Associations of childhood adiposity with adult intima-media thickness and inflammation: a 20-year longitudinal population-based cohort

BACKGROUND

The associations between childhood adiposity and adult increased carotid intima-media thickness (cIMT) have been well established, which might be corroborated by the association between adiposity in children and inflammation in adults. However, longitudinal data regarding biological pathways associated with childhood adiposity are lacking.

METHODS

The current study included participants from the STANISLAS cohort who had adiposity measurements at age 5-18 years [ N  = 519, mean (SD) age, 13.0 (2.9) years; 46.4% male], and who were measured with cIMT, vascular-related and metabolic-related proteins at a median follow-up of 19 ± 2 years. BMI, waist-to-height ratio and waist circumference were converted to age-specific and sex-specific z -scores.

RESULTS

A minority of children were overweight/obese (16.2% overweight-BMI z -score >1; 1.3% obesity- z -score >2). Higher BMI, waist-height ratio and waist circumference in children were significantly associated with greater adult cIMT in univariable analysis, although not after adjusting for C-reactive protein. These associations were more pronounced in those with consistently high adiposity status from childhood to middle adulthood. Participants with higher adiposity during childhood (BMI or waist-height ratio) had higher levels of insulin-like growth factor-binding protein-1, protein-2, matrix metalloproteinase-3, osteopontin, hemoglobin and C-reactive protein in adulthood. Network analysis showed that IL-6, insulin-like growth factor-1 and fibronectin were the key proteins associated with childhood adiposity.

CONCLUSION

In a population-based cohort followed for 20 years, higher BMI or waist-to-height ratio in childhood was significantly associated with greater cIMT and enhanced levels of proteins reflective of inflammation, supporting the importance of inflammation as progressive atherosclerosis in childhood adiposity.

Aetiology, clinical features, diagnostic studies, and outcomes of community-acquired pneumonia in kidney transplant recipients admitted to hospital: a multicentre retrospective French cohort study

OBJECTIVES

To assess the aetiology, clinical features, diagnostic studies and outcomes of community-acquired pneumonia (CAP) in a French cohort of hospitalized kidney transplant recipients.

METHODS

We performed a retrospective, multicentre study in kidney transplant recipients admitted to ten French centres for CAP from January 2016 to December 2018. CAP discharge diagnoses were clinically and radiologically validated. We assessed a descriptive analysis of all confirmed CAP including medical ward and intensive care unit admissions.

RESULTS

One hundred sixty-five CAP episodes in 132 patients were included. Median time from transplantation to admission was 6.4 (interquartile range, 1.6-12.3) years, with corticosteroid exposure in 112/165 (67.9%) cases. Sputum culture was performed in 47/165 (28.5%) cases including 7/47 (14.9%) positive samples. Bronchoscopy was performed in 87/165 (52.7%) cases with pathogens identified in 39/87 (44.8%) cases. Microbiological studies led to identifying a respiratory pathogen in 64/165 (38.8%) CAP episodes including 11/64 (17.2%) polymicrobial cases. Among these 64 episodes, 75 microorganisms were identified; 46/75 (61.3%) were core respiratory pathogens and 29/75 (38.7%) were opportunistic or drug-resistant organisms including Pneumocystis jirovecii 9/75 (12%), Pseudomonas aeruginosa 5/75 (6.7%), multidrug-resistant Enterobacteriaceae 4/75 (5.3%), and Aspergillus 4/75 (5.3%). Patients required intensive care unit admission in 26/165 (15.8%) episodes, invasive ventilation in 20/165 (12.1%) cases, and 22/165 (13.3%) needed in-hospital dialysis.

DISCUSSION

CAP episodes occurred in kidney transplant recipients with a long history of immunosuppressive drug exposure. Diagnostic studies identified a microorganism in more than one-third of CAP episodes, including drug-resistant and opportunistic pathogens.

Impaired renal reserve contributes to preeclampsia via the kynurenine and soluble fms-like tyrosine kinase 1 pathway

To understand how kidney donation leads to an increased risk of preeclampsia, we studied pregnant outbred mice with prior uninephrectomy and compared them with sham-operated littermates carrying both kidneys. During pregnancy, uninephrectomized (UNx) mice failed to achieve a physiological increase in the glomerular filtration rate and during late gestation developed hypertension, albuminuria, glomerular endothelial damage, and excess placental production of soluble fms-like tyrosine kinase 1 (sFLT1), an antiangiogenic protein implicated in the pathogenesis of preeclampsia. Maternal hypertension in UNx mice was associated with low plasma volumes, an increased rate of fetal resorption, impaired spiral artery remodeling, and placental ischemia. To evaluate potential mechanisms, we studied plasma metabolite changes using mass spectrometry and noted that l-kynurenine, a metabolite of l-tryptophan, was upregulated approximately 3-fold during pregnancy when compared with prepregnant concentrations in the same animals, consistent with prior reports suggesting a protective role for l-kynurenine in placental health. However, UNx mice failed to show upregulation of l-kynurenine during pregnancy; furthermore, when UNx mice were fed l-kynurenine in drinking water throughout pregnancy, their preeclampsia-like state was rescued, including a reversal of placental ischemia and normalization of sFLT1 levels. In aggregate, we provide a mechanistic basis for how impaired renal reserve and the resulting failure to upregulate l-kynurenine during pregnancy can lead to impaired placentation, placental hypoperfusion, an antiangiogenic state, and subsequent preeclampsia.

Impact of early mean arterial pressure level on severe acute kidney injury occurrence after out-of-hospital cardiac arrest

Background

The optimal early mean arterial pressure (MAP) level in terms of renal function remains to be established in patients with out-of-hospital cardiac arrest (OHCA). We aimed to evaluate the association between early MAP level and severe acute kidney injury (AKI) occurrence in patients with OHCA.

Results

In 568 consecutive patients, the percentage time spent below a predefined MAP threshold and the corresponding area below threshold (ABT) were calculated from continuous MAP measurement. Both MAP-derived variables were calculated for different MAP thresholds (65, 75 and 85 mmHg) and time periods (the first 6 and 12 after ICU admission). 274 (48%) patients developed severe AKI defined as stage 3 of KDIGO. Both ABT and percentage time were independently associated with severe AKI, regardless of the MAP threshold and time period considered. Highest adjusted odds ratios for developing severe AKI were observed while considering the first 6 h period. Within the first 6 h, every 100 mmHg-h increase in ABT under MAP thresholds of 65, 75 and 85 mmHg increased severe AKI risk by 69% (OR = 1.69; 95% CI 1.26–2.26; p < 0.01), 13% (OR = 1.13; 95% CI 1.07–1.20; p < 0.01) and 4% (OR = 1.04; 95% CI 1.02–1.06; p < 0.01), respectively. Every 10% increase in percentage time spent under MAP thresholds of 65, 75 and 85 mmHg increased severe AKI risk by 19% (OR = 1.19; 95% CI 1.06–1.33; p < 0.01), 12% (OR = 1.12; 95% CI 1.04–1.19; p < 0.01) and 8% (OR = 1.08; 95% CI 1.02–1.14; p < 0.01), respectively.

Conclusions

Both severity and duration of early arterial hypotension after ICU admission remained associated with severe AKI occurrence while considering a MAP threshold as high as 85 mmHg after OHCA.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13613-022-01045-1.

Difficulties interpreting concentrations in fatal cases: example of 2,5-dimethoxy-4-chloroamphetamine

PURPOSE

Death related to the use of drugs is evident when drugs are detected in biological matrices within toxic levels, but sometimes it can be less obvious. Intoxications after 2,5-dimethoxy-4-chloroamphetamine (DOC) use are occurring but up to date, only one fatality has been reported. Here we present the case of a young woman admitted to hospital as she presented vomiting, convulsions and cardiorespiratory arrest.

METHODS

Blood ethanol concentration was determined using gas chromatography with flame ionization detection and toxicological screenings (blood, gastric content and hair samples) were performed using liquid chromatography with diode array detection, gas chromatography or liquid chromatography with mass spectrometry detection.

RESULTS

Her health state declined with cardiac troubles, organs failure and cerebral edema till death occurring 4 days later. The autopsy revealed the presence of hemorrhagic infiltration inside the left ventricle, pulmonary edema and hemorrhagic infiltration of the terminal ileum. The analysis of biological fluids confirmed the presence of DOC (< 10 ng/mL in cardiac blood sample), buprenorphine, cocaine and cannabis metabolites. The analysis of hair highlighted a history of drugs abuse.

CONCLUSION

In the absence of evident identified cause, the hypothesis of a death due to acute drugs use within a history of chronic consumption of drugs has been put forward. The concentration of some substances such as new psychoactive substances can be low in biological matrices but the toxic effects can be additive and lead to death even within young people, hence the importance of the knowledge of consumption history.

Excess Soluble fms-like Tyrosine Kinase 1 Correlates With Endothelial Dysfunction and Organ Failure in Critically Ill Coronavirus Disease 2019 Patients

Excess soluble fms-like tyrosine kinase 1 (sFlt-1), a soluble inhibitor of vascular endothelial growth factor pathway, has been demonstrated to promote endothelial dysfunction. Here, we demonstrate that sFlt-1 plasma levels correlate with respiratory symptom severity, expression of endothelial dysfunction biomarker, and incidence of organ failure in coronavirus disease 2019 patients. Clinical Trials Registration: NCT04394195.

Intra-abdominal hypertension in early post-kidney transplantation period is associated with impaired graft function

BACKGROUND

Moderate hyperhydration is often achieved in the early post-kidney transplantation period. Whether this strategy could lead to the development of intra-abdominal hypertension (IAH) has never been assessed so far. We aimed to study the incidence of IAH after kidney transplantation and its association with graft function recovery.

METHODS

We conducted a prospective monocentric study among patients undergoing kidney transplantation at the University Hospital of Reims between May 2017 and April 2019. Intravesical pressure (IVP) was monitored every 8 h from Day 0 to 3.

RESULTS

A total of 107 patients were enrolled. Among 55 patients included in the analysis, 74.5% developed IAH. Body mass index >25 kg/m2 was associated with IAH development {odds ratio [OR] 10.4 [95% confidence interval (CI) 2.0-52.9]; P = 0.005}. A previous history of peritoneal dialysis was protective [OR 0.06 (95% CI 0.01-0.3); P = 0.001]. IAH Grades III and IV occurred in 30.9% of patients and correlated with higher Day 3 creatininaemia (419.6 ± 258.5 versus 232.5 ± 189.4 μmol/L; P = 0.02), higher delayed graft function incidence (41.2 versus 7.9%; P = 0.04), lower Kirchner index measured using scintigraphy (0.47 ± 0.09 versus 0.64 ± 0.09; P = 0.0005) and decreased Day 30 estimated glomerular filtration rate (35.8 ± 18.8 versus 52.5 ± 21.3, P = 0.05). IAH patients had higher fluid balance (P = 0.02). Evolution of IVP correlated with weight gain (P < 0.01) and central venous pressure (P < 0.001).

CONCLUSIONS

IAH is frequent after kidney transplantation and IAH Grades III and IV are independently associated with impaired graft function. These results question current haemodynamic objectives and raise for the first time interest in intra-abdominal pressure monitoring in these patients.

CLINICAL TRIAL NOTATION

ClinicalTrials.gov identifier: NCT03478176.

AgeR deletion decreases soluble fms-like tyrosine kinase 1 production and improves post-ischemic angiogenesis in uremic mice

Peripheral arterial disease occurs more frequently and has a worse prognosis in patients with chronic kidney disease (CKD). The receptor for advanced glycation end products (RAGE) is involved in multiple aspects of uremia-associated vasculopathy. Previous data suggest that the RAGE pathway may promote soluble fms-like tyrosine kinase 1 (sFlt1) production, an anti-angiogenic molecule. Thus, we tested the hypothesis that the deletion of AgeR would decrease sFlt1 production and improve post-ischemic revascularization in uremic condition. We used a well-established CKD model (5/6 nephrectomy) in WT and AgeR-/- C57/Bl6 mice. Hindlimb ischemia was induced by femoral artery ligation. Revascularization was evaluated by complementary approaches: ischemic limb retraction, LASCA imagery, and capillary density. The production of sFlt1 was assessed at both RNA and protein levels. After hindlimb ischemia, uremic mice showed slower functional recovery (p < 0.01), decreased reperfusion (p < 0.01), lower capillary density (p = 0.02), and increased circulating sFlt1 levels (p = 0.03). AgeR deletion restored post-ischemic angiogenesis and was protective from sFlt1 increase in uremic mice. These findings show the main role of RAGE in post-ischemic angiogenesis impairment associated with CKD. RAGE may represent a key target for building new therapeutic approaches to improve the outcome of CKD patients with PAD.

Outcome of autosomal dominant polycystic kidney disease patients on peritoneal dialysis: a national retrospective study based on two French registries (the French Language Peritoneal Dialysis Registry and the French Renal Epidemiology and Information Network)

Background

Pathological features of autosomal dominant polycystic kidney disease (ADPKD) include enlarged kidney volume, higher frequency of digestive diverticulitis and abdominal wall hernias. Therefore, many nephrologists have concerns about the use of peritoneal dialysis (PD) in ADPKD patients. We aimed to analyse survival and technique failure in ADPKD patients treated with PD.

Methods

We conducted two retrospective studies on patients starting dialysis between 2000 and 2010. We used two French registries: the French Renal Epidemiology and Information Network (REIN) and the French language Peritoneal Dialysis Registry (RDPLF). Using the REIN registry, we compared the clinical features and outcomes of ADPKD patients on PD (n = 638) with those of ADPKD patients on haemodialysis (HD) (n = 4653); with the RDPLF registry, those same parameters were determined for ADPKD patients on PD (n = 797) and compared with those of non-ADPKD patients on PD (n = 12 059).

Results

A total of 5291 ADPKD patients and 12 059 non-ADPKD patients were included. Analysis of the REIN registry found that ADPKD patients treated with PD represented 10.91% of the ADPKD population. During the study period, PD was used for 11.2% of the non-ADPKD population. Compared with ADPKD patients on HD, ADPKD patients on PD had higher serum albumin levels (38.8 ± 5.3 versus 36.8 ± 5.7 g/dL, P < 0.0001) and were less frequently diabetic (5.31 versus 7.71%, P < 0.03). The use of PD in ADPKD patients was positively associated with the occurrence of a kidney transplantation but not with death [hazard ratio 1.15 (95% confidence interval 0.84-1.58)]. Analysis of the RDPLF registry found that compared with non-ADPKD patients on PD, ADPKD patients on PD were younger and had fewer comorbidities and better survival. ADPKD status was not associated with an increased risk of technique failure or an increased risk of peritonitis.

Conclusions

According to our results, PD is proposed to a selected population of ADPKD patients, PD does not have a negative impact on ADPKD patients' overall survival and PD technique failure is not influenced by ADPKD status. Therefore PD is a reasonable option for ADPKD patients.

Burned bodies: post-mortem computed tomography, an essential tool for modern forensic medicine

Abstract

Currently, post-mortem computed tomography (PMCT) has become an accessible and contemporary tool for forensic investigations. In the case of burn victims, it provides specific semiologies requiring a prudent understanding to differentiate between the normal post-mortem changes from heat-related changes. The aim of this pictorial essay is to provide to the radiologist the keys to establish complete and focused reports in cases of PMCT of burn victims. Thus, the radiologist must discern all the contextual divergences with the forensic history, and must be able to report all the relevant elements to answer to the forensic pathologist the following questions: Are there tomographic features that could help to identify the victim? Is there evidence of remains of biological fluids in liquid form available for toxicological analysis and DNA sampling? Is there another obvious cause of death than heat-related lesions, especially metallic foreign bodies of ballistic origin? Finally, what are the characteristic burn-related injuries seen on the corpse that should be sought during the autopsy?

Teaching points

• CT is highly useful to find features permitting the identification of a severely burned body.

• PMCT is a major asset in gunshot injuries to depict ballistic foreign bodies in the burned cadavers.

• CT is able to recognise accessible blood for tests versus heat clot (air-crescent sign).

• Heat-related fractures are easily differentiated from traumatic fractures.

• Epidural collections with a subdural appearance are typical heat-related head lesions.

Outcome of polycystic kidney disease patients on peritoneal dialysis: Systematic review of literature and meta-analysis

Background

Polycystic kidney disease (PKD) is the most frequent hereditary cause of chronic kidney disease. Peritoneal dialysis (PD) is often avoided for patients with PKD because of the suspected risk of mechanical and infectious complications. Only a few studies have analyzed the outcome of PKD patients on PD with sometimes conflicting results. The purpose of this meta-analysis was to investigate outcomes of patients with PKD treated by PD.

Methods

A systematic review and meta-analysis were performed examining all studies which included “Polycystic kidney disease” and “Peritoneal dialysis” in their titles, excluding commentaries, letters to the authors and abstracts. PubMed, Embase, Google scholar and Scopus were searched to December 31^st 2017. The primary outcome was overall patient survival. Additional outcomes were PD technique survival, incidence of peritonitis and incidence of abdominal wall hernia.

Results

9 studies published between 1998 and 2016 were included for analysis with a total of 7,197 patients including 882 PKD patients. Overall survival of PKD patients was found to be better compared to non-PKD patients (HR = 0.70 [95% CI, 0.54–0.92]). There were no statistical differences between PKD and non-PKD patients in terms of peritonitis (OR = 0.86 [95% CI, 0.66–1.12]) and technical survival (HR = 0.98 [95% CI, 0.83–1.16]). There was an increased risk of hernia in PKD patients (OR = 2.28 [95% CI, 1.26–4.12]).

Conclusions

PKD is associated with a better global survival, an increased risk of abdominal hernia, but no differences in peritonitis rate or technical survival were found. PD is a safe dialysis modality for PKD patients. Properly designed controlled studies are needed to determine whether all PKD patients are eligible for PD or whether some specific criteria should be determined.

[How to explain glomerular filtration rate decrease in intra-abdominal hypertension?]

Intra-abdominal hypertension (IAH) is a frequent and serious condition affecting critical care patients. IAH diagnostic needs intravesical pressure (IVP) measurement which is recommended for monitoring patients presenting IAH risk factors. IVP monitoring is probably insufficient in daily practice. This could be explained by lack of knowledge about IAH physiopathology, which leads to absence of therapeutic target. Acute kidney injury (AKI) is the earliest and most described organ dysfunction associated with IAH. Moreover, AKI gravity seems to correlates with IAH severity. Physiopathological aspects explaining glomerular filtration rate (GFR) decrease with IAH are probably multifactorial and not completely understood. The role of renal venous congestion is essential to explain AKI in IAH. GFR decrease may reflect a "glomerular capillary shunt" due to a decrease of renal plasmatic flow. Monitoring IVP in daily practice in patients presenting risk factors of IAH would improve knowledge about this condition and the associated AKI.

The problem with medical research on tissue and organ samples taken in connection with forensic autopsies in France

Currently, in France, it is legally impossible to conduct scientific research on tissue and organ samples taken from forensic autopsies. In fact, the law schedules the destruction of such samples at the end of the judicial investigation, and the common law rules governing cadaver research cannot be applied to the forensic context. However, nothing seems in itself to stand in the way of such research since, despite their specific nature, these samples from forensic autopsies could be subject, following legislative amendments, to common law relating to medical research on samples taken from deceased persons. But an essential legislative amendment, firstly to allow the Biomedicine Agency to become authorized to issue a research permit and secondly, to change the research conditions in terms of the non-opposition of the deceased to said research. Such an amendment would be a true breakthrough because it would allow teams to continue to move forward calmly in research, and allow this research to be placed within a legal framework, which would promote international exchanges.

Hydrogen from ethanol reforming with aqueous fraction of pine pyrolysis oil with and without chemical looping

Reforming ethanol ('EtOH') into hydrogen rich syngas using the aqueous fraction from pine bio-oil ('AQ') as a combined source of steam and supplementary organic feed was tested in packed bed with Ni-catalysts 'A' (18wt%/α-Al2O3) and 'B' (25wt%/γ-Al2O3). The catalysts were initially pre-reduced by H2, but this was followed by a few cycles of chemical looping steam reforming, where the catalysts were in turn oxidised in air and auto-reduced by the EtOH/AQ mixture. At 600°C, EtOH/AQ reformed similarly to ethanol for molar steam to carbon ratios (S/C) between 2 and 5 on the H2-reduced catalysts. At S/C of 3.3, 90% of the carbon feed converted on catalyst A to CO2 (58%), CO (30%) and CH4 (2.7%), with 17wt% H2 yield based on dry organic feedstock, equivalent to 78% of the equilibrium value. Catalyst A maintained these outputs for four cycles while B underperformed due to partial reduction.

Characterisation of palm empty fruit bunch (PEFB) and pinewood bio-oils and kinetics of their thermal degradation

Ultimate and proximate analyses and thermal degradation of bio-oils from pinewood and palm empty fruit bunches (PEFB) were carried out to evaluate the oils' potential for production of fuels for transport, heat and power generation, and of hydrogen via the calculation of performance indicators. The pinewood and PEFB oils indicated good theoretical hydrogen yields of 13.7 and 15.9 wt.% via steam reforming, but their hydrogen to carbon effective ratios were close to zero, and their propensity for fouling and slagging heat exchanger surfaces via combustion was high. Both oils exhibited two phases during mass loss under nitrogen flow at heating rates of 3-9 Kmin(-1), but the kinetics of their thermal degradation from TGA-FTIR analysis indicated different degradation mechanisms that were well reproduced by a nth order reaction model for pinewood and Jander's 3D-diffusion model for PEFB. These findings lead to recommendations on pretreatments prior to the oils' utilisation.

Use of the Richtmyer-Meshkov instability to infer yield stress at high-energy densities

We use the Richtmyer-Meshkov instability (RMI) at a metal-gas interface to infer the metal's yield stress (Y) under shock loading and release. We first model how Y stabilizes the RMI using hydrodynamics simulations with a perfectly plastic constitutive relation for copper (Cu). The model is then tested with molecular dynamics (MD) of crystalline Cu by comparing the inferred Y from RMI simulations with direct stress-strain calculations, both with MD at the same conditions. Finally, new RMI experiments with solid Cu validate our simulation-based model and infer Y~0.47 GPa for a 36 GPa shock.

[X-linked adrenoleukodystrophy or the trap of making commonplace of child's psycho-cognitive disorders]

A 10-year-old boy is referred to the pediatric ward for regression of school performance and behavior problems. The clinic has been evolving for two years in a context of parental separation. Given the clinical deterioration, the patient is sent to child psychiatrist. A complete somatic checkup is achieved, he reveals white matter lesions suggesting the diagnosis of X-linked adrenoleukodystrophy (X-ALD) confirmed by the metabolic assay. No curative treatment will be offered given the stage of the disease; the patient dies within two years. The X-ALD is a degenerative disease of the white matter having a prevalence estimated at 1/20,000 cases worldwide. The mutated gene, located on the long arm of chromosome X, encodes a peroxisomal membrane protein. Over 500 mutations are known and cause a disorder of fatty acids beta-oxidation. Several phenotypes exist without phenotype-genotype relationship. The diagnosis of X-ALD is mainly based on brain magnetic resonance and blood very long chain fatty acids (VLCFA) blood level. Allogenic hematopoietic stem cell transplantation, only known cure can be achieved in patients with asymptomatic (from screening) or early stage. Without treatment, the survival prognosis at diagnosis is an average of 3 years. Genetic counseling and screenings (pre-natal, neo-natal and family) are essentials to improve this diagnosis. Vigilance is crucial when dealing with child's psycho-cognitive disorders.

High purity H2 by sorption-enhanced chemical looping reforming of waste cooking oil in a packed bed reactor

High purity hydrogen (>95%) was produced at 600 degrees C and 1 atm by steam reforming of waste cooking oil at a molar steam to carbon ratio of 4 using chemical looping, a process that features redox cycles of a Ni catalyst with the in-situ carbonation/calcination of a CO(2) sorbent (dolomite) in a packed bed reactor under alternated feedstreams of fuel-steam and air. The fuel and steam conversion were higher with the sorbent present than without it. Initially, the dolomite carbonation was very efficient (100%), and 98% purity hydrogen was produced, but the carbonation decreased to around 56% with a purity of 95% respectively in the following cycles. Reduction of the nickel catalyst occurred alongside steam reforming, water gas shift and carbonation, with H(2) produced continuously under fuel-steam feeds. Catalyst and CO(2)-sorbent regeneration was observed, and long periods of autothermal operation within each cycle were demonstrated.

Chemical looping reforming of waste cooking oil in packed bed reactor

Chemical looping steam reforming for hydrogen production from waste cooking oil was investigated using a packed bed reactor. The steam to carbon ratio of 4 and temperatures between 600 and 700 degrees C yielded the best results of the range of conditions tested. Six cycles at two weighted hourly space velocities (WHSV of 2.64 and 5.28 h(-1)) yielded high (>0.74) and low (<0.2) oil conversion fractions, respectively, representing low and high coking conditions. The WHSV of 2.64 h(-1) yielded product concentrations closest to equilibrium values calculated assuming a fresh rapeseed oil composition. Repeated cycling revealed some output oscillations in reactant conversion and in the extent of Ni-NiO conversion, but did not exhibit deterioration by the 6th cycle. The selectivity of CO, CO(2) and CH(4) were remarkably constant over the performed cycles, resulting in a repeatable syngas composition with H(2) selectivity very close to the optimum.

[Escherichia coli meningitis and parietal osteomyelitis in an infant: a rare complication of cephalohematoma]

We report the case of a 30-day-old infant presenting a E. coli meningitis with recurrence 5 days after stopping antibiotics. The clinical investigations concluded to the diagnosis of osteomyelitis of the parietal bone probably as a consequence of the infection of a cephalohematoma due to a wound caused by a foetal monitoring. Cephalohematoma is frequent in infant and is usually without consequences. Though rare, cases of infected cephalohematomas are described in the literature, with possible complications of meningitis (E. coli) and osteomyelitis. Sometimes the both pathologies are associated. A secondary infection of cephalohematomas must be taken in consideration when the etiology of a E. coli meningitis is not quite clear enough. In this situation, looking for an osteomyelitis whose presence may influence the infant's treatment is needed.

Learning from technical documents: the role of intermodal referring expressions

OBJECTIVE

We investigated the impact of two types of intermodal referring expressions on efficiency of instructions for use.

BACKGROUND

User manuals for software or technical devices such as a video recording system frequently combine verbal instructions and illustrations. Much research has shown that the presence of an illustration has a beneficial effect on learning. The present study focuses on a factor that modulates this beneficial effect. The combination of text and an illustration can be effective only if the user integrates the information coming from these two media. This integration depends largely on the intermodal referential expressions, the function of which is to mark explicitly the relations between the text and the illustration.

METHOD

In an experiment (N = 104), we compared the effectiveness of two intermodal referring expressions often used in procedural texts: indexes (numbers introduced in the illustrations and in the instructions to establish cross-references) and icons (visual representations of the components of the device, which are inserted in the verbal instructions).

RESULTS

The icons condition led to the most efficient use of the device.

CONCLUSION

This experiment shows that learning from multimedia documents depends on the possibility of effectively connecting the verbal instructions to the illustration.

APPLICATION

Taking into account the ergonomic properties of the cross-media referring expressions should allow text designers to improve the effectiveness of technical documents.

The construction of spatial situation models during reading

Psycholinguistic research faces a major challenge in describing the mental representations readers construct from a text. It is now widely accepted that readers end with a representation of the situation described in the text. However, it is unclear whether this representation allows the activation of elements in accordance with their situation proximity. To answer this question, two experiments were conducted. Participants read texts, sentence by sentence, which gave them instructions about how to arrange items in a layout; they then performed a recognition task. By manipulating the spatial proximity between prime and probe items, this task allowed the measurement of a spatial priming effect. In the first experiment, a larger priming effect was observed for closer items on the spatial layout. The second experiment replicated these findings and showed that the priming effects are better explained by categorical distance than by Euclidean distance.

[Nursing notes: what do they contribute to the quality of medical records?]

Treatment records are preferential tools in nursing care. Depending on the setting, its development has gained greater importance during the last thirty years. In the environment of an organization in charge of the computerization of patient files, an evaluation was conducted on the contents of the anamneses and daily observations of nurses. This study, concerning 110 medical records demonstrated the different facets in the methods of transcribing data from notes ensuing from observations, action, and evaluation. Alternatively, the impact of this procedure translates into concrete propositions by the medical teams, as well as exploring the benefits of charting the treatment records themselves.

Bacterial swarming: a biochemical time-resolved FTIR-ATR study of Proteus mirabilis swarm-cell differentiation

Fourier transform infrared spectroscopy was applied to the study of the differentiation process undergone by Proteus mirabilis. This bacterium exhibits a remarkable dimorphism, allowing the cells to migrate on a solid substratum in a concerted manner yielding characteristic ring patterns. We performed an in situ noninvasive analysis of biochemical events occurring as vegetative cells differentiate into elongated, multinucleate, nonseptate, and hyperflagellated swarm cells. The major findings arising from this study are (i) the real-time monitoring of flagellar filament assembly, (ii) the evidence for de novo synthesis of qualitatively different lipopolysaccharides (LPS) and/or exopolysaccharides (EPS) constituting the slime into which bacteria swarm, and (iii) the alteration in the membrane fatty acid composition with a concomitant 10 degrees C decrease in the gel/liquid crystal phase transition resulting in an elevated membrane fluidity in swarm cells at the growth temperature. The time course of events shows that the EPS-LPS syntheses are synchronous with membrane fatty acid alterations and occur about 1 h before massive flagellar filament assembly is detected. This study not only provided a time sketch of biochemical events involved in the differentiation process but also led to the identification of the major spectral markers of both vegetative and swarm cells. This identification will allow to resolve the time-space structure of P. mirabilis colonies by using infrared microscopy.

Folded structures in protonated reduced dipeptides

Reduced dipeptides with the general formula RCO-Xaa-rXbb-N+HR'R" (rXbb, reduced analogue of residue Xbb: NH-C alpha HR1-CrH2) are shown to adopt a folded conformation in solution and in the solid state. The protonated reduced amide bond is an active proton donor capable of interacting with a peptide carbonyl to give a strong hydrogen bond topologically equivalent to the i+2 or i+3-->i interaction. The resulting conformation is similar to the y- or beta-turn structure found in peptides and proteins.

Invasive candidiasis complicating spontaneous esophageal perforation (Boerhaave syndrome)

Spontaneous esophageal perforation is a rare condition that frequently results in infectious complications. Empirical broad-spectrum antibacterial therapy is therefore part of the standard management. We describe two patients suffering from spontaneous esophageal perforation who developed invasive candidiasis with hematogenous dissemination. One patient died of multiple organ failure due to Candida sepsis. Preexistent Candida colonization, incomplete mediastinal drainage, broad-spectrum antibacterial therapy, and prolonged intensive care therapy place patients with esophageal perforation at high risk for secondary fungal infection. Intense microbiological searching is mandatory, but the distinction between colonization and infection may be impossible. Empirical antifungal treatment with imidazole derivatives, particularly in patients with potential risk factors, should be considered.

Turn induction by N-aminoproline. Comparison of the Gly-Pro-Gly and Gly psi [CO-NH-N]Pro-Gly sequences

The folded structure induced by the N-aminoproline residue (the hydrazino analogue of proline, denoted hPro) in the Boc-Gly1-hPro2-Gly3-NHiPr hydrazino tripeptide has been characterized in the solid state by X-ray diffraction, and compared to the usual beta II-turn structure in the Boc-Gly1-Pro2-Gly36-NHiPr cognate tripeptide. It is stabilized by a bifurcated hydrogen bond in which (Gly3)NH interacts with both (Gly1)CO and (hPro2)N alpha. This conformation is retained in CH2Cl2 and CHCl3 solutions, and allows an overall folded conformation of the hydrazino tripeptide in which (iPr)NH is hydrogen-bonded to (Boc)CO. The hPro alpha-hydrazino acid residue appears to promote a local folded structure, and might behave as a beta-turn mimic.

[Enteral nutrition at home with jejunostomy catheter]

Ten patients with obstructive tumors of the upper gastrointestinal tract received a catheter jejunostomy (CJ) for long periods of enteral nutritional support. Seven of those patients received home enteral nutritional support for a period of 2-9 months. Body weight and serum albumin remained constant during the nutritional therapy. Complications (diarrhea, leakage) were rare and could successfully treated without interruption of feeding. In our experience CJ is a safe and effective method for home enteral nutritional support.