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A heuristic procedure based on tabu search (TS) and intelligent memory structures is developed to solve the problem of audit staff scheduling. The TS method works by developing a feasible schedule derived from a greedy forward dispatching procedure. It then improves on the initial schedule by conducting a series of intensification and diversification procedures. Test results reveal that the method can be used in highly constrained scheduling problems that include rigid precedence relations and impacted completion times and resources.

Infantile pyknocytosis is a neonatal hemolytic disorder which causes anemia and icterus and is characterized by the presence of an increased number of distorted red blood cells called pyknocytes. Resolution spontaneously occurs in the first semester of life. It has been generally described as a rare entity, with an occasional family history. We report seven cases of infantile pyknocytosis observed in our hospital in 3 years. Most of the infants presented with hemolytic icterus and profound anemia that was reaching its peak by the 3rd week of life. Three neonates received one to three red blood cell transfusions, according to former recommendations. However, the following four received a treatment with recombinant erythropoietin administered subcutaneously. Only one of these four cases required a transfusion. All of them were free of hematological disease 2-3 months after completion of treatment. Infantile pyknocytosis is a recognized cause of neonatal hemolytic anemia, which requires careful examination of red cell morphology on a peripheral blood smear. The cause of this transient disorder remains unknown. Our observations show that recombinant erythropoietin therapy is effective in treating infantile pyknocytosis and increases the reticulocyte response, thus improving the hemoglobin level. [ABSTRACT FROM AUTHOR]

Homozygous or compound heterozygous for frameshift or nonsense mutations in the ATP–binding cassette transporter A3 (ABCA3) is associated with neonatal respiratory failure and death within the first year of life without lung transplantation. We report the case of a newborn baby girl who developed severe respiratory distress soon after birth. She was diagnosed with compound heterozygous frameshift mutation of the ABCA3 gene. Despite extensive treatment (intravenous corticosteroids pulse therapy, oral corticosteroids, azithromycin, and hydroxychloroquine), she developed chronic respiratory failure. As the parents refused cardio-pulmonary transplantation and couldn't resolve to an accompaniment of end of life, a tracheostomy was performed resulting in continuous mechanical ventilation. A neurodevelopmental delay and an overall muscular dystrophy were noted. At the age of 5 years, after 2 episodes of pneumothorax, the patient died from severe respiratory failure. To our knowledge, this was the first case of a child with compound heterozygous frameshift mutation who posed such an ethical dilemma with a patient surviving till the age of five years. [ABSTRACT FROM AUTHOR]

Abstract: The distribution of zooplanktonic prey of fish larvae was examined in three bays and two lagoonal stations in the Southwest lagoon of New Caledonia. Water column conditions were characterized by increasing chlorophyll a and particulate organic matter (POM) concentrations from the lagoon to the estuarine bay. The mean zooplankton settled volume and total density were significantly higher in the estuarine bay, reaching 35.1mLm−3 and 3.5×105 individualsm−3, respectively. The total zooplankton density also progressively increased along the sampling period. The composition of assemblages differed between the lagoon and the bays, and was similar in the three bays. Wind speed, surface temperature, chlorophyll a and POM explained these variations, as revealed by a co-inertia analysis (COIA). The prey preferred by fish larvae, i.e. small crustaceans and small copepods, were more abundant in bays. Sheltered bays, most influenced by terrigenous inputs, are likely to provide the best feeding conditions. [ABSTRACT FROM AUTHOR]

Abstract: Ureteral stenosis is the most frequent complication after kidney transplantation. The diagnosis is based on an elevated creatinine level and a dilatation of the urinary cavity. The first step of the management is a urinary diversion with endo-ureteral prosthesis or a nephrostomy placement. The surgical gold standard is the pyelo-ureterostomy. This is a safe and efficient technique in the treatment of this complication. We describe the different surgical alternatives and the endo-urologic management of the stenosis. [Copyright &y& Elsevier]

Abstract: Aim: The aim of this study was to determine the mechanisms involved in muscle weakness in elderly patients with unilateral knee osteoarthritis. Subjects: We investigated 7 patients with unilateral knee osteoarthritis. Method: We measured knee position sense and isometric maximal voluntary contraction (MVC) of the knee extensors. Electromyographic (EMG) measurement of biceps femoris (BF), rectus femoris (RF), vastus lateralis (VL) and vastus medialis (VM) involved different levels of contraction (25, 50, 75 and 100% MVC). Neuromuscular efficiency of quadriceps was also calculated (MVC/EMG). Ultrasonography was used to investigate the VL architectural parameters at the median part of the VL for different levels of contraction (25, 50, and 75% MVC). All tests were performed on the osteoarthritic and healthy knees. Results: The quadriceps MVC of the affected knee was reduced by 30%. The VL thickness of the affected knee was 10% smaller than that of the unaffected knee. VL activity seen on EMG did not differ between knees, but RF, VM and BF activity was greater in the unaffected than affected knee. Neuromuscular efficiency was higher (26%) in the unaffected knee. Knee position sense was reduced by 33% in the affected knee. Conclusion: Quadriceps weakness associated with knee osteoarthritis seems to be related to changes in muscle rather than pennation angle and changes in fascicule length. [Copyright &y& Elsevier]

Résumé Le syndrome d’activation macrophagique (SAM) est une complication rare de la maladie de Kawasaki (MK). Il doit être recherché au cours d’une MK se présentant avec des signes cliniques inhabituels tels qu’une hépatosplénomégalie, une hypertriglycéridémie ou une cytopénie, notamment une thrombopénie. Nous présentons 4 observations. La première est celle d’un enfant de 11 mois chez qui une MK est survenue 15 jours après une spondylodiscite infectieuse. Pour la seconde, une myocardite aiguë avait inauguré la MK chez une fillette de 5 ans. La troisième est celle d’un adolescent de 15 ans qui avait présenté une défaillance multiviscérale avec choc. La dernière est celle d’un nourrisson de 3 mois avec une MK incomplète. Tous présentaient une hépatosplénomégalie, une thrombopénie, une hyperferritinémie et des images d’hémophagocytose sur le frottis médullaire. L’évolution a été rapidement favorable sous immunoglobulines polyvalentes ou corticothérapie. Les enquêtes microbiologiques étendues avaient été infructueuses. Aucun patient n’a présenté de séquelle coronarienne à distance. La MK s’ajoute à la liste des conditions inflammatoires susceptibles de se compliquer d’un SAM, qui en modifie la présentation, mimant un choc toxinique ou un SAM lié à une infection et rend le diagnostic plus difficile. L’association SAM/MK ne semble pas avoir d’impact pronostique sur le cours de la maladie dans la littérature, ce que reflète aussi l’analyse de cette petite série. Summary Macrophage activation syndrome (MAS) is a rarely reported complication of Kawasaki disease (KD). It must be sought during KD with unusual clinical signs, such as enlargement of the liver or spleen, cytopenia (including thrombocytopenia), and elevated serum triglycerides. Here, we report four cases from a single center. The first is the description of a case of KD occurring in an 11-month-old child 15 days after the occurrence of infectious spondylitis. For the second, acute myocarditis heralded KD in a 5-year-old child. A 15-year-old boy had multiorgan failure with shock. The last case describes an infant with atypical KD. All had hepatosplenomegaly, thrombocytopenia, and increased serum ferritin. For all of them, hemophagocytosis was present on the bone marrow smears. The condition rapidly evolved favorably with intravenous immunoglobulins or steroids. The extensive microbiological work-up was unrevealing. None had any coronary sequelae after the episode. KD should be added to the list of inflammatory conditions that may be complicated by MAS that modifies the presentation mimicking toxic shock or infection-associated activation syndrome and makes the diagnosis difficult. This association does not appear to have a prognostic impact on the course of the disease in the literature, confirmed by the analysis of this small series. [ABSTRACT FROM AUTHOR]

Progressive cerebellar ataxias are well-known hereditary neurological disorders. Among them, spinocerebellar ataxia type 7 (SCA7) is inherited as an autosomal dominant trait and is ascribed to the expansion of a CAG trinucleotide repeat within the ATXN7 gene. An anticipation phenomenon can occur during paternal transmission and sometimes is responsible for a severe infantile form. The specificity of SCA7 is the retinal involvement with retinitis pigmentosa and cone rod dystrophy. We describe a familial form with two siblings who died of a severe infantile form. Diagnosis was made in their father, who had a recent history of macular atrophy and presented with gait disturbance thereafter. Retrospectively, substantial triplet repeat expansion was confirmed in the two affected infants. These infantile forms are rare and difficult to diagnose in the absence of suggestive family symptoms. [ABSTRACT FROM AUTHOR]

Background: Circulating tumor cells (CTCs) are a prognostic marker in metastatic breast cancer, but comparisons with serum tumor markers (CA 15-3, carcinoembryonic antigen and lactate dehydrogenase) variations are needed. Patients and methods: CTCs were counted with CellSearch® at baseline, before cycle 2 (C2) and cycle 3 or 4 (C3/4) in 267 metastatic breast cancer patients on first-line chemotherapy with/without targeted therapy. Results: Baseline CTC detection rate was 65% with ≥1 CTC/7.5 ml threshold and 44% with ≥5 CTC/7.5 ml and was independent of subtypes (luminal, triple negative, human epithelial growth factor receptor 2 (HER2)+). CTCs were associated with tumor markers, bone/liver involvement, tumor burden and performance status. CTC detection ≥1 CTC/7.5 ml was a strong prognostic factor for progression-free survival (PFS), P < 0.0001. Threshold of CTC ≥5 was statistically significant for PFS and overall survival (OS), P = 0.03 on multivariate analysis. Among patients with ≥5 CTC/7.5 ml at baseline, 50% had <5 CTC/7.5 ml at C2. Changes were correlated with both PFS and OS (P < 0.0001). All patients receiving anti-HER2 therapy had <5 CTC/7.5 ml after three cycles of treatment. Conclusion: This is the largest prospective series validating the prognostic value of CTC independently from serum tumor marker. Elevated CTCs before C2 are an early predictive marker of poor PFS and OS, which could be used to monitor treatment benefit. CTC decrease under treatment seems stronger with targeted therapy. [ABSTRACT FROM PUBLISHER]

Abstract: Subject: This article reports preliminary findings relating to the use of a new preservation solution, the Solution de Conservation des Organes et des Tissus (SCOT), in renal transplantation. This fourth-generation solution combines an extracellular-like composition with 20 kDa polyethylene-glycol, known for its cell-protection capacity and immunocamouflage properties. Methods: We have reported preliminary data obtained in 29 transplantations (25 cadaveric donors and 4 living related donors) between December 2004 and November 2005. The SCOT solution was used for both in situ flush and static preservation. We compared primary organ nonfunction and delayed graft function rates as well as blood creatinine levels in recipients of grafts processed with SCOT solution, versus University of Wisconsin solution (paired for age with the previous group) and with EuroCollins solution (historic data). Results: We observed delayed graft-function in 10% of the SCOT-processed group, 14% in the University of Wisconsin solution group, and 23% of the EuroCollins group. No case of primary organ nonfunction was reported. Creatinine levels in both SCOT and University of Wisconsin solution groups were similar. We did not observe any humoral or cellular graft rejection in the first 3 months after transplantation. In light of these preliminary results, the use of SCOT is safe for kidney preservation in the human setting. Further experience is warranted to assess the clinical consequences of its immunocamouflage properties as described in animal models. [Copyright &y& Elsevier]