Global validation of the WSES Sepsis Severity Score for patients with complicated intra-abdominal infections: a prospective multicentre study (WISS Study).

BACKGROUND To validate a new practical Sepsis Severity Score for patients with complicated intra-abdominal infections (cIAIs) including the clinical conditions at the admission (severe sepsis/septic shock), the origin of the cIAIs, the delay in source control, the setting of acquisition and any risk factors such as age and immunosuppression. METHODS The WISS study (WSES cIAIs Score Study) is a multicenter observational study underwent in 132 medical institutions worldwide during a four-month study period (October 2014-February 2015). Four thousand five hundred thirty-three patients with a mean age of 51.2 years (range 18-99) were enrolled in the WISS study. RESULTS Univariate analysis has shown that all factors that were previously included in the WSES Sepsis Severity Score were highly statistically significant between those who died and those who survived (p < 0.0001). The multivariate logistic regression model was highly significant (p < 0.0001, R2 = 0.54) and showed that all these factors were independent in predicting mortality of sepsis. Receiver Operator Curve has shown that the WSES Severity Sepsis Score had an excellent prediction for mortality. A score above 5.5 was the best predictor of mortality having a sensitivity of 89.2 %, a specificity of 83.5 % and a positive likelihood ratio of 5.4. CONCLUSIONS WSES Sepsis Severity Score for patients with complicated Intra-abdominal infections can be used on global level. It has shown high sensitivity, specificity, and likelihood ratio that may help us in making clinical decisions.

Modeling, design, and optimization of radiofrequency micromechanical structures

Coupled Electromechanical Analysis, MEMS Modeling, MEMS, RF MEMS Switches, Defected Ground Structures, Reconfigurable Resonator

The use and limitations of ultrasonography in the diagnosis of liver morbidity attributable to Schistosoma mansoni infection in community-based surveys

The objective of this population-based study was to estimate the liver morbidity attributable to Schistosoma mansoni infection by ultrasonography adopting the proposed standard protocols of the Cairo Meeting on Ultrasonography, 1991. We examined 2384 individuals representing 20 of the households of the rural population of the Ismailia Governorate, East of Delta, Egypt. Prevalence of S. mansoni and S. haematobium infections were 40.3 and 1.7 respectively. Portal tract thickening (PTT) grade 1, 2 and 3 considered diagnostic of schistosomal liver morbidity was detected in 35.1, 1.3 and 0.2 individuals respectively. Generally, ultrasonographically-detected pathological changes increased with age, but correlated with intensity of infection only in age group 20-59 years. Comparing individuals with and without S. mansoni infections in an endemic and a non-endemic community indicated no significant difference between the former and the latter in either case. In conclusion: ultrasonography had a limited value in estimating schistosomal liver morbidity in our population-based study where early grades of liver morbidly were prevalent. The criteria of diagnosing grade I portal fibrosis need to be revised as well as the staging system proposed by the Cairo Meeting on ultrasonography in schistosomiasis.

Vertebral artery occlusion after chemotherapy

We present a patient who experienced a stroke due to vertebral artery occlusion after chemotherapy

Performance of diagnostic biomarkers in predicting liver fibrosis among hepatitis C virus-infected Egyptian children

The aim of the present study was to identify specific markers that mirror liver fibrosis progression as an alternative to biopsy when biopsy is contraindicated, especially in children. After liver biopsies were performed, serum samples from 30 hepatitis C virus (HCV) paediatric patients (8-14 years) were analysed and compared with samples from 30 healthy subjects. All subjects were tested for the presence of serum anti-HCV antibodies. Direct biomarkers for liver fibrosis, including transforming growth factor-β1, tissue inhibitor of matrix metalloproteinase-1 (TIMP-1), hyaluronic acid (HA), procollagen type III amino-terminal peptide (PIIINP) and osteopontin (OPN), were measured. The indirect biomarkers aspartate and alanine aminotransferases, albumin and bilirubin were also tested. The results revealed a significant increase in the serum marker levels in HCV-infected children compared with the healthy group, whereas albumin levels exhibited a significant decrease. Significantly higher levels of PIIINP, TIMP-1, OPN and HA were detected in HCV-infected children with moderate to severe fibrosis compared with children with mild fibrosis (p < 0.05). The diagnostic accuracy of these direct biomarkers, represented by sensitivity, specificity and positive predictive value, emphasises the utility of PIIINP, TIMP-1, OPN and HA as indicators of liver fibrosis among HCV-infected children.

Extraits de CHRONIQUES, et en particulier de textes relatifs à la NORMANDIE.

Contient : Extrait des Annales S. Dionysii ad cyclos paschales [cf. E. Berger, dans Bibl. de l'Ecole des chartes, t. XL, p. 270] ; Extrait de la chronologie des rois de France, de Bernard Gui, d'après un ms. de Petau, communiqué par Camuzat ; Fragment sur Philippe le Bel, par un moine de Saint-Denis (Frère Ives) [cf. Molinier, Sources, n° 2847] ; Extrait du Chronicon Colmariense [Mon. Germ., SS., t. XVII, p. 240] ; Lettre de Philippe IV relative à la bataille de Mons-en-Pévèle, septembre 1304 ; Fragment (1285-1343) de la chronique de l'Anonyme de Caen [Molinier, n° 1163] ; Extraits historiques relatifs aux fils de Philippe le Bel ; Chartes de Guillaume le Conquérant et d'Henri Ier pour l'abbaye de Montebourg ; Notice de la fondation de ladite abbaye ; Gesta abbatum Fontanellensium, rédaction abrégée. Incipit : « Wandregisilus qui et Wando... » [cf. Archiv, VIII, 373] ; Gesta abbatum Fontanellensium, précédés de la Commemoratio Ansberti [cf. éd. Loewenfeld, Hanovre, 1888, in-8°, et D'Achery, Spicil., éd. in-fol., t. II, p. 263] ; Chartes de l'abbaye de Saint-Wandrille (1024-1177) et extraits de pièces des XIIIe et XIVe siècles relatives à la même abbaye ; Extraits de la chronique de Robert de Thorigny, d'après un ms. du Mont-Saint-Michel ; Extraits d'Annales de Rouen, d'après un ms. de Bigot [ms. lat. 5530 ; cf. L. Delisle, dans Hist. littér., t. XXXII, p. 196] ; Chronologia urbis Rothomagensis (94-1549), composée par M. de La Mare ; Chron. Nortmannorum [cf. Duchesne, Rer. Franc. scriptores, t. II, p. 524, et L. Delisle, dans Notices et extraits, t. XXXVIII, p. 697] ; Annales de Saint-Wandrille, dites Chronicon Thosanum, [cf. Hist. littér., t. XXXII, p. 204] ; Eloge en vers de Lanfranc [Mabillon, AA. SS. Ben., t. VI, II, p. 659], d'après un ms. de Saint-Florent-lès-Saumur ; Trêve de Dieu pour la Normandie, du temps de Gullaume le Conquérant ; Extrait d'un ms. intitulé « Cursus Normanniae », communiqué par J. Sirmond ; Notice sur les abbés de Fécamp, jusqu'à Henri de Lorraine (1613-1642), d'après un ms. de M. de la Meschinière ; Catalogue des abbés du même monastère jusqu'à François de Joyeuse (1600-1613) ; Extraits d'un cartulaire de Saint-Michel du Tréport ; Extraits d'un calendrier de la même abbaye ; Extraits de la vie de saint Exupère, évêque de Bayeux ; Vers sur l'abbaye de Jumièges, attribués au moine Adrien (cf. Frère, Bibliogr. normand, t. I, p. 154) ; Extraits d'un calendrier des chanoines d'Eu ; Liste des évêques de Lisieux jusqu'à Guillaume Du Vair (1618-1621) ; Evêques de Bayeux jusqu'à Jacques d'Angennes (1606-1647) ; Evêques de Coutances jusqu'à Nicolas de Briroi (1589-1620) ; Evêques d'Evreux jusqu'à François de Péricard (1613-1646) ; Notes sur les chartes de l'abbaye de Savigny ; Chartes du Breuil-Benoît ; Catalogue des abbés de Jumièges ; Fondation de l'abbaye de Blanchelande (1154), et extraits des chartes de ce monastère ; Notes sur le fouage à lever en Normandie et sur les forteresses occupées par le roi, d'après les registres du Trésor des chartes ; Extraits des archives de Notre-Dame d'Ardenne ; Extraits des archives de Saint-Etienne de Caen ; Chartes diverses relatives à la Normandie (1217-1262) ; Annales d'Avranches, 837-1359 [cf. Hist. de Fr., t. XXIII, p. 568] ; Extraits de deux rédactions de la Vita Vanengi [Bibl. hag. lat., 8811 et 8813] ; Traité entre Abu-Issac et Vibaldus, envoyé de l'empereur Frédéric II (1231), traduction latine par M. Obelius Cicero [Mon. Germ., Const., t. II, p. 187] ; Extraits de chroniques arabes relatifs à l'histoire de Sicile, traduits par le même

A large deletion in the adRP gene PRPF31: evidence that haploinsufficiency is the cause of disease.

PURPOSE: To report a large deletion that encompasses more than 90% of PRPF31 gene and two other neighboring genes in their entirety in an adRP pedigree that appears to show only the typical clinical features of retinitis pigmentosa. METHODS: To identify PRPF31 mutation in a dominant RP family (ADRP2) previously linked to the RP11 locus, the 14 exons of PRPF31 were screened for mutations by direct sequencing. To investigate the possibility of a large deletion, microsatellite markers near PRPF31 gene were analyzed by non-denaturing PAGE. RESULTS: Initial screening of PRPF31 gene in the ADRP2 family did not reveal an obvious mutation. A large deletion was however suspected due to lack of heterozygosity for nearly all PRPF31 intragenic single nucleotide polymorphysm (SNPs). In order to estimate the size of the deletion, SNPs and microsatellite markers spanning and flanking PRPF31 were analyzed in the entire ADRP2 family. Haplotype analysis with the above markers suggested a deletion of approximately 30 kb that included the putative promoter region of a novel gene OSCAR, the entire genomic content of genes NDUFA3, TFPT and more than 90% of PRPF31 gene. Sequence analysis of the region flanking the potential deletion showed a high presence of Alu elements implicating Alu mediated recombination as the mechanism responsible for this event. CONCLUSIONS: This mutation provides evidence that haploinsufficiency rather than aberrant function of mutated proteins is the cause of disease in these adRP patients with mutations in PRPF31 gene.

Ruling out coronary artery disease in primary care: development and validation of a simple prediction rule.

BACKGROUND: Chest pain can be caused by various conditions, with life-threatening cardiac disease being of greatest concern. Prediction scores to rule out coronary artery disease have been developed for use in emergency settings. We developed and validated a simple prediction rule for use in primary care. METHODS: We conducted a cross-sectional diagnostic study in 74 primary care practices in Germany. Primary care physicians recruited all consecutive patients who presented with chest pain (n = 1249) and recorded symptoms and findings for each patient (derivation cohort). An independent expert panel reviewed follow-up data obtained at six weeks and six months on symptoms, investigations, hospital admissions and medications to determine the presence or absence of coronary artery disease. Adjusted odds ratios of relevant variables were used to develop a prediction rule. We calculated measures of diagnostic accuracy for different cut-off values for the prediction scores using data derived from another prospective primary care study (validation cohort). RESULTS: The prediction rule contained five determinants (age/sex, known vascular disease, patient assumes pain is of cardiac origin, pain is worse during exercise, and pain is not reproducible by palpation), with the score ranging from 0 to 5 points. The area under the curve (receiver operating characteristic curve) was 0.87 (95% confidence interval [CI] 0.83-0.91) for the derivation cohort and 0.90 (95% CI 0.87-0.93) for the validation cohort. The best overall discrimination was with a cut-off value of 3 (positive result 3-5 points; negative result <or= 2 points), which had a sensitivity of 87.1% (95% CI 79.9%-94.2%) and a specificity of 80.8% (77.6%-83.9%). INTERPRETATION: The prediction rule for coronary artery disease in primary care proved to be robust in the validation cohort. It can help to rule out coronary artery disease in patients presenting with chest pain in primary care.

Smith Predictor Sliding Mode Closed-loop Glucose Controller in Type 1 Diabetes

Type 1 diabetic patients depend on external insulin delivery to keep their blood glucose within near-normal ranges. In this work, two robust closed-loop controllers for blood glucose regulation are developed to prevent the life-threatening hypoglycemia, as well as to avoid extended hyperglycemia. The proposed controllers are designed by using the sliding mode control technique in a Smith predictor structure. To improve meal disturbance rejection, a simple feedforward controller is added to inject meal-time insulin bolus. Simulations scenarios were used to test the controllers, and showed the controllers ability to maintain the glucose levels within the safe limits in the presence of errors in measurements, modeling and meal estimation

A Gain Scheduling Model Predictive Controller for Blood Glucose Control in Type 1 Diabetes

This paper presents a control strategy for blood glucose(BG) level regulation in type 1 diabetic patients. To design the controller, model-based predictive control scheme has been applied to a newly developed diabetic patient model. The controller is provided with a feedforward loop to improve meal compensation, a gain-scheduling scheme to account for different BG levels, and an asymmetric cost function to reduce hypoglycemic risk. A simulation environment that has been approved for testing of artificial pancreas control algorithms has been used to test thecontroller. The simulation results show a good controller performance in fasting conditions and meal disturbance rejection, and robustness against model–patient mismatch and errors in mealestimation

Qualitative modeling identifies IL-11 as a novel regulator in maintaining self-renewal in human pluripotent stem cells.

Pluripotency in human embryonic stem cells (hESCs) and induced pluripotent stem cells (iPSCs) is regulated by three transcription factors-OCT3/4, SOX2, and NANOG. To fully exploit the therapeutic potential of these cells it is essential to have a good mechanistic understanding of the maintenance of self-renewal and pluripotency. In this study, we demonstrate a powerful systems biology approach in which we first expand literature-based network encompassing the core regulators of pluripotency by assessing the behavior of genes targeted by perturbation experiments. We focused our attention on highly regulated genes encoding cell surface and secreted proteins as these can be more easily manipulated by the use of inhibitors or recombinant proteins. Qualitative modeling based on combining boolean networks and in silico perturbation experiments were employed to identify novel pluripotency-regulating genes. We validated Interleukin-11 (IL-11) and demonstrate that this cytokine is a novel pluripotency-associated factor capable of supporting self-renewal in the absence of exogenously added bFGF in culture. To date, the various protocols for hESCs maintenance require supplementation with bFGF to activate the Activin/Nodal branch of the TGFβ signaling pathway. Additional evidence supporting our findings is that IL-11 belongs to the same protein family as LIF, which is known to be necessary for maintaining pluripotency in mouse but not in human ESCs. These cytokines operate through the same gp130 receptor which interacts with Janus kinases. Our finding might explain why mESCs are in a more naïve cell state compared to hESCs and how to convert primed hESCs back to the naïve state. Taken together, our integrative modeling approach has identified novel genes as putative candidates to be incorporated into the expansion of the current gene regulatory network responsible for inducing and maintaining pluripotency.

Sequentially aerated membrane biofilm reactors for autotrophic nitrogen removal: microbial community composition and dynamics

Membrane-aerated biofilm reactors performing autotrophic nitrogen removal can be successfully applied to treat concentrated nitrogen streams. However, their process performance is seriously hampered by the growth of nitrite oxidizing bacteria (NOB). In this work we document how sequential aeration can bring the rapid and long-term suppression of NOB and the onset of the activity of anaerobic ammonium oxidizing bacteria (AnAOB). Real-time quantitative polymerase chain reaction analyses confirmed that such shift in performance was mirrored by a change in population densities, with a very drastic reduction of the NOB Nitrospira and Nitrobacter and a 10-fold increase in AnAOB numbers. The study of biofilm sections with relevant 16S rRNA fluorescent probes revealed strongly stratified biofilm structures fostering aerobic ammonium oxidizing bacteria (AOB) in biofilm areas close to the membrane surface (rich in oxygen) and AnAOB in regions neighbouring the liquid phase. Both communities were separated by a transition region potentially populated by denitrifying heterotrophic bacteria. AOB and AnAOB bacterial groups were more abundant and diverse than NOB, and dominated by the r-strategists Nitrosomonas europaea and Ca. Brocadia anammoxidans, respectively. Taken together, the present work presents tools to better engineer, monitor and control the microbial communities that support robust, sustainable and efficient nitrogen removal

The ADO Index as a Predictor of Two-Year Mortality in General Practice-Based Chronic Obstructive Pulmonary Disease Cohorts.

BACKGROUND: Existing prediction models for mortality in chronic obstructive pulmonary disease (COPD) patients have not yet been validated in primary care, which is where the majority of patients receive care. OBJECTIVES: Our aim was to validate the ADO (age, dyspnoea, airflow obstruction) index as a predictor of 2-year mortality in 2 general practice-based COPD cohorts. METHODS: Six hundred and forty-six patients with COPD with GOLD (Global Initiative for Chronic Obstructive Lung Disease) stages I-IV were enrolled by their general practitioners and followed for 2 years. The ADO regression equation was used to predict a 2-year risk of all-cause mortality in each patient and this risk was compared with the observed 2-year mortality. Discrimination and calibration were assessed as well as the strength of association between the 15-point ADO score and the observed 2-year all-cause mortality. RESULTS: Fifty-two (8.1%) patients died during the 2-year follow-up period. Discrimination with the ADO index was excellent with an area under the curve of 0.78 [95% confidence interval (CI) 0.71-0.84]. Overall, the predicted and observed risks matched well and visual inspection revealed no important differences between them across 10 risk classes (p = 0.68). The odds ratio for death per point increase according to the ADO index was 1.50 (95% CI 1.31-1.71). CONCLUSIONS: The ADO index showed excellent prediction properties in an out-of-population validation carried out in COPD patients from primary care settings. © 2014 S. Karger AG, Basel.