MedTech Forum 2021 (April 20-22, 2021 - Virtual Meeting).

The MedTech Forum 2021 was an online event at which participants from the field of medical devices, diagnostics and digital health openly shared their views on the latest trends, challenges and opportunities currently being faced. The event enticed representatives from around 30 companies from the healthcare sector, as well as those from competent authorities, notified bodies, healthcare providers, academia and patients. Parallel sessions distributed across 3 days enabled the audience to interact with the speakers through a live-chat platform. Various sessions covering health data space, digitalization and interoperability were held in a forum and were a highlight of the meeting due to the potential of health data for the improvement of patient management and healthcare systems. Hot topics included the imminent application of the Medical Device Regulation (MDR) in May 2021 and the application of the In Vitro Diagnostic Device Regulation (IVDR) by May 2022. European competitiveness in the healthcare sector, learnings from the COVID-19 crisis and how to make legislation more friendly with innovations were also topics widely discussed during the event. This report provides a summary of sessions on health digitalization, the application of the new European regulations and lessons learnt from COVID-19.

Parasitic egg rejection decisions of chalk-browed mockingbirds Mimus saturninus are independent of clutch composition.

Obligate avian brood parasites lay their eggs in nests of other host species, which assume all the costs of parental care for the foreign eggs and chicks. The most common defensive response to parasitism is the rejection of foreign eggs by hosts. Different cognitive mechanisms and decision-making rules may guide both egg recognition and rejection behaviors. Classical optimization models generally assume that decisions are based on the absolute properties of the options (i.e., absolute valuation). Increasing evidence shows instead that hosts' rejection decisions also depend on the context in which options are presented (i.e., context-dependent valuation). Here we study whether the chalk-browed mockingbird's (Mimus saturninus) rejection of parasitic shiny cowbird (Molothrus bonariensis) eggs is a fixed behavior or varies with the context of the clutch. We tested three possible context-dependent mechanisms: (1) range effect, (2) habituation to variation, and (3) sensitization to variation. We found that mockingbird rejection of parasitic eggs does not change according to the characteristics of the other eggs in the nest. Thus, rejection decisions may exclusively depend on the objective characteristics of the eggs, meaning that the threshold of acceptance or rejection of a foreign egg is context-independent in this system.

Host switching in cowbird brood parasites: how often does it occur?

Avian obligate brood parasites lay their eggs in nests of host species, which provide all parental care. Brood parasites may be host specialists, if they use one or a few host species, or host generalists, if they parasitize many hosts. Within the latter, strains of host-specific females might coexist. Although females preferentially parasitize one host, they may occasionally successfully parasitize the nest of another species. These host switching events allow the colonization of new hosts and the expansion of brood parasites into new areas. In this study, we analyse host switching in two parasitic cowbirds, the specialist screaming cowbird (Molothrus rufoaxillaris) and the generalist shiny cowbird (M. bonariensis), and compare the frequency of host switches between these species with different parasitism strategies. Contrary to expected, host switches did not occur more frequently in the generalist than in the specialist brood parasite. We also found that migration between hosts was asymmetrical in most cases and host switches towards one host were more recurrent than backwards, thus differing among hosts within the same species. This might depend on a combination of factors including the rate at which females lay eggs in nests of alternative hosts, fledging success of the chicks in this new host and their subsequent success in parasitizing it.

“Comparación de técnicas de laboratorio para el diagnóstico de Giardia intestinalis” / “Comparison of Laboratory Techniques For the Diagnosis of Giardia Intestinalis”

Evaluar la sensibilidad y especificidad de tres técnicas de laboratorio para el diagnóstico de Giardia intestinalis. Materiales y Métodos: 31 muestras de heces provenientes de niños en edad preescolar, se procesaron a través del examen microscópico con SSF-lugol, método de concentración de Ritchie y método inmunológico “Giardia-Strip”. La Técnica de Ritchie fue considerada como “Gold Standard”. Resultados: Se identificaron quistes de Giardia intestinalis en 6 muestras (19,35%) a través de la técnica de Ritchie. La técnica del examen al fresco identificó en 5 de ellas quistes del protozoario (16,1%), mostrando una sensibilidad de 83% y especificidad del 100%. La técnica Giardia-Strip identificó quistes en 4 muestras (12,9%) con sensibilidad de 66,66% y especificidad del 100%. El valor predictivo positivo para el método de “Giardia-Strip” fue 14% y valor predictivo negativo de 93%. El examen al fresco mostró valor predictivo positivo del 100% y valor predictivo negativo de 96%. Conclusiones: El concentrado de Ritchie y el examen al fresco mostraron mayor sensibilidad y especificidad en el diagnóstico de Giardia intestinalis, cuando las muestras contienen solo quistes. Sin embargo, el método Giardia-Strip, demostró mayor rapidez en la obtención de los resultados.

Objective: To evaluate the sensitivity and specificity of three laboratory techniques for the diagnosis of Giardia intestinalis. Materials and Methods: 31 fecal samples from preschoolers were submitted to microscopic examination with SSF-Lugol, the Ritchie concentration method and the “Giardia-Strip” immunological method. The Ritchie technique was considered the “gold standard.“ Results: G. intestinalis cysts were identified in 6 samples (19.35%) using the Ritchie technique. The fresh test identified 5 cases of protozoan cysts (16.1%), showing a sensitivity of 83 % and specificity of 100 %. The Giardia-Strip identified cysts in 4 samples (12.9%) with 66.66 % sensitivity and 100% specificity. The positive predictive value for the “Giardia Strip” method was 14% and the negative predictive value was 93%. The fresh test showed a positive predictive value of 100% and a negative predictive value of 96 %. Conclusions: Ritchie concentrate and the fresh test showed higher sensitivity and specificity in the diagnosis of Giardia intestinalis, when samples contain only cysts. However, the Giardia-Strip method proved faster in obtaining results.

Impaired autophagic flux is associated with increased endoplasmic reticulum stress during the development of NAFLD.

The pathogenic mechanisms underlying the progression of non-alcoholic fatty liver disease (NAFLD) are not fully understood. In this study, we aimed to assess the relationship between endoplasmic reticulum (ER) stress and autophagy in human and mouse hepatocytes during NAFLD. ER stress and autophagy markers were analyzed in livers from patients with biopsy-proven non-alcoholic steatosis (NAS) or non-alcoholic steatohepatitis (NASH) compared with livers from subjects with histologically normal liver, in livers from mice fed with chow diet (CHD) compared with mice fed with high fat diet (HFD) or methionine-choline-deficient (MCD) diet and in primary and Huh7 human hepatocytes loaded with palmitic acid (PA). In NASH patients, significant increases in hepatic messenger RNA levels of markers of ER stress (activating transcription factor 4 (ATF4), glucose-regulated protein 78 (GRP78) and C/EBP homologous protein (CHOP)) and autophagy (BCN1) were found compared with NAS patients. Likewise, protein levels of GRP78, CHOP and p62/SQSTM1 (p62) autophagic substrate were significantly elevated in NASH compared with NAS patients. In livers from mice fed with HFD or MCD, ER stress-mediated signaling was parallel to the blockade of the autophagic flux assessed by increases in p62, microtubule-associated protein 2 light chain 3 (LC3-II)/LC3-I ratio and accumulation of autophagosomes compared with CHD fed mice. In Huh7 hepatic cells, treatment with PA for 8 h triggered activation of both unfolding protein response and the autophagic flux. Conversely, prolonged treatment with PA (24 h) induced ER stress and cell death together with a blockade of the autophagic flux. Under these conditions, cotreatment with rapamycin or CHOP silencing ameliorated these effects and decreased apoptosis. Our results demonstrated that the autophagic flux is impaired in the liver from both NAFLD patients and murine models of NAFLD, as well as in lipid-overloaded human hepatocytes, and it could be due to elevated ER stress leading to apoptosis. Consequently, therapies aimed to restore the autophagic flux might attenuate or prevent the progression of NAFLD.

Different recognition cues reveal the decision rules used for egg rejection by hosts of a variably mimetic avian brood parasite.

Brood parasitism imposes several fitness costs on the host species. To reduce these costs, hosts of avian brood parasites have evolved various defenses, of which egg rejection is the most prevalent. In the face of variable host-parasite mimicry and the costs of egg discrimination itself, many hosts reject only some foreign eggs. Here, we experimentally varied the recognition cues to study the underlying cognitive mechanisms used by the Chalk-browed Mockingbird (Mimus saturninus) to reject the white immaculate eggs laid by the parasitic Shiny Cowbird (Molothrus bonariensis). Immaculate eggs are the only parasite eggs rejected by this host, as it accepts all polymorphic, spotted eggs laid by cowbirds. Using a within-breeding pair experimental design, we tested for the salience of spotting, UV reflectance, and brightness in eliciting rejection. We found that the presence of spotting significantly decreased the probability of rejection while increments in brightness significantly increased rejection frequencies. The cognitive rules underlying mockingbird rejection behavior can be explained by a decision-making model which predicts changes in the levels of rejection in direct relation to the number of relevant attributes shared between host and parasite eggs.

Sustained remission of SAPHO syndrome with pamidronate: a follow-up of fourteen cases and a review of the literature.

OBJECTIVE: To evaluate the efficacy of intravenous (i.v.) pamidronate in patients with SAPHO syndrome refractory to first line treatments and to review the available literature on pamidronate for this indication. METHODS: We report 14 cases of SAPHO syndrome refractory to non-steroideal anti-inflammatory drugs (NSAIDs), glucocorticoids and disease modifying anti-rheumatic drugs (DMARDs) treated with i.v. pamidronate. All patients received i.v. 60 mg pamidronate/day for 3 consecutive days. The primary evaluation criterion was the disappearance of bone pain, considered as the reduction in the visual analogic scale for pain (VAS) greater than 50%. RESULTS: Ten patients were females and 4 were males. The mean age at onset was 40.4 years old. Ten patients presented a relapsing-remitting course, while in 4 cases the disease followed a prolonged course. In all cases anterior chest wall involvement occurred early in the disease. In 2 cases there was also a peripheral monoarthritis. Eleven patients experienced several flares of palmo-plantar pustulosis, while severe acne was present in 2. In one case there was no cutaneous involvement. Twelve of the 14 patients had a good response after 3 infusions and in 8 of these patients a sustained remission was observed. The recurrence of skin manifestations does not seem to be influenced by pamidronate. CONCLUSIONS: Pamidronate appears to be an effective treatment in the osteo-articular manifestations of SAPHO syndrome. As far as cutaneous lesions are concerned, evidence of efficacy is not so impressive.

Combination treatment with etanercept and an intensive spa rehabilitation program in active ankylosing spondylitis.

The aim of this study is to determine the effects of a combination treatment with etanercept and spa rehabilitation versus etanercept alone on function, disability and quality of life in a group of patients with active ankylosing spondylitis (AS). Sixty patients with AS underwent etanercept as suggested by ASAS/EULAR recommendations. As the clinical and laboratory conditions improved, 30 patients accepted the proposal of coupling the medical therapy with a 7-day rehabilitation program in a thermal baths centre; the remaining 30 subjects continued to take the biologic agent alone. The comparisons between the 2 groups were made after 3 and 6 months. The primary outcome was an improvement in BASFI. The secondary outcome was an improvement in the visual analogic scale of EuroQol (EQ-5Dvas). After 6 months a statistically significant improvement in BASFI (p < 0.05) and EQ-5DVAS (p < 0.05) scores was observed in both groups. The mean change in EQ-5DVAS value showed a statistically significant difference in favour of the combination therapy group versus the monotherapy group (22 vs 32, p < 0.05). A therapeutic regimen combining etanercept with an intensive rehabilitation program contributes to disability reduction and ameliorates quality of life for AS patients.

Endoglina: estructura, funciones biológicas y papel en la fibrogénesis / No disponible

No disponible

Propionibacterium acnes and SAPHO syndrome: a case report and literature review.

OBJECTIVE: To describe the presence of Propionibacterium acnes (P. acnes) in a series of patients with SAPHO syndrome in which a bone biopsy has been carried out and to discuss the results comparing them to the data described in the literature. METHODS: In 6 out of 56 patients with SAPHO syndrome, a bone biopsy from osteitic lesion was carried out. This invasive investigation was performed only in those cases in which it was necessary to clarify the diagnosis. RESULTS: Of the 6 biopsies processed, P. acnes was isolated in only one case. No other infectious agents were identified. CONCLUSION: P. acnes is not often found in bone lesions of SAPHO syndrome. A bone biopsy may represent a procedure useful for corroborating the diagnosis or for excluding other diseases only in specific cases.

[Diffuse idiopathic skeletal hyperostosis (D.I.S.H.)]. / La iperostosi scheletrica idiopatica diffusa (D.I.S.H.).

Diffuse idiopathic skeletal hyperostosis (D.I.S.H.) is a common disorder of unknown aetiology characterized by exuberant hyperostosis of the antero-lateral aspect of the spinal column, that sometimes leads to bone ankilosis, and by ossification of extra-spinal entheses. This condition is often associated with the metabolic derangement of type 2 diabetes. Primary hypertension, its cardiovascular aftereffects and lithiasis are also often present in these patients. D.I.S.H. has to be distinguished from osteoarthritis, although they often coexist in the same patient. The mean difference lies in the anatomical target of the pathological process, that is represented by articular cartilage in osteoarthritis and by entheses in diffuse idiopathic skeletal hyperostosis. The enthesopathy leads to the ossification of the anterior longitudinal ligament of the spine and causes the formation of flowing osteophytes, while intervertebral disc space is quite preserved in early phases of the disease. Symptoms of spine involvement are not typical of the disease and consist of pain and stiffness, usually worsened by inaction and damp. It has also been described the ossification of posterior longitudinal ligament which can lead to medullary canal stenosis. Appendicular skeleton is symmetrically involved in early phases of the disease, the most distinctive affected sites being feet, olecranus and patella. Hip involvement is also frequent and may lead to severe disability and represents an important cause of invalidity. The purpose of the present review is to remark on aetiopathogenetic and clinical aspects of diffuse idiopathic skeletal hyperostosis.

DNA deposition through laser induced forward transfer.

Laser induced forward transfer (LIFT) is a laser direct write technique that appears to be specially adequate for the production of biosensors, since it permits to deposit patterns of biomolecules with high spatial resolution. In the LIFT technique, a laser pulse is focused on a thin film of the material to be transferred through a transparent support, and under the action of the laser pulse, a small fraction of the film is transferred to a receptor substrate that is placed parallel to the film-support system. In the case of biomolecules transfer, the thin film consists in a liquid solution containing the biomolecules. In this work, microarrays of two different cDNAs have been both spotted by LIFT and pin microspotting onto a poly-L-lysine treated glass slide. Once transferred, all the microarrays have been submitted to hybridization with the complementary strands of the spotted cDNAs, each one tagged with a different fluorochrome. Comparative fluorescence scanner analyses have revealed that the microarrays transferred through LIFT are equivalent to those transferred through pin microspotting in terms of signal intensity and gene discrimination capacity, and that the action of the laser pulse does not result in significant damage of the transferred DNA.

[Secretory otitis media of unconventional course]. / Otitis serosa, una evolución inusual.

Case report of a secretory otitia of sluggish unfolding that put forward serious diagnostic difficulties resulting, at last, to be an otic tuberculousis. Review and discussion on bibliography on otic tuberculousis, its presentation forms, diagnosis difficulties, complications and management.

Spectroscopic characterization of the uptake of essential and xenobiotic metal cations in cells of the soil bacterium Azospirillum brasilense.

The results of flame (FAAS) or graphite furnace atomic absorption spectrometric (GFAAS) analyses are presented and discussed on the accumulation of essential metals (Mg, Ca, Mn and Fe contained in the cultivation medium) and traces of each one of the conventionally xenobiotic elements from the group V, Co, Ni, Cu, Zn or Pb, added to the medium in concentrations (0.2 mM) which do not essentially suppress growth of the bacterial culture, in cells of the plant root-associated nitrogen-fixing bacterium Azospirillum brasilense. Along with the essential cations assimilated by the bacterium, Zn and Cu were found to effectively accumulate in the biomass from the environment. The uptake of Co and Ni was significantly less pronounced, whereas Pb and V appeared to be present in cells in much lower concentrations than in the cultivation medium evidently showing no tendency to be assimilated by azospirilla. The effect of the above xenobiotics on the uptake level of the four essential elements provided evidence that they may compete for the formation of biologically active complexes with substances of both intracellular and extracellular localization. The analytical data obtained are compared with Fourier transform infrared (FTIR) spectra of intact vacuum-dried bacterial cells grown in a standard medium and under the conditions of an increased metal uptake.

Mercury determination by CV-AAS in wastewater and sewage sludge from a stabilization pond system.

The mercury concentrations in wastewater and sewage sludge of a stabilization pond system have been evaluated. The system is built by three parallel facultative ponds followed by two systems of three maturation ponds in series. The samples of wastewater and sludge were digested using nitric acid and placed into a Parr-type bomb for 4 h at 110 degrees C. Mercury was measured by Cold Vapour Atomic Absorption Spectrometry (CV-AAS) at 253.7 nm with sodium tetrahydroborate as reductant. The methodologies were checked with an USEPA quality control sample, a standard reference material from NIST and with another method of mineralization (cold mineralization) showing good results. Concentrations of mercury in wastewater between 1.47 +/- 0.75 microgl(-1) have been found at the entrance of the system and 0.74 +/- 0.0 microgl(-1) at the exit, while in sludge the results were between 0.29 +/- 0.12 microgkg(-1) in the facultative pond and 0.04 +/- 0.02 microgkg(-1) in the second maturation pond (exit).