Skin lesions by Scedosporium apiospermum and Nocardia pulmonary infection in an oncologic patient: a case report.

BACKGROUND: Fungal infections, other than candidiasis and aspergillosis, are an uncommon entity. Despite this, emerging pathogens are a growing threat. In the following case report, we present the case of an immunocompromised patient suffering from two serious opportunistic infections in the same episode: the first of these, Nocardia multilobar pneumonia; and the second, skin infection by Scedosporium apiospermum. These required prolonged antibacterial and antifungal treatment. CASE PRESENTATION: This case is a 71-year-old oncological patient admitted for recurrent pneumonias that was diagnosed for Nocardia pulmonary infection. Nervous system involvement was discarded and cotrimoxazole was started. Haemorrhagic skin ulcers in the lower limbs appeared after two weeks of hospital admission. We collected samples which were positive for Scedosporium apiospermum and we added voriconazole to the treatment. As a local complication, the patient presented a deep bruise that needed debridement. We completed 4 weeks of intravenous treatment with slow improvement and continued with oral treatment until the disappearance of the lesions occurs. CONCLUSIONS: Opportunistic infections are a rising entity as the number of immunocompromised patients is growing due to more use of immunosuppressive therapies and transplants. Clinicians must have a high suspicion to diagnose and treat them. A fluid collaboration with Microbiology is necessary as antimicrobial resistance is frequent.

Caregiver knowledge of obstructive sleep apnoea in Down syndrome.

BACKGROUND: Down syndrome (DS) population has a very high prevalence of obstructive sleep apnoea (OSA), but this remains underdiagnosed. Hence, we aimed to evaluate caregiver's knowledge of OSA and related sociodemographic factors that could contribute to OSA screening patterns in this population. METHODS: An online survey though the LuMind IDSC Foundation focused on OSA diagnosis, treatments and the number of sleep studies performed. Data were compared between subjects born before and after the American Academy of Pediatrics (AAP) recommendations for OSA screening. RESULTS: Of the caregivers, 724 (parents 96.3%), responded to the survey. The median [interquartile (IQR)] age of the subjects with DS was 12 [20;7] years. The majority (84.3%) had sleep apnoea diagnosis, and half of them were initially referred for a sleep study due to disturbed sleep symptoms. Only 58.7% of the responders were aware of the AAP recommendations. This was linked to higher socioeconomic and/or educational level and to an earlier OSA diagnosis. The median (IQR) age of OSA diagnosis was lowered after the AAP guidelines publication compared with before its publication (3 [4;2] years vs. 10 [18;5] years, P < 0.000). Adenotonsillectomy (81.9%) and continuous positive airway pressure (61.5%) were the most commonly prescribed treatments. Few had discussed other new therapies such as hypoglossal nerve stimulation (16.0%). Only 16.0% of the subjects repeated the sleep study to monitor OSA with ageing, and 30.2% had to wait more than 4 years between studies. CONCLUSIONS: This study reinforces the need to improve OSA knowledge of caregivers and clinicians of individuals with DS to promote an earlier diagnosis and optimal treatment of OSA in this population.

The Mars Environmental Dynamics Analyzer, MEDA. A Suite of Environmental Sensors for the Mars 2020 Mission.

NASA's Mars 2020 (M2020) rover mission includes a suite of sensors to monitor current environmental conditions near the surface of Mars and to constrain bulk aerosol properties from changes in atmospheric radiation at the surface. The Mars Environmental Dynamics Analyzer (MEDA) consists of a set of meteorological sensors including wind sensor, a barometer, a relative humidity sensor, a set of 5 thermocouples to measure atmospheric temperature at ∼1.5 m and ∼0.5 m above the surface, a set of thermopiles to characterize the thermal IR brightness temperatures of the surface and the lower atmosphere. MEDA adds a radiation and dust sensor to monitor the optical atmospheric properties that can be used to infer bulk aerosol physical properties such as particle size distribution, non-sphericity, and concentration. The MEDA package and its scientific purpose are described in this document as well as how it responded to the calibration tests and how it helps prepare for the human exploration of Mars. A comparison is also presented to previous environmental monitoring payloads landed on Mars on the Viking, Pathfinder, Phoenix, MSL, and InSight spacecraft.

Grupos de Estudio Dirigido en la educación veterinaria: una propuesta estudiantil para fortalecer la comunicación de los futuros profesionales / Directed Studies Groups in the veterinary education: a proposal to enhance communication in future professionals

De la lectura de solicitudes laborales para cualquier empresa, y en particular las relacionadas con la labor del Médico Veterinario, al mismo nivel que los conocimientos científico-técnicos se solicita que éste posea “espíritu proactivo”, “capacidad de liderazgo” “competencias para trabajar en equipo”, entre otras habilidades sociales importantes. Ya no alcanza con saberes “sabios” ni experiencia “técnica”, hoy se necesitan sujetos hábiles para la comunicación, con confianza en sí mismos y en los demás, solidarios, empáticos con su entorno y capaces de integrarse con éxito a equipos de trabajo. En el currículo oficial de la carrera de Medicina Veterinaria de la Universidad Nacional del Litoral, la habilidad de trabajar en equipo no forma parte de los contenidos específicos que el estudiante debe aprender. Los Grupos de Estudios Dirigidos (GED), son grupos de alumnos de distintos niveles de la carrera, que motivados por un tema en común gestionan tareas de profundización en temáticas específicas, investigación y/o extensión para fortalecerse en esa área. Para ellos aprender a trabajar en equipo implica aprender a comunicarse eficazmente, a ser solidario, a comprometerse con el logro de metas comunes, habilidades que no deben descuidarse y que son fundamentales para hablar de un profesional con una formación integral.

Reading job applications sent to any company and, particularly, those related to the Veterinary profession, it becomes clear that, apart from the required specific technical and scientific expertise, applicants should also have a proactive spirit, leadership abilities and the capacity to work in a team, among other important social skills. Nowadays, it's not enough having "wise" knowledge or "technical" expertise. Subjects should also have the ability to communicate effectively, demonstrate they can rely upon themselves and others, be sympathetic and empathetic and capable of integrating successfully in new work teams. In the official syllabus of the Veterinary Medicine career in Argentina, the ability to work in teams is not part of the specific content that the students have to learn. The Directed Studies Groups (DSG), are groups of students of different levels of the graduate course, that motivated by a common topic embark on tasks to deepen their knowledge on specific subjects, including research and / or extension. For them, learning to work in a team means learning to communicate effectively, to be supportive, to commit to the achievement of common goals, skills that should not be neglected and that are fundamental to speak of a professional with a comprehensive education.

SEOM clinical guideline on unknown primary cancer (2017)

Cancer of unknown primary site is a histologically confirmed cancer that manifests in advanced stage, with no identifiable primary site following standard diagnostic procedures. Patients are initially categorized based on the findings of the initial biopsy: adenocarcinoma, squamous-cell carcinoma, neuroendocrine carcinoma, and poorly differentiated carcinoma. Appropriate patient management requires understanding several clinical and pathological features that aid in identifying several subsets of patients with more responsive tumors (AU)

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SEOM clinical guideline on unknown primary cancer (2017).

Cancer of unknown primary site is a histologically confirmed cancer that manifests in advanced stage, with no identifiable primary site following standard diagnostic procedures. Patients are initially categorized based on the findings of the initial biopsy: adenocarcinoma, squamous-cell carcinoma, neuroendocrine carcinoma, and poorly differentiated carcinoma. Appropriate patient management requires understanding several clinical and pathological features that aid in identifying several subsets of patients with more responsive tumors.

Bioactivity of essential oils in phytopathogenic and post-harvest fungi control.

Commercial thyme and lavender essential oils were analysed by GC/MS. Sixty-six compounds accounting for 98.6-99.6% of total essential oil were identified. Thymol (52.14 ± 0.21%), followed by p-cymene (32.24 ± 0.16%), carvacrol (3.71 ± 0.01%) and γ-terpinene (3.34 ± 0.02%), were the main compounds in thyme essential oil, while large amounts of oxygenated monoterpenes linalool acetate (37.07 ± 0.24%) and linalool (30.16 ± 0.06%) were found in lavender one. In vitro antifungal activity of the essential oils was evaluated at 200 and 300 µg/mL against 10 phytopathogenic and post-harvest fungi, which significantly affect agriculture. Micelial growth inhibition was calculated for each tested fungus and dose. Thyme essential oil showed satisfactory results with 90-100% growth inhibition in almost all the assayed fungi at 300 µg/mL, while lavender essential oil showed no noteworthy inhibition data at either dose, and its growth was even enhanced. Thyme essential oil represents a natural alternative to control harvest and post-harvest fungi, and to extend the shelf-life of agriculture products.

Disordered eating in French high-level athletes: association with type of sport, doping behavior, and psychological features.

PURPOSE: Over the last few years, disordered eating in athletes has received increasing attention. According to several studies, athletes could be more vulnerable to disordered eating and some characteristics specific to the athletic community could be in favour of an increased risk of poor body image and disturbed eating habits in athletes. However, the literature is sparse and some methodological issues in studies have been pointed out. In this context, we aimed at determining the prevalence of disordered eating in French high-level athletes using clinical interviews of three different clinicians and identifying what are the factors associated with disordered eating in athletes. METHODS: In France, all athletes registered on the French high-level list have to undergo a yearly evaluation. Data collected during the somatic assessment, the dietary consultation, and the psychological of the yearly evaluation were used. Multivariate analysis was performed for identification of factors associated with disordered eating. RESULTS: Out of the 340 athletes included, 32.9% have been detected with a disordered eating. They were difficult to detect by clinicians, as usual criteria did not seem to be reliable for athletes. Competing in sports emphasizing leanness or low body weight was associated with disordered eating; however, gender was not. CONCLUSION: These results highlight the need for the development of specific screening tools for high-level athletes. Furthermore, the identification of factors associated with disordered eating could improve early detection and prevention program effectiveness.

Análisis coste-efectividad de celecoxib frente a antiinflamatorios no esteroideos no selectivos en el tratamiento de la artrosis en España: una perspectiva actual / Cost-effectiveness analysis of celecoxib versus non-selective non-steroidal anti-inflammatory drug therapy for the treatment of osteoarthritis in Spain: a current perspective

OBJETIVO: Realizar un análisis coste-efectividad de celecoxib y antiinflamatorios no esteroideos no selectivos en el tratamiento de la artrosis según práctica habitual en España. MÉTODOS: El análisis coste-efectividad se realizó mediante un modelo analítico tipo árbol de decisión utilizando la distribución, dosis y duración de los tratamientos y la incidencia de eventos gastrointestinales (GI) y cardiovasculares observados en el estudio pragmático «GI-Reasons». La efectividad se expresó en eventos evitados y años de vida ajustados por calidad (AVAC) ganados. Los AVAC ganados se calcularon a partir del coeficiente de utilidad asociado a cada tipo de evento GI o cardiovascular observados en el estudio GI-Reasons. La perspectiva fue la del Sistema Nacional de Salud para el cálculo de los costes de tratamiento usando precios actuales (€, noviembre de 2014) de los fármacos y eventos GI y cardiovascular. El análisis coste-efectividad se expresó como coste incremental por AVAC ganado y por evento evitado. Se llevaron a cabo análisis de sensibilidad probabilísticos y univariantes. RESULTADOS: En comparación con antiinflamatorios no esteroideos no selectivos, celecoxib, a su precio actual, mostró mayores costes sanitarios por paciente: 157 € versus 201 €. Sin embargo, se asoció con un aumento de la ganancia de AVAC y una incidencia significativamente menor de eventos GI (p < 0,001), mostrando un coste incremental de 13.286 € por AVAC ganado y 4.471 € por evento evitado. Los análisis de sensibilidad confirmaron los resultados. CONCLUSIÓN: Celecoxib a su precio actual puede ser considerado una alternativa coste-efectiva frente a los antiinflamatorios no esteroideos no selectivos en el tratamiento de la artrosis en España

OBJECTIVE: To assess the cost-effectiveness of celecoxib and non-selective non-steroidal anti-inflammatory drugs for the treatment of osteoarthritis in clinical practice in Spain. METHODS: A decision-tree model using distribution, doses, treatment duration and incidence of GI and CV events observed in the pragmatic PROBE-designed «GI-Reasons» trial was used for cost-effectiveness. Effectiveness was expressed in terms of event averted and quality-adjusted life-years (QALY) gained. QALY were calculated based on utility decrement in case of any adverse events reported in GI-Reasons trial. The National Health System perspective in Spain was applied; cost calculations included current prices of drugs plus cost of adverse events occurred. The analysis was expressed as an incremental cost-effectiveness ratio per QALY gained and per event averted. One-way and probabilistic analyses were performed. RESULTS: Compared with non-selective non-steroidal anti-inflammatory drugs, at current prices, celecoxib treatment had higher overall treatment costs € 201 and € 157, respectively. However, celecoxib was associated with a slight increase in QALY gain and significantly lower incidence of gastrointestinal events (p<.001), with mean incremental cost-effectiveness ratio of € 13,286 per QALY gained and € 4,471 per event averted. Sensitivity analyses were robust, and confirmed the results of the base case. CONCLUSION: Celecoxib at current price may be considered as a cost-effective alternative vs. non-selective non-steroidal anti-inflammatory drugs in the treatment of osteoarthritis in daily practice in the Spanish NHS

[Cost-effectiveness analysis of celecoxib versus non-selective non-steroidal anti-inflammatory drug therapy for the treatment of osteoarthritis in Spain: A current perspective]. / Análisis coste-efectividad de celecoxib frente a antiinflamatorios no esteroideos no selectivos en el tratamiento de la artrosis en España: una perspectiva actual.

OBJECTIVE: To assess the cost-effectiveness of celecoxib and non-selective non-steroidal anti-inflammatory drugs for the treatment of osteoarthritis in clinical practice in Spain. METHODS: A decision-tree model using distribution, doses, treatment duration and incidence of GI and CV events observed in the pragmatic PROBE-designed «GI-Reasons¼ trial was used for cost-effectiveness. Effectiveness was expressed in terms of event averted and quality-adjusted life-years (QALY) gained. QALY were calculated based on utility decrement in case of any adverse events reported in GI-Reasons trial. The National Health System perspective in Spain was applied; cost calculations included current prices of drugs plus cost of adverse events occurred. The analysis was expressed as an incremental cost-effectiveness ratio per QALY gained and per event averted. One-way and probabilistic analyses were performed. RESULTS: Compared with non-selective non-steroidal anti-inflammatory drugs, at current prices, celecoxib treatment had higher overall treatment costs €201 and €157, respectively. However, celecoxib was associated with a slight increase in QALY gain and significantly lower incidence of gastrointestinal events (p<.001), with mean incremental cost-effectiveness ratio of €13,286 per QALY gained and €4,471 per event averted. Sensitivity analyses were robust, and confirmed the results of the base case. CONCLUSION: Celecoxib at current price may be considered as a cost-effective alternative vs. non-selective non-steroidal anti-inflammatory drugs in the treatment of osteoarthritis in daily practice in the Spanish NHS.

Efectividad de una intervención educativa para acortar el tratamiento antibiótico parenteral en infecciones moderadas y graves en un hospital pediátrico de alta complejidad / Effectiveness of an educational intervention to shorten parenteral antibiotic treatment in moderate and severe infections in a tertiary-care pediatric hospital

Introducción: Las intervenciones destinadas a acortar la duración de los tratamientos antibióticos parenterales son consideradas estrategias de utilidad para reducir complicaciones relacionadas con los tratamientos parenterales prolongados en forma inadecuada, la selección de resistencia y los costos hospitalarios. El objetivo del estudio fue evaluar la efectividad de un programa para reducir la duración del tratamiento antibiótico parenteral innecesario en el tratamiento de infecciones moderadas y severas en niños hospitalizados. Material y Métodos: Estudio antes después sin grupo control. Se incluyeron niños entre 3 meses y 18 años que recibían tratamiento antibiótico parenteral como tratamiento de peritonitis, infección de piel y partes blandas, infección osteoarticular, neumonía neutropenia febril sin foco clínico de infección internados en el Hospital Garrahan. Período Pre-intervención (Pre-I) 2011 vs. Post-intervención 2012. Intervención: talleres interactivos, difusión de algoritmos diagnósticos y de tratamiento de las infecciones consideradas y monitoreo regular de las prescripciones antibióticas parenterales y su duración. Análisis estadístico: STATA version 8.0 software. Resultados: Pre-I vs. post-I se incluyeron un total de 194 vs. 227 pacientes respectivamente. La mediana de edad fue de 49 meses (RIC: 19-92 m) vs. 39 meses (13-108m), respectivamente p>0.05., se obtuvo documentación microbiológica en 52 (27%) vs. 63 (28%), p>0.05. La mediana de días de tratamiento antibiótico parenteral según pre vs. post I fue de 6 días (RIC: 5-7d.) vs. 3 días (RIC 2-4) para Infección de piel y partes blandas, 5 días (RIC: 3-8) vs. 4 días (RIC 3-6) para neumonía, 6 días (RIC:5-8) vs. 4 días (RIC:4-5) para peritonitis, 7 días(RIC: 6-8) vs. 5 días (RIC: 5-7 días) para infecciones osteoarticulares y 5 días (RIC: 4-6) vs. 4 días (RIC: 3-5) para neutropenia febril sin foco clínico de infección. Mediana del total de días de tratamiento antibiótico parenteral pre-I vs. post-I fue 6.5 días (RIC: 5-7) vs. 4 días (RIC: 4-5), p<0.01, la mediana días totales de internación fue de 7(6-8) vs. 5 (5-6) p<0.01. Conclusiones: Se observó una reducción en la duración de los tratamientos endovenosos de infecciones moderadas y graves en el periodo post-intervención generando una mayor disponibilidad de camas en la institución (au)

Introduction: Interventions to shorten parenteral antibiotic treatment are considered useful strategies to reduce complications related to inadequately long parenteral treatment, resistance, and hospital costs. The aim of this study was to assess the effectiveness of a program for the reduction of unnecessary parenteral antibiotic treatment in the management of hospitalized children with moderate and severe infections. Material and methods: A before-and-after study without control group. Children between 3 months and 18 years of age receiving parental antibiotics for the treatment of peritonitis, skin and soft tissue infection, osteoarticular infection, pneumonia, and febrile neutropenia without a clear focus of infection admitted to the Garrahan Hospital were included in the study. Pre-intervention period (Pre-I) 2011 vs. post-intervention period 2012. Intervention: Interactive workshops, diffusion of diagnostic and treatment algorithms for infections used, and regular monitoring of prescriptions for parenteral antibiotics and their duration. Statistical analysis: STATA version 8.0 software. Results: In the pre-I vs. post-I a total of 194 vs. 227 patients were included, respectively. Median age was 49 months (IQR: 19-92 m) vs. 39 months (13-108 m), respectively, p>0.05. Microbiological documentation was obtained in 52 (27%) vs. 63 (28%) patients, p>0.05. Median days of parenteral antibiotic treatment in the pre vs. post I period was 6 days (IQR: 5-7 d) vs. 3 days (IQR: 2-4 d) for skin and soft tissue infection, 5 days (IQR: 3-8) vs. 4 days (IQR: 3-6) for pneumonia, 6 days (IQR: 5-8) vs. 4 days (IQR: 4-5) for peritonitis, 7 days (IQR: 6-8) vs. 5 days (IQR: 5-7 days) for osteoarticular infections, and 5 days (IQR: 4-6) vs. 4 days (IQR: 3-5) for febrile neutropenia without a clear focus of infection. Median total days of parenteral antibiotic treatment in the pre vs. post I period was 6.5 days (IQR: 5-7) vs. 4 days (IQR: 4-5), p<0.01 and the median total days of length of hospital stay was 7 (IQR: 6-8) vs. 5 (IQR: 5-6), p<0.01. Conclusions: A decrease in the duration of intravenous treatment duration for moderate and severe infections was observed in the post-intervention period leading to an improved availability of beds at the institution (AU)

Un caso de comorbilidad de psicosis compartida y Trastorno de la conducta alimentaria / A case of comorbidity of shared psychosis and eating disorder

Presentamos un caso de trastorno de ideas delirantes compartidas por una madre y su hija que es quien acude a la consulta de Salud Mental con 15 años por un TCA. Evoluciona desde la anorexia restrictiva a la bulimia y poco antes de cumplir los 18 años presenta un cuadro delirante que comparte con su madre (miembro activo). Tras una tentativa de suicidio, con relación a la alteración del esquema corporal, se procede al ingreso de la hija. En ese momento apreciamos el empeoramiento del cuadro delirante de la madre, quien se niega a aceptar ayuda terapéutica (AU)

We present a case of shared psychotic disorder in a mother and her daughter, who is irst seen at age of 15 at the Mental Health Unit for an Eating Disorder. She evolved from restrictive anorexia to bulimia, and before the age of 18 a psychotic disorder begins shared with her mother (who is the active member). After a suicidal attempt, related to body image disturbance, she was admitted to hospitalization and we observe how the delusional disorder gets worse in the mother, who rejects therapeutic help (AU)

Paciente de 33 años coexcesiva somnolencia diurna / No disponible

Varón de 33 años remitido a la Unidad de Trastornos Respiratorios del Sueño desde el servicio de Neurología por clínica de excesiva somnolencia diurna (ESD) (AU)

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Permanent genetic resources added to Molecular Ecology Resources Database 1 December 2011-31 January 2012.

This article documents the addition of 473 microsatellite marker loci and 71 pairs of single-nucleotide polymorphism (SNP) sequencing primers to the Molecular Ecology Resources Database. Loci were developed for the following species: Barteria fistulosa, Bombus morio, Galaxias platei, Hematodinium perezi, Macrocentrus cingulum Brischke (a.k.a. M. abdominalis Fab., M. grandii Goidanich or M. gifuensis Ashmead), Micropogonias furnieri, Nerita melanotragus, Nilaparvata lugens Stål, Sciaenops ocellatus, Scomber scombrus, Spodoptera frugiperda and Turdus lherminieri. These loci were cross-tested on the following species: Barteria dewevrei, Barteria nigritana, Barteria solida, Cynoscion acoupa, Cynoscion jamaicensis, Cynoscion leiarchus, Cynoscion nebulosus, Cynoscion striatus, Cynoscion virescens, Macrodon ancylodon, Menticirrhus americanus, Nilaparvata muiri and Umbrina canosai. This article also documents the addition of 116 sequencing primer pairs for Dicentrarchus labrax.

Single port donor nephrectomy.

In 2007, Rane presented the first single port nephrectomy for a small non-functioning kidney at the World Congress of Endourology. Since that time, the use of single port surgery for nephrectomy has expanded to include donor nephrectomy. Over the next two years the technique was adopted for many others types of nephrectomies to include donor nephrectomy. We present our technique for single port donor nephrectomy using the Gelpoint device. We have successfully performed this surgery in over 100 patients and add this experience to our experience of over 1000 laparoscopic nephrectomies. With the proper equipment and technique, single port donor nephrectomy can be performed safely and effectively in the majority of live donors. We have found that our operative times and most importantly our transplant outcomes have not changed significantly with the adoption of the single port donor nephrectomy. We believe that single port donor nephrectomy represents a step forward in the care of living donors.

Síndrome Poliglandular Autoinmune Tipo II: Posible Asociación con HLA DRB1*-DQB1* / Possible association of Type II Autoimmune Polyendrocrine Syndrome with HLA DRB1*-DQB1*

Los síndromes poliendocrinos autoinmunes (APS) asocian enfermedades endocrinas autoinmunes con otros desórdenes autoinmunes no endocrinos. El APS tipo II se caracteriza por compromiso primario suprarrenal, tiroideo y/o DM tipo I. Presentamos un paciente masculino de 46 años que fue internado por astenia, adinamia, hiporexia, severa disminución de peso, mareos y vómitos. Antecedente de obesidad y diabetes diagnosticada 3 años antes. Presentaba hipotensión arterial, hiperpigmentación de mucosas y pliegues, anemia, hiponatremia e hipoglucemias frecuentes a pesar de la disminución de la dosis de insulina. Se diagnosticó insuficiencia suprarrenal, concomitantemente con hipotiroidismo y diabetes tipo 1, todas de origen autoinmune, iniciándose reemplazo hormonal. Se encontró una posible asociación del HLA DRB1*-DQB1* en los estudios genéticos. Conclusiones: Nuestro paciente presenta el HLA DQB1*0302 descripto en el APSII, pero el HLA DRB1 *08 encontrado no está descripto en este síndrome ni en ningún otro desorden autoinmune. En pacientes con Diabetes tipo 1 que disminuyan el requerimiento insulínico, habría que descartar insuficiencia suprarrenal, un componente del APS II, como factor etiológico, a pesar de su baja prevalencia.

Autoimmune polyendocrine syndromes (APS) are the association of autoimmune endocrine diseases with other non-endocrine autoimmune disorders. Type II APS is defined by occurrence of Addison´s disease with thyroid autoimmune disease and/or type 1 diabetes mellitus. We present a 46-year-old male patient who was hospitalized because of asthenia, adynamia, hyporexia, severe loss of weight, dizziness and vomiting. Diabetes mellitus had been diagnosed 3 years earlier when he was obese. He presented arterial hypotension, anemia, darkening of the skin and oral mucosa, hyponatremia and frequent hypoglycemia although his insulin dose was decreased. Adrenal insufficiency was diagnosed together with hypothyroidism and type 1 diabetes, all of them of autoimmune origin. Hormonal replacement treatment was initiated. Genetic studies were performed and a new polymorphism was found. Conclusions: HLA DRB1 *08 found in our patient has not been described in APS II or in any other autoimmune disorders. He also has HLA DQB1*0302 described in previous reports related to APS II. In type 1 diabetic patients whose insulin requirement decreases, it would be advisable to rule out adrenal insufficiency, a component of APS II, as an etiologic factor in spite of its low prevalence. In diabetic obese patients (mainly young) who lose weight without a defined cause, type 1 diabetes mellitus should be excluded.

Extensive synteny conservation of holocentric chromosomes in Lepidoptera despite high rates of local genome rearrangements.

The recent assembly of the silkworm Bombyx mori genome with 432 Mb on 28 holocentric chromosomes has become a reference in the genomic analysis of the very diverse Order of Lepidoptera. We sequenced BACs from two major pests, the noctuid moths Helicoverpa armigera and Spodoptera frugiperda, corresponding to 15 regions distributed on 11 B. mori chromosomes, each BAC/region being anchored by known orthologous gene(s) to analyze syntenic relationships and genome rearrangements among the three species. Nearly 300 genes and numerous transposable elements were identified, with long interspersed nuclear elements and terminal inverted repeats the most abundant transposable element classes. There was a high degree of synteny conservation between B. mori and the two noctuid species. Conserved syntenic blocks of identified genes were very small, however, approximately 1.3 genes per block between B. mori and the two noctuid species and 2.0 genes per block between S. frugiperda and H. armigera. This corresponds to approximately two chromosome breaks per Mb DNA per My. This is a much higher evolution rate than among species of the Drosophila genus and may be related to the holocentric nature of the lepidopteran genomes. We report a large cluster of eight members of the aminopeptidase N gene family that we estimate to have been present since the Jurassic. In contrast, several clusters of cytochrome P450 genes showed multiple lineage-specific duplication events, in particular in the lepidopteran CYP9A subfamily. Our study highlights the value of the silkworm genome as a reference in lepidopteran comparative genomics.

Prognostic markers and targeted therapies for renal cell carcinoma.

Management of advanced renal cell carcinoma remains a persistent clinical challenge with high morbidity and mortality for a large proportion of patients. Until recently, available medical immunotherapy regimens yielded a therapeutic response in only 20% of patients. Advances in the understanding of molecular mechanisms of renal cell carcinoma have led to a rapidly expanding body of work exploring biomarkers for the disease and targeted therapeutics. We review current investigations into biomarkers and novel therapies for renal cell carcinoma, discuss the concept of anticancer vaccines, and propose a novel target for anticancer vaccine development.