Uncertain in the face of change: Lack of contingency shift awareness during extinction is associated with higher fear-potentiated startle and PTSD symptoms in children.

Intolerance of uncertainty is a transdiagnostic risk factor for fear-related disorders and is associated with higher levels of anxiety in children and adolescents. It is unclear how uncertainty relates to development of psychopathology in children who have experienced trauma in early life. The present study used a fear-potentiated startle paradigm in children to examine associations between uncertainty (assessed as unawareness of a change in reinforcement during fear extinction) and symptoms of anxiety and posttraumatic stress disorder (PTSD), as well as startle potentiation to threat and safety cues. Results showed that unaware children had strong positive associations between trauma exposure and PTSD symptoms, whereas aware children did not. Uncertainty interacted with anxiety in that children who were both unaware and had higher anxiety displayed higher fear-potentiated startle to safety cues and did not show discrimination between threat and safety during fear conditioning. These results suggest that anxious children who persist in associating a threat cue with an aversive event during extinction, after repeated presentations of the no longer reinforced conditioned stimulus, may express psychophysiological phenotypes related to PTSD.

Auscultation in flight: comparison of conventional and electronic stethoscopes.

OBJECTIVES: The ability to auscultate during air medical transport is compromised by high ambient-noise levels. The aim of this study was to assess the capabilities of a traditional and an electronic stethoscope (which is expected to amplify sounds and reduce ambient noise) to assess heart and breath sounds during medical transport in a Boeing C135. METHODS: We tested one model of a traditional stethoscope (3MTM Littmann Cardiology IIITM) and one model of an electronic stethoscope (3MTM Littmann Stethoscope Model 3000). We studied heart and lung auscultation during real medical evacuations aboard a medically configured C135. For each device, the quality of auscultation was described using a visual rating scale (ranging from 0 to 100 mm, 0 corresponding to "I hear nothing," 100 to "I hear perfectly"). Comparisons were accomplished using a t-test for paired values. RESULTS: A total of 36 comparative evaluations were performed. For cardiac auscultation, the value of the visual rating scale was 53 ± 24 and 85 ± 11 mm, respectively, for the traditional and electronic stethoscope (paired t-test: P = .0024). For lung sounds, quality of auscultation was estimated at 27 ± 17 mm for traditional stethoscope and 68 ± 13 for electronic stethoscope (paired t-test: P = .0003). The electronic stethoscope was considered to be better than the standard model for hearing heart and lung sounds. CONCLUSION: Flight practitioners involved in air medical evacuation in the C135 aircraft are better able to practice auscultation with this electronic stethoscope than with a traditional one.

[Antitoxin treatments for necrotizing pneumonia due to Panton-Valentine leukocidin-secreting Staphylococcus aureus]. / Traitements antitoxiniques et pneumopathies nécrosantes àStaphylococcus aureus sécréteurs de leucocidine de Panton-Valentine.

Staphylococcus aureus is responsible for two main clinical presentations in humans: suppurative infections and toxigenic diseases. A small percentage of S. aureus strains secrete Panton-Valentine leukocidin (PVL). This toxin is implicated in skin infections, furunculosis, osteoarticular infections, and particularly, in serious pulmonary infections known as necrotizing pneumonia, which affect immunocompetent patients with no comorbidity. A clear outline of the clinical presentation was described recently. Necrotizing pneumonia caused by PVL-secreting S. aureus strains is characterized by a combination of fever, hemoptysis, multilobar alveolar infiltrations, and leukopenia. The disease usually progresses to toxic shock or refractory hypoxemia. A number of interesting therapies targeting leukocidin have been proposed over the past few years based on in vitro data. This review focuses on the physiopathological basis and on the therapeutic relevance of various drugs.

[Perioperative management of a patient with an acquired von Willebrand syndrome]. / Gestion périopératoire d'un patient porteur d'un syndrome de von Willebrand acquis.

We report the case of a man suffering from a monoclonal gammapathy with an acquired von Willebrand disease in a perioperative context. This pathology is rare, but is important to diagnose because of the possible haemorrhagic complications encountered. We describe the main therapeutic options available today to prevent bleeding during major surgery.

[A rare aetiology of acute respiratory distress syndrome in adult: leptospirosis]. / Une étiologie rare de syndrome de détresse respiratoire aiguë de l'adulte: la leptospirose.

We report the case of an 18-year-old man with pulmonary leptospirosis presenting as an atypical pneumonia with alveolar haemorrhage, without icterus. Has he developed ARDS the patient was admitted in intensive care unit. This patient was contaminated when swimming in a lake. The purpose of this article is to remind doctors that in patient presenting atypical pneumopathy with haemoptysis, the pulmonary leptospirosis should be considered.

Quantity and economic importance of nine selected by-products used in California dairy rations.

Food processing representatives, brokers, nutritionists, livestock producers, and trade associations were surveyed to quantify 9 by-products used for feeding livestock during 1992 in California. The commodities were almond hulls, dried beet pulp, wet brewers grains, wet citrus pulp, pressed citrus pulp, wet corn gluten feed, corn gluten meal, whole cottonseed, and rice bran. The 9 by-products contributed over 2.5 million tonnes and about 27% of the total feed concentrate moved within California during 1992. Market value of these 9 by-products was almost .25 billion dollars. Whole cottonseed accounted for about 31% of the total tonnage of these 9 by-products and provided about 66% of the total CP and 53% of the total NEL of these 9 by-products. The by-products were more valuable as energy sources than CP sources compared with NEL from corn and CP from soybean meal, respectively. Calculations of milk production, based on the CP content or NEL content of the by-products, showed that these 9 by-products could have contributed sufficient CP or NEL for over 31% of the milk produced in California during 1992. Ration formulations demonstrated that the economic value of by-products changed with feedstuffs available and, in general, would be used in rations over a range of market prices.