Dispersal is a major driver of the latitudinal diversity gradient of Carnivora

AimUnderstanding the relative contribution of diversification rates (speciation and extinction) and dispersal in the formation of the latitudinal diversity gradient - the decrease in species richness with increasing latitude - is a main goal of biogeography. The mammalian order Carnivora, which comprises 286 species, displays the traditional latitudinal diversity gradient seen in almost all mammalian orders. Yet the processes driving high species richness in the tropics may be fundamentally different in this group from that in other mammalian groups. Indeed, a recent study suggested that in Carnivora, unlike in all other major mammalian orders, net diversification rates are not higher in the tropics than in temperate regions. Our goal was thus to understand the reasons why there are more species of Carnivora in the tropics. LocationWorld-wide. MethodsWe reconstructed the biogeographical history of Carnivora using a time-calibrated phylogeny of the clade comprising all terrestrial species and dispersal-extinction-cladogenesis models. We also analysed a fossil dataset of carnivoran genera to examine how the latitudinal distribution of Carnivora varied through time. ResultsOur biogeographical analyses suggest that Carnivora originated in the East Palaearctic (i.e. Central Asia, China) in the early Palaeogene. Multiple independent lineages dispersed to low latitudes following three main paths: toward Africa, toward India/Southeast Asia and toward South America via the Bering Strait. These dispersal events were probably associated with local extinctions at high latitudes. Fossil data corroborate a high-latitude origin of the group, followed by late dispersal events toward lower latitudes in the Neogene. Main conclusionsUnlike most other mammalian orders, which originated and diversified at low latitudes and dispersed out of the tropics', Carnivora originated at high latitudes, and subsequently dispersed southward. Our study provides an example of combining phylogenetic and fossil data to understand the generation and maintenance of global-scale geographical variations in species richness.

Low latitude Paleocene to early Eocene radiolarian systematics, biochronology and paleoenvironmental analysis

Highly diverse radiolarian faunas of latest Maastrichtian to early Eocene age have been recovered from the low latitude realm in order to contribute to the clarification of radiolarian taxonomy, construct a zonation based on a discrete sequence of co-existence intervals of species ranging from the late Paleocene to early Eocene and to describe a rich low latitude latest Cretaceous to late Paleocene fauna. 225 samples of late Paleocene to early Eocene age have been collected from ODP Leg 171 B-Hole 1051 A (Blake Nose), DSDP Leg 43-Site 384 (Northwest Atlantic) and DSDP Leg 10-Sites 86, 94, 95, 96. Sequences consist of mainly pelagic oozes and chalks, with some clay and ash layers. A new imaging technique is devised to perform (in particular on topotypic material) both transmitted light microscopy and SEM imaging on individual radiolarian specimens. SEM precedes transmitted light imaging. Radiolarians are adhered to a cover slip (using nail varnish) which is secured to a stub using conductive levers. Specimens are then photographed in low vacuum (40-50Pa; 0.5mbar), which enables charge neutralization by ionized molecules of the chamber atmosphere. Thus gold coating is avoided and subsequently this allows transmitted light imaging to follow. The conductive levers are unscrewed and the cover slip is simply overturned and mounted with Canada balsam. In an attempt towards a post-Haeckelian classification, the initial spicule (Entactinaria), micro- or macrosphere (Spumellaria) and initial spicule and cephalis (Nassellaria) have been studied by slicing Entactinaria and Spumellaria, and by tilting Nassellaria in the SEM chamber. A new genus of the family Coccodiscidae is erected and Spongatractus HAECKEL is re-located to the subfamily Axopruinae. The biochronology has been carried out using the Unitary Association Method (Guex 1977, 1991). A database recording the occurrences of 112 species has been used to establish a succession of 22 Unitary Associations. Each association is correlated to chronostratigraphy via calcareous microfossils that were previously studied by other authors. The 22 UAs have been united into seven Unitary Associations Zones (UAZones) (JP10- JE4). The established zones permit to distinguish supplementary subdivisions within the existing zonation. The low-latitude Paleocene radiolarian zonation established by Sanfilippo and Nigrini (1998a) is incomplete due to the lack of radiolarian-bearing early Paleocene sediments. In order to contribute to the study of sparsely known low latitude early Paleocene faunas, 80 samples were taken from the highly siliceous Guayaquil Formation (Ecuador). The sequence consists of black cherts, shales, siliceous limestones and volcanic ash layers. The carbonate content increases up section. Age control is supplied by sporadic occurrences of silicified planktonic foraminifera casts. One Cretaceous zone and seven Paleocene zones have been identified. The existing zonation for the South Pacific can be applied to the early-early late Paleocene sequence, although certain marker species have significantly shorter ranges (notably Buryella foremanae and B. granulata). Despite missing marker species in the late Paleocene, faunal distribution correlates reasonably to the Low-Latitude zonation. An assemblage highly abundant in Lithomelissa, Lophophaena and Cycladophora in the upper RP6 zone (correlated by the presence of Pterocodon poculum, Circodiscus circularis, Pterocodon? sp. aff. P. tenellus and Stylotrochus nitidus) shows a close affinity to contemporaneous faunas reported from Site 1121, Campbell Plateau. Coupled with a high diatom abundance (notably Aulacodiscus spp. and Arachnoidiscus spp.), these faunas are interpreted as reflecting a period of enhanced biosiliceous productivity during the late Paleocene. The youngest sample is void of radiolarians, diatoms and sponge spicules yet contains many pyritized infaunal benthic foraminifera which are akin to the midway-type fauna. The presence of this fauna suggests deposition in a neritic environment. This is in contrast to the inferred bathyal slope depositional environment of the older Paleocene sediments and suggests a shoaling of the depositional environment which may be related to a coeval major accretionary event. RESUME DE LA THESE Des faunes de radiolaires de basses latitudes très diversifiées d'âge Maastrichtien terminal à Eocène inférieur, ont été étudiées afin de contribuer à la clarification de leur taxonomie, de construire une biozonation basée sur une séquence discrète d'intervalles de coexistence des espèces d'age Paléocène supérieur à Eocène inférieur et de décrire une riche faune de basse latitude allant du Crétacé terminal au Paléocène supérieur. L'étude de cette faune contribue particulièrement à la connaissance des insaisissables radiolaires de basses latitudes du Paléocène inférieur. 225 échantillons d'âge Paléocène supérieur à Eocène inférieur provenant des ODP Leg 171B-Site 1051A (Blake Nose), Leg DSDP 43-Site 384 (Atlantique Nord -Ouest) et des DSDP Leg 10 -Sites 86, 94, 95, 96, ont été étudiés. Ces séquences sont constituées principalement de « ooze » et de « chalks »pélagiques ainsi que de quelques niveaux de cendres et d'argiles. Une nouvelle technique d'imagerie a été conçue afin de pouvoir prendre conjointement des images en lumière transmise et au Microscope Electronique à Balayage (MEB) de spécimens individuels. Ceci à été particulièrement appliqué à l'étude des topotypes. L'imagerie MEB précède l'imagerie en lumière transmise. Les radiolaires sont collés sur une lame pour micropaléontologie (au moyen de vernis à ongles) qui est ensuite fixée à un porte-objet à l'aide de bras métalliques conducteurs. Les spécimens sont ensuite photographiés en vide partiel (40-50Pa; 0.5mbar), ce qui permet la neutralisation des charges électrostatiques dues à la présence de molécules ionisées dans l'atmosphère de la chambre d'observation. Ainsi la métallisation de l'échantillon avec de l'or n'est plus nécessaire et ceci permet l'observation ultérieure en lumière transmise. Les bras conducteurs sont ensuite dévissés et la lame est simplement retournée et immergée dans du baume du Canada. Dans une approche de classification post Haeckelienne, le spicule initial (Entactinaires), la micro- ou macro -sphère (Spumellaires) et le spicule initial et cephalis (Nassellaires) ont été étudiés. Ceci a nécessité le sectionnement d'Entactinaires et de Spumellaires, et de pivoter les Nassellaires dans la chambre d'observation du MEB. Un nouveau genre de la Famille des Coccodiscidae a été érigé et Spongatractus HAECKEL à été réassigné à la sous-famille des Axopruninae. L'analyse biostratigraphique à été effectuée à l'aide de la méthode des Associations Unitaires {Guex 1977, 1991). Une base de données enregistrant les présences de 112 espèces à été utilisée poux établir une succession de 22 Associations Unitaires. Chaque association est corrélée à la chronostratigraphie au moyen de microfossiles calcaires précédemment étudiés par d'autres auteurs. Les 22 UAs ont été combinées en sept Zones d'Associations Unitaires (UAZones) (JP10- JE4). Ces Zones permettent d'insérer des subdivisions supplémentaires dans la zonation actuelle. La zonation de basses latitudes du Paléocène établie par Sanfilippo et Nigrini (1998a) est incomplète due au manque de sédiments du Paléocène inférieur contenant des radiolaires. Afin de contribuer à l'étude des faunes peu connues des basses latitudes du Paléocène inférieur, 80 échantillons ont été prélevés d'une section siliceuse de la Formation de Guayaquil (Equateur). La séquence est composée de cherts noirs, de shales, de calcaires siliceux et de couches de cendres volcaniques. La fraction carbonatée augmente vers le haut de la section. Des contraintes chronologiques sont fournies par la présence sporadique de moules de foraminifères planctoniques. Une zone d'intervalles du Crétacé et sept du Paléocène ont été mises en évidence. Bien que certaines espèces marqueur ont des distributions remarquablement plus courtes (notamment Buryella foremanae et B. granulata), la zonation existante pour le Pacifique Sud est applicable à la séquence d'age Paléocène inférieure à Paléocène supérieur basal étudiée. Malgré l'absence d'espèces marqueur du Paléocène supérieur, la succession faunistique se corrèle raisonnablement avec la zonation pour les basses latitudes. Un assemblage contenant d'abondants représentant du genre Lithomelissa, Lophophaena et Cycladophora dans la zone RP6 (correlée par la présence de Pterocodon poculum, Circodiscus circularis, Pterocodon? sp. aff. P. tenellus et Stylotrochus nitidus) montre une grande similitude avec certaines faunes issues des hauts latitudes et d'age semblable décrites par Hollis (2002, Site 1121, Campbell Plateau). Ceci, en plus d'une abondance importante en diatomés (notamment Aulacodiscus spp. et Arachnoidiscus spp.) nous mènent à interpréter cette faune comme témoin d'un épisode de productivité biosiliceuse accrue dans le Paléocène supérieur. L'échantillon le plus jeune, dépourvu de radiolaires, de diatomés et de spicules d'éponge contient de nombreux foraminifères benthiques infaunaux pyritisés. Les espèces identifiées sont caractéristiques d'une faune de type midway. La présence de ces foraminifères suggère un environnement de type néritique. Ceci est en contraste avec l'environnement de pente bathyale caractérisent les sédiments sous-jacent. Cette séquence de diminution de la tranche d'eau peut être associée à un événement d'accrétion majeure. RESUME DE LA THESE (POUR LE GRAND PUBLIC) Les radiolaires constituent le groupe de plancton marin le plus divers et le plus largement répandu de l'enregistrement fossile. Un taux d'évolution rapide et une variation géographique considérable des populations font des radiolaires un outil de recherche sans égal pour la biostratigraphie et la paléocéanographie. Néanmoins, avant de pouvoir les utiliser comme outils de travail, il est essentiel d'établir une solide base taxonomique. L'étude des Radiolaires peut impliquer plusieurs techniques d'extraction, d'observation et d'imagerie qui sont dépendantes du degré d'altération diagénétique des spécimens. Le squelette initial, qu'il s'agisse d'un spicule initial (Entactinaria), d'une micro- ou macro -sphère (Spumellaria) ou d'un spicule initial et d'un cephalis (Nassellaria), est l'élément le plus constant au cours de l'évolution et devrait représenter le fondement de la systématique. Des échantillons provenant de carottes de basses latitudes du Deep Sea Drilling Project et de l' Ocean Drilling ont été étudiés. De nouvelles techniques d'imagerie et de sectionnement ont été développées sur des topotypes de radiolaires préservés en opale, dans le but d'étudier les caractéristiques de leur squelette initial qui n'étaient pas visibles dans leur illustration originale. Ceci aide entre autre à comparer des spécimens recristallisés en quartz, provenant de terrains accrétés, avec les holotypes en opale de la littérature. La distribution des espèces étudiés a fourni des données biostratigraphiques qui ont été compilées à l'aide de la méthode des Associations Unitaires (Guez 1977, 1991). Il s'agit d'un modèle mathématique déterministe conçu pour exploiter la totalité de l'assemblage plutôt que de se confiner à l'utilisation de taxons marqueurs individuels. Une séquence de 22 Associations Unitaires a été établie pour la période allant du Paléocène supérieur à l'Éocène inférieur. Chaque Association Unitaire a été corrélée à l'échelle de temps absolue à l'aide de microfossiles calcaires. Les 22 UAs ont été combinées en sept Zones d'Associations Unitaires (JP10- JE4). Ces Zones permettent d'insérer des subdivisions supplémentaires dans la zonation actuelle. Les radiolaires du Paléocène inférieur à moyen des basses latitudes sont rares. Les meilleures sections connues se trouvent dans les hautes latitudes (Nouvelle Zélande). Quelques assemblages épars ont été mentionnés par le passé en Californie, en Équateur et en Russie. Une séquence siliceuse de 190 mètres dans la Formation de Guayaquil (Équateur), s'étendant du Maastrichtien supérieur au Paléocène supérieur, a fourni des faunes relativement bien préservées. L'étude de ces faunes a permis de mettre en évidence la première séquence complète de radiolaires de basses latitudes dans le Paléocène inférieure. Huit zones allant du Crétacé terminal au Paléocène supérieur ont pu être appliqués et la présence de foraminifères planctoniques a fournie plusieurs points d'attache chronologiques. Dans le Paléocène supérieur, un riche assemblage contenant d'abondants diatomés et radiolaires ayant des similitudes faunistiques marquantes avec des assemblages de hautes latitudes de Nouvelle Zélande, témoigne d'un épisode de productivité biosiliceuse accrue pendant cette période. Étant donné que la pointe du continent sud-américain et l'Antarctique étaient plus proches au cours du Paléocène, ce phénomène peut être expliqué par le transport, le long de la côte ouest de l'Amérique du Sud, d'eaux riches en nutriments en provenance de l'Océan Antarctique. Suite à cet épisode, l'enregistrement en radiolaires est interrompu. Ceci peut être associé à des événements tectoniques régionaux qui ont eu pour effet de diminuer la tranche d'eau relative, rendant l'environnement plus favorable aux foraminifères benthiques qui sont abondamment présents dans l'échantillon le plus jeune de la séquence.

An 40Ar/39Ar, Rb/Sr, and stable isotope study of micas in low-grade fold-and-thrust belt: An example from the Swiss Helvetic Alps

White micas in carbonate-rich tectonites and a few other rock types of large thrusts in the Swiss Helvetic fold-and-thrust belt have been analyzed by Ar-40/Ar-39 and Rb/Sr techniques to better constrain the timing of Alpine deformation for this region. Incremental Ar-40/Ar-39 heating experiments of 25 weakly metamorphosed (anchizone to low greenschist) samples yield plateau and staircase spectra. We interpret most of the staircase release spectra result from variable mixtures of syntectonic (neoformed) and detrital micas. The range in dates obtained within individual spectra depends primarily on the duration of mica nucleation and growth, and relative proportions of neoformed and detrital mica. Rb/Sr analyses of 12 samples yield dates of ca. 10-39 Ma (excluding one anomalously young sample). These dates are slightly younger than the Ar-40/Ar-39 total gas dates obtained for the same samples. The Rb/ Sr dates were calculated using initial Sr-87/Sr-86 ratios obtained from the carbonate-dominated host rocks, which are higher than normal Mesozoic carbonate values due to exchange with fluids of higher Sr-87/Sr-86 ratios (and lower O-18/O-16 ratios). Model dates calculated using Sr-87/Sr-86 values typical of Mesozoic marine carbonates more closely approximate the Ar-40/Ar-39 total gas dates for most of the samples. The similarities of Rb/Sr and Ar-40/Ar-39 total gas dates are consistent with limited amounts of detrital mica in the samples. The delta(18)O values range from 24-15%. (VSMOW) for 2-6 mum micas and 27-16parts per thousand for the carbonate host rocks. The carbonate values are significantly lower than their protolith values due to localized fluid-rock interaction and fluid flow along most thrust surfaces. Although most calcite-mica pairs are not in oxygen isotope equilibrium at temperatures of ca. 200-400 degreesC, their isotopic fractionations are indicative of either 1) partial exchange between the minerals and a common external fluid, or 2) growth or isotopic exchange of the mica with the carbonate after the carbonate had isotopically exchanged with an external fluid. The geological significance of these results is not easily or uniquely determined, and exemplifies the difficulties inherent in dating very fine-grained micas of highly deformed tectonites in low-grade metamorphic terranes. Two generalizations can be made regarding the dates obtained from the Helvetic thrusts: 1) samples from the two highest thrusts (Mt. Gond and Sublage) have all of their Ar-40/Ar-39 steps above 20 Ma, and 2) most samples from the deepest Helvetic thrusts have steps (often accounting for more than 80% of Ar-39 release) between 15 and 25 Ma. These dates are consistent with the order of thrusting in the foreland-imbricating system and increase proportions of neoformed to detrital mica in the more metamorphosed hinterland and deeply buried portions of the nappe pile. Individual thrusts accommodated the majority of their displacement during their initial incorporation into the foreland-imbricating system, and some thrusts remained active or were reactivated down to 15 Ma.

Appropriateness criteria for surgery improve clinical outcomes in patients with low back pain and/or sciatica.

STUDY DESIGN: Prospective, controlled, observational outcome study using clinical, radiographic, and patient/physician-based questionnaire data, with patient outcomes at 12 months follow-up. OBJECTIVE: To validate appropriateness criteria for low back surgery. SUMMARY OF BACKGROUND DATA: Most surgical treatment failures are attributed to poor patient selection, but no widely accepted consensus exists on detailed indications for appropriate surgery. METHODS: Appropriateness criteria for low back surgery have been developed by a multispecialty panel using the RAND appropriateness method. Based on panel criteria, a prospective study compared outcomes of patients appropriately and inappropriately treated at a single institution with 12 months follow-up assessment. Included were patients with low back pain and/or sciatica referred to the neurosurgical department. Information about symptoms, neurologic signs, the health-related quality of life (SF-36), disability status (Roland-Morris), and pain intensity (VAS) was assessed at baseline, at 6 months, and at 12 months follow-up. The appropriateness criteria were administered prospectively to each clinical situation and outside of the clinical setting, with the surgeon and patients blinded to the results of the panel decision. The patients were further stratified into 2 groups: appropriate treatment group (ATG) and inappropriate treatment group (ITG). RESULTS: Overall, 398 patients completed all forms at 12 months. Treatment was considered appropriate for 365 participants and inappropriate for 33 participants. The mean improvement in the SF-36 physical component score at 12 months was significantly higher in the ATG (mean: 12.3 points) than in the ITG (mean: 6.8 points) (P = 0.01), as well as the mean improvement in the SF-36 mental component score (ATG mean: 5.0 points; ITG mean: -0.5 points) (P = 0.02). Improvement was also significantly higher in the ATG for the mean VAS back pain (ATG mean: 2.3 points; ITG mean: 0.8 points; P = 0.02) and Roland-Morris disability score (ATG mean: 7.7 points; ITG mean: 4.2 points; P = 0.004). The ATG also had a higher improvement in mean VAS for sciatica (4.0 points) than the ITG (2.8 points), but the difference was not significant (P = 0.08). The SF-36 General Health score declined in both groups after 12 months, however, the decline was worse in the ITG (mean decline: 8.2 points) than in the ATG (mean decline: 1.2 points) (P = 0.04). Overall, in comparison to ITG patients, ATG patients had significantly higher improvement at 12 months, both statistically and clinically. CONCLUSION: In comparison to previously reported literature, our study is the first to assess the utility of appropriateness criteria for low back surgery at 1-year follow-up with multiple outcome dimensions. Our results confirm the hypothesis that application of appropriateness criteria can significantly improve patient outcomes.

Low-Dose Vascular Photodynamic Therapy Decreases Tumor Interstitial Fluid Pressure, which Promotes Liposomal Doxorubicin Distribution in a Murine Sarcoma Metastasis Model.

INTRODUCTION: Solid tumors are known to have an abnormal vasculature that limits the distribution of chemotherapy. We have recently shown that tumor vessel modulation by low-dose photodynamic therapy (L-PDT) could improve the uptake of macromolecular chemotherapeutic agents such as liposomal doxorubicin (Liporubicin) administered subsequently. However, how this occurs is unknown. Convection, the main mechanism for drug transport between the intravascular and extravascular spaces, is mostly related to interstitial fluid pressure (IFP) and tumor blood flow (TBF). Here, we determined the changes of tumor and surrounding lung IFP and TBF before, during, and after vascular L-PDT. We also evaluated the effect of these changes on the distribution of Liporubicin administered intravenously (IV) in a lung sarcoma metastasis model. MATERIALS AND METHODS: A syngeneic methylcholanthrene-induced sarcoma cell line was implanted subpleurally in the lung of Fischer rats. Tumor/surrounding lung IFP and TBF changes induced by L-PDT were determined using the wick-in-needle technique and laser Doppler flowmetry, respectively. The spatial distribution of Liporubicin in tumor and lung tissues following IV drug administration was then assessed in L-PDT-pretreated animals and controls (no L-PDT) by epifluorescence microscopy. RESULTS: L-PDT significantly decreased tumor but not lung IFP compared to controls (no L-PDT) without affecting TBF. These conditions were associated with a significant improvement in Liporubicin distribution in tumor tissues compared to controls (P < .05). DISCUSSION: L-PDT specifically enhanced convection in blood vessels of tumor but not of normal lung tissue, which was associated with a significant improvement of Liporubicin distribution in tumors compared to controls.

Cost-effectiveness of low-molecular-weight heparin for secondary prophylaxis of cancer-related venous thromboembolism.

Although extended secondary prophylaxis with low-molecular-weight heparin was recently shown to be more effective than warfarin for cancer-related venous thromboembolism, its cost-effectiveness compared to traditional prophylaxis with warfarin is uncertain. We built a decision analytic model to evaluate the clinical and economic outcomes of a 6-month course of low-molecular-weight heparin or warfarin therapy in 65-year-old patients with cancer-related venous thromboembolism. We used probability estimates and utilities reported in the literature and published cost data. Using a US societal perspective, we compared strategies based on quality-adjusted life-years (QALYs) and lifetime costs. The incremental cost-effectiveness ratio of low-molecular-weight heparin compared with warfarin was 149,865 dollars/QALY. Low-molecular-weight heparin yielded a quality-adjusted life expectancy of 1.097 QALYs at the cost of 15,329 dollars. Overall, 46% (7108 dollars) of the total costs associated with low-molecular-weight heparin were attributable to pharmacy costs. Although the low-molecular-weigh heparin strategy achieved a higher incremental quality-adjusted life expectancy than the warfarin strategy (difference of 0.051 QALYs), this clinical benefit was offset by a substantial cost increment of 7,609 dollars. Cost-effectiveness results were sensitive to variation of the early mortality risks associated with low-molecular-weight heparin and warfarin and the pharmacy costs for low-molecular-weight heparin. Based on the best available evidence, secondary prophylaxis with low-molecular-weight heparin is more effective than warfarin for cancer-related venous thromboembolism. However, because of the substantial pharmacy costs of extended low-molecular-weight heparin prophylaxis in the US, this treatment is relatively expensive compared with warfarin.

Use of a human-like low-grade bacteremia model of experimental endocarditis to study the role of Staphylococcus aureus adhesins and platelet aggregation in early endocarditis.

Animal models of infective endocarditis (IE) induced by high-grade bacteremia revealed the pathogenic roles of Staphylococcus aureus surface adhesins and platelet aggregation in the infection process. In humans, however, S. aureus IE possibly occurs through repeated bouts of low-grade bacteremia from a colonized site or intravenous device. Here we used a rat model of IE induced by continuous low-grade bacteremia to explore further the contributions of S. aureus virulence factors to the initiation of IE. Rats with aortic vegetations were inoculated by continuous intravenous infusion (0.0017 ml/min over 10 h) with 10(6) CFU of Lactococcus lactis pIL253 or a recombinant L. lactis strain expressing an individual S. aureus surface protein (ClfA, FnbpA, BCD, or SdrE) conferring a particular adhesive or platelet aggregation property. Vegetation infection was assessed 24 h later. Plasma was collected at 0, 2, and 6 h postinoculation to quantify the expression of tumor necrosis factor (TNF), interleukin 1α (IL-1α), IL-1β, IL-6, and IL-10. The percentage of vegetation infection relative to that with strain pIL253 (11%) increased when binding to fibrinogen was conferred on L. lactis (ClfA strain) (52%; P = 0.007) and increased further with adhesion to fibronectin (FnbpA strain) (75%; P < 0.001). Expression of fibronectin binding alone was not sufficient to induce IE (BCD strain) (10% of infection). Platelet aggregation increased the risk of vegetation infection (SdrE strain) (30%). Conferring adhesion to fibrinogen and fibronectin favored IL-1β and IL-6 production. Our results, with a model of IE induced by low-grade bacteremia, resembling human disease, extend the essential role of fibrinogen binding in the initiation of S. aureus IE. Triggering of platelet aggregation or an inflammatory response may contribute to or promote the development of IE.

Impact of low-level viremia on clinical and virological outcomes in treated HIV-1-infected patients.

BACKGROUND: The goal of antiretroviral therapy (ART) is to reduce HIV-related morbidity and mortality by suppressing HIV replication. The prognostic value of persistent low-level viremia (LLV), particularly for clinical outcomes, is unknown. OBJECTIVE: Assess the association of different levels of LLV with virological failure, AIDS event, and death among HIV-infected patients receiving combination ART. METHODS: We analyzed data from 18 cohorts in Europe and North America, contributing to the ART Cohort Collaboration. Eligible patients achieved viral load below 50 copies/ml within 3-9 months after ART initiation. LLV50-199 was defined as two consecutive viral loads between 50 and 199 copies/ml and LLV200-499 as two consecutive viral loads between 50 and 499 copies/ml, with at least one between 200 and 499 copies/ml. We used Cox models to estimate the association of LLV with virological failure (two consecutive viral loads at least 500 copies/ml or one viral load at least 500 copies/ml, followed by a modification of ART) and AIDS event/death. RESULTS: Among 17 902 patients, 624 (3.5%) experienced LLV50-199 and 482 (2.7%) LLV200-499. Median follow-up was 2.3 and 3.1 years for virological and clinical outcomes, respectively. There were 1903 virological failure, 532 AIDS events and 480 deaths. LLV200-499 was strongly associated with virological failure [adjusted hazard ratio (aHR) 3.97, 95% confidence interval (CI) 3.05-5.17]. LLV50-199 was weakly associated with virological failure (aHR 1.38, 95% CI 0.96-2.00). LLV50-199 and LLV200-499 were not associated with AIDS event/death (aHR 1.19, 95% CI 0.78-1.82; and aHR 1.11, 95% CI 0.72-1.71, respectively). CONCLUSION: LLV200-499 was strongly associated with virological failure, but not with AIDS event/death. Our results support the US guidelines, which define virological failure as a confirmed viral load above 200 copies/ml.

First-line chemotherapy with local treatment can prevent external-beam irradiation and enucleation in low-stage intraocular retinoblastoma.

PURPOSE: To evaluate the efficacy of first-line chemotherapy (CT) in preventing external-beam radiotherapy (EBR) and/or enucleation in patients with retinoblastoma (Rbl). PATIENTS AND METHODS: Twenty-four patients with newly diagnosed unilateral or bilateral Rbl received CT associated with local treatment (LT). Two to five courses of etoposide and carboplatin were administered at 3- to 4-week intervals, depending on tumor response, and were completed each time by LT. RESULTS: Tumor response was observed in all eyes. Twenty-one of 24 patients showed a complete response (CR) that persisted at a median follow-up (FU) of 31 months (range, 4 to 41 months). Among the three patients who relapsed, two were lost to FU and one died of progressive disease. CR was achieved by CT and LT alone in 15 (71.4%) of 21 patients with less advanced disease (groups I to III). Six other patients with advanced disease (groups IV and V) experienced treatment failure and needed salvage treatment by EBR and/or enucleation. The difference between the two patient groups with regard to disease stage was statistically significant (P <.0001). EBR could be avoided in 13 (68.4%) of 19 patients, who presented with groups I to III (15 eyes) and group V (one eye) disease, whereas enucleation could be avoided in only two (40%) of five. CONCLUSION: CT combined with intensive LT is effective in patients with groups I to III Rbl, permitting the avoidance of EBR in the majority of these young children and, thus, reducing the risk of long-term sequelae. This is in contrast with the disappointing results for patients with groups IV and V Rbl, in whom EBR and/or enucleation was needed.

Low-frequency drug-resistant HIV-1 and risk of virological failure to first-line NNRTI-based ART: a multicohort European case-control study using centralized ultrasensitive 454 pyrosequencing.

OBJECTIVES: It is still debated if pre-existing minority drug-resistant HIV-1 variants (MVs) affect the virological outcomes of first-line NNRTI-containing ART. METHODS: This Europe-wide case-control study included ART-naive subjects infected with drug-susceptible HIV-1 as revealed by population sequencing, who achieved virological suppression on first-line ART including one NNRTI. Cases experienced virological failure and controls were subjects from the same cohort whose viraemia remained suppressed at a matched time since initiation of ART. Blinded, centralized 454 pyrosequencing with parallel bioinformatic analysis in two laboratories was used to identify MVs in the 1%-25% frequency range. ORs of virological failure according to MV detection were estimated by logistic regression. RESULTS: Two hundred and sixty samples (76 cases and 184 controls), mostly subtype B (73.5%), were used for the analysis. Identical MVs were detected in the two laboratories. 31.6% of cases and 16.8% of controls harboured pre-existing MVs. Detection of at least one MV versus no MVs was associated with an increased risk of virological failure (OR = 2.75, 95% CI = 1.35-5.60, P = 0.005); similar associations were observed for at least one MV versus no NRTI MVs (OR = 2.27, 95% CI = 0.76-6.77, P = 0.140) and at least one MV versus no NNRTI MVs (OR = 2.41, 95% CI = 1.12-5.18, P = 0.024). A dose-effect relationship between virological failure and mutational load was found. CONCLUSIONS: Pre-existing MVs more than double the risk of virological failure to first-line NNRTI-based ART.