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Funding Acknowledgements Type of funding sources: None. Background Postoperative atrial fibrillation (POAF) is a common complication of cardiac surgery (CS) associated with prolonged hospitalization and increased risk of future adverse events. Epicardial adipose tissue (EAT), defined as adipose tissue between the myocardium and the visceral pericardium, has been recently recognized as a potential contributor to AF pathogenesis. Purpose to evaluate the role of EAT, measured by preoperative CT, in predicting the occurrence of POAF after CS. Methods All patients without prior AT/AF history who underwent CS at our centre were prospectively enrolled and retrospectively analyzed. All the included patients had performed a cardiac CT for the evaluation of the pre-operative coronary arteries. Baseline and surgical characteristics were systematically collected along with pre-operative echocardiographic parameters (LA diameter and area; EF) and CT EAT values. For the evaluation of the EAT we selected the area delimited superiorly from the center of the right pulmonary artery and inferiorly to the end of the pericardial sac. The adipose tissue between the myocardium and the pericardium was manually delimited and the total EAT volume was expressed in mL (total EATV; Fig. 1). Also the thickness (mm) of the EAT at the level of the free wall of the right ventricle (RV EAT) and posterior to the left atrium in a 4-chamber plane (LA EAT) were reported. All the measured EAT were indexed for BSA. Multivariate logistic regression analysis was used to identify independent predictors of the study endpoint: the occurrence POAF during the early postoperative period. Results A total of 117 patients (age 65±15 years old; M= 71%) were enrolled. Soon after surgery, POAF was observed in 55 patients (47%). Patients with POAF were significantly older, with higher comorbidities burden (diabetes; CHA2DS2-VASc score ≥1) than patients without POAF. No other significant differences for clinical features or surgical procedures were observed. Echocardiographic and CT parameters did not significantly differ between the two groups however older patients who developed POAF had elevated levels of indexed total EATV (96.1±46.6 cm3/m2) (Fig.2). At multivariate logistic regression analysis the only indipendent predictor of POAF remained age (OR: 1.053; 95% CI: 1.018-1.089; p=0.003). Conclusions Advanced age is a recognized risk factor for POAF following CS in patients without prior AF history. Older patients who developed POAF had elevated EAT values, however our study did not evidence any link between EAT and POAF.

Influence maximization (IM) under a continuous-time diffusion model requires finding a set of initial adopters which when activated lead to the maximum expected number of users becoming activated within a given amount of time. State-of-the-art approximation algorithms applicable to solving this intractable problem use reverse reachability influence samples to approximate the diffusion process. Unfortunately, these algorithms require storing large collections of such samples which can become prohibitive depending on the desired solution quality, properties of the diffusion process and seed set size. To remedy this, we design an algorithm that allows the influence samples to be processed in a streaming manner, avoiding the need to store them. We approach IM using two fractional objectives: a fractional relaxation and a multi-linear extension of the original objective function. We derive a progressively improved upper bound to the optimal solution, which we empirically find to be tighter than the best existing upper bound. This enables instance-dependent solution quality guarantees that are observed to be vastly superior to the theoretical worst case. Leveraging these, we develop an algorithm that delivers solutions with a superior empirical solution quality guarantee at comparable running time with greatly reduced memory usage compared to the state-of-the-art. We demonstrate the superiority of our approach via extensive experiments on five real datasets of varying sizes of up to 41M nodes and 1.5B edges.

Background Maintenance ART with dolutegravir-based dual regimens have proved their efficacy among HIV-1-infected subjects in randomized trials. However, real-life data are scarce, with limited populations and follow-up. Objectives We assessed virological failure (VF) and resistance-associated mutations (RAMs) on dolutegravir maintenance regimens in combination with rilpivirine or with lamivudine or emtricitabine (xTC) and analysed the factors associated with VF. Methods Between 2014 and 2018, all HIV-1-infected adults included in the Dat’AIDS cohort and starting dolutegravir/rilpivirine or dolutegravir/xTC as a maintenance dolutegravir-based dual regimen were selected. VF was defined as two consecutive HIV RNA values >50 copies/mL or a single value >400 copies/mL. We compared cumulative genotypes before initiation of a maintenance dolutegravir-based dual regimen with genotype at VF. Results We analysed 1374 subjects (799 on dolutegravir/rilpivirine and 575 on dolutegravir/xTC) with a median follow-up of 20 months (IQR = 11–31) and 19 months (IQR = 11–31), respectively. VF occurred in 3.8% (n = 30) of dolutegravir/rilpivirine subjects and 2.6% (n = 15) of dolutegravir/xTC subjects. Among subjects receiving dolutegravir/rilpivirine, two genotypes harboured emerging RAMs at VF: E138K on NNRTI (n = 1); and E138K+K101E on NNRTI and N155H on INSTI (n = 1). Among subjects receiving dolutegravir/xTC, no new RAM was detected. The only predictive factor of VF on dolutegravir/rilpivirine was the history of failure on an NNRTI-based regimen (adjusted HR = 2.97, 95% CI = 1.28–6.93). No factor was associated with VF on dolutegravir/xTC. Conclusions In this large real-life cohort, dolutegravir/rilpivirine and dolutegravir/xTC sustained virological suppression and were associated with a low rate of VF and RAM emergence. Careful virological screening is essential before switching to dolutegravir/rilpivirine in virologically suppressed patients with a history of NNRTI therapy.

Introduction In patients (pts) undergoing cardiac surgery for primary mitral regurgitation (PMR), coronary angiography (CA) is always scheduled shortly before surgery to rule out significant coronary artery disease (CAD), despite this population is often young and with relatively low risk for CAD. Computed Tomography Coronary Angiography (CTCA) could be an alternative approach to evaluate coronary arteries, at least ruling out significant CAD in selected pts, due to its high negative predictive value. Purpose A safer, more appropriate and efficient clinical and diagnostic pathway for patients undergoing cardiac surgery for PMR by stratifying patients prior cardiac surgery according to pretest probability score (PTP) and therefore shifting imaging of epicardial coronary arteries from invasive to noninvasive in specific patients subsets. Methods A retrospective analysis (Jan 2014–Dec 2020) was carried out through the extraction of 7343 electronic medical records of pts who underwent cardiac valve surgery. In 1556 pts with PMR (1195 with no-CAD and 361 with CAD) a PTP was retrospectively calculated according to Genders, 2012, to stratify their risk of CAD. A Decision oriented Health Technology Assessment (DoHTA) and a cost analysis were also performed to support the analysis results. A survey was distributed to a team of experts with a multidisciplinary background to analyze the most significant evaluation areas (Economic Aspects, Clinical Effectiveness, Safety, Innovation) and the sub-criteria related to them. Following the Core Model Eunethta as a guideline, a Rapid Report HTA has been drawn up to identify the best solution. Results Patients characteristics are listed in Picture 1. Pts with normal coronary arteries showed a PTP low-to intermediate while pts with high PTP had CAD and therefore had a real pretest need for a CA (average 11 percent ± 9 in noCAD group vs 20 percent ± 14 in the CAD group). In two thirds of PMR population coronary angiography could have been avoided according to a PTP score The cost analysis results were significantly lower in CTCA (1,315.00 EUR vs 180.00 EUR, CA vs CTCA respectively), The Decision Oriented HTA conducted by a multidisciplinary team showed a relevant preference for the new pathway (Picture 2) with a score of 70.23 percent of preference among the Team. Conclusions This new pathway, already proposed for selected pts in ESC guidelines on valve diseases (class IIA, LOE C) could be always adopted in PMR pts with low-to intermediate PTP score undergoing cardiac surgery. It could improve workflow efficiency and reduce LOS, and last but not least, avoid an invasive test, reduce radiation exposure and AKI risk in in a relatively young population The DoHTA provided a more effective and efficient support to the decision-making process. Funding Acknowledgement Type of funding sources: None. Picture 1. Patients characteristics (noCAD-CAD)Picture 2. HTA Score CTCA vs CA

Context There are no validated Spanish tools to assess symptom burden in pediatric cancer. The Pediatric Memorial Symptom Assessment Scale (Pediatric-MSAS) is an English valid multidimensional and comprehensive instrument. Objectives To validate Pediatric-MSAS-Spanish (MSAS-Child, MSAS-Teen, and MSAS-Caregiver versions) in patients with cancer treated in two public hospitals in Buenos Aires, Argentina. Methods Cross-sectional study, classical psychometric theory. We recruited a convenience sample of 148 caregivers of children ≥ two years, 51 young children (seven to 12 years), and 48 adolescents (≥13 years). We assessed feasibility, comprehensibility, internal consistency, and convergent and known-groups validity. Results Pediatric-MSAS-Spanish was feasible, acceptable, and comprehensible. Reliability of MSAS-total and subscale scores was satisfactory (Cronbach alpha: 0.90, 0.89, 0.71, respectively, for caregiver, teen, and child MSAS-total score). MSAS-total caregiver, teen, and child scores met a priori criteria for convergent validity correlating with Pediatric Quality of Life Inventory total scores (Spearman correlation (rs) = −0.59, −0.66, and −0.32, respectively) and visual -analogue well-being scores (rs = −0.63, −0.46, and −0.4, respectively). Caregiver-teen correlation was strong for total (rs = 0.78) and physical (rs = 0.85) scores, and moderate for global distress index (rs = 0.64) and psychological (rs = 0.45) scores. MSAS-total caregiver-child correlation was moderate (rs = 0.30) and Kappa analysis showed poor agreement. All MSAS-Caregiver scores and MSAS-Teen total and physical scores differentiated inpatients/outpatients and patients on/off-treatment, while MSAS-Teen psychological and global distress index subscales or MSAS-Child scores did not. Conclusion Pediatric-MSAS-Spanish is feasible and reliable for assessing symptom burden in children with cancer. Validity of MSAS-Caregiver and MSAS-Teen was largely supported. Further work on MSAS-Child is warranted.

Objectives The authors report the results of a 15-year antibiotic stewardship policy in the Nancy Teaching Hospital and assess the impact of reinforcing this policy on antibiotic consumption. Methods Antibiotic stewardship policy was initiated in the mid 90 s and then reinforced from 2006 onwards. It was completed by prescription guidelines, nominative prescription of antibiotics, and an operational infectious diseases team (OIDT). The objectives were to promote antibiotic stewardship and decrease the use of extended broad spectrum or costly molecules and intravenous administration. Antibiotics consumption, as defined daily dose per 1000 patient days (DDD/1000 PD) and in euros, was monitored from 2005 onwards. Results Between 2005 and 2008, overall yearly cost of antibiotics dropped by 34% (− € 1,308,902) and consumption in DDD/1000 PD by 10%. This drop in consumption concerned all antibiotic classes. Teicoplanin prescription dropped by more than 50% and use of fluoroquinolone IV decreased by 15% in 3 years. The operational team's interventions were effective since nearly 80% of suggested prescription amendments were accepted by prescribers. Conclusions This experiment shows that it is possible to implement antibiotic stewardship policy. Our results prove a significant decrease in overall consumption of antibiotic, a change in prescribing patterns, with a shift towards the use of cheaper antibiotics.

La prise orale des comprimes ou des gelules est sou-vent difficile en cas de nausees, de vomissements, de dyspha-gies, de troubles de la deglutition… Cependant, des galeniques specifiques existent. nous proposons un guide de prescription en cas de voie digestive haute alteree. Notre source est la base de donnees Vidal Hoptimal 2010. Les medicaments sont classes par classe therapeutique, forme galenique, denomination commune internationale (DCI), specialite.

Resume Objectifs Evaluer le bon usage des fluoroquinolones (FQ) a l’echelon d’une region par une revue de pertinence organisee par le reseau Antibiolor. Methodes Debut 2008, les praticiens des etablissements de Lorraine volontaires ont rempli une fiche type mentionnant l’indication, le nom de la FQ, sa voie et sa duree sur les prescriptions des trois derniers mois. Des binomes ont verifie la pertinence de la prescription par rapport a l’Antibioguide, distribue dans chaque etablissement, et etabli un score d’index d’adequation therapeutique pour chaque fiche. Chaque etablissement a recu ses resultats. Des mesures correctrices ont ete adoptees lors d’une reunion de la commission regionale des antibiotiques en janvier 2009. Resultats Cent vingt-quatre services (61 medecines, 33 chirurgies, 17 reanimations, 2 SAU, 11 SSR) de 28 etablissements ont complete 1538 fiches. Les indications les plus frequentes etaient : pulmonaires (632), urinaires (445), digestives (130). L’indication des FQ a ete jugee non conforme pour 36 % des fiches ( n = 554), Lorsque l’indication des FQ etait justifiee (984 fiches), l’analyse a juge non conforme le choix de la molecule dans 222 cas (23 %), la posologie dans 115 cas (12 %), la duree dans 250 cas (25 %) ; la voie d’administration etait non appropriee dans 83 cas (8 %) seulement. Les prescriptions etaient entierement conformes pour 425 fiches (28 %). Conclusion Les etablissements lorrains ont massivement participe a cette etude. Le deuxieme tour suivra la meme methodologie. L’objectif de ce dernier est de reduire le nombre de prescriptions injustifiees de FQ et d’augmenter le nombre de fiches entierement conformes.

Biopolymers are alternative materials used in the production of edible and/or biodegradable films. A very important restriction factor concerning the films is their sensitivity to environmental conditions, such as temperature and relative humidity. The production of films based on gelatin and polyvinyl alcohol blends can be an alternative solution in order to reduce the sensitivity to the humidity. Thus, the aim of this work was to apply the microwave transmittance technique to measure qualitative effects of the presence of glycerol and polyvinyl alcohol on the moisture content of gelatin-based films. The results show that the films with glycerol, conditioned for one week in NaBr, revealed visible changes between 11 and 13 GHz as the plasticizer concentration increased. For gelatin films containing PVA, the results revealed very low microwave insertion losses. Thus, this behaviour was attributed to the presence of water molecules in gelatin films.

Resume Malgre plus de 7 000 cas par an de tuberculose declares en France, le diagnostic de la tuberculose reste encore trop tardif. La symptomatologie de la tuberculose pulmonaire est non specifique, mais caracterisee par sa chronicite. Dans ce contexte, le cliche thoracique et la prise en compte des facteurs environnementaux demeurent une etape importante dans l’evocation du diagnostic. Les tuberculoses extrapulmonaires (de 20 a 30 % des tuberculoses) concernent actuellement les patients d’origine etrangere, les patients âges, ceux infectes par le virus de l’immunodeficience humaine, ou traites par immunosuppresseurs ou infliximab.

Resume Materiels et methodes. – Etude epidemiologique, clinique, biologique, radiologique et therapeutique des legionelloses de l'epidemie lorraine de juillet–aout 2004. Resultats. – Douze cas recenses dont 11 hommes. L'âge moyen est de 68,5 ans [min = 48 ; max = 96]. Six patients etaient fumeurs dont quatre alcoolotabagiques, trois diabetiques, trois porteurs d'hemopathie, un sous corticotherapie. Pour un patient, aucun facteur de risque n'a ete reconnu. Dans neuf cas, le debut a ete brutal. Neuf patients avaient une fievre superieure ou egale a 40 °C, neuf une dyspnee, sept une toux seche, sept une bradycardie relative, trois une diarrhee, trois un malaise, trois un syndrome confusionnel. Atteintes radiologiques unilaterales, unilobaires dans dix cas. Biologie : hyponatremie dans dix cas, cytolyse hepatique dans huit cas, rhabdomyolyse dans quatre cas, CRP > 300 mg/l dans huit cas. Le diagnostic a ete confirme par recherche d'antigenurie chez les 12 patients. Deux antigenuries se sont averees negatives rapidement apres l'initiation du traitement alors qu'une recherche prealable avait ete positive. Dans tous les cas, la premiere serologie realisee dans les premiers jours suivant l'apparition de la symptomatologie s'est averee negative. Deux serologies de controle se sont averees positives (sur quatre). Un seul prelevement d'expectoration sur sept realises s'est avere positif (tous ces prelevements ont ete realises apres la mise sous traitement). Dans sept cas, une bitherapie a ete instauree avec l'association preferentielle : fluoroquinolone–rifampicine. Deux deces ont ete recenses. La source de contamination n'a pu etre precisee. Conclusion. – La culture de Legionella pneumophila reste indispensable en contexte epidemique pour confronter des souches cliniques et environnementales afin de localiser la source de l'infection.

Resume Objectif Analyser les causes de deces chez les adultes infectes par le VIH survenues au cours de l’annee 2000. Methode A partir d’une enquete nationale, notre etude decrit et analyse les causes et les caracteristiques des deces des patients en succes immunologique et virologique (CD4 > 200/mm 3 , ARN-VIH plasmatique Resultats Parmi un total de 964 deces notifies, des informations detaillees etaient disponibles pour 864 patients. 149 patients (17 %) etaient en succes immunovirologique. La cause sous-jacente du deces etait pour 36 un cancer non classant sida (24 %) dont 16 cancers du poumon, 7 hepatocarcinomes et 3 neoplasies colorectales, pour 22 une pathologie classant sida (15 %) dont 10 lymphomes malins non hodgkiniens et 3 carcinomes du col, pour 22 une maladie cardiovasculaire (15 %), pour 16 une insuffisance hepatique post-hepatite C (11 %), pour 16 un suicide (11 %), pour 14 une infection bacterienne (9 %). En comparant les caracteristiques de ces 149 patients a ceux des 715 autres patients, les repondeurs etaient significativement plus souvent co-infectes par le VHC (45 vs 33 %), toxicomanes (40 vs 27 %), alcooliques (38 vs 28 %), dyslipidemiques (19 vs 11 %). En 2000, pres de 20 % des deces notifies en France parmi les patients infectes par le VIH, sont survenus sous traitement en succes immunovirologique. Conclusion Pour reduire la mortalite parmi ces patients traites efficacement, une attention doit etre portee sur des causes curables comme l’hepatite C, les dyslipidemies et sur la prevention des cancers comme ceux du poumon, du col uterin ou de l’intestin.

COSMO-SkyMed is an Earth Observation space program funded by the Italian Ministry of Research and Italian Ministry of Defence (It-MoD) and conducted by the Italian Space Agency (ASI) in conjunction with It-MoD. In the framework of the programmatic phase concerning the maintenance of the constellation in operational conditions, already in place, new parameters have been conceived in order to automatically monitor end-to-end system performances and engineering support efficiency. Aim of this paper is to describe all the parameters currently used to measure availability, effectiveness and efficiency figures of COSMO-SkyMed system, the lessons learned and optimization strategies concerning the parameters used during the development phase, with a particular focus on the new parameters recently designed and introduced to assess anomalies and non conformance management process efficiency. Methodologies, process architecture solutions, parameters detailed algorithms, test cases and validation strategy will be assessed in this paper, pointing out how the conceived frame gives the system owner the right confidence of an automatic monitoring of the end-to-end performances of the COSMO-SkyMed system.

Because of its high diffusing capacity through the alveolar-blood barrier and its high selectivity for the pulmonary vasculature, inhaled nitric oxide (NO) has been recently shown to be a viable and efficient approach to restore pulmonary NO deficiency. The most relevant applications of inhaled NO are in infants with primary pulmonary hypertension or hypoxia. In these patients, inhaled NO improves gas exchange and ventilation-perfusion matching, reduces the length of hospitalization and is without severe detrimental effects. The use of inhaled NO has also been extended to adults with pulmonary hypertension and the acute respiratory distress syndrome. In addition, recent clinical evidence supported by data from animal models, shows beneficial extra-pulmonary effects of inhaled NO, including protection against myocardial ischaemia-reperfusion injury.

A cell line derived from a pleiomorphic liposarcoma (LSA) secretes a factor exhibiting specific and selective oncotoxic properties. This factor, a variant isoform of manganese superoxide dismutase (MnSOD), by injection in mammary cancer affected cats and dogs, was internalized only in the tumor cells. So, when labelled, it could be used as tumor marker or as radiopharmaceuticals.

During the past few years, it has become evident that metabolic control is a major determinant of postoperative outcomes, not only for diabetic patients but for all patients undergoing surgery. In cardiac and vascular surgery, myocardial ischemia is a common challenge and the management of hyperglycemia should be part of the strategy aimed at optimizing cardiac protection during these types of surgery, since performed in high risk patients. Little informations are available on the relation between glucose substrate and the type of anesthesia and few studies have been performed on glucose metabolism in the perioperative risk assessment as well as on intraoperative and post surgical management of hyperglycemia in patients submitted to cardiac and vascular surgery. Evidence exists that even slight increased in glycemia are detrimental for patients (diabetic and non) elective for cardiac and vascular surgery, though the precise details of the timing of insulin therapy, the desired target serum glucose level, and the duration of therapy are so far to be completely elucidated. Anesthestiologists can therefore affect outcome by simply preserving a normal blood glucose concentration initiating in the operating room. The challenge to optimize glucose control should begin during preoperative evaluation.

Recently, there has been significant interest in social influence analysis. One of the central problems in this area is the problem of identifying influencers, such that by convincing these users to perform a certain action (like buying a new product), a large number of other users get influenced to follow the action. The client of such an application is essentially a marketer who would target these influencers for marketing a given new product, say by providing free samples or discounts. It is natural that before committing resources for targeting an influencer the marketer would be interested in validating the influence (or network value) of influencers returned. This requires digging deeper into such analytical questions as: who are their followers, on what actions (or products) they are influential, etc. However, the current approaches to identifying influencers largely work as a black box in this respect. The goal of this paper is to open up the black box, address these questions and provide informative and crisp explanations for validating the network value of influencers. We formulate the problem of providing explanations (called PROXI) as a discrete optimization problem of feature selection. We show that PROXI is not only NP-hard to solve exactly, it is NP-hard to approximate within any reasonable factor. Nevertheless, we show interesting properties of the objective function and develop an intuitive greedy heuristic. We perform detailed experimental analysis on two real world datasets - Twitter and Flixster, and show that our approach is useful in generating concise and insightful explanations of the influence distribution of users and that our greedy algorithm is effective and efficient with respect to several baselines.

The Antibiolor network assessed the good use of fluoroquinolones (FQ) in the French Lorraine region by a relevance review.At the beginning of 2008, the experts in voluntary hospitals filled out a standard card mentioning the indication, FQ name, route, and duration according to prescriptions in the last 3 months. Two experts checked the relevance of prescriptions according to the local Antibioguide, and determined a score of therapeutic adequacy index for each card. Each establishment was given its results. Corrective measures were adopted at a meeting of the regional antibiotics commission in January 2009.One hundred and twenty-four units (61 medical, 33 surgical, 17 ICU, 2 ER, 11 long-stay hospital) in 28 hospitals filled 1538 cards. The most frequent indications were: pulmonary (632), urinary (445), digestive (130). The FQ indication was non-conform for 36% of the cards (n=554). When the FQ indication was justified (984 cards), the chosen molecule was non-conform in 222 cases (23%), dose in 115 cases (12%), duration in 250 cases (25%), and route of administration in 83 cases (8%). The prescriptions were entirely conform for 425 cards (28%).The Lorraine hospitals massively took part in this study. The second survey will use the same methodology. The objective will be to reduce the number of unjustified FQ prescriptions and to increase the number of conform cards.

To describe epidemiological, clinical, biological, radiological data and therapeutic features of legionnaire's disease during an outbreak occurring in Meurthe-et-Moselle between July-August 2004.12 cases were recorded including 11 men, 6 smokers, 4 alcoholo-nicotinic, 3 diabetics, 3 with hemopathy, 1 with corticotherapy; in one case no risks factors were found; mean age was 68.5 years [minimum=48; maximum=96]. Nine cases had sudden symptoms. Nine cases had a fever up to 40 degrees C, 9 with dyspnoea, 7 with cough, 7 with a relative bradycardia, 3 with diarrhoea, 3 felt faint, 3 with confusion. Radiology: unilateral unilobe localisation in 10 cases. Biological data: cytolysis in 8 cases, CRP300 mg/l in 8. The diagnosis confirmed with urinary antigen of Legionella pneumophila serogroup 1 (UrAgLp1) in 12 cases. In 2 cases, UrAgLp1 appeared negative between 3rd and 10th day after the beginning of a treatment although UrAgLp1 was positive before the treatment. In all cases, the first serology realised during first days following occurrence the first symptoms remained negative. Two serology of control in four were positive. One search of L. pneumophila serogroup 1 in sputum was positive in 7. Bitherapy was used in 7 cases with preferential association: fluoroquinolone+rifampicin. Two patients died. Origin of the contamination remains unknown.Culture of Legionella is essential, in epidemic context, to compare clinical and environmental Legionella and to locate the origin of contamination.

To analyse the causes of death among HIV-infected adults in France in the year 2000.Based on data from a national survey, our study describes and analyses the causes and characteristics of patients with immunological and virological response (CD4200/mm3, ARN-HIV500 copies/mL), who died during antiretroviral treatment.Among a total of 964 deaths registered, data on 864 cases were available for analysis. One hundred forty-nine patients (17%)were immunovirological responders. The underlying causes of death were non AIDS-defining malignancies for 36 (24%), mainly due to lung cancer (16 cases), hepatocarcinoma (7) and ano-rectal carcinoma (3), AIDS for 22 (15%), mainly due to Non Hodgkin Lymphoma (10 cases) and uterine cancer (3), cardiovascular diseases for 22 (15%), post hepatitis C hepatic failure for 16 (11%), suicide for 16 (11%), and bacterial infections for 14(9%). When comparing characteristics of death in the 149 responders versus the 715 other patients, the responders were significantly more frequently: co-infected by HCV+ (45 vs. 33%), injected drug addicts (40 vs. 27%),alcoholics (38 vs. 28 %), and dyslipidemics (19 vs. 11%). In 2000,around 20% of registered deaths of HIV patients in France had occurred among good immunovirological responders.To further reduce mortality among such efficiently treated patients, attention must be focused on treatable conditions such as hepatitis C, dyslipidemia and on the prevention of malignancies such as lung cancer and cervical or ano-rectal carcinoma.

Background. Colorectal cancer is a frequent cause of mortality in Western countries, including Italy, where a definite screening policy has not yet been adopted. It is likely that most patients with colorectal cancer refer, first of all, to their primary care physician at onset of symptoms. Aim. To perform a survey on the approach, of primary care physicians, to patients with symptoms suggesting the presence of colorectal cancer. Methods. A total of 280 consecutive symptomatic patients without previous diagnosis of organic colon disease or recent colon investigation in whom, after consulting, 159 primary care physicians in Lazio (Italy) prescribed colonoscopy or double-contrast barium enema. Results. Most frequent presenting symptoms were lower abdominal pain (79.6%), bloating (59.6%), constipation (47.8%), diarrhoea (30.3%), iron deficiency anaemia (24.6%), change in bowel habits (20.3%) and weight loss (15%). Colonoscopy and barium enema were equally advised by physicians to rule out the presence of cancer (56% versus 44%, P =ns). Cancer was found in 14.6% of patients. Age >50 years and iron deficiency anaemia were the only independent variables associated with colorectal cancer (Odds ratios 9.0 and 8.8 at multivariate analysis, respectively). Conclusion. The symptom-based selection criteria used by primary care physicians have been shown to be scarcely effective. Colonic investigation should be requested, irrespective to the symptoms, in patients aged >50 years with iron deficiency anaemia.

Because of its high diffusing capacity through the alveolar-blood barrier and its high selectivity for the pulmonary vasculature, inhaled nitric oxide (NO) has been recently shown to be a viable and efficient approach to restore pulmonary NO deficiency. The most relevant applications of inhaled NO are in infants with primary pulmonary hypertension or hypoxia. In these patients, inhaled NO improves gas exchange and ventilation-perfusion matching, reduces the length of hospitalization and is without severe detrimental effects. The use of inhaled NO has also been extended to adults with pulmonary hypertension and the acute respiratory distress syndrome. In addition, recent clinical evidence supported by data from animal models, shows beneficial extra-pulmonary effects of inhaled NO, including protection against myocardial ischaemia-reperfusion injury.

Discharges derived from industries, crude sewage, municipal wastes and petroleum have been the most common and important source of pollution to the main rivers of the Province of Buenos Aires, Argentina. During the last decade, several investigations have been carried out to determine the effects of pollution upon the biotic communities of the rivers located in this region. The present paper describes the density variations of the main groups of phyto- and zooplankton in relation to several environmental variables, including heavy metals, throughout the main channel of the river. The effects of complex chemical mixtures present in the water were assessed through genotoxic activity and algal assays. Phytoplankton (mean: 25,000 ind. mL-1) and zooplankton (mean: 534 ind. L-1) densities were high, exceeding by approximately an order of magnitude the mean records from Reconquista River. Cyanophyceae (38%), Chlorophyceae (33%), Bacillariophyceae (23%) and Euglenophyceae (10%) were the dominant algal classes. Rotifers were widely dominant among zooplankton groups (99%). Algal bioassays showed that the inhibition of growth was correlated with nickel. This river has been and still undergoes recovery plans that focus the treatment mainly on the cleaning of its river bed. The results obtained suggest that a definitive recovery of the river should not only rely on river bed cleaning and a decrease in the input of crude effluents, but also on the care and recovery of the river banks and surrounding lands. Fil: Magdaleno, Anahí. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Puig, Alba. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Museo Argentino de Ciencias Naturales "Bernardino Rivadavia"; Argentina Fil: de Cabo, Laura Isabel. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Museo Argentino de Ciencias Naturales "Bernardino Rivadavia"; Argentina Fil: Salinas, Cristian. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Museo Argentino de Ciencias Naturales "Bernardino Rivadavia"; Argentina Fil: Arreghini, Silvana. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Museo Argentino de Ciencias Naturales "Bernardino Rivadavia"; Argentina Fil: Korol, Sonia. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica; Argentina Fil: Bevilacqua, S.. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica; Argentina Fil: López, Laura. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica; Argentina Fil: Moretton, Juan. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica; Argentina

To assess and record the response to continuous infusion of the phosphodiesterase inhibitor enoximone during weaning from mechanical circulatory support (MCS) and to verify the possibility of success with this indication in pediatric patients.Retrospective study.Pediatric cardiac surgery intensive care unit.Two pediatric patients operated for complex congenital heart disease with low cardiac output syndrome in the immediate postoperative period, evolved in cardiocirculatory arrest despite massive inotropic pharmacological support, and then assisted by mechanical circulatory support.Weaning from mechanical circulatory support with continuous infusion of enoximone, only in one case preceded by a loading dose and associated with catecholamine infusion.During weaning hemodynamic parameters (LAP, CVP, MAP, HR), SvO2, diuresis, rectal and cutaneous temperatures were assessed and recorded. A serial echocardiographic assessment of left ventricular systolic and diastolic diameters and ejection fraction (EF%) has also been performed every 12 hours. Weaning from MCS using enoximone as inotropic support was possible in both cases.Enoximone proved to be useful in weaning from MCS in two pediatric patients, despite the difficulty to assess its effect in one of the two cases in which enoximone was used together with high dosages of other inotropic drugs. These initial positive results urge us to further investigate applications of this drug in pediatric patients.

Background Optimising glycopeptide and aminoglycoside treatment with Therapeutic Drug Monitoring is recommended. Under-dosing can lead to resistance and ineffective treatment while over-dosing is associated with toxicity. Purpose To evaluate current practise by monitoring aminoglycosides and glycopeptides in a French university hospital: levels (trough and peak concentrations) and percentage of optimal concentrations based on our internal antibiotics guide. Materials and Methods Prescriptions for glycopeptides and/or aminoglycosides, of which at least one dose had been given, were reviewed over one month (February–March 2012). Our data pool contained: patient characteristics, infection and antibiotic treatment background, serum concentration. Results A wide range of official optimal target serum concentrations has been recommended (Consensus Review of the American Society of Health-System Pharmacists, French Pharmacology and Therapeutic Society, internal guidelines, etc.) 91 prescriptions (31 aminoglycosides, 60 glycopeptides) were analysed: the largest percentage was represented by vancomycin (55%) 80% of which were for continuous infusion. Serum vancomycin concentrations are optimised by using continuous regimens (Table 1). For the two regimens, (continuous and intermittent, 10% of trough vancomycin serum concentrations were below 10 mg/L, exposing the patient to to subtherapeutic doses and a higher risk of selecting resistant microorganisms. 10 prescriptions for teicoplanin were reviewed: 70% of serum concentrations were below 20 mg/L and 30% below 10 mg/L. 50% of aminoglycosides trough concentrations were below the internal guideline values and target peak concentrations were not reached (amikacin: 67% under 60 mg/L, gentamycin: 90% under 30 mg/L). Conclusions Most aminoglycosides and glycopeptides concentrations didn’t reach required therapeutic levels during this study. Consensus guidelines should be proposed to avoid bacterial resistance and guide clinical practise. No conflict of interest.

To assess the relationship between the age of pediatric patients and the likelihood of difficult intubations and to confirm the importance of Down Syndrome causing difficult intubations.Retrospective study.Pediatric cardiac surgery operating room.627 pediatric patients, suffering from congenital heart disease, operated in our hospital from 1992 to 1994, divided in three age groups (under 1 month, between 1 month and 1 year, over 1 year of age).Translaryngeal intubation performed in the operating room before the operation.The percentage of difficult intubations was assessed in the three age groups and the association with Down syndrome was also considered. The likelihood of orotracheal intubations in each of the preceding groups was also examined.The percentage of difficult intubation in our experience was estimated to be 4.62%. Intubation's difficulty increases with decreasing age of non Down patients. The risk of difficult intubation in Down patients is, irrespectively of age, nearly 27% higher than in non-Downs (5.77% versus 4.52). However Down Syndrome seems to be important only in the age group between one month and one year. The percentage of orotracheal intubations in the preceding groups, even if indirectly, seem to confirm this observation.

Incidence of Mycobacterium avium complex (MAC) infection has increased in HIV infected patients. We report a retrospective study of 25 cases of MAC infection occurring in HIV patients. Stools examination was performed in 5 (31%) of the patients without digestive symptoms and in the 9 (100%) patients presenting with diarrhoea. The stools culture are positive in 79% of cases (11/14). In all the patients with diarrhoea, direct examination of the stools gave the diagnosis of MAC infection. All the patients had profound immunodepression with CD4+ cell count5/mm3. The mean survival time from mycobacteriosis diagnosis was 122 +/- 90 days despite antimycobacteriosis therapy.

Objectif Evaluer l’efficacite et les contraintes d’une unite de cohorting pendant une epidemie d’ERV. Methode Face a une epidemie de colonisation a ERV affectant plusieurs services, une unite d’hospitalisation a ete dediee specifiquement a la prise en charge de ces patients. Une unite de 22 lits de Maladies Infectieuses a ete designee, unite qui a du suspendre son activite habituelle. Resultats Du 26 mars 2007 au 1 er fevrier 2008 cette unite a effectue 275 entrees, concernant 159 patients, d’âge moyen 68 ans (18-102) ; sex ratio (H/F) 0,87 ; en provenance de 12 services de medecine pour 55 % des patients, de 6 services de chirurgie pour 14 %, de reanimation pour 5 % et d’autres (domicile ou maisons de retraite) pour 26 %. La duree moyenne de sejour a ete de 16,3 jours (1-187) du fait des difficultes de placement. Les modes de sortie ont ete : un long sejour pour 81 patients (29,5 %), le domicile pour 144 patients (52,4 %), en reanimation pour 15 malades (5,5 %) et le retour a l’hopital de provenance pour 10 malades (3,6 %). Le nombre de deces pendant le sejour a ete de 25 (9 %), dont seulement 1 en relation avec l’ERV. L’hospitalisation a genere des nombreuses difficultes de prise en charge, refus ou retard d’examens complementaires, relations conflictuelles avec les familles, epuisement des soignants, mais a neanmoins permis de circonscrire cette epidemie. La perte de recettes T2A a ete evaluee a 1 065 €/patient, soit 282 000 € pour l’annee. Conclusion Le cohorting dans un secteur specifique est une solution efficace pour enrayer une epidemie ERV touchant tout un etablissement au prix d’une chute de 25 % des recettes T2A de ce service « volontaire » et de l’epuisement de toute une equipe soignante.

Le CHU de Nancy a developpe des actions a plusieurs niveaux pour le bon usage des antibiotiques : elaboration d’un referentiel, utilisation d’ordonnances nominatives et une consultation interservices, partenariat entre infectiologue et pharmacien. Cette equipe operationnelle a ete mise en place en fevrier 2006. Apres analyse des ordonnances nominatives par le binome infectiologue-pharmacien, celui-ci intervient aupres des cliniciens si l’antibiotherapie n’est pas conforme au referential ou en l’absence de justification suffisante. L’equipe se rend dans les services. Apres 20 mois, nous denombrons 639 interventions qui ont cible certains mesusages, comme des antibiotherapies inadaptees aux situations cliniques ou aux donnees bacteriologiques, des associations sans interet, voire antagonistes, une monotherapie dans des infections nosocomiales ou une absence de desescalade therapeutique malgre une documentation bacteriologique. En 2007, 90 % des avis emis a ete accepte contre 64 % en 2006, 5 % a ete refuse contre 9 % en 2006. Outre l’amelioration de la conformite des prescriptions, l’analyse des interventions montrequ’associee aux autres mesures, il y a un veritable impact sur la consommation des antibiotiques avec une baisse de 11 % (soit 253 853 euros) en 2006 et en 2007 de 11,3 % par rapport a 2006 (soit 228 305 €) ainsi qu’une relative stabilite en DDJ soit 88,46 DDJ/100 JH en 2007 contre 86,48 DDJ/100 JH en 2006. Les resultats obtenus montrent qu’il est possible d’influer de facon durable sur la consommation des antibiotiques. La poursuite de cette action doit etre associee a un projet pedagogique d’information et de formation de l’ensemble des prescripteurs qui pourra aboutir a la mise en place d’une politique de controle des prescriptions mieux acceptee.