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Patients who undergo trans-catheter aortic valve replacement (TAVR) may have concomitant aortic aneurysms. We sought to clarify the incidence of aortic aneurysms and its impact on clinical outcomes among patients undergoing TAVR.

There is a growing demand for malting barley in the world and the supply relies on introducing the crop into new agricultural regions, such as the Brazilian Savannah. This requires selection for high yield and seed quality, critical factors for the success of commercial production. This study aimed at estimating genetic parameters associated with morpho‐agronomic characterization of 433 preliminarily selected accessions from a worldwide barley collection. The accessions were grown on a limed and fertilized Haplustox soil, using interpolated control experimental design, in the Savannah highlands, in Brazil. High‐magnitude heritability and genetic variation coefficients were found for agronomic traits, allowing the identification of genotypes for crossing schemes to generate high‐yield recombinants. Strong negative correlation between yield and number of days to heading and protein content indicated that selection should be directed at early‐maturity cultivars with desirable malting quality. The method proved efficient and revealed interesting indicators to be considered in barley breeding programmes directed at high‐quality malting production in the tropics. Copyright © 2018 The Institute of Brewing & Distilling

Les objectifs de l’étude étaient d’évaluer l’exposition radiologique des équipes opératoires au cours d’actes de chirurgie endovasculaire afin de proposer d’éventuelles actions de prévention et d’optimisation des doses reçues.

Management of visceral ischemia due to non-A, non-B dissection is extremely challenging due to the position of the primary entry tear at the level of the brachiocephalic vessels. We report on a patient who was admitted for a complicated non-A, non-B-type dissection with visceral and leg ischemia. A covered stent graft was implanted below the primary entry tear to redirect the flow in the true lumen, associated with stents implantation in the visceral arteries, to treat the dissection's static component. The patient did well, without need for bowel resection visceral or late stent restenosis. Stent-graft implantation below the primary entry tear in cases of visceral ischemia due to non-A, non-B dissection seems feasible.

This study investigates the variability in the spectral absorption of phytoplankton in Antarctic waters. A large in situ data set comprising phytoplankton pigments and hyperspectral absorption was measured in the northern tip of Antarctic Peninsula during 2013 and 2014 summers at several depths. A proxy of package effect was estimated from the phytoplankton absorption spectra, independently of chlorophyll a. Variations in the concentration of photosynthetic and photoprotective pigments were discernible by changes in this metric but not in the chlorophyll aspecific absorption coefficient of phytoplankton. The fucoxanthin to chlorophyll aratio correlated positively to package effect due to an increase in cell size of phytoplankton (diatoms) and increasing fucoxanthin content per cell to maximize light harvesting in depth. The package effect was found to covary inversely with photoprotective pigments relative to chlorophyll a, partially due to their contribution to enhance absorption in the blue part of the spectrum. Using a cluster analysis (k‐means algorithm) on the phytoplankton absorption spectra, we illustrate the capacity to identify a regular increase in the degree of package effect. This approach can be useful to classify the phytoplankton assemblages in Antarctic waters according to different degrees of pigment packaging, each one related to a specific pigment composition. Our results demonstrate the potential for this classification at different temporal and spatial scales from ocean color satellite data. This should improve our understanding of deviations in global bio‐optical algorithms when applied to the Southern Ocean. Variations in photosynthetic and photoprotective pigments are not discernible by changes in the chlorophyll‐specific absorption of phytoplanktonA cluster analysis identifies a regular increase in the degree of package effect of phytoplankton absorptionA regular increase in the degree of package effect is associated with an increase of fucoxanthin and decrease of photoprotective pigments relative to chlorophyll a

La coronaropathie instable a un potentiel évolutif plus sévère que la coronaropathie stable, expliquant l’incidence élevée des complications cardiovasculaires chez les sujets en post-SCA, notamment la nécessité de revascularisation itérative. Le but du dépistage est d’arriver à détecter cette évolution défavorable. Bien qu’il n’y ait pas de recommandation stricte dans cette situation, le dépistage doit se baser sur l’usage des techniques d’imagerie d’effort avec une fréquence qui dépendra des caractéristiques cliniques des patients.

•324 uropathogenic Escherichia coliisolated from outpatients in a tertiary hospital were analysed.•61 strains (18.8%) were resistant to ciprofloxacin.•Resistance and virulence genes were distributed independently of clonality.•Multilocus sequence typing showed the presence of pandemic clones.•Ciprofloxacin resistance dissemination was associated with multidrug resistance.

BackgroundPhysical inactivity is common in older age, yet increased activity benefits older people in terms of preventing chronic disease and maximising independence. Health coaching is a behaviour change intervention that has been shown to increase physical activity in clinical populations. This systematic review and meta-analysis investigated the effect of health coaching on physical activity, mobility, quality of life and mood in older people.MethodsMEDLINE, EMBASE, CENTRAL, PsycINFO, PEDro, SPORTDiscus, LILACS and CINAHL databases were used to identify randomised controlled trials which evaluated the effect of health coaching on physical activity (primary outcome) among people aged 60+. Secondary outcomes were mobility, quality of life and mood. We calculated standardised mean differences (SMDs, Hedges’ g) with 95% CIs from random effects meta-analyses.Results27 eligible trials were included. Health coaching had a small, statistically significant effect on physical activity (27 studies; SMD = 0.27; 95% CI 0.18 to 0.37; p<0.001). There was no evidence of an effect of health coaching on mobility (eight studies; SMD = 0.10; 95% CI −0.03 to 0.23; p=0.13), quality of life (eight studies; SMD = 0.07; 95% CI −0.06 to 0.20; p<0.05) or mood (five studies; SMD = 0.02; 95% CI −0.12 to 0.16; p=0.83).ConclusionsHealth coaching significantly increased physical activity in people aged 60+. There was no evidence of an effect of health coaching on quality of life, mobility and mood, so different approaches may be required to impact on these outcomes.

L’actualité récente met en évidence la possibilité d’un conflit sur le territoire national.

Le contexte actuel et l’expérience du Service de santé des armées dans le domaine nucléaire et radiologique amènent tout naturellement les auteurs de cet article à présenter cette méthode simplifiée de prise en charge des blessés radiocontaminés ou irradiés. Le MOOC Nucléaire et Radiologique constitue un outil pédagogique original dans le domaine de l’intervention en situation d’urgence radiologique. Il est le fruit d’un travail collégial associant le SPRA et l’IRBA, sous l’égide de l’École du Val-de-Grâce. Il propose de constituer une boîte à outils structurée sous la forme d’un triple triptyque mnémotechnique. Ce MOOC est présenté comme étant une base robuste de formation qui doit bien évidemment être réassurée par des entraînements réguliers.

Tricuspid valve ring annuloplasty (TA) is associated with increased risk of atrioventricular block, and subsequent implantation of a permanent pacemaker (PPM). However, the exact incidence of PPM, associated risk factors, and outcomes in this frame remain debated. The aim of the study was to report PPM incidence, risk factors, and outcomes following TA from nationwide databases.

Contexte :L'apprentissage de l'habileté technique chirurgicale (HTC) dans le système français de formation en chirurgie repose essentiellement sur l'immersion en situation réelle et le compagnonnage. De nouvelles contraintes pèsent sur l'exercice de la chirurgie dans les centres hospitaliers universitaires et pourraient réduire l'efficience de ce mode unique de transmission de l'HTC. Objectif :Évaluer l'impact sur l'acquisition de gestes chirurgicaux élémentaires (suture, ligature) d'un stage d'initiation à la gestuelle chirurgicale (SIGC) basé sur l'apprentissage et l'entraînement sur modèle inanimé hors bloc opératoire en complément du mode habituel d'apprentissage par immersion compagnonnage. Méthodes :Nous avons comparé lors d'un exercice standardisé de suture et ligature proposé 3 mois après le début du premier stage hospitalier, les performances (scores et durée) d'un groupe d'internes premier semestre exposé au SIGC, à celles d'un groupe d'internes premier semestre non exposés. Résultats :La moyenne du score de performance obtenu, était de 23,9 (15–28) pour le groupe exposé contre 17,1 (2–24) pour le groupe non exposé (p=0{,}036). Le test de connaissance du matériel était aussi en faveur du groupe exposé. Le temps moyen de suture ne montrait qu'une tendance en faveur du groupe exposé. Conclusion :Nos résultats suggèrent un impact positif et mesurable d'un stage de technique préliminaire en début d'internat de chirurgie sur la rapidité d'acquisition de gestes de base de chirurgie. Ce type d'enseignement basé sur la simulation pourrait être un complément essentiel au principe d'immersion/compagnonnage pour la transmission de l'HTC.

ABSTRACTIntroduction: Cachexia and sarcopenia are conditions phenotypically characterized by muscle loss and represent a factor of poor prognosis, increasing patients’ morbidity and mortality. Cachectic and sarcopenic patients often suffer from low quality of life, presenting lower muscle strength and appetite loss, which makes research on novel treatment strategies to ameliorate clinical response including patient’s symptoms, the objective of scientific interest.Areas covered: This article covers recent developments in the area of cachexia and sarcopenia treatment and therapeutic interventions, targeting central nervous system involvement, key inflammatory and muscle-specific metabolic pathways.Expert opinion: A number of promising agents have being evaluated, such as enobosarm, a selected androgen receptor modulator, and anamorelin, a ghrelin agonist which have been recently studied in phase III trials. These and other agents (i.e., infliximab, tocilizumab, MABp1, bimagrumab) have shown significant impact on reversal of skeletal muscle loss, but limited effect on physical function.In the last few years advancement in the number and type of potential treatments for cachexia and sarcopenia have been obtained and we have now available more data on measurable effects of several drugs on patients’ nutritional and metabolic parameters and outcomes.

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•We analysed 324 uropathogenic Escherichia coliisolated from outpatients in a teaching hospital in Brazil.•23 strains (7.1%) produced extended-spectrum β-lactamase (ESBL).•Clonal analysis showed that multidrug resistance and CTX-M ESBL were distributed among all strains.•Multilocus sequence typing showed the presence of pandemic clones.•The results may explain the frequent occurrence of antibiotic multiresistance in the region.

The minimalist immediate mechanical intervention (MIMI) strategy aims to restore normal anterograde flow in the culprit artery (by using manual thrombectomy or small-sized balloon predilation) and to defer potential stent implantation. This study evaluated the applicability and midterm clinical results of the MIMI strategy for ST-elevation myocardial infarction (STEMI) management.

Fractional flow reserve (FFR) measurement requires adenosine injection. However, adenosine can induce conductive and rhythmic complications, or be contraindicated in some patients. Contrast-induced hyperemia could provide a simple first-line method (contrast-enhanced FFR; cFFR) to assess coronary lesions. In this study we evaluated the accuracy of cFFR to predict lesion significance.

Rett syndrome (RTT) is a severe neurodevelopmental disorder associated with mutations in either MECP2, CDKL5or FOXG1. The precise molecular mechanisms that lead to the pathogenesis of RTT have yet to be elucidated. We recently reported that expression of GluD1 (orphan glutamate receptor δ-1 subunit) is increased in iPSC-derived neurons obtained from patients with mutations in either MECP2or CDKL5. GluD1 controls synaptic differentiation and shifts the balance between excitatory and inhibitory synapses toward the latter. Thus, an increase in GluD1 might be a critical factor in the etiology of RTT by affecting the excitatory/inhibitory balance in the developing brain. To test this hypothesis, we generated iPSC-derived neurons from FOXG1+/−patients. We analyzed mRNA and protein levels of GluD1 together with key markers of excitatory and inhibitory synapses in these iPSC-derived neurons and in Foxg1+/−mouse fetal (E11.5) and adult (P70) brains. We found strong correlation between iPSC-derived neurons and fetal mouse brains, where GluD1 and inhibitory synaptic markers (GAD67 and GABA AR-α1) were increased, whereas the levels of a number of excitatory synaptic markers (VGLUT1, GluA1, GluN1 and PSD-95) were decreased. In adult mice, GluD1 was decreased along with all GABAergic and glutamatergic markers. Our findings further the understanding of the etiology of RTT by introducing a new pathological event occurring in the brain of FOXG1+/−patients during embryonic development and its time-dependent shift toward a general decrease in brain synapses.

Foxg1 gene encodes for a transcription factor essential for telencephalon development in the embryonic mammalian forebrain. Its complete absence is embryonic lethal while Foxg1 heterozygous mice are viable but display microcephaly, altered hippocampal neurogenesis and behavioral and cognitive deficiencies. In order to evaluate the effects of Foxg1 alteration in adult brain, we performed expression profiling in total brains from Foxg1+/− heterozygous mutants and wild-type littermates. We identified statistically significant differences in expression levels for 466 transcripts (P<0.001), 29 of which showed a fold change ≥1.5. Among the differentially expressed genes was found a group of genes expressed in the basal ganglia and involved in the control of movements. A relevant (three to sevenfold changes) and statistically significant increase of expression, confirmed by qRT-PCR, was found in two highly correlated genes with expression restricted to the hypothalamus: Oxytocin (Oxt) and Arginine vasopressin (Avp). These neuropeptides have an important role in maternal and social behavior, and their alteration is associated with impaired social interaction and autistic behavior. In addition, Neuronatin (Nnat) levels appear significantly higher both in Foxg1+/− whole brain and in hippocampal neurons after silencing Foxg1, strongly suggesting that it is directly or indirectly repressed by Foxg1. During fetal and neonatal brain development, Nnat may regulate neuronal excitability, receptor trafficking and calcium-dependent signaling and, in the adult brain, it is predominantly expressed in parvalbumin-positive GABAergic interneurons. Overall, these results implicate the overexpression of a group of neuropeptides in the basal ganglia, hypothalamus, cortex and hippocampus in the pathogenesis FOXG1 behavioral impairments.