Candida tropicalis PMT2 Is a Dispensable Gene for Viability but Required for Proper Interaction with the Host.

Candidemia is an opportunistic mycosis with high morbidity and mortality rates. Even though Candida albicans is the main causative agent, other Candida species, such as Candida tropicalis, are relevant etiological agents of candidiasis and candidemia. Compared with C. albicans, there is currently limited information about C. tropicalis' biological aspects, including those related to the cell wall and the interaction with the host. Currently, it is known that its cell wall contains O-linked mannans, and the contribution of these structures to cell fitness has previously been addressed using cells subjected to chemical treatments or in mutants where O-linked mannans and other wall components are affected. Here, we generated a C. tropicalis pmt2∆ null mutant, which was affected in the first step of the O-linked mannosylation pathway. The null mutant was viable, contrasting with C. albicans where this gene is essential. The phenotypical characterization showed that O-linked mannans were required for filamentation; proper cell wall integrity and organization; biofilm formation; protein secretion; and adhesion to extracellular matrix components, in particular to fibronectin; and type I and type II collagen. When interacting with human innate immune cells, it was found that this cell wall structure is dispensable for cytokine production, but mutant cells were more phagocytosed by monocyte-derived macrophages. Furthermore, the null mutant cells showed virulence attenuation in Galleria mellonella larvae. Thus, O-linked mannans are minor components of the cell wall that are involved in different aspects of C. tropicalis' biology.

Mucormycosis in Liver Allograft Following Transplant for Secondary Biliary Cirrhosis.

Mucormycosis, a group of opportunistic mycoses caused by Mucorales, present a significant threat to immunocompromised patients. In this report, we present the case of a 57-year-old male patient who underwent liver transplant for secondary biliary cirrhosis following inadvertent bile duct injury. Despite initial satisfactory postoperative evolution, the patient developed fever, and imaging revealed a suspicious lesion. Preliminary culture growth suggested a filamentous fungus, leading to initiation of liposomal amphotericin B. However, the lesion progressed, and a surgical debridement was necessary. During surgery, involvement of the liver dome and diaphragm was observed, and a nonanatomical hepatectomy was performed. Despite efforts, the patient's condition deteriorated, ultimately resulting in multiple organ failure and mortality. This case emphasizes the challenging nature of mucormycosis in livertransplant recipients.

Comparison of MAF-32 and a One-Pot Synthesized Superparamagnetic Iron Oxide/MAF-32 Composite for the Adsorption of Diclofenac.

The global presence of pharmaceutical pollutants in water sources represents a burgeoning public health concern. Recent studies underscore the urgency of addressing this class of emerging contaminants. In this context, our work focuses on synthesizing a composite material, FexOy/MAF-32, through a streamlined one-pot reaction process, as an adsorbent for diclofenac, an emerging environmental contaminant frequently found in freshwater environments and linked to potential toxicity towards several organisms such as fish and mussels. A thorough characterization was performed to elucidate the structural composition of the composite. The material presents magnetic properties attributed to its superparamagnetic behavior, which facilitates the recovery efficiency of the composite post-diclofenac adsorption. Our study further involves a comparative analysis between the FexOy/MAF-32 and a non-magnetic counterpart, comprised solely of 2-ethylimidazolate zinc polymer. This comparison aims to discern the relative advantages and disadvantages of incorporating magnetic iron oxide nanoparticles in the contaminant removal process facilitated by a coordination polymer. Our findings reveal that even a minimal incorporation of iron oxide nanoparticles substantially enhanced the composite's overall performance in pollutant adsorption.

Microevolution of Candida glabrata (Nakaseomyces glabrata) during an infection.

Candida glabrata (Nakaseomyces glabrata) is an emergent and opportunistic fungal pathogen that colonizes and persists in different niches within its human host. In this work, we studied five clinical isolates from one patient (P7), that have a clonal origin, and all of which come from blood cultures except one, P7-3, obtained from a urine culture. We found phenotypic variation such as sensitivity to high temperature, oxidative stress, susceptibility to two classes of antifungal agents, and cell wall porosity. Only isolate P7-3 is highly resistant to the echinocandin caspofungin while the other four isolates from P7 are sensitive. However, this same isolate P7-3, is the only one that displays susceptibility to fluconazole (FLC), while the rest of the isolates are resistant to this antifungal. We sequenced the PDR1 gene which encodes a transcription factor required to induce the expression of several genes involved in the resistance to FLC and found that all the isolates encode for the same Pdr1 amino acid sequence except for the last isolate P7-5, which contains a single amino acid change, G1099C in the putative Pdr1 transactivation domain. Consistent with the resistance to FLC, we found that the CDR1 gene, encoding the main drug efflux pump in C. glabrata, is highly overexpressed in the FLC-resistant isolates, but not in the FLC-sensitive P7-3. In addition, the resistance to FLC observed in these isolates is dependent on the PDR1 gene. Additionally, we found that all P7 isolates have a different proportion of cell wall carbohydrates compared to our standard strains CBS138 and BG14. In P7 isolates, mannan is the most abundant cell wall component, whereas ß-glucan is the most abundant component in our standard strains. Consistently, all P7 isolates have a relatively low cell wall porosity compared to our standard strains. These data show phenotypic and genotypic variability between clonal isolates from different niches within a single host, suggesting microevolution of C. glabrata during an infection.

Browning, nutrient inputs, and fast vertical mixing from simulated extreme rainfall and wind stress alter estuarine phytoplankton productivity.

Browning and nutrient inputs from extreme rainfall, together with increased vertical mixing due to strong winds, are more frequent in coastal ecosystems; however, their interactive effects on phytoplankton are poorly understood. We conducted experiments to quantify how browning, together with different mixing speeds (fluctuating radiation), and a nutrient pulse alter primary productivity and photosynthetic efficiency in estuarine phytoplankton communities. Phytoplankton communities (grazers excluded) were exposed simultaneously to these drivers, and key photosynthetic targets were quantified: oxygen production, electron transport rates (ETRs), and carbon fixation immediately following collection and after a 2-d acclimation/adaptation period. Increasing mixing speeds in a turbid water column (e.g. browning) significantly decreased ETRs and carbon fixation in the short term. Acclimation/adaptation to this condition for 2 d resulted in an increase in nanoplanktonic diatoms and a community that was photosynthetically more efficient; however, this did not revert the decreasing trend in carbon fixation with increased mixing speed. The observed interactive effects (resulting from extreme rainfall and strong winds) may have profound implications in the trophodynamics of highly productive system such as the Southwest Atlantic Ocean due to changes in the size structure of the community and reduced productivity.

Efficacy of topical Miltefosine formulations in an experimental model of cutaneous leishmaniasis.

Cutaneous leishmaniasis (CL) is a neglected tropical disease endemic in ~ 90 countries, with an increasing incidence. Presently available pharmacotherapy implies the systemic administration of moderately/very toxic drugs. Miltefosine (Milt) is the only FDA-approved drug to treat CL via the oral route (Impavido®). It produces side effects; in particular, teratogenic effects are of concern. A topical treatment would have the great advantage of minimising the systemic circulation of the drug, preventing side effects. We prepared dispersions containing Milt and liposomes of different compositions to enhance/modulate trans-epidermal penetration and evaluated in vitro and in vivo efficacy and toxicity, in vitro release rate of the drug and particles size stability with time. Treatments were topically administered to BALB/c mice infected with Leishmania (Leishmania) amazonensis. The dispersions containing 0.5% Milt eliminated 99% of the parasites and cured the lesions with a complete re-epithelisation, no visible scar and re-growth of hair. Fluid liposomes decreased the time to heal the lesion and the time needed to eliminate viable amastigotes from the lesion site. Relapse of the infection was not found 1 month after treatment in any case. Ultraflexible liposomes on the other hand had no significant in vitro effect but decreased in vivo efficacy. A topical Milt formulation including fluid liposomes seems a promising treatment against CL.

Draft genome sequence of Staphylococcus agnetis 4244, a strain with gene clusters encoding distinct post-translationally modified antimicrobial peptides.

OBJECTIVES: Here we report the draft genome sequence of Staphylococcus agnetis 4244, a strain involved in bovine mastitis, and its ability to inhibit different species of antibiotic-resistant Gram-positive bacteria owing to bacteriocin production. METHODS: An Illumina MiSeq platform was used for genome sequencing. De novo genome assembly was done using the A5-miseq pipeline. Genome annotation was performed by the RAST server, and mining of bacteriocinogenic gene clusters was done using the BAGEL4 and antiSMASH v.5.0 platforms. Investigation of the spectrum of activity of S. agnetis 4244 was performed on BHI agar by deferred antagonism assay. RESULTS: The total scaffold size was determined to be 2 511 708 bp featuring a G+C content of 35.6%. The genome contains 2431 protein-coding sequences and 80 RNA sequences. Genome analyses revealed three prophage sequences inserted in the genome as well as several genes involved in drug resistance and two bacteriocin gene clusters (encoding a thiopeptide and a sactipeptide) encoded on the bacterial chromosome. Staphylococcus agnetis 4244 was able to inhibit all 44 strains of antibiotic-resistant Gram-positive bacteria tested in this study, including vancomycin-resistant enterococci (VRE), methicillin-resistant Staphylococcus aureus (MRSA) and other antibiotic-resistant staphylococcal strains. CONCLUSION: This study emphasises the potential biotechnological application of this strain for production of bacteriocins that could be used in the food industry as biopreservatives and/or in medicine as alternative therapeutic options against VRE, MRSA, vancomycin-intermediate S. aureus and other antibiotic-resistant Gram-positive bacteria, including biofilm-forming isolates. It also provides some genetic features of the draft genome of S. agnetis 4244.

Efficacy of topical risedronate and risedronate - Eudragit E complex in a model of cutaneous leishmaniasis induced by Leishmania (Leishmania) amazonensis.

An efficacious topical treatment for cutaneous leishmaniasis (CL) is highly desirable but still an ongoing challenge. Systemic risedronate (Ris) has been reported to have anti-leishmanial properties and Eudragit EPO (EuE) has shown in vitro activity against L. (L.) amazonensis. The aim of this work was to investigate the in vivo efficacy of topical Ris and EuE-Ris complexes on CL. Surface charge and Ris release kinetics from the different dispersions were analyzed. BALB/c mice were infected intradermally with promastigotes of L. (L.) amazonensis. Ulcers were treated with Ris or EuE-Ris hydrogels. All the lesions that received topical Ris or EuE-Ris showed an improvement with respect to control: reduction of ulcer average size, cicatrization, flattened edges and no signs of necrosis. In addition, a marked parasitic inhibition of 69.5 and 73.7% was observed in the groups treated with Ris and EuE-Ris, respectively, with the IgG2a levels indicating a tendency towards cure. The results are promising and the system should now be enhanced to achieve total parasite elimination.

Ovarian Vein to Portal Vein Reconstruction: Another Option in Liver Transplant With Portal Vein Thrombosis.

Portal vein thrombosis is a common complication in patients with cirrhosis and a challenge for the transplant team. Not so long ago, portal vein thrombosis was considered an absolute contraindication for liver transplant, but improvements in surgical techniques have overcome this problem in many transplant centers around the world. Here, we present the case of a 52-year-old female patient with cirrhosis from a primary biliary cholangitis and a complex portal vein thrombosis. She underwent a deceased donor liver transplant with a Model for End-Stage Liver Disease of 40. The portal thrombosis was handled using a portosystemic shunt from the splenic vein to the left ovarian vein, which was visualized on a computed tomography scan performed as part of the study protocol. The donor was a 52-year-old woman with brain death secondary to a vascular cerebral accident. A caval replacement technique was used with no complications during surgery. For the portal anastomosis, the dilated left ovarian vein was carefully dissected and brought through the lesser sac, behind the stomach, to obtain a suitable length. An end-to-end anastomosis of the graft portal vein to the left ovarian vein was performed with a 6-0 Prolene running suture. An abdominal computed tomography scan was performed 6 months after liver transplant showing patency of portal vein and no anastomotic defects, and after 24 months of follow-up the patient is in good clinical condition with normal laboratory values and Doppler ultrasonography with no vascular anomalies and adequate portal flow. To our knowledge, the use of a spleno-ovarian shunt has not been reported as an alternative for portal reconstruction in a case of thrombosis.

Extreme and gradual rainfall effects on winter and summer estuarine phytoplankton communities from Patagonia (Argentina).

Rainfall events bring both, terrigenous materials (including DOM) and nutrients to the aquatic system (e.g., via riverine runoff) having potential effects on the structure and metabolism of the phytoplankton communities. As extreme rainfall events in Patagonia occurred more frequently in the last decade (2010-2019) as compared to the previous ones (1972-2009), we exposed winter and summer phytoplankton communities (using microcosms) to solar radiation, simulating two rainfall conditions - a single extreme vs. intermittent i.e., with gradual inputs, and we assessed their photosynthetic and growth rates responses and taxonomic changes. Rainfall scenarios significantly increased growth of both communities, mainly of small nanoplanktonic species, as compared to the control. Small nanoplanktonic centric diatoms increased and dominated in both rainfall scenarios, as compared to the control, during winter and summer, with significantly smaller cells during summer as compared to winter. Photosynthetic efficiency increased in both rainfall scenarios at the end of the experiment as compared to the control. Overall, the change towards small cells (associated to rainfall events) that can use more effectively solar radiation and nutrients (as compared to large cells) may have a significant impact on the trophic webs of the South West Atlantic Ocean by favoring grazing pressure by microzooplankton, especially during summer.

Role of Protein Mannosylation in the Candida tropicalis-Host Interaction.

Mannans are components of the fungal wall attached to proteins via N- or O-linkages. In Candida albicans, Och1 is an α1,6-mannosyltransferase that adds the first mannose unit to the N-linked mannan outer chain; whereas Pmr1 is an ion pump that imports Mn2+ into the Golgi lumen. This cation is the cofactor of Golgi-resident mannosyltransferases, and thus Pmr1 is involved in the synthesis of both N- and O-linked mannans. Since we currently have limited information about the genetic network behind the Candida tropicalis protein mannosylation machinery, we disrupted OCH1 and PMR1 in this organism. The C. tropicalis pmr1Δ and och1Δ mutants showed increased doubling times, aberrant colony and cellular morphology, reduction in the wall mannan content, and increased susceptibility to wall perturbing agents. These changes were accompanied by increased exposure of both ß1,3-glucan and chitin at the wall surface of both mutant strains. Our results showed that O-linked mannans are dispensable for cytokine production by human mononuclear cells, but N-linked mannans and ß1,3-glucan are key ligands to trigger cytokine production in a co-stimulatory pathway involving dectin-1 and mannose receptor. Moreover, we found that the N-linked mannan core found on the surface of C. tropicalis och1Δ null mutant was capable of inducing cytokine production; and that a mannan-independent pathway for IL-10 production is present in the C. tropicalis-mononuclear cell interaction. Both mutant strains showed virulence attenuation in the Galleria mellonella and the mouse model of systemic candidiasis. Therefore, mannans are relevant for cell wall composition and organization, and for the C. tropicalis-host interaction.

Intestinal failure functional classification type associated with an extended length of stay at the intestinal failure unit, Central Hospital in Chihuahua, Mexico.

BACKGROUND: Intestinal failure (IF) was first defined as "a reduction in the functioning gut mass below the minimal amount necessary for adequate digestion and absorption." In our environment, there are no statistical data for IF in adult patients' extended length of stay (LOS), nor the economic impact that it implies. OBJECTIVE: The objective of the study was to describe the association between the IF type and extended LOS. METHODS: Patients admitted to our IF Unit between March 2016 and March 2018 were enrolled. We conducted a 2-year retrospective cross-sectional study. RESULTS: From the total of 53 patients, 35% corresponded to type I IF, 58.5% to type II IF, and 7.5% to type III IF. The mean LOS, according to the type of functional IF was 51 days for type I, 77.48 days for type II, and 68.25 days for type III. The mean LOS for the three IF types was 67.79 days. CONCLUSION: Extended LOS occurs in an important proportion of patients with IF, resulting in increased morbidity and mortality, as well as in costs and associated side effects. Future research should focus on economic studies, to know the economic impact that this subject entails for our health systems.

ANTECEDENTES: En nuestro entorno no existen datos estadísticos sobre la falla intestinal en adultos, su estancia hospitalaria prolongada (EHP) ni el impacto económico que implica. OBJETIVO: Describir la asociación entre el tipo de falla intestinal y la estancia hospitalaria prolongada en pacientes de la unidad de falla intestinal del Hospital Central del Estado Chihuahua, México. MÉTODO: Se realizó un estudio transversal retrospectivo con un total de 53 participantes durante el periodo de marzo de 2016 a marzo de 2018. RESULTADOS: De los 53 pacientes, el 35% tuvieron falla intestinal tipo I, el 58.5% tipo II y el 7.5% tipo III. La media de estancia fue de 51 días para la falla intestinal tipo I, 77,48 días para la tipo II y 68,25 días para la tipo III. La media de estancia hospitalaria para los tres tipos de insuficiencia intestinal fue de 67,79 días. CONCLUSIONES: La estancia hospitalaria prolongada ocurre en una proporción importante de pacientes con falla intestinal, lo que resulta en un aumento de la morbilidad, la mortalidad y los costos. Investigaciones futuras deberían centrarse en la realización de estudios económicos para conocer el impacto que esta cuestión tiene para nuestros sistemas de salud.

Recombinant Cysteine Proteinase B from Leishmania braziliensis and Its Domains: Promising Antigens for Serodiagnosis of Cutaneous and Visceral Leishmaniasis in Dogs.

Leishmaniasis represents a group of parasitic diseases caused by a protozoan of the genus Leishmania and is widely distributed in tropical and subtropical regions. Leishmaniasis is one of the major tropical neglected diseases, with 1.5 to 2 million new cases occurring annually. Diagnosis remains a challenge despite advances in parasitological, serological, and molecular methods. Dogs are an important host for the parasite and develop both visceral and cutaneous lesions. Our goal was to contribute to the diagnosis of canine cutaneous leishmaniasis (CL) and visceral leishmaniasis (VL) using the recombinant cysteine proteinase B (F-CPB) from Leishmania braziliensis and its N- and C-terminal domains (N-CPB and C-CPB) as antigens in an enzyme-linked immunosorbent assay (ELISA). Sera from dogs from Northwest Argentina diagnosed with CL were tested by ELISA against a supernatant of L. braziliensis lysate, the F-CPB protein, and its domains. We found values of sensitivity (Se) of 90.7%, 94.4%, and 94.3% and specificity (Sp) of 95.5%, 90.9%, and 91.3% for F-CPB and its N- and C-terminal domains, respectively. In sera from dogs diagnosed with VL from Northeast Argentina, we found Se of 93.3%, 73.3%, and 66.7% and Sp of 92.3%, 76.9%, and 88.5% for F-CPB and its N- and C-terminal domains, respectively. These results support CPB as a relevant antigen for canine leishmaniasis diagnosis in its different clinical presentations. More interestingly, the amino acid sequence of CPB showed high percentages of identity in several Leishmania species, suggesting that the CPB from L. braziliensis qualifies as a good antigen for the diagnosis of leishmaniasis caused by different species.

Multiple Wire-Mesh Sensors Applied to the Characterization of Two-Phase Flow inside a Cyclonic Flow Distribution System.

Wire-mesh sensors are used to determine the phase fraction of gas⁻liquid two-phase flow in many industrial applications. In this paper, we report the use of the sensor to study the flow behavior inside an offshore oil and gas industry device for subsea phase separation. The study focused on the behavior of gas⁻liquid slug flow inside a flow distribution device with four outlets, which is part of the subsea phase separator system. The void fraction profile and the flow symmetry across the outlets were investigated using tomographic wire-mesh sensors and a camera. Results showed an ascendant liquid film in the cyclonic chamber with the gas phase at the center of the pipe generating a symmetrical flow. Dispersed bubbles coalesced into a gas vortex due to the centrifugal force inside the cyclonic chamber. The behavior favored the separation of smaller bubbles from the liquid bulk, which was an important parameter for gas-liquid separator sizing. The void fraction analysis of the outlets showed an even flow distribution with less than 10% difference, which was a satisfactorily result that may contribute to a reduction on the subsea gas⁻liquid separators size. From the outcomes of this study, detailed information regarding this type of flow distribution system was extracted. Thereby, wire-mesh sensors were successfully applied to investigate a new type of equipment for the offshore oil and gas industry.

Effectiveness, safety and cost of abiraterone acetate in patients with metastatic castration-resistant prostate cancer: a real-world data analysis.

PURPOSE: New therapies with diverse mechanisms of action are available for metastatic castration-resistant prostate cancer (mCRPC). This study aims to evaluate the effectiveness, safety and cost of abiraterone acetate (AA) in patients with mCRPC. MATERIALS AND METHODS: Observational retrospective cohort study in which mCRPC patients who initiated AA between January 1, 2012 and December 31, 2017, were included. The patients were followed-up until death or March 31, 2018. Demographic, clinical and economic data were collected from the corporate electronic information systems. Survival distributions were estimated using the Kaplan-Meier method and compared using the log-rank test. RESULTS: A total of 69 mCRPC patients were started on AA, of whom 18 (26.1%) received prior chemotherapy (post-CT) and 51 (73.9%) did not receive it (CT-naïve). A PSA decline of ≥ 50% was achieved in five (27.8%) post-CT and 32 (62.7%) CT-naïve patients (p = 0.011). Median time to PSA progression, progression-free survival (PFS) and overall survival (OS) were 4.4/7.9 months (p = 0.003), 5.1/7.5 months (p = 0.034) and 12.1/21.3 months (p = 0.119), respectively, for post-CT/CT-naïve patients. Treatment-related adverse events (AEs) occurred in 10 (55.6%) post-CT and 11 (21.6%) CT-naïve patients (p = 0.007). The most common AEs were hypokalaemia (11.6%), hypertension (8.7%) and fatigue (5.8%). The cost per median PFS month and per median OS month was €2818.4/€2784.3 and €1187.9/€980.4 for post-CT/CT-naïve patients, respectively. CONCLUSIONS: CT-naïve patients treated with AA obtained a better clinical benefit in terms of effectiveness, safety and cost-effectiveness ratio than post-CT patients. The effectiveness outcomes were poorer than those reported previously in the clinical trial setting.

Hipema traumático en paciente con hemoglobinopatía / Trauma hyphema in a patient with hemoglobinopathy

El hipema traumático es la presencia de sangre en la cámara anterior y puede presentarse en traumas oculares a globo abierto o cerrado, así como coexistir con otras lesiones. Se presenta un paciente masculino de 52 años de edad, coloración de la piel negra, quien sufrió un trauma contuso del ojo derecho que le provocó hipema y requirió ingreso hospitalario. A pesar del tratamiento médico convencional, evolucionó desfavorablemente, ya que presentó resangrado tardío. motivados por esto le indicamos un estudio de electroforesis de hemoglobina e incorporamos un tratamiento sistémico con antifibrinolíticos. Se obtuvo resolución de la hemorragia en las primeras 48 horas de iniciar el tratamiento. Se concluye que el uso de antifibrinolíticos resulta efectivo para el tratamiento del hipema postraumático en pacientes con hemoglobinopatías(AU)

Trauma hyphema is the presence of blood in the anterior chamber and may occur in open or closed eyeball traumas as well as coexist in other lesions. This is the case of a Black male patient aged 52 years, who suffered a blunt trauma in his right eye causing hyphema and requiring hospitalization. Despite the conventional medical treatment, the recovery was unfavorable since he presented with late rebleeding. Due to the above-mentioned condition, he was performed a hemoglobin electrophoresis study and he received a systemic treatment with antifibrinolytics. Hemorrhage disappeared after 48 hours of treatment. It was concluded that the use of antifibrinolytics is effective for the treatment of post-trauma hyphema in patients with hemoglobinopathy. Key words: Hyphema; antifibrinolytics; hemoglobinopathy(AU)

Hipema traumático en paciente con hemoglobinopatía / Trauma hyphema in a patient with hemoglobinopathy

El hipema traumático es la presencia de sangre en la cámara anterior y puede presentarse en traumas oculares a globo abierto o cerrado, así como coexistir con otras lesiones. Se presenta un paciente masculino de 52 años de edad, coloración de la piel negra, quien sufrió un trauma contuso del ojo derecho que le provocó hipema y requirió ingreso hospitalario. A pesar del tratamiento médico convencional, evolucionó desfavorablemente, ya que presentó resangrado tardío. motivados por esto le indicamos un estudio de electroforesis de hemoglobina e incorporamos un tratamiento sistémico con antifibrinolíticos. Se obtuvo resolución de la hemorragia en las primeras 48 horas de iniciar el tratamiento. Se concluye que el uso de antifibrinolíticos resulta efectivo para el tratamiento del hipema postraumático en pacientes con hemoglobinopatías(AU)

Trauma hyphema is the presence of blood in the anterior chamber and may occur in open or closed eyeball traumas as well as coexist in other lesions. This is the case of a Black male patient aged 52 years, who suffered a blunt trauma in his right eye causing hyphema and requiring hospitalization. Despite the conventional medical treatment, the recovery was unfavorable since he presented with late rebleeding. Due to the above-mentioned condition, he was performed a hemoglobin electrophoresis study and he received a systemic treatment with antifibrinolytics. Hemorrhage disappeared after 48 hours of treatment. It was concluded that the use of antifibrinolytics is effective for the treatment of post-trauma hyphema in patients with hemoglobinopathy. Key words: Hyphema; antifibrinolytics; hemoglobinopathy(AU)

Prognostic role for the derived neutrophil-to-lymphocyte ratio in early breast cancer: a GEICAM/9906 substudy.

PURPOSE: Elevated markers of host inflammation, a hallmark of cancer, have been associated with worse outcomes in several solid tumors. Here, we explore the prognostic role of the derived neutrophil-to-lymphocyte ratio (dNLR), across different tumor subtypes, in patients with early breast cancer. PATIENTS AND METHODS: This was a retrospective analysis of 1246 patients with lymph node-positive, operable early breast cancer enrolled in the GEICAM/9906 trial, a multicenter randomized phase 3 study evaluating adjuvant chemotherapy. dNLR was calculated as the ratio of neutrophils and the difference between total leukocytes and neutrophils in peripheral blood before chemotherapy. Disease-free survival (DFS) and overall survival were explored using a Cox proportional hazard analysis. RESULTS: The analysis comprised 1243 (99.8%) patients with dNLR data, with a median follow-up of 10 years. Data on intrinsic subtypes were available from 818 (66%) patients (luminal A 34%, luminal B 32%, HER2-enriched 21% and basal-like 9%). Median dNLR was 1.35 [interquartile range (IQR) 1.08-1.71]. In the whole population, dNLR was not prognostic after adjustment for clinico-pathological factors. However, dNLR ≥ 1.35 was independently associated with worse DFS in the hormone receptor-negative/HER2+ population (HR 2.86; p = 0.038) and in patients with one to three lymph node metastases (HR 1.32, p = 0.032). There was a non-significant association with worse DFS in non-luminal and in HER2-enriched tumors (HR 1.40, p = 0.085 and HR 1.53, p = 0.067). No significant interaction was observed between the treatment arm and dNLR. CONCLUSION: Elevated dNLR appears to be an adverse prognostic factor in hormone receptor-negative early breast cancer. TRIAL REGISTRATION: EudraCT: 2005-003108-12 (retrospectively registered 28/06/2005). ClinicalTrials.gov Identifier: NCT00129922 (retrospectively registered 10/08/2005). Results of this study were presented in part at the 2016 ESMO conference October 7-11, 2016, Copenhagen, Denmark (oral presentation).

Abiotic control of phytoplankton blooms in temperate coastal marine ecosystems: A case study in the South Atlantic Ocean.

Coastal waters of the South Atlantic Ocean (SAO) sustain one of the highest levels of production of the World's ocean, maintained by dense phytoplankton winter blooms that are dominated by large diatoms. These blooms have been associated to calm weather conditions that allow the formation of a shallow and well illuminated upper mixed layer. In Bahía Engaño, a coastal site in Patagonia, Argentina (chosen as a model coastal ecosystem) winter blooms recurrently peaked on June and they were dominated almost entirely by the microplanktonic diatom Odontella aurita. However, during the year 2015, a new wind pattern was observed - with many days of northerly high-speed winds, deviating from the calm winter days observed during a reference period (2001-2014) used for comparison. We determined that this new wind pattern was the most important factor that affected the phytoplankton dynamics, precluding the initiation of a June bloom during 2015 that instead occurred during late winter (August). Furthermore, the 2015 bloom had a higher proportion of nanoplanktonic cells (as compared to the reference period) and it was co-dominated by O. aurita and Thalassiossira spp. Other variables such as nutrient supply and incident solar radiation did not have an important role in limiting and/or initiating the June 2015 bloom, but temperature might have benefited the growth of small cells during August 2015. If these changes in the timing and/or the taxonomic composition of the bloom persist, they may have important consequences for the secondary production and economic services of the coastal SAO.

Minimally invasive and endoscopic versus open necrosectomy for necrotising pancreatitis: a pooled analysis of individual data for 1980 patients.

OBJECTIVE: Minimally invasive surgical necrosectomy and endoscopic necrosectomy, compared with open necrosectomy, might improve outcomes in necrotising pancreatitis, especially in critically ill patients. Evidence from large comparative studies is lacking. DESIGN: We combined original and newly collected data from 15 published and unpublished patient cohorts (51 hospitals; 8 countries) on pancreatic necrosectomy for necrotising pancreatitis. Death rates were compared in patients undergoing open necrosectomy versus minimally invasive surgical or endoscopic necrosectomy. To adjust for confounding and to study effect modification by clinical severity, we performed two types of analyses: logistic multivariable regression and propensity score matching with stratification according to predicted risk of death at baseline (low: <5%; intermediate: ≥5% to <15%; high: ≥15% to <35%; and very high: ≥35%). RESULTS: Among 1980 patients with necrotising pancreatitis, 1167 underwent open necrosectomy and 813 underwent minimally invasive surgical (n=467) or endoscopic (n=346) necrosectomy. There was a lower risk of death for minimally invasive surgical necrosectomy (OR, 0.53; 95% CI 0.34 to 0.84; p=0.006) and endoscopic necrosectomy (OR, 0.20; 95% CI 0.06 to 0.63; p=0.006). After propensity score matching with risk stratification, minimally invasive surgical necrosectomy remained associated with a lower risk of death than open necrosectomy in the very high-risk group (42/111 vs 59/111; risk ratio, 0.70; 95% CI 0.52 to 0.95; p=0.02). Endoscopic necrosectomy was associated with a lower risk of death than open necrosectomy in the high-risk group (3/40 vs 12/40; risk ratio, 0.27; 95% CI 0.08 to 0.88; p=0.03) and in the very high-risk group (12/57 vs 28/57; risk ratio, 0.43; 95% CI 0.24 to 0.77; p=0.005). CONCLUSION: In high-risk patients with necrotising pancreatitis, minimally invasive surgical and endoscopic necrosectomy are associated with reduced death rates compared with open necrosectomy.