Prognosis of prosthetic valve infective endocarditis due to Streptococcus spp., a retrospective multi-site study to assess the impact of antibiotic treatment duration

PURPOSE

The duration of antibiotic treatment for prosthetic valve endocarditis caused by Streptococcus spp. is largely based on clinical observations and expert opinion rather than empirical studies. Here we assess the impact of a shorter antibiotic duration.

OBJECTIVES

To assess the impact of antibiotic treatment duration for streptococcal prosthetic valve endocarditis on 12-month mortality as well as subsequent morbidity resulting in additional cardiac surgical interventions, and rates of relapse and reinfection.

METHODS

This retrospective multisite (N= 3) study examines two decades of data on patients with streptococcal prosthetic valve endocarditis receiving either 4 or 6 weeks of antibiotics. Overall mortality, relapse, and reinfection rates were also assessed for the entire available follow-up period.

RESULTS

The sample includes 121 patients (median age 72 years, IQR [53; 81]). The majority (74%, 89/121) received a ß-lactam antibiotic combined with aminoglycoside in 74% (89/121, median bi-therapy 5 days [1; 14]). Twenty-eight patients underwent surgery guided by ESC-guidelines (23%). The 12-month mortality rate was not significantly affected by antibiotic duration (4/40, 10% in the 4-week group vs 3/81, 3.7% in the 6-week group, p=0.34) or aminoglycoside usage (p=0.1). Similarly, there were no significant differences between the 2 treatment groups for secondary surgical procedures (7/40 vs 21/81, p=0.42), relapse or reinfection (1/40 vs 2/81 and 2/40 vs 5/81 respectively).

CONCLUSIONS

Our study found no increased adverse outcomes associated with a 4-week antibiotic duration compared to the recommended 6-week regimen. Further randomized trials are needed to ascertain the optimal duration of treatment for streptococcal endocarditis.

Prevalence of 2-year "No evidence of disease activity" (NEDA-3 and NEDA-4) in relapsing-remitting multiple sclerosis. A real-world study

BACKGROUND

No evidence of disease activity (NEDA) is becoming a gold standard in the evaluation of disease modifying therapies (DMT) in relapsing-remitting multiple sclerosis (RRMS). NEDA-3 status is the absence of relapses, new activity on brain MRI, and disability progression. NEDA-4 meets all NEDA-3 criteria plus lack of brain atrophy.

OBJECTIVE

Aim of this study was to investigate the prevalence of two-year NEDA-3, NEDA-4, six-month delayed NEDA-3 (6mdNEDA-3), and six-month delayed NEDA-4 (6mdNEDA-4) in a cohort of patients with RRMS. Six-month delayed measures were introduced to consider latency of action of drugs.

METHODS

Observational retrospective monocentric study. All the patients with RRMS starting DMT between 2015 and 2018, and with 2-year of follow-up, were included. Annualized brain volume loss (a-BVL) was calculated by SIENA software.

RESULTS

We included 108 patients, the majority treated with first line DMT. At 2-year follow-up, 35 % of patients were NEDA-3 (50 % 6mdNEDA-3), and 17 % NEDA-4 (28 % 6mdNEDA-4). Loss of NEDA-3 status was mainly driven by MRI activity (70 %), followed by relapses (56 %), and only minimally by disability progression (7 %).

CONCLUSION

In our cohort 2-year NEDA status, especially including lack of brain atrophy, was hard to achieve. Further studies are needed to establish the prognostic value of NEDA-3 and NEDA4 in the long-term follow-up.

Hybrid electronic-photonic sensors on a fibre tip

Most sensors rely on a change in an electrical parameter to the measurand of interest. Their direct readout via an electrical wire and an electronic circuit is, in principle, technically simple, but it is subject to electromagnetic interference, preventing its application in several industrial environments. Fibre-optic sensors can overcome these limitations because the sensing region and readout region can be spaced apart, sometimes by kilometres. However, fibre-optic sensing typically requires complex interrogation equipment due to the extremely high wavelength accuracy that is required. Here we combine the sensitivity and flexibility of electronic sensors with the advantages of optical readout, by demonstrating a hybrid electronic-photonic sensor integrated on the tip of a fibre. The sensor is based on an electro-optical nanophotonic structure that uses the strong co-localization of static and electromagnetic fields to simultaneously achieve a voltage-to-wavelength transduction and a modulation of reflectance. We demonstrate the possibility of reading the current-voltage characteristics of the electro-optic diode through the fibre and therefore its changes due to the environment. As a proof of concept, we show the application of this method to cryogenic temperature sensing. This approach allows fibre-optic sensing to take advantage of the vast toolbox of electrical sensing modalities for many different measurands.

Optimising mopane worm (Gonimbrasia belina) processing for improved nutritional and microbial quality

Mopane worms (Gonimbrasia belina) is an important source of food and contribute to the nutrition of people who consume them. However, the traditional processing methods may have detrimental effects on the nutritional value and should also guarantee microbial quality. In this study, the nutritional composition and microbial quality of mopane worms processed under different boiling time (0-20 min) and drying temperature (40-60 °C) conditions were investigated and optimised using response surface methodology. An increase in the boiling time at the lowest drying temperature resulted in an increase in protein content and reduction in coliform counts. The optimum conditions of boiling for 20 min and drying at 40 °C resulted in mopane worms with a protein content of 49.4% DW and coliform counts <1.5 log cfu/g. In addition, high concentrations of crude fibre (13.6% DW) and fat (20.2% DW), as well as Fe (19.0 mg/100 g) and Zn (17.9 mg/100 g) were also recorded. A decrease in the total bacterial count, Escherichia coli and yeasts and moulds at the boiling time ≥20 min irrespective of the drying temperature suggested that exposure to heat reduced the microbial growth and contamination. Reduction of the mopane worms' moisture content (<7%) due to drying further slowed down the rate of microbial growth. The optimal processing conditions (boiling for 20 min and drying at 40 °C) are recommended for pretreatment of mopane worms prior to further processing into various products.

FRI0439 PET-CT IN THE ASSESSMENT OF OSTEOARTICULAR INFECTIONS ASSOCIATED WITH INFECTIVE ENDOCARDITIS

Background:

Five to eleven percent of infective endocarditis (IE) are associated with a musculoskeletal infection. Thanks to its good sensitivity, the use of PET-CT in this pathology makes it possible to confirm the diagnosis by seeking valvular hypermetabolism but also by mapping distant septic foci.

Objectives:

The main objective of our study was to assess the prevalence of osteoarticular fixation (OAF) with PET-CT, symptomatic or not, in patients with IE. The secondary objectives were to determine predictive factors for osteoarticular infections such as the type of valve damage (native or prosthetic) and germ.

Methods:

This study was carried out on the basis of a prospective cohort of patients admitted in the department of cardiology in Henri Mondor Hospital for IE suspicion between August 2015 and July 2019. Demographic, clinical, bacteriological, imaging and therapeutic data have been collected. Patients matching Duke’s modified criteria according to ESC 2015 (Duke + IE) and / or a cardiac fixation according to standard whole-body PET-CT were included in the analysis. All of the PET-CT scans were reviewed by a nuclear medicine specialist to confirm whether or not there was a heart condition and to look for septic-looking OAF.

Results:

From this cohort, we included 90 IE Duke + patients and 42 patients with cardiac PET-CT fixation (including 31 IE Duke +). In the IE Duke + group, we found OAF in 18 patients (20%), 39% of whom were asymptomatic. There were 9 spondylodiscitis (4 on the cervical level, 7 on the thoracic level, and 2 on the lumbar level), 5 glenohumeral arthritis, 2 coxofemoral arthritis, 1 sternoclavicular arthritis and 1 sacroiliac arthritis. The IE affected the aortic valve in 50% of the cases and the mitral valve in 22%. In other cases, the infection involved the internal automatic defibrillator (ICD) or the pacemaker. The valves were prosthetic in 73% of the cases. The bacterial ecology was mainly represented by Enterococcus faecalis (39%) then staphylococcus aureus (17%) against 14% and 13% respectively in the entire IE Duke + group. In the group with cardiac PET-CT fixation, OAF was found in 10 patients (40%), 70% of whom were asymptomatic. Among them, there were 5 spondylodiscitis (2 cervico- thoracic and 3 exclusively thoracic), 2 glenohumeral arthritis (20%), 2 coxofemoral arthritis and 1 sternoclavicular arthritis. The IE affected the aortic valve in 60% of the cases, mitral in 30% of the cases and it was an infection on ICD in 10% of the cases. The main germs found were Enterococcus faecalis (30% of cases) and Staphylococcus epidermidis (20% of cases).

Conclusion:

In patients with IE, PET-CT seems to be interesting in detection of osteoarticular infections, and consequently, could impact the diagnosis and the treatment modalities. In our cohort, 1 patient in 5 had an OAF and nearly 40% of them were asymptomatic. The overrepresentation of enterococcus is consistent with recent data in the literature

References:

[1]Dahl A, Iversen K, Tonder N, Hoest N, Arpi M, Dalsgaard M, et al. Prevalence of Infective Endocarditis in Enterococcus faecalis Bacteremia. J Am Coll Cardiol. 16 juill 2019;74(2):193‑201.

Disclosure of Interests:

Benjamin HUGUES: None declared, Bérivan EMSEN: None declared, Julien TERNACLE: None declared, Raphaëlle HUGUET: None declared, Antonio FIORE: None declared, Raphaëlle LEPEULE: None declared, Xavier Chevalier: None declared, Mukedaisi ABULIZI: None declared, Florent Eymard Consultant of: Regenlab

Anti-stiction coating for mechanically tunable photonic crystal devices

A method to avoid the stiction failure in nano-electro-opto-mechanical systems has been demonstrated by coating the system with an anti-stiction layer of Al₂O₃ grown by atomic layer deposition techniques. The device based on a double-membrane photonic crystal cavity can be reversibly operated from the pull-in back to its release status. This enables to electrically switch the wavelength of a mode over ~50 nm with a potential modulation frequency above 2 MHz. These results pave the way to reliable nano-mechanical sensors and optical switches.

Baropodometry on patients after total knee arthroplasty

PURPOSE

It is well known that total knee replacement surgery decreases pain and improves function, but the effect on postural assessment needs to be studied better with the use of new technological devices. Total knee arthroplasty (TKA) improves motor coordination and stability of the knee. On the other hand, changing joint functionality can modify the balance. The aim of this trial is to record and analyze the static and dynamic baropodometric data of patients in the first few months following joint replacement. For the physiatrist, this tool can be useful to check if the rehabilitation treatment protocols and times are correct.

METHODS

We designed a prospective observation longitudinal study to assess postural stability following TKA. Between December 2014 and May 2015, sixty consecutive patients were recruited through local orthopedic physician offices and hospitals. The patients scheduled to undergo TKA were recruited and were monitored before surgery (T0) and at 1 (T1), 3 (T2) and 6 months (T3) after knee surgery. The correction of varus/valgus deviation at X-ray and the Knee Society Score were performed to verify the functional recovery. We used static and dynamic baropodometric analysis to evaluate postural assessment.

RESULTS

After surgery, there was a significant improvement in physiological alignment of knee axes (p < 0.0001) and of Knee and Function Scores (excellent, mean values 80.5 and 80.7, respectively, p < 0.0001). The static analysis showed that the center of gravity and the pressure on the foot of the operated limb were corrected toward the physiological center (p < 0.0001) and the body weight displaced to the forefeet and to the hindfeet reduced bilaterally (p < 0.0001). The type of footprint did not change. The dynamic analysis confirmed the significant normalization of the pressure on the foot of the operated limb at all follow-ups (p < 0.0001). The percentage of load was reduced on the operated limb (p = 0.0096) and speed of step, cadence and semi-step length increased (p < 0.0001).

CONCLUSION

These data show the progressive recovery of stability after TKA from the immediate postoperative to the subsequent months. The clinical and functional improvement correlated with a load redistribution between the two limbs. The baropodometry could be an excellent noninvasive method for monitoring effects of rehabilitation treatment.

Ultralow Surface Recombination Velocity in Passivated InGaAs/InP Nanopillars

The III-V semiconductor InGaAs is a key material for photonics because it provides optical emission and absorption in the 1.55 μm telecommunication wavelength window. However, InGaAs suffers from pronounced nonradiative effects associated with its surface states, which affect the performance of nanophotonic devices for optical interconnects, namely nanolasers and nanodetectors. This work reports the strong suppression of surface recombination of undoped InGaAs/InP nanostructured semiconductor pillars using a combination of ammonium sulfide, (NH₄)₂S, chemical treatment and silicon oxide, SiO_x, coating. An 80-fold enhancement in the photoluminescence (PL) intensity of submicrometer pillars at a wavelength of 1550 nm is observed as compared with the unpassivated nanopillars. The PL decay time of ∼0.3 μm wide square nanopillars is dramatically increased from ∼100 ps to ∼25 ns after sulfur treatment and SiO_x coating. The extremely long lifetimes reported here, to our knowledge the highest reported to date for undoped InGaAs nanostructures, are associated with a record-low surface recombination velocity of ∼260 cm/s. We also conclusively show that the SiO_x capping layer plays an active role in the passivation. These results are crucial for the future development of high-performance nanoscale optoelectronic devices for applications in energy-efficient data optical links, single-photon sensing, and photovoltaics.

Waveguide-coupled nanopillar metal-cavity light-emitting diodes on silicon

Nanoscale light sources using metal cavities have been proposed to enable high integration density, efficient operation at low energy per bit and ultra-fast modulation, which would make them attractive for future low-power optical interconnects. For this application, such devices are required to be efficient, waveguide-coupled and integrated on a silicon substrate. We demonstrate a metal-cavity light-emitting diode coupled to a waveguide on silicon. The cavity consists of a metal-coated III–V semiconductor nanopillar which funnels a large fraction of spontaneous emission into the fundamental mode of an InP waveguide bonded to a silicon wafer showing full compatibility with membrane-on-Si photonic integration platforms. The device was characterized through a grating coupler and shows on-chip external quantum efficiency in the 10⁻⁴–10⁻² range at tens of microamp current injection levels, which greatly exceeds the performance of any waveguide-coupled nanoscale light source integrated on silicon in this current range. Furthermore, direct modulation experiments reveal sub-nanosecond electro-optical response with the potential for multi gigabit per second modulation speeds.

Despite much progress, nanoscale light sources suitable for photonic integration are lacking. Here, the authors present a metal-cavity nanopillar LED on a silicon substrate working at telecommunications wavelengths, which demonstrates compatibility with membrane-on-Si photonic integration platforms.

Effects of the self-myocardial retroperfusion with aortic-coronary sinus shunt on cardiac output and ischemic events in high-risk patients undergoing OPCAB surgery

AIM

Despite controversies, off-pump coronary artery bypass (OPCAB) surgery has become a routine procedure. Obvious advantages have been demonstrated in high-risk patients. However, OPCAB surgery has limitations in specific high-risk situations with hazards of operative deleterious events. We describe an innovative procedure of self-myocardial retroperfusion (SMR) with an aortic-coronary sinus shunt (ACSS). We prospectively evaluated the protective effects and benefits of SMR in high-risk coronary patients with impaired LVEF.

METHODS

Eighteen consecutive high-risk (ES>10) coronary patients (mean age: 65.94 years; range: 34-85; mean ES: 26.97%) with LVEF≤35% who were not eligible for IABP were assigned for OPCAB surgery. Following sternotomy, the cardiac indexes (CI) were measured before, during SMR and after completion of coronary artery bypasses. Operative events with and without SMR were accurately collected, and postoperative cardiac Troponin T release was measured.

RESULTS

OPCAB procedures were performed in all patients. Intraoperative use of SMR significantly increased CI (P=3.1041810.10-8) and reversed deleterious operative events (ECG changes/low cardiac output). Hospital mortality was 0%. Incidence of transient atrial fibrillation was 33.33%. Neither stroke nor renal insufficiency was observed. The mean graft number/patient was 2.05. Mean postoperative cardiac Troponin T value was 0.79 μg/L. Beating heart preservation optimized by SMR contributed to reduce ischemia-reperfusion injury, as validated by an immediate increase of CI after completion of coronary bypasses (P=3.35009.10-9).

CONCLUSION

The concept of SMR with an ACSS during OPCAB procedures definitely improved CI and reversed ischemic features in high-risk patients and should be considered as an operative temporary myocardial assistance.

Position-Dependent Local Detection Efficiency in a Nanowire Superconducting Single-Photon Detector

We probe the local detection efficiency in a nanowire superconducting single-photon detector along the cross-section of the wire with a far subwavelength resolution. We experimentally find a strong variation in the local detection efficiency of the device. We demonstrate that this effect explains previously observed variations in NbN detector efficiency as a function of device geometry.

Role of TachoSil® in distal pancreatectomy: a single center experience

AIM

Distal pancreatectomies (DP) are associated with high risk of postoperative complications, and in many series higher morbidity rate than duodenopancreatectomies has been reported. To evaluate the role of a collagen sponge with human fibrinogen and thrombin film (TachoSil®) in limiting the incidence of complications after DP.

METHODS

From 1996 to 2013, 221 patients have been submitted to distal pancreatectomy (± splenectomy) in our Division. A retrospective analysis has been conducted in a group of 36 consecutive and prospectively collected DP treated with intraoperative placement of TachoSil® on pancreatic stump from 2010 to 2013 (group 1). A control series of 36 consecutive patients (group 2) was matched 1:1 from hystorical database. The variables considered in the analysis were: age, gender, ASA score, pancreatic texture (hard vs. soft), histology, operative time, postoperative mortality, morbility (postoperative pancreatic fistula - POPF, postoperative hemorrage - PPH, delayed gastric emptying - DGE) and hospital stay. Differences between POPF, PPH, DGE and hospital stays between grops were investigated with χ² and t-Student test. Univariate analysis was conducted to determine factors related to POPF development. Statistical analysis was performed using freeware Microsoft Excel based program.

RESULTS

Post operative mortality was 0% in both groups. POPF were registered in 36.1% (13/36) and 41.6 % (15/36) in groups 1 and 2, respectively (P=n.s.); in group 1 we didn't observe grade C POPF, while 4 patients in control group developed grade C POPF (P<0,05). No differences were found between two groups in terms of incidence of PPH and DGE. The median duration of postoperative hospital stay in group 1 was 21.8 (7-189) days compared with 31.13 (9-249) days in group 2 (P<0.001).

CONCLUSION

The use of TachoSil® seems to be associated with lower incidence of grade C POPF but larger controlled trials are needed to surely assess the usefulness of TachoSil® in pancreatic surgery in order to reduce pancreatic specific complications and their severity.

Prognostic factors of extracorporeal shock wave therapy for tendinopathies

INTRODUCTION

Extracorporeal shock wave therapy is very widely used for the management of tendinopathies and plantar fasciitis.

AIM

The aim of the study is to determine whether there are prognostic factors that may influence the outcome of extracorporeal shock wave therapy for these diseases.

METHODS

Three hundred fifty-five patients were analyzed 2 months after shock wave treatment for rotator cuff tendinitis, epicondylitis, Achilles tendinopathy, trocanteritis, jumper's knee or plantar fasciitis. We recorded the epidemiological, clinical and treatment protocol, and these data were correlated with treatment outcome.

RESULTS

Clinical improvement was achieved in 45.9 % of these patients. We discovered that laterality different to the dominant limb (p < 0.0001) and repeated shock wave treatments (p = 0.004) are prognostic factors in an unsuccessful therapy, while being male (p = 0.015) and a high body mass index (p = 0.004) are factors for success. We found no differences in relation to age, diet, blood type, work or sport activity, presence of co-morbidities, drugs, type of tendinopathy, density of energy delivered and other physiotherapy treatment. Knowledge of these prognostic factors may lead to improved insight for physicians and physiotherapists to predict the extent of the recovery and adjust rehabilitation and patient expectations accordingly.

hERG1 channels drive tumour malignancy and may serve as prognostic factor in pancreatic ductal adenocarcinoma

Background:

hERG1 channels are aberrantly expressed in human cancers. The expression, functional role and clinical significance of hERG1 channels in pancreatic ductal adenocarcinoma (PDAC) is lacking.

Methods:

hERG1 expression was tested in PDAC primary samples assembled as tissue microarray by immunohistochemistry using an anti-hERG1 monoclonal antibody (α-hERG1-MoAb). The functional role of hERG1 was studied in PDAC cell lines and primary cultures. ERG1 expression during PDAC progression was studied in Pdx-1-Cre,LSL-Kras^G12D/+,LSL-Trp53^R175H/+ transgenic (KPC) mice. ERG1 expression in vivo was determined by optical imaging using Alexa-680-labelled α-hERG1-MoAb.

Results:

(i) hERG1 was expressed at high levels in 59% of primary PDAC; (ii) hERG1 blockade decreased PDAC cell growth and migration; (iii) hERG1 was physically and functionally linked to the Epidermal Growth Factor-Receptor pathway; (iv) in transgenic mice, ERG1 was expressed in PanIN lesions, reaching high expression levels in PDAC; (v) PDAC patients whose primary tumour showed high hERG1 expression had a worse prognosis; (vi) the α-hERG1-MoAb could detect PDAC in vivo.

Conclusions:

hERG1 regulates PDAC malignancy and its expression, once validated in a larger cohort also comprising of late-stage, non-surgically resected cases, may be exploited for diagnostic and prognostic purposes in PDAC either ex vivo or in vivo.

A decade with nucleic acid-based microbiological methods in safety control of foods

In the last decade, nucleic acid-based methods gradually started to replace or complement the culture-based methods and immunochemical assays in routine laboratories involved in food control. In particular, real-time polymerase chain reaction (PCR) was technically developed to the stage of good speed, sensitivity and reproducibility, at minimized risk of carry-over contamination. Basic advantages provided by nucleic acid-based methods are higher speed and added information, such as subspecies identification, information on the presence of genes important for virulence or antibiotic resistance. Nucleic acid-based methods are attractive also to detect important foodborne pathogens for which no classical counterparts are available, namely foodborne pathogenic viruses. This review briefly summarizes currently available or developing molecular technologies that may be candidates for involvement in microbiological molecular methods in the next decade. Potential of nonamplification as well as amplification methods is discussed, including fluorescent in situ hybridization, alternative PCR chemistries, alternative amplification technologies, digital PCR and nanotechnologies.

Efficacy of TachoSil® as a sutureless hemostatic patch to repair a perforation of the interventricular groove during endocardial radiofrequency ablation

Catheter ablation is a well-established therapeutic option for management of recurrent ventricular tachycardia in patients with ischemic/non-ischemic heart disease and procedural complications include a mortality rate of up to 3% and a risk of major complications up to 10%. Cardiac perforation following a catheter ablation is rare but serious complication and occurs in 1% of ventricular ablation procedures. The appropriate surgical repair may be challenging and need cardiopulmonary bypass support according to the location of the lesion and the hemodynamic status of the patient. We report the case of a free wall right ventricular perforation of the interventricular groove with cardiac tamponade following catheter ablation for recurrent ventricular tachycardia. Due to the proximity of the left anterior descending artery and the extreme fragility of tissues, the patient was treated successfully by a sutureless patch technique using a fibrin tissue-adhesive collagen fleece (TachoSil®). This technique is a safe and effective surgical option to repair a ventricular perforation especially when the ventricular tissues are fragile. It is simple and enable to realize surgical repair also if the localization of tear is difficult to access and without the need for cardiopulmonary bypass support if hemodynamic conditions are stable.

Experimental test of theories of the detection mechanism in a nanowire superconducting single photon detector

We report an experimental test of the photodetection mechanism in a nanowire superconducting single photon detector. Detector tomography allows us to explore the 0.8-8 eV energy range via multiphoton excitations. High accuracy results enable a detailed comparison of the experimental data with theories for the mechanism of photon detection. We show that the temperature dependence of the efficiency of the superconducting single photon detector is determined not by the critical current but by the current associated with vortex unbinding. We find that both quasiparticle diffusion and vortices play a role in the detection event.

Mapping the 3D distribution of CdSe nanocrystals in highly oriented and nanostructured hybrid P3HT-CdSe films grown by directional epitaxial crystallization

Highly oriented and nanostructured hybrid thin films made of regioregular poly(3-hexylthiophene) and colloidal CdSe nanocrystals are prepared by a zone melting method using epitaxial growth on 1,3,5-trichlorobenzene oriented crystals. The structure of the films has been analyzed by X-ray diffraction using synchrotron radiation, electron diffraction and 3D electron tomography to afford a multi-scale structural and morphological description of the highly structured hybrid films. A quantitative analysis of the reconstructed volumes based on electron tomography is used to establish a 3D map of the distribution of the CdSe nanocrystals in the bulk of the films. In particular, the influence of the P3HT-CdSe ratio on the 3D structure of the hybrid layers has been analyzed. In all cases, a bi-layer structure was observed. It is made of a first layer of pure oriented semi-crystalline P3HT grown epitaxially on the TCB substrate and a second P3HT layer containing CdSe nanocrystals uniformly distributed in the amorphous interlamellar zones of the polymer. The thickness of the P3HT layer containing CdSe nanoparticles increases gradually with increasing content of NCs in the films. A growth model is proposed to explain this original transversal organization of CdSe NCs in the oriented matrix of P3HT.

Electromechanical tuning of vertically-coupled photonic crystal nanobeams

We present the design, the fabrication and the characterization of a tunable one-dimensional (1D) photonic crystal cavity (PCC) etched on two vertically-coupled GaAs nanobeams. A novel fabrication method which prevents their adhesion under capillary forces is introduced. We discuss a design to increase the flexibility of the structure and we demonstrate a large reversible and controllable electromechanical wavelength tuning (> 15 nm) of the cavity modes.

Usefulness of ultrasounds in the management of breast phyllodes tumors

INTRODUCTION

Breast phyllodes tumors (PT) are uncommon fibroepithelial lesions having potential malignant features. These tumors have characteristic features, like pleomorphism, mitoses and overgrowth of the stroma with possible infiltrative margins. The clinical behaviour could be unpredictable, since the relatively high recurrence rate despite correct surgical strategy. Conventional diagnostic examinations show high sensitivity and specificity, but cannot demonstrate the differences between benign and malignant PT. MRI is not more effective.

PATIENTS AND METHODS

Sixteen patients affected by PT have been surgically treated at our Institution. All patients received mammography and ultrasonography (US) as preoperative diagnostic work-up.

RESULTS

in 13 patients, US was effective in preoperative diagnosis of PT. Mammography was uneffective in detecting breast lesions in 5 cases, while in 11 cases mammographic findings presented benign features, with a round opacity with moderate tissue density and well-defined wall.

CONCLUSION

US remains the most useful diagnostic test in detecting PT. However, there is no test effective in identifying malignat PT. In case of suspicion, fine needle biopsy should be performed.

Modified detector tomography technique applied to a superconducting multiphoton nanodetector

We present an experimental method to characterize multi-photon detectors with a small overall detection efficiency. We do this by separating the nonlinear action of the multiphoton detection event from linear losses in the detector. Such a characterization is a necessary step for quantum information protocols with single and multiphoton detectors and can provide quantitative information to understand the underlying physics of a given detector. This characterization is applied to a superconducting multiphoton nanodetector, consisting of an NbN nanowire with a bowtie-shaped subwavelength constriction. Depending on the bias current, this detector has regimes with single and multiphoton sensitivity. We present the first full experimental characterization of such a detector.

A time bomb in the thorax: the giant ascending aortic aneurysm: case report

We report the case of a 82-year-old woman, asymptomatic, subject to chest computed tomography for trauma. Then the patient underwent surgery. Before sternotomy, femoro-femoral bypass was starter in order to decompress the aneurysm; using deep hypothermia and circulatory arrest, ascending aorta and hemiarch replacement were performed with a Dacron graft. Post-operative course was uneventful.

Young's type interference for probing the mode symmetry in photonic structures

A revisited realization of the Young's double slit experiment is introduced to directly probe the photonic mode symmetry by photoluminescence experiments. We experimentally measure the far field angular emission pattern of quantum dots embedded in photonic molecules. The experimental data well agree with predictions from Young's interference and numerical simulations. Moreover, the vectorial nature of photonic eigenmodes results in a rather complicated parity property for different polarizations, a feature which has no counterpart in quantum mechanics.

Sacral neuromodulation for the treatment of fecal incontinence: analysis of cost-effectiveness

PURPOSE

The cost-effectiveness and budget impact of introducing sacral nerve modulation (SNM) as a treatment for fecal incontinence in Italy were evaluated in a simulation model.

METHODS

A decision-analysis model with a Markov submodel was used to represent clinical pathways for treatment of patients with fecal incontinence in a scenario with SNM and a scenario without SNM. Data were obtained from published studies and from an expert panel. Evaluation of resource consumption was conducted from the perspective of the Italian National Health Service, and costs were retrieved from the Italian NHS procedures reimbursement list. The time horizon was 5 years, and a 3% discount rate was applied to costs and outcomes. Effectiveness was measured in symptom-free years and in quality-adjusted life-years (QALYs). Fecal incontinence prevalence data and SNM usage forecasts were used to estimate budget impact over the next 5 years.

RESULTS

The incremental cost-effectiveness ratio for introducing SNM was €28,285 per QALY gained for patients with a structurally deficient anal sphincter and €38,662 per QALY gained for patients with intact anal sphincters. If a threshold of €40,000 per QALY gained is set as the level that a decision-maker would regard as cost-effective, the probability that the introduction of SNM will be cost-effective would be 99% for patients with a structurally deficient sphincter and 53% for patients with an intact sphincter. Budget impact analysis showed that introducing SNM would have an estimated budget impact of 0.56% over 5 years on the budget allocated for fecal incontinence treatment.

CONCLUSION

Our data show SNM to be an efficient investment with an acceptable incremental cost-effectiveness ratio and a limited impact on the total allocated budget for fecal incontinence.

[Retroperitoneal dedifferentiated liposarcoma (DDLS) with hyperglycemic activity: case report and literature review]

The authors describe a Retroperitoneal De Differentiated LipoSarcomas (DDLs), that for its clinical behavior shows peculiar characteristics and original aspects: typical is the recurrence due to local invasiveness, but absolutely original seems to be the surviving time, maybe correlated to its histological evolution (dedifferentiation from leiomyosarcoma to liposarcoma) and an interesting correlation from the tumor recurrence and the glycemic curve first and after the surgical treatments. A 66-year-old woman, presenting typically with very big abdominal masses, treated three times in almost three years, every time with aggressive surgical treatments. Histological response was leiomyo-sarcoma in the first two operations and liposarcoma in the last treatment and in every preoperative phase the patient, normally prediabetic, started to have problem of glycemia balancing, needing an insulin support until the postoperative phases when its glycemia was coming back in normal value without insulin needs, of course until a new tumor recurrence. This last aspect, not depending on pancreas involvement or hormonal activity (immune-histo-chemistry was never conforming a neuro-endocrine activity), seems probably due directly to a mass and metabolic effect of the tumor. Beginning from the description of this case and its interesting biology and reviewing most of the literature on the argument, authors hope to give our support to still debated and partially unknown aspects of these kinds of tumors.

Lipodepsipeptides from Pseudomonas syringae are partially proteolyzed and are not absorbed by humans: an in vitro study

There are some concerns about the use of Pseudomonas-based products as biocontrol agents because of the hemolytic activity shown by their metabolites. The effects of Pseudomonas lipodepsipeptides (LDPs) on mammals via ingestion and the LDP degradation during the digestion and intestinal permeability have not been evaluated. In this research, the susceptibility of different LDPs to degradation was assayed with enzymatic gastrointestinal digestion, and intestinal permeability to LDPs was investigated in an in vitro system based on an intestinal cell layer system. Results demonstrated that trypsin and chymotrypsin hydrolyze up to 50% of the various LDPs, and that proteolysis was further increased by pronase E treatment. A decrease in LDP hemolytic activity matched LDP degradation during the various steps of the digestion process. Moreover, it was shown that syringomycin E (SRE), the main known LDP, was not able to cross the intestinal cell layer, suggesting that SRE does not reach the bloodstream in vivo. It was concluded that the Pseudomonas-based biocontrol products do not represent a serious risk for consumer health. In fact, LDPs possibly present on biocontrol-treated agricultural commodities would likely be partially digested by gastrointestinal enzymes and would not be absorbed at the intestinal level.

High efficiency NbN nanowire superconducting single photon detectors fabricated on MgO substrates from a low temperature process

We demonstrate high-performance nanowire superconducting single photon detectors (SSPDs) on bN thin films grown at a temperature compatible with monolithic integration. NbN films ranging from 150 nm to 3 nm in thickness were deposited by dc magnetron sputtering on MgO substrates at 400 degrees C SSPDs were fabricated on high quality NbN films of different thickness (7 to 3 nm) deposited under optimal conditions. Electrical and optical characterizations were performed on the SSPDs. The highest QE value measured at 4.2K is 20% at 1300 nm.

Intraband carrier photoexcitation in quantum dot lasers

We unveil the role of bound-to-continuum photoexcitation of carriers as a relevant process that affects the performance of quantum dot (QD) lasers. We present the response of an InAs/InGaAs QD laser to a sub-band gap pump, showing an unexpected depletion of the emitted photons. We relate this observation with carrier photoexcitation through additional transmission and photocurrent measurements. We provide a theoretical support to the experimental data and highlight the important role of this process in the laser characteristics.

Survival of Listeria monocytogenes in uncooked Italian dry sausage (salami)

This study was undertaken to supplement existing information on the survival of Listeria monocytogenes in Italian salami. The fact that Italian salami is frequently consumed by a large number of people poses some serious health implications. Some raw materials have been found to be microbiologically contaminated, for their production occurs without any thermic treatment, and these are in circulation throughout Italy all year round. We selected the product for its microbiological, technological, and commercial characteristics. We analyzed 1,020 samples taken during the autumn and winter 2002 and spring and summer 2003 periods and immediately before selling. The samples were collected from 17 plants with an annual production of between 1 and 2000 metric tons and with a distribution of products in over 80% of Italy in geographic terms. To detect and enumerate L. monocytogenes, we followed International Organization for Standardization (ISO) 11290 part 1 and 2: 1996 (modified using chromogenic medium Agar Listeria according to Ottarviani and Agosti [ALOA]). L. monocytogenes was found in 22.7% of samples, but the contamination level was less than 10 CFU/g. Contamination prevalence ranged from 1.6 to 58.3% and was lower than 10% in 5 of the 17 plants checked. The most frequently isolated serotypes were 1/2c, 1/2a, 1/2b, and 4b. Additional studies are necessary to establish if the exposure to a small number of L. monocytogenes cells through the consumption of salami represents a significant health risk and, in light of the future introduction of the SANCO/4198/2001 revision 21 "Commission Regulation on Microbiological Criteria for Foodstuffs," is a necessary investigation.

The global atmospheric environment for the next generation

Air quality, ecosystem exposure to nitrogen deposition, and climate change are intimately coupled problems: we assess changes in the global atmospheric environment between 2000 and 2030 using 26 state-of-the-art global atmospheric chemistry models and three different emissions scenarios. The first (CLE) scenario reflects implementation of current air quality legislation around the world, while the second (MFR) represents a more optimistic case in which all currently feasible technologies are applied to achieve maximum emission reductions. We contrast these scenarios with the more pessimistic IPCC SRES A2 scenario. Ensemble simulations for the year 2000 are consistent among models and show a reasonable agreement with surface ozone, wet deposition, and NO2 satellite observations. Large parts of the world are currently exposed to high ozone concentrations and high deposition of nitrogen to ecosystems. By 2030, global surface ozone is calculated to increase globally by 1.5 +/- 1.2 ppb (CLE) and 4.3 +/- 2.2 ppb (A2), using the ensemble mean model results and associated +/-1 sigma standard deviations. Only the progressive MFR scenario will reduce ozone, by -2.3 +/- 1.1 ppb. Climate change is expected to modify surface ozone by -0.8 +/- 0.6 ppb, with larger decreases over sea than over land. Radiative forcing by ozone increases by 63 +/- 15 and 155 +/- 37 mW m(-2) for CLE and A2, respectively, and decreases by -45 +/- 15 mW m(-2) for MFR. We compute that at present 10.1% of the global natural terrestrial ecosystems are exposed to nitrogen deposition above a critical load of 1 g N m(-2) yr(-1). These percentages increase by 2030 to 15.8% (CLE), 10.5% (MFR), and 25% (A2). This study shows the importance of enforcing current worldwide air quality legislation and the major benefits of going further. Nonattainment of these air quality policy objectives, such as expressed by the SRES-A2 scenario, would further degrade the global atmospheric environment.