[Monkeypox]. / Variole du singe.

Monkeypox (MPX), is a rare endemic zoonotic disease of certain areas of Central and West Africa. Nevertheless, in recent years, several outbreaks have occurred outside the African continent. Monkeypox usually presents with a flu-like prodromal period (fever, headache, chills, sweating) associated or followed by the appearance of lymphadenopathy and a typical skin rash. Transmission is suspected to be direct or indirect via contact with saliva, respiratory droplets or skin lesions of infected animals or more rarely of humans. The gold standard for diagnosis is the detection of MPX virus (MPXV) by PCR on skin lesion fluid. The evolution is usually favourable in 2 to 5 weeks but severe complications and sequelae are possible. In the absence of a specific treatment, the management is essentially supportive: appropriate local care, rehydration, analgesia and management of eventual complications.

La variole du singe (monkeypox, MPX), ou orthopoxvirose simienne, est une zoonose rare et endémique de certains pays d'Afrique Centrale et de l'Ouest. Néanmoins, ces dernières années, plusieurs épidémies sont survenues en dehors du continent africain. La MPX se manifeste, habituellement, par un prodrome pseudogrippal (fièvre, céphalées, frissons, sudations), associé ou suivi par l'apparition d'une lymphadénopathie et d'un rash typique. La transmission serait directe ou indirecte, via contact avec la salive, les gouttelettes respiratoires ou les lésions cutanées d'animaux ou, plus rarement, d'humains contaminés. Le gold standard du diagnostic est la mise en évidence du virus monkeypox (MPXV) par «polymerase chain reaction¼ (PCR) sur lésion cutanée. L'évolution est habituellement favorable en 2 à 5 semaines, mais des complications et des séquelles sévères sont possibles. En l'absence d'un traitement spécifique, le traitement de soutien comporte: soins locaux adaptés, réhydratation, antalgie et prise en charge des éventuelles complications.

A higher-than-predicted measurement of iron opacity at solar interior temperatures.

Nearly a century ago it was recognized that radiation absorption by stellar matter controls the internal temperature profiles within stars. Laboratory opacity measurements, however, have never been performed at stellar interior conditions, introducing uncertainties in stellar models. A particular problem arose when refined photosphere spectral analysis led to reductions of 30-50 per cent in the inferred amounts of carbon, nitrogen and oxygen in the Sun. Standard solar models using the revised element abundances disagree with helioseismic observations that determine the internal solar structure using acoustic oscillations. This could be resolved if the true mean opacity for the solar interior matter were roughly 15 per cent higher than predicted, because increased opacity compensates for the decreased element abundances. Iron accounts for a quarter of the total opacity at the solar radiation/convection zone boundary. Here we report measurements of wavelength-resolved iron opacity at electron temperatures of 1.9-2.3 million kelvin and electron densities of (0.7-4.0) × 10(22) per cubic centimetre, conditions very similar to those in the solar region that affects the discrepancy the most: the radiation/convection zone boundary. The measured wavelength-dependent opacity is 30-400 per cent higher than predicted. This represents roughly half the change in the mean opacity needed to resolve the solar discrepancy, even though iron is only one of many elements that contribute to opacity.

Systematic Study of L-Shell Opacity at Stellar Interior Temperatures.

The first systematic study of opacity dependence on atomic number at stellar interior temperatures is used to evaluate discrepancies between measured and modeled iron opacity [J. E. Bailey et al., Nature (London) 517, 56 (2015)NATUAS0028-083610.1038/nature14048]. High-temperature (>180 eV) chromium and nickel opacities are measured with ±6%-10% uncertainty, using the same methods employed in the previous iron experiments. The 10%-20% experiment reproducibility demonstrates experiment reliability. The overall model-data disagreements are smaller than for iron. However, the systematic study reveals shortcomings in models for density effects, excited states, and open L-shell configurations. The 30%-45% underestimate in the modeled quasicontinuum opacity at short wavelengths was observed only from iron and only at temperature above 180 eV. Thus, either opacity theories are missing physics that has nonmonotonic dependence on the number of bound electrons or there is an experimental flaw unique to the iron measurement at temperatures above 180 eV.

Cost Effectiveness Analysis of Knee Osteoarthritis Treatment.

INTRODUCTION: Resource allocation is challenging in times of economic restraint and cannot be based only on clinical judgments, but must also take into account economic aspects. A method for assessing patient outcome is to estimate the quality-adjusted life years (QALYs). These will quantify the benefit gained by a certain treatment by measuring the change in health-related quality of life with time. This study will assess the cost effectiveness of conservative management, consisting in rehabilitation program, and compare the cost effectiveness of total knee arthroplasty when implanted to a non operated arthritic knee with cost effectiveness of the same procedure following high tibial osteotomy. MATERIALS AND METHODS: This study reviewed 30 patients who were treated for knee osteoarthritis with rehabilitation care (group 1-G1), 30 patients who underwent unilateral TKA to an non-operated knee (group 2-G2) and 30 patients who underwent TKA following HTO for degenerative arthritis of the knee (group 3-G3). The economical endpoint were the total direct costs (Euro), based on DRG rates for procedures. The cost effectiveness analysis was assessed by the ratio between direct costs as assessed by the economical endpoint and the associated patient benefit as assessed by the clinical endpoint (EUR/QALY). RESULTS: No statistically significant differences was found between G2 and G3 regarding clinical or radiological outcomes of this study. Yet the patients who did not previously suffered a HTO procedure showed lower mean values of KSS, ROM and femurotibial angle. A significant benefit is observed for G2 and G3 towards G1 patients. Neither a clinically relevant nor a statistically significant association between groups is observed in G2 and G3 (median benefit estimates 2.5 versus 2.6 QALYs). Median benefit estimate for patients who did not previously suffered a HTO procedure was though smaller then benefit for those who did. A median cost effectiveness ratio of 1800 EUR/QALY (450 - 2000 EUR / QALY) was found based on the EuroQuol scores for G1; 1268 EUR/QALY (720 - 2160 EUR/QALY), for G2, and 1975 EUR/QALY (720 - 2160 EUR/QALY) for G3. DISCUSSION: Regarding surgical treatment, the results showed a statistically significant better cost benefit relation for patients from G2 (p 0,001). Conservative management for knee OA is neither clinically effective for pain or disease progression nor cost effective, when applied for late stages of OA. CONCLUSION: We report the lowest cost per QALY in the literature for TKA. If financial constraints is a cause for rationalizing the medical services, careful patient selection to optimise the clinical and economical aspects of procedures may help to improve further the cost-effectiveness of these interventions.

Comparative study of design and PCL-substituting systems of total knee prosthesis.

UNLABELLED: The aim of this study is to assess postoperative results obtained by different knee implants. The main implant types differences are given by generally implant design and by PCL substituting systems that are used. MATERIAL AND METHOD: Between 04.2004 - 02.2012 we have performed 506 total knee arthroplasties (TKA), on a group of 460 patients. Our choice, was for cemented total knee prostheses, using PCL-substituting systems. Regarding general design and PCL-substituting systems of the implant we had divided the main group in three lots. In order to assess post operative result we had used the American Knee Society Score(AKSS). RESULTS AND DISCUSSIONS: All prostheses types that we had implanted, had registered satisfactory values of AKSS. Our study showed that one group scored higher values of AKSS, compared the other two, but there are not statistical semnificative differences (p=0,09).

Management of hepatocellular carcinoma -- experience of a single center.

BACKGROUND AND AIMS: Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide and the third most common cause of cancer-related death. We aim to study the diagnosis and treatment options for HCC. METHODS: We used standard methods of diagnosis for HCC:radiology, determining serum alpha fetoprotein (AFP). We included 190 patients diagnosed with HCC between April 2011 and May 2012. RESULTS: All patients were classified and treated according to the BCLC staging. Our study included 43 patients with early stage HCC, 58 patients with intermediate stage HCC (Stage B) and 89 patients with advanced stage HCC (Stage C). Most patients in the early stage underwent local ablation, while TACE was preferred in 46 patients in the intermediate stage.Systemic therapy was the most frequent treatment for patients in the advanced stage (48 patients), followed by Sorafenib (16 patients). 21 patients with end-stage disease did not receive treatment. Survival rates depended on the HCC stage: 2 - 18 months in the intermediate stage and 1 - 12 months in the advanced stage. CONCLUSION: Early diagnosis of HCC is essential in improving the patients outcomes, as there are several classic therapeutic options and new emerging ones addressing patients with early stage disease.

A rare case of ileal metastasis from cervical cancer.

We present the case of a 70-year-old woman, with a history of radiation-treated and surgically- resected cervical cancer, who was admitted to our clinic for intermittent sub occlusive symptoms. CT scan revealed a liver nodule and intestinal obstruction. The patient underwent surgery for excision of suspected liver metastasis and resolution of intestinal obstruction.Intraoperatively an ileal tumour was found to be the cause of the obstruction. Anatomo-pathological findings were consistent with an ileal metastasis from the cervical cancer.The liver nodule was only an area of focal steatosis.

The importance of early diagnosis of sepsis in severe burned patients: outcomes of 100 patients.

BACKGROUND/AIM: The burn-injured patient has a major potential to develop an infection because the wound itself, surgical treatment, mechanical ventilation and blood transfusions may potentially lead to a secondary immunodeficiency syndrome. PATIENTS AND METHODS: A total number of 100 consecutive burn-injured patients with sepsis were treated in the Clinical Emergency Hospital of Plastic Surgery and Burns, Bucharest,between 2009 and 2011. Their clinical and bioumoral data were analyzed. RESULTS: Flame was the main cause of burn injuries in the present series (78%). The mean body surface area burn wound was 49.7%. Most of the patients (97%) experienced the first septic episode within two weeks after burn injury.Sepsis was mainly due to Gram-positive (58%) and Gramnegative(26%) bacteria. Staphylococcus aureus (32%) and Pseudomonas aeruginosa (21%) were the most frequently encountered germs. The susceptibility for Gram-positive bacteria was the best for imipenem/cilastatin, followed byamikacin, ceftriaxone and ciprofloxacin. For Gram-negative bacteria, the susceptibility decreased from ciprofloxacin to imipenem/ cilastatin, amikacin and gentamicin. Mortality rate was 9%. CONCLUSIONS: The extensive knowledge of physiopathology,clinics, epidemiology, bioumoral and microbiology features of the sepsis in burn-injured patients allows an early and precise diagnosis and an adequate and efficient treatment.All these elements have been associated with a significant improvement of the survival rates. Every patient with burn injured sepsis must be treated as a different entity in order to obtain the best results.

Stress distribution on a valgus knee prosthetic inclined interline -- a finite element analysis.

Total knee arthroplasty following valgus deformity is a challenging procedure due to the unique set of problems that must be addressed. The aim of this study is to determine, with a finite element analysis, the load distribution for an inclined valgus prosthetic balanced knee and to compare these results with those of a prosthetic balanced knee with an uninclined interline. Computational simulations, using finite element analysis, focused on a comparision between load intensity and distribution for these situations. We studied valgus inclination at 3 and 8 degrees. We noticed that for an inclination of 3 degrees, the forces are distributed almost symmetrically on both condyles, similar to the distribution of forces in the uninclined interline case. The maximum contact pressure is greater, increasing from 15 MPa to 19.3 MPa (28%). At 8 degrees of inclination, the contact patch moved anterolateraly on the tibia, meaning that the tibial condyles will be unequally loaded. The maximum contact pressure increases to 25 MPa (66%). These greater forces could lead to polyethylene wear and collapse. Additional tibial resection could be a useful method for balancing in severe valgus knee, when valgus inlination does not exceed 3 degrees.

The influence of total knee arthroplasty on postural control.

INTRODUCTION: The aim of this study is to assess the changes induced by the unilateral total knee arthroplasty procedure in human postural control. MATERIALS AND METHODS: The measurements were performed using the "AMTI AccuGait" force plate. Subjects completed three consecutive double-limb standing balance trials. The mediolateral and anteroposterior displacements were derived from the force and moment profiles measured by the force platform. The path length per unit time (average velocity) and Elipse 95 (collect 95% of data) were also assessed. RESULTS: Mediolateral displacement increase of 3.4% was observed postoperatively. Postoperative anterolateral displacement increase of 23.2% was recorded. The average velocity also rose by 16.8% postoperatively. The Elipse 95 grew by 33.7%postoperatively. DISCUSSION: Excepting mediolateral displacement, all the other studied parameters showed significantly (p 0.05) higher values in the postoperative period compared with the preoperative one, in both open and closed eye trials. CONCLUSIONS: The study results demonstrate that balance control is weaker shortly after unilateral knee arthroplasty,than in the preoperative period. Although proprioception is altered in osteoarthritic knees, the TKA procedure may additionally affect proprioceptors. The TKA causes additional instability in the days after the procedure, therefore the risk of falling injuries is higher in this period.

Multiple endocrine neoplasia type 2A: case report.

Multiple endocrine neoplasia type 2A (MEN 2A) is a complex autosomal dominant inherited syndrome characterized by medullary thyroid carcinoma (MTC), pheochromocytoma and primary parathyroid hyperplasia. In patients with only one or two clinical features, identification of a germline RET(REarranged in Transfection) mutation or the identification of the clinical features of MEN 2A in other first degree relatives is required to make the diagnosis. We present the case of a family with MEN 2A syndrome confirmed by genetic analysis which identified RET gene mutation in 634 codon in father - DV - aged 48 years and also in daughter DM -aged 20 years. The specific feature in this case is that the index case was the daughter (diagnosed and operated for pheochromocytoma at the age of 19 years), the father being diagnosed later with medullary thyroid carcinoma by mutational screening in all family members. This family supports the phenomenon of anticipation, in which severity increases and the age of onset decreases in successive generations, the syndrome being discovered earlier and with a worse prognostic in the daughter.

Diagnostic criteria for sepsis in burn patients.

Sepsis with multiple-organ dysfunction represents the major cause of death in severe burns patients. Adequate and rapid treatments presume an accurate and prompt diagnosis. Specific criteria for sepsis diagnosis were proposed and introduction in clinical practice of the Surviving Sepsis Campaign has been associated with an improvement in sepsis management and decreased mortality. Hereby, the specific criteria for sepsis diagnosis adapted for burns patients are discussed.

Arthroplasty risk after kidney or liver transplant.

In recent years the rate of kidney or liver transplantation has increased considerably, with an increasing rate of immunosuppressant medication for secondary bone disorders. As the rate of organ transplantation increases, the greater predisposition of these patients to hip or knee arthroplasty is noticed. Although arthroplasty is safe in the general population, its safety in liver transplant recipients is unclear. The purpose of this study is to evaluate safety and durability of hip or knee arthroplasties in liver or kidney transplanted patients. Our study included 5 hip and knee arthroplasties performed in transplanted liver and kidney. All patients underwent immunosuppressive therapy. All cases were submitted to postoperative antibiotic therapy and in the case of cemented implants, antibiotic impregnated cement was used. There were no major short-term or long-term complications. We noticed no case of postoperative sepsis, and implant durability has not been affected by the directly transplant related causes. In conclusion arthroplasty for patients with kidney or liver transplant has a positive impact on their quality of life, being a safe and successful procedure with minimum perioperative safeguards.

6 years follow-up of hip revision surgery.

Revision total hip arthroplasty often presents surgeons with difficult bone loss problems. The purpose of this study was to evaluate the results of hip revision surgery according to bone stock We evaluated, in a retrospective study, 148 hip revision surgeries during 2004 to 2010. The Harris Hip Score (HHS), the acetabular cementation, the AAOS classification, the SOFCOT 99 bone loss grading and Barrack classification were used for clinical and radiological assessment. It can be observed significant improvement of HHS from a mean value of 45 preoperatively to 77.2 points postoperatively. Grade B acetabular cementation was observed in a significantly higher rate for situations that needed acetabular allograft reconstruction and where it cannot be performed because of allografts lack. Barrack grades C and D cementation were associated with 70% of SOFCOT 99 stage III and IV cases and only 5% of SOFCOT 99 stage 0-II cases.Using bone graft seems to be a reliable solution for restoring bone stock and stabilizing the cup in revision total hip arthroplasty with type II-IV acetabular defect according to the AAOS classification. Because SOFCOT 99 stages III-IV are often associated with poor cementation we prefer using uncemented distally fixed with screws revision stems for these cases.

Effects of naltrexone are influenced by childhood adversity during negative emotional processing in addiction recovery.

Naltrexone is an opioid receptor antagonist used in the management of alcohol dependence. Although the endogenous opioid system has been implicated in emotion regulation, the effects of mu-opioid receptor blockade on brain systems underlying negative emotional processing are not clear in addiction. Individuals meeting criteria for alcohol dependence alone (n=18, alcohol) and in combination with cocaine and/or opioid dependence (n=21, alcohol/drugs) and healthy individuals without a history of alcohol or drug dependence (n=21) were recruited. Participants were alcohol and drug abstinent before entered into this double-blind, placebo-controlled, randomized, crossover study. Functional magnetic resonance imaging was used to investigate brain response while viewing aversive and neutral images relative to baseline on 50 mg of naltrexone and placebo. We found that naltrexone modulated task-related activation in the medial prefrontal cortex and functional connectivity between the anterior cingulate cortex and the hippocampus as a function of childhood adversity (for aversive versus neutral images) in all groups. Furthermore, there was a group-by-treatment-by-condition interaction in the right amygdala, which was mainly driven by a normalization of response for aversive relative to neutral images under naltrexone in the alcohol/drugs group. We conclude that early childhood adversity is one environmental factor that influences pharmacological response to naltrexone. Pharmacotherapy with naltrexone may also have some ameliorative effects on negative emotional processing in combined alcohol and drug dependence, possibly due to alterations in endogenous opioid transmission or the kappa-opioid receptor antagonist actions of naltrexone.

A novel femtosecond-gated, high-resolution, frequency-shifted shearing interferometry technique for probing pre-plasma expansion in ultra-intense laser experiments.

Ultra-intense laser-matter interaction experiments (>10(18) W/cm(2)) with dense targets are highly sensitive to the effect of laser "noise" (in the form of pre-pulses) preceding the main ultra-intense pulse. These system-dependent pre-pulses in the nanosecond and/or picosecond regimes are often intense enough to modify the target significantly by ionizing and forming a plasma layer in front of the target before the arrival of the main pulse. Time resolved interferometry offers a robust way to characterize the expanding plasma during this period. We have developed a novel pump-probe interferometry system for an ultra-intense laser experiment that uses two short-pulse amplifiers synchronized by one ultra-fast seed oscillator to achieve 40-fs time resolution over hundreds of nanoseconds, using a variable delay line and other techniques. The first of these amplifiers acts as the pump and delivers maximal energy to the interaction region. The second amplifier is frequency shifted and then frequency doubled to generate the femtosecond probe pulse. After passing through the laser-target interaction region, the probe pulse is split and recombined in a laterally sheared Michelson interferometer. Importantly, the frequency shift in the probe allows strong plasma self-emission at the second harmonic of the pump to be filtered out, allowing plasma expansion near the critical surface and elsewhere to be clearly visible in the interferograms. To aid in the reconstruction of phase dependent imagery from fringe shifts, three separate 120° phase-shifted (temporally sheared) interferograms are acquired for each probe delay. Three-phase reconstructions of the electron densities are then inferred by Abel inversion. This interferometric system delivers precise measurements of pre-plasma expansion that can identify the condition of the target at the moment that the ultra-intense pulse arrives. Such measurements are indispensable for correlating laser pre-pulse measurements with instantaneous plasma profiles and for enabling realistic Particle-in-Cell simulations of the ultra-intense laser-matter interaction.

Coupling of high-intensity laser light to fast electrons in cone-guided fast ignition.

Cu wires attached to Al cones are used to investigate the energy coupling efficiency of laser light to fast electrons through a cone into a dense plasma. We present experimental and simulation results demonstrating the effect on the energy coupling of effectively placing the cone in a surrounding high density plasma as well as the effect of a large preformed plasma inside the cone. Thick cone walls, simulating plasma surrounding the cone in fast ignition, reduce the energy coupling by a factor of up to 4. An increase in prepulse inside the cone by a factor of 50 further reduces coupling by a factor of 3. Simulations with the pic code lsp that include the laser plasma interaction and the preformed plasma from the flash code show that electron refluxing in thin cone-wall targets enhances coupling to the wire. The implications for full-scale cone-guided fast ignition are discussed.