Long-term Sonographic and Serological Follow-up of Inactive Echinococcal Cysts of the Liver: Hints for a “Watch-and-Wait” Approach

Human cystic echinococcosis is a chronic, complex and neglected infection. Its clinical management has evolved over decades without adequate evaluation of efficacy. Recent expert opinion recommends that uncomplicated inactive cysts of the liver should be left untreated and solely monitored over time (“watch-and-wait” approach). However, clinical data supporting this approach are still scant and published mostly as conference proceedings. In this study, we report our experience with long-term sonographic and serological follow-up of inactive cysts of the liver. From March 1994 to October 2013, 38 patients with 47 liver cysts, diagnosed as inactive without any previous treatment history, were followed with ultrasound and serology at 6–12 months intervals for a period of at least 24 months (median follow-up 51.95 months) in our outpatient clinic. In 97.4% of patients, the cysts remained inactive over time and in only one case was reactivation of the cyst detected. No complications occurred during the time of monitoring. During follow-up, serology tests for CE were negative at diagnosis or became negative in 74.1% and were positive or became positive in 25.9% of cases. Patients with inactive cysts on ultrasound but positive serological tests were also investigated by CT scan (chest and abdomen) to rule out extra-hepatic cyst localization. This study confirms the importance of a stage-specific approach to the management of cystic echinococcosis and supports the use of a monitoring-only approach to inactive, uncomplicated cysts of the liver. It also confirms that serology plays only an ancillary role in the clinical management of these patients, compared to ultrasound and other imaging techniques. The implications of these findings for clinical management and natural history of cystic echinococcosis are discussed.     

Stratigraphy,facies and synsedimentary tectonics in the Jurassic Rosso Ammonitico Veronese (Altopiano di Asiago,NE Italy)

Summary The red, pelagic limestones of the Rosso Ammonitico Veronese (Upper Bajocian-Tithonian) of the Altopiano di Asiago area can be subdivided into eight facies. They differ from each other in structure (bedding style, presence and type of nodularity) and texture (nature of components, grain-vs mud-support, compactional features). Several discontinuities could be recognized, based on sedimentological or biostratigraphic evidence. In the context of a drowned platform, where sediments essentially consist of skeletal remains of both planktonic and benthic organism, the different facies are interpreted as reflecting a varying influence of currents on the winnowing of micrite and on triggering early cementation. Early cementation in turn, controlled the patterns of bioturbation and the response of sediments to later compaction and pressure-dissolution. At times, microbial mats, of unidentified nature, were important in trapping and binding sediment, giving rise to early lithified nodules and layers of stromatolitic aspect. The Rosso Ammonitico Veronese can be subdivided into three units: lower Rosso Ammonitico (RAI: Upper Bajocian-Lower Callovian), middle Rosso Ammonitico (RAM: Upper Callovian-Middle Oxfordian), and upper Rosso Ammonitico (RAS: Lower Kimmeridgian-Tithonian). Frequent ammonite moulds allow the precise dating of the base and top of each unit, and the documentation of facies heteropies and hiatusses in the more fossiliferous RAS. The lower unit (RAM) is massive and essentially nodular; the middle unit (RAM) is well bedded, non-nodular, and cherty; the upper unit (RAS) is richer in clay and typically nodular. The RAI and the RAS are present everywhere, though significant facies and thickness changes affect particularly the RAS; the RAM is much more variable, ranging from 0 to 10 metres. These variations, that may be gradual or abrupt, are inter-preted as the result of Middle-Late Callovian block-faulting which generated an irregular sea floor topography where the swells were more exposed to currents that continuously removed sediments, inducing long-lasting periods of nondeposition. Sediments preferentially accumulated in the adjacent lows. A confirmation of this hypothesis is provided by evidence of synsedimentary tectonics, described for the first time in the Rosso Ammonitico Veronese. Neptunian dykes, both vertical and horizontal, are developed at the top of the RAI and are filled with laminated sediments or collapse breccias. Glides of metre-size blocks and slumps are present at the top of the RAI and at the base of the RAM, respectively. Cm-thick layers of mud supported breccias are intercalated in the upper part of the RAI and within the RAM: they are interpreted as seismites. All these features document a tensional regime that generated fractures in more or less lithified sediments and failure along steep fault scarps or gently dipping slopes of tilted fault blocks. Recognition of this Callovian-Oxfordian tectonic activity shows that, after the Bajocian drowning, the Trento Plateau did not simply experience a uniform and general foundering: a small-scale block-faulting was still active and affected the pattern of facies distribution.     

Functional Complementation in Yeast Allows Molecular Characterization of Missense Argininosuccinate Lyase Mutations

Deficiency of argininosuccinate lyase (ASL) causes argininosuccinic aciduria, an urea cycle defect that may present with a severe neonatal onset form or with a late onset phenotype. To date phenotype-genotype correlations are still not clear because biochemical assays of ASL activity correlate poorly with clinical severity in patients. We employed a yeast-based functional complementation assay to assess the pathogenicity of 12 missense ASL mutations, to establish genotype-phenotype correlations, and to screen for intragenic complementation. Rather than determining ASL enzyme activity directly, we have measured the growth rate in arginine-free medium of a yeast ASL^null strain transformed with individual mutant ASL alleles. Individual haploid strains were also mated to obtain diploid, “compound heterozygous” yeast. We show that the late onset phenotypes arise in patients because they harbor individual alleles retaining high residual enzymatic activity or because of intragenic complementation among different mutated alleles. In these cases complementation occurs because in the hybrid tetrameric enzyme at least one active site without mutations can be formed or because the differently mutated alleles can stabilize each other, resulting in partial recovery of enzymatic activity. Functional complementation in yeast is simple and reproducible and allows the analysis of large numbers of mutant alleles. Moreover, it can be easily adapted for the analysis of mutations in other genes involved in urea cycle disorders.Argininosuccinic aciduria (ASAuria, MIM 207900)³ is an autosomal recessive disorder of the urea cycle caused by mutations of the ASL gene (hASL, MIM 608310), encoding argininosuccinate lyase (ASL; EC 4.3.2.1.) (1). This enzyme is ubiquitously expressed and catalyzes the reversible breakdown of argininosuccinate to arginine and fumarate. ASL belongs to a superfamily of hydrolases that includes adenylosuccinate lyase and fumarase, which share a homotetrameric structure and a similar catalytic mechanism. The tetrameric structure of ASL accounts for the phenomenon of intragenic complementation. This particular situation occurs when a multimeric protein is formed from subunits produced by differently mutated alleles of the same gene. On complementation, a partially functional hybrid protein is produced from the two distinct types of mutant subunits, neither of which individually has appreciable enzymatic activity (2).ASL participates to the urea cycle, and in humans it is essential for ammonia detoxification, whereas in lower organisms it is required for the biosynthesis of arginine. Saccharomyces cerevisiae strains harboring a deletion of the homolog of human ASL (ARG4) cannot grow on media lacking arginine (3).ASAuria is characterized by accumulation of argininosuccinic acid (ASA) in body fluids, and severe hyperammonaemia. The disease displays clinical heterogeneity with two main clinical phenotypes: the acute/neonatal onset form, with symptoms rapidly progressing to deep coma, apnea, and death (1), and the subacute/late onset type, which is diagnosed in infancy or childhood (4). Such patients may present simply with mental retardation or an epileptic disorder. In both types the diagnosis is established unambiguously by measuring plasma levels of ammonia (not always elevated in the late onset form), ASA, and its anhydrides by plasma amino acids assay (1). Over 40 mutations of the ASL gene have been reported, both amino acid substitutions and truncating variants, which are scattered throughout the gene (5, 6).We have previously reported the identification of novel mutations of the ASL gene in a cohort of Italian patients (7). In this study we employed a yeast model to validate the pathogenicity of missense ASL mutations found in our cohort, to study the effects of different allelic combinations, and to establish possible genotype-phenotype correlations.     

Coralloid root regeneration on Macrozamia megagametophites

Abstract

Megagametophytes of Macrozamia communis were incubated in White's Basal Medium and in White's Basal Medium modified with 2,4-D and kinetin. On the medium enriched with growth substances, regeneration of coralloid roots was induced. These are morphologically identical to sporophytic coralloid roots, without any endosymbiont and displaying negative geotropism. These results confirm the fact that coralloid roots represent an inherent feature of the root system of the Cycadales rather than being the result of induction by microbial factors. Therefore it is possible to suggest that coralloid roots represent vestigial pneumatophores.     

Proteome analysis of bronchoalveolar lavage in lung diseases

The proteomic approach is complementary to genomics and enables protein composition to be investigated under various clinical conditions. Its application to the study of bronchoalveolar lavage (BAL) is extremely promising. BAL proteomic studies were initially based on two-dimensional electrophoretic separation of complex protein samples and subsequent identification of proteins by different methods. With the techniques available today it is possible to attain many different research objectives. BAL proteomics can contribute to the identification of proteins in alveolar spaces with possible insights into pathogenesis and clinical application for diagnosis, prognosis and therapy. Many proteins with different functions have already been identified in BAL. Some could be biomarkers that need to be individually confirmed by correlation with clinical parameters and validation by other methods on larger cohorts of patients. The standardization of BAL sample preparation and processing for proteomic studies is an important goal that would promote and facilitate clinical applications. Here, we review the principal literature on BAL proteomic analysis applied to the study of lung diseases.