Palm phytoliths of mid-elevation Andean forests

Palms are one of the most common tropical plant groups. They are widespread across lowland tropical forests, but many are found in higher altitudes have more constrained environmental ranges. The limited range of these species makes them particularly useful in paleoecological and paleoclimate reconstructions. Palms produce phytoliths, or silica structures, which are found in their vegetative parts (e.g., wood, leaves, etc.). Recent research has shown that several palms in the lowland tropical forests produce phytoliths that are diagnostic to the sub-family or genus-level. Here we characterize Andean palm phytoliths, and determine whether many of these species can also be identified by their silica structures. All of our sampled Andean palm species produced phytoliths, and we were able to characterize several previously unclassified morphotypes. Some species contained unique phytoliths that did not occur in other species, particularly Ceroxylon alpinium, which is indicative of specific climatic conditions. The differences in the morphologies of the Andean species indicate that palm phytolith analysis is particularly useful in paleoecological reconstructions. Future phytolith analyses will allow researchers to track how these palm species with limited environmental ranges have migrated up and down the Andean slopes as a result of past climatic change. The phytolith analyses can track local-scale vegetation dynamics, whereas pollen, which is commonly used in paleoecological reconstructions, reflects regional-scale vegetation change

Flatfoot in children and adolescents. Analysis of imaging findings and therapeutic implications

SummaryIntroductionPes planovalgus (PPV) is a complex three-dimensional deformity of which routine radiographs provide only a two-dimensional analysis.HypothesisAngles and other radiographic parameters of the foot in children and adolescents, when studied on both the dorsoplantar and the lateral view, can be used to establish a radiographic classification system for PPV that provides useful therapeutic guidance in clinical practice.Materials and methodsA retrospective single-centre study was conducted on 65 feet in 35 patients aged 7 to 18 years and having adequate ossification. All patients had a clinical diagnosis of idiopathic or neurologic PPV and available weight-bearing dorsoplantar and strict lateral radiographs. We excluded pes planus due to tarsal coalition, congenital bone deformities, or overcorrection of talipes equinovarus (n=25). All possible axes were drawn and angles measured after an evaluation of interindividual agreement.ResultsWe identified four patterns of PPV: subtalar pes planus (n=16) with marked subtalar valgus and longitudinal sag predominating at the talonavicular joint, midtarsal pes planus (n=12) without subtalar valgus but with marked midtarsal abduction and sag predominating at the cuneonavicular joint, mixed pes planus (n=28) with subtalar valgus, midtarsal abduction, and sag at both the talonavicular and cuneonavicular joints, and pes planocavus (n=9) with sag of the medial arch and cavus deformity of the lateral arch.ConclusionThis original classification system provides therapeutic guidance by helping to match the surgical procedure to the nature and location of the deformities.Level of evidenceLevel IV

Long-term ecological legacies in western Amazonia

M.B.B would like to acknowledge funding from the National Science Foundation (grant nos. EAR1338694 and BCS0926973), the Belmont Forum, and the National Aeronautics and Space Administration (grant no. NNX14AD31G). C.N.H.M would like to acknowledge funding from the European Research Council (ERC 2019 StG 853394). C.N.H.M and M.F.R would like to acknowledge funding from the Netherlands Organisation for Scientific Research (ALWOP.322). S.N.H, M.P, and Jo.V performed this research as a part of the BSc research program of the Institute for Biodiversity and Ecosystem Dynamics at the University of Amsterdam.1. Modifications of Amazonian forests by pre‐Columbian peoples are thought to have left ecological legacies that have persisted to the modern day. Most Amazonian palaeoecological records do not, however, provide the required temporal resolution to document the nuanced changes of pre‐Columbian disturbance or post‐disturbance succession and recovery, making it difficult to detect any direct, or indirect, ecological legacies on tree species. 2. Here, we investigate the fossil pollen, phytolith and charcoal history of Lake Kumpaka, Ecuador, during the last 2,415 years in c. 3–50 year time intervals to assess ecological legacies resulting from pre‐Columbian forest modification, disturbance, cultivation and fire usage. 3. Two cycles of pre‐Columbian cultivation (one including slash‐and‐burn cultivation, the other including slash‐and‐mulch cultivation) were documented in the record around 2150–1430 cal. year BP and 1250–680 cal. year BP, with following post‐disturbance succession dynamics. Modern disturbance was documented after c. 10 cal. year BP. The modern disturbance produced a plant composition unlike those of the two past disturbances, as fire frequencies reached their peak in the 2,415‐year record. The disturbance periods varied in intensity and duration, while the overturn of taxa following a disturbance lasted for hundreds of years. The recovery periods following pre‐Columbian disturbance shared some similar patterns of early succession, but the longer‐term recovery patterns differed. 4. Synthesis. The trajectories of change after a cessation of cultivation can be anticipated to differ depending on the intensity, scale, duration and manner of the past disturbance. In the Kumpaka record, no evidence of persistent enrichment or depletion of intentionally altered taxa (i.e. direct legacy effects) was found but indirect legacy effects, however, were documented and have persisted to the modern day. These findings highlight the strengths of using empirical data to reconstruct past change rather than relying solely on modern plant populations to infer past human management and ecological legacies, and challenge some of the current hypotheses involving the persistence of pre‐Columbian legacies on modern plant populations.Publisher PDFPeer reviewe

Three-Dimensional Reconstruction of Foot in the Weightbearing Position From Biplanar Radiographs: Evaluation of Accuracy and Reliability

The initial assessment and postoperative monitoring of patients with various abnormalities of the foot in clinical routine practice is primarily based on the analysis of radiographs taken in the weightbearing position. Conventional x-ray imaging, however, only provides a 2-dimensional projection of 3-dimensional (3D) bony structures, and the clinical parameters assessed from these images can be affected by projection biases. In the present work, we addressed this issue by proposing an accurate 3D reconstruction method of the foot in the weightbearing position from low-dose biplanar radiographs with clinical index measurement assessment for clinical routine practice. The accuracy of the proposed reconstruction method was evaluated for both shape and clinical indexes by comparing 3D reconstructions of 6 cadaveric adult feet from computed tomographic images and from biplanar radiographs. For the reproducibility study, 3D reconstructions from the biplanar radiographs of the foot of 6 able-bodied subjects were considered, with 2 observers repeating each measurement of anatomic landmarks 3 times. Baseline assessment of important 3D clinical parameters was performed on 17 subjects (34 feet; mean age 27.7, range 20 to 52 years). The average point to surface distance between the 3D stereoradiographic reconstruction and the computed tomographic scan-based reconstruction was 1 mm (range 0mm to 6mm). The selected radiographic landmarks were highly reproducible (95% confidence interval <2.0 mm). The greatest interindividual variability for the clinical parameters was observed for the twisting angle (mean 87°, range 73° to 100°). Such an approach opens the way for routine 3D quantitative analysis of the foot in the weightbearing position.The authors thank the ParisTech BiomecAM chair program on subject-specific musculoskeletal modeling, and in particular COVEA and Société Générale. The authors also thank Audrey Arts, Roxane Huet, and Thomas Joubert for their kind technical assistance

Analysis of OXA-204 carbapenemase-producing <i>Enterobacteriaceae</i> reveals possible endoscopy-associated transmission, France, 2012 to 2014.

OXA-48-like beta-lactamase producing bacteria are now endemic in several European and Mediterranean countries. Among this carbapenemase family, the OXA-48 and OXA-181 variants predominate, whereas other variants such as OXA-204 are rarely reported. Here, we report the molecular epidemiology of a collection of OXA-204-positive enterobacterial isolates (n = 29) recovered in France between October 2012 and May 2014. This study describes the first outbreak of OXA-204-producing &lt;i&gt;Enterobacteriaceae&lt;/i&gt; in Europe, involving 12 isolates of an ST90 &lt;i&gt;Escherichia coli&lt;/i&gt; clone and nine isolates of an ST147 &lt;i&gt;Klebsiella pneumoniae&lt;/i&gt; clone. All isolates co-produced the cephalosporinase CMY-4, and 60% of them co-produced the extended-spectrum beta-lactamase CTX-M-15. The &lt;i&gt;bla&lt;/i&gt; &lt;sub&gt;OXA-204&lt;/sub&gt; gene was located on a 150-kb IncA/C plasmid, isolated from various enterobacterial species in the same patient, indicating a high conjugative ability of this genetic vehicle

Congenital dislocation of the hip: Optimal screening strategies in 2014

AbstractA prospective multi-centre nationwide study of patients with congenital dislocation of the hip (CDH) diagnosed after 3 months of age was conducted with support from the French Society for Paediatric Orthopaedics (Société Française d’Orthopédie Pédiatrique [SoFOP]), French Organisation for Outpatient Paediatrics (Association Française de Pédiatrie Ambulatoire [AFPA]), and French-Speaking Society for Paediatric and Pre-Natal Imaging (Société Francophone d’Imagerie Pédiatrique et Prénatale [SFIPP]). The results showed inadequacies in clinical screening for CDH that were patent when assessed quantitatively and probably also present qualitatively. These findings indicate a need for a communication and educational campaign aimed at highlighting good clinical practice guidelines in the field of CDH screening. The usefulness of routine ultrasound screening has not been established. The findings from this study have been used by the authors and French National Health Authority (Haute Autorité de Santé [HAS]) to develop recommendations about CDH screening. There is an urgent need for a prospective randomised multi-centre nationwide study, which should involve primary-care physicians

Time delays in the diagnosis and treatment of malaria in non-endemic countries: a systematic review

Background Delays in diagnosis and treatment for malaria are associated with an increased risk for severe disease and mortality. Identifying the extent of patient and health system delay can provide a benchmark against which interventions to reduce delays can be measured. Methods We performed an electronic search in PubMed, EMBASE, Web of Science and LILACS for studies reporting time to diagnosis and treatment after return from travel, onset of symptoms and seeking healthcare in non-endemic countries. Additionally, theses, conference proceedings and nationally reported surveillance data were also searched for information on time delays. There were no language restrictions and all the studies were assessed for methodological quality. Results Data from 69 papers out of 1719 identified records published between 2005 and 2017 were extracted; our findings show that median diagnosis delays of four or more days are common and patient delays accounted for a large proportion of diagnostic delay. There were limited data available on medical diagnostic delay. Conclusion Patient delays accounted for a large proportion of the overall diagnostic delay; however the retrospective nature of the studies could have overestimated patient delay since previous healthcare contacts were not included. Additionally, the high frequency of studies reporting a clinically significant delay is a major concern

A simple and fast method to exclude high Plasmodium falciparum parasitaemia in travellers with imported malaria

Background: Counts of malaria parasites in peripheral blood are important to assess severity of Plasmodium falciparum malaria. Thin and thick smears are routinely used for this purpose. Methods. In this study the Binax NOW® Malaria Test, an easy-to-perform rapid diagnostic test, with Histidine Rich Protein-2 (HRP-2) and aldolase as diagnostic markers, was used for semi-quantitative assessment of parasitaemia of P. faciparum. Results: In 257 patients with imported P. falciparum malaria, reactivity of aldolase increased with higher parasitaemia. In all patients with a parasitaemia above 50,000 asexual parasites/l (> 1%) co-reactivity of HRP-2 and aldolase was observed. Absence of aldolase reactivity in the presence of HRP-2 was a reliable predictive marker to exclude high (> 1%) parasitaemia in P. falciparum malaria. Conclusions: Assessment of HRP-2 and aldolase co-reactivity can be of help in clinical decision making in the acute care setting of returning travellers suspected of having malaria

Imported Plasmodium falciparum malaria in HIV-infected patients: a report of two cases

As HIV becomes a chronic infection, an increasing number of HIV-infected patients are travelling to malaria-endemic areas. Association of malaria with HIV/AIDS can be clinically severe. Severe falciparum malaria is a medical emergency that is associated with a high mortality, even when treated in an Intensive Care Unit. This article describes two cases of HIV-positive patients, who returned from malaria-endemic areas and presented a parasitaemia > 5% of erythrocytes and clinical signs of severe falciparum malaria, both with > 350 CD4 cell count/μl, absence of chemoprophylaxis and successful response. Factors like drug interactions and the possible implication of anti-malarial therapy bioavailability are all especially interesting in HIV-malaria co-infections