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Objectives. – Evaluation of the thin-layer technique we have developed.Patients and method. – An adequate shaking, a calibration and a centrifugation in liquid phase are the essential and specific stages of this technique. More than 160 000 samples were prepared according to this methodology in eight years.Results. – The immediate profit of the technique is the increase of the number of interpretable samples: 99.9%.First years: net increase of the lesion detection rate in comparison with conventional cervical smear. 1.7 versus 0.9% for the low-grade lesions; 1.0 versus 0.4% for the high-grade lesions. After three years the detection rate of low-grade lesions remained high: 1.7% while the ASCUS/AGUS and high-grade lesions decreased to reach, respectively, 1.1 and 0.4%.Discussion and conclusion. – The quality of the thin-layer preparation, the best approach of the endocervical pathology, and the possibility to identify rare events, allowed us at first to increase detection of lesions. After three years of “picking up” of lesions forgotten by conventional cervical smear, the rate of high-grade lesions stabilised in 0.4%. Thus, it is advisable to take into account the notion of time as for the estimate of the lesion rate when using thin-layer technique compared with that of conventional cervical smear. [Copyright &y& Elsevier]

Fish fecundity scales hyperallometrically with body mass, meaning larger females produce disproportionately more eggs than smaller ones. We explore this relationship beyond the species-level to estimate the "reproductive potential" of 1633 coral reef sites distributed globally. We find that, at the site-level, reproductive potential scales hyperallometrically with assemblage biomass, but with a smaller median exponent than at the species-level. Across all families, modelled reproductive potential is greater in fully protected sites versus fished sites. This difference is most pronounced for the important fisheries family, Serranidae. When comparing a scenario where 30% of sites are randomly fully protected to a current protection scenario, we estimate an increase in the reproductive potential of all families, and particularly for Serranidae. Such results point to the possible ecological benefits of the 30 × 30 global conservation target and showcase management options to promote the sustainability of population replenishment., (© 2024. The Author(s).)

Trachoma, caused by ocular Chlamydia trachomatis infection, is targeted for global elimination as a public health problem by 2030. To provide evidence for use of antibodies to monitor C. trachomatis transmission, we collated IgG responses to Pgp3 antigen, PCR positivity, and clinical observations from 19,811 children aged 1-9 years in 14 populations. We demonstrate that age-seroprevalence curves consistently shift along a gradient of transmission intensity: rising steeply in populations with high levels of infection and active trachoma and becoming flat in populations near elimination. Seroprevalence (range: 0-54%) and seroconversion rates (range: 0-15 per 100 person-years) correlate with PCR prevalence (r: 0.87, 95% CI: 0.57, 0.97). A seroprevalence threshold of 13.5% (seroconversion rate 2.75 per 100 person-years) identifies clusters with any PCR-identified infection at high sensitivity ( >90%) and moderate specificity (69-75%). Antibody responses in young children provide a robust, generalizable approach to monitor population progress toward and beyond trachoma elimination., (© 2023. The Author(s).)

Background: Global elimination of trachoma as a public health problem was targeted for 2020. We reviewed progress towards the elimination of active trachoma by country and geographical group., Methods: In this retrospective analysis of national survey and implementation data, all countries ever known to be endemic for trachoma that had either implemented at least one trachoma impact survey shown in the publicly available Trachoma Atlas, or are in Africa were invited to participate in this study. Scale-up was described according to the number of known endemic implementation units and mass drug administration implementation over time. The prevalence of active trachoma-follicular among children aged 1-9 years (TF 1-9 ) from baseline, impact, and surveillance surveys was categorised and used to show programme progress towards reaching the elimination threshold (TF 1-9 <5%) using dot maps, spaghetti plots, and boxplots., Findings: We included data until Nov 10, 2021, for 38 countries, representing 2097 ever-endemic implementation units. Of these, 1923 (91·7%) have had mass drug administration. Of 1731 implementation units with a trachoma impact survey, the prevalence of TF 1-9 had reduced by at least 50% in 1465 (84·6%) implementation units and 1182 (56·4%) of 2097 ever-endemic implementation units had reached the elimination threshold. 2 years after reaching a TF 1-9 prevalence below 5%, most implementation units sustained this target; however, 58 (56·3%) of 103 implementation units in Ethiopia showed recrudescence., Interpretation: Global elimination of trachoma as a public health problem by 2020 was not possible, but this finding masks the great progress achieved. Implementation units in high baseline categories and recrudescent TF 1-9 might prolong the attainment of elimination of active trachoma. Elimination is delayed but, with an understanding of the patterns and timelines to reaching elimination targets and a commitment toward meeting future targets, global elimination can still be achieved by 2030., Funding: None., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Trachoma is the leading infectious cause of blindness. In 2016, Morocco was validated by WHO as having eliminated trachoma as a public health problem. We evaluated two previously endemic districts in Morocco for trachomatous inflammation-follicular (TF), trachomatous trichiasis (TT), and antibodies against Chlamydia trachomatis, the causative agent of trachoma. Community-based cross-sectional surveys in the districts of Boumalene Dades and Agdez included 4,445 participants for whom both questionnaire and serology data were available; 58% were aged 1-9 years. Participants had eyes examined for TF and blood collected for analysis of antibodies to the C. trachomatis antigen Pgp3 by both a multiplex bead assay (MBA) and lateral flow assay (LFA). Seroconversion rates (SCR) per 100 people per year were used to estimate changes in the force of infection using Bayesian serocatalytic models. In Agdez, TF prevalence in 1-9-year-olds was 0.3%, seroprevalence ranged from 9.4% to 11.4%, and SCR estimates ranged from 2.4 to 3.0. In Boumalene Dades, TF prevalence in 1-9-year-olds was 0.07%, and modeling data from the different assays indicated a decrease in transmission between 20 and 24 years ago. The TF data support an absence of active trachoma in the two districts examined. However, seroprevalence and SCR in younger people were higher in Agdez than Boumalene Dades, showing that there can be differences in serology metrics in areas with similar TF prevalence. Data will be included in multicountry analyses to better understand potential thresholds for serological surveillance in trachoma.

Marine reserves are known to impact the biomass, biodiversity, and functions of coral reef fish communities, but the effect of protective management on fish traits is less explored. We used a time-series modelling approach to simultaneously evaluate the abundance, biomass, and traits of eight fish families over a chronosequence spanning 44 years of protection. We constructed a multivariate functional space based on six traits known to respond to management or disturbance and affect ecosystem processes: size, diet, position in the water column, gregariousness, reef association, and length at maturity. We show that biomass increased with a log-linear trend over the time-series, but abundance only increased after 20 years of closure, and with more variation among reserves. This difference is attributed to recovery rates being dependent on body sizes. Abundance-weighted traits and the associated multivariate space of the community change is driven by increased proportions over time of the trait categories: 7-15 cm body size; planktivorous; species low in the water column; medium-large schools; and species with high levels of reef association. These findings suggest that the trait compositions emerging after the cessation of fishing are novel and dynamic., (© 2021. The Author(s).)

Trachoma is a blinding disease caused by repeated conjunctival infection with different Chlamydia trachomatis (Ct) genovars. Ct B genovars have been associated with more severe trachoma symptoms. Here, we investigated associations between Ct genovars and bacterial loads in ocular samples from two distinct geographical locations in Africa, which are currently unclear. We tested ocular swabs from 77 Moroccan children (28 with trachomatous inflammation-follicular (TF) and 49 healthy controls), and 96 Sudanese children (54 with TF and 42 healthy controls) with a Ct-specific real-time polymerase chain reaction (PCR) assay. To estimate bacterial loads, Ct-positive samples were further processed by multiplex real-time qPCR to amplify the chromosomal outer membrane complex B and plasmid open reading frame 2 of Ct. Genotyping was performed by PCR-based amplification of the outer membrane protein A gene (~1120 base pairs) of Ct and Sanger sequencing. Ct-positivities among the Moroccan and Sudanese patient groups were 60·7% and 31·5%, respectively. Significantly more Sudanese patients than Moroccan patients were genovar A-positive. In contrast, B genovars were significantly more prevalent in Moroccan patients than in Sudanese patients. Significantly higher Ct loads were found in samples positive for B genovars (598596) than A genovar (51005). Geographical differences contributed to the distributions of different ocular Ct genovars. B genovars may induce a higher bacterial load than A genovars in trachoma patients. Our findings emphasize the importance of conducting broader studies to elucidate if the noted difference in multiplication abilities are genovar and/or endemicity level dependent., Competing Interests: The authors have declared that no competing interests exist.

Since the 1950s, the Kingdom of Morocco has been and remains one of the pioneers in the fight against trachoma, a disease that has completely disappeared in the majority of its national territory, but some endemic pockets have persisted and pose a health risk, particularly for children and women. Morocco finds itself today, thanks to years of joint efforts, at the forefront of the world stage of the fight against trachoma. The country has demonstrated through its experience the effectiveness and relevance of the "SAFE" strategy - an extensive programme designed to tackle trachoma and its complications. The strategy is complex in its implementation and requires the synergy of a set of actors dedicated to specific activities, whether medico-surgical management activities aimed at setting up a physical project for local development, or information and awareness-raising activities. The key to the long-term success of eliminating blinding trachoma was not only to link distribution of drugs to the entire project area for several years to reduce substantially the reservoir of human- to-human transmission, but also to ensure permanence. In addition, services that provide quality palpebral surgery and especially repeat treatment campaigns with antibiotics, as well as health education campaigns and the promotion of personal and collective hygiene have generated sustainable changes in the living environment of receiving populations., (Copyright © World Health Organization (WHO) 2020. Open Access. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license (https://creativecommons.org/licenses/by-nc-sa/3.0/igo).)

An annotated checklist of the 271 strict-endemic taxa (235 species) and 387 near-endemic taxa (337 species) of vascular plants in Mozambique is provided. Together, these taxa constitute c. 9.3% of the total currently known flora of Mozambique and include five strict-endemic genera ( Baptorhachis , Emicocarpus , Gyrodoma , Icuria and Micklethwaitia ) and two near-endemic genera ( Triceratella and Oligophyton ). The mean year of first publication of these taxa is 1959, with a marked increase in description noted following the onset of the two major regional floristic programmes, the "Flora of Tropical East Africa" and "Flora Zambesiaca", and an associated increase in botanical collecting effort. New taxa from Mozambique continue to be described at a significant rate, with 20 novelties described in 2018. Important plant families for endemic and near-endemic taxa include Fabaceae, Rubiaceae and Euphorbiaceae s.s. There is a high congruence between species-rich plant families and endemism with the notable exceptions of the Poaceae, which is the second-most species rich plant family, but outside of the top ten families in terms of endemism, and the Euphorbiaceae, which is the seventh-most species rich plant family, but third in terms of endemism. A wide range of life-forms are represented in the endemic and near-endemic flora, with 49% being herbaceous or having herbaceous forms and 55% being woody or having woody forms. Manica Province is by far the richest locality for near-endemic taxa, highlighting the importance of the cross-border Chimanimani-Nyanga (Manica) Highlands shared with Zimbabwe. A total of 69% of taxa can be assigned to one of four cross-border Centres of Endemism: the Rovuma Centre, the Maputaland Centre sensu lato, and the two mountain blocks, Chimanimani-Nyanga and Mulanje-Namuli-Ribaue. Approximately 50% of taxa have been assessed for their extinction risk and, of these, just over half are globally threatened (57% for strict-endemics), with a further 10% (17% for strict-endemics) currently considered to be Data Deficient, highlighting the urgent need for targeted conservation of Mozambique's unique flora. This dataset will be a key resource for ongoing efforts to identify "Important Plant Areas - IPAs" in Mozambique, and to promote the conservation and sustainable management of these critical sites and species, thus enabling Mozambique to meet its commitments under the Convention on Biological Diversity (CBD)., (Iain Darbyshire, Jonathan Timberlake, Jo Osborne, Saba Rokni, Hermenegildo Matimele, Clayton Langa, Castigo Datizua, Camila de Sousa, Tereza Alves, Alice Massingue, Jeneen Hadj-Hammou, Sonia Dhanda, Toral Shah, Bart Wursten.)

Background: Trichiasis is present when one or more eyelashes touches the eye. Uncorrected, it can cause blindness. Accurate estimates of numbers affected, and their geographical distribution, help guide resource allocation., Methods: We obtained district-level trichiasis prevalence estimates in adults for 44 endemic and previously-endemic countries. We used (1) the most recent data for a district, if more than one estimate was available; (2) age- and sex-standardized corrections of historic estimates, where raw data were available; (3) historic estimates adjusted using a mean adjustment factor for districts where raw data were unavailable; and (4) expert assessment of available data for districts for which no prevalence estimates were available., Findings: Internally age- and sex-standardized data represented 1,355 districts and contributed 662 thousand cases (95% confidence interval [CI] 324 thousand-1.1 million) to the global total. Age- and sex-standardized district-level prevalence estimates differed from raw estimates by a mean factor of 0.45 (range 0.03-2.28). Previously non- stratified estimates for 398 districts, adjusted by ×0.45, contributed a further 411 thousand cases (95% CI 283-557 thousand). Eight countries retained previous estimates, contributing 848 thousand cases (95% CI 225 thousand-1.7 million). New expert assessments in 14 countries contributed 862 thousand cases (95% CI 228 thousand-1.7 million). The global trichiasis burden in 2016 was 2.8 million cases (95% CI 1.1-5.2 million)., Interpretation: The 2016 estimate is lower than previous estimates, probably due to more and better data; scale-up of trichiasis management services; and reductions in incidence due to lower active trachoma prevalence., Competing Interests: The authors have declared that no competing interests exist.

While the role of citizen science in engaging the public and providing large-scale datasets has been demonstrated, the nature of and potential for this science to supplement environmental monitoring efforts by government agencies has not yet been fully explored. To this end, the present study investigates the complementarity of a citizen science programme to agency monitoring of water quality. The Environment Agency (EA) is the governmental public body responsible for, among other duties, managing and monitoring water quality and water resources in England. FreshWater Watch (FWW) is a global citizen science project that supports community monitoring of freshwater quality. FWW and EA data were assessed for their spatio-temporal complementarity by comparing the geographical and seasonal coverage of nitrate (N-NO3) sampling across the River Thames catchment by the respective campaigns between spring 2013 and winter 2015. The analysis reveals that FWW citizen science-collected data complements EA data by filling in both gaps in the spatial and temporal coverage as well as gaps in waterbody type and size. In addition, partial spatio-temporal overlap in sampling efforts by the two actors is discovered, but EA sampling is found to be more consistent than FWW sampling. Statistical analyses indicate that regardless of broader geographical overlap in sampling effort, FWW sampling sites are associated with a lower stream order and water bodies of smaller surface areas than EA sampling sites. FWW also samples more still-water body sites than the EA. As a possible result of such differences in sampling tendencies, nitrate concentrations, a measure of water quality, are lower for FWW sites than EA sites. These findings strongly indicate that citizen science has clear potential to complement agency monitoring efforts by generating information on freshwater ecosystems that would otherwise be under reported.

Purpose: To assess the reliability of percutaneous breast biopsies in diagnosing and managing non malignant papillary lesions and determine if subsequent excision must be systematic. MATERIALS AND METHODS. Retrospective review of 2233 breast biopsies over a 43 months period (September 2001 to March 2005): sonographically guided core biopsies (n = 836), ultrasound (n = 346) or stereotactic (n:1051) guided vacuum biopsies. 86 non malignant papillary tumors were diagnosed (core biopsy:28, US:38 and stereotactic guided vacuum biopsy:20). A larger sample was systematic after core biopsy: lumpectomy (n = 19) or vacuum biopsy (n = 9). Surgical excision followed vacuum biopsy (n = 18) in case of atypia or sampling excision. Alternatively, yearly follow-up was advised (n = 40). Correlation with surgical findings (n = 37) or mammographic follow-up (n = 49) is presented. The influence of various factors on the risk of underestimation was analysed., Results: Surgical resection revealed an underestimation of 5/37 (13.5%): 4/19 with core- and 1/18 with vacuum-assisted biopsy corresponding to 4 low grade ductal carcinoma in situ and a microinvasive ductal carcinoma in situ. It was higher for core biopsies and related to age and size: higher when women<50 years and when radiological image>1 cm. The influence of the other factors was not significant. Of the 9 non operated papillomas after core biopsy, vacuum biopsy revealed an additional underestimation (low-grade ductal carcinoma in situ). Of the 49 papillary lesions that were not surgically biopsied, 40 were monitored at 2-42 months (average: 19 months). No carcinoma was detected during this follow-up., Conclusion: Percutaneous biopsy is an accurate technique in managing papillary tumors. A larger histologic specimen is necessary after core biopsy. Vacuum biopsy is an attractive alternative to surgery for smaller papillomas (<1 cm), but in spite of nonsignificant results we advise subsequent excision in case of multiple papillomas, atypia or residual tumor.

Purpose: To evaluate the use of US-guided vacuum biopsy for diagnosis and treatment of probably benign breast masses., Materials and Method: Retrospective review of 382 US guided vacuum biopsies over a 44 months period (september 2001 to may 2005) with the 11-g handheld mammotome. A total of 308 benign tumors, 59 borderline lesions and 15 carcinomas were diagnosed. The average number of specimens is 13.1 (3-37). Surgical resection has been systematic for carcinomas and selective for papillomas. Surgical correlation (n:35) or mammographic follow-up (n:347) are presented., Results: Complete removal occurred in 371/382 (97.1%) immediately after biopsy and 337/382 (88.2%) after one month: 138/142 (93.7%) for fibroadenomas and 52/53 (98.1%) papillomas less than 15 mm. Open surgical biopsy was carried out for 35 patients on the basis of incomplete removal (3 cases) or histologic findings (8 invasive carcinomas, 7 ductal carcinoma in situ, 3 atypical ductal hyperplasia, 1 fibrocystic changes with atypia and 11 papillomas). No lesion was under-diagnosed and the rate of avoided surgery was 94.5%. Of the 347 lesions that were not surgically biopsied (42 borderline lesions and 305 benign lesions), 337 were monitored at 1-43 months (average: 20 months, > or =24 months: 57 patients). Ten underwent additional biopsy but no missed cancer was detected. Patients tolerance was good or very good in 83%, and the complication rate was 1.3%., Conclusion: US-guided vacuum biopsy is an accurate and well tolerated technique. It is an alternative to surgery for masses less than 15 mm including fibroadenomas and papillomas or in patients with imaging-histologic discordance at core biopsy.

Purpose: To assess the reliability of vacuum-assisted biopsy in diagnosing and managing atypical ductal hyperplasia and ductal carcinoma in situ of the breast., Materials and Method: Retrospective review of 2130 stereotactic large-core biopsies in 1638 patients over a 40 month period (January 2000 to May 2003) using the mammotome 11-gauge and a dedicated Fischer table. A total of 135 cases of atypical ductal hyperplasia and 322 cases of ductal carcinoma in situ were diagnosed. The average number of cores was 18 (5-64). Surgical resection was systematic for carcinomas and selective for atypical ductal hyperplasia. Correlation with surgical findings (n:356) or mammographic follow-up (n:98) is presented. The influence of various factors on the risk of underestimation was analyzed., Results: Resection revealed an underestimation of 10/37 (27%) for atypical ductal hyperplasia. It was lower (9%) when the radiological lesion had completely disappeared. Underestimation of ductal carcinoma in situ was 12/319 (3.8%). It was higher for masses, high-grade lesions or with micro-infiltration, or in the case where the peripheral edge was affected. Of the 98 atypical ductal hyperplasia that were not surgically biopsied, 81 were monitored at 9-42 months (average: 29 months). Sixteen underwent repeat biopsy: two infiltrating lobular carcinomas were detected in the same area., Conclusion: Underestimation of atypical ductal hyperplasia was high, justifying systematic surgical resection. Underestimation of ductal carcinoma in situ and its practical consequences are not significant with the extension of sentinel lymphadenectomy to the wide high-grade lesions or with micro-infiltration.

Both flow cytometry (FCM) and image cytometry (ICM) were used to assess the DNA content of 1864 lesions (benign and malignant tumors, dysplasias, dystrophies and normal tissue). In total there were 1274 cases of bladder washings and 590 fresh solid tumor specimens. Of the total number of specimens, 1737 (93.2%) were satisfactorily assessed by ICM and 1424 (76.4%) by FCM. In only 100 (5.4%) cases was the DNA content unable to be assessed by either method. When bladder washings were excluded, 99.5% of samples could be evaluated by one method or the other. Concomitant determinations with both technologies were made in 1397 cases. When comparing all evaluable cases, concordance between the ploidy measurements of FCM and ICM was 92.8% (1297 concordant cases out of 1397). When bladder washings were excluded and only solid tumors considered, the concordance was 96.1% (545 concordant cases out of 567). From the experience of applying ICM and FCM to the 1864 lesions the technical limitations of each method became evident, specifically the problems of doubtful DNA diploidy and doubtful DNA aneuploidy. When there were 'doubtful' ploidy findings, the cause was generally found to be morphologic alterations of the nuclei or differences in staining procedures employed, and often the complementary use of both FCM and ICM provided ploidy clarification in questionable cases.

Seven patients presenting with recurrent diffuse, non-infiltrating tumors of the bladder were treated for several years by repeated endo-urethral resection, because radical exeresis was not possible. Each operative specimen was subjected to examination of the ABH blood-group antigens, pneumo-14 precursor, and carcino-embryonic antigens. The authors emphasize the prognostic interest of such studies.

Acid phosphatase activity estimated cytochemically is markedly increased in myeloma plasma cells compared to that found in normal plasma cells, polyclonal plasma-cytoses and most interestingly in the non-myelomatous monoclonal dysglobulinaemias. In the differential diagnosis of this last group the test has a useful role.

The authors report two cases of urothelial inverse papilloma and review the 94 observations in the published literature. Some fundamental features of the condition are outlined: 1) DEFINITION: paramalpighian papillary tumor which spreads towards the chorium but does not invade it, and lies under the intact urothelium which is folded towards the lumen of the urinary tract, 2) Site: usually cervicotrigonal but may be urethral; 3) Evolution: usually benign but sometimes recurrent; 4) Histogenesis: abnormal proliferation of Von Brunn's islets. 5) Association: possible with bladder carcinomas.

The authors have studied 125 stage A bladder tumours with a follow-up period of at least 5 years. The ABH cell surface antigens were collected by a double-layer immunofluorescence technique which has already been described. All the cross sections were read by the same pathologist who knew nothing about the clinical developments. The results were divided into 3 groups : (I) all the tumour cells had retained their surface antigens. (II) Only some cells had retained surface antigens. (III) All cells were negative. Study of the development of the 3 groups shows that : in group I, all the patients (11) are alive 5 years later, and only one has presented with a lesion evolving towards infiltration. In group II (32 patients), only 38 p. cent of the patients are still living 5 years later, and 65 p. cent developed towards muscular infiltration. In group III (77 patients), 27 p. cent are alive after 5 years and 80 p. cent have developed towards muscular infiltration. Homogeneous retention of the surface antigens would therefore seem to be a favourable factor in the prognosis, even in the case of a tumour which has already infiltrated the chorion. The significance of the loss of surface antigens is less clear-cut, but is on the whole adverse. The significance would, however, probably be enhanced by study of the mucosa distal from the lesion, and by marking the substances which determine the blood groups.