family at around 143 Ma. The results suggest that all extant subfamilies had already diversified by the Late Cretaceous. All topologies suggest that Glenosema and Chilepyris form a clade separate from other Scleroderminae; owing to the morphological distinctiveness of each genus, we propose that they are accommodated in two new subfamilies, Glenoseminae subf. nov. and Chilepyrinae subf. nov. The monotypic sclerodermine genus Galodoxa was consistently recovered within Epyrinae and is transferred to the latter subfamily.

Does metformin reduce the risk of cancer in obesity and diabetes? A systematic review and meta-analysis.

AIM: To evaluate the effect of metformin on cancer incidence in subjects with overweight/obesity and/or prediabetes/diabetes. MATERIALS AND METHODS: We searched MEDLINE, Embase and CENTRAL for randomized controlled trials (RCTs) in adults with overweight/obesity and/or prediabetes/diabetes that compared metformin to other interventions for ≥24 weeks. Independent reviewers selected and extracted data including population and intervention characteristics and new diagnoses of cancer. We used the RoB 2.0 risk-of-bias tool and the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework to assess risk of bias and certainty of evidence. RESULTS: From 14 895 records after removal of duplicates, 27 trials were included, providing a total of 10 717 subjects in the metformin group and 10 003 in the control group, with 170 and 208 new cases of cancer, respectively. Using a random-effects model, the relative risk was 1.07 (95% confidence interval 0.87-1.31), with similar results in subgroup analyses by study duration or effect of control intervention on weight. Risk of bias in most studies was low, and no evidence of publication bias was found. Trial sequential analysis provided evidence that the cumulative sample size was large enough to exclude a significant effect of metformin on cancer incidence. CONCLUSIONS: Metformin did not reduce cancer incidence in RCTs involving subjects with overweight/obesity and/or prediabetes/diabetes.

Role of indigenous microorganisms and organics in the release of iron and trace elements from sediments impacted by iron mine tailings from failed Fundão dam.

After Fundão Dam failure in 2015, most of Gualaxo do Norte River in Doce River Basin in Brazil became silted by iron mining tailings consisting mainly of fine-grained quartz, hematite, and goethite. Previous work pointed to the possibility of reductive dissolution of iron and manganese from tailings, leading to mobilization of iron, manganese and trace elements. Several microorganisms were shown to reduce Fe(III) to Fe(II) and Mn(III, IV) to Mn(II) "in vitro", but their roles in mobilization of Fe and trace elements from freshwater sediments are poorly understood. In this work, bottom sediments and water collected in Gualaxo do Norte River were used to build anoxic microcosms amended with acetate, glucose or yeast extract, in order to access if heterotrophic microorganisms, either fermenters or dissimilatory Fe reducers, could reduce Fe(III) from minerals in the sediments to soluble Fe(II), releasing trace elements. The Fe(II) concentrations were measured over time, and trace elements concentrations were evaluated at the end of the experiment. In addition, minerals and biopolymers in bottom sediments were quantified. Results showed that organic substrates, notably glucose, fuelled microbial reduction of iron minerals and release of Fe(II), Mn, Ba, Al and/or Zn from sediments. In general, higher concentrations of organic substrates elicited mobilization of larger amounts of Fe(II) and trace elements from sediments. The results point to the possibility of mobilization of huge amounts of iron and trace elements from sediments to water if excess biodegradable organic matter is released in rivers affected by iron mine tailings.

Ultraconserved elements-based systematics reveals evolutionary patterns of host-plant family shifts and phytophagy within the predominantly parasitoid braconid wasp subfamily Doryctinae.

Phytophagy has promoted species diversification in many insect groups, including Hymenoptera, one of the most diverse animal orders on Earth. In the predominantly parasitoid family Braconidae, an association with insect-induced, plant galls in angiosperms have been reported in three subfamilies, but in particular in the Doryctinae, where it has been recorded to occur in species of ten genera. Allorhogas Gahan is the most species-rich of these genera, with its species having different phytophagous strategies. Here we conducted a comprehensive phylogenomic study for the doryctine gall-associated genera, with an emphasis on Allorhogas, using ultraconserved elements (UCEs). Based on this estimate of phylogeny we: (1) evaluated their taxonomic composition, (2) estimated the timing of origin of the gall-associated clade and divergence of its main subclades, and (3) performed ancestral state reconstruction analyses for life history traits related to their host-plant association. Our phylogenetic hypothesis confirmed Allorhogas as polyphyletic, with most of its members being nested in a main clade composed of various subclades, each comprising species with a particular host-plant family and herbivorous feeding habit. The origin of gall-association was estimated to have occurred during the late Oligocene to early Miocene, with a subsequent diversification of subclades during the middle to late Miocene and Pliocene. Overlap in divergence timing appears to occur between some taxa and their host-associated plant lineages. Evolution of the feeding strategies in the group shows "inquilinism-feeding" as the likely ancestral state, with gall-formation in different plant organs and seed predation having independently evolved on multiple occasions.

Phylogenomics of braconid wasps (Hymenoptera, Braconidae) sheds light on classification and the evolution of parasitoid life history traits.

The parasitoid lifestyle is largely regarded as a key innovation that contributed to the evolutionary success and extreme species richness of the order Hymenoptera. Understanding the phylogenetic history of hyperdiverse parasitoid groups is a fundamental step in elucidating the evolution of biological traits linked to parasitoidism. We used a genomic-scale dataset based on ultra-conserved elements and the most comprehensive taxon sampling to date to estimate the evolutionary relationships of Braconidae, the second largest family of Hymenoptera. Based on our results, we propose Braconidae to comprise 41 extant subfamilies, confirmed a number of subfamilial placements and proposed subfamily-level taxonomic changes, notably the restoration of Trachypetinae stat. rev. and Masoninae stat. rev. as subfamilies of Braconidae, confirmation that Apozyx penyai Mason belongs in Braconidae placed in the subfamily Apozyginae and the recognition of Ichneutinae sensu stricto and Proteropinae as non-cyclostome subfamilies robustly supported in a phylogenetic context. The correlation between koinobiosis with endoparasitoidism and idiobiosis with ectoparasitoidism, long thought to be an important aspect in parasitoid life history, was formally tested and confirmed in a phylogenetic framework. Using ancestral reconstruction methods based on both parsimony and maximum likelihood, we suggest that the ancestor of the braconoid complex was a koinobiont endoparasitoid, as was that of the cyclostome sensu lato clade. Our results also provide strong evidence for one transition from endo- to ectoparasitoidism and three reversals back to endoparasitoidism within the cyclostome sensu stricto lineage. Transitions of koino- and idiobiosis were identical to those inferred for endo- versus ectoparasitoidism, except with one additional reversal back to koinobiosis in the small subfamily Rhysipolinae.

Exploring Conflict of Interest in University Accreditation in Chile.

The university accreditation system in Chile appears to be influenced by tensions between interest groups from well-established institutions and newer (private) institutions. These institutions depend to a certain extent on accreditation decisions to obtain indirect public funding. However, the system relies on faculty nominated by conglomerates formed by these same institutions to decide on accreditation. This arrangement creates a potential conflict of interest that can jeopardize the accreditation's legitimacy. We explore this potential bias through an empirical study examining voting behaviour by commissioners of the Chilean National Commission of Accreditation from March 2013 to October 2016. We assess whether commissioners appeared as favouring institutions within their appointing conglomerates. To our knowledge, this is the first study in the region designed to examine the presence of bias in higher education accreditation. Findings indicate commissioners, on average, tended to favour institutions in their appointing conglomerates. We discuss the findings in the broader context of a forthcoming reform of the accreditation system.

Genomic architecture of endogenous ichnoviruses reveals distinct evolutionary pathways leading to virus domestication in parasitic wasps.

BACKGROUND: Polydnaviruses (PDVs) are mutualistic endogenous viruses inoculated by some lineages of parasitoid wasps into their hosts, where they facilitate successful wasp development. PDVs include the ichnoviruses and bracoviruses that originate from independent viral acquisitions in ichneumonid and braconid wasps respectively. PDV genomes are fully incorporated into the wasp genomes and consist of (1) genes involved in viral particle production, which derive from the viral ancestor and are not encapsidated, and (2) proviral segments harboring virulence genes, which are packaged into the viral particle. To help elucidating the mechanisms that have facilitated viral domestication in ichneumonid wasps, we analyzed the structure of the viral insertions by sequencing the whole genome of two ichnovirus-carrying wasp species, Hyposoter didymator and Campoletis sonorensis. RESULTS: Assemblies with long scaffold sizes allowed us to unravel the organization of the endogenous ichnovirus and revealed considerable dispersion of the viral loci within the wasp genomes. Proviral segments contained species-specific sets of genes and occupied distinct genomic locations in the two ichneumonid wasps. In contrast, viral machinery genes were organized in clusters showing highly conserved gene content and order, with some loci located in collinear wasp genomic regions. This genomic architecture clearly differs from the organization of PDVs in braconid wasps, in which proviral segments are clustered and viral machinery elements are more dispersed. CONCLUSIONS: The contrasting structures of the two types of ichnovirus genomic elements are consistent with their different functions: proviral segments are vehicles for virulence proteins expected to adapt according to different host defense systems, whereas the genes involved in virus particle production in the wasp are likely more stable and may reflect ancestral viral architecture. The distinct genomic architectures seen in ichnoviruses versus bracoviruses reveal different evolutionary trajectories that have led to virus domestication in the two wasp lineages.

Metal Bioaccumulation by the Neotropical Clam Anomalocardia flexuosa to Estimate the Quality of Estuarine Sediments.

This investigation evaluated the bioaccumulation potential of the tropical estuarine bivalve Anomalocardia flexuosa for trace metals. To this aim, chemical and sedimentological analyses and bioaccumulation tests were performed. The sediments were mainly composed by fine-sands and mud, with variable levels of organic matter and CaCO3. Muddy sediments from a depositional site (P2) presented the highest concentrations of metals, despite SEM/AVS not indicating bioavailability. Bioaccumulation factors showed high ratios for Cd, Ni, and Zn, while associations between the contents of mud, organic matter, CaCO3 and metals in sediments and tissues of A. flexuosa were indicated by a principal component analysis. The SEM/AVS was not effective to predict the bioavailability through dissolved metals. The results showed that contaminants were bioavailable, while the performed bioaccumulation test proved to be a reliable technique for assessing sediment contamination in estuarine regions. Moreover, A. flexuosa was considered an adequate test organism for bioaccumulation studies.

Running in circles in phylomorphospace: host environment constrains morphological diversification in parasitic wasps.

Understanding phenotypic diversification and the conditions that spur morphological novelty or constraint is a major theme in evolutionary biology. Unequal morphological diversity between sister clades can result from either differences in the rate of morphological change or in the ability of clades to explore novel phenotype ranges. We combine an existing phylogenetic framework with new phylogenomic data and geometric morphometrics to explore the relative roles of rate versus mode of morphological evolution for a hyperdiverse group: cryptine ichneumonid wasps. Data from genomic ultraconserved elements confirm that cryptines are divided into two large clades: one specialized in the use of hosts that are deeply concealed under hard substrates, and another with a much more diversified host range. Using a phylomorphospace approach, we show that both clades have experienced similar rates of morphological evolution. Nonetheless, the more specialized group is much more restricted in morphospace occupation, indicating that it repeatedly evolved morphological change through the same morphospace regions. This is in agreement with our prediction that host use imposes constraints in the morphospace available to lineages, and reinforces an important distinction between evolutionary stasis as opposed to a scenario of continual morphological change restricted to a certain range of morphotypes.

Echo Intensity Reliability for the Analysis of Different Muscle Areas in Athletes.

Lanferdini, FJ, Manganelli, BF, Lopez, P, Klein, KD, Cadore, EL, and Vaz, MA. Echo intensity reliability for the analysis of different muscle areas in athletes. J Strength Cond Res 33(12): 3353-3360, 2019-Skeletal muscles' echo intensity (EI) is used as a parameter to evaluate muscle damage and muscle quality after exercise or training. However, recent muscle EI studies have used regions of interest (ROIs) of different sizes for assessing muscle damage and muscle quality, which may lead to different results if the different ROIs from the same muscle are not reliable. Although a maximum rectangular ROI (RET-ROI), included in the muscles' anatomical cross-sectional area, can be used to represent the maximum muscle ROI (MAX-ROI), no studies were found that investigated the reliability of the evaluations of different ROIs for the EI of superficial vs. deep muscles of the thigh. In addition, no studies have evaluated different ROIs in cyclists, at different days and analyzed by different raters. The aim of this study was to evaluate the EI reliability of rectus femoris (RF) and vastus intermedius (VI) muscles of cyclists. Twenty cyclists visited the laboratory 4 times for the evaluation of RF and VI muscles transversal ultrasound images. Echo intensity was determined from grayscale mean values by 2 examiners who performed the analysis with 3 different ROIs: MAX-ROI, RET-ROI, and 1-cm ROI (1CM-ROI). The between-ROI EI data reliability showed a strong correlation in both RF (r ≥ 0.79) and VI (r ≥ 0.87) muscles. Bland-Altman tests demonstrated high agreement among RF ROI muscle areas (p > 0.05), with no agreement between the VI areas (p < 0.05). Only the RF muscle MAX-ROI, RET-ROI, and 1CM-ROI areas are similar for EI analysis, with no similarities for the same VI muscle areas.

Metal accumulation in roadside soils of Rio de Janeiro, Brazil: impact of traffic volume, road age, and urbanization level.

Traffic-related metal emissions have become a global concern due to their deposition in roadside soils and potential hazardous effects. This study evaluates metal levels in soils adjoining four highways of Rio de Janeiro (Linha Vermelha, Via Dutra, BR-465, and Avenida Brasil), chosen for their diverse traffic volumes, age, and urban/rural settings. In addition to soil physicochemical properties, 11 elements (Cd, Co, Cr, Cu, Fe, Mn, Ni, Pb, Sr, V, and Zn) were assessed on samples collected at different distances from the road (1, 3, 5, 10, 15 m) and soil depths (0-15 and 15-30 cm). Moreover, the geoaccumulation index was also computed to infer the soil contamination extent. The results indicate that soil metal levels at each highway are highly dependent on factors like traffic volume, distance to road, other anthropogenic sources of pollution, and their rural or urban location. The highways with greater traffic volume, Linha Vermelha and Avenida Brasil (154,000 and 126,000 vehicles day-1, respectively), clearly presented the highest soil metal concentrations. Still, as stressed by the principal component analysis, traffic volume alone fails to explain the distribution of metals in soils neighboring these highways. Thus, factors like their urban setting and larger exposure to anthropogenic activities may play a pivotal role. On the other hand, soils from Via Dutra and BR-465, both on a rural backdrop, were mostly influenced by traffic as their metal levels decreased with increasing distances from the road. Comparison with reference and preventive values for Brazilian soils and the assessment of the geoaccumulation index have shown that concentrations of Pb and V have reached concerning thresholds at Linha Vermelha and Avenida Brasil.

Testing the Dutilleul syndrome: host use drives the convergent evolution of multiple traits in parasitic wasps.

Common life-history aspects among independent lineages often result in the repeated evolution of suites of adaptive traits, or 'syndromes'. Such syndromes can be key avenues to understand relationships between morphological and ecological traits, but are rarely tested due to insufficient trait shift repetitions. We use a hyperdiverse lineage to investigate the evolution of a syndrome. Cryptine ichneumonid wasps that parasitize insects concealed in hard substrates display several traits that are putative adaptations to that end. Using a phylogenetic framework from a combined multigene molecular and morphological data set with 308 cryptine species, we tested whether these traits were part of a morphofunctional syndrome related to host use. Ancestral state estimations show multiple origins for six investigated traits, which are correlated to each other and to the use of deeply concealed hosts, suggesting adaptation. Putatively adaptive traits showed a much stronger link among themselves than with an assemblage of 49 other morphological traits. However, estimation of the order of evolution in adaptive traits showed no structured pattern. The results indicate that the challenge of attacking deeply concealed hosts induced the repeated evolution of a 'Dutilleul syndrome', named after the 'walker-through-walls' character from French literature. They also point towards a dynamic scenario in the evolution of complex functional systems. These findings highlight the power of morphology to illuminate poorly known aspects of natural history, and how hyperdiverse lineages can be used to understand the evolution of complex traits.

Using species-specific enriched stable isotopes to study the effect of fresh mercury inputs in soil-earthworm systems.

The fate of mercury (Hg) in the soil-earthworm system is still far from being fully understood, especially regarding recurrent and challenging questions about the importance of the reactivity of exogenous Hg species. Thus, to predict the potential effect of Hg inputs in terrestrial ecosystems, it is necessary to evaluate separately the reactivity of the endogenous and exogenous Hg species and, for this purpose, the use of enriched stable isotope tracers is a promising tool. In the present work, earthworms (Lumbricus terrestris) were exposed to historically Hg contaminated soils from the Almadén mining district, Spain. The soils were either non-spiked, which contain only endogenous or native Hg naturally occurring in the soil, or spiked with isotopically enriched inorganic Hg (199IHg), representing exogenous or spiked Hg apart from the native one. The differential reactivity of endogenous and exogenous Hg in the soil conditioned the processes of methylation, mobilization, and assimilation of inorganic Hg by earthworms. Both endogenous and exogenous Hg species also behave distinctly regarding their bioaccumulation in earthworms, as suggested by the bioaccumulation factors, being the endogenous methylmercury (MeHg) the species more readily bioaccumulated by earthworms and in a higher extent. To the best of our knowledge, this work demonstrates for the first time the potential of enriched stable isotopes to study the effects of fresh Hg inputs in soil-earthworm systems. The findings of this work can be taken as a case study on the dynamics of Hg species in complex terrestrial systems and open a new door for future experiments.

Coal emissions adverse human health effects associated with ultrafine/nano-particles role and resultant engineering controls.

There are multiple elements which enable coal geochemistry: (1) boiler and pollution control system design parameters, (2) temperature of flue gas at collection point, (3) feed coal and also other fuels like petroleum coke, tires and biomass geochemistry and (4) fuel feed particle size distribution homogeneity distribution, maintenance of pulverisers, etc. Even though there is a large number of hazardous element pollutants in the coal-processing industry, investigations on micrometer and nanometer-sized particles including their aqueous colloids formation reactions and their behaviour entering the environment are relatively few in numbers. X-ray diffraction (XRD), High Resolution-Transmission Electron microscopy (HR-TEM)/ (Energy Dispersive Spectroscopy) EDS/ (selected-area diffraction pattern) SAED, Field Emission-Scanning Electron Microscopy (FE-SEM)/EDS and granulometric distribution analysis were used as an integrated characterization techniques tool box to determine both geochemistry and nanomineralogy for coal fly ashes (CFAs) from Brazil´s largest coal power plant. Ultrafine/nano-particles size distribution from coal combustion emissions was estimated during the tests. In addition the iron and silicon content was determined as 54.6% of the total 390 different particles observed by electron bean, results aimed that these two particles represent major minerals in the environment particles normally. These data may help in future investigations to asses human health actions related with nano-particles.

Introduction and prolonged circulation of G12 rotaviruses in Sicily.

Genotype G12 strains are now considered to be the sixth most prevalent human rotaviruses worldwide. In two Sicilian cities, Palermo and Messina, surveillance of rotavirus circulation performed since 1985 and 2009, respectively, did not detect G12 strains until 2012. From 2012 to 2014 rotavirus infection was detected in 29·7% of 1647 stool samples collected from children admitted for acute gastroenteritis to three Sicilian hospitals in Palermo, Messina and Ragusa. In 2012, G12P[8] was first detected in Palermo and then in Messina where it represented the second most frequent genotype (20% prevalence) after G1P[8]. Thereafter, G12 strains continued to circulate in Sicily, showing a marked prevalence in Ragusa (27·8%) in 2013 and in Palermo (21%) and Messina (16·6%) in 2014. All but one of the Sicilian G12 strains carried a P[8] VP4 genotype, whereas the single non-P[8] rotavirus strain was genotyped as G12P[9]. Phylogenetic analysis of the VP7 and VP4 sequences allowed distinction of several genetic lineages and separation of the G12P[8] strains into three cluster combinations. These findings indicate independent introductions of G12 rotavirus strains in Sicily in recent years.

Changes in macular layers in the early course of non-arteritic ischaemic optic neuropathy.

PURPOSE: To characterise the changes of the retinal layers in patients with acute anterior ischaemic optic neuropathy (AION), aiming to identify imaging markers for predicting the residual visual function. METHODS: This was a retrospective review of consecutive patients with unilateral AION from January 2010 to December 2013. We analysed affected eyes at baseline and 1 month later, compared to fellow healthy eyes. Utilising novel image analysis software, we conducted algorithmic segmentation in layers and division in early treatment of diabetic retinopathy study (ETDRS) quadrants of optical coherence tomography images of the macula. Pearson product moment regression analysis of retinal layer thickness and best corrected visual acuity (BCVA) in logMAR units and mean deviation of the SITA 24-2 visual field (VF) were carried out at the 1-month time point. RESULTS: Twenty eyes from 20 patients were included and compared to 20 healthy fellow eyes. At baseline, we found a significantly increased mean thickness of the retinal nerve fibre layer (RNFL) of 42.2 µm (±6.7SD) in AION eyes compared to 37.9 µm (±4.2 SD) in healthy eyes (p = 0.002). The outer nuclear layer (ONL) was also significantly thickened at 96.6 µm (±7.2 SD) compared to 90.8 µm (±5.7 SD) in the fellow eye (p < 0.001). After 1 month, the RNFL and the ganglion cell layer (GCL) were thinned 17.7 % [to 31.2 µm (±6.4 SD), p < 0.001] and 19.3 % [to 66.5 µm (±7.0 SD), p < 0.001] compared to the contralateral eye. Additionally, the ONL remained thickened at 96.7 µm (±7.0 SD, p < 0.001). At baseline, we found a significant correlation between the ONL thickness and the VF (r = -0.482, p = 0.005) and the BCVA at discharge (r = 0.552, p < 0.001), indicating that a thicker ONL correlates with poorer visual function. The GCL thickness also correlates with the BCVA at discharge (r = 0.411, p = 0.02), where a thinner GCL predicts worse BCVA. At the 1-month time point, the GCL thinning was correlated with both the VF (r = 0.471, p = 0.005) and the BCVA (r = -0.456, p = 0.007), indicating worse visual function. CONCLUSIONS: Changes in the thickness of different layers of the retina occur early in the course of AION and evolve over time, resulting in the atrophy of the GCL and RNFL. ONL thickening at baseline is associated with visual dysfunction. Thinning of the GCL after 1 month correlates with poorer VF and BCVA at 1 month after acute AION.

Phylogeny and historical biogeography of the paper wasp genus Polistes (Hymenoptera: Vespidae): implications for the overwintering hypothesis of social evolution.

The phylogeny of the paper wasp genus Polistes is investigated using morphological and behavioural characters, as well as molecular data from six genes (COI, 12S, 16S, 28S, H3, and EF1-α). The results are used to investigate the following evolutionary hypotheses about the genus: (i) that Polistes first evolved in Southeast Asia, (ii) that dispersal to the New World occurred only once, and (iii) that long-term monogyny evolved as an adaptation to overwintering in a temperate climate. Optimization of distribution records on the recovered tree does not allow unambiguous reconstruction of the ancestral area of Polistes. While the results indicate that Polistes dispersed into the New World from Asia, South America is recovered as the ancestral area for all New World Polistes: Nearctic species groups evolved multiple times from this South American stock. The final tree topology suggests strongly that the genus first arose in a tropical environment, refuting the idea of monogyny as an overwintering adaptation.

SIMIFF study: Italian fungal registry of mold infections in hematological and non-hematological patients.

PURPOSE: We compared the risk factors, the diagnostic tools and the outcome of filamentous fungal infections (FFIs) in hematological patients (HAEs) and non-hematological patients (non-HAEs). METHODS: Prospective surveillance (2009-2011) of proven and probable FFIs was implemented in 23 Italian hospitals. RESULTS: Out of 232 FFIs, 113 occurred in HAEs and 119 in non-HAEs. The most frequent infection was invasive aspergillosis (76.1 % for HAEs, 56.3 % for non-HAEs), and the localization was principally pulmonary (83.2 % for HAEs, 74.8 % for non-HAEs). Neutropenia was a risk factor for 89.4 % HAEs; the main underlying condition was corticosteroid treatment (52.9 %) for non-HAEs. The distribution of proven and probable FFIs was different in the two groups: proven FFIs occurred more frequently in non-HAEs, whereas probable FFIs were correlated with the HAEs. The sensitivity of the galactomannan assay was higher for HAEs than for non-HAEs (95.3 vs. 48.1 %). The overall mortality rate was 44.2 % among the HAEs and 35.3 % among the non-HAEs. The etiology influenced the patient outcomes: mucormycosis was associated with a high mortality rate (57.1 % for HAEs, 77.8 % for non-HAEs). CONCLUSIONS: The epidemiological and clinical data for FFIs were not identical in the HAEs and non-HAEs. The differences should be considered to improve the management of FFIs according to the patients' setting.

Multidisciplinary management of multiple sclerosis symptoms.

BACKGROUND: Effective management of multisymptomatic chronic diseases such as multiple sclerosis (MS) requires a multimodal, interdisciplinary approach. At MS clinics, numerous healthcare specialties are coordinated to provide patients with quality clinical care for all aspects of their disease. Settings and resource availability may vary between countries. Four specific specialty services from different EU countries are examined in more detail. SUMMARY: The multidisciplinary neurorehabilitation team in Rennes, France, provides specialized consultations (e.g. spasticity, urodynamic unit, devices), inpatient and outpatient intensive rehabilitation programs and therapeutic education. Management approaches are based on a patient's level of impairment as assessed by the Expanded Disability Status Scale. In Girona, Spain, neuropsychologists perform assessments as part of the neurological protocol for all patients with MS. Depending on the level of impairment and patients' characteristics (e.g. working or not working), cognitive deficits may be treated at home or at a neurorehabilitation center. In Barcelona, Spain, neuro-ophthalmologists are involved in the differential diagnosis and follow-up care of MS patients with visual disturbances; particular attention is given to patients' vision-related quality of life. Pain specialists at the Marianne Strauß Klinik in Berg, Germany, have developed a system for classifying MS pain syndromes and differentiating MS-related pain from non MS-related pain. Chronic pain management involves numerous disciplines and requires active engagement by patients in developing treatment plans. Key Messages: MS affects several body systems and patients invariably require specialized interdisciplinary support. Insight into services provided by various specialties and their fit within multidisciplinary care models at MS centers may facilitate the design or refinement of care models in other locations.