Overloaded! Critical revision and a new conceptual approach for snow indicators in ski tourism

Indicators are widely used in climate variability and climate change assessments to simplify the tracking of complex processes and phenomena in the state of the environment. Apart from the climatic criteria, the snow indicators in ski tourism have been increasingly extended with elements that relate to the technical, operational, and commercial aspects of ski tourism. These non-natural influencing factors have gained in importance in comparison with the natural environmental conditions but are more difficult to comprehend in time and space, resulting in limited explanatory power of the related indicators when applied for larger/longer scale assessments. We review the existing indicator approaches to derive quantitative measures for the snow conditions in ski areas, to formulate the criteria that the indicators should fulfill, and to provide a list of indicators with their technical specifications which can be used in snow condition assessments for ski tourism. For the use of these indicators, a three-step procedure consisting of definition, application, and interpretation is suggested. We also provide recommendations for the design of indicator-based assessments of climate change effects on ski tourism. Thereby, we highlight the importance of extensive stakeholder involvement to allow for real-world relevance of the achieved results.

Management of immune checkpoint blockade dysimmune toxicities: a collaborative position paper

Monoclonal antibodies targeted against the immune checkpoint molecules CTLA-4 and PD-1 have recently obtained approval for the treatment of metastatic melanoma and advanced/refractory non small-cell lung cancers. Therefore, their use will not be limited anymore to selected hospitals involved in clinical trials. Indeed, they will be routinely prescribed in many cancer centers across the world. Besides their efficacy profile, these immune targeted agents also generate immune-related adverse events (irAEs). This new family of dysimmune toxicities remains largely unknown to the broad oncology community. Although severe irAEs remain rare (∼10% of cases under monotherapy), they can become life-threatening if not anticipated and managed appropriately. Over the last 5 years, Gustave Roussy has accumulated a significant experience in the prescription of immune checkpoint blockade (ICB) antibodies and the management of their toxicities. Together with the collaboration of Gustave Roussy's network of organ specialists with expertise in irAEs, we propose here some practical guidelines for the oncologist to help in the clinical care of patients under ICB immunotherapy.

Alcohol-related emergency department admissions among adolescents in the Ghent and Sint-Niklaas areas

Alcohol abuse is a major health concern. The aim of this retrospective study was to analyse the alcohol-related emergency department (ED) admissions among adolescents in all hospitals of distinct areas during a 1-year period. In each hospital, all ED patients with a blood alcohol concentration (BAC) of at least 0.5 g/l were surveyed in a standardised way. Of the 3918 included patients, only 146 (3.7%) were < 18  years. The male-to-female ratio was 1.5:1. There was a strong preponderance of weekend and night time admissions. Most of the patients were transported by ambulance (77% of 138 patients with information on this item). The main reason for ED admittance was depressed level of consciousness (64%), trauma (12%), vomiting and/or abdominal pain (12%), agitation or aggression (4%), syncope (4%) and psychological problems (4%). The context of the alcohol intoxication was related to some kind of festivity in 85%, mental problems in 14% and chronic abuse in 1%. Median BAC values (and range) were 2.08 g/l (0.73-3.70 g/l) for boys and 1.51 g/l (0.73-2.90 g/l) for girls. Most patients (87%) could be discharged home within 24  hours. Our study confirms that problematic alcohol use leading to ED admissions starts in adolescence. Although the numbers of cases below 18 years are low when compared to adults, the phenomenon is alarming as it is associated with substantial health problems. Therefore, Belgium urgently needs a global national alcohol plan, with youngsters being one of the target groups.

Short-term effects of airborne ragweed pollen on clinical symptoms of hay fever in a panel of 30 patients

OBJECTIVES

Ragweed, Ambrosia artemisiifolia, is a highly allergenic annual herbaceous plant that is spreading quickly across the globe. Few studies have investigated the relationship between ragweed pollen counts and hay fever symptoms. We investigate the dose-response relationship between ragweed exposure in patients sensitized to ragweed and daily hay fever symptoms.

METHOD

A panel study was conducted among 31 adult patients sensitized to A artemisiifolia in France and Switzerland. Rhinitis, conjunctivitis, and bronchial symptoms were recorded daily, as well as daily pollen counts of ragweed, air pollutants, and meteorological data over 2 successive years. Data were analyzed with generalized estimating equation models to quantify effects of ragweed pollen whilst controlling for confounders.

RESULTS

The relationship between ragweed pollen and the percentage of patients with nasal, ocular, and bronchial symptoms was linear. For every increase of 10 grains/m3, the odds ratio (OR) (95% confidence interval) for nasal symptoms was, in 2009, 1.18 [1.04-1.35] on weekdays and 1.43 [1.16-1.75] at weekends, and in 2010, 1.04 [1.00-1.07] on weekdays and 1.25 [1.06-1.46] at weekends.The OR for ocular symptoms was 1.32 [1.16-1.56] in 2009 and 1.05 [1.02-1.07] in 2010. Finally, the OR for bronchial symptoms was 1.14 [1.03-1.25] in 2009 and 1.03 [0.97-1.08] in 2010.

CONCLUSION

There is a statistically significant linear relationship between ragweed pollen counts and hay fever symptoms. Our study shows that nasal symptoms differ on weekdays and at weekends.

Persistence of yellow fever vaccine-induced antibodies after solid organ transplantation

Immunization using live attenuated vaccines represents a contra-indication after solid organ transplantation (SOT): consequently, transplant candidates planning to travel in countries where yellow fever is endemic should be vaccinated prior to transplantation. The persistence of yellow fever vaccine-induced antibodies after transplantation has not been studied yet. We measured yellow-fever neutralizing antibodies in 53 SOT recipients vaccinated prior to transplantation (including 29 kidney recipients and 18 liver recipients). All but one (98%) had protective titers of antibodies after a median duration of 3 years (min.: 0.8, max.: 21) after transplantation. The median antibody level was 40 U/L (interquartile range: 40-80). For the 46 patients with a known or estimated date of vaccination, yellow-fever antibodies were still detectable after a median time of 13 years (range: 2-32 years) post-immunization. Our data suggest there is long-term persistence of antibodies to yellow fever in SOT recipients who have been vaccinated prior to transplantation.

A curable cause of chronic idiopathic intestinal pseudo-obstruction in children: idiopathic myositis of the small intestine

We report an intestinal pseudo-obstruction syndrome occurring in a 6-month-old infant girl suffering from acquired major and persistent abdominal distension, which 2 months later required ileostomy. Histologic examination of samples of the small intestine showed considerable inflammatory reaction in the muscular layers of the intestinal wall. Steroid therapy, begun as soon as the histologic results were known, resulted in recovery. In a similar case, reported previously, steroid therapy used after the lesions had already caused fibrosis and atrophy of the intestinal wall, proved ineffective. This particular form of pseudo-obstruction is classified as "idiopathic myositis of the small intestine." It is important to identify the condition because an early course of steroid therapy, before the appearance of fibrotic lesions, could improve the prognosis.

[Total rectal prolapse in children. Diagnostic and therapeutic trends. Statistics apropos of 52 cases]

Rectal procidentia represents classically only 2% of rectal prolapse in children. This rarity is more apparent than real, because peritoneographies showing the excess of migration of the rectogenital pouch, allows to diagnose more often this pathology. The normal trend of this anomaly of the infant and the young child even if it could be serious with strangulation is usually a spontaneous healing. Accordingly therapeutic indications should be cautious. Surgery is only indicated in confirmed or complicated forms. After analysis of the statistic of 52 observations, the modified Lockhart-Mummery is our prefered procedure. It needs a short and simple surgery and the results appear satisfactory.

[Endometriosis and ureteral stenosis. Apropos of 4 cases]

If endometriosis is particularly well known by Gynecologists, ureteral complications of this disease are very rare. We have had the occasion to observe four cases of ureteral stenosis by extrinsic compression of a pelvic endometriosis, and about these four cases, we have reviewed one hundred and fifty six cases in literature. We have emphasize that the fibrosis provoked by endometriosis can look like a neoplastic lesion, and get involved in very heavy therapeutic gestures. We insist on the fact that every endometriosis discovered should be on surgery of kidneys and ureters.

Prostate-specific antigen (PSA) in the management of 500 prostatic patients

Blood samples from 500 patients with clinical prostatic symptoms were radioimmunoassayed with prostate-specific antigen (PSA) and prostatic acid phosphatase (PAP) kits. On the basis of histological data, directed by PSA results and other investigations, 200 prostatic cancers (adenocarcinomas), 276 benign prostatic hypertrophy (BPH), 16 cases of prostatitis, 5 cancers of the bladder, and 3 prostatodynias were diagnosed. All of the serum samples from prostatic cancer patients showed elevated PSA levels at diagnosis, whereas about 70% of these showed normal PAP values. The sensitivity of the PSA assay is 100% when 2.5 ng/ml is taken as the upper limit of normal. However, the specificity and the positive predictive value are better at 10 ng/ml: 99 and 79%, respectively. High PSA values alerted the clinician when diagnosing a cancer without symptoms on rectal or ultrasonographic examination (3%). In BPH, when the PSA level is between 2.5 and 10 ng/ml, a PSA control must be performed within 2 months. If PSA increases above 10 ng/ml, the risk of cancer has to be considered. In the follow-up, PSA is a better marker than PAP to detect disease progression and seems to constitute an evolutive tumor mass index. PSA is the most sensitive, the earliest, and the most prognostically reliable marker for diagnosis and follow-up of prostate cancer patients.

[A case of very destructive dorsal spondylodiscopathy surgically treated in ankylosing spondylitis complicated by amyloidosis]

An ankylosing spondylarthritis was complicated by a D9-D10 spondylo-discopathy, with severe destructive alterations. After strict immobilization for three months, when the lesions partly regressed, non-steroid anti-inflammatory (NSAI) drugs were unable to cause a cure. An excellent result was obtained with a surgical arthrodesis after 5 years. The vertebral location was filed with fibrous tissue. The patient died from an amyloid disease with renal insufficiency. The presence of amyloid tissue in the vertebral location did not prevent a good healing of the vertebral arthrodesis.

Life Sciences: Radiobiological Advanced Biostack Experiment

The radiobiological properties of the heavy ions of cosmic radiation were investigated on Spacelab 1 by use of biostacks, monolayers of biological test organisms sandwiched between thin foils of different types of nuclear track detectors. Biostacks were exposed to cosmic radiation at several locations with different shielding environments in the module and on the pallet. Evaluations of the physical and biological components of the experiment to date indicate that in general they survived the spaceflight in good condition. Dosimetric data are presented for the different shielding environments.

[Computed x-ray tomography in the detection of venous extension in renal cancer]

With reference to eleven cases of renal cancer with involvement of the inferior vena cava, CT semeiology of this venous complication is detailed. Furthermore, the authors suggest that the images are capable of a pathological interpretation which may indicate whether the obstruction is caused by the tumor or a thrombus. Lastly, the value and limitations of CT scan for detecting caval obstructions associated with renal cancer are analyzed.

[Malignant systemic mastocytosis (author's transl)]

The case of a 37 year old man with systemic malignant cutaneous mastocytosis is reported. The outcome was fatal after eight months. Death was due to a diffuse hemorrhagic syndrome which originated in an abnormal circulating heparinoid. Nosologically, this is a border-line case between mast cell leukemia and leukemic systemic mastocytosis.