Speleothem Paleoclimatology for the Caribbean, Central America, and North America

Speleothem oxygen isotope records from the Caribbean, Central, and North America reveal climatic controls that include orbital variation, deglacial forcing related to ocean circulation and ice sheet retreat, and the influence of local and remote sea surface temperature variations. Here, we review these records and the global climate teleconnections they suggest following the recent publication of the Speleothem Isotopes Synthesis and Analysis (SISAL) database. We find that low-latitude records generally reflect changes in precipitation, whereas higher latitude records are sensitive to temperature and moisture source variability. Tropical records suggest precipitation variability is forced by orbital precession and North Atlantic Ocean circulation driven changes in atmospheric convection on long timescales, and tropical sea surface temperature variations on short timescales. On millennial timescales, precipitation seasonality in southwestern North America is related to North Atlantic climate variability. Great Basin speleothem records are closely linked with changes in Northern Hemisphere summer insolation. Although speleothems have revealed these critical global climate teleconnections, the paucity of continuous records precludes our ability to investigate climate drivers from the whole of Central and North America for the Pleistocene through modern. This underscores the need to improve spatial and temporal coverage of speleothem records across this climatically variable region

Temporal correlation of population composition and environmental variables in the marine invader Ciona robusta

The capacity for ascidians to inhabit coastal sea floor worldwide relies on their peculiar tolerance to environmental variables and pollution, which is considered, together with high levels of genetic diversity, among the main drivers of their invasive potential. In spite of the continued interest in the genetics of invasive species, little attention has been paid toward the microevolutionary processes that drive structure and fate of ascidian populations over time under chemically polluted conditions. Understanding the interplay between environmental and population dynamics is critical to predict the biodiversity of marine coastal ecosystems. In the present study, a local population of the ascidian Ciona robusta living in the Fusaro Lagoon has been monitored over a 13-month period of sampling. Physico-chemical parameters (temperature, salinity, turbidity, dissolved oxygen, heavy metals), genetic composition (microsatellites, ITS-2), abundance and biomass (wet and dry weight) were assessed with the aim to infer fine-scale temporal variation of population structure with respect to rapid environmental change. Analysis of biomass showed that C. robusta is highly sensitive to salinity and oxygen concentrations. Further, genetic analysis suggested a highly dynamic population structure, likely due to the strong clustering of temporal samples and distinct responses to environmental conditions, including bioaccumulation of heavy metals. Here, we hypothesize that rapid variation in allele frequencies of neutral markers in C. robusta populations may increase the ability of the species to colonize habitats that are subject to strong variation and are under heavy human pressure

Histologic findings at diagnosis as predictive markers of clinical outcome in pediatric ulcerative colitis

Background: The role of histological inflammation at diagnosis as a possible prognostic factor for disease course has not been investigated. Aims: To assess whether histologic findings at diagnosis could predict clinical outcomes and evaluate the association between clinical, biochemical, endoscopic, and histological findings. Methods: Prospective single-center study including pediatric UC patients with a minimum follow-up of 12 months. The association between histological activity (Nancy Index, Robarts Histopathology Index, and Geboes Score) and 12-month clinical outcomes was evaluated. Secondarily, we assessed the correlation between histological scores and endoscopic and inflammatory markers at the diagnosis. Inter-observer agreement for histologic and endoscopic scores was also evaluated. Results: Forty-nine UC patients were included. No association was found between 1-year clinical relapse and the three histological indices at diagnosis (p > 0.05). Good concordance was found among the three histological scores (p < 0.001), and between all histological and endoscopic indices (p < 0.05). No correlation was found between histologic scores and serum inflammatory markers. Inter-observer agreement was good for eMayo, Nancy and Robarts score (k = 0.71, k = 0.74 and k = 0.68, respectively) and moderate for Geboes (k = 0.46). Conclusions: Histological findings at diagnosis cannot be used as a predictor of the disease course. The three histological scores used in routine clinical practice show an overall good correlation and reliability

Syphilis, the great Imitator—clinical and dermoscopic features of a rare presentation of secondary syphilis

Syphilis is characterized by a wide range of variable clinical symptoms; therefore, it is often referred to as "The Great Imitator". Here, we report the case of a 69-year-old hepatitis-C-positive MSM patient, who was admitted to our clinic due to a solitary firm painless erythematous maculopapular lesion with a central crater-like crust on the upper right thigh that occurred two months prior. The dermoscopy showed an erythematous, copper-colored, oval lesion with diffuse monomorphic dotted and glomerular vessels, central crust, and circular scaling (Biett's sign). The histological findings ruled out neoplasia and described a plasma cell infiltrate and endothelial swelling. Finally, the combination of the dermoscopic image, histological findings and the additionally acquired knowledge about the sexual history of the patient at the second visit led to the diagnosis, which was then confirmed with serological tests. Dermoscopy may become a supportive tool to facilitate the recognition of secondary syphilis; however, the reporting of these atypical cases is crucial to highlight the many faces of the disease so that clinicians consider syphilis as part of the differential diagnosis of non-specific lesions

Submucosal Tunnel Endoscopic Resection of Gastric Lesion Before Obesity Surgery: a Case Series

Background: Submucosal tumors (SMTs) of the gastrointestinal tract are a rare pathological entity comprising a wide variety of neoplastic and non-neoplastic lesions. Even if most SMTs are benign tumors (e.g., leiomyomas), a smaller portion may have a malignant potential (e.g., gastrointestinal stromal tumor (GIST)). Preoperative diagnosis of SMT in bariatric patients may arise challenging clinical dilemmas. Long-term surveillance may be difficult after bariatric surgery. Moreover, according to SMT location, its presence may interfere with planned surgery. Submucosal tunneling endoscopic resection (STER) has emerged as an effective approach for minimally invasive en bloc excision of SMTs. This is the first case series of STER for SMTs before bariatric surgery. Methods: Seven female patients underwent STER for removal of SMTs before bariatric surgery. All lesions were incidentally diagnosed at preoperative endoscopy. STER procedural steps comprised mucosal incision, submucosal tunneling, lesion enucleation, and closure of mucosal defect. Results: En bloc removal of SMT was achieved in all cases. Mean procedural time was of 45 min (SD 18.6). No adverse event occurred. Mean size of the lesions was 20.6 mm (SD 5.8). Histological diagnoses were 5 leyomiomas, 1 lipoma, and 1 low grade GIST. Bariatric procedure was performed after a mean period of 4.1 months (SD 1.6) from endoscopic resection. Conclusion: STER is a safe and effective treatment for the management of SMT even in bariatric patients awaiting surgery. Preoperative endoscopic resection of SMTs has the advantages of reducing the need for surveillance and removing lesions that could interfere with planned surgery. STER did not altered accomplishment of bariatric procedures

SAT0305 Histology of minor salivary glands in patients with sjÖgren's syndrome, association with clinical and laboratory aspects

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Endoscopic internal drainage for the management of leak, fistula, and collection after sleeve gastrectomy: our experience in 617 consecutive patients

Background: Endoscopy plays a pivotal role in the management of adverse events (AE) following bariatric surgery. Leaks, fistulae, and post-operative collection after sleeve gastrectomy (SG) may occur in up to 10% of cases. Objectives: To evaluate the efficacy and safety of endoscopic internal drainage (EID) for the management of leak, fistula, and collection following SG. Setting: Retrospective, observational, single center study on patients referred from several bariatric surgery departments to an endoscopic referral center. Methods: EID was used as first-line treatment for the management of leaks, fistulae, and collections. Leaks and fistulae were treated with double pigtail stent (DPS) deployment in order to guarantee internal drainage and second intention cavity obliteration. Collections were treated with endoscropic ultrasound (EUS)–guided deployment of DPS or lumen apposing metal stents. Results: A total of 617 patients (83.3% female; mean age, 43.1 yr) were enrolled in the study for leak (n = 300, 48.6%), fistula (n = 285, 46.2%), and collection (n = 32, 5.2%). Median follow-up was 19.5 months. Overall clinical success was 84.7% whereas 15.3% of cases required revisional surgery after EID failure. Clinical success according to type of AE was 89.5%, 78.5%, and 90% for leak, fistula, and collection, respectively. A total of 10 of 547 (1.8%) presented a recurrence during follow-up. A total of 28 (4.5%) AE related to the endoscopic treatment occurred. At univariate logistic regression predictors of failure were: fistula (OR 2.012), combined endoscopic approach (OR 2.319), need for emergency surgery (OR 1.755), and previous endoscopic treatment (OR 4.818). Conclusion: Early EID for the management of leak, fistula, and post-operative collection after SG seems a safe and effective first-line approach with good long-term results

P055 CXCL13 as biomarker for histological involvement in sjogren's syndrome

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