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• Abetalipoproteinemia (ABL) is a rare monogenic familial hypobetalipoproteinemia caused by bi-allelic variants in MTTP gene. • We identified four French-Canadian patients homozygous for the same MTTP variant. • The ABL carrier frequency in Saguenay-Lac-Saint-Jean is estimated at 1:203. • This represents the 2nd highest worldwide carrier estimates for ABL. • Screening for ABL should be considered in this population. Abetalipoproteinemia (ABL) is a rare recessive genetic disease caused by bi-allelic pathogenic variants in the microsomal triglyceride transfer protein (MTTP) gene. This disease is characterized by a deficiency in the secretion of apolipoprotein B-containing lipoproteins. Patients with ABL present with neurological, hematological, and gastrointestinal symptoms due to fat malabsorption and a deficiency in liposoluble vitamins. In this report, we present a total of four ABL cases, including three new cases, all originating from the same French-Canadian founder population in Saguenay-Lac-Saint-Jean, Québec, Canada. These individuals are homozygous for the same pathogenic variant in the MTTP gene (c.419dup, p.Asn140Lysfs*2). We found that this variant is more common than anticipated in this population, with an estimated carrier frequency of 1:203. Early diagnosis is essential to initiate treatment known to prevent complications associated with ABL. Population carrier screening or newborn screening for ABL should be considered in this French-Canadian founder population. [ABSTRACT FROM AUTHOR]

Physical literacy (PL) is essential to the holistic human experience, emphasizing embodied capability and affording opportunities for inclusive engagement. Despite its recent use as a core programming element, PL from the experiential point of view of individuals experiencing disability has yet to be explored. Excluding these perspectives promotes a culture of ableism, one that devalues the embodied capabilities of those experiencing the world differently. The purpose of this study was to highlight the participant perspective related to PL and explore the value individuals experiencing disability attribute to PL and its development. Using the communities of practice theoretical model of knowledge as a conceptual framework, 13 participants experiencing disability participated in two focus groups. Participants' experiences were thematized via the use of thematic analysis, and voices were portrayed through composite narratives, highlighting the shared participant experience and value associated with PL. Three themes emerged: (1) imagine the possibilities , (2) dance like nobody's watching , and (3) no wrong way to move. Composite narratives reflect PL as a valued means of exploration and learning, personal growth, and opportunity related to physical activity and social interaction. Participant value was considered to be enhanced via a learning climate affording opportunities for developing autonomy and a sense of belonging. This research provides an authentic understanding of PL within the context of disability, and what might be used to facilitate its development in such an environment. Individuals experiencing disability contributed to this knowledge and must be continually involved to ensure PL development is inclusive to all. [ABSTRACT FROM AUTHOR]

In this paper, we analyze the use of qualitative, quantitative, and mixed methods in the field of rural studies by means of a content analysis of the leading journals. We begin with a short discussion of the pros and cons of mixed methods research in rural studies. We then move on to the empirical portion. We use a classification of published articles for the years 2000, 2004, 2008, 2012, and 2016 in the leading journals in the field: Sociologia Ruralis, Rural Sociology, and Journal of Rural Studies. We found striking differences in the publication policy of the three journals regarding methods applied. Sociologia Ruralis primarily accepts articles of a qualitative nature, and this has scarcely changed over the years. Rural Sociology, on the other hand, accepts mostly quantitative articles, and this has also been quite stable over time. The Journal of Rural Studies has traditionally been oriented towards qualitative research, but, in recent years, mixed method approaches play a visible role (around 20% in 2016). JRS is also the only journal that shows a sharp increase in papers of non-Western origin, with an emphasis on quantitative methods but not on mixed methods. The overall conclusion is that the rural research context offers considerable scope for a broader and increased application of mixed methods, and this merits greater attention among rural journals. • The use of mixed methods research in rural studies is increasing. • There are striking differences in the publication policy of the main journals of rural studies regarding methods applied. • The share of non-Western countries in the published articles is still very limited. • JRS is the only journal that shows a sharp increase in papers of non-Western origin, mainly from China. • The rural research context offers considerable scope for a broader and increased application of mixed methods. [ABSTRACT FROM AUTHOR]

Copyright of Archives of Cardiovascular Diseases is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Nitrate accumulation in aquatic reservoirs from agricultural pollution has often been overlooked as a water quality hazard, yet a growing body of literature suggests negative effects on human and wildlife health following nitrate exposure. This research seeks to understand differences in oxygen consumption rates between different routes of laboratory nitrate exposure, whether via immersion or injection, in zebrafish ( Danio rerio ) embryos. Embryos were exposed within 1 h post fertilization (hpf) to 0, 10, and 100 mg/L NO 3 -N with sodium nitrate, or to counter ion control (CIC) treatments using sodium chloride. Embryos in the immersion treatments received an injection of 4 nL of appropriate treatment solution into the perivitelline space. At 24 hpf, Oxygen Consumption Rates (OCR) were measured and recorded in vivo using the Agilent Technologies XF e 96 Extracellular Flux Analyzer and Spheroid Microplate. Immersion exposures did not induce significant changes in OCR, yet nitrate induced significant changes when injected through the embryo chorion. Injection of 10 and 100 mg/L NO 3 -N down-regulated OCR compared to the control treatment group. Injection of the 100 mg/L CIC also significantly down-regulated OCR compared to the control treatment group. Interestingly, the 100 mg/L NO 3 -N treatment further down-regulated OCR compared to the 100 mg/L CIC treatment, suggesting the potential for additive effects between the counter ion and the ion of interest. These data support that elevated nitrate exposure can alter normal metabolic activity by changing OCR in 24 hpf embryos. These results highlight the need for regularly examining the counter ion of laboratory nitrate compounds while conducting research with developing zebrafish, and justify examining different routes of laboratory nitrate exposure, as the chorion may act as an effective barrier to nitrate penetration in zebrafish, which may lead to conservative estimates of significant effects in other species for which nitrate more readily penetrates the chorion. [ABSTRACT FROM AUTHOR]

Objective To explore faculty and student utilization of social media and its professional implications in nurse education. Methods A descriptive study. Five hundred six Bachelor of Nursing students, 112 Practical Nursing students and 74 faculty members were invited to complete a questionnaire of 28 questions relating to social media. Results Three hundred thirty-seven students and 29 faculty responded. Students spent significantly more time using social media compared to faculty and both groups used it mainly for personal use. However, almost twice as many students used social media for educational purposes than did faculty (58.5% vs 27.6%, p < 0.001). While almost 96% of students used social media to talk about academic related problems, only 28% of faculty did so ( p < 0.000). Almost 60% of faculty expressly disagreed with using social media to discuss academic related problems. YouTube and text messaging were popular platforms for educational purposes. While Facebook was also a popular educational site for students (95% used it for informal learning; 67% for formal learning), it was much less commonly used by faculty (45% used it for informal learning; 17% for formal learning). More students than faculty felt that they were aware of privacy features, and of the professional behavior expected when using social media. In addition, more students (90.7%) than faculty (71.43%) used these privacy features ( p < 0.000). However, 100% of students compared to only 13.79% of faculty reported that they had posted information that they would not want a prospective employer/member of academic staff to view ( p = 0.003). Conclusion There is a high reported usage of social media among students and faculty. Utilization of public platforms, while potentially beneficial, can have professional implications if not used appropriately with both personal and academic use. Developing best practice approaches for using social media in nurse education is essential to ensure that faculty and students are informed of e-professionalism. [ABSTRACT FROM AUTHOR]

Copyright of Revue Francaise d'Allergologie is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Le contexte sanitaire lié à la pandémie COVID-19 a entraîné le développement rapide de nombreux vaccins contre le virus SarS-Cov-2. Quatre d'entre eux sont actuellement disponibles en France et contiennent comme excipients du polyethylène glycol (PEG) ou du polysorbate 80, déjà décrits comme pourvoyeurs d'anaphylaxie. Des recommandations françaises ont été suggérées par plusieurs instances d'allergologie et proposaient une conduite à tenir face à une suspicion d'allergie à ces vaccins. Ainsi, les allergies aux excipients constituaient la seule contre-indication à la vaccination anti COVID-19. Notre objectif principal était de déterminer l'impact de ces recommandations vaccinales d'allergologie sur la prise en charge de ces patients. Notre objectif secondaire était de déterminer la prévalence des allergies vraies à ces vaccins. Nous avons mené une étude rétrospective descriptive unicentrique concernant l'ensemble des patients de plus de 18 ans adressés pour un avis allergologique avant ou après une vaccination anti COVID-19. Les patients ont été classés en différents groupes d'intérêt, à partir des recommandations françaises. La vaste majorité des patients n'ont pas nécessité de bilan allergologique pré vaccinal. En effet, seulement 25 patients ont reçu des tests cutanés préalables à la vaccination. Le reste des patients ont pu être vaccinés sans bilan allergologique. Les patients non vaccinés pour cause d'allergie aux excipients représentent moins de 1 % de l'effectif total (n = 3/320). Les recommandations françaises ont permis de vacciner la grande majorité des patients inclus dans notre étude. L'allergie au PEG, polysorbate ou leurs dérivés, seule contre-indication à la vaccination anti COVID, d'après les recommandations de février 2021, reste rare. À ce jour, plusieurs auteurs proposent des inductions de tolérance permettant la vaccination de patients allergiques aux PEG ou à leurs dérivés avec une bonne tolérance. The health context with COVID-19 pandemic has led to fast development of many vaccines against the SarS-Cov-2 virus. Four of them are currently available in France and contain polyethylene glycol (PEG) or polysorbate 80 as excipients, already described as causing anaphylaxis. French recommendations have been suggested by allergology authorities and proposed a course of action in the event of a suspected allergy to these vaccines. Thus, allergies to excipients were the only contraindication to COVID-19 vaccination. Our main objective was to determine the impact of these allergology vaccine recommendations on the management of these patients. Our secondary objective was to determine prevalence of true allergies to these vaccines. We conducted a unicentric descriptive retrospective study with all patients over 18 years of age referred for an allergological opinion before or after an injection of one of the anti-COVID-19 vaccines. Nineteen patients were classified into different interest groups, based on french recommendations. The vast majority of patients did not require a pre-vaccination allergological assessment. Indeed, only 25 patients received skin tests prior to vaccination. The rest of patients were able to be vaccinated without allergological assessment. Patients not vaccinated due to allergy to excipients represent less than 1% of the population (n = 3/320). French recommendations made it possible to vaccinate the vast majority of patients included in our study. Allergy to PEG, polysorbate or their derivatives, the only contraindication to anti-COVID vaccination, according to the recommendations of February 2021, remains rare. Today, several authors propose tolerance inductions allowing the vaccination of patients allergic to PEGs or their derivatives with good tolerance. [ABSTRACT FROM AUTHOR]

The objective of the study was to evaluate the Integrated Comprehensive Care (ICC) program, a novel health system integration initiative that coordinates home care and hospital-based clinical services for patients undergoing major thoracic surgery relative to traditional home care delivery. Methods included a pilot retrospective cohort analysis that compared the intervention cohort (ICC), composed of all patients undergoing major thoracic surgery in the 2012-2013 fiscal year with a control cohort, who underwent surgery in the year before the initiation of ICC. Length of stay, hospital costs, readmission, and emergency room visit data were stratified by degree and approach of resection and compared using univariate logistic regression analysis. A total of 331 patients under ICC and 355 control patients were enrolled. Hospital stay was significantly shorter in patients under video-assisted thoracoscopic surgery (VATS) ICC (sublobar median 3 vs 4 days, P = 0.013; lobar median 4 vs 5 days, P = 0.051) but not for open resections. The frequency of emergency room visits within 60 days of surgery was lower for all stratification groups in the ICC cohort, except for VATS sublobar (25.7% control vs 13.9% ICC, P = 0.097). There were no significant differences in 60-day readmission frequency in any subcohort. The mean inpatient case cost was significantly lower for ICC VATS sublobar resections ($8505.39 vs $11,038.18, P = 0.007), with the other resection types trending lower for ICC but nonsignificant. In conclusion, a hospital-based, postdischarge, patient-centered program could potentially result in shorter hospital stay, fewer readmission and emergency room visits, costsavings, and no increase in adverse postdischarge outcomes after major thoracic surgery. [ABSTRACT FROM AUTHOR]

Chlorine-36 production rates obtained from different geological calibration studies (e.g. Evans et al., 1997; Phillips et al., 2001; Schimmelpfennig et al., 2011; Stone et al., 1996; Swanson and Caffee, 2001) vary significantly, principally because of the many reactions contributing to the production of this nuclide. The CRONUS-Earth Project has provided high-quality geological calibration sites, including Lake Bonneville, Peru, and Scotland, for a large-scale calibration of 36 Cl production rates. Three sites were used to calibrate the K and Ca spallation pathways for 36 Cl production yielding production rates of 56.0 ± 4.1 at 36 Cl (g Ca) −1 yr −1 and 155 ± 11 at 36 Cl (g K) −1 yr −1 respectively, using Lifton-Sato-Dunai scaling (LSDn). The low-energy production parameter, P f ( 0 ), was calibrated separately using CRONUS-Earth data from the Bonneville and Baboon Lakes sites where Cl concentrations were higher, and yielded a value of 759 ± 180 neutrons (g air) −1 yr −1 . There is significant uncertainty associated with this pathway due to the sensitivity of this reaction to environmental conditions. The uncertainties associated with the calibrated production parameters were estimated based on the variance of calculated ages from independent ages for an independent secondary dataset. [ABSTRACT FROM AUTHOR]

Geological surface-exposure dating using cosmogenic-nuclide accumulation became a practical geochronological endeavor in 1986, when the utility of 10 Be, 26 Al, 36 Cl, and 3 He were all demonstrated. In response to the lack of a common basis for quantifying analytical consistency and calibrating cosmogenic-nuclide production, the CRONUS-Earth Project in the U.S. was started in 2005, along with a European partner project, CRONUS-EU. The goal of the CRONUS-Earth Project was to improve the accuracy and precision of terrestrial cosmogenic nuclide dating in general, focusing especially on nuclide production rates and their variation with altitude, latitude, and time, and to attempt to move from empirically based methods to ones with a stronger basis in physics. The CRONUS-Earth Project conducted extensive intercomparisons of reference materials to attempt to quantify analytical reproducibility at the community level. We found that stated analytical uncertainties nearly always underestimate the actual degree of variability, as quantified by the over-all coefficient of variation of the intercalibration data. The average amount by which the actual coefficient of variation exceeded the analytical uncertainty was a factor of two (100%), but ranged from 15% to 300% depending on the nuclide and material. Coefficients of variation ranged from 3−4% for 10 Be to 6–8% for 36 Cl, 14 C, and 21 Ne, to 5–11% for 26 Al. Both interlaboratory bias and within-laboratory excess spread of the data played a role in increasing variability above the stated analytical uncertainties. The physical basis for cosmogenic nuclide production was investigated through numerical modeling and the measurement of energy-dependent neutron cross sections for nuclide interactions. We formulated new, physically based, scaling models, denoted LSD and LSDn, by generalizing global numerical simulations of cosmic-ray processes. The CRONUS-Earth Project identified new geological calibration sites, including one at low latitude and high elevation (Huancané, Peru), and replicated nuclide measurement at numerous laboratories. At many sites multiple nuclides were measured, providing much more confidence in the equivalence of surface-exposure ages calculated from differing nuclides. The data were interpreted using an original cosmogenic-nuclide calculator, CRONUScalc, that incorporates the new physically based scaling. The new data and model produced significantly better fits than previous efforts, but do not fully resolve apparent spatial variations in production rates. The CRONUS-Earth and CRONUS-EU Projects have provided a firm foundation for assessing the strengths and weaknesses of cosmogenic-nuclide analytical methods, adjusted the AMS standards for 10 Be and consequently revised the half-life, and have provided improved calibration data sets and interpretative tools. [ABSTRACT FROM AUTHOR]

The CRONUS-Earth and CRONUS-EU Projects have recently examined the reproducibility of cosmogenic nuclide measurements and the ability of cosmogenic-production models to fit high-quality global calibration data sets. In both cases, although results are adequate for present geochronological needs, they must be improved to meet future demands. We recommend that the cosmogenic-nuclide community embark on a continuing effort to understand the sources of the remaining model-versus-data discrepancy, and that in the meanwhile all cosmogenic ages be benchmarked against reference ages calculated in a consistent fashion. We also recommend that interlaboratory reference materials be routinely analyzed along with samples and blanks, that the results be tracked, and that methods of achieving consistency and precision in sample preparation and analysis be shared within the community. We also recommend additional organization of the community to facilitate the use of intercomparison materials, foster analytical improvements, oversee the evolution of the community age calculator, and synthesize ongoing calibration efforts. [ABSTRACT FROM AUTHOR]

Well-dated bedrock surfaces associated with the highstand and subsequent catastrophic draining of Pleistocene Lake Bonneville, Utah, during the Bonneville flood are excellent locations for in situ cosmogenic nuclide production rate calibration. The CRONUS-Earth project sampled wave-polished bedrock and boulders on an extensive wave-cut bench formed during the Bonneville-level highstand that was abandoned almost instantaneously during the Bonneville flood. CRONUS-Earth also sampled the Tabernacle Hill basalt flow that erupted into Lake Bonneville soon after its stabilization at the Provo level, following the flood. New radiocarbon dating results from tufa at the margins of Tabernacle Hill as part of this study have solidified key aspects of the exposure history at both sites. Both sites have well-constrained exposure histories in which factors such as potential prior exposure, erosion, and shielding are either demonstrably negligible or quantifiable. Multi-nuclide analyses from multiple labs serve as an ad hoc inter-laboratory comparison that supplements and expands on the formalized CRONUS-Earth and CRONUS-EU inter-laboratory comparisons (Blard et al., 2015; Jull et al., 2015; Vermeesch et al., 2015). Results from 10 Be, 26 Al, and 14 C all exhibit scatter comparable to that observed in the CRONUS-Earth effort. Although a 36 Cl inter-laboratory comparison was not completed for Jull et al. (2015), 36 Cl from plagioclase mineral separates exhibits comparable reproducibility. Site production rates derived from these measurements provide valuable input to the global production rate calibration described by Borchers et al. (2015). Whole-rock 36 Cl concentrations, however, exhibit inter-laboratory variation exceeding analytical uncertainty and outside the ranges observed for the other nuclides (Jull et al., 2015). A rigorous inter-laboratory comparison studying the systematics of whole-rock 36 Cl extraction techniques is currently underway with the goals of delineating the source(s) of this discrepancy and standardizing these procedures going forward. [ABSTRACT FROM AUTHOR]

Highlights: [•] Three iPad apps were designed to teach literacy concepts to adults with low literacy skills. [•] The iPad apps were formally tested with participating clients at an adult skills centre. [•] Participants recommended teaching concepts using both traditional lessons and iPad apps in the future. [•] Short, medium and long term rewards were effective at motivating participant behavior. [•] Time limits and gradually increasing challenge difficulty appeared to induce a state of flow in participants. [ABSTRACT FROM AUTHOR]

Abstract: The decision to repair an orbital blow-out fracture depends on several factors, but evidence for the optimum timing of surgery is not clear. We retrospectively studied all patients with orbital injuries who were referred to the eye department at a Scottish teaching hospital over a 10-year period from 1997 to 2006. We aimed to document the incidence and pattern of disturbances of ocular motility after blow-out fractures, and identify the rates of early and late resolution of these deficits, both spontaneously and after surgical repair. We found that most patients with blow-out fractures had a motility defect for an acute phase; approximately one third of which resolved spontaneously within 2 weeks. Recovery of motility after orbital surgery occurred in less than half the patients, and was not immediate. Continuing recovery also occurred in those who did not undergo surgery. Entrapment of muscle or tissue is not the only cause of motility disturbance after blow-out fractures, and orbital surgery is only one aspect of management in those patients with persistent motility defects. [Copyright &y& Elsevier]

Copyright of Revue Francaise d'Allergologie is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Changes to ecosystems caused by introduced herbivores can be predictable, stepwise transitions or unpredictable and even irreversible state changes. This study''s objectives were to explore effects on forest succession and soil development 5 years after moose (Alces alces L.) were fenced out of areas within and adjacent to a national park in Newfoundland, Canada. Study plots spanned a range of understorey broadleaf plant associations with regenerating balsam fir (Abies balsamea (L.) Mill.), an important winter forage plant for moose and a dominant canopy tree throughout Newfoundland. After 5 years, height–diameter ratios were significantly larger for larger basal diameters of understorey balsam fir in unfenced, but not in fenced subplots, suggesting that growth of the conifer is compromised within the exclosure. In contrast, for most broadleaf trees and shrubs, moose removal by fencing results in greater heights and basal diameters than in control subplots. The competitive advantage of broadleaf trees and shrubs over balsam fir in the short-term may be a result of past sustained heavy moose browsing benefiting plants that are better at investing resources into below-ground growth or benefiting plants that have broader leaf canopies. It is not clear how long the broadleaf transition state we document will continue. Restorative actions intended to mimic usual patterns of forest regeneration in this region of Newfoundland might best consider moose removal with site preparation and/or planting to historic densities. [Copyright &y& Elsevier]

Malignant hypertension (MHT) is a very serious, potentially lethal form of hypertension. However, there are currently no specific guidelines for therapeutic management. Our study based on the MHT prospective cohort of the Bordeaux University Hospital included 74 patients treated in the acute phase of the disease between 2009 and 2019. When no life-threatening organ damage was observed ("uncomplicated MHT"), patients received an oral titration of Angiotensin converting enzyme inhibitors (ACEI) up to twice the full-recommended dose. Our objective was to describe the results of this protocol in terms of feasibility, efficiency and safety. Of the 74 patients, 66% were men and 15% were of Afro-Caribbean origin. The patients treated averaged 47.1 years of age with an entry blood pressure of 219 (± 29)/125 (± 22) mmHg, an average organ damage of 3.2 ± 0.9 (including brain, eye, heart, hemolysis, and kidneys) and 11% of MOD-HTA. The protocol was completed on all 74 patients. Saline infusion was used in 34% of patients. No serious adverse event such as acute renal failure, hyperkalaemia or hypotension requiring the transfer to an intensive care unit occurred. Substantial reduction of blood pressure was observed in 97%of patients, and one-month average blood pressure was ≤ 140/90 mmHg in 84% of patients. This remains true in the subgroups of patients with renal failure or renal artery stenosis. Management of uncomplicated MHT by titration of ACE inhibitors makes it possible to achieve effective blood pressure control with a very good tolerance profile. The comparatively low cost of this protocol, its wide availability in developing countries and its focus on MHT pathophysiology cornerstone seem to make it a robust alternative to the IV approach. [ABSTRACT FROM AUTHOR]

Abstract: Field evidence based on sedimentology, geomorphology, and sediment provenance, supported by thermo-mechanical ice sheet model simulations, are used to classify the thermal regime of paleo-ice cover in northern central Baffin and evaluate the spatial and temporal variability of those conditions. A new means to identify paleo-glacier polythermal conditions from the measurement of terrestrial in situ cosmogenic nuclides (TCN) in till was developed to test the assertion that glacial erosion and till production are partially controlled by the thermal regime at the base of a glacier. Concentrations of cosmogenic 10Be and 26Al in 19 till samples from north central Baffin Island reflect the spatial pattern of areas classified as warm-based or cold-based (end member) systems. An ice sheet simulation of bed conditions produces the same pattern. The 26Al/10Be ratio is also used to confirm the long cold-based ice burial histories of surfaces that have not been significantly eroded. The data suggest that till and regolith near the current terminus of the Oliver Glacier preserve a record of >3Ma of continuous glacial cover. In three localities resembling intermediate cases (i.e., where field observations yield conflicting interpretations of basal thermal regime), the TCN concentrations and 26Al/10Be reveal that the surface experienced a combination of cold-based ice burial and glacial erosion. When coupled with a high-resolution ice sheet model, the 10Be concentrations in till provide a more robust means of establishing the temporal and spatial variability in glacial erosion, and can be an important new tool for mineral exploration in glaciated terrain. [Copyright &y& Elsevier]

Copyright of EMC-Medecine is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction. – Distensibility is the ability of large elastic arteries to increase in diameter from diastole to systole. Pulse wave velocity (PWV) is one of the ways to measure this parameter. Several techniques, including QKd, are able to measure PWV.Purpose. – QKd is the time interval between the Q wave on EKG and auscultation of the second Korotkoffˈs sound at the brachial artery. QKd is measured by a specific apparatus that registers ambulatory blood pressure as well as EKG (normal > 200 ms). Arterial distensibility seems to be able to predict cardiovascular morbidity and QKd has been demonstrated to predict such morbidity in a sample of elderly hypertensives. Currently the relationship between QKd and prognosis is under investigation in systemic sclerosis (ERAMS study).Conclusion. – QKd is a noninvasive ambulatory method that measures arterial distensibility as well as blood pressure. [ABSTRACT FROM AUTHOR]

Although this reversal would not have been significant for most surface-exposure age calculations, the P SB f sb (0) calibration samples from Tabernacle Hill (whole-rock samples) used in the original calibration were significantly affected owing to their high Cr contents (up to 300 ppm). The effect of the coding error on the basalt calibration samples was sufficient to require an update of the SP 36 sp Cl production rate calibration. Most normalisations are small (multiplying inputs by 0.995-1.000), but this error has a small but non-trivial effect on the calibration of P SB f sb (0) owing to the high total Cl content of the calibration samples and so has also been included in this update. [Extracted from the article]

Malignant hypertension still remains a severe condition that requires early recognition and treatment. The therapy has evolved from extreme measures in the first 70 years of the last century to intravenous treatment with modern antihypertensive treatment. Today, in the absence of trials and solid evidences, there are no formal guidelines on how to treat MHT. There is a relative consensus on a treatment based on intravenous infusion of antihypertensive treatments in the first days. This review summarizes the historical background and pathophysiological evidences which led to the actual most common pharmacological management of this condition but also can contribute to challenge this management. Oral treatment starting with low dose angiotensin converting enzyme inhibitors appears as a solid option and may improve the management of malignant hypertension in low-income countries where this form of hypertension remains relatively frequent. Future developments are considered according to the latest progress on the topic. [ABSTRACT FROM AUTHOR]

Malignant arterial hypertension is a poorly known pathology, with a poor prognosis in absence of adequate emergency care. Since 1995, the excellence center in Bordeaux University Hospital has been implementing a therapeutic protocol based on rapid titration of angiotensin converting enzyme inhibitor for the management of these acute patients. This "Bordeaux protocol" has demonstrated its effectiveness and safety but its widespread use is limited by the fear of complications in patients with renal artery stenosis. The objective of this study is to compare the protocol safety and efficacy in patients with renovascular and non-renovascular malignant hypertension. Our retrospective case-control study compared 2 groups of patients from the Bordeaux cohort of malignant hypertension since 2008. The first group included patients with renovascular malignant hypertension and the second one the rest of the cohort. We excluded patients managed in non-urgent basis. We included 10 patients with renovascular malignant hypertension and 74 control patients. No serious adverse events occurred in both groups (acute kidney failure requiring dialysis, threatening hyperkalemia, sudden drop in blood pressure requiring immediate attention). Discontinuation of ACE inhibitors for significant elevation of creatinine occurred once in each group (P = 0.22). Blood pressure drop between admission and discharge was similar in the 2 groups (-73mmHg ± 43 mmHg vs. −75mmHg ± 31.7 in the control group, P = 0.9). One-month prevalence of normotensive patients was also comparable (85% vs. 73% in the control group, P = 0.67). Efficacy and safety of the "Bordeaux Protocol" is maintained in patients with renovascular malignant hypertension, thanks to close monitoring. These results need to be replicated to be widespread. [ABSTRACT FROM AUTHOR]

Malignant hypertension (MHT) still exists, leading young people to a poor prognosis. Yet, we lack clear guidelines, mainly because data are scarce. We initiated the first MHT multicentric network to assess these issues. We built a 28 centers network so far, aiming for 40–50 French centers end 2020, and European participation in 2021. We prospectively recruit patients with severe hypertension (> 180/110) and severe hypertensive retinopathy (common definition) or 3-target organ damage among heart, kidney, brain and thrombotic microangiopathy (MOD HTN definition). We hope to recruit 500 patients in 5 years, with a 5 years follow up. We currently collect clinical and examination data, aiming for building a biobank and a target organ damage corelab to entirely reconsider the disease. During the first 6 months, we recruited as planned 58 patients, 41% were male, 49.1 ± 15 years old. Half of them were not known hypertensive, and one third presented a secondary hypertension. Non-observance was reported in 25% of patients as a trigger. Mean blood pressure was 219 ± 29//119 ± 20 mmHg. Patient care pathway was very different according to initial symptoms, target organ damage and centers: hypertension, neurology, nephrology, cardiology, internal medicine, intensive care unit and emergency department. Target organ damage was respectively 70%, 33%, 25% and 25% for kidney, heart, brain and thrombotic microangiopathy, mostly improving during follow up. Most of patients (70%) benefited from intravenous antihypertensive treatment and saline infusion. Length of stay was on average 8 days. Malignant Hypertension clearly didn't disappear, but was diluted between the different specialities and forgotten. This most severe presentation has to be considered once again to better manage our patients. The unique HAMA network should make it possible to gather high-quality data to improve our knowledge and rediscover the disease. [ABSTRACT FROM AUTHOR]

Malignant hypertension, the most severe form of hypertension, is characterized by acute and diffuse microvascular damage. The ophthalmological, renal and cardiological consequences are well described. Brain damage is considered rare and poorly known, although it is one of the main causes of death. We performed a systematic cerebral MRI on patients of the Bordeaux cohort with malignant hypertension between 2008 and 2018, regardless of their neurological symptoms. A subgroup of patients benefited from a second cerebral MRI. All MRI were analysed by the same trained operator. 92 patients were included, 67.5% male, mean age 47.8 ± 12 years. On admission, 41.5% of the patients were totally asymptomatic from a neurological aspect. Cerebral MRI was normal in 18.5% of patients. A posterior reversible encephalopathy syndrom was found in 16.5% of patients, 33.5% had an ischemic or hemorrhagic stroke. Patients had marked microvascular impairment (SVD score 2 or higher) in 59% of cases. In asymptomatic patients or patients with headaches only, MRI found PRES in 15.5% of cases, recent ischemic or hemorrhagic stroke in 29% of cases, and SVD score 2 or higher in 51.5% of cases. Most patients with malignant hypertension have brain injuries, regardless of their symptoms. This warrants systematic cerebral MRI, as the results may impact on their management. The consequences of these severe lesions, which are disproportionately severe for young patients, raise questions about the need for cognitive assessment and management. [ABSTRACT FROM AUTHOR]

Exposure of nursing students to global health care systems and cultures that are vastly different from which they are accustomed allow them to gain a unique perspective of our global village. A plethora of research has studied the lived experiences of visiting students during international clinical placements. Many studies have noted a multitude of benefits for visiting students. However, very little research examined the perspectives of host participants. This study explores both visiting and host students and faculty's perceptions of reciprocity during international learning experiences. A qualitative descriptive design was utilised. Intercultural collaboration between visiting and host participants occurred over a two week clinical learning experience in a regional hospital in Jamaica. Ten third year undergraduate Bachelor of Nursing students and two faculty from Canada engaged in clinical learning experiences with twelve fourth year host nursing students and three faculty from Jamaica. Visiting students submitted reflective papers, participated in interviews, and a focus group two months later. Two separate focus groups were held to gather data from the hosting students and faculty. All data was analysed using thematic analysis for recurring themes. The findings of this study show that both host and visiting students and faculty mutually gain benefits from intercultural exchange and collaboration. Reciprocity was noted in experiential knowledge acquisition, cultural awareness from educational and professional perspectives, and personal and professional transformative learning. Although notable differences from contrasting health care worlds were identified, the recognition of similarities and opportunities for transformative learning greatly outweighed the differences. There are reciprocal benefits to be gained in nursing education for visiting and host participants through the development of collaborative international partnerships. More research is required to further explore mutuality for students and faculty from different countries. • Mutual gains were noted between host and visiting nursing students and faculty. • Similarities outweighed the differences between health care and culture. • Personal and professional growth occurred for participating students and faculty. • Knowledge sharing and intercultural collaboration developed mutual cultural awareness. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effects of coeliosurgery by catecholamine assays and the use of urapidil in the management of phaeochromocytoma.Study design: Prospective cohort study.Patients: Nine consecutive patients from April 1997 to April 2001.Methods: Urapidil (250 mg·j–1) was administered by continuous intravenous infusion three days before surgery and continued throughout anaesthesia. Plasma catecholamine concentrations were measured before surgery, after induction of anaesthesia, during insufflation, after adrenalectomy and in the recovery room. Haemodynamic disorders were treated by nicardipine ± esmolol bolus doses.Results: Creation of pneumoperitoneum and adrenal gland manipulations resulted in significant catecholamine releases associated with hypertension in five and eight patients respectively. Preventive urapidil use enabled easy control of blood pressure variations by additive antihypertensive drugs.Conclusion: Perioperative α1 blockade by urapidil enables an effective and easy control of acute peroperative haemodynamic changes. [Copyright &y& Elsevier]

Une étude réalisée en IRM cardiaque suggère que l'exposition chronique à un phéochromocytome « stable » induit des plages de fibrose et de myocardite ventriculaires gauches. Ces anomalies étant classiquement associées à une altération de la déformation systolique longitudinale, nous émettons l'hypothèse que cette déformation est altérée chez les patients porteurs d'un phéochromocytome. Cette étude cas-témoin rétrospective a été réalisée à partir des patients de la base de données du CHU de Bordeaux, inclus entre 2008 et 2016. Nous avons comparé le global longitudinal strain (GLS), les autres paramètres de déformation systolique et les paramètres échocardiographiques classiques entre un groupe de patients porteurs de phéochromocytome et un groupe de témoins appariés pour l'âge, le sexe, l'indice de masse corporelle et la pression artérielle systolique moyenne. L'analyse a porté sur 47 patients et 47 témoins correctement appariés. Nous n'avons pas retrouvé de différence statistiquement significative entre les 2 groupes en termes de GLS (−20,7 ± 2,4 % vs −20,2 ± 2,7 %, p = 0,40), de déformation radiale, de masse ventriculaire gauche ou de fonction diastolique. La fraction d'éjection ventriculaire gauche et la déformation circonférentielle étaient significativement plus élevées chez les patients que chez les témoins, le diamètre télédiastolique significativement plus bas. Aucune altération significative du GLS n'a été identifiée chez nos patients porteurs d'un phéochromocytome. Plusieurs hypothèses peuvent expliquer ces résultats. La présence de foyers de fibrose et de myocardite étant associés à un pronostic cardiologique péjoratif, une IRM cardiaque systématique pourrait se discuter, dans l'attente d'études complémentaires. Pheochromocytoma is a rare disease, which may manifest as severe cardiac complications. Apart from these situations, the "chronic" cardiac impact is not clearly defined. A cardiac MRI study suggests that these patients are carrying areas of fibrosis and foci of left ventricular myocarditis. Since these abnormalities are usually associated with altered left ventricular longitudinal systolic strain, we hypothesize that this strain is altered in patients with a "chronic" pheochromocytoma. This retrospective case-control study was performed using patients from the Bordeaux University Hospital database, included between 2008 and 2016. We compared the left ventricular global longitudinal strain (GLS), radial and circumferential systolic strain and classic echocardiographic parameters between patients with pheochromocytoma and controls matched for age, sex, body mass index and systolic blood pressure. The analysis included 47 patients and 47 correctly matched controls. There were no statistically significant differences between the 2 groups in terms of GLS (−20.7 ± 2.4% vs. −20.2 ± 2.7%, P = 0.40), radial strain, left ventricular mass or diastolic function. Left ventricular ejection fraction and circumferential strain were significantly higher in patients than in controls, with a significantly lower telediastolic diameter. No significant changes in GLS were observed in our pheochromocytoma patients, compared with controls. Several hypotheses may explain these results. The presence of fibrosis foci and areas of left ventricular myocarditis being associated with a poor cardiological prognosis, a systematic cardiac MRI could be discussed in these patients, until further studies are performed. [ABSTRACT FROM AUTHOR]

Résumé But de l'étude L'hyperaldostéronisme primaire est la première cause d'hypertension artérielle secondaire, et entraîne de fréquentes complications cardiovasculaires. De nombreuses études ont étudié la géométrie et la fonction ventriculaire gauche dans cette population, mais la fonction systolique longitudinale est encore mal décrite. Patients et méthode Nous avons étudié 35 patients hypertendus porteurs d'un hyperaldostéronisme primaire et 35 d'une hypertension essentielle appariés pour l'âge, le sexe, l'indice de masse corporelle et la pression artérielle sur 24 heures. Ces patients ont bénéficié d'une échocardiographie pour mesurer la masse, la géométrie la fraction d'éjection du ventricule gauche, sa déformation systolique longitudinale, circonférentielle et radiale, et sa fonction diastolique. Résultats Les patients atteints d' hyperaldostéronisme primaire présentaient une masse ventriculaire gauche indexée et une épaisseur relative des parois significativement plus élevées (60,3 ± 16,1 g/m2,7 vs 47,3 ± 18,6, p = 0,003 et 0,44 ± 0,08 vs 0,36 ± 0,06, p = 5 × 10−5), ainsi qu'une fonction systolique longitudinale par le strain bidimensionnel significativement réduite (−17,8 ± 3,4 vs − 20,3 ± 3,6 %, p = 0,004). Il n'y avait pas de différences significatives dans les autres paramètres. Conclusion L'hyperaldostéronisme primaire est associé à une détérioration de la fonction systolique longitudinale du ventricule gauche par rapport aux patients hypertendus essentiels. Ce paramètre simple et reproductible pourrait être un marqueur d'atteinte cardiaque et aider au dépistage de ces patients. Abstract Objective Primary hyperaldosteronism is the leading cause of secondary hypertension, and leads to frequent cardiovascular complications. Many studies have studied left ventricular geometry and function in this population, but longitudinal systolic function is still poorly described. Methods We studied 35 hypertensive patients with primary aldosteronism, and 35 with essential hypertension matched for age, sex, body mass index, and 24 h blood pressure. Patients benefited from an echocardiography to measure the mass and the geometry of the left ventricle, left ventricle ejection fraction, systolic longitudinal, circumferential, and radial strain, and diastolic function. Results Compared to essential hypertensive patients, patients with primary aldosteronism presented a significantly higher left ventricular mass index and relative wall thickness (60.3 ± 16.1 g/m2 vs 47.3 ± 18.6, P = 0.003, and 0.44 ± 0.08 vs 0.36 ± 0.06, P = 0.00005, respectively), as well as a significantly reduced longitudinal systolic strain (−17.8 ± 3,4 vs −20.3 ± 3,6%, P = 0.004). There were no significant differences in the other parameters. Conclusions Primary aldosteronism is associated with a deterioration of longitudinal systolic function of the left ventricle compared with essential hypertensive patients. This marker of cardiac damage, reproducible and easily available in routine could help for the screening of these patients. [ABSTRACT FROM AUTHOR]

Objectifs Une définition de l'hypertension artérielle (HTA) maligne a été proposée en 2013 par la Société Européenne d'Hypertension Artérielle. Il s'agit d'une atteinte ischémique aiguë d'un organe cible en présence d'une HTA sévère. Peu de grandes séries ont été publiées sur l'HTA maligne, aucune en France. Méthodes Nous avons étudié les facteurs pronostiques de mortalité, d'événements cardiovasculaires sévères et d'arrivées au stade terminal de la maladie rénale chronique (critère composite). L'étude était rétrospective. Les patients présentant une HTA maligne entre 1995 et 2015, et pris en charge au sein de l'Unité d'Hypertension Artérielle du CHU de Bordeaux ont été inclus. Résultats 124 sujets ont été analysés au cours d'un suivi médian de 60 mois. Il s'agissait majoritairement d'hommes (67,7 %). La moyenne d'âge était de 45,6 ans. La pression artérielle à l'entrée était de 205,7/117,6 mmHg. L'atteinte ophtalmologique était retrouvée dans 87,4 % des cas, l'atteinte cardiaque dans 81,81 %, l'atteinte cérébrale dans 81,1 % et l'atteinte rénale dans 38,5 %. La fonction rénale s'était dégradée pour 17,1 % des cas au cours du suivi. à 5 ans, la probabilité d'apparition du critère composite était de 12,41 %; de 27,33 % à 10 ans et de 43,48 % à 15 ans. L'âge (HR : 1,005 p : 0,027) et la créatinine à la sortie d'hospitalisation (HR : 1,0046 p : 0,01) étaient les facteurs pronostiques du critère composite. Seulement 9,5 % des sujets n'avaient qu'un seul organe atteint. Ils ne développaient pas le critère composite. Le nombre d'organes atteints influençait la probabilité d'apparition du critère composite au cours du suivi (p : 0,04). Les patients sans rétinopathie ne différaient pas des autres sujets. Ces résultats suggèrent la grande fréquence des atteintes rétiniennes, cérébrales et cardiaques. Conclusion Les critères pronostiques principaux sont l'âge et la créatinine de sortie d'hospitalisation. La définition de l'HTA maligne mérite d'être précisée. L'atteinte ophtalmologique ne paraît pas nécessaire pour retenir le diagnostic. [ABSTRACT FROM AUTHOR]