Search

The aim of this study was to evaluate the risk of catheter-associated bloodstream infection (CABSI) among different catheter types using a large prospective database in the neonatal intensive care unit (NICU) of a tertiary care centre in Switzerland. We included all neonates admitted to the NICU with at least one central intravascular catheter inserted between January 2017 and December 2020. We used marginal Cox model to determine the risk of CABSI among different catheter types. A total of 574 neonates and 1103 intravascular catheters were included in the study: 581 venous umbilical catheters, 198 arterial umbilical catheters and 324 peripherally inserted central catheters (PICCs). We identified 17, four and four CABSIs in neonates with venous umbilical catheters, arterial umbilical catheters and PICCs, respectively. The risk of CABSI increased after two days of umbilical catheter maintenance. Using univariable Cox models, and adjusting for sex and gestational age, we observed a similar CABSI risk between venous and arterial umbilical catheters (HR 0.57; 95% CI 0.16e2.08). Birth weight was associated with CABSI, with higher weight being protective (HR 0.37, 95% CI 0.16e0.81). Strategies aimed at reducing umbilical catheter dwell time, particularly in low and very low birth weight neonates, may be effective in decreasing the incidence of CABSI in this population. [ABSTRACT FROM AUTHOR]

Prophylactic lymph node dissection is considered only for papillary cancers. It is not indicated for vesicular cancers or oncocytic cancers, nor should it entail a secondary surgical intervention in the event of an incidental discovery of papillary cancer on a thyroidectomy specimen. Prophylactic lymph node dissection means a cervical lymph node dissection in the absence of any pre- or intraoperative evidence (biological, cytological, histological, clinical or ultrasound) of lymph node metastases. There is currently no evidence in the literature that prophylactic central dissection improves overall survival, which is similar for N0 and NX patients. Yet although prophylactic lymph node dissection is not justified by overall survival, it does seem to reduce the risk of locoregional recurrence in the case of micro-N1, and it allows occult metastases to be detected and a tumour to be reclassified. This enables patients at risk of recurrence to be more surely identified and therapeutic strategy and follow-up adapted accordingly. Prophylactic homolateral central lymph node dissection is warranted for papillary cancers with largest ultrasound diameter 4 cm and above and/or with intraoperative macroscopic evidence of perithyroid tissue invasion. The benefits and risks of lymph node dissection must be assessed and discussed on a case-by-case basis. Only a central lymph node dissection homolateral to the tumour is recommended, except for bilateral or isthmic cancers, for which a prophylactic bilateral central lymph node dissection may be considered. This bilateral lymph node dissection incurs an increased risk of complications (parathyroids, recurrent laryngeal nerve). Prophylactic lateral lymph node dissection is not recommended. [ABSTRACT FROM AUTHOR]

Anatomical modifications implemented during bariatric surgery not only result in weight loss, but also lead to metabolic corrections that translate into better glycemia stability and improvement in cardiovascular and liver disorders. The logical extension of surgical indications beyond mere reduction of the body mass index (BMI) (i.e. patients with < 35 kg/m2) is a hot topic today in France and worldwide. Metabolic surgeries make use of multiple modalities (endoscopic, mini-invasive, invasive) that should be carried out by trained physicians and within the same type of multidisciplinary formation as that for bariatric surgery. The aim of this update is to describe the physiological mechanisms that result in the benefits of bariatric surgery, the various procedures currently available and the perspectives for this new field in visceral and digestive surgery. [ABSTRACT FROM AUTHOR]

Background: Prompt and definitive diagnosis of adverse drug reactions (ADRs) is a challenge for health care providers. There is a global burden of ADRs worldwide associated with a negative impact on the patient's health, in parallel with increasing costs for the community. This study aims to determine the annual incidence of ADRs in the cohort of patients requiring immediate intervention of the French prehospital emergency medical service (PEMS). The definitive diagnosis of ADR was provided by the follow-up of the entire course of hospitalization from PEMS presentation to final discharge in each suspected case.Methods: A retrospective study examining the incidence of ADR at the Paris PEMS was performed in 2015.Results: From January the 1st to December the 31st, 2015, 485 cases of suspected ADR were selected. Twenty-eight patients could not be identified at the hospital and were considered as lost to follow-up. For the 457 cases with the final diagnosis and outcome available, 359 had a definitive and new diagnosis of ADR, 9 were related to substance of abuse and alcohol, 14 were duplicates and 75 were excluded by drug causality was ruled out. Long-term follow-up was performed for 359 cases. Among them, 22 patients (6.1%) died of an ADR. Twenty-five severe ADRs were notified for children ages 2 to 16 with a cluster of 9 cases (36%) resulting from an accidental outbreak of poisonings with alimemazine in a classroom. No fatality was reported among children suffering from an ADR.Conclusion: The collaboration between PEMS and in hospital Pharmacovigilance Centre is feasible from the PEMS report to the long-term follow-up. The definition of a clinical pattern for some drugs is needed to allow the medical team to anticipate the clinical outcome of the involved patient and therefore adapting the patient's support as soon as possible. [ABSTRACT FROM AUTHOR]

Copyright of Revue Francaise d'Allergologie is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revue Francaise d'Allergologie is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The value of non-invasive tests for monitoring the resolution of significant liver fibrosis after treatment is poorly investigated. We compared the performances of six non-invasive tests to predict the resolution of significant fibrosis after bariatric surgery. Participants were individuals with obesity submitted to needle liver biopsy at the time of bariatric surgery, and 12 and/or 60 months after surgery. We calculated the fibrosis-4 index (FIB-4), NAFLD fibrosis score (NFS), AST to platelet ratio index (APRI), Hepatic fibrosis score (HFS), Fibrotic NASH index (FNI), and Liver risk score (LRS) at each time point, and compared their performances for predicting significant fibrosis (F ≥ 2) and its resolution following surgery. At baseline, 2436 patients had liver biopsy, including 261 (10.7 %) with significant fibrosis. Overall, 672 patients had pre- and post-operative biopsies (564 at M12 and 328 at M60). The fibrosis stage decreased at M12 and M60 (p < 0.001 vs M0). Resolution of significant fibrosis occurred in 58/121 (47.9 %) at M12 and 32/50 (64 %) at M60. The mean value of all tests decreased after surgery, except for FIB-4. Performances for predicting fibrosis resolution was higher at M60 than at M12 for all tests, and maximal at M60 for FNI and LRS: area under the curve 0.843 (95%CI 0.71–0.95) and 0.92 (95%CI 0.84–1.00); positive likelihood ratio 3.75 (95 % CI 1.33–10.59) and 4.58 (95 % CI 1.65–12.70), respectively. Results showed the value and limits of non-invasive tests for monitoring the evolution of liver fibrosis after an intervention. Following bariatric surgery, the best performances to predict the resolution of significant fibrosis were observed at M60 with tests combining liver and metabolic traits, namely FNI and LRS. [Display omitted] • Bariatric surgery (BS) leads to the resolution of significant fibrosis in 64% of cases at 5 years • The performance of NITs for monitoring the resolution of fibrosis was limited at 1 year and improved at 5 years after BS • NITs including metabolic parameters showed better performance in predicting the resolution of fibrosis after BS [ABSTRACT FROM AUTHOR]

Purpose: There are multidien patterns of seizure occurrence. Predicting seizure risk may be easier with biomarker correlates to multidien patterns. We hypothesize multiday hyper or hypoglycemia contributes to seizure risk.Methods: In a type I diabetic (T1D) with focal onset epilepsy with continuous glucose monitoring (CGM) and responsive neurostimulation (RNS) devices, we studied multiday interictal activities (IEA), seizures, and glucose. Hourly CGM data was matched to hourly RNS captures of interictal and ictal activities over 33 months. RNS detection settings were unchanged. Multidien cycles were analyzed, active blocks of IEA and ictal episodes defined, and tissue glucose averages studied.Results: Average glucose was 161 mg/dl. A 40-day cycle of interictal and ictal activities occurred, though no similar glucose cycle was evident. Glucose elevations relative to patient average were associated with increases in IEA but not seizure. Frequent seizures were not associated with obvious elevations or decreases of glucose from baseline, most seizures occurred at +/- 10 mg/dl of average daily glucose (i.e. 150-170 mg/dl).Conclusion: Tissue glucose may influence IEA but may not influence multiday seizure activity or very frequent seizures. In an ambulatory T1D patient multiday hypo or hyperglycemic extremes do not appear to provoke seizure activities. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic commands a major reorganisation of the entire French healthcare system. In France, general rules have been issued nationally and implemented by each healthcare centre, both public and private, throughout France. Guidelines drafted by an expert group led by the French-speaking Association of Endocrine Surgery (AFCE) propose specific surgical management principles for thyroid, parathyroid, endocrine pancreas and adrenal surgery during and after the COVID-19 epidemic. [ABSTRACT FROM AUTHOR]

Introduction: Intrauterine growth restriction (IUGR) is a leading cause of perinatal mortality and morbidity, and is linked to an increased risk to develop chronic diseases in adulthood. We previously demonstrated that IUGR is associated, in female neonates, with a decreased nitric oxide (NO)-induced relaxation of the umbilical vein (UV). The present study aimed to investigate the contribution of the smooth muscle components of the NO/cyclic GMP (cGMP) pathway to this alteration.Methods: UVs were collected in growth-restricted or appropriate for gestational age (AGA) human term newborns. Soluble guanylyl cyclase (sGC) and cGMP-dependent protein kinase (PKG) were studied by Western blot, cGMP production by ELISA and cyclic nucleotide phosphodiesterases (PDEs) activity using a colorimetric assay. Contribution of PDEs was evaluated using the non-specific PDEs inhibitor 3-isobutyl-1-methylxanthine (IBMX) in isolated vessel tension studies.Results: NO-induced relaxation was reduced in IUGR females despite increased sGC protein and activity, and some increase in PKG protein compared to AGA. In males, no significant difference was observed between both groups. In the presence of IBMX, NO-stimulated cGMP production was significantly higher in IUGR than AGA females. Pre-incubation with IBMX significantly improved NO-induced relaxation in all groups and abolished the difference between IUGR and AGA females.Conclusion: IUGR is associated with sex-specific alterations in the UV's smooth muscle. The impaired NO-induced relaxation observed in growth-restricted females is linked to an imbalance in the NO/cGMP pathway. The beneficial effects of IBMX suggest that PDEs are implicated in such alteration and they could represent promising targets for therapeutic intervention. [ABSTRACT FROM AUTHOR]

Inflammation is a key contributor to the pathogenesis of bronchopulmonary dysplasia (BPD) in preterm infants, and cortisol plays a central role in controlling inflammation. Insufficient cortisol limits the ability of the sick newborn to handle stress and inhibit pulmonary inflammation. Evidence of lower cortisol and lower response to adrenocorticotropic hormone in infants subsequently developing BPD led to studies of early low-dose hydrocortisone to prevent BPD. Based on four randomised clinical trials enrolling almost 1000 extremely preterm infants, prophylaxis of early adrenal insufficiency with low-dose hydrocortisone significantly decreased BPD and mortality, as well as medical treatment for a patent ductus arteriosus. An increase in late-onset sepsis reported in the most immature infants had no adverse effect on mortality or neurodevelopmental outcomes. There was no increase in gastrointestinal perforation in the absence of indomethacin. The demonstrated beneficial effects of early low-dose hydrocortisone make a strong case for its use in extremely preterm infants at high risk for BPD. [ABSTRACT FROM AUTHOR]

Abstract Background Encapsulated follicular variant of papillary thyroid carcinoma has recently been reclassified as noninvasive follicular thyroid neoplasm with papillary-like nuclear features on the basis of its highly indolent behavior, as proposed by an international group of experienced thyroid pathologists. Methods All patients from 9 high-volume endocrine surgery departments who underwent surgery between 2005 and 2015 and whose final surgical pathology revealed noninvasive follicular thyroid neoplasm with papillary-like nuclear features (>10 mm) were included in this study. The primary outcome was to determine the potential for recurrent disease in these patients. Results Among the 363 patients with noninvasive follicular thyroid neoplasm with papillary-like nuclear features, 76% were female with a median age of 50 years (5–86 years); 345 patients (95%) underwent total thyroidectomy. A total of 65 patients had an associated micropapillary thyroid carcinoma. In the group of 133 patients who underwent prophylactic lymph node dissection (37%), 1 patient had a micrometastasis but with an associated micropapillary thyroid carcinoma. Over a median follow-up period of 5 years, 1 patient with an associated micropapillary thyroid carcinoma had recurrent disease at 6 years. All patients with noninvasive follicular thyroid neoplasm with papillary-like nuclear features without micropapillary thyroid carcinoma had no lymph node metastasis or recurrent disease. Conclusion We found that noninvasive follicular thyroid neoplasm with papillary-like nuclear features presents with indolent behavior. However, the identification of an associated micropapillary thyroid carcinoma should be carefully evaluated because it could be a factor for lymph node metastasis and/or of recurrence. [ABSTRACT FROM AUTHOR]

Red and brown seaweeds are species with high ecological and economic importance. Here we report the feasibility of cost-effective molecular marker development in 6 species from different phyla. Microsatellite markers of two brown seaweed species Alaria esculenta and Pylaiella littoralis , and of four red seaweed species Calliblepharis jubata, Gracilaria gracilis , Gracilaria dura and Palmaria palmata were identified and characterized in genomic sequences obtained using Double-Digest Restriction site Associated DNA (ddRAD). A total of 64,623,186 reads were generated from two runs of multiplexed Illumina Miseq sequencing, from which 30,636 reads containing microsatellite motifs including 15,443 where primer pairs could be designed. Five hundred seventy-six primers pairs were selected for amplification trials to determine levels of polymorphism. Of these 576 loci, 338 could be amplified and 142 of the 338 loci were polymorphic. A total of 28 usable polymorphic markers were developed in A. esculenta , 18 in P. littoralis , 11 in C. jubata , 14 in G. gracilis , 21 in G. dura and 13 in P. palmata. The overall number of alleles per locus ranged from 2 to 22. These 105 new microsatellite markers will be useful for further studies of population genetics, breeding programs and conservation genetics of these species. Compared with traditional approaches, our study yielded thousands of microsatellite loci for six different species in a short time and with affordable costs. This study, based on the use of ddRADseq, provided preliminary data about the genetic structure and reproduction mode of these six non-model species based on a small number of individuals from two geographically-distant populations and on the genetic structure and reproduction mode of two non-model species, i.e. detection of clonality for two red algae, C. jubata and G. dura and detection of highly genetically divergent populations corresponding probably to different cryptic species under the name P. littoralis. • Development of microsatellite markers using ddRAD-sequencing in 6 non-model species • Method of rapid and cost-effective microsatellite markers development • Evaluation of genetic resources, sustainable conservation in seaweed populations • Deciphering the clonality processes involved in the reproduction of seaweed species in natural populations [ABSTRACT FROM AUTHOR]

After the latest Permian mass extinction event, microbial mats filled the ecological niche previously occupied by metazoan reefs, resulting in widespread microbialites. This study focuses on the lipid biomarker (molecular fossil) and invertebrate fossil records from Neotethyan platform margin sections to understand microbial-metazoan bioherm formation. Here, we find that early Griesbachian thrombolitic and stromatolitic microbialites from Çürük Dag (Turkey) and Kuh e Surmeh (Iran) contain abundant lipid biomarkers, representing input from cyanobacteria, anoxygenic phototrophic bacteria, sulfate-reducing bacteria, and halophilic archaea. The biomarker inventory suggests that the microbialites were constructed by cyanobacteria-dominated microbial mats. Biomarkers of halophilic archaea are interpreted to reflect input from the water column, suggesting that the Neotethys experienced at least episodically hypersaline conditions. We also demonstrate that bacteria, possible keratose sponges (up to 50% of the carbonate is represented by the possible sponges), and microconchids lived synergistically to form microbial-metazoan bioherms in the immediate aftermath of the extinction along the western margin of the Neotethys. Abundant fossils of oxygen-dependent invertebrates (i.e. microconchids, bivalves, gastropods, brachiopods, and ostracods) and foraminifers were also found within these bioherms. The presence of invertebrates in conjunction with abundant molecular fossils of cyanobacteria indicates an oxygenated water column. Even though the presence of the biomarker isorenieratane in microbialites may considered as evidence for euxinic conditions in the water column, its absence in the background sediments rather points to a source organism belonging to the mat community. The new finding of bioherms built in part by metazoans suggests that reef ecosystems underwent a major turnover across the extinction event, and shortens the ‘metazoan reef gap’ to just the uppermost Changhsingian. During the Early Triassic, therefore, reefal ecosystems were able to recover in oxygenated settings since the earliest Griesbachian, albeit in an impoverished state. [ABSTRACT FROM AUTHOR]

Preterm birth disrupts important neurodevelopmental processes occurring from mid-fetal to term-age. Musicotherapy, by enriching infants' sensory input, might enhance brain maturation during this critical period of activity-dependent plasticity. To study the impact of music on preterm infants' brain structural changes, we recruited 54 very preterm infants randomized to receive or not a daily music intervention, that have undergone a longitudinal multi-shell diffusion MRI acquisition, before the intervention (at 33 weeks' gestational age) and after it (at term-equivalent-age). Using whole-brain fixel-based (FBA) and NODDI analysis (n = 40), we showed a longitudinal increase of fiber cross-section (FC) and fiber density (FD) in all major cerebral white matter fibers. Regarding cortical grey matter, FD decreased while FC and orientation dispersion index (ODI) increased, reflecting intracortical multidirectional complexification and intracortical myelination. The music intervention resulted in a significantly higher longitudinal increase of FC and ODI in cortical paralimbic regions, namely the insulo-orbito-temporopolar complex, precuneus/posterior cingulate gyrus, as well as the auditory association cortex. Our results support a longitudinal early brain macro and microstructural maturation of white and cortical grey matter in preterm infants. The music intervention led to an increased intracortical complexity in regions important for socio-emotional development, known to be impaired in preterm infants. • Preterm infants show specific WM and cortical maturation from 33 to 40 weeks GA. • Fiber density (FD) and cross-section (FC) increase in WM, indicating myelination. • In the cortex, FD decreases while FC/ODI increase, suggesting dendritic complexity. • Music enhances maturation of cortical regions implied in socio-emotional processing. [ABSTRACT FROM AUTHOR]

New investigations in the Nanpanjiang Basin indicate that the onset of the iconic microbialites associated with the Paleozoic-Mesozoic boundary was Early Triassic in age. Bathymetry (water agitation, oxygenation, light penetration) and clastic load are shown to have exerted a direct control on the growth of microbialites. Carbonate supersaturation is also required for the deposition of the microbialites. Bathymetric control is further corroborated by the inheritance of the topography of a latest Permian pull-apart basin into Early Triassic times, with a distribution of basal Early Triassic microbialites (BETM) restricted to uplifted blocks and the accumulation of carbonaceous black shales in adjacent troughs. The geographically most extensive Nanpanjiang BETM bloomed on a large NW–SE trending uplifted block exceeding 12,000 km 2 (Luolou Platform) centered on northwestern Guangxi. Post-Triassic displacements along the Youjiang Fault obscure the paleogeographic relation of BETM exposed west of this fault. Triassic foraminifers occur in the basal most BETM episode, which is locally bracketed by high-energy grainstones made of reworked Permian foraminifers. Therefore, the Permian-Triassic boundary (PTB) is within the unconformity that separates the Late Permian Heshan Fm. from the basal most BETM. Where accommodation space was sufficient, up to five event surfaces are associated with the unconformity. Microfacies analysis supports chemical dissolution but did not reveal evidence for subaerial erosion, although intercalated grainstone made of Permian foraminifers indicate reworking. Chemical dissolution and mechanical erosion both conceivably contributed to the genesis of the unconformity. The upward shift from tabulated to domical microbial build-ups is accompanied by accumulation of coquinoid lenses between domes, which indicates deepening of the Luolou Platform BETM. The main drowning resulting from both regional tectonic subsidence and a global sea-level rise led to the cessation of the BETM that were buried under predominant fine siliciclastics. Any concomitant change in sea water chemistry appears unlikely. [ABSTRACT FROM AUTHOR]

Acidification and eutrophication are common limnological stressors impacting many water bodies across the globe. While the negative impacts of these stressors on limnetic communities are generally known, their influence on the accumulation of specific sediment constituents, such as metals, remains unclear. Benefitting from past research and long-term monitoring, lakes at the International Institute for Sustainable Development - Experimental Lakes Area (IISD-ELA) in northwestern Ontario, Canada are invaluable to understand the extent to which these two common lake stressors can influence the accumulation of metals in lacustrine sediment. To address these issues, sediment cores were retrieved from six lakes: four were subjected to past experimental acidification or eutrophication and two were reference lakes. Focusing on elemental lead (Pb), a metal known to have accumulated in lake sediments worldwide and generally exhibiting a relatively small fraction of terrigenous input, we assessed the hypothesis that greater accumulation of Pb would be observed in lakes subjected to eutrophication, while the reverse was expected for lakes subjected to acidification experiments. Our analyses support this hypothesis, whereby relatively low enrichment was recorded in sediments deposited in the acidified lake during the manipulation era. On the other hand, eutrophied lakes demonstrated a strong enrichment in Pb during experimental manipulation. When investigating the mechanisms behind these divergent responses, we found epilimnetic dissolved organic carbon (DOC) and conductivity were associated with a relative increase in Pb accumulation in sediments. Acidic pH is also expected to mediate these responses by decreasing epilimnetic DOC concentrations leading to reduced Pb accumulation in the sediment. [Display omitted] • From: The impacts of whole-lake acidification and eutrophication on the accumulation of lead in sediments from manipulated lakes in the Experimental Lakes Area (IISD-ELA). • Eutrophication led to significant increases in accumulation of elemental Pb. • Acidification tended to lead to less Pb accumulation compared to Reference lakes. • Epilimnetic DOC and conductivity were positively associated with Pb accumulation. • Eutrophication and acidification act in opposite ways on DOC, mediating Pb burial. [ABSTRACT FROM AUTHOR]

Before the arrival of Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) modulators women with CF and impaired lung function were experiencing a high risk of complications and mortality during and the years after pregnancy. The arrival of the highly efficient CFTR modulator, Elexacaftor-Tezacaftor-Ivacaftor (ETI) resulted in an improvement of lung function, quality of life and fertility. Here we report a case of successful pregnancy and uncomplicated delivery for a CF patient with severely impaired lung function receiving ETI prior to conception. [ABSTRACT FROM AUTHOR]

The 2022 monkeypox outbreak, caused by the zoonotic monkeypox virus, has spread across 6 World Health Organization regions (the Americas, Africa, Europe, Eastern Mediterranean, Western Pacific, and South-East Asia) and was declared a public health emergency of international concern on July 23, 2022. The global situation is especially concerning given the atypically high rate of person-to-person transmission, which suggests viral evolution to an established human pathogen. Pregnant women are at heightened risk of vertical transmission of the monkeypox virus because of immune vulnerability and natural depletion of population immunity to smallpox among reproductive-age women, and because orthopoxviral cell entry mechanisms can overcome the typically viral-resistant syncytiotrophoblast barrier within the placenta. Data on pregnancy outcomes following monkeypox infection are scarce but include reports of miscarriage, intrauterine demise, preterm birth, and congenital infection. This article forecasts the issues that maternity units might face and proposes guidelines to protect the health of pregnant women and fetuses exposed to the monkeypox virus. We review the pathophysiology and clinical features of monkeypox infection and discuss the obstetrical implications of the unusually high prevalence of anogenital lesions. We describe the use of real-time polymerase chain reaction tests from mucocutaneous and oropharyngeal sites to confirm infection, and share an algorithm for the antenatal management of pregnant women with monkeypox virus exposure. On the basis of the best available knowledge from prenatal orthopoxvirus infections, we discuss the sonographic features of congenital monkeypox and the role of invasive testing in establishing fetal infection. We suggest a protocol for cesarean delivery to avoid the horizontal transmission of the monkeypox virus at birth and address the controversy of mother-infant separation in the postpartum period. Obstetrical concerns related to antiviral therapy with tecovirimat and vaccinia immune globulin are highlighted, including the risks of heart rate-corrected QT-interval prolongation, inaccuracies in blood glucose monitoring, and the predisposition to iatrogenic venous thromboembolism. The possibility of monkeypox vaccine hesitancy during pregnancy is discussed, and strategies are offered to mitigate these risks. Finally, we conclude with a research proposal to address knowledge gaps related to the impact of monkeypox infection on maternal, fetal, and neonatal health. [ABSTRACT FROM AUTHOR]

While water is known to significantly reduce the strength of rocks, there remains a paucity of data on water-weakening of gypsum. Here, we quantify water-weakening in a natural gypsum facies from Monferrato (Italy) by performing experiments on nominally dry, oil-saturated, and water-saturated samples. Uniaxial and conventional triaxial experiments revealed significant water-weakening in Monferrato gypsum as well as a strong strain-rate dependence of uniaxial compressive strength. Moreover, uniaxial creep tests showed significant time-dependent deformation in samples saturated with sulphate over-saturated water, but not in dry and oil-saturated samples. The creep phenomenology is similar to that observed in other rock types and is consistent with stress-corrosion microcracking, which is supported by our microstructural observations. However, we systematically recorded more inelastic strain in samples deformed at low strain-rates suggesting that additional mechanisms were also active. Comparing our new data on short-term strength with published results for other rock types, we conclude that, when saturated with water in equilibrium with the rock, weakening in gypsum is not notably higher than in other rocks and is partially due to a reduction of fracture toughness in the presence of water. [ABSTRACT FROM AUTHOR]

Abstract: This study observes the evolution of persons with pervasive developmental disorders (PDD) and profound intellectual disabilities living in residences with a Program for Residents with Autism Spectrum Disorders (ASD) characterised by a different educator''s presence ratio and different logistic accommodations. This population is characterised by the need to live in a very structured and predictable environment and greatly benefits from specific programs in residential settings. We evaluated the evolution during 2.5 years of 2 groups of 10 residents using the Aberrant Behaviour Checklist (ABC) and the Children Autism Rating Scale (CARS). Evolution appears to be slow and irregular but we observed significant changes in social withdrawal along the study for one group. Possible implications of this study are discussed. [Copyright &y& Elsevier]

Active sodium-glucose transporters play a role to glucose homeostasis and represent novels targets for the management of type 2 diabetes (T2D). Sodium-glucose cotransporter 1 (SGLT1) is essential for intestinal glucose absorption from the lumen into enterocytes, whereas glucose reabsorption by the kidney is mainly mediated by sodium-glucose cotransporter 2 (SGLT2). SGLT2 inhibitors were developed to occlude SGLT2 glucose reabsorption pathway and cause glycosuria, thereby reducing plasma glucose concentrations. This new class of antidiabetic drugs has been shown to be effective in reducing cardiovascular morbidity and mortality in patients with T2D. Initial clinical studies also suggest that SGLT1 inhibition increases glucagon-like peptide 1 (GLP-1) secretion and decreases postchallenge blood glucose excursion, resulting in a dose-dependent improvement of glucose control. In parallel, we recently identified a previously unknown effect of bile diversion in gastric bypass on sodium glucose transport and postprandial glucose homeostasis, through the modulation of intestinal trafficking of endogenous sodium. This mechanism is consistent with available clinical evidence, and opens up new perspectives in metabolic surgery. More generally, the modulation of intestinal sodium-glucose cotransport appears to be a promising avenue to prevent or treat T2D. [ABSTRACT FROM AUTHOR]

Background/purpose Obesity has become a major public health priority. Because of disappointing results obtained with dietary and medical programs, bariatric surgery has been offered to adolescents, although this practice remains controversial. Our aim was to evaluate laparoscopic adjustable gastric banding (LAGB) in adolescents at 2-year follow-up. Material and methods This prospective study, from 2008 to 2013, compared results between adolescent patients and young adult controls. The LAGB technique and the follow-up program were similar. Weight loss and comorbid disease were analyzed. Results Thirty-six adolescents (mean age at surgery = 16.7 ± 1.3 years) were operated on and compared to 53 young adults (mean age at surgery = 21.7 ± 1.9 years). The mean weight and BMI at surgery were 124.4 ± 20.7 and 43.9 ± 5.5 kg/m 2 , respectively. Among the adolescents, none were diabetic or hypertensive. The mean glycated hemoglobin was 5.6 ± 1.2%. In four cases (11%) dyslipidemia was observed. There was no significant difference between the two groups in terms of initial preoperative weight or BMI. The absolute BMI values at 6, 12 and 24 months after surgery were comparable between adolescents and young adults: 38.7 vs 39.8, 36.0 vs 37.6 and 33.5 vs 36.1 kg/m 2 , respectively. The excess weight loss was higher in adolescents at 12 and 24 months: 48.6 vs 37.6% ( p = 0.03); and 62.3 vs 45.5% ( p = 0.02). During this period, insulin resistance and dyslipidemia decreased similarly in both groups. Conclusion Provided there is careful selection of patients and a supportive multidisciplinary team, satisfying results can be obtained after LAGB in adolescents, comparable to those obtained in young adults at 2-year follow-up. [ABSTRACT FROM AUTHOR]

Introduction Induced birth of fetuses with gastroschisis from 34 weeks gestational age (GA) has been proposed to reduce bowel damage. We aimed to determine the effect of birth timing on time to full enteral feeds (ENT), length of hospital stay (LOS), and sepsis. Methods A retrospective analysis (2000–2014) of gastroschisis born at ≥ 34 weeks GA was performed. Associations between birth timing and outcomes were analyzed by Mann–Whitney test, Cox regression, and Fisher's exact test. Results 217 patients were analyzed. Although there was no difference in ENT between those born at 34–36 + 6 weeks GA (median 28 range [6–639] days) compared with ≥ 37 weeks GA (27 [8–349] days) when analyzed by Mann–Whitney test (p = 0.5), Cox regression analysis revealed that lower birth GA significantly prolonged ENT (p = 0.001). LOS was significantly longer in those born at 34–36 + 6 weeks GA (42 [8–346] days) compared with ≥ 37 weeks GA 34 [11–349] days by both Mann–Whitney (p = 0.02) and Cox regression analysis (p < 0.0005). Incidence of sepsis was higher in infants born at 34–36 + 6 weeks (32%) vs. infants born at ≥ 37 weeks (17%; p = 0.02). Conclusions Early birth of fetuses with gastroschisis was associated with delay in reaching full enteral feeds, prolonged hospitalization, and a higher incidence of sepsis. [ABSTRACT FROM AUTHOR]

Summary Gastro-intestinal exclusion by Roux-en-Y gastric bypass (RYGB) improves glucose metabolism, independent of weight loss. Although changes in intestinal bile trafficking have been shown to play a role, the underlying mechanisms are unclear. We performed RYGB in minipigs and showed that the intestinal uptake of ingested glucose is blunted in the bile-deprived alimentary limb (AL). Glucose uptake in the AL was restored by the addition of bile, and this effect was abolished when active glucose intestinal transport was blocked with phlorizin. Sodium-glucose cotransporter 1 remained expressed in the AL, while intraluminal sodium content was markedly decreased. Adding sodium to the AL had the same effect as bile on glucose uptake. It also increased postprandial blood glucose response in conscious minipigs following RYGB. The decrease in intestinal uptake of glucose after RYGB was confirmed in humans. Our results demonstrate that bile diversion affects postprandial glucose metabolism by modulating sodium-glucose intestinal cotransport. [ABSTRACT FROM AUTHOR]

In most Latin American countries, issues concerning water governance and control also reflect broader conflicts over authority and legitimacy between the state and civil society. What lies behind the diverse water policy reforms is not simply a question of governing water affairs but also a drive to control or co-opt water user groups. This paper examines the efforts by the present Ecuadorian government to ‘control water users’ through new forms of ‘governmentality’ ( Foucault, 1991 ). We use the ‘cathedral and bazaar’ metaphor ( Lankford and Hepworth, 2010 ) to illustrate government rationale and practices in water governance shifts in the last decades. We analyze how Rafael Correa’s government sets out to reshape the relations between state, market and society. In its ‘Twenty-first Century Socialism’ project, based on a proclaimed ‘Citizen Revolution’, actual policy reform does not reverse but rather transforms the process of neoliberalizing water governance – creating a hybrid bazaar-cathedral model. We argue that the current water govermentality project implements reforms that do not challenge established market-based water governance foundations. Rather it aims to contain and undermine communities’ autonomy and ‘unruly’ polycentric rule-making, which are the result of both historical and present-day processes of change. Interestingly, water user federations that emerged during the neoliberal wave of the last two decades now claim water control space and search for new forms of democratizing water governance. They act as agents who fiercely – yet selectively and strategically – oppose both elements of the State-centered (cathedral) and market-based (bazaar) water governance models. [ABSTRACT FROM AUTHOR]

Introduction Intrauterine growth restriction (IUGR) affects ∼8% of all pregnancies and is associated with major perinatal mortality and morbidity, and with an increased risk to develop cardiovascular diseases in adulthood. Despite identification of several risk factors, the mechanisms implicated in the development of IUGR remain poorly understood. In case of placental insufficiency, reduced delivery of oxygen and/or nutrients to the fetus could be associated with alterations in the umbilical circulation, contributing further to the impairment of maternal–fetal exchanges. We compared the structural and functional properties of umbilical cords from growth-restricted and appropriate for gestational age (AGA) term newborns, with particular attention to the umbilical vein (UV). Methods Human umbilical cords were collected at delivery. Morphological changes were investigated by histomorphometry, and UV's reactivity by pharmacological studies. Results Growth-restricted newborns displayed significantly lower growth parameters, placental weight and umbilical cord diameter than AGA controls. Total cross-section and smooth muscle areas were significantly smaller in UV of growth-restricted neonates than in controls. Maximal vasoconstriction achieved in isolated UV was lower in growth-restricted boys than in controls, whereas nitric oxide-induced relaxation was significantly reduced in UV of growth-restricted girls compared to controls. Conclusion IUGR is associated with structural alterations of the UV in both genders, and with a decreased nitric oxide-induced relaxation in UV of newborn girls, whereas boys display impaired vasoconstriction. Further investigations will allow to better understand the regulation of umbilical circulation in growth-restricted neonates, which could contribute to devise potential novel therapeutic strategies to prevent or limit the development of IUGR. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Intrauterine Growth Restriction (IUGR) is a multifactorial disease defined by an inability of the fetus to reach its growth potential. IUGR not only increases the risk of neonatal mortality/morbidity, but also the risk of metabolic syndrome during adulthood. Certain placental proteins have been shown to be implicated in IUGR development, such as proteins from the GH/IGF axis and angiogenesis/apoptosis processes. Methods: Twelve patients with term IUGR pregnancy (birth weight < 10th percentile) and 12 CTRLs were included. mRNA was extracted from the fetal part of the placenta and submitted to a subtraction method (Clontech PCR-Select cDNA Subtraction). Results: One candidate gene identified was the long non-coding RNA NEAT1 (nuclear paraspeckle assembly transcript 1). NEAT1 is the core component of a subnuclear structure called paraspeckle. This structure is responsible for the retention of hyperedited mRNAs in the nucleus. Overall, NEAT1 mRNA expression was 4.14 (±1.16)-fold increased in IUGR vs. CTRL placentas (P = 0.009). NEAT1 was exclusively localized in the nuclei of the villous trophoblasts and was expressed in more nuclei and with greater intensity in IUGR placentas than in CTRLs. PSPC1, one of the three main proteins of the paraspeckle, co-localized with NEAT1 in the villous trophoblasts. The expression of NEAT1_2 mRNA, the long isoform of NEAT1, was only modestly increased in IUGR vs. CTRL placentas. Discussion/conclusion: The increase in NEAT1 and its co-localization with PSPC1 suggests an increase in paraspeckles in IUGR villous trophoblasts. This could lead to an increased retention of important mRNAs in villous trophoblasts nuclei. Given that the villous trophoblasts are crucial for the barrier function of the placenta, this could in part explain placental dysfunction in idiopathic IUGR fetuses. [Copyright &y& Elsevier]

Objective: The objective of this study was to evaluate long-term survival and prognostic factors in patients with malignant pleural mesothelioma. Methods: All consecutive patients referred for surgical diagnosis and/or pleurodesis for malignant pleural mesothelioma between 2000 and 2010 were studied. The following parameters were prospectively recorded: age, sex, tobacco consumption, asbestos exposure, type and duration of symptoms, American Society of Anesthesiologists (ASA) score, body mass index, preoperative C-reactive protein levels, white blood cells and platelet count, pachypleuritis on chest radiograph, type of diagnostic surgical procedure, histologic type, modality of pleurodesis, and chemotherapy. Survival was assessed on March 1, 2011. Results: A total of 170 patients were included. For the entire population, median survival was 12 months (95% confidence interval [CI], 10-15). Two-, 5-, and 7-year overall survival was 26% (95% CI, 19-35), 11% (95% CI, 6-21), and 5% (95% CI, 9-22), respectively. Asbestos exposure, age, ASA class III versus ASA classes I and II, nonepithelioid histology, C-reactive protein levels >3 mg/L, and white cell count >12,000/mm3 influenced outcome in univariate analysis. Multivariate analysis showed that nonepithelioid histology (hazard ratio [HR], 2.76; 95% CI, 1.50-5.08); age (HR, 1.05; 95% CI, 1.01-1.08); C-reactive protein levels between 4 and 50 mg/L, and >51 (HR, 2.28; 95% CI, 1.18-4.42; and HR, 2.69; CI, 1.29-5.60, respectively); and leukocytosis >12,000/mm3 (HR, 2.28; 95% CI, 1.22-4.25) were independent worse survival predictors. Conclusions: Median survival in an unselected population of patients with malignant pleural mesothelioma treated nonsurgically is 12 months. Nonepithelioid histology, older age, abnormal C-reactive protein levels, and leukocytosis are independent predictors of worse survival. [Copyright &y& Elsevier]

Use of cardiac allograft for transplantation from donors after acute poisoning is a matter of debate because of potential toxic organ injuries, especially if death results from massive ingestion of cardiotoxic drugs. We report successful allograft cardiac transplantation from a brain-dead patient after severe flecainide and betaxolol self-poisoning requiring extracorporeal life support. Extracorporeal life support was initiated in the emergency department because of a refractory cardiac arrest caused by the cardiotoxicants'' ingestion and continued after the onset of brain death to facilitate organ donation of the heart, liver, and kidneys. Forty-five months later, each organ recipient was alive, with normal graft function. [Copyright &y& Elsevier]

Abstract: Analyzing the heterogeneity in metropolitan areas of India utilizing remote sensing data can help to identify more precise patterns of sub-standard residential areas. Earlier work analyzing inequalities in Indian cities employed a constructed index of multiple deprivations (IMDs) utilizing data from the Census of India 2001 (http://censusindia.gov.in). While that index, described in an earlier paper, provided a first approach to identify heterogeneity at the citywide scale, it neither provided information on spatial variations within the geographical boundaries of the Census database, nor about physical characteristics, such as green spaces and the variation in housing density and quality. In this article, we analyze whether different types of sub-standard residential areas can be identified through remote sensing data, combined, where relevant, with ground-truthing and local knowledge. The specific questions address: (1) the extent to which types of residential sub-standard areas can be drawn from remote sensing data, based on patterns of green space, structure of layout, density of built-up areas, size of buildings and other site characteristics; (2) the spatial diversity of these residential types for selected electoral wards; and (3) the correlation between different types of sub-standard residential areas and the results of the index of multiple deprivations utilized at electoral ward level found previously. The results of a limited number of test wards in Delhi showed that it was possible to extract different residential types matching existing settlement categories using the physical indicators structure of layout, built-up density, building size and other site characteristics. However, the indicator ‘amount of green spaces’ was not useful to identify informal areas. The analysis of heterogeneity showed that wards with higher IMD scores displayed more or less the full range of residential types, implying that visual image interpretation is able to zoom in on clusters of deprivation of varying size. Finally, the visual interpretation of the diversity of residential types matched the results of the IMD analysis quite well, although the limited number of test wards would need to be expanded to strengthen this statement. Visual image analysis strengthens the robustness of the IMD, and in addition, gives a better idea of the degree of heterogeneity in deprivations within a ward. [Copyright &y& Elsevier]

A 72-year-old flecainide-poisoned woman developed refractory cardiogenic shock treated with veno-arterial extracorporeal membrane oxygenation (ECMO). Ten days after weaning ECMO, she developed Lance and Adams Syndrome and delayed Parkinsonism despite the absence of circulatory arrest onset. Magnetic resonance imaging (MRI) showed isolated globi pallidi infarcts explaining the patient’s Parkinsonism. We emphasize the unusual concomitance of these two entities. Furthermore, this case highlights the need for early MRI in ECMO-treated patients presenting persistent abnormal neurological examination on ECMO weaning to guide appropriate further pharmacological treatment and rehabilitation. [ABSTRACT FROM AUTHOR]

Copyright of Archives of Cardiovascular Diseases is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Summary: Bronchopulmonary dysplasia is a chronic lung disease that affects premature infants and contributes to their morbidity and mortality. With the advent of prenatal steroids and postnatal exogenous surfactant and less aggressive respiratory support, premature infants can develop chronic oxygen dependency without even acute respiratory distress. This ‘new bronchopulmonary dysplasia’ could be the result of impaired postnatal growth. Several experimental studies have suggested a possible role of the vascular endothelial growth factor/nitric oxide (VEGF/NO) pathway in restoring pulmonary angiogenesis and enhancing distal lung growth. The results of the clinical studies are, however, inconclusive, and it is currently unclear which subsets of premature infants might benefit from inhaled nitric oxide. Besides, severe intracranial haemorrhage and/or cystic periventricular leucomalacia may affect the most immature babies, many of whom are spared from severe initial respiratory disease. Recently, inhaled nitric oxide was shown to significantly decrease the incidence of these neurological events, and to improve the long-term outcome in a few clinical trials. At times neuroprotective, at times neurotoxic, nitric oxide is capable of divergent effects depending upon the extent of cerebral damage, the redox state of the cell, and the experimental model used. Recently, our group found that inhaled nitric oxide had remote effects including angiogenesis and maturation on the developing brain in rodent pups. Thus, we await the results of the recently completed randomised clinical trial of inhaled nitric oxide to prevent bronchopulmonary dysplasia (the European Nitric Oxide or ‘EUNO’ trial) where, besides the primary endpoint of chronic oxygen dependency reduction at 36 weeks'' postconceptional age, long-term lung and brain will be followed-up until 7 years of age. [Copyright &y& Elsevier]

Summary: Antenatal glucocorticoid therapy remains one of the most striking successes in the perinatal management of complicated pregnancies that result in premature birth. The anti-inflammatory and maturative properties of fluorocorticoids are such that all women at risk of preterm delivery before 34weeks gestation should be treated. Betamethasone is preferred to dexamethasone and no more than two courses, 2weeks apart, should be given until the evidence from further controlled trials on repeated doses becomes available. In particular, the early use of postnatal dexamethasone should be avoided in preterm infants because of the deleterious effects on neurological development, including not only cerebral palsy but also cognitive function and psychiatric-related behavior. Treatment with other steroids should be restricted to the context of randomized controlled trials. [Copyright &y& Elsevier]

Abstract: This chart review was undertaken to assess efficacy and safety of hydroxocobalamin for acute cyanide poisoning. Hospital records of the Fernand Widal and Lariboisière Hospitals were reviewed for intensive care unit admissions with cyanide poisoning for which hydroxocobalamin was used as first-line treatment from 1988 to 2003. Smoke inhalation cases were excluded. Hydroxocobalamin (5-20 g) was administered to 14 consecutive patients beginning a median 2.1 hours after cyanide ingestion or inhalation. Ten patients (71%) survived and were discharged. Of the 11 patients with blood cyanide exceeding the typically lethal threshold of 100 μmol/L, 7 survived. The most common hydroxocobalamin-attributed adverse events were chromaturia and pink skin discoloration. Severe cyanide poisoning of the nature observed in most patients in this study is frequently fatal. That 71% of patients survived after treatment with hydroxocobalamin suggests that hydroxocobalamin as first-line antidotal therapy is effective and safe in acute cyanide poisoning. [Copyright &y& Elsevier]

Study objective: To assess outcomes in patients treated with hydroxocobalamin at the fire scene or in the ICU for suspected smoke inhalation-associated cyanide poisoning. Methods: Adult smoke inhalation victims with suspected cyanide poisoning as determined by soot in the face, mouth, or nose or expectorations and neurologic impairment received an intravenous infusion of hydroxocobalamin 5 g (maximum 15 g) at the fire scene or in the ICU in this observational case series conducted from 1987 to 1994. Blood cyanide specimens were collected before administration of hydroxocobalamin. The threshold for cyanide toxicity was predefined as greater than or equal to 39 μmol/L. Results: The sample included 69 patients (mean age 49.6 years; 33 men), of whom 39 were comatose. Out-of-hospital deaths were excluded. Fifty of the 69 patients (72%) admitted to the ICU survived after administration of hydroxocobalamin. In the group in which cyanide poisoning was confirmed a posteriori (n=42), 67% (28/42) survived after administration of hydroxocobalamin. The most common adverse events were chromaturia (n=6), pink or red skin discoloration (n=4), hypertension (n=3), erythema (n=2), and increased blood pressure (n=2). No serious adverse events were attributed to hydroxocobalamin. Laboratory tests revealed transient alterations in renal and hepatic function consistent with the critical condition of the patients and mild anemia consistent with progressive hemodilution. Conclusion: Empiric administration of hydroxocobalamin was associated with survival among 67% of patients confirmed a posteriori to have had cyanide poisoning. Hydroxocobalamin was well tolerated irrespective of the presence of cyanide poisoning. Hydroxocobalamin appears to be safe for the out-of-hospital treatment of presumptive cyanide poisoning from smoke inhalation. [Copyright &y& Elsevier]