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As opposed to steady state characteristics which have been, in the past, estensively investigated, the transient dehumidification characteristics of silica gel under different flat bed configurations, has not been studied in detail with respect to varying mass and air flow rates. Such data is essential in the design of systems employing this method of dehumidification. Moreover, numerical models of the performance of flat bed desiccant configurations generally take the form of fundamental studies with explicit modelling of the desiccant particle geometries. The primary objective of this work aims is to generate dehumidification characteristics in high humidity environments. Secondly, a more simplified and practical approach is proposed here on the basis of experimental calibration. The methodology consists of two main approaches: (i) the development of a test rig for the experimental determination of the transient dehumidification characteristics and, (ii) the development of a Computational Fluid Dynamics (CFD) model using experimental data as input to provide easy extrapolation of experimental data. This paper presents detailed dehumidification results for varying air volume flow rate and desiccant mass. The numerical model, on the other hand, successfully predicts the dehumidification performance of varying silica gel masses by using only a single experimental test case. This proves the validity of using such a model to extrapolate on experimental data.

Background:In breast cancer (BC), radiotherapy (RT) is used adjuvantly to prevent recurrence and also in the palliative setting. Clinical signs of RT response are often not apparent for several weeks post-treatment and we currently lack tools to predict or monitor tumor response to RT early during treatment. The aim was to identify tumor-secreted biomarkers whose release reflects response to RT, which could be monitored during treatment in the blood or intratumorally by an implantable biosensor, currently under development within the Implantable Microsystems for Personalised Anti-Cancer Therapy (IMPACT) program. Methods: A series of experiments assessed the effect of different radiation doses (2-10Gy) on 3 human BC cell lines – MDA-MB-231 (ER-), MCF-7 (ER+) and HBL-100 (ER-) –, 1 canine breast cancer and 2 sheep lung cancer lines. Culture media was collected from each dose experiment at a range of post-radiation time-points (1-24 hours). Proteins were isolated from collected media for secretome mass spectrometry (MS) analysis. A subset of treatment/time conditions were repeated in the same BC cell lines and radioresistant (RR) derivatives from which RNA was extracted and analysed using Lexogen QuantSeq for whole-genome transcriptomics.In-lab candidate biomarker validation was carried out using immuhistochemistry (IHC), immunofluorescence (IF) and western blotting (WB) using validated antibodies. Levels of candidate biomarkers were also assessed in normal and untreated BC tissues using IHC. ELISA-based methods are currently under investigation for detection of the lead candidate biomarkers in the blood of large animal cancer models treated with RT. Results: Biomarker discovery using the MS data revealed 4 promising candidates: EIF3G, SEC24C, YBX3 and TK1. These are released from BC and animal cancer cells sensitive to radiation in a dose-dependent manner 24 hours after treatment. Analysis of the transcriptomic data showed an 8-fold higher expression of the genes encoding the 4 candidates in the radio-sensitive parental cell lines compared to the RR cell lines. IF and WB confirmed lower intracellular expression of the 4 proteins in RR cells compared to the parental lines. WB of collected culture media confirmed release of each of the 4 candidates 24 hours after a 2Gy dose of radiation in only the parental lines. GAPDH was not found in these media samples, demonstrating that protein release was not due to cell lysis. Conclusions: · We have identified 4 promising biomarkers which are released from cancer cells sensitive to RT and not released from RR derivatives. · All 4 candidates are released 24 hours after a 2Gy radiation dose, which fits with the current clinical dosing schedule where radiation is administered at 24 hour intervals. Ongoing work will elucidate if these biomarkers can be reliably detected in blood or intratumorally using implantable biosensors. · There are currently no validated predictive tools to monitor RT response during treatment. If successfully validated, these biomarkers could have a clinical role in personalising RT dosing schedules and durations for solid tumors in the neoadjuvant and palliative setting, thus optimising treatment and preventing the administration of ineffective RT and its associated side effects. Citation Format: Meehan J, Gray M, Turnbull AK, Martinez-Perez C, Bonello M, Ward C, Langdon SP, McLaughlin S, MacLennan M, Dixon JM, Wills J, Quinn N, Finich AJ, von Kriegsheim A, Cameron D, Kunkler IH, Murray A, Argyle D. Tumor-secreted predictive biomarkers of response to radiotherapy in breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-12-24.

Chronic lymphocytic leukemia (CLL) is characterized by the existence of subsets of patients with (quasi)identical, stereotyped B-cell receptor (BcR) immunoglobulins. Patients in certain major stereotyped subsets often display remarkably consistent clinicobiological profiles, suggesting that the study of BcR immunoglobulin stereotypy in CLL has important implications for understanding disease pathophysiology and refining clinical decision-making. Nevertheless, several issues remain open, especially pertaining to the actual frequency of BcR immunoglobulin stereotypy and major subsets, as well as the existence of higher-order connections between individual subsets. To address these issues, we investigated clonotypic IGHV-IGHD-IGHJ gene rearrangements in a series of 29 856 patients with CLL, by far the largest series worldwide. We report that the stereotyped fraction of CLL peaks at 41% of the entire cohort and that all 19 previously identified major subsets retained their relative size and ranking, while 10 new ones emerged; overall, major stereotyped subsets had a cumulative frequency of 13.5%. Higher-level relationships were evident between subsets, particularly for major stereotyped subsets with unmutated IGHV genes (U-CLL), for which close relations with other subsets, termed “satellites,” were identified. Satellite subsets accounted for 3% of the entire cohort. These results confirm our previous notion that major subsets can be robustly identified and are consistent in relative size, hence representing distinct disease variants amenable to compartmentalized research with the potential of overcoming the pronounced heterogeneity of CLL. Furthermore, the existence of satellite subsets reveals a novel aspect of repertoire restriction with implications for refined molecular classification of CLL. Key Points: • In a series of 29 856 CLL patients, the incidence of BcR stereotypy peaked at 41%. • Higher-order relations exist between stereotyped subsets, particularly for those from U-CLL, for which satellite subsets were identified. © 2021 American Society of Hematology

Holmes Tremor (HT) is a unique and debilitating movement disorder. It usually results from lesions of the midbrain and its connection but can also result from posterior thalamic injury. Clinical examination can help lesion localization between these two areas. We studied the clinical features and their radiological correlations to distinguish midbrain HT (HT-m) from thalamic HT (HT-t).Retrospective review of 17 patients with a HT-type presentation was conducted. Tremor characteristics, associated clinical signs and radiological findings were studied.Eleven patients had a myorythmic rest tremor, large amplitude proximal tremor with goal-directed worsening, with or without mild distal dystonic posturing, representing HT-m. Six patients had slow, large amplitude proximal tremors and distal choreathetoid movements, significant proximal/distal dystonic posturing, associated with proprioceptive sensory loss, representing HT-t. Haemorrhagic lesions were the predominant cause of HT-m; whereas, ischaemia was more commonly associated with HT-t.When assessing patients with HT, attentiveness to the presence of associated signs in the affected limb, such as a proprioceptive sensory deficits and additional movement disorders, can aid lesion localisation, which can have implications for management.

When considering Deep Brain Stimulation (DBS) surgical treatment of dystonia syndromes, it is important to consider multiple aspects of the disease and its presentation. It is crucial to know if the dystonia is idiopathic, inherited or acquired as well as focal, segmental or generalised. Careful phenotyping of idiopathic as well as inherited dystonias and accurate diagnosis of acquired dystonias informs the decision-making process for patients and clinicians by providing them with useful predictors of outcomes of the proposed surgery. Here, we provided a review of the current literature, highlighted the areas where evidence is scarce and suggested future directions for research.

A patient presented with fulminant pulmonary oedema and required acute intubation and ventilation. There was no history of a prior cardiac disorder. As he was weaned from sedation, following stabilisation of his pulmonary status, neurological signs suggestive of brainstem dysfunction became apparent. Investigations showed infarcts in the posterior cerebral circulation secondary to a vertebral artery dissection. Neurogenic pulmonary oedema needs to be considered in any patient with fulminant pulmonary oedema without overt evidence or history of cardiac disease.

Humidity is an important parameter in understanding the micro-climate in indoor spaces. Existing literature focuses mostly on spatially averaged humidity levels leaving a gap on the spatio-temporal character of this variable. This is contrary to the well populated literature on other environmental parameters such as air temperature and air velocity. The aim of this paper is therefore twofold. First it presents transient humidity and temperature distribution experimental results for a test chamber containing a seated test subject. Secondly, using a validated Computational Fluid Dynamics model, humidity isotropy or lack thereof under conditions of a humidified jet of air was studied. The experimental measurements were carried out at specific points in space over a period of circa 2 h. The CFD model enabled a more complete understanding of the spatial and temporal variations occurring within the space. Comparing the experimental results with those from the CFD model shows that the latter manages to adequately predict the transient specific humidity distribution inside the chamber with a maximum error of 0.0015 g g −1, which, following an initial settling stage, becomes practically homogeneous throughout. Temperature profiles were found difficult to predict with the model. The minor spatial gradients of humidity found are governed by convection and shearing of the flow.

ABSTACTObjective: To examine the diagnostic utility of applause sign scores for the diagnosis of dementia and mild cognitive impairment. Methods: Consecutive unselected new outpatient referrals to a dedicated cognitive disorders clinic over a 12-month period were administered the clapping test. Criterion diagnosis was by usual clinic assessment using standard diagnostic criteria, blind to applause sign score. Results: Applause sign scores differed significantly (p

Introduction Reduire le taux d’amputations liees a l’ulcere du pied diabetique (UPD) est un enjeu majeur du diabete ; pour les patients en termes de qualite de vie et de pronostic, pour les soignants confrontes a des situations graves et complexes, pour la societe sur un plan medicoeconomique. Les recommandations apportent des reperes precis et codifies sur les strategies de prise en charge du pied tant au niveau du traitement de la plaie que la prevention de sa survenue. Le concept de multidisciplinarite et de structures specialisees sur une approche ambulatoire a fait la preuve de son efficacite sur la reduction forte du taux d’amputations majeures. Cependant, le parcours des patients porteurs d’ulcere du pied est jalonne de points critiques limitant l’efficacite. En dehors de la meconnaissance des recommandations par les soignants et du manque de sensibilisation des patients au risque, l’absence ou les difficultes d’identification des structures specialisees par les acteurs du premier recours ou leur absence au sein d’un territoire est une cause identifiee. Au sein du Board Urgo Pied (BUP), ces constats ont conforte notre volonte de concevoir un annuaire regroupant les structures specialisees au niveau national avec deux objectifs : obtenir une premiere cartographie nationale et renforcer la demarche d’amelioration de la qualite de chaque structure. Methode Pour cela, nous avons defini sur les bases des guidelines huit criteres essentiels definissant une structure specialisee « pied diabetique ». Notre volonte n’est pas de faire une selection mais de creer une dynamique nationale en faveur d’une meilleure organisation de la prise en charge de ces patients. Resultats Dans une premiere version, editee a l’occasion des 2e Journees de formation Jean-Louis Richard (octobre 2017), 69 structures ont ete identifiees. Chaque centre peut evaluer ainsi son niveau de developpement et d’organisation. Bien evidemment, cet annuaire est evolutif et ouvert a de nouvelles structures qui souhaitent y etre recensees. Il reste un outil informatif au service des soignants. Il pourra etre presente sous forme de carte de France afin de visualiser les zones pourvues et celles en besoin. Conclusion Les membres du BUP expriment clairement leur absence de legitimite pour apposer a cet annuaire une demarche de labellisation ou d’agrement, mais il peut etre un outil de reflexion pour nos tutelles sur la mise en place d’une politique de soins pour ameliorer la prise en charge et le pronostic de cette pathologie.

Compliance is crucial in the treatment with statins. It is generally evaluated by comparing the daily dose received on average by treated patients with a standard parameter, which is often the corresponding DDD (Defined Daily Dose) issued by WHO (World Health Organisation). As regards statins, the DDDs issued by WHO (which will be hereafter referred to as WHO-DDDs) have shown to be poor indicators of a correct dosing (which they generally underestimate). As an alternative evaluation standard, reference based DDDs were drawn, for this study, from NCEP (National Cholesterol Education Program) guidelines, i.e. from in progress clinical research on efficacy and safety of statins. This multicenter, retrospective study is based on a statistical sample including six ASLs (ASL: Azienda Sanitaria Locale, Local Health Unit), located in as many Italian Regions, on the whole providing health care for 2,625,000 people. Subjects were eligible to whom statins had been prescribed at least once in the period 2001–2005 (observation period). Data relative to 294,295 patients were selected from the ASL administrative databases. Sampled patients were aged 61 on average and 48% males. The patient’s compliance (measured as the ratio between the average daily dose and the reference based DDD) increased on the whole from less than 40% to more than 50% in the observation period. (Had the compliance been evaluated with WHO-DDDs, the analogous values would have been 85% and 100%). The compliance was analysed through appropriateness bands. In particular, the frequency of quite incorrectly-treated patients (compliance up to 25%) decreased from 65% to 50% of the whole sample, while the frequency of patients in the optimal treatment band (75% to 100% compliance) soared from 3% to 10%. The ASLs were chosen based on availability and reliability criteria, which resulted in their being concentrated in the Northern-Central part of Italy (with the Marche Region weighing more than half of the sample). They could nevertheless be considered as fairly representative of the whole country. The compliance constantly improved during the observation period, even if it reached (only) 50% on the overall average in 2005. If the WHO-DDDs had been used, the compliance would have been too optimistically evaluated, even suggesting an over-treatment area with statins (resulting in the high frequency of patients included in the band with more than 100% compliance).

The molecular orientation, spatial distribution, and thermal behavior of the powerful chiral catalyst modifier precursor (S)-naphthylethylamine adsorbed on Pt[111] have been studied by NEXAFS, XPS, STM, and temperature programmed reaction. At 300 K, both in the presence and in the absence of coadsorbed hydrogen, the strongly tilted molecules do not form ordered arrays. These results constitute the first direct evidence against the template model and are at least consistent with the 1:1 interaction model of chiral induction in the enantioselective hydrogenation of alkyl pyruvates. Raising the temperature beyond 320 K (the temperature of enantioselectivity collapse) leads either to irreversible dimerization with hydrogen elimination or to dissociation of the ethylamine moiety, depending on whether coadsorbed H(a) is present. Either way, the stereogenic center is destroyed. These findings provide the first direct clue as to the possible origin of enantioselectivity collapse, by a mechanism not previously considered. When NEA and methyl pyruvate are coadsorbed in the presence of H(a), STM reveals entities that could correspond to a 1:1 docking complex between the prochiral reactant and the chiral modifier.

Proton magnetic resonance spectra (MRS) were acquired from 1.5×1.5×1.5-cm voxels in the left and right mesial temporal lobes of 20 schizophrenic patients and 20 non-psychiatric comparison subjects. Choline (Cho) to creatine (and phosphocreatine) (Cr(PCr)) ratios were estimated as were the percent gray matter, white matter and CSF contributing to the voxel. The Cho/Cr(PCr) metabolite ratio was significantly lower in the left temporal lobe than in the right temporal lobe for both the schizophrenia subjects and control group. This difference was greater in the schizophrenia subjects. Left temporal lobe gray matter voxel content was significantly higher and white matter content was significantly lower than in the right temporal lobe for both the schizophrenia subjects and control group. This difference was the same for the schizophrenia subjects and control group. Left voxel gray matter and white matter content correlated with Cho/Cr(PCr) metabolite ratios for the schizophrenic subjects but not for the control subjects. No such correlations were noted on the right side. No significant difference was found between Cho/Cr(PCr) in the left temporal lobe or in the right temporal lobe of the schizophrenia subjects vs. the control group.

The adsorption geometry of quinoid species at platinum and palladium surfaces is relevant to an understanding of enantioselective catalytic hydrogenation. Accordingly, quinoline multilayers and monolayers on Pd{111} have been characterized by XPS and the adsorption geometry within the monolayer determined by NEXAFS at 295 K and 360 K. The molecule lies approximately flat (α < 18° ± 5°), bound to the Pd{111} surface predominantly via the aromatic π-system. This adsorption geometry remains unaffected upon heating to 360 K, and the adsorbed layer does not exhibit long range order under any conditions. Comparison with the corresponding results for Pt{111} indicates that the different intrinsic rates and the reversal in the sense of enantioselectivity observed for pyruvate hydrogenation on palladium catalysts relative to platinum is unlikely to originate in either significantly different modifier adsorption geometries or spatial distributions in the two cases. In addition, it now seems less likely that the col...

NEXAFS, variable temperature STM and TPR have been used to study model adsorbates of relevance to heterogeneous chiral hydrogenation on platinum surfaces. In both the presence and absence of co-adsorbed hydrogen, quinoline molecules are uniformly though randomly distributed on Pt {1 1 1} at 300 K. At 350 K, irreversible surface reactions denude the Pt terraces of modified adsorption sites. Under conditions of hydrogen starvation, extensive polymerisation of quinoline occurs. In the presence of hydrogen, polymerisation is accompanied by hydrogenolysis. In both cases, the {1 1 1} terraces are depleted of quinoid-modified adsorption sites. Quinoline lies approximately flat at 300 K (α∼15°), bonded to the surface predominantly via the aromatic π system. This adsorption geometry remains largely unaffected by heating to 360 K, although the data suggest that molecular tilt increases somewhat with surface coverage (α∼20°). Lepidine exhibits a greater tilt angle than quinoline on Pt {1 1 1} (α∼32°), the likely result of steric hindrance due to the substituent at the C4′ position––a characteristic that is present in all known efficient chiral modifiers for the reaction of interest. These findings are discussed with respect to the mechanism of chiral induction and the origin of enantioselectivity collapse in the asymmetric hydrogenation of α-ketoesters on Pt catalysts.

During the past two decades, many American police departments have developed Citizen Police Academies. These programs are intended to improve police-community relations, to educate the public, and to further the implementation of community policing strategies. Despite their widespread use, few efforts have been made to empirically evaluate Citizen Police Academies. This study examines the impact of one Citizen Police Academy program by surveying past program participants. The results show that although the Citizen Police Academy satisfied the department's objectives, the majority of participants entered the program with positive views of the agency. These findings are discussed in terms of the program's overall impact within the community.

Near-edge X-ray absorption fine structure (NEXAFS) and X-ray photoelectron spectroscopy have been used to characterise the adsorption and reactivity of methyl pyruvate and ( S )-(−)-1-(1-napthyl) ethylamine (( S )-NEA) on Pt{1 1 1}. Methyl pyruvate polymerises at room temperature yielding chains that contain CO bonds and no CC bonds; the CO bonds are inclined at 64±5° with respect to the metal surface. Polymerisation probably occurs by an aldol condensation that involves elimination of methanol. This mechanism is in excellent accord with the intramolecular bonding deduced from the NEXAFS results. These findings suggest that irreversible deactivation during start-up or steady state operation of Pt catalysts during enantioselective hydrogenation of alkyl pyruvates can be due to hydrogen starvation, which results in polymerisation of the prochiral reactant. For ( S )-NEA, the naphthalene ring is inclined at 46±5° with respect to the metal surface. It is proposed that ( S )-NEA binds to the surface via contributions from both the aromatic π-system and the lone pair of electrons on the amine nitrogen atom.

STM, NEXAFS, XPS, and TPR have been used to characterize the adsorption and reactivity of methyl pyruvate on Pt{111}. In the absence of coadsorbed hydrogen, methyl pyruvate polymerizes at room temperature yielding polymer chains, partly dendritic. The STM and XPS data provide independent estimates of the average length, found to be ∼9 monomer units. NEXAFS shows that this polymer contains CO bonds and no CC bonds; the CO bonds are inclined at 64° ± 5° with respect to the metal surface. It is proposed that polymerization occurs by hydrogen elimination from the monomer, followed by an aldol condensation that involves elimination of methanol. This mechanism is in excellent accord with the intramolecular bonding, shape, and reactivity of the polymer deduced from the NEXAFS, STM, and TPR results. Coadsorbed hydrogen completely suppresses polymerization. These findings suggest that irreversible deactivation during start-up or steady-state operation of Pt catalysts during enantioselective hydrogenation of alkyl ...

The authors investigated whether there were differences in cerebral and cerebellar gray and white matter volumes in depressed patients compared to controls, and whether this was associated with treatment response to fluoxetine. Brain magnetic resonance images were obtained from 38 unipolar depressed patients and 20 age, gender, and educationally matched comparison subjects. Patients were divided into groups of "responders" and "nonresponders" based on change in 17-item Hamilton Depression Rating Scale (HDRS) after an 8-week standardized trial of fluoxetine, 20 mg/day. There were no group mean differences in cerebral or cerebellar tissue volumes between patients and controls, or responders and nonresponders. For nonresponders to fluoxetine treatment, cerebral and cerebellar gray matter volume, and total cerebellar tissue volume decreased as baseline HDRS increased. The results suggest an association between gray matter volume and severity of illness in nonresponders to fluoxetine treatment.

Peritoneal catheter exit-site and tunnel infections remain critical problems in patients undergoing peritoneal dialysis. Catheter-related peritonitis occurs in about 20% of patients and exit-site infections are responsible for catheter removal in more than one-fifth of the cases. For the last 2 years in the Department of Nephrology, San Bortolo Hospital, Vicenza, Italy, we have been treating exit-site infections caused by Pseudomonas with sodium hypochlorite packs as well as systemic and local antibiotic therapy. Considering the encouraging results obtained on Pseudomonas infection, we decided to utilize the same schedule for the treatment of exit-site infections caused by other germs which are generally difficult to eradicate to prevent peritonitis and catheter removal. Between 2003 and 2004, 10 patients contracted infection of the exit-site. All patients underwent a swab test because of the reddening and the purulent secretion of the exit-site. The swab resulted positive for Pseudomonas in 7 patients, Corynebacterium sp. in 2 patients, and Candida albicans in 1 patient. All patients were treated with systemic antibiotic therapy or antifungal therapy, local sodium hypochlorite 50% packs. After 15 days all patients were submitted to a swab test of the exit site. In all patients, the swab test resulted negative after 15 days and 1 month, and they could continue peritoneal dialysis. This procedure avoided peritoneal catheter removal and temporary switch to hemodialysis in all patients with exit site infection. The mechanism of action is related to the wide antimicrobial spectrum and the rapid action of sodium hypochlorite possibly creating a protective barrier on the exit-site.

Sequential dialysis techniques (i.e. pure ultrafiltration followed by dialysis) have been used in the past, due to their capability to remove large volumes of fluids without inducing hemodynamic instability. The disadvantages of the inadequate dialysis and the lack of technology lead to the decline such methods. Hemofiltration (HF) and hemodiafiltration (HDF) are recently being utilized in a greater proportion thanks to the on line fluid preparation systems. Each process (HF and HDF) has its own benefits in the removal of small, medium and high-molecular weight substances and in the hemodynamic stability. Sequential hemofiltration/ hemodiafiltration (SHF/HDF), may combine the benefits and eliminate the disadvantages of each method. Furthermore they can be easily applied nowadays, due to the development of new high technological hemodialysis machines. In order to evaluate the feasibility and the effects of SHF/HDF we studied 7 chronic hemodialysis patients (6 months of treatment with SHF/HDF switched to 6 months of SHDF/HF), using the same machine (AK200 ULTRA), with on line fluid preparation system and the same type of dialyzer (Polyflux 210). The feasibility of such techniques (SHF/HDF or vice versa) resulted excellent. All sessions left the patients in a condition of well-being making fulltime work. No difference was observed between the different period of treatment, but a reduction in pre value was observed in calcium-phosphorous product, C-reactive protein and beta2-microglobulin, at the end of the sequential techniques. SHF/HDF therapy is a very promising technique. Further studies are needed to better explore the potential of such a therapeutic approach in the quality of life, the hemodialysis adequacy and the hemodynamic stability of our patients.

Background: Previous studies have shown that major depression is frequently accompanied by hypercortisolemia. There is some evidence suggesting that an increase in the glucocorticoid levels may make hippocampal cells more vulnerable to insults caused by hypoxia, hypoglycemia, or excitatory neurotransmitters. Using magnetic resonance imaging (MRI), the hippocampi of patients with major depression were measured and compared with values observed in control subjects. Methods: Thirty-eight patients with primary unipolar major depression were recruited. Twenty control subjects were matched for age, gender, and years of education. The hippocampal volume was measured from coronal MRI scans in all of the subjects. Patients were also grouped and compared as responders and nonresponders to treatment with fluoxetine of 20 mg/day, for 8 weeks. Hamilton Depression Rating Scale (HDRS) was used to determine the severity of depression. Results: No significant differences were observed between the hippocampal volumes of patients with major depression and control subjects; however, a significant correlation was observed between the left hippocampal volume of men and their HDRS baseline values. In addition, female responders had a statistically significant higher mean right hippocampal volume than nonresponders. Conclusions: The results of our study indicate no reduction in the volume of the hippocampus in patients with major depression. Nonetheless, the results do suggest that the effects of disease severity, gender, and treatment response may influence hippocampal volume.

Systemic Lupus Erythematosus (SLE) is a pathology of unknown cause, characterized by tissue and cellular damage, secondary to production of autoantibodies and to deposition of immunocomplexes. Lupus nephritis is one of the most common complications of SLE. Our purpose is to propose a therapeutic protocol for patients suffering from Lupus nephritis. This consists of Plasmapheresis associated with pharmacological therapy so that dosage of immunosuppressors can be reduced and consequently also the side effects of the pharmacological therapy.

We studied 15 patients suffering from nephrotic syndrome (NS) in bioptically-accertained primary and secondary glomerulopathies responding poorly to the common pharmacological treatment. They were monitored for one year by assessing their immunological and kidney functionality parameters, especially proteinuria. The patients underwent 3 apheretic sittings using the cascade double-filtration technique. After the third apheretic sitting the patients received metilprednisolone 300 mg/m2. This therapy was repeated every month for 6 months. At the end of the apheretic cycle it was shown that all patients had responded well to the therapy with a dramatic decrease in proteinuria, maintenance and/or recuperation of kidney functionality and improvement of lipidic asset; these data remained unchanged over time. Considering our preliminary results, we believe that therapeutic apheresis has a precise function in refractory nephrotic syndrome and, in particular, we propose the use of the cascade double-filtration technique. (Int J Artif Organs 2000; 23: 111–3)

The authors investigated whether there were differences in caudate and lenticular nucleus volumes in depressed patients relative to comparison subjects, and whether differences in basal ganglia volume were associated with treatment response to fluoxetine. Brain magnetic resonance images were obtained from 38 unipolar depressed patients and 20 matched comparison subjects. Patients were divided into groups of 'responders' and 'non-responders' based on change in the 17-item Hamilton Depression Rating Scale (HDRS) score after a 10-week open trial of fluoxetine, 20 mg/day. There were no group mean differences in caudate and lenticular nucleus volumes between patients and comparison subjects. Female treatment responders tended to have larger caudate nucleus volumes than male 'responders', and also larger right caudate nucleus volumes than their female 'non-responder' counterparts. Baseline HDRS scores correlated negatively with left caudate nucleus volume in depressed patients. Thus, in mild to moderately depressed patients, we were unable to find differences in caudate and lenticular nucleus-gray matter volumes relative to comparison subjects. One possible reason is that caudate nucleus-gray matter volume and severity of depression are inversely correlated, suggesting that severity of depression may be an important covariate when comparing caudate volumes in depressed patients and control subjects.

Haemodynamics modifications in 49 patients divided in two groups consisting of 21 young people (average age 43 +/- 12 yrs.) and 28 elderly people (average age 72 +/- 7 yrs.) who have undergone at least three treatments with haemofiltration for congestive cardiac decompensation and chronic renal failure have been evaluated. Systolic and diastolic blood pressure and heart rate have been monitored for each patient in a length of time of iT, T30 min., T60 min., fT. The results show a statistically significant reduction of the systolic pressure during the time interval iT-T30 min. in subjects over 65, contrary to the control group. Such preliminary results can be justified by the haemodynamic modifications correlated to the elderly process. In any case the hypothesis cited by the authors need further testing even if confirming the indication of the dialytic treatment on patients over 65 through haemofiltration techniques.

We have investigated proton magnetic resonance spectra of the basal ganglia in 41 medication-free outpatients with major depression, prior to starting an 8-week standardized trial of open-label fluoxetine, and 22 matched comparison subjects. Upon completing the trial, depressed subjects were classified as treatment responders ( n = 18) or nonresponders ( n = 23), based on changes in the Hamilton Depression Rating Scale. Depressed subjects had a lower area ratio of the choline resonance to the creatine resonance (Cho/Cr) than comparison subjects. This statistically significant difference between the depressed subjects and comparison subjects was more pronounced in the treatment responders than in the nonresponders. There were no differences in the relative volumes of gray matter or white matter in the voxel used for proton spectroscopy in depressed subjects relative to comparison subjects. These results are consistent with an alteration in the metabolism of cytosolic choline compounds in the basal ganglia of depressed subjects and, in particular, those who are responsive to fluoxetine.

We followed for a period of six months, 54 patients of over 60 years old, submitted to hemodialitic treatment. We gave human recombinant erythropoietin, average dosage 50 UI/Kg subcutaneously on alternative days, folic acid and iron supplements together with a proteic supply of 1.2 g/Kg/die (35 Kcal/Kg). The medullary response has been monitored with hematochemical tests; blood pressure and nutritional conditions have been evaluated. Furthermore, the patients were given a questionnaire to evaluate their quality of life. At the end of the follow up, 50 patients responded positively to therapy. These patients showed an increase of RBC (from 2,789,780 +/- 259,310 to 3,313,110 +/- 472,780 p0.001) of HCT (from 21.86% +/- 2.16% to 27.18 +/- 2.74% p0.0001) and of Hb (from 7.72 +/- 1.12 g/dl to 9.28 +/- 0.98 g/dl p0.006). Total protein and albumin increased too. Furthermore they showed a progressive increase of "performance status". Our results confirm efficacy of erythropoietin in the treatment of anemia in elderly hemodialized patients.

Normal pressure hydrocephalus is a potentially treatable disorder of progressive gait decline usually associated with variable degrees of cognitive impairment. It is considered to be predominantly a disorder of gait, although urinary incontinence may be a feature. It still remains a challenging condition to diagnose and treat. There appears to be a lack of clarity with regards to diagnostic criteria and investigation. It is our aim to produce guidelines on diagnosis, investigation and management that do not rely on complex investigations and could be used in most centres. To this end we have performed an extensive literature review focussing on clinical features, radiological diagnostic features and optimum use of the large volume CSF tap test. We feel that a national database would greatly facilitate further research into this disorder and would help to better characterise the clinical and radiological features that predict shunt responsiveness. We propose an assessment framework based on published evidence that takes into account clinical, brain imaging and CSF tap test parameters that can be used as a basis for referral for shunt or more invasive investigation.The framework can also be used to collect data for a national database for retrospective analysis of the outcome of shunting and for further research.

Objectif La decouverte d'une plaie du pied chez un diabetique doit faire rechercher une osteite. Le diagnostic en etant parfois difficile, nous avons evalue l'apport des marqueurs inflammatoires, procalcitonine (PCT), CRP, VS, fibrinogene, leucocytes (GB) et polynucleaires neutrophiles (PNN), a partir d'une serie retrospective de patients diabetiques avec osteite (O) compliquant une plaie du pied, versus un groupe temoin (T) avec plaie non infectee. Patients et methodes Groupe O=65 patients avec osteite confirmee par la clinique, la radiologie et l'evolution. Groupe T=25 patients indemnes de toute infection. Les cas douteux ont ete exclus. Age moyen 67±9 ans pour le groupe O, 72±11 ans pour le groupe T (p=0,045). Sex-ratio (90% d'hommes), IMC (28±6 vs 30±7 kg/m 2 ), duree d'evolution du diabete (20±11 vs 19±11 ans), type de diabete et taux de complications similaires pour les 2 groupes. Resultats HbA1c, bilan lipidique et microalbuminurie etaient comparables entre les 2 groupes. CRP (58±65 vs 18±39 mg/l), VS (77±39 vs 45±37 mm), fibrinogene (4,9±1,4 vs 3,5±0,9 g/l), GB (9,5±3,8 vs 7,5±2,1 109/l) et PNN (6,3±3,3 vs 4,8±2,0 109/l) etaient statistiquement (p Conclusion La PCT n'est pas discriminante pour le diagnostic d'osteite sauf en cas d'infection des parties molles avec cellulite associee, ce qui rejoint une etude anterieure (Jeandrot, Diabetologia 2008).

The sepsis syndrome is the most common cause of acute renal failure and multiple organ dysfunction in critically ill subjects and continues to have an alarmingly high mortality. Normal immune homeostasis is interrupted by a complex storm of inflammatory mediators responsible for the deleterious effects. Extracorporeal blood purification techniques can confer benefits in sepsis by proven non-specific removal of these mediators (pro- or anti-inflammatory), and provide a logical and adequate approach to treat this syndrome. High volume hemofiltration (HVHF) has had the most dramatic effect conferring benefits in hemodynamics, reduction in vasopressor doses and improvement in survival. “Pulse HVHF” is the latest approach which may offer the most efficient results: a daily schedule of 6–8 hours followed by standard CVVH. This paper describes the rationale and potential of this technique. Reliability and tolerance of this technique and biological effects are described.