Invasive Candida infections in the ICU

Invasive candidiasis, including candidemia and deep-seated Candida infections, is a severe opportunistic infection with an overall mortality in ICU patients comparable to that of severe sepsis/septic shock. With an incidence ranging from 5 to 10 cases per 1000 ICU admissions, invasive candidiasis represents 510% of all ICU-acquired infections. Although a high proportion of critically ill patients is colonised with Candida spp., only 540% develop an invasive infection. The occurrence of this complication is difficult to predict and an early diagnosis remains a major challenge. Indeed, blood cultures are positive in a minority of cases and often late in the course of infection. New non-culture based laboratory techniques may contribute to early diagnosis and management of invasive candidiasis. Recent data suggest that prediction rules based on risk factors, clinical and microbiological parameters or monitoring of Candida colonisation may efficiently identify critically ill patients at high risk of invasive candidiasis who may benefit of preventive or pre-emptive antifungal therapy. In many cancer centres, exposure to azoles antifungals has been associated with an epidemiological shift from Candida albicans to non-albicans Candida species with reduced antifungal susceptibility or intrinsic resistance. This trend has not been observed in recent surveys on candidemia in non-immunocompromised ICU patients. Prophylaxis, pre-emptive or empirical antifungal treatment are possible approaches for prevention or early management of invasive candidiasis. However, the selection of high-risk patients remains critical for an efficient management aimed at reducing the number needed to treat and thus avoiding unnecessary treatments associated with the emergence of resistance, drug toxicity and costs.

Flux and composition of settling particles across the continental margin of the Gulf of Lion: the role of dense shelf water cascading

Settling particles were collected using sediment traps deployed along three transects in the Lacaze-Duthiers and Cap de Creus canyons and the adjacent southern open slope from October 2005 to October 2006. The settling material was analyzed to obtain total mass fluxes and main constituent contents (organic matter, opal, calcium carbonate, and siliciclastics). Cascades of dense shelf water from the continental shelf edge to the lower continental slope occurred from January to March 2006. They were traced through strong negative near-bottom temperature anomalies and increased current speeds, and generated two intense pulses of mass fluxes in January and March 2006. This oceanographic phenomenon appeared as the major physical forcing of settling particles at almost all stations, and caused both high seasonal variability in mass fluxes and important qualitative changes in settling material. Fluxes during the dense shelf water cascading (DSWC) event ranged from 90.1 g m(-2) d(-1) at the middle Cap de Creus canyon (1000 m) to 3.2 g m(-2) d(-1) at the canyon mouth (1900 m). Fractions of organic matter, opal and calcium carbonate components increased seaward, thus diminishing the siliciclastic fraction. Temporal variability of the major components was larger in the canyon mouth and open slope sites, due to the mixed impact of dense shelf water cascading processes and the pelagic biological production. Results indicate that the cascading event remobilized and homogenized large amounts of material down canyon and southwardly along the continental slope contributing to a better understanding of the off-shelf particle transport and the internal dynamics of DSWC events.

Douteur testiculaire, un défi diagnostique [Testicular pain, a diagnostic challenge?].

Scrotal pain is frequently encountered in practice, as it affects 4 men in 1000, with a peak of incidence between the ages of 45 and 50. After excluding an urological or gastrointestinal cause, referred pain of musculoskeletal origin should be considered, even in the absence of back pain. Described by Dr. Robert Maigne, this referred pain originates from a minor intervertebral dysfunction of the thoracolumbar junction. Imaging of the spine is not helpful. Rather, the diagnosis is made by seeking pain triggered by the mobilization of the lumbar vertebrae; the pinch and roll skin manoeuvre will highlight this referred pain. Treatment is symptomatic, though manual therapies by spine specialists are also recommended.

Bataille de Friedland le 14 juin 1807 / gravé par J. Fialkowski

Échelle(s) : [ca 1:33 600], échelle de 1000 toises [= 5,8 cm]

Physiopathologie et prévention des infections liées aux accès vasculaires [Pathophysiology and prevention of intravascular catheter-related infection]

Les infections liées aux accès vasculaires sont à l'origine d'une proportion importante des infections nosocomiales. Elles comprennent leur colonisation par des micro-organismes, les infections du site d'insertion et les bactériémies et fongémies qui leur sont associées ou attribuées. Une bactériémie complique l'insertion de 3 à 5 % des voies veineuses, correspondant à une incidence de 2 à 14 épisodes pour 1000 jourcathéters. Cette proportion ne représente toutefois que la partie visible de l'iceberg puisque la plupart des épisodes de sepsis clinique sans foyer infectieux associé sont également considérés comme liés aux accès vasculaires. Après un rappel de leur physiopathologie, cet article passe en revue les éléments importants pour leur prévention, y compris ceux concernant l'utilisation de cathéters imprégnés de désinfectants ou d'antibiotiques. Pour terminer, nous discutons en détail les stratégies préventives globales. Fondées sur la prise en compte d'un ensemble d'éléments spécifiques, ces approches sont centrées sur l'éducation du personnel au respect des règles d'hygiène de base et sur l'introduction de recommandations précises pour l'insertion et l'utilisation des accès vasculaires.

Curva de retenção de água no solo pelo método do papel-filtro

O método mais tradicional para determinação da curva de retenção de água no solo emprega a câmara de pressão de Richards. Por questões práticas, a busca por métodos alternativos ao de Richards, financeiramente mais acessíveis e menos morosos, faz-se interessante. Diante disso, desenvolveu-se o presente trabalho com o objetivo de avaliar o uso do método do papel-filtro. Para isso, realizou-se inicialmente coleta, caracterização física e preparo de amostras indeformadas de um Latossolo Vermelho distroférrico típico e ensaio em câmara de Richards, utilizando pressões de 0, 10, 30, 60, 100, 300, 500, 1000 e 1500 kPa. No ensaio com o papel-filtro, mediu-se o potencial matricial da água em amostras cujas umidades foram previamente estabelecidas, utilizando-se curva de calibração adequada. Os ensaios resultaram em pontos de pressão versus umidade, que foram ajustados pelo modelo de van Genuchten, utilizando o programa RETC. Realizou-se uma análise comparativa de valores de umidade volumétrica estimados pelo modelo ajustado nos ensaios com o papel-filtro com a curva de retenção ajustada obtida pela câmara de Richards. Por meio dessa comparação, verificou-se a aplicabilidade do método do papel-filtro para determinação da curva de retenção de água no solo agrícola utilizado.

Runoff and sediment transport in a degraded area

Gully erosion occurs by the combined action of splash, sheetwash and rill-wash (interrill and rill erosion). These erosion processes have a great capacity for both sediment production and sediment transport. The objectives of this experiment were to evaluate hydrological and sediment transport in a degraded area, severely dissected by gullies; to assess the hydraulic flow characteristics and their aggregate transport capacity; and to measure the initial splash erosion rate. In the study area in Guarapuava, State of Paraná, Brazil (lat 25º 24' S; long 51º24' W; 1034 m asl), the soil was classified as Cambissolo Húmico alumínico, with the following particle-size composition: sand 0.116 kg kg-1; silt 0.180 kg kg-1; and clay 0.704 kg kg-1. The approach of this research was based on microcatchments formed in the ground, to study the hydrological response and sediment transport. A total of eight rill systems were simulated with dry and wet soil. An average rainfall of 33.7 ± 4.0 mm was produced for 35 to 54 min by a rainfall simulator. The equipment was installed, and a trough was placed at the end of the rill to collect sediments and water. During the simulation, the following variables were measured: time to runoff, time to ponding, time of recession, flow velocity, depth, ratio of the initial splash and grain size. The rainsplash of dry topsoil was more than twice as high as under moist conditions (5 g m-2 min-1 and 2 g m-2 min-1, respectively). The characteristics of the flow hydraulics indicate transition from laminar to turbulent flow [Re (Reynolds number) 1000-2000]. In addition, it was observed that a flow velocity of 0.12 m s-1 was the threshold for turbulent flow (Re > 2000), especially at the end of the rainfall simulation. The rill flow tended to be subcritical [Fr (Froude Number) < 1.0]. The variation in hydrological attributes (infiltration and runoff) was lower, while the sediment yield was variable. The erosion in the rill systems was characterized as limited transport, although the degraded area generated an average of 394 g m-2 of sediment in each simulation.

Bound states of 3He at the edge of a 4He drop on a cesium surface

We show that small amounts of 3He atoms, added to a 4He drop deposited on a flat cesium surface at zero temperature, populate bound states localized at the contact line. These edge states show up for drops large enough to develop well defined surface and bulk regions together with a contact line, and they are structurally different from the well-known Andreev states that appear at the free surface and at the liquid-solid interface of films. We illustrate the one-body density of 3He in a drop with 1000 4He atoms, and show that for a sufficiently large number of impurities the density profiles spread beyond the edge, coating both the curved drop surface and its flat base and eventually isolating it from the substrate.

Geometric morphometric analyses provide evidence for the adaptive character of the Tanganyikan cichlid fish radiations.

The cichlids of East Africa are renowned as one of the most spectacular examples of adaptive radiation. They provide a unique opportunity to investigate the relationships between ecology, morphological diversity, and phylogeny in producing such remarkable diversity. Nevertheless, the parameters of the adaptive radiations of these fish have not been satisfactorily quantified yet. Lake Tanganyika possesses all of the major lineages of East African cichlid fish, so by using geometric morphometrics and comparative analyses of ecology and morphology, in an explicitly phylogenetic context, we quantify the role of ecology in driving adaptive speciation. We used geometric morphometric methods to describe the body shape of over 1000 specimens of East African cichlid fish, with a focus on the Lake Tanganyika species assemblage, which is composed of more than 200 endemic species. The main differences in shape concern the length of the whole body and the relative sizes of the head and caudal peduncle. We investigated the influence of phylogeny on similarity of shape using both distance-based and variance partitioning methods, finding that phylogenetic inertia exerts little influence on overall body shape. Therefore, we quantified the relative effect of major ecological traits on shape using phylogenetic generalized least squares and disparity analyses. These analyses conclude that body shape is most strongly predicted by feeding preferences (i.e., trophic niches) and the water depths at which species occur. Furthermore, the morphological disparity within tribes indicates that even though the morphological diversification associated with explosive speciation has happened in only a few tribes of the Tanganyikan assemblage, the potential to evolve diverse morphologies exists in all tribes. Quantitative data support the existence of extensive parallelism in several independent adaptive radiations in Lake Tanganyika. Notably, Tanganyikan mouthbrooders belonging to the C-lineage and the substrate spawning Lamprologini have evolved a multitude of different shapes from elongated and Lamprologus-like hypothetical ancestors. Together, these data demonstrate strong support for the adaptive character of East African cichlid radiations.

Geographical and altitudinal population genetic structure of two dung fly species with contrasting mobility and temperature preference.

Local adaptation of populations requires some degree of spatio-temporal isolation. Previous studies of the two dung fly species Scathophaga stercoraria and Sepsis cynipsea have revealed low levels of geographic and altitudinal genetic differentiation in quantitative life history and morphological traits, but instead high degrees of phenotypic plasticity. These patterns suggest that gene flow is extensive despite considerable geographic barriers and large spatio-temporal variation in selection on body size and related traits. In this study we addressed this hypothesis by investigating genetic differentiation of dung fly populations throughout Switzerland based on the same 10 electrophoretic loci in each species. Overall, we found no significant geographic differentiation of populations for either species. This is inconsistent with the higher rates of gene flow expected due to better flying capacity of the larger S. stercoraria. However, heterozygote deficiencies within populations indicated structuring on a finer scale, seen for several loci in S. cynipsea, and for the locus PGM (Phosphoglucomutase) in S. stercoraria. Additionally, S. cynipsea showed a tendency towards a greater gene diversity at higher altitudes, mediated primarily by the locus MDH (malate dehydrogenase), at which a second allele was only present in populations above 1000 m. This may be caused by increased environmental stress at higher altitudes in this warm-adapted species. MDH might thus be a candidate locus subject to thermal selection in this species, but this remains to be corroborated by direct evidence. In S. stercoraria, no altitudinal variation was found.

Crescimento e produção de milho associados com o intervalo hídrico ótimo

O Intervalo hídrico ótimo (IHO) é muito utilizado como indicador agronômico de qualidade física do solo, contudo pouquíssimas pesquisas relacionaram o IHO com crescimento e produção de plantas. Os escassos resultados são insuficientes para confirmar ou negar a eficiência do IHO, porém apontam para a discordância entre IHO e produção das culturas. O objetivo deste estudo foi analisar a correlação do IHO com as variáveis de crescimento e com a produção de grãos da cultura de milho (Zea mays L.) de oito cultivos (quarto na safra 2010/11 e quatro na safra 2011/12) em Latossolo Vermelho distroférrico típico, com diferentes estados de compactação. Os tratamentos consistiram de plantio direto, que recebeu escarificação e compactação adicional. Foram medidos a altura de plantas (Ap), o índice de área foliar (IAF), a profundidade efetiva de raízes (Ze), o rendimento de grãos e o peso de 1000 grãos nos oito cultivos de milho. O IHO foi determinado para seis combinações de resistência do solo à penetração e potencial matricial (RP:Ψ), usadas nos limites inferiores: (2:-0,8), (3:-0,8), (4:-0,8), (2:-1,5), (3:-1,5) e (4:-1,5), expressos em MPa. O IHO esteve fracamente associado com Ap, IAF e Ze. Os coeficientes de correlação variaram entre -0,20 e 0,36 e a maioria das correlações não foi significativa. Além disso, a melhor relação linear explicou apenas 17 % da variação da altura das plantas em função da variação do IHO. Não houve correlação entre IHO e produção de grãos de milho. Esses resultados indicaram que, embora o IHO seja sensível à compactação do solo, ele não é um índice agronômico robusto para orientar o manejo da compactação para culturas, cujo objetivo principal é a produção de grãos.

Neoadjuvant treatment with docetaxel plus lapatinib, trastuzumab, or both followed by an anthracycline-based chemotherapy in HER2-positive breast cancer: results of the randomised phase II EORTC 10054 study.

BACKGROUND: Neoadjuvant trials conducted using a double HER2 blockade with lapatinib and trastuzumab, combined with different paclitaxel-containing chemotherapy regimens, have shown high pathological complete response (pCR) rates, but at the cost of important toxicity. We hypothesised that this toxicity might be due to a specific interaction between paclitaxel and lapatinib. This trial assesses the toxicity and activity of the combination of docetaxel with lapatinib and trastuzumab. PATIENTS AND METHODS: Patients with stage IIA to IIIC HER2-positive breast cancer received six cycles of chemotherapy (three cycles of docetaxel followed by three cycles of fluorouracil, epirubicin, cyclophosphamide). They were randomised 1 : 1 : 1 to receive during the first three cycles either lapatinib (1000 mg orally daily), trastuzumab (4 mg/kg loading dose followed by 2 mg/kg weekly), or trastuzumab + lapatinib at the same dose. The primary end point was pCR rate defined as ypT0/is. Secondary end points included safety and toxicity. pCR rate defined as ypT0/is ypN0 was assessed as an exploratory analysis. In June 2012, arm A was closed for futility based on the results from other studies. RESULTS: From October 2010 to January 2013, 128 patients were included in 14 centres. The percentage of the 122 assessable patients with pCR in the breast, and pCR in the breast and nodes, was numerically highest in the lapatinib + trastuzumab group (60% and 56%, respectively), intermediate in the trastuzumab group (52% and 52%), and lowest in the lapatinib group (46% and 36%). Frequency (%) of the most common grade 3-4 toxicities in the lapatinib /trastuzumab/lapatinib + trastuzumab arms were: febrile neutropenia 23/15/10, diarrhoea 9/2/18, infection (other) 9/4/8, and hepatic toxicity 0/2/8. CONCLUSIONS: This study demonstrates a numerically modest pCR rate increase with double anti-HER2 blockade plus chemotherapy, but suggests that the use of docetaxel rather than paclitaxel may not reduce toxicity. CLINICALTRIALSGOV: NCT00450892.

Redução de haste verde e retenção foliar na soja em razão de maior disponibilidade de nitrogênio pelo tratamento de sementes

Problemas relacionados à retenção foliar e maturação desuniforme na cultura da soja têm sido relatados em várias regiões do país, inclusive no Estado do Paraná, desafiando pesquisadores brasileiros. Várias hipóteses já foram levantadas sobre o desequilíbrio nutricional das plantas e intensificação do problema, porém nenhuma com conclusão definitiva. Com o objetivo de avaliar como a disponibilidade de N via inoculação e uso de Co e Mo no tratamento de sementes, associado ao uso de fungicida e inseticida, pode minimizar a retenção foliar e haste verde, instalou-se um ensaio no campo da Estação Experimental da Copacol, em Cafelândia, PR. Oito combinações de produtos foram usadas no tratamento de sementes de soja, considerando a presença ou ausência de Co e Mo, inoculante e inseticida/fungicida. Avaliaram-se o teor de N foliar, a frequência de plantas anormais por ocasião da colheita, a porcentagem de vagens, com 0, 1, 2, 3 e 4 grãos formados, o peso de 1000 grãos, o teor de umidade, a impureza na colheita e o rendimento de grãos. O uso do Co e Mo e a inoculação de sementes promoveram aumento do teor de N foliar na soja e reduziram o número de plantas anormais, refletindo positivamente no rendimento e seus componentes. Os resultados evidenciaram efeito positivo da melhor nutrição das plantas de soja com relação ao N na redução de haste verde e reafirmaram a necessidade do uso do Co e Mo e da inoculação de sementes.

Wideband dual sphere detector of gravitational waves

We present the concept of a sensitive and broadband resonant mass gravitational wave detector. A massive sphere is suspended inside a second hollow one. Short, high-finesse Fabry-Perot optical cavities read out the differential displacements of the two spheres as their quadrupole modes are excited. At cryogenic temperatures, one approaches the standard quantum limit for broadband operation with reasonable choices for the cavity finesses and the intracavity light power. A molybdenum detector, of overall size of 2 m, would reach spectral strain sensitivities of 2x10-23Hz-1/2 between 1000 and 3000 Hz.