A hybrid artificial intelligence model leverages multi-centric clinical data to improve fetal heart rate pregnancy prediction across time-lapse systems.

STUDY QUESTION: Can artificial intelligence (AI) algorithms developed to assist embryologists in evaluating embryo morphokinetics be enriched with multi-centric clinical data to better predict clinical pregnancy outcome? SUMMARY ANSWER: Training algorithms on multi-centric clinical data significantly increased AUC compared to algorithms that only analyzed the time-lapse system (TLS) videos. WHAT IS KNOWN ALREADY: Several AI-based algorithms have been developed to predict pregnancy, most of them based only on analysis of the time-lapse recording of embryo development. It remains unclear, however, whether considering numerous clinical features can improve the predictive performances of time-lapse based embryo evaluation. STUDY DESIGN, SIZE, DURATION: A dataset of 9986 embryos (95.60% known clinical pregnancy outcome, 32.47% frozen transfers) from 5226 patients from 14 European fertility centers (in two countries) recorded with three different TLS was used to train and validate the algorithms. A total of 31 clinical factors were collected. A separate test set (447 videos) was used to compare performances between embryologists and the algorithm. PARTICIPANTS/MATERIALS, SETTING, METHODS: Clinical pregnancy (defined as a pregnancy leading to a fetal heartbeat) outcome was first predicted using a 3D convolutional neural network that analyzed videos of the embryonic development up to 2 or 3 days of development (33% of the database) or up to 5 or 6 days of development (67% of the database). The output video score was then fed as input alongside clinical features to a gradient boosting algorithm that generated a second score corresponding to the hybrid model. AUC was computed across 7-fold of the validation dataset for both models. These predictions were compared to those of 13 senior embryologists made on the test dataset. MAIN RESULTS AND THE ROLE OF CHANCE: The average AUC of the hybrid model across all 7-fold was significantly higher than that of the video model (0.727 versus 0.684, respectively, P = 0.015; Wilcoxon test). A SHapley Additive exPlanations (SHAP) analysis of the hybrid model showed that the six first most important features to predict pregnancy were morphokinetics of the embryo (video score), oocyte age, total gonadotrophin dose intake, number of embryos generated, number of oocytes retrieved, and endometrium thickness. The hybrid model was shown to be superior to embryologists with respect to different metrics, including the balanced accuracy (P ≤ 0.003; Wilcoxon test). The likelihood of pregnancy was linearly linked to the hybrid score, with increasing odds ratio (maximum P-value = 0.001), demonstrating the ranking capacity of the model. Training individual hybrid models did not improve predictive performance. A clinic hold-out experiment was conducted and resulted in AUCs ranging between 0.63 and 0.73. Performance of the hybrid model did not vary between TLS or between subgroups of embryos transferred at different days of embryonic development. The hybrid model did fare better for patients older than 35 years (P < 0.001; Mann-Whitney test), and for fresh transfers (P < 0.001; Mann-Whitney test). LIMITATIONS, REASONS FOR CAUTION: Participant centers were located in two countries, thus limiting the generalization of our conclusion to wider subpopulations of patients. Not all clinical features were available for all embryos, thus limiting the performances of the hybrid model in some instances. WIDER IMPLICATIONS OF THE FINDINGS: Our study suggests that considering clinical data improves pregnancy predictive performances and that there is no need to retrain algorithms at the clinic level unless they follow strikingly different practices. This study characterizes a versatile AI algorithm with similar performance on different time-lapse microscopes and on embryos transferred at different development stages. It can also help with patients of different ages and protocols used but with varying performances, presumably because the task of predicting fetal heartbeat becomes more or less hard depending on the clinical context. This AI model can be made widely available and can help embryologists in a wide range of clinical scenarios to standardize their practices. STUDY FUNDING/COMPETING INTEREST(S): Funding for the study was provided by ImVitro with grant funding received in part from BPIFrance (Bourse French Tech Emergence (DOS0106572/00), Paris Innovation Amorçage (DOS0132841/00), and Aide au Développement DeepTech (DOS0152872/00)). A.B.-C. is a co-owner of, and holds stocks in, ImVitro SAS. A.B.-C. and F.D.M. hold a patent for 'Devices and processes for machine learning prediction of in vitro fertilization' (EP20305914.2). A.D., N.D., M.M.F., and F.D.M. are or have been employees of ImVitro and have been granted stock options. X.P.-V. has been paid as a consultant to ImVitro and has been granted stocks options of ImVitro. L.C.-D. and C.G.-S. have undertaken paid consultancy for ImVitro SAS. The remaining authors have no conflicts to declare. TRIAL REGISTRATION NUMBER: N/A.

Low prevalence of tissue detection of cefepime and daptomycin used as empirical treatment during revision for periprosthetic joint infections: results of a prospective multicenter study.

Data demonstrating that antibiotics administered intraoperatively in patients with surgical revision for periprosthetic joint infection achieve concentrations exceeding minimal inhibitory concentrations of the identified bacteria at the surgical site when the new implant is inserted are lacking. We prospectively included patients with periprosthetic joint infection operated with one- or two-stage replacement during which cefepime (2g)-daptomycin (10mg/kg) combination was administered intravenously as intraoperative empirical antibiotic treatment. Three biopsies (two bones and one synovial membrane) were taken from each patient just before the insertion of the new implant. Eighteen adults of median age 68 years were included. Knee was involved in 10 patients (55.6%) and surgery consisted in one-/two-stage replacement in 11/7 patients. A tourniquet was used during the intervention in the 10 patients with knee prosthesis. Among 54 tissue samples, cefepime and daptomycin were detected respectively in 35 (64.8%) and 21 (38.9%) cases (P=0.01). A total of 17 bacteria dominated by staphylococci (n=14) were identified in 10 patients; tissue inhibitory quotient calculated in 51 samples was >1 in 22 cases (43.1%) for cefepime and in 16 cases (31.4%) for daptomycin. The proportion of tissue samples with detectable antibiotic was significantly higher in hip versus knee prosthesis (P=0.03). The present study suggests that intraoperative empirical administration of cefepime-daptomycin combination during septic prosthetic joint replacement results in a high proportion of tissue samples in which at least one of the two antibiotics was not detected or at a low concentration despite satisfactory concomitant blood serum concentrations.

Is it worth it to cryopreserve embryos with blastulation delay at day 5?

This is a retrospective study over a 5-year period. In total, 3139 embryos were individually cryopreserved (Cryotop®) and warmed using the Kitazato vitrification/warming kit. They were classified into three categories based on their expansion degree. Transfer, implantation and pregnancy rates were assessed for each embryo category and compared using SPSS (Statistical Package for the Social Sciences) software. In total, 1139 couples enrolled in infertility treatment programme benefitted from embryo vitrification at day 5. After warming, embryos belonging to the three categories showed similar success rates. Although there was a trend towards better outcomes when grade 3 embryos were transferred, the differences did not reach statistical significance: implantation rates (n fetal sac/n embryo transferred) grade 1: 21.9%, grade 2: 22.7% and grade 3: 30.3% (=0.19). Pregnancy rate (n clinical pregnancy/n transfer) (21.9%, 22.7%, 30.3%, respectively; P=0.11). Miscarriage rate was not statistically different in the three categories (14.5%, 20.4%, 20%, respectively, P=0.51). Our overall results show that it is worth vitrifying slow kinetics embryos as they provide a non-negligible chance to give rise to a pregnancy.

Longitudinal growth of French singleton children born after in vitro fertilization and intracytoplasmic sperm injection. Body mass index up to 5 years of age.

BACKGROUND: The literature presents conflicting results on the epigenetic effect of in vitro fertilization (IVF) on the short-term and mid-term growth of children. These contradictory results may be related to the use of heterogeneous methodologies and non-longitudinal data. The goal of this study was to compare the body mass index (BMI) of children conceived via IVF and spontaneous conception (SC) children, using longitudinal data from birth to 5 years. METHODS: This study compared 118 singleton children born after in vitro fertilization, with or without intracytoplasmic sperm injection (ICSI), selected from a pre-existing single-center cohort to 320 SC children from the same geographic area. BMI and its evolution were analyzed using the mixed-effect model during three periods: before standing acquisition (from birth to 1 year of age), during standing acquisition, and the following period from 2 to 5 years of age. RESULTS: BMI means were not significantly different between groups regardless of the period, when adjusting for confounding factors related to parents, pregnancy, and children's characteristics and lifestyle. Nevertheless, during the standing acquisition period, children born after IVF-ICSI presented a less significant decrease in BMI (P<0.05). In addition, for each period we identified influencing factors (maternal BMI, level of wealth indicator) associated with BMI. CONCLUSION: In the study population, the suspected epigenetic influence of IVF reported in the literature was not observed for BMI from birth to 5 years of age. Further investigations need to be conducted to determine if the suspected influence of IVF on adiposity could be expressed through other parameters.

Early-life dietary spray-dried plasma influences immunological and intestinal injury responses to later-life Salmonella typhimurium challenge.

Increasing evidence supports the concept that early-life environmental influences, including nutrition and stress, have an impact on long-term health outcomes and disease susceptibility. The objective of the present study was to determine whether dietary spray-dried plasma (SDP), fed during the first 2 weeks post-weaning (PW), influences subsequent immunological and intestinal injury responses to Salmonella typhimurium challenge. A total of thirty-two piglets (age 16-17 d) were weaned onto nursery diets containing 0, 2·5 % SDP (fed for 7 d PW) or 5 % SDP (fed for 14 d PW), and were then fed control diets (without SDP), for the remainder of the experiment. At 34 d PW (age 50 d), pigs were challenged with 3 × 109 colony-forming units of S. typhimurium. A control group (non-challenged) that was fed 0 % SDP in the nursery was included. At 2 d post-challenge, the distal ileum was harvested for the measurement of inflammatory, histological and intestinal physiological parameters. S. typhimurium challenge induced elevated ileal histological scores, myeloperoxidase (MPO), IL-8 and TNF, and increased intestinal permeability (indicated by reduced transepithelial voltage (potential difference) and elevated 4 kDa fluorescein isothiocyanate dextran (FD4) flux rates). Compared with S. typhimurium-challenged controls (0 % SDP), pigs fed the 5 % SDP-14 d diet exhibited reduced ileal histological scores, MPO levels, IL-8 levels and FD4 flux rates. Pigs fed the 5 % SDP-14 d nursery diet exhibited increased levels of plasma and ileal TNF-α in response to the challenge, compared with the other treatments. These results indicate that inclusion of SDP in PW diets can have an influence on subsequent immunological and intestinal injury responses induced by later-life S. typhimurium challenge.

Normal live birth after vitrified/warmed oocytes intracytoplasmic sperm injection with immotile spermatozoa in a patient with Kartagener's syndrome.

The present article is a report on two cases of male Kartagener's syndrome enrolled in intraconjugal IVF programme due to akinetospermia. Viable spermatozoa were selected using a hypo-osmotic swelling test (HOST) and pentoxifylline activation and subsequently microinjected into vitrified/warmed oocytes. The treatment enabled one of these two couples to achieve a pregnancy and to give birth to a healthy baby girl.

Morphokinetics analysis of embryos derived from vitrified/warmed oocytes.

PURPOSE: Oocyte vitrification is a worldwide used technique that has proved its worth. Although it was shown not to alter oocyte integrity, a recent study concluded that it may affect oocyte embryo development. As the morphology and kinetics of embryos derived from sibling fresh and vitrified oocytes have not been described previously, the present study evaluates cleavage rate, blastomeres size, fragmentation rate, and blastocyst formation in vitrified/warmed oocyte derived embryos (VODE) as compared with sibling fresh oocytes derived embryos (FODE). METHODS: This investigation included 90 infertility cases displaying large cohort of mature oocytes at pick up, divided into 2 groups after denudation. A part of oocytes underwent ICSI while others were vitrified. Oocyte warming cycles were performed when no pregnancy was achieved using fresh eggs. Zygote to blastocyst development was recorded prospectively in an image database up to day 5. RESULTS: VODE did not show major difference as compared with FODE in terms of cleavage rate, number of blastomeres, fragmentation rate, and blastomeres size. Furthermore, percentage of morulae at day 4 and blastocysts at day 5 are not affected by oocyte vitrification. CONCLUSION: Although our results show that embryo development is not altered by oocyte vitrification, offspring follow-up is essential to exclude any adverse developmental effect of the technique.

Control of paradoxical kinematics in posterior cruciate-retaining total knee arthroplasty by increasing posterior femoral offset.

PURPOSE: Balancing the posterior cruciate ligament (PCL) with posterior cruciate-retaining total knee replacement (PCR-TKR) aims to restore femoral rollback. In practice, paradoxical roll forward persists. The purpose of this study is to propose a technique for optimizing PCL tension. Because PCL function starts above 60° of flexion, we hypothesize that PCL balancing requires flexion gap tightening by oversizing the femoral component and increasing posterior condylar offset (PCO). METHODS: PCR-TKR was performed in 21 osteoarthritis patients with a gap-balancing technique. The femoral component was oversized if more than a 5-mm posterior drawer existed after tibial component implantation. Kinematics was recorded intra-operatively in two steps with dedicated navigation software (Praxim, La Tronche, Isère, France): antero-posterior (AP) displacements of condylo-tibial contact points were observed in native and implanted knees, with each knee serving as its own control. The absence of paradoxical displacements was verified once the final implants were inserted. RESULTS: Paradoxical medial condyle displacement (11 mm) persisted in a single case. On average, posterior displacement of the medial condyle decreased from 9 ± 9 to 1 ± 6 mm (p = 0.001) and that of the lateral condyle from 16 ± 14 to 6 ± 6 mm (p = 0.006). In the 0°-30° flexion interval, posterior displacement was 2 times less than before implantation for the medial condyle (p = 0.001), and 4 times less for the lateral condyle (p = 0.004). The course of the lateral condyle decreased from 2 ± 3 to 0 ± 4 mm in the 90°-120° flexion interval (p = 0.046). Six-month flexion was 124° ± 17°. CONCLUSION: Femoral component oversizing allows us to control paradoxical forward displacements in 95 % of cases. When balancing PCR prostheses, AP laxity should be taken into account. Increasing PCO appears to be a reliable technique for adjusting PCL balance. Thus, it may optimize extensor mechanism action and, subsequently, the functional results of PCR-TKR. LEVEL OF EVIDENCE: Diagnostic study, Level II.

Arthroscopic double-row cuff repair with suture-bridging: a structural and functional comparison of two techniques.

PURPOSE: The aim of this study was to compare the functional and structural outcomes of 2 techniques for double-row, suture-bridging cuff repair. METHODS: A consecutive series of 73 patients who underwent arthroscopic, double-row, suture-bridge primary rotator cuff repair of full-thickness supraspinatus tear were evaluated. Thirty-eight shoulders were repaired by the arthroscopic, tied, suture-bridging technique (group A), and 35 shoulders by knot-less bridging with suture tape material (group B). Constant scores, pain, range of motion, strength, and complications were measured after a minimum follow-up period of 12 months post-operatively. Structural integrity of the repairs was evaluated systematically by either magnetic resonance imaging or computed tomography arthrography. RESULTS: Median follow-up after surgery was 29 (23-32) months in group A, and 21 (12-23) months in group B. Mean pain relief, range of motion, strength, and constant score improved significantly in both groups. No statistical differences were found between groups in the post-operative period. According to control imaging, the re-tear rate trended to be higher in group A (23.4 %) than in group B (17.1 %), although not significantly. CONCLUSION: Both bridging repair techniques achieved successful functional outcomes. In terms of structural outcome, the knot-less tape-bridging construct showed a lower but not significant re-tear rate. Longer follow-up is needed to confirm these results and to evaluate potential differences between the two techniques. LEVEL OF EVIDENCE: A prospective, non-randomized, comparative study, Level III.

Satisfactory long-term MRI after autologous chondrocyte implantation at the knee.

PURPOSE: Autologous chondrocyte implantation (ACI) to address isolated condylar lesions is supposed to limit degenerative deterioration in neutrally aligned knees. Here, we report long-term results of the first-generation ACI technique with periosteal flap. METHODS: Twelve patients, 29 years old on average, were included on the basis of pre-operative MRI selection of lesions >2 cm2. Cartilage carrots were harvested arthroscopically, then cultured and finally re-implanted within a mean time interval of 12 weeks. Ten-year MRI results were analysed according to a semi-quantitative scale, along with functional assessment based on International Knee Documentation Committee score, Lysholm et al. score and the Tegner et al. activity scale. RESULTS: One patient secondarily required valgus tibial osteotomy with mosaic plasty. Another incurred graft hypertrophy that necessitated arthroscopic peeling. MRI showed that cartilage repair filled more than 50% of the initial defect in 9 patients. Standard radiographs revealed slight narrowing of the joint line. Overall, functional scores improved durably by 50%, although activity level decreased substantially. CONCLUSION: ACI contained degenerative changes within moderate stages while maintaining durable functional improvement. However, in the absence of controls, it was difficult to differentiate between these findings and the spontaneous evolution of non-treated lesions. LEVEL OF EVIDENCE: Case series, Level IV.

Incidence and Time-to-Onset of Carbapenemase-Producing Enterobacterales (CPE) Infections in CPE Carriers: a Retrospective Cohort Study.

This study aimed to assess the proportion of carbapenemase-producing Enterobacterales (CPE) infections among all infectious episodes in CPE carriers, compare the time-to-onset of CPE infections with that of other infections, assess the mortality of patients with CPE infections, and identify risk factors for CPE infections in CPE carriers. A retrospective cohort study was performed over a 10-year period in our University Hospital, and 274 CPE carriers were identified. All infectious episodes within the first 6 months following the diagnosis of CPE rectal carriage were considered. Risk factor analysis for CPE infections in CPE carriers was performed by univariate and multivariate analyses. This study revealed an incidence of 24.1% (66/274) of CPE infection within 6 months of CPE carriage diagnosis. The 28-day all-cause mortality due to CPE infections was 25.7%. CPE infections represented 52.6% (70/133) of all infectious episodes in CPE carriers in the first 6 months following CPE carriage detection, and these significantly occurred earlier than non-CPE infections, with a median time of 15 versus 51 days, respectively (P < 0.01). Based on the multivariate analysis, prior neurological disease was the only risk factor associated with CPE infections in CPE carriers. CPE infections have an early onset, accounting for a large proportion of infections in CPE carriers, and are associated with high mortality. IMPORTANCE Carbapenemase-producing Enterobacterales (CPE) infections are emerging infections and may represent a therapeutic challenge, while effective antibiotic therapy is likely to be delayed. We aimed to assess the proportion of CPE infections in CPE carriers and to identify risk factors of CPE infections among this population that could guide empirical antibiotic therapy. We showed that CPE infections are frequent in CPE carriers, have an early onset after CPE carriage diagnosis, and represent a significant proportion of all infectious episodes in CPE carriers. No significant risk factors for CPE infections could be identified. Overall, this study suggests that empirical antibiotic treatment covering CPE might be initiated in CPE carriers at least in the first month after its diagnosis and in severe infections due to the high frequency and early occurrence of CPE infections in these patients.

Scientific production and impact of national registers: the example of orthopaedic national registers.

OBJECTIVE: National arthroplasty registers are often cited as examples of a non-randomized design that have made an essential contribution to advances in assessing arthroplasty procedures. We aimed to compare national registers to randomized controlled trials (RCTs) and meta-analyses in the field of arthroplasty in terms of scientific production and impact. METHOD: We systematically searched Medline via PubMed and the registers' websites to select all articles from national registers, RCTs and meta-analyses assessing hip and knee arthroplasty. The scientific production and impact were evaluated by number of publications, number of citations (total and the 3-year citation counts), and information on the 2008 journal impact factor (IF), for each design and identified articles. We also contacted representatives of all the selected registers to determine the availability of the data for external research projects. RESULTS: We retrieved information on 13 active national hip or knee arthroplasty registers; for 9, data were available for research projects under specific conditions. Overall, 190 publications in peer-reviewed journals resulted from national arthroplasty registers, 476 from RCTs, and 40 from meta-analyses. We found 4,112 citations for national register reports, 7,328 for RCT reports and 552 for meta-analysis reports. The median [interquartile [IQR] range] number of citations for register, RCT and meta-analysis reports in the 3-year period after publication was 3.5 [1.0-6.0], 2.0 [1.0-6.0], and 2.5 [0.5-7.5], respectively. CONCLUSION: Publications from national registers may have the highest impact among the 3 designs in terms of median citation counts, but data from RCTs remain the most productive evidence in the arthroplasty field. Because of the number of patients recruited by registers, the quality of data collected, and the potential availability of data, scientific production and impact from national registers should be improved.

Ellipsometric and Rutherford Back scattering Spectrometry studies of SiO(X)N(Y) films elaborated by plasma-enhanced chemical vapour deposition technique.

Silicon oxynitride (SiO(X)N(Y)) thin films were deposited by plasma-enhanced chemical vapour deposition technique (PECVD) from silane (SiH4), nitrous oxide (N2O), ammonia (NH3) and nitrogen (N2) mixture. Spectroscopic ellipsometry (SE), in the range of wavelengths 450-900 nm, was used to define the film thickness and therefore the deposition rate, as well as the refractive index as a function of the N2O gaseous flow. While considering the (Si3N4, SiO2, H2 or void) heterogeneous mixture, Maxwell Garnett (MG) theory allows to fit the SE measurements and to define the volume fraction of the different phases. Finally, Rutherford Backscattering Spectrometry (RBS) results showed that x = O/Si ratio increases gradually with increasing the N2O flow, allowing the correlation of the SiO(X)N(Y) films main parameters.

[Procedure used to follow-up a cohort of IVF children. Interests and limits of tools performed to longitudinal follow up for a monocentric cohort]. / Procédure de suivi d'une cohorte d'enfants FIV. Intérêts et limites de l'outil développé pour un suivi longitudinal et monocentrique.

BACKGROUND: Follow-up of in vitro fertilization (IVF) children is recommended by the French health authorities. Follow-up procedures were set-up in a medically assisted reproduction unit at the Saint-Joseph Hospital in Marseille. The objective was to ensure effective follow-up. In this context, it is important to determinate weather the designated tools are appropriate for evaluating the desired developmental outcomes. This study was designed to describe the surveillance tool and to demonstrate its usefulness and limitations. METHODS: The procedure was initiated in 2004. All existing data for every livebirth child were collected, including data concerning all IVF attempts, medical reports of pregnancy, and child health records. Parents were asked to complete questionnaires and provide their child's personal health records since birth. The quality of the data was evaluated using prenatal and postnatal analysis. The longitudinal anthropometric data of the health records were used to describe the percentiles of weights and heights from birth to 6 years in this population at age-specific reference intervals. RESULTS: The follow-up concerned 2081 children born since 1995 with a response rate of 68,9%. A brief descriptive analysis was performed for the cohort and for a group of 1053 children aged five years and older, 225 representative personal health records were used to estimate quintiles for anthropometric data. CONCLUSION: The procedure adopted for the follow-up of in vitro fertilization children meets the established qualitative health requirements. This method provides many benefits with no risk for the children. Data collection from personal health records enabled an exploitation of growth data by including the calculation of anthropometric percentiles in this IVF population. This report presents the first set of IVF child growth standards used as health indicator and health trend measurement.

HAM-D17 and HAM-D6 sensitivity to change in relation to desvenlafaxine dose and baseline depression severity in major depressive disorder.

INTRODUCTION: This retrospective analysis compared sensitivity to change on the 17-item and 6-item Hamilton Rating Scales For Depression (HAM-D (17) and HAM-D (6), respectively) in relation to antidepressant dose and baseline depression severity. METHODS: Data were derived from 6 randomized, double-blind, placebo-controlled, 8-week trials of fixed-dose desvenlafaxine (50, 100, 200 or 400 mg/d) for major depressive disorder. HAM-D (17) and HAM-D (6) effect sizes were assessed. RESULTS: HAM-D (17) effect sizes were negative (favoured placebo) for higher desvenlafaxine doses (200-400 mg/d) at week 1, but were positive for all doses after week 2, with no clear dose-response pattern. However, HAM-D (6) effect sizes were positive for all doses at all weeks. Effect sizes were consistently greater for HAM-D (6) vs. HAM-D (17), regardless of time spent under therapy. Effect sizes were greater for HAM-D (6) vs. HAM-D (17) for all desvenlafaxine doses among patients with baseline HAM-D (17) <25, but not among patients with baseline HAM-D (17) ≥ 25. DISCUSSION: The HAM-D (6) demonstrated greater sensitivity to change and robustness than the HAM-D (17), supporting the greater homogeneity of the HAM-D (6).

Revisional Notes on the Cloud Forest Butterfly Genus Oxeoschistus Butler in Central America (Lepidoptera: Nymphalidae: Satyrinae).

So far, six species of Oxeoschistus Butler, including its junior synonym Dioriste Thieme, were listed from Central America, with five of them from Costa Rica alone, which appears to represent the highest regional diversity of this Neotropical montane butterfly genus. Our research based on field work, morphological studies and barcode analysis proved that one record is a misunderstanding perpetuated in scientific literature for over a century: Oxeoschistus cothonides Grose-Smith is identified here as an individual form of the female of O. cothon Salvin. The presence of Oxeoschistus tauropolis (Westwood) in Costa Rica, subject to some controversy, is confirmed, and a new local subspecies is described from Costa Rica, O. tauropolis mitsuko Pyrcz & Nakamura n. ssp. Specific status of O. euriphyle Butler is reinstated based on morphological and molecular data. A new subspecies O. hilara lempira Pyrcz n. ssp. is described from Honduras. O. puerta submaculatus Butler is reported for the first time from the Darién region on the Panama-Colombia border. Species relationships are preliminarily evaluated based on COI data concluding, among others, that O. hilara and O. euriphyle are less closely related than previously assumed. Altitudinal and distributional data are revised, and ecological and behavioural information of all the species of Central American Oxeoschistus is provided.

Factors associated with treatment failure after advice from infectious disease specialists.

OBJECTIVE: Risk factors associated with treatment failure after the infectious disease specialist's (IDS) advice remain unknown. We aimed to identify these risk factors. METHODS: We included patients hospitalized in our tertiary care center who consulted an infectious disease specialist between January 2013 and April 2015. Treatment failure was defined by a composite criterion: signs of sepsis beyond Day 3, ICU admission, or death. Treatment success was defined by the patient's sustained clinical improvement. RESULTS: A total of 240 IDS recommendations were made. Diagnosis was changed for 64 patients (26.7%) and 50 patients experienced treatment failure after the IDS advice. In multivariate analysis, compliance with the IDS advice was associated with a higher rate of success (OR=0.09, 95%CI [0.01-0.67]). Variables associated with treatment failure in the multivariate analysis were Charlson comorbidity score at admission (OR=1.24, 95%CI [1.03-1.50]), a history of infection or colonization with multidrug-resistant bacteria (OR=8.27, 95%CI [1.37-49.80]), and deterioration of the patient's status three days after the IDS advice (OR=12.50, 95%CI [3.16-49.46]). CONCLUSION: Reassessing IDS recommendations could be interesting for specific patients to further adapt and improve them.

Model testing of radioactive contamination by 90Sr, 137Cs and 239,240Pu of water and bottom sediments in the Techa River (Southern Urals, Russia).

This paper presents results of testing models for the radioactive contamination of river water and bottom sediments by (90)Sr, (137)Cs and (239,240)Pu. The scenario for the model testing was based on data from the Techa River (Southern Urals, Russia), which was contaminated as a result of discharges of liquid radioactive waste into the river. The endpoints of the scenario were model predictions of the activity concentrations of (90)Sr, (137)Cs and (239,240)Pu in water and bottom sediments along the Techa River in 1996. Calculations for the Techa scenario were performed by six participant teams from France (model CASTEAUR), Italy (model MARTE), Russia (models TRANSFER-2, CASSANDRA, GIDRO-W) and Ukraine (model RIVTOX), all using different models. As a whole, the radionuclide predictions for (90)Sr in water for all considered models, (137)Cs for MARTE and TRANSFER-2, and (239,240)Pu for TRANSFER-2 and CASSANDRA can be considered sufficiently reliable, whereas the prediction for sediments should be considered cautiously. At the same time the CASTEAUR and RIVTOX models estimate the activity concentrations of (137)Cs and (239,240)Pu in water more reliably than in bottom sediments. The models MARTE ((239,240)Pu) and CASSANDRA ((137)Cs) evaluated the activity concentrations of radionuclides in sediments with about the same agreement with observations as for water. For (90)Sr and (137)Cs the agreement between empirical data and model predictions was good, but not for all the observations of (239,240)Pu in the river water-bottom sediment system. The modelling of (239,240)Pu distribution proved difficult because, in contrast to (137)Cs and (90)Sr, most of models have not been previously tested or validated for plutonium.

Proposed diagnostic criteria for apathy in Alzheimer's disease and other neuropsychiatric disorders.

There is wide acknowledgement that apathy is an important behavioural syndrome in Alzheimer's disease and in various neuropsychiatric disorders. In light of recent research and the renewed interest in the correlates and impacts of apathy, and in its treatments, it is important to develop criteria for apathy that will be widely accepted, have clear operational steps, and that will be easily applied in practice and research settings. Meeting these needs is the focus of the task force work reported here. The task force includes members of the Association Française de Psychiatrie Biologique, the European Psychiatric Association, the European Alzheimer's Disease Consortium and experts from Europe, Australia and North America. An advanced draft was discussed at the consensus meeting (during the EPA conference in April 7th 2008) and a final agreement reached concerning operational definitions and hierarchy of the criteria. Apathy is defined as a disorder of motivation that persists over time and should meet the following requirements. Firstly, the core feature of apathy, diminished motivation, must be present for at least four weeks; secondly two of the three dimensions of apathy (reduced goal-directed behaviour, goal-directed cognitive activity, and emotions) must also be present; thirdly there should be identifiable functional impairments attributable to the apathy. Finally, exclusion criteria are specified to exclude symptoms and states that mimic apathy.

Total knee replacement in the fixed valgus deformity using a lateral approach: role of the automatic iliotibial band release for a successful balancing.

The purpose of this work was to document eleven years of experience in knee replacement for fixed knee valgus through a lateral approach with special emphasis on the balancing procedures. At a mean follow-up of seven years, only one revision for sepsis was required in this series of 63 knee replacements. The mean knee score improved from 37 (range 20-45) to 91 (range 65-100) at the last review (p < 0.01) while the function score increased from 29.5 (range 0-50) to 78.7 (range 10-100) (p = 0.01). The mean mechanical axis (HKA) was 14.7 degrees of valgus preoperatively and 1 degrees of valgus postoperatively. After the iliotibial band was automatically released in the approach, only four of 63 knees required additional release for tightness in extension. These results underline the appeal of the lateral approach with the automatic release of the iliotibial band. If required, additional ligament release is recommended step-by-step after bone section to avoid postoperative instability.