Graph theory for automatic structural recognition in molecular dynamics simulations.

Graph theory algorithms have been proposed in order to identify, follow in time, and statistically analyze the changes in conformations that occur along molecular dynamics (MD) simulations. The atomistic granularity level of the MD simulations is maintained within the graph theoric algorithms proposed here, isomorphism is a key component together with keeping the chemical nature of the atoms. Isomorphism is used to recognize conformations and construct the graphs of transitions, and the reduction in complexity of the isomorphism has been achieved by the introduction of "orbits" and "reference snapshots." The proposed algorithms are applied to MD trajectories of gas phase molecules and clusters as well as condensed matter. The changes in conformations followed over time are hydrogen bond(s), proton transfer(s), coordination number(s), covalent bond(s), multiple fragmentation(s), and H-bonded membered rings. The algorithms provide an automatic analysis of multiple trajectories in parallel, and can be applied to ab initio and classical MD trajectories alike, and to more coarse grain representations.

Advanced DNA- and Protein-based Methods for the Detection and Investigation of Food Allergens.

Currently, food allergies are an important health concern worldwide. The presence of undeclared allergenic ingredients or the presence of traces of allergens due to contamination during food processing poses a great health risk to sensitized individuals. Therefore, reliable analytical methods are required to detect and identify allergenic ingredients in food products. The present review addresses the recent developments regarding the application of DNA- and protein-based methods for the detection of allergenic ingredients in foods. The fitness-for-purpose of reviewed methodology will be discussed, and future trends will be highlighted. Special attention will be given to the evaluation of the potential of newly developed and promising technologies that can improve the detection and identification of allergenic ingredients in foods, such as the use of biosensors and/or nanomaterials to improve detection limits, specificity, ease of use, or to reduce the time of analysis. Such rapid food allergen test methods are required to facilitate the reliable detection of allergenic ingredients by control laboratories, to give the food industry the means to easily determine whether its product has been subjected to cross-contamination and, simultaneously, to identify how and when this cross-contamination occurred.

The effect of fatigue on climbing fluidity and hand movements.

In rock climbing, climbers use their arms to regulate their posture on the wall, which can lead to localised muscle fatigue. Evidence shows fatigue is the primary cause of falls, but little is known about how fatigue specifically affects climbing rhythm and hand movements. The present study examined climbing fluidity and hand movements on an indoor climbing wall before and after a specific fatiguing protocol. Seventeen climbers completed three repetitions of a challenging climbing route (21 on Ewbank scale) with different levels of localised arm fatigue. Climbers' movements were tracked using 3D motion capture, and their hand actions assessed using notational analysis. Seventy markers were used to create 15 rigid body segments and the participants' centre of mass. The global entropy index was calculated on the path of the participants' centre of mass. Climbers fell more often when fatigued, but there were no significant differences in hip jerk or global entropy index when fatigued. No significant differences were found between the number of exploratory or performatory hand movements with different amounts of fatigue. The results suggest that localised arm fatigue affects a climber's ability to prevent themselves from falling, but it does not specifically affect their fluidity.

Evaluation of a new training program to reassure primary school teachers about glucagon injection in children with type 1 diabetes during the 2017-2018 school year.

INTRODUCTION: The prevalence of type 1 diabetes (T1D) in children is increasing. Adequate knowledge and skills of primary school staff are required to deal with children affected by T1D. We aimed to evaluate a video training program (VTP) to improve the level of confidence of teachers in administering intramuscular glucagon injection during severe hypoglycemia. The secondary goal was to improve the teachers' theoretical knowledge. MATERIAL AND METHODS: In this interventional study, we submitted a VTP to all primary school teachers in the French region of Normandy who received a child with T1D during the 2017-2018 school year. The VTP began with a questionnaire focused on their confidence in performing T1D-related actions and on their theoretical knowledge. Next, we offered a 10-min video covering the main issues of T1D, which could be watched freely for a fortnight. The questionnaire was subsequently resubmitted. The level of confidence was assessed on a scale of 1 to 4. Knowledge was assessed as a score out of 20. Before-after comparisons were made using the Wilcoxon signed-rank test. Determinants of a good level of confidence and knowledge before VTP were assessed in the first questionnaires using multivariate analysis. RESULTS: Of 221 eligible teachers, 157 (71%) answered the first questionnaire and 77 (34.8%) answered both. The VTP significantly improved the teachers' confidence to administer a glucagon injection (+0.36 points, P<0.001). Their theoretical knowledge was also significantly improved (+1.5 points, P<0.001). CONCLUSIONS: We propose an original practical VTP that could be useful to improve teachers' T1D-related self-confidence in their skills and knowledge.

Comparison of breathing tube connectors during invasive bronchial procedures.

Bronchoscopy and bronchial suctioning during intra-operative artificial ventilation often causes leakage from the ventilation circuit with a decrease in ventilatory parameters and possible workplace contamination with anaesthetic gases. Different connectors have been developed to reduce gas leakage. We evaluated the following connectors : VBM 2 mm, 3 mm and 5 mm, Bodai Suction-Safe, Bodai Bronch-Safe and Bodai Trach-Safe, as well as the BE 105-7, BE 105-8 and SH 7-45. Invasive bronchial instruments (catheters, bronchoscopes and bronchial blockers) with 1.67-7.33 mm diameter were used. Pressure-controlled ventilation was performed on a test lung using a ventilator. Sevoflurane concentration in the room was measured 0.2 and 1.5 m from the connector using a photo-acoustic infrared-spectroscope. The VBM connectors caused the least gas leak and ensured stability of ventilation parameters even at peak pressures when combined with smaller instruments. With instruments > 6 mm, BE 105-7, BE 105-8 and SH 7-45 connectors performed best. The Bodai connectors showed a reduced ability to prevent leakage and to keep ventilatory parameters stable. All connectors, excluding the Bodai Trach-Safe, prevented exposure to anaesthetic gases beyond the current safety recommendations when combined with the fitting instruments. The connectors showed different ranges of tightness, equivalent to different ranges of compatibility with the instruments used.

Estimating impacts on developing countries of the decrease in U.S. training opportunities for foreign medical graduates.

Between 1973 and 1983, the number of foreign nationals from developing nations who entered the United States for graduate medical education decreased by approximately 90%. Many of those who would have studied in the United States if this decrease had not occurred would have returned home to serve their countries. To estimate the impact of this loss, a survey was conducted in six major cities in Latin America between 1983 and 1989. Selected local medical students interviewed 554 physicians who had returned home after U.S. training and 60 of their classmates who had not trained there. The findings indicate that the returned physicians had given approximately twice as much time to teaching, research, and medical administration as did those who had not left home. The authors maintain that this and related findings show how the curtailment of opportunities for training foreign nationals in the United States is detrimental to both the aspirations of developing nations and the influence of the United States in world affairs.

Volume delineation by fusion of fuzzy sets obtained from multiplanar tomographic images.

Techniques of three-dimensional (3-D) volume delineation from tomographic medical imaging are usually based on 2-D contour definition. For a given structure, several different contours can be obtained depending on the segmentation method used or the user's choice. The goal of this work is to develop a new method that reduces the inaccuracies generally observed. A minimum volume that is certain to be included in the volume concerned (membership degree mu = 1), and a maximum volume outside which no part of the volume is expected to be found (membership degree mu = 0), are defined semi-automatically. The intermediate fuzziness region (0 < mu < 1) is processed using the theory of possibility. The resulting fuzzy volume is obtained after data fusion from multiplanar slices. The influence of the contrast-to-noise ratio was tested on simulated images. The influence of slice thickness as well as the accuracy of the method were studied on phantoms. The absolute volume error was less than 2% for phantom volumes of 2-8 cm3, whereas the values obtained with conventional methods were much larger than the actual volumes. Clinical experiments were conducted, and the fuzzy logic method gave a volume lower than that obtained with the conventional method. Our fuzzy logic method allows volumes to be determined with better accuracy and reproducibility.

Clinical and morphological recovery between two episodes of acute glomerulonephritis: a light and electron microscopic study with immunofluorescence.

A 4 year-old girl presented with 2 episodes of acute glomerulonephritis with clinical and morphological recovery between them. Both episodes were preceded by impetigo. The first and third renal biopsies showed glomerulitis with diffuse dense deposits in the mesangium, segmentary intramembranous dense deposits, atypical "humps" and granular C3. The second biopsy, taken between episodes, was considered to be normal. Two years and 5 months after the second episode the clinical evaluation and laboratory tests were normal.

Acute glomerulonephritis in children. An evolutive morphologic and immunologic study of the glomerular inflammation.

This study deals with 80 children showing a clinically typical acute nephritic syndrome with proteinuria and/or hematuria, edema, and hypertension. Their ages ranged between 2 years 5 months and 16 years; 36 cases were female. In 73 cases a streptococcal infection was demonstrated; the remaining 7 cases did not show morphologic differences with the former. No previous renal disease nor familial history of nephropathies were elicited. In every case a renal biopsy was obtained in the first 60 days of clinical disease; in 46 cases a second renal biopsy was obtained sometime between 6 and 45 months since the beginning of the disease. In 3 cases the renal tissue was considered to be normal by light microscopy, immunofluorescence and electron microscopy in both the first and second biopsies. These 3 patients were not considered as cases of morphologic acute glomerulonephritis in spite of showing a typical clinical picture and they are not included in the evaluation of the glomerular inflammatory evolution. In all the remaining 77 cases C3 granular and segmentary intramembranous and mesangial dense deposits were found in the first biopsy. The second biopsy showed morphologic and immunologic normalization in 27% of the cases, slight lesions in 56% and an increase in severity in 17% of the cases.

Amyloidosis secondary to gout. Identification with a monoclonal antibody to amyloid protein A.

A patient with amyloidosis secondary to polyarticular gout is presented in whom amyloid protein A (AA) was demonstrated in the kidney with a monoclonal antibody against protein A. The rarity of this association is discussed and a pathogenetic mechanism proposed.

[Determination of target volume for dosimetric planning in stereotactic radiosurgery]. / Détermination de volumes cibles pour la planification dosimétrique en radiochirurgie stéréotaxique.

Stereotactic radiosurgery needs an accurate determination of the target volumes to be irradiated and of sensitive volumes to be spared: position, external boundaries, internal volume. These parameters can be obtained by using either projection imaging (radiographs, digital angiography), or tomographic imaging (magnetic resonance imaging, computerized tomography). The authors describe the methods used in these different imaging modalities and the problems encountered in target determination. Methods of validations are described. Results obtained on phantoms and on actual target volume are given and discussed.

[Acute renal insufficiency secondary to ureteral obstruction]. / Insuficiencia renal aguda secundaria a obstrucción ureteral.

Acute renal insufficiency due to ureteral obstruction is relatively uncommon and gives rise to difficulties of diagnosis and treatment. The series presented here analyzes these aspects in 24 patients who had 27 episodes of proven anuria due to ureteral obstruction. Their average age was 62. Six patients had only one kidney (25%). The most common etiology was cancer (two thirds of the cases), mainly of genitourinary origin (10/16). Calcium or uric acid urethral lithiasis was the main cause of obstruction in the benign group. Treatment corresponded to a wide range of obstruction removal procedures depending on the etiology, but in the secondary to cancer it was very aggressive and the most used was nephrostomy. The decision to perform any treatment of obstructive anuria in patients with cancer should take into account a variety of important aspects amongst which prevail the prognosis of the basal illness, the handling of cancerous pain, the complications and mortality associated with the procedure and the patient's prospects.

Espondilodiscitis causada por Kingella kingae en pediatría: reporte de un caso / Espondilodiskitis caused by Kingella kingae in children: a case report

During the last years, spondilodiskitis due to Kingella kingae has been a new target of interest, since it is the second agent that causes non tuberculous espondilodiskitis in children, after Staphylococcus aureus. Its clinical presentation is very inespecific, sometimes with fever, abdominal or lumbar disconfort, nocturnal pain, altered walking and sedestation. Images, culture methods and PCR (polymerase chain reaction) can be helpful for diagnosis, although in an important percent of the cases, etiology cannot be determined. Although there are no established guidelines for treatment, before the suspicion, empiric antibiotic treatment should be started for good prognosis. We describe a case of a 3 year old boy, who had this disease and then a review about spondilodiskitis in childhood and microbiological aspects of Kingella kingae.

La espondilodiscitis por Kingella kingae ha sido blanco de mayor interés en los últimos años, dado que constituye el segundo agente etiológico, luego de Staphylococcus aureus en espondilodiscitis no tuberculosa en niños. Clínicamente presenta sintomatología inespecífica, a veces acompañada de fiebre y de molestias abdominales o lumbares, con dolor de predominio nocturno y con alteraciones en la marcha y en la sedestación. El diagnóstico se puede ayudar con imágenes y métodos de cultivo o RPC (reacción polimerasa en cadena), aunque en un gran porcentaje de los casos no se logra determinar la etiología. Sin embargo, pese a que no exista un protocolo establecido para el tratamiento, ante la sospecha se debe iniciar tratamiento empírico, con buen pronóstico. Describimos un caso de un paciente de tres años que cursó con esta patología y posteriormente se expone una revisión sobre espondilodiscitis en la infancia y los aspectos microbiológicos de K. kingae.

[The teaching hospital]. / El hospital docente.

The teaching hospital is essential for Medical schools. Careful selection of students and a faculty with a commitment of teaching are very important. Development of a critical attitude and care for ethical principles should always be present. The acquisition of high technology should be considered a means for academic development rather than a purpose in itself. A national accreditation process is an important step towards achieving these goals in all teaching centers. A stronger cooperation between universities and national health authorities is urgently needed to avoid deviations in postgraduate training that are observed today.

[The experience of 15 years in the accreditation of training centers for medical specialists]. / La experiencia de quince años en la acreditación de centros formadores de especialistas médicos.

The National Committee of the Association of Medical Schools for the Accreditation of Medical Centers to train specialists is active since 1979. At the present time, 1547 postgraduate medical students are engaged in training programs lasting 2 to 3 years. During the period in which the Committee has operated, 591 centers were assessed. Sixty percent were approved but the deficient academic or technical facilities for clinical practice or teaching motivated the rejection of 14%. During these years, several problems were detected such as the support given by the authorities of medical schools to accreditation, the instability and shortage of teaching faculty, the persistence of training programs in rejected centers, the excessive number of students for the capacity of the teaching center, the faulty integration between Medical Schools and the National Health Service and the increasing competition of scientific societies and private health institutions with medical schools in teaching activities. These issues must be appraised both at medical schools and the National Health Services.

[The training of specialists. The case of nephrologists]. / La formación de especialistas médicos. El caso de los nefrólogos.

Specialists must be trained in properly certified university centers. There are established applicant selection programs and mechanisms and faculties maintain a favorable learning environment. The careful selection of teachers must be based in their personal attributes, their interest and dedication to academic work and their real concern about ethical issues. The center's technological equipment, as a means to favor the action of future specialists, is considered important. Several critical aspects of the training centers that, at the present time threaten post graduate training, are mentioned. The teaching activities of scientific societies and private and public health organisms should concentrate around training centers to reinforce their academic work, favoring their scientific and practicing activities. The interests of faculties and Ministry of Health medical centers should be made compatible for their own benefit. Medical specialties are closely interrelated. Therefore, the boundaries of nephrology should be established to define a training program. A common environment for pediatric and adult nephrology should be created, training centers should be accredited and specialists should be certified using common criteria. Our country has a deficit of nephrologists and scientific societies should encourage cooperative actions between the different training centers.

[Accreditation of training centers for medical specialists]. / La acreditacion de los centros formadores de especialistas medicos.

A National Committee from the Association of Medical Faculties has conducted a process of accreditation of training centers for specialists. Over a period of 13 years, 483 centers have been reviewed. Rejection of accreditation has been based on inadequate Faculty staff, or insufficient technical support for practice and teaching. Maximal number of trainees for each program are defined according to the available facilities. The Committee makes a strong recommendation to keep training programs under direct tuition from Medical Schools, especially faced with the interest of other medical care institutions in developing in service training. Also, a recommendation is put forward to organize cooperative programs among different Medical Schools and to give special emphasis to training programs for specialists in short supply.

[Certification of specialists and their training outside the university]. / La certificación de especialistas y su formación fuera del marco universitario.

A better appraisal of the training of medical specialists has been possible since the establishment of the National Certification Board in 1984. Participation of training centers outside the university environment has been considerable. Thus, after certification of the first 4500 medical specialists, it was noted that 7.5 of all applicants and 25% of those applying for official programs have received training in one or more of 137 extra-university programs. The quality and contents of these programs is variable. Their emergence is an inevitable fact derived from shortage of training centers in university teaching hospitals. Some control of these training programs is required to ascertain minimal standards of quality.

Selectivity of silymarin on the increase of the glutathione content in different tissues of the rat.

Silymarin, a flavonoid extracted from the seeds of the milk thistle, Silybum marianum, increases the redox state and the total glutathione content of the liver, intestine, and stomach of the rat. The same treatment does not affect the levels of the tripeptides in the kidney, lung, and spleen. This selective effect of the flavonoid on the digestive organs is ascribed to its pharmacokinetics on the digestive track, where the biliary concentration of silymarin is increased and maintained via the entero-hepatic circulation.