Phylogenomics of Salvia L. subgenus Calosphace (Lamiaceae).

The evolutionary relationships of Salvia have been difficult to estimate. In this study, we used the Next Generation Sequencing method Hyb-Seq to evaluate relationships among 90 Lamiaceae samples, including representatives of Mentheae, Ocimeae, Salvia subgenera Audibertia, Leonia, Salvia, and 69 species of subgenus Calosphace, representing 32 of Epling's sections. A bait set was designed in MarkerMiner using available transcriptome data to enrich 119 variable nuclear loci. Nuclear and chloroplast loci were assembled with hybphylomaker (HPM), followed by coalescent approach analyses for nuclear data (ASTRAL, BEAST) and a concatenated Maximum Likelihood analysis of chloroplast loci. The HPM assembly had an average of 1,314,368 mapped reads for the sample and 527 putative exons. Phylogenetic inferences resolved strongly supported relationships for the deep-level nodes, agreeing with previous hypotheses which assumed that subgenus Audibertia is sister to subgenus Calosphace. Within subgenus Calosphace, we recovered eight monophyletic sections sensu Epling, Cardinalis, Hastatae, Incarnatae, and Uricae in all the analyses (nDNA and cpDNA), Biflorae, Lavanduloideae, and Sigmoideae in nuclear analyses (ASTRAL, BEAST) and Curtiflorae in ASTRAL trees. Network analysis supports deep node relationships, some of the main clades, and recovers reticulation within the core Calosphace. The chloroplast phylogeny resolved deep nodes and four monophyletic Calosphace sections. Placement of S. axillaris is distinct in nuclear evidence and chloroplast, as sister to the rest of the S. subg. Calosphace in chloroplast and a clade with "Hastatae clade" sister to the rest of the subgenus in nuclear evidence. We also tested the monophyly of S. hispanica, S. polystachia, S. purpurea, and S. tiliifolia, including two samples of each, and found that S. hispanica and S. purpurea are monophyletic. Our baits can be used in future studies of Lamiaceae phylogeny to estimate relationships between genera and among species. In this study, we presented a Hyb-Seq phylogeny for complex, recently diverged Salvia, which could be implemented in other Lamiaceae.

Medical education from the point of view of medical students: Results from four participatory Delphi panels in Quito, Ecuador.

BACKGROUND: Medical curricula have historically been designed in a top-down approach, usually excluding students. While Delphi panels have been used as a tool for medical education curricula design, none have been conducted in Ecuador. In addition, no such approach has ever included students both as panelists and researchers. MATERIAL AND METHODS: Four Delphi panels were developed and conducted using a participatory approach that allowed medical students to take part both as expert panelists and researchers: specifically, students developed the questionnaire and conducted a qualitative synthesis. Questionnaire responses were anonymized and dispatched online to panelists. The information was organized and collected to develop the qualitative syntheses and prepare the final statements. RESULTS: Thirty-two medical students participated between February and May 2018. A total of 32 questions were developed, corresponding to five different categories. For some questions, consensus was reached; for other questions, general statements were obtained.Discussion and conclusion: Developing the questionnaire, responding to it and analyzing the answers allowed students to raise significant concerns regarding medical education topics proposing relevant policy and curricula change. Participatory Delphi panels can be an efficient tool to obtain organized feedback, improve student class involvement, and promote research skills.

Fates of angiosperm species following long-distance dispersal: Examples from American amphitropical Polemoniaceae.

PREMISE OF THE STUDY: Following establishment after long-distance dispersal, species may experience stasis, accumulate changes leading to new species identity, diversify into multiple species, interact with related species to form novel species, and even become extirpated. We examined each species of temperate Polemoniaceae in South America via the literature and new analyses to better understand the fates of species in this family after their dispersal from North America. METHODS: We reviewed literature for the 15 species of Polemoniaceae in South America amphitropically disjunct from their relatives in North America. We conducted DNA sequence analyses to infer relationships, timing of dispersal, and processes involved since dispersal in Microsteris gracilis, three Gilia, two Giliastrum, and three Collomia. Analyses included construction of haplotype networks and phylogenetic trees using maximum likelihood and Bayesian inference. KEY RESULTS: For all species examined in detail, origins in South America are compatible with dispersal via epizoochory from ca. 0.092-19.46 million years ago. Most species in South America are unique relative to their North American congeners, yet few have radiated into two or more species. Relative stasis, divergence, and hybridization with, and without, allopolyploid formation have occurred postdispersal in Polemoniaceae, as well as extirpation following at least brief establishment. CONCLUSIONS: Polemoniaceae that have established in South America share many features likely inherited from their North American progenitors, but some traits may have arisen in situ in specific taxa, such as cleistogamy, self-incompatibility, and the annual habit, evidencing the rich nature of diversification processes.

Prevalence and risk factors of restrictive spirometry in a cohort of Peruvian adults.

INTRODUCTION: Few studies have described the prevalence of and lung function decline among those with a restrictive spirometric pattern (RSP) in low- and middle-income countries. METHODS: We analyzed prospective data from 3055 adults recruited across four diverse settings in Peru over a 3-year period. Multivariable logistic regression was used to study the association between the presence of restriction and associated risk factors. Multivariable linear mixed models were used to determine lung function decline. RESULTS: Among 3055 participants, the average age was 55.4 years (SD 12.4); 49% were male. Overall prevalence of RSP was 4.7%, ranging from 2.8% (Lima) to 6.9% (Tumbes). The odds of having RSP were higher among those who lived in a rural environment (OR 2.19, 95%CI 1.43-3.37), had a diagnosis of diabetes (OR 1.94, 95%CI 1.10-3.40) and among women (OR 2.09, 95%CI 1.41-3.09). When adjusting for baseline lung function, adults with RSP had accelerated decline in forced expiratory volume in 1 s (FEV1) compared with non-obstructed, non-restricted individuals. DISCUSSION: RSP is prevalent particularly among women and in individuals living in rural settings of Peru. When adjusted for baseline lung function, participants with RSP had accelerated rates of FEV1 decline. Our findings are consistent with the notion that RSP is an insidious inflammatory condition with deleterious effects of lung function decline.

Permanent neonatal diabetes in an Asian infant.

We describe a novel homozygous missense glucokinase mutation (R397L) resulting in insulin-treated neonatal diabetes in an infant from a consanguineous Asian family. Both parents were heterozygous for R397L and had mild hyperglycemia. Glucokinase mutations should be considered in infants of all ethnic groups with neonatal diabetes and consanguinity.

Local research ethics committees of the Mexican Institute of Social Security: results of a national survey.

OBJECTIVE: To identify the structure, composition and work of the local research ethics committees (LRECs) of the Mexican Institute of Social Security (IMSS) in Mexico. DESIGN: A descriptive cross-sectional study was performed that included all LRECs of the IMSS. METHODS: A total of 335 questionnaires coded in advance were posted to each LREC secretary. The requested information was from January to December 2001. RESULTS: The response rate was 100%. Two hundred and thirty-eight (71%) LRECs were reported as 'active' during the evaluation period. Although almost all LRECs were composed of diverse professionals, physicians dominated the LRECs' membership. The rejection rate for research projects was lower than 1 per 1000, and less than half of the LRECs held meetings to issue a report of projects' evaluation. CONCLUSIONS: LRECs need to foster good ethical research; implementation of an audit system to examine their work might help improve LRECs' performance and accountability.

The street/treatment barrier: treatment experiences of Puerto Rican injection drug users.

This study describes, through ethnographic interviews, the treatment experiences of Puerto Rican long-term heroin users who are at extremely high risk for HIV infection and the barriers they perceive to drug treatment. On the basis of this information we suggest policy recommendations for increasing drug treatment access for Puerto Rican long-term injectors of heroin. It is critical that Puerto Rican populations access drug treatment facilities given their risk factors for HIV infection and the high rate of poverty in Puerto Rican communities that exacerbates drug use.

Diagnostic and therapeutic laparoscopy for penetrating abdominal trauma: a multicenter experience.

BACKGROUND: Considerable skepticism still exists about the role of diagnostic laparoscopy in the evaluation of penetrating abdominal trauma. The reported experience with therapeutic laparoscopy has been limited. METHODS: Retrospective analysis of a collective experience from three large urban trauma centers with 510 patients (316 stab wounds, 194 gunshot wounds) who were hemodynamically stable and had no urgent indications for celiotomy. RESULTS: Laparotomy was avoided in 277 of the 510 patients (54.3%) either because of nonpenetration or insignificant findings on laparoscopy. All were discharged uneventfully after a mean hospital stay of 1.7 days. Twenty-six had successful therapeutic procedures on laparoscopy (diaphragmatic repair in 16 patients, cholecystectomy in 1 patient, hepatic repair in 6 patients, and closure of gastrotomy in 3 patients) with uneventful recovery. In the remaining 203 patients, laparotomy was therapeutic in 155. Fifty-two patients had nontherapeutic celiotomy for exclusion of bowel injuries or as mandatory laparotomy for penetrating gunshot wounds (19.7%). The overall incidence of nontherapeutic laparotomy was 10.2%. Complications from laparoscopy were minimal (10 of 510) and minor. CONCLUSIONS: Laparoscopy has an important diagnostic role in stable patients with penetrating abdominal trauma. In carefully selected patients, therapeutic laparoscopy is practical, feasible, and offers all the advantages of minimally invasive surgery.

Recombinant human erythropoietin reduces the need for erythrocyte and platelet transfusions in pediatric patients with sarcoma: a randomized, double-blind, placebo-controlled trial.

OBJECTIVE: To evaluate the effect of recombinant human erythropoietin (EPO) and iron supplementation on transfusion requirements in pediatric patients with sarcoma who were receiving chemotherapy, we performed a double-blind, placebo-controlled, randomized trial. METHODS: Twenty-four pediatric patients with malignant solid tumors were randomly assigned to receive either placebo (saline solution) or EPO for a 16-week study period. The starting dose was 150 IU/kg per dose three times a week and was escalated by 50 IU/kg per dose increments monthly until packed red blood cell (PRBC) transfusion independence was achieved or a dosage of 300 IU/kg per dose was reached. Iron supplementation was prescribed at a dose of 6 mg of elemental iron per kilogram daily. The primary study end point was the comparison of PRBC transfusion requirements in the two groups. RESULTS: Of 24 patients, 20 were evaluable for response. The median PRBC transfusion requirement during the 16-week period was 23 ml/kg in EPO-treated patients versus 80 ml/kg in placebo patients (p = 0.02). The median number of single-donor platelet units transfused was zero in the EPO-treated patients compared with four in the placebo group (p = 0.005). No statistical difference in the intensity of bone marrow suppression was seen, as measured by the median number of complete blood cell counts with an absolute neutrophil count of < 1000 cells/microliter. CONCLUSIONS: Treatment with EPO and iron significantly reduces PRBC transfusions in pediatric patients receiving concomitant chemotherapy for malignant sarcomas. A decrease in the number of platelet transfusions was also seen and deserves further study.

[Bioethics panorama in Mexico]. / Panorama bioético en México.

Ethical values and principles are singular and immutable, but this is not true of their interpretation and application. In Mexico, even though these values and principles are respected in medical practice, the teaching of bioethics is non-existent and in most of the schools for health professionals the subject is not included in the curriculum. Nevertheless, Mexican society has made notable progress in the legislation and regulation of ethical aspects of such activities as research on human subjects, fertility regulation, the right to death with dignity, organ transplants, and AIDS.

Screening for prolonged incubation of HTLV-I infection in British and Jamaican relatives of British patients with tropical spastic paraparesis.

OBJECTIVE: To compare the prevalence of antibody to and proviral DNA of the retrovirus HTLV-I in relatives of 11 British patients with tropical spastic paraparesis who had migrated from Jamaica before they developed symptoms, and to examine factors possibly related to transmission of HTLV-I. DESIGN: Migrant, family study. Antibody state was determined by several methods and confirmed by western blotting; the polymerase chain reaction was used to detect proviral DNA. SETTING: Britain and Jamaica. SUBJECTS: All available first degree relatives: those born and still resident in Jamaica (group 1); those born in Jamaica who migrated to Britain (group 2); and index patients' children who were born and resident in Britain (group 3). All had been breast fed and none had had blood transfusions. RESULTS: Of the 66 living relatives, 60 were traced. Seroprevalence among those born in Jamaica (irrespective of current residence) was 22% (10/46; 95% confidence limits 9 to 34%) compared with zero among British born offspring (0/14) and was higher in group 2 at 33% (7/21; 12 to 55%) than in group 1 at 12% (3/25; 0 to 25%). (Patients in group 1 had the greatest mean age.) Proviral DNA was not detected in any subject negative for HTLV-I antibody, making prolonged viral incubation in those negative for the antibody unlikely. CONCLUSION: In this sample factors related to place of birth and early residence were more important in transmission of HTLV-I than maternal or age effects. In areas with a low to moderate prevalence policies of preventing mothers who are carriers of the virus from breast feeding would be premature.

Screening for prolonged incubation of HTLV-I infection in British and Jamaican relatives of British patients with tropical spastic paraparesis [see comments]

OBJECTIVE -- To compare the prevalence of antibody to and proviral DNA of the retrovirus HTLV-I in relatives of 11 British patients with tropical spastic paraparesis who migrated from Jamaica before they developed symptoms, and to examine factors possibly related to transmission of HTLV-I. DESIGN -- Migrant family study. Antibody state was determined by several methods and confirmed by western blotting; the polymerase chain reaction was used to detect proviral DNA. SETTING -- Britain and Jamaica. SUBJECTS -- All available first degree relatives: those born and still resident in Jamaica (group 1); those born in Jamaica who migrated to Britian (group 2); and index patients' children who were born and resident in Britian (group 3). All had been breast fed and none had had blood transfusions. RESULTS -- Of the 66 living relatives, 60 were traced. Seroprevalence among those born in Jamaica (irrespective of current residence) was 22 percent (10/46; 95 percent confidence limits 9 to 34 percent) compared with zero among British born offspring (0/14) and was higher in group 2 at 33 percent (7/21; 12 to 55 percent) than in group 1 at greatest mean age.) Proviral DNA was not detected in any subject negative for HTLV-I antibody, making prolonged viral incubation in those negative for the antibody unlikely. CONCLUSION -- In this sample factors related to place of birth and early residence were more important in transmission of HTLV-I than naternal or age effects. In areas with a low to moderate prevalence policies of preventing mothers who are carriers of the virus from breast feeding would be premature (AU)

Overview of bioethics in Mexico.

In Mexico, as in many other countries, there are numerous situations involving bioethics that are not necessarily covered by officially sanctioned policies or guidelines. In such cases, it is reasonable to describe commonly accepted rules, opinions, and practices in a general way so as to illustrate how bioethical questions are being managed. This article describes certain goals and practices relating to education in bioethics in Mexico. It then outlines Mexican laws and procedures governing research on human subjects, cites certain official rules and activities relating to regulation of human reproduction, quotes literature dealing with intervention in human procreation, discusses artificial prolongation of life, describes laws and practices governing organ transplants, considers ethical issues relating to such transplants, reviews the AIDS situation, and describes how the need for confidentiality is dealt with in managing AIDS cases and related data. In this manner it indicates how bioethical questions in these various areas are being handled and points out certain priority areas needing work.

[Giant bronchiectasis caused by chronic inhalation of porcine hair]. / Bronquiectasias gigantes por inhalación crónica del pelo porcino.

A rare case of gigantic bronchiectasis consecutive to chronic inhalation of pork hair (hog's bristle) is presented. The possible pathogenic mechanisms are discussed. The case was subject to surgical resection of the affected lung segment, lingula.

Detection of HTLV-I DNA in peripheral blood of tropical spastic paraparesis patients and their relatives using gene amplification - abstract

Sero-epidemiological studies have revealed familial clustering of HTLV-1 infection consistent with a pattern of mother-to-child transmission. Cross sectional studies, however, show that antibodies to HTLV-1 are uncommon before adolescence, which could suggest that a proportion of children born to seropositive mothers may be infected early in life but do not sero-convert until adulthood. We previously described a study of HTLV-1 antibody prevalence in UK patients with TSP (all of West Indian origin) and their family members (CCMRC 1987). All 18 TSP patients and 8 of the 60 relatives tested (13 percent) were found to have serum antibodies to HTLV-1 (3 siblings aged 45, 52 and 68 yrs, 2 spouses 55 and ?yrs., 3 children (32,27 and 30 years). We have now used a DNA amplification technique (the polymerase chain reaction) to look for HTLV-1 DNA in the peripheral blood of 12 TSP cases and 48 relatives, of whom 42 were seronegative. Of particular interest were the seronegative children, 5 of them under the age of 20, born to positive mothers. Each DNA sample was tested with two pairs of primers specific for the gag and X-I regions of the HTLV-1 genome, and conditions were established under which fewer than 10 copies of the viral genome in 10(to the fifth power) cells could be detected. Viral DNA sequences could be amplified from the TSP case and seronegative relatives but not from seropositive relatives. Our data do not support the idea that people may be persistently infected with HTLV-I but fail to generate a humoral response due to immunological tolerance. While not ruling out the possibility of latent infection in antibody negative relatives, our data would suggest that latently infected cell are either very rare (fewer than 1 cell per 100,000) or located in some tissue other than peripheral blood (AU)

Tropical spastic paraparesis and HTLV-1 viral prevalence among relatives of UK patients in Britain and Jamaica - abstract

Over 75 percent of patients, worldwide, with tropical spastic paraparesis (TSP) have HTLV-1 antibodies (AB). Each of the 18 patients, of West Indian origin tested so far in Britain, has Ab. Ab prevalence in Jamaica and in UK migrants is 4-6 percent. We have examined factors associated with transmission (breastfeeding, blood transfusion, etc). We have also tested the hypothesis that viral spread is commoner in Jamaica than in a temperate zone, such as Britain. If the hypothesis is true, Ab prevalence should be higher in Jamaican-born and resident (Group 1) than in UK-resident subjects; Jamaican-born (Group 2) first degree relatives should have the next highest prevalence; Ab should be least frequent in UK-born offspring (Group 3) of UK-TSP patients. Of 69 living relatives of the TSP patients, 64 were available and 60 were tested. All the relatives had been breastfed and none had had a blood transfusion. Group 1 were slightly older than Group 2 (mean 5 vs 46 yrs.) and both groups were a generation older thanb Group 3 (20 yrs.). Group 2 had been in Britain a mean of 26 years. Ab prevalence was much greater, based on immunofluorescence than with an ELISA system (confirmed by Western blot). Using ELISA confirmation, positive results (>1:20 titres) were found in 3/25 (12 percent) of Group 1, 7/21 (33 percent) of Group 2 and 0/14 of Group 3. Only 3 of 7 spouses were Ab-positive. These data illustrate that a slight excess of HTLV-1 Ab occurs in family members of UK-TSP patients compared with the general Jamaican population. Mother-to-child transmission is not common (AU)