Serum procalcitonin as a marker of post-cardiac arrest syndrome and long-term neurological recovery, but not of early-onset infections, in comatose post-anoxic patients treated with therapeutic hypothermia.

OBJECTIVE: To examine the relationship of early serum procalcitonin (PCT) levels with the severity of post-cardiac arrest syndrome (PCAS), long-term neurological recovery and the risk of early-onset infections in patients with coma after cardiac arrest (CA) treated with therapeutic hypothermia (TH). METHODS: A prospective cohort of adult comatose CA patients treated with TH (33°C, for 24h) admitted to the medical/surgical intensive care unit, Lausanne University Hospital, was studied. Serum PCT was measured early after CA, at two time-points (days 1 and 2). The SOFA score was used to quantify the severity of PCAS. Diagnosis of early-onset infections (within the first 7 days of ICU stay) was made after review of clinical, radiological and microbiological data. Neurological recovery at 3 months was assessed with Cerebral Performance Categories (CPC), and was dichotomized as favorable (CPC 1-2) vs. unfavorable (CPC 3-5). RESULTS: From December 2009 to April 2012, 100 patients (median age 64 [interquartile range 55-73] years, median time from collapse to ROSC 20 [11-30]min) were studied. Peak PCT correlated with SOFA score at day 1 (Spearman's R=0.44, p<0.0001) and was associated with neurological recovery at 3 months (peak PCT 1.08 [0.35-4.45]ng/ml in patients with CPC 1-2 vs. 3.07 [0.89-9.99] ng/ml in those with CPC 3-5, p=0.01). Peak PCT did not differ significantly between patients with early-onset vs. no infections (2.14 [0.49-6.74] vs. 1.53 [0.46-5.38]ng/ml, p=0.49). CONCLUSIONS: Early elevations of serum PCT levels correlate with the severity of PCAS and are associated with worse neurological recovery after CA and TH. In contrast, elevated serum PCT did not correlate with early-onset infections in this setting.

Automated quantitative pupillometry for the prognostication of coma after cardiac arrest.

BACKGROUND: Sedation and therapeutic hypothermia (TH) delay neurological responses and might reduce the accuracy of clinical examination to predict outcome after cardiac arrest (CA). We examined the accuracy of quantitative pupillary light reactivity (PLR), using an automated infrared pupillometry, to predict outcome of post-CA coma in comparison to standard PLR, EEG, and somato-sensory evoked potentials (SSEP). METHODS: We prospectively studied over a 1-year period (June 2012-June 2013) 50 consecutive comatose CA patients treated with TH (33 °C, 24 h). Quantitative PLR (expressed as the % of pupillary response to a calibrated light stimulus) and standard PLR were measured at day 1 (TH and sedation; on average 16 h after CA) and day 2 (normothermia, off sedation: on average 46 h after CA). Neurological outcome was assessed at 90 days with Cerebral Performance Categories (CPC), dichotomized as good (CPC 1-2) versus poor (CPC 3-5). Predictive performance was analyzed using area under the ROC curves (AUC). RESULTS: Patients with good outcome [n = 23 (46 %)] had higher quantitative PLR than those with poor outcome [n = 27; 16 (range 9-23) vs. 10 (1-30) % at day 1, and 20 (13-39) vs. 11 (1-55) % at day 2, both p < 0.001]. Best cut-off for outcome prediction of quantitative PLR was <13 %. The AUC to predict poor outcome was higher for quantitative than for standard PLR at both time points (day 1, 0.79 vs. 0.56, p = 0.005; day 2, 0.81 vs. 0.64, p = 0.006). Prognostic accuracy of quantitative PLR was comparable to that of EEG and SSEP (0.81 vs. 0.80 and 0.73, respectively, both p > 0.20). CONCLUSIONS: Quantitative PLR is more accurate than standard PLR in predicting outcome of post-anoxic coma, irrespective of temperature and sedation, and has comparable prognostic accuracy than EEG and SSEP.

Sand flies (Diptera, Psychodidae, Phlebotominae) from Central Amazonia and four new records for the Amazonas state, Brazil

Sand flies from Central Amazonia and four new records for the Amazonas state, Brazil. A survey was conducted in May and June 2008 to study the fauna of insects in Central Amazonia, Brazil. As part of the survey, we report here that sixty species of phlebotomine were identified, totaling 13,712 specimens from 13 genera. The collection sites were located at the border between the states of Pará and Amazonas, comprising three municipalities from the Amazonas state (Borba, Maués, and Nhamundá). Malaise, CDC and Shannon traps were used to collect the insects. Most of the sand flies were collected by CDC traps (89.5%), while Malaise and Shannon traps collected 7% and 3.5%, respectively. The most abundant genera, representing 97.1% of the total sand flies identified were: Trichopygomyia Barretto, 1962 (47.6%), Psathyromyia Barretto, 1962 (17.9%), Psychodopygus Mangabeira, 1941 (17.5%) and Trichophoromyia Barretto, 1962 (14.3%). The genera with the largest number of species identified were: Psychodopygus (14), Psathyromyia (10), Evandromyia Mangabeira, 1941 (7), Trichophoromyia (5) and Trichopygomyia (5). The most abundant species was Trichopygomyia trichopyga (Floch & Abonnenc, 1945), which represented 29% of the total sand flies identified. Here we also report new records for four species in the Amazonas state: Ps. complexus (Mangabeira, 1941), Ps. llanosmartinsi Fraiha & Ward, 1980, Ty. pinna (Feliciangeli, Ramirez-Pérez & Ramirez, 1989), and Th. readyi (Ryan, 1986). The results of this study provide new, additional information on the distribution of sand flies in the Amazon and increase the number of species in the Amazonas state from 127 to 131.

Impact of physical activity on energy balance, food intake and choice in normal weight and obese children in the setting of acute social stress: a randomized controlled trial.

BACKGROUND: Psychological stress negatively influences food intake and food choices, thereby contributing to the development of childhood obesity. Physical activity can also moderate eating behavior and influence calorie intake. However, it is unknown if acute physical activity influences food intake and overall energy balance after acute stress exposure in children. We therefore investigated the impact of acute physical activity on overall energy balance (food intake minus energy expenditure), food intake, and choice in the setting of acute social stress in normal weight (NW) and overweight/obese (OW/OB) children as well as the impact of psychological risk factors. METHOD: After receiving written consent from their parents, 26 NW (BMI < 90(th) percentile) and 24 7-to 11-year-old OW (n = 5)/OB (n = 19, BMI ≥ 90(th) percentile) children were randomly allocated using computer-generated numbers (1:1, after stratification for weight status) to acute moderate physical or to sedentary activity for 30 min. Afterwards, all children were exposed to an acute social stressor. Children and their parents completed self-report questionnaires. At the end of the stressor, children were allowed to eat freely from a range of 12 different foods (6 sweet/6 salty; each of low/high caloric density). Energy balance, food intake/choice and obesity-related psychological risk factors were assessed. RESULTS: Lower overall energy balance (p = 0.019) and a decreased choice of low density salty foods (p < 0.001) in NW children compared with OW/OB children was found after acute moderate physical activity but not sedentary activity. Independent of their allocation, OW/OB children ate more high density salty foods (104 kcal (34 to 173), p = 0.004) following stress. They scored higher on impulsive behavior (p = 0.005), restrained eating (p < 0.001) and parental corporal punishment (p = 0.03), but these psychological factors were not related to stress-induced food intake/choice. Positive parenting tended to be related to lower intake of sweet high density food (-132 kcal, -277 to 2, p = 0.054). CONCLUSIONS: In the setting of stress, acute moderate physical activity can address energy balance in children, a benefit which is especially pronounced in the OW/OB. Positive parenting may act as a protective factor preventing stress-induced eating of comfort food. TRIAL REGISTRATION: clinicaltrials.gov NCT01693926 The study was a pilot study of a project funded by the Swiss National Science Foundation (CRSII3_147673).

The predictive value of trabecular bone score (TBS) on whole lumbar vertebrae mechanics: an ex vivo study.

We investigated the association of trabecular bone score (TBS) with microarchitecture and mechanical behavior of human lumbar vertebrae. We found that TBS reflects vertebral trabecular microarchitecture and is an independent predictor of vertebral mechanics. However, the addition of TBS to areal BMD (aBMD) did not significantly improve prediction of vertebral strength. INTRODUCTION: The trabecular bone score (TBS) is a gray-level measure of texture using a modified experimental variogram which can be extracted from dual-energy X-ray absorptiometry (DXA) images. The current study aimed to confirm whether TBS is associated with trabecular microarchitecture and mechanics of human lumbar vertebrae, and if its combination with BMD improves prediction of fracture risk. METHODS: Lumbar vertebrae (L3) were harvested fresh from 16 donors. The anteroposterior and lateral bone mineral content (BMC) and areal BMD (aBMD) of the vertebral body were measured using DXA; then, the TBS was extracted using TBS iNsight software (Medimaps SA, France). The trabecular bone volume (Tb.BV/tissue volume, TV), trabecular thickness (Tb.Th), degree of anisotropy, and structure model index (SMI) were measured using microcomputed tomography. Quasi-static uniaxial compressive testing was performed on L3 vertebral bodies to assess failure load and stiffness. RESULTS: The TBS was significantly correlated to Tb.BV/TV and SMI (râeuro0/00=âeuro0/000.58 and -0.62; pâeuro0/00=âeuro0/000.02, 0.01), but not related to BMC and BMD. TBS was significantly correlated with stiffness (râeuro0/00=âeuro0/000.64; pâeuro0/00=âeuro0/000.007), independently of bone mass. Using stepwise multiple regression models, we failed to demonstrate that the combination of BMD and TBS was better at explaining mechanical behavior than either variable alone. However, the combination TBS, Tb.Th, and BMC did perform better than each parameter alone, explaining 79 % of the variability in stiffness. CONCLUSIONS: In our study, TBS was associated with microarchitecture parameters and with vertebral mechanical behavior, but TBS did not improve prediction of vertebral biomechanical properties in addition to aBMD.

Overview of primary monogenic dystonia.

Primary monogenic forms of dystonia manifest solely or mainly with dystonia; they have been linked to a number of genes and loci and assigned "DYT" numbers. The pure dystonia syndrome early-onset primary dystonia (DYT1) manifests with dominantly-inherited generalized dystonia, often with focal onset in a limb. DYT1 is caused by a GAG deletion in the TOR1A gene. Mutations in the THAP1 gene cause DYT6, a form of pure dystonia that primarily involves cranio-cervical and upper limb muscles. Patients with the dystonia plus syndrome DYT5 display levodopa-responsive dystonia sometimes associated with tremor or parkinsonism (DYT5a, mutations in GCH1); a more severe phenotype with psychomotor involvement can be seen in recessive forms (DYT5b with TH mutations, SPR-deficiency syndrome). Other forms of dystonia plus syndromes include myoclonic dystonia (DYT11) and rapid-onset dystonia-parkinsonism (DYT12). Finally, paroxysmal exertion-induced dystonia (DYT18, GLUT1 deficiency) is caused by mutations in the SLC2A1 gene (DYT9 and DYT18). It is part of the paroxysmal dystonia group and manifests with paroxystic movements sometimes associated with seizures and psychomotor developmental delay.

Multiple plume events in the genesis of the peri-Caribbean Cretaceous oceanic plateau province

The oceanic crust fragments exposed in central America, in north-western South America, and in the Caribbean islands have been considered to represent accreted remnants of the Caribbean-Colombian Oceanic Plateau (CCOP). On the basis of trace element and Nd, Sr, and Pb isotopic compositions we infer that cumulate rocks, basalts, and diabases from coastal Ecuador have a different source than the basalts from the Dominican Republic. The latter suite includes the 86 Ma basalts of the Duarte Complex which are light rare earth element (REE) -enriched and display (relative to normal mid-ocean ridge basalts, NMORB) moderate enrichments in large ion lithophile elements, together with high Nb, Ta, Pb, and low Th contents. Moreover, they exhibit a rather restricted range of Nd and Pb isotopic ratios consistent with their derivation from an ocean island-type mantle source, the composition of which includes the HIMU (high U-238/Pb-204) component characteristic of the Galapagos hotspot. In contrast, the 123 Ma Ecuadorian oceanic rocks have flat REE patterns and (relative to NMORB) are depleted in Zr, Hf, Th, and U. Moreover, they show a wide range of Nd and Pb isotopic ratios intermediate between those of ocean island basalts and NMORB. It is unlikely, on geochemical grounds, that the plume source of the Ecuadorian fragments was similar to that of the Galapagos. In addition, because of the NNE motion of the Farallon plate during the Early Cretaceous, the Ecuadorian oceanic plateau fragments could not have been derived from the Galapagos hotspot but were likely formed at a ridge-centered or near-ridge hotspot somewhere in the SE Pacific.

Microscopic and macroscopic polarization within a combined quantum mechanics and molecular mechanics model

A polarizable quantum mechanics and molecular mechanics model has been extended to account for the difference between the macroscopic electric field and the actual electric field felt by the solute molecule. This enables the calculation of effective microscopic properties which can be related to macroscopic susceptibilities directly comparable with experimental results. By seperating the discrete local field into two distinct contribution we define two different microscopic properties, the so-called solute and effective properties. The solute properties account for the pure solvent effects, i.e., effects even when the macroscopic electric field is zero, and the effective properties account for both the pure solvent effects and the effect from the induced dipoles in the solvent due to the macroscopic electric field. We present results for the linear and nonlinear polarizabilities of water and acetonitrile both in the gas phase and in the liquid phase. For all the properties we find that the pure solvent effect increases the properties whereas the induced electric field decreases the properties. Furthermore, we present results for the refractive index, third-harmonic generation (THG), and electric field induced second-harmonic generation (EFISH) for liquid water and acetonitrile. We find in general good agreement between the calculated and experimental results for the refractive index and the THG susceptibility. For the EFISH susceptibility, however, the difference between experiment and theory is larger since the orientational effect arising from the static electric field is not accurately described

Clinical outcome after a reactive hypothermic EEG following cardiac arrest.

BACKGROUND: Reactive electroencephalography (EEG) background during therapeutic hypothermia (TH) is related to favorable prognosis after cardiac arrest (CA), but its predictive value is not 100 %. The aim of this study was to investigate outcome predictors after a first reactive EEG recorded during TH after CA. METHODS: We studied a cohort of consecutive comatose adults admitted between February 2008 and November 2012, after successful resuscitation from CA, selecting patients with reactive EEG during TH. Outcome was assessed at three months, and categorized as survivors and non-survivors (no patient was in vegetative state). Demographics, clinical variables, EEG features, serum neuron-specific enolase (NSE) and procalcitonin, were compared using uni- and multivariable analyses. RESULTS: A total of 290 patients were treated with TH after cardiac arrest; 146 had an EEG during TH, which proved reactive in 90 of them; 77 (86 %) survived and 13 (14 %) died (without recovery from coma). The group of non-survivors had a higher occurrence of discontinuous EEG (p = 0.006; multivariate analysis p = 0.026), and a higher serum NSE peak (p = 0.021; multivariate analysis p = 0.014); conversely, demographics, and other clinical variables including serum procalcitonin did not differ. CONCLUSIONS: A discontinuous EEG and high serum NSE are associated with mortality after CA in patients with poor outcome despite a reactive hypothermic EEG. This suggests more severe cerebral damage, but not to higher extent of systemic disease.

Uusi institutionalismi EU-tutkimuksessa : suurista integraatioteorioista päätöksenteon ja verkostojen tutkimukseen

Olli Rehn

Discovery of an albite gneiss from the Ile de Groix (Armorican Massif, France): Geochemistry and LA-ICP-MS U-Pb geochronology of its Ordovician protolith

For the first time, an albite orthogneiss has been recognised and dated within the HP-LT blueschist facies metabasites and metapelites of the Ile de Groix. It is characterised by a peraluminous composition, high LILE, Th and U contents, MORB-like HREE abundances and moderate Nb and Y values. A U-Pb age of 480.8 +/- A 4.8 Ma was obtained by LA-ICP-MS dating of zircon and titanite. It is interpreted as the age of the magmatic emplacement during the Early Ordovician. Morphologically different zircon grains yield late Neoproterozoic ages of 546.6-647.4 Ma. Zircon and titanite U-Pb ages indicate that the felsic magmatism from the Ile de Groix is contemporaneous with the acid, pre-orogenic magmatism widely recognised in the internal zones of the Variscan belt, related to the Cambro-Ordovician continental rifting. The magmatic protolith probably inherited a specific chemical composition from a combination of orogenic, back-arc and anorogenic signatures because of partial melting of the Cadomian basement during magma emplacement. Besides, the late Devonian U-Pb age of 366 +/- A 33 Ma obtained for titanite from a blueschist facies metapelite corresponds to the age of the HP-LT peak metamorphism.

Monitoring de l'immunosuppression par les thiopurines dans les maladies inflammatoires chroniques de l'intestin par le suivi de la macrocytose

Background¦Erythrocyte MCV might be used as an inexpensive marker to predict and¦optimize the efficacy and tolerability of thiopurine therapy in IBD patients.¦Aim and methods¦This retrospective observational study aimed to assess the monitoring¦performances of MCV in patients under 3 months or more thiopurine treatment followed up¦in the Swiss IBD Cohort Study. All available MCV, white blood cells (WBC) and 6¦thioguanine nucleotide (6TGN) measurements, among others, were recorded. An IBD¦"flare" was defined as a composite outcome encompassing treatment change,¦colonoscopy, histology, CT scan or MRI reports showing active IBD lesions, occurrence of¦intestinal surgery and IBD-related hospitalisations. Whether MCV measurements predicted¦efficacy of thiopurine treatment was investigated by assessing the statistical association¦between the occurrence of IBD "flares", and the current or recent MCV values, taking into¦account the patient clustering and longitudinal aspect of data.¦Results¦140 patients (77 women), mean age 38 years (17-74), 104 diagnosed with¦Crohn's disease, 36 with ulcerative colitis, mean disease duration 8 years (0.25-36),¦receiving either azathioprine (n=125) or 6-mercaptopurine (n=15) were included, most of¦them over 3-year follow up.¦Thiopurines increased mean patient MCV by an average 5.8±5.2 fL, while¦patientsfluctuated by ±4.3 fL around their individual mean (p<0.001). They decreased¦WBC by an average of 2.4+/- 2.6 G/L (p<0.001).¦Significant associations were observed between the probability of flare occurrence and low¦current MVC (p=0.017) or high current WBC (p=0.009) and, with a relative risk of 3.7% for¦every fL of MCV decrease or 8% for every G/L of WBC increase. Both markers revealed¦some memory effect.¦Despite this, the performance of MCV and WBC to predict IBD "flare" remained rather¦limited, as it is less accurate than the 6-TGN-level , although only determined in a¦subgroup of patients in this study.¦Conclusion¦MCV and WBC deserve to be observed to check and monitor therapeutic¦exposure to thiopurine agents in IBD patients. Unfortunately, their predictive performance¦precludes their privileged use for optimization of therapy. Further prospective studies¦should suitably include the systematic measurement of metabolite concentration.