Surgical approach to the locoregional recurrence of cancer of the rectum

A literature review has been made on the pelvic recurrence of rectal cancer using the MedLine, Ovid, EMBASE, Cochrane and Cinahl data bases. Assessment of the locoregional recurrence must be made using imaging tests in order to rule out the presence of metastasis, as well as for locating its exact location within the pelvis. As the only curative treatment should be complete resection of the recurrence with negative margins, a pre-operative CT, NMR, endorectal ultrasound and PET-CT must be performed to determine its resectability. For a potential cure, radical resections must be made, with the technique varying according to whether the location is central (axial), posterior (presacral) or lateral, as well as treatment directed at the primary tumour. Neoadjuvant treatments, brachiterapy and intra-operative radiotherapy improve the local control results and survival in these patients.     

A fungicidal monoclonal antibody protects against murine invasive candidiasis

Mice infected by Candida albicans and treated with monoclonal antibody C7 survived longer than saline-treated animals. A prozone-like effect was observed. The in vitro candidacidal activity of macrophages was strongly enhanced when C. albicans was opsonized by C7 and complete murine serum was present.     

Influence of antipseudomonal agents on Pseudomonas aeruginosa colonization and acquisition of resistance in critically ill medical patients

Objective  To assess the role of antipseudomonal agents on Pseudomonas aeruginosa colonization and acquisition of resistance. Design  Prospective cohort study. Setting  Two medical intensive care units. Patients and participants  346 patients admitted for ≥ 48 h. Intervention  Analysis of data from an 8-month study comparing a mixing versus a cycling strategy of antibiotic use. Measurements and results  Surveillance cultures from nares, pharynx, rectum, and respiratory secretions were obtained thrice weekly. Acquisition of resistance was defined as the isolation, after 48 h of ICU stay, of an isolate resistant to a given antibiotic if culture of admission samples were either negative or positive for a susceptible isolate. Emergence of resistance refers to the conversion of a defined pulsotype from susceptible to non-susceptible. Forty-four (13%) patients acquired 52 strains of P. aeruginosa. Administration of piperacillin-tazobactam for ≥ 3 days (OR 2.6, 95% CI 1.09–6.27) and use of amikacin for ≥ 3 days (OR 2.6, 95% CI 1.04–6.7) were positively associated with acquisition of P. aeruginosa, whereas use of quinolones (OR 0.27, 95% CI 0.1–0.7) and antipseudomonal cephalosporins (OR 0.27, 95% CI 0.08–0.9) was protective. Exposure to quinolones and cephalosporins was not associated with the acquisition of resistance, whereas it was linked with usage of all other agents. Neither quinolones nor cephalosporins were a major determinant on the emergence of resistance to themselves, as resistance to these antibiotics developed at a similar frequency in non-exposed patients. Conclusions  In critically ill patients, quinolones and antipseudomonal cephalosporins may prevent the acquisition of P. aeruginosa and may have a negligible influence on the acquisition and emergence of resistance.     

Ergonomic comparison of a chem/bio prototype firefighter ensemble and a standard ensemble

Firefighter turnout gear and equipment protect the wearer against external hazards but, unfortunately, restrict mobility. The aim of this study was to determine the ease of mobility and comfort while wearing a new prototype firefighter ensemble (PE) with additional chemical/biological hazard protection compared to a standard ensemble (SE) by measuring static and dynamic range of motion (ROM), job-related tasks, and comfort. Eight healthy adults (five males, three females), aged 20-40 years, participated in this study. The study consisted of two repeated phases, separated by five uses of the ensembles. Subjects randomly donned either the SE or PE in either dry or wet conditions on separate days. In each phase, five tests were carried out as follows: baseline (non-ensemble), SE-dry, SE-wet, PE-dry, and PE-wet. There was a significant reduction (P < 0.05) of wrist flexion for PE-dry condition compared to the same SE-dry condition. Donning the PE took 80 s longer than the SE in phase 1, this difference disappeared in phase 2. There was a significant decrease (P < 0.05) in post-test comfort wearing the PE compared to the SE. The data collected in this study suggest that, in spite of design features to enhance chemical/biological hazard protection, the PE design does not decrease the wearer's overall functional mobility compared to the SE. However, subjects seem to be more comfortable wearing the SE compared to the PE. These overall findings support the need for a comprehensive ergonomic evaluation of protective clothing systems to ascertain human factors issues.     

DNA methylation clocks for dogs and humans

DNA methylation profiles have been used to develop biomarkers of aging known as epigenetic clocks, which predict chronological age with remarkable accuracy and show promise for inferring health status as an indicator of biological age. Epigenetic clocks were first built to monitor human aging, but their underlying principles appear to be evolutionarily conserved, as they have now been successfully developed for many mammalian species. Here, we describe reliable and highly accurate epigenetic clocks shown to apply to 93 domestic dog breeds. The methylation profiles were generated using the mammalian methylation array, which utilizes DNA sequences that are conserved across all mammalian species. Canine epigenetic clocks were constructed to estimate age and also average time to death. We also present two highly accurate human–dog dual species epigenetic clocks (R = 0.97), which may facilitate the ready translation from canine to human use (or vice versa) of antiaging treatments being developed for longevity and preventive medicine. Finally, epigenome-wide association studies here reveal individual methylation sites that may underlie the inverse relationship between breed weight and lifespan. Overall, we describe robust biomarkers to measure aging and, potentially, health status in canines.

Ideally, model species for antiaging research should be representative of human characteristics such as size and genetic diversity, as well as shared environment. Domestic dogs (Canis lupus familiaris) fulfill most of these criteria, offering a unique opportunity to evaluate the effectiveness of emerging antiaging interventions (1–5). There is also a significant need to develop health-monitoring tools for dogs, as there are more than 76 million companion dogs in the United States alone (6).Over 340 dog breeds are recognized worldwide, which are each a closed breeding population under strong selection for morphologic and behavioral traits. As a result, dogs share extensive phenotypic and genetic homogeneity within breeds and increased heterogeneity between breeds (7). Small breeds live considerably longer than large breeds (8), offering the rare chance to understand the relationship between size and lifespan within a single mammalian species. Dogs also share a similar yet accelerated trajectory of development as humans including infancy, puberty, adulthood, and senescence in about 20% of the human lifespan (5, 9). As a result, dogs represent an ideal system for studies of comparative aging, where intrabreed studies can be conducted on a background of limited diversity.Our previous work on DNA-methylation-based age estimators (i.e., epigenetic clocks) for dogs and wolves (10) described one of the first nonhuman epigenetic clocks. We determined that the age dependence of DNA methylation (DNAm) is conserved at syntenic sites in the genomes of multiple mammalian species including humans. However, a small sample size (n < 150) and technical limitations associated with the measurement platform (reduced representation bisulfite sequencing) limited the generalizability of the results. Furthermore, our initial study utilized only a few canine breeds, which prevented testing the relationship between epigenetic aging and breed lifespan. Here, we report the development of a canine epigenetic clock based on 93 recognized dog breeds (11) using a mammalian array (HorvathMammalMethylChip40) that profiles highly conserved cytosines across mammalian species (12).In this study, we present dual-species epigenetic clocks that apply to both humans and dogs. We test whether short-lived breeds exhibit faster epigenetic aging than long-lived breeds and develop epigenetic predictors of the average time to death. Finally, we investigate the relationship between breed size and lifespan and characterize 5''-C-phosphate-G-3'' regions (CpGs) that are correlated with age or breed characteristics such as median lifespan or average adult weight.     

Electrocardiographic Characteristics and Associated Outcomes in Patients with Takotsubo Syndrome. Insights from the RETAKO Registry

Electrocardiographic disturbances in Takotsubo syndrome have been previously partially described but their consequences remain mostly unknown. Our aim was to describe the prevalence and prognostic significance of different electrocardiographic features in patients with Takotsubo syndrome. Our data come from the Spanish multicenter REgistry of TAKOtsubo syndrome (RETAKO). All patients with an available 12-lead surface electrocardiogram at admission and 48 hours post-admission were included. A total of 246 patients were studied, mean age was 71.3 ± 11.5 and 215 (87.4%) were women. ST-segment elevation was seen in 143 patients (59.1%) and was present in ≥2 wall leads in 97 (39.8%). Exclusive elevation in inferior leads was infrequent (5% - 2.0%). After 48 hours, 198 patients (88.0%) developed negative T waves in a median of 8 leads with a mean amplitude of 0.7 ± 0.5 mV and 137 (60.9%) had pathological Q waves. The mean corrected QT interval was 520 ± 72 ms. Corrected QT interval was independently associated with the primary endpoint of all-cause death and nonfatal cardiovascular events (P = 0.002) and all-cause death (P = 0.008). A higher heart rate at admission was an independent predictor of the primary endpoint (P = 0.001) and of acute pulmonary edema (P = 0.04). ST-segment elevation with reciprocal depression was an independent predictor of all-cause death (P = 0.04). Absence of ST-segment deviation was a protective factor (P = 0.005) for the primary endpoint. Tachyarrhythmias were independently associated with cardiogenic shock (P< 0.001). Takotsubo syndrome patients present with distinct electrocardiographic features. Prolonged corrected QT interval, tachyarrhythmias, heart rate at admission, and more extensive repolarization alterations are associated with poor outcomes.     

Worldwide patterns of genomic variation and admixture in gray wolves

The gray wolf (Canis lupus) is a widely distributed top predator and ancestor of the domestic dog. To address questions about wolf relationships to each other and dogs, we assembled and analyzed a data set of 34 canine genomes. The divergence between New and Old World wolves is the earliest branching event and is followed by the divergence of Old World wolves and dogs, confirming that the dog was domesticated in the Old World. However, no single wolf population is more closely related to dogs, supporting the hypothesis that dogs were derived from an extinct wolf population. All extant wolves have a surprisingly recent common ancestry and experienced a dramatic population decline beginning at least ∼30 thousand years ago (kya). We suggest this crisis was related to the colonization of Eurasia by modern human hunter–gatherers, who competed with wolves for limited prey but also domesticated them, leading to a compensatory population expansion of dogs. We found extensive admixture between dogs and wolves, with up to 25% of Eurasian wolf genomes showing signs of dog ancestry. Dogs have influenced the recent history of wolves through admixture and vice versa, potentially enhancing adaptation. Simple scenarios of dog domestication are confounded by admixture, and studies that do not take admixture into account with specific demographic models are problematic.The gray wolf (Canis lupus) is a dominant large predator that exerts important top-down effects on biodiversity (Levi and Wilmers 2012; Ripple et al. 2014). The species is widely distributed throughout the Holarctic (including the Nearctic and Palearctic regions), and as many as 32 subspecies have been described (Aggarwal et al. 2003). Gray wolves have an ancient origin, first appearing about 500 thousand years ago (kya) in Eurasia and in North America soon thereafter (Nowak 1979; Kurten and Anderson 1980). Initial studies based on mitochondrial DNA (mtDNA) data suggested that the gray wolf had a complex evolutionary history without clear worldwide phylogeographic structure (e.g., Wayne et al. 1992; Vilà et al. 1999). However, subsequent studies found subpopulation structure related to local environmental characteristics (e.g., Carmichael et al. 2001; Geffen et al. 2004; Pilot et al. 2006, 2010, 2014; Musiani et al. 2007; vonHoldt et al. 2011). Genome-wide approaches using SNP genotyping arrays have confirmed these environmentally related genetic partitions and demonstrated extensive admixture with coyotes and, to a more limited extent, with domestic dogs (Pilot et al. 2010, 2014; vonHoldt et al. 2010, 2011). Using complete genome sequence data of a wolf from Europe, Israel, and China, Freedman et al. (2014) found an unexpected recent coalescence of ∼30 kya, suggesting that wolves existing before that time were phylogenetically distinct, a result supported by genetic, isotopic, and morphologic analyses (Leonard et al. 2007; Thalmann et al. 2013). The wolves from these three regions also suffered a substantial bottleneck that initiated ∼15 kya, which was nearly coincident with the Wisconsin glacial maximum (Freedman et al. 2014). However, as inferred from genomic data, Zhang et al. (2014) found that Tibetan wolves experienced earlier and more dramatic population declines perhaps due to the extreme loss of wolf habitat with Late Pleistocene glaciations in the Tibetan Plateau. These findings suggest the recent worldwide history of wolves is complex and needs to be assessed with a fuller sample of genomes from throughout the historic range of the species.The domestic dog (Canis lupus familiaris), a descendant of gray wolves, is the most widely abundant large carnivore (Vilà et al. 1999; Thalmann et al. 2013), but the specific region of origin is controversial. Previous genetic evidence suggested that dogs were domesticated either in the Middle East or East Asia (Savolainen et al. 2002; vonHoldt et al. 2010; Wang et al. 2013). However, a recent study based on ancient mtDNA analysis of dogs and wolves infers an origin in Europe from a now-extinct lineage of gray wolves (Thalmann et al. 2013). This result is consistent with whole-genome analysis, showing that none of the extant wolf lineages from putative domestication centers (Europe, Israel, and China) were more closely related to dogs (Freedman et al. 2014). Very recently, however, these conclusions were questioned by results from an extensive study of SNP genotypes in a worldwide sample of breed and village dogs, which concluded that dogs originated in Central Asia (Shannon et al. 2015). Consequently, we test for alternative regions of origin with a geographically broad sample of gray wolves.The release of the boxer genome in 2005 (Lindblad-Toh et al. 2005) provided a high-quality dog reference for comparison to wolves and other canids (e.g., Wang et al. 2013; Freedman et al. 2014; Zhang et al. 2014; Koepfli et al. 2015). However, no studies have been performed to investigate population subdivision, demography, and relationships of gray wolves based on whole-genome sequences. In this study, we generate whole genomes of nine individual wolves, one coyote, and one golden jackal at 9–28× coverage using the Illumina HiSeq 2000 platform to geographically complement existing canine sequences. Combined with published genomes, we assemble a data set with 34 canid genomes to (1) assess relationship patterns across the entire geographic range of wolves; (2) affirm their recent demographic decline with a more geographically extensive sample; (3) assess admixture between dogs and wolves; and (4) explore the possibility of dog domestication outside the Middle East, Europe, and East Asia, which was not addressed in previous studies but is a possibility suggested by new findings (Shannon et al. 2015; Skoglund et al. 2015).     

Heavy metal concentration in feathers of Little Egret (<Emphasis Type="Italic">Egretta garzetta</Emphasis>) nestlings in three coastal breeding colonies in Spain

The colonial ardeid Little Egret (Egretta garzetta), which is is protected under the European Birds Directive (2009/147/EC), can be a reliable bioindicator of aquatic environmental pollution. Concentrations of the heavy metals Cd, Cr, Cu, Hg, Ni, Pb and Zn in nestling feathers were assessed for three different breeding colonies of Little Egret on the Spanish coast during 2013 (5 individuals in Urdaibai, 10 in Santoña and 26 in Odiel). There were no significant differences in mean tissue residues of Cd, Ni, Pb and Zn between the colonies; however, mean concentration of Hg in Odiel nestlings was approximately three times lower than that of the other colonies, while Cr and Cu were significantly higher. In general, Little Egret nestlings from the three study sites had low levels of most of the measured metals, and thus the breeding populations did not appear to be at risk from heavy metal pollution. Baseline metal concentration in feathers derived from this study and calculated as the 90th percentile values were: 0.02 μg Cd g^?1 dw, 0.42 μg Cr g^?1 dw, 1.63 μg Hg g^?1 dw, 0.40 μg Pb g^?1 dw and 122 μg Zn g^?1 dw. However, mean Cu residues attained relatively high levels (17.6–26.9 μg Cu g^?1 dw) compared with data reported elsewhere, which raises concern and indicates a need for further research.     

SARS-CoV-2 outbreak impact on a trauma unit

BACKGROUND From February 2020 onwards, our country has been hit by the coronavirus severe acute respiratory syndrome-2(SARS-CoV-2) infection. At a glance, hospitals became overrun and had to reformulate all the assistance guidelines, focusing on the coronavirus disease 2019. One year after the start of the pandemic, we present the results of a morbimortality study.AIM To analyze how our department was affected by the outbreak in terms of morbimortality, and to analyze demographic data, admission to hospital-related data, and subgroups analyses for patients with hip fractures and polytrauma.METHODS We designed a study comparing data from patients who were admitted to our unit due to a lower limb fracture or a high energy trauma during the pandemic(from March to April 2020) to those admitted during the same period in 2019 before the pandemic. during the pandemic situation. Both cohorts completed a minimum of 6 mo of follow-up.RESULTS The number of patients admitted to hospital in 2020 was nearly half of those in 2019. Hip fractures in the elderly represented 52 out of 73 of the admitted patients. Twenty patients had a positive test result for SARS-CoV-2 infection. Patients with SARS-CoV-2 infection were admitted to the hospital for a longer time than the non-infected(P 0.001), and had a higher mortality rate during hospitalization and follow-up(P = 0.02). Patients with a hip fracture associated with a severe respiratory syndrome were mostly selected for conservative treatment(P = 0.03).CONCLUSION Mortality and readmission rates were higher in the 2020 cohort and during follow-up, in comparison with the cohort in 2019.