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Portable in situ ultraviolet-visual spectrometers, through high frequency water quality measurements, provide new insight into biogeochemical processes occurring within dynamic ecosystems. Nitrogen and carbon cycling were observed in two distinct wetland mesocosm environments during a two-year mesocosm study. Simulated drainage water was loaded into the mesocosms across seasons with target nitrate-N levels between 2.5 and 10 mg L−1. Nitrate-N and dissolved organic carbon concentrations in the water column were measured hourly with the spectrometer and calibrated with water quality grab samples. Prominent and unique diel cycles were observed in both nitrate-N and dissolved organic carbon readings from the spectrometer, which reveal biogeochemical processes in these systems are more complicated than typically considered in empirical models. Findings support the importance of utilizing high frequency monitoring to advance current knowledge of nitrogen and carbon processes occurring in treatment wetland ecosystems.

Nebraskan streams contribute excess nitrogen to the Mississippi/Atchafalaya River Basin and Gulf of Mexico, which results in major water-quality impairments. Reducing the amount of nitrogen (N) exported in these streams requires the use of best management practices (BMPs) within the landscape. However, proper BMP utilization has rarely been statistically connected to potential controls of N export within watersheds, particularly precipitation and soil characteristics. In this study, 19 watershed variables were evaluated in five categories (hydrological, physiographic, point sources, land use, and soil properties) to determine the characteristics that influenced variable nitrate nitrogen (NO3-N) concentrations in 17 Nebraska watersheds with known high NO3-N export rates. Each characteristic was derived from publicly-available datasets in an effort to develop a multiregional method. Of the 19 variables evaluated, 10 variables (developed, cropland, herbaceous, forest, excessively-drained soils, precipitation, base-flow index, slope, organic matter and point sources) were identified to statistically influence stream NO3-N concentrations. The 17 watersheds were divided into five subset groups using principal component analysis. Distributions of the 10 watershed variables were then used to determine the most applicable BMPs for NO3-N reductions for each stream subset: excessively drained with high baseflow index (Groups 1 and 2), dominantely row crop land usage with well-drained soils, higher precipitation, and an increased tendency for surface runoff concerns (Group 3), highly developed watersheds (Group 4), and single river dominated by wastewater treatment plant discharge (Group 5). Based on the most influential variables a variety of BMPs were recommended, including N fertilizer application management and accounting for N credit from mineralization and NO3-N in irrigation water (Groups 1 and 2), installation of riparian buffers and wetlands (Group 3), urban BMPs such as bioretention cells and permeable pavement (Group 4), and upgrades to the wastewater treatment plant (Group 5). This study provides an improved technique for facilitating watershed management by linking BMPs directly to the characteristics of each watershed to reduce current nitrate export.

Efforts to improve water quality of eutrophic ponds often involve implementing changes to watershed management practices to reduce external nutrient loads. While this is required for long-term recovery and prevention, eutrophic conditions are often sustained through the recycling of internal nutrients already present within the waterbody. In particular, internal phosphorus bound to organic material and adsorbed to sediment has the potential to delay lake recovery for decades. Thus, pond and watershed management techniques are needed that not only reduce external nutrient loading but also mitigate the effects of internal nutrients already present. Therefore, our objective was to demonstrate a biological and chemical approach to remove and sequester nutrients present and entering an urban retention pond. A novel biological and chemical management technique was designed by constructing a 37 m

Floating treatment wetlands are an innovative wetland design to passively improve water quality and remove pollutants from reservoirs with limited infrastructure modification or construction as compared to traditional treatment wetlands. However, design recommendations remain limited. Therefore, the objectives of this study were: 1. Determine nitrate-N removal rates in two floating treatment wetland vegetation designs entering a second growing season and 2. Evaluate nitrate-N removal performance in floating treatment wetland designs following the addition of two carbon amendments during the growing season. Three floating treatment wetland mesocosm experiments were conducted during the summer of 2019, where nitrate-N removal was evaluated. Two floating treatment wetland plant designs (Rush species and Diverse species) and three carbon conditions (no amendment, spent coffee grounds, and barley straw) were assessed in replicates of three. Floating treatment wetland vegetation design (Rush versus Diverse) was found to have significant (P

Introduction Les études vaccinales de grande ampleur et les registres apportent des résultats précieux mais souvent de manière retardée par rapport à l’urgence pandémique. Les perfusions de biologiques intraveineux en hôpital de jour (HDJ) permettent de garantir un recueil de données fiables en temps réel. C’est ainsi que nous avions mis en évidence le surrisque d’une forme grave de COVID-19 sous rituximab. Nous avons souhaité étudier l’impact des bDMARDs sur la réponse vaccinale humorale des patients suivis en HDJ. Patients et méthodes Nous avons étudié la réponse vaccinale après un schéma vaccinale complet, 2 ou 3 doses de vaccin, suivis en hôpital de jour dans 5 centres hospitaliers français et traités par un biomédicament intraveineux entre septembre 2019 et août 2021. Après information et consentement des patients, nous avons inclus ceux disposant ou acceptant de réaliser une sérologie anti-SARS-CoV-2. Les patients étaient considérés comme non-répondeurs si le taux d’anticorps détecté était inférieur au seuil de positivé du kit utilisé. Résultats Sur les 925 patients suivis en HDJ dans les 5 centres, les données préliminaires de 205 patients sont disponibles (148 F/57 H). L’âge médian était de 64 ans (Interquartile Range [IQR] 56–71). 25 étaient traités par tocilizumab (TCZ), 36 par abatacept (ABA), 53 par infliximab (IFX) et 91 par rituximab (RTX). 156 étaient traités pour une PR, 33 pour une spondyloarthrite et 16 pour une autre pathologie (connectivite n = 5, myosite n = 3, vascularite n = 2, arthrite juvénile idiopathique n = 2, autres n = 4). 25 patients étaient co-traités par corticoïdes, 126 par csDMARDs et 2 par d’autres immunossuppresseurs (aziathioprine). Trois quarts des patients traités par RTX ont débuté leur schéma vaccinal plus de 4 mois après leur dernier cycle de traitement. Un total de 23 patients avaient un antécédent de COVID-19 confirmé (par PCR ou sérologie). Un total de 169 patients ont été vaccinés par Pfizer, 16 par Astra-Zeneca, 14 par Moderna, 5 par Janssen et un par Astra-Zeneca puis Pfizer. Un total de 167 patients ont bénéficié d’une sérologie après 2 doses de vaccin (ou un schéma vaccinal complet en cas de COVID-19 préalable). Parmi eux, 28 (16,8 %) étaient non-répondeurs. Il n’y avait pas de différence en fonction de l’âge (p = 0,24) ou du sexe des patients (p = 0,51), du type de pathologie ou du co-traitement par corticoïdes ou csDMARD. La réponse vaccinale était différente en fonction du bDMARD utilisé (p = 0,0003) : aucun patient traité par IFX (0/42) n’était non-répondeur, un seul sous TCZ (1/25, 4 %) contre 25 % sous ABA (8/32) et 27,9 % sous RTX (19/68). Un total de 94 % des non répondeurs après 2 ou 3 doses de vaccin avaient été traités par RTX ou ABA. Chez les patients traités par rituximab, le délai entre la dernière perfusion et la première dose de vaccin était significativement plus courte chez les non-répondeurs (médiane 4,3 IQR [2,9–6,1] mois chez les non-répondeurs versus 8,4 IQR [5,7–14,5] chez les répondeurs, p = 0,0007). La diminution de réponse vaccinale post-ABA ou RTX étaient similaires après 3 doses de vaccin (56 patients), 25 % de non répondeurs sous ABA (1/4), 25 % sous RTX (10/40) contre 19 % sous IFX (9/11) et aucun sous TCZ (0/1). 18 des 56 patients ont bénéficié d’une sérologie après 2 doses et également après 3 doses de vaccin. 7 étaient non-répondeurs après 2 doses (6 RTX et 1 TCZ). Parmi eux, 5 sont restés non-répondeurs après leur 3e dose, tous traités par RTX. Conclusion L’ABA et le RTX altèrent la réponse vaccinale anti-SARS-CoV-2 : associés à 94 % des non-réponses vaccinales. La réponse vaccinale est altérée si un délai suffisant n’est pas respecté entre la perfusion de RTX, permettant une repopulation lymphocytaire B, et la vaccination.

Stabilization projects are increasingly used to mitigate the effects of anthropogenic streambank erosion, yet the effectiveness of stabilization has been insufficiently measured. Sound monitoring practices inform adjustments in implementation and maintenance, which improve engineered effectiveness. Thus, the objectives of this study were to: 1) measure streambank migration from in three reaches stabilized with wooden jetties following a major flooding event, and 2) quantify deposition around the jetties between pre-flood and post-flood. Streambank deposition was measured in 2019 with a River Surveyor and Global Positioning System (GPS). Bank erosion rates in Reaches 1, 2 and 3 were 0.41, 0.96 and 0.07 m2 m−1 yr−1, respectively, from pre-installation of wooden jetties. After streambanks in these reaches were stabilized, Reach 1 experienced 0.11 m2 m−1 yr−1 of erosion while Reaches 2 and 3 had 0.13 and 0.01 m2 m−1 yr−1 of deposition. Deposition increased in 2019 (1.61 and 0.81 m2 m−1) following a high magnitude flood. We utilized a new method for quantifying accumulated sediment in stream beds and banks. Our application of this new method demonstrates that jetties in the Cedar River have decreased streambank migration and increased sediment deposition at the point of implementation. The quantification of stream-sediment dynamics near jetties provides crucial information for stream-restoration design and decision-making, specifically for bioengineering design implementation.

Quantitative information about the fate of applied nitrate (NO 3 -N) in pulse-flow constructed wetlands is essential for designing wetland treatment systems and assessing their nitrogen removal services for agricultural and stormwater applications. Although many studies have documented NO 3 -N losses in wetlands, controlled experiments indicating the relative importance of different processes and N sinks are scarce. In the current study, 15 NO 3 -N isotope enrichment tracer experiments were conducted in wetland mesocosms of two different wetland soil types at two realistic agricultural NO 3 -N source loads. The 15 N label was traced from the source NO 3 -N into plant biomass, soil (including organic matter and ammonium), and N-gas constituents over 7–10 day study periods. All sinks responded positively to higher NO 3 -N loading. Plant uptake exceeded denitrification 2–3 fold in the low NO 3 -N loading experiments, while both fates were nearly equivalent in the high loading experiments. One to two years later, soils largely retained the assimilated tracer N, whereas plants had lost much of it. Results demonstrated that plant and microbial assimilation in the soil (temporary N sinks) can exceed denitrification (permanent N loss) in pulse-flow environments and must be considered by wetland designers and managers for optimizing nitrogen removal potential.

Wetland restoration is often conducted in Eastern U.S. coastal plain watersheds alongside agricultural lands that frequently export significant amounts of nitrogen in drainage water. Restoration plans that incorporate the addition of agricultural drainage water can simultaneously increase the success of achieving a target hydroperiod and reduce discharge of nitrogen to nearby surface water. The potential nitrogen removal effectiveness of two wetland restoration sites with such a restoration plan was evaluated in a two-year mesocosm study. Six large wetland mesocosms (3.5 m long × 0.9 m wide × 0.75 m deep) along with unplanted controls were used in this experiment. Three replicates of two soils that differed in organic matter and pH were planted with soft-stem bulrush (Schoenoplectus tabernaemontani) and allowed to develop in the two growing seasons prior to the study. Simulated drainage water was loaded into the mesocosms over eighteen batch studies across seasons with target nitrate-N levels between 2.5 to 10 mg L−1. Grab samples were collected from the water column and analyzed for nitrate-N, dissolved organic carbon, and chloride, along with other environmental parameters such as pH, water temperature, and soil redox. Seasonally, nitrogen and carbon within the wetland plants and soil were also measured. Multivariate statistical analyses were utilized to determine differences in nitrate-N reductions between treatments. Variables included carbon availability, temperature, antecedent moisture condition, nitrogen loading, and water pH. Contrary to the hypothesis that higher nitrate-N removal rates would be observed in the wetlands with higher organic matter, overall removal rates were higher in the wetland mesocosms containing Deloss soils (WET-Min) (maximum of 726 mg m−2 d−1) than those containing Scuppernong soil (WET-Org) (maximum of 496 mg m−2 d−1) and were dependent on daily NO3-N concentrations and season. Significant differences in NO3-N removal were found between seasons and soil types (α = 0.05), which helped to provide insight to the expected magnitude of nitrogen removal within these systems throughout the year, and potential mechanisms (i.e. denitrification vs. plant uptake) that will govern these removals.

Introduction Le risque evolutif de l’infection au nouveau coronavirus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2], responsable de la maladie a coronavirus-2019 [COVID-19]) dans la population de patients atteints de rhumatismes inflammatoires chroniques (RIC) sous traitements immunomodulateurs (disease-modifying-anti-rheumatic drugs [DMARDs]) est incompletement connu. Cette population de patients immunodeprimes est consideree jusqu’a preuve du contraire comme une population a risque de formes severes de COVID-19. Cette etude a ete menee pour evaluer le degre de severite et l’issue de l’infection a SARS-CoV-2/COVID-19 chez les patients avec RIC exposes a des DMARDs, en pratique courante rhumatologique, au sein d’un des epicentres francais de la pandemie. Patients et methodes Nous avons mene entre mars et aout 2020 une etude observationnelle retrospective monocentrique aux hopitaux civils de Colmar (Alsace ; France) dediee a la collection des donnees des patients suivis pour un RIC ou une maladie auto-immune systemique qui ont developpe une infection a SARS-CoV-2, documentee par RT-PCR sur prelevements nasopharynges, ou de facon retrospective par la serologie (IgM/IgG diriges contre le SARS-CoV-2) et/ou sur la mise en evidence d’une pneumopathie bilaterale typique au scanner thoracique. Les caracteristiques cliniques des patients et les modalites d’immunomodulation (DMARDs conventionnels [csDMARDs], biologiques [bDMARDs] ou cibles [tsDMARDs]) ont ete collectees et analysees au regard de l’evolution benigne, moderee ou severe du COVID-19 et de l’issue de l’infection (guerison/deces). Resultats Un total de 19 patients, dont 9 polyarthrites rhumatoides, 6 spondyloarthrites, 2 syndromes de Sjogren primaire, 1 arterite a cellules geantes et 1 maladie de Still de l’adulte, ont ete confirmes par RT-PCR pour 10 patients (52,6 %), par serologie pour 8 patients (42,1 %) et sur la base d’un pattern compatible au scanner thoracique pour 1 patients (5,3 %). Sept patients (36,8 %) beneficiaient d’une association de traitements fonds combinant un csDMARDs avec un bDMARDs ou un tsDMARDs. Parmi les 15 patients sous csDMARDs (78,9 %), 11 etaient traites par methotrexate (MTX) (57,9 %), dont 2 en association a l’hydroxychloroquine (10,5 %), 3 recevaient du leflunomide (15,8 %), et 1 de l’azathioprine (5,3 %). Dix patients (52,6 %) etaient sous bDMARDs au debut des symptomes de COVID-19, dont 6 (31,6 %) sous anti-TNF alpha, 3 (15,8 %) sous anti-IL6R, tocilizumab et 1 patient (5,3 %) sous anti-CD20, rituximab. Une seule patiente (5,3 %) etait traitee par tsDMARD, baricitinib, en combinaison au MTX. Au total, 18 des 19 patients (94,7 %) analyses ont gueri sans sequelles. Parmi eux, 14 (73,7 %) ont developpe une forme benigne et 4 (21,1 %) une forme moderee necessitant une hospitalisation, mais sans transfert en soins intensifs. Une seule forme severe de COVID-19, compliquee de syndrome de detresse respiratoire aigue dont l’issue a ete fatale (5,3 %), a ete observee chez un patient de 83 ans, avec comorbidites cardiovasculaires, traite en monotherapie par anti-TNF alpha monoclonal (golimumab) pour une spondyloarthrite axiale. Conclusion Quelles que soient les modalites d’immunomodulation et le type de rhumatisme inflammatoire, le profil evolutif dans cette cohorte montre une predominance de formes benignes de COVID-19, avec guerison sans sequelles. L’âge et les comorbidites cardiovasculaires semblent dominer le pronostic, davantage que l’exposition a un traitement immunosuppresseur.

There is a need to evaluate high surface nitrate concentrations across agricultural watersheds, both spatially and temporally, to increase understanding of source and timing of nitrogen loads in streams and rivers. Bazile Creek is a high-nitrate stream originating in the agriculturally intensive Bazile Groundwater Management Area of Eastern Nebraska, USA. It is a gaining stream that receives groundwater with high nitrate concentrations originating from nonpoint sources. The objective of this study was to determine spatial and temporal variability of baseflow nitrate concentrations in Bazile Creek and its tributaries and to relate this variability to watershed characteristics. Surface-water nitrate samples were collected monthly from July 2018 through September 2019 from nine sites in the watershed and were analyzed for nitrate concentration. Average surface water nitrate-N concentrations within the watershed ranged from 2.7 to 15 mg L−1 and were significantly different between the sites (p

Introduction La goutte et le rhumatisme psoriasique (RPso) peuvent co-exister chez un meme patient. L’hyperuricemie pourrait etre un determinant important du RPso. Notre objectif est d’etudier l’impact de l’hyperuricemie sur la presentation clinique du RPso, sa severite et les comorbidites associees. Patients et methodes Nous avons mene une etude bicentrique cas-temoins retrospective. La selection des patients a ete realisee via les codages CIM-10 “L40,5 psoriasis arthropathique” entre 2009 et 2019. Critere d’inclusion : patient atteint de RPso avec au moins un dosage d’uricemie disponible. Cas : RPso hyperuricemiques (uricemie mediane ≥ 360 μmol/l). Temoins : RPso normo-uricemiques. Nous avons recueilli pour chaque patient : les donnees cliniques (presentation et evolution du RPso et d’une eventuelle goutte, reponse du RPso au traitement : « bons repondeurs » si absence de poussee de RPso, de syndrome inflammatoire biologique et de modification therapeutique au dernier suivi), les comorbidites (avec calcul du score de Charlson) et les caracteristiques radiographiques (relecture de tous les examens d’imagerie et definition des patients comme « destructeurs » si presence d’au moins 1 erosion(s) objectivee(s) en radiographie standard, echographie, IRM ou TDM). Resultats 242 patients ont ete inclus : 73 (30,2 %) avaient une hyperuricemie et 15 (6,2 %) repondaient aux criteres ACR/EULAR 2015 de goutte. La mediane de suivi etait de 4 ans (IQR 1-8,8). En analyse univariee, les patients hyperuricemiques etaient significativement plus frequemment de sexe masculin (72,6 % vs 39,1 %, p = 1,6 × 10-06), avaient un IMC plus eleve (IMC moyen 30,9 kg/m2 vs 28,7 kg/m2, p = 0,015) et plus de comorbidites (score de Charlson moyen a 2,6 vs 1,8, p = 0,005). Chez les patients hyperuricemiques, le RPso debutait plus tardivement (âge moyen 47,5 ans vs 43 ans, p = 0,016) avec une presentation plus polyarticulaire (56,2 % vs 41,9 %, p = 0,049) qu’axiale (9,6 % vs 22,8 %, p = 0,019) et se caracterisait par une atteinte radiographique plus destructrice (52,8 % vs 37,4 %, p = 0,032). L’uricemie mediane etait plus elevee chez les patients destructeurs (respectivement 321 μmol/l vs 288,75 μmol/l, p = 0,0038). En analyse multivariee les patients hyperuricemiques etaient plus frequemment de sexe masculin (OR 3,78, p = 0,0006), hypertendus (OR 2,28, p = 0,016) et avaient plus souvent une insuffisance renale chronique (OR 7,15, p = 0,0048). Ils avaient une atteinte articulaire plus frequemment peripherique (OR 2,98, p = 0,025) et moins souvent une bonne reponse au traitement du RPso au dernier suivi (OR 0,35, p = 0,024). Discussion La distinction claire entre une poussee de RPso et une crise de goutte peut etre difficile et conduire a une prise en charge inadaptee. La reconnaissance d’un RPso dans lequel l’hyperuricemie jouerait un role aggravant pourrait modifier la prise en charge de ces patients. Ceci justifierait une reevaluation diagnostique en cas de doute, l’eventuelle introduction d’un traitement hypo-uricemiant et l’utilisation prudente des AINS dans le contexte de multi-morbidites. Conclusion Les patients atteints de RPso avec hyperuricemie ont un profil clinique et de comorbidites different des patients normo-uricemiques. Leur reponse au traitement du RPso est moins bonne et leur atteinte articulaire plus frequemment peripherique et destructrice. Notre etude est la premiere a etudier l’impact de l’uricemie sur le RPso et confirme l’existence d’une variete particuliere de RPso : le psoutte.

A wide variety of antibiotics and other pharmaceuticals are used in livestock production systems and residues passed to the environment, often unmetabolized, after use and excretion. Antibiotic residues may be transported from manure-treated soils via runoff and are also capable of reaching surface and groundwater systems through a variety of pathways. The occurrence and persistence of antibiotics in the environment is a concern due to the potential for ecological effects and proliferation of environmental antibiotic resistance in pathogenic organisms. In the present study, the occurrence and seasonal variation of 24 commonly-used veterinary antibiotics was evaluated in surface water adjacent to several livestock production systems using Polar Organic Chemical Integrative Samplers (POCIS). Uptake rates for all compounds, nine of which have not been previously reported, were measured in the laboratory to permit estimation of changes in the time-weighted average (TWA) antibiotic concentrations during exposure. The antibiotics detected in POCIS extracts included sulfadimethoxine, sulfamethoxazole, trimethoprim, sulfamerazine, sulfadiazine, lincomycin, erythromycin, erythromycin anhydro- and monensin. The maximum TWA concentration belonged to sulfadiazine (25 ng/L) in the August–September sampling period and coincided with the highest number of precipitation events. With the exception of monensin that showed an increase in concentration over the stream path, none of the detected antibiotics were prescribed to livestock at the facility. The detection of antibiotics not prescribed by the facility may be attributable to the environmental persistence of previously used antibiotics, transfer by wind from other nearby livestock production sites or industrial uses, and/or the natural production of some antibiotics.

Recent pathogenic Escherichia coli contamination of fresh vegetables that originated from irrigation water has increased awareness and importance of identifying sources of E. coli entering agroecosystems. However, inadequate methods for accurately predicting E. coli occurrence and sources in waterways continue to limit the identification of appropriate and effective prevention and treatment practices. Therefore, the primary objectives of this study were to: (1) Determine the concentration of E. coli during storm events in a hydrologic controlled stream situated in a livestock research operation that is located in the Central Flyway for avian migration in the United States. Great Plains; and (2) Identify trends between E. coli concentrations, grazing rotations, and avian migration patterns. The study sampled five rainfall events (three summer and two fall) to measure E. coli concentrations throughout storm events. A combination of cattle density and waterfowl migration patterns were found to significantly impact E. coli concentrations in the stream. Cattle density had a significant impact during the summer season (p .0001), while waterfowl density had a significant impact on E. coli concentrations during the fall (p = .0422). The downstream reservoir had exceedance probabilities above the Environmental Protection Agency freshwater criteria 85% of the growing season following rainfall events. Based on these findings, implementation of best management practices for reducing E. coli concentrations during the growing season and testing of irrigation water prior to application are recommended.

Introduction Nous rapportons le cas d’une patiente souffrant d’un syndrome pancreatite-panniculite-polyarthrite (PPP), tableau rare compliquant une maladie pancreatique au cours duquel les manifestations digestives sont minimes, au second plan d’une symptomatologie dominee par des signes cutanes et articulaires. Observation Une patiente etait admise en reanimation pour choc septique a E. clocacae. Elle avait de multiples nodules sous-cutanes erythemateux inflammatoires sur les membres, le tronc et le visage et des arthrites des genoux, chevilles, metacarpophalangiennes et interphalangiennes. Les nodules evoluaient vers une fistulisation laissant sourdre un liquide huileux. La biopsie cutanee mettait en evidence une panniculite neutrophilique septale et interlobulaire associee a des images de necrose adipocytaire avec fantomes adipocytaires, typique de cytosteatonecrose. Il n’y avait aucune douleur abdominale. A la biologie on notait une lipasemie a 5192 U/L et au scanner abdomino-pelvien une masse tumorale de la tete du pancreas sans coulee de necrose et sans dilatation des voies biliaires. Le prelevement de liquide articulaire d’un genou ramenait un liquide opaque chyleux. Le liquide etait aseptique avec un denombrement cellulaire impossible, car riche en lipides et lipases et un taux de triglycerides cinq fois superieur a celui du cholesterol. L’IRM revelait une pseudotumeur cephalique pancreatique deja connue 2 ans auparavant, chez une femme aux antecedents d’ethylisme, refusant tout prelevement diagnostique profond (probable pancreatite chronique alcoolique). Le tableau clinique s’aggravait avec defaillance multiviscerale menant au deces ( Fig. 1 et 2 ). Discussion Le syndrome PPP est une complication rare de maladies pancreatiques (pancreatites aigues principalement). La panniculite pancreatique n’est presente que dans 2 a 3 % des maladies pancreatiques. Le syndrome PPP est encore plus rare (67 cas dans la litterature), l’atteinte osteoarticulaire completant le tableau avec des polyarthrites, voire une osteonecrose aseptique des os des articulations concernees. Les articulations les plus touchees sont peripheriques. Le liquide articulaire est riche en lipases et en lipides, responsables de son aspect chyleux. L’etat general est tres altere avec une lipasemie pouvant etre tres augmentee, alors que les douleurs abdominales sont absentes ou moderees, ce qui pourrait faire recuser a tort le diagnostic de pancreatite. La physiopathologie serait l’existence d’une lipolyse des tissus sous-cutanes, synoviaux et de la moelle osseuse, secondaire a l’augmentation massive d’enzymes pancreatiques dans la circulation. Le traitement repose sur celui la maladie pancreatique sous-jacente. Le pronostic est sombre. Conclusion Le syndrome PPP est une complication rare et severe d’une maladie pancreatique latente qu’il peut reveler.

Atrazine, one of the most widely used herbicides in the world, threatens human health along with terrestrial and aquatic biota. Recent reports have found atrazine in drinking water to be associated with increased birth defects and incidences of Non-Hodgkin's Lymphoma, with higher levels of significance from exposure to both atrazine and nitrate-N. The Midwest region of the United States, which includes Nebraska, is one of the leading regions for high nitrate-N concentrations and agrochemicals, including atrazine, in surface waters. Therefore, the objective of this study was to provide a case study for completing an environmental risk analysis for the potential exposure of atrazine and nitrate-N to ecosystems and humans through interaction with surface waters using two approaches: (1) Identify watersheds across Nebraska that were at risk for exceeding atrazine and nitrate-N maximum contaminant limits (MCLs) in surface water; and (2) Determine the specific times of year where risks were greatest. Factors were then analyzed using Geographic Information System (GIS) software to identify areas of high risk. Impairments for both nitrate-N and atrazine in the surface water were found predominately during the early growing season in the southeastern region of Nebraska, in watershed areas with the highest amount of corn production and annual precipitation. Further, the methodology developed in this study has the potential for application in regions with higher dependency on surface water to determine multiple agrochemical load influxes from upstream regions and evaluate other surface water contaminants during the same time periods.

Background Data describing inpatient health care utilization in children with nephrotic syndrome and related severe complications are limited. Our goals were to describe the charges, length of stay (LOS), and number of hospitalizations among children, adolescents, and young adults with nephrotic syndrome. Study Design A cross-sectional analysis of the Kids' Inpatient Database (KID) database from the Healthcare Cost and Utilization Project (HCUP). The HCUP-KID is an all-payer database of hospital discharges for children, adolescents, and young adults in the United States compiled every 3 years by the Agency for Healthcare Research and Quality. Setting & Participants HCUP-KID data were obtained for the 2006 and 2009 cohort years. We identified patients by searching discharges for nephrotic syndrome International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes. Predictor Patient demographics, disease complications in children, adolescents, and young adults hospitalized with nephrotic syndrome. Outcome Number of hospitalizations, mean charges, and LOS for children, adolescents, and young adults hospitalized with nephrotic syndrome. Results There were 6,308 hospitalization discharges in children, adolescents, and young adults with a primary or secondary diagnosis of nephrotic syndrome reported by 38 and 44 states in 2006 and 2009, respectively, representing an estimated 9,934 discharges nationally. Nephrotic syndrome resulted in an estimated 48,700 inpatient days and charges totaling $259 million. The mean charge per hospitalization was ∼$26,500 (SE, $1,100) and LOS was 5 days (SE, 0.1). 16% of discharges for nephrotic syndrome had a diagnosis code for at least one severe complication, including thromboembolism (3.6%), septicemia (3.8%), peritonitis (2.6%), pneumonia (5.4%), or diabetes (2.4%). Multivariable analysis showed age 15 years or older, race, higher socioeconomic status, acute renal failure, thromboembolic disease, hypertension, and infections predicted higher mean hospitalization charges. Limitations The HCUP-KID database collects data on a hospitalization level. Consequently, health care utilization on an individual patient level or in the outpatient environment is not possible. Conclusions We present a comprehensive description of inpatient health care utilization in children, adolescents, and young adults with nephrotic syndrome. The complications of nephrotic syndrome, including thromboembolism, infection, and hypertension, contribute significantly to these charges.

The objective of this study was to evaluate the water quality benefits provided by a buffer enrolled in the North Carolina Conservation Reserve Enhancement Program (NC CREP). A 5-year study was conducted on two distinct buffer sections along the same stream to evaluate the hydrology and attenuation of groundwater nitrate (NO 3 − -N) entering from nearby agricultural fields. The average buffer widths were 60 m (Section 1, upstream) and 45 m (Section 2, downstream). Three transects of groundwater monitoring well nests within each buffer zone were installed to monitor water quality and water table depths for 5 years. Mean groundwater NO 3 − -N concentrations at the 1.5 m depth decreased from 4.5 mg L −1 to 1.7 mg L −1 and from 12.9 mg L −1 to 1.4 mg L −1 in buffer Sections 1 and 2 respectively. These differences were significant in both buffer sections ( α = 0.05), but the wider Section 1 received significantly less NO 3 − -N than did Section 2 ( P 3 − -N loads were reduced by 0.003 kg m −2 yr −1 (76% reduction) at the 1.5 m depth, while in Section 2 these loads were reduced by 0.02 kg m −2 yr −1 (94% reduction) and 0.04 kg m −2 yr −1 (86% reduction) at the 1.5 m and 3 m depths, respectively. Topography, water table and redox measurements, nitrate to chloride ratios, and deep groundwater cation analyses, indicated both sections were suitable for denitrification to proceed. However, the position of the wider Section 1 buffer in the landscape limited the amount of NO 3 − -N contaminated groundwater that entered from the agricultural fields, and thus could have been designed to be narrower. The effectiveness of NO 3 − -N reduction in riparian buffer systems is dependent on multiple landscape and biogeochemical factors and not buffer width alone. Findings provide design guidance for conservation buffer program managers as related to the influence of buffer landscape position on groundwater nitrate reduction.

The potential for improving response rates by changing from one mode of data collection to another mode and the consequences for measurement and nonresponse errors are examined. Data collection from 8999 households was done in two phases. Phase 1 data collection was conducted by telephone interview, mail, interactive voice response, or the Internet, while Phase 2 focused on nonrespondents to Phase 1, and was conducted by a different mode, either telephone or mail. Results from our study suggest that switching to a second mode is an effective means of improving response. We also find that for the satisfaction–dissatisfaction questions asked in this survey, respondents to the aural modes (telephone and IVR) are significantly more likely than are respondents to the visual modes (mail and web) to give extreme positive responses, a difference that cannot be accounted for by a tendency towards recency effects with telephone. In general, switching to a second mode of data collection was not an effective means of reducing nonresponse error based on demographics.

Although the role of dental casting alloys has changed in recent years with the development of improved all-ceramic materials and resin-based composites, alloys will likely continue to be critical assets in the treatment of missing and severely damaged teeth. Alloy shave physical, chemical, and biologic properties that exceed other classes of materials. The selection of the appropriate dental casting alloy is paramount to the long-term success of dental prostheses,and the selection process has become complex with the development of many new alloys. However, this selection process is manageable if the practitioner focuses on the appropriate physical and biologic properties, such as tensile strength, modulus of elasticity,corrosion, and biocompatibility, and avoids dwelling on the less important properties of alloy color and short-term cost. The appropriate selection of an alloy helps to ensure a longer-lasting restoration and better oral health for the patient.

Resume Les zoonoses sont un champ en constante evolution. Streptococcus equi subsp. ruminatorum est une sous-espece de streptocoque du groupe C identifiee pour la premiere fois en 2004. Recemment, un premier cas d’infection humaine a ete rapporte. Nous rapportons ici un second cas d’infection par cette sous-espece chez l’homme. Il s’agit d’un homme de 70 ans qui a presente une spondylodiscite aigue associee a une endocardite de la grande valve mitrale. Le germe a ete identifie dans les hemocultures. L’evolution a ete favorable sous antibiotherapie. Cette situation pathologique a fait decouvrir une hypogammaglobulinemie associee, a un myelome stade I. L’interrogatoire a mis en evidence un contact frequent avec des chevaux dont deux presentaient, quelques jours avant les signes cliniques du patient, un episode infectieux des voies aeriennes superieures. Le diagnostic d’infection a S. equi a ete confirme retrospectivement par la serologie chez ces animaux. Cette observation originale conforte le role de S. equi subsp. ruminatorum en pathologie humaine et a permis de suspecter un mode de transmission jusque-la non decrit qui est direct par une porte d’entree cutanee. Ce fait clinique met aussi en lumiere l’importance pour le diagnostic du recours aux techniques de biologie moleculaire dont l’utilisation devrait etre systematique en cas d’infection streptococcique du groupe C dans un contexte evocateur de zoonose.

Introduction La polyarthrite rhumatoide se complique parfois de dermatoses neutrophiliques, notamment sous la forme de dermatose neutrophilique rhumatoide, dont nous rapportons ici une forme floride et polymorphe. Observations Une femme de 75 ans atteinte de polyarthrite rhumatoide seropositive non erosive consultait pour des lesions cutanees evoluant depuis plus d’un an. On observait des nodules violaces et keratosiques des coudes, des papules erythemateuses a conformation annulaire d’evolution parfois purpurique des mains, des plaques a bordure infiltree et a contours polycycliques du dos ainsi que des pustules du tronc et des jambes. Les biopsies realisees sur ces differentes lesions montraient toutes des infiltrats dermiques denses neutrophiliques, sans vascularite. L’evolution clinique etait initialement favorable sous Dapsone, mais celle-ci devait etre arretee en raison d’une anemie. Un relais etait realise par corticotherapie locale forte, colchicine et prednisone a faible dose. L’evolution etait marquee par des poussees successives et l’apparition de lesions hyperkeratosiques, purpuriques et hyperalgiques palmo-plantaires et de plaques ulcerees violacees malleolaires externes a type de pyoderma gangrenosum. De nouveau, les biopsies montraient des infiltrats dermiques neutrophiliques denses, associes a de la leucocytoclasie sans vascularite. Il existait par ailleurs une degradation de l’etat general et la patiente developpait une endophtalmie sur abces corneen perforant droit, correspondant a un infiltrat inflammatoire a polynucleaires neutrophiles aseptique. Une augmentation de la corticotherapie locale forte et orale a 1 mg/kg/j permettait de soulager les douleurs palmo-plantaires et de controler les lesions cutanees. Discussion L’association de la polyarthrite rhumatoide et de dermatoses neutrophiliques est connue, notamment sous la forme de la « dermatose neutrophilique rhumatoide », entite caracterisee par des plaques et nodules erythemateux en regard des articulations et sur les faces d’extension des membres, simulant des nodules rhumatoides ou l’erythema elevatum diutinum. Le cas de notre patiente etait plus severe et polymorphe que le cas princeps decrit par Ackermann en 1978, avec, d’une part, des elements cutanes evoquant une dermatose neutrophilique rhumatoide mais aussi une pustulose sous-cornee, un pyoderma gangrenosum et meme une atteinte ophtalmologique. Notre cas correspond a une dermatose neutrophilique de chevauchement entre plusieurs entites individualisees, associee a une atteinte extracutanee aseptique mieux prise en compte par le terme de maladie neutrophilique. Conclusion Notre observation presente un cas de dermatose neutrophilique severe et tres polymorphe au cours de la polyarthrite rhumatoide, associee a une atteinte extracutanee ophtalmologique, d’une particuliere gravite, a notre connaissance jamais rapportee.

La Presse Medicale - In Press.Proof corrected by the author Available online since mercredi 10 juin 2015

Introduction La maladie de Pick-Herxheimer constitue la forme cutanee tertiaire de l’infection borrelienne. Sa presentation la plus typique est celle d’une atrophie progressive de la peau (acrodermatite chronique atrophiante). Nous rapportons deux cas d’une variete clinique peu connue de cette entite : la forme nodulaire fibrosante juxta-articulaire. Observations Observation no 1 : un homme de 62 ans consultait pour un nodule inflammatoire du coude droit evoluant depuis 8 mois. A la palpation on sentait un nodule erythemateux indure olecrânien avec extension sous forme d’un cordon infiltre de quelques centimetres le long du bord cubital du membre, ainsi que des lesions analogues au dos de la main gauche. Une echographie articulaire eliminait une atteinte articulaire. L’examen histologique de peau montrait une inflammation lymphoplasmocytaire dermique interstitielle et perinerveuse. Observation no 2 : un homme de 55 ans consultait pour des gonalgies bilaterales avec a l’examen un nodule prerotulien indure erythemateux evoluant depuis plus d’un an. Une echographie articulaire eliminait une atteinte articulaire. L’examen histologique de peau montrait des infiltrats lymphoplasmocytaires dermiques profonds de topographie volontiers perinerveuse ainsi qu’un derme fibrotique. Dans les deux cas, la serologie des borrelioses etait fortement positive en Elisa (IgG superieures a 450 U) et au western blot, et Borrelia afzelii etait identifie par PCR sur biopsie de peau. L’evolution etait favorable sous doxycycline (200 mg par jour pendant 28 jours). Discussion Ces deux patients presentaient un tableau remarquablement similaire : apparition progressive de nodules satellites de grosses articulations des membres ayant motive une consultation initiale en rhumatologie, histologie suggestive du diagnostic de borreliose, responsabilite borrelienne prouvee par la positivite des serologies et de la PCR. Ce tableau, qui rappelle les classiques nodosites de Lutz-Jeanselme des treponematoses tertiaires, correspond a une variete particuliere de maladie de Pick-Herxheimer revetant la forme de nodules fibrosants juxta-articulaires. Des bandes fibreuses tibiales ou cubitales ou d’authentiques manifestations articulaires sont parfois associees. Le caractere hypertrophique, nettement fibreux des lesions, differe non seulement du lymphocytome borrelien qui pourrait etre evoque cliniquement, mais egalement du tableau classique d’acrodermatite chronique atrophiante vers lequel l’evolution peut se faire. Quoiqu’il s’agisse d’une entite relativement classique, peu d’observations en ont ete rapportees, ce qui peut etre a l’origine d’errances diagnostiques notamment rhumatologiques. Conclusion Nous souhaitons attirer l’attention sur une forme clinique peu connue de borreliose cutanee tertiaire, particuliere par son caractere nodulaire non atrophique et son siege juxta-articulaire.

We report a case of a 72-year-old man who presented with bilateral panuveitis in a context of unclassified arthritis. The recurrence of uveitis associated with ear chondritis led to the diagnosis of relapsing polychondritis. Ocular symptoms are frequent in the course of relapsing polychondritis, but uveitis is a rare symptom and could compromise the visual outcome.

LEARNING OUTCOME: Infection with HIV was associated with significant decrements in growth, weight gain and CD4+ T-lymphocyte count Poor growth, weight loss, low energy intake and depletion of CD4+ T-lymphocyte cell counts are prominent findings in infants and children with human immunodeficiency virus infection (HIV). The purpose of this study was to analyze on a cross-sectional basis the relationship between growth, body weight, nutrient intake, CD4+ T-lymphocyte cell counts and HIV status in infants and children perinatally exposed to HIV infection. The children (n=48 HIV-infected, n=35 uninfected, age 0-12y) attended a pediatric infectious disease clinic in New York City. Anthropometric measurements and CD4+ T-lymphocyte counts were obtained from medical records and food intake was assessed from multiple 24-hour dietary recall records for 34 HIV-exposed children. Statistical analysis (T-tests, chi square tests) showed that infants and children infected with HIV weighed less (NCHS-weight for age z-score - .57 vs .01, p=.04) and were shorter in stature (length for age z-score - .90 vs - .42, p=.04) than uninfected children. The mean CD4+ T-lymphocyte count of infected children was significantly lower (743 vs 2316, p=.000) than that of uninfected children. Infected children, whose CD4+ levels

A library of seven monoclonal antibodies has been prepared against rat brain hexokinase (ATP:D-hexose 6-phosphotransferase, EC 2.7.1.1). Four of these antibodies, all of the IgG class, react with both native hexokinase and, to a more limited extent, with a ureadenatured S-carboxymethylated form of the enzyme. The other three antibodies, all of the IgM class, react readily with the denatured enzyme but are quite ineffective at binding native hexokinase. The monoclonal IgGs were further characterized with respect to their effects on certain functional properties of hexokinase. None had any detectable effect on catalytic properties, including inhibition by glucose 6-phosphate. One of the antibodies, designated 3C, totally blocked binding of the enzyme to the mitochondrial membrane, and significantly enhanced the release of the mitochondrially bound enzyme in either the absence or presence of glucose 6-phosphate, a ligand which promotes solubilization of mitochondrial hexokinase. It was concluded that the epitope recognized by 3C lies in, or immediately adjacent to, the region of the hexokinase molecule directly involved in interaction with the mitochondrial membrane. Two other IgGs, designated 1B and 2B, had only marginal effects on the binding of hexokinase to mitochondria, but were highly effective in preventing solubilization of the mitochondrially bound hexokinase by glucose 6-phosphate. Since these antibodies did not prevent binding of this ligand, as evidenced by the lack of an effect on inhibition, it is suggested that the effect of 1B and 2B on glucose 6-phosphate-induced solubilization is due to selective modification of the conformational changes that result from binding of glucose 6-phosphate. The monoclonal IgG designated 13 had no appreciable effect on either binding or glucose 6-phosphate-induced solubilization. The epitope for 13 is thought to lie in a "neutral" region of the hexokinase molecule, not involved in either catalytic or membrane-binding functions of the enzyme.

Brain hexokinase (ATP:D-hexose-6-phosphotransferase, EC 2.7.1.1) binds selectively to the outer membrane of rat liver mitochondria but not to inner mitochondrial or microsomal membranes nor to the plasma membrane of human erythrocytes. A protein having subunit molecular weight of 31,000, determined by sodium dodecyl sulfate-gel electrophoresis, has been highly purified from the outer mitochondrial membrane by repetitive solubilization with octyl-beta-D-glucopyranoside followed by reconstitution into membranous vesicles when the detergent is removed by dialysis. When incorporated into lipid vesicles, the protein confers the ability to bind brain hexokinase in a Glc-6-P-sensitive manner as is seen with the intact outer mitochondrial membrane. Hexokinase binding ability and the 31,000 subunit molecular weight protein co-sediment during sucrose density gradient centrifugation. Both hexokinase binding ability and the 31,000 subunit molecular weight protein are resistant to protease treatment of the intact outer mitochondrial membrane while other membrane proteins are extensively degraded. It is concluded that this protein, designated the hexokinase-binding protein (HBP), is an integral membrane protein responsible for the selective binding of hexokinase by the outer mitochondrial membrane.

The case record of a seventy-three year old man with congenital dextrocardia and situs inversus viscerum complicated by hypertension, coronary artery disease and myocardial infarction is presented. Electrocardiographic recordings of the limb leads, with and without reversal of the arm lead wires, and of the precordial leads of the V series derived from both right and left chest areas are presented. In this instance the electrocardiographic findings in precordial leads taken over the right chest point to fresh anteroseptal infarction; those leads recorded from the left chest were not informative. This serves to emphasize the fact that precordial leads should be recorded from the right side of the chest rather than the left in order that the exploring precordial electrode may overlie the area of cardiac damage, and thus manifest maximal changes in the electrocardiogram. We agree that the electrocardiogram may best be interpreted by application of the usual criteria to the limb leads taken with the arm lead wires reversed although in this case the limb leads yielded no information of diagnostic significance.