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Introduction: Biological risks are a major global problem in the workplace. The recent COVID-19 pandemic has highlighted the need for a more comprehensive understanding of the biological risks at work. This study presents data on both communicable infectious biological agents and noncommunicable factors leading to death and disability for the year 2021. Methods: We followed the methodology established by the International Labour Organization (ILO) in their past global estimates on occupational accidents and work-related diseases. We used relevant ILO estimates for hazardous substances and related population attributable fractions derived from literature, which were then applied to World Health Organization mortality data. The communicable diseases included in the estimates were tuberculosis, pneumococcal diseases, malaria, diarrheal diseases, other infectious diseases, neglected tropical diseases, influenza associated respiratory diseases and COVID-19. Noncommunicable diseases and injuries considered were Chronic Obstructive Diseases (COPD) due to organic dusts, asthma, allergic reactions and risks related to animal contact. We estimated death attributable to biological risk at work and disability in terms of disability adjusted life years (DALYs). Results: We estimated that in 2022, 550,819 deaths were caused by biological risk factors, with 476,000 deaths attributed to communicable infectious diseases and 74,000 deaths caused by noncommunicable factors. Among these, there were 223,650 deaths attributed to COVID-19 at work. We calculated the rate of 584 DALYs per 100,000 workers, representing an 11% increase from the previous estimate of the global burden of work-related disabilities measured by DALYs. Conclusion: This is a first update since previous 2007 ILO estimates, which has now increased by 74% and covers most biological risks factors. However, it is important to note that there may be other diseases and deaths are missing from the data, which need to be included when new information becomes available. It is also worth mentioning that while deaths caused by major communicable diseases including COVID-19 are relatively rare within the working population, absences from work due to these diseases are likely to be very common within the active workforce.

Abstract Ceramics compositions (1-x)Pb(Zr0.53Ti0.47)O3-xGdMnO3 (x= 0, 0.01, 0.02, 0.03, 0.04, and 0.05) were synthesized by solid-state route and sintered at 1180 °C for 2 h. Structural, microstructural, and dielectric properties of the system were investigated. X-ray structural analysis of the materials confirmed their formation in a single phase with a tetragonal crystal structure. The PZT ceramics doped with 0.04 moles of GdMnO3 exhibited denser and finer microstructures, which produced a high relative density of 7.22 g/cm3 (~98% of the theoretic density). Scanning electron microscopy showed uniform distribution of grain and grain boundaries. Comparing with the undoped ceramics, the dielectric properties of the GM-doped PZT specimens are significantly improved. The maximum dielectric constant (εr=475324) and the minimum dielectric loss (6%) were observed for 0.04 moles of GdMnO3, which indicated that the PZT-GM ceramics are promising to lead to practical applications.

The effect of using inverse opal photonic crystals as back reflectors on the power conversion efficiency of c-Si solar cells is investigated. The reflection spectra of inverse opal photonic crystals with different diameters of air spheres are simulated using the finite difference time domain (FDTD) method. The reflection peaks are correlated with photonic band gaps present in the photonic band gap diagram. Significant improvement in the optical absorption of the crystalline silicon layer is recorded when inverse opal photonic crystals are considered. Physical mechanisms which may contribute to the enhancement of the light absorption are underlined. With higher short-circuit current enhancement possible, and with no corresponding degradation in open-circuit voltage Voc or the fill factor, the power conversion efficiency is increased significantly when inverse opal photonic crystals are used as back reflectors with optimized diameter of air spheres. [ABSTRACT FROM AUTHOR]

The present paper reports the study of a porous silicon based microcavity for a potential chemical sensing application using tris-(8-hydroxyquinoline) aluminum (Alq3) molecules. Porous silicon based planar microcavity was first designed and fabricated using the electrochemical etching technique. Photoluminescence emission of a single porous silicon layer after immersion in an Alq3solution was first carried out in order to verify that the Alq3molecules were bound to the porous surface. A wide green band centered at 519 nm, typical of a nano-structured Alq3 film, was observed. Reflectivity measurements of the porous silicon microcavity were then performed for different aluminum concentrations of the Alq3 solution. The microcavity device showed a good sensibility for the Alq3molecules and an important shift of the microcavity photonic resonance was observed. This device might be considered for a potential aluminiun sensing application. [ABSTRACT FROM AUTHOR]

Introduction: Despite the increased scrutiny on vaccine safety following the coronavirus disease 2019 (COVID-19) pandemic, Morocco's Centre of Antipoison and Pharmacovigilance (CAPM) remained concerned that the pharmacovigilance system in Morocco was insufficiently implemented, including limited adverse event (AE) reporting, poor data use, and inconsistent training nationwide., Objectives: We sought to assess the status of pharmacovigilance activities (PAs) prior to formally institutionalizing them across university hospital centers (UHCs), given their position as the main providers of healthcare in Morocco and key sources for reporting serious AEs., Methods: We assessed seven UHCs (housing 30 hospitals) in 2023 using a structured questionnaire with pharmacovigilance focal points developed from the World Health Organization's indicators of pharmacovigilance and the Global Benchmarking Tool. Data were grouped into 28 PAs and scored from 0 (not implemented) to 3 (fully implemented). We then calculated an implementation rate for each site on the basis of percent of PAs fully implemented (≥ 70%, well established; > 40% to < 70%, partially implemented; and ≤ 40%, not implemented). A desk review was also performed at the sites. Using the results of the assessment, three working groups of pharmacovigilance stakeholders developed recommendations to be formally adopted by UHCs., Results: Basic elements of pharmacovigilance (notification forms and VigiFlow ® or Excel databases) were present at all the UHCs assessed. In total, 14 hospitals (47%) had well-established PAs, including advanced activities such as signal detection of adverse events following the use of medicines and vaccines, as well as causality assessment; 9 hospitals (30%) were partially implementing pharmacovigilance, and 7 hospitals (23%) had no established activities or very basic activities. Within four UHCs, activities had not been implemented at the same level from one hospital to another and vaccine vigilance was largely deprioritized. The working groups made recommendations for improving collaboration, standardizing procedures, and outlining a new organizational structure for pharmacovigilance, which was institutionalized by a formal agreement among UHCs in July 2023., Conclusions: The assessment revealed a subgroup of centers with well-established AE signal detection and causality assessment abilities, which could play a leading role in the country. After the site assessment, our collaborative approach of bringing together focal points to identify next steps and generate buy-in helped to formalize pharmacovigilance across centers., Competing Interests: Declarations. Funding: This work was supported by funding from the US Centers for Disease Control and Prevention (CDC) through the Task Force for Global Health (TFGH) under Cooperative Agreement NU51IP000942-01-00. Conflict of interest: The authors declare no competing interests. Disclaimer: The findings and conclusion of this paper are those of the authors and do not necessarily represent the official position of the US Centers for Disease Control and Prevention. Ethics approval: Not applicable. No identifiable information about individuals was disclosed in the manuscript and all findings are reported in aggregated form. The project was determined to be non-research by both the Moroccan Ministry of Health and the US Centers for Disease Control and Prevention (US CDC). Consent to participate: Not applicable. Consent for publication: Not applicable. Availability of data and materials: Not applicable. Code availability: Not applicable. Author contributions: R.S.B., H.H., and I.C. designed the assessment study. R.S.B., H.H., H.S., G.B., I.T., L.A.M., A.S., O.S., and S.F. developed the benchmarking questionnaire. R.S.B., H.H., I.C., H.S., G.B., I.T., L.A.M., and A.S. assisted with study implementation and/or provided oversight of study personnel. H.H., H.S., G.B., I.T., and L.A.M. helped with data collection. I.C. performed data analysis and interpretation of results. I.C. and A.S. drafted the manuscript. R.S.B., H.H., H.S., G.B., I.T., and L.A.M. helped with drafting the manuscript. All authors have read and approved the manuscript., (© 2025. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

Objective: Pre-filled syringes (PFSs) have become popular as a convenient and cost-effective container closure system for delivering biotherapeutics. However, standard siliconized PFSs may compromise the stability of therapeutic proteins due to their exposure to the silicone oil-water interface. To address this concern, silicone oil-free (SOF) glass syringes coupled with silicone-oil free plunger stoppers have been developed. This study aims to compare the impact of silicone oil-free (SOF) and siliconized syringes as primary container on protein stability and device functionality of the combination products., Methods: The stability of proteins with different modalities was assessed in SOF and siliconized 1 mL glass syringes for up to 6 months at 5℃, 25℃, and 40℃ with levels of subvisible particles and soluble aggregate determined by micro-flow imaging (MFI) and ultra performance size-exclusion chromatography (UP-SEC). The functionality of SOF glass syringes, including break loose force, extrusion force and delivery time in autoinjectors, was evaluated at different time points during the stability study. Additionally, SOF glass syringes were filled with viscosity surrogate ranging from 1 to 90 cP to understand the impact of solution viscosity on break loose force, extrusion force, and autoinjector delivery time., Results: SOF demonstrates compatibility with proteins and exhibited significantly low particle counts compared to siliconized PFS. SOF syringes show significantly higher break-loose and extrusion forces. However, unlike siliconized syringes where silicone oil migration increases extrusion force, no significant change in functionality was observed in SOF glass syringe during stability testing. Overall, SOF glass syringes showed great potential as an alternative package for biologics with comparable performance on functionality as siliconized PFS., Conclusions: The combination of SOF glass and its PTFE coated stopper presents a new primary container closure system with both adequate protein stability and desired functionality features., Competing Interests: Declarations. Conflict of Interest: The authors declare no conflict of interests., (© 2024. Merck & Co., Inc., Rahway, NJ, USA and its affiliates, under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: The surgical treatment of anterior shoulder instability with arthroscopic cortical-button Latarjet procedure has been the subject of very few medium and long-term studies. The aim of this study was to analyze the clinical and radiologic results of arthroscopic cortical-button Latarjet procedure with minimum 5 years follow-up., Method: This is a monocentric retrospective study including 40 patients who have undergone shoulder stabilization with primary arthroscopic cortical-button Latarjet procedure and been reviewed with minimum 5 years follow-up. The average age at the time of surgery was 26.6 years (16-59; ±10) and 92.5% were sporty individuals. The average Instability Severity Index score was 6 points (2-9; ±1.6). The clinical evaluation involved active range of motion measurement, apprehension test, Rowe and Walch-Duplay scores, Subjective Shoulder Value and Net Promoter Score. Radiologically, evolution of the bone graft and degenerative arthritis of the shoulder joint were analyzed at the last follow-up., Results: At an average follow-up of 71 months (60-97; ±12), 3 patients (7.5%) experienced recurrence as a dislocation or subluxation, which was responsible for revision in 1 case. Moreover, apprehension persisted in 6 (16%) patients. There were no significant restrictions in recovery of active ranges of motion, including external rotation. Return to sports was effective in 94.6% of cases. The average Rowe and Walch-Duplay scores were 87 points (15-100; ±20) and 88 points (15-100; ±19) respectively. Subjective Shoulder Value was 91% (10-100; ±16) and NET Promoter Score was 9.3 points (5-10; ±1,3). Radiologically, degenerative arthritis occurred in 18.7% of patients, mainly asymptomatic stage 1 (9.4%). Bone healing was acquired in 72% of cases and partial lysis of the bone block in 41%., Conclusion: At an average follow-up of 6 years, arthroscopic cortical-button Latarjet procedure is effective, enabling return to sport in 95% of cases. Onset of asymptomatic arthritis seems similar to conventional techniques but justifies a longer-term follow-up., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Introduction: The COVID-19 pandemic turned biological hazards in the working environment into a global concern. This systematized review of published reviews aimed to provide a comprehensive overview of the specific jobs and categories of workers exposed to biological hazards with the related prevention., Methods: We extracted reviews published in English and French in PubMed, Embase, and Web of Science. Two authors, working independently, subsequently screened the potentially relevant titles and abstracts recovered (step 1) and then examined relevant full texts (step 2). Disagreements were resolved by consensus. We built tables summarizing populations of exposed workers, types of hazards, types of outcomes (types of health issues, means of prevention), and routes of transmission., Results: Of 1426 studies initially identified, 79 studies by authors from every continent were selected, mostly published after 2010 ( n  = 63, 79.7%). About half of the reviews dealt with infectious hazards alone ( n  = 38, 48.1%). The industrial sectors identified involved healthcare alone ( n  = 16), laboratories ( n  = 10), agriculture (including the animal, vegetable, and grain sectors, n  = 32), waste ( n  = 10), in addition of 11 studies without specific sectors. The results also highlighted a range of hazards (infectious and non-infectious agents, endotoxins, bioaerosols, organic dust, and emerging agents)., Conclusion: This systematized overview allowed to list the populations of workers exposed to biological hazards and underlined how prevention measures in the healthcare and laboratory sectors were usually well defined and controlled, although this was not the case in the agriculture and waste sectors. Further studies are necessary to quantify these risks and implement prevention measures that can be applied in every country., (© 2023 The Authors.)

Prefilled syringes (PFS) as a primary container for parenteral drug products offer significant advantages, such as fast delivery time, ease of self-administration and fewer dosing errors. Despite the benefits that PFS can provide to patients, the silicone oil pre-coated on the glass barrels has shown migration into the drug product, which can impact particle formation and syringe functionality. Health authorities have urged product developers to better understand the susceptibility of drug products to particle formation in PFS due to silicone oil. In the market, there are multiple syringe sources provided by various PFS suppliers. Due to current supply chain shortages and procurement preferences for commercial products, the PFS source may change in the middle of development. Additionally, health authorities require establishing source duality. Therefore, it is crucial to understand how different syringe sources and formulation compositions impact the drug product quality. Here, several design of experiments (DOE) are executed that focus on the risk of silicone oil migration induced by syringe sources, surfactants, protein types, stress, etc. We utilized Resonant Mass Measurement (RMM) and Micro Flow Imaging (MFI) to characterize silicone oil and proteinaceous particle distribution in both micron and submicron size ranges, as well as ICP-MS to quantify silicon content. The protein aggregation and PFS functionality were also monitored in the stability study. The results show that silicone oil migration is impacted more by syringe source, siliconization process and surfactant (type & concentration). The break loose force and extrusion force across all syringe sources increase significantly as protein concentration and storage temperature increase. Protein stability is found to be impacted by its molecular properties and is less impacted by the presence of silicone oil, which is the same inference drawn in other literatures. A detailed evaluation described in this paper enables a thorough and optimal selection of primary container closure and de-risks the impact of silicone oil on drug product stability., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 American Pharmacists Association. Published by Elsevier Inc. All rights reserved.)

Silicone oil is often applied to the inner surface of glass syringes and cartridges to reduce friction between the glass surface and elastomeric plunger stopper. This oil can appear as intrinsic and non-proteinaceous particles in the ejected fluid or drug product. Limited data is available to understand the impact of age (time between syringe manufacture and filling) on silicone oil migration into the drug product. This study compares subvisible particle count and extrusion force of siliconized syringes from two different manufacturers stored at ambient condition for 2-3 (fresh syringes) and 13-14 (aged syringes) months then filled and placed at 40°C for an additional three months. The fresh syringes exhibit a 2.5-fold increase in subvisible particle count compared to those aged ones. Moreover, the fresh syringes exhibit up to a 2-fold increase in extrusion force. These findings suggest the degree and amount of silicone oil migration is influenced by the time in storage of the glass syringe prior to filling. This rapid communication highlights syringe storage time prior to filling as a factor to be considered during development., Competing Interests: Declaration of Competing Interest The authors declare there is no conflict of interest., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Objectives: We provide a brief introduction to the objectives, data, methods and results of the World Health Organization (WHO)/International Labor Organization (ILO) Joint Estimates of the Work-related Burden of Disease and Injury (WHO/ILO Joint Estimates), which estimated the burden attributable to 19 selected occupational risk factors., Methods: The WHO/ILO Joint Estimates were produced within the global Comparative Risk Assessment framework, which attributes the burden of one specific health outcome (ie, disease/injury) to a specific occupational risk factor. For 39 established occupational risk factor-health outcome pairs, estimates are produced using population attributable fractions (PAF) from recent burden of disease estimates. For two additional pairs, PAF are calculated from new databases of exposure and risk ratios produced in WHO/ILO systematic reviews. Attributable disease burdens were estimated by applying the PAF to total disease burdens., Results: Globally in 2016, it is estimated that 1.88 [95% uncertainty range (UR) 1.84-1.92] million deaths and 89.72 (95% UR 88.61-90.83) million disability-adjusted life years were attributable to the 19 selected occupational risk factors and their health outcomes. A disproportionately large work-related burden of disease is observed in the WHO African Region (for disability-adjusted life years), South-East Asia Region, and Western Pacific Region (for deaths), males and older age groups., Conclusions: The WHO/ILO Joint Estimates can be used for global monitoring of exposure to occupational risk factors and work-related burden of disease and to identify, plan, cost, implement and evaluate policies, programs and actions to prevent exposure to occupational risk factors and their associated burden.

Aloe gel (Alg), which is a natural extract from the Aloe sp. plant, was evaluated in this study for its potential use as a bioflocculant to treat urban wastewater sewage sludge. The gel was used alone and combined with water glass (WG) under controlled conditions in laboratory experiments. Alg was found effective to settle the flocculated sludge rapidly and remove distinctive unpleasant odours of the sludge as highlighted by gas chromatography-mass spectrometry (GC/MS) analysis. Furthermore, Alg was pH tolerant and had no effect in changing the pH of the wastewater. The optimum dose of Alg was 3% at which a sludge volume index (SVI) of 45.4 mL/g was obtained within 30 min settling time. To enhance the treatment performances of Alg, WG was also evaluated as an alkali agent to further reduce the chemical oxygen demand (COD) and ammonia (NH 4 -N) in the wastewater. At equal doses of 3% of WG and Alg each, the combined treatment outcomes showed high turbidity and NH 4 -N removals of 83 and 89%, respectively, but the overall COD removal was at best 25%. The settling rate of treated sludge with combined Alg/WG was very rapid giving an SVI of 25.4 mL/g within only 5 min.

Backgrounds/aims: The main objective of this study is to compare the ventilatory effects of AFVC and PC modes with the VC mode in laparoscopic surgery of the gall bladder., Methods: Thirty-five patients programmed for laparoscopic cholecystectomy were included. Four times were defined for all patients. The parameters studied were recorded ten minutes after anesthetic induction; and this is the time T1. The time T2 fits to 10 min after induction of pneumoperitoneum. Then, the ventilator mode was changed from VC mode to AFVC mode. Ten minutes later, the variables were scored; it was the time T3. The ventilator mode was then changed to a PC mode. The set pressure was adjusted in order to obtain the same Vt as at the time T2. The time T4 was 10 minutes after switching to PC mode., Results: The Vte were increased, compared to time T2, during the AFVC and PC modes. The induction of pneumoperitoneum with CO 2 induced a rise of P ET CO 2 between T1 and T2. These had been accompanied by a significant rise in airway pressures. The change from VC mode to AFVC mode resulted in lower Prpeak and Prtray elevation without impacting dynamic compliance., Conclusions: AFVC mode appears safe for patients in laparoscopic surgery. Its use, compared with VC, is associated with a decrease in Prpeak without effects on the Cdyn, oxygenation, capnia and hemodynamic parameters. We conclude that is no necessary to change ventlatory modes to improve ventilation conditions in non-obese patients.

Background: Spontaneous rupture of the kidney is uncommon and is mainly caused by renal tumors. Only a few cases are caused by vasculitis. We report here the first case of spontaneous rupture of kidney resulting from mixed cryoglobulinemia., Case Presentation: A 44-year-old man presented with sudden onset of fever, acute pulmonary edema, left flank abdominal pain unassociated with trauma, and rapidly progressive renal failure requiring dialysis. Computed tomography of the abdomen revealed a large perirenal hematoma of the left kidney. During conservative surgery, the patient underwent renal biopsy that showed renal vasculitis and membranoproliferative glomerulonephritis with intracapillary microthrombi. Tests were positive for mixed cryoglobulinemia caused by Sjögren's syndrome. The patient was better after immunosuppressive therapy, with the disappearance of clinical symptoms and the recovery of baseline renal function., Conclusion: We report on this case and discuss a possible link between spontaneous rupture of kidney and mixed cryoglobulinemia-associated Sjögren's syndrome.

Background: There is wide variation in clinical presentation and outcome of lupus nephritis (LN) among different ethnic groups. Few data for LN exist on North Africans, especially those from Morocco. The aim of our study was to review retrospectively the features and outcome of LN in Moroccan patients., Patients and Methods: We performed a single-center retrospective study. A total of 114 patients with LN were included. All patients met American Rheumatism Association criteria. LN was classified according to the International Society of Nephrology/Renal Pathology Society classification. We adopted previously defined outcome criteria for LN., Results: There were 101 females and 13 males, with a mean age of 29.9 years. At first presentation, we noted hypertension in 33%, hematuria in 76%, nephrotic syndrome in 53%, and renal failure in 60% of cases. Renal biopsy revealed predominant proliferative classes in more than 80% of patients. Patients received different regimens mainly based on intravenous cyclophosphamide. After a mean follow-up of 22 months, remission occurred in 45.5%, relapses in 82%, end-stage renal failure in 21%, and death in 16% of cases. Infection and neurological and cardiovascular diseases were the most frequent causes of death., Conclusion: LN seems to be severe in our study, with a predominance of proliferative forms, severe renal manifestations, and poor renal and overall survival.

Parathyroid hormone-related protein (PTHrP) is upregulated in primary breast cancers and a major candidate for osteoclastic bone resorption present at sites of breast cancer to bone metastases. Using a human model of mammary epithelial cell lines differing in tumorigenicity and PTHrP expression, we investigated the role of epigenetic modifications for PTHrP expression. Quantitative analysis of the DNA methylation patterns at a total of 104 CpGs in the promoter region of PTHrP by pyrosequencing showed the absence of methylation in all analyzed cell lines in the large CpG island upstream of exon 1C. In the second intron of promoter 2 (P2) a region was identified containing 4 CpG nucleotides for which differential methylation correlated with the PTHrP expression level. The functional importance of this control mechanism was confirmed by the ability of the demethylating agent 5'-azacytidine to induce PTHrP mRNA and iPTHrP protein expression in previously non-expressing cell lines and increase their production by metastatic NS2T2A1 cells. In particular, transcription from P2 was activated non-tumoral S1T3 cells upon treatment with 5'-azacytidine. Our findings support the hypothesis that the methylation status of specific CpG dinucleotides is the dominant mechanism involved in silencing of PTHrP expression rather than the overall methylation of the CpG island. Methylation of the PTHrP P2 is a potential marker of breast cancer progression and might be used to evaluate the metastatic potential of breast tumors.

Aim: Pregnancies in women with lupus nephritis (LN) are a high-risk situation. The aim of this study is to evaluate the impact of pregnancy on LN on either maternal and fetal prognosis., Patients and Methods: It is a retrospective study of 20 pregnancies in 12 women with lupus nephritis., Results: There were 19 live births and five fetal losses. LN flares were observed in 50 % of the cases during pregnancy and 25 % after delivery., Conclusion: Pregnancies in women with LN require a multidisciplinary monitoring and intense maternal and fetal care., (Copyright © 2010 Association Société de néphrologie. Published by Elsevier SAS. All rights reserved.)

The occurrence of non-diabetic renal disease (NDRD) in diabetic patients is well established, with different frequencies from all around the world. We report 13 cases of isolated NDRD in diabetic patients diagnosed in our unit and present our biopsy criteria in these patients. From January 2000 to December 2008, 13 diabetic patients with suspected NDRD underwent renal biopsy. The case records of these patients were retrospectively analysed. Nine were males and the mean age was 51 years (10-75). Two had a type I diabetes and 11 had a type II diabetes. The mean duration of diabetes was 36 and 30 months in type I and II respectively. Indications for renal biopsy included: absent retinopathy in 11 cases (84%), heavy proteinuria in four cases (30%), acute renal failure (ARF) in three cases (23%), rapidly progressive renal failure (RPRF) in one case (7%), hematuria in five cases (38%), extra-renal signs in four cases (30,7%), short duration of diabetes in all cases. In conclusion, NDRD was observed in our study in patients with a short duration of diabetes and atypical clinical or biological findings.

Acute renal failure (ARF) is a rare complication of acute pyelonephritis in adult immunocompetent patients. Recovery of renal function usually occurs if antibiotics are promptly initiated. However, long-term consequences of renal scarring due to acute pyelonephritis are probably underestimated, and some patients present with prolonged renal failure despite adequate antibiotic therapy. We report two cases of severe ARF complicating bacterial pyelonephritis successfully treated with corticosteroids in association with conventional antibiotics.

Unlabelled: Ethylene glycol is present predominantly in antifreeze,and in industrial solvents. Accidental ingestion of ethylene glycol is relatively rare, but may be potentially lethal. It results in a depression of the central nervous system, a severe metabolic acidosis and an acute renal failure by tubular precipitation of calcium oxalate crystals. We report a case of ethylene glycol poisoning by through skin absorption., Observation: A 38-year-old man, working in a cement factory, with a history of cutaneous psoriasis for 10 years, was admitted to our hospital due to acute nausea, vomiting and diffuse abdominal pain, followed by generalized convulsive status epilepticus and worsening of his mental status. Biologic analysis showed severe metabolic acidosis and acute renal failure which required hemodialysis. On renal biopsy, there were intratubular crystals of calcium oxalate. Cerebral magnetic resonance imaging showed posterior encephalitis. Evolution was marked by normalization of renal function at two weeks and improvement of the mental status. Retrospectively, the patient's history-taking revealed that he manipulated ethylene glycol without gloves., Conclusion: Cutaneous contact with ethylene glycol may cause poisoning in presence of skin lesions. The triad neurologic involvement, renal failure due to oxalate crystals deposits and metabolic acidosis leads to the diagnosis of ethylene glycol intoxication. In the case of acute renal failure with oliguria, haemodialysis is the treatment of choice. It allows the removal of the toxic substance and its metabolites with correction of the metabolic acidosis. The precocity of the treatment may improve the prognosis.

Adrenocortical tumors (ACT) are rare and heterogeneous, but their pathogenesis is unclear. The oncoprotein parathyroid hormone-related protein (PTHrP), found in many common tumors, can regulate their growth in an autocrine/paracrine fashion through the PTH-R1 receptor. Little is known about the role of PTHrP in ACT. We monitored the synthesis of PTHrP and PTH-R1 in a series of 25 ACT: 12 adrenocortical carcinomas (ACC) and 13 adrenocortical adenomas (ACA), and investigated the effects of PTHrP(1-34) on H295R cells derived from an ACC. PTH-R1 mRNA and proteins were detected by real-time PCR and Western blotting in all the ACT samples and in H295R cells. Their concentrations did not differ significantly from one ACT to another. PTHrP mRNA was assayed by quantitative real-time PCR. It was detected in 90% of ACC, and in 10% of ACA. There was a positive correlation with the prognostic factors, McFarlane stage and Weiss score. Tissue-specific PTHrP protein processing was shown by Western blotting. Immunohistochemical staining revealed numerous, dense foci of PTHrP-containing cells in ACC, but few positive cells in ACA or normal tissue. PTHrP stimulated the growth of H295R cells, whereas a specific anti-PTHrP antibody and a PTHrP-R1 antagonist both enhanced their apoptosis. PTHrP activated both adenylate cyclase/protein kinase A and the intracellular calcium/protein kinase C pathways via PTHrP-R1. The active synthesis of PTHrP is linked to poor prognosis in ACC, in which it may act as an autocrine/paracrine factor in tumor growth and malignancy.

Parathyroid hormone-related protein (PTHrP) is produced by many tumors including breast cancer. We have reported that Ets1 factor activates P3 PTHrP promoter in our model of tumorigenic breast cancer cell and not in pre- or non-tumorigenic cell lines, thus contributing to an increased PTHrP production. In this study, gel retardation assays revealed that Etsl and its promoter binding site (EBS) specifically formed complexes whose abundance correlates with Ets1 levels in the three cell lines. Coexpression of Etsl and CBP induced a synergistic activation of the P3 promoter only in the tumorigenic cell line. This synergism required the integrity of the EBS and was abrogated by E1A. All breast cancer cell lines showed high basal concentrations of phosphorylated CREB. Moreover a CRE-like sequence was also required for Ets1/CBP synergy and, finally, CREB expression was found to enhance the PTHrP P3 promoter activity. Thus a multipartite complex of transcription factors and coactivators seems to regulate PTHrP transcription and contribute to the alterations that promote tumorigenic behavior in breast epithelial cells.