Combined exposure of the bivalve Mytilus galloprovincialis to polyethylene microplastics and two pharmaceuticals (citalopram and bezafibrate): Bioaccumulation and metabolomic studies

Pharmaceuticals and microplastics constitute potential hazards in aquatic systems, but their combined effects and underlying toxicity mechanisms remain largely unknown. In this study, a simultaneous characterization of bioaccumulation, associated metabolomic alterations and potential recovery mechanisms was performed. Specifically, a bioassay on Mediterranean mussels (Mytilus galloprovincialis) was carried out with polyethylene microplastics (PE-MPLs, 1 mg/L) and citalopram or bezafibrate (500 ng/L). Single and co-exposure scenarios lasted 21 days, followed by a 7-day depuration period to assess their potential recovery. PE-MPLs delayed the bioaccumulation of citalopram (lower mean at 10 d: 447 compared to 770 ng/g dw under single exposure), although reaching similar tissue concentrations after 21 d. A more limited accumulation of bezafibrate was observed overall, regardless of PE-MPLs co-exposure (<MQL-3.2 ng/g dw). Metabolic profiles showed a strong effect of pharmaceuticals, generally independent of PE-MPLs co-exposure. Alterations of the citrate cycle (bezafibrate exposure) and steroid and prostaglandin metabolism (citalopram and bezafibrate exposures) were highlighted. PE-MPLs alone also impacted metabolic pathways, such as neurotransmitters or purine metabolism. After depuration, relevant latent or long-lasting effects were demonstrated as, for instance, the effect of citalopram on neurotransmitters metabolism. Altogether, the observed molecular-level responses to pharmaceuticals and/or PE-MPLs may lead to a dysregulation of mussels' reproduction, energy metabolism, and/or immunity.

Compact laser modulation system for a transportable atomic gravimeter

Nowadays, atom-based quantum sensors are leaving the laboratory towards field applications requiring compact and robust laser systems. Here we describe the realization of a compact laser system for atomic gravimetry. Starting with a single diode laser operating at 780 nm and adding only one fiber electro-optical modulator, one acousto-optical modulator and one laser amplifier we produce laser beams at all the frequencies required for a Rb-87 atomic gravimeter. Furthermore, we demonstrate that an atomic fountain configuration can also be implemented with our laser system. The modulated system reported here represents a substantial advance in the simplification of the laser source for transportable atom-based quantum sensors that can be adapted to other sensors such as atomic clocks, accelerometers, gyroscopes or magnetometers with minor modifications.

[French practical guidelines for the diagnosis and management of IPF - 2021 update, full version]

BACKGROUND

Since the previous French guidelines were published in 2017, substantial additional knowledge about idiopathic pulmonary fibrosis has accumulated.

METHODS

Under the auspices of the French-speaking Learned Society of Pulmonology and at the initiative of the coordinating reference center, practical guidelines for treatment of rare pulmonary diseases have been established. They were elaborated by groups of writers, reviewers and coordinators with the help of the OrphaLung network, as well as pulmonologists with varying practice modalities, radiologists, pathologists, a general practitioner, a head nurse, and a patients' association. The method was developed according to rules entitled "Good clinical practice" in the overall framework of the "Guidelines for clinical practice" of the official French health authority (HAS), taking into account the results of an online vote using a Likert scale.

RESULTS

After analysis of the literature, 54 recommendations were formulated, improved, and validated by the working groups. The recommendations covered a wide-ranging aspects of the disease and its treatment: epidemiology, diagnostic modalities, quality criteria and interpretation of chest CT, indication and modalities of lung biopsy, etiologic workup, approach to familial disease entailing indications and modalities of genetic testing, evaluation of possible functional impairments and prognosis, indications for and use of antifibrotic therapy, lung transplantation, symptom management, comorbidities and complications, treatment of chronic respiratory failure, diagnosis and management of acute exacerbations of fibrosis.

CONCLUSION

These evidence-based guidelines are aimed at guiding the diagnosis and the management in clinical practice of idiopathic pulmonary fibrosis.

O-067 Artificial intelligence system detects “goldilocks” morphokinetic zone for embryos transferred or frozen in time-lapse videos

Study question

Are there specific morphokinetic time points which can be used to determine whether an embryo should be discarded?

Summary answer

Morphokinetic ranges where embryos will be discarded rather than transferred or cryopreserved, can be defined using time-lapse annotations automatically generated with artificial intelligence (AI).

What is known already

Time-lapse incubation has changed the way embryos are selected. Instead of static daily observations, continuous monitoring of embryos allows for generation of morphokinetic parameters which quantify the pace of development. However, annotations by humans have been shown to incur operator variations and are time-consuming to perform. AI can automatically annotate embryos with equivalence in accuracy to experienced embryologists. Although most embryo selection methods are designed to identify the embryo with the highest chance of becoming a healthy live birth baby, the ability to identify embryos that will not be suitable for treatment is equally important for clinical decision making.

Study design, size, duration

This is a prospective, observational, cohort study. Time-lapse videos from 142 embryos from a private fertility clinic in Spain were automatically annotated using CHLOE (Fairtility), an AI-based software. CHLOE automatically generated the following morphokinetic parameters: tPNa, tPNf, t2, t3, t4, t5, t6, t7, t8, t9+, tM, tSB, tB, tEB.

Participants/materials, setting, methods

Embryos analysed were from donor and own oocyte’s treatments. Selected embryos were analysed using CHLOE, to automatically identify morphokinetic parameters. The distribution for each morphokinetic parameter was compared between fates (data presented for transferred + frozen vs discarded as mean+-standard deviation, 2-sided t-test). Each continuous morphokinetic parameter was categorised according to the ranges where embryo utilisation was futile (&lt;1%), optimal (maximum utilisation rate) or reduced utilisation rate (between optimal and futile).

Main results and the role of chance

For every morphokinetic parameter the difference in event time between frozen+transferred vs discarded embryos was statistically significant(p &lt; 0.003). The results detail the time point in hours for each morphokinetic feature to occur (mean(SD) frozen+transferred vs discarded, p-value):

tPNa (7.68(2.03)vs22.04(27.15),p&lt;0.0001),

tPNf (21.71(2.86)vs34.63(24.11),p&lt;0.0001),

t2 (24.92(2.71)vs33.78(16.17),p&lt;0.0001),

t3 (34.62(4.03)vs42.58(22),p=0.0024),

t4 (37.29(4.31)vs48.29(20.29,p&lt;0.0001),

t5 (47.03(6.47)vs55.32(22.63),p=0029),

t6 (49.54(5.63)vs60.56(22.20),p&lt;0.0001),

t7 (53.1(7.86)vs69.13(24.54),p&lt;0.0001),

t8 (57.78(9.78)vs77.33(25.79),p&lt;0.0001),

t9+ (69.14(7.39)vs81.9(21.96),p&lt;0.0001),

tM (83.9(8.72)vs96.08(16.88),p&lt;0.0001),

tSB (97.89(7.55)vs105.38(11.38),p=0.0005),

tB (105.74(7)vs113.25(15.53),p=0.0002),

eEB (110.65(7.58)vs120.47(11.36),p=0.0031).

When looking at the exact distribution of these embryos according to time, it became apparent that a goldilocks zone appeared whereby the proportion of embryos transferred or frozen peaked, and the number discarded was at its minimum. The converse was true when looking at the more extreme values of a particular parameter. Thus, we were able to determine the (optimal vs futile time ranges): tPNa (4.4-8.8 hours, where the utilization rate was at its maximum vs &lt; 4.4 or &gt; 13.7, where the utilization rate was at its minimum), tPNf (19.1-23.2vs&lt;9.4,&gt;28.9), t2 (23.-36.4vs&lt;19.9,&gt;33.6), t3 (32.1-37.4vs&gt;24.6,&gt;43), t4 (34-40.2vs&lt;29.5,&gt;55), t5 (42.7-52vs&lt;33.7, &gt;63.5), t6 (45-4-54.2vs&lt;36.10,&gt;63.70), t7 (47.8-56.7vs&lt;42.8,&gt;77.5), t8 (49.2-64.5 vs &lt;44.5,&gt;82.5), t9+ (64.1-74.2vs&lt;57,&gt;90), tM (76.6-92.6 vs &lt;64.7,&gt;104.2), tSB (91.2-105vs&lt;81.3,&gt;113.8), tB(97.2-111.2 vs &lt;92,&gt;118.7), tEB (103.4-116.7,&lt;94.7,&gt;122.5).

A 60% of the embryos were in the futile range in at least 1 parameter, from which only 1 in 3 were utilised.

Limitations, reasons for caution

This is a single centre study. Further work will (i) test the limits across different clinics, with different geographical demographic variations, and varied clinical practices, to understand how these factors affect the limits between futile and optimal ranges of morphokinetics, and (ii) assess clinical outputs (implantation, ploidy, live birth).

Wider implications of the findings

Identifying objective ranges for determining when an embryo is not suitable for treatment will help reduce variation between and within embryologists and clinics; will avoid overly optimistic decisions which waste time and resources and increase patient’s emotional burden, and increase professional confidence when selecting embryos for discarding, transfer or freezing

Trial registration number

not applicable

AV synchronous pacing in patients implanted with leadless pacemakers: a real-world cohort study

Funding Acknowledgements

Type of funding sources: None.

Backgroung

Leadless pacemakers (LPM) were developed to overcome complications related to endovenous devices. Devices carrying an accelerometer-based atrial sensing algorithm provided good AV synchrony in a 5-hours study.

Methods

Prospective study of patients implanted with LPM capable of AV synchronous pacing at our institution. We performed a close follow-up consisting of device check-ups 24 h after the implant and 1-3-6-12 months later. Changes in programming were guided by device counters and rate histograms. Once AV synchrony derived from counters (AM-VP + AM-VS) remained stable for at least two consecutive months, a 24 hours Holter monitoring was performed. ECG recordings were automatically and blindly analyzed with a delineation system based on the wavelet transform developed by Martinez et al.1 Cardiac cycles were defined as synchronous if a ventricular event followed the P-wave by ≤300 ms. AV synchrony was calculated by dividing the number of synchronous cycles by the total number of cardiac cycles.

Our aim was to describe AV synchrony in a real-world setting and to determine which echocardiographic and programming parameters were related to optimal AV synchrony (≥85% of total cardiac cycles).

Results

A total of 18 patients (12 males, mean age 82.6 ±8.1) were included. Indications for pacing were complete AV block (n=10) and second-degree AV block (n=8). Device reprogramming was needed in all patients at follow-up. The 24 h Holter monitoring was performed 118.8±43.8 days after the implant. Implant data and, device settings and programming at Holter date is displayed in Table 1. One patient was excluded from the analysis due to the development of severe sinus node disease. Total ECG recorded time was 386.8 hours and 1,537,995 cardiac cycles were analyzed.

Median AV synchrony, after Holter monitoring analysis, was 88.2% (interquartile range 79.9-95,1%) and 12 out of 17 patients showed an AV synchrony ≥85% of cardiac cycles. Optimal AV synchrony was related to smaller right atrium size (13.2±3.4 cm2 vs 15.6±1.2 cm2 for AV synchrony ≥85 and &lt;85%, respectively) but no association appeared between diastolic parameters (E, A, E/A ratio, E´, A´) and AV synchrony. Rate smoothing algorithm was associated with higher rates of optimal AV synchrony (81.8% of patients with algorithm OFF vs 50% of patients activated). Besides, higher A3 threshold (7.1±3.5 m/s2 vs 4.2 ± 1.1 m/s2) and longer A3 window (620.8±25.7 ms vs 600 ms for AV synchrony ≥85% and &lt;85%, respectively) were also linked to optimal AV synchrony. Multivariate analysis did not show any independent predictor of AV synchrony.

Conclusions

In our cohort of LPM patients we obtained high percentages of AV synchronous pacing in a real-life setting. Device reprogramming was often needed, and larger studies are desirable to confirm our data.

[French practical guidelines for the diagnosis and management of IPF - 2021 update, short version]

BACKGROUND

Since the previous French guidelines were published in 2017, substantial additional knowledge about idiopathic pulmonary fibrosis has accumulated.

METHODS

Under the auspices of the French-speaking Learned Society of Pulmonology and at the initiative of the coordinating reference center, practical guidelines for treatment of rare pulmonary diseases have been established. They were elaborated by groups of writers, reviewers and coordinators with the help of the OrphaLung network, as well as pulmonologists with varying practice modalities, radiologists, pathologists, a general practitioner, a head nurse, and a patients' association. The method was developed according to rules entitled "Good clinical practice" in the overall framework of the "Guidelines for clinical practice" of the official French health authority (HAS), taking into account the results of an online vote using a Likert scale.

RESULTS

After analysis of the literature, 54 recommendations were formulated, improved, and validated by the working groups. The recommendations covered a wide-ranging aspects of the disease and its treatment: epidemiology, diagnostic modalities, quality criteria and interpretation of chest CT, indication and modalities of lung biopsy, etiologic workup, approach to familial disease entailing indications and modalities of genetic testing, evaluation of possible functional impairments and prognosis, indications for and use of antifibrotic therapy, lung transplantation, symptom management, comorbidities and complications, treatment of chronic respiratory failure, diagnosis and management of acute exacerbations of fibrosis.

CONCLUSION

These evidence-based guidelines are aimed at guiding the diagnosis and the management in clinical practice of idiopathic pulmonary fibrosis.

Combining social network analysis and agent-based model for enabling nature-based solution implementation: The case of Medina del Campo (Spain)

Several barriers still hamper the effective implementation of Nature-Based Solutions (NBS). Among the others, this work focuses on collaboration barriers. NBS implementation claims for effective collaboration among different decision-agents. However, ambiguity in problem framings, which is ineradicable in multi-agents' decision environments, could create collaboration barriers. This work aims to demonstrate that collaboration barriers to NBS implementation can be overcome by enhancing the network of interactions among the decision-agents. An innovative method based on the integration between Social Network Analysis and hybrid Agent-Based Model/System Dynamic Model was adopted to this aim. The analysis results were used for designing networking interventions, i.e. efforts using social network characteristics that could enhance interactions mechanisms among decision-agents. The developed method was implemented in the Medina del Campo (Spain) case study. This area is characterised by one of the most critical groundwater bodies of the Duero River Basin. This work aims at supporting the implementation of suitable NBS to stop the degradation of the groundwater status and associated ecosystem services. The activities carried out within the framework of the NAIAD project showed that, by enhancing the interaction mechanisms, ambiguity in problem frames can still yield collective actions for NBS implementation.

Cholesteryl ester transfer protein rs5833 genetic variant affect HDL-cholesterol levels and ratio total cholesterol/HDL-cholesterol in postmenopausal obese female patient

OBJECTIVE

One SNP in exon 9 (r5883) has been involved with high risk of cardiovascular disease in hypertensive subjects. The goal of the present study was to test the role of this genetic variant on lipid levels and Metabolic Syndrome (MS) in menopausal obese females.

PATIENTS AND METHODS

The study enrolled a sample of 112 menopausal obese females. Measurements of adiposity parameters, blood pressure, fasting blood glucose, insulin concentration, insulin resistance (HOMA-IR), lipid profile, C reactive protein and prevalence of MS were recorded. Genotype of CETP gene polymorphism (rs5883) was studied.

RESULTS

The distribution of the rs5883 polymorphism in this menopausal obese population was 83.9% (n=94) (CC), 15.2% (n=17) (CT) and 0.9% (n=1) (TT). Adiposity parameters, blood pressure, fasting glucose levels, insulin levels, HOMA-IR, C reactive protein, total cholesterol, LDL-cholesterol and triglycerides were similar in both genotype groups (CC vs. CT+TT). Moreover, HDL cholesterol (8.5+1.2 mg/dl; p=0.01) and ratio total cholesterol/HDL-cholesterol (0.5±0.2; p=0.04) were higher in T allele carriers (dominant model). MS percentage was similar in both genotypes (37.6% vs. 27.2%; p=0.43). Logistic regression analysis showed a decreased risk of low-HDL cholesterol in T allele carriers (OR=0.18, 95% CI=0.02-0.77, p=0.03) after adjusting by dietary fatty acid intakes, body mass index and age.

CONCLUSIONS

The results reported here support that CETP variant rs5883 is related with HDL-cholesterol levels and ratio total cholesterol/HDL-cholesterol.

Validation of leadless atrioventricular synchronous pacing with Holter-ECG: a pilot study

Background

The novel MICRA AV leadless pacemaker can provide atrioventricular (AV) synchronous pacing using an accelerometer-based atrial sensing algorithm.

Purpose

To describe the performance of MICRA AV pacemaker in a real-life setting and to determine the agreement between AV synchrony determined by the device counters and AV synchrony obtained by a 24 h ECG Holter test.

Methods

This pilot study included the first ten patients implanted with a MICRA AV leadless pacemaker at our institution. All implants were performed according to standard protocols and under deep sedation. A close follow-up was performed, and atrial sensing parameters were adjusted following AV synchrony given by the device counters. Patients underwent a 24 h ECG Holter test once AV synchrony remained stable for at least two months. The ECG Holter signal was analyzed in a blinded manner by an automatic delineation system based on the wavelet transform (Figure). This algorithm has a sensivity of 98.9% and a positive predictive value of 91.9% to detect p waves. Cardiac cycles were defined as synchronous if a QRS complex followed the P-wave by ≤300 ms, according to MARVEL 2 study criterion. AV synchrony obtained from the 24 h Holter test was compared with AV synchrony extracted from the device counters (AM-VP + AM-VS) during the same 24 h.

Results

From June to November 2020, 10 patients (7 males, mean age 83.5±5.4) were implanted with a MICRA AV leadless pacemaker (5 patients due to complete AV block and 5 patients due to second degree AV block). All devices were implanted after 1 deployment and no major complications appeared. Data related to implant parameters are displayed in Table 1. Device reprogramming was needed in all patients during follow-up. The 24 h ECG Holter monitoring was performed 141.4±45 days after the implant (mean time). Device settings and programming at Holter date is displayed in Table 1. Total ECG recorded time was 210.6 h and 915,488 cardiac cycles were analyzed. The mean percentage of synchronous cardiac cycles was 88.6±8.5% of total cycles while the mean AV synchrony determined by the device counters (AM-VP + AM-VS) during those 24 h was 89.8±5.5%. A good patient to patient correlation between these two measures was found (coefficient of intraclass correlation = 0.72).

Conclusions

We obtained high rates of AV synchrony with MICRA AV leadless pacemaker, in our short-term follow-up pilot study. Manual adjustment of the atrial sensing parameters, guided by the device counters, seems to be useful to obtain an optimal performance.

Funding Acknowledgement

Type of funding sources: None.

Elucidating venlafaxine metabolism in the Mediterranean mussel (Mytilus galloprovincialis) through combined targeted and non-targeted approaches

Exposure of aquatic organisms to antidepressants is currently well documented, while little information is available on how wild organisms cope with exposure to these pharmaceutical products. Studies on antidepressant metabolism in exposed organisms could generate information on their detoxification pathways and pharmacokinetics. The goal of this study was to enhance knowledge on the metabolism of venlafaxine (VEN)-an antidepressant frequently found in aquatic ecosystems-in Mytilus galloprovincialis, a bivalve that is present worldwide. An original tissue extraction technique based on the cationic properties of VEN was developed for further analysis of VEN and its metabolites using targeted and non-targeted approaches. This extraction method was assessed in terms of recovery and matrix effects for VEN metabolites. Commercial analytical standards were applied to characterize metabolites found in mussels exposed to 10 μg/L VEN for 3 and 7 days. Targeted and non-targeted approaches using liquid chromatography (LC) combined with high-resolution mass spectrometry (HRMS) were implemented to screen for expected metabolites based on the literature on aquatic species, and for metabolites not previously documented. Four venlafaxine metabolites were identified, namely N-desmethylvenlafaxine and O-desmethylvenlafaxine, which were clearly identified using analytical standards, and two other metabolites revealed by non-target analysis. According to the signal intensity, hydroxy-venlafaxine (OH-VEN) was the predominant metabolite detected in mussels exposed for 3 and 7 days.

[IgG4-Related Disease: A rare cause of severe interstitial lung disease]

BACKGROUND

The intrathoracic manifestations of IgG4-related disease include a range of conditions and severity, and can on occasion cause acute respiratory failure as reported in the case described here.

OBSERVATION

A 69-year-old male former smoker, was admitted to our hospital with dyspnea, fever, cough, fatigue, and a 3-month history of weight loss. He received high flow oxygen therapy and non-invasive ventilation for severe respiratory failure. Chest computed tomography revealed multifocal condensations and ground glass opacities, accompanied by thickening of the perilymphatic interstitium, mediastinal lymphadenopathy and bilateral pleural effusion. Elevated serum concentrations of IgG4 suggested an IgG4-Related Disease. He developed renal failure and underwent a renal biopsy. Histopathological analysis of which supported the diagnosis by showing dense lymphocytic infiltrate with a count of IgG4+ cells/hpf higher than 60, and storiform fibrosis - a swirling, "cartwheel" pattern of fibrosis which may have a patchy distribution. The patient responded well to steroid therapy.

CONCLUSION

Although respiratory symptoms are usually mild in IgG4-relatd disease, thoracic features can evolve into acute respiratory failure with few extra thoracic manifestations.

An Indo-Pacific coral spawning database

The discovery of multi-species synchronous spawning of scleractinian corals on the Great Barrier Reef in the 1980s stimulated an extraordinary effort to document spawning times in other parts of the globe. Unfortunately, most of these data remain unpublished which limits our understanding of regional and global reproductive patterns. The Coral Spawning Database (CSD) collates much of these disparate data into a single place. The CSD includes 6178 observations (3085 of which were unpublished) of the time or day of spawning for over 300 scleractinian species in 61 genera from 101 sites in the Indo-Pacific. The goal of the CSD is to provide open access to coral spawning data to accelerate our understanding of coral reproductive biology and to provide a baseline against which to evaluate any future changes in reproductive phenology.

[Familial pulmonary veno-occlusive disease with a composite biallelic heterozygous EIF2AK4 mutation]

Pulmonary veno-occlusive disease (PVOD) is a rare cause of pulmonary hypertension. Heritable and sporadic forms have been distinguished. Hypoxemia, profound reduction in the diffusion of carbon monoxide and haemodynamic confirmation of pre-capillary pulmonary hypertension are the major diagnostic criteria. Thoracic CT scanning and a response to pharmaceutical therapy provide additional information to confirm the diagnosis. A 52-year-old patient, three of whose siblings had pulmonary hypertension, was admitted with dyspnoea, malaise and palpitations. Right heart catheterisation confirmed pre-capillary pulmonary hypertension. A search for an EIF2AK4 mutation was carried out, and this showed a composite biallelic heterozygous mutation compatible with the diagnosis of familial PVOD, identical to that showed in one of his brothers. Given the signs of severity of the disease and the diagnosis of PVOD, whose response to pharmaceutical therapy is often poor, the patient was placed on a waiting list for lung transplantation. Despite a similar diagnosis in 3 brothers and follow-up proposed 11 years before the diagnosis, pulmonary hypertension appeared within a few weeks and led immediately to a severe clinical situation. Annual clinical and echocardiographic monitoring had been strongly advised to the patient, but had not allowed diagnosis at a mild or moderate stage of the disease. This clinical case shows that the identification of factors predicting the development of heritable PVOD at a pre-symptomatic stage is an important issue for clinical research.

Analysis of pressure-driven membrane preconcentration for point-of-care assays

Point-of-care diagnostic devices for both physicians and patients themselves are now ubiquitous, but often not sensitive enough for highly dilute analytes (e.g., pre-symptomatic viral detection). Two primary methods to address this challenge include (1) increasing the sensitivity of molecular recognition elements with greater binding affinity to the analyte or (2) increasing the concentration of the analyte being detected in the sample itself (preconcentration). The latter approach, preconcentration, is arguably more attractive if it can be made universally applicable to a wide range of analytes. In this study, pressure-driven membrane preconcentration devices were developed, and their performance was analyzed for detecting target analytes in biofluids in the form of point-of-care lateral-flow assays (LFAs). The demonstrated prototypes utilize negative or positive pressure gradients to move both water and small interferents (salt, pH) through a membrane filter, thereby concentrating the analyte of interest in the remaining sample fluid. Preconcentration up to 33× is demonstrated for influenza A nucleoprotein with a 5 kDa pore polyethersulfone membrane filter. LFA results are obtained within as short as several minutes and device operation is simple (very few user steps), suggesting that membrane preconcentration can be preferable to more complex and slow conventional preconcentration techniques used in laboratory practice.

[Eosinophilic pneumonia: A rare complication of sodium divalproate]

INTRODUCTION

Eosinophilic pneumonias are characterized by an increase in lung eosinophils. These disorders can be induced by drug reactions.

CASE REPORT

A 57-year-old woman suffering from bipolar disorder and treated by sodium divalproate for more than 2 years was hospitalised in the department of respiratory medicine for dyspnoea and cough. The investigations showed severe hypoxaemia, airflow limitation, multiple ground-glass opacities and crazy paving on the chest CT-scan and a blood eosinophilia. A significant alveolar eosinophilia was found in the broncho-alveolar lavage. A complete assessment of possible causes was made. Finally, we made the diagnosis of eosinophilic pneumonia secondary to sodium divalproate. The treatment was stopped and systemic corticosteroid therapy was not introduced. The patient showed an improvement of her dyspnoea in a few days. Lung function and the CT-scan were normal within a few months.

CONCLUSIONS

Sodium divalproate, frequently used in the treatment of bipolar disorder, is a rare cause of eosinophilic lung disease, even years after its introduction. Rapid diagnosis and withdrawal of treatment led to complete resolution in the reported case.

Evaluation of “Sophia Diabetes”, a diabetic patient support programme, 8 years after its initiation

Background

“Sophia Diabetes” is a personalized diabetic patient support program piloted by French National Health Insurance, launched experimentally in 10 primary health insurance funds in March 2008, extended in 2010 and then generalized to all of France in 2012-2013. A new evaluation was performed in 2018 to determine long-term (2008-2016) improvement of medical follow-up indicators, impact on morbidity, mortality and healthcare expenditure.

Methods

A sample of patients (n = 49,016) eligible for the programme in 2008, but also a sub-group of participating patients (n = 17,007), was matched, using propensity score, with controls randomly selected from the SNDS. Difference in difference method was applied for comparisons at each year of follow-up (Ti) while controlling for differences between populations.

Results

Sophia had a significant positive impact on recommended follow-up indicators, right from the first year. This improvement was maintained for most indicators even if compliance rates remained lower than targets. Sophia Diabetes does not appear to have a major impact on hospitalization rates in either eligible patients or participating patients. However, comparison between participants and controls revealed a less marked increase of hospitalizations for major cardiovascular events at T6 and T7. Compared to their controls, a better use of hospital emergency departments was observed for participants. Ambulatory care expenditure of participants increased more markedly between T4 and T7 (+€105 to €233), related to a better follow-up but in contrast, hospital expenditure increased less markedly during the first year of follow-up (-€139) and the last 2 years (-€360 to -€380).

Conclusions

For the first time in France, a disease management program has been evaluated over a long period. Globally, Sophia programresults in improved patient follow-up, decreased emergency visits, and a less marked increase of hospitalizations for major cardiovascular events at the end of period.

Key messages

First long term evaluation (8 years) of a disease management program in France. Sophia diabetes management program shows a positive impact on some follow-up and morbidity indicators.

P4344An example that big data analysis is ready for the prime time

Introduction

Data about the epidemiology of valvular heart disease (VHD) is scarce. The increasing aging of the population may cause an augmented prevalence of VHD, with a great number of comorbidities that conveys a higher surgical risk. The aim of this study was to describe the prevalence of VHD in the patients attended at our institution from 2007 until 2017 and to describe the main characteristics of this population.

Methods

We used a new tool based on EHRead Technology to extract clinical relevant information from Electronic Health Records, designed for descriptive and predictive big data analysis. All medical reports generated at the outpatient clinic, ER or hospitalization ward were examined. Patients with a diagnosis of moderate or severe VHD were selected. The prevalence of VHD was also estimated in 2 quintiles, from 2008 until Feb 2013 and from March 2013 until Dec 2017.

Results

The total prevalence of VHD in our population was 1.04% (n=3431). Mitral regurgitation was the most frequent valvular lesion (0.4%, n=1318), followed by aortic stenosis (0.3%, n=967) and aortic regurgitation (0.28%, n=938). There was a clear female predominance (63%), and the median age was 76.4. In the 1st quintile the prevalence of VHD was 0.25%, and increased to 0.79% in the 2nd. This trend was consistent in all type of valvular lesions. The prevalence of comorbidities was higher than in other epidemiological studies (Table).

Prevalence of comorbidities Severe MR Severe AS Severe AR Euro Heart Valve Survey Hypertension 54,5% 69,1% 47,9% 49% Dyslipidemia 32,2% 40,6% 27,4% 35% Diabetes Mellitus 28,0% 31,5% 16,4% 15% Smoking (current) 5,6% 5,4% 13,7% 39% Coronary heart disease 12,0% 17,0% 12,3% 13% Stroke 7,0% 8,9% 5,5% 7% Chronic kidney disease 18,9% 16,9% 20,5% 15% Chronic obstructive pulmonary disease 11,2% 9,9% 11,0% 15% MR: Mitral regurgitation, AS: aortic stenosis, AR: aortic regurgitation, MS: mitral stenosis.

Sex Distribution

Conclusions

The older age and greater number of comorbidities seen in our series over the past ten years, compared to the Euroheart Valve Survey reinforce the idea that the percutaneous valvular therapies should play a major role in the treatment of patients with VHD. Although, the prevalence of VHD may be underestimated in our population, due to the methodology, it reflects an ever-growing pathology in an older and sicker population.

Experimental generation of a flat-top beam profile in a stable ring cavity

In this Letter, we present a spatially homogeneous field inside of a ring cavity that was created by combining two transverse modes generated by a single laser through modulation. The interference term between the two modes averages out because of the frequency difference that exists between them, eliminating the need for interferometric control of their relative phase. The use of a ring cavity allows for a large waist for the flat-top profile, big enough to cover the atoms in an atomic trap. The cavity is mechanically and thermally isolated, and the laser light is locked to the cavity using the Pound-Drever-Hall technique. The flat-top profile technique reported here fulfills the vanishing curvature criterion at the center of the profile.

Prevalence and management of chronic breathlessness in COPD in a tertiary care center

Background

Breathlessness is the prominent symptom of chronic obstructive pulmonary disease (COPD). Despite optimal therapeutic management including pharmacological and non-pharmacological interventions, many COPD patients exhibit significant breathlessness. Chronic breathlessness is defined as breathlessness that persists despite optimal treatment of the underlying disease. Because of the major disability related to chronic breathlessness, symptomatic treatments including opioids have been recommended by several authors. The prevalence of chronic breathlessness in COPD and its management in routine clinical practice have been poorly investigated. Our aim was to examine prevalence, associated characteristics and management of chronic breathlessness in patients with COPD recruited in a real-life tertiary hospital-based cohort.

Methods

A prospective study was conducted among 120 consecutive COPD patients recruited, in stable condition, at Nancy University Hospital, France. In parallel, 88 pulmonologists of the same geographical region were asked to respond to an on-line questionnaire on breathlessness management.

Results

Sixty four (53%) patients had severe breathlessness (modified Medical Research Council scale≥3), despite optimal inhaled medications for 94% of them; 40% had undergone pulmonary rehabilitation within the past 2 years. The severity of breathlessness increased with increasing airflow limitation. Breathlessness was associated with increased symptoms of anxiety, depression and with osteoporosis. No relation was found with other symptoms, exacerbation rate, or cardiovascular comorbidities. Among the patients with chronic breathlessness and Hospitalized Anxiety and/or Depression score > 10, only 25% were treated with antidepressant or anxiolytic. Among the pulmonologists 46 (52%) answered to the questionnaire and expressed a high willingness to prescribe opioids forchronic breathlessness, which contrasted with the finding that none of these patients received such treatments against breathlessness.

Conclusion

Treatment approaches to breathlessness and associated psychological distress are insufficient in COPD. This study highlights underuse of pulmonary rehabilitation and symptomatic treatment for breathlessness.

Electronic supplementary material

The online version of this article (10.1186/s12890-019-0851-5) contains supplementary material, which is available to authorized users.

Anthropic impacts on Sub-Saharan urban water resources through their pharmaceutical contamination (Yaoundé, Center Region, Cameroon)

Sub-Saharan urban centers have to tackle high population growth, lack of sanitation infrastructures and the need for good quality water resources. To characterize the impacts of anthropization on the water resources of the capital of Cameroon (Yaoundé), a multi-disciplinary approach was used in ten sub-watersheds (peri-urban and urban) of the Méfou watershed. Pharmaceutical residues were used as tracers of surface and groundwater contamination caused by the release of domestic wastewater from pit latrines and landfills. A water use survey was conducted in the vicinity of the sampling sites to better assess water use, treatment and management. Available land use and hydro-geomorphological data completed characterization of the sub-watersheds. The combined data showed that natural features (elevation, slope, and hydrography) and human activities (land use) favor rainfall-runoff events and hence surface water contamination. Pharmaceutical monitoring revealed contamination of both surface and groundwater especially in the urban sub-watersheds. Analgesics/anti-inflammatory drugs and anti-epileptic carbamazepine were the most frequently found compounds (in up to 91% of water samples) with concentrations of acetaminophen reaching 5660 ng/L. In urban sub-watersheds, 50% of the groundwater sites used for drinking water were contaminated by diclofenac (476-518 ng/L), carbamazepine (263-335 ng/L), ibuprofen (141-276 ng/L), sulfamethoxazole (<2-1285 ng/L) and acetaminophen (110-111 ng/L), emphasizing the need for a deeper understanding of the interactions between surface and groundwater. The use of groundwater as drinking water by 68% of the total population surveyed raises concerns about population exposure and potential health risks. This case study highlights the need for strategies to limit contamination of the water resource given the predicted future expansion of Sub-Saharan urban centers.

Study of polycyclic aromatic hydrocarbon contamination in sediments and northern waters Lebanon: Rivers, transition zones and port sites

Contamination of the marine environment is associated with continental activities, marine activities and accidental spills. Providing answers to the origin of the contamination ofthe aquatic environment by PAHsis an objective of the present work. The originality of this work is to study pollutants in two types of matrix (water and sediments) during2 seasons (dry and wet) for an environmental monitoringof 6 years. This study provides a more complete overview of the state of contaminationin three coastal rivers, their transition zones and harborsin the Eastern Mediterranean following the Jiyyeh oil spill in 2006.Contaminantsconcentrations wereexpressed asthe sum of the 16 PAHs classified as prority substances by the United StatesEnvironmental Protection Agency(US-EPA). Overall,contamination was noted for all the analyzedsites. Oil spill seem to be one of the main sources of pollution in the area, as the highest levels of PAH(> 9000 ng.g-1s.w&> 8000 ng.L-1) were reported in the coastal environment of the three rivers and harbors.High levels of PAHswere also observed in rivers transitional zones, revealing the importance of terrestrial inputs (untreated wastewater discharge, leachate, solid wastes, etc.).Comparing the PAHsconcentrations measured in the sediments of the sitesanalyzed with the empirical sediment quality criteria "SQG" for the support of the general assessment of sediment toxicity, we can notice that some individual PAHand their sum can present a significant ecotoxicological risk to aquatic organisms. Further research through monitoring campaigns and toxicity tests is encouraged, as the exposure of the resident aquatic organisms and human population to these chemicals might be expected to increase over the years.

Complete validation of a continuous and blood-correlated sweat biosensing device with integrated sweat stimulation

A wearable sweat biosensing device is demonstrated that stimulates sweat and continuously measures sweat ethanol concentrations at 25 s intervals, which is then correlated with blood ethanol during a >3 hour testing phase. The testing involves a baseline condition (no ethanol) followed by a rapid blood and sweat rise of ethanol (oral bolus), and finally, the physiological response of the body as ethanol concentrations return to baseline (metabolized). Data sets include multiple in vivo validation trials and careful in vitro characterization of the electrochemical enzymatic ethanol sensor against likely interferents. Furthermore, the data is analyzed through known pharmacokinetic models with a strong linear Pearson correlation of 0.9474-0.9996. The continuous nature of the data also allows analysis of blood-to-sweat lag times that range between 2.3 to 11.41 min for ethanol signal onset and 19.32 to 34.44 min for the overall pharmacokinetic curve lag time. This work represents a significant advance that builds upon a continuum of previous work. However, unresolved questions include operation for 24 hours or greater and with analytes beyond those commonly explored for sweat (electrolytes and metabolites). Regardless, this work validates that sweat biosensing can provide continuous and blood-correlated data in an integrated wearable device.

[Tunnelled central venous catheter infection during treatment with epoprostenol]

INTRODUCTION

Pulmonary arterial hypertension is a pulmonary vascular disease with a poor prognosis. Continuous intravenous treatment with prostacyclin analogues requires the placement of a tunnelled catheter. The occurrence of catheter-related infections in this context is unusual due to the alkaline pH of the prostacyclin analogue solutions.

OBSERVATION

A 50-year-old patient with inherited pulmonary artery hypertension, treated with bosentan, sildenafil and epoprostenol, experienced generalized malaise associated with a weight loss of 9kg over a 12-month period without evidence of a source of infection or malignancy. There was no evidence of hemodynamic disturbance. The diagnosis was made after 1 year of follow-up, when the patient presented with a 38° fever and a biological inflammatory syndrome. Repeated peripheral blood cultures were positive for Dietzia, an alkalophilic coryneform bacillus. The patient's condition responded favourably to antibiotic therapy.

CONCLUSION

Infection of a tunneled intravenous catheter should be considered in the case of non-specific symptoms or where there is evidence of sepsis, in patients treated with intravenous prostacyclin analogues administered intravenously. In this context, the laboratory should be warned to search for slow-growing organisms.

Dermoscopic features and patterns of poromas: a multicentre observational case-control study conducted by the International Dermoscopy Society

BACKGROUND

Poromas are benign cutaneous sweat gland tumours that are challenging to identify. The dermoscopic features of poromas are not well characterized.

OBJECTIVE

To determine the clinical-dermoscopic features of poromas.

METHODS

Cross-sectional, observational study of 113 poromas and 106 matched control lesions from 16 contributors and eight countries. Blinded reviewers evaluated the clinical and dermoscopic features present in each clinical and dermoscopic image.

RESULTS

Poromas were most commonly non-pigmented (85.8%), papules (35.4%) and located on non-acral sites (65.5%). In multivariate analysis, dermoscopic features associated with poroma included white interlacing areas around vessels (OR: 7.9, 95% CI: 1.9-32.5, P = 0.004), yellow structureless areas (OR: 2.5, 95% CI: 1.1-6.0, P = 0.04), milky-red globules (OR: 3.9, 95% CI: 1.4-11.1, P = 0.01) and poorly visualized vessels (OR: 33.3, 95% CI: 1.9-586.5, P = 0.02). The presence of branched vessels with rounded endings was positively associated with poromas but did not reach statistical significance (OR: 2.4, 95% CI: 0.8-6.5, P = 0.10). The presence of any of these five features was associated with a sensitivity and specificity of 62.8% and 82.0%, respectively.

CONCLUSION

We identified dermoscopic features that are specific to the diagnosis of poroma. Overall, however, the prevalence of these features was low. Significant clinical and dermoscopic variability is a hallmark of these uncommon tumours, which are most prevalent on non-acral sites.