Predictive value of C-reactive protein levels for the early and later detection of postoperative complications after cytoreductive surgery and HIPEC.

Synopsis: C-reactive protein (CRP), white blood cells and procalcitonin (PCT) participate in the systemic response to inflammation and increase after postoperative infective complications. Postoperative complications after CRS and HIPEC could be predicted using the CRP cut-off value (169 mg/L at PODs 3-5 and 62 mg/L at PODs 7-10). Background: Postoperative elevation of C-reactive protein (CRP) can be used in order to predict the postoperative complications in many indications. Cytoreduction surgery (CRS) associated with hyperthermic intraperitoneal chemotherapy (HIPEC) is associated with high morbidity. Objectives: The aim of the study was to demonstrate the CRP predictive value for the occurrence of complications. Methods: All patients who had CRS and HIPEC, regardless of the origin of peritoneal metastasis, were included in this retrospective study. Postoperative complications and CRP and white blood cell (WBC) counts were recorded from postoperative day (POD) 1 through 10. Results: Among the 127 patients included, 58 (45.7%) had no complications (NCs), 53 (41.7%) had infective complications (ICs), and 16 (12.6%) had non-infective complications (NICs). The IC group had a higher CRP value than the NC group, which was statistically significant from POD7 to POD10 (41.1 versus 107.5 p = 0.023 and 77.8 versus 140 p = 0.047, respectively). A cut-off CRP value was 169 mg/L at PODs 3-5 and 62 mg/L at PODs 7-10. The area under the curve (AUC) at POD5 was 0.56 versus 0.76 at POD7, p=0.007. The sensibility, specificity, positive and negative predictive values of these cut-offs were 55%, 83%, 74% and 67%, respectively. Moreover, 17 patients (32%) with ICs had a CRP value higher than these cut-offs before the diagnosis was made by the medical team. Conclusion: This study suggested that postoperative complications could be predicted using the CRP cut-off value on PODs 3-5 (169 mg/l) and PODs 7-10 (62 mg/l) after CRS and HIPEC.

Managing chemotherapy extravasation in totally implantable central venous access: Use of subcutaneous wash-out technique.

BACKGROUND: Totally implanted venous access is widely used in chemotherapy administration. With over 1 million intravenous chemotherapy infusions given worldwide each day, complications are frequent. Accidental cases of extravasation in the presence of a catheter are rare yet very serious and may require discontinuation of chemotherapy. The aim of this study was to evaluate the feasibility and efficacy of the subcutaneous wash-out technique for chemotherapy extravasation treatment. METHODS: We retrospectively reviewed the medical charts of patients who had received chemotherapy and sustained extravasation in our hospital between October 2013 and October 2016. Subcutaneous wash-out treatments were carried out exclusively, without the application of antidotes or the use of specific antidotes. RESULTS: We documented seven cases of chemotherapy extravasation. Two cases were treated with antidotes and suffered necrosis in the following weeks. The five patients treated using subcutaneous wash-out had no necrosis and had a steady decrease in the inflammatory reaction of the cutaneous and subcutaneous soft tissues. For these five patients, chemotherapy was restarted within 1 month following extravasation. CONCLUSION: This study would argue for the feasibility and effectiveness of subcutaneous wash-out in the treatment of chemotherapy extravasations.

In-Flight Observation of Positron Annihilation by ILDAS.

We report a 511-keV photon flux enhancement that was observed inside a thundercloud and is a result of positron annihilation. The observation was made with the In-flight Lightning Damage Assessment System (ILDAS) on board of an A340 test aircraft. The aircraft was intentionally flying through a thunderstorm at 12-km altitude over Northern Australia in January 2016. Two gamma ray detectors showed a significant count rate increase synchronously with fast electromagnetic field variations registered by an on-board antenna. A sequence of 10 gamma ray enhancements was detected, each lasted for about 1 s. Their spectrum mainly consists of 511-keV photons and their Compton component. The local electric activity during the emission was identified as a series of static discharges of the aircraft. A full-scale Geant4 model of the aircraft was created to estimate the emission area. Monte Carlo simulation indicated that the positrons annihilated in direct vicinity or in the aircraft body.

In-Flight Observation of Gamma Ray Glows by ILDAS.

An Airbus A340 aircraft flew over Northern Australia with the In-Flight Lightning Damage Assessment System (ILDAS) installed onboard. A long-duration gamma ray emission was detected. The most intense emission was observed at 12 km altitude and lasted for 20 s. Its intensity was 20 times the background counts, and it was abruptly terminated by a distant lightning flash. In this work we reconstruct the aircraft path and event timeline. The glow-terminating flash triggered a discharge from the aircraft wing that was recorded by a video camera operating onboard. Another count rate increase was observed 6 min later and lasted for 30 s. The lightning activity as reported by ground networks in this region was analyzed. The measured spectra characteristics of the emission were estimated.

Pushing NMR sensitivity limits using dynamic nuclear polarization with closed-loop cryogenic helium sample spinning.

We report a strategy to push the limits of solid-state NMR sensitivity far beyond its current state-of-the-art. The approach relies on the use of dynamic nuclear polarization and demonstrates unprecedented DNP enhancement factors for experiments performed at sample temperatures much lower than 100 K, and can translate into 6 orders of magnitude of experimental time-savings. This leap-forward was made possible thanks to the employment of cryogenic helium as the gas to power magic angle sample spinning (MAS) for dynamic nuclear polarization (DNP) enhanced NMR experiments. These experimental conditions far exceed what is currently possible and allows currently reaching sample temperatures down to 30 K while conducting experiments with improved resolution (thanks to faster spinning frequencies, up to 25 kHz) and highly polarized nuclear spins. The impressive associated gains were used to hyperpolarize the surface of an industrial catalyst as well as to hyperpolarize organic nano-assemblies (self-assembling peptides in our case), for whom structures cannot be solved using diffraction techniques. Sustainable cryogenic helium sample spinning significantly enlarges the realm and possibilities of the MAS-DNP technique and is the route to transform NMR into a versatile but also sensitive atomic-level characterization tool.

Lymphoma in patients treated with anti-TNF: results of the 3-year prospective French RATIO registry.

OBJECTIVE: To describe cases of lymphoma associated with anti-TNF therapy, identify risk factors, estimate the incidence and compare the risks for different anti-TNF agents. METHODS: A national prospective registry was designed (Research Axed on Tolerance of bIOtherapies; RATIO) to collect all cases of lymphoma in French patients receiving anti-TNF therapy from 2004 to 2006, whatever the indication. A case-control analysis was conducted including two controls treated with anti-TNF per case and an incidence study of lymphoma with the French population was used as the reference. RESULTS: 38 cases of lymphoma, 31 non-Hodgkin's lymphoma (NHL) (26 B cell and five T cell), five Hodgkin's lymphoma (HL) and two Hodgkin's-like lymphoma were collected. Epstein-Barr virus was detected in both of two Hodgkin's-like lymphoma, three of five HL and one NHL. Patients receiving adalimumab or infliximab had a higher risk than those treated with etanercept: standardised incidence ratio (SIR) 4.1 (2.3-7.1) and 3.6 (2.3-5.6) versus 0.9 (0.4-1.8). The exposure to adalimumab or infliximab versus etanercept was an independent risk factor for lymphoma in the case-control study: odds ratio 4.7 (1.3-17.7) and 4.1 (1.4-12.5), respectively. The sex and age-adjusted incidence rate of lymphoma was 42.1 per 100 000 patient-years. The SIR was 2.4 (95% CI 1.7 to 3.2). CONCLUSION: The two to threefold increased risk of lymphoma in patients receiving anti-TNF therapy is similar to that expected for such patients with severe inflammatory diseases. Some lymphomas associated with immunosuppression may occur, and the risk of lymphoma is higher with monoclonal-antibody therapy than with soluble-receptor therapy.

Selective inhibition of Trypanosoma brucei GAPDH by 1,3-bisphospho-D-glyceric acid (1,3-diPG) analogues.

Various phosphono-phosphates and diphosphonates were synthesized as 1,3-diphosphoglycerate (1,3-diPG) analogues by using a beta-ketophosphonate, an alpha-fluoro,beta-ketophosphonate or a beta-ketophosphoramidate to mimic the unstable carboxyphosphate part of the natural substrate. The inhibitory effect of these analogues on glyceraldehyde-3-phosphate dehydrogenases (GAPDH) from Trypanosoma brucei (Tb) and rabbit muscle were measured with respect to both substrates, glyceraldehyde-3-phosphate (GAP) and 1,3-diPG. Interestingly, all 1,5-diphosphono,2-oxopentanes without substitution at the C-3 position selectively inhibit the Tb GAPDH with respect to 1,3-diPG and are without effect on Rm GAPDH. All 1-phospho,3-oxo,4-phosphonobutanes show themselves to be non-selective inhibitors either with regard to substrates or organisms, but they will be of a great interest as 1,3-diPG stable models for structural studies of co-crystals with GAPDHs.

Two-dimensional spin-exchange solid-state NMR studies of 13 C-enriched wood.

Two-dimensional high-resolution solid-state NMR has been used to study 13C-enriched wood. Wood is a complex material containing three major polymers: cellulose, hemicelluloses and lignin. The use of an enriched 13C-compound allows the observation of intra-molecular spin-diffusion driven by dipolar couplings. Correlations between spins at progressively longer distances have been obtained as the mixing time is increased, corresponding, for each of the separate polymer chains, to intra-unit and then to inter-unit interactions, and in the case of cellulose to inter-chain interactions. A straightforward qualitative analysis of the spin diffusion spectra is shown to yield the assignment of the carbon-13 spectrum. The cellulose resonances can all be sequentially assigned using the spin diffusion experiment. Using the experiments it is shown that, at least on a distance scale of several nanometres explored by the spin diffusion process, the three main components of wood occur in separate phases. Also, a question concerning the structure of the hemicellulose units is resolved by locating the O-acetyl group at the 2-position of the xylan chains.

Gamma irradiation of 2'-deoxyadenosine in oxygen-free aqueous solutions: identification and conformational features of formamidopyrimidine nucleoside derivatives.

The two major radiation-induced decomposition products of 2'-deoxyadenosine in oxygen-free aqueous solution have been isolated by reverse-phase HPLC. The 1H and 13C NMR features of the two modified nucleosides obtained in DMSO-d6 are indicative of a similar formamidopyrimidine structure for the base residue (the ring-opened form of a C-8 hydroxylated purine). Interestingly, the sugar moiety exhibits a pyranose configuration, the two nucleosides being a pair of alpha and beta anomers. One-bond and long-range 1H-13C 2D NMR experiments have allowed the complete assignment of the carbon atoms. Confirmation of the base structure was obtained by 1H-15N scalar-correlated 2D NMR experiments. Attempts were made to characterize the expected furanose form of the initially generated formamidopyrimidine derivative. In this respect, isomerization reaction of the sugar moiety of the latter compound takes place rapidly after gamma-irradiation as inferred from 1H NMR analysis. The conformational study of the sugar moiety of the two pyranose anomers was inferred from detailed 600.13 MHz 1H NMR analysis in D2O. The alpha anomer exhibits a predominant 1C4 conformation whereas the beta anomer adopts preferentially a 4C1 conformation. In addition, the dynamic study of the restricted rotation of the formamido bond has revealed a 1/5 ratio in favor of the s-cis rotamer for both nucleosides. The energy barrier at coalescence was determined to be delta G# = 75.5 kJ.mol-1 (Tc = 370 K).

[Lyme disease. Clinical, biological and developmental aspects. 29 cases in the Orléans region]. / Maladie de Lyme. Aspects cliniques, biologiques et évolutifs. 29 cas en région orléanaise.

The description of Lyme's disease (LD) in 3 stages (like syphilis), has now become classical. 29 cases of LD, between June 1981 and November 1986, have been recorded at the Hospital in Orleans. The first twelve patients that were clinically diagnosed before the serology was introduced in France, have been recalled in order to search for possible late forms and assay their antibody level of anti-Borrelia burgdorferi. The preponderance of neurological forms (22 cases) and the scarcity of peripheral and/or arthralgic arthritis (8 cases) are emphasized by this study. Radiculalgias (18 cases in 22 meningo-radiculitis), especially in the lower extremities (14 cases), required hospitalization in rheumatology in 21 instances. Spinal algias (16 cases), were only isolated, at the time of hospitalization, in one case. The intense and nocturnal nature of the radiculalgias and spinal algias was noted in 17 of 18 cases, and 16 of 16 cases, respectively. Two atrio-ventricular blocks required hospitalization in cardiology. The long-term follow-up (3 to 5 years) of 12 patients revealed only 2 cases of severe asthenia and swelling at the puncture site in one case. There were no entesopathies nor chronic arthritis. The search for anti-Borrelia burgdorferi antibodies in the serum, was positive 24 times in 28. In the 4 cases where the serology was negative, the samplings were taken after a follow-up of more than three years in 3 instances.(ABSTRACT TRUNCATED AT 250 WORDS)

[Geographic distribution of multiple myeloma in the Loiret region. 10-year retrospective epidemiological survey]. / Répartition géographique du myélome multiple dans le Loiret. Enquête épidémiologique rétrospective sur dix ans.

Suspecting the presence of a myeloma focus in a forest area of the Loiret department, we have undertaken a retrospective epidemiological survey on this disease. Three surveys were conducted, between 1972 and 1982: the first one among general practitioners; the second one was carried out from immuno-electrophoreses performed at the University Hospital in Orleans; the third survey was carried out from reports on the medical causes of deaths. The mean number of myelomas in the Loiret (0.029 p. cent) is comparable to the national mean (0.025 p. cent), with a sex ratio of 47.09 p. cent of men, also quite similar to the national sex ratio (46.7 p. cent). The different districts were classified according to the percentages observed in "neutral areas" (mean plus or minus a typical variation), "cold areas" (between one and two typical variations below the mean) and "hot areas" (between one and two typical variations above the mean). These results do not permit to ascertain the existence of a geographical focus of myelomas in Loiret but require a more in-depth study of "hot areas".

[Value of the measurement of intra-articular lactates. Contribution to the diagnosis of septic arthritis. Interpretation of 370 evaluations]. / Intérêt de la mesure des lactates intra-articulaires. Apport au diagnostic des arthrites septiques. Interprétation de 370 évaluations.

This retrospective study interprets the results of 370 evaluations of the lactate level of joint fluid. 5 groups were established: joint fluid from cases of mechanical (114) and microcrystalline (67) joint diseases, from inflammatory arthritis (149) and from septic arthritis (40). There was a significant difference between the lactate level in fluid from septic joints and that in the other groups. However, there was no significant difference between the rheumatoid joint fluid and the septic joint fluid. The increased level of intra-articular lactate can therefore be considered to be an argument in favour of the diagnosis of septic arthritis, but there is a certain rate of false positives (particularly in the case of rheumatoid arthritis) and false negatives, which require a very careful interpretation of the test. In cases of inflammatory arthritis with a cell count of more than 10,000 per mm3, there is a correlation between the white cell count and the lactate level. This relation is not observed in the case of septic arthritis. The authors did not detect any difference in the levels of intra-articular lactate according to the nature of the infecting organism. They studied 4 specimens of joint fluid from gonococcal arthritis and the levels of lactate were similar to those of other types of septic arthritis.

[Chronic arthritis in palmo-plantar pustulosis. Bacterid of Andrews]. / Arthrites chroniques des pustuloses palmo-plantaires. Bactérides d'Andrews.

Report of a 30 years old man story pustulosis palmaris et plantaris, spondylodiscitis L5-S1, right sterno-clavicular arthritis, right sacro-iliitis, and pubic symphysitis. Multiple bacteriologic investigations did not discover any infectious articular process. Histologic articular findings were inflammatory pattern, non steroid anti-inflammatory drugs corrected the arthritis. Anterior thoracic arthropathies are quasi-constant. Inflammatory spondylodiscitis are frequent, while sacro-iliac involvement is infrequent, this pattern distinguishing pustular arthro-osteitis from classic pelvispondylitis. Radiologic lesions are peculiar by predominance on one articular side at each site. Nosology is discussed. Slow infection by non virulent germs has been suspected , but seems improbable. This affection seems close seronegative spondylo-arthropathies and reactive arthritis, like acne conglobata arthritis for instance. Usual absence of HLA-B27 antigen must be noted.