Postmortem diagnosis of unsuspected diabetes mellitus.

Vitreous glucose, blood beta-hydroxybutyrate and glycated hemoglobin were systematically measured in a series of 500 medico-legal autopsies in order to characterize the glycemic control during the weeks preceding death and identify ketoacidosis as the cause of death in diagnosed and unsuspected diabetics. Unenhanced CT-scans, histology and toxicology were performed in all cases. 16 cases of diabetic ketoacidosis were identified based on the results of all investigations. Among those, 13 cases concerned individuals with pre-existing diagnoses of diabetes mellitus whereas 3 cases concerned individuals with undiagnosed diabetes. A recent cocaine use was observed in 2 cases. C-reactive protein, interleukin-6 and interleukin-10 were measured and proved to be increased in all cases of diabetic ketoacidosis, whereas markers of generalized, bacterial infection and sepsis were normal in most of these cases. The results of this study highlight the usefulness of systematically performing biochemistry to identify ketoacidosis in unsuspected diabetics. It also emphasizes the role of toxicology and biochemistry to support the diagnosis of diabetic ketoacidosis and delineate the pathophysiological mechanisms that may disrupt the metabolic balance and finally lead to death in diabetic individuals.

Enhancement of writings on a damaged medieval manuscript using ultraviolet imaging

The Minutarium Majus, a register dating from the 13th and 14th centuries, was transferred by the paleographers responsible for its transcription to the Institute of Forensic Science of the University of Lausanne with the aim of enhancing portions of text that had become worn away and illegible. The manuscript had suffered from deterioration and damage for different unknown reasons, but most likely because of the colour instability of the ink, contaminations, storage conditions and repeated human manipulation. A total of 69 areas of text, ranging in size from just a few words to full pages, were photographically recorded under both white and ultraviolet (UV) light illumination. UV illumination observed in the visible range proved to be efficient in detecting the writings. Most of the texts could thus be successfully transcribed by the paleographers. The technique proved to be extremely useful for the exposure of damaged medieval writings.

Microscòpia d'alta resolució aplicada a anàlisis traceològiques, tafonòmiques i zooarqueològiques

El projecte Microscòpia d'alta resolució aplicada a anàlisis traceològiques, tafonòmiques y zooarqueològiques ha permès donar continuïtat i ampliar la xarxa científica posada en marxa gràcies a dos projectes PBR anteriors entre l’IPHES i quatre centres anglesos: l’Institute of Archaeology del University College of London, el Dept of Prehistory and Europe del British Museum, el Dept of Palaeontology del Natural History Museum, i el Lithic Microwear Research Laboratory de la University of Bradford. El tema tractat ha estat l’avaluació de la resolució i de la possible complementarietat de diferents tècniques avançades de microscòpia per a l’anàlisi de les superfícies d’ossos i eines de pedra prehistòriques: microscòpia òptica, electrònica (SEM i ESEM), microscòpia làser confocal (LSCM) i el sistema Alicona 3D Infinite Imaging. Les diverses accions de mobilitat entre Catalunya i el Regne Unit realitzades han permès satisfactòriament posar en comú els procediments emprats pels diferents especialistes de cada centre. Les proves realitzades sobre materials de jaciments arqueològics clau tant britànics com de l’estat espanyol han permès avaluar els avantatges i limitacions que cada tècnica presentava segons la mostra estudiada (eines de pedra, ossos, dents...) i segons els requeriments específics de l’estudi plantejat. En termes generals, s’ha posat en evidència que les diferents tècniques explorades són força complementàries. És a dir, la gran capacitat d’augments i de resolució d’imatge dels microscopis electrònics es complementa amb unes meravelloses prestacions quant anàlisi de textures, de perfils i de reconstrucció 3D dels altres aparells. La principal conclusió que podem extreure, doncs, és que l’estudi d’aquest tipus d’objectes arqueològics requereix de l’ús combinat de diferents aparells de microscòpia. Tant els treballs realitzats com els contactes entre especialistes establerts al llarg del projecte s’han plasmat ja en treballs concrets, alguns d’ells ja publicats o en fase final de publicació.

Advanced nursing role to improve care among breast cancer patients

Background: Breast cancer is a devastating disease for women as it impacts on their intimate, familial, social life. We study the specificities of breast cancer nurse interventions related to demands of support, information and coordination. Material and Methods: More than 300 patients are treated every year in our institution. From 2006 January to 2008 December, the specialist nurse has reported demands of patients and professionals: 1. Patients' needs related to support, information and coordination of care were collected from consultations with her and from their phone calls on using working days help line 2. Demands of breast cancer specialists and general practitioners related to information and coordination for specific patients were collected from their phone calls. Results: The specialist nurse received 679 phone calls respectively 71.5% from patients and 28.5% from professionals. Data are presented in the following table. Table 1: Evolution of number of patients and professionals demands Patients consultations Patients calls Professionals calls 2006 93 45 32 2007 210 200 40 2008 245 240 122 - Seventy percent (70%) of women asked for information about exams and treatments by phone and in nurse consultation. - Forty percent (40%) of women asked for support after announce of diagnosis. The specialist nurse proposed consultations, 2 to 4 consultations were necessary for women to express emotional distress or psychosocial problem. With this specialised nursing support less than 15% of patients were referred to the psycho-oncologist setting. - Forty percent (40%) of professionals asked support for patients and 60% for information and coordination of care. Conclusion: The interventions of the specialist nurse have improved coordination and quality of care. The increase of professionals' demands showed that it was necessary that a nurse assures continuity of information between hospital and extrahospital structures. The breast cancer nurse empowers patients and helps them to get well by providing support to fulfil specific needs.

Nanomotors: new strategies of (bio)sensing based on motion

Nanomotors are nanoscale devices capable of converting energy into movement and forces. Among them, self-propelled nanomotors offer considerable promise for developing new and novel bioanalytical and biosensing strategies based on the direct isolation of target biomolecules or changes in their movement in the presence of target analytes. The mainachievements of this project consists on the development of receptor-functionalized nanomotors that offer direct and rapid target detection, isolation and transport from raw biological samples without preparatory and washing steps. For example, microtube engines functionalized with aptamer, antibody, lectin and enzymes receptors were used for the direct isolation of analytes of biomedical interest, including proteins and whole cells, among others. A target protein was also isolated from a complex sample by using an antigen-functionalized microengine navigating into the reservoirs of a lab-on-a-chip device. The new nanomotorbased target biomarkers detection strategy not only offers highly sensitive, rapid, simple and low cost alternative for the isolation and transport of target molecules, but also represents a new dimension of analytical information based on motion. The recognition events can be easily visualized by optical microscope (without any sophisticated analytical instrument) to reveal the target presence and concentration. The use of artificial nanomachines has shown not only to be useful for (bio)recognition and (bio)transport but also for detection of environmental contamination and remediation. In this context, micromotors modified with superhydrophobic layer demonstrated that effectively interacted, captured, transported and removed oil droplets from oil contaminated samples. Finally, a unique micromotor-based strategy for water-quality testing, that mimics live-fish water-quality testing, based on changes in the propulsion behavior of artificial biocatalytic microswimmers in the presence of aquatic pollutants was also developed. The attractive features of the new micromachine-based target isolation and signal transduction protocols developed in this project offer numerous potential applications in biomedical diagnostics, environmental monitoring, and forensic analysis.

"INTERMED": a method to assess health service needs. I. Development and reliability.

The purpose of this paper is to describe the development and to test the reliability of a new method called INTERMED, for health service needs assessment. The INTERMED integrates the biopsychosocial aspects of disease and the relationship between patient and health care system in a comprehensive scheme and reflects an operationalized conceptual approach to case mix or case complexity. The method is developed to enhance interdisciplinary communication between (para-) medical specialists and to provide a method to describe case complexity for clinical, scientific, and educational purposes. First, a feasibility study (N = 21 patients) was conducted which included double scoring and discussion of the results. This led to a version of the instrument on which two interrater reliability studies were performed. In study 1, the INTERMED was double scored for 14 patients admitted to an internal ward by a psychiatrist and an internist on the basis of a joint interview conducted by both. In study 2, on the basis of medical charts, two clinicians separately double scored the INTERMED in 16 patients referred to the outpatient psychiatric consultation service. Averaged over both studies, in 94.2% of all ratings there was no important difference between the raters (more than 1 point difference). As a research interview, it takes about 20 minutes; as part of the whole process of history taking it takes about 15 minutes. In both studies, improvements were suggested by the results. Analyses of study 1 revealed that on most items there was considerable agreement; some items were improved. Also, the reference point for the prognoses was changed so that it reflected both short- and long-term prognoses. Analyses of study 2 showed that in this setting, less agreement between the raters was obtained due to the fact that the raters were less experienced and the scoring procedure was more susceptible to differences. Some improvements--mainly of the anchor points--were specified which may further enhance interrater reliability. The INTERMED proves to be a reliable method for classifying patients' care needs, especially when used by experienced raters scoring by patient interview. It can be a useful tool in assessing patients' care needs, as well as the level of needed adjustment between general and mental health service delivery. The INTERMED is easily applicable in the clinical setting at low time-costs.

Probabilistic evidential assessment of gunshot residue particle evidence (Part II) : Bayesian parameter estimation for experimental count data.

Part I of this series of articles focused on the construction of graphical probabilistic inference procedures, at various levels of detail, for assessing the evidential value of gunshot residue (GSR) particle evidence. The proposed models - in the form of Bayesian networks - address the issues of background presence of GSR particles, analytical performance (i.e., the efficiency of evidence searching and analysis procedures) and contamination. The use and practical implementation of Bayesian networks for case pre-assessment is also discussed. This paper, Part II, concentrates on Bayesian parameter estimation. This topic complements Part I in that it offers means for producing estimates useable for the numerical specification of the proposed probabilistic graphical models. Bayesian estimation procedures are given a primary focus of attention because they allow the scientist to combine (his/her) prior knowledge about the problem of interest with newly acquired experimental data. The present paper also considers further topics such as the sensitivity of the likelihood ratio due to uncertainty in parameters and the study of likelihood ratio values obtained for members of particular populations (e.g., individuals with or without exposure to GSR).

Colaniella, foraminifère index du Permien tardif téthysien: propositions pour une taxonomie simplifiée, répartition géographique et environnements

Une classification simplifiee du genre Colaniella LIKHAREV est proposee: Colaniella ex gr. parva, Colaniella ex gr. lepida, Colaniella ex gr. minima. Elle correspond a la division du taxon en trois groupes morphologiques. La repartition geographique de ce taxon est inventoriée de meme que les environnements sedimentaires et les microfaunes associees. Les nouvelles decouvertes de C. ex gr. parva dans Ie Permien superieur des coupes de Mesagros (ile d'Egine, Grece), d'Emarat (N Elbourz, Iran) et du Wadi Wasil dans les montagnes centrales d'Oman sont decrites en detail. L'importance des Colanielles dans la biostratigraphie du Permien superieur tethysien est analysee et clarifiee au vu des travaux recents et Ie problème des migrations est abordé. A simplified taxonomic classification in 3 groups of the genus Colaniella LIKHAREV is proposed: Colaniella ex gr. parva, Colaniella ex gr. lepida, Colaniella ex gr. minima. The repartition of the eight main Colaniella biofacies is given and the paleogeographic distribution of this genus is presented on a late Permian map configuration. New late Permian localities with Colaniella ex gr. parva have been found: Aegina island (Greece), Emmarat in the northern Alborz (Iran) and Wadi Wasit in the central Oman Mountains. The stratigraphic range of Colaniella ex gr. parva is much longer than previously accepted even by specialists. This range begins in the early Midian (Abadehian) and ends in the late Changhsingian (Dorashamian), very close to the range of the genus. For environmental reasons and slow eastward migration we have apparent shorter ranges in the Eastern part of the Tethyan domain.

A strange foot not far from CRPS I

Introduction.- Since the work of the "International Association for the Study of Pain" (IASP), complex regional pain syndrome type 1 (CRPS I) or algodystrophy includes motor disorders (tremor, dystony, myoclony) as diagnosis criterion. This can lead to confusion with some neurologic disorders which can wrongly be considered as CRPS I. The following observation illustrates this problem.Observation.- A 31-year-old man was hospitalised in a rehabilitation clinic in April 2007 with suspected CRPS I with persistent pain in the left leg. In 2005, the patient underwent ligament reconstruction at the right ankle. In May 2006, a recurrence of his ankle sprain was treated conservatively. The course of this pathology was unfavourable with an extension of the pain areas (leg and foot) as well as an appearance of abnormal motion. Toe motion in abduction was observed (especially T5) followed by a flexion cramp; an hypoesthesia in the sural nerve area, a scar allodynia and discrete vasomotor disorders. The scintigraphy was compatible with a stage 2 algodystrophy. Lower limb electromyography was normal; measurement of pseudo periodic activity of the motor unit at the foot level (abductor of the 5th toe, 4th interosseous). A "Painful legs and moving toes syndrome" was diagnosed which was treated with gabapentin and carbamazepine with a partial improvement.Discussion.- The "Painful legs and moving toes syndrome" is a rare pathology rehabilitation specialists should recognize. The origin is often peripheral nerve damage. The medullar interneuron activation (between the dorsal and ventral horn) is considered as the source of the efferent motor nerves which are responsible for the abnormal movements. This observation illustrates the need for a demanding approach before establishing the diagnosis of CRPS I and the respect of the 4th criterion of the ASP (exclusion of this syndrome when another pathology may explain pain and dysfunction).

EAACI Food Allergy and Anaphylaxis Guidelines: diagnosis and management of food allergy.

Food allergy can result in considerable morbidity, impact negatively on quality of life, and prove costly in terms of medical care. These guidelines have been prepared by the European Academy of Allergy and Clinical Immunology's (EAACI) Guidelines for Food Allergy and Anaphylaxis Group, building on previous EAACI position papers on adverse reaction to foods and three recent systematic reviews on the epidemiology, diagnosis, and management of food allergy, and provide evidence-based recommendations for the diagnosis and management of food allergy. While the primary audience is allergists, this document is relevant for all other healthcare professionals, including primary care physicians, and pediatric and adult specialists, dieticians, pharmacists and paramedics. Our current understanding of the manifestations of food allergy, the role of diagnostic tests, and the effective management of patients of all ages with food allergy is presented. The acute management of non-life-threatening reactions is covered in these guidelines, but for guidance on the emergency management of anaphylaxis, readers are referred to the related EAACI Anaphylaxis Guidelines.

Postmortem distribution of 3-beta-hydroxybutyrate.

The concentrations of 3-beta-hydroxybutyrate (3HB) in femoral blood, urine, vitreous humor as well as pericardial and cerebrospinal fluids were retrospectively examined in a series of medico-legal autopsies, which included cases of diabetic ketoacidosis, hypothermia fatalities without ethanol in blood, bodies presenting mild decompositional changes, and sudden deaths in chronic alcoholics. Similar increases in 3HB concentrations were observed in blood, vitreous, and pericardial fluid, irrespective of the cause of death, suggesting that pericardial fluid and vitreous can both be used as alternatives to blood for postmortem 3HB determination. Urine 3HB levels were higher than blood values in most cases. Cerebrospinal fluid 3HB levels were generally lower than concentrations in blood and proved to be diagnostic of underlying metabolic disturbances only when significant increases occurred.