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The transition from a predominantly milk-based diet to a diverse family diet is a window of opportunity for optimal child growth and development.The study aims to examine the nutritional status and food-consumption patterns of children under 4 y of age in the United Arab Emirates (UAE) and their adherence to nutrient and dietary recommendations.A population-based cross-sectional survey of 525 children aged 0-47.9 mo was conducted in 3 major emirates: Abu Dhabi, Dubai, and Sharjah. Anthropometric measurements were obtained, and dietary assessment was conducted using the 24-h dietary recall approach. Usual intakes of energy, macronutrient, and micronutrients, including from supplements, were assessed using PC-SIDE software. Adherence to food-group recommendations was evaluated based on the American Heart Association/American Academy of Pediatrics dietary guidelines.Among 0-4-y-old children, 10% were stunted, 6% were wasted, 17% were at risk of overweight, 5% were overweight, and 3% were obese. The contribution of sweets and sugar sweetened beverages to energy intake increased from 5% in 6-11.9-mo-old children to 17% in 36-47.9-mo-old children. Compared with dietary guidelines, the lowest adherence was for fruit (13-18%) and vegetables (7-12%), while protein was within the recommendations, and 92% and 89% of children (aged 24 to 35.9 mo and 36 to 47.9 mo, respectively) had high intakes of saturated fat. Almost all toddlers failed to meet the Adequate Intake for fiber. The proportions of children exceeding the free-sugar upper limit increased from 10.6% in infants (0-5.9 mo) to 56.7% in toddlers (12- 23.9 mo). Micronutrient inadequacies were observed, particularly for calcium, zinc, folate, and vitamins A and D.This study suggests a triple burden of malnutrition among infants and young children in the UAE. Results call for national nutrition intervention strategies aimed at improving dietary quality in the pediatric population.

Purpose The purpose of this study was to report the clinical evaluation of a 3D-printed protective face shield designed to protect interventional radiologists from droplet transmission of the SARS-Cov-2. Materials and methods A protective face shield consisting in a standard transparent polymerizing vinyl chloride (PVC) sheet was built using commercially available 3D printers. The 3D-printed face shield was evaluated in 31 interventional procedures in terms of ability to perform the assigned intervention as usual, quality of visual comfort and tolerance using a Likert scale (from 1, as very good to 5, as extremely poor). Results The mean rating for ability to perform the assigned intervention as usual was 1.7 ± 0.8 (SD) (range: 1–4). The mean visual tolerance rating was 1.6 ± 0.7 (SD) (range: 1–4). The mean tolerability rating was 1.4 ± 0.7 (SD) (range: 1–3). Conclusion The 3D-printed protective face shield is well accepted in various interventions. It may become an additional option for protection of interventional radiologists.

Patient order management (POM) is a mission-critical task for perioperative workflow. Interface complexity within different EHR systems result in poor usability, increasing documentation burden. POM interfaces were compared across two systems prior to (Cerner SurgiNet) and subsequent to an EHR conversion (Epic). Here we employ a navigational complexity framework useful for examining differences in EHR interface systems. The methodological approach includes 1) expert-based methods—specifically, functional analysis, keystroke level model (KLM) and cognitive walkthrough, and 2) quantitative analysis of observed interactive user behaviors. We found differences in relation to navigational complexity with the SurgiNet interface displaying a higher number of unused POM functions, with 12 in total whereas Epic displayed 7 total functions. As reflected in all measures, Epic facilitated a more streamlined task-focused user experience. The approach enabled us to scrutinize the impact of different EHR interfaces on task performance and usability barriers subsequent to system implementation.

Introduction Les traitements administres aux patients âges hospitalises necessitent frequemment l’usage de voies veineuses peripheriques (VVP), surtout en unite de geriatrie aigue. L’usage de ces VVP expose ces patients fragiles a des complications infectieuses, dont l’incidence et les facteurs de risque n’ont pas ete etudies specifiquement dans cette population. L’objectif principal de l’etude etait de mesurer la densite d’incidence des complications locales liees aux VVP chez le sujet âge. Les objectifs secondaires etaient d’identifier les facteurs de risque de ces complications, de decrire leur epidemiologie microbiologique et de determiner l’impact de ces complications sur le devenir des patients hospitalises. Materiels et methodes Dans cette etude de cohorte prospective (01/12/2019-30/05/2020), observationnelle, non interventionnelle, tous les patients hospitalises en geriatrie aigue (26 lits, 1 IDE/13 lits) et onco-geriatrie (10 lits, 1 IDE/10 lits) d’un hopital universitaire et necessitant une VVP ont ete inclus, sauf refus exprime par le patient ou sa personne de confiance. Le suivi etait tri-quotidien par l’infirmier (surveillance des VVP selon une classification standardisee des complications locales adaptee de l’Infusion Nurse Society, date de pose et retrait, solutes perfuses) et medical en cas de complication. En cas de complication locale ou bacteriemie, l’extremite distale de la VVP etait envoyee en microbiologie pour culture. Resultats Sur 322 patients inclus, 274 (85,4%) venaient du domicile et 71,7% et 77,6% d’entre eux etaient continents urinaire et fecal, respectivement (231/321 et 250/321). Les scores ADL et IADL moyens etaient de 4,2 ± 2,0 et 3,3 ± 2,9. Vingt-trois patients recevaient des corticoides, 97 une anticoagulation efficace et 95 un antiagregant plaquettaire (soit 7,2 %, 30,5 % et 29,5 %, respectivement). Sur les 849 VVP (2,64 ± 1,96 VVP/patient), la densite d’incidence de complication locale etait de 50,5/1000 VVP-jour. En analyse multivariee, les facteurs de risque de ces complications etaient la refection de Tegaderm® (OR 1,175 (1,055 ;1,309), p = 0,014), l’administration de furosemide (OR 1,129 (1,064 ;1,198), p = 0,01) et de vancomycine (OR 1,542 (1,265 ;1,88), p Conclusion Les complications locales liees aux VVP chez la personne âgee sont frequentes et evitables. L’identification de facteurs de risque modifiable et non modifiables permet d’envisager: – d’ameliorer les procedures de soins; – de mieux identifier les patients a risque de developper des complications locales pour lesquels les strategies d’ablation precoce de VVP devraient etre renforcees.

Background Few studies have investigated infections in human immunodeficiency virus (HIV)-infected liver transplant patients. The aim of this study was to describe the prevalence, time of onset, mortality of infectious complications, other than hepatitis C virus (HCV), and to identify risk factors for their development in a large single-center cohort of HIV-infected liver transplant patients. Methods We studied 109 consecutive HIV-infected patients who underwent liver transplantation (LT) between 1999 and 2010 and followed until December 2012. Results The median age was 44 years (interquartile range [IQR] 41–49), 82.6% were male, and the median follow-up was 45.7 months (IQR 14–65). The major indications for LT were HCV cirrhosis (61%) and hepatocellular carcinoma (19%). Forty patients (37%) developed at least 1 infection during the first year after LT. Twenty-eight (26%) patients had an episode of bacteremia. Five (4.6%) patients developed a cytomegalovirus infection. Fungal infections occurred in 5 (4.5%) patients. Four (3.6%) patients developed an HIV-related opportunistic infection. A total of 43 (39.4%) patients died during follow-up. Mortality related to infection occurred in 9 (7%) cases, and 20 (42.5%) patients died because of HCV recurrence. No patients died from opportunistic infections. Model for end-stage liver disease (MELD) score >17 was associated with a 2-fold higher risk (hazard ratio 1.96; 95% confidence interval 1.01–3.80) of developing infectious complications. Conclusions Infections are not a major cause of mortality after LT in HIV patients and opportunistic infections of acquired immunodeficiency syndrome are infrequent. A MELD score >17 increased the risk of developing post-LT infectious complications. Recurrence of HCV infection remains a major cause of mortality.

Background The Anti-Her 2 (AH2) drugs [trastuzumab (T.) and ertuzumab (P.)] are essential components in HER2 + Breast Cancer treatment. Although these kinds of therapies represent a breakthrough in different studies, a group of patients (p.) presented left ventricular dysfunction (LVD) in the follow-up. The vast majority recovered the left ventricular ejection fraction (LVEF) after withdrawal of treatment. We analysed prospectively a group of p. who presented a LVD after AH2 treatment. We propose that the early treatment with beta-blockers (BB), angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blockers (ARB), aldosterone antagonist (AA); could help an early recovery of LVEF and allow the reintroduction of the AH2 therapy without a new risk of LVD. Methods We evaluated 587 consecutive p. with HER2+ breast cancer who received T. alone or with P. from January 2017 to August 2018. We evaluated LVEF with ultrasonography (US.) before treatment (t). 43 p. had developed LVD and started t. with BB [Carvedilol (C.], ACEI [Enalapril (E.)] or ARB [Valsartan (V.)], AA [eplerenone (EP.)] at the moment of HF diagnosis and kept under t. after LVEF recovery. AH2 therapies were reintroduced when the patients improved their LVEF. Follow-up was with US.: 30 days, 60 days, 3 and 6 months (m.). We used SPSS for the statistical analysis. Results 43 p. aged 54 +/- 8, 100% female. Risk Factors: arterial hypertension 10 p., diabetes 5 p, dyslipidemia 6 p., smoking 9 p. Previous oncological therapies: doxorubicin - cyclophosphamide 22 p., paclitaxel 22 p. Median of the basal LVEF was 61.4 % and at HF diagnosis was 39.3 %. Patient's New York Heart Association (NYHA) at diagnosis moment class was: I 15 %, II 60% and III 25%. All of the p. stopped the AH2 therapy. HF t. was: C 42 patients, E 33 patients, V. 10 patients and EP. 42 patients. LVEF recovery at 30 days was 81.39 % of p, at 60 days 95.34 %, at 3 and 6 m 97.67 %. When p. recuperated the LVEF we restarted the AH2 therapy. No patients had a new LVD at 3 m. and 6 m.. Patient's NYHA class at 6 m was: I 30%, II 25% and asymptomatic 45%. Conclusions While the LVD related with AH2 therapies is a real problem in HER2+ breast cancer patients’ care, a timely diagnosis and t. with therapies for HF can allow LVEF recovery and specific oncological therapy continuance. Legal entity responsible for the study The authors. Funding Has not received any funding. Disclosure All authors have declared no conflicts of interest.

Policosanols (PC) are very long chain aliphatic alcohols derived from the wax constituent of plants. In the early 1990s, researchers at Dalmer Laboratories in La Habana Cuba isolated and produced the first PC supplement from sugarcane wax. The original PC supplement has been approved as a cholesterol-lowering drug in over 25 countries throughout the Caribbean and South America. Cuban studies claim that 1 to 20 mg/day of the original PC supplement are effective at producing significant reductions in total cholesterol (TC) and low density lipoprotein cholesterol (LDL-C). These studies also show that PC supplements are potent antioxidants, promote proper arterial endothelial cell function, inhibit platelet aggregation and thrombosis, and serve as effective treatments for intermittent claudication. However, for the most part, those studies reporting therapeutic efficacy of PC were carried out by one research group situated in Cuba. Conversely, research groups outside of Cuba have failed to validate the cholesterol-lowering and antioxidant efficacy of PC. Cuban researchers, however, continue to claim that the efficacy is attributed to the unique purity and composition of the original PC preparation, a mixture not found in PC products used by external research groups. The absence of independent and external studies confirming the therapeutic benefits of PC in disease prevention and treatment raises questions regarding their true efficacy.

Policosanol is a mixture of higher aliphatic alcohols shown to have beneficial effects on plasma lipid levels in animals and humans. Over 50 studies have reported significant reductions in plasma cholesterol using policosanol obtained from Cuban sugar cane (Dalmer, La Havana, Cuba). However, other research groups using policosanol from alternative sources have failed to reproduce the efficacy of these alcohols observed in earlier studies. Therefore, the objective of the present study was to compare the cholesterol-lowering effect of the Dalmer sugar cane policosanol (SCP) product versus an alternative mixture of similar policosanol composition. Forty-eight male Golden Syrian hamsters were randomly assigned to four groups and fed experimental diets ad libitum for a period of 4 weeks: (i) non-cholesterol control, (ii) 0.1% cholesterol control, (iii) 0.1% cholesterol diet supplemented with 275 mg/kg diet of Dalmer Cuban sugar cane policosanol and (iv) 0.1% cholesterol diet supplemented with 275 mg/kg diet of alternative sugar cane policosanol. Hamsters were sacrificed and blood was collected at the end of the feeding period. Body weights and food intakes were similar across study groups. Neither of the two policosanol treatments had any significant effect on plasma lipid levels, as compared to cholesterol control. The outcome of the present study questions the clinical usefulness of policosanol mixtures as cholesterol-lowering nutraceuticals.

Background More than 50 studies have reported substantial reductions in plasma lipid concentrations in response to 2-40 mg Cuban sugar cane policosanol (SCP) mixtures/d. However, several animal and human trials conducted outside of Cuba that used non-Cuban mixtures have failed to reproduce the efficacy of policosanols observed in earlier studies. Objective The objective was to evaluate lipid-modulating actions of the authentic Cuban SCPs on plasma lipids in healthy hypercholesterolemic volunteers. Design Twenty-one volunteers consumed, under supervision, 10 mg SCPs/d or a placebo incorporated in margarine as an afternoon snack, for a period of 28 d with the use of a randomized, double-blind crossover study design. Subjects maintained their habitual diet and physical activity and were weighed daily throughout the study period. Blood was collected at days 1, 2, 28, and 29 of the feeding trial, and lipid concentrations were measured. Results Body weights did not vary significantly throughout the trial and did not affect plasma lipid values. No significant difference was observed between treatment and control groups in plasma total, LDL-, HDL-cholesterol, and triacylglycerol concentrations. Conclusion Present results show no beneficial effects of Cuban SCPs on lipid indicators in hypercholesterolemic persons and question the clinical usefulness of policosanol mixtures as cholesterol-lowering neutraceutical agents.

Repeated outbreaks of vancomycin-resistant Enterococcus faecium (VRE) occurred between 2004 and 2010 in Assistance Publique--Hopitaux de Paris (AP-HP), a 23,000-bed multi-hospital institution. From August 2004 to December 2005, the French guidelines for preventing cross-transmission of multiresistant bacteria were applied. Because the number of VRE cases continued to increase, an institutional control programme was implemented from January 2006 onwards: it foresees stopping transfer of VRE and contact patients, separating VRE and contact patients in distinct cohorts, intervention of a central infection control team to support local teams, and quick application of measures as soon as first VRE cases are identified. Between August 2004 and December 2010, 45 VRE outbreaks occurred in 21 of the 38 AP-HP hospitals, comprising 533 cases. Time series analysis showed that the mean number of cases increased by 0.8 cases per month (95% confidence interval (CI): 0.3 to 1.3, p=0.001) before, and decreased by 0.7 cases per month after implementation of the programme (95% CI: -0.9 to -0.5, p

An outbreak of Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae type 2 was detected in September 2009 in two hospitals in a suburb south of Paris, France. In total, 13 KPC-producing K. pneumoniae type 2 cases (four with infections and nine with digestive-tract colonisations) were identified, including a source case transferred from a Greek hospital. Of the 13 cases, seven were secondary cases associated with use of a contaminated duodenoscope used to examine the source case (attack rate: 41%) and five were secondary cases associated with patient-to-patient transmission in hospital. All isolated strains from the 13 patients: (i) exhibited resistance to all antibiotics except gentamicin and colistin, (ii) were more resistant to ertapenem (minimum inhibitory concentration (MIC) always greater than 4 mg/L) than to imipenem (MIC: 1-8 mg/L, depending on the isolate), (iii) carried the blaKPC-2 and blaSHV12 genes and (iv) had an indistinguishable pulsed-field gel electrophoresis (PFGE) pattern. These cases occurred in three hospitals: some were transferred to four other hospitals. Extended infection control measures implemented in the seven hospitals included: (i) limiting transfer of cases and contact patients to other wards, (ii) cohorting separately cases and contact patients, (iii) reinforcing hand hygiene and contact precautions and (iv) systematic screening of contact patients. Overall, 341 contact patients were screened. A year after the outbreak, no additional case has been identified in these seven hospitals. This outbreak emphasises the importance of rapid identification and notification of emerging highly resistant K. pneumoniae strains in order to implement reinforced control measures. .

We report the successful control of an outbreak caused by imipenem-resistant VIM-1-producing Klebsiella pneumoniae (IR-Kp) in France. This outbreak occurred in a care centre for abdominal surgery that includes a 15-bed liver intensive care unit and performs more than 130 liver transplantations per year. The index case was a patient with acute liver failure transferred from a hospital in Greece for urgent liver transplantation who was carrying IR-Kp at admission as revealed by routine culture of a rectal swab. Infection control measures were undertaken and included contact isolation and promotion of hand hygiene with alcohol-based hand rub solution. Nevertheless, secondary IR-Kp cases were identified during the six following months from 3 December 2003 to 2 June 2004. From 2 June to 21 October, extended infection control measures were set up, such as cohorting IR-Kp carriers, contact patients and new patients in distinct sections with dedicated staff, limiting ward admission, and strict control of patient transfer. They led to a rapid control of the outbreak. The global attack rate of the IR-Kp outbreak was 2.5%, 13% in liver transplant patients and 0.4% in the other patients in the care centre (p

A fundamental understanding regarding postprandial glycemic responses to foods containing whole yellow-pea flour (WYPF) remains unknown. This, alongside concerns that WYPF possesses unfavorable sensory characteristics has limited the incorporation of WYPF into new functional food products as a healthy novel ingredient. The objective of this study was to evaluate how WYPF modulates postprandial glycemic responses as well as sensory characteristics in novel foods. In a single-blind crossover trial, the present study assessed postprandial glycemic responses of banana bread, biscotti, and spaghetti containing either WYPF or whole wheat flour (WWF). Boiled yellow peas (BYP) and white bread (WB) were used as positive and negative controls, respectively. On day 1, subjects evaluated appearance, taste, texture, smell as well as overall acceptance of each WYPF and WWF food on a 5-point hedonic scale. WYPF banana bread (97.9 +/- 17.8 mmol x min/L) and biscotti (83 +/- 13 mmol x min/L), as well as BYP (112.3 +/- 19.9 mmol x min/L), reduced (P < 0.05) glycemic responses compared to WB (218.1 +/- 29.5 mmol x min/L). The glycemic response of WYPF pasta (160.7 +/- 19.4 mmol x min/L) was comparable to WB. WYPF biscotti produced a lower (P = 0.019) postprandial glycemic response compared to WWF biscotti (117.2 +/- 13.1 mmol x min/L). Hedonic responses between corresponding foods were similar except for the WYPF pasta (2.9 +/- 0.9) which possessed a lower sensory score (P = 0.02) for smell compared to WWF pasta (3.6 +/- 1). WYPF can be used to produce low-glycemic functional foods possessing sensory attributes that are comparable to identical food products containing WWF.

Sugar cane policosanols (SCP) have been shown to exert antioxidant properties in various studies conducted in Cuba. Independent studies have since reported no significant effect of SCP consumption on oxidized LDL levels. The objective of the present study was to confirm the effects of Cuban SCP on LDL oxidation using a high-precision capture ELISA procedure in hypercholesterolemic individuals. Twenty-one otherwise healthy hypercholesterolemic men and post-menopausal women participated in a randomized double blind crossover study where they received 10 mg/day of policosanol or a placebo incorporated in margarine as an evening snack for a period of 28 days. Subjects maintained their usual dietary and exercise habits throughout the duration of the study. Blood was collected on the first as well as the last 2 days of the trial. LDL oxidation was measured from plasma using a solid phase two-site enzyme immunoassay. A lack of effect of SCP was observed on LDL cholesterol levels, as well as no difference in LDL oxidation between the SCP treatment and placebo at the end of the intervention period. Subject body weights remained stable throughout the study and showed no significant correlation with LDL oxidation levels. Absolute levels of plasma LDL cholesterol were significantly (P < 0.05) correlated with plasma concentrations of oxidized LDL. The findings of the present study suggest that SCP do not significantly affect LDL oxidation. Our results align with results of recent policosanol research questioning the efficacy of these natural extracts as cardio-protective agents.

Plant sterols (PSs) reduce plasma total and low-density lipoprotein cholesterol (LDL-C) levels by reducing cholesterol absorption; however, it is not known whether the level of dietary cholesterol intake has an impact on the efficacy of PSs on blood lipids. The purpose of this study was to determine the effect of high vs low dietary cholesterol levels on the lipid-lowering efficacy of free PSs. The study was a semirandomized, double-blind, crossover trial consisting of four 28-day feeding phases each separated by a 4-week washout period. Otherwise healthy hypercholesterolemic subjects (n = 22) consumed each of (a) low-cholesterol control (C(-)S(-)), (b) high-cholesterol control (C(+)S(-)), (c) 22 mg PSs per kilogram of body weight with a low-cholesterol diet (C(-)S(+)), and (d) 22 mg PSs per kilogram of body weight with a high-cholesterol diet (C(+)S(+)). Blood was drawn on the first and last 2 days of each phase to measure plasma total cholesterol, LDL-C, high-density lipoprotein cholesterol, and triacylglycerols as well as plasma campesterol and beta-sitosterol concentrations. Dietary cholesterol had no effect on PS efficacy as a cholesterol-lowering agent because no interaction was found between the 2 factors. However, dietary cholesterol and PS intake had significant independent effects on plasma total cholesterol, LDL-C, and high-density lipoprotein cholesterol levels. beta-Sitosterol levels in plasma increased (P < .0001) as a result of PS supplementation. Data from the present study indicate that, although PSs and dietary cholesterol exert independent effects on plasma cholesterol, PS efficacy is not affected by varying levels of cholesterol intake.

Policosanols (PC) exist as very-long-chain alcohols derived from sugarcane currently used in many countries as a cholesterol-lowering therapy. PC purity and relative percentage composition have been suggested as primary reasons why the original Cuban PC (OPC) supplements possess lipid-lowering efficacy. The purpose of the present study was, first, to compare the relative percentage purity and PC composition of both OPC and alternative sources of PC (APC). A second objective was to feed Syrian hamsters a diet containing 0·275 mg PC/g of either the OPC or an APC product (APC1) and compare subsequent tissue, plasma and faecal PC levels. Five animals from the APC1 dietary group received a diet containing ten times the original amount of PC. Results indicate that the APC formulations have a composition that is highly consistent with the OPC supplement, with octacosanol being present within the cited 60–70 % range. PC were undetectable in the small intestine, liver, adipose or plasma in animals fed either source. Hamsters fed OPC excreted octacosanol (C28) more rapidly (P

Introduction La prise alimentaire est motivee par des stimuli odorants et le statut metabolique impacte la sensibilite olfactive et le comportement alimentaire des animaux. La Prokineticine-2 (Prok2) est un neuropeptide hypothalamique anorexigene qui est fortement exprime dans le bulbe olfactif (BO), comme le recepteur au GLP-1 (GLP-1R). Notre etude vise a determiner le role de la Prok2 olfacto-bulbaire dans la regulation de la prise alimentaire et ses interactions avec la voie de signalisation GLP-1R. Materiels et methodes Le niveau d’expression des ARNm de Prok2 et de GLP-1R a ete mesure par RTqPCR dans le BO de souris sauvages nourries ou a jeun et soumises a un regime standard (CD) ou hyperlipidique (HFD). La prise alimentaire a ete mesuree chez des souris sauvages injectees dans le BO avec de la Prok2 recombinante (rPK2) +/– de l’Exendine-9 (Ex9), un antagoniste du GLP-1R, apres un jeune de 24 heures ainsi que chez des souris GLP-1RKO injectees avec de la rPK2 dans le BO. Resultats Le niveau d’expression des ARNm de Prok2 et de GLP-1R dans le BO est dependant des statuts metabolique (mince ou obese) et nutritionnel (nourri ou a jeun): le jeune diminue l’expression de Prok2 dans le BO des souris minces alors qu’il l’augmente significativement dans celui des souris obeses et l’expression de GLP-1R est augmentee par le jeune dans le BO des souris HFD. L’injection de rPK2 dans le BO diminue significativement la reprise alimentaire durant 24 heures chez les souris CD et HFD. Cet effet est supprime par la co-injection d’Ex9. Enfin, l’effet anorexigene induit par l’injection de rPK2 dans le BO de souris sauvages est aboli chez les souris GLP-1RKO. Conclusion La Prok2 olfacto-bulbaire regule la prise alimentaire et son effet anorexigene est relaye par la voie GLP-1R. Declaration d’interet Les auteurs declarent ne pas avoir d’interet direct ou indirect (financier ou en nature) avec un organisme prive, industriel ou commercial en relation avec le sujet presente.

The aim of this study was to investigate the cholesterol-lowering mechanisms of corn fiber oil (CFO), ferulate phytostanyl esters (FPEs) and parent compounds of FPE, including sitostanol and ferulic acid, in hamsters.Seventy male Golden Syrian hamsters were randomly assigned to six experimental diets for 4 weeks: (1) cornstarch-casein-sucrose-based control diet (control); and (2) control diet plus 0.1% (wt/wt) cholesterol (cholesterol-control). The remaining four groups were given cholesterol-control diet with: (3) 10% (wt/wt) CFO; (4) 0.5% (wt/wt) sitostanol; (5) 0.23% (wt/wt) ferulic acid; and (6) 0.73% (wt/wt) FPE. At the end of dietary intervention, total plasma cholesterol, high-density lipoprotein cholesterol and triglyceride concentrations were determined. Parameters of cholesterol kinetics, including cholesterol absorption and synthesis, as well as mRNA expression of sterol transporters such as Niemann-Pick C1 like 1 (NPC1L1), ATP-binding cassette G5 (ABCG5) and ABCG8, were assessed.Supplementation with CFO decreased (P.0001) plasma total cholesterol levels by 29% as compared with the cholesterol-control group, while FPE and sitostanol reduced (P.02) cholesterolemia by 15% and 14%, respectively. CFO and sitostanol decreased (P.05) cholesterol absorption by 24% compared to the cholesterol-control group. Dietary intervention did not alter the intestinal gene expression of ABCG5, ABCG8 and NPC1L1.The present results show that the CFO-induced and sitostanol-induced decrease in cholesterol absorption is independent of intestinal enterocyte sterol transporters such as ABCG5, ABCG8 and NPC1L1 in hamsters.

Recommendations for decreasing the risk of developing cardiovascular disease include increasing the intake of plant sterols and fish oil. The cholesterol-lowering action of plant sterols, when provided in a fish-oil fatty acids vehicle, remains to be investigated in humans. A randomized, crossover-feeding, single-blind trial was conducted in 30 subjects with mild-to-moderate hypercholesterolemia to study the effects on plasma lipids of 2 novel forms of plant sterols: those combined with, or esterified to, fish-oil fatty acids. The treatments were margarine (control), free plant sterols, plant sterols esterified to fatty acids from sunflower oil, plant sterols esterified to very long-chained fatty acids from fish oil, and plant sterols combined with the same amount of very long-chained fatty acids from fish oil. Each sterol-containing food (1.0-1.8 g plant sterols/d) was consumed for 29 d as a single dose with breakfast under staff supervision. Compared with the control treatment, none of the plant sterol preparations reduced plasma total cholesterol or LDL cholesterol, triacylglycerol, apolipoprotein A-I, apolipoprotein B, lipoprotein (a), or C-reactive protein concentration. Relative to the control phase, all plant sterols treatment increased the plasma HDL cholesterol concentration (P < 0.05) by approximately 8%. In conclusion, because standard forms of plant sterols did not reduce plasma cholesterol concentrations, the efficacy of the new formulation of plant sterols cannot be confirmed from the present study design, where plant sterols were given as a single morning dose.

We previously showed that a 48-h intravenous lipid infusion in rats induces pancreatic beta-cell hypersensitivity to catecholamines. Our aim was to study the lipid-related changes that may account for such hypersensitivity in pancreatic islets. We show here that a 48-h increase in plasma FFA alters the binding characteristics of beta-cell alpha2 adrenoceptors in rats. Lipid infusion decreases pancreatic norepinephrine (NE) turnover rate by 28%, reflecting a reduction of pancreatic NE stores. Following lipid infusion, the density of alpha2 adrenoceptor binding sites is significantly lower and receptor affinity higher, both in islet homogenates (by three- and fivefold, respectively) and isolated whole beta-cells (by two- and sixfold, respectively). These changes correlate with the elevated insulin response to glucose found in lipid-infused rats. We also found a modification of islet phospholipid content, particularly in phosphoethanolamine species containing infused FA such as palmitate, oleate, stearate, and linoleate. This may account for the modifications in receptor affinity. These results suggest that hyperlipidemia-associated pathologies such as diabetes and obesity not only may result from alterations of metabolic pathways but also may be a consequence of early modifications in nervous firing rates and signal transduction pathways.

We sought to determine the epidemiological characteristics of patients in an intensive care unit (ICU) who developed ventilator-associated pneumonia (VAP) caused by piperacillin-resistant Pseudomonas aeruginosa (PRPA; n=34) or piperacillin-susceptible P. aeruginosa (PSPA; n=101). According to univariate analysis, the factors associated with the development of PRPA VAP were presence of an underlying fatal medical condition, immunocompromised status, longer previous hospital stay, less-severe illness at the time of ICU admission, duration of mechanical ventilation before onset of VAP, number of classes of antibiotic received, and previous exposure to imipenem or fluoroquinolone. Multivariate logistic regression analysis identified the following significant independent factors: presence of an underlying fatal medical condition (odds ratio [OR], 5.6), previous fluoroquinolone use (OR, 4.6), and initial disease severity (OR, 0.8). We concluded that the clinical characteristics of patients who develop PRPA VAP differ from those of patients who develop PSPA VAP. Restricted fluoroquinolone use is the sole independent risk factor for PRPA VAP that is open to medical intervention.

Policosanols were shown to have positive effects on cholesterol levels in more than 30 clinical studies originating from Cuba. The policosanol controversy revolves around the fact that these studies were conducted by one single jurisdiction using one single mixture. Based on thorough searches for full text manuscripts in the policosanol literature, no independent studies using the original policosanol mixture was able to replicate the cholesterol efficacy seen in Cuban studies. The two clinical trials cited by Dr. Jargin (Nikitin et al. 2000; Prat et al. 1999) do indeed add to the positive body of evidence provided by Cuban researchers. However, these studies were not included in the aforementioned thesis due to the inaccessibility of corresponding full texts and our lack of resources to translate the manuscripts from Russian and Spanish to English. In fact, these studies are not available in English and are therefore only accessible to a restricted audience. Furthermore, the limited details on study designs included in the abstract clearly show that although sample size and randomization were appropriate, the lack of placebo in the trials (often noted as a limitation of Cuban studies as well) weaken the con

Atherosclerosis prevention is now a main focus of the scientific community and pharmaceutical industry. Sugar cane policosanols (SCPs) have gained increasing popularity over the last decade as a result of numerous studies conducted in Cuba that consider SCPs as a natural alternative to statin drugs. However, independent research on policosanols was not able to replicate cholesterol reductions reported by Cuban laboratories. No independent study to date has examined the cholesterol-lowering effect and antioxidant capacity of original SCPs in humans. In addition, since independent research was criticized because of the use of alternative policosanol formulations, the source and composition of policosanol mixtures are now at the core of the policosanol controversy. The aim of this thesis project was first to compare the composition and cholesterol-lowering effects of different SCP preparations in hamsters, and second to test the cholesterol-lowering efficacy, mechanism of action, and antioxidant capacity of the original Cuban SCP in hypercholesterolemic humans. In study 1, 48 male hamsters were randomly assigned to 4 groups for a period of 4 weeks: (i) non-cholesterol control, (ii) cholesterol control, (iii) original SCPs, and (iv) alternative SCPs. Hamsters were sacrificed and blood was collected at the end of the feeding period for lipid measurements. In study 2, 21 hypercholesterolemic volunteers consumed 10 mg·d–1 of SCPs or a placebo for a period of 28 days in a crossover trial. Plasma lipid levels and low-density lipoprotein (LDL) oxidation were measured at the start and end of supplementation phases. Cholesterol absorption and synthesis were assessed using a single-isotope, single-tracer technique and deuterium incorporation, respectively. There was no significant difference in cholesterol-lowering efficacy between hamsters in the original and alternative SCP groups relative to the control. Similarly, in hypercholesterolemic humans, supplementation with original SCPs did not significantly improve lipid parameters and no change in cholesterol absorption or synthesis was observed relative to the control. In vivo assessment of LDL oxidation showed no significant changes in oxidized LDL concentration relative to baseline and control. The present thesis disagrees with previous Cuban data on the cardio-protective role of SCPs in animals and humans and supports independent studies showing no cholesterol-lowering effect and no antioxidant capacity.

A 68 year old man developed progressive cognitive impairment with an akinetic-rigid syndrome which was atypically responsive to levodopa. The patient died after 18 months and the postmortem examination showed typical Lewy bodies in the substantia nigra and pale bodies in the cortex which were unlabelled by ubiquitin antibodies. This case is particular by the neuropathological examination (no immunoreactivity to antibodies against ubiquitin) and by the abnormal response to treatment (dystonia). These two aspects are discussed.

Introduction et objectifs Une epidemie a ERG est survenue dans le service hepatobiliaire de l’hopital Paul Brousse. Evaluer l’impact economique de cette epidemie dans le service de maladies infectieuses ou les cas ont ete regroupes. Materiels et methodes Au total 13 cas, dont le cas index, 11 cas secondaires, 1 cas isole et 294 contacts ont ete identifies. Un secteur geographiquement isole, dedie aux cas a ete mis en place dans le service des Maladies Infectieuses (MI). Les mesures instaurees ont ete : personnel dedie, renforcement de l’hygiene des mains, precautions contact, depistage hebdomadaire par ecouvillonnage rectal, controle des prescriptions des antibiotiques. La duree moyenne de sejour (DMS), le nombre d’admissions, l’activite et le cout ont ete analyses. Resultats L’occupation des lits dans le secteur dedie a ete de 74,6 %. La DMS en isolement a ete de 19,7 jours versus 9,6 en MI. Les admissions ont diminue de 49,2 % pendant la crise, soit un manque a gagner de 138 818 € (prix moyen du cout de traitement : 4 478 €). Les besoins en personnel paramedical ont represente 954 heures supplementaires (5 719,18 €). Les couts specifiques constitues par les examens de laboratoire (242 recherches ERG), les consommables, la consommation de solution hydro-alcoolique ont ete de 14 168,4€. Le surcout en medicaments a ete de 25 142 €. Conclusion La creation d’un secteur dedie avec un personnel specialise a permis de maitriser rapidement l’epidemie et de maintenir l’activite du service de transplantation hepatique. La gestion de l’epidemie a ERG a eu un reel impact financier en MI (cout total estime a 183 847 €), d’organisation, de fonctionnement. La codification specifique des sejours en isolement pourrait pallier a ce surcout.

Introduction et objectifs Evaluer la pertinence des prescriptions des fluoroquinolones (FQ), de la piperacilline-tazobactam (TZP), de l’imipeneme (IPM), de la vancomycine (VA) et du linezolide (LZD) dans les services de medecine, maladies infectieuses et onco-hematologie de l’hopital Paul Brousse. Materiels et methodes Pendant trois mois, tous les patients traites par FQ, TZP, IPM, VA ou LZD, dans ces 3 services ont ete inclus dans l’etude. Les prescriptions et le dossier patient ont ete analyses par un groupe d’experts. Les referentiels utilises etaient : le guide de bonne pratique de prescription des antibiotiques de l’hopital Paul Brousse et les recommandations professionnelles de l’HAS 2008. L’evaluation portait sur la pertinence des indications de prescription, choix de la molecule, respect des posologies, reevaluation a 72 h et duree de traitement. Resultats 181 prescriptions correspondant a 159 patients ont ete analysees. La prescription des antibiotiques etait conforme dans 80,7 % des cas, adaptee au germe dans 100 % des cas et avec des posologies conformes dans 100 % des cas. La reevaluation antibiotique a 72 heures etait inscrite dans le dossier dans 34,6 % des cas. Une desescalade etait realisee dans 67,5 % des cas, sur documentation bacteriologique. La poursuite d’une antibiotherapie probabiliste au-dela de 3-4 jours etait motivee pour 62,1 % des cas. La duree depassait une semaine sans justification dans 25 % des cas. Conclusion La diffusion du guide de bonne pratique en antibiotherapie en 2007 et les consultations du referent antibiotique ont ameliore la pertinence des prescriptions des antibiotiques a large spectre. La mise en place d’une consultation mobile d’antibiotherapie pourrait aider a une plus juste prescription des antibiotiques.

Introduction et objectifs Demontrer l’interet d’une collaboration entre un service de chirurgie et un service de Maladies Infectieuses (MI) dans la gestion d’une epidemie Materiels et methodes Transfert du Portugal d’un patient porteur d’un ERV au CHB. Pendant la periode 1 les mesures prisent au CHB : precautions « contact », isolement geographique des cas, pratique de la marche en avant pour les soins (difficultes a pouvoir le service en IDE), renforcement de l’utilisation des SHA. Malgre ces mesures, 11 cas secondaires et un patient porteur d’une souche isolee sont detectes. Devant le profil des patients (transplantes hepatiques), et pour faire face a la penurie de personnel infirmier, une nouvelle organisation a ete mise en place, periode 2 : transfert des cas dans une unite du service de MI et creation de 3 secteurs au CHB, un pour les patients contacts, un pour les suspects microbiologiquement, un pour les non contacts et non suspects. Resultats Pendant la P1, 7 cas secondaires ont ete detectes et 3 pendant la P2 au CHB et tous ont ete transferes en MI pendant la P2. Une semaine apres la mise en place de cette nouvelle organisation, il n’a plus ete observe de nouveaux cas. Conclusion Le controle de l’epidemie peut s’expliquer par : (a) une sensibilisation et une collaboration etroite entre les 2 equipes soignantes entre elles et avec l’EOH dans la gestion et la prise en charge des cas ; (b) l’architecture des locaux en MI est plus adaptee a la gestion d’une epidemie : unite geographiquement isolee, poste soin dedie et integre dans le secteur ; (c) le transfert des cas en MI a permis de preserver les patients les plus a risques d’acquisition d’EVR (transplantes hepatiques), et de maintenir l’activite de greffes. La difficulte etait de maintenir un secteur dedie en MI avec pour consequence une baisse de l’activite. Les mesures sont maintenues en MI pour toute rehospitalisation de cas.

Objectifs Evaluer les motifs d’ablation, la frequence des complications des CCI et les criteres de diagnostic cliniques et microbiologiques d’infection. Methodologie Analyse retrospective sur une periode de 1 an (2007) des dossiers cliniques et microbiologiques des patients traites dans notre hopital dont le CCI a ete retire. L’infection sur CCI a ete etablie a partir de donnees cliniques et/ou microbiologiques : culture positive d’au moins un des elements du CCI suivant : chambre, liquide de rincage, extremite du catheter avec un seuil a 10 3 UFC/ml ou bacteriemie liee au CCI. Resultats 152 ablations de CCI ont ete analysees, representant 150 patients (âge = 61 ans ± 12 ans, 99,3 % de cancers) et 49 337 jours de catheterisme (JC). 79 (52 %) CCI ont ete enleves pour infection, 73 (48 %) pour une cause non infectieuse dont fin de traitement 55 (36 %). Parmi les 79 CCI enleves pour infection, 47 (59,5 % -0,95/1 000 JC) patients avaient au moins un critere microbiologique d’infection : 34 avaient une culture positive pour au moins un element de la chambre (seuil 10 3 UFC/ml) dont 19 associees a une bacteriemie ; 13 ont eu une bacteriemie liee au CCI (CCI cultures negatives). 32 (40,5 %) n’avaient aucun critere microbiologique d’infection. Les bacteries retrouvees etaient : enterobacteries ( n = 16), Pseudomonas aeruginosa ( n = 8), A. baumannii ( n = 1), staphylocoque a coagulase negative ( n = 14), S. aureus ( n = 7), streptocoque ( n = 1), E. faecium ( n = 1), levures ( n = 1). Conclusion La moitie des CCI etaient enlevees pour une complication infectieuse. Cette infection etait averee dans 30 % des cas. Une concertation pluridisciplinaire pourrait contribuer a ameliorer la decision d’ablation des CCI.

The third-order contribution to the binding energy of 16O is shown to be small and of opposite sign to the second-order contribution. By contrast third-order contributions to the single-particle energies of 17O are relatively more important though again of opposite sign to the second-order contributions. Third-order contributions improve both the spin-orbit splitting and l-spacing in 17O.

Partial and total vapor pressures over Na2O.3SiO2 anhd Rb2O.3SiOz melts were determined at 1150° to 1300°C with the Knudsen-effusion method. A Pt Knudsen cell was placed on a microbalance so that the weight loss due to effusion from the Knudsen hole could be recorded continuously. The specific vaporization rates are between ∼3.10−6 and 3.10−4 gcm−2 s−1; the corresponding vapor pressures are between ∼3.10−2 and 3 Pa.

Partial and total vapor pressures over Na2O.3SiO2 anhd Rb2O.3SiOz melts were determined at 1150° to 1300°C with the Knudsen-effusion method. A Pt Knudsen cell was placed on a microbalance so that the weight loss due to effusion from the Knudsen hole could be recorded continuously. The specific vaporization rates are between ∼3.10−6 and 3.10−4 gcm−2 s−1; the corresponding vapor pressures are between ∼3.10−2 and 3 Pa.