Carte géologique des environs des Sards (Vendée) / par A. Rivière ; Écrit par Hellrigel ; Lith. de P. Bineteau

Échelle(s) : [1:10 000], échelle de 1 à 10000

β-Lactam Monotherapy vs β-Lactam-Macrolide Combination Treatment in Moderately Severe Community-Acquired Pneumonia: A Randomized Noninferiority Trial.

IMPORTANCE: The clinical benefit of adding a macrolide to a β-lactam for empirical treatment of moderately severe community-acquired pneumonia remains controversial. OBJECTIVE: To test noninferiority of a β-lactam alone compared with a β-lactam and macrolide combination in moderately severe community-acquired pneumonia. DESIGN, SETTING, AND PARTICIPANTS: Open-label, multicenter, noninferiority, randomized trial conducted from January 13, 2009, through January 31, 2013, in 580 immunocompetent adult patients hospitalized in 6 acute care hospitals in Switzerland for moderately severe community-acquired pneumonia. Follow-up extended to 90 days. Outcome assessors were masked to treatment allocation. INTERVENTIONS: Patients were treated with a β-lactam and a macrolide (combination arm) or with a β-lactam alone (monotherapy arm). Legionella pneumophila infection was systematically searched and treated by addition of a macrolide to the monotherapy arm. MAIN OUTCOMES AND MEASURES: Proportion of patients not reaching clinical stability (heart rate <100/min, systolic blood pressure >90 mm Hg, temperature <38.0°C, respiratory rate <24/min, and oxygen saturation >90% on room air) at day 7. RESULTS: After 7 days of treatment, 120 of 291 patients (41.2%) in the monotherapy arm vs 97 of 289 (33.6%) in the combination arm had not reached clinical stability (7.6% difference, P = .07). The upper limit of the 1-sided 90% CI was 13.0%, exceeding the predefined noninferiority boundary of 8%. Patients infected with atypical pathogens (hazard ratio [HR], 0.33; 95% CI, 0.13-0.85) or with Pneumonia Severity Index (PSI) category IV pneumonia (HR, 0.81; 95% CI, 0.59-1.10) were less likely to reach clinical stability with monotherapy, whereas patients not infected with atypical pathogens (HR, 0.99; 95% CI, 0.80-1.22) or with PSI category I to III pneumonia (HR, 1.06; 95% CI, 0.82-1.36) had equivalent outcomes in the 2 arms. There were more 30-day readmissions in the monotherapy arm (7.9% vs 3.1%, P = .01). Mortality, intensive care unit admission, complications, length of stay, and recurrence of pneumonia within 90 days did not differ between the 2 arms. CONCLUSIONS AND RELEVANCE: We did not find noninferiority of β-lactam monotherapy in patients hospitalized for moderately severe community-acquired pneumonia. Patients infected with atypical pathogens or with PSI category IV pneumonia had delayed clinical stability with monotherapy. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00818610.

Carte géologique des environs d'Olonne (Vendée) / par A. Rivière

Échelle(s) : 1:10 000, échelle de 1 à 10000

Research involving biological material from forensic autopsies: legal and ethical issues.

Recommendations and laws do not always contain specific and clear provisions on the use of cadaveric material in research, and even more rarely do they address explicitly the ethical issues related to research on material obtained during forensic autopsy. In this article we analyse existing legal frameworks in Europe by comparing the legal provisions in 2 European Countries which are member states of the Council of Europe, the UK and Switzerland. They were chosen because they have distinct legal frameworks that make comparisons interesting. In addition, the detailed laws of the UK and a specific law project and national ethical recommendations in Switzerland permit us to define more clearly the legal range of options for researchers using cadaveric material obtained during forensic investigations. The Human Tissue Act 2004 in England, Wales and Northern Ireland, its Scottish equivalent with the same title (2006) and the national ethical guidelines in Switzerland all require consent from the deceased person, an appropriate relative or a person with power of attorney for healthcare decisions before cadaveric biological material can be obtained and used for research. However, if the purpose of the autopsy is purely forensic, no such authorization will be sought to carry out the autopsy and related analyses, which might include genetic testing. In order to be allowed to carry out future research projects, families need to be approached for informed consent, unless the deceased person had left written directives including permission to use his or her tissues for research.

IPI Newsletter, Ocotber 2004

A quarterly newsletter produced by Iowa Prison Industries

IPI Newsletter, October 2005

A quarterly newsletter produced by Iowa Prison Industries

Tioglykolaattiputki bakteerien tunnistuksen apuna

Teimme opinnäytetyömme HUSLABin Kliinisen mikrobiologian vastuualueen bakteriologian osaston pyynnöstä.Osastolla toivottiin, että opinnäytetyömme auttaisi bakteriologian osaston työntekijöitä paremmin hyödyntämään päivittäin märkäviljelytyöpisteissä käytettävistä tioglykolaattiputkista saatavaa informaatiota. Opinnäytetyömme on jatkoa vuonna 2005 tehdylle opinnäytetyölle Oppimismateriaali gramvärjäyksestä, joka on myös tehty HUSLABin bakteriologian osastolle. Opinnäytetyössämme tutkimme, miten eri anaerobit ja aerobit bakteerilajit kasvavat tioglykolaattiputkessa, sekä miten tätä tietoa voitaisiin käyttää hyödyksi bakteerien alustavassa tunnistuksessa ja esimerkiksi jatkotunnistustestejä valittaessa. Tutkittavia bakteerilajeja oli 20 ja yksi sieni. Bakteerilajit valittiin niin, että jokaisesta ryhmästä tulisi ainakin yksi tyypillinen esimerkki. Valokuvasimme tulokset ja valmistimme kuvallisen materiaalin HUSLABin Kliinisen mikrobiologian vastuualueen bakteriologian osastolle työntekijöiden ja opiskelijoiden käyttöön. Valmistamamme kuvamateriaalin pitäisi auttaa tioglykolaattiputkesta saatavan informaation parempaan hyödyntämiseen bakteriologian osaston märkäviljelytyöpisteessä. Aluksi etsimme kokeilemalla sopivan, potilasnäytteitä lähinnä olevan laimennoksen. Teimme 1/10 laimennossarjan muutamalle bakteerille. Sopivan bakteeripitoisuuden löydyttyä käytimme samaa pitoisuutta jatkossa kaikkille viljellyille bakteereille. Kasvatimme tioglykolaattiputkia lämpökaapissa, kunnes bakteerien kasvu tuli näkyviin. Varmistimme, että tioglykolaattiputkissa kasvoivat tutkimamme bakteerit puhtaina tekemällä putkissa kasvavasta bakteerimassasta gramvärjäykset sekä puhdasviljelmät maljoille. Lopuksi valokuvasimme tulokset ja kokosimme niistä kuvallisen tulososion, jossa kuvaillaan myös sanallisesti bakteerien kasvua tioglykolaattiputkessa. Bakteerit kasvoivat putkissa niille ominaisella tavalla. Kokkibakteerit kasvoivat niille tyypillisenä raemaisena kasvuna ja sauvabakteerit enemmän harsomaisesti, kuten mikrobiologian kirjoissa on kuvattu. Obligatorisesti eli ehdottomasti anaerobit bakteerit kasvoivat tioglykolaattiputken alaosassa, koska ne eivät siedä happea. Obligatorisesti aerobien bakteerien kasvu sijoittui putken yläosaan, koska ne tarvitsevat ehdottomasti happea elääkseen. Fakultatiivisesti eli valinnaisesti anaerobit bakteerit kasvoivat kauttaaltaan koko tioglykolaattiputkessa, koska ne pystyvät kasvamaan yhtä hyvin sekä hapettomissa että hapellisissa oloissa. Mikroaerofiilit bakteerit kasvoivat koko tioglykolaattiputkessa suosien kuitenkin enemmän putken anaerobista osaa.

Chromatic pupillometry in patients with retinitis pigmentosa.

OBJECTIVE:: To evaluate the chromatic pupillary response as a means of assessing outer and inner retinal function in patients with retinitis pigmentosa (RP). DESIGN:: Evaluation of diagnostic technology. PARTICIPANTS:: Thirty-two patients with RP and visual loss and 43 normal subjects. METHODS:: Patients were tested with a chromatic pupillometer using red and blue lights (1, 10, and 100 cd/m(2)), and their pupil responses were compared with those from 43 normal subjects (reported previously). Visual field and electroretinography (ERG) results were examined and compared with the pupil responses. MAIN OUTCOME MEASURES:: The percent pupil contraction of the transient response to a low-intensity (1 cd/m(2)) blue light and high-intensity (100 cd/m(2)) red light and the sustained response to a high-intensity blue light was calculated for 1 eye of each subject. RESULTS:: The pupil responses to red and blue light at all intensities were recordable in all patients except 1, whose pupil responded only to bright blue light. There was a significant difference of the pupil response between patients with RP and normal subjects in testing conditions that emphasized rod (1 cd/m(2) blue light) or cone (100 cd/m(2) red light) contribution (P<0.001). Patients with a non-recordable scotopic ERG showed significantly reduced pupil responses (P<0.001) to low-intensity blue light (1 cd/m(2)). Patients with a non-recordable or abnormal photopic ERG showed significantly reduced pupil responses (P<0.05) to high-intensity red light (100 cd/m(2)). Patients with a nonrecordable ERG had the most visual field loss and reduced pupil responses. Unexpectedly, patients with RP showed a slower re-dilation of the pupil after termination of bright blue light compared with red light, a pattern not observed in normal subjects. CONCLUSIONS:: Pupil responses to red and blue light stimuli weighted to favor cone or rod input are significantly reduced in patients with RP but are still recordable in patients having a non-recordable ERG. In addition, outer photoreceptor disease appears to unmask a post-illumination pupillary constriction to bright blue light, most likely mediated by intrinsic activation of melanopsin ganglion cells. Chromatic pupillometry provides a novel, noninvasive method for following retinal functional status, particularly in patients with severe RP and non-recordable ERG. FINANCIAL DISCLOSURE(S):: Proprietary or commercial disclosure may be found after the references.

Activin a inhibits antigen-induced allergy in murine epicutaneous sensitization.

Activin A, a member of the TGFβ superfamily, is involved in physiological processes such as cell differentiation, tissue homeostasis, wound healing, reproduction, and in pathological conditions, such as fibrosis, cancer, and asthma. Activin enhances mast cell maturation, as well as regulatory T-cell and Langerhans cell differentiation. In this study we investigated the potential role of activin in epicutaneous sensitization with ovalbumin (OVA), notably with respect to its effect on known Th2-polarization. For this purpose, transgenic mice overexpressing activin in keratinocytes and their wild-type (WT) controls were sensitized epicutaneously with OVA. Skin biopsies were analyzed with regard to histopathological features and mRNA expression of pro-inflammatory and Th1/Th2 cytokines, and Ig levels were measured in the serum. Unexpectedly, activin overexpressing animals were protected from Th2-cytokine expression and induction of OVA-specific IgE levels compared to WT animals. On the other hand, transgenic mice were more susceptible to inflammation compared to WT littermates after tape-stripping and saline (vehicle) or OVA application, as shown by increased pro-inflammatory cytokine mRNA levels and neutrophil accumulation at the site of the treatment. We conclude that activin protects from antigen-induced cutaneous Th2-polarization through modulation of the immune response. These findings highlight the role of activin in cutaneous sensitization, allergy, and in skin homeostasis.

Role of T-cell-mediated inflammation in psoriasis: pathogenesis and targeted therapy

Psoriasis is one of the most common chronic, inflammatory, T-cell-mediated autoimmune diseases. Over the past decade, increased knowledge of disease pathogenesis has fundamentally changed psoriasis treatment, with the introduction of biologics, and this has led to a multitude of improved selective targets providing potential therapeutic options. Indeed, numerous pathogenesis-based treatments are currently in development, as psoriasis has also become increasingly relevant for proof-of-concept studies. The purpose of this review was to summarize current knowledge of psoriasis immunopathogenesis, focusing on the T-cell-mediated immune response and its initiation. The authors describe recent advances in psoriasis treatment and discuss pathogenesis-based therapies that are currently in development or which could be envisioned for the future. Although current biologics are well tolerated, several issues such as long-term efficacy, long-term safety, and high costs keep driving the search for new and better therapies. With further advances in understanding disease pathogenesis, more genomic data from psoriasis patients becoming available, and potentially the identification of autoantigens in psoriasis, current research should lead to the development of a growing arsenal of improved targeted treatments and to further breakthrough immunotherapies.

Effectiveness of heparin versus 0.9% saline solution in maintaining the permeability of central venous catheters: a systematic review

Abstract OBJECTIVE Determining which is the most effective solution (heparin flush compared to 0.9% saline flush) for reducing the risk of occlusions in central venous catheters (CVC) in adults. METHOD The systematic review followed the principles proposed by the Cochrane Handbook; critical analysis, extraction and synthesis of data were performed by two independent researchers; statistical analysis was performed using the RevMan program 5.2.8. RESULTS Eight randomized controlled trials and one cohort study were included and the results of the meta-analysis showed no difference (RR=0.68, 95% CI=0.41-1.10; p=0.12). Analysis by subgroups showed that there was no difference in fully deployed CVC (RR=1.09, CI 95%=0.53-2.22;p=0.82); Multi-Lumen CVC showed beneficial effects in the heparin group (RR=0.53, CI 95%=0.29-0.95; p=0.03); in Double-Lumen CVC for hemodialysis (RR=1.18, CI 95%=0.08-17.82;p=0.90) and Peripherally inserted CVC (RR=0.14, CI 95%=0.01-2.60; p=0.19) also showed no difference. CONCLUSION Saline solution is sufficient for maintaining patency of the central venous catheter, preventing the risks associated with heparin administration.

Hypertension prevalence among indigenous populations in Brazil: a systematic review with meta-analysis

Abstract OBJECTIVE Evaluating the evidence of hypertension prevalence among indigenous populations in Brazil through a systematic review and meta-analysis. METHODS A search was performed by two reviewers, with no restriction of date or language in the databases of PubMed, LILACS, SciELO, Virtual Health Library and Capes Journal Portal. Also, a meta-regression model was designed in which the last collection year of each study was used as a moderating variable. RESULTS 23 articles were included in the review. No hypertension was found in indigenous populations in 10 studies, and its prevalence was increasing and varied, reaching levels of up to 29.7%. Combined hypertension prevalence in Indigenous from the period of 1970 to 2014 was 6.2% (95% CI, 3.1% - 10.3%). In the regression, the value of the odds ratio was 1.12 (95% CI, 1.07 - 1.18; p <0.0001), indicating a 12% increase every year in the probability of an indigenous person presenting hypertension. CONCLUSION There has been a constant increase in prevalence despite the absence of hypertension in about half of the studies, probably due to changes in cultural, economic and lifestyle habits, resulting from indigenous interaction with non-indigenous society.

TBS (trabecular bone score) and diabetes-related fracture risk.

CONTEXT: Type 2 diabetes is associated with increased fracture risk but paradoxically greater bone mineral density (BMD). Trabecular bone score (TBS) is derived from the texture of the spine dual x-ray absorptiometry (DXA) image and is related to bone microarchitecture and fracture risk, providing information independent of BMD. OBJECTIVE: This study evaluated the ability of lumbar spine TBS to account for increased fracture risk in diabetes. DESIGN AND SETTING: We performed a retrospective cohort study using BMD results from a large clinical registry for the province of Manitoba, Canada. Patients: We included 29,407 women 50 years old and older with baseline DXA examinations, among whom 2356 had diagnosed diabetes. MAIN OUTCOME MEASURES: Lumbar spine TBS was derived for each spine DXA examination blinded to clinical parameters and outcomes. Health service records were assessed for incident nontraumatic major osteoporotic fractures (mean follow-up 4.7 years). RESULTS: Diabetes was associated with higher BMD at all sites but lower lumbar spine TBS in unadjusted and adjusted models (all P < .001). The adjusted odds ratio (aOR) for a measurement in the lowest vs the highest tertile was less than 1 for BMD (all P < .001) but was increased for lumbar spine TBS [aOR 2.61, 95% confidence interval (CI) 2.30-2.97]. Major osteoporotic fractures were identified in 175 women (7.4%) with and 1493 (5.5%) without diabetes (P < .001). Lumbar spine TBS was a BMD-independent predictor of fracture and predicted fractures in those with diabetes (adjusted hazard ratio 1.27, 95% CI 1.10-1.46) and without diabetes (hazard ratio 1.31, 95% CI 1.24-1.38). The effect of diabetes on fracture was reduced when lumbar spine TBS was added to a prediction model but was paradoxically increased from adding BMD measurements. CONCLUSIONS: Lumbar spine TBS predicts osteoporotic fractures in those with diabetes, and captures a larger portion of the diabetes-associated fracture risk than BMD.

Investigation de liens de parenté à l'aide de l'ADN: lecture différentielle de rapports d'expertise

De nos jours, l'ADN apparaît fréquemment dans les affaires judiciaires et la littérature spécialisée. L'évaluation de ce type d'indice est vaste. En général, les débats restent toutefois assez théoriques. Dans la présente contribution, deux types courants d'analyse sont abordés, l'ADN nucléaire et l'ADN mitochondrial, dans le cadre d'une recherche en demi-fraternité. Deux rapports d'expertise seront décortiqués ligne par ligne pour en offrir une lecture critique et cerner la fiabilité et l'utilité des conclusions apportées par les experts.

Caracterização Geológica e Geotécnica das Unidades Litológicas da Cidade da Praia (Santiago, Cabo Verde)

Este trabalho produz uma avaliação das características geológicas e geotécnicas de um território da ilha de Santiago, Cabo Verde, incidindo sobre a cidade da Praia e a área envolvente. Os objectivos principais do trabalho são a representação cartográfica das unidades litológicas, com uma proposta de coluna litológica sintética, a correlação com as unidades geológicas definidas por outros autores, bem como a realização de um conjunto de ensaios in situ e análises laboratoriais visando a caracterização dos parâmetros físicos e mecânicos das diferentes unidades litológicas definidas para a área em estudo. É efectuada uma compilação sobre as principais investigações geológicas realizadas em Cabo Verde, desde o séc. XIX até a actualidade, assim como a descrição das características geológicas da ilha de Santiago e dos principais processos de formação e evolução das formas de relevo e dos recursos naturais (hídricos e solos). A pesquisa incluiu uma revisão dos conceitos descritivos de caracterização dos vulcanitos e vulcanoclastitos presentes e compreendeu a redefinição das unidades litológicas da região, a respectiva representação cartográfica na escala 1: 10.000 (com maior detalhe do que a informação pré-existente) e o levantamento de campo dos principais alinhamentos estruturais. São igualmente apresentados os resultados do tratamento das bandas espectrais de imagens de satélite que suportam a definição das unidades litológicas, bem como dos principais alinhamentos tectónicos que afectam as unidades da área de estudo. Para a caracterização das diferentes unidades litológicas com base nas propriedades in situ, recorreu-se a perfis-tipo, estabelecendo uma descrição das características mineralógicas, petrográficas, texturais e estruturais das materiais presentes. Os materiais foram igualmente ensaiados in situ e amostrados para uma caracterização laboratorial. Os resultados dos ensaios geotécnicos, geomecânicos, mineralógicos e de radioactividade natural permitiram refinar a cartografia proposta e estabelecer parâmetros de comportamento para as 30 unidades litológicas consideradas, a partir de intervalos de valores não homogéneos, contudo representativos da variabilidade observada. Com base nestes resultados são apresentados valores indicativos de aptidão dos materiais, nomeadamente para fundações de edifícios, aterros, construção e potencial hidrogeológico.