Trismus as the first manifestation of cholangiocarcinoma

The initial presentation of a cholangiocarcinoma (CC) as trismus due to metastasis to the parotid gland is extremely rare and no previous reports have been found in the literature. A 29-year-old woman presented trismus that initiated 2 months before admission, just after superior left third molar extraction. Physical examination revealed severe trismus and a mass in the parotid gland. Computed tomography (CT) showed a heterogeneous mass in the left parotid gland. The next day she presented jaundice, bilirubinuria, and fever, followed by massive bleeding, intravascular disseminated coagulation, and respiratory insufficiency. Two days later she died. At autopsy, the parotid tumor was identified as a metastasis from a CC of the extrabiliary tract. To our knowledge, this is the first reported case of a metastatic CC that initially presented as trismus due to a mass in the parotid gland. This case represents a rare but important diagnosis that otolaryngologists and oral surgeons should add to the catalog of uncommon causes of trismus

A first approach to assess the impact of bottom trawling over Vulnerable Marine Ecosystems on the High Seas of the Southwest Atlantic

Versión del edito

Insights on the Early Pleistocene Hominin Population of the Guadix-Baza Depression (SE Spain) and a Review on the Ecology of the First Peopling of Europe

The chronology and environmental context of the first hominin dispersal in Europe have been subject to debate and controversy. The oldest settlements in Eurasia (e.g., Dmanisi, ∼1.8 Ma) suggest a scenario in which the Caucasus and southern Asia were occupied ∼0.4 Ma before the first peopling of Europe. Barranco León (BL) and Fuente Nueva 3 (FN3), two Early Pleistocene archeological localities dated to ∼1.4 Ma in Orce (Guadix-Baza Depression, SE Spain), provide the oldest evidence of hominin presence in Western Europe. At these sites, huge assemblages of large mammals with evidence of butchery and marrow processing have been unearthed associated to abundant Oldowan tools and a deciduous tooth of Homo sp. in the case of BL. Here, we: (i) review the Early Pleistocene archeological sites of Europe; (ii) discuss on the subsistence strategies of these hominins, including new estimates of resource abundance for the populations of Atapuerca and Orce; (iii) use cartographic data of the sedimentary deposits for reconstructing the landscape habitable in Guadix-Baza; and (iv) calculate the size of the hominin population using an estimate of population density based on resource abundance. Our results indicate that Guadix-Baza could be home for a small hominin population of 350–280 individuals. This basin is surrounded by the highest mountainous reliefs of the Alpine-Betic orogen and shows a limited number of connecting corridors with the surrounding areas, which could have limited gene flow with other hominin populations. Isolation would eventually lead to bottlenecks, genetic drift and inbreeding depression, conditions documented in the wild dog population of the basin, which probably compromised the viability of the hominin population in the medium to long term. This explains the discontinuous nature of the archeological record in Guadix-Baza, a situation that can also be extrapolated to the scarcity of hominin settlements for these ancient chronologies in Europe

Zoonotic "Enterocytozoon bieneusi" genotypes in free-ranging and farmed wild ungulates in Spain

Microsporidia comprises a diverse group of obligate, intracellular, and spore-forming parasites that infect a wide range of animals. Among them, Enterocytozoon bieneusi is the most frequently reported species in humans and other mammals and birds. Data on the epidemiology of E. bieneusi in wildlife are limited. Hence, E. bieneusi was investigated in eight wild ungulate species present in Spain (genera Ammotragus, Capra, Capreolus, Cervus, Dama, Ovis, Rupicapra, and Sus) by molecular methods. Faecal samples were collected from free-ranging (n = 1058) and farmed (n = 324) wild ungulates from five Spanish bioregions. The parasite was detected only in red deer (10.4%, 68/653) and wild boar (0.8%, 3/359). Enterocytozoon bieneusi infections were more common in farmed (19.4%, 63/324) than in wild (1.5%, 5/329) red deer. A total of 11 genotypes were identified in red deer, eight known (BEB6, BEB17, EbCar2, HLJD-V, MWC_d1, S5, Type IV, and Wildboar3) and three novel (DeerSpEb1, DeerSpEb2, and DeerSpEb3) genotypes. Mixed genotype infections were detected in 15.9% of farmed red deer. Two genotypes were identified in wild boar, a known (Wildboar3) and a novel (WildboarSpEb1) genotypes. All genotypes identified belonged to E. bieneusi zoonotic Groups 1 and 2. This study provides the most comprehensive epidemiological study of E. bieneusi in Spanish ungulates to date, representing the first evidence of the parasite in wild red deer populations worldwide. Spanish wild boars and red deer are reservoir of zoonotic genotypes of E. bieneusi and might play an underestimated role in the transmission of this microsporidian species to humans and other animal

Estudio de los Ecosistemas Marinos Vulnerables en aguas internacionales del Atlántico Sudoccidental

En este libro, basado en la mejor información científica disponible hasta la fecha, se presentan los resultados y conclusiones de una serie de trece campañas de investigación multidisciplinar realizadas entre octubre de 2007 y abril de 2010 por los componentes del Grupo ATLANTIS a bordo del B/O MIGUEL OLIVER, propiedad de la Secretaría General de Pesca (SGP). El estudio surge a raíz de la solicitud por parte de la SGP (anteriormente denominada Secretaría General del Mar) al Instituto Español de Oceanografía (IEO), para la realización de una serie de campañas de investigación multidisciplinar en aguas internacionales del Atlántico Sudoccidental, dirigidas al estudio de los Ecosistemas Marinos Vulnerables (EMVs) y de las posibles interacciones con las actividades pesqueras. El objetivo final de dichas campañas era el estudio y la identificación cuantitativa, cualitativa y geográfica de los EMVs y de los grupos taxonómicos de organismos sensibles que pudieran existir en la zona de estudio, incluyendo la propuesta de posibles zonas marinas a proteger, para una explotación sostenible de los recursos pesqueros en el ámbito del respeto a los EMVs. Los resultados que se presentan en este libro comprenden los obtenidos a través de los trabajos de geología, geomorfología, bentos, pesca, oceanografía física y análisis de contaminantes en la zona de aguas internacionales del Atlántico Sudoccidental comprendida entre los paralelos 42º y 48ºS, y la isobata de los 1500 m de profundidad (Figura 2.2). Entre estos resultados se incluye el cartografiado y una batimetría detallada de la zona, la descripción del substrato geológico y de los aspectos bentónicos, el análisis de la distribución y abundancia de las especies de mayor interés comercial, la huella de la pesquería, la identificación y descripción preliminar de los EMVs, y la propuesta de Zonas de Protección, basada en criterios Geológicos, Geomorfológicos y Biológicos. Toda esta información ha sido incorporada para su tratamiento en una plataforma SIG (Sistema de Información Geográfica) y los resultados obtenidos y presentados en este libro vienen acompañados de abundante información gráfica, como imágenes batimétricas en 3D, fotografías de bentos (infauna y epifauna), imágenes tomadas con un ROV (Remotely Operated Vehicle) y con una cámara digital submarina, así como una serie de mapas de distribución, capturas y densidad de las principales especies de interés pesquero. Se incluye también un mapa con la huella de la pesquería (1989-2010) que permita observar la incidencia de las Zonas de Protección propuestas en el área en la que faena habitualmente la flota española de arrastre de fondo. Como información adicional a la obtenida en las trece campañas de investigación, también se ha utilizado la base de datos creada con la información recogida por el Programa de Observadores del IEO entre los años 1989-2010, referente a datos comerciales, biológicos, oceanográficos y físicos (batimetría, temperatura superficial del mar y temperatura del fondo). Entre octubre de 2007 y abril de 2010 se han realizado un total de trece campañas de investigación multidisciplinar, que se han concretado en los siguientes trabajos: • 347 días efectivos de mar • Prospección de una superficie total de 59.105 km2 • Realización de un total de 91.905 km de perfiles geofísicos • 102 muestreos con draga de roca • 209 muestreos con draga box corer • 519 estaciones de CTD • 413 lances de pesca • 413 muestras de sedimentos con el colector de red • Recogida de varios miles de lotes de muestras de bentos que representan varios centenares de miles de especímenes y/o colonias • Realización de miles de fotografías de especies bentónicas, centenares de imágenes digitales de alta resolución y decenas de horas de vídeo realizadas con el ROV del barco Entre los principales resultados de los trabajos de investigación multidisciplinar presentados en este libro hay que destacar la identificación, descripción y delimitación de los EMVs, siguiendo criterios biológicos, geológicos y mixtos; la identificación de los principales grupos bentónicos indicadores de EMVs; la determinación de los valores que representan una captura significativa de los distintos taxones considerados como vulnerables según criterios de la ONU y OSPAR, y finalmente, la propuesta de áreas marinas que deberían ser consideradas como candidatas a ser protegidas. En total se proponen nueve polígonos de diferente superficie para su valoración como zonas de protección (Figura 7.5) y se hace referencia a la incidencia que el cierre de dichas zonas podría tener sobre la actividad de la flota, es decir, el grado de solapamiento entre las zonas de protección y la huella de la pesquería (Figura 7.6). Todos estos resultados se presentan acompañados de abundantes gráficas, figuras y mapas.Instituto Español de OceanografíaVersión del edito

Identification of genetic variants associated with Huntington's disease progression: a genome-wide association study

Background Huntington's disease is caused by a CAG repeat expansion in the huntingtin gene, HTT. Age at onset has been used as a quantitative phenotype in genetic analysis looking for Huntington's disease modifiers, but is hard to define and not always available. Therefore, we aimed to generate a novel measure of disease progression and to identify genetic markers associated with this progression measure. Methods We generated a progression score on the basis of principal component analysis of prospectively acquired longitudinal changes in motor, cognitive, and imaging measures in the 218 indivduals in the TRACK-HD cohort of Huntington's disease gene mutation carriers (data collected 2008–11). We generated a parallel progression score using data from 1773 previously genotyped participants from the European Huntington's Disease Network REGISTRY study of Huntington's disease mutation carriers (data collected 2003–13). We did a genome-wide association analyses in terms of progression for 216 TRACK-HD participants and 1773 REGISTRY participants, then a meta-analysis of these results was undertaken. Findings Longitudinal motor, cognitive, and imaging scores were correlated with each other in TRACK-HD participants, justifying use of a single, cross-domain measure of disease progression in both studies. The TRACK-HD and REGISTRY progression measures were correlated with each other (r=0·674), and with age at onset (TRACK-HD, r=0·315; REGISTRY, r=0·234). The meta-analysis of progression in TRACK-HD and REGISTRY gave a genome-wide significant signal (p=1·12 × 10−10) on chromosome 5 spanning three genes: MSH3, DHFR, and MTRNR2L2. The genes in this locus were associated with progression in TRACK-HD (MSH3 p=2·94 × 10−8 DHFR p=8·37 × 10−7 MTRNR2L2 p=2·15 × 10−9) and to a lesser extent in REGISTRY (MSH3 p=9·36 × 10−4 DHFR p=8·45 × 10−4 MTRNR2L2 p=1·20 × 10−3). The lead single nucleotide polymorphism (SNP) in TRACK-HD (rs557874766) was genome-wide significant in the meta-analysis (p=1·58 × 10−8), and encodes an aminoacid change (Pro67Ala) in MSH3. In TRACK-HD, each copy of the minor allele at this SNP was associated with a 0·4 units per year (95% CI 0·16–0·66) reduction in the rate of change of the Unified Huntington's Disease Rating Scale (UHDRS) Total Motor Score, and a reduction of 0·12 units per year (95% CI 0·06–0·18) in the rate of change of UHDRS Total Functional Capacity score. These associations remained significant after adjusting for age of onset. Interpretation The multidomain progression measure in TRACK-HD was associated with a functional variant that was genome-wide significant in our meta-analysis. The association in only 216 participants implies that the progression measure is a sensitive reflection of disease burden, that the effect size at this locus is large, or both. Knockout of Msh3 reduces somatic expansion in Huntington's disease mouse models, suggesting this mechanism as an area for future therapeutic investigation

Donor-specific circulating cell free DNA as a noninvasive biomarker of graft injury in heart transplantation

[Background] Considerable effort has been exerted to develop noninvasive diagnostic biomarkers that might replace or reduce the need to perform endomyocardial biopsies. In this context, graft DNA circulating on transplant recipients has been proposed as a potential biomarker of organ rejection or cellular graft injury. [Methods] We propose a digital PCR (dPCR) method based on the amplification of ten specific InDels sufficiently sensitive to detect small amounts of specific donor circulating DNA diluted on the host cell free DNA (cfDNA). We obtained 23 informative mismatches from 30 host and donor organ biopsy pairs. [Results] Patients without heart-related complications showed a high increase in the specific genomic marker levels during the first 24 h after transplantation that dropped to the basal levels on days 3–4 post-surgery. In contrast, patients with complications presented a significantly lagged decay pattern from day one after transplantation. A specific donor cfDNA increase was detected in one patient two days before rejection diagnosis, diminishing the basal levels after successful immunotherapy. A cfDNA increase was also observed during graft injury due to heart damage. [Conclusion] These results suggest that cfDNA monitoring of transplanted patients may be a useful tool to detect and probably anticipate graft rejection.This work was supported by a grant from the Instituto de Salud Carlos III [FIS: PI15/00939]-Fondos FEDER

Zoonotic Enterocytozoon bieneusi genotypes in free-ranging and farmed wild ungulates in Spain.

Microsporidia comprises a diverse group of obligate, intracellular, and spore-forming parasites that infect a wide range of animals. Among them, Enterocytozoon bieneusi is the most frequently reported species in humans and other mammals and birds. Data on the epidemiology of E. bieneusi in wildlife are limited. Hence, E. bieneusi was investigated in eight wild ungulate species present in Spain (genera Ammotragus, Capra, Capreolus, Cervus, Dama, Ovis, Rupicapra, and Sus) by molecular methods. Faecal samples were collected from free-ranging (n = 1058) and farmed (n = 324) wild ungulates from five Spanish bioregions. The parasite was detected only in red deer (10.4%, 68/653) and wild boar (0.8%, 3/359). Enterocytozoon bieneusi infections were more common in farmed (19.4%, 63/324) than in wild (1.5%, 5/329) red deer. A total of 11 genotypes were identified in red deer, eight known (BEB6, BEB17, EbCar2, HLJD-V, MWC_d1, S5, Type IV, and Wildboar3) and three novel (DeerSpEb1, DeerSpEb2, and DeerSpEb3) genotypes. Mixed genotype infections were detected in 15.9% of farmed red deer. Two genotypes were identified in wild boar, a known (Wildboar3) and a novel (WildboarSpEb1) genotypes. All genotypes identified belonged to E. bieneusi zoonotic Groups 1 and 2. This study provides the most comprehensive epidemiological study of E. bieneusi in Spanish ungulates to date, representing the first evidence of the parasite in wild red deer populations worldwide. Spanish wild boars and red deer are reservoir of zoonotic genotypes of E. bieneusi and might play an underestimated role in the transmission of this microsporidian species to humans and other animals