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This article reviews the available literature for novel cervical total disc replacement devices, including ones which are available inside and outside of the United States. It includes biomechanical consideration as well as design characteristics and clinical data when available.

L’Osservatorio delle acque del Dipartimento dell’Acqua e dei Rifiuti (DAR) della Regione Siciliana e l’Istituto Nazionale di Geofisica e Vulcanologia - Sezione di Palermo hanno attivato un accordo di collaborazione che prevede l’effettuazione di attività finalizzate alla redazione del “Piano di gestione delle Acque” della Regione Siciliana per numerosi bacini idrogeologici del territorio siciliano attraverso la definizione di modelli concettuali da sviluppare, previo approfondimento del quadro conoscitivo esistente, con l’effettuazione di indagini geologiche, idrogeologiche, geofisiche, idrogeochimiche ed isotopiche. In questo contesto, è stato analizzato il corpo idrico sotterraneo della fiumara di Caronia attraverso numerose indagini geofisiche integrate con dati stratigrafici

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Nelson's syndrome (NS) is a long-term complication of bilateral adrenalectomy in patients with Cushing's disease. The best therapeutic strategy in NS has not been well defined. Gamma knife radiosurgery (GKRS) is very effective to stop the growth of the pituitary adenoma, which is the main goal of the treatment of patients with NS. We report the largest series of patients with NS treated by GKRS at a single center.The study was an observational, retrospective analysis of 28 consecutive patients with NS treated by GKRS in our department between 1995 and 2019. All patients had a growing ACTH-secreting pituitary adenoma. The main outcome of the study was to assess by the Kaplan-Meier method the risk of tumor progression after GKRS.The median follow-up after GKRS treatment was 98 months (IQR 61-155 months, range 7-250 months). Two patients (7.1%) had a recurrence of disease during follow-up. The 10-year progression-free survival was 91.7% (95% CI 80.5-100%). No patient had deterioration of visual function or oculomotor function after GKRS. New onset of hypogonadism and hypothyroidism occurred in 18.8% and 14.3% of the patients at risk.Our study confirms that GKRS may stop the tumor growth in the majority of patients with NS, even though very aggressive adenomas may ultimately escape this treatment. Safety of GKRS was good in our experience, but due attention must be paid to planning the distribution of radiation to critical structures, especially in patients previously treated by radiation.

BackgroundWhilst there are a number of publications comparing the relationship between body mass index (BMI) of kidney transplant recipients and graft/patient survival, no study has assessed this for a French patient cohort.MethodsIn this study, cause-specific Cox models were used to study patient and graft survival and several other time-to-event measures. Logistic regressions were performed to study surgical complications at 30 days post-transplantation as well as delayed graft function.ResultsAmong the 4691 included patients, 747 patients were considered obese with a BMI level greater than 30 kg/m2. We observed a higher mortality for obese recipients (HR = 1.37,p = 0.0086) and higher risks of serious bacterial infections (HR = 1.24,p = 0.0006) and cardiac complications (HR = 1.45,p p = 0.0666) and no significant increased risk of early surgical complications.ConclusionsWe showed that obesity increased the risk of death and serious bacterial infections and cardiac complications in obese French kidney transplant recipients. Further epidemiologic studies aiming to compare obese recipients versus obese candidates remaining on dialysis are needed to improve the guidelines for obese patient transplant allocation.

BACKGROUND: Obesity rates differ between Hispanic and White (non-Hispanic) women in the United States, with higher rates among Hispanic women. Socioeconomic processes contribute to this disparity both at the individual and the environmental level. Understanding these complex relationships requires multilevel analyses within cohorts of women that have a shared environment. In population-based samples of Hispanic and White (non-Hispanic) women from the same neighborhoods, we evaluated within each ethnic group a) The association of individual-level socioeconomic status (SES) with body mass index (BMI); and b) The additional contribution of neighborhood-level measures of SES. METHODS: Using population-based multi-stage sampling methods, we oversampled low SES and Hispanic block groups. During household screening, we identified women aged 30 to 50 years. Among White women, we specifically oversampled women with low educational levels. 515 Hispanic and 503 White women completed baseline. Height and weight were measured. Baseline surveys, in Spanish and English, included four measures of SES. Three measures of area-level SES were examined. Analysis of log(e) BMI on each SES measure used linear mixed models, incorporating design effects. RESULTS: Among White women, low education, social status, and neighborhood SES were associated with higher BMI (p < 0.001, p < 0.0001, and p < 0.05, respectively), independent of other SES measures. Although the highest grouped category of education, income and subjective social status within the Hispanic cohort had the lowest mean estimated BMI, the point estimates across categories were not monotonic, and had wide confidence intervals. As a result, in contrast to the findings among White women, no statistically significant associations were found between BMI and measures of SES among Hispanic women. DISCUSSION: Neighborhood and individual measures of SES operate differently in Hispanic compared with White women. We had assumed the measures we included to be most salient and operate similarly for both groups of women. Rather the salient factors for Hispanic women have yet to be identified. Improved understanding may ultimately inform the design of culturally-relevant multilevel obesity prevention strategies.

Animal and human in vitro models suggest that stress-related B lymphocyte decrements are due to high levels of glucocorticoids which cause apoptosis of pre-B-cells as they emerge from the bone marrow. The present study sought to explore the relationships among distress, salivary cortisol, and human B lymphocytes in vivo. Distress (perceived stress, negative affect, depressive symptoms), lymphocyte phenotype, and salivary cortisol were assessed among first-year graduate students (n = 22) and a community control sample (n = 30) at the start of classes in the fall and the week immediately before spring preliminary exams. Compared to controls, students reported greater distress on all measures at each time point except baseline perceived stress. Hierarchical linear regression with necessary control variables was used to assess the effect of student status on the three measures of distress, the four measures of lymphocyte phenotype, and cortisol AUC and CAR over time (T1-T2). Student status was associated with a significant decrease in CD19 + B lymphocytes and flattened cortisol awakening response (CAR). Change in CAR was associated with the decrease in CD19 + B lymphocytes. Results indicated that there are significant associations among student status, flattening of CAR, and decrements in CD19 + lymphocytes.

In recent years, the seroprevalence of anti-hepatitis E virus immunoglobulins (HEV) has increased in European countries with significant variability among the different geographical areas. HEV infection is spread in a wide range of animal species of which domestic pigs and wild boar represent the main reservoirs of genotype 3 and 4 (the genotypes present also in Europe). European citizens are incidental hosts, mainly infected by direct contact or consumption of foods derived from undercooked or insufficient hygiene handling infected pork products or wild boar meat. Epidemiologically, the HEV incidence is low in humans but serological data show a high proportion of subclinical infection caused by genotypes 3 or 4. In the general population, asymptomatic infection represents a high potential risk in particular subjects such as blood component recipients or occupationally exposed workers. This review offers a landscape of the current epidemiological status of HEV infection (genotypes 1, 2, 3, 4, 7) both in European asymptomatic subjects, patients with chronic diseases, and domestic pig impact on humans. We also underline advantages/disadvantages of high sensitivity and specificity tests using for detecting viral RNA or anti-HEV antibodies.

SPIRIT 2013 checklist: recommended items to address in a clinical trial protocol and related documents. (PDF 82 kb)

Ethical approval document from the Committee for Personal Protection. (PDF 39 kb)

Financing: Proof of financing from the French Ministry of Health. (PDF 15 kb)

Made available in DSpace on 2019-10-06T16:49:58Z (GMT). No. of bitstreams: 0 Previous issue date: 2019-01-01 In the context of project management, the attention given to project portfolio management has increased in recent years. The use of mathematical programming for portfolio management is also on the rise, because it integrates the project interactions with the multiple objectives of portfolio management into a single model. Among the possible objectives, recent studies have paid special attention to the emerging objective of future preparedness, which has not yet been incorporated into the existing mathematical models. This paper presents a mixed-integer nonlinear optimization model for portfolio selection that considers four main performance measures for project management, namely, value maximization, strategic alignment, balance, and future preparedness. Given the importance of the last measure, the purpose of this paper is to provide a more complete model that provides the marginal contribution and the best combination of projects according to the needs of the company. The model is tested using real data from two companies, one in Brazil and one in Canada, and the results obtained are coherent with their respective practices. Production Engineering Department, São Paulo State University (UNESP), Bauru, SP 17033-360, Brazil (e-mail: taisealbano@gmail.com). Mathematics Department, São Paulo State University (UNESP), Bauru, SP 17033-360, Brazil (e-mail: edmea.c.baptista@unesp.br). Department of Mathematics and Industrial Engineering, Polytechnique Montréal, Montreal, QC H3T 1J4, Canada (e-mail: fabiano.armellini@polymtl.ca). Production Engineering Department, São Paulo State University (UNESP), Bauru, SP 17033-360, Brazil (e-mail: daniel.jugend@unesp.br). Mathematics Department, São Paulo State University (UNESP), Bauru, SP 17033-360, Brazil (e-mail: edilaine.soler@unesp.br).

Ethical approval document from Advisory Committee on Information Processing for Research in the Field of Health. (PDF 408 kb)

The objective of this effort is to gather data to tailor interventions appropriately. Greater understanding of the correlates of socioeconomic status and obesogenic dietary behaviors was the focus of this manuscript. Using multistage sampling, women with varied education levels completed a baseline assessment in a longitudinal study of women aged 30 to 50 years. This study was conducted in low-SES areas of South King County, Washington State. This study included 530 Caucasian and 510 Hispanic women. Fruit and vegetable consumption was positively associated and soft drink consumption inversely associated with the level of education in Caucasian women. In contrast, percentage calories from fat was positively associated with the level of education in Hispanic women. In Hispanic women, level of education interacted significantly with food security in relation to percentage calories from fat, and with eating norms in relation to soft drink consumption. Neighborhood presence of ethnic food stores was associated with outcomes for Hispanic women, but for Caucasians, presence of fast food restaurants was important. Education was consistently associated with two of the three obesogenic dietary behaviors studied among Caucasian women. Education played a moderating role in the associations of food security and eating norms, independent of area level food availability, in two of three obesogenic dietary behaviors studied. However, these patterns differed for Hispanic women, indicating the need for more research into important variables to support change in Hispanic women. Women of differing ethnic groups did not respond similarly to environmental conditions and policy-relevant surroundings. These data have meaning for considering urban policy that impacts obesity levels in the population.

We examined food consumption in response to a laboratory-induced stressor (two challenging neuropsychological tasks) among non-Hispanic White women categorized as lower or higher in socioeconomic status based on education. The two socioeconomic status groups did not differ with respect to current hunger or baseline dietary habits. Perceived stress was measured pre- and post-challenge. Snacks were offered post-challenge; food consumption was measured by weighing snack bowls pre- and post-offering. Perceived stress increased pre- to post-challenge for both groups, but this effect was stronger for women lower in socioeconomic status. In addition, women lower versus higher in socioeconomic status consumed more food overall and more high-fat sweet food in particular (large effect sizes). These findings provide evidence of socioeconomic status differences in food consumption following an acute stressor.

Women at risk for breast cancer report elevated psychological distress, which has been adversely associated with cancer-relevant behaviors and biology.The present study sought to examine the effects of a 10-week cognitive behavioral stress management (CBSM) group intervention on distress among women with a family history of breast cancer.Participants were randomly assigned to CBSM (N = 82) or a wait-list comparison group (N = 76). Baseline to postintervention effects of CBSM on depressive symptoms and perceived stress were examined using hierarchical regression.CBSM participants reported significantly lower posttreatment depressive symptoms (β = -0.17, p 0.05) and perceived stress (β = -0.23, p 0.05) than wait-list comparison participants. Additionally, greater relaxation practice predicted lower distress.Group-based CBSM intervention is feasible and can reduce psychological distress among women with a family history of breast cancer. The present findings represent an encouraging avenue for the future application of CBSM. ( Clinicaltrials.gov number NCT00121160).

Objective Breast cancer risk is a chronic stressor associated with depression. Optimism is associated with lower levels of depression among breast cancer survivors. However, to our knowledge, no studies have explored the relationship between optimism and depression among women at risk for breast cancer. We hypothesized that women at risk for breast cancer who have higher levels of optimism would report lower levels of depression and that social support would mediate this relationship. Method Participants (N = 199) with elevated distress were recruited from the community and completed self-report measures of depression, optimism, and social support. Participants were grouped based on their family history of breast cancer. Path analysis was used to examine the cross-sectional relationship between optimism, social support, and depressive symptoms in each group. Results Results indicated that the variance in depressive symptoms was partially explained through direct paths from optimism and social support among women with a family history of breast cancer. The indirect path from optimism to depressive symptoms via social support was significant (β = −.053; 90% CI = −.099 to −.011, p = .037) in this group. However, among individuals without a family history of breast cancer, the indirect path from optimism to depressive symptoms via social support was not significant. Conclusions These results suggest that social support partially mediates the relationship between optimism and depression among women at risk for breast cancer. Social support may be an important intervention target to reduce depression among women at risk for breast cancer. Copyright © 2015 John Wiley & Sons, Ltd.

Dear Editor,IntroductionWomen with a family history of breast cancer (FH+) haveelevated cancer worry [1]. Objective breast cancer riskcontributes to reports of cancer worry among FH+women; however, perceived breast cancer risk, which isoften overestimated, is a stronger predictor of breastcancer worry [2]. Lazarus and Folkman’s paradigm is ahelpful model to understand how individuals appraisetheir vulnerability to breast cancer (perceived risk) [3].The original framework focused on three major con-structs: cognitive appraisal, coping, and daily stress.Primary cognitive appraisal of experienced and antici-pated stressors may result in specific types of coping pro-cesses, which in turn may influence emotional reactions tostressors [3]. With regard to breast cancer, overestimatedcognitive appraisal or perceived risk of breast cancermay result in specific types of coping, which areassociated with unnecessarily high levels of cancerworry. To date, no research has tested the theoreticalmediation framework posed by Lazarus and Folkmanin the context of cognitive appraisal of breast cancerrisk, coping, and breast cancer worry [3]. The currentstudy addressed this gap and tested the hypothesis thatincreased perceived breast cancer risk was associatedwith breast cancer worry because of decreased engagedor increased disengaged coping.MethodsProcedures

Background The Guide to Community Preventive Services ( Community Guide ) offers evidence-based intervention strategies to prevent chronic disease. The American Cancer Society (ACS) and the University of Washington Health Promotion Research Center co-developed ACS Workplace Solutions (WPS) to improve workplaces' implementation of Community Guide strategies. Purpose To test the effectiveness of WPS for midsized employers in low-wage industries. Design Two-arm RCT; workplaces were randomized to receive WPS during the study (intervention group) or at the end of the study (delayed control group). Setting/participants Forty-eight midsized employers (100–999 workers) in King County WA. Intervention WPS provides employers one-on-one consulting with an ACS interventionist via three meetings at the workplace. The interventionist recommends best practices to adopt based on the workplace's current practices, provides implementation toolkits for the best practices the employer chooses to adopt, conducts a follow-up visit at 6 months, and provides technical assistance. Main outcome measures Employers' implementation of 16 best practices (in the categories of insurance benefits, health-related policies, programs, tracking, and health communications) at baseline (June 2007–June 2008) and 15-month follow-up (October 2008–December 2009). Data were analyzed in 2010–2011. Results Intervention employers demonstrated greater improvement from baseline than control employers in two of the five best-practice categories; implementing policies (baseline scores: 39% program, 43% control; follow-up scores: 49% program, 45% control; p =0.013) and communications (baseline scores: 42% program, 44% control; follow-up scores: 76% program, 55% control; p =0.007). Total best-practice implementation improvement did not differ between study groups (baseline scores: 32% intervention, 37% control; follow-up scores: 39% intervention, 42% control; p =0.328). Conclusions WPS improved employers' health-related policies and communications but did not improve insurance benefits design, programs, or tracking. Many employers were unable to modify insurance benefits and reported that the time and costs of implementing best practices were major barriers. Trial registration This study is registered at clinicaltrials.gov NCT00452816.

The potential of harvesting heat energy from asphalt pavement using a piping network with fluid flowing through it needs to be evaluated before spending a significant amount of time on planning details of design and construction. The key factors involved in this evaluation include the temperature of the pavement at the depth at which the system is being considered, as well as the temperature of the fluid used for harvesting the heat energy. Costs include those required for the system such as pumps and pipes, and cost of energy required for pumping. Taking all of the factors into consideration, a macro-enabled spreadsheet has been developed that allows the user to input air temperature data as well as pipe location and cost parameters. The end results are data on flow rate versus yearly savings and payback period. From these data, a user can easily determine whether the payback period is reasonable or not and could also evaluate the effect of the different parameters on the payback period. Examples of the results of analysis for different cities in four different parts of the USA and Singapore and Chennai, India, are presented. The payback period shows a good relationship with the latitude of the location - the period increases with an increase in latitude. The public domain location from where the spreadsheet can be downloaded is provided. � 2011 Taylor & Francis.

Resume L’immunosuppression a base d’inhibiteurs de la calcineurine (ICN) doit etre maintenue dans les semaines suivant une transplantation pour eviter le rejet aigu. Cependant, a plus long terme, leur nephrotoxicite et la morbidite qu’elle induit a un impact negatif sur la survie du patient et du greffon. C’est pourquoi, pour chaque organe, l’enjeu est de s’affranchir de la nephrotoxicite des ICN sans risquer la sous-immunosuppression et en conservant une bonne tolerance globale. En transplantation renale, la minimisation des ICN associee au mycophenolate semble relativement sure et permet une amelioration de la fonction renale sans sur-risque de rejet. La strategie d’arret total des ICN au profit d’un inhibiteur du signal de proliferation (ISP) parait egalement interessante. Chez les patients presentant une dysfonction chronique d’allogreffe, la diminution des doses d’ICN de 30 a 50% en association au MPA semble sure et efficace et leur remplacement par des ISP est pertinent, mais limite par leur effet sur la proteinurie. Chez le greffe hepatique, leur introduction retardee et minimisee sous couvert d’une induction semble sure et efficace pour preserver la fonction renale notamment lorsqu’elle est precaire. En transplantation cardiaque, les premieres etudes realisees sur un petit nombre de patients suggerent que l’introduction retardee des ICN, leur minimisation et leur elimination tardive semblent possibles et sures apres transplantation.

The calcineurin inhibitors (CNI) cyclosporine micro emulsion (CyA-ME) and tacrolimus (Tac) both display renal and vascular toxicities. We undertook a single-center retrospective study among 149 surviving liver transplant recipients. The primary outcome was kidney function over 10 years posttransplant, evaluating the glomerular filtration rate (GFR) by the abbreviated Modification of Diet in Renal Disease formula with subsequent Kidney Disease Outcomes Quality Initiative staging. The secondary outcomes included correlations between CNI trough levels (C0), GFR, and items of cardiovascular toxicity. At 1 and 5 years, the mean GFRs were 74.2 and 76.9 mL/min/1.73 m(2) under Tac versus 62.8 and 66.0 mL/min/1.73 m(2) under CyA-ME (P < .001). The mean value in favor of Tac was + 10 mL/min/1.73 m(2). Distribution of GFR stages showed more Tac patients at stage 1 or 2 and more at stage 4 or 5 under CyA-ME. There was no significant correlation between CNI-C0 and GFR. Switches between CNI or to mycophenolate mofetil did not show any significant GFR improvement. Patients under CyA-ME displayed significantly higher blood pressures with 3 requiring dialysis versus none under Tac. In conclusion, we observed that liver transplant patients under Tac maintained significantly better renal function with less progression to dialysis as compared with CyA-ME, indicating a lower renal and vascular (lower BP) toxicity.

The stress hormone cortisol exhibits a diurnal rhythm throughout the day, as well as within person variability. Recent statistical approaches allow for the estimation of intraindividual cortisol variability ("ICV") and a greater ICV has been observed in some mood disorders (major depression, remitted bipolar disorder); however, ICV has not been examined following stress management. In this secondary analyses of an efficacious randomized clinical trial, we examine how ICV may change after cognitive behavioral stress management (CBSM) among healthy stressed women at risk for breast cancer. Second, we concurrently compare other calculations of cortisol that may change following CBSM.Multilevel modeling (MLM) was applied to estimate ICV and to test for a group by time interaction from baseline, post-intervention, to 1 month following CBSM. Forty-four women were randomized to the CBSM; 47 to the comparison group; mean age of the entire group was 44.2 (SD=10.27).After controlling for relevant covariates, a significant time by group interaction emerged (β estimate=-.070; p.05), such that CBSM participants demonstrated a lower ICV following CBSM compared to the comparison group. The interaction for cortisol slope and cortisol output (area under the curve) approached significance (β estimates=-.10 and -.062, respectively; p's.08), while other cortisol outcomes tested were not significantly changed following CBSM.ICV may represent a novel index of cortisol dysregulation that is impacted by CBSM and may represent a more malleable within-person calculation than other, widely applied cortisol outcomes. Future research should examine these relationships in larger samples, and examine ICV and health outcomes.NCT01048528.

INTRODUZIONE: La vitamina B12 ha un importante ruolo nello sviluppo del sistema nervoso centrale. Le manifestazioni della carenza di tale metabolita sono spesso aspecifiche (ritardo dello sviluppo, debolezza, ritardo della crescita) ma i programmi di screening neonatale consentono di identificare precocemente questa condizione che può essere facilmente trattata. In accordo con recenti studi (1,2), i nostri dati confermano che la carenza di vitamina B12 nei neonati è più comune di quanto si pensi e che tale condizione è principalmente secondaria a carenza materna. SCOPO DEL LAVORO E METODI: Scopo di questo studio è stato valutare se questo dato dipendesse da un inadeguato range di riferimento della vitamina B12 sierica. Nei neonati sottoposti a screening allargato è stato eseguito il dosaggio degli amminoacidi e delle acilcarnitine su spot da sangue essiccato mediante spettrometria di massa tandem. Sui neonati che presentavano incremento di C3, C3/C2 e/o C3/C16 è stato eseguito il second-tier test per l’acido metilmalonico (MMA). Sui positivi a questo test, sulle loro madri e su 162 madri controllo sono state dosate vitamina B12, olotranscobalamina (holo-TC), folati ed omocisteina. RISULTATI E CONCLUSIONI: Su 33000 neonati screenati sono stati identificati 7 casi positivi per la presenza di MMA il cui accumulo può essere dovuto a deficit di metilmalonil-CoA mutasi o a deficit nutrizionale di vitamina B12. Poichè tutti i neonati erano allattati esclusivamente al seno abbiamo ipotizzato che tale carenza potesse essere secondaria a deficit materno. Dei 7 neonati trovati positivi, 2 erano sintomatici e mostravano, come le madri, bassi livelli di vitamina B12 ed holo-TC e alti livelli di omocisteina, parametri normalizzatisi dopo supplementazione con vitamina B12. Gli altri 5 che non erano sintomatici presentavano carenza di vitamina B12 ed holo-TC, incremento di omocisteina e MMA nell’intervallo 0.29-1.4μM nonostante le madri mostrassero una vitamina B12 nella norma, seppure al limite inferiore. Tali dati suggerivano che dovesse essere rivalutato il limite inferiore dell’intervallo di riferimento della vitamina B12 per evitare falsi negativi. A tale scopo è stata dosata la vitamina B12 in 162 madri controllo e nei loro figli. I figli di 7 di esse con livelli di vitamina B12 vicini al limite inferiore dell’intervallo di riferimento sono stati monitorati per valutare eventuale carenza di vitamina B12 ma tali neonati, negativi per C3 allo screening, hanno mostrato parametri biochimici nella norma. Il nostro studio sottolinea che madri con valori borderline di vitamina B12 e neonati con valori borderline di MMA (3) dovrebbero essere monitorati per valutare l’eventuale insorgenza in questi ultimi di carenza di vitamina B12; in alternativa la somministrazione di vitamina B12 associata a quella dell’acido folico in gravidanza potrebbe prevenire il rischio di carenza secondaria a deficit materno. Referenze 1. Sarafoglou K. et al. JAMA 2011; 305 : 1198-1200 2. Hinton C.F. et al. The Journal of Pediatrics 2010; 157:162-163 3 Hvas A.M. et al. Haematologica 2006; 91:1506-1512

INTRODUZIONE: Il deficit di 3-Metilcrotonil-CoA Carbossilasi (3-MCCD) sembra essere l’aciduria organica più frequente individuata in numerosi paesi attraverso i programmi di screening neonatale (1). Questa malattia metabolica, autosomica recessiva, è dovuta a difetti di un enzima coinvolto nel catabolismo della leucina. L’enzima 3-MCC è costituito da 2 subunità, MCCα e MCCβ, codificate dai geni MCCA e MCCB, rispettivamente. A questa malattia è associato un ampio spettro di fenotipi clinici che vanno dalla totale mancanza di sintomi alla presenza di manifestazioni quali ritardo della crescita, cardiomiopatia, ipoglicemia, problemi neurologici fino alla morte. SCOPO DEL LAVORO E METODI: in questo report presentiamo la caratterizzazione biochimica e molecolare di una bambina positiva allo screening effettuato su spot di sangue essiccato mediante spettrometria di massa tandem. La caratterizzazione biochimica è stata ottenuta attraverso analisi delle acilcarnitine sieriche, degli acidi organici urinari e saggio enzimatico di biotinidasi. L’analisi molecolare è stato effettuata mediante PCR e sequenziamento diretto di tutta la regione codificante e il 5’- e 3’ UTR dei geni MCCA ed MCCB. RISULTATI E CONCLUSIONI: la paziente, nata a termine da genitori non consanguinei, all’esame fisico si presentava normale. Il profilo delle acilcarnitine mostrava incremento di C5OH (4,58 μM, n.r.T nell’esone 7 e c.1150-1G>A nell’esone13. Questa patologia non mostra buona correlazione genotipo-fenotipo ma è stato dimostrato che l’attività enzimatica residua è inversamente correlata ai livelli iniziali di C5OH (2). Pertanto ulteriori dati sull’attività residua dell’enzima difettivo potrebbero essere di aiuto per predire il decorso clinico della malattia nella paziente. Scopo di questo report è sottolineare l’importanza di un continuo monitoraggio, principalmente dei neonati asintomatici. L’eventuale mancanza di sintomi, infatti, non dovrebbe indurre genitori e pediatri a sottovalutare questa patologia. Referenze: 1. Baumgartner MR et al. J Clin Invest 2001; 107:495-504 2. Arnold GL et al. Mol Genet Metab 2012; 106:439-441

Non-Shiga toxin-associated hemolytic uremic syndrome (non-Stx-HUS) is a rare disease. The clinical outcome is often unfavorable: 50% of patients progress to end-stage renal failure. Several mutations in complement regulatory genes predispose to non-Stx-HUS. Transplantation outcomes are poor among patients with either mutation in the genes encoding complement H or I factors, with 80% graft loss due to HUS recurrence. In contrast, patients with mutation in the gene encoding MCP have no disease relapse after transplantation. There are no treatment guidelines for non-Stx-HUS recurrence. Herein we have presented 8 patients with non-Stx-HUS recurrence after transplantation during the last 10 years in the South of France. HUS recurrence, which occurred early after transplantation in all but 1 patient, was treated by plasma exchange (PE) with substitution by fresh frozen plasma (FFP). Three patients still treated with long-term plasma therapy have no recurrence at 15, 19, or 24 months. An international registry would help to define new guidelines.

To assess treatment-related complication outcomes in the management of the bladder cuff removal by open excision (OE) or transurethral resection of the ureteral orifice (TURUO) after laparoscopic radical nephroureterectomy (LNU) in upper urinary tract urothelial carcinoma (UUT-UC).We did a retrospective study involving patients having UUT-UC who underwent LNU from 2004 to 2012 in two references center. Flexible ureteroscopy was carried out for multiple biopsies. Patients were assigned to one of two different surgical groups consisting of LNU with OE versus TURUO for the bladder cuff removal. Perioperative characteristics, complication related treatment and oncological outcomes were collected during the follow-up.Overall, 29 patients underwent LNU over-time including 16 using LNU with OE and 13 LNU with TURUO. LNU+OE were older (66.5 years [48-87] [P0.01]). Operative time was shorter (180 min vs. 240 min [P=0.01]) with a longer hospital stay (7 days vs. 5 days [P0.01]) than TURUO technic. No difference in the complication rate was reported. LNU +OE was associated with higher grade (81.3% vs. 38.5% [P=0.026]) and more invasive tumor (37.5% vs. 24.1% [P=0.03]). Regardless the technic, the cancer-specific survival rate was 63.7 years without significant differences between technics.TURUO was shorter in hospital stay but had a longer operative time with no impact on the treatment-related complication. Oncological control not highlighted any difference between technics however longer follow up is expected for recommendations.

The Guide to Community Preventive Services (Community Guide) offers evidence-based intervention strategies to prevent chronic disease. The American Cancer Society (ACS) and the University of Washington Health Promotion Research Center co-developed ACS Workplace Solutions (WPS) to improve workplaces' implementation of Community Guide strategies.To test the effectiveness of WPS for midsized employers in low-wage industries.Two-arm RCT; workplaces were randomized to receive WPS during the study (intervention group) or at the end of the study (delayed control group).Forty-eight midsized employers (100-999 workers) in King County WA.WPS provides employers one-on-one consulting with an ACS interventionist via three meetings at the workplace. The interventionist recommends best practices to adopt based on the workplace's current practices, provides implementation toolkits for the best practices the employer chooses to adopt, conducts a follow-up visit at 6 months, and provides technical assistance.Employers' implementation of 16 best practices (in the categories of insurance benefits, health-related policies, programs, tracking, and health communications) at baseline (June 2007-June 2008) and 15-month follow-up (October 2008-December 2009). Data were analyzed in 2010-2011.Intervention employers demonstrated greater improvement from baseline than control employers in two of the five best-practice categories; implementing policies (baseline scores: 39% program, 43% control; follow-up scores: 49% program, 45% control; p=0.013) and communications (baseline scores: 42% program, 44% control; follow-up scores: 76% program, 55% control; p=0.007). Total best-practice implementation improvement did not differ between study groups (baseline scores: 32% intervention, 37% control; follow-up scores: 39% intervention, 42% control; p=0.328).WPS improved employers' health-related policies and communications but did not improve insurance benefits design, programs, or tracking. Many employers were unable to modify insurance benefits and reported that the time and costs of implementing best practices were major barriers.This study is registered at clinicaltrials.gov NCT00452816.

We analyze the statistics of observables in continuous variable quantum teleportation in the formalism of the characteristic function. We derive expressions for average values of output state observables in particular cumulants which are additive in terms of the input state and the resource of teleportation. Working with Squeezed Bell-like states, which may be optimized in a free parameter for better teleportation performance we discuss the relation between resources optimal for fidelity and for different observable averages. We obtain the values of the free parameter which optimize the central momenta and cumulants up to fourth order. For the cumulants the distortion between in and out states due to teleportation depends only on the resource. We obtain optimal parameters for the second and fourth order cumulants which do not depend on the squeezing of the resource. The second order central momenta which is equal to the second order cumulants and the photon number average are optimized by the same resource. We show that the optimal fidelity resource, found in reference (Phys. Rev. A {\bf 76}, 022301 (2007)) to depend also on the characteristics of input, tends for high squeezing to the resource which optimizes the second order momenta. A similar behavior is obtained for the resource which optimizes the photon statistics which is treated here using the sum of the squared differences in photon probabilities of input and output states as the distortion measure. This is interpreted to mean that the distortions associated to second order momenta dominates the behavior of the output state for large squeezing of the resource. Optimal fidelity and optimal photon statistics resources are compared and is shown that for mixtures of Fock states they are equivalent., Comment: 25 pages, 11 figures

The incidence of neoplastic complications after solid organ transplantation is increasing tremendously probably as the consequence of long term immunosupression. Beside usual risk factors, the oncogenic role of some viruses like Epstein-Barr virus is well established. We report a case of a primitive EBV-induced liver leiomyosarcoma after renal transplantation.

Immunosuppressive therapy with calcineurin inhibitors (CNI) must be continued during the weeks following transplant to avoid acute rejection. Over the long-term, however, nephrotoxicity and morbidity induced by CNIs have a negative impact on patient and transplant survival. Therefore, for any organ, it is crucial to free patients from the nephrotoxicity associated with CNIs without risking under-immunosuppression and while maintaining good overall tolerance. For kidney transplants, minimization of CNI use in association with mycophenolate seems to be relatively safe and allows for improved kidney function without an added risk of rejection. The strategy of making a complete switch from CNIs to proliferation signal inhibitors (PSI) also seems to be promising. In patients with chronic allotransplant dysfunction, reduction of CNI doses by 30 to 50% in association with MPA seems to be safe and effective and replacement of CNIs with PSIs is pertinent, though limited by their effect on proteinuria. For liver transplants, late and minimal introduction of CNIs under induction seems to be safe and effective for the preservation of kidney function, especially when precarious. For heart transplants, preliminary studies conducted on a small number of patients suggest that delayed introduction of CNIs at minimal doses and late elimination of the therapy are safe after transplant.

We investigate continuous variable (CV) quantum teleportation using relevant classes of non-Gaussian states of the radiation field as entangled resources. First, we introduce the class two-mode squeezed symmetric superposition of Fock states, including finite truncations of twin-beam Gaussian states as special realizations. These states depend on a set of free independent parameters that can be adjusted for the optimization of teleportation protocols, with an enhancement of the success probability of teleportation both for coherent and Fock input states. We show that the optimization procedure reduces the entangled resources to truncated twin beam states, which thus represents an optimal class of non-Gaussian resources for quantum teleportation. We then introduce a further class of two-mode non-Gaussian entangled resources, in the form of squeezed cat-like states. We analyze the performance and the properties of such states when optimized for (CV) teleportation, and compare them to the optimized squeezed Bell-like states introduced in a previous work \cite{CVTelepNoi}. We discuss how optimal resources for teleportation are characterized by a suitable balance of entanglement content and squeezed vacuum affinity. We finally investigate the effects of thermal noise on the efficiency of quantum teleportation. To this aim, a convenient framework is to describe noisy entangled resources as linear superpositions of non-Gaussian state and thermal states. Although the presence of the thermal component strongly reduces the teleportation fidelity, noisy non-Gaussian states remain preferred resources when compared to noisy twin-beam Gaussian states., Comment: 11 pages, 8 figures. Largely revised and expanded version. New material and sections added. To appear in EPJ-ST (Proceedings of the Central European Workshop on Quantum Optics 2007. 14th Edition, 1-5 June 2007, Palermo, Italy)

The use of elderly deceased donors requires refining criteria for both the donor and the recipient. This report attempted to identify parameters susceptible to further improvement. This retrospective multicenter study analyzed the outcomes of kidney recipients from 15 consecutive elderly deceased donors in the south French region (IR9). Donors were 65 to 74 years old. Mean creatinine clearance was 80 mL/min/1.73 m 2 . The donor risk factors for allograft dysfunction were stroke, hypertension, cardiovascular disease, cardiac death, smoking, arrhythmia, and diabetes. The recipients were 35 to 70 years old. The median cold ischemia time was 24 hours. Four patients (16%) suffered delayed graft function (DGF). Three recipients (12%) died within the first 2 months after transplantation. The postoperative complications (29%) were 2 renal artery thromboses, 4 renal artery stenoses, and 1 toe ischemia. Two years after transplantation, their mean serum creatinine was 157 μmol/L. The patient and graft survivals were 88% and 70%, respectively. These results seemed worse than those reported in the literature, but it was a small cohort and a new experience. DGF is probably linked to improvable management to reduce cold ischemia time. The elevated rate of surgical complications might be related to a lack of experience in donor and recipient evaluations. Kidney transplantation from elderly donors requires an efficient organization and an accurate evaluation of both donor renal function and recipient cardiovascular state.