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Elemental enteral nutrition (EEN) decreases gut-associated lymphoid tissue (GALT) function, including fewer Peyer's patch lymphocytes and lower levels of the tissue T helper 2 (Th2) cytokines and mucosal transport protein polymeric immunoglobulin receptor (pIgR), leading to lower luminal secretory immunoglobulin A (sIgA) levels. Since we recently demonstrated that cranberry proanthocyanidins (PACs) maintain the Th2 cytokine interleukin (IL)-4 when added to EEN, we hypothesized the addition of PACs to EEN would normalize other GALT parameters and maintain luminal levels of sIgA.Institute of Cancer Research mice were randomized (12/group) to receive chow, EEN, or EEN + PACs (100 mg/kg body weight) for 5 days, starting 2 days after intragastric cannulation. Ileum tissue was collected to measure IL-4 by enzyme-linked immunosorbent assay, pIgR by Western blot, and phosphorylated STAT-6 by microarray. Intestinal wash fluid was collected to measure sIgA by Western blot.Compared with chow, EEN significantly decreased tissue IL-4, phosphorylated STAT-6, and pIgR. The addition of PACs to EEN prevented these alterations. Compared with chow, EEN resulted in significantly lower levels of luminal sIgA. The addition of PACs to EEN increased luminal sIgA levels compared with EEN alone.This study suggests the addition of PACs to EEN may support GALT function and maintain intestinal sIgA levels compared with EEN administration alone.

Background Parenteral nutrition (PN) increases infectious risk in critically ill patients compared with enteral feeding. Previously, we demonstrated that PN feeding suppresses the concentration of the Paneth cell antimicrobial protein secretory phospholipase A2 (sPLA2) in the gut lumen. sPLA2 and other Paneth cell proteins are released in response to bacterial components, such as lipopolysaccharide (LPS), and they modulate the intestinal microbiome. Because the Paneth cell protein sPLA2 was suppressed with PN feeding, we hypothesized PN would diminish the responsiveness of the small bowel to LPS through reduced secretions and as a result exhibit less bactericidal activity. Methods The distal ileum was harvested from Institute of Cancer Research mice, washed, and randomized for incubation with LPS (0, 1, or 10 μg/mL). Culture supernatant was collected and sPLA2 activity was measured. Bactericidal activity of the ileum segment secretions was assessed against Pseudomonas aeruginosa with and without an sPLA2 inhibitor at 2 concentrations, 100 nmol/L and 1 μmol/L. Institute of Cancer Research mice were randomized to chow or PN for 5 days. Tissue was collected for immunohistochemistry (IHC) and ileal segments were incubated with LPS (0 or 10 μg/mL). sPLA2 activity and bactericidal activity were measured in secretions from ileal segments. Results Ileal segments responded to 10 μg/mL LPS with significantly greater sPLA2 activity and bactericidal activity. The bactericidal activity of secretions from LPS stimulated tissue was suppressed 50% and 70%, respectively, with the addition of the sPLA2-inhibitor. Chow displayed greater sPLA2 in the Paneth cell granules and secreted higher levels of sPLA2 than PN before and after LPS. Accordingly, media collected from chow was more bactericidal than PN. IHC confirmed a reduction in Paneth cell granules after PN. Conclusion This work demonstrates that ileal segments secrete bactericidal secretions after LPS exposure and the inhibition of the Paneth cell antimicrobial protein sPLA2 significantly diminishes this. PN feeding resulted in suppressed secretion of the sPLA2 and resulted in increased bacterial survival. This demonstrates that PN significantly impairs the innate immune response by suppressing Paneth cell function.

Parenteral nutrition (PN) is a lifesaving therapy that provides intravenous nutrition support to patients who cannot, or should not, feed via the gastrointestinal (GI) tract. Unfortunately, PN also carries certain risks related to infection and metabolic complications compared with enteral nutrition. In this review, an overview of PN and GI immune and microbiome changes is provided. PN impacts the gut-associated lymphoid tissue functions, especially adaptive immune cells, changes the intestinal epithelium and chemical secretions, and significantly alters the intestinal microbiome. Collectively, these changes functionally result in increased susceptibility to infectious and injurious challenge. Since PN remains necessary in large numbers of patients, the search to improve outcomes by stimulating GI immune function during PN remains of interest. This review closes by describing recent advances in using enteric nervous system neuropeptides or microbially derived products during PN, which may improve GI parameters by maintaining immunity and physiology.

Two-particle angular correlations in jet cones have been measured in e(+)e(-) annihilation into hadrons at LEP energies (root s = 91 and 183 GeV) and are compared with QCD predictions using the LPHD hypothesis. Two different functions have been tested. While the differentially normalized correlation function shows substantial deviations from the predictions, a globally normalized correlation function agrees well. The size of alpha(s)(eff) land other QCD parameters) and its running with the relevant angular scale, the validity of LPHD, and problems due to non-perturbative effects are discussed critically. (C) 1998 Elsevier Science B.V. All rights reserved.

Bose-Einstein correlation between pairs of like-sign charged particles produced in e+e- annihilations near the Z0 peak have been studied using data taken with the DELPHI detector at LEP. An enhancement is found in the production of pairs of identical pions of similar moments, with respect to a reference sample. Under the hypothesis that the pions are emitted by a spherically symmetrical source with gaussian density, the data indicate a radius of the source of r = 0.62±0.04(stat.)±0.20(syst.) fm. The large systematic uncertainty reflects the sensitivity of r to the choice of the reference sample, 0, info:eu-repo/semantics/published

The metabolic benefits induced by gastric bypass, currently the most effective treatment for morbid obesity, are associated with bile acid (BA) delivery to the distal intestine. However, mechanistic insights into BA signaling in the mediation of metabolic benefits remain an area of study. The bile diversion () mouse model, in which the gallbladder is anastomosed to the distal jejunum, was used to test the specific role of BA in the regulation of glucose and lipid homeostasis. Metabolic phenotype, including body weight and composition, glucose tolerance, energy expenditure, thermogenesis genes, total BA and BA composition in the circulation and portal vein, and gut microbiota were examined. BD improves the metabolic phenotype, which is in accord with increased circulating primary BAs and regulation of enterohormones. BD-induced hypertrophy of the proximal intestine in the absence of BA was reversed by BA oral gavage, but without influencing BD metabolic benefits. BD-enhanced energy expenditure was associated with elevated TGR5, D2, and thermogenic genes, including UCP1, PRDM16, PGC-1α, PGC-1β, and PDGFRα in epididymal white adipose tissue (WAT) and inguinal WAT, but not in brown adipose tissue. BD resulted in an altered gut microbiota profile (i.e., Firmicutes bacteria were decreased, Bacteroidetes were increased, and Akkermansia was positively correlated with higher levels of circulating primary BAs). Our study demonstrates that enhancement of BA signaling regulates glucose and lipid homeostasis, promotes thermogenesis, and modulates the gut microbiota, which collectively resulted in an improved metabolic phenotype.

A strong scientific workforce is critical to overcoming challenges presented by the 21st century. Among the problems currently facing research - including diminished research funding, impaired grant peer-review processes, and skewed publishing incentives - the concept of a postdoc crisis within the academic workforce has been increasingly recognized. Here, an argument is made for greater data collection on the postdoc community - for which very few metrics are known - so that needed policy decisions in the future are better informed to improve training and help strengthen all aspects of the US scientific workforce.

International audience; We have used the medium energy ion scattering (MEIS) technique to assess the strain relaxation in molecular-beam epitaxial (MBE) grown CdTe (211)/Ge (211) system. A previous X-ray diffraction study, on 10 samples of the same heterostructure having thicknesses ranging from 25 nm to 10 mu m has allowed the measurement of the strain relaxation on a large scale. However, the X-ray diffraction measurements cannot achieve a stress measurement in close proximity to the CdTe/Ge interface at the nanometer scale. Due to the huge lattice misfit between the CdTe and Ge, a high degree of disorder is expected at the interface. The MEIS in channeling mode is a good alternative in order to profile defects with a high depth resolution. For a 21 nm thick CdTe layer, we observed, at the interface, a high density of Cd and/or Te atoms moved from their expected crystallographic positions followed by a rapid recombination of defects. Strain relaxation mechanisms in the vicinity of the interface are discussed (C) 2016 Elsevier B.V. All rights reserved.

In 1909, Millikan showed that the charge of electrically isolated systems is quantized in units of the elementary electron charge e. Today, the persistence of charge quantization in small, weakly connected conductors allows for circuits where single electrons are manipulated, with applications in e.g. metrology, detectors and thermometry. However, quantum fluctuations progressively reduce the discreteness of charge as the connection strength is increased. Here we report on the full quantum control and characterization of charge quantization. By using semiconductor-based tunable elemental conduction channels to connect a micrometer-scale metallic island, the complete evolution is explored while scanning the entire range of connection strengths, from tunnel barrier to ballistic contact. We observe a robust scaling of charge quantization as the square root of the residual electron reflection probability across a quantum channel when approaching the ballistic critical point, which also applies beyond the regimes yet accessible to theory. At increased temperatures, the thermal fluctuations result in an exponential suppression of charge quantization as well as in a universal square root scaling, for arbitrary connection strengths, in agreement with expectations. Besides direct applications to improve single-electron functionalities and for the metal-semiconductor hybrids emerging in the quest toward topological quantum computing, the knowledge of the quantum laws of electricity will be essential for the quantum engineering of future nanoelectronic devices., Letter and Methods; See also Nature News & Views: Y. Nazarov, Nature 536, 38 (2016)

Lamina propria Th2 cytokines, interleukin (IL)-4 and IL-13, stimulate goblet cell (GC) proliferation and MUC2 production, which protect the intestinal mucosa. Elemental enteral nutrition (EEN) reduces tissue IL-4 and impairs barrier function. Proanthocyanidins (PACs) stimulate oral mucin levels. We hypothesized that adding PAC to EEN would maintain Th2-without stimulating Th1-cytokines and preserve luminal MUC2 vs EEN alone.Seventy mice were randomized to 5 diet groups-standard chow, intragastric EEN, or EEN with lowPAC, midPAC (50 mg), or highPAC (100 mg PAC/kg BW)-for 5 days, starting 2 days after gastric cannulation. Ileal tissue was analyzed for histomorphology and the cytokines IL-4, IL-13, IL-1β, IL-6, and TNF-α by enzyme-linked immunosorbent assay. MUC2 was measured in intestinal washes.EEN lowered IL-13 (P.05) compared with standard chow, whereas IL-4 was not significant (P.07). LowPAC and midPAC increased IL-13 (P.05), whereas highPAC increased both IL-4 and IL-13 (P.05) compared with EEN. All EEN diets reduced (P.05) crypt depth compared with the chow group. Compared with standard chow, GC numbers and luminal MUC2 were reduced with EEN (P.05). These effects were attenuated (P.05) with midPAC and highPAC. No changes were observed in tissue Th1 cytokines.Adding PACs to EEN reverses impaired intestinal barrier function following EEN by improving the gut mucous layer and function through increased GC size and number as well as levels of MUC2 and ileal IL-4 and IL-13.

Resume La laparoscopie est une voie d’abord qui est generatrice de nouvelles complications. Un tiers des complications est secondaire a la creation d’un pneumoperitoine. La procedure laparosocopique initiale debute par la mise en place d’un pneumoperitoine qui peut se faire soit par un trocart d’open cœlio, soit par l’utilisation d’une methode fermee a l’aide d’une aiguille de Veress, puis introduction d’un trocart ou l’introduction directe du trocart sans pneumoperitoine prealable. Lors de cette derniere technique, les complications peuvent survenir lors de l’introduction de l’aiguille de Veress ou le plus souvent lors de l’introduction du trocart ombilical. Nous avons aborde uniquement les problemes de la creation d’un pneumoperitoine par une technique fermee et les tests de securite. La ponction a l’aiguille de Palmer dans l’hypochondre gauche chez un patient en decubitus dorsal semble etre la technique la plus sure. Parmi les quatre tests de securite pour l’analyse du bon placement de l’aiguille de Veress (double « clic », test a la seringue, test d’aspiration, pression initiale avant insufflation) pour l’insufflation, seul le test de verification de la pression semble posseder une valeur diagnostique. Celui-ci consiste a mesurer les cinq premieres pressions enregistrees par l’insufflateur a cinq secondes d’intervalle et qui doivent etre inferieures a 10 mmHg avec une pression d’insufflation de 1 L/min, chez un patient bien curarise. L’hyperpression transitoire de 25 mmHg permet l’introduction du premier trocart dans les meilleures conditions de securite. A ce jour, malgre l’absence d’augmentation significative de plaie digestive ou vasculaire lors de l’introduction d’un trocart sans pneumoperitoine, il n’existe pas de test de securite pour sa mise en place.

Background: The function of secretory phospholipase A2 (sPLA2) is site dependent. In tissue, sPLA2 regulates eicosanoid produc- tion; in circulation, sPLA2 primes neutrophils; and in the intes- tinal lumen, sPLA2 provides innate bactericidal immunity as a defensin-related protein. Since parenteral nutrition (PN) primes leukocytes while suppressing intraluminal mucosal immunity, the authors hypothesized that (1) PN would diminish luminal sPLA2 activity but increase activity in intestinal tissue and serum and (2) stress would accentuate these changes. Methods: Mice received chow, a complex enteral diet (CED), intragastric PN (IG-PN), or PN in experiment 1 and chow, chow+stress, PN, or PN+stress in experiment 2. Results: In experiment 1, luminal sPLA2 activity was greatest in chow and decreased in CED, IG-PN, and PN, with PN lower than CED and IG-PN. Compared to that after chow, serum sPLA2 activity dropped after CED, IG-PN, and PN. Serum sPLA2 was higher in portal than systemic serum. In experiment 2, PN lowered luminal sPLA2 activity vs chow. Stress lowered luminal sPLA2 activity in chow, without change in PN. Following stress, luminal immu- noglobulin A increased in chow but not PN. Serum sPLA2 activity increased in PN. Conclusions: PN attenuates sPLA2 activity in intestinal fluid, consistent with suppressed innate mucosal defense. Stress suppresses luminal fluid sPLA2 activity in chow but not the immunoglobulin A response; PN impairs both. Stress significantly elevates serum sPLA2 in PN-fed mice, consistent with known increased neutrophil priming with PN. PN reduces innate bactericidal immunity of the gut but upregu- lates serum proinflammatory products poststress. (JPEN J Parenter Enteral Nutr. 2011;35:748-756)

The mucosal associated lymphoid tissue (MALT) provides the specific immune protection of moist mucosal surfaces and constitutes the largest immune organ outside the liver and spleen. It produces IgA to protect against the huge load of bacteria and toxins within the gut lumen as well as the normally sterile pulmonary tissue. Naive T&B cells destined for mucosal immunity express two integrins - L-selectin and α4β7 – directing them into Peyer's patches (PP) of the small intestine via interaction with mucosal addressin cellular adhesion molecule-1 (MAdCAM-1), a molecule expressed on the high endothelial venules of the Peyer's patches. 1,2 Regional chemokines stimulate migration of the cells into the Peyer's patches: CCL19 regulates T-cell entry, CCL-25 recruits antibody-secreting cells, and CCL-20 recruits dendritic cells.3 The T&B cells are sensitized in PP to luminal antigens absorbed by specialized M cells covering the PP.4 Our previous work shows that blockade of either the integrins- L-selectin and α4β7 - or the adhesion molecule- MAdCAM-1 - reduces cell entry into MALT, reduces secretory IgA and impair of mucosal immune protection.1,2 This work examines the specific pathways involved in this entry. Lymphotoxin β receptor (LTβR) expressed in the endothelial surfaces of PPs control production of nuclear factor-kappa B (NF-κB) which is the key transcriptional regulator of these critical entry molecules in vitro. Normally, lymphotoxin α and β (LT α1β2) expressed on activated T&B cells stimulates the lymphotoxin β receptor (LTβR).5 This interaction activates NF-κB via the non-canonical pathway to produce MAdCAM-1, cytokines, and the specific chemokines critical to cell entry and function3. LTβR deficient (LTβR -/-) mice lack PP and lymph nodes and express low levels of MAdCAM-1, CCL-20, CCL25, and CXCL13. These mice also have lower levels of two Th-2 type IgA-stimulating cytokines, IL-4 & IL-10, and IgA itself. We and others showed that administration of a fusion protein which blocks LTβR interfering with this LTβR/ lymphotoxin interaction reduced the size and numbers of lymphocytes in PP. 5,6. PN also interferes with this sequence. Our previous work3,7-9 demonstrated that PN feeding decreases the number of PP lymphocytes and the mRNA or/and protein levels of MAdCAM-1, CCL-20, CCL25, CXCL13 as well as LTβR itself compared to chow fed mice. The administration of a stimulatory (agonistic) LTβR antibody to PN mice prevented the reduction in PP lymphocytes and intestinal IgA.7 Also, LTβR blockade in chow fed animals significantly reduced MAdCAM-1 mRNA level and PP lymphocyte mass. 6 In this work we hypothesized that the PN effects occurs through down-regulation of NF-κB pathway(s). Two distinct NF-κB activation pathways have been described (Figure 1).10 The canonical (classical) NF-κB pathway is activated by proinflammatory cytokines, toll like receptor (TLR) ligands, or stresses such as γ-radiation, ultraviolet light and oxidative stress. These stimuli induce degradation of IκBα and the nuclear accumulation of mainly p50–RelA (p65) dimer, which regulate the expression of immunoregulatory and anti-apoptotic genes but not the cell entry proteins. The pathway which we hypothesize is relevant to the PN changes is the non-canonical (alternative) NF-κB pathway which is activated by receptors involved in lymphoid organogenesis and lymphocyte development. Receptors such as LTβR induce processing of p100 to p52 and nuclear accumulation of p52–RelB dimmers. This non-canonical NF-κB pathway appears to control processes directing PP T&B cell entry. In this work, we define in detail the mechanisms of PN-induced immune deficits and hypothesize that PN negatively affects LTβR signaling via the non-canonical NF-κB pathway. To test this hypothesis, we quantified the inflammatory canonical NF-κB pathway products - p50 & p65- as well as the non-canonical NF-κB pathway products - p52 and Rel B levels – together with levels of MAdCAM-1, CCL-19, CCL20, CCL25, IL-4 and IL-10 in the PP of animals receiving PN or chow feeding. To establish cause and effect, we measured these same parameters in PN fed animals administrated an agonistic LTβR mAb and chow fed animals receiving LTβR blockade. Figure 1 NF-κB Signaling Pathways Methods Animals All experimental protocols were approved by the Animal Care and Use Committee of the University of Wisconsin–Madison and Middleton Veterans Administration Hospital, Madison, WI. Six-week-old, male mice from Institute of Cancer Research (Harlan, Indianapolis, IN) were used for the experiments. The mice were kept in an environment with controlled temperature, humidity, and light cycle (12-hour light/12-hour dark). They were acclimatized for 1 week and fed a standard mouse chow (PMI Nutrition International, St. Louis, MO) ad libitum before protocol entry. During feeding protocol, mice had free access to water and were individually housed in metal metabolism cages with wire grid floors to eliminate coprophagia.

Resume Introduction La symptomatologie dermatologique de la primo-infection par le parvovirus B19 est variable. Nous rapportons deux cas ou elle a ete revelee par un erytheme des grands plis similaire au « syndrome babouin » induit par divers medicaments, mais avec une inflexion purpurique ou œdemato-bulleuse. Observations Une femme de 23 ans, enceinte a 39 semaines d’amenorrhee, et une femme de 49 ans ont consulte pour une eruption des plis evoluant dans un contexte febrile. L’examen clinique montrait dans les deux cas une eruption erythemateuse des grands plis, particuliere chez la premiere par la presence de vesicules et d’elements purpuriques, et chez la seconde par une composante œdemato-bulleuse. Dans les deux cas, le diagnostic de primo-infection a parvovirus B19 etait affirme par la positivite de la recherche du genome viral en PCR et par une seroconversion apres 15 jours. Les lesions cutanees regressaient spontanement en quelques jours. Discussion Initialement rattache exclusivement a une cause toximedicamenteuse, le « syndrome babouin » est aujourd’hui rapporte a plusieurs etiologies (toxidermie, dermite de contact et causes infectieuses virales et streptococciques). Parmi ces dernieres, la primo-infection a parvovirus B19 merite d’etre consideree.

Resume Les diverses recommandations des societes savantes et l’analyse de la jurisprudence amenent a proposer les principes suivants pour la communication lors de la prise en charge des patientes en preeclampsie (PE). Ces principes concernent les professionnels et les femmes enceintes. Pour les premiers, dans le cadre d’un fonctionnement en reseau, il convient : – de sensibiliser les professionnels de proximite aux signes devant faire evoquer une PE ; – de favoriser le reperage des situations a haut risque de PE (antecedents de PE, nephropathie ou hypertension chronique) et l’elaboration d’une prise en charge concertee ; – de sensibiliser les equipes au controle de l’hypertension, en particulier systolique, a l’utilisation adequate du sulfate de magnesium, a l’organisation rapide de la naissance devant l’aggravation rapide d’une PE ou a l’issue d’une eclampsie ; – d’effectuer un examen autopsique en cas de deces maternel et/ou fœtal dans le cadre de complication de la PE ainsi qu’un examen du placenta. Pour les secondes, il faut insister sur : – l’incitation a consulter sans delai devant des signes evocateurs de PE, meme en l’absence d’antecedents ou de facteurs de risque particuliers ; – la diffusion precoce de l’information sur l’organisation des soins perinatals en reseau, et les possibilites de transfert in utero (entretien precoce, documents d’information des reseaux) ; – l’organisation d’une information idealement conjointe obstetricale et pediatrique lors des transferts in utero.

Preeclampsia, eclampsia and HELLP syndrome are severe complications of pregnancy associated with a high morbidity and mortality for both mother and foetus. The issue of prognosis with regards to risk of relapse is therefore of upmost importance for both the patients and doctors managing their subsequent pregnancies. The overall risk of relapse is estimated to be less than 10%. The risk is especially increased in case of early onset, before the 28(th) week of amenorrhea. In such patients, an underlying renal disease, essential hypertension or secondary hypertension might be identified. A renal consultation must ensure the complete resolution of the hypertension and proteinuria, otherwise investigations need to be carried out looking for an underlying renal or vascular disease affecting the renal parenchyma or outflow. Screening for a hereditary thrombophilia is performed in the immediate post-partum period following and early onset PE, especially if associated with an IUGR, fetal death, or in an early and severe relapse. A renal biopsy is only rarely considered: it is either performed within the first post-partum days whenever a systemic disease flare-up is suspected (i.e. SLE), or late if the proteinuria failed to settle beyond 6 months post-part. Severe PE is a marker of a vascular disease of short duration, but must be considered a risk factor for later atherosclerosis with cardiovascular complications, justifying long term cardiovascular, renal and metabolic follow-up.

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 39 - N° 3 - p. 246-250

The original article was updated to correct the listing of A. Hamy’s name; it is correct as displayed above.

A design of experiments (derived from the Taguchi method) was implemented to optimize experimental conditions of a surfactant free polyol method for the synthesis of PtCo electrocatalysts. Considered responses were the active surface area and the catalytic activity toward oxygen reduction reaction. Metallic salt concentration, pH, temperature ramp, addition order of reactants and particle cleaning step were chosen as main parameters according to considerations coming from literature and previous experiments. Matrix models describing the behaviour of the synthesis system was elaborated taking into account the effects of each considered parameter and their interactions. From this model, an optimized PtCo/C catalyst, in terms of active surface area and activity towards the oxygen reduction reaction, was synthesized. Both the measured values of the active surface area and the electrocatalytic activity are in very good agreement with the calculated ones from the matrix model. Furthermore, actions of parameters and interactions between parameters can be better understood using this method.

Resume Objectif Apprecier le taux d’intubation en salle de naissance des grands prematures nes par cesarienne avant travail, en fonction du type d’anesthesie maternelle (rachianesthesie versus anesthesie generale [AG]). Population et methode Deux cent dix-neuf grands prematures (28–32 semaines d’amenorrhee) nes vivants par cesarienne avant travail dans une des 27 maternites de 2 reseaux perinatals (Poitou-Charentes et Franche-Comte). Cent quatre-vingt-deux sur 219 (83 %) sont nes dans la maternite regionale de reference de type III. Resultats Parmi les grands prematures (73/219), 33,3 % ont beneficie d’une intubation en salle de naissance, quelle qu’en soit l’indication (mauvaise adaptation a la vie extra-uterine ou detresse respiratoire). Les grands prematures nes apres AG maternelle ont ete plus souvent intubes que les grands prematures nes apres rachianesthesie (48,7 % versus 25,2 % ; OR = 2,8 ; 95 % IC = 1,8–5,1). L’exces de risque d’intubation en salle de naissance lie a l’AG demeurait significatif apres ajustement sur le terme gestationnel, l’hypotrophie, l’existence d’une detresse respiratoire, le type de maternite de naissance et un score de propensite prenant en compte les caracteristiques maternelles et le mecanisme de grande prematurite (aOR = 3,4 ; IC 95 % = 1,4–8,2). La significativite de l’exces de risque d’intubation lie a l’AG devenait limite au seuil p = 0,05 apres ajustement sur le score d’Apgar (aOR = 2,8 ; IC 95 % = 1,0–7,3). Conclusion Cette etude prospective en population montre que les grands prematures nes par cesarienne sous AG sont plus souvent intubes en salle de naissance que ceux nes sous rachianesthesie. De par sa construction, elle ne peut etablir un lien de causalite entre type d’anesthesie maternelle et necessite d’intubation. Cependant, elle suggere qu’une attention particuliere doit etre portee au type d’anesthesie maternelle car il est susceptible d’interferer avec la strategie de ventilation non invasive du grand premature.

Heat transport has large potentialities to unveil new physics in mesoscopic systems. A striking illustration is the integer quantum Hall regime, where the robustness of Hall currents limits information accessible from charge transport. Consequently, the gapless edge excitations are incompletely understood. The effective edge states theory describes them as prototypal one-dimensional chiral fermions - a simple picture that explains a large body of observations and calls for quantum information experiments with quantum point contacts in the role of beam splitters. However, it is in ostensible disagreement with the prevailing theoretical framework that predicts, in most situations, additional gapless edge modes. Here, we present a setup which gives access to the energy distribution, and consequently to the energy current, in an edge channel brought out-of-equilibrium. This provides a stringent test of whether the additional states capture part of the injected energy. Our results show it is not the case and thereby demonstrate regarding energy transport, the quantum optics analogy of quantum point contacts and beam splitters. Beyond the quantum Hall regime, this novel spectroscopy technique opens a new window for heat transport and out-of-equilibrium experiments., Comment: 13 pages including supplementary information, Nature Physics in print

Objective The rate of venous thromboembolism in patients undergoing multimodality therapy for lung malignancy and the impact of preoperative venous thromboembolism on postoperative outcome have not been analyzed systematically. Methods We performed a retrospective review of all patients undergoing induction therapy before lung resection for non–small cell lung cancer and malignant pleural mesothelioma at the University Health Network between January 1996 and December 2007. Results Venous thromboembolism developed in 23 (12.3%) of 186 patients undergoing induction therapy. The venous thromboembolism was diagnosed during induction therapy in 11 patients. The proportion of pulmonary embolism was higher during induction therapy (9/11 patients), whereas deep venous thromboses were observed predominantly postoperatively (7/12 patients) ( P = .02). The risk of postoperative complications or death was not increased in patients undergoing surgery despite a preoperative diagnosis of venous thromboembolism. However, the risk of postoperative pulmonary embolism was higher in patients undergoing surgery without insertion of an inferior vena cava filter (1/2 patients vs 0/7 after insertion of an inferior vena cava filter, P = .047). The overall survival was similar between patients with or without venous thromboembolism complications. Conclusion This study demonstrates that venous thromboembolism events in patients undergoing multimodality therapy for lung malignancies is high and deserves careful consideration. Patients with a venous thromboembolism diagnosis during induction therapy may potentially benefit from a temporary inferior vena cava filter before surgery to limit the risk of recurrent pulmonary embolism. A preoperative diagnosis of venous thromboembolism, however, does not affect early and late outcomes after surgery and should not be viewed as a negative prognostic marker.

A large volume TPC will be used in the near future in a variety of experiments including T2K. The bulk Micromegas detector for this TPC is built using a novel production technique particularly suited for compact, thin and robust low mass detectors. The capability to pave a large Surface with a simple mounting Solution and small dead space is of particular interest for these applications. We have built several large bulk Micromegas detectors (36 x 34 cm(2)) and we have tested one in the former HARP field cage with a magnetic field. Prototypes cards of the T2K front end electronics, based on the AFTER ASIC chip, have been used in this TPC test for the first time. Cosmic ray data have been acquired in a variety of experimental conditions. Good detector performances, space point resolution and energy loss measurement have been achieved.-- et al. We would like to thank the HARP Collaboration for providing us with the TPC field cage and associated instrumentation. We gratefully acknowledge support from CERN for hosting this prototype test and providing invaluable support. Some of us acknowledge the support from the Ministerio de Educacion y Ciencia of Spain under Project code FPA2006-12120-C03 with the support of the FEDER fund from the European Community.

Resume Propos L’approche d’un chiffre de plaquettes au-dessous de 150 × 109 par litre au cours de la grossesse est tres simple en pratique. Points forts Il faut ecarter une thrombopenie factice, distinguer les cas de thrombopenie isolee (thrombopenie gestationnelle idiopathique benigne, purpura thrombopenique idiopathique) de ceux ou elle est associee a d’autre signes, determiner si elle est recente, donc a priori specifique de la grossesse ou preexistante a la grossesse, preciser sa gravite, son evolutivite, son mecanisme et sa cause. Une thrombopenie fœtale doit toujours etre recherchee a la naissance sur le sang du cordon. La corticotherapie peut etre necessaire dans certains cas de purpura thrombopenique idiopathique, de lupus ou de syndrome HELLP. Un controle doit etre effectue trois mois apres l’accouchement ainsi que lors d’une eventuelle grossesse ulterieure. Conclusion La thrombopenie est un exemple demonstratif de l’aide que l’interniste apporte a l’obstetricien dans les pathologies medicales de la grossesse.

Primary graft dysfunction (PGD) continues to be a major cause of early death after lung transplantation. Moreover, there remains a lack of accurate pretransplant molecular markers for predicting PGD. To identify distinctive donor lung gene expression signatures associated with PGD, we profiled human donor lungs using microarray technology prior to implantation. The genomic profiles of 10 donor lung samples from patients who subsequently developed clinically defined severe PGD were compared with 16 case-matched donor lung samples from those who had a favorable outcome without PGD (development set, n = 26). Selected PCR validated predictive genes were tested by quantitative reverse transcription-polymerase chain reaction in an independent test set (n = 81). Our microarray analyses of the development set identified four significantly upregulated genes (ATP11B, FGFR2, EGLN1 and MCPH1) in the PGD samples. These genes were also significantly upregulated in donor samples of the test set of patients with poor outcomes when compared to those of patients with good outcomes after lung transplantation. This type of biological donor lung assessment shows significant promise for development of a more accurate diagnostic strategy to assess donor lungs prior to implantation.

Resume Le lien entre corpulence maternelle et issue de la grossesse est mal connu. Objectif principal Apprecier le role de la corpulence maternelle avant la grossesse sur l’incidence d’une naissance tres prematuree (22 a 32 semaines d’amenorrhee revolues (SA)). Objectif secondaire Apprecier le lien entre corpulence maternelle et mecanisme de la grande prematurite parmi les enfants nes vivants. Population et methodes Toutes les meres ayant donne naissance entre 22 et 32 SA dans 2 regions sanitaires (Poitou-Charentes et Franche-Comte) ont ete inclus dans une enquete regionale prospective avec groupe temoin pendant les annees 2005 a 2006. La maigreur etait definie par un indice de masse corporelle avant grossesse (IMC) inferieur a 18,5 kg/m 2 et le surpoids et l’obesite par un IMC superieur ou egal a 25 kg/m 2 . Le risque d’une issue prematuree de la grossesse (interruption medicale de grossesse, mort fœtale in utero, deces perpartum ou en salle de naissance et naissance vivante transferee en neonatalogie) liee a un trouble de la corpulence maternelle a ete apprecie par une regression polychotomique portant sur 832 meres de grands prematures et 431 meres temoins ayant accouche a terme, avec ajustement sur l’âge maternel, le pays de naissance, le niveau d’education scolaire, la profession, le tabagisme maternel en fin de grossesse, la parite et le caractere induit de la grossesse. Resultats Si la maigreur est un facteur de risque de naissance tres prematuree d’un enfant vivant ( odd ratio (OR) = 1,73 [IC 95 % : 1,12–2,68]), le surpoids est un facteur de mortalite in utero (OR = 1,71 [IC 95 % : 1,03–2,84]). Chez les meres donnant naissance a un enfant vivant, la maigreur augmente le risque de grande prematurite spontanee (OR = 2,12 [IC 95 % : 1,20–3,74]) et le surpoids augmente le risque de grande prematurite medicalement consentie liee a une hypertension gravidique (OR = 2,85 [IC 95 % : 1,80–4,52]). Conclusion Une corpulence anormale avant la grossesse est un facteur de risque complexe d’une issue tres prematuree de la grossesse. Les acteurs de sante doivent en etre informes pour proposer un suivi plus specifique de ces grossesses ; de plus, l’etude des phenomenes qui relient les anomalies de la corpulence et les complications fœtales pourrait permettre de proposer des mesures de prevention.

The T2K (Tokai-to-Kamioka) experiment is a long baseline neutrino oscillation experiment in Japan, for which a near detector complex (ND280), used to characterize the beam, will be built 280 m from the target in the off-axis direction of the neutrino beam produced using the 50 GeV proton synchrotron of J-PARC (Japan Proton Accelerator Research Complex). The central part of the ND280 is a detector including 3 large Time Projection Chambers based on Micromegas gas amplification technology with anodes pixelated into about 125,000 pads and requiring therefore compact and low power readout electronics. A 72-channel front-end Application Specific Integrated Circuit has been developed to read these TPCs. Each channel includes a low noise charge preamplifier, a pole zero compensation stage, a second order Sallen-Key low pass filter and a 511-cell Switched Capacitor Array. This electronics offers a large flexibility in sampling frequency (50 MHz max.), shaping time (16 values from 100 ns to 2 ), gain (4 ranges from 120 fC to 600 fC), while taking advantage of the low physics events rate of 0.3 Hz. Fabricated in 0.35 CMOS technology, the prototype has been validated and meets all the requirements for the experiment so that mass production has been launched at the end of 2007.

Background Among data on medical liability for obstetrical practice in labour ward, one of the claims concerns the decision-to-delivery interval during emergency caesarean section, for which an optimal time is frequently advocated. A realistic review on this subject is needed. Literature review It mainly allows to note that: unlike current opinion, neonatal prognosis is more dependent on the causal pathology than on decision-to-delivery interval; the transfer time to the operating theater, which represents approximately half of this interval, should benefit an internal audit for each maternity as it is mainly dependent on organization and architectural specifications; the choice of mode of anesthesia in relation with the obstetrical context and the induction time have a strong incidence, which shows the importance of a good communication between the obstetrician and the anesthetist. Conclusion A detailed analysis of obstetrical context and of each sequence of the decision-to-delivery interval is more efficient and realistic for evaluation in medical liability cases than an optimal "gold standard". In addition, it allows a prophylactic reflexion for a risk management approach in each labour ward.

Obesity is a major risk factor in the development of chronic renal failure. Rimonabant, a cannabinoid CB1 receptor antagonist, improves body weight and metabolic disorders; however, its effect on mortality and chronic renal failure associated with obesity is unknown. Obese Zucker rats received either rimonabant or vehicle for 12 months and were compared to a pair-fed but untreated group of obese rats. Mortality in the obese rats was significantly reduced by rimonabant along with a sustained decrease in body weight, transient reduction in food intake, and an increase in plasma adiponectin. This was associated with significant reduction in plasma total cholesterol, low-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratio, triglycerides, glucose, norepinephrine, plasminogen activator inhibitor 1, and preservation of pancreatic weight and β -cell mass index. The cannabinoid antagonist attenuated the increase in proteinuria, urinary N -acetylglucosaminidase excretion, plasma creatinine, and urea nitrogen levels while improving creatinine clearance. Renal hypertrophy along with glomerular and tubulointerstitial lesions were reduced by rimonabant. Although the drug did not modify hemodynamics, it normalized the pressor response to angiotensin II. Our study suggests that in a rat model of chronic renal failure due to obesity, rimonabant preserves renal function and increases survival.

In multidisciplinary prenatal diagnosis centers, the search for a tetrasomy 12p mosaic is requested following the discovery of a diaphragmatic hernia in the antenatal period. Thus, the series of Pallister Killian syndromes (PKS: OMIM 601803) probably overestimate the prevalence of diaphragmatic hernia in this syndrome to the detriment of other morphological abnormalities.A multicenter retrospective study was conducted with search for assistance from members of the French society for Fetal Pathology. For each identified case, we collected all antenatal and postnatal data. Antenatal data were compared with data from the clinicopathological examination to assess the adequacy of sonographic signs of PKS. A review of the literature on antenatal morphological anomalies in case of PKS completed the study.Ten cases were referred to us: 7 had cytogenetic confirmation and 6 had ultrasound screening. In the prenatal as well as post mortem period, the most common sign is facial dysmorphism (5 cases/6). A malformation of limbs is reported in half of the cases (3 out of 6). Ultrasound examination detected craniofacial dysmorphism in 5 cases out of 6. We found 1 case of left diaphragmatic hernia. Our results are in agreement with the malformation spectrum described in the literature.Some malformation associations could evoke a SPK without classical diaphragmatic hernia.

There are immunologic benefits gained when nutrients are delivered via the gut that do not occur when nutrients are delivered parenterally. Clinically, these differences are noted when the 2 routes are studied in appropriate patient populations who are at risk of nutrition-related complications. The critical difference appears to be the lack of enteral stimulation and gut starvation upon the GI immune system during PN. Immunological changes are evident throughout the multiple layers of mucosal defenses employed to protect the host from intestinal microorganisms and environmental toxins. The changes to these layers range from mucosal atrophy and increased epithelial permeability to the loss of physical and chemical secretions that protect the epithelial surface and modulate the intestinal microbiome community. Breakdown in these intestinal layers of defense renders the host susceptible to subsequent infectious and inflammatory complications.

Parenteral nutrition (PN) increases the risk of infection in critically ill patients and is associated with defects in gastrointestinal innate immunity. Goblet cells produce mucosal defense compounds, including mucin (principally MUC2), trefoil factor 3 (TFF3), and resistin-like molecule β (RELMβ). Bombesin (BBS), a gastrin-releasing peptide analogue, experimentally reverses PN-induced defects in Paneth cell innate immunity. We hypothesized that PN reduces goblet cell product expression and PN+BBS would reverse these PN-induced defects.Two days after intravenous cannulation, male Institute of Cancer Research mice were randomized to chow (n = 15), PN (n = 13), or PN+BBS (15 µg tid) (n = 12) diets for 5 days. Defined segments of ileum and luminal fluid were analyzed for MUC2, TFF3, and RELMβ by quantitative reverse transcriptase polymerase chain reaction and Western blot. Th2 cytokines interleukin (IL)-4 and IL-13 were measured by enzyme-linked immunosorbent assay.Compared with chow, PN significantly reduced MUC2 in ileum (P.01) and luminal fluid (P = .01). BBS supplementation did not improve ileal or luminal MUC2 compared with PN (P.3). Compared with chow, PN significantly reduced TFF3 in ileum (P.02) and luminal fluid (P.01). BBS addition did not improve ileal or luminal TFF3 compared with PN (P.3). Compared with chow, PN significantly reduced ileal RELMβ (P.01). BBS supplementation significantly increased ileal RELMβ to levels similar to chow (P.03 vs PN; P.6 vs chow). Th2 cytokines were decreased with PN and returned to chow levels with BBS.PN significantly impairs the goblet cell component of innate mucosal immunity. BBS only preserves goblet cell RELMβ during PN but not other goblet cell products measured.

Parenteral nutrition (PN) is the IV delivery of nutrients to individuals unable intake nutrients via the gut. During PN, intestinal and pancreatic physiology is compromised, leading to tissue atrop...

Many-body correlations and macroscopic quantum behaviors are fascinating condensed matter problems. A powerful test-bed for the many-body concepts and methods is the Kondo model which entails the coupling of a quantum impurity to a continuum of states. It is central in highly correlated systems and can be explored with tunable nanostructures. Although Kondo physics is usually associated with the hybridization of itinerant electrons with microscopic magnetic moments, theory predicts that it can arise whenever degenerate quantum states are coupled to a continuum. Here we demonstrate the previously elusive `charge' Kondo effect in a hybrid metal-semiconductor implementation of a single-electron transistor, with a quantum pseudospin-1/2 constituted by two degenerate macroscopic charge states of a metallic island. In contrast to other Kondo nanostructures, each conduction channel connecting the island to an electrode constitutes a distinct and fully tunable Kondo channel, thereby providing an unprecedented access to the two-channel Kondo effect and a clear path to multi-channel Kondo physics. Using a weakly coupled probe, we reveal the renormalization flow, as temperature is reduced, of two Kondo channels competing to screen the charge pseudospin. This provides a direct view of how the predicted quantum phase transition develops across the symmetric quantum critical point. Detuning the pseudospin away from degeneracy, we demonstrate, on a fully characterized device, quantitative agreement with the predictions for the finite-temperature crossover from quantum criticality., Letter (5 pages, 4 figures) and Methods (10 pages, 6 figures)

Stimulation of digestive organs by enteric peptides is lost during total parental nutrition (PN). Here we examine the role of the enteric peptide bombesin (BBS) in stimulation of the exocrine and endocrine pancreas during PN. BBS protects against exocrine pancreas atrophy and dysfunction caused by PN. BBS also augments circulating insulin levels, suggesting an endocrine pancreas phenotype. While no significant changes in gross endocrine pancreas morphology were observed, pancreatic islets isolated from BBS-treated PN mice showed a significantly enhanced insulin secretion response to the glucagon-like peptide-1 (GLP-1) agonist exendin-4, correlating with enhanced GLP-1 receptor expression. BBS itself had no effect on islet function, as reflected in low expression of BBS receptors in islet samples. Intestinal BBS receptor expression was enhanced in PN with BBS, and circulating active GLP-1 levels were significantly enhanced in BBS-treated PN mice. We hypothesized that BBS preserved islet function indirectly, through the enteroendocrine cell-pancreas axis. We confirmed the ability of BBS to directly stimulate intestinal enteroid cells to express the GLP-1 precursor preproglucagon. In conclusion, BBS preserves the exocrine and endocrine pancreas functions during PN; however, the endocrine stimulation is likely indirect, through the enteroendocrine cell-pancreas axis.

Assess pregnant women's knowledge on first-trimester combined Down syndrome screening, at the time of their first trimester ultrasound scan.A questionnaire was submitted to the patients coming for their 12-week pregnancy ultrasonographic evaluation in a University Hospital prenatal clinic between May 2012 and May 2013. Correct and incorrect statements on Down syndrome screening were proposed to the mothers who were asked to rate them. Each patient was questioned on her prior exposition to Down syndrome screening, the category of medical of professional she previously consulted, and the information she received. Patients' knowledge was evaluated according to these criteria.Two hundred and one patients were included in this study. The average correct answer rating was 4.6 (out of 8 questions). The average incorrect answer rating was 2.4 (out of 6 questions). No difference was found between the different social and demographic groups, nor according to the category of professional consulted before the first ultrasound scan. Higher correct answer ratings were observed when the patient had already been submitted to a Down syndrome screening (P=0.039), when they had previously received explanations about the screening (P=0.003); and when they stated that they had been sufficiently informed (P=0.042).These results show that patients' knowledge on Down syndrome screening is inadequate and depends on their experience of previous screening and information. It is deemed necessary to improve information especially to young women who are pregnant for the first time.

International audience; La théorie quantique est le socle sur lequel repose notre compréhension de la nature. Bien qu’elle ait été élaborée il y a presque un siècle, l’établissement expérimental de ses fondements se poursuit. En particulier, l’exploration des aspects quantiques du transport de chaleur n’en est qu’à ses débuts. Nous présentons ici la démonstration expérimentale d’une des pierres angulaires du transport de la chaleur en régime quantique, l’existence d’une limite maximum fondamentale à la conduction thermique appelée, pour un canal élémentaire de transport, le quantum de conductance thermique.Ce quantum, ici mesuré dans un système électronique et égal à 1 pW/K à une température de 1 K, est prédit complètement universel, indépendant même du mécanisme de conduction thermique.

Hirschsprung’s disease (HSCR) is characterized by aganglionosis from failure of neural crest cell (NCC) migration to the distal hindgut. Up to 40% of HSCR patients suffer Hirschsprung’s-associated enterocolitis (HAEC), with an incidence that is unchanged from the pre-operative to the post-operative state. Recent reports indicate that signaling pathways involved in NCC migration may also be involved in the development of secondary lymphoid organs. We hypothesize that gastrointestinal (GI) mucosal immune defects occur in HSCR that may contribute to enterocolitis. EdnrB was deleted from the neural crest (EdnrB NCC-/-) resulting in mutants with defective NCC migration, distal colonic aganglionosis and the development of enterocolitis. The mucosal immune apparatus of these mice was interrogated at post-natal day (P) 21–24, prior to histological signs of enterocolitis. We found that EdnrB NCC-/- display lymphopenia of their Peyer’s Patches, the major inductive site of GI mucosal immunity. EdnrB NCC-/- Peyer’s Patches demonstrate decreased B-lymphocytes, specifically IgM+IgDhi (Mature) B-lymphocytes, which are normally activated and produce IgA following antigen presentation. EdnrB NCC-/- animals demonstrate decreased small intestinal secretory IgA, but unchanged nasal and bronchial airway secretory IgA, indicating a gut-specific defect in IgA production or secretion. In the spleen, which is the primary source of IgA-producing Mature B-lymphocytes, EdnrB NCC-/- animals display decreased B-lymphocytes, but an increase in Mature B-lymphocytes. EdnrB NCC-/- spleens are also small and show altered architecture, with decreased red pulp and a paucity of B-lymphocytes in the germinal centers and marginal zone. Taken together, these findings suggest impaired GI mucosal immunity in EdnrB NCC-/- animals, with the spleen as a potential site of the defect. These findings build upon the growing body of literature that suggests that intestinal defects in HSCR are not restricted to the aganglionic colon but extend proximally, even into the ganglionated small intestine and immune cells.

Measurements of the Xi(-) and (Xi) over bar (+) masses, mass differences, lifetimes and lifetime differences are presented. The (Xi) over bar (+) sample used is much larger than those used previously for such measurements. In addition, the S production rates in Z -> b (b) over bar and Z -> q (q) over bar events are compared and the position xi* of the maximum of the distribution in Z -> q (q) over bar events is measured.