Vedolizumab and ART in recent HIV-1 infection unveil the role of α4ß7 in reservoir size.

We evaluated the safety and viral rebound, after analytical treatment interruption (ATI), of vedolizumab and ART in recent HIV-1 infection. We used this model to analyze the impact of α4ß7 on the HIV-1 reservoir size. Participants started ART with monthly Vedolizumab infusions and ATI was performed at week 24. Biopsies were obtained from ileum and caecum at baseline and week 24. Vedolizumab levels, HIV-1 reservoir, flow cytometry and cell-sorting and antibody competition experiments were assayed. Vedolizumab was safe and well-tolerated. No participant achieved undetectable viremia off ART 24 weeks after ATI. Only a modest effect on the time to achieve >1000 HIV-RNA copies/mL and the proportion of participants off ART was observed, being higher compared to historical controls. Just before ATI, α4ß7 expression was associated with HIV-1 DNA and RNA in peripheral blood and with PD1 and TIGIT levels. Importantly, a complete blocking of α4ß7 was observed on peripheral CD4+ T-cells but not in gut (ileum and caecum), where α4ß7 blockade and vedolizumab levels were inversely associated with HIV-1 DNA. Our findings support α4ß7 as an important determinant in HIV-1 reservoir size, suggesting the complete α4ß7 blockade in tissue as a promising tool for HIV-cure combination strategies.

Surgical ciliated cyst of the maxilla after orthognathic surgery: A case report.

Surgical ciliated cysts are rare benign cystic lesions that generally occur a number of years after invasive surgical procedures or trauma involving the maxilla. The appearance of this cyst after orthognathic surgery is a complication that has rarely been reported. It usually shows as a well-defined radiolucency in the maxilla in young adults mimicking other maxillary cysts. Therefore, an exhaustive clinical-radiological diagnosis is needed to establish its differential diagnosis and appropriate treatment. The present study describes the case of a surgical ciliated cyst that appeared 20 years after LeFort I orthognathic surgery. Treatment consisted of complete enucleation with primary closure and removal of osteosynthesis material. Histopathological examination confirmed the diagnosis of a maxillary cyst lined with pseudostratified ciliated columnar cells. Clinicians should be aware of this rare type of cyst in patients with a history of maxillary surgery or trauma to establish a differential diagnosis and ensure appropriate management.

Economic Impact of Low Adherence to COPD Management Guidelines in Spain.

OBJECTIVE: The objective of this study was to assess the non-adherence level of Spanish clinical practice to guideline recommendations for the treatment of chronic obstructive pulmonary disease (COPD) and to estimate the potential impact on pharmaceutical expenditure resulting from transitioning current treatment patterns according to guidelines. METHODS: A model was developed to compare current prescribing patterns with two alternative scenarios: the first aligned with the Global Initiative for Chronic Obstructive Lung Disease (GOLD 2020) recommendations, and the second with the Spanish Guidelines for COPD (GesEPOC 2017). Current treatment practice was obtained from publications that describe treatment patterns by pulmonology departments in Spain. The economic impact between patterns was calculated from the perspective of the Spanish National Health System (NHS), considering the annual pharmacological costs of COPD inhaled maintenance therapy. Two additional analyses were performed: one that included current prescribing patterns of patients managed by pulmonology and primary care centers in Spain (published aggregated data); and another that only considered the appropriate use of inhaled corticosteroids (ICS) treatment according to guidelines. RESULTS: It was estimated that 54% and 38% of patients were not treated in line with GOLD and GesEPOC recommendations, respectively, mainly due to a broader use of ICS-based therapies. Adapting treatment to recommendations could provide a potential annual cost-saving of €17,792,022 (according to GOLD) and €5,881,785 (according to GesEPOC). In scenario analysis 1, a 26% of non-adherence to GesEPOC guideline was observed with a potential annual pharmacological cost-saving of €2,707,554. In scenario analysis 2, considering only inappropriate use of ICS treatment, an annual cost-saving of €17,863,750 (according to GOLD) and €9,904,409 (according to GesEPOC) was calculated. CONCLUSION: More than a third of treatments for COPD patients in Spain are not prescribed in accordance with guideline recommendations. The adaptation of clinical practice to guideline recommendations could provide important cost-savings for the Spanish NHS.

First osteohistological and histotaphonomic approach of Equus occidentalis Leidy, 1865 (Mammalia, Equidae) from the late Pleistocene of Rancho La Brea (California, USA).

Rancho La Brea (California, USA) is the most emblematic Quaternary fossiliferous locality in the world, since both the high number and diversity of the specimens recovered and their excellent preservational quality. In the last decades, paleobiological and paleoecological knowledge of the different groups of mammals from this site has increased notably; however, some aspects have not yet been inquired or there is little information. In this work we provide information on one of the most abundant mammals of this site, the equid Equus occidentalis, based on the study, from osteohistological and histotaphonomic perspectives, of thin sections of different limb bones. On the one hand, from an osteohistological viewpoint, we observe that the distribution and characterization of bone tissues in the different skeletal elements are, in general lines, similar to that mentioned for other extant and extinct equids. Cyclical growth marks allowed us to propose preliminary skeletochronological interpretations. On the other hand, from a taphonomic viewpoint, we note that all the samples reflect an excellent preservation of the bone microstructure, slightly altered by different pre- and post-burial processes. The variations recorded evidence different taphonomic history and preservation conditions among pits. This is the first study including fossil material from Rancho La Brea exclusively based on the analysis of the bone microstructure features.

The rise and fall of proboscidean ecological diversity.

Proboscideans were keystone Cenozoic megaherbivores and present a highly relevant case study to frame the timing and magnitude of recent megafauna extinctions against long-term macroevolutionary patterns. By surveying the entire proboscidean fossil history using model-based approaches, we show that the dramatic Miocene explosion of proboscidean functional diversity was triggered by their biogeographical expansion beyond Africa. Ecomorphological innovations drove niche differentiation; communities that accommodated several disparate proboscidean species in sympatry became commonplace. The first burst of extinctions took place in the late Miocene, approximately 7 million years ago (Ma). Importantly, this and subsequent extinction trends showed high ecomorphological selectivity and went hand in hand with palaeoclimate dynamics. The global extirpation of proboscideans began escalating from 3 Ma with further extinctions in Eurasia and then a dramatic increase in African extinctions at 2.4 Ma. Overhunting by humans may have served as a final double jeopardy in the late Pleistocene after climate-triggered extinction trends that began long before hominins evolved suitable hunting capabilities.

Síndrome de Sagliker / Sagliker Syndrome

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Teenager with a Primary Renal Lymphoma: A Case Report.

We report a case of an 18-year-old male patient who was diagnosed with primary renal lymphoma (PRL) through biopsy findings and imaging studies. The patient presented with clinical manifestations of distal renal tubular acidosis including polyuria, polydipsia, lower limb weakness, involuntary weight loss, asthenia and dyspnea. No personal background or relevant medical history was reported. A kidney biopsy showed high grade immature B-cell lymphoproliferative process (Non-Hodgkin's Lymphoma) with a Ki67 value greater than 90%. Complementary studies excluded primary lymphoid migration sites, which confirmed the diagnosis of PRL. The oncology unit initiated treatment with a combination of medications due to lack of protocols for the specific treatment. Besides the fact that this condition is rare, it also shows a unique symptoms presentation and non-typical findings in imaging methods. Also, it is important to underline the fact that the treatment is not yet specified for such type of cancer and different combinations are needed to control the disease.

The Great American Biotic Interchange revisited: a new perspective from the stable isotope record of Argentine Pampas fossil mammals.

This study aims at assessing resource and habitat use, niche occupation and trophic interactions from a stable isotope perspective on fossil mammals from the Argentine Pampas during the Great American Biotic Interchange (GABI). We present stable isotope data of more than 400 samples belonging to 10 mammalian orders and spanning a temporal range from ~9.5 Ma to ~12 ky. Rodents, notoungulates and pilosians record an increase in the consumption of C4 plants, whereas litopterns and cingulates show δ13C values that remain mostly within a C3-dominated diet. Our stable isotope data indicates that the expansion of C4 vegetation opened up new niche opportunities, probably alleviating resource competition among endemic taxa. Gomphothere, equid and camelid δ13C records show a broad variability pointing to consumption of C3 and mixed C3-C4 vegetation. This flexible dietary behavior may have facilitated the successful settlement of immigrant groups in South America. In the case of carnivorous taxa, Late Miocene pre-GABI endemic sparassodonts consumed prey from C3 environments, whereas immigrant carnivorans preferred prey from mixed C3-C4 areas. Our research contributes to the study of the GABI from a different perspective as stable isotope records permit to characterize, from a (semi)quantitative standpoint, ecological traits within extinct fauna.

Extragingival Pregnancy Pyogenic Granuloma on the Lip.

Pregnancy pyogenic granuloma is considered a benign common growth that usually develops on the gingiva in the second and third trimester of gestation, in response to local irritation, trauma or hormonal factors. Here, the authors report a case of a primigravida who presented an extragingival pyogenic granuloma with a rapid progression in the post-partum. The occurrence on the lower lip in the first few days after delivery was a relatively rarity in the present case which provoked a meaningful state of anxiety and cancerophobia to the female. Complete excision was curative and brought immediate relief of pain and discomfort. This clinical report highlights the possibility of pyogenic granuloma presenting like a rapid-growing mass on the lip and the importance of clinical differential diagnosis of such presentation in this atypical location.

Eritema necrolítico migratorio: clave diagnóstica en el síndrome del glucagonoma / Necrolytic migratory erythema: A diagnostic clue in glucagonoma syndrome

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Context-dependent regulation of Th17-associated genes and IFNγ expression by the transcription factor NFAT5.

Stress-activated transcription factors influence T-cell function in different physiopathologic contexts. NFAT5, a relative of nuclear factor κB and the calcineurin-activated NFATc transcription factors, protects mammalian cells from hyperosmotic stress caused by the elevation of extracellular sodium levels. In T cells exposed to hypernatremia, NFAT5 not only induces osmoprotective gene products but also cytokines and immune receptors, which raises the question of whether this factor could regulate other T-cell functions in osmostress-independent contexts. Here we have used mice with a conditional deletion of Nfat5 in mature T lymphocytes to explore osmostress-dependent and -independent functions of this factor. In vitro experiments with CD4 T cells stimulated in hyperosmotic medium showed that NFAT5 enhanced the expression of IL-2 and the Th17-associated gene products RORγt and IL-23R. By contrast, NFAT5-deficient CD4 T cells activated in vivo by anti-CD3 antibody exhibited a different activation profile and were skewed towards enhanced interferon γ (IFNγ) and IL-17 expression and attenuated Treg responses. Using a model of experimental colitis, we observed that mice lacking NFAT5 in T cells exhibited exacerbated intestinal colitis and enhanced expression of IFNγ in draining lymph nodes and colon. These results show that NFAT5 can modulate different T-cell responses depending on stress conditions and stimulatory context.

Mitochondrial genomes reveal the extinct Hippidion as an outgroup to all living equids.

Hippidions were equids with very distinctive anatomical features. They lived in South America 2.5 million years ago (Ma) until their extinction approximately 10 000 years ago. The evolutionary origin of the three known Hippidion morphospecies is still disputed. Based on palaeontological data, Hippidion could have diverged from the lineage leading to modern equids before 10 Ma. In contrast, a much later divergence date, with Hippidion nesting within modern equids, was indicated by partial ancient mitochondrial DNA sequences. Here, we characterized eight Hippidion complete mitochondrial genomes at 3.4-386.3-fold coverage using target-enrichment capture and next-generation sequencing. Our dataset reveals that the two morphospecies sequenced (H. saldiasi and H. principale) formed a monophyletic clade, basal to extant and extinct Equus lineages. This contrasts with previous genetic analyses and supports Hippidion as a distinct genus, in agreement with palaeontological models. We date the Hippidion split from Equus at 5.6-6.5 Ma, suggesting an early divergence in North America prior to the colonization of South America, after the formation of the Panamanian Isthmus 3.5 Ma and the Great American Biotic Interchange.

Global evolution of Equidae and Gomphotheriidae from South America.

The contemporary South American mammalian communities were determined by the emergence of the Isthmus of Panama and by the profound climatic oscillations during the Pleistocene. Horses and gomphotheres were 2 very conspicuous groups of immigrant mammals from North America that arrived in South America during the Pleistocene. The present study compiles updated data on the phylogeny, systematics and ecology of both groups in South America. The horses in South America are represented by 2 genera, Hippidion and Equus, as are the gomphotheres, represented by Cuvieronius and Stegomastodon. Both genera of horses include small (Hippidion devillei, H. saldiasi, E. andium and E. insulatus) and large forms (Equus neogeus and H. principale), which dispersed into South America using 2 different routes. The possible model for this dispersion indicates that the small forms used the Andes corridor, while larger horses dispersed through the eastern route and through some coastal areas. In the case of gomphotheres, Cuvieronius and Stegomastodon reached South America in 2 independent dispersal events, and Cuvieronius dispersed across the Andean corridor, while large Stegomastodon spread along the eastern route. Horses and gomphotheres present values of δ(13) C from woodlands to C4 grasslands. Hippidion present lower values of δ(13) C than Equus in the late Pleistocene, whereas the gomphotheres diverge from value of δ(18) O, reflecting that Cuvieronius inhabited the Andean corridor and Stegomastodon dispersed through eastern plains. The gomphothere and horse species recorded in South America became extinct around the time that humans arrived.

Life-history traits of the Miocene Hipparion concudense (Spain) inferred from bone histological structure.

Histological analyses of fossil bones have provided clues on the growth patterns and life history traits of several extinct vertebrates that would be unavailable for classical morphological studies. We analyzed the bone histology of Hipparion to infer features of its life history traits and growth pattern. Microscope analysis of thin sections of a large sample of humeri, femora, tibiae and metapodials of Hipparion concudense from the upper Miocene site of Los Valles de Fuentidueña (Segovia, Spain) has shown that the number of growth marks is similar among the different limb bones, suggesting that equivalent skeletochronological inferences for this Hipparion population might be achieved by means of any of the elements studied. Considering their abundance, we conducted a skeletechronological study based on the large sample of third metapodials from Los Valles de Fuentidueña together with another large sample from the Upper Miocene locality of Concud (Teruel, Spain). The data obtained enabled us to distinguish four age groups in both samples and to determine that Hipparion concudense tended to reach skeletal maturity during its third year of life. Integration of bone microstructure and skeletochronological data allowed us to identify ontogenetic changes in bone structure and growth rate and to distinguish three histologic ontogenetic stages corresponding to immature, subadult and adult individuals. Data on secondary osteon density revealed an increase in bone remodeling throughout the ontogenetic stages and a lesser degree thereof in the Concud population, which indicates different biomechanical stresses in the two populations, likely due to environmental differences. Several individuals showed atypical growth patterns in the Concud sample, which may also reflect environmental differences between the two localities. Finally, classification of the specimens' age within groups enabled us to characterize the age structure of both samples, which is typical of attritional assemblages.