Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century: the International Collaboration on Endocarditis-Prospective Cohort Study.

We sought to provide a contemporary picture of the presentation, etiology, and outcome of infective endocarditis (IE) in a large patient cohort from multiple locations worldwide. Prospective cohort study of 2781 adults with definite IE who were admitted to 58 hospitals in 25 countries from June 1, 2000, through September 1, 2005. The median age of the cohort was 57.9 (interquartile range, 43.2-71.8) years, and 72.1% had native valve IE. Most patients (77.0%) presented early in the disease (<30 days) with few of the classic clinical hallmarks of IE. Recent health care exposure was found in one-quarter of patients. Staphylococcus aureus was the most common pathogen (31.2%). The mitral (41.1%) and aortic (37.6%) valves were infected most commonly. The following complications were common: stroke (16.9%), embolization other than stroke (22.6%), heart failure (32.3%), and intracardiac abscess (14.4%). Surgical therapy was common (48.2%), and in-hospital mortality remained high (17.7%). Prosthetic valve involvement (odds ratio, 1.47; 95% confidence interval, 1.13-1.90), increasing age (1.30; 1.17-1.46 per 10-year interval), pulmonary edema (1.79; 1.39-2.30), S aureus infection (1.54; 1.14-2.08), coagulase-negative staphylococcal infection (1.50; 1.07-2.10), mitral valve vegetation (1.34; 1.06-1.68), and paravalvular complications (2.25; 1.64-3.09) were associated with an increased risk of in-hospital death, whereas viridans streptococcal infection (0.52; 0.33-0.81) and surgery (0.61; 0.44-0.83) were associated with a decreased risk. In the early 21st century, IE is more often an acute disease, characterized by a high rate of S aureus infection. Mortality remains relatively high.

Clara cells drive eosinophil accumulation in allergic asthma.

Development of allergic asthma is a complex process involving immune, neuronal and tissue cells. In the lung, Clara cells represent a major part of the "immunomodulatory barrier" of the airway epithelium. To understand the contribution of these cells to the inflammatory outcome of asthma, disease development was assessed using an adjuvant-free ovalbumin model. Mice were sensitised with subcutaneous injections of 10 μg endotoxin-free ovalbumin in conjunction with naphthalene-induced Clara cell depletion. Clara epithelial cell depletion in the lung strongly reduced eosinophil influx, which correlated with decreased eotaxin levels and, moreover, diminished the T-helper cell type 2 inflammatory response, including interleukin (IL)-4, IL-5 and IL-13. In contrast, airway hyperresponsiveness was increased. Further investigation revealed Clara cells as the principal source of eotaxin in the lung. These findings are the first to show that Clara airway epithelial cells substantially contribute to the infiltration of eotaxin-responsive CCR3+ immune cells and augment the allergic immune response in the lung. The present study identifies Clara cells as a potential therapeutic target in inflammatory lung diseases such as allergic asthma.

Clara cell protein and surfactant protein B in garbage collectors and in wastewater workers exposed to bioaerosols

OBJECTIVES: Inhalation of bioaerosols has been hypothesised to cause "toxic pneumonitis" that should increase lung epithelial permeability at the bronchioloalveolar level. Serum Clara cell protein (CC16) and serum surfactant protein B (SPB) have been proposed as sensitive markers of lung epithelial injury. This study was aimed at looking for increased lung epithelial permeability by determining CC16 and SPB in workers exposed to bioaerosols from wastewater or garbage. METHODS: Subjects (778 wastewater, garbage and control workers; participation 61%) underwent a medical examination, lung function tests [American Thoracic Society (ATS) criteria], and determination of CC16 and SPB. Symptoms of endotoxin exposure and several potential confounders (age, gender, smoking, kidney function, obesity) were looked for. Results were examined with multiple linear or logistic regression. RESULTS: Exposure to bioaerosols increased CC16 concentration in the wastewater workers. No effect of exposure on SPB was found. No clue to work-related respiratory diseases was found. CONCLUSIONS: The increase in CC16 in serum supports the hypothesis that bioaerosols cause subclinical "toxic pneumonitis", even at low exposure. [Authors]

Histoire des (re-)traductions et (re-)traducteurs de la poésie de Rainer Maria Rilke dans l'espace francophone

Le présent travail rend compte de la double articulation d'analyse pensée par Antoine Berman dans Pour une critique des traductions: John Donne (Gallimard, 1994). La méthode bermanienne s'attache tant à une histoire, événementielle et individuelle, des traductions qu'à une analyse des textes à la lumière de leurs entours (paratextes, projets de traduction, etc.). Dans une première partie, nous tenterons de décrire et de comprendre à l'aide d'un panorama historique l'importation de la poésie de Rilke en traduction française, des premières versions du début du XXe siècle aux dernières traductions des Élégies de Duino (2008, 2010). Reprenant la formule de Berman, nous « irons au traducteur », à sa façon de traduire et à la traduction qu'il livre. Nous nous pencherons ainsi sur l'identité de ces traducteurs (premiers ou bien nouveaux), sur leur statut socioculturel ainsi que sur les circonstances dans lesquelles ils furent amenés à traduire et virent leur travail publié. Il s'agira d'établir de façon synthétique ce que Berman, sous l'influence de H. R. Jauss, dénomme l' « horizon » d'une traduction qui, à une date donnée, prend en compte une pluralité de critères allant de traits propres au traducteur aux codes poétiques en vigueur dans le vaste champ des Lettres et la société. Nous replacerons ainsi la traduction dans le plus large contexte du transfert culturel et de l'importation et examinerons les traducteurs en présence : les universitaires, les poètes, les traducteurs à plein temps et, dans une moindre mesure, les philosophes. De ce panorama historique émergera l'idée d'une concurrence entre les multiples traducteurs de la poésie de Rilke, plus spécialement entre universitaires et poètes. Dans une seconde partie, reflet de l'autre facette de la pensée bermanienne, nous procèderons à la comparaison et à l'évaluation critique de plusieurs versions françaises de la première Élégie de Duino - opus poétique rilkéen le plus retraduit en français. Notre corpus se limitera à cette première Élégie et à une dizaine de versions françaises que nous faisons dialoguer ou s'opposer. Partant de premières considérations sur l'enveloppe prosodique et typographique du poème, qui nous permettent de saisir la diversité des entreprises et de cerner tant des lignes de force communes que la singularité d'expérimentations plus marginales, nous « confronterons » ensemble les quatre premières versions françaises de la première Élégie, accomplies quasi simultanément dans les années 1930 par des traducteurs d'horizons variés (un germaniste, J.F. Angelloz, une artiste-peintre, L. Albert-Lasard, un traducteur de métier, M. Betz, et un poète, A. Guerne). Il s'agira de saisir l'apport de chacune d'entre elles, ainsi que le type de lien qui les unit (ou les oppose). L'étude de la quatrième version, celle d'Armel Guerne, nous mènera presque naturellement vers la question de la perception de l'écart poétique et du caractère extra-ordinaire de l'original. A la lumière de cette problématique cardinale en poésie, nous procèderons à la comparaison de versions issues des cinquante dernières années et, en considérant plusieurs éléments de sens, nous tenterons de voir comment chaque traducteur, qui est aussi et avant tout un lecteur, a perçu et restitué dans son texte français la matière poétique propre de l'original. Au terme de ce parcours contrastif parmi différentes versions de la première Élégie, nous confronterons les résultats de notre analyse textuelle et le constat de concurrence qui se dégageait de la première partie. Il s'agira de voir alors si la pratique traductive, telle qu'elle se manifeste concrètement au niveau du texte, reflète un antagonisme particulier entre Poésie et Université, ou s'il convient au contraire de relativiser, voire démystifier cette dichotomie.

Clinical determinants of early parasitological response to ACTs in African patients with uncomplicated falciparum malaria: a literature review and meta-analysis of individual patient data.

BACKGROUND: Artemisinin-resistant Plasmodium falciparum has emerged in the Greater Mekong sub-region and poses a major global public health threat. Slow parasite clearance is a key clinical manifestation of reduced susceptibility to artemisinin. This study was designed to establish the baseline values for clearance in patients from Sub-Saharan African countries with uncomplicated malaria treated with artemisinin-based combination therapies (ACTs). METHODS: A literature review in PubMed was conducted in March 2013 to identify all prospective clinical trials (uncontrolled trials, controlled trials and randomized controlled trials), including ACTs conducted in Sub-Saharan Africa, between 1960 and 2012. Individual patient data from these studies were shared with the WorldWide Antimalarial Resistance Network (WWARN) and pooled using an a priori statistical analytical plan. Factors affecting early parasitological response were investigated using logistic regression with study sites fitted as a random effect. The risk of bias in included studies was evaluated based on study design, methodology and missing data. RESULTS: In total, 29,493 patients from 84 clinical trials were included in the analysis, treated with artemether-lumefantrine (n = 13,664), artesunate-amodiaquine (n = 11,337) and dihydroartemisinin-piperaquine (n = 4,492). The overall parasite clearance rate was rapid. The parasite positivity rate (PPR) decreased from 59.7 % (95 % CI: 54.5-64.9) on day 1 to 6.7 % (95 % CI: 4.8-8.7) on day 2 and 0.9 % (95 % CI: 0.5-1.2) on day 3. The 95th percentile of observed day 3 PPR was 5.3 %. Independent risk factors predictive of day 3 positivity were: high baseline parasitaemia (adjusted odds ratio (AOR) = 1.16 (95 % CI: 1.08-1.25); per 2-fold increase in parasite density, P <0.001); fever (>37.5 °C) (AOR = 1.50 (95 % CI: 1.06-2.13), P = 0.022); severe anaemia (AOR = 2.04 (95 % CI: 1.21-3.44), P = 0.008); areas of low/moderate transmission setting (AOR = 2.71 (95 % CI: 1.38-5.36), P = 0.004); and treatment with the loose formulation of artesunate-amodiaquine (AOR = 2.27 (95 % CI: 1.14-4.51), P = 0.020, compared to dihydroartemisinin-piperaquine). CONCLUSIONS: The three ACTs assessed in this analysis continue to achieve rapid early parasitological clearance across the sites assessed in Sub-Saharan Africa. A threshold of 5 % day 3 parasite positivity from a minimum sample size of 50 patients provides a more sensitive benchmark in Sub-Saharan Africa compared to the current recommended threshold of 10 % to trigger further investigation of artemisinin susceptibility.