Sensitivity and specificity of NT-proBNP to detect heart failure at post mortem examination.

NT-proBNP, a marker of cardiac failure, has been shown to be stable in post mortem samples. The aim of this study was to assess the accuracy of NT-proBNP to detect heart failure in the forensic setting. One hundred sixty-eight consecutive autopsies were included in the study. NT-proBNP blood concentrations were measured using a chemiluminescent immunoassay kit. Cardiac failure was assessed by three independent forensic experts using macro- and microscopic findings complemented by information about the circumstances of body discovery and the known medical story. Area under the receiving operator curve was of 65.4% (CI 95%, from 57.1 to 73.7). Using a standard cut-off value of >220 pg/mL for NT-proBNP blood concentration, heart failure was detected with a sensitivity of 50.7% and a specificity of 72.6%. NT-proBNP vitreous humor values were well correlated to the ones measured in blood (r (2) = 0.658). Our results showed that NT-proBNP can corroborate the pathological findings in cases of natural death related to heart failure, thus, keeping its diagnostic properties passing from the ante mortem to the post mortem setting. Therefore, biologically inactive polypeptides like NT-proBNP seem to be stable enough to be used in forensic medicine as markers of cardiac failure, taking into account the sensitivity and specificity of the test.

Spatio-temporal Brain Dynamics Mediating Post-error Behavioral Adjustments.

Optimal behavior relies on flexible adaptation to environmental requirements, notably based on the detection of errors. The impact of error detection on subsequent behavior typically manifests as a slowing down of RTs following errors. Precisely how errors impact the processing of subsequent stimuli and in turn shape behavior remains unresolved. To address these questions, we used an auditory spatial go/no-go task where continual feedback informed participants of whether they were too slow. We contrasted auditory-evoked potentials to left-lateralized go and right no-go stimuli as a function of performance on the preceding go stimuli, generating a 2 × 2 design with "preceding performance" (fast hit [FH], slow hit [SH]) and stimulus type (go, no-go) as within-subject factors. SH trials yielded SH trials on the following trials more often than did FHs, supporting our assumption that SHs engaged effects similar to errors. Electrophysiologically, auditory-evoked potentials modulated topographically as a function of preceding performance 80-110 msec poststimulus onset and then as a function of stimulus type at 110-140 msec, indicative of changes in the underlying brain networks. Source estimations revealed a stronger activity of prefrontal regions to stimuli after successful than error trials, followed by a stronger response of parietal areas to the no-go than go stimuli. We interpret these results in terms of a shift from a fast automatic to a slow controlled form of inhibitory control induced by the detection of errors, manifesting during low-level integration of task-relevant features of subsequent stimuli, which in turn influences response speed.

Rôle du médecin interniste ou du généraliste dans le diagnostic et le suivi d'une collagénose [Family physician and connective tissue disorders].

The exact place of the family physician in the diagnosis and management of connective tissue disease is poorly studied moreover will essentially depend on the health system and the organization of medical network of each country. Connective tissue diseases are rare and complex diseases that require in all cases referral to specialists for their diagnosis as well as monitoring. All patients must still keep a family doctor whose importance increases more and more as our specialized treatments prolong survival of patients who become chronically ill with multi-organic sequelae. A closely interaction between the various specialists and family physicians is necessary to ensure a good long-term follow-up.

Mutant Huntingtin impairs post-Golgi trafficking to lysosomes by delocalizing optineurin/Rab8 complex from the Golgi apparatus

Huntingtin regulates post-Golgi trafficking of secreted proteins. Here, we studied the mechanism by which mutant huntingtin impairs this process. Colocalization studies and Western blot analysis of isolated Golgi membranes showed a reduction of huntingtin in the Golgi apparatus of cells expressing mutant huntingtin. These findings correlated with a decrease in the levels of optineurin and Rab8 in the Golgi apparatus that can be reverted by overexpression of full-length wild-type huntingtin. In addition, immunoprecipitation studies showed reduced interaction between mutant huntingtin and optineurin/Rab8. Cells expressing mutant huntingtin produced both an accumulation of clathrin adaptor complex 1 at the Golgi and an increase of clathrin-coated vesicles in the vicinity of Golgi cisternae as revealed by electron microscopy. Furthermore, inverse fluorescence recovery after photobleaching analysis for lysosomal-associated membrane protein-1 and mannose-6-phosphate receptor showed that the optineurin/Rab8-dependent post-Golgi trafficking to lysosomes was impaired in cells expressing mutant huntingtin or reducing huntingtin levels by small interfering RNA. Accordingly, these cells showed a lower content of cathepsin D in lysosomes, which led to an overall reduction of lysosomal activity. Together, our results indicate that mutant huntingtin perturbs post-Golgi trafficking to lysosomal compartments by delocalizing the optineurin/Rab8 complex, which, in turn, affects the lysosomal function.

Late and post-Hercyniam low temperature veins in the Catalonian Coastal Ranges

Many of the veins enclosed within the Paleozoic basement of the Catalonian Coastal Ranges show severa1 common characteristics: low temperature of formation (between 75 and 200C), the presence of complex polisaline fluids and a certain relationship to the pretriassic paleosurface. Mineralogical composition and age are variable, ranging from Pb-Zn veins with carbonate gangue of late Hercynian age through metal poor fluorite rich veins to barite rich veins of Triasssic age. Mineralizing fluids are not related to late Hercynianmagmatism and deposition took place in active fractures developed either in extensional as in compressive regimes.

Mandalas des émotions et traumatismes

Comment dans notre travail thérapeutique, aborder le vécu douloureux de nos patients gravement traumatisés, sans s'y enfermer ni blesser une fois de plus la victime ? C'est avec cette préoccupation et face à bon nombre de nos patients qui se retrouvent enfermés dans un seul ressenti qui envahit tout, jusqu'à leur identité même, que nous avons eu l'idée de travailler avec le Mandala des émotions, fait de sables colorés. Nous présenterons cette technique, utilisée comme un objet flottant, au travers de deux vignettes cliniques de suivi individuel : l'une avec un enfant et la seconde avec un adulte. Nous exposerons comment cet outil permet la création d'un espace intersubjectif où thérapeutes et patients se rencontrent autour de l'exploration du vécu intérieur post-traumatique et de l'élaboration d'une renarration du récit de vie de la victime.

Améliorer la prescription d'un traitement hypolipémiant lors d'un syndrome coronarien aigu: absence de benefice d'une alerte automatique.

Introduction: Seulement 25-30% des patients avec syndrome coronarien aigu (SCA) atteignent les valeurs cibles de LDL-cholestérol (LDL-C) dans leur suivi. L'objectif de cette étude pré/post est de tester une alerte automatique centralisée pour améliorer les pratiques. L'alerte apparaît sur les feuilles de laboratoire pour tous les patients ayant une troponine >= 0,1 microg/l; elle précise notamment les recommandations en matière de profil lipidique (LDL-C cible) à atteindre. Méthode: Tout patient admis au CHUV pour un SCA avec troponine >= 0,1 microg/l était éligible. Durant les 2 phases de l'étude (du 23.11.2008 au 15.08.201), un bilan lipidique complet a été dosé à l'admission et à 3 mois. La phase 1 (pré) était observationnelle et le message d'alerte a été introduit pour la phase 2 (post). Résultats: Phase 1: 157 patients dont 56 (35%) étaient déjà traités par une statine: 114 hommes (âge moyen 62 ans) et 43 femmes (73 ans). LDL-C moyen: 3,4 ± 1,0 mmol/l à l'admission et 2,4 ± 0,8 mmol/l à 3 mois (p <0,001). Phase 2: 140 patients dont 42 (30%) étaient déjà traités par une statine: 116 hommes (62 ans) et 24 femmes (67 ans). LDL-C moyen: 3,4 ± 1,1 mmol/l à l'admission et 2,2 ± 1,0 mmol/l à 3 mois (p <0,001). 66 % (104 patients) atteignent un LDL-C cible < = 2,6 mmol/l à 3 mois lors de la phase 1, versus 78% (110 patients) lors de la phase 2 (p = 0,2). Les patients déjà sous statine à l'admission ont une faible diminution du LDL-C à 3 mois (de 2,8 à 2,5 mmol/l phase 1, p <0,05; de 2,5 à 2,6 mmol/l phase 2, p = 0.2), alors que les patients chez qui une statine est introduite à l'admission ont une baisse significative et plus importante du LDL-C à 3 mois (de 3,8 à 2,3 mmol/l phase 1, p <0,001; de 3,7 à 2,1 mmol/l phase 2, p <0,001) que les patients déjà sous statine au préalable. Conclusion: La phase observationnelle montre un taux élevé de patients atteignant un LDL-C cible à 3 mois. L'introduction d'une alarme automatique centralisée n'a pas permis d'améliorer ces résultats. Par contre, les patients arrivant à l'hôpital avec un SCA et étant déjà sous statine devraient avoir une intensification de leur traitement.