Are Cutibacterium acnes delivered from skin to deep tissues in primary reverse shoulder arthroplasty? A prospective study

INTRODUCTION

The objective of this study is to determine whether the deep tissues are inoculated during surgery with the Cutibacterium acnes still present in the skin after the surgical preparation in reverse shoulder arthroplasties.

MATERIALS AND METHODS

Prospective study including patients undergoing surgery with reverse shoulder arthroplasty. All the patients received preoperative antibiotic prophylaxis with cefazolin (2 g IV) and the skin was prepared with 2% chlorhexidine gluconate and 70% isopropyl alcohol. From all the patients, 9 cultures were obtained after the antibiotic was administrated and the skin surgically prepared. The cultures were sent to isolate C. acnes. DNA was extracted from the C. acnes isolated colonies. Isolate nucleotide distances were calculated using the Genome-based distance matrix calculator from the Enveomics collection toolbox.

RESULTS

The study included 90 patients. C. acnes was isolated in 24 patients (26.6%) with a total of 61 positive cultures. There were 12 phylotype II, 27 IB and 22 IA. In 9 patients, C. acnes was present in both skin and deep tissues, and they constituted the sample to be studied by means of genomic analysis. In 7 out of the 9 patients, deep tissue samples clustered closer to at least one of its corresponding skin isolates when compared to the other independent bacterial ones.

CONCLUSIONS

The C. acnes present in the skin at the beginning of the surgery are the same as those found in the deep tissues at the end of the surgery. This result strengthens the possibility that the C. acnes is delivered from the skin to the deep tissues.

Cell-Free DNA as a Biomarker at Diagnosis and Follow-Up in 256 B and T-Cell Lymphomas

BACKGROUND

Cell-free DNA (cfDNA) analysis has become a promising tool for the diagnosis, prognosis, and monitoring of lymphoma cases. Until now, research in this area has mainly focused on aggressive lymphomas, with scanty information from other lymphoma subtypes.

METHODS

We selected 256 patients diagnosed with lymphomas, including a large variety of B-cell and T-cell non-Hodgkin and Hodgkin lymphomas, and quantified cfDNA from plasma at the time of diagnosis. We further selected 49 large B-cell lymphomas (LBCL) and analyzed cfDNA levels at diagnosis (pre-therapy) and after therapy. In addition, we performed NGS on cfDNA and tissue in this cohort of LBCL.

RESULTS

Lymphoma patients showed a statistically significant higher cfDNA concentration than healthy controls (mean 53.0 ng/mL vs. 5.6 ng/mL, p < 0.001). The cfDNA concentration was correlated with lymphoma subtype, lactate dehydrogenase, the International Prognostic Index (IPI) score, Ann Arbor (AA), and B-symptoms. In 49 LBCL cases, the cfDNA concentration decreased after therapy in cases who achieved complete response (CR) and increased in non-responders. The median cfDNA at diagnosis of patients who achieved CR and later relapsed was higher (81.5 ng/mL) compared with levels of those who did not (38.6 ng/mL). A concordance of 84% was observed between NGS results in tumor and cfDNA samples. Higher VAF in cfDNA is correlated with advanced stage and bulky disease.

CONCLUSIONS

cfDNA analysis can be easily performed in almost all lymphoma cases. The cfDNA concentration correlated with the characteristics of the aggressiveness of the lymphomas and, in LBCL, with the response achieved after therapy. These results support the utility of cfDNA analysis as a complementary tool in the management of lymphoma patients.

Automated quantification of stromal tumour infiltrating lymphocytes is associated with prognosis in breast cancer

Stromal tumour infiltrating lymphocytes (sTIL) in haematoxylin and eosin (H&E) stained sections has been linked to better outcomes and better responses to neoadjuvant therapy in triple-negative and HER2-positive breast cancer (TNBC and HER2 +). However, the infiltrate includes different cell populations that have specific roles in the tumour immune microenvironment. Various studies have found high concordance between sTIL visual quantification and computational assessment, but specific data on the individual prognostic impact of plasma cells or lymphocytes within sTIL on patient prognosis is still unknown. In this study, we validated a deep-learning breast cancer sTIL scoring model (smsTIL) based on the segmentation of tumour cells, benign ductal cells, lymphocytes, plasma cells, necrosis, and 'other' cells in whole slide images (WSI). Focusing on HER2 + and TNBC patient samples, we assessed the concordance between sTIL visual scoring and the smsTIL in 130 WSI. Furthermore, we analysed 175 WSI to correlate smsTIL with clinical data and patient outcomes. We found a high correlation between sTIL values scored visually and semi-automatically (R = 0.76; P = 2.2e-16). Patients with higher smsTIL had better overall survival (OS) in TNBC (P = 0.0021). In the TNBC cohort, smsTIL was as an independent prognostic factor for OS. As part of this work, we introduce a new segmentation dataset of H&E-stained WSI.

MultiCOVID: a multi modal deep learning approach for COVID-19 diagnosis

The rapid spread of the severe acute respiratory syndrome coronavirus 2 led to a global overextension of healthcare. Both Chest X-rays (CXR) and blood test have been demonstrated to have predictive value on Coronavirus Disease 2019 (COVID-19) diagnosis on different prevalence scenarios. With the objective of improving and accelerating the diagnosis of COVID-19, a multi modal prediction algorithm (MultiCOVID) based on CXR and blood test was developed, to discriminate between COVID-19, Heart Failure and Non-COVID Pneumonia and healthy (Control) patients. This retrospective single-center study includes CXR and blood test obtained between January 2017 and May 2020. Multi modal prediction models were generated using opensource DL algorithms. Performance of the MultiCOVID algorithm was compared with interpretations from five experienced thoracic radiologists on 300 random test images using the McNemar-Bowker test. A total of 8578 samples from 6123 patients (mean age 66 ± 18 years of standard deviation, 3523 men) were evaluated across datasets. For the entire test set, the overall accuracy of MultiCOVID was 84%, with a mean AUC of 0.92 (0.89-0.94). For 300 random test images, overall accuracy of MultiCOVID was significantly higher (69.6%) compared with individual radiologists (range, 43.7-58.7%) and the consensus of all five radiologists (59.3%, P < .001). Overall, we have developed a multimodal deep learning algorithm, MultiCOVID, that discriminates among COVID-19, heart failure, non-COVID pneumonia and healthy patients using both CXR and blood test with a significantly better performance than experienced thoracic radiologists.

Comprehensive NGS profiling to enable detection of ALK gene rearrangements and MET amplifications in non-small cell lung cancer

Introduction

Next-generation sequencing (NGS) is currently widely used for biomarker studies and molecular profiling to identify concurrent alterations that can lead to the better characterization of a tumor's molecular landscape. However, further evaluation of technical aspects related to the detection of gene rearrangements and copy number alterations is warranted.

Methods

There were 12 ALK rearrangement-positive tumor specimens from patients with non-small cell lung cancer (NSCLC) previously detected via fluorescence in situ hybridization (FISH), immunohistochemistry (IHC), and an RNA-based NGS assay, and 26 MET high gene copy number (GCN) cases detected by FISH, selected for this retrospective study. All 38 pre-characterized cases were reassessed utilizing the PGDx™ elio™ tissue complete assay, a 505 gene targeted NGS panel, to evaluate concordance with these conventional diagnostic techniques.

Results

The detection of ALK rearrangements using the DNA-based NGS assay demonstrated excellent sensitivity with the added benefit of characterizing gene fusion partners and genomic breakpoints. MET copy number alterations were also detected; however, some discordances were observed likely attributed to differences in algorithm, reporting thresholds and gene copy number state. TMB was also assessed by the assay and correlated to the presence of NSCLC driver alterations and was found to be significantly lower in cases with NGS-confirmed canonical driver mutations compared with those without (p=0.0019).

Discussion

Overall, this study validates NGS as an accurate approach for detecting structural variants while also highlighting the need for further optimization to enable harmonization across methodologies for amplifications.

Characterization and spatial distribution of the immune cell infiltrate in triple-negative breast cancer: a novel classification based on plasma cells and CD8+ T cells

Stromal tumor-infiltrating lymphocytes (sTILs) are a robust prognostic and predictive biomarker in triple-negative breast carcinoma. However, the sTIL compartment comprises different cell populations. The aim of the study is to characterize the distribution of T cells (CD3+ and CD8+), B cells, and plasma cells and explore their association with outcome in the surgical specimen of 62 patients. Furthermore, programmed death ligand 1 expression and the presence of tertiary lymphoid structures (TLSs) are explored. Patients with higher sTILs achieve better progression-free survival (PFS) (P = .0013), and tumors have more plasma cells in the infiltrate. Specifically, higher counts of T cells (both CD3+ and CD8+) have better PFS (P = .002 and P = .0086, respectively) as it is observed in tumors with higher infiltration of CD8+ T cells in the tumor core (P = .035). Higher infiltration by B cells and plasma cells shows a positive tendency toward increased PFS (P = .06 and P = .058). Programmed death ligand 1 (SP142) is positive in 56% of tumors. Tumors with at least 1 TLS (42%) show higher CD8+ T cell infiltration in the tumor core and the sTIL value doubles compared to tumors devoid of TLSs [sTIL mean: 36 ± 11% and 18 ± 5% (CI [Confidence Interval]: 95%), respectively]. Our study demonstrates that the characterization of the immune cell infiltration is as relevant as its distribution. Moreover, the importance of considering different immune cell types for classification is emphasized. Therefore, a new classification of triple-negative breast carcinoma immune infiltration with CD8+ T cell and plasma cell densities in the tumor core and infiltrative margin is proposed.

Palbociclib Rechallenge for Hormone Receptor-Positive/HER-Negative Advanced Breast Cancer: Findings from the Phase II BioPER Trial

PURPOSE

To assess the efficacy and exploratory biomarkers of continuing palbociclib plus endocrine therapy (ET) beyond progression on prior palbociclib-based regimen in patients with hormone receptor-positive/HER2-negative (HR+/HER2-) advanced breast cancer (ABC).

PATIENTS AND METHODS

The multicenter, open-label, phase II BioPER trial included women who had experienced a progressive disease (PD) after having achieved clinical benefit on the immediately prior palbociclib plus ET regimen. Palbociclib (125 mg, 100 mg, or 75 mg daily orally for 3 weeks and 1 week off as per prior palbociclib-based regimen) plus ET of physician's choice were administered in 4-week cycles until PD or unacceptable toxicity. Coprimary endpoints were clinical benefit rate (CBR) and percentage of tumors with baseline loss of retinoblastoma (Rb) protein expression. Additional endpoints included safety and biomarker analysis.

RESULTS

Among 33 patients enrolled, CBR was 34.4% [95% confidence interval (CI), 18.6-53.2; P < 0.001] and 13.0% of tumors (95% CI, 5.2-27.5) showed loss of Rb protein expression, meeting both coprimary endpoints. Median progression-free survival was 2.6 months (95% CI, 1.8-6.7). No new safety signals were reported. A signature that included baseline mediators of therapeutic resistance to palbociclib and ET (low Rb score, high cyclin E1 score, ESR1 mutation) was independently associated with shorter median progression-free survival (HR, 22.0; 95% CI, 1.71-282.9; P = 0.018).

CONCLUSIONS

Maintaining palbociclib after progression on prior palbociclib-based regimen seems to be a reasonable, investigational approach for selected patients. A composite biomarker signature predicts a subset of patients who may not derive a greater benefit from palbociclib rechallenge, warranting further validation in larger randomized controlled trials.

Are Cutibacterium acnes present at the end of primary shoulder prosthetic surgeries responsible for infection? Prospective study

The purpose of this study was to investigate if the C. acnes present at the end of a primary shoulder arthroplasty could be responsible for shoulder arthroplasty infection. Prospective study includes patients undergoing primary shoulder arthroplasty from January 2015 until December 2018. From all the patients included, 5 to 12 tissue samples were obtained and were specifically cultured to detect the presence of C. acnes. DNA was extracted from the C acnes isolated colonies and Whole Genome Sequencing (WGS) analysis was done. A cohort of 156 patients was finally included. In twenty-seven patients, the C. acnes was present at the end of the primary surgery. Two of these patients developed a C. acnes periprosthetic shoulder infection at 6 and 4 months after the primary surgery. WGS of C. acnes isolated colonies showed that all the revision-surgery isolates clustered near to the corresponding primary-surgery isolates compared to the other independent bacterial colonies. (99.89% of similarity). C. acnes present at the end of the primary surgery can be the cause of early or delayed periprosthetic joint infections in shoulder arthroplasty.

Circulating cell-free DNA improves the molecular characterisation of Ph-negative myeloproliferative neoplasms

Genetic studies in patients with Philadelphia-negative myeloproliferative neoplasms (MPNs) are essential to establish the correct diagnosis and to optimise their management. Recently, it has been demonstrated that it is possible to detect molecular alterations analysing cell-free DNA (cfDNA) in plasma samples, which is known as liquid biopsy. We have assessed the molecular profile of a cohort of 107 MPN patients [33 polycythaemia vera (PV), 56 essential thrombocythaemia (ET), 14 primary myelofibrosis (PMF) and 4 unclassifiable MPN] by next-generation sequencing (NGS) using cfDNA and paired granulocyte DNA. A high concentration of cfDNA in plasma was observed in patients with high molecular complexity, in MPL-mutated cases, and in PMF patients. Targeted sequencing of cfDNA showed a comparable mutational profile (100% accuracy) to the one obtained in granulocytic DNA and a strong correlation was observed between the variant allele frequency (VAF) of gene mutations in both DNA sources. The median VAF detected in cfDNA (29·0%; range: 0·95-91·73%) was significantly higher than the VAF detected in granulocytes (median 25·2%; range: 0·10-95·5%), especially for MPL mutations (44·3% vs. 22·5%). In conclusion, our data support the use of cfDNA as a fast, sensitive and accurate strategy for performing molecular characterisation of MPN patients.

Investigating ultrasound-induced acoustic softening in aluminum and its alloys

Ultrasonic vibration has been observed to lower the flow stress necessary to initiate plastic deformation, a phenomenon known as "acoustic softening". This unique effect of ultrasound has been extensively applied in welding, machining, forming of metals, and ultrasonic additive manufacturing to lower the yield stress necessary to initiate plastic deformation, it nevertheless lacks fundamental investigation. Some prior studies showed experimental errors due to the design of experimental setups and the associated testing methods that have been introduced, leading to questions about their observations and conclusions. Therefore, an experimental setup described in this paper is designed to minimize the constraints identified from the setups in prior studies. Three types of aluminum are studied: Al 1100-O a commercially pure aluminum, Al 6061-O an aluminum alloy without precipitate strengthening, and Al 6061-T6 a precipitate-strengthened aluminum alloy. The acoustic softening and residual effect are compared based on the similarities and differences in microstructures of the three types of aluminum. In both acoustic softening and residual effect, linear relations are obtained between stress change and ultrasound intensities. The slope defined by the linear relations, i.e. the acoustic softening factor, depends on the microstructure of the specific material. The underlying mechanism of acoustic softening is associated with the activation of dislocations by ultrasonic energy and subsequently their interactions with other dislocations and precipitates, whereas the residual effects are attributed to the permanent changes in dislocation density due to dislocation annihilation, dynamic annealing, and dislocation-precipitate interaction.

Concomitant genomic alterations in KRAS mutant advanced lung adenocarcinoma

OBJECTIVES

KRAS mutations are one of the most prevalent alterations in non-small cell lung cancer. However, patients with this driver alteration present heterogeneous clinical outcomes. In this study, we have explored the potential clinical impact of coexisting alterations in this subset of patients.

MATERIALS AND METHODS

Samples from a cohort of 69 lung adenocarcinoma patients homogenously treated with platinum doublet as first-line therapy were evaluated using targeted next generation sequencing (NGS). Mutations and copy number alterations were assessed in 37 advanced KRAS-mutant (KRASm) and in 32 KRAS wild-type (KRASwt).

RESULTS

TP53 was the most frequent additional alteration found in both cohorts. Interestingly, TP53 mutations were more frequent in KRASwt than in KRASm patients (80 % vs. 34 %; p <  0.05) as well as STK11 mutations (17 % vs 8 %, p=NS). FGFR3 mutations were only found concomitantly with KRASm (11 %). No genomic co-alteration had an impact on overall survival within the KRASm patients treated with chemotherapy.

CONCLUSIONS

KRAS mutated lung adenocarcinoma is a heterogeneous entity and comprehensive characterization of co-alterations using NGS may lead to more accurate patient stratification.

The pancreatic niche inhibits the effectiveness of sunitinib treatment of pancreatic cancer

Current treatments for pancreatic ductal adenocarcinoma (PDA) are ineffective, making this the 4^th leading cause of cancer deaths. Sunitinib is a broad-spectrum inhibitor of tyrosine kinase receptors mostly known for its anti-angiogenic effects. We tested the therapeutic effects of sunitinib in pancreatic cancer using the Ela-myc transgenic mouse model. We showed that Ela-myc pancreatic tumors express PDGFR and VEGFR in blood vessels and epithelial cells, rendering these tumors sensitive to sunitinib by more than only its anti-angiogenic activity. However, sunitinib treatment of Ela-myc mice with either early or advanced tumor progression had no impact on either survival or tumor burden. Further histopathological characterization of these tumors did not reveal differences in necrosis, cell differentiation, angiogenesis, apoptosis or proliferation. In stark contrast, in vitro sunitinib treatment of Ela-myc– derived cell lines showed high sensitivity to the drug, with increased apoptosis and reduced proliferation. Correspondingly, subcutaneous tumors generated from these cell lines completely regressed in vivo after sunitinib treatments. These data point at the pancreatic tumor microenvironment as the most likely barrier preventing sunitinib treatment efficiency in vivo. Combined treatments with drugs that disrupt tumor fibrosis may enhance sunitinib therapeutic effectiveness in pancreatic cancer treatment.

Laboratory study highlights the key influences of stormwater sediment thickness and bioturbation by tubificid worms on dynamics of nutrients and pollutants in stormwater retention systems

In urban area, the accumulation of polluted stormwater sediments (SWS) in retention ponds may be a source of dissolved pollutants and nutrients for the aquatic ecosystems. Our objective was to quantify the influence of the thickness of SWS layer and the occurrence of tubificid worms on organic matter processing (O(2) uptake and fluxes of NH(4)(+), NO(3)(-), PO(4)(3-), and dissolved organic carbon between sediment and water), releases of 17 PAHs and 4 heavy metals, and microbial characteristics. Results showed that oxidation of SWS organic matter (O(2) and NO(3)(-) uptakes) and releases of nutrients were significantly increased by the quantity of accumulated SWS and the worm bioturbation. Releases of acenaphtene and naphthalene from sediments were significantly increased by the thickness of the SWS layer. In contrast, tubificid worms did not promote the mobilization of pollutants. In conclusion, biological activities and stormwater sediment characteristics need to be assessed to quantify the fate of pollutants and nutrients in stormwater retention ponds.

Testing dispersal and cryptic diversity in a widely distributed groundwater amphipod (Niphargus rhenorhodanensis)

Theories about colonization and evolution in groundwater have assumed that the fragmented structure of groundwater strongly limits dispersal. The high number of endemic and allopatric species in groundwater supports this hypothesis, but the occurrence of widely distributed groundwater taxa calls into question its universality. These widely distributed taxa might also be sets of cryptic species because extreme conditions of life in groundwater promote cryptic diversity by inducing convergent morphological evolution. Niphargus rhenorhodanensis is a widely distributed and ubiquitous groundwater amphipod which supposedly colonized the Alps after Quaternary glaciations. We tested the dispersal and the cryptic species hypotheses within this species using a phylogeographic approach based on two mitochondrial genes (COI and 16S) and a nuclear gene (28S). Results support the view that poor dispersal is a main evolutionary factor in groundwater. All genes independently supported the existence of numerous cryptic and mostly allopatric units within N. rhenorhodanensis, indicating that its apparently wide distribution range is an artefact generated by cryptic diversity. We reject the hypothesis of a recent and global colonization of the Alps and argue that some N. rhenorhodanensis lineages probably survived glaciations near or within the Alps.

Relationship between morphological taxonomy and molecular divergence within Crustacea: proposal of a molecular threshold to help species delimitation

With today's technology for production of molecular sequences, DNA taxonomy and barcoding arose as a new tool for evolutionary biology and ecology. However, their validities still need to be empirically evaluated. Of most importance is the strength of the correlation between morphological taxonomy and molecular divergence and the possibility to define some molecular thresholds. Here, we report measurements of this correlation for two mitochondrial genes (COI and 16S rRNA) within the sub-phylum Crustacea. Perl scripts were developed to ensure objectivity, reproducibility, and exhaustiveness of our tests. Our analysis reveals a general correlation between molecular divergence and taxonomy. This correlation is particularly high for shallow taxonomic levels allowing us to propose a COI universal crustacean threshold to help species delimitation. At higher taxonomic levels this correlation decreases, particularly when comparing different families. Those results plead for DNA use in taxonomy and suggest an operational method to help crustacean species delimitation that is linked to the phylogenetic species definition. This pragmatic tool is expected to fine tune the present classification, and not, as some would have believed, to tear it apart.

Phylogeography of a subterranean amphipod reveals cryptic diversity and dynamic evolution in extreme environments

Extreme conditions in subsurface are suspected to be responsible for morphological convergences, and so to bias biodiversity assessment. Subterranean organisms are also considered as having poor dispersal abilities that in turn generate a large number of endemic species when habitat is fragmented. Here we test these general hypotheses using the subterranean amphipod Niphargus virei. All our phylogenetic analyses (Bayesian, maximum likelihood and distance), based on two independent genes (28S and COI), revealed the same tripartite structure. N. virei populations from Benelux, Jura region and the rest of France appeared as independent evolutionary units. Molecular rates estimated via global or Bayesian relaxed clock suggest that this split is at least 13 million years old and accredit the cryptic diversity hypothesis. Moreover, the geographical distribution of these lineages showed some evidence of recent dispersal through apparent vicariant barrier. In consequence, we argue that future analyses of evolution and biogeography in subsurface, or more generally in extreme environments, should consider dispersal ability as an evolving trait and morphology as a potentially biased marker.

[Intestinal hemangiopericytoma]

A case of intestinal hemangiopericytoma is described. This localization is extremely rare. Clinical presentation consisted of upper digestive hemorrhage and abdominal mass; 9 months after surgical removal, the patient presented a single liver metastasis located in the left lobe, which was resected. Twenty-one months after the first surgical procedure the patient shows a favorable outcome. We review the literature and discuss this exceptional form of hemangiopericytoma, as well as its outcome.

Do tubificid worms influence the fate of organic matter and pollutants in stormwater sediments?

In urban area, management of stormwater leads to the accumulation of polluted sediments at the water-sediment interface of various aquatic ecosystems. In many cases, these sediments are colonised by dense populations of tubificid worms. However, the influence of tubificid worms on the fate of stormwater sediments has never been tackled. The aim of this study was to measure in sediment columns the influence of tubificid worms on sediment reworking, organic matter processing (O(2) uptake and release of NH(4)(+), NO(3)(-), PO(4)(3-), and dissolved organic carbon), release of hydrocarbons and heavy metals, and microbial characteristics. Results showed that tubificid worms increased the release of NH(4)(+), PO(4)(3-), and dissolved organic carbon by 2-, 4-, and 3-fold, respectively. O(2) uptake also increased by more than 35% due to tubificid activity. The increase in the percentages of active bacteria and hydrolytic activity in the presence of worms indicated that the higher sediment respiration was caused by the stimulation of microbial communities. A reduction of the number of sulphate-reducing bacteria in the uppermost layers of the sediment was attributed to the penetration of O(2) due to worm activity. These significant effects of tubificid worms were probably linked to the dense network of burrows, which enhanced the exchange surface between the water column and the sediment. No release of heavy metals and hydrocarbons to the water phase was detected in the sediment columns. Understanding the fate and effect of organic stormwater sediments in the natural environment requires the integration of the role of bioturbation in urban pollution studies.

Dynamics of solutes and dissolved oxygen in shallow urban groundwater below a stormwater infiltration basin

Artificial recharge of urban aquifers with stormwater has been used extensively in urban areas to dispose of stormwater and compensate for reduced groundwater recharge. However, stormwater-derived sediments accumulating in infiltration beds may act as a source of dissolved contaminants for groundwater. Concentrations of hydrocarbons, heavy metals, nutrients and dissolved oxygen (DO) were monitored at multiple depths in shallow groundwater below a stormwater infiltration basin retaining large amounts of contaminated organic sediments. Multilevel wells and multiparameter loggers were used to examine changes in groundwater chemistry occurring over small spatial and temporal scales. Rainfall events produced a plume of low-salinity stormwater in the first 2 m below the groundwater table, thereby generating steep vertical physico-chemical gradients that resorbed during dry weather. Heavy metals and hydrocarbons were below reference concentrations in groundwater and aquifer sediments, indicating that they remained adsorbed onto the bed sediments. However, mineralization of organic sediments was the most probable cause of elevated concentrations of phosphate and DOC in groundwater. DO supply in groundwater was severely limited by bed respiration which increased with temperature. Cold winter stormwater slightly re-oxygenated groundwater, whereas warm summer stormwater lowered DO concentrations in groundwater. Among several results provided by this study, it is recommended for management purposes that infiltration practices should minimize the contact between inflow stormwater and organic sediments retained in infiltration basins.

Consensus on Drug Treatment, Definition and Diagnosis for Insomnia

Thirty-four experts and a literature supervisor got together in order to reach a 'consensus' regarding the definition, diagnosis and pharmacological treatment of insomnia. Insomnia is a subjective perception of dissatisfaction with the amount and/or quality of sleep. It includes difficulty in initiating or maintaining sleep or early awakening with inability to fall asleep again. It is associated with complaints of non-restorative sleep and dysfunction of diurnal alertness, energy, cognitive function, behaviour or emotional state, with a decrease in quality of life. The diagnosis is based on clinical and sleep history, physical examination and additional tests, although polysomnography is not routinely indicated. Therapy should include treatment of the underlying causes, cognitive and behavioural measures and drug treatment. Hypnotic therapy can be prescribed from the onset of insomnia and non-benzodiazepine selective agonists of the GABA-A receptor complex are the drugs of first choice. It is recommended that hypnotic treatment be maintained in cases where withdrawal impairs the patient's quality of life and when all other therapeutic measures have failed. Experience suggests that intermittent treatment is better than continuous therapy. The available data do not confirm safety of hypnotics in pregnancy, lactation and childhood insomnia. Benzodiazepines are not indicated in decompensated chronic pulmonary disease but no significant adverse effects on respiratory function have been reported with zolpidem and zopiclone in stable mild to moderate chronic obstructive pulmonary disease and in treated obstructive sleep apnoea syndrome. Data for zaleplon are inconclusive. If the patient recovers subjective control over the sleep process, gradual discontinuation of hypnotic treatment can be considered.

Treatment of severely psychotic inpatients with schizophrenia: olanzapine versus other antipsychotic drugs

Nine hundred and ten schizophrenic inpatients suffering from acute psychotic episodes were included in a naturalistic study. Patients were prescribed treatment with olanzapine (OLZ) or with typical antipsychotic (TYP) drugs. Patients receiving another atypical antipsychotic were excluded. Of the whole sample, 483 (53.4%) were treated with olanzapine and 421 (46.6%) with typical antipsychotics. Three specific subpopulations of greater severity were defined: patients with prominent psychotic symptoms, agitated patients, and patients initially treated with intramuscular (i.m.) medication because of their acute clinical condition. Severity of illness was assessed using the Clinical Global Impression (CGI) scale for severity, the Brief Psychiatric Rating Scale (BPRS) and the Nursing Observational Scale for Inpatient Evaluation. Baseline differences were adjusted per data analysis. The mean change from baseline to endpoint of overall symptomatology (total BPRS score) was significantly greater in the olanzapine group compared to the typical antipsychotic-treated group, both in the sample of patients with prominent positive symptoms (P < 0.001) and in the sample of agitated patients (P =0.015). Significant differences were also found in BPRS positive scores, BPRS negative scores and CGI scores in these two populations. Patients who had received previous i.m. drugs showed no statistically significant differences in symptomatic improvement between both treatments groups, except for a more favourable response of BPRS negative subscores in the olanzapine group (P =0.015). The results suggest that olanzapine may be considered as a first line treatment for severely psychotic inpatients with schizophrenia.

Sensitivity of epigean and hypogean freshwater macroinvertebrates to complex mixtures. Part I: Laboratory experiments

The impact of waste storage on aquatic systems is a regulatory requirement in Europe, but it is nowadays only considered to a limited extent. The complexity of mixtures, which contain many inorganic and organic compounds, requires the use of combining chemical measurements with ecotoxicological observations. This research employed an integrated laboratory and outdoor mesocosms approach to assess the effects of mixtures on freshwater macroinvertebrates. The effects of percolates coming from water having percolated through maturated secondary smelting slags, on freshwater macroinvertebrates (molluscs, crustaceans and insect larvae) were investigated under laboratory conditions using a continuous flow-through testing apparatus. Lethality (LC50 96 and 240 h) was chosen as the endpoint. The results indicate that the difference in sensitivity of macroinvertebrates is correlated with their ability to regulate or neutralize contaminants in the mixture during short-term exposure. Moreover, differences in sensitivity were dependent on duration of exposure. Because of the variability of toxicity among mixtures coming from the same waste, bioassays are required to determine the toxicities of these mixtures.

Implementation of a monitoring system to measure impact of stormwater runoff infiltration

Stormwater infiltration is a drainage mode, which is more and more used in urban areas in France. Given the characteristics of urban surfaces, and especially the loads of various pollutants contained in stormwater, it is important to assess the impact of stormwater infiltration systems on soil and groundwater by carrying out field experiments. The main difficulty is due to the complexity of the system observed and the need of multidisciplinary approaches. Another difficulty is that measurements are carried out in situ, in an uncontrolled environment submitted to quantitatively and qualitatively highly variable interferences. Very long term monitoring is needed to get representative results. In order to contribute to solve these problems, the OTHU project has recently been launched in Lyon (France). One of its key action concerns a long-term (10 years) experiment on an infiltration basin specifically rehabilitated for measurements and operational drainage issues. This paper presents the experimental site, the objectives of the project and the way the monitoring process has been built according to the various disciplines involved (biology, ecology, hydrology, chemistry and soil sciences) and to the will of assessing all the uncertainties in the measurement process.

Waste ecocompatibility in storage and reuse scenarios: global methodology and detailed presentation of the impact study on the recipient environments

In 1995, the ADEME launched a research program called "Waste Ecocompatibility" in order to define a reliable methodology for measuring the impact of waste in storage or reuse scenarios. The French concept of "Ecocompatibility" is defined as the situation where the pollutant flux from waste disposed of or used in specified conditions is compatible with the environmental acceptance of the receiving environments. The chief feature of this definition is to integrate the evaluation of the three following terms: pollutants emission from the waste, transport of the pollutants from the waste to the receptor cells and the environmental acceptance of the receiving environments. The "Waste Ecocompatibility" program consisted of a literature survey and an experimental part. The literature study aimed to determine factors and waste characteristics to be considered for a reliable ecocompatility assessment, to provide an overview of the available tools for measuring those factors and characteristics and to propose a first approach of the methodology. In the framework of the experimental program, this approach was then applied to three theoretical scenarios to validate the laboratory tools (comparative study of laboratory and field results) and to calibrate the global methodology. This paper deals with the results of the experimental program concerning the impact study on receiving environments: impact on plants and microorganisms living in soil, impacts on soil fauna and aquatic fauna. In other papers we intend to present the operational methodology for the assessment of waste ecocompatibility. It includes bio-assays at laboratory scale (microcosms), pilot scale (mesocosms) and in situ experiments (experimental prairie). To limit the use of in situ experiments other research works are necessary to validate bio-assays at laboratory or pilot scale.

[Risperidone in the treatment of psychotic patients with opiate abuse and dependence]

INTRODUCTION

180 psychotic patients with opiate dependence and abuse (ICD-10) were included in an open label study. The study objectives were to evaluate safety and efficacy of risperidone for a six month follow-up period. The total mean dose was 4.4 (SD: 2.4 mg/daily; range: 0.5-12 mg/daily).

METHODS

BPRS, CGI and DDS-SV were used to assess efficacy and UKU subscale for neurological side effects and spontaneous reports for safety.

RESULTS

Risperidone treatment improved symptoms, disability of the included patients with a significant reduction in the mean total scores of BPRS, CGI and DDS-SV observed from the first month of treatment onwards. Risperidone also reduced illegal opiate abuse patients from 39% basedate to 18% at month 6. There was a significant reduction (p< 0.0001) in the total UKU subscale for neurological side effects scores from visit 1 onwards for studied sample. Risperidone was well tolerated by the study patients. From 165 elegible patients, just 10 (6.1%) discontinued treatment due to adverse reactions, 94% of the patients did not suffer any adverse event; the most frequent adverse events according spontaneous reports were extrapyramidal effects (3%) and anxiety (1.8%).

DISCUSSION

Risperidone improved disability, psychotic symptoms and tolerability of these patients. Those results could mean an outstanding breakthrough in the treatment of these type of disorders and, if it is confirmed that risperidone can lead to abstinence, we would be before a new line of treatment for dual pathology.

Toxicity and bioaccumulation of arsenic and chromium in epigean and hypogean freshwater macroinvertebrates

Lethal toxicity levels of two inorganic water pollutants, chromium (Cr6+) and arsenic (As3+), were determined toward six freshwater macroinvertebrate species collected from a single field site. Crustaceans were represented by two amphipod species, an epigean one (Gammarus fossarum) and a hypogean one (Niphargus rhenorhodanensis), and by an isopod species (Asellus aquaticus). There were two insect larvae, Heptagenia sulphurea (Ephemeroptera) and Hydropsiche pellucidula (Trichoptera) and a snail, Physa fontinalis. Median lethal concentrations (LC50s) were determined over 96-h and 240-h periods for chromium and over a 240-h period for arsenic. Arsenic bioaccumulation was studied, too. The macroinvertebrates tested showed a wide range of sensitivity and bioaccumulation. A comparison between 96-h and 240-h experiments demonstrated that there was an increase in toxicity values following a longer time exposure for chromium. Also chromium was more toxic toward crustaceans than arsenic; conversely, arsenic was more toxic for the insect larvae and snail tested here. The lethal concentrations determined for the two metals were discussed and compared to results from other toxicity studies. The use of such macroinvertebrates, collected in the field and tested for longer exposure periods than within the standardized 96-h tests, should provide more suitable results for monitoring the general environmental quality of freshwater systems.

[Quality of life and disability in chronic schizophrenics treated with with risperidone and previously treated with depot neuroleptics]

OBJECTIVES

1. Assess the evolution of disability and quality of life in schizophrenic patients treated with risperidone and who had received depot neuroleptics; 2. Evaluate risperidone efficiency; 3. Evaluate safety of this drug.

METHOD

Post-marketing multicentric observational (8 months) surveillance study was carried out.

PATIENTS

109 schizophrenic patients (ICD-10 criteria).

ASSESSMENTS

baseline and months 2, 4 and 8.

INSTRUMENTS

SF-36, WHO/DDS-S, BPRS and CGI. Safety was evaluated by the UKU subscale for neurological side effects and spontaneous reports.

RESULTS

statistically significant improvement of the mean scores of BPRS, CGI, WHO/DDS-S and SF-36 at 2, 4 and 8 months. There was a significant reduction in the total UKU subscale for neurological side effects scores from visit 1 (month 2) onwards. Risperidone was generally well tolerated by the study patients. From a total of 104 patients included, only 4 (3.8%) discontinued treatment due to adverse reactions. During the 8 months of study period, 87.6% of the patients did not suffer any adverse event; the resting 12.4 suffered one or more side effects. The most frequently reported adverse events according spontaneous reports were: anxiety and restlessness (n= 4; 3.8%), weight increase (n= 4; 3.8%), sexual disturbances (n= 4; 3.8%) and amenorrhea (n= 2; 1.9%) among others.

CONCLUSION

the long-term treatment with risperidone has improved the disability and quality of life levels of a large group of schizophrenic patients previously treated with depot neuroleptics.

[Long term evolution of the incapacity in schizophrenic patients in maintenance treatment with risperidone]

OBJECTIVE

To determine the evolution of the degree of long term disability (8 months) in a group of schizophrenic outpatients undergoing monotherapy with risperidone. DESIGN, An observational multicentre study of 8 months follow up.

PATIENTS

354 patients with schizophrenic disorder (ICD-10).

EVALUATION

Baseline, 2, 4 and 8 months.

INSTRUMENTS

BPRS, CGI, UKU, WHO/DAS-S.

RESULTS

a significant decrease in both the global scores and in each of the 4 areas of disability. Improvement in disability depends to a large degree on the improvement of the disorder as shown on the BPRS and CGI. After 8 months, those patients with paranoid subtype and the less severe ones (BPRS and CGI) showed a considerably lesser degree of disability. The final level of disability (square root = 0,61) is narrowly related to the baseline level of disability, the 3 clusters of the final BPRS, the final CGI, gender and the subtype of schizophrenia.

[Risperidone in the treatment of acute exacerbation of schizophrenia symptoms]

A total of 439 schizophrenic patients according to ICD-10 criteria was included in an open label postmarketing surveillance study to evaluate the efficiency of resperidone as maintenance treatment of the schizophrenic acute exacerbation. The efficiency of risperidone was assessed according the number of patients who responded to treatment, the duration of the hospitalization period an the decrease in the total score as well as in the different clusters of the Brief Psychiatric Rating Scale (BPRS) during the study period. A patient was considered as responder to treatment when a decrease of, at least, a 20% was achieved in the total BPRS score while being treated in monotherapy with risperidone. Safety was evaluated by the UKU subscale for neurological side effects and spontaneous reports. Patients were evaluated at baseline and weeks 1, 2, 6 and 12. Forty patients (9.1%) were excluded from the statistical analysis due to protocol violation. Eighty one patients (20.3%) dropped out due to lost for follow-up (n = 25; 6.3%), new hospitalization (n = 23; 5.8%), inefficacy (n = 12; 3%), side effects (n = 7; 1.8%) and others (n = 14; 3.5%). Risperidone was used at doses between 1.5 and 19 mg daily (mean dosage: 7.66 +/- 3.07 mg daily). The duration of the hospitalization when dosages of risperidone of less than 6 mg daily were used was 32.1 days. However, when higher dosages were used, the number of days in-hospital decreased (26.6 days at dosages between 6 and 9 mg daily and 25.3 days when dosages higher than 9 mg daily were used). There was a significant reduction, versus baseline, in the BPRS mean total scores as well as in it's different clusters. (positive symptoms, negative symptoms, anxiety/depression) from week one onwards. At week 1, 66.9% of the patients had an improvement (20% versus baseline in their BPRS total score. At the end of the study period, 93.2% of the patients had an improvement (20% in their BPRS total score. There was a significant reduction in the total UKU subscale for neurological side effects scores (p < 0.005) from week 1 onwards, as well as for the total score of the following symptoms: rigidity, hypokinesia, hyperkinesia tremor and akatysia.

Determination of neutral lipids from subcutaneous fat of cured ham by capillary gas chromatography and liquid chromatography

The determination of neutral lipids in fat of cured ham is reported. Fat samples were extracted with chloroform-methanol (2:1) and neutral lipids and free fatty acids were separated on an aminopropyl minicolumn, the first fraction with chloroform-2-propanol (neutral lipids) and the second fraction with 2% acetic acid in diethyl ether (free fatty acids). Neutral lipids were fractionated with minicolumns, with aminopropyl and silica stationary phases. Two fractions were obtained with the first column: (A) triglyceride and cholesteryl esters and (B) cholesterol and mono- and diglycerides. Fraction A was applied to the silica column to obtain two new fractions: (C) cholesteryl esters and (D) triglycerides. Fractions B and C were analysed by capillary gas chromatography (cGC) and fraction D by cGC and HPLC. The R.S.D.s obtained were below 5% except for the monoglycerides (8%). Cholesteryl esters were determined by cGC in 5 min with R.S.D. 5%. The main triglycerides identified were PPO, POS, POO, POL and OOO (P = palmitic acid, O = oleic acid, L = linoleic acid; S = stearic). Monoglyceride and diglycerides having 18, 34 and 36 carbon atoms were the most abundant. The determination of triglycerides by HPLC was more difficult than by cGC because the linearity with HPLC was concentration dependent. The procedure allowed the determination of neutral lipid classes without derivatization of mono- and diglycerides.

[Prevention of late post-traumatic epilepsy by phenytoin in severe brain injuries. 2 years' follow-up]

The high incidence rate and the invalidating nature of post-traumatic epilepsy after severe brain injury have encouraged the authors to review the prophylactic treatment of this type of epilepsy. Thirty-four out of 86 randomised patients with brain injuries admitted into a neurotraumatology intensive care unit were treated prophylactically, immediately after the injury, with an intravenous hydantoin injection in a dose sufficient to provide stable and effective blood levels. This was followed by dose-adjusted oral administration maintained for a minimum period of 3 months. After a 2 years' follow-up, there was a significant difference between treated and untreated patients, since only 6 per cent of the patients treated suffered from post-traumatic epilepsy, as against 42 percent in the untreated group.

[Central effects of five beta-adrenergic receptor blockers in healthy volunteers: a quantitative EEG study]

The effects of five beta blockers on the central nervous system of healthy subjects was studied by computerized EEG analysis. All subjects underwent continuous recording with a Holter magnetic type recorder during the experimental period. For 10 consecutive days, five groups of subjects received alternately placebo and the beta blockers acebutolol 600 mg, carteolol 20 mg, metoprolol 200 mg, pindolol 30 mg and sotalol 320 mg. EEG recordings (C4/P4, P4/02 and C3/P3, P3/01) lasting 5 min were made between 8.30 and 9.30 a.m. Subjects were at rest with eyes closed and there was no vigilance control. The signal was recorded on a magnetic tape recorder and then processed by Nicolet MED 80 system. Comparisons of absolute and relative powers and of average frequencies were then made between the different sequences and groups. The possible correlations between the changes observed in the power spectrum and the clinical, pharmacological and pharmacokinetic specific properties of each beta blocker are discussed.

[Demonstration, by the cartographic test, of an unusual reaction to intermittent light stimulation in patients with migraine]

Topographic electroencephalography was carried out to study reaction to photic stimulation in 29 normal volunteers, and 12 patients who had presented frequent clinically confirmed migraines for at least 3 years. In the group of migraineurs photic stimulation resulted in an increase in the alpha band power. The difference between the two groups was statistically significant. This reaction to photic stimulation is of help in diagnosis and suggests that a diagnosis and therapeutic orientation might be possible in patients for whom clinical diagnosis is not clear. The specificity of the migraineur's reaction to photic stimulation and its possible origin are discussed.

Tuberculosis chemoprophylaxis practices in metropolitan clinics

A survey of tuberculosis chemoprophylaxis policies was conducted from September 1977 through January 1978 of all metropolitan programs in the United States that reported more than 100 cases of tuberculosis during 1976. Twenty-eight programs were surveyed, and all responded. Uniform practice was found with regard to the dosage of isoniazid administered, duration of treatment, and most other indications for preventive therapy recommended by the American Thoracic Society and the U.S. Public Health Service Center for Disease Control. One third of the programs surveyed administered chemoprophylaxis to pregnant women, and one third regularly dispensed more than a one-month supply of isoniazid to patients. Three programs (11%) routinely monitored hepatic function by serum laboratory tests during chemoprophylaxis. Four programs (14%) regularly or occasionally used bacillus Calmette-Guérin vaccine for prevention of tuberculosis. Although large metropolitan programs generally followed the guidelines of the American Thoracic Society and the Center for Disease Control for tuberculosis chemoprophylaxis, some major variances in practice were reported.

[The treatment of epileptic encephalopathies with gamma globulin in children (author's transl)]

PRELIMINARY RESULTS

The authors have treated 10 children presenting with severe epilepsy with repeated large doses of gamma-globulin. They noted a marked improvement in 7 of the children with respect to behaviour and a disappearance of seizures in 8 with comparable EEG improvement. Four children have been able to reduce their conventional anticonvulsant therapy considerably and 2 others havers received no other medication at all for 8 months. The possibility of an immune disturbance in some childhood epilepsies is thus suggested.