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International audience; Background Renal dysfunction can complicate home parenteral nutrition (HPN). The aims were, in the context of pediatric HPN, to assess renal function using the measured glomerular filtration rate (mGFR), determine the most accurate formula(s) to estimate GFR, and identify possible underlying mechanisms of renal impairment.Methods A retrospective study was performed in 2 centers. Patients receiving HPN and aged 2-16 years without medical history of nephropathy were included. GFR was measured using iohexol clearance. Estimated GFR (eGFR) was calculated using creatinine, cystatin C-based, and combined (eGFR(cr+cyst)) Schwartz formulas.Results A total of 36 patients (18 females) were included; they received HPN for 8 (2-16) years. The primary digestive disease was short-bowel syndrome for 16 (44%) patients, gastrointestinal motility disorder for 10 (28%), or congenital diarrhea for 10 (28%). The median (range) mGFR was 99 (33-136) ml/min/1.73 m(2); 9 (25%) patients had mildly decreased mGFR (= 60 ml/min/1.73 m(2)), and 2 (6%) had mildly to severely decreased mGFR (

Most cognitive models of apraxia assume that impaired tool use results from a deficit occurring at the conceptual level, which contains dedicated information about tool use, namely, semantic and action tool knowledge. Semantic tool knowledge contains information about the prototypical use of familiar tools, such as function (e.g., a hammer and a mallet share the same purpose) and associative relations (e.g., a hammer goes with a nail). Action tool knowledge contains information about how to manipulate tools, such as hand posture and kinematics. The present review aimed to better understand the neural correlates of action and semantic tool knowledge, by focusing on activation, stimulation and patients' studies (left brain-damaged patients). We found that action and semantic tool knowledge rely upon a large brain network including temporal and parietal regions. Yet, while action tool knowledge calls into play the intraparietal sulcus, function relations mostly involve the anterior and posterior temporal lobe. Associative relations engaged the angular and the posterior middle temporal gyrus. Moreover, we found that hand posture and kinematics both tapped into the inferior parietal lobe and the lateral occipital temporal cortex, but no region specificity was found for one or the other representation. Our results point out the major role of both posterior middle temporal gyrus and inferior parietal lobe for action and semantic tool knowledge. They highlight the common and distinct brain networks involved in action and semantic tool networks and spur future directions on this topic.

The analgesic efficacy and safety of 2 phase 2b studies of EMA401 (a highly selective angiotensin II type 2 receptor antagonist) in patients with postherpetic neuralgia (EMPHENE) and painful diabetic neuropathy (EMPADINE) were reported. These were multicentre, randomised, double-blind treatment studies conducted in participants with postherpetic neuralgia or type I/II diabetes mellitus with painful distal symmetrical sensorimotor neuropathy. Participants were randomised 1:1:1 to either placebo, EMA401 25 mg, or 100 mg twice daily (b.i.d) in the EMPHENE and 1:1 to placebo or EMA401 100 mg b.i.d. in the EMPADINE. The primary outcome for both the studies was change in weekly mean of the 24-hour average pain score, using a numeric rating scale from baseline to week 12. Both the studies were prematurely terminated due to preclinical hepatotoxicity on long-term dosing, although not observed in these studies. Out of the planned participants, a total of 129/360 (EMPHENE) and 137/400 (EMPADINE) participants were enrolled. The least square mean reduction in numeric rating scale pain score was numerically in favour of EMA401 100 mg arm in both EMPHENE (treatment difference: -0.5 [95% confidence interval: -1.6 to 0.6; P value: 0.35]) and EMPADINE (treatment difference: -0.6 [95% confidence interval: -1.4 to 0.1; P value: 0.10]) at the end of week 12. However, as the studies were terminated prematurely, no firm conclusion could be drawn but the consistent clinical improvement in pain intensity reduction across these 2 studies in 2 different populations is worth noting.

Introduction Des analyses longitudinales sont necessaires pour mieux comprendre l’apparition des symptomes a long terme de la maladie a virus Ebola (MVE) chez les survivants. Les etudes precedentes ont rapporte des analyses transversales ponctuelles a chaque visite d’etude, ignorant l’evolution temporelle des symptomes et leur caractere intermittent entre les visites. L’objectif de cette etude etait d’estimer la prevalence et d’identifier les facteurs de risque associes a l’apparition des symptomes chez les survivants de la MVE en Guinee. Methodes Il s’agissait d’une etude de cohorte prospective de personnes declarees gueries de la MVE en Guinee (PosEtboGui). Chaque patient a beneficie d’une consultation a l’inclusion et tous les six mois jusqu’a 48 mois. Une premiere publication a ete realisee sur les symptomes cliniques a l’inclusion. Dans cette analyse, etaient exclus les patients qui avaient moins de six mois de suivi. Les symptomes cliniques, leurs dates de debut et de fin ont ete enregistres a chaque visite. Les durees des episodes symptomatiques recurrents ont ete estimees en utilisant la methode de Turnbull adaptee pour les evenements censures par intervalles et en utilisant l’imputation multiple. Les estimations et leur Intervalle de confiance a 95 % (IC95 %) ont ete calculees selon la methode de Rubin en constituant cinq bases de donnees imputees et en tenant compte de la variance intra et inter. Une analyse multivariee par le modele de Cox a ete utilisee sur chaque base imputee pour analyser les facteurs de risque associes a l’apparition des symptomes et les estimations moyennes ont ete calculees avec leurs 95 %IC tenant a compte de l’incertitude liee au modele et au processus d’imputation. Resultats Sur 802 gueris de la cohorte, les analyses ont porte sur les donnees de 722 survivants. Parmi eux 320 (44 %) etaient des hommes et 585 (81 %) avaient plus de 18 ans (âge median : 28,7 ans ; intervalle interquartile [IIQ] : 19,6–39,7). Le suivi median des patients etait de 35,7 mois (IIQ : 31,3–41,6). Le nombre median de visites dans l’etude etait de 12 mois (IIQ : 10–16 mois). Au total, 98 % des 722 patients ont signale au moins un symptome au cours du suivi. Dans l’ensemble, la prevalence de tous les symptomes diminue significativement avec le temps, mais les symptomes restent presents 48 mois apres la sortie du CTE, avec une prevalence de 30,68 % (IC95 % : 21,40–39,96) pour les symptomes abdominaux, 30,55 % (IC95 % : 20,68–40,41) pour les symptomes neurologiques, 5,80 % (IC95 % : 1,96–9,65) pour les symptomes musculosquelettiques et 4,24 % (IC95 % : 2,26–6,23) pour les symptomes oculaires. La moitie des patients (50,70 % ; IC95 % : 47,26–54,14) se sont plaints de symptomes generaux deux ans apres leur sortie du CTE et 25,35 % (IC95 % : 23,63–27,07) quatre ans apres leur sortie du CTE. L’hemorragie (rapport de risque [HR] : 2,70 ; p = 0,007), les symptomes neurologiques (HR : 2,63 ; p = 0,021) et generaux (HR 0,34 ; p = 0,003) dans la phase aigue de la maladie etaient independamment associes a la persistance des symptomes oculaires, tandis que l’hemorragie (HR : 1,91 ; p = 0,046) et les douleurs abdominales (HR : 2,21 ; p = 0,033) de la phase aigue etaient significativement associes a la persistance des symptomes musculosquelettiques. Conclusion Les conclusions de cette etude apportent un nouvel eclairage sur les complications cliniques a long terme de la MVE et leur association significative avec les symptomes dans la phase aigue et renforce la necessite d’un suivi regulier et adapte aux survivants de MVE.

Permanently crosslinked polymer networks, such as fully cured thermosets derived from fossil-based epoxies, cannot be reuse after damage and/or recycled since they cannot be reprocessed by heating or solubilization as non-crosslinked thermoplastics. As a result, they are not really sustainable materials, generating non-renewable resources consumption, CO2 emissions and plastic pollution. Herein we employed a strategy to tackle the lack of sustainability in conventional thermosets by the development of a promising partially biobased epoxy for numerous applications, integrating a covalent adaptable network using associative dynamic chemistry and catalyst free mechanism. This strategy is based in two sustainable approaches. First, vegetal biomass has been used as a renewable resource for the synthesis of epoxy systems from epoxidized eugenol oil. Then, the crosslinking reaction with a diamine integrating disulfide bonds to attain a thermally induced reorganizable eugenol-derived epoxy network in a dynamic way by disulfide metathesis reaction. The viscoelastic behavior characterization of eugenol-derived epoxy network displays a fast macroscopic flow with a stress relaxation time of 37 s at 230 °C, suggesting an interesting melt-reprocessability of this network at high temperatures in short times. Moreover, this strategy has a strong potential for the progress of sustainable plastic applications as yield a synthetic procedure to develop stiff thermosets (storage modulus of around 1 GPa at glassy state) with high renewable carbon contents (around 70 wt%), enhanced thermal properties (Tg of around 190 °C) and additional properties such as promising reshaping, repairing and recycling capability.

In PARADIGM-HF, sacubitril/valsartan demonstrated superiority to enalapril in reducing mortality and morbidity in patients with heart failure (HF) with reduced ejection fraction (HFrEF). Several patient-centred outcomes like improved physical activity and quality of life have been emphasised as important treatment goals in HF management. OUTSTEP-HF has been designed to evaluate the effect of sacubitril/valsartan compared with enalapril on non-sedentary daytime physical activity in patients with HFrEF.OUTSTEP-HF is a randomised, actively controlled, double-blind, double-dummy study that plans to enrol 600 ambulatory patients with symptomatic HFrEF in 19 European countries. Patients will be randomised 1:1 to receive sacubitril/valsartan 97/103 mg bid or enalapril 10 mg bid. The primary objective of the study is to assess changes from baseline (Week 0) to Week 12 in exercise capacity measured by the 6-min walk test and in daily non-sedentary daytime activity. Physical activity and objective sleep parameters will be measured by accelerometry using a wrist-worn device, worn continuously from screening (Week -2) until the end of study (Week 12). As a co-primary outcome, changes from baseline in sub-maximal exercise capacity will be assessed by the 6-min walk test. Patient- and physician-reported questionnaires will be used to assess quality of life, changes in signs and symptoms of HF and sleep parameters.OUTSTEP-HF will be the largest randomised trial in HF to date to use non-invasive accelerometry to assess whether treatment with sacubitril/valsartan improves patients' daily physical activity and exercise capacity compared with enalapril.

Objective and Background: Men’s experiences of first-fatherhood discovery differ widely with various circumstances; they were examined according to the intended/unintended occurrence of partner’s p...

Additional file 1. Questionnaire. questionnaire used in the study.

International audience; Motivated by the potential devastating effect of a COVID-19 outbreak in retirement homes and long-term facilities for dependent elderly, we present the impact of worst-case scenarios in French institutions using a specific age structure and case-age fatality ratios. The death toll could equal the yearly death toll caused by seasonal influenza in those older than 65 years or could largely exceed that, depending on the final attack rate and proportion of infected institutions.

Traduction par N. Bacaer de l'article en anglais paru dans Eurosurveillance vol 25 n15; Les rapports sur l'épidémie de maladie à coronavirus (COVID-19) en Chine ont identifié la vieillesse comme un prédicteur de gravité et de mortalité [1]. Une analyse rétrospective des données de cas individuels en Chine et ailleurs a montré un très fort gradient d'âge dans le taux de mortalité par infection (IFR) et le taux de létalité (CFR) [2]. En France, au 15 mars 2020, les personnes de plus de 75 ans représentaient 20% des cas confirmés mais 79% des décès [3]. Les maladies cardiovasculaires, l'hypertension et le diabète sucré étaient les comorbidités les plus fréquemment associées au COVID-19, et de nombreux patients sont décédés de leurs comorbidités d'origine [4 , 5]. Toutes ces comorbidités sont très fréquentes chez les personnes âgées dépendantes hébergées en institution. À l'aide de calculs simples, nous présentons ici l'impact de plusieurs scénarios du pire dans les établissements français.

Aim In PARADIGM-HF, sacubitril/valsartan demonstrated superiority to enalapril in reducing mortality and morbidity in patients with heart failure (HF) with reduced ejection fraction (HFrEF). Several patient-centred outcomes like improved physical activity and quality of life have been emphasised as important treatment goals in HF management. OUTSTEP-HF has been designed to evaluate the effect of sacubitril/valsartan compared with enalapril on non-sedentary daytime physical activity in patients with HFrEF. Methods OUTSTEP-HF is a randomised, actively controlled, double-blind, double-dummy study that plans to enrol 600 ambulatory patients with symptomatic HFrEF in 19 European countries. Patients will be randomised 1:1 to receive sacubitril/valsartan 97/103 mg bid or enalapril 10 mg bid. The primary objective of the study is to assess changes from baseline (Week 0) to Week 12 in exercise capacity measured by the 6-min walk test and in daily non-sedentary daytime activity. Physical activity and objective sleep parameters will be measured by accelerometry using a wrist-worn device, worn continuously from screening (Week -2) until the end of study (Week 12). As a co-primary outcome, changes from baseline in sub-maximal exercise capacity will be assessed by the 6-min walk test. Patient- and physician-reported questionnaires will be used to assess quality of life, changes in signs and symptoms of HF and sleep parameters. Conclusion OUTSTEP-HF will be the largest randomised trial in HF to date to use non-invasive accelerometry to assess whether treatment with sacubitril/valsartan improves patients daily physical activity and exercise capacity compared with enalapril. Funding Agencies|Novartis Pharma AG

International audience; The epithelial ovarian cancer is one of the most lethal gynecological malignancy due to its late diagnostic and many relapses observed after first line of treatment. Once diagnose, the most important prognostic factor is the completeness of cytoreductive surgery. To achieve this goal, surgeons have to pinpoint and remove nodules, especially the smallest nodules. Recent advances in fluorescence-guided surgery led us to develop a recombinant lectin as a nanoprobe for the microscopic detection of nodules in the peritoneal cavity of tumor-bearing mice. This lectin has an intrinsic specificity for a carcinoma-associated glycan biomarker, the Thomsen-Friedenreich antigen. In this study, after its labelling by a near infrared dye, we first demonstrated that this nanoprobe allowed indirect detection of nodules already implanted in the peritoneal cavity, through tumor microenvironment targeting. Secondly, in a protocol mimicking the scattering of cells during surgery, we obtained a direct and long-lasting detection of tumor cells in vivo. This lectin as already been described as a nanocontainer able to do targeted delivery of a therapeutic compound to carcinoma cells. Future developments will focus on the combination of the nanoprobe and nanocontainer aspects in an intraperitoneal nanotheranostic approach.

While investigation on family estrangement is growing within the academic circles (Agllias 2015, 2016; Blake 2017; Authors), research regarding the interconnection between experiences of estrangement and higher education is still very limited. Existing literature is largely in the form of policy briefings and recommendations, in particular in relation to funding from UK bodies such as the Student Loans Company (SLC) and the Student Awards Agency for Scotland (SAAS) (StandAlone 2015). Moreover, most research on estranged students has been carried out by Stand Alone, a charity whose core goal is to support estranged adults generally. As such, a deeper and wider understanding of estranged students’ experiences is important in also foregrounding their voices and perspectives. Here, we report on a qualitative study on the experiences of higher education students who are estranged from their family, investigating how estranged students develop a sense of identity in the context of their academic lives. The paper borrows from Goffman’s work on stigma and identity management and Bourdieu’s work on capitals to cast a critical perspective on research participants’ accounts. The combination of Goffman’s and Bourdieu’s work makes an important theoretical contribution here as it allows for the conceptualisation of estranged students’ access to or lack of resources (capitals) in relation to what Goffman calls a ‘spoiled identity’. The scarcity of knowledge in this area impels us to hybridise different concepts as a form of achieving a greater depth of understanding (author 1, forthcoming) of the phenomenon at hand. The stigmatisation of estrangement is intrinsically connected to the logic of capitals that prevails in academia and which allows for forms of distinction and differentiation among peers. This introduction is followed by a review of literature on estrangement and its connection to higher education, followed by an outline of the methodology underpinning the study and finally, a discussion of findings as informed by combining Goffman’s concept of stigma and Bourdieu’s understandings of capitals.

Background In most health areas, an information system is necessary for an effective fight against COVID-19. Current methods for surveillance of diseases with epidemic potential do not include monitoring the adherence to preventive measures. Furthermore, modern data collection methods depend often on technologies (e.g., cameras or drones) that are hardly available in low-income countries. Simpler solutions could be just as effective. Methods A dashboard was used over a whole week to monitor preventive measures in Bukavu (DRC) by mid-May 2020. It was designed to collect from street passers-by information on the adherence to barrier measures, the level of awareness of these measures, the opinion on their usefulness, and the health status of people in the households. Results Creating a dashboard and collecting the necessary data proved feasible. The use of barrier measures was very limited and that of masks practically nil despite repeated recommendations from the health authorities. The end of each day was the worst moment due to clearly insufficient distancing. Barrier measures were significantly more used in areas where they were best known and most acknowledged. At the time of the study, there were few sick people and only rare severe cases were attributed to COVID-19. Conclusions Creating COVID-19 situation dashboards in limited-resource metropoles is feasible. They give real-time access to data that help fight the epidemic. The findings of this pilot study call for a rapid community awareness actions to back national media-based prevention campaigns.

Background All patients with lower extremity peripheral arterial disease (LE-PAD) should benefit from recommended pharmacologic therapies including antiplatelet agents, angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), and HMG-CoA-reductase inhibitors (statins). In the present study, this triple therapy was defined as the best medical treatment. This study was designed to determine the current risk of cardiovascular (CV) events and mortality and also to evaluate the effect of pharmacologic treatment on patient's survival, CV events, and additional vascular surgery in vascularized LE-PAD patients. This observational, cohort study analyzed prospectively collected data of 140 consecutive patients after hospitalization for LE-PAD revascularization in the vascular surgery department of our university hospital, between January 1 and June 30, 2013. Methods Data from guideline-recommended classes of medications (ACE, ARB, statins, and antiplatelet agents or anticoagulation) were collected at the time of discharge to hospitalization and at the end of the follow-up. Information about mortality, CV events, and additional vascular surgery was collected during follow-up. Results The mean follow-up of patients was 41 months. Mortality and CV events concerned 24% and 12% of the patients, respectively, and additional vascular surgery was performed in 33% of the patients. There was no difference in mortality and CV event rates according to pharmacologic treatment. Additional vascular surgery rate of LE-PAD patients with best medical treatment tended to be lower than without (incidence rate ratio = 0.5777; 95% confidence interval, 0.3101–1.06; P = 0.08). Best medical treatment was prescribed in 54% of patients at discharge of hospitalization. This proportion (54%) was statistically unchanged at the end of follow-up. Conclusions In this small cohort, we failed to show that best medical treatment decreased mortality or CV event rates, but it tended to be associated with decreased additional vascular surgery rate. Further studies taking into consideration the control of CV risk factors could be interesting to demonstrate better outcome from LE-PAD patients with best medical treatment compared with LE-PAD patients without. There is an urgent need for a more effective implementation of currently recommended medication and a continued search after more effective pharmacologic treatment options in LE-PAD.

Background and objectivesIdentifying virilisation of the genitalia in female newborns early during the neonatal period is important to diagnose pathologies. However, there is no clear threshold for clitoromegaly or for the anogenital ratio. The objective of this study was to define reference values for the external genitalia of full-term and pre-term female neonates.DesignThis was a prospective study of all females born in the study centre between May 2014 and July 2016. Clitoral length and anogenital ratio were measured in 619 newborns with a gestational age of 24+2 to 41+3 weeks during their first 3 days of life. Associations between the values at day 3 and gestational age, birth weight and other newborn characteristics were examined by linear regression.ResultsThe mean clitoral length at day 3 of life was 3.69±1.53 mm (n=551; 95th percentile, 6.5 mm; maximum, 8 mm), and the mean anogenital ratio was 0.42±0.09 (95th percentile, 0.58). There was no significant variation with gestational age or birth weight, and no significant difference between the results at day 0 and day 3.ConclusionThese results suggest that clitoromegaly can be defined as a clitoral length >6.5 mm. Values ≥8 mm should prompt further investigations. An anogenital ratio >0.6 should be considered a sign of virilisation. Since clitoral size does not vary with gestational age or birth weight, clitoromegaly should not be attributed to prematurity.

Low muscle mass and strength are associated with poor bone microarchitecture. We studied the association of muscle mass and strength with changes in bone microarchitecture of distal radius in 821 older men during an 8-year prospective follow-up. Bone microarchitecture was assessed by high resolution peripheral quantitative computed tomography (XtremeCT-1, Scanco) at baseline, then after 4 and 8 years. Relative appendicular lean mass of the upper limbs (RALM-u.l.) was calculated as DXA-measured lean mass of upper limbs divided by (height)2 . Relative grip strength was calculated as grip strength divided by height. Decrease in bone mineral content (BMC), total volumetric bone mineral density (Tt.vBMD), cortical thickness (Ct.Th), cortical area (Ct.Ar) and cortical vBMD (Ct.vBMD) accelerated with age. Trabecular area (Tb.Ar) expansion and trabecular bone deterioration accelerated with age. Men in the first RALM-u.l. quartile had more rapid loss of BMC, Tt.vBMD, Ct.Th, Ct.vBMD and Ct.Ar vs. the highest quartile. They had more rapid increase in Tb.Ar. Men in the lowest quartile of grip strength had greater decrease in BMC, Tt.vBMD, Ct.Th, Ct.vBMD, Ct.Ar, and greater increase in Tb.Ar vs. the highest quartile. In the models including ALM-u.l. and grip strength (not corrected for height), both muscle-related variables were associated with more rapid bone microarchitectural deterioration (slightly more so for grip strength). Trabecular vBMD (Tb.vBMD) and Central.Tb.vBMD increased in men having higher muscle mass and strength. Trends in trabecular number and thickness did not differ across the groups in all the analyses. Thus, in men, aging-related deterioration of bone microarchitecture was most rapid after the age of 80. Low grip strength (and slightly more weakly low RALM-u.l.) is associated with the more rapid decrease in Tt.vBMD and cortical variables, and with greater Tb.Ar expansion. In conclusion, dynapenia and sarcopenia contribute to the deterioration of bone microarchitecture in older men. © 2018 American Society for Bone and Mineral Research.

Summary Background: Even in normally cycling women, hormone level shapes may widely vary between cycles and between women. Over decades, finding ways to characterize and compare cycle hormone waves was difficult and most solutions, in particular polynomials or splines, do not correspond to physiologically meaningful parameters. Objective: We present an original concept to characterize most hormone waves with only two parameters. Methods: The modelling attempt considered pregnanediol-3-alpha-glucuronide (PDG) and luteinising hormone (LH) levels in 266 cycles (with ultrasound-identified ovulation day) in 99 normally fertile women aged 18 to 45. The study searched for a convenient wave description process and carried out an extended search for the best fitting density distribution. Results: The highly flexible beta-binomial distribution offered the best fit of most hormone waves and required only two readily available and understandable wave parameters: location and scale. In bell-shaped waves (e.g., PDG curves), early peaks may be fitted with a low location parameter and a low scale parameter; plateau shapes are obtained with higher scale parameters. I-shaped, J-shaped, and U-shaped waves (sometimes the shapes of LH curves) may be fitted with high scale parameter and, respectively, low, high, and medium location parameter. These location and scale parameters will be later correlated with feminine physiological events. Conclusion: Our results demonstrate that, with unimodal waves, complex methods (e.g., functional mixed effects models using smoothing splines, second-order growth mixture models, or functional principal-component- based methods) may be avoided. The use, application, and, especially, result interpretation of four-parameter analyses might be advantageous within the context of feminine physiological events.