La leucocorie chez l'enfant

Introduction : La leucocorie ou le reflet pupillaire blanchâtre traduit la réflexion de la lumière dans l'aire pupillaire d'une lésion intraoculaire lors de l'éclairage du fond d'oeil. Elle peut prendre des colorations diverses, blanche, jaune, grise, selon la nature de la maladie, présenter un caractère intermittent et fugitif dépendant de l'éclairage, de l'angle d'observation, de la localisation et de la taille de la lésion. La leucocorie est la première manifestation de nombreuses affections oculaires dont le rétinoblastome, tumeur maligne de la rétine, constitue l'atteinte la plus grave parce qu'elle peut mettre en péril non seulement la vue mais aussi la vie de l'enfant. Les autres maladies en cause sont dans l'ordre de fréquence la maladie de Coats, la persistance et hyperplasie du vitré primitif, les maladies inflammatoires (uvéites, toxoplasmose, toxocarose oculaire,...), la rétinopathie du prématuré, les malformations oculaires (fibres à myéline, colobomes, plis falciformes,...), la cataracte, l'hémorragie vitréenne et le décollement de rétine. Objectif : Le but de ce travail est d'analyser les maladies oculaires de l'enfant qui se manifestent par une leucocorie comme signe d'appel et d'étudier leur fréquence relative. Méthode: Il s'agit d'une étude rétrospective de 1037 enfants consécutifs examinés à l'unité d'oncopédiatrie de l'Hôpital Ophtalmique de Lausanne du 1er janvier 1980 au 31 décembre 2010 pour une affection oculaire. Les diagnostics des patients ayant présenté une leucocorie comme signe ont été collectés. En complément, l'âge au premier symptôme, l'âge au diagnostic, le genre, l'hérédité et la latéralité ont été pris en compte selon la nature de la lésion et la documentation disponible. Résultats : Sur 1037 patients, nous avons dénombré 537 cas de rétinoblastome (52%), 281 cas de malformations congénitales (27%), 169 cas de maladies vasculaires (16%). Parmi les affections s'étant manifestées par une leucocorie, le rétinoblastome arrive en première place (315 cas sur 537) (59%), puis viennent la maladie de Coats (21 cas sur 67) (31%), la cataracte (17 cas sur 68) (25%) et la persistance et hyperplasie du vitré primitif (16 cas sur 66) (24%). Conclusion : La connaissance des caractéristiques de la leucocorie chez l'enfant et la prise de conscience de son importance diagnostique sont essentielles dans le dépistage précoce d'affections rétiniennes qui peuvent avoir des répercussions non seulement sur la fonction visuelle mais aussi sur le pronostic vital.

Contemporary engagements within corridors of the past: temporal elasticity, graffiti, and the materiality of St. Rock Street, Barcelona

In a medieval Barcelonan side-street, urine, rubbish, and a bewildering array of graphic imagery splatters the narrowing walls between two major thoroughfares. A contemporary conflict between residents, unknown artists and others is played out using banners, bottles, stickers, posters, stencils, spray paint, and bodily substances. In this shadowed liminality, local and global debates are superimposed upon substructures constructed from disease, prostitution, and the Saint of the Plague. The continuing urban struggle constitutes temporal statements of dirt and purity, violence and humour, dominance and resistance, death and salvation. Like the renovated facades masking the crumbling remains of structures long neglected, the government’s literal whitewashing of the art is a temporal cover-up of a discursive symptom stretching from deeply embedded preconditions. However, from his niche in the angular bend of the alley bearing his name, the statue of St. Rock remains unblinkingly staring, raised above the contestations expressed below.

Puristinhuopien pesutehokkuuden vaikutus puristinosan ajettavuuteen

Työn tarkoituksena oli kehittää jatkuvatoimiseen pesuun soveltuva emäksinen ja hapan huovanpesuaine sekä tutkia huovanpesun parametreja laboratoriossa ja paperikoneella. Kirjallisuusosassa tarkasteltiin paperikoneen puristinosaa, puristinhuopien ominaisuuksia, puristinhuovissa esiintyviä saostumia ja puristinhuopien kunnostusta sekä esiteltiin FeltPerm-vedenläpäisykykymittari. Kokeellisessa osassa analysoitiin käytetty huopa kvalitatiivisesti ja kvantitatiivisesti ja kun huopaa tukkivien yhdisteiden kemiallinen luonne oli selvitetty, kehitettiin käynninaikaiseen pesuun soveltuva emäksinen ja hapan huovanpesuaine. Huovanpesuaineiden kehitystyössä pesuaineiden tehokkuutta tutkittiin kolmella eri menetelmällä, joista kaksi perustui huovan massan muutoksen määrittämiseen pesussa ja yksi huovan vedenläpäisykyvyn mittaamiseen. Kehitetyillä pesuaineilla optimoitiin laboratoriossa happo- ja emäspesun pH sekä vaikutusaika. Lisäksi tutkittiin huovan turpoamista emäspesussa ja lämpötilan vaikutusta pesutulokseen. Puristinhuopien vedenläpäisykykyä tutkittiin FeltPerm-laitteella kahdella eri SC-paperikoneella, joista toisella oli käytössä käynninaikainen jaksottainen pesu ja toisella pelkät seisokkipesut. Koneella, jossa huovat pestiin käynninaikaisesti, määritettiin pesuparametreja ja optimoitiin emäsvaiheen aikainen pH. Kehitetyillä pesuaineilla suoritettiin koeajo tehtaalla.

Experimental insights into deformation dynamics and intermittency in rapid granular shear flows

This work concerns the experimental study of rapid granular shear flows in annular Couette geometry. The flow is induced by continuous driving of the horizontal plate at the top of the granular bed in an annulus. The compressive pressure, driving torque, instantaneous bed height and rotational speed of the shearing plate are measured. Moreover, local stress fluctuations are measured in a medium made of steel spheres 2 and 3 mm in diameter. Both monodisperse packing and bidisperse packing are investigated to reveal the influence of size diversity in intermittent features of granular materials. Experiments are conducted in an annulus that can contain up to 15 kg of spherical steel balls. The shearing granular medium takes place via the rotation of the upper plate which compresses the material loaded inside the annulus. Fluctuations of compressive force are locally measured at the bottom of the annulus using a piezoelectric sensor. Rapid shear flow experiments are pursued at different compressive forces and shear rates and the sensitivity of fluctuations are then investigated by different means through monodisperse and bidisperse packings. Another important feature of rapid granular shear flows is the formation of ordered structures upon shearing. It requires a certain range for the amount of granular material (uniform size distribution) loaded in the system in order to obtain stable flows. This is studied more deeply in this thesis. The results of the current work bring some new insights into deformation dynamics and intermittency in rapid granular shear flows. The experimental apparatus is modified in comparison to earlier investigations. The measurements produce data for various quantities continuously sampled from the start of shearing to the end. Static failure and dynamic shearing ofa granular medium is investigated. The results of this work revealed some important features of failure dynamics and structure formation in the system. Furthermore, some computer simulations are performed in a 2D annulus to examine the nature of kinetic energy dissipation. It is found that turbulent flow models can statistically represent rapid granular flows with high accuracy. In addition to academic outcomes and scientific publications our results have a number of technological applications associated with grinding, mining and massive grain storages.

A European survey on current practices in epilepsy monitoring units and implications for patients' safety.

OBJECTIVE: This study aimed to survey current practices in European epilepsy monitoring units (EMUs) with emphasis on safety issues. METHODS: A 37-item questionnaire investigating characteristics and organization of EMUs, including measures for prevention and management of seizure-related serious adverse events (SAEs), was distributed to all identified European EMUs plus one located in Israel (N=150). RESULTS: Forty-eight (32%) EMUs, located in 18 countries, completed the questionnaire. Epilepsy monitoring unit beds are 1-2 in 43%, 3-4 in 34%, and 5-6 in 19% of EMUs; staff physicians are 1-2 in 32%, 3-4 in 34%, and 5-6 in 19% of EMUs. Personnel operating in EMUs include epileptologists (in 69% of EMUs), clinical neurophysiologists trained in epilepsy (in 46% of EMUs), child neurologists (in 35% of EMUs), neurology and clinical neurophysiology residents (in 46% and in 8% of EMUs, respectively), and neurologists not trained in epilepsy (in 27% of EMUs). In 20% of EMUs, patients' observation is only intermittent or during the daytime and primarily carried out by neurophysiology technicians and/or nurses (in 71% of EMUs) or by patients' relatives (in 40% of EMUs). Automatic detection systems for seizures are used in 15%, for body movements in 8%, for oxygen desaturation in 33%, and for ECG abnormalities in 17% of EMUs. Protocols for management of acute seizures are lacking in 27%, of status epilepticus in 21%, and of postictal psychoses in 87% of EMUs. Injury prevention consists of bed protections in 96% of EMUs, whereas antisuffocation pillows are employed in 21%, and environmental protections in monitoring rooms and in bathrooms are implemented in 38% and in 25% of EMUs, respectively. The most common SAEs were status epilepticus reported by 79%, injuries by 73%, and postictal psychoses by 67% of EMUs. CONCLUSIONS: All EMUs have faced different types of SAEs. Wide variation in practice patterns and lack of protocols and of precautions to ensure patients' safety might promote the occurrence and severity of SAEs. Our findings highlight the need for standardized and shared protocols for an effective and safe management of patients in EMUs.

Sprint performance under heat stress: A review.

Training and competition in major track-and-field events, and for many team or racquet sports, often require the completion of maximal sprints in hot (>30 °C) ambient conditions. Enhanced short-term (<30 s) power output or single-sprint performance, resulting from transient heat exposure (muscle temperature rise), can be attributed to improved muscle contractility. Under heat stress, elevations in skin/core temperatures are associated with increased cardiovascular and metabolic loads in addition to decreasing voluntary muscle activation; there is also compelling evidence to suggest that large performance decrements occur when repeated-sprint exercise (consisting of brief recovery periods between sprints, usually <60 s) is performed in hot compared with cool conditions. Conversely, poorer intermittent-sprint performance (recovery periods long enough to allow near complete recovery, usually 60-300 s) in hotter conditions is solely observed when exercise induces marked hyperthermia (core temperature >39 °C). Here we also discuss strategies (heat acclimatization, precooling, hydration strategies) employed by "sprint" athletes to mitigate the negative influence of higher environmental temperatures.

Quaternary active tectonic structures in the offshore Bajo Segura basin (SE Iberian Peninsula Mediterranean Sea).

The Bajo Segura fault zone (BSFZ) is the northern terminal splay of the Eastern Betic shear zone (EBSZ), a large left-lateral strike-slip fault system of sigmoid geometry stretching more than 450 km from Alicante to Almería. The BSFZ extends from the onshore Bajo Segura basin further into the Mediterranean Sea and shows a moderate instrumental seismic activity characterized by small earthquakes. Nevertheless, the zone was affected by large historical earthquakes of which the largest was the 1829 Torrevieja earthquake (IEMS98 X). The onshore area of the BSFZ is marked by active transpressive structures (faults and folds), whereas the offshore area has been scarcely explored from the tectonic point of view. During the EVENT-SHELF cruise, a total of 10 high-resolution single-channel seismic sparker profiles were obtained along and across the offshore Bajo Segura basin. Analysis of these profiles resulted in (a) the identification of 6 Quaternary seismo-stratigraphic units bounded by five horizons corresponding to regional erosional surfaces related to global sea level lowstands; and (b) the mapping of the active sub-seafloor structures and their correlation with those described onshore. Moreover, the results suggest that the Bajo Segura blind thrust fault or the Torrevieja left-lateral strike-slip fault, with prolongation offshore, could be considered as the source of the 1829 Torrevieja earthquake. These data improve our understanding of present deformation along the BSFZ and provide new insights into the seismic hazard in the area.

Inflammatory and coagulation biomarkers and mortality in patients with HIV infection.

Background In the Strategies for Management of Anti-Retroviral Therapy trial, all-cause mortality was higher for participants randomized to intermittent, CD4-guided antiretroviral treatment (ART) (drug conservation [DC]) than continuous ART (viral suppression [VS]). We hypothesized that increased HIV-RNA levels following ART interruption induced activation of tissue factor pathways, thrombosis, and fibrinolysis. Methods and Findings Stored samples were used to measure six biomarkers: high sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6), amyloid A, amyloid P, D-dimer, and prothrombin fragment 1þ2. Two studies were conducted: (1) a nested case-control study for studying biomarker associations with mortality, and (2) a study to compare DC and VS participants for biomarker changes. For (1), markers were determined at study entry and before death (latest level) for 85 deaths and for two controls (n¼170) matched on country, age, sex, and date of randomization. Odds ratios (ORs) were estimated with logistic regression. For each biomarker, each of the three upper quartiles was compared to the lowest quartile. For (2), the biomarkers were assessed for 249 DC and 250 VS participants at study entry and 1 mo following randomization. Higher levels of hsCRP, IL-6, and D-dimer at study entry were significantly associated with an increased risk of all-cause mortality. Unadjusted ORs (highest versus lowest quartile) were 2.0 (95% confidence interval [CI], 1.0-4.1; p¼0.05), 8.3 (95% CI, 3.3-20.8; p , 0.0001), and 12.4 (95% CI, 4.2-37.0; p , 0.0001), respectively. Associations were significant after adjustment, when the DC and VS groups were analyzed separately, and when latest levels were assessed. IL-6 and D-dimer increased at 1 mo by 30% and 16% in the DC group and by 0% and 5% in the VS group (p , 0.0001 for treatment difference for both biomarkers); increases in the DC group were related to HIV-RNA levels at 1 mo (p , 0.0001). In an expanded case-control analysis (four controls per case), the OR (DC/VS) for mortality was reduced from 1.8 (95% CI, 1.1-3.1; p¼0.02) to 1.5 (95% CI, 0.8-2.8) and 1.4 (95% CI, 0.8-2.5) after adjustment for latest levels of IL-6 and D-dimer, respectively. Conclusions IL-6 and D-dimer were strongly related to all-cause mortality. Interrupting ART may further increase the risk of death by raising IL-6 and D-dimer levels. Therapies that reduce the inflammatory response to HIV and decrease IL-6 and D-dimer levels may warrant investigation.

Tendinopathies du coude [Elbow tendinopathy].

The lateral and medial epicondylitis is often manifested in a professional or in a sport context leading to repetitive wrist movements. The diagnosis is primarily clinical. Additional tests are indicated in chronic evolution and in searching for differential diagnoses. Elbow X-ray can be completed with ultrasound or MRI, the most efficient but expensive diagnostic procedure. There is no consensus on treatment. After a period of rest, stretching then strengthening exercises are recommended. Corticosteroid injections may provide a short-term beneficial effect. Platelet-Rich Plasma injections have recently gained notoriety. In case of failure of treatment, surgery is possible, but only in a minority of patients.

Kuopion Energian keskijänniteverkon kehittämissuunnitelma

Tämän työn tavoitteena oli laatia Kuopion Energian keskijänniteverkon kehittämissuunnitelma. Kehittämissuunnitelmaa varten selvitettiin ensin verkon nykytila ja toimivuus korvaustilanteissa. Tämän jälkeen laadittiin vuoteen 2020 asti ulottuvat kuormitusennusteet. Nykytilan ja kuormitusennusteiden pohjalta selvitettiin toimenpiteet, joilla Kuopion Energian keskijänniteverkko selviää tulevaisuuden vaatimuksista. Kehittämissuunnitelmassa selvitettiin alueet, joilla kuormitettavuus, korvattavuus tai oikosulkukestoisuus muodostuisi tulevaisuudessa toimivan sähkönjakelun esteeksi. Työn painopistealueiksi muodostuivat Savilahden ja Petosen alueet. Työssä selvitettiin, kuinka Petosen alueen nopean kuormituksen kasvun aiheuttama lisätehontarve saadaan hoidettua. Vaihtoehtoisina ratkaisutapoina selvitettiin lisäkapasiteetin rakentamista Petosen aluetta nykyisin syöttävälle Leväsen sähköasemalle tai uuden sähköaseman rakentamista. Savilahden alueen kasvavan tehontarpeen tyydyttämiseksi selvitettiin lisätehon saneeraamista Savilahden sähköasemalle tai vastaavasti uuden sähköaseman rakentamista Iloharjun kytkinasemalle.

Survey on current practices for neurological prognostication after cardiac arrest.

PURPOSE: To investigate current practices and timing of neurological prognostication in comatose cardiac arrest patients. METHODS: An anonymous questionnaire was distributed to the 8000 members of the European Society of Intensive Care Medicine during September and October 2012. The survey had 27 questions divided into three categories: background data, clinical data, decision-making and consequences. RESULTS: A total of 1025 respondents (13%) answered the survey with complete forms in more than 90%. Twenty per cent of respondents practiced outside of Europe. Overall, 22% answered that they had national recommendations, with the highest percentage in the Netherlands (>80%). Eighty-nine per cent used induced hypothermia (32-34 °C) for comatose cardiac arrest patients, while 11% did not. Twenty per cent had separate prognostication protocols for hypothermia patients. Seventy-nine per cent recognized that neurological examination alone is not enough to predict outcome and a similar number (76%) used additional methods. Intermittent electroencephalography (EEG), brain computed tomography (CT) scan and evoked potentials (EP) were considered most useful. Poor prognosis was defined as cerebral performance category (CPC) 3-5 (58%) or CPC 4-5 (39%) or other (3%). When prognosis was considered poor, 73% would actively withdraw intensive care while 20% would not and 7% were uncertain. CONCLUSION: National recommendations for neurological prognostication after cardiac arrest are uncommon and only one physician out of five uses a separate protocol for hypothermia treated patients. A neurological examination alone was considered insufficient to predict outcome in comatose patients and most respondents advocated a multimodal approach: EEG, brain CT and EP were considered most useful. Uncertainty regarding neurological prognostication and decisions on level of care was substantial.

Obstructive Sleep Apnea Severity and Overnight Body Fluid Shift before and after Hemodialysis.

BACKGROUND AND OBJECTIVES: Obstructive sleep apnea is associated with significantly increased cardiovascular morbidity and mortality. Fluid overload may promote obstructive sleep apnea in patients with ESRD through an overnight fluid shift from the legs to the neck soft tissues. Body fluid shift and severity of obstructive sleep apnea before and after hemodialysis were compared in patients with ESRD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Seventeen patients with hemodialysis and moderate to severe obstructive sleep apnea were included. Polysomnographies were performed the night before and after hemodialysis to assess obstructive sleep apnea, and bioimpedance was used to measure fluid overload and leg fluid volume. RESULTS: The mean overnight rostral fluid shift was 1.27±0.41 L prehemodialysis; it correlated positively with fluid overload volume (r=0.39; P=0.02) and was significantly lower posthemodialysis (0.78±0.38 L; P<0.001). There was no significant difference in the mean obstructive apnea-hypopnea index before and after hemodialysis (46.8±22.0 versus 42.1±18.6 per hour; P=0.21), but obstructive apnea-hypopnea index was significantly lower posthemodialysis (-10.1±10.8 per hour) in the group of 12 patients, with a concomitant reduction of fluid overload compared with participants without change in fluid overload (obstructive apnea-hypopnea index +8.2±16.1 per hour; P<0.01). A lower fluid overload after hemodialysis was significantly correlated (r=0.49; P=0.04) with a lower obstructive apnea-hypopnea index. Fluid overload-assessed by bioimpedance-was the best predictor of the change in obstructive apnea-hypopnea index observed after hemodialysis (standardized r=-0.68; P=0.01) in multivariate regression analysis. CONCLUSIONS: Fluid overload influences overnight rostral fluid shift and obstructive sleep apnea severity in patients with ESRD undergoing intermittent hemodialysis. Although no benefit of hemodialysis on obstructive sleep apnea severity was observed in the whole group, the change in obstructive apnea-hypopnea index was significantly correlated with the change in fluid overload after hemodialysis. Moreover, the subgroup with lower fluid overload posthemodialysis showed a significantly lower obstructive sleep apnea severity, which provides a strong incentive to further study whether optimizing fluid status in patients with obstructive sleep apnea and ESRD will improve the obstructive apnea-hypopnea index.

Transcranial Magnetic Stimulation Combined with EEG Reveals Covert States of Elevated Excitability in the Human Epileptic Brain.

BACKGROUND: Transcranial magnetic stimulation combined with electroencephalogram (TMS-EEG) can be used to explore the dynamical state of neuronal networks. In patients with epilepsy, TMS can induce epileptiform discharges (EDs) with a stochastic occurrence despite constant stimulation parameters. This observation raises the possibility that the pre-stimulation period contains multiple covert states of brain excitability some of which are associated with the generation of EDs. OBJECTIVE: To investigate whether the interictal period contains "high excitability" states that upon brain stimulation produce EDs and can be differentiated from "low excitability" states producing normal appearing TMS-EEG responses. METHODS: In a cohort of 25 patients with Genetic Generalized Epilepsies (GGE) we identified two subjects characterized by the intermittent development of TMS-induced EDs. The high-excitability in the pre-stimulation period was assessed using multiple measures of univariate time series analysis. Measures providing optimal discrimination were identified by feature selection techniques. The "high excitability" states emerged in multiple loci (indicating diffuse cortical hyperexcitability) and were clearly differentiated on the basis of 14 measures from "low excitability" states (accuracy = 0.7). CONCLUSION: In GGE, the interictal period contains multiple, quasi-stable covert states of excitability a class of which is associated with the generation of TMS-induced EDs. The relevance of these findings to theoretical models of ictogenesis is discussed.

Wavelet Analysis in Turbulence

The objective of this thesis is to study wavelets and their role in turbulence applications. Under scrutiny in the thesis is the intermittency in turbulence models. Wavelets are used as a mathematical tool to study the intermittent activities that turbulence models produce. The first section generally introduces wavelets and wavelet transforms as a mathematical tool. Moreover, the basic properties of turbulence are discussed and classical methods for modeling turbulent flows are explained. Wavelets are implemented to model the turbulence as well as to analyze turbulent signals. The model studied here is the GOY (Gledzer 1973, Ohkitani & Yamada 1989) shell model of turbulence, which is a popular model for explaining intermittency based on the cascade of kinetic energy. The goal is to introduce better quantification method for intermittency obtained in a shell model. Wavelets are localized in both space (time) and scale, therefore, they are suitable candidates for the study of singular bursts, that interrupt the calm periods of an energy flow through various scales. The study concerns two questions, namely the frequency of the occurrence as well as the intensity of the singular bursts at various Reynolds numbers. The results gave an insight that singularities become more local as Reynolds number increases. The singularities become more local also when the shell number is increased at certain Reynolds number. The study revealed that the singular bursts are more frequent at Re ~ 107 than other cases with lower Re. The intermittency of bursts for the cases with Re ~ 106 and Re ~ 105 was similar, but for the case with Re ~ 104 bursts occured after long waiting time in a different fashion so that it could not be scaled with higher Re.

The Bacterium Frischella perrara Causes Scab Formation in the Gut of its Honeybee Host.

UNLABELLED: Honeybees harbor well-defined bacterial communities in their guts. The major members of these communities appear to benefit the host, but little is known about how they interact with the host and specifically how they interface with the host immune system. In the pylorus, a short region between the midgut and hindgut, honeybees frequently exhibit scab-like structures on the epithelial gut surface. These structures are reminiscent of a melanization response of the insect immune system. Despite the wide distribution of this phenotype in honeybee populations, its cause has remained elusive. Here, we show that the presence of a common member of the bee gut microbiota, the gammaproteobacterium Frischella perrara, correlates with the appearance of the scab phenotype. Bacterial colonization precedes scab formation, and F. perrara specifically localizes to the melanized regions of the host epithelium. Under controlled laboratory conditions, we demonstrate that exposure of microbiota-free bees to F. perrara but not to other bacteria results in scab formation. This shows that F. perrara can become established in a spatially restricted niche in the gut and triggers a morphological change of the epithelial surface, potentially due to a host immune response. As an intermittent colonizer, this bacterium holds promise for addressing questions of community invasion in a simple yet relevant model system. Moreover, our results show that gut symbionts of bees engage in differential host interactions that are likely to affect gut homeostasis. Future studies should focus on how these different gut bacteria impact honeybee health. IMPORTANCE: As pollinators, honeybees are key species for agricultural and natural ecosystems. Their guts harbor simple communities composed of characteristic bacterial species. Because of these features, bees are ideal systems for studying fundamental aspects of gut microbiota-host interactions. However, little is known about how these bacteria interact with their host. Here, we show that a common member of the bee gut microbiota causes the formation of a scab-like structure on the gut epithelium of its host. This phenotype was first described in 1946, but since then it has not been much further characterized, despite being found in bee populations worldwide. The scab phenotype is reminiscent of melanization, a conserved innate immune response of insects. Our results show that high abundance of one member of the bee gut microbiota triggers this specific phenotype, suggesting that the gut microbiota composition can affect the immune status of this key pollinator species.