Preprocedural Anxiety in Adults With Congenital Heart Disease: The PANIC Study.

Background: Preprocedural anxiety may have detrimental effects both cognitively and physiologically. Objectives: The objective of this study was to determine the association between state (situational) and trait (persistent in everyday life) anxiety and differences between the adult congenital heart disease (ACHD) and acquired heart disease populations. Methods: The State-Trait Anxiety Inventory and financial stress scale were administered to adults with acquired and CHD at 4 tertiary referral centers in the United States prior to cardiac catheterization. Student's t-test and least absolute shrinkage and selection operator regression analyses were used to assess differences in anxiety between groups and identify the optimal model of predictors of anxiety. Results: Of the 291 patients enrolled, those with CHD (n = 91) were younger (age 41.3 ± 16.3 years vs 64.7 ± 11.3 years, P < 0.001), underwent more cardiac surgeries (P < 0.001), and had higher levels of trait anxiety (t[171] = 2.62, P = 0.001, d = 0.33). There was no difference in state anxiety between groups (t[158.65] = 1.37, P = 0.17, d = 0.18). State anxiety was singularly associated with trait anxiety. Trait anxiety was negatively associated with age and positively associated with state anxiety and financial stress. Patients with CHD of great complexity were more trait (F[2,88] = 4.21, P = 0.02) and state anxious (F[2,87] = 4.59, P = 0.01), though with relatively small effect size. Conclusions: Trait anxiety levels are higher in the ACHD population and directly associated with state anxiety. Specialists caring for ACHD patients should not only recognize the frequency of trait anxiety but also high-risk subgroups that may benefit from psychological or social interventions to reduce preprocedural anxiety.

Inspiratory Airway Resistance in Respiratory Failure Due to COVID-19.

To measure inspiratory airflow resistance in patients with acute respiratory distress syndrome (ARDS) due to COVID-19. DESIGN: Observational cohort of a convenience sample. SETTING: Three community ICUs. SUBJECTS: Fifty-five mechanically ventilated patients with COVID-19. INTERVENTIONS: Measurements of ventilatory mechanics during volume control ventilation. MEASUREMENTS: Flow-time and pressure-time scalars were used to measure inspiratory airways resistance. RESULTS: The median inspiratory airflow resistance was 12 cm H2O/L/s (interquartile range, 10-16). Inspiratory resistance was not significantly different among patients with asthma or chronic obstructive pulmonary disease compared with those without a history of obstructive airways disease (median 12.5 vs 12 cm H2O/L/s, respectively; p = 0.66). Survival to 90 days among patients with inspiratory resistance above 12 cm H2O/L/s was 68% compared with 60% for patients below 12 cm H2O/L/s (p = 0.58). Inspiratory resistance did not correlate with C-reactive protein, ferritin, Pao2/Fio2 ratio, or static compliance. CONCLUSIONS: Inspiratory airflow resistance was normal to slightly elevated among mechanically ventilated patients with ARDS due to COVID-19. Airways resistance was independent of a history of obstructive airways disease, did not correlate with biomarkers of disease severity, and did not predict mortality.

[Direct diagnosis of Chlamydia trachomatis genital infections: culture or PCR?]. / Diagnostic direct des infections génitales à Chlamydia trachomatis: culture ou PCR?

PCR and culturing were compared for the routine diagnosis of Chlamydia trachomatis infections. Two laboratories experienced in both techniques participated in the study, which included 513 specimens. Both techniques were performed on each specimen; the portion of the specimen used for PCR was divided in two, and each half was sent to one of the two laboratories, where the tests were run in a blinded fashion. The PCR primers used by the two laboratories matched different parts of the bacterial genome. PCR inhibitors were looked for in all specimens. Overall, PCR was more sensitive than culturing; the difference was marked for sperm and endopelvic specimens and nonsignificant for urethral and cervical specimens. False-positive PCR results were few in number; there were no consistent false-positive results when each specimen was amplified twice. PCR inhibitors were rarely present in urethral and cervical specimens but were found in 7% of sperm and endopelvic specimens. PCR inhibitors should be looked for routinely during PCR testing of sperm or endopelvic specimens.

Rectus femoris sheath: a new localization of hip synovial cyst.

Iliopsoas bursitis is the classical manifestation of synovial cysts of the hip. We report the first observation of a new localization of these cysts: the sheath of rectus femoris muscle. The patient presented with a hip osteoarthritis and an important mass of the front of the thigh. Computed tomography was useful in establishing the diagnosis and hip arthrography confirmed the communication between the joint and the rectus femoris sheath.

Morphologic heterogeneity and plasmablastic transformation in advanced plasmacytic/plasmablastic myeloma: a study of 35 serial bone marrow biopsies in 9 patients.

Thirty-five bone marrow biopsies were performed in 9 patients with plasmacytic/plasmablastic myeloma stage IIIA of the Durie and Salmon classification. The cytologic and/or histologic transformation observed in the serial bone marrow biopsy specimens of 3 patients reflected an aggravation of the disease, and was expressed as an increase of bone marrow plasmablasts associated with a gradual decrease or even disappearance of the plasmacytic component. Beyond 50% of bone marrow plasmablasts, the plasmablastic myeloma represented a more aggressive phase in the course of the disease. In 2 patients this transformation was manifested by the development of extramedullary lesions. The possibility of chemotherapy influencing the progression of the plasmablastic clone by destroying the initial plasmacytic clone cannot be ruled out. These results are not devoid of therapeutic implications. They also emphasize the need for serial bone marrow biopsies for better detection of transformation into a less favorable cytologic and/or histologic type of myeloma.

[Antibody activity of monoclonal immunoglobulins]. / L'activité anticorps des immunoglobulines monoclonales.

Monoclonal immunoglobulins present a normal structure and have an antibody activity. This activity may be directed against exo-antigens especially bacterial, but more frequently against auto-antigens. It may then be symptomatic and therefore explain unusual clinical or biological manifestations in the course of monoclonal dysglobulinemias; but, most of the time, the monoclonal auto-antibody activity is asymptomatic and polyspecific, as it is only the monoclonal expression of polyclonal natural auto-antibodies. A comprehensive review of the various antibody activities of monoclonal immunoglobulins is presented. With the presence, in large quantities, of monoclonal immunoglobulins and their antibody activity, the links between dysglobulinemia and autoimmune disease are discussed as well as the pathogenic role of auto-antibodies.

[The percentage of bone marrow plasmacytes and prognosis in multiple myeloma]. / Pourcentage de plasmocytes médullaires et pronostic dans le myélome multiple.

The degree of medullary infiltration by plasmocytes has a prognostic value which completes the clinical classifications proposed in multiple myeloma. Beyond a 50 p. cent medullary infiltration, the mean survival of the patients is significantly shorter (p less than 0.02) than survival of patients presenting less than 50 p. cent medullary infiltration. The degree of medullary infiltration is unrelated to the stage of Durie and Salmon classification, but is correlated to the degree of differentiation of the plasmocytes.

Simple, rapid enzymatic determination of glycerophosphocholine in human seminal plasma.

We have devised a new enzymatic determination of sn-glycero-3-phosphocholine (GPC) in human seminal plasma. This is based on GPC hydrolysis by a phosphodiesterase (PDE), free choline being then determined by the choline oxidase method. The whole procedure involves a first incubation in the presence of choline oxidase and catalase, to eliminate the excess of choline present in seminal plasma (10-fold, compared with GPC). Absorbance and concentration are linearly related up to at least 100 nmol per assay, analytical recovery ranges between 89% and 105%, and intra- and interassay CVs are 3.2% and 5.6%, respectively, at the highest substrate concentration. Using this procedure, we found seminal plasma from 21 fertile men to contain 5.22 (SD 3.33) mumol per ejaculate--within the same range as previously reported values obtained chromatographically. After vasectomy, GPC in seminal plasma decreased to 28% of its original value, as determined in 10 volunteers. Thus this new method displays appropriate characteristics of specificity, reliability, and convenience, allowing its use in routine evaluation of male fertility.