Impact of influenza season and environmental factors on the clinical presentation and outcome of invasive pneumococcal disease

Influenza and meteorological factors have been associated with increases in the incidence of invasive pneumococcal disease (IPD). However, scant data regarding the impact of influenza and the environment on the clinical presentation of IPD are available. An observational study of all adults hospitalized with IPD was performed between 1996 and 2012 in our hospital. The incidence of IPD correlated with the incidence rates of influenza and with environmental data. A negative binominal regression was used to assess the relationship between these factors. Clinical presentation of IPD during the influenza and non-influenza periods was compared. During the study, 1,150 episodes of IPD were diagnosed. After adjusting for confounding variables, factors correlating with the rates of IPD were the incidence of influenza infection (IRR 1.229, 95% CI 1.025-1.472) and the average ambient temperature (IRR 0.921, 95% CI 0.88-0.964). Patients with IPD during the influenza period had a worse respiratory status. A greater proportion of patients had respiratory failure (45.6% vs 52%, p = 0.032) and higher requirements for ICU admission (19.3% vs 24.7%, p = 0.018) and mechanical ventilation (11% vs 15.1%, p = 0.038). When we stratified by invasiveness of pneumococcal serotypes and the presence of comorbid conditions, the increase in the severity of clinical presentation was focused on healthy adults with IPD caused by nonhighly invasive serotypes. Beyond the increase in the burden of IPD associated with influenza, a more severe clinical pattern of pneumococcal disease was observed in the influenza period. This effect varied according to pneumococcal serotype, host comorbidities, and age.

Identification and classification of involuntary leg muscle contractions in electromyographic records from individuals with spinal cord injury

Involuntary muscle contractions (spasms) are common after human spinal cord injury (SCI). Our aim was to compare how well two raters independently identified and classified different types of spasms in the same electromyographic records (EMG) using predefined rules. Muscle spasms were identified by the presence, timing and pattern of EMG recorded from paralyzed leg muscles of four subjects with chronic cervical SCI. Spasms were classified as one of five types: unit, tonic, clonus, myoclonus, mixed. In 48h of data, both raters marked the same spasms most of the time. More variability in the total spasm count arose from differences between muscles (84%; within subjects) than differences between subjects (6.5%) or raters (2.6%). Agreement on spasm classification was high (89%). Differences in spasm count, and classification largely occurred when EMG was marked as a single spasm by one rater but split into multiple spasms by the other rater. EMG provides objective measurements of spasm number and type in contrast to the self-reported spasm counts that are often used to make clinical decisions about spasm management. Data on inter-rater agreement and discrepancies on muscle spasm analysis can both drive the design and evaluation of software to automate spasm identification and classification.

Lack of detection of Middle East respiratory syndrome coronavirus in mild and severe respiratory infections in Catalonia, northeastern Spain

Surveillance of Middle East respiratory syndrome coronavirus (MERS-CoV) was conducted to explore the possible introduction and circulation of this novel virus in Catalonia, northeastern Spain. Five hundred and sixty-three samples from mild and severe respiratory infections collected between January 2012 and April 2013 were screened using real-time RT-PCR. All samples were negative, suggesting that MERS-CoV is not circulating silently in Catalonia.

Frequency resolved optical gating characterization of sub-ps pulses from single-section InAs/InP quantum dash based mode-locked lasers

Mode-locking of single-section Fabry-Pérot InAs/InP edge emitting quantum dash based lasers at 1.56 µm under continuous wave operation is studied by second-harmonic generation frequency resolved optical gating. Self-starting pulses of a width down to 374 fs can be observed after external chirp compensation using standard single-mode fiber (SMF-28). Pulse compression using different lengths of SMF-28 and pulse shape as well as phase dependence on bias conditions are investigated. Consistency with stepped-heterodyne technique for advanced pulse characterization is shown.

Acute adverse reactions to iopromide vs iomeprol: a retrospective analysis of spontaneous reporting from a radiology department

OBJECTIVE

To compare the safety of iopromide and iomeprol use in a hospital that switched from the former to the latter and found an apparent increase in the number (and a different profile) of adverse reactions reported for iomeprol, putting the safety of its use into question.

METHODS

This was a retrospective study of cases of acute reactions to iopromide and iomeprol reported in two successive time periods. Data from examinations using iopromide (62539 CT scans and 10348 urography scans) and iomeprol (34308 CT scans and 2846 urography scans) were obtained from the computer system of the hospital.

RESULTS

For each period, 154 cases of reactions were reported for iopromide and 86 for iomeprol, being severe in 10 (6.5%) patients for iopromide vs 17 (19.8%) patients for iomeprol; a statistically significant difference of p<0.003 was recorded. The most frequent adverse reactions (%/%) for iopromide/iomeprol were urticaria (29.1/17.2), pruritus (22.6/15.6), upper respiratory tract signs and symptoms (12.1/16.7), oedema (4.3/0), erythemas (3.4/5.0), nausea or vomiting (1.2/11.7) and chest pain (0/3.9) (p<0.0001 for the global comparison). The distribution of the reactions (%/%) by System Organ Class for iopromide/iomeprol was skin (56.7/41.1), respiratory (19.2/26.7), vascular (6.8/2.2), general (5.3/7.2), gastrointestinal (4.6/15.0) and others (7.4/7.9) (p<0.0002 for the global comparison).

CONCLUSION

Adverse reactions were more severe for iomeprol. Skin and vascular reactions with no chest pain were more frequent for iopromide, whereas gastrointestinal reactions were more frequent for iomeprol.

ADVANCES IN KNOWLEDGE

Comparative studies of media contrast safety are scarce and summary information on product characteristics is insufficient. This study showed the differences in severity and profile of adverse reactions between iopromide and iomeprol.

Disseminated ovarian Growing Teratoma Syndrome: a case -report highlighting surgical safety issues

The ovarian Growing Teratoma Syndrome (GTS) is a rare condition among patients with primary Non-Seminomatous Germ Cell Tumours (NSGCT) presenting with enlarging masses during or after appropriate chemotherapy in the context of normalized serum markers. Several modes of dissemination are suggested, with the most frequent site of metastasis being the peritoneum. We report a case of a young patient with primary ovarian mixed NSGCT, who presented with Growing Teratoma Syndrome not only in the peritoneum but also within a trocar site after an initial surgery consisting in the laparoscopic morcellation and extraction of the ovarian neoplasm. Beside the rarity of this clinical entity, it also demonstrates the utmost importance of the safe laparoscopic management of all complex ovarian masses.

23 and 39 GHz low phase noise monosection InAs/InP (113)B quantum dots mode-locked lasers

Here we report for the first time a passive mode-locking of single section Fabry-Perot (FP) lasers based on InAs quantum dots(QDs) grown on (113)B InP substrate. Devices under study are a 1 and 2 mm long laser diodes emitting around 1.58 µm. Self-starting pulses with repetition rates around 23 and 39 GHz and pulse widths down to 1.5 ps are observed after propagation through a suitable length of single-mode fiber for intracavity dispersion compensation. A RF spectral width as low as 20 kHz has been obtained leading to a low timing jitter RMS.

Small-sided game training improves aerobic capacity and technical skills in basketball players

The aim of this study was to compare the effects of 2 training interventions based on small-sided games (SGG) and high-intensity interval training (HIT) on physical and technical performance of male junior basketball players. A secondary objective was to investigate if these effects were similar in starting and bench players. 18 players participated in a pre-testing session, 6-weeks intervention period and a post-testing session. Pre- and post-sessions involved assessments of aerobic fitness, repeated sprint ability (RSA), defensive and offensive agility, upper and lower body power, shooting and passing skills. Mixed-design analysis of variance (ANOVA) with Bonferroni corrected pairwise comparisons examined the effects of time and type of intervention on physical and technical performances. The main results showed that both interventions resulted in similar improvements in aerobic capacity (+3.4% vs. +4.1%), with greater improvements in bench players compared to starting players (+7.1% vs. +1.1%, P<0.05). However, RSA was unchanged after both interventions. In addition, compared to HIT, SSG resulted in greater improvements in defensive agility (+4.5% vs. -2.7%, P<0.05), shooting skills (+7.4% vs. -2.4%, P<0.05) and upper body power (+7.9% vs. -2.0%, P<0.05). These results suggest that SSG should be prioritized in physical conditioning of junior basketball players during the season. However, when RSA is targeted, more specific training seems necessary.

The EMT activator ZEB1 promotes tumor growth and determines differential response to chemotherapy in mantle cell lymphoma

Mantle cell lymphoma (MCL) is a B-cell malignancy characterized by a poor response to treatment and prognosis. Constitutive activation of different signaling pathways in subsets of MCLs, through genetic and/or nongenetic alterations, endows tumor cells with enhanced proliferation and reduced apoptosis. The canonical Wnt pathway (β-catenin/TCF-LEF), implicated in the pathogenesis of numerous cancers, is constitutively active in half of MCLs. Here, we show that ZEB1, a transcription factor better known for promoting metastasis in carcinomas, is expressed in primary MCLs with active Wnt signaling. ZEB1 expression in MCL cells depends on Wnt, being downregulated by β-catenin knockdown or blocking of Wnt signaling by salinomycin. Knockdown of ZEB1 reduces in vitro cell viability and proliferation in MCL cells, and, importantly, tumor growth in mouse xenograft models. ZEB1 activates proliferation-associated (HMGB2, UHRF1, CENPF, MYC, MKI67, and CCND1) and anti-apoptotic (MCL1, BCL2, and BIRC5) genes and inhibits pro-apoptotic ones (TP53, BBC3, PMAIP1, and BAX). We show that ZEB1 expression in MCL cells determines differential resistance to chemotherapy drugs and regulates transporters involved in drug influx/efflux. Downregulation of ZEB1 by salinomycin increases the sensitivity of MCL cells to the cytotoxic effect of doxorubicin, cytarabine and gemcitabine. Lastly, salinomycin and doxorubicin display a synergistic effect in established and primary MCL cells. These results identify ZEB1 in MCL where it promotes cell proliferation, enhanced tumor growth and a differential response to chemotherapy drugs. ZEB1 could thus potentially become a predictive biomarker and therapeutic target in this lymphoma.

[Optimal use of peritoneal dialysis with multi-disciplinary management]

INTRODUCTION

Considering the increasing incidence of chronic kidney disease and the increased use of peritoneal dialysis, we wanted to assess whether the multidisciplinary management of patients in peritoneal dialysis might produce improvement in the quality of patients' lives when compared to management by a routine team of operators.

METHODS

Our study observed 40 patients on peritoneal dialysis in our Department between 2010 and 2012. They were randomly assigned to either group A, the routine team which consisted of a nephrologist and a nurse, or group B, a multidisciplinary team comprising several medical specialists, a nurse, a psychologist and a social worker. Two tests, KDQOL-SF and MMPI-2, were administered to both groups.

RESULTS

In group B, the number of days of hospitalization and day hospital were more than 88% lower when compared to group A. The multidisciplinary team achieved better results with the KDQOL-SF test with regards to both emotional and objective dimensions. The Pearson coefficient between the results of the two questionnaires shows how multidisciplinary management can positively influence the perceived well-being of the patient and his or her adherence to treatment.

CONCLUSIONS

In a multidisciplinary team, each operator, in addition to his or her specific role, also contributes to the achievement of the overall objective, namely of ensuring an optimal quality of life to the patient on peritoneal dialysis thereby allowing these patients to continue their professional and social lives.

[Complex fronto-orbital reconstruction with a PEEK prosthesis and skin expansion: about a case]

INTRODUCTION

Reconstructions of the fronto-orbital area remain a challenge to the reconstructive surgeon, due to the functional and esthetic impact.

OBSERVATION

The authors present a case of a complex fronto-orbital reconstruction with a PEEK (PolyEtherEtherKetone) implant, associated with a skin expansion.

DISCUSSION

With a follow-up of over three years, the cosmetic result is excellent. The authors believe that this technique is reliable, fast with long-term good results.

Craniofacial and dental development in cardio-facio-cutaneous syndrome: the importance of Ras signaling homeostasis

Cardio-facio-cutaneous syndrome (CFC) is a RASopathy that is characterized by craniofacial, dermatologic, gastrointestinal, ocular, cardiac, and neurologic anomalies. CFC is caused by activating mutations in the Ras/mitogen-activated protein kinase (MAPK) signaling pathway that is downstream of receptor tyrosine kinase (RTK) signaling. RTK signaling is known to play a central role in craniofacial and dental development, but to date, no studies have systematically examined individuals with CFC to define key craniofacial and dental features. To fill this critical gap in our knowledge, we evaluated the craniofacial and dental phenotype of a large cohort (n = 32) of CFC individuals who attended the 2009 and 2011 CFC International Family Conferences. We quantified common craniofacial features in CFC which include macrocephaly, bitemporal narrowing, convex facial profile, and hypoplastic supraorbital ridges. In addition, there is a characteristic dental phenotype in CFC syndrome that includes malocclusion with open bite, posterior crossbite, and a high-arched palate. This thorough evaluation of the craniofacial and dental phenotype in CFC individuals provides a step forward in our understanding of the role of RTK/MAPK signaling in human craniofacial development and will aid clinicians who treat patients with CFC.

Transient Enhanced Diffusion of Dopants in Preamorphised Si Layers

Transient Enhanced Diffusion (TED) of dopants in Si is the consequence of the evolution, upon annealing, of a large supersaturation of Si self-interstitial atoms left after ion bombardment. In the case of amorphizing implants, this supersaturation is located just beneath the c/a interface and evolves through the nucleation and growth of End-Of-Range (EOR) defects.

For this reason, we discuss here the relation between TED and EOR defects. Modelling of the behavior of these defects upon annealing allows one to understand why and how they affect dopant diffusion. This is possible through the development of the Ostwald ripening theory applied to extrinsic dislocation loops. This theory is shown to be readily able to quantitatively describe the evolution of the defect population (density, size) upon annealing and gives access to the variations of the mean supersaturation of Si self-interstitial atoms between the loops and responsible for TED. This initial supersaturation is, before annealing, at least 5 decades larger than the equilibrium value and exponentially decays with time upon annealing with activation energies that are the same than the ones observed for TED. It is shown that this time decay is precisely at the origin of the transient enhancement of boron diffusivity through the interstitial component of boron diffusion. Side experiments shed light on the effect of the proximity of a free surface on the thermal behavior of EOR defects and allow us to quantitatively describe the space and time evolutions of boron diffusivity upon annealing of preamorphised Si layers.

Encapsulation of contrast imaging agents by polypropyleneimine-based dendrimers

Polypropyleneimines (PPIs) functionalized by glycerol-based entities are prepared and characterized by diffusion-ordered spectroscopy NMR. Showing low cytotoxicity against MRC5 fibroblasts, their encapsulation capacities of gadolinium complexes was evaluated. T(1) measurements were performed to determine the relaxivity of the encapsulated gadopentetate dimeglumine (GdBOPTA) in dendrimers of fourth and fifth generation (GD-PPI-4 and GD-PPI-5). Comparison of the GdBOPTA relaxivity and the relaxivity of GdBOPTA-loaded dendrimers showed a slight increase of the gadolinium chelate relaxivity.