Association of dynamics of anellovirus loads with hospital-acquired pneumonia in brain-injured patients during the intensive care unit stay.

BACKGROUND: Critical illness induces immune disorders associated with an increased risk of hospital-acquired pneumonia (HAP) and acute respiratory distress syndrome (ARDS). Torque Teno Virus (TTV), from the Anelloviridae family, are proposed as a biomarker to measure the level of immunosuppression. Our objective was to describe the kinetics of TTV DNA loads and their association with critical-illness related complications. METHODS: We performed a longitudinal study in 115 brain-injured patients from a prospective cohort, collected endotracheal and blood samples at three time points (T1, T2, T3) during the two weeks post-admission in intensive care unit, and measured viral DNA loads using the TTV R-gene® kit (Biomerieux) and a pan-Anelloviridae in house qRT-PCR. RESULTS: TTV DNA was detected in the blood of 69, 71, and 64% of brain-injured patients at T1, T2 and T3 respectively. Time-associated variations of TTV and Anellovirus (AV) DNA loads were observed. Using a linear mixed-effects model, we found that HAP and ARDS were associated with lower blood AV DNA loads. CONCLUSION: Our results show that HAP or ARDS in critically ill patients are associated to changes in AV DNA loads, and should be evaluated further as a biomarker of immune disorders leading to these complications.

Outcome of twin pregnancies associated with glucose intolerance.

OBJECTIVES: There is little information about the impact of hyperglycaemia in twin pregnancies. The objective of our study was to evaluate the maternal, foetal and neonatal complications in patients with twin pregnancy and glucose intolerance defined by gestational diabetes mellitus and gestational mild hyperglycaemia. STUDY DESIGN: We performed a single-centre retrospective study. Screening for gestational diabetes was achieved by a two-step method. Patients were managed according to the French guidelines. After matching for age and body mass index, outcomes were compared in 177 patients with glucose intolerance and 509 controls. Macrosomia was defined as birth weight above the 90th percentile of gestational age adjusted for parity, foetal sex and maternal biometrics. RESULTS: Prevalence of glucose intolerance was 17.5% in our population. Complications of pregnancy and mode of delivery were similar between the two groups. Caesarean section was associated with age >35 years, vascular complications of pregnancy and non-cephalic presentation of the first twin. Rate of macrosomia was not different between the two groups. The only risk factor for macrosomia was a history of macrosomia in a previous pregnancy (odds ratio = 5.9, 95% confidence interval = 1.8-19.2). CONCLUSION: Twin pregnancies complicated by glucose intolerance were not associated with an increased risk of macrosomia or Caesarean section. Further studies should assess the value of screening gestational diabetes mellitus in twin pregnancies.

Non-radiographic axial spondyloarthritis: what is it?

The classification criteria recently developed by the Assessment of Spondyloarthritis International Society (ASAS) highlighted a specific entity: non radiographic axial spondyloarthritis (nr-axSpA). Although more and more widely used in the literature as well as clinical trials, limits and profile of this entity is still under known or debated. Some studies have already compared those forms to classical AS, even in recent forms. They showed that, apart from the difference in the ossification process, and the greater degree and frequency of systemic and MRI inflammation in AS, those 2 forms of SpA share the same genetic background, clinical patterns, and burden of disease. TNF antagonists seemed as effective in controlling symptoms in patients with nr-axSpA. Concerning the long-term outcome of nr-ax-SpA, only long-term ongoing cohorts of patients with recent nr-axSpA will be able to determine what proportion of patients have persistent non-radiographic disease and what proportion do progress to AS.

[Audits of good practice: implantable medical devices are also concerned]. / Audits de bon usage : les dispositifs médicaux implantables sont aussi concernés.

INTRODUCTION: Within the framework of a good practices agreement, French hospitals must perform clinical audits of costly molecules and implantable medical devices (IMD) to justify their medical costs. We present two examples of clinical audits of IMD: hip arthroplasties and cardiac stimulators. PATIENTS AND METHODS: The clinical audits were managed by the pharmacy with the support of the medical teams. Retrospective evaluation of patient files was performed by a pharmaceutical team using evaluation grids developed from official references from the French National Authority for Health and French National Health Insurance. RESULTS: The audit of hip arthroplasty procedures, including a retrospective and prospective study, showed that 95.4% and 96.9% of the surgical procedures followed guidelines. The audit of cardiac stimulators showed 100% agreement with guidelines. The audit of traceability showed that 97% of the files were complete. DISCUSSION: These audits show that the cost increases of the IMD are linked to following guidelines. It is important for these audits of pertinent use to be performed by both physicians and pharmacists. CONCLUSION: There is very little information in the literature or from authorities to help implement these audits. It would be interesting to propose common prospective and retrospective methods to evaluate the pertinent use of IMD.

Prevalence and clinical features of celiac disease in 950 children with type 1 diabetes in France.

UNLABELLED: The prevalence of celiac disease is higher in children with type 1 diabetes mellitus (DM) than in the general pediatric population, but may vary widely across countries. Sensitive and specific antibody tests are available for detecting celiac disease. AIMS: To evaluate the prevalence in France of histologically documented celiac disease in a vast cohort of children with type 1 DM, and to describe the features of celiac disease and treatment response. METHODS: Retrospective cohort study of 950 children with type 1 diabetes seen between 1994 and 2001. Antibodies to gliadin, reticulin, endomysium and transglutaminase were looked for one to seven times in each patient. RESULTS: Fifteen patients (1.6%) had biopsy-confirmed celiac disease. Symptoms led to the diagnosis in six patients (mean age, 7 years) and screening tests in nine patients (mean age, 11 years). Anti-endomysium antibodies were consistently positive. Tests for HLA-DQB1 0201 and/or 0302 were positive. Anti-endomysium antibody seroconversion was seen in two patients, 2 and 6 years, respectively, after the diagnosis of diabetes. In another patient, the biopsy became abnormal 6 years after the first positive anti-endomysium antibody test (latent form). After a mean of 3 years on a gluten-free diet, significant increases were noted in body weight (P=0.04) and insulin dose (P=0.05); clinical symptoms completely resolved in five of the six symptomatic patients. CONCLUSIONS: The prevalence of celiac disease is higher in children with type 1 DM than in the general pediatric population. Serological screening is useful for diagnosing asymptomatic celiac disease, detecting seroconversion and monitoring latent forms of disease.

Neurological toxicity of acyclovir: report of a case in a six-month-old liver transplant recipient.

Acyclovir-induced neurotoxicity is a rare adverse effect, found especially in adults with pre-existing renal failure. We report a case of neurotoxicity of acyclovir in a six-month-old liver transplant recipient. Case report and review of literature are discussed.

Cardiac resynchronisation therapy in chronic atrial fibrillation: impact on left atrial size and reversal to sinus rhythm.

OBJECTIVE: To evaluate the impact of long term cardiac resynchronisation therapy (CRT) on left atrial and left ventricular (LV) reverse remodelling and reversal to sinus rhythm (SR) in patients with heart failure with atrial fibrillation (AF). PATIENTS: 74 consecutive patients (age 68 (8) years; 67 men) with advanced heart failure and AF (20 persistent and 54 permanent) were implanted with a CRT device. MAIN OUTCOME MEASURES: Patients were evaluated clinically (New York Heart Association (NYHA) class, quality of life, six minute walk test) and echocardiographically (LV ejection fraction, LV diameters, and left atrial diameters) before and after six months of CRT. Additionally, restoration of SR was evaluated after six months of CRT. RESULTS: NYHA class, quality of life score, six minute walk test, and LV ejection fraction had improved significantly after six months of CRT. In addition, left atrial and LV end diastolic and end systolic diameters had decreased from 59 (9) to 55 (9) mm, from 72 (10) to 67 (10) mm, and from 61 (11) to 56 (11) mm, respectively (all p < 0.01). During implantation 18 of 20 (90%) patients with persistent AF were cardioverted to SR. At follow up 13 of 18 (72%) patients had returned to AF and none had spontaneously reverted to SR; thus, only 5 of 74 (7%) were in SR. CONCLUSION: Six months of CRT resulted in significant clinical benefit with significant left atrial and LV reverse remodelling. Despite these beneficial effects, 93% of patients had not reverted to SR.

Statistics of Fourier modes of velocity and vorticity in turbulent flows: intermittency and long-range correlations.

We perform a statistical analysis of experimental fully developed turbulence longitudinal velocity data in the Fourier space. We address the controversial issue of statistical intermittency of spatial Fourier modes by acting on the finite spectral resolution. We derive a link between velocity structure functions and the flatness of Fourier modes thanks to cascade models. Similar statistical behaviors are recovered in the analysis of spatial Fourier modes of vorticity obtained in an acoustic scattering experiment. We conclude that vorticity is long-range correlated and found more intermittent than longitudinal velocity.

Efficient numerical methods for nonlinear-facilitated transport and exchange in a blood-tissue exchange unit.

The analysis of experimental data obtained by the multiple-indicator method requires complex mathematical models for which capillary blood-tissue exchange (BTEX) units are the building blocks. This study presents a new, nonlinear, two-region, axially distributed, single capillary, BTEX model. A facilitated transporter model is used to describe mass transfer between plasma and intracellular spaces. To provide fast and accurate solutions, numerical techniques suited to nonlinear convection-dominated problems are implemented. These techniques are the random choice method, an explicit Euler-Lagrange scheme, and the MacCormack method with and without flux correction. The accuracy of the numerical techniques is demonstrated, and their efficiencies are compared. The random choice, Euler-Lagrange and plain MacCormack method are the best numerical techniques for BTEX modeling. However, the random choice and Euler-Lagrange methods are preferred over the MacCormack method because they allow for the derivation of a heuristic criterion that makes the numerical methods stable without degrading their efficiency. Numerical solutions are also used to illustrate some nonlinear behaviors of the model and to show how the new BTEX model can be used to estimate parameters from experimental data.

Modulation of type A K+ current in Drosophila larval muscle by internal Ca2+; effects of the overexpression of frequenin.

The calcium-dependent modulation of type A K+ current (IA) has been investigated using a two-electrode voltage clamp on larval muscle cells of Drosophila. It was found that the amplitude of IA increases when [Ca2+]o is changed from 0.2 mM to 2 mM. The increase in IA amplitude is not due to overlap with the Ca(2+)-dependent fast K+ current, ICF, since it is observed also in slo1 mutants, which are deficient for this current. This effect is not due to Ca(2+)-dependent shifts in the steady-state activation/inactivation kinetics. The phenomenon is probably due to elevations in internal calcium since it is abolished by Ca2+ channel blockers and promoted by caffeine (5 mM) if added in the absence of external calcium. This calcium effect was dose-dependent since it was not observed in the presence caffeine plus 2 mM calcium in the bath nor for values of [Ca2+]o above 4 mM. The Ca(2+)-dependent modulation of IA is absent in V7, a mutation that causes overexpression of frequenin, a recoverin-like Ca(2+)-binding protein which stimulates guanylyl cyclase [31]. One possible explanation for the loss of IA modulation in the V7 mutation is that the excess of frequenin alters intracellular cGMP-dependent metabolic pathways responsible for the internal calcium homeostasis.

Pressor responses of rat isolated tail arteries to contractile stimulation after methylene blue treatment: effect of adventitial versus intimal entry.

To test the hypothesis that drug entry site (intimal vs. adventitial surface) may be an important determinant of methylene blue (MB) action on vascular reactivity to contractile stimulation, we used preparations of rat isolated tail arteries perfused at constant flow (2 ml/min). Perfusion pressure changes reflecting vascular responses to cumulative addition of phenylephrine (PE) or dopamine (DOP) were recorded before and after MB addition (2.5 x 10(-4) M final concentration) at the intimal or adventitial surface. Intraluminal addition of MB resulted in strong potentiation of subsequent responses to intimal contractile stimulation using PE or DOP. This effect was not observed when MB was added at the adventitial surface. These results suggest that drug entry site is an important determinant of MB action on vascular responsiveness in the rat tail artery and might account for the divergent results in the literature on the vascular action of MB.

Nerve terminal excitability and neuromuscular transmission in T(X;Y)V7 and Shaker mutants of Drosophila melanogaster.

We investigated the neuromuscular transmission in relation with genetic neuronal excitability changes in mutants T(X;Y)V7 and ShK,S133 of Drosophila. These mutations affect two different genes belonging to the Shaker gene complex which encode different yet functionally related proteins. Experiments were performed on neuromuscular junctions from Drosophila larvae by recording pre- and postsynaptic membrane currents using external electrodes. It was found that the neuromuscular electrophysiological phenotype of T(X;Y)V7 is caused by presynaptic membrane hyperexcitability probably in relation with a Ca2(+)-dependent down regulation of voltage dependent K channels. By contrast, the ShKS133 phenotype can be explained solely by action potential widening due to the absence of type-A K channels.

Thermal changes observed before and after J.-L. Etienne's journey to the North Pole. Is central nervous system temperature preserved in hypothermia?

The thermoregulatory responses of a French doctor, Jean-Louis Etienne, were examined in a standard cold test before and after his journey to the North Pole, to investigate whether general and/or local cold adaptation had occurred. The two tests were carried out in a climatic chamber for 2 h at rest (dry bulb temperature, 1 degree C; relative humidity, 40%; wind speed, 0.8 m.s-1). After his journey, Etienne showed a general hypothermic-hypometabolic adaptation, i.e. a decrease in rectal temperature (Tre) and metabolic heat production (M), and an increased local skin temperature of the extremities. Between the two tests, a change occurred in the relationship between tympanic temperature (Tty) and M. During the post-journey cold test, Tty [as representative of the central nervous system (CNS) temperature] increased while the decrease in Tre was accelerated, probably due to a redistribution of blood volume towards the CNS. Such a mechanism would protect the central core with special reference to the CNS.

Laminar distribution of neocortical senile plaques in senile dementia of the Alzheimer type.

A prospective longitudinal study was undertaken in a geriatric hospital on women over 75 years of age, clinically diagnosed as either intellectually normal or having senile dementia of the Alzheimer type (SDAT) of varying degrees of severity. Mental impairment was assessed prospectively. Fifteen brains from this population were studied to evaluate quantitatively the distribution of senile plaques (SP) in relation to cortical lamination. SP density in four neocortical areas (first temporal gyrus; supramarginal gyrus calcarine area; precentral gyrus) was significantly correlated with the degree of mental impairment. SP distribution in the cortical layers was evaluated by an indirect method and appeared to be fairly constant from one case to another. Significantly higher SP densities were observed in layers II and III of the temporal and occipital samples, while minimal values were noted in layer I. Lower densities of SP were found in layers V and IV of the occipital and temporal lobes. These data suggest a selective vulnerability of some areas of cortical projections in SDAT.