Motor Vehicle Crash Fatalities for Week Ending, August 1, 2008

Motor Vehicle Crash Fatalities

The Bcl-2/Bcl-XL inhibitor ABT-737 promotes death of retinoblastoma cancer cells.

Purpose: Retinoblastoma is a malignant tumor that usually develops in early childhood. During retinoblastoma spreading, RB1 gene inactivation is followed by additional genomic modifications which progressively lead to resistance of tumor cells to death. Drugs that act at downstream levels of death signaling pathways should therefore be interesting in killing retinoblastoma cells. ABT-737, a BH3 mimetic molecule effective at the mitochondrial level, has been shown to induce apoptosis in different human tumoral cell lines as well as in primary patient-derived cells, and in a mouse xenograph model. Methods: In this report, we analyzed the pro-death effect of ABT-737 on two human retinoblastoma cell lines, Y79 and WERI-Rb, as well as on the mouse photoreceptor cell line 661W. Results: We observed that ABT-737 was very effective as a single agent in inducing human WERI-Rb cells apoptosis without affecting the mouse 661W photoreceptor cells. However human Y79 cells were resistant to ABT-737, as a probable consequence of the absence of Bax. The high sensitivity of WERI-Rb to ABT-737 can be increased by downregulating Mcl-1 using the proteasome inhibitor MG-132. Preliminary analysis in primary mouse retinoblastoma tumoral cell lines predicts high sensitivity to ABT-737. Conclusion: Our data suggest that ABT-737 or related compounds could be a highly effective drug in the treatment of some retinoblastomas.

Nitric oxide activity through guanylate cyclase and phosphodiesterase modulation is impaired in fetal lambs with congenital diaphragmatic hernia.

BACKGROUND: Congenital diaphragmatic hernia (CDH) is associated with pulmonary hypertension and death. Administration of nitric oxide (NO) alone remains ineffective in CDH cases. We investigated in near full-term lambs with and without CDH the role of guanylate cyclase (GC), the enzyme activated by NO in increasing cyclic 3'-5'-guanylosine monophosphate, and the role of phosphodiesterase (PDE) 5, the enzyme-degrading cyclic 3'-5'-guanylosine monophosphate. METHODS: Congenital diaphragmatic hernia was surgically created in fetal lambs at 85 days of gestation. Pulmonary hemodynamics were assessed by means of pressure and blood flow catheters (135 days). In vitro, we tested drugs on rings of isolated pulmonary vessels. RESULTS: In vivo, sodium nitroprusside, a direct NO donor, and methyl-2(4-aminophenyl)-1,2-dihydro-1-oxo-7-(2-pyridinylmethoxy)-4-(3,4,5 trimethoxyphenyl)-3-isoquinoline carboxylate sulfate (T-1032) and Zaprinast, both PDE 5 blockers, reduced pulmonary vascular resistance in CDH and non-CDH animals. The activation of GC by sodium nitroprusside and the inhibition of PDE 5 by T-1032 were less effective in CDH animals. In vitro, the stimulation of GC by 3(5'hydroxymethyl-2'furyl)-1-benzyl indazole (YC-1) (a benzyl indazole derivative) and the inhibition of PDE 5 by T-1032 were less effective in pulmonary vascular rings from CDH animals. The YC-1-induced vasodilation in rings from CDH animals was higher when associated with the PDE 5 inhibitor T-1032. CONCLUSIONS: Guanylate cyclase and PDE 5 play a role in controlling pulmonary vascular tone in fetal lambs with or without CDH. Both enzymes seem to be impaired in fetal lambs with CDH.

Production et évaluation de l'anticorps NIMP-R14 pour dépléter chroniquement les neutrophiles chez un modèle expérimental d'athérosclérose avancée : la souris ApoE-/- 2 reins-1clip (2K1C)

L'athérosclérose (ATS) est une maladie artérielle inflammatoire chronique à l'origine des nombreuses maladies cardiovasculaires que sont l'infarctus du myocarde, l'accident vasculaire cérébral ou encore l'artériopathie oblitérante des membres inférieurs. L'ATS se définit comme la formation de plaques fibro-lipidiques dans l'intima des artères. Les facteurs de risque majeurs associés à l'ATS sont l'hypertension, l'hypercholestérolémie, le tabagisme, le diabète, la sédentarité, ou encore des prédispositions génétiques. L'ATS peut être asymptomatique durant des années ou alors engendrer des complications aiguës pouvant parfois mettre le pronostic vital en jeu. Les complications les plus graves surviennent principalement lors de la rupture d'une plaque athéromateuse dite vulnérable ou instable. En effet, cette dernière peut se rompre et entraîner la formation d'un thrombus artériel occlusif avec, pour conséquence, l'ischémie/nécrose des tissus en aval. Prévenir le développement de la plaque vulnérable et/ou la « stabiliser » permettrait donc de prévenir les complications cliniques de l'ATS. Cet objectif requiert une connaissance éclairée des mécanismes cellulaires et moléculaires impliqués dans la physiopathologie de l'ATS et de la plaque vulnérable. Les travaux expérimentaux menés au sein du laboratoire du service d'angiologie du CHUV sous la direction du Prof. Lucia Mazzolai ont montré que l'angiotensine II (ang II), produit final de la cascade du système rénine-angiotensine, joue un rôle majeur dans la « vulnérabilité » des plaques athéromateuses (1). Ces travaux ont été réalisés à partir d'un modèle animal original développant des plaques d'ATS vulnérables dépendantes de l'ang II: la souris ApoE-/- 2 reins-1 clip (2K1C). Plus récemment, le laboratoire d'angiologie a mis en évidence une implication directe des leucocytes, plus précisément des macrophages et des lymphocytes T CD4+, dans l'athérogenèse ang II-dépendante (2,3). Dernièrement, des travaux ont également suggéré un rôle possible des granulocytes neutrophiles dans l'ATS (4,5,6,7). Toutefois, les études sont encore limitées de sorte que le rôle exact des neutrophiles dans l'ATS et plus spécialement dans l'ATS induite par l'ang II reste à démontrer. Une des recherches actuelles menée dans le laboratoire est donc d'étudier le rôle des neutrophiles dans le développement de la plaque athéromateuse vulnérable à partir du modèle animal, la souris ApoE-/- 2K1C. Pour évaluer le rôle direct des neutrophiles chez notre modèle animal, nous avons choisi comme méthode la déplétion des neutrophiles circulants par l'utilisation d'un anticorps spécifique. Il a été reporté dans la littérature que l'anticorps monoclonal NIMP-R14 3 permettait de dépléter sélectivement in vivo les neutrophiles dans différents modèles murins (8,9). Cependant, ces études ont utilisé cet anticorps anti-neutrophiles majoritairement sur des périodes expérimentales de durées relativement limitées (12-14 jours) et la question s'est donc posée de savoir si cet anticorps pouvait aussi dépléter les neutrophiles chez notre modèle animal, qui requiert une période expérimentale de 4 semaines pour développer des plaques vulnérables (1). Le but de ce travail a donc été de produire l'anticorps NIMP-R14 et d'évaluer son efficacité chez la souris ApoE-/- 2K1C qui développe des plaque d'ATS vulnérables dépendantes de l'ang II.

Efeito do grau de moagem, do tipo de frasco e do volume vazio sobre a variabilidade analítica do fósforo extraído pelos métodos Mehlich-1 e Mehlich-3

Na execução de uma análise química de solo são empregados diversos procedimentos que, mesmo seguindo-se o protocolo preconizado pelo método de análise utilizado, estão sujeitos a variações nos resultados analíticos, causadas por manipulação das amostras ou dos materiais utilizados. Objetivou-se neste estudo avaliar a influência do grau de moagem da amostra, do tipo de frasco e do volume vazio no frasco na execução dos métodos Mehlich-1 e Mehlich-3 para determinar o P no solo. Para tanto, foram conduzidos três experimentos. No primeiro experimento, as amostras de solo foram moídas e tamisadas em peneiras com aberturas de 2,000; 1,700; 0,850; 0,600; e 0,300 mm. No segundo, foram utilizados dois modelos de frasco (erlenmeyer e snap-cap), ambos com volume de 50 mL. Já no terceiro, foi alterado o volume vazio no frasco, mantendo-se a relação solo:solução extratora utilizando-se as quantidades dentro do frasco de 1:10; 1,5:15; 2,5:25; 3:30; e 4:40 cm³ cm-3. O grau de moagem das amostras não influenciou a capacidade de extração do Mehlich-1; entretanto, a capacidade extrativa do Mehlich-3 foi influenciada, principalmente em solos argilosos. Tanto para o Mehlich-1 quanto para o Mehlich-3, os teores de P extraído foram significativamente mais elevados com o uso de frasco tipo snap-cap em relação ao erlenmeyer. O volume vazio no frasco alterou os teores de P extraído para o Mehlich-1 e Mehlich-3 em 100 e 64 % das amostras, respectivamente. Deve-se padronizar a intensidade da moagem das amostras de solo para extração do P pela solução de Mehlich-3. Um modelo único de frasco deve ser adotado pelos laboratórios de rotina para análise do P, independentemente do método de extração, mantendo-se sempre constante no frasco o volume da amostra (cm³) para o volume de solução extratora (cm³).

Brevia de fide catholica (f. 1-52v). Acta paparum (f. 53-139v).

F. 1-52v. Recueil de textes de piété, en italien sauf le premier. « Confiteor Deo omnipotenti Patri et Filio et Spiritui sancto (...) martiribus tuis Grisanto et Darie, confessoribus tuis Prospero et Venerio atque beato Francisco... - ... eternam amen » (1). — [Rubrique :] « Quisti son li X comandam. de la leze ». « Primo non adorare altro che uno solo dio et per questo commandamento se veta le idole... - ... non e » (1v-3v). — [Rubrique :] « Quisti son li XII articoli de la fede ». « Credo in Dio padre omnipotente creatore del celo et de la terra. 1. S. Petro. Et in Yesu... - ... alli boni. 11. S. Thadeo. 12. S. Mathia » (3v). — [Rubrique :] « Quisti son li septe peccati mortali. Lo primo Elatio ». « Superbia cio e reputare de havere bene per propria virtu et non da Dio... - ... tante fiade pecca mortalmente » (3v-10). — [Rubriques :] « Quisti son li dexe comandamenti soto brevita » (...) « Quisti sono li septe sacramenti » (...) « Que son le VII opere de la misericordia temporale » (...) « Queste son le spirituale » (...) « Questi son li setti peccati mortali » (...) « Circha de sopra in li dexe comandamenti. Quista sun li V sentimenti de lo corpo » (...) « Quisti sono li septi doni del Spirito sancto che sono contra li VII peccati mortali » (...) « Queste sono le III virtu theologie » (...) « Quatuor sono le cardinale » (...) « Queste son le conditione de la confessione » (...) « Quisti son li casi de la papa sive papali » (...) « Casus exclusi » (...) « Quisti sun li cassi de lo episcopo sive episcopali » (...) (10-12). — [NICOLAUS DE AUXIMO, O. F. M. (Nicolò da Osimo), Compendio de salute], cf. Umberto Picciafuoco, Fr. Nicolò da Osimo: vita, opera, spiritualità, 1980 ; « Per dare breve introductione delle cose necessarie ad la salute ad ciaschuno simplice lo quale desidera de salvarse, me sono studiato de redirre le dicte cose sotto breve compendio, retracto de uno libro dicto Quadriga spirituale... - ... molto cose secondo li doctori » (12-52v).F. 53-139v. Actes pontificaux et varia. EUGENIUS IV papa, Bulla [ad Jacobum de Primadiciis de Bononia, O. F. M. (Giacomo Primadizzi) ?], de communione pascali, [07/07/1446], cf. Archivum Franciscanum Historicum, 21, 1928, p. 270 n. 1, 282-283 « Eugenius papa IIIIus. Dilecte fili salutem et apostolicam benedictionem. Fidedigna relatione percepimus in civitate Licii non parvam... - ... VIII kal. julii 1446, po. no. anno XVI° » (éd. ibid., p. 282-283, avec une date corrigée) (53-54). — [PAULUS II papa], Bulla, 14/04/1469 « I ». [Rubrique :] « Bulla que quotannis in cena Domini publicari per summum pontificem consuevit ». « Dilecti filii salutem et apostolicam benedictionem. Consueverunt predecessores nostri romani pontifices annis singulis in die cene Domini sedentes...-... die XIIII° aprilis 1469 p. n. anno quinto. L. Dathus » (55-56). — PAULUS II papa, Bulla, 30/03/1469 « 2. Bulla. Paulus (...). Consueverunt sancte memorie romani pontifices predecessoris [sic] nostri ad retinendam puritatem... - ... tertio kal. aprilis, p. n. anno quinto. De curia. Signata A. Ingherannus, L. Dathus » (56v-64). — PAULUS II papa, Bulla, 06/06/1469 « 3. Paulus (...). Decet romanum pontificem sic in suis fore gratiis liberalem quod in ecclesiarum... - ... octavo id. junii, p. n. anno quinto. De curia, B. Lunensis » (64v-67). — PAULUS II papa, Bulla, 02/07/1469 « Paulus papa II. 4. [Rubrique :] Presidenti monasteriorum Sancte Justine de Padua ». « Dilecte fili salutem et apostolicam benedictionem. Bullam presentibus alligatam constitutionis et decreti nostri circa annexa et juncta beneficia... - ... die IIa julii M° CCCC LXVIIII p. n. anno quinto. L. Dathus » (67v-68). — PAULUS II papa, Bulla, de casibus reservatis, [03/03/1470] cf. Cesare Censi, Manoscritti francescani della Biblioteca Nazionale di Napoli, 2 vol., 1971 (Spicilegium bonaventurianum, VII-VIII), t. I, p. 222, qui renvoie au ms. Napoli, Biblioteca Nazionale, V H 33 (n° 125 a de la liste de Cenci) ; incomplet de la fin « 5. [Rubrique :] Bulla pro casibus reservatis ». « Paulus (...). Etsi dominici gregis saluti semper intenti singulis cum humilitate poscentibus ea benigne... - ... omnipotentis Dei et beatorum » [Petri et Pauli...] (68v-70). — PAULUS II papa, Bulla, 23/11/1464 « 6. [Rubrique :] Contra symoniacos ». « Paulus (...). Cum detestabile scelus simoniace pravitates tam divinorum quam sacrorum canonum... - ... nono kal. decembres, p. n. anno primo » (70v-72). — PAULUS II papa, Bulla, [01/03/1468], cf. C. Censi, op. cit., ms. Napoli, Bibl. Naz., I H 43 et V H 33 (n° 50 ap et 125 d) « 7. [Rubrique :] Bulla prohibens ne bona ecclesiarum et Dei alienari possint ultra triennium ». « Paulus (...). Ambitiose perversorum cupiditati illorum precipue qui divinis et humanis legibus affectata... - ... M° CCCC LXVII kalendis martii p. n. anno quarto » (72v-74). — PAULUS II papa, Bulla, 31/01/1468 « 8. [Rubrique :] De celebratione dierum festorum in terris ecclesie ». « Paulus (...). Perniciosa consuetudo aut verius corruptela que in gravem divine majestatis ac sanctorum... - ... M° CCCC LXVII pridie kal. febr. anno p. n. IIII° » (74v-76v). — Exemplum de Raymundo cardinale nepote Honorii pape et beata Maria virgine et Annunciatione ejus. [Rubrique :] « Pro jejunio domine nostre ». « Honorius summus pontifex habuit ex sorore nepotem Raymundum nomine tituli sanctorum Johannis et Pauli cardinalem libidini ita deditum... - ... regna migravit » (77-79). — PAULUS II papa, Bulla, de jubilaeo, 19/04/1470 « 10 ( ?). [Rubrique :] De publicatione anni jubilei redacti ad M CCCC LXXV ». « Paulus (...). Ineffabilis providentia summi patris qui pro redemptione humani generis ejusque reconcilianda natura... - ... tertiodecimo kalendas maii p. n. anno sexto » (79-85). — PAULUS II papa, Breve, ad episcopum Cumanensem, 22/04/1471 « Breve pontificis ad episcopum Cumanensem. Paulus II. Venerabilis frater (...). Expositum fuit nobis nonnullos istius civitatis Cumane ejusque diocesis existere qui contra libertatem... - ... XXII aprilis 1471 p. n. anno septimo » (86-86v). — PAULUS II papa, Breve, ad episcopum Cumanensem, 07/06/1471 « Suprascriptum breve non habuit locum sed reformatum fuit in formam infrascriptam : Paulus II. Ven. (...). Expositum nobis fuit pro parte dilecti filii nobilis viri Galeaz Marie ducis Mediolani nonnullos istius civitatis Cumane... - ... 7° junii 1471 p. n. anno 7° » (86v-87v). — PAULUS II papa, Breve, [ad Galeazzum Mariam Sforza ducem Mediolanensem], 31/05/1471 « Dilecte fili (...). Diligenter exposuit nobis dilectus filius Augustinus de Rubeis eques et doctor Parmensis consiliarius et orator ad nos tuus... - ... ultimo maii 1471, p. n. anno septimo » (87v-88v). — NICODEMUS [TRANCHEDINI], Littera ad Galeazzum Mariam Sforza ducem Mediolanensem, 13/05/1471, cf. Paola Sverzelatti, « Per la biografia di Nicodemo Tranchedini [1413-1481] di Pontremoli, ambasciatore sforzesco », Aevum, 1998, LXII, 485-557 [4° Z 4794] « Littere Nicodemi ad illustrissimum d. ducem. El papa me ha dicto questa sera che heri sera deputo et immediate hebbe ad se li inferri... - ... Johachinus et Franciscus de Padua advocati consistoriales ». « Suprascriptis videnda commissa fuit bulla pontificis » (89-89v). — AUGUSTINUS DE RUBEIS (Agostino de’Rossi) et NICODEMUS [TRANCHEDINI], Littera ad Galeazzum Mariam Sforza ducem Mediolanensem, 25/05/1471 « Littere d. Augustini et Nicodemi ad principem. Illustrissimo (...). Questi xi sonno mo stati piu volte insieme et col papa anchora et heri se fece el consistorio... - ... XXV maii 1471. Augustinus et Nicodemus » (89v-91). — Iidem ad eumdem, 27/05/1471 « Eorundem. Illustrissimo (...). Credace la vestra signoria per cosa se havesse ad agitar. qua postquam questo nostro sancto patre fu facto papa... - ... XXVII maii 1471 » (91-94v). — [EUGENIUS IV papa, Gratiae concessae Francisco de Platea de Bononia, O. F. M., 01/1440], cf. Cesare Censi, Manoscritti francescani della Biblioteca Nazionale di Napoli, 2 vol., 1971 (Spicilegium bonaventurianum, VII-VIII), t. II, p. 1060, qui renvoie à deux exemplaires du texte, mss. Napoli, Biblioteca Nazionale, cod. VII G 50 et VII G 66 [n° 371 et 383 de la liste de Cenci] « Copia. Ego frater Franciscus de Bononia frater venerabilis viri fratris Jacobi de Primidiciis de Bononia Florentiam accessi... - ... M CCCC XL die III et die decima januarii » (95-98v). — PAULUS II papa, Breve ( ?), ad Julium Cesari de Varano domicellum, incomplet de la fin « Paulus episcopus (...) dilecto filio nobili viro Julio Cesari de Varano domicello civitatis nostre Camerini et pro nobis (...) gubernatori (...). Inter cura multiplices quibus assidue permimur illa precipue sollicitat mentem nostram... - ... merito commendari » (100-106v). — NICOLAUS V papa, Breve ( ?), ad Franciscum Sforza, 24/07/1447 « Nicolaus (...) dilecto filio nobili viro Francisco Sfortie vicecomiti, comiti et marchioni (...). Sedes apostolica pia mater recurrentibus ad eam cum humilitate filiis post excessum libenter... - ... nono kal. augusti, p. n. anno primo. Pe. de Noxeto » (107-111v). — FRANCISCUS PHILELPHUS ( ?), [De Sacerdotio Christi (extractum et translatum e graeco Souda), versio italica], cf. Giovanni Mercati, Ultimi contributi alla storia degli Umanistici, 1939, I, p. 74-76 (4° Z 1722 (90)) « Tractatello traducto per messere Francescho Philelpho singularissimo poetha de greco in latino per luy trovato presso autentici et antiqui autori, reducto in volgare ad contemplatione d’alcuni devoti cortesani del illustrissimo signiore duca di Milano, ad confirmatione de la fede nostra et confusione de Judei. Regnando Justiniano imperatore clementissimo fo uno homo principe de Judei chiamato Theodosio... - ... teneva occulto » (112-118v). — « Electi beneficii et superni doni data ad quella anima che oldira la sancta messa integramente monifestati per li sancti doctori... - ... ligno de la vita » (118v-119). — MARTINUS V papa, Bulla, de excommunicatione hereticorum, [28/03/1426 ?], incomplète de la fin ; cf. C. Censi, op. cit., I, p. 501-502 (n° 304 f) « 1. Excommunicationes plures contente in processu qui fit annuatim in curia in cena Domini. Martinus (...). Excommunicamus et anathematizamus ex parte omnipotentis Dei Patris et Filii et Spiritus sancti auctoritate Petri... - ... incursurum. Datum Rome etc » (120-122v). — « Item excommunicamus et anathematizamus omnes illos qui per se vel per alium vel alios directe vel indirecte... - ... cautione prestitis » (122v-123v). — PAULUS II papa, Bulla, 11/04/1471 « 2. Paulus (...). Consueverunt sancte memorie romani pontifices predecessores nostri ad retinendam puritatem... - ... tertio idus aprilis, p. n. anno VII° » (124-130v). — SIXTUS IV papa, Bulla, de excommunicatione hereticorum, 26/03/1472 « 2. Sixtus (...). Excommunicamus et anathematizamus ex parte omnipotentis Dei Patris et Filii et Spiritus sancti auctoritate quoque beatorum... - ... septimo kal. aprilis etc. anno primo » (131-134v). — SIXTUS IV papa, Breve ( ?), ad Ferdinandum I regem Sicilie, 01/03/1472 « 4. Sixtus (...) carissimo in Christo filio Ferdinando regi Sicilie illustri (...). Dum eximie fidelitatis devotionis atque prudentie tue ceterasque tibi a Domino traditas virtutes...-... kalendis martiis [sic] p. n. anno primo. M. Milinus » (135-139v).

Acute multivessel revascularization improves 1-year outcome in ST-elevation myocardial infarction: a nationwide study cohort from the AMIS Plus registry.

BACKGROUND: The optimal strategy for percutaneous coronary intervention (PCI) of ST-segment elevation myocardial infarction (STEMI) in multi-vessel disease (MVD), i.e., multi-vessel PCI (MV-PCI) vs. PCI of the infarct-related artery only (IRA-PCI), still remains unknown. METHODS: Patients of the AMIS Plus registry admitted with an acute coronary syndrome were contacted after a median of 378 days (interquartile range 371-409). The primary end-point was all-cause death. The secondary end-point included all major adverse cardiovascular and cerebrovascular events (MACCE) including death, re-infarction, re-hospitalization for cardiac causes, any cardiac re-intervention, and stroke. RESULTS: Between 2005 and 2012, 8330 STEMI patients were identified, of whom 1909 (24%) had MVD. Of these, 442 (23%) received MV-PCI and 1467 (77%) IRA-PCI. While all-cause mortality was similar in both groups (2.7% both, p>0.99), MACCE was significantly lower after MV-PCI vs. IRA-PCI (15.6% vs. 20.0%, p=0.038), mainly driven by lower rates of cardiac re-hospitalization and cardiac re-intervention. Patients undergoing MV-PCI with drug-eluting stents had lower rates of all-cause mortality (2.1% vs. 7.4%, p=0.026) and MACCE (14.1% vs. 25.9%, p=0.042) compared with those receiving bare metal stents (BMS). In multivariate analysis, MV-PCI (odds ratio, OR 0.69, 95% CI 0.51-0.93, p=0.017) and comorbidities (Charlson index ≥ 2; OR 1.42, 95% CI 1.05-1.92, p=0.025) were independent predictors for 1-year MACCE. CONCLUSION: In an unselected nationwide real-world cohort, an approach using immediate complete revascularization may be beneficial in STEMI patients with MVD regarding MACCE, specifically when drug-eluting stents are used, but not regarding mortality. This has to be tested in a randomized controlled trial.

How critical is timing for the diagnosis of influenza in general practice?

QUESTIONS UNDER STUDY: The diagnostic significance of clinical symptoms/signs of influenza has mainly been assessed in the context of controlled studies with stringent inclusion criteria. There was a need to extend the evaluation of these predictors not only in the context of general practice but also according to the duration of symptoms and to the dynamics of the epidemic. PRINCIPLES: A prospective study conducted in the Medical Outpatient Clinic in the winter season 1999-2000. Patients with influenza-like syndrome were included, as long as the primary care physician envisaged the diagnosis of influenza. The physician administered a questionnaire, a throat swab was performed and a culture acquired to document the diagnosis of influenza. RESULTS: 201 patients were included in the study. 52% were culture positive for influenza. By univariate analysis, temperature >37.8 degrees C (OR 4.2; 95% CI 2.3-7.7), duration of symptoms <48 hours (OR 3.2; 1.8-5.7), cough (OR 3.2; 1-10.4) and myalgia (OR 2.8; 1.0-7.5) were associated with a diagnosis of influenza. In a multivariable logistic analysis, the best model predicting influenza was the association of a duration of symptom <48 hours, medical attendance at the beginning of the epidemic (weeks 49-50), fever >37.8 and cough, with a sensitivity of 79%, specificity of 69%, positive predictive value of 67%, negative predictive value of 73% and an area under the ROC curve of 0.74. CONCLUSIONS: Besides relevant symptoms and signs, the physician should also consider the duration of symptoms and the epidemiological context (start, peak or end of the epidemic) in his appraisal, since both parameters considerably modify the value of the clinical predictors when assessing the probability of a patient having influenza.