Effects of diclofenac on sentinel species and aquatic communities in semi-natural conditions.

Due to the potential hazard of diclofenac on aquatic organisms and the lack of higher-tier ecotoxicological studies, a long-term freshwater mesocosm experiment was set up to study the effects of this substance on primary producers and consumers at environmentally realistic nominal concentrations 0.1, 1 and 10 µg/L (average effective concentrations 0.041, 0.44 and 3.82 µg/L). During the six-month exposure period, the biovolume of two macrophyte species (Nasturtium officinale and Callitriche platycarpa) significantly decreased at the highest treatment level. Subsequently, a decrease in dissolved oxygen levels was observed. High mortality rates, effects on immunity, and high genotoxicity were found for encaged zebra mussels (Dreissena polymorpha) in all treatments. In the highest treatment level, one month after the beginning of the exposure, mortality of adult fish (Gasterosteus aculeatus) caused effects on the final population structure. Total abundance of fish and the percentage of juveniles decreased whereas the percentage of adults increased. This led to an overall shift in the length frequency distribution of the F1 generation compared to the control. Consequently, indirect effects on the community structure of zooplankton and macroinvertebrates were observed in the highest treatment level. The No Observed Effect Concentration (NOEC) value at the individual level was < 0.1 µg/L and 1 µg/L at the population and community levels. Our study showed that in more natural conditions, diclofenac could cause more severe effects compared to those observed in laboratory conditions. The use of our results for regulatory matters is also discussed.

Implementation of protocolized tight control and biological dose optimization in daily clinical practice: results of a pilot study.

OBJECTIVES: To assess the effects of education, guideline development, and individualized treatment advice on rheumatologist adherence to tight control-based treatment and biological dose optimization in rheumatoid arthritis (RA), psoriatic arthritis (PsA), and spondyloarthropathy (SpA) patients. METHOD: This pilot study, among two rheumatologists and two specialized nurses in a general hospital, combined education, feedback, local guideline development, and individualized treatment advice. Outcomes (baseline and 1 year post-intervention) were the percentage of patients with a Disease Activity Score in 28 joints (DAS28) or Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) measured during the visit, mean DAS28/BASDAI, and the percentage of patients using a reduced biological dose. DAS28 outcomes only applied to RA and PsA patients, BASDAI outcomes only applied to SpA patients whereas outcomes on biological dose applied to all patients. RESULTS: A total of 232 patients (67% RA, 15% PsA, 18% SpA; 58% female, mean age 56 ± 15 years) were included in the study. The percentage of DAS28 and BASDAI measurements performed increased after the intervention [DAS28 15-51%, odds ratio (OR) 3.3, 95% confidence interval (CI) 2.1-5.5; BASDAI 23-50%, OR 2.2, 95% CI 1.0-5.5], with mean DAS28 and BASDAI scores remaining similar (DAS28: mean difference 0.1, 95% CI -0.3 to 0.5; BASDAI: mean difference 0.03, 95% CI -1.8 to 1.9). Use of a reduced biological dose increased from 10% to 61% (OR 3.9, 95% CI 2.4-6.5). CONCLUSIONS: A multicomponent intervention strategy aimed at rheumatologists can lead to improved adherence to tight control-based treatment and a reduction in the use of biologicals in RA, SpA, and PsA patients.

[Quality standards for ultrasonographic assessment of peripheral vascular malformations and vascular tumors. Report of the French Society for Vascular Medicine]. / Standards de qualité pour la pratique de l'examen écho-doppler dans l'étude des malformations et tumeurs vasculaires. Rapport de la Société française de médecine vasculaire (SFMV).

THE QUALITY STANDARDS OF THE FRENCH SOCIETY OF VASCULAR MEDICINE FOR THE ULTRASONOGRAPHIC ASSESSMENT OF VASCULAR MALFORMATIONS ARE BASED ON THE TWO FOLLOWING REQUIREMENTS: Technical know-how: mastering the use of ultrasound devices and the method of examination. Medical know-how: ability to adapt the methods and scope of the examination to its clinical indication and purpose, and to rationally analyze and interpret its results. AIMS OF THE QUALITY STANDARDS: To describe an optimal method of examination in relation to the clinical question and hypothesis. To achieve consistent practice, methods, glossary, and reporting. To provide good practice reference points, and promote a high-quality process. ITEMS OF THE QUALITY STANDARDS: The three levels of examination; their clinical indications and goals. The reference standard examination (level 2), its variants according to clinical needs. The minimal content of the examination report; the letter to the referring physician (synthesis, conclusion and proposal for further investigation and/or therapeutic management). Commented glossary (anatomy, hemodynamics, semiology). Technical bases. Settings and use of ultrasound devices. Here, we discuss the methods of using ultrasonography for the assessment of peripheral vascular malformations and tumors.

Interleukin-1beta and interleukin-1 receptor antagonist gene polymorphisms in ankylosing spondylitis.

OBJECTIVE: Since ulcerative colitis and Crohn's disease, which are associated with ankylosing spondylitis (AS), have been found to be variably associated with the IL-1B and the IL-1RN genes encoding interleukin-1beta (IL-1beta) and the interleukin-1 receptor antagonist (IL-1ra), we have investigated whether these polymorphisms in IL-1B and IL-1RN are also involved in AS. METHODS: DNA was isolated from peripheral blood of 106 patients with AS and 104 healthy controls. All patients and controls were Dutch Caucasians. Bi-allelic polymorphisms at positions +3,953 and -511 in the IL-1B gene, and a penta-allelic polymorphism in intron 2 of the IL-1RN gene were studied by polymerase chain reaction-based methods. RESULTS: Allele IL-1RN*2 was significantly increased in AS (odds ratio=1.60; 95% confidence interval=1.20-2.80; P=0.031) compared with healthy controls, and independent from the polymorphism in loci IL-1B-511 and IL-1B+3,953. No significant associations were found between AS and the IL-1B-511 or IL-1B+3,953 polymorphisms. CONCLUSION: Similar to other chronic inflammatory diseases, AS is associated with the IL-1RN*2 allele. Further studies are necessary to determine the biological significance of these findings in relation to susceptibility or severity of the disease.

Examination of lightbulb filaments after a car crash: difficulties in interpreting the results.

A drunk car driver was involved in a fatal crash with a scooter at night. Examination of the lightbulbs from the vehicles revealed some mechanical and analytical incompatibilities. The laboratory's initial observations led to complementary police investigations which finally solved the first incompatibility. The different precautions taken by the technical police investigators on the crime scene finally allowed the forensic scientists to establish the functional state of the lightbulbs during the crash.

Increased risk of developing ankylosing spondylitis among first-born children.

OBJECTIVE: Studies in mice have demonstrated an increased risk of ankylosing enthesopathy in earlier litters compared with later-born offspring. In humans, birth order and maternal age as risk factors for ankylosing spondylitis (AS) have not been investigated previously. This study was undertaken to investigate whether first-born children have a higher risk of AS than later-born children and whether maternal age at delivery is another risk factor. METHODS: The birth order of 162 AS patients was compared with that of their healthy siblings, both for the total group and with stratification for maternal age at first delivery. Maternal age at the time of delivery of AS patients who were first-born children was compared with the mean maternal age at first delivery in the Dutch population. RESULTS: The number of first-born children with AS was significantly higher than would be expected in case of an equal risk between first-born and later-born children (26 versus 20 for families with 2 children [P = 0.029] and 63 versus 47.6 for all families [P = 0.004]). Also, the mean maternal age at first delivery was lower in mothers of AS patients (24.8 years) compared with mothers of healthy controls (26.1 years). CONCLUSION: Low birth order is a risk factor for AS in humans.

Effects of age at the time of unilateral nephrectomy and dietary protein on long-term renal function in rats.

Glomerular filtration rate (GFR) and urinary protein excretion (UpV) were studied in male rats with a uninephrectomy at 3 (UNX-3) or 15 weeks of age (UNX-15) and fed a low (12%, LP), normal (24%, NP) or high (36%, HP) protein diet. Measurements were made every 12 weeks throughout the entire life-span. The UNX rats were compared with sham-operated (2K) rats of the same age and on the same diets. At 12 weeks after surgery, the GFR of UNX rats, corrected for differences in body weight, age and protein intake (GFRcor), ranged between 73% and 77% of that of 2K rats. On the HP and NP diet, UpV was higher in UNX-3 than in UNX-15 rats. On the LP diet, UpV was equally low in both groups. Long-term follow-up indicated that the GFR of UNX rats on the HP diet started to decline first, followed by those on an NP diet, while those on an LP diet had the longest period of stable GFR. For UNX rats, the time to reach a GFRcor of 50% was used as an indicator of the length of renal survival. Analysis of variance of the renal survival times indicated a highly significant interaction between the protein diet and age at the time of UNX. On the HP diet, UNX-3 rats have a shorter renal survival time than UNX-15, while on the LP diet UNX-3 rats have a longer renal survival time. This indicates that the long-term outcome of UNX at young age depends on the protein intake.(ABSTRACT TRUNCATED AT 250 WORDS)

Renal function up to 50 years after unilateral nephrectomy in childhood.

Removal of one kidney during childhood differs from removal of a kidney from an adult as the child's future depends on an adequate function of the remaining kidney during a longer period of time. We assessed the long-term effect of unilateral nephrectomy in childhood on renal function, protein excretion, and blood pressure. Data were obtained from 111 subjects undergoing uninephrectomy for unilateral renal disease before the age of 16 years who had no evidence of renal abnormalities in the contralateral kidney at the time of surgery. At investigation the patients were 18 to 56 years of age with an interval of up to 52 years after uninephrectomy. On average, renal function was well maintained at approximately 75% of the reported normal two-kidney value. Blood pressure in men was higher than in women. Stratification for age showed no statistically significant differences between those undergoing uninephrectomy before or after the age of 4.5 years. Stratification for post-uninephrectomy interval revealed renal function to be lower and blood pressure, urinary albumin excretion, and protein excretion to be higher in those with an interval of more than 25 years. In men over 30 years of age, linear regression analysis indicated a decrease in glomerular filtration rate, effective renal plasma flow, and creatinine clearance, and an increase in blood pressure and albumin excretion with time. Controlled longitudinal studies are needed to detect true changes and to ascertain whether such changes are different from the age-related changes seen in individuals with two kidneys.(ABSTRACT TRUNCATED AT 250 WORDS)

Inversio uteri puerperalis.

Uterine inversion is a rare condition that occurs in various degrees. Predisposing and etiologic factors are discussed, as are therapy and prophylaxis. These points are illustrated by 4 own cases and by 172 cases collected from literature.

[Diagnostic criteria in rheumatic pelvispondylitis without radiological sacro-iliac signs. Proposals for updating]. / Critères de diagnostic de la pelvispondylite rhumatismale sans atteinte radiologique des sacro-iliaques. Propositions de mise à jour.

The authors propose a limited number of changes and additions to criteria for diagnosing spondylitis without the radiological sacro-iliac signs established by Sèze and Lequesne in 1961, taking into account the evolution of the diagnostic means that have appeared since this date, especially the attempt to locate HLA 27 leucocyte antigen, now a common practice. The application of these revised criteria in 75 cases, including 41 with certain or probable spondylitis, appeared satisfactory.